S. HRG. 112–590, PT. 6 

DEPARTMENT OF DEFENSE AUTHORIZATION FOR 

APPROPRIATIONS FOR FISCAL YEAR 2013 AND 

THE FUTURE YEARS DEFENSE PROGRAM 

HEARINGS 

BEFORE THE

COMMITTEE ON ARMED SERVICES 

UNITED STATES SENATE 

ONE HUNDRED TWELFTH CONGRESS 

SECOND SESSION 

ON 

S. 3254 

TO AUTHORIZE APPROPRIATIONS FOR FISCAL YEAR 2013 FOR MILITARY 

ACTIVITIES OF THE DEPARTMENT OF DEFENSE, FOR MILITARY CONSTRUCTION, AND FOR DEFENSE ACTIVITIES OF THE DEPARTMENT OF 

ENERGY, TO PRESCRIBE MILITARY PERSONNEL STRENGTHS FOR 

SUCH FISCAL YEAR, AND FOR OTHER PURPOSES 

PART 6 

PERSONNEL 

MARCH 28; APRIL 25; JUNE 21, 2012 

( 

Printed for the use of the Committee on Armed Services 

DEPARTMENT OF DEFENSE AUTHORIZATION FOR APPROPRIATIONS FOR FISCAL YEAR 2013 AND THE 

FUTURE YEARS DEFENSE PROGRAM—Part 6 PERSONNEL 

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76–542 PDF 2013

S. HRG. 112–590 PT. 6 

DEPARTMENT OF DEFENSE AUTHORIZATION FOR 

APPROPRIATIONS FOR FISCAL YEAR 2013 AND 

THE FUTURE YEARS DEFENSE PROGRAM 

HEARINGS 

BEFORE THE

COMMITTEE ON ARMED SERVICES 

UNITED STATES SENATE 

ONE HUNDRED TWELFTH CONGRESS 

SECOND SESSION 

ON 

S. 3254 

TO AUTHORIZE APPROPRIATIONS FOR FISCAL YEAR 2013 FOR MILITARY 

ACTIVITIES OF THE DEPARTMENT OF DEFENSE, FOR MILITARY CONSTRUCTION, AND FOR DEFENSE ACTIVITIES OF THE DEPARTMENT OF 

ENERGY, TO PRESCRIBE MILITARY PERSONNEL STRENGTHS FOR 

SUCH FISCAL YEAR, AND FOR OTHER PURPOSES 

PART 6 

PERSONNEL 

MARCH 28; APRIL 25; JUNE 21, 2012 

Printed for the use of the Committee on Armed Services 

( 

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

COMMITTEE ON ARMED SERVICES 

CARL LEVIN, Michigan, Chairman 

JOSEPH I. LIEBERMAN, Connecticut 

JACK REED, Rhode Island 

DANIEL K. AKAKA, Hawaii 

E. BENJAMIN NELSON, Nebraska 

JIM WEBB, Virginia 

CLAIRE MCCASKILL, Missouri 

MARK UDALL, Colorado 

KAY R. HAGAN, North Carolina 

MARK BEGICH, Alaska 

JOE MANCHIN III, West Virginia 

JEANNE SHAHEEN, New Hampshire 

KIRSTEN E. GILLIBRAND, New York 

RICHARD BLUMENTHAL, Connecticut 

JOHN MCCAIN, Arizona 

JAMES M. INHOFE, Oklahoma 

JEFF SESSIONS, Alabama 

SAXBY CHAMBLISS, Georgia 

ROGER F. WICKER, Mississippi 

SCOTT P. BROWN, Massachusetts 

ROB PORTMAN, Ohio 

KELLY AYOTTE, New Hampshire 

SUSAN M. COLLINS, Maine 

LINDSEY GRAHAM, South Carolina 

JOHN CORNYN, Texas 

DAVID VITTER, Louisiana 

RICHARD D. DEBOBES, Staff Director 

ANN E. SAUER, Minority Staff Director 

SUBCOMMITTEE ON PERSONNEL

JIM WEBB, Virginia, Chairman 

JOSEPH I. LIEBERMAN, Connecticut 

DANIEL K. AKAKA, Hawaii 

CLAIRE MCCASKILL, Missouri 

KAY R. HAGAN, North Carolina 

MARK BEGICH, Alaska 

RICHARD BLUMENTHAL, Connecticut 

LINDSEY GRAHAM, South Carolina 

SAXBY CHAMBLISS, Georgia 

SCOTT P. BROWN, Massachusetts 

KELLY AYOTTE, New Hampshire 

SUSAN M. COLLINS, Maine 

DAVID VITTER, Louisiana 

(II) 

C O N T E N T S 

CHRONOLOGICAL LIST OF WITNESSES 

ACTIVE, GUARD, RESERVE, AND CIVILIAN PERSONNEL PROGRAMS

MARCH 28, 2012

Page 

Rooney, Hon. Jo Ann, Acting Under Secretary of Defense for Personnel and 

Readiness .............................................................................................................. 4 

Hale, Hon. Robert F., Under Secretary of Defense, Comptroller, and Chief 

Financial Officer ................................................................................................... 34 

Woodson, Hon. Jonathan, Assistant Secretary of Defense for Health Affairs 

and Director of TRICARE Management Activity .............................................. 39 

McGinnis, David L., Acting Assistant Secretary of Defense for Reserve Affairs ....................................................................................................................... 50

Appendix A ............................................................................................................... 113 

Appendix B ............................................................................................................... 141 

Appendix C ............................................................................................................... 166 

Appendix D ............................................................................................................... 200 

Appendix E ............................................................................................................... 206 

Appendix F ............................................................................................................... 214 

CONTINUATION OF TESTIMONY ON THE ACTIVE, GUARD, RESERVE, AND CIVILIAN

PERSONNEL PROGRAMS

APRIL 25, 2012

Lamont, Hon. Thomas R., Assistant Secretary of the Army for Manpower 

and Reserve Affairs; Accompanied by LTG Thomas P. Bostick, USA, Deputy 

Chief of Staff G–1, U.S. Army ............................................................................. 229 

Garcia, Hon. Juan M., III, Assistant Secretary of the Navy for Manpower 

and Reserve Affairs; Accompanied by VADM Scott R. Van Buskirk, USN, 

Chief of Naval Personnel, U.S. Navy; and Lt.Gen. Robert E. Milstead, 

Jr., USMC, Assistant Commandant for Manpower and Reserve Affairs, 

U.S. Marine Corps ............................................................................................... 242 

Ginsberg, Hon. Daniel B., Assistant Secretary of the Air Force for Manpower 

and Reserve Affairs; Accompanied by Lt. Gen. Darrell D. Jones, USAF, 

Deputy Chief of Staff for Manpower, Personnel and Services, U.S. Air 

Force ...................................................................................................................... 270

Appendix A ............................................................................................................... 305 

DEPARTMENT OF DEFENSE PROGRAMS AND POLICIES TO SUPPORT MILITARY

FAMILIES WITH SPECIAL NEEDS

JUNE 21, 2012

Guice, Dr. Karen S., Principal Deputy Assistant Secretary of Defense for 

Health Affairs and Principal Deputy Director, TRICARE Management Activity ...................................................................................................................... 320 

(III) 

Page

IV 

Posante, Dr. Rebecca L., Deputy Director, Office of Community Support for 

Military Families with Special Needs, Department of Defense ....................... 328 

Tait, Dr. Vera F., Associate Executive Director, Department of Community 

and Specialty Pediatrics, American Academy of Pediatrics ............................. 329 

Hilton, Jeremy L., Military Spouse, Veteran, and Family Advocate ................... 333 

Attachments A through I ..................................................................................... 341 

Dawson, Dr. Geraldine, Chief Science Officer, Autism Speaks, and Professor 

of Psychiatry, University of North Carolina at Chapel Hill ............................. 471 

O’Brien, John, Director of Healthcare and Insurance, U.S. Office of Personnel 

Management ......................................................................................................... 475 

Appendix A ............................................................................................................... 492 

Appendix B ............................................................................................................... 500 

(1) 

DEPARTMENT OF DEFENSE AUTHORIZATION 

FOR APPROPRIATIONS FOR FISCAL YEAR 

2013 AND THE FUTURE YEARS DEFENSE 

PROGRAM 

WEDNESDAY, MARCH 28, 2012 

U.S. SENATE, SUBCOMMITTEE ON PERSONNEL, COMMITTEE ON ARMED SERVICES, Washington, DC. 

ACTIVE, GUARD, RESERVE, AND CIVILIAN PERSONNEL 

PROGRAMS 

The subcommittee met, pursuant to notice, at 2:03 p.m. in room 

SR–232A, Russell Senate Office Building, Senator Jim Webb (chairman of the subcommittee) presiding. 

Committee members present: Senators Webb, Begich, 

Blumenthal, Brown, Ayotte, and Graham. 

Majority staff members present: Jonathan D. Clark, counsel; 

Gabriella E. Fahrer, counsel; and Gerald J. Leeling, counsel. 

Minority staff members present: Diana G. Tabler, professional 

staff member; and Richard F. Walsh, minority counsel. 

Staff assistant present: Jennifer R. Knowles. 

Committee members’ assistants present: Gordon Peterson, assistant to Senator Webb; Lindsay Kavanaugh, assistant to Senator 

Begich; Ethan Saxon, assistant to Senator Blumenthal; Charles 

Prosch, assistant to Senator Brown; Brad Bowman, assistant to 

Senator Ayotte; and Sergio Sarkany, assistant to Senator Graham. 

OPENING STATEMENT OF SENATOR JIM WEBB, CHAIRMAN 

Senator WEBB. Good afternoon. 

The subcommittee meets today to receive testimony from the Department of Defense (DOD) on military and civilian personnel programs contained in the administration’s Defense Authorization Request for Fiscal Year 2013 and the Future Years Defense Program 

(FYDP). 

I am pleased to have Senator Graham by my side again this year 

as the subcommittee’s ranking member. 

With us today are senior DOD leaders with whom we will discuss 

not only DOD personnel policy issues but specific budget items in 

furtherance of our subcommittee’s oversight responsibilities, which 

I take very seriously. Our witnesses are: the Honorable Jo Ann 

Rooney, Acting Under Secretary of Defense for Personnel and 

Readiness; the Honorable Robert F. Hale, Under Secretary of DeVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
2 

fense, Comptroller, and Chief Financial Officer (CFO) for DOD; Mr. 

David L. McGinnis, Acting Assistant Secretary of Defense for Reserve Affairs; and the Honorable Jonathan Woodson, Assistant Secretary of Defense for Health Affairs and Director of TRICARE 

Management Activity. 

Virtually every leader in DOD who testifies before the Senate 

Armed Services Committee addresses the importance of their personnel. In just the past few weeks, for example, we heard: ‘‘as we 

move forward, the Department is committed to our most important 

asset, our sailors, marines, civilians, and their families.’’ ‘‘The individual marine is our greatest asset.’’ ‘‘The hallmark of our success 

as an Air Force has always been and will always be our people.’’ 

‘‘The strength of our Army is our soldiers.’’ 

We agree. Taking care of our military and civilian personnel and 

their families is the priority for this subcommittee. There are a 

number of military and civilian personnel policy issues on our 

radar this year. They include the administration’s proposal to reduce military end strength by more than 120,000 personnel by the 

end of fiscal year 2017. Past experience tells us this cannot be accomplished through attrition alone. Many servicemembers who 

have served multiple combat tours will be asked to leave the military even though they want to remain in the ranks. This subcommittee will seek to provide the Services with the force management tools necessary to reduce end strength in a responsible manner while keeping faith with those who have sacrificed so much. 

We also want to ensure that the Services have robust transition 

programs to assist servicemembers and their families as they leave 

the Active Duty military. 

DOD has just released a proposed policy change that will open 

more than 14,000 positions to women at the conclusion of the congressionally required notification period in a few months. We are 

encouraged that the Services are continuing to explore the possibility of opening additional specialties and positions to women. 

This subcommittee will continue to monitor the implementation 

of the Secretary of Defense’s decision to eliminate, reduce, or reallocate 140 general and flag officer positions and 150 Senior Executive 

Service positions. 

The subcommittee remains concerned about the number of 

servicemember suicides and will continue to monitor Service suicide prevention policies and programs. 

Sexual assault prevention and response remains a priority for 

this subcommittee. Last year we enacted a number of legislative 

provisions to assist victims of sexual assault. Secretary Panetta has 

announced that he will have additional proposals this year, some 

of which will require legislation. We stand ready to work with him 

on this important issue. 

Our National Guard and Reserves are an integral part of the 

military forces. As an operational reserve, the Reserve component 

is an economical force multiplier, providing flexibility and access to 

valuable capabilities resident in the National Guard and Reserves. 

This subcommittee will continue its effort to ensure that there is 

adequate legislative authority for optimal use of the operational reserve. 

3 

The total force includes military personnel, DOD civilian employees, and contractor personnel. This subcommittee will continue to 

press the Services to include civilians and contract personnel when 

addressing total force requirements. 

The subcommittee remains committed to the care and treatment 

of our wounded warriors and their families. We believe that the Integrated Disability Evaluation System is an improvement over the 

legacy disability evaluation system, but it is still too bureaucratic 

and timeconsuming. 

The subcommittee faces a very clear challenge this year as we 

address the need to control the increasing costs of personnel programs. As the Chief of Staff of the Air Force stated during a recent 

hearing, ‘‘among all the other challenges facing us, the reality of 

fewer members of the Armed Forces costing increasingly more to 

recruit, train, and retain for promising careers is, ‘in his view,’ the 

monumental defense issue of our time.’’ 

The total personnel-related base budget in DOD’s fiscal year 

2013 request, including the costs of providing health care to 

servicemembers, their families, and retirees, amounts to $168 billion, or about 32 percent of the overall DOD base budget. However, 

while we must achieve savings in our defense programs, we must 

do this in a way that does not unfairly impact military benefits for 

a force that is serving and has served so well during more than 10 

years of combat operations. 

Our task is even more difficult this year because of the funding 

limitations imposed by the Budget Control Act (BCA) passed by 

Congress last year. To comply with this act, the administration has 

proposed several major actions to reduce military personnel costs, 

including end strength reductions of more than 120,000 military 

personnel, limiting pay raises beginning 2015, establishing a base 

realignment and closure (BRAC)-like commission to conduct a comprehensive review of military retirement, and increasing health 

care fees for military retirees. Each of these proposals warrants 

careful consideration. 

There is no greater responsibility for Congress and military leaders than to care and provide for our servicemembers and their families. Our military—Active, Guard, and Reserve—is still engaged in 

the longest sustained period of major conflict in our Nation’s history. We look forward to learning more about the programs and 

priorities DOD has emphasized to make certain that despite today’s fiscal challenges, our servicemembers, civilian personnel, retirees, and their families will continue to receive the support and 

benefits they have earned commensurate with their service. 

I look forward to all of your testimony today on all of these 

issues, and as always, I encourage you to express your views candidly and to tell us what, in your view, is working and to raise any 

concerns and issues you may want to bring to the subcommittee’s 

attention. Please let us know how we can best assist our servicemembers and their families to ensure that our military remains 

steadfast and strong. 

Senator Graham. 

4 

STATEMENT OF SENATOR LINDSEY GRAHAM 

Senator GRAHAM. Thank you, Mr. Chairman. It has been a pleasure working with you. 

We have our work cut out for us. The BCA is going to require some $400-plus billion in defense spending reductions over the next 

decade. Sequestration—I hope in a bipartisan fashion—we can stop 

that. That would be devastating according to Secretary Panetta to 

do $600 billion on top of the $400-plus billion. To get there, you are 

going to have to put everything on the table like reducing the numbers of people we have in the military, looking at benefits anew. 

But as the chairman just mentioned, the number one priority of the 

Federal Government from my point of view is to defend the Nation, 

and you can only do that with people who are willing to serve, and 

taking care of those who have served is the best way to recruit people in the future. 

The chairman has a unique background in terms of his experience in the government and being a marine. So as we try to find 

out solutions to hard problems, we will work together the best we 

can. I look forward to hearing from each of you. 

Senator WEBB. Thank you, Senator Graham. As always, it has 

been a pleasure working with you on this subcommittee and on 

other issues as well. 

We have received statements for the record from a number of different military and veterans organizations. Rather than list them 

all—I may be missing some here—all of those that will have been 

submitted by close of business today will be included at the end of 

this record, if there is no objection from anyone on this subcommittee. 

Senator WEBB. We will now hear opening statements from our 

witnesses. Their complete prepared statements will be included in 

the record. I am going to make a point here because I really got 

into trouble on a recent hearing—we are going to have 7-minute 

rounds for questions from the subcommittee once the testimony is 

over. Those of you here will recall that when we had a panel full 

of lawyers and a subcommittee full of lawyers, the conversations 

went on for about 2 hours. So we will do it 7 minutes at a turn 

here. I think everybody on this end of the table is an attorney. 

Welcome, Dr. Rooney, why do you not begin? 

STATEMENT OF HON. JO ANN ROONEY, ACTING UNDER 

SECRETARY OF DEFENSE FOR PERSONNEL AND READINESS 

Dr. ROONEY. Thank you. Chairman Webb, Senator Graham, and 

distinguished members of the subcommittee, I appreciate the opportunity to appear before you to discuss the personnel and readiness programs in support of the President’s budget request for fiscal year 2013. 

Thank you for your support of our Active and Reserve military 

members, their families, and our government civilians who have 

done everything we ask of them and more. 

As you have heard from Secretary Panetta, the fiscal year 2013 

budget request was the product of an intensive review of our defense strategy necessitated by the critical turning point of our 

country after a decade of war and substantial growth in our budgets. 

5 

Today, I will describe how we can sustain the All-Volunteer 

Force for generations to come, a force that has a proven record of 

unprecedented success in operations around the world. Accomplishing this will require DOD to make hard choices regarding 

competing priorities for limited funding. This budget plan is predicated on the assumption that the Services are appropriately 

trained, resourced, and flexible enough to rapidly adapt to emerging threats. Resourcing the reset of the force while maintaining 

readiness will undoubtedly be one of the most challenging issues of 

our time. 

As the Acting Under Secretary of Defense for Personnel and 

Readiness, my priorities focus on total force readiness, improving 

the military health system, and total force support. 

After 10 years of intensive operations, our forces are among the 

most capable in our Nation’s history. Our Active and Reserve 

servicemembers and defense civilians are well-prepared to execute 

current operations and respond to emergent needs. They are experienced and proficient in a wide range of real-world operations, including those that were not traditionally within DOD’s scope of responsibility. As we end today’s wars and adjust to new and changing missions, we find ourselves naturally transitioning back toward 

a broader range of security missions. 

Although this transition is occurring in the midst of unavoidable 

fiscal pressure, we have committed to maintaining a ready, capable 

All-Volunteer Force. 

The performance of our military medical system at a time of war 

continues to set new standards. DOD strives to provide the best 

health care in the world to our servicemembers, but the current 

cost growth of the military health system is unsustainable. DOD is 

pursuing a balanced, four-pronged approach for improving the 

health of our population and the fiscal stability of the health care 

system to ensure we can continue to provide this benefit in the future. Our four approaches include: moving from a system of health 

care to one of health; continuing to improve our internal efficiencies; implementing provider payment reform; and rebalancing 

cost sharing. 

Another key component of overall health and readiness of the 

force is support to the families of our servicemembers. One of the 

four overarching principles of the defense strategy guidance is to 

preserve the quality of the All-Volunteer Force and not break faith 

with our men and women in uniform or their families. Despite difficult economic circumstances requiring budget reductions across 

all levels of the Federal Government, DOD remains committed to 

providing servicemembers and military families with support programs and resources, empowering them to address the unique challenges of military life. 

Ensuring the needs of military families and servicemembers are 

met contributes to the overall well-being of the total force. This includes access to mental health care, providing for the educational 

needs of servicemembers’ children, support of morale, welfare, and 

recreation programs, and maintaining benefits at defense commissaries. 

Secretary Panetta has directed that family programs continue to 

be a priority for DOD and it remains my priority as well. 

6 

Putting together this year’s budget request in a balanced package was a difficult undertaking and took the combined effort of our 

senior military and civilian leadership. Throughout that process, I 

believe we have developed the right mix of programs and policies 

in place to shape the force we need. Yes, we will reduce the rate 

of growth of manpower costs, including reductions in the growth of 

compensation and health care costs. But as we take these steps, we 

will do so in a way that we continue to keep faith with those who 

serve. 

During the past decade, the men and women who comprise the 

All-Volunteer Force have demonstrated versatility, adaptability, 

and commitment, enduring constant stress and strain of fighting 

two overlapping conflicts. They have also endured prolonged and 

repeated deployments. 47,775 have been wounded, and 6,376 members of our Armed Forces have lost their lives. As DOD reduces the 

size of the force, we will do so in a way that respects and honors 

these sacrifices. 

I look forward to continuing to work with you, Chairman Webb, 

Senator Graham, and distinguished members of the subcommittee, 

to support the men and women in our Nation’s Armed Forces. 

Accompanying me today is the Under Secretary of Defense 

Comptroller, Mr. Robert F. Hale, and two senior members of my 

staff, Dr. Jonathan Woodson, Assistant Secretary of Defense for 

Health Affairs and Director of TRICARE Management Activity, 

and Mr. David L. McGinnis, Acting Assistant Secretary of Defense 

for Reserve Affairs. All of us before you today look forward to your 

questions. 

[The prepared statement of Dr. Rooney follows:] 

PREPARED STATEMENT BY HON. JO ANN ROONEY

INTRODUCTION

Chairman Webb, Senator Graham, and distinguished members of the subcommittee, I appreciate the opportunity to appear before you to discuss Personnel 

and Readiness programs in support of the President’s budget request for fiscal year 

2013. Thank you for your support of our Active, Reserve component military members, their families, and our government civilians who have done everything we 

have asked of them and more. 

As you have heard from Secretary Panetta, the fiscal year 2013 budget request 

was the product of an intensive review of our defense strategy necessitated by the 

fact that our country is at a critical turning point after a decade of war and substantial growth in our budgets. Today, I will describe how we can sustain the All-Volunteer Force for generations to come—a force that has a proven record of unprecedented success in operations around the world. Accomplishing this will require the 

Department to make hard choices regarding competing priorities for limited funding. This plan is predicated on the assumption that the Military Services are appropriately resourced, experienced, and flexible enough to rapidly adapt to emerging 

threats. Resourcing the reset of the force, while maintaining force readiness, will 

undoubtedly be one of the most challenging issues of our time. 

As the acting Under Secretary of Defense for Personnel and Readiness my priorities focus on: Total Force Readiness, Improving the Military Health System, and 

Total Force Support. 

READINESS

After 10 years of intensive operations our forces are among the most capable in 

our Nation’s history. Our Active and Reserve component members and defense civilians are well prepared to execute current operations and respond to emergent needs, 

and are experienced and proficient in a wide range of real world operations. We 

have, by necessity, mastered a host of specialized capabilities that depend heavily 

on language and culture, governance, rule of law, development, and other specialVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00012 Fmt 6633 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
7 

ized skills; not all of which are within the Department’s traditional scope of responsibility. However, fully preparing for these missions means that there have been 

fewer capabilities available for large-scale, major combat operations. As we end today’s wars and adjust to new strategic guidance, we find ourselves naturally 

transitioning back toward a broader range of security missions. 

The first sign of this transition is the return of full-spectrum exercises that we 

have seen over the last year. Specifically, the Marine Corps exercised its first largescale amphibious assault in 10 years just a few weeks ago. Similarly, the Army is 

shifting to decisive action training exercises at the Combat Training Centers. We 

will see more of these exercises as forces return and reset from current operations. 

In addition, the Army has begun to regionally align maneuver and enabler forces 

to some combatant commands to conduct security cooperation and security force assistance activities. These forces will have appropriate language, culture, advisor 

training and skills to enable expanded engagement with critical partners in the region. 

Although this transition is occurring in the midst of unavoidable fiscal pressure, 

we have committed to maintaining a ready, capable All-Volunteer Force. Program 

reductions were deliberately managed to preserve operational flexibility and to keep 

faith with servicemembers and their families who have made significant sacrifices. 

We realize that sometimes, either due to unforeseen circumstances or a changing 

world, even the most well-conceived plans must be revised. For this reason, my office is maintaining its role of closely monitoring the readiness of our forces for the 

dual purposes of identifying and remediating critical deficiencies or unmet requirements. 

End Strength 

We know that multiple deployments to Iraq and Afghanistan, with limited time 

at home for recovery, have stressed our military members and their families. With 

the draw down in Iraq and Afghanistan, this stress is fundamentally reduced. We 

have withdrawn 50,000 troops from Iraq since 2010, and will have reduced Afghanistan troop levels by 30,000 at the end of this year. Barring unforeseen events, the 

Secretary’s goal of 2 or more years at home for every year deployed will likely be 

met this coming year. The All-Volunteer Active and Reserve Force is healthy, and 

our Services are achieving or exceeding their recruiting and retention goals. 

Today, our overall military end strength, which includes the base force and overseas contingency operations, is at 2,269,700 in fiscal year 2012. While the initial 

changes to force size are muted, a 1.4 percent reduction equating to a 31,300 person 

reduction in fiscal year 2012, ultimately the Department will be at 2,145,800 by fiscal year 2017. This 5.5 percent reduction equates to 123,900 fewer troops and will 

be spread throughout the components of the force. 

• Army Active, Reserve, and Army National Guard (NG) end strength in 

fiscal year 2013 is projected to be 1,115,300—0.9 percent less than fiscal 

year 2012. In fiscal year 2017 the end strength will be 1,048,200, a 6.8 percent reduction from fiscal year 2012. 

• Navy Active and Reserve end strength in fiscal year 2013 is projected to 

be 385,200—1.7 percent less than fiscal year 2012. In fiscal year 2017, the 

end strength will be 376,600, a 3.9 percent reduction from fiscal year 2012. 

• Marine Corps Active and Reserve end strength in fiscal year 2013 is projected to be 236,900–2.0 percent less than fiscal year 2012. In fiscal year 

2017 the end strength will be 221,700, an 8.3 percent reduction from fiscal 

year 2012. 

• Air Force Active, Reserve, and Air NG end strength in fiscal year 2013 

is projected to be 501,000—1.9 percent less than fiscal year 2012. In fiscal 

year 2017, the end strength will be 499,300, a 2.3 percent reduction from 

fiscal year 2012. 

A force drawdown of this size has not been experienced since well before September 11. 

Total Force Management and Planning 

The Department relies on a Total Force of Active and Reserve military, government civilians, and contracted support to provide for the Nation’s defense and execute its core missions. We will face force management challenges over the next several years which are far greater than those we have experienced since September 

11, 2001 and, therefore, must balance the competing requirements for equipment 

reset, modernization and support for our servicemembers and their families in a climate of reduced budgets. Responsibly managing the required force reduction, while 

ensuring we keep faith with those who have sacrificed so much to secure our Nation’s interests, and properly caring for our military families as many 

8 

servicemembers transition to veteran status is a responsibility taken very seriously 

and one which my organization is helping to facilitate. Congress aided this effort 

immeasurably by recently enacting legislation that expanded voluntary separation 

programs which provide appropriate recognition for significant military service, such 

as the temporary early retirement authority (TERA) which gives the military departments the flexibility to offer retirement to servicemembers with more than 15 

but less than 20 years of service. We will continue to work with Congress to reinstate additional expired authorities from previous drawdowns that would offer the 

Department the ability to focus separations and avoid the loss of critical expertise. 

The Department’s Total Force of Active and Reserve military, government civilians and contracted services represents a carefully coordinated approach that balances operational needs, satisfies mission requirements, and recognizes fiscal constraints. Our future plans will seek to balance the capabilities and cost of all elements of the Total Force. They cannot be managed in isolation if we are to avoid 

a hollow force and unnecessary expense. Our plans recognize: 

• Decreased operational commitments and revised overseas posture; 

• A Reserve Force that is an operational asset; 

• A highly skilled civilian workforce capable of performing mission essential and inherently governmental tasks; 

• Contracted support that is cost effective and designed to provide appropriate and complimentary support to our operational needs; 

• Civilian decreases that have been carefully targeted to deliver efficiencies 

initiated by Secretary Gates; and 

• Efficient management of our contracted support as part of our Total 

Force mix and not as just an acquisition management action. 

Active Duty Recruiting 

Recruiting for the All-Volunteer Force continues at unprecedented levels. The Department closed out fiscal year 2011 with all active Services meeting or exceeding 

recruiting objectives, both numerically and by recruit quality. As shown in Table 1, 

we continue that record pace into fiscal year 2012, with 44,414 new recruits against 

an objective of 44,323 through January of this year. Recruit quality remains considerably above Department benchmarks (or standards), with 98 percent of new recruits having a high school diploma (90 percent benchmark) and 80 percent scoring 

above average in aptitude (60 percent benchmark) on the Armed Forces Qualification Test (AFQT). Of particular note is the fact that very few recruits accessed at 

or below the 30th percentile on the AFQT through January of this year. 

Table 1—Recruit Quality (Fiscal Year 2012 Through January) Active Components 

Quantity Quality 

AC Enlisted Recruiting 

Fiscal Year 2012 

(End of January) 

Accessions Goal Percent of 

Goal 

Percent High School 

Graduate: 

Benchmark=90 percent 

Percent Scoring at/ 

above 50th Percentile 

on AFQT; 

Benchmark=60 percent 

Percent Scoring at/ 

above 30th Percentile 

on AFQT; 

Benchmark=4 percent 

Army 17,123 17,050 100 G 95 G 64 G <1 G 

Navy 9,289 9,289 100 G 99 G 93 G 0 G 

Marine Corps 7,795 7,777 100 G 100 G 76 G 0 G 

Air Force 10,207 10,207 100 G 100 G 99 G 0 G 

DOD Total 44,414 44,323 100 98 80 <1

Quantity Key: 100 percent or above goal; 90–99 percent of goal; below 90 percent of goal. 

Quality Key: 100 percent or above benchmark; 90–99 percent of benchmark; below 90 percent of benchmark. 

Generally, a slow economy makes recruiting less challenging, and operates to the 

advantage of those who are hiring, including the U.S. military; clearly, the current 

state of our economy has been one of the drivers of this recruiting success. As we 

see signs of economic improvement, we will remain vigilant and continue to monitor 

the impact of that improvement on our recruiting efforts. Despite the positive effect 

of the economy on recruiting, there remain other factors counterbalancing our ability to attract bright, young Americans into the Armed Forces—the lower likelihood 

of influencers of youth (e.g., parents and teachers) to recommend service, a large 

and growing proportion of youth who are ineligible to serve in the military, higher 

numbers of youth going to college directly from high school, and continuing concerns 

about the prolonged worldwide, irregular campaign with its concomitant high operations tempo. Therefore, we are in uncharted waters with significant factors directly 

affecting military recruiting in both positive and negative ways. 

9 

Due to these direct effects on recruiting, and as the Nation faces a demographic 

shift, it is important that the Department align its recruiting assets to tap emerging 

markets. Leveraging the diverse perspectives, and cultural, language and regional 

competencies present in our force ensures we encourage innovation and optimize 

mission success with respect to evolving challenges we will face well into the 21st 

century. We are carefully reviewing recruiting programs to align funding and policies with current realities as we recognize the necessity of current and future budget constraints. We will strive to ensure the resources dedicated to recruiting are reasonable and remain at levels that will not compromise success. The Services will 

decide where best to take those cuts and any realignments undertaken will be done 

carefully and their effects closely monitored. 

Recruit Quality: The Department generally reports recruit quality along two dimensions—aptitude and education. Both are important, but for different reasons. 

Aptitude is an indicator of trainability and job performance. All recruits take an 

enlistment test called the Armed Services Vocational Aptitude Battery (ASVAB). 

One component of the ASVAB, the Armed Forces Qualification Test (AFQT), measures math and verbal skills. Those who score at or above average on the AFQT are 

in Categories I–IIIA, while those who score between the 10th and 49th percentile 

are placed in Categories IIIB and IV. Applicants scoring below the 10th percentile 

are ineligible to enlist. We value higher-aptitude recruits because their training and 

job performance are superior to those who score in the lower categories. 

The Department’s educational enlistment policy groups education credentials into 

three tiers—Tier 1, consists primarily of traditional high school diploma graduates; 

Tier 2 consists of alternate credential holders, to include home-school and virtual/ 

correspondence schools; and Tier 3 is nongraduates. Education credential is used not 

to measure the quality of education or the intelligence of the applicant, but rather 

the applicant’s likelihood of completing his or her enlistment term. Years of research 

and experience indicate about three-quarters of recruits with a high school diploma 

complete their first 3 years of service, whereas only about half of those without a 

high school credential will complete 3 years. The attrition rates of those holding an 

alternative credential (e.g., GED) fall between these extremes. The Department’s 

benchmark is that 90 percent of new recruits are high school diploma graduates. 

As a result of the evolving methods of education delivery across the Nation, the 

National Defense Authorization Act (NDAA) for Fiscal Year 2012 required restructuring of the education credential tiers we use to determine enlistment priority. Specifically, the act expanded Tier 1, ‘‘High School Diploma Graduate,’’ to include graduates of alternative educational delivery methods. From past experience, we find 

these individuals, on average, have significantly higher attrition rates—the current 

first-term attrition rate for high school diploma holders is 28 percent; alternate credential holders average a 38 percent rate. We remain concerned about the long-term 

impacts of this policy change as it costs the Services approximately $55,000 to replace (recruit, train, equip, pay) each individual who fails to complete his or her initial term of service. Nevertheless, the new policy will be in place by July of this year 

as directed, and we will monitor the attrition behavior of these recruits. Additionally, as encouraged in the legislation, we will continue to develop new methods of 

identifying those who are qualified for recruitment and enlistment. These methods 

may include use of a non-cognitive test, adaptive personality assessment, or other 

operational attrition screening tools to predict performance, behaviors, and attitudes 

of potential recruits which influence attrition and ability to adaptively perform the 

required missions. 

Active Component Retention: 

Similar to our recruitment numbers, the Army, Air Force, Navy, and Marine 

Corps all exhibit strong retention numbers for the first 4 months of fiscal year 2012 

continuing a trend from the previous year (Table 2). The resilience of the All-Volunteer Force through two wars continues to prove the tremendous dedication and patriotism of the men and women serving our great Nation. I am humbled by their 

willingness to place themselves in harm’s way and do their Nation’s bidding. 

That said, I also recognize we will face new challenges as the economy improves, 

conflicts subside, and uncertainty rises over the drawdown of the force. The Department must ensure meaningful missions, support for our military families, and complete transparency regarding our reduction efforts. Despite budget pressures we are 

committed to careful and deliberate reviews of servicemember and family programs 

with an eye on retention. We can ill afford to arrive at the end of the drawdown 

with a force that does not match the capabilities the Nation requires and without 

the resources necessary to make adjustments. Towards this end, I am encouraged 

by the plans offered by the Services as they make difficult force reduction decisions. 

For example, the Services are limiting reductions in accessions to ensure we meet 

10 

future requirements, and they are offering voluntary separation programs to 

servicemembers prior to taking involuntary separation actions whenever possible. 

We also intend to extend to Congress our commitment of transparency in these efforts. Together I am convinced we can create an environment that avoids the pitfalls 

experienced throughout history by most post-conflict militaries. While this will undoubtedly prove extraordinarily challenging, I believe you will agree we owe it to 

our Nation and to the soldiers, sailors, airmen, and marines who will continue to 

stand watch for the generations to come. 

Women in the Service 

The Department has recently completed a review of how we assign women in the 

Service. As requested by Congress, the Department, in coordination with the military departments, reviewed laws, policies, and regulations, including our co-location 

policy, to determine if any changes were needed to ensure female members have an 

equitable opportunity to compete and excel in the Armed Forces. We took a hard 

look at the current restrictions on women, and recommend changes within the report to Congress (available to the public online http://www.defense.gov/news/WISR— 

Report—to—Congress.pdf). Pending expiration of the congressionally-required notification period, the Department will implement a change to policy that eliminates 

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quired to physically co-locate and remain with direct ground combat units that are 

closed to women. These recommendations will open over 14,000 positions to women, 

including 6 Army occupational specialties. The Department is not stopping with the 

policy changes set forth in the report. The Services will continue to evaluate these 

recommendations to inform future policy revisions in addition to developing genderneutral standards for physically demanding occupations. Secretary Panetta directed 

the Secretaries of the Military Departments and Chiefs of Military Services to report their progress on the development of gender-neutral standards, assessment of 

newly opened positions and recommendations for any further positions that can be 

opened, 6 months after implementing these changes. We continue to reiterate our 

commitment to removing all barriers that would prevent servicemembers from rising to the highest level of responsibility that their talents and capabilities warrant. 

Implementation of the Repeal of ‘‘Don’t Ask, Don’t Tell’’ 

Since September 20, 2011, the effective date of repeal, the Services report there 

have been no significant issues related to the implementation of the repeal of ‘‘Don’t 

Ask, Don’t Tell.’’ By all accounts, implementation is going smoothly across the force. 

We attribute this success to our comprehensive pre-repeal training programs, combined with the discipline of our servicemembers and continued close monitoring and 

enforcement of standards by our military leaders at all levels. Prior to repeal, the 

Department saw a preponderance of the force, 2.25 million servicemembers, trained 

regarding the necessary policy and regulation changes that went into effect on ‘‘Repeal Day.’’ 

The Department and the Services remain engaged in ongoing implementation efforts. A formal monitoring process ensures continual assessment and reporting to 

the Secretary of Defense. Elements of this monitoring process include regular Service assessment reports and periodic surveys of servicemembers. Through this feedback mechanism, the most common question we hear from the field is about benefits—specifically, whether or not benefits will be extended to same-sex partners. The 

Department is engaged in a comprehensive review of the possibility of extending eligibility for additional benefits, when legally permitted, to same-sex partners, and 

our goal is to complete this review by the end of the fiscal year. With leadership, 

professionalism, discipline, and respect, the Department and our servicemembers remain fully committed to the implementation effort, consistent with our standards 

of military readiness, effectiveness, unit cohesion, and recruiting and retention for 

the Armed Forces. 

General, Flag Officer, and Civilian Senior Executive/Equivalent Efficiencies 

In 2011, the Secretary of Defense made the decision to eliminate, reduce, or reallocate 140 general or flag officer (GFO) positions and a minimum of 150 Civilian 

Senior Executive/Equivalent (CSE) positions. The Department designated 102 GFO 

positions for elimination (complete removal from structure or downgrade of a position to a grade of O–6 or below) and 211 CSE positions for elimination. By the end 

of the year, we had eliminated 29 GFO positions and reduced 20 positions to a lower 

grade of GFO. We are moving forward to implement the remaining efficiencies 

gradually over the next several years as conditions allow, not adversely affecting 

missions or forcing readiness. Three years ago, Congress’ authorization of the Joint 

Pool created the foundation for increased flexibility for the Department in the management of positions. This latest efficiency effort will take those policies to the next 

level and will create flexibility for each of the Military Departments to ensure their 

readiness to respond to any emerging threat. CSE reductions are being implemented 

based on a 2-year strategy. To date, 93 Senior Executive Service, Senior Level or 

Senior Technical (SES/SL/ST) positions, and 57 Defense Intelligence Senior Executive and Defense Intelligence Senior Level (DISES/DISL) positions have been reduced. The remaining CSE efficiencies will be completed by March 2013. 

Growing Language and Culture Capabilities 

The President directed the Department to sustain U.S. global leadership as we 

transition from a long-term engagement in two wars toward a more global presence 

focused on the Asia-Pacific and the Middle East. Though Service end strengths will 

decrease, the demand for language skills, regional expertise, and cultural awareness 

will increase, as these capabilities are essential not only to our mission readiness 

but to achieving national security, building partner capacity, and strengthening alliances. Currently, 9 percent of military personnel have tested or self-professed foreign language skills at any level of proficiency and 5 percent have skills that meet 

the Department’s need for limited working language proficiency or above. 

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partmental language capabilities, as well as initiatives for long-term sustainment. 

The goal is to ensure a spectrum of programs that include pre-accession, and inservice military and civilian training, while establishing new career paths for personnel with language and culture skills. These efforts include increasing the foreign 

language skills of the Department’s military and civilian personnel, as well as outreach to our Nation’s schools and universities to promote the teaching of critical languages. All these efforts are essential to achieving a force, a Nation, and a citizenry 

capable of facing the threats, opportunities, and challenges we will confront in the 

21st century. 

Drug Demand Reduction 

The abuse of illicit and prescription drugs in the U.S. military has substantial implications on force readiness and safety. The goal of the Drug Demand Reduction 

(DDR) Program is to protect readiness and the well-being of our civilian and military personnel by detecting and deterring drug abuse. Toward that end, the Department and Services have recently expanded the existing panel of tested drugs to include frequently abused prescription medications, such as Vicodin and Valium. The 

Department’s minimum random drug testing goal is 100 percent with a positive rate 

below 2 percent. Overall, drug positive rates for active duty military personnel 

across all Services have continued to decline and the current rate of positive specimens is below 1 percent, the lowest in the program’s history. As with many programs, the DDR Program incurred a reduction in budget which will require additional efficiencies in collection, outreach, and educational programs. This will also 

require increased targeted random drug testing. 

Suicide Prevention 

Every person within the Department of Defense is a valuable team member and 

each loss to suicide is a preventable tragedy. For this reason, we are taking aggressive steps to address suicide by enacting policies, providing supportive services and 

assistance, implementing training initiatives and publishing education materials, 

and conducting data surveillance and research to support servicemembers and their 

families. For example, the Department increased behavioral health providers from 

6,590 to 8,898 total providers, a 35 percent increase over the past 3 years, adding 

mental health providers in primary care settings and embedding them with frontline units. We have also partnered with the Department of Veterans Affairs (VA) 

to build a continuum of support for transitioning members. This partnership will not 

only provide more service options for our members, it will allow us to compile more 

complete data that could lead to better predictive and preventative measures. 

We are building and shaping resiliency and coping skills through realistic and 

interactive training to ensure every servicemember can recognize the warning signs 

of suicide and encompass the skills and knowledge necessary to purposely intervene. 

We are also committed to further research on understanding and preventing suicide 

as with the Army Study to Assess Risk and Resilience in servicemembers (ARMY 

STARRS), which is the largest study of mental health risk and resilience factors 

ever conducted among military personnel. Conceived by scientists at the National 

Institute of Health’s National Institute of Mental Health (NIMH), ARMY STARRS 

was formalized through a memorandum of agreement that authorized NIMH to conduct an extensive investigation with Army funding. The ARMY STARRS program 

is led by an interdisciplinary team of Army, Academic, and NIH investigators. 

Though we have been able to arrest the increasing rate of suicides over the past 

3 years, the Department continues to work hard to reduce these tragedies. We have 

established a Defense Suicide Prevention Office to serve as the focal point for developing and overseeing suicide prevention policy, training, and programs across the 

Department. This office will also collaborate with Military Departments to implement the recommendations of the Department of Defense Task Force on the Prevention of Suicide, and serve as our lead with the VA and nongovernment organizations 

to identify and institute a continuum of suicide prevention efforts for personnel leaving the Department. 

Sexual Assault Prevention and Response 

As Secretary Panetta has stated, this Department has a zero-tolerance policy 

against sexual assault and this is a leadership issue first and foremost. We have 

received the final numbers from the Services and the Department had 3,192 reports 

of sexual assault in fiscal year 2011; because of underreporting, estimates are closer 

to 19,000 (per a fiscal year 2010 Defense Manpower Data Center survey). This is 

in stark contrast to the first sample survey in 2006, when the estimate was 34,000. 

Since 2006, more victims are stepping forward to report assaults and the percentage 

of alleged sexual assault offenders facing court-martial proceedings has increased. 

13 

In this past year alone, we have made significant strides. We recently published 

a revised Directive expanding our support to assault victims to include military 

spouses and adult military dependents, the Department’s civilians stationed abroad 

and the Department’s U.S. citizen contractors in combat areas. In addition, two new 

policies address expedited transfers and the retention of law enforcement records for 

50 years. To ensure national standards for victim services, we are establishing a 

sexual assault advocate certification program and, we established the DOD Safe 

Helpline which provides anonymous and confidential, 24/7 hotline and texting support to victims anywhere in the world. We are collaborating with the VA and Department of Labor (DoL) to establish a continuum of care for victims of sexual assault transitioning from military to civilian life and will use the DOD Safe Helpline 

as a vehicle to help these transitioning servicemembers. 

To improve the tracking of reports, the Defense Sexual Assault Incident Database 

will be implemented by March 31 and be fully operational by August 31st. Because 

sexual assault cases are some of the toughest cases to investigate and to prosecute, 

the Department has committed funding through fiscal year 2017 to provide sexual 

assault specific training for judge advocates and criminal investigators and we are 

assessing the Sexual Assault Prevention and Response training for commanding officers and senior enlisted leaders. We will continue to hold the perpetrators appropriately accountable and all military servicemembers will live up to the high standards set. 

Compensation 

Senior leaders in the Department place a high value on the willingness of America’s military personnel to serve their country. We understand our compensation 

system must be competitive, recognize the demands of military service, and always 

provide sufficient compensation to attract and retain qualified personnel. The 9th 

Quadrennial Review of Military Compensation shows that servicemembers need to 

be paid equal to or better than 70 percent of their civilian counterparts. 

Through the work of Congress, our servicemembers received generous military 

pay raises over the past decade and, as a result, military compensation has increased and significantly exceeds that 70th percentile. Additionally, over the past 

decade, the Department and Congress addressed a host of challenges ensuring military compensation remained competitive, and this has allowed the Department to 

continue to succeed in recruiting and retaining the high-quality, All-Volunteer Force 

required by the Nation, despite nearly a decade at war. 

As we reset following the end to combat operations in Iraq, the beginnings of force 

reductions in Afghanistan, and in light of the Nation’s economic crisis and our expected manpower reductions, slowing the future growth of military compensation 

will be important. As mentioned earlier, we expect challenges in recruiting and retention to grow over the next few years as both the economy and labor market continue to improve. The current, competitive military compensation package makes 

the Department well suited to respond to those challenges, even during this time 

of war. As a result, we have requested full pay raises for fiscal year 2013 and fiscal 

year 2014, and more limited pay raises beginning in fiscal year 2015. For fiscal year 

2013, this would provide an increase in military basic pay for all servicemembers 

of 1.7 percent, which is in line with earnings increases seen in the private sector 

as measured by the annual change in the Employment Cost Index. 

The Department also understands current fiscal pressures demand change, and 

that the costs of military compensation are significant. Some cost savings will be 

achieved through proposing more limited pay raises beginning in fiscal year 2015. 

However, in the continuing search for budget cuts and efficiencies, we are evaluating the military compensation system, focusing first on military retirement. As I 

stated before the subcommittee in October of last year, we have been conducting a 

vigorous, internal review, and are working diligently to identify and evaluate retirement alternatives. In addition to this ongoing review, the Department recommends 

Congress establish an independent commission to review military retirement, as requested by the administration. We fully support formation of such a commission, 

and if enacted, we will provide significant input. Most importantly, our review is 

performing critical and rigorous modeling and analysis of various alternatives. 

While many in the private sector, and elsewhere, have suggested alternatives to the 

current military retirement system, few have undergone rigorous modeling or analysis. We are committed to ensure any proposal we develop is sound and does not 

harm the Department’s ability to recruit and retain the future force. Secretary Panetta has also made clear that current members will be grandfathered; for those 

who serve today, there will be no changes in retirement benefits. Following the review of military retirement, we plan to continue our comprehensive, broad-based review of military compensation in search of additional efficiencies and savings. 

14 

Reserve Component 

The fiscal year 2013 budget supports the increased utilization of the Reserve components (RC) as called for in the National Defense Strategy and will enable the RCs 

to continue to fulfill their vital national security role. The Department’s Ready Reserve totaling about 1.1 million members contributes 43 percent of total military end 

strength at a cost of 9 percent of the total base budget. The National Guard (NG) 

and Reserve provide trained, ready, and cost-effective forces that can be employed 

on a regular operational basis, while also ensuring strategic depth for large-scale 

contingencies or other unanticipated national crises. 

Prior to 2001, the RCs were primarily a strategic reserve with occasional operational missions as needed to augment active forces. Since 2001, RC units and individuals have been heavily employed across the full spectrum of military operations 

and have demonstrated their readiness and criticality. Our current NG and Reserve 

is, arguably, the most combat seasoned reserve force ever, and we plan to capitalize 

on this significant investment to provide needed military capacity during current 

austere economic times. 

The fiscal year 2013 budget anticipates the Department will continue to use the 

Guard and Reserve as a vital part of the operational force and—where it makes 

sense—as a force of first choice. Today’s Citizen Warriors have made a conscious decision to serve, with full knowledge that their decisions mean periodic recalls to active duty under arduous and hazardous conditions. In approximate numbers, as of 

December 31, 2011, the Ready Reserve currently consists of: 

• Selected Reserve: 844,400 • Individual Ready Reserve: 220,000 • Inactive NG: 3,700 

Reserve Component Utilization 

The Reserve component has become an integral part of the Nation’s military force 

participating in nearly every mission worldwide for the past two decades. As this 

practice continues, the Department has emphasized prudent and judicious management and use of the RC to help mitigate stress on the Total Force. Total Reserve 

component usage in support of Contingency Operations since September 11, 2001 

is 835,689 (809,913 Selected Reserve and 25,776 Individual Ready Reserve). Of 

those, 80 percent have deployed in the U.S. Central Command area of responsibility. 

On December 31, 2011, there were 86,213 Reserve component members activated in 

support of Operation Noble Eagle (ONE) and Operation Enduring Freedom; of those, 

35,361 were deployed in the Central Command theater. 

Realigning Capabilities 

The Reserve component is well suited for use as a source of strategic depth as 

well as in a wide variety of operational roles, including providing: (1) rotating operational units deployed in response to Combatant Commander needs and Service requirements; (2) units and teams deployed in support of Theater Security Cooperation and Building Partner Capacity activities around the globe; (3) individual 

augmentees who can be deployed in response to Combatant Commander, Defense 

agency, or Service needs; (4) units, teams, and individuals to support core Unified 

Command Plan missions such as Homeland Defense and Defense Support of Civil 

Authorities, as well as to support Governors in state security; and (5) units, teams, 

and individuals assigned to support Department or Service institutional needs. Reserve component forces are well-suited for missions and tasks in support of Theater 

Security Cooperation and Building Partner Capacity activities and specialty missions requiring unique skills, particularly when the RC units have an enduring relationship with a supported command. 

Individual and Medical Readiness 

One of the key aspects of maintaining a viable, operational RC is to ensure that 

our military members and our civilian employees maintain the highest level of individual readiness. We must focus on maintaining the appropriate physical fitness levels for a force that has a higher average age than the Active component. Similarly, 

ensuring that our RC members are medically and dentally ready to serve is of the 

utmost importance. 

Employing the RC as operational force requires modifications to training schedules and funding requirements. Before we operationalized the RC, normal minimum 

training profiles consisted of training 2 days per month plus 14–15 days of active 

duty for training annually. During that training time, RC personnel were required 

to meet the same standards as their Active counterparts. While that training profile 

remains in-place for some types of units, for those with planned deployments, training days prior to mobilization increases. This training profile, with more training 

15 

pre-deployment and less post-deployment, minimizes mobilized time away from families and civilian jobs. Increasing individual readiness by modifying training profiles 

with resources and policies is a major focus area that will allow the Guard and Reserve to capitalize on the gains made during the last decade and enable sustained 

use of the RC as an operational force. 

We continue to monitor Individual Medical Readiness of the NG and Reserve to 

ensure availability of ready RC members for deployment, as it is a priority for the 

Department. By the fourth quarter of fiscal year 2011, the RC had increased its 

Fully and Partially Medically Ready (FMR/PMR) rate 5 percent over first quarter 

fiscal year 2011 rates, and reduced the Indeterminate population by 6 percent. Most 

notably, the Marine Corps Reserves improved their FMR status by 16 percent and 

reduced the PMR rate by 14 percent—over half of the fiscal year 2011 first quarter 

rates. The Coast Guard Reserve also made great improvements increasing their 

FMR rate by 9 percent, and reducing their Indeterminate and Not Medically Ready 

population by 4 and 6 percent respectively. While we continue to face challenges 

with Dental Readiness, all Services are over the 75 percent goal except Army Reserve and Army NG which are at 71 and 73 percent respectively. We are working 

diligently to improve access to medical and dental services for RC members. For example, the Army Reserve now budgets additional medical and dental services into 

their Readiness Accounts for RC members if needed. 

Yellow Ribbon Reintegration Program (YRRP) 

The YRRP is a Congressionally-mandated program whereby the Services provide 

RC servicemembers and their families with critical support, information, services, 

and referrals throughout the entire deployment cycle focused primarily on local community resources to maximize successful servicemember reintegration back into 

their civilian lives. During the past 3 years, the YRRP has evolved into a successful, 

forward-leaning program providing essential readiness and resiliency training and 

resources to over 800,000 servicemembers and designees. In fiscal year 2011, Congress appropriated $16 million to the YRRP for enhanced outreach and reintegration 

employment activities which allowed the Department to support various State-led 

initiatives. YRRP’s fiscal year 2012 funding is entirely dedicated to supporting its 

legislatively mandated core activities. To support the use of the operational reserve 

in the future, we will ensure funding for Service YRRPs is moved to their base line 

budgets. 

Transition to Veterans Affairs 

Today’s Veterans face a number of challenges in making the transition to civilian 

life, and among these is embarking on a productive post-military career. For every 

success story of a Veteran who has turned skills developed in the military into success in the civilian workplace, there are, as President Obama has said, stories of 

Veterans who come home and ‘‘struggle to find a job worthy of their experience and 

worthy of their talent.’’ We see these struggles most clearly in high unemployment 

rates for Veterans. Making this situation more urgent is that, as we draw down 

from the wars in Iraq and Afghanistan and we make difficult decisions about our 

future force structure in light of the fiscal challenges the Nation faces, the number 

of servicemembers—particularly young servicemembers—departing the military over 

the next several years will increase. 

Making a firm commitment to employ America’s Veterans, in August 2011, the 

President called for the creation of a Task Force led by the DOD and VA with and 

other agencies including the DoL, Department of Education (DoE), Department of 

Commerce, Small Business Administration, and the Office of Personnel Management, to develop proposals to maximize the career readiness of all servicemembers. 

In coordination with our VA, DoL, and DoE partners, DOD’s role involves implementing and sustaining a comprehensive plan to ensure that all transitioning 

servicemembers have the support they need and deserve when they leave the military. This includes working with other agencies in developing a clear path to civilian 

employment; admission into and success in an academic or technical training program; or successful start-up of an independent business entity or nonprofit organization. The effort is fully aligned with the VOW to Hire Heroes Act of 2011 and is 

consistent with DOD’s commitment for keeping faith with all of our military members and their families, providing them a comprehensive set of transition tools and 

support mechanisms as they complete their service to our Nation. 

Civilian Personnel 

The Department continues to hold, with limited exceptions, the civilian workforce 

to authorized fiscal year 2010 levels. This continues the direction from last year’s 

efficiency initiative and was implemented in conjunction with organizational assessments and mission/function prioritization. This direction reflects the Department’s 

16 

commitment to challenge workload demand; more appropriately size our workforce 

to meet our most pressing and critical priorities; and focuses on reducing administrative functions associated with headquarters staff while realigning resources to 

warfighting capability, recapitalization, and unit readiness. As Secretary Panetta 

has testified, our spending choices must be based on sound strategy and policy. and 

reductions in the civilian workforce reflect changes in the Department’s strategy, 

overseas presence, and force structure. 

Despite the overall decreases to the Department’s civilian workforce, there have 

been areas where mission workload, requirements, and fiscal considerations warranted growth and exceptions. Growth and increases to the civilian workforce have 

continued in critical areas such as acquisition, cyber, and intelligence. Targeted exceptions to fiscal year 2010 levels have also been approved for shipyard and security 

guard workforces in the Navy; the test and evaluation workforce in the Army and 

Air Force; joint basing requirements for the Navy and Air Force; and in-sourcing 

of contracted services at some combatant commands and defense agencies. 

Reductions in the Department’s civilian workforce are being executed very deliberately to minimize adverse impacts to our dedicated civilian service workforce and 

to avoid unintended consequences, such as: 

• ‘‘borrowing’’ or ‘‘repurposing’’ military personnel for non-military tasks, 

which would risk hollowing the force; 

• potentially paying more for contracted services or inappropriately realigning work to the private sector; and 

• jeopardizing our ability to sustain and develop mission critical skills and 

competencies. 

To support these goals, I reconstituted the Defense Human Resources Board 

(DHRB) on December 8, 2011. The DHRB is my primary advisory body for Total 

Force management across the Department. Specifically, the DHRB serves to promote and facilitate improved Department-wide Total Force management, both current and future, through the improved alignment of statutes, policy, business practices, information technology, and resources. 

It is imperative we improve the management of our Total Force of Active and Reserve military, government civilians, and contracted services. To do so, leaders and 

managers throughout the Department must be provided the information, tools, and 

flexibility necessary to make sound and well-reasoned decisions. To that end, there 

are a number of specific areas that we have focused attention on. 

In October 2011, the Office of Federal Procurement Policy (OFPP) issued its policy 

letter regarding inherently governmental (IG) and other work Reserved for government performance. The Department was an active participant in developing that 

policy letter, and my staff is currently working to ensure its implementation and 

application across the Department. The identification of IG functions, work that is 

closely associated with IG, and workload critical to the Department’s ability to execute its mission are fundamental processes in our Total Force management strategy. 

Ensuring the Department’s workforce is sufficiently sized and comprised of the 

appropriate mix of personnel is critical to maintain readiness and capabilities in our 

constrained fiscal environment. The Department’s ‘‘sourcing’’ of necessary functions 

and work between military, civilian, and contracted services must be consistent with 

workload requirements, funding availability, readiness and management needs, and 

applicable laws. In particular, workforces must be structured to not use military 

personnel outside of their primary specialty to perform functions or tasks that would 

limit their availability to mobilize and perform the operational mission, support and 

maintain necessary states of readiness, or impede their training and career progression requirements. As planned military end strength reductions happen, the Department will continue to focus on the proper mix of personnel. 

Inventory of Contracts for Services (ICS) 

Contracted services remain the largest element of the Total Force. The Department remains committed to meeting its statutory obligations under title 10 to annually review its contracted services. After 6 months of working with the more than 

40 components that comprise the Department, we delivered, on November 22, 2011, 

a consolidated plan to the congressional defense committees that identified both 

short- and long-term actions that will improve the ICS, make it a more reliable and 

complete data set, and improve visibility and accountability in the area of contracted services. Consistent with changes to the statute, this plan, and subsequent 

guidance issued on December 29, 2011, specifically addresses how the Department 

will: 

• measure contracted support level of effort using direct labor hours and 

associated cost data collected from contractors; 

17 

• assess the type of work being performed by the private sector and for 

whom based on standardized taxonomies and portfolio groups; 

• strengthen the relationship between the ICS and annual budget justification materials; and 

• ensure the ICS supports strategic workforce planning and an appropriately balanced, effective, and efficient workforce. 

The actions being taken will improve the long-term utility of the ICS, beginning 

with the next submission this summer, and will enable us to more accurately and 

holistically assess contracted workload. Coupled with an improved IG&CA Inventory, the ICS will help us achieve the right balance in our workforce, aligning inherently governmental activities to military and civilian workforces, and commercial activities to the most cost effective service provider. 

In-sourcing 

The Department greatly values the support provided by private sector firms and 

recognizes the private sector is a vital source of expertise, innovation, and support 

to the Department’s Total Force. However, in-sourcing continues to be a necessary 

workforce shaping tool to reduce excessive or inappropriate reliance on contract support; appropriately align inherently governmental activities; and protect the public’s 

interest while providing the best value for taxpayers. Therefore, we are continuing 

to in-source contracted services that are closely associated with inherently governmental work; that provide unauthorized personal services; or that may otherwise be 

exempted from private sector performance (to mitigate risk, ensure continuity of operations, build internal capability, and to meet and maintain readiness requirements). While some contracted services may be identified for in-sourcing, some services may no longer be required, or be of lower priority, and therefore reduced in 

scope or eliminated. Contracted services that meet the necessary criteria (i.e. consistent with statutes, policies, and regulations) will be in-sourced by: 

• absorbing work into existing government positions by refining duties or 

requirements; 

• establishing new positions to perform contracted services by eliminating 

or shifting equivalent existing manpower resources (personnel) from lower 

priority activities; and 

• as appropriate or necessary, requesting an exception to the civilian levels 

currently reflected in the budget. 

Our in-sourcing efforts are focused on rebalancing the workforce, rebuilding critical internal capabilities (including the acquisition workforce), and reducing operational risks. 

OMB Circular A–76 

Consistent with statutory changes that restrict the ‘‘direct’’ conversion of work 

currently performed (or designated for performance) by any number of civilian personnel to private sector (contract) performance, I issued guidance to the Department 

on December 1, 2011. In it, I urged vigilance to prevent the inappropriate conversion of work to contract performance, as we adapt to declining budgets and operating in a constrained fiscal environment. We are also preparing guidance that reiterates the current statutory moratoriums on public-private competitions. 

As noted earlier, contract support is critical to the Department’s operations. Last 

summer, we submitted a report on our public-private competition policy and procedures under OMB Circular A–76, making recommendations to improve the end-toend competition process. The public-private competition process can be a useful tool 

for our commanders and managers to validate an organization’s manpower and 

other requirements; drive a more consistent delivery of mission support and services 

to our servicemembers and families; improve business process; and deliver readiness 

while minimizing fiscal opportunity costs to meet the compelling needs of the Department. Congress, in the NDAA for Fiscal Year 2012, accepted many of our recommendations and made changes to the governing statute for public-private competitions. We are committed to making improvements to ensure the process is more 

equitable, less time consuming, and minimizes disruptions to incumbent workforces. 

Together with improvements to the ICS that will enable us to more accurately 

gauge the extent of private sector reliance, we look forward to providing an improved A–76 process to our decision makers in the future. In summary, we must 

shape an efficient, effective, and viable Total Force aligned to strategy and is supported by robust analysis. The fiscal year 2013 budget and our associated plans reflect our best judgment today. 

18 

Strategic Human Capital Management and Competency Management 

The Department is making progress toward developing a more systematic approach and enterprise tools for strategic human capital planning that covers over 

750,000 civilian employees in over 600 occupations. In fiscal year 2012, we developed initiatives to meet statutory civilian strategic workforce planning requirements 

by fiscal year 2015. First, the Department expanded its functional community construct to cover all major occupations in the civilian workforce. Previously, only mission critical occupations, which made up less than 40 percent of the workforce, were 

covered in the DOD Strategic Workforce Plan. Second, the Department updated criteria for designating mission critical occupations following a more structured process 

defined by the Federal-wide Strategic Human Capital Management High Risk Initiative. Third, an Enterprise Competency Management Framework has been designed that includes phased development of Department-wide occupational competency models and deployment of a tool for competency assessments. An Army system is now being updated for Department-wide use to replace multiple competency 

tools with a single enterprise system. That system, the Defense Competency Assessment Tool is scheduled for deployment in fiscal year 2013; and through it, we will 

be able to assess workforce competencies and develop strategies to reduce critical 

skill gaps that may impact mission accomplishment by fiscal year 2015. 

The Department continues to focus on life-cycle management of the civilian workforce by integrating strategic workforce planning, competency management, hiring 

process improvements, and workforce development initiatives to ensure that plans 

support the recruitment, retention, and development of a ready civilian workforce 

that is responsive to swiftly changing mission demands and complex challenges. 

These are multi-year initiatives to improve the Department’s ability to rapidly grow, 

contract, and shift the workforce in response to emerging mission requirements. 

Hiring Reform 

The Department has made great strides in reforming the hiring process by reducing hiring timelines, streamlining the process, and focusing on efficient practices. 

Prior to implementing the May 2010 Presidential Memorandum for Improving the 

Federal Recruitment and Hiring Process, measurement of all hiring practices was 

inconsistent and lacked input from individual components and servicing agencies. 

In 2010, we adopted standard measurement practices that enabled our leadership 

to analyze and measure hiring timelines across multiple dimensions, and to drive 

mission-critical changes. 

In 2011, we continued to make positive and meaningful progress toward reforming civilian hiring practices. We reduced the number of days it takes to hire an employee by developing a common business process, deployed tools to automate key 

steps in the hiring process, and provided manager and human resources specialist 

training and job aids. In addition, our arsenal of hiring-related metrics and measurements has grown, thereby enabling transparency and targeted improvements to 

the hiring process. In fiscal year 2011, the Department reduced its external hiring 

timeline by 31 percent, from the fiscal year 2010 baseline of 116 days to 91 days. 

As a result of progress made in the early part of fiscal year 2011, the Department’s 

external hiring timeline target was adjusted downward to 95 days from the original 

101 day target. Our goal for external hiring in fiscal year 2012 is 80 days, with 

quarterly goals established to monitor progress. The overall reduction in hiring 

timeline for external hires contributed to an overall time to fill for all hiring actions, 

both internal and external, of 75 days for fiscal year 2011 and 63 days for fiscal 

year 2012 year-to-date. Another area of improvement is the automation of our hiring 

process. We procured an automated staffing tool (USA Staffing) in fiscal year 2010 

and successfully deployed it to over 70 percent of the Department in fiscal year 

2011, and are aggressively working toward completing deployment this year. 

The Department continues to partner with the Office of Personnel Management 

(OPM) on the re-engineering of USAJOBS, the job posting portal used by the Federal Government. The USAJOBS 3.0 project is a high visibility project and DOD is 

the largest consumer of USAJOBS’ services. The deployment of USA Staffing and 

improvements to USAJOBS are critical initiatives; however, without participation 

and engagement from our Hiring Managers and Human Resource (HR) Professionals, the benefit of these initiatives cannot be fully realized. As a result, a primary objective is to foster and encourage strong partnerships between these key 

stakeholders. To assist, the Hiring Reform Website (http://www.cpms.osd.mil/ 

HiringReform/) provides a Hiring Managers Toolkit containing 24 guides, and a 

Webinar series is now available that provides content based on the four phases of 

the hiring process. 

The initiatives outlined represent the Department’s continued approach to hiring 

reform implementation, an approach aligned with the Department’s overall mission, 

19 

and with its Strategic Workforce Planning objectives. A key success criterion is the 

involvement of senior leadership. We continue to solicit and use our cadre of senior 

leaders to guide our efforts, communicate and campaign for process improvements, 

and provide direction throughout each hiring reform effort. We will continue to monitor these efforts closely. 

Termination of the National Security Personnel System (NSPS)/New DOD-wide 

Performance Management System, Redesigned Hiring, and Workforce Incentives 

The NDAA for Fiscal Year 2010 repealed the statutory authority for NSPS, mandating all employees transition from NSPS no not later than January 1, 2012. The 

Department successfully completed the termination of NSPS and the transition of 

all employees and positions from NSPS to the appropriate successor statutory pay 

and personnel system in December 2011. No employees or positions remained under 

NSPS on the statutory deadline of January 1, 2012. 

In September 2010, we launched our ‘‘New Beginnings’’ effort to involve labor representatives in design of a new performance management system and hiring processes. New Beginnings was an evolving effort and included labor and management 

planning sessions, conferences, and design team working meetings for more than 18 

months, which culminated in over 100 pre-decisional proposals developed by labor 

and management employees for leadership consideration. The pre-decisional process 

culminated in a comprehensive report from the design teams that captures their research, conclusions, and proposals, and Department leadership has considered the 

report’s recommendations. We will continue to involve employees through their 

labor representatives as we move forward on particular recommendations and decisions about the new authorities and practices. 

Civilian Leadership Development 

The Defense Civilian Emerging Leaders Program (DCELP), as authorized by the 

NDAA for Fiscal Year 2010, fills a critical need by focusing on a corporate scale on 

developing civilian leaders at the entry and mid-level. We recognize the need for an 

improved model to attract, retain, and develop civilian leaders to support pipeline 

readiness and enhance bench strength. We conducted a gap analysis between existing programs and requirements, and designed a framework to create a new program 

to recruit and develop new civilian leaders, using proven models such as the Presidential Management Fellows program. Recognizing the financial environment and 

to ensure we have a sound programmatic framework, we implemented a DCELP 

pilot in September 2011 with 103 participants at the General Schedule (GS) 7 

through 11 level from the Acquisition, Financial Management, and Human Resources career fields. A second cohort, which expands our intake to 180 participants, 

will begin before the end of 2012. 

This new DCELP is additive to the Department’s current leadership programs, 

which include the Executive Leadership Development Program (ELDP) and the Department of Defense Senior Leader Development Program (DSLDP). DSLDP was established in 2008 to meet emergent leadership needs and provides a competencybased approach to the deliberate development of senior civilian leaders (GS 14 or 

15 and equivalent grades) with the enterprise-wide perspective needed to lead organizations and programs and achieve results in the joint, interagency, and multi-national environments. We are pleased to report that DSLDP is soon graduating its 

second cohort and just commenced its fourth cohort. DSLDP is a critical feeder pipeline for executive talent. Established in 1985, ELDP provides mid-level civilians 

(GS–12 through GS–14 and equivalent grades) with an extensive exposure to the 

roles and mission of the Department and our Interagency partners and, an increased understanding of, and appreciation for, today’s warfighters through intensive hands-on field experiences. Both programs are aligned with the 21st century 

competency framework and designed to ensure application of critical leader competencies and have garnered success for their target senior grade populations. These 

highly competitive Department-wide programs will serve as building blocks for the 

new leader development framework. 

In addition to the programs just mentioned, another critical building block in this 

arena is training managers and supervisors. Pursuant to the NDAA for Fiscal Year 

2010, the Department has established a holistic training curriculum and baseline 

learning objectives for each training topic. We have piloted and launched our first 

course, focusing on new supervisors. Our attention has turned to developing the curriculum for refresher training, which the NDAA requires occur at least every 3 

years. The refresher pilot will take place in May 2012. Following that, we will develop and then launch for Departmental use training for managers—those who supervise other supervisors. All courses will be launched this year. Also, we are 

partnering with OPM and vendors to design assessment and developmental tools 

20 

that will help predict interest and success for aspiring and current supervisors. 

Those assessment tools are planned for use by May 2012. 

Senior Mentors/Highly Qualified Experts 

In April 2010, in response to media and congressional concern, the Secretary 

issued policy guidance regarding how the Department may acquire certain advisory 

services from retired senior officials—the so-called senior mentor (SM) policy. The 

guidance prohibits contracting for mentoring services and directs that senior mentors must be employed as Federal officials under the specific Highly qualified Expert 

(HQE) appointing authority, which subjects them to certain Federal ethics rules and 

salary limits. The NDAA for Fiscal Year 2011 formalized the requirement that senior mentors be hired as HQEs, and comply with all applicable Federal laws and regulations on personnel and ethics matters. 

In November 2010, the Deputy Secretary of Defense issued a memorandum directing all HQE–SMs position descriptions be revised within 30 days, requiring all 

HQE–SMs complete the public disclosure forms. In addition, all HQE–SMs were to 

submit completed public disclosure forms within 30 days of the position description 

being updated, but no later than January 12, 2011. Accordingly, all HQE–SM either 

separated or completed the public financial disclosure form as of January 12, 2011. 

Currently, the Department has 34 HQE–SMs on board, and approximately 164 

HQEs total while Congress has authorized 2,500, and the number of HQEs has declined by 8 percent since December of last year. As a result of ongoing efficiency 

initiatives, the total number of HQEs will change as functions are discontinued. 

To further ensure SM services are acquired in strict compliance with Department 

policies, the Defense Federal Acquisition Regulation Supplement (DFARS) incorporated the prohibition on contracting for SM services in DFARS 237.102–72 issued 

on November 24, 2010. After a Department-wide audit, the Department of Defense’s 

Inspector General reported on October 31, 2011, that the Department complied with 

these new policies for hiring senior mentors as HQEs. 

As a result of these changes, the Department has successfully balanced the critical need for SM services with the public’s need for confidence in the integrity of 

the program. We are committed to ensuring consistency and transparency in the use 

of SM across the Department. Further, as we greatly value the contributions of our 

SM to the training and professional development of our current and future Joint 

and Service commanders, we believe this policy provides the rigorous oversight required for the proper employment of these experts. 

Civilian Expeditionary Workforce 

The Department is working to better employ the talents of our civilian workforce 

to meet expeditionary mission challenges, including those not directly related to war 

fighting. Global security challenges require adequate civilian capacity to conduct 

complex operations, including those missions that require close military-civilian 

planning and cooperation in theater. Since 2001, approximately 50,000 Department 

civilians have been involved in contingency operations around the globe. Currently, 

approximately 4,800 civilian employees are serving in the CENTCOM theater. 

The Department institutionalized the Civilian Expeditionary Workforce (CEW) to 

provide deployable civilian experts to support military operations, contingencies, 

emergency operations, humanitarian missions, disaster relief, and stabilization and 

reconstruction operations. The CEW is designed to enhance the Department’s ability 

to work alongside and help build the capacity of partner defense ministries and provide surge support where needed. Since June 2010, CEW deployments have increased by 56 percent, from 171 deployed civilians to 388 as of the end of February 

2012. Civilians deployed under the CEW receive general and theatre-specific, urban 

training, and are eligible for the same health care benefits in-theatre as deployed 

military personnel, including medical evacuation and access to hospital services. 

With the support of Congress, we have obtained important incentives and benefits 

to help compensate for the inherent risks of deployment. The Department continues 

to identify pertinent issues and propose fully integrated solutions to ensure force 

health protection, surveillance, deployment benefits, and medical care for civilians 

who have been injured, wounded, or have contracted diseases while deployed in support of contingency operations. We have worked in partnership with OPM, the Department of State, and the DoL to ensure all similarly-situated Federal civilians receive consistent and equitable benefits commensurate with the risks of deployment. 

In this endeavor, working with our partner agencies, we developed proposed legislation to provide a standard benefits package for all Federal employees. 

More work is underway to transform the CEW program mission. Consistent with 

the Department’s strategic direction, the goal is to implement an enduring solution 

which will enable the CEW to achieve a rapid response capability in support of all 

21 

1This represents an overall reduction from 1,070,000 in 1987 to 751,000 in 2012. 

Combatant Commands. The transformation will include consolidation of four key 

functions across the Department, including: 

• Policy formulation that enables standard, DOD-level instructions for the 

deployment of civilians that will allow sufficient flexibility to meet future 

demand and ensure personnel are identified for potential deployment in any 

event; 

• HR Servicing that provides end-to-end lifecycle support, from recruitment 

to separation; 

• Management support for arranging travel; performing audience targeted 

training; conducting final medical screening and vaccinations; providing 

passport services and travel voucher training; issuing travel orders, uniforms, and equipment; tracking time and attendance during deployment; 

and providing redeployment services; and 

• Payroll support allowing for a centralized payroll function to ensure 

standardized policies and administration. 

These efforts will help transform the capability of the CEW to efficiently support 

future contingency staffing needs to unify and improve the efficiencies in support 

of operations. 

Workforce Shaping 

The Department has long experience managing a civilian workforce in transition. 

Beginning with the first installation closures in the mid-1960s, our predecessors formulated a strategy for maintaining a relatively stable workforce despite the instability that is inherent in major downsizing and restructuring. The centerpiece of 

that strategy was, and continues to be, the Priority Placement Program (PPP). 

Through this vital program, we have retained the skills of more than 258,000 

transitioning civilian employees by matching them with Department job vacancies. 

During the last 25 years, which have been largely defined by five Base Realignment 

and Closure rounds and a workforce reduction of 30 percent 1, our overall objective 

has been to reshape the Department as efficiently and humanely as possible. By 

maintaining constant focus on this goal, we have been able to develop a broad-based 

career transition assistance program to complement the PPP. 

In view of the efficiency initiatives implemented by former Secretary Gates, ongoing efforts by Secretary Panetta to further streamline, and the specter of even deeper spending cuts, it is very unlikely that involuntary separations can be avoided in 

fiscal years 2012 and 2013. Although the scope of involuntary separations is uncertain at this time, we will fully exploit all available tools and resources to minimize 

the human impact of force restructuring while maintaining mission readiness. 

Under our current plan, the civilian workforce will decrease in size from about 

764,300 full-time equivalents (FTEs) to 756, 800 in fiscal year 2013. This represents 

a reduction of about 1 percent, and is approximately 2 percent lower than our fiscal 

year 2011 actual execution of 771, 300. Absent additional constraints, the workforce 

will gradually decrease to 738,000 FTEs by fiscal year 2017. 

Federal agencies are required to use standard reduction-in-force (RIF) procedures 

when reorganization, lack of work, shortage of funds, or insufficient personnel ceilings necessitate separating or demoting civilian employees. When RIF becomes necessary, employees compete for retention based on several factors established by law 

and regulation. These factors include tenure, veterans’ preference, length of service, 

and performance ratings. Together, these factors determine each employee’s RIF retention standing. 

During periods of force reductions, the Department’s policy is to use voluntary 

separation programs to the maximum extent possible prior to imposing any involuntary actions. The most familiar and publicized of these are Voluntary Separation Incentive Pay (VSIP) and the Voluntary Early Retirement Authority (VERA). The Secretary has independent authority to allow up to 25,000 VSIP buyouts annually. This 

figure, which does not include incentives paid in conjunction with Base Realignment 

and Closure (BRAC), has thus far been sufficient to meet our needs. Although there 

is no limit on the number of VERAs, the use of this authority can be constrained 

by the VSIP limit, since employees who elect VERA frequently also take VSIP. 

The Department also partners with the DoL to provide downsizing and restructuring installations outplacement assistance under the Workforce Investment System (WIS). The WIS is administered through the various State One-Stop Career 

Centers, and includes assistance such as retraining, career counseling, testing, and 

job placement assistance. While working constantly to refine and enhance existing 

force shaping tools, the Department will continue to seek regulatory and legislative 

22 

changes to further assist affected civilian employees in transitioning to other positions, careers, or to private life. 

HEALTH AFFAIRS

The Military Health System provides extraordinary care on the battlefield to our 

servicemembers—both preventing illness and injury to those in harm’s way, and 

rapidly treating those who are wounded. The performance of our military medical 

system in a time of war continues to set new standards for battlefield survival rates, 

the reintegration of many who are wounded back into their units and for returning 

those who need additional care back to the United States. 

In addition to these successes, the military health system provides access to care 

for over 9.6 million beneficiaries, no matter where they live. We provide this access 

through our direct health care system and through our managed care support contracts. This health care benefit is justifiably one of the finest in the county and is 

an appropriate benefit for those who serve our county. However, the costs of providing this care continue to increase more rapidly than overall inflation. For a number of years, and through several administrations, there have been continuous, incremental steps taken to reduce the rate of growth in the costs of healthcare. 

The Department is pursuing a balanced, four-pronged approach by which all 

stakeholders share responsibility for improving the health of our population and the 

financial stability of the system of care. Our four approaches—moving from a system of healthcare to one of health; continuing to improve our internal efficiencies; 

implementing provider payment reform; and rebalancing cost-sharing—are further 

described below. In some instances, they reflect efforts already underway, or new 

initiatives that the Department is implementing within existing legislative and regulatory authorities. 

Moving from Healthcare to Health 

The Department of Defense’s military medical leaders are leading a strategic effort to move our system to one that promotes and sustains the optimal health of 

those we serve, while providing world class healthcare when and where it is needed. 

Central to this effort are the Department’s investments in initiatives that keep our 

people well; that promote healthy lifestyles; and that reduce inappropriate emergency room visits and unnecessary hospitalizations. 

Over the last 2 years, the Department introduced the Patient-Centered Medical 

Home and over 2.2 million are currently enrolled. We are beginning to see the benefits of this new model of care with decreases in emergency room visits; increased 

compliance with provider directions and drug prescriptions; and increased patient 

satisfaction for those enrolled. We’ve also placed behavioral health staff within these 

medical homes, improving access with reduced stigma, for our patients needing the 

support of mental health providers. A valued component of the medical home is the 

introduction of secure patient-provider email communications, allowing our patients 

to directly communicate with their medical providers without the need for a physical 

visit to the clinic. In 2013, we will continue to expand this model to all of our primary care clinics in the military health system, and increase the tools available to 

patients to help manage their own care. 

Aligned with that initiative is the introduction of a 24/7 nurse advice line for all 

stateside beneficiaries based on our effective use of this approach for our military 

beneficiaries in Europe. This will provide beneficiaries with around-the-clock access 

to toll-free nurse advice services. When the caller requires follow-up care, this service will provide direct appointing services for beneficiaries enrolled to TRICARE 

Prime in our military treatment facilities. We will implement this added service this 

year. 

In moving from healthcare to health, we have also engaged the broader DOD community—line leaders, commissaries, dining facilities, schools and child development 

centers. By changing menus, promoting better food choices and healthy lifestyles we 

will encourage healthy lifestyle changes. The First Lady, Michelle Obama, recently 

visited one of our leading installations, Little Rock Air Force Base, to highlight the 

progress we have made. 

Finally, we have taken a number of steps to support preventive services. Our 

TRICARE beneficiaries—whether enrolled to TRICARE Prime or in TRICARE 

Standard—have no copayments for recommended preventive services, such as influenza immunizations. 

The ‘‘Healthcare to Health’’ element of our strategy will not produce immediate 

cost savings. Nonetheless, based on early results from our efforts, as well as experience in the private sector, we are confident that these, and other ongoing enhancements to the TRICARE program, will produce improvements to health that also 

23 

‘‘bend the cost curve.’’ In the longer term, it is the strategy most likely to produce 

the greatest amount of savings to our system. 

Internal Efficiencies 

Over the last 24 months, we have reduced internal costs by decreasing headquarters administrative overhead, reviewing more cost-effective governance models, 

jointly purchasing medical supplies and equipment, and directing patients to lower 

cost venues for medications. 

Last year, the Secretary of Defense directed specific efficiency targets across the 

Department. As a result, over the last 11 months we have reduced or eliminated 

contractor support in the Office of the Assistant Secretary of Defense (Health Affairs) and the TRICARE Management Activity (TMA). Overall savings from internal 

efficiencies are projected to provide $259 million in savings for fiscal year 2013. 

In June 2011, the Deputy Secretary of Defense established a Task Force on Military Health System (MHS) Governance, with the purpose of evaluating options for 

the long-term governance of the MHS as a whole; governance in those areas where 

more than one Service operates medical treatment facilities—referred to as multiService markets, and governance for the National Capital Region (NCR). In late 

September, the Task Force provided their recommendations, after which senior Department leaders including Chairman of the Joint Chiefs of Staff began review of 

the Task Force recommendations. 

Implementation of any organizational efficiencies resulting from this Task Force 

has been placed on hold at the direction of Congress, subject to a review by the 

Comptroller General and Congress. We will provide congressional committees with 

the information requested regarding the Task Force work, and will develop more detailed cost and savings estimates for any eventual governance model. The Deputy 

Secretary of Defense approved and released a ‘‘way ahead,’’ on March 2, and while 

we are still awaiting the Government Accountability Office (GAO) report, we are 

prepared to answer any additional questions you may have. 

The Department has accelerated tri-service processes to standardize and jointly 

acquire medical supplies and equipment. We project savings that grow from $31 million in fiscal year 2012 to more than $69 million in fiscal year 2017. We have also 

engaged with our beneficiaries who have chronic medical conditions and high utilization of prescription drugs. Through a targeted outreach campaign, we have redirected a significant number of our patients from retail network pharmacies (our 

most expensive outlet) to home delivery—an option that is more economical for the 

government and the beneficiary, and has been shown to increase drug compliance. 

Provider Payment Reform 

We are committed to identifying greater efficiencies and cost savings in all areas 

of our operations. In addition to internal efficiencies we can achieve through reorganization and consolidation, we are also seeing significant savings through a number 

of initiatives we have introduced in the last several years. These include the implementation of the outpatient prospective payment system; further use of Federal ceiling prices for acquisition of pharmaceutical products; a redirection of patients to our 

TRICARE mail order pharmacy—where prescription drugs are less expensive to 

both the government and patients, and is shown to increase patient adherence to 

their medication regimen; and the policy changes we made for reimbursement to select hospitals and health plans in the TRICARE network. 

The Department has undertaken a broad-based, multi-year effort to ensure all aspects of our provider payments for care purchased from the civilian sector are 

aligned with best practices in Medicare and in private sector health plans. The most 

notable efforts have included implementation of changes to the outpatient prospective payment system (OPPS) and reform of payment to Sole Community Hospitals. 

OPPS is modeled after the payment process that Medicare uses for similar health 

care services—setting a fixed fee per procedure, inclusive of provider and institutional charges for care. To allow medical facilities to transition to this new method 

of payment, TRICARE phased in the reimbursement levels over 4 years, with the 

full implementation of this policy set to occur in 2013. In fiscal year 2012, we project 

$840 million in savings, and $5.5 billion over the fiscal years 2012–2017. 

Our provider payment reform for Sole Community Hospitals was approved by 

Congress in the NDAA for Fiscal Year 2012. This reform is also phased-in over time, 

producing a projected $31 million in savings in fiscal year 2012, but growing to more 

than $108 million in savings by 2017. 

In the area of purchasing prescription drugs, in 2009 we instituted a process for 

obtaining discounts on drugs distributed through retail network pharmacies. Known 

as Federal Ceiling Prices (FCP), prescriptions purchased under FCP are at least 24 

percent less than non-Federal Average Manufacturer prices. In 2012, the FCP proVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00029 Fmt 6633 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
24 

gram will save the Department over $1.6 billion, and will grow to almost $2 billion 

in savings by 2017. 

Beneficiary Cost-Shares 

In addition to the focus on internal and external efficiencies, our proposed budget 

introduces changes to the health care out-of-pocket costs for our beneficiaries. 

I want to make three critical points related to these proposals. First, even accounting for these proposed fee changes, the TRICARE benefit will remain one of 

the finest health benefits available in the country, with among the lowest beneficiary out-of-pocket costs available to anyone—and certainly lower than costs by 

other Federal Government employees. We believe that is appropriate and properly 

recognizes the special sacrifices of our men and women in uniform, past and 

present. 

Second, these proposals were developed within the Department, and represent the 

input and consensus of our uniformed leadership. They have endorsed these proposals, and believe that we have appropriately balanced the need for a superb benefit that assists with both recruitment and retention of an All-Volunteer Force with 

our need to sustain a cost-effective approach for the long-term. 

Third, we recognize that some beneficiary groups should be insulated from increases in out-of-pocket costs. We propose to exempt those servicemembers, and 

their families, who were medically retired from military service, as well as the families of servicemembers who died on active duty. We also propose to establish costsharing tiers, with lower increases for retirees based on their retirement rank. More 

junior enlisted retirees, for example, will experience the lowest dollar increases in 

out-of-pocket costs. Finally, we have also avoided any changes in cost-sharing for active duty families with the exception of prescription drug copayments obtained outside of our medical treatment facilities (MTFs). Prescription drugs distributed within MTFs will continue to be free of charge for all beneficiaries. 

For over 15 years, patient out-of-pocket costs were either frozen or decreased. This 

was true for all beneficiary categories—active duty families; retirees under age 65 

and their families; and retirees and their families who are Medicare-eligible. Last 

year, we introduced very modest changes in one segment of our population—increasing TRICARE Prime enrollment fees for retiree families by $5/month. We further 

recommended that these enrollment fees be indexed so that future increases continue to be modest and beneficiaries can plan for them. We greatly appreciate Congress’ support for these proposals in the fiscal year 2012 budget, and have implemented those fee changes in the current year. 

For fiscal year 2013, we propose additional changes to fees across a broader set 

of programs. Although last year’s changes were a necessary step, the Federal budget 

crisis and the need to balance cost reduction efforts throughout the Department necessitate these actions begin in 2013, with most changes phased in over time. The 

following sections provide a high-level overview of the proposed changes in beneficiary out-of-pocket costs, and Table 3 summarizes the proposed phased-in fees 

through 2017, followed by the estimated indexing of the proposed fees through 2022. 

25 


328pe119.eps

Table 3 

New TRICARE Proposals 

TRiCARE Prime for Working Age Retirees (under Age 55} 

As part of the FY 2013 President's Budget, the Department will seek additional increases in the TRICARE Prime (Health 

Maintenance Organization (HMO) type plan) enrollment fees in order to bring the beneficiary cost share closer to the original levels 

mandated by Congress when the program was established. These increases will be phased-in over a 4-year period and will be 

tiered based on the amount of the beneficiary's military retirement pay. 

Below displayed are the proposed fees by fiscal year for the three tiers of retired pay. After FY 2016, the enrollment fees will be 

indexed to increases in Nationall-lea!th Expenditures (NHE). The retired pay tiers will also be indexed to ensure beneficiaries are 

not pushed into a higher tier as a result of annual cost-of-livlng (COLA) increases. The construct and tiering are generally based on 

recommendations of the 2007 Task Force on the Future of Military Health Cere. 

TRICARE Prime Annual Family Enrollment Fees (Individual Fees = 50%) 

Retired Pay FY 2012 FY2013 FY 2014 FY2015 FY 2016" FY2017 

Tier1: $0 $4601$520 $600 $680 $760 $850 $893 

$22.589 

Tier 2: $22,590 $460/$520 $720 $920 $1.185 $1.450 $1,523 

-$45.178 

TIer 3: $45.179 $460/$520 $820 $1,120 $1,535 $1,950 $2,048 

& above , Indexed to med!Callnfiatlon (National Health Expenditures) after FY 2016 

TRICARE Standard and Extra for Working Age Retirees (under Age 66) 

The TRICARE Standard lind Extra (fee-far-service type) benefit programs currently have no enrollment fees and modest annual 

deductlbles of$150 per individual and $300 per family. For FY 2013, the Department proposal will seek to implement an annual 

enrollment fee and increase deductibles. These increases displayed in below will be phased-in over a 5 year period and will then be 

indexed to increases in NHE. 

TRICARE SlandardlExtra Fees/Deductibles 

Annual FY 2012 FY2013 FY2014 FY 2015 FY 2016 FY 2017' 

Enrollment 

Fees 

Individual $0 $70 $85 $100 $115 $130 

Familv $0 $140 $170 $200 $230 $250 

Annual 

Deductlbles 

Individual $150 $160 $200 $230 $260 $290 

Family $300 $320 $400 $460 $520 $580 

Indexed to mechcallnflatlon (National Health Expenditures) after FY 2017 

TRiCARE-tor-Life Benefit (!FLl Benef"rt Program for Retirees age 65 and Older 

Like almost all Americans. upon reaChing age 65, TRICARE beneficiaries must enroll in Medicare and begin paying Medicare Part B 

(outpatient care coverage) premiums. With Part B coverage, Medicare typically covers only 80 percent of eligible health care 

services and some people choose to be covered by NMedigapn or other private insurance polk:les to lower cost-sharing and receive 

additional coverage. Enacted in 2001, the TFL program acts as a second payer plan for TRICARE beneficiaries covering the costs 

not paid by Medicare. While the average ·Medi9ap~ plan with comparable coverage carried premiums $2,100 per individual in 2009, 

there are currently no annual fees for TFL coverage. As part of the FY 2013, President's Budget, the Department is proposing to 

implement modest annual fees for TFL coverage. These fees will be phased In over a 4-year period and use the same tiering based 

on the beneficiary's retired pay along with the same indexing and exemptions as the proposed TRICARE Prime fees. The table 

below displays the proposed TFL fees by fiscal year for the three tiers of retired pay. 

TRICARE -for Life Annual Enrollment Fees - Per Individual 

RetIred P FY 2012 FY2013 FY 2014 FY 2015 FY2016' FY 2017 

Trer1:$0 $0 $35 $75 $115 $150 $158 

$22,589 

Tier 2: 522,590 $0 $75 $150 $225 $300 $317 

-$45178 

Tier 3: $45,179 $0 $115 $225 $335 $450 $475 

& above 

Indexed to medIca! Inflation (National Health Expenditures) after FY 2016 
26 

Fee increases for TRICARE programs. The following proposed changes represent 

increases from existing patient out-of-pocket costs: 

• TRICARE Prime Enrollment Fees. We propose to raise the enrollment 

fees in 2013 for retired servicemembers and their families between $80– 

$300 per year, based on the retirement pay of the servicemember, and continue to provide similar increases through 2017. 

• TRICARE Deductibles. We propose to increase deductibles for the 

TRICARE Standard program for retired servicemembers and their families 

beginning in fiscal year 2013. TRICARE deductibles have not been changed 

since before the TRICARE program was introduced, having last been adjusted over 20 years ago. 

• TRICARE Pharmacy Copays. We propose to increase pharmacy copayments for generic, brand name, and non-formulary prescriptions in both the 

retail and mail order settings, although we will continue to offer significant 

incentives for beneficiaries to elect mail order over retail pharmacy networks. This change is proposed for all non-active duty beneficiaries, to include active duty family members. Prescription drugs obtained in military 

hospitals and clinics will continue to be provided without copay for any 

beneficiaries. 

New fees for TRICARE programs. Our proposed budget also calls for the introduction of new fees not previously part of the TRICARE program. 

• TRICARE Standard/Extra Enrollment Fee. We propose to introduce an 

annual enrollment fee in TRICARE Standard/Extra for retired 

servicemembers and their families. This enrollment action will require 

beneficiaries to elect their preferred primary benefit coverage—TRICARE 

Prime, TRICARE Standard, or other health insurance offered through an 

employer. The proposed fee for 2013 will be $40/year for an individual retired beneficiary, or $140 per retired family. 

• TRICARE For Life (TFL) Enrollment Fee. When TFL was introduced in 

2002, there was no enrollment fee in the program, only a requirement that 

beneficiaries be enrolled in Medicare Part B to enjoy their TFL benefit. 

Medicare Part B was always a step that we recommended our retirees elect, 

and prior to 2002, over 95 percent of eligible military retirees were enrolled 

in Medicare Part B. The TFL benefit has reduced beneficiary out-of-pocket 

costs by thousands of dollars per year in copayments or Medicare supplemental health insurance plan payments. The proposed TFL enrollment fees, 

similar to the TRICARE Prime enrollment fees, are tiered, based on an individual’s retirement pay—and range from $35 to $115 per beneficiary per 

year. 

• Exclusion of Enrollment Fees from the Catastrophic Cap. We propose 

that enrollment fees, which had previously accumulated toward a retiree’s 

catastrophic cap limit, will not be counted toward the cap beginning in 

2013. 


328pe120.eps
27 

• Indexing all fees beginning in 2014. In addition to the indexing of the 

TRICARE Prime enrollment fee, which is already indexed, we propose to 

index other beneficiary out-of-pocket costs identified in this set of proposals, 

to include the TRICARE Standard deductible, TRICARE Standard enrollment fee, TFL enrollment fees, pharmacy copayments, and catastrophic 

caps. 

These proposed changes continue to be modest by historic standards of cost-sharing in the TRICARE program. In 1994, when TRICARE was originally created, a 

working age retiree’s family of three contributed approximately 27 percent towards 

the total cost of their care; today that percentage has dropped to 10 percent. Even 

with these proposed changes, the percentage would still remain below the percentage originally set by Congress, averaging approximately 14 percent of range of overall health care costs in 2017—and stabilizing at that level for the out-years. 

These adjustments are an important step to setting the TRICARE benefit on a 

more sustainable path that maintains the quality of the medical benefit for future 

generations. Moreover, the overwhelming majority of these adjustments will be 

phased in over a 4- to 10-year period and will be appropriately indexed to ensure 

future sustainability and guarantee transparency. These proposals—one element of 

a four-pronged effort at cost control—will help shift us toward more effective and 

cost-efficient processes that will allow us to provide better care while meeting our 

obligations to help reduce our budgets. 

Wounded Warriors 

The 2007 revelations regarding Walter Reed were a stark wakeup call for us all. 

In the nearly 5 years since, the Department has worked in tandem with VA to improve policies, procedures, and legislation that impacts the care of our wounded 

warriors. As a result of efforts in both Departments and in Congress, we have 

reached important milestones in improving care for our wounded warriors. These 

milestones include a new disability evaluation system and improved case management that are the result of a programmatic cohesion with the VA that is better than 

ever before. More so than at any time in our Nation’s history, separating servicemembers are greeted by more comprehensive mental and physical care; by greater 

opportunity for education, and by a deeper societal commitment to ensuring their 

welfare. 

Disability Evaluation System/Integrated Disability Evaluation System 

The genesis of the Disability Evaluation System (DES) was the Career Compensation Act of 1949. The DES remained relatively unchanged until November of 2007 

when, as a result of public concern and congressional interest, the joint DOD and 

VA Senior Oversight Committee (SOC) chartered a DES Pilot designed to create a 

‘‘servicemember-centric’’ seamless and transparent DES, administered jointly by the 

DOD and VA. 

The Pilot launched at the three major military treatment facilities (Walter Reed, 

Bethesda, Naval Medical Center, and Malcolm Grow) in the NCR on November 21, 

2007 and successfully created a seamless process that delivers DOD benefits to 

wounded, ill and injured servicemembers and VA benefits to servicemembers as 

soon as possible following release from duty. We found the DES Pilot to be a faster, 

fairer, more efficient system; and, as a result, in July 2010, the SOC co-chairs (Deputy Secretary of Defense and Deputy Secretary of Veterans Affairs) directed worldwide implementation to start in October 2010 and to complete in September 2011. 

On December 31, 2010, the first Integrated Disability Evaluation System (IDES) 

site became operational, which marked the end of the pilot, and the name was formally changed to the IDES. 

The IDES, similar to the pilot, streamlines the DES process so that the member 

receives a single set of physical disability examinations conducted according to VA 

examination protocols, proposed disability ratings prepared by VA that both DOD 

and VA can use, and processing by both Departments to ensure the earliest possible 

delivery of disability benefits. Both Departments use the VA protocols for disability 

examination and the proposed VA disability rating to make their respective determinations. DOD determines fitness for duty and compensates for unfitting conditions incurred in the line of duty (title 10), while VA compensates for all disabilities 

incurred or aggravated in line of duty during active military, naval, or air service 

for which a disability rating of 10 percent or higher is awarded, and also determines 

eligibility for other VA benefits and services (title 38). The IDES permits both Departments to provide disability benefits at the earliest point allowed under both titles. servicemembers who separate or retire (non-disability) may still apply to the 

VA for service-connected disability compensation. 

28 

In summary, the IDES features a servicemember-centric design, a simplified process, more consistent evaluations and compensation, a single medical exam and disability rating, seamless transition to Veteran status, case management advocacy, 

and establishment of a servicemember relationship with the VA prior to separation. 

It also provides increased transparency through better information flow to 

servicemembers and their families and a reduced gap between separation/retirement 

from Service to receipt of VA benefits. As of January, IDES enrollment is 23,602 

servicemembers (66 percent Army, 14 percent Marines, 10 percent Navy, 10 percent 

Air Force). Since November 2007, cumulative enrollment has been 40,911, with 

12,640 completing the queue and receiving benefits. Including return to duty cases 

in the process, Active component member IDES completion time averages 380 days 

as of January 2012, RC members average 441 days, and the Guard averages 371 

days. These averages are above our targeted goals but still are significantly lower 

than the 1940-era legacy system it replaced which averaged an estimated 540 days 

by combining DOD and VA systems. 

This past year, the Department partnered closely with the VA to implement the 

IDES at all 139 sites worldwide; however, we recognize the need to do better in the 

areas of timeliness to complete the process. This year our focus will be on such timeliness improvements. We have made significant policy adjustment to remove efficiency impediments, made procedural improvements, enhanced oversight and assistance to the Military Departments, and added resources that should improve Military Department performance in this area. We will enhance our emphasis on leadership, execution, and resourcing the IDES to handle increased volume while decreasing the time spent in the process. 

In addition, the Departments are looking closely at the stages of the system that 

are outside of timeliness tolerances and are developing other options to bring these 

stages within goal. We are committed to working closely with Congress to explore 

new initiatives to further advance the efficiency and effectiveness of the disability 

evaluation process. 

Recovery Coordination Program 

The Recovery Coordination Program (RCP) was established by the NDAA for Fiscal Year 2008 , and was further defined by the Department of Defense Instruction 

(DODI) 1300.24, entitled ‘‘Recovery Coordination Program.’’ Together these provide 

a comprehensive policy on the care and management of recovering servicemembers, 

including the assignment of a Recovery Care Coordinator (RCC) to help wounded, 

ill, and injured servicemembers and families through the phases of recovery, rehabilitation and reintegration. The policy also provides for standardized training, and 

a caseload ratio of not more than 40 recovering servicemembers per RCC. 

Currently, there are 171 RCCs in 84 locations worldwide, placed within the Army, 

Navy, Marines, Air Force, U.S. Special Operations Command, and Army Reserves. 

More than 3,800 servicemembers and families have the assistance of an RCC, whose 

responsibilities include ensuring the servicemember’s non-medical needs are met, 

and assisting in the development and implementation of the Comprehensive Recovery Plan (CRP). Each RCC receives more than 40 hours of Department-sponsored 

standardized training, including information on roles and responsibilities and concepts for developing the CRP. Additionally, we are now beginning to train Army 

‘‘Advocates’’ in order to bring their program into compliance with the legislative 

mandate that every recovering servicemember be provided a DOD-trained RCC. 

RCC training is continually enhanced based on feedback from participants. After the 

October 2011 training, 90 percent of students rated the instruction and course materials as ‘‘excellent.’’ 

Over the past 5 years, we have added $26.953 million, resulting in increased numbers of RCCs available to provide care coordination to our recovering servicemembers. Looking ahead, each Military Service will continue to identify and resource their requirements for additional RCCs. In addition to standardized training 

for RCCs, the CRP has expanded to include several other portfolios, many of them 

identified as key priorities for the non-medical care management of recovering 

servicemembers during a Wounded Warrior Care Coordination Summit held in 

March 2011. 

The Wounded Warrior Education and Employment Initiative (E2I) operates on a 

regional basis and engages recovering servicemembers early in the recovery process 

to identify skills they have, career opportunities that match those skills, and any 

additional skills they might need to be successful. The process is overseen by Regional Managers currently located in five regions across the United States. The E2I 

process also relies on collaboration with the VA, which is governed by a Memorandum of Understanding to provide VA’s vocational rehabilitation services earlier 

in the recovery process than ever before. 

29 

The Operation Warfighter program (OWF) also supports this White House priority 

by placing wounded, ill, and injured servicemembers in Federal internship opportunities that positively impact their rehabilitation and augment career readiness by 

building resumes, exploring employment interests, obtaining formal on-the-job training, and gaining valuable Federal Government work experience. There are currently 

more than 500 OWF interns working in approximately 75 Federal agencies and subcomponents around the country, with a total of more than 2,500 placements in 105 

agencies and subcomponents since the inception of the program. The program is also 

supported by five Regional Coordinators placed across the country. Going forward, 

the Regional Coordinators will continue to focus on local and regional outreach to 

strengthen relationships with Federal agencies to improve and enhance internship 

and employment opportunities for wounded, ill and injured servicemembers. 

The Warrior Athletic Reconditioning Program (WARP) engages wounded, ill and 

injured servicemembers early in individualized physical activities outside of traditional therapy settings, inspiring recovery and encouraging new opportunities for 

growth and achievement. This new initiative will be implemented throughout the 

Department. WARP partners include the Service chiefs from each branch of the 

Military, as well as the United States Olympic Committee. WARP goals include increasing awareness and participation in adaptive sports at the Service-level, as well 

as preparing athletes for participation in competitive events such as the Warrior 

Games. 

These measures when taken together, substantially and materially affect the life 

experience of our men and women in uniform and the families who support them. 

Our work to improve the care of wounded warriors, especially as they transition 

from DOD to VA, is the core of our efforts to provide those who have sacrificed so 

much with the care and benefits they deserve. Despite the significant achievements, 

we should not underestimate what remains to be done as we care for a new generation of veterans who have served under very difficult circumstances for sustained 

periods. We will continue to work with our colleagues at VA and throughout the 

government to provide our servicemembers with the highest quality care and treatment. Taking care of our wounded, ill and injured servicemembers is one of the 

highest priorities for the Department, the Service Secretaries, and the Service 

Chiefs. 

TOTAL FORCE SUPPORT

Military Family Policy 

One of the four overarching principles of the Defense strategy is to preserve the 

quality of the All-Volunteer Force and not break faith with our men and women in 

uniform or their families. Despite difficult economic circumstances necessitating 

budget reductions across all levels of government, the Department remains committed to providing military families with support programs and resources that empower them to address the unique challenges of military life. To this end, the Secretary of Defense has directed that Family Programs and Mental Health Care be 

maintained as a priority for the Department. 

The Department conducted a Front End Assessment of family programs and nonmedical mental health care. The purpose of the review was to ensure that mission 

critical needs would be met for family programs or mental health care during the 

next 5 years. To ensure efficiency of programs, without redundancy, programs were 

reviewed with the intent of identifying, comparing and contrasting methods of program delivery. 

These efficiencies did not cut programs for servicemembers or their families but 

resulted in a more cost-effective approach to program delivery. The review identified 

the following efficiencies. 

• Maximized use of military family life consultants (MFLC) and Military 

OneSource counselors; 

• Limited number of full-time rotational personal MFLC financial counselors due to identified overlaps with Services’ programs, while allowing the 

capability for surge support through the MFLC program; and, 

• Right-sized MyCAA program based on new eligibility criteria, which reduced the number of eligible spouses. 

Some key programs and initiatives are: 

• Spouse Education and Career Opportunities: The DOD Spouse Education 

and Career Opportunities (SECO) program is a holistic, spouse-centric initiative designed to meet the needs of all military spouses as they explore 

portable career interests and strive to overcome common barriers to their 

education and career goals. One of the components of SECO is the My CaVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00035 Fmt 6633 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
30 

reer Advancement Account (MyCAA) that provides eligible military spouses 

with tuition assistance as they pursue requirements for a portable career. 

The Department has also expanded upon the Army’s Spouse Employment 

Partnership program model. A significant number of ‘‘Fortune 500 Plus’’ 

employers now participate in the Military Spouse Employment Partnership 

(MSEP), with over 150,000 jobs posted on the www.MSEPJobs.com web 

portal and 15,000 spouses hired by MSEP employers. We are expanding the 

portal to include a new function which automatically matches posted spouse 

resumes to posted employer job openings. We are also instituting an electronic MSEP partner application and streamlining the vetting and approval 

process. These enhancements will allow companies to become partner employers more quickly. Webinars and online training resources are helping 

new schools and employers to improve their understanding and support for 

military spouse employees who seek employment continuity and upward career growth as they relocate to new duty stations. 

• Voluntary Education Opportunities: During fiscal year 2011, our Voluntary Education program helped fund 866,788 enrollments by over 

300,000 servicemembers, which resulted in 44,692 diplomas and 528 certifications/licensures. servicemembers are ‘‘blending’’ their course work, taking 

both traditional and online courses, with approximately 73 percent of 

servicemembers taking some courses online. Due to this, we now require all 

post-secondary institutions participating in the DOD Tuition Assistance 

program to follow certain standards of conduct; we are tracking compliance 

and monitoring to ensure there is continuous quality improvement. 

• Family Readiness Programs: With budget and personnel reductions we 

can expect an increase in stress-related demand for support from our military families and we are prepared to meet that demand using the wide 

range of family support programs and partnerships. This includes developing virtual applications for the delivery of what has traditionally been inperson support, and providing surge capability. The Department is working 

closely with the Services to reduce redundancy and increase efficiency. For 

instance, we are in the process of developing a new community capacitybuilding toolkit and online professional development modules to streamline 

the training and development of our family support staff, and improve capacity. The last Military Family Readiness Council meeting was held in December 2011. We are identifying new members and working in coordination 

with the military Services to select spouses and/or parents to represent 

their Services. The next MFRC is projected to be during the third quarter 

of fiscal year 2012. 

• Non-Medical Counseling: Demand for non-medical counseling continues 

to increase, and access to non-medical counseling is a Department focus 

area. We continue to enhance confidential non-medical counseling via two 

delivery systems, the Military Family Life Consultants (MFLC) and the 

Military One Source (MOS) Program. Non-Medical Counseling augments 

the military support programs currently in place, and is designed to help 

servicemembers and families cope with normal reactions to the stressful situations created by deployments, family separations, war, and reintegration.. MOS non-medical counseling is offered by licensed clinicians who 

have private practices in the local community. The MFLC program began 

as a pilot in 2004, and today, more than 1,100 MFLCs provide confidential 

non-medical counseling support on 229 installations throughout the world. 

In fiscal year 2011, the program provided face-to-face counseling sessions 

to approximately 6.6 million people. At a commander’s request, additional 

MFLCs may also be mobilized and deployed to provide ‘‘surge’’ counseling 

support. Non-medical counseling is provided by licensed clinicians who are 

deployed to installations and are assigned to work at the family centers, 

child development centers, youth centers, schools, and are embedded into 

brigades. 

• Military OneSource (MOS): MOS provides call center and web-based information, referral, counseling, and educational materials. Services are 

available worldwide, 24 hours a day, at no cost to the user. In fiscal year 

2011, MOS responded to almost a million telephone calls, received 3.6 million online visits and assisted servicemembers and families with over 

200,000 Federal and State tax filings. Other MOS services include relocation assistance, document translation, child care and education resources, 

special needs consultation, elder care consultation, on-line library resources, 

and health and wellness coaching. Accessed via MOS, the Wounded Warrior 

Resource Center (WWRC) provides immediate assistance to wounded, ill, 

31 

and injured servicemembers, their families, and caregivers. In 2011, WWRC 

resolved 3,056 cases for wounded warriors, an increase from 2010. 

• Family Advocacy Programs (FAP): The FAP addresses physical, sexual, 

and emotional abuse and neglect involving Active component military personnel and family members either as victims or abusers. We evaluate the 

effectiveness of FAP through rates of child abuse and neglect and spouse/ 

intimate partner abuseand outcome measures for prevention and treatment. 

Through 10 years of high stresses on our families due to wartime deployments, our rates of such family maltreatment have remained relatively stable; however, we continue to monitor this carefully. For 2 consecutive years, 

85 percent of those who participated in our New Parent Support Program 

for at least 6 months had no substantiated child abuse or neglect the following year, and 90 percent of substantiated spouse abusers who completed 

FAP treatment had no substantiated spouse abuse the following year. 

• Child Care: The Department continues to expand child care capacity that 

supports RC families while the servicemember is deployed, geographicallydispersed active duty military families, and servicemembers living in areas 

in the continental United States where on-installation military child care 

is unavailable. Ongoing efforts are focused on ensuring the availability of 

child care options that meet quality standards, including health and safety 

standards and standards for developmentally-appropriate practices. 

• Youth Programs: Faced with their own unique challenges, military youth 

aged 6–18 can turn to a number of quality programs serving more than 

600,000 military youth around the world designed to prepare young people 

to meet the challenges of military life, adolescence, and adulthood. We have 

developed relationships with other Federal agencies and nationally-recognized organizations such as the Boys and Girls Clubs of America and the 

USDA’s 4–H Youth Development Program. Through these relationships, we 

offer more than 300 camp opportunities each year for military youth, and 

are a vital component of our support to geographically-dispersed youth of 

the NG and RCs. 

Special Needs 

The Department and the Military Services continue to provide support to military 

families with special needs. During the last 2 years, 120 additional family support 

personnel have been hired and deployed to installations worldwide; we now have a 

total of over 400 providers who provide information, referral and education to families with special needs. The Exceptional Family Member Program (EFMP) family 

support component also provides non-clinical case management to those families 

who need additional assistance with accessing services on the installation and in 

their local communities. The Office of Community Support for Military Families 

with Special Needs developed a mobile website, accessible from smart phones; that 

website provides military families with information on the EFMP and contact information for enrollment and family support providers. The mobile website also provides podcasts and links to other materials available to military families with special needs. 

The Department engages with military families with special needs by participating in the Congressional Military Family Caucus sessions and reviewing input 

from families during focus groups and online. We also established an EFMP family 

panel composed of ten families who represent all military Services, active duty, and 

RCs, and ranks. Family members with special needs are of all ages (children 

through adults) and with a wide variety of disabilities. Their issues range from access to medical care, availability of comparable services in the public schools, and 

lengthy waiting lists for Federal and State programs. 

To address the needs of this population, the Office of Special Needs has partnered 

with the DOD children and youth programs to provide training through Kids Included Together© on the inclusion of children with special needs into children and 

youth programs. They have also partnered with the TRICARE Management Activity 

to communicate better with families about their benefits and accessing care, and to 

support them with portability of care during moves. 

DOD–State Initiatives 

The Department continues to work with State governments to educate policymakers on the life-challenges faced by servicemembers and their families, and to ensure that State-level policies do not disadvantage military families due to their transient life style. States have addressed several key quality of life issues, to include 

the impact of frequent school transitions experienced by military children, the loss 

of income by spouses as a result of military moves, and enforcement of the CongresVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00037 Fmt 6633 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
32 

sionally-mandated DOD predatory lending regulation. The State responses have affirmed their commitment to the well-being of the Nation’s fighting force. For example, 39 States have approved the Interstate Compact on Educational Opportunity 

for Military Children, 39 States (plus DC) now provide eligibility for unemployment 

compensation to military spouses, and 34 States (plus DC) enforce the DOD predatory lending regulation. The Department is continuing this effort in the 2012 State 

legislative sessions with strong emphasis on support of military families through the 

issues listed above. We are also promoting expedited occupational licensure processes to allow military spouses to resume their work faster in a new State, and provisions for separating servicemembers to receive credit for their military education, 

training and experience toward a State occupational license or an academic degree. 

The Department is continuing to partner with the Uniform Law Commission to inform State legislators of the Uniform Military and Overseas Voters Act which simplifies the absentee voting process by making it more uniform, convenient and efficient. This year we are advocating for States to consider establishing Veterans 

Treatment Courts for servicemembers and Veterans in the criminal justice system 

who are suffering substance abuse and mental health issues. 

MWR Support to Troops in Combat: 

Support is critical to allow servicemembers to communicate with family and 

friends, stay physically and mentally fit, and reduce stress. The Department now 

funds over 514 free MWR Internet Cafes in Iraq and Afghanistan and 135 portable 

satellite units (known as Cheetahs) to support remote locations. The DOD MWR Online Library offers free downloads of audio and e-books, and access to up-to-date 

recreation, education and career transition support databases. 

The ability of injured servicemembers to engage in recreation and sports is a very 

important component of rehabilitation and reintegration. Under a contract with 

Penn State University, MWR specialists are trained to work with medical personnel, 

wounded warrior units, and community and non-profit organizations to ensure inclusive and adaptive sports and recreation are included in recreation programs. The 

DOD Paralympics Program continues to provide rehabilitation support and mentoring to injured servicemembers and veterans who have sustained various types of 

injuries. 

We remain fully committed to supporting the All-Volunteer Force and their families, particularly in light of the unprecedented demands that have been placed on 

them in recent years. 

The Department continues to pursue innovations, initiatives, and efficiencies that 

improve the quality of life of its military members and their families. With your continued support, our military force will remain ready, willing and able to serve this 

Nation with distinction. 

Military Voting 

The Department is well positioned for the 2012 election, building on its considerable success in the 2010 election efforts. Through direct-to-the-voter outreach programs, easy and quick online voting assistance tools, and aggressive communications and marketing programs, we experienced a 21 percent increase in military 

voter participation rates between 2006 and 2010. The Department is refining and 

expanding those programs for the 2012 election, as well as providing direct support 

to State and local election jurisdiction which deploy online ballot delivery systems, 

reducing ballot delivery time from 20 to 30 days to 20 to 30 milliseconds. 

Department of Defense Education Activity 

Ensuring excellence in the education of military children is a top priority for Secretary Panetta and the entire Department. A quality education is both a stabilizing 

influence in the lives of our children and their families and an overall recruitment, 

retention and morale element in the readiness of our Force. There are 1.2 million 

school-aged children with a parent serving in the military. Nearly 86,000 of these 

children attend one of the schools operated by the Department of Defense Education 

Activity (DODEA). Not unlike other parents, military families frequently say that 

the quality of their children’s education is one of the most important criteria when 

selecting a place to live. The demands of extended conflict and frequent relocations 

add to the challenges faced by military families. While they are often described as 

a resilient group, the cumulative effects of multiple moves and significant parental 

absences can erode this resilience and, as the research suggests, diminish academic 

performance in school. 

The DODEA schools offer a 21st century, student-centered learning environment 

that is tailored to meet the needs of military families. To this end, DODEA is leaning forward and providing military-connected children an educational experience 

that challenges each student to maximize his or her potential and prepares them 

33 

to be successful, productive and contributing citizens in today’s global economy. 

DODEA also is mobilizing its knowledge, expertise, and resources to support military-connected children in the U.S. public schools. 

The Department has made a number of sweeping commitments to improving the 

educational experience for military children. Some of these far-reaching commitments are highlighted below: 

• DODEA has joined 46 States in the adoption of the Common Core State 

Standards. Today, the differences between State educational standards, including variances in graduation requirements, can and have negatively impacted achievement for military children. The Common Core State Standards will help mitigate this academic disruption and provide greater continuity in the educational experiences of our highly mobile children. 

• DODEA has launched a vibrant Virtual Learning program which includes 

the use of tele-presence equipment in classrooms, to expand course offerings 

for students. No longer will small enrollments and limited course offerings 

at one DODEA school significantly drive the educational experience of students. Student interests and needs now have considerable influence. 

Through virtual learning, students have access to courses such as Advanced 

Placement, foreign language, and STEM-related courses that simply would 

not be possible in some locations. 

• DODEA is adopting a 21st century teaching and learning framework, 

where technology is leveraged to improve the educational experience of children. Ten middle and high schools will be using a digital instruction platform on a pilot basis. As we leverage technology in our learning environments, we will need to make a significant investment in the professional 

development of our teachers and leaders. 

• DODEA is modernizing and replacing school facilities to ensure that military children have school facilities that are safe, secure, in good repair and 

provide an optimal learning environment that supports current and future 

educational requirements. In fiscal year 2013, DODEA requested $657 million for 11 school Military Construction projects. 

• DODEA has ramped up its outreach to U.S. public schools to improve the 

educational experience for students in non-DODEA schools. Since 2008, 

DODEA has provided 146 grants totaling $167 million to school districts, 

in over 900 schools. All grants focus on enhancing student learning opportunities, social-emotional support, and educator professional development. 

As we move forward with Force structure changes, DODEA will continue to work 

with the Military Services to right-size schools in the affected communities, will 

keep students in the forefront, and will stay focused on delivering an excellent education and supporting our families. DODEA will ensure a ‘‘warm-hand off’’ to the 

U.S. public schools who may be receiving an influx of military-connected students. 

Further, we will leverage our civilian workforce shaping tools to provide continuity 

of employment for all those who wish to continue with their Federal careers. 

The Department is charged with the responsibility and privilege of educating the 

children of our Nation’s military. We know full-well the toll that war, conflict and 

frequent movements have exacted from our servicemembers and their families. The 

Department is committed to ensuring that the education of the children of 

servicemembers will not be among the many sacrifices our families must make to 

defend our great Nation. 

Defense Commissaries 

The commissary continues to be one of the most popular benefits with military 

members and families and is an efficient provider of non-pay compensation to our 

military personnel. Operated by the Defense Commissary Agency (DeCA), this integral element of the total compensation package significantly contributes to the financial readiness of our military families. An average family of four that consistently shops at the commissary will save nearly $4,500 per year by taking advantage 

of the 32 percent savings on their overall purchases. The commissary further enhances financial readiness as a major employer of military spouses and family members. Last fiscal year, 39 percent of DeCA employees in the United States were military spouses or other family members; and the total rises to 63 percent when including military retirees, other veterans, and members of the Guard and Reserve. While 

enhancing military families’ quality of life, the commissary also provides an excellent return on investment. Last fiscal year, the commissary provided direct savings 

to commissary customers of $2.8 billion for a taxpayer cost of $1.4 billion, a 2-for1 return. DeCA implemented efficiency reductions in fiscal year 2012 and there are 

no plans for additional budget reductions at this time. 

34 

CONCLUSION

Putting together this year’s budget request in a balanced package was a difficult 

undertaking, but I believe we have the right mix of programs and policies in place 

to shape the force we need in support of the strategic guidance. We will reduce the 

rate of growth of manpower costs, to include reductions in the growth of compensation and health care costs. But as we take those steps, we will continue to keep faith 

with those who serve. 

During the past decade, the men and women who comprise the All-Volunteer 

Force have shown versatility, adaptability, and commitment, enduring the constant 

stress and strain of fighting two overlapping conflicts. They have also endured prolonged and repeated deployments. Some—more than 46,000 men and women—have 

been wounded, and still others—more than 6,200 members of the Armed Forces— 

have lost their lives. As the Department reduces the size of the force, we will do 

so in a way that respects and honors these sacrifices. 

Senator WEBB. Thank you very much, Dr. Rooney. 

Secretary Hale, welcome. 

STATEMENT OF HON. ROBERT F. HALE, UNDER SECRETARY 

OF DEFENSE, COMPTROLLER, AND CHIEF FINANCIAL OFFICER 

Mr. HALE. Thank you, Mr. Chairman, Senator Graham, members 

of the subcommittee. Let me underscore Dr. Rooney’s thanks to all 

of you for the support of our men and women in uniform and the 

civilians who support them. 

I am going to focus on some budget aspects of the personnel 

budget with just a few overall numbers. 

We have asked Congress for $525.4 billion of discretionary budget authority in fiscal year 2013. If you adjust that for inflation, it 

is a 2.5 percent real decline, the third consecutive year of real decline in the defense budget. As you look beyond fiscal year 2013, 

the budget is basically flat in real terms or slightly up. 

To get to this request while also remaining consistent with title 

I, the non-sequestered title of the BCA, we reduced overall defense 

spending by $259 billion in the next 5 years, our budget period 

2013 to 2017, compared to the last year’s plan. We took three steps 

to reduce our plan funding. 

First, more disciplined use of defense dollars by eliminating 

lower priority programs and through efficiencies, including some 

cutbacks in contractor workforce. 

Second, we propose force structure changes to carry out a new 

defense strategy, particularly important to this subcommittee. For 

example, our military will be smaller and leaner, especially our 

ground forces which will no longer be sized to carry out large, prolonged operations such as the one we undertook in Iraq. On the investment side, we made a number of decisions to fund high priority 

programs, cyber, special operations, for example, but also restructured and reduced investments for many weapons systems. 

Third, and I know of particular importance to this subcommittee, 

the budget continues to fully support America’s All-Volunteer Force 

even in the face of the BCA. We fully funded personnel, took a 

number of steps, funded family support programs fully. 

But we also carefully reviewed and slowed the growth in military 

pay and benefits. 

Let me expand on just two aspects of this budget in my oral 

statement. 

35 

The new 5-year budget plan calls for a reduction in end strength, 

Active end strength of about 100,000 and 20,000 in the Reserve 

components, mostly in our ground forces. To achieve these substantial end strengths, the Army will eliminate at least eight brigade 

combat teams; the Marine Corps, six battalions, four tactical air 

squadrons. There will be significantly smaller cuts in the Navy and 

the Air Force. Altogether these force structure reductions will save 

us about $9 billion in fiscal year 2013 compared to last year’s plan, 

$53 billion over the FYDP, so we are about 20 percent with those 

on the way toward being consistent with the BCA. 

We made substantial changes in investment—the cuts in this 

budget were disproportionately on the investment side—and 

pushed for more disciplined use of resources through streamlining 

and efficiencies. But it did not get us to where we needed to be. 

In the end—and it was in the end—we made a decision to address military pay and benefits issues to avoid what we viewed as 

overly large cuts in force structure and investment. Our assessment took note of important trends in military pay and benefits. 

Pay and benefits, defined as military personnel and health care 

and some others, are up over 87 percent since 2001, 30 percent 

more than inflation, while the Active Duty end strength grew by 

only 3 percent during that period. 

While we strongly believe that changes are needed in military 

pay and benefits, we also believe they must take into account some 

vital principles. The military compensation system has to recognize 

the unique stress of military life. We cannot simply copy the civilian system. It must enable us to recruit and retain needed personnel. We judged that it should be disproportionately small in 

terms of the amount of the savings. So our total savings were about 

10 percent of the target we were working toward under the BCA, 

military pay and benefits more than a third of our budget. No one’s 

pay can be cut. Growth can be slowed, but no pay cuts, no freezes. 

Now, statements by other witnesses have described the proposals 

to reduce the size of our out-year pay raises, increase fees and 

deductibles for retirees, and raise pharmacy copays in ways that 

increase incentive to buy by mail order and to use generic drugs. 

I am not going to go over those again. 

But I would like to do a couple of things, and I would like to correct first a misimpression we created. I am sorry Senator Ayotte 

is not here because I did not do a very good job. I did not have a 

chance really when I testified before the Senate Budget Committee, 

and she asked a question about what we were doing for fees of our 

civilian personnel—health care fees. 

While the President’s budget does not propose changes in the 

mechanism for fees charged to Federal civilian employees and retirees, those fees are tied to private sector insurance costs. Those fees 

have increased substantially over recent years, more than doubling 

for some large cuts over the last decade, and they are almost certain to continue to grow. Moreover, even when our proposed increases in military fees are fully in place, the military fees will remain substantially less than the ones charged to Federal civilian 

employees and retirees. So this budget does require increases for 

Federal civilian personnel and substantial ones. 

36 

Perhaps the most important point regarding our military compensation proposals is this, the proposals have the full support of 

our military leaders and that includes all the members of the Joint 

Chiefs, the senior enlisted, and advisors, and they have indicated 

that support in a formal letter sent to Congress earlier this year. 

Several of our proposed compensation changes require legislative 

authority. None can be put into effect without your support. We 

fully recognize that. But if that support is not forthcoming—and 

you asked me to be candid, Mr. Chairman, so I will be—what keeps 

the CFO up at night—further cuts in forces and investment will be 

required of us to remain consistent with the targets of the BCA. 

Even if somehow we fit in changes in 2013, I have to worry about 

2014 through 2018, and those cuts get bigger in that period. 

If, for example, Congress turned down all of our compensation 

proposals and we offset that hole in our budget with additional 

force cuts, we would have to cut roughly another 60,000 troops by 

2017. We might look at other ways and we probably would. But 

just to give you an idea of the magnitude, these additional cuts 

would surely jeopardize the new defense strategy that we have just 

recently put in place. 

As this point suggests, our budget is a balanced, interconnected 

whole. I very much ask that you consider it as such. 

Mr. Chairman, thank you again for your support of our troops 

and to all the subcommittee members for support of our troops and 

for the opportunity to testify today. When the witnesses are done, 

I welcome your questions. 

[The prepared statement of Dr. Hale follows:] 

PREPARED STATEMENT BY HON. ROBERT F. HALE

Mr. Chairman, Senator Graham, members of the subcommittee, thank you for the 

opportunity to join you this afternoon. I will not repeat the thorough statements 

presented by the Department’s other witnesses. I would like to discuss selected personnel and readiness issues in the context of the Department’s budget request for 

fiscal year 2013. 

The fiscal year 2013 budget for the Department of Defense (DOD) responds to two 

broad factors. First, to be consistent with Title I of the Budget Control Act of 2011, 

it reduces defense funding for fiscal year 2013 to fiscal year 2017 by $259 billion 

compared with last year’s plans. We started by culling $45 billion from our spending 

plans in fiscal year 2013, resulting in a request for $525.4 billion in discretionary 

budget authority. Adjusted for inflation, that is a reduction of 2.5 percent compared 

to the enacted budget for fiscal year 2012—the third consecutive year of real decline 

in the Defense budget. 

Second, our proposed budget for fiscal year 2013 reflects the new defense strategy 

that we announced in January. That strategy has been documented in a white paper 

issued in January. The budget implements this new strategy in four key ways: 

• We seek to make more disciplined use of defense dollars. Key changes include streamlining in the Office of the Secretary of Defense and defense 

agencies, rephasing of military construction projects in view of force structure changes, further IT consolidations, efforts to improve our purchasing 

activities, and continued efforts to improve financial management and 

achieve audit readiness. 

• Our budget proposes force structure and investment changes that are 

consistent with the new strategy. Our military will be smaller and leaner, 

but also ready and agile. We continue to invest in high priority areas such 

as Special Operations Forces, cyber, and unmanned aerial vehicles. However, reflecting strategy and good management along with budgetary limits, 

we propose to restructure and reduce investments in programs including 

the Joint Strike Fighter, shipbuilding programs, the Army Ground Combat 

Vehicle program, and the SSBN–X submarine program. We terminate six 

weapon programs in this budget proposal. 

37 

• We continue full support for America’s All-Volunteer Force, which is the 

very foundation of our military strength. But we carefully review and slow 

the growth in military pay and benefits. 

• Finally, we provide full support for our warfighters in combat through 

our request for funding for Overseas Contingency Operations. 

Our budget proposal for fiscal year 2013 needs to be considered as a whole. It proposes changes that are balanced in order to be consistent with both our new strategy and good management. We hope that Congress will be cautious in making 

changes lest the revised version fail to fully support our new strategy or the current 

budgetary limits. 

Finally, while this budget is consistent with Title I of the Budget Control Act, it 

does not accommodate the sequestration that could occur under Title III of that Act. 

Sequestration could have devastating effects on defense activities. It would force us 

to revisit our strategy and could lead to involuntary separations of personnel, reductions in readiness, and the disruption of numerous investment programs. We still 

have time to avert sequestration, and the President’s fiscal year 2013 budget represents a path to doing so. We urge Congress to enact a large, balanced program 

of deficit reductions and then enact legislation to halt the sequestration. 

In addition to this brief overview of our fiscal year 2013 request, I want to mention three specific considerations as they relate to personnel and readiness. 

BUDGETARY IMPORTANCE OF FORCE STRUCTURE CUTS

The first of these involves force structure changes. Consistent with our strategy 

and budgetary limits, we assume there will be force structure cuts, primarily in 

ground forces. Our strategy envisions a force that is smaller and leaner and that 

no longer maintains forces sized for large, prolonged stability operations. 

Specifically, the new 5-year budget plan calls for an end strength reduction of 

about 72,000 Army soldiers and about 20,000 marines by fiscal year 2017. This will 

result in an Army of 490,000 soldiers and a Marine Corps of 182,100 marines. To 

accommodate these reductions, the Army will eliminate a minimum of eight brigade 

combat teams, and the marines will disestablish six battalions and four tactical aircraft squadrons. 

There will be smaller cuts in the Navy and Air Force. The Navy will be retiring 

11 older vessels, and the Air Force will cut 7 TACAIR squadrons. By fiscal year 

2017, the Navy’s Active-Duty end strength will be reduced by 6,200 to a force of 

319,500 sailors, and the Air Force will lose 4,200 airmen, to bring their total to 

328,600. 

We will also be reducing end strength in the Reserve components by 21,500 by 

fiscal year 2017. This will result in a total Reserve Force of 825,600, with Navy Reserve, Air Force National Guard, and Army National Guard components experiencing the greatest force reductions. There will be no reduction to the Marine Corps 

Reserve. 

Altogether, compared to last year’s plans, force structure reductions will save 

about $53 billion over the FYDP and $9 billion in fiscal year 2013 alone. Most of 

these savings reflect reduced operating costs but there are some investments savings as well. 

These force structure changes mean that we need to consolidate our infrastructure. The President will ask Congress to authorize the Base Realignment and Closure (BRAC) process for 2013 and 2015. We recognize the political difficulty associated with the BRAC process, but it is the only effective way to achieve needed infrastructure savings. 

BUDGETARY IMPORTANCE OF PAY AND BENEFIT CHANGES

The second item I want to mention is the budgetary importance of pay and benefit 

changes. Since 2001, the cost of military pay and benefits has grown by over 87 percent (30 percent more than inflation), while Active Duty end strength has grown by 

about 3 percent. We felt we had to review pay and benefits to avoid overly large 

reductions in forces and investments. 

As my colleagues have noted, the military and civilian leadership considered 

changes in pay and benefits based on several guiding principles. To begin with, the 

military compensation system must take into account the unique stress of military 

life. It should not simply be a copy of civilian systems. The system must also enable 

us to recruit and retain needed personnel. We must keep faith with our military 

personnel. That means changes to the system of pay and benefits that do not cut 

anyone’s pay. We propose to slow the rate of growth, not to institute pay freezes 

or pay cuts. 

38 

Changes affecting pay and compensation were designed to be disproportionately 

small when compared to the changes in forces and investments. While pay and benefits account for about one-third of the Defense budget, savings from the initiatives 

we are proposing will amount to about $29 billion over the FYDP, which is slightly 

more than 10 percent of our savings target. 

As our acting Under Secretary for Personnel and Readiness indicated, we plan 

military pay raises in fiscal years 2013 and 2014 consistent with the Employment 

Cost Index. In later years increases will be lower, but by then servicemembers and 

their families will have had time to plan. Over the 5 years of the FYDP, this approach will realize total savings of about $16.5 billion. 

We have also proposed changes in the cost-sharing formula for health care. This 

will mostly affect retirees and, especially, retirees who are under the age of 65 and 

are still in their working years. We have exempted those who are medically retired 

and survivors of those killed on Active Duty. Our proposed changes save about $12.9 

billion over the next 5 years. Dr. Rooney’s statement expands on these changes, and 

I will not repeat them here. 

However, I do want to emphasize one very important point that Dr. Rooney has 

made. Changes in cost sharing represent only one of the key steps that we are taking to improve health care and to hold down cost growth. We are also working to 

improve overall health care—moving from health care to health. We are reducing 

internal costs by cutting administrative overhead at headquarters and buying more 

effectively. We have significantly reduced payments to our civilian providers in 

order to slow the growth in health care costs. 

I also want to note that, while our budget does not change the formula for enrollment fees for Federal civilian employees or civilian retirees, those fees have and are 

increasing. Fees for civilian employees and retirees are tied to private-sector plans 

and increase with increases in health care costs. It is important to note that fees 

paid by civilian employees and retirees will remain substantially higher than those 

paid by military retirees even after all of the changes proposed for military retirees 

have taken effect. 

Our health care proposals, and all of our proposals for military compensation, 

have the full support of our military leaders—including both officer and enlisted 

leaders. These leaders have supported these changes in a letter to each of our oversight committees. 

Several of our proposed changes in pay and benefits will require legislative authority. For instance, we need authority to exempt survivors of members who die 

while on Active Duty or military disability retirees and their families; to establish 

an annual TRICARE Standard enrollment fee for most retirees and their families; 

and to introduce an annual enrollment fee for TRICARE For Life beneficiaries. 

While these particular proposals require legislation, we need your support for all of 

these important changes. 

If Congress does not provide us with needed support, we will face a major problem 

that would jeopardize our defense strategy. Without needed authority, we will face 

further cuts in forces and investment to be consistent with the Budget Control Act. 

Because our budget proposal already makes substantial reductions in the investment accounts, further cuts might fall mostly on forces. If, for example, Congress 

did not support any of our proposed changes to pay raises and health care, and we 

elected not to make further cuts in investment, we would be required to increase 

the size of our force reductions by roughly half. That could mean cutting roughly 

another 60,000 Active Duty and Reserve Forces by fiscal year 2017. Additional force 

cuts of this magnitude would jeopardize our ability to pursue the new defense strategy. 

READINESS

The third and final concern that I would raise today is the matter of readiness. 

Our strategy calls for a force that is leaner and smaller, but also agile and ready. 

Readiness is a complex topic. There is no single part of the budget that we could 

characterize as the ‘‘readiness’’ budget. That said, Operation and Maintenance 

(O&M) is the title most often associated with readiness. I would point out that O&M 

is the only title that would increase in the President’s budget. Total O&M increases 

by 6 percent between fiscal year 2012 and fiscal year 2013 while the overall budget 

declines by 1 percent. We believe that we have made budgetary decisions designed 

to protect the readiness of our military forces. 

When making our force structure decisions, we also favored the forces that are 

especially agile. Special Ops forces are a case in point. These forces, designed to be 

agile, continue to increase under this budget proposal. We also preferentially retained forces that can self-deploy. Accordingly, we maintained funding for a fleet 

39 

with long-term level of 11 aircraft carriers and 10 air wings. We also maintained 

funding for the bomber force. 

CONCLUSION

In conclusion, I would emphasize again that our budget is an interconnected 

whole, and we ask that Congress consider it as such. 

Thank you again for the opportunity to testify this afternoon. As always, thank 

you for the support of our men and women in uniform, and the civilian employees 

who support them. I welcome your questions. 

Senator WEBB. Thank you very much, Secretary Hale. 

Secretary Woodson, welcome. 

STATEMENT OF HON. JONATHAN WOODSON, ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS AND DIRECTOR 

OF TRICARE MANAGEMENT ACTIVITY 

Dr. WOODSON. Thank you, Mr. Chairman, Senator Graham, 

members of the subcommittee. Thank you for the opportunity to 

appear before you today to discuss the future of the military health 

system and in particular, our priorities for this coming year. 

Over the last 10 years, the men and women serving in the military health system have performed with great skill and undeniable 

courage in combat. Their contributions to advancing military and 

American medicine are immense. The military health system’s ability to perform this mission and be able to respond to humanitarian 

crises around the world is unique among all military or non-military organizations on this globe. I am committed to sustaining this 

indispensable instrument of national security. 

One of the most critical elements of our strategy is to ensure the 

medical readiness of the men and women in our Armed Forces. We 

are using every tool at our disposal to assess our servicemembers’ 

health—before, during, and following deployment to the combat 

theaters. For those who return with injuries and illnesses, we continue to provide comprehensive treatment and rehabilitation services supported by medical research and development portfolios appropriately focused on the visible and invisible wounds of war. 

Concurrent with our mission of maintaining a medically ready 

force, this ready medical force concept has many interdependent 

parts. It requires our entire medical team to be well-trained. It requires development of our physicians in active, accredited, graduate medical education programs. It requires our military hospitals 

and clinics to be operating at near-optimal capacity, and for our 

beneficiaries, it requires an active decision to choose military medicine as their preferred source of care. 

To meet these readiness imperatives means we need to compete 

with the rest of American medicine to recruit and retain top talent, 

to provide state-of-the-art medical facilities that attract both patients and medical staff, and to sustain a high quality system of 

care. 

The budget we propose provides the resources we need to sustain 

the system. As we maintain our readiness, we also must be responsible stewards of the taxpayers’ dollars. The 2011 BCA required 

DOD to identify $487 billion in budget reductions over the next 10 

years. Health care costs could not be exempt from this analysis. 

The military health system is undertaking four simultaneous actions to reduce costs: one, internal efficiencies to better organize 

40 

our decisionmaking and execution arm; two, a continuation of our 

efforts to appropriately pay private sector providers; three, initiatives to promote health, and reduce illness, injury, and hospitalization; and four, propose changes to beneficiary costsharing under 

the TRICARE program. 

The military and civilian leaders in DOD developed these proposals and have publicly communicated their support for these proposals to you in writing and in person. 

I want to identify the core principles to which we adhered when 

developing these proposals. We believe the TRICARE benefit has 

been one of the most comprehensive and generous health benefits 

in this country and our proposals keep it that way. In 1996, military retirees were responsible for about 27 percent of overall 

TRICARE costs. In 2012, the percentage share of costs borne by the 

beneficiary has dropped to about 10 percent of overall costs. If 

these proposals we have put forward are accepted, beneficiary outof-pocket costs will rise to 14 percent of costs by 2017. This is about 

half of what beneficiaries paid in 1996. 

Second, we have exempted the most vulnerable populations from 

our costsharing proposals. Medically retired servicemembers and 

families of servicemembers who have died on Active Duty are protected under this principle. 

Additionally, we have introduced costsharing tiers based upon retirement pay, reducing the increases for those with lower retirement pensions. I would mention that that was led by the uniformed 

line leadership. 

Mr. Chairman, we recognize the concerns of the members of this 

subcommittee and the beneficiary organizations have voiced regarding these proposals. I want to emphasize that these proposals 

are targeted to mitigate the burden on any one particular group of 

beneficiaries while simultaneously meeting our congressionallymandated costsaving responsibilities under the BCA. We have recently submitted to Congress the Secretary’s recommended path 

forward for how to organize the military health system. We have 

learned a great deal from our joint medical operations over the last 

10 years. We recognize that there is much opportunity for introducing an even more agile headquarters operation that shares common services and institutes common clinical and business practices 

across the system of care. 

The budget we have put forward for 2013 is a responsible path 

forward to sustaining the military health system in a changing 

world and recognizes that the fiscal health of the country is a vital 

element in our national security. 

I am proud to be here with you today to represent the men and 

women who comprise the military health system. I look forward to 

your questions. 

[The prepared statement of Dr. Woodson follows:] 

PREPARED STATEMENT BY HON. JONATHAN WOODSON

Mr. Chairman and distinguished members of the subcommittee, thank you for the 

opportunity to appear before you today on behalf of the men and women who comprise the Military Health System (MHS) and address our strategic priorities for the 

coming year. 

We enter 2012 now having over 10 years of experience in preparing for and responding to the consequences of war. We have seen the end of one major conflict 

41 

and the implementation of a concrete timeline for the drawdown of the other. Yet, 

even with these milestones in our sights, we have many challenges to address in 

the coming year, both operational and fiscal. 

I am proud of the performance of our military medical personnel on the battlefield 

and here at home. Last year, I provided this committee with some of the accomplishments achieved in combat—the lowest levels of disease, non battle injury 

(DNBI) rates in warfare; the highest survival from wounds rate; the safety and 

speed of an aeromedical evacuation system that has no peer; and the treatment and 

rehabilitation of wounded warriors that is allowing ever greater numbers of our severely wounded to return to their units, or to pursue careers in the civilian sector. 

These accomplishments bear repeating. I do this not simply to honor the men and 

women who made them happen, but also to point out that the actions and lessons 

that led to these outcomes are now being replicated in trauma centers, surgical 

suites, and rehabilitation centers around the country and around the world. The 

MHS is transferring our medical knowledge gained from battlefield medicine to the 

rest of society. 

As we share our experiences with our colleagues in American medicine, we are 

also mindful of the need to look internally and assess what lessons we have 

learned—and consider how we should be organized to meet our future missions. In 

June 2011, the Deputy Secretary of Defense established an internal task force to 

study this issue. We have now also shared the task force report and the Deputy Secretary’s planned reorganization with Congress, consistent with Section 716 of the 

National Defense Authorization Act for Fiscal Year 2012. The plan we developed increases unity of effort, agility, and the opportunity for cost savings both through reduced overhead and, more importantly, through the implementation of common clinical and business practices across the enterprise. Our ability to implement this 

model will enhance virtually all of the programmatic issues we discuss in the MHS 

today. 

The Department has proposed a $32.5 billion Defense Health Program (DHP) appropriation (Figure 1), reflecting a small increase from the fiscal year 2012 enacted 

budget. 

Figure 1: Fiscal Year 2013 Defense Health Program (DHP) Summary 

[In millions of dollars] 

Appropriation Summary 

Fiscal Year 

2011 1

Actual 

Price 

Growth 

Program 

Growth 

Fiscal Year 

2012 2

Enacted 

Price 

Growth 

Program 

Growth 

Fiscal Year 

2013 3

Estimate 

Operation & Maintenance ............. 29,953.5 721.7 ¥89.0 30,586.2 859.6 ¥96.6 31,349.3 

RDT&E ............................................ 1,205.8 22.9 38.1 1,266.8 22.8 ¥616.6 673.0 

Procurement ................................... 546.7 12.4 73.4 632.5 14.2 ¥140.2 506.5 

Total, DHP ................................. 31,706.0 757.0 22.5 32,485.5 896.4 ¥853.4 32,528.7 

MERHCF Receipts 4 ........................ 8,600.0 9,470.6 9,727.1 

Total Health Care Costs ........... 40,306.0 41,956.1 42,255.8 

Numbers may not add due to rounding 

1 Fiscal year 2011 actuals include Operation and Maintenance (O&M) funding of $1,394.0 million and Research and Development funding of 

$24.0 million from the fiscal year 2011 Overseas Contingency Operations (OCO), Title IX, Public Law 112–10. 2 Fiscal year 2012 enacted (base), excludes O&M funding of $1,215.3 million of OCO. 

3 Fiscal year 2013 estimate excludes O&M funding of $993.9 million for OCO. The Department of Defense projects $135.6 million O&M

funding should transfer in fiscal year 2012, and $139.2 million in fiscal year 2013 to the Joint Department of Defense-Department of Veterans Affairs Medical Facility Demonstration Fund established by section 1704 of Public Law 111–84 (National Defense Authorization Act for 

Fiscal Year 2011). 4 Reflects Departmental DOD Medicare-Eligible Retiree Health Care Fund (MERHCF) for fiscal year 2011, fiscal year 2012, and fiscal year 

2013 (O&M). 

Our proposal includes realistic cost growth for pharmacy, TRICARE contracts and 

other services provided both in our medical treatment facilities (MTFs) and care 

purchased from the private sector; as well as sustained investment in medical research and development. 

I will outline the major elements of our strategy for 2013, using the Quadruple 

Aim—the MHS strategic framework—to discuss our initiatives. This framework captures the core mission requirements of the MHS: Assure Readiness; Improve Population Health; Enhance the Patient Experience of Care; and Responsibly Manage the 

Cost of Care. 

42 

ASSURING READINESS

The MHS continues to closely monitor the health and medical readiness of the 

military force. We have consistently witnessed improvements in the medical preparedness of our servicemembers, both Active and Reserve component. 

We have ensured that our medical forces are also ready through sustained investments in our enlisted and officer training programs, through our comprehensive 

Graduate Medical Education (GME) programs conducted at a number of our MTF 

training platforms throughout the MHS and with select civilian partners; at the 

Medical Education and Training Center (METC) in San Antonio, TX, in our military 

medical school, the Uniformed Services University of the Health Sciences. 

We also assess the health of the force upon their return from deployment. In our 

continued commitment to ensuring the mental health of our servicemembers, the 

Department has issued policy that servicemembers deployed in connection with a 

contingency operation receive a person-to-person, privately-administered mental 

health assessment before deployment, and three times after return from deployment. These person-to-person assessments are conducted by licensed mental health 

professionals or by designated individuals trained and certified to perform the assessments. 

As part of our monitoring of the medical readiness of the force, we also assess 

our performance in ensuring that those servicemembers who are identified as needing behavioral health services receive a referral and seek treatment. In this area, 

we have also witnessed improvement each year in both the referral for behavioral 

health services, and the rate at which servicemembers seek ongoing treatment. 

Senior leaders, both officer and enlisted, have led the effort to reduce the stigma 

associated with seeking mental health care. A DOD Mental Health Advisory Team 

(MHAT) survey from February 2011 showed that Marines who screened positive for 

mental health issues, had a substantial (and statistically significant) decrease in behavioral health stigma levels from 2006. The percent of marines who agreed that 

seeking mental health care would harm their career dropped by more than 50 percent. Responses by the Marines on whether seeking mental health care would cause 

members of their unit to have less confidence in them, cause unit leaders to treat 

them differently, cause unit leaders to blame them for the problem, or cause the Marine to be seen as weak, also saw similar statistically significant decreases. 

Together with the Department of Veterans Affairs (VA), we have developed an integrated Mental Health Strategy that has 28 discrete strategic actions designed to 

strengthen access to clinical services, improve continuity of care across the Departments, streamline the adoption and implementation of evidence-based practices and 

ensure our mental health providers are delivering state-of-the-art care. 

We have increased the number of behavioral health care providers over the past 

3 years and embedded more in frontline units. Along with providing care, we have 

undertaken the largest study of mental health risk and resilience ever conducted 

among military personnel. This study will identify risk and protective factors as well 

as moderators of suicide-related behaviors by 2014. The Department continues to 

improve access to behavioral health services through a number of initiatives. In fiscal year 2012, we have begun the process of embedding, over a 4-year period, over 

400 behavioral health providers into our patient-centered medical homes. We enhanced confidential, non-medical counseling through the Military Family Life Consultants (MFLC) and Military OneSource (MOS) programs, to include surge support—for both deployment/reintegration points in time, as well as other crises that 

emerge on a short-notice basis, such as the Ft Hood shooting and the Japanese 

earthquake/tsunami/nuclear incident. Recent legislation now permits mobile VA Readjustment Counseling Services to provide outreach and readjustment counseling to 

active duty servicemembers. 

We have also made efforts to ensure continuity of behavioral health care for members in transition—to a new installation, from active to Reserve status, or to the 

VA. We offer a diverse set of services to reach those military members seeking 

greater support. One notable program—‘‘inTransition’’—was developed in response 

to the Mental Health Task Force recommendation to ‘‘maintain continuity of care 

across transitions for servicemembers and veterans,’’ and offers a voluntary telephonic coaching program designed to facilitate a smooth transition to a new source 

of care. Afterdeployment.org is another program, serving over 5,000 users monthly, 

that provides servicemembers and their families with behavioral health information 

in a setting that preserves anonymity, and offers tools to help them recognize problematic behavioral health issues early and how to address these challenges. Recently, the VA has been using the site’s interactive workshops in their walk-in clinics. 

43 

Just as the Department has established a comprehensive approach to its mental 

health destigmatization efforts, we have employed the same model for our suicide 

prevention programs. The Deputy assistant Secretary of Defense for Readiness is 

standing up the Defense Suicide Prevention Office that will be staffed and resourced 

to develop, implement, integrate, and evaluate suicide prevention policies, procedures, and surveillance activities across the Department. This action specifically addresses a key recommendation contained in the DOD Task Force Report on Suicide 

Prevention and will greatly facilitate the timely implementation of additional recommendations contained in the report. 

The Department of Defense has made great strides in implementing early identification and treatment programs for traumatic brain injuries (TBIs). Through the 

work of the Defense Centers of Excellence for Psychological Health and Traumatic 

Brain Injury (DCoE), the DOD in-theater concussion policy has significantly improved the early detection of servicemembers with concussion by providing clear and 

specific guidelines for the management of acute concussions. The Department’s focus 

on TBI treatment has resulted in the standardization of 62 TBI programs at military treatment facilities (MTFs) in the nondeployed setting and the cultivation of 

11 concussion restoration/care centers in the deployed setting. We have also helped 

update the behavioral health curriculum for all medical technicians and corpsmen 

at our Medical Education and Training Center (METC) to ensure our knowledge 

base is advanced throughout the MHS. 

Our fiscal year 2013 program sustains the significant investments we have made 

in all of our medical research and development programs, and in particular in the 

area of TBI and Post-Traumatic Stress (PTS). The Center for Neuroscience and Regenerative Medicine (CNRM) is a collaborative intramural Federal program that 

bridges DOD and the National Institutes of Health (NIH) in order to catalyze innovative approaches to TBI research, and emphasizes research that is relevant to military populations. Our other focus areas for the Defense Medical Research and Development Program include polytrauma and blast injury; operational health and 

performance; regenerative medicine; rehabilitation; psychological health and wellbeing for military personnel and families; and military medical training systems and 

health information technology applications. 

Within the readiness area, the health of our servicemembers is also protected 

through sound occupational health practices. This past fall, the Institute of Medicine 

(IOM) concluded its independent study of the long-term health consequences of exposure to burn pits in Iraq and Afghanistan. The IOM was unable to identify any 

long-term health risks from these exposures. Nonetheless, DOD and the VA are continuing to monitor of the health of deployed servicemembers and veterans and provide for a longer period of post-exposure health assessments to ensure these initial 

findings are sustained over time. 

Finally, at the core of our medical readiness posture is our people. Our recruitment of medical professionals—physicians, dentists, nurses, ancillary professionals 

and administrators—remains high. With the support of Congress, through the use 

of flexible bonuses and special salary rates, we have been able to meet most of our 

recruiting goals. Yet we recognize that competition for medical professionals will 

grow in the coming years, amidst a growing shortage of primary care providers and 

nurses. We will continue to work with Congress on potential new flexibilities to ensure we remain competitive in this environment. 

IMPROVING POPULATION HEALTH

Closely linked with our readiness mission are our efforts to improve the health 

of the entire MHS population. We are going to engage in a multi-year effort on two 

of the greatest contributors to ill health—tobacco use and obesity in our population. 

Our servicemembers use tobacco and tobacco products at a much higher rate than 

their peers; we have started to reduce tobacco use, but we plan to do more. In addition to the existing suite of smoking cessation pharmaceuticals available at MTFs, 

and counseling services, we will soon offer the pharmaceutical benefit through our 

mail order program, and allow for a 24/7 smoking cessation line with counseling 

services over the phone. 

In the area of obesity and overweight persons, in some circumstances we reflect 

what is occurring within the larger society. Our active-duty servicemembers—as you 

would expect—do well in maintaining their weight and their fitness, and exceptionally well when compared to their peers. However, the influence of nutritional habits 

in the larger society is having effects on the military population and particularly 

on entry-level candidates. When those in uniform leave active service, too many reverse the physical fitness habits and discipline of military service. There is a financial cost to this; one DOD study found that $1.4 billion could be attributed to overVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00049 Fmt 6633 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
44 

weight and obesity-related medical problems and services. But, more importantly, 

the quality of life for our overweight and obese beneficiary population is often far 

worse than it should be as many are affected by obesity-related disease, such as diabetes and heart disease. 

We have worked across the Services to develop and launch both adult and childhood obesity management and prevention guidelines, emphasizing the provider’s 

role and positive steps to take in assisting and advising patients. We have also implemented a demonstration project to determine whether monetary incentives can 

be used to improve the overall health and wellness of the MHS population. We do 

not yet have the results of this demonstration project, but will report interim findings to Congress this year. Finally, we have joined with a broader set of partners 

in DOD, that includes bringing together everyone on a military installation—commanders, senior enlisted advisors, the military family program leaders and medical 

personnel—in a set of initiatives aimed at further improving the fitness of our entire 

community. Our military dining halls, schools and child development centers are offering healthier food choices—both here and in Afghanistan; our commissaries and 

exchanges will help identify better nutritional choices; and we’re redesigning our 

military communities in ways that will increase exercise and fitness. 

ENHANCING THE PATIENT EXPERIENCE OF CARE

As the MHS moves into 2012, we will re-evaluate our efforts and mission through 

the lens of enhancing the patient experience of care by focusing on maximizing the 

value we provide to our beneficiaries. 

The MHS is continuing the implementation of the Patient-Centered Medical 

Home (PCMH), a program with the principle focus of developing a cohesive relationship between the patient and the provider team. The PCMH is a transformative effort within our system, with the potential to positively affect all aspects of our strategic focus—readiness, population health, patient experience and per member cost. 

Begun in 2009 as a strategic initiative, the MHS has formalized through directive 

and accreditation our PCMH program. In 2011, 44 of our facilities were formally 

recognized by the National Committee on Quality Assurance (NCQA), with 93 percent recognized as Level 3 PCMHs (as compared to a private sector rate of 60 percent with Level 3 recognition). Our more mature PCMHs—at facilities throughout 

the Army, Navy and Air Force, and representing more than 25 percent of our medical homes—are achieving the outcomes we sought: improved access to care (increased percentage of the enrolled population getting an acute appointment within 

24 hours, and a routine appointment in 72 hours); improved continuity with the 

same team of providers (increased percentage receiving care from their assigned primary care manager); and reduced emergency room utilization. In fiscal year 2012, 

we will further augment our medical homes with a 24/7 nurse advice line to offer 

both enrollees (and all beneficiaries) access to essential health information. This 

nurse advice line will be linked with MTF appointing to further improve access to 

care, and reduce bureaucratic hurdles for our patients. 

The Department has long been a national leader in developing and deploying a 

global, electronic health record (EHR). Our first EHR was put into the field in the 

late 1980s. We are now on the cusp of developing our third generation EHR—and 

the first to be co-developed with the Department of Veterans Affairs—the integrated 

Electronic Health Record (iEHR). Both DOD and the VA are encouraged by the 

progress that our interagency teams have made in refining or developing the IPO 

charter, and the principles, strategies and architectural framework for the iEHR as 

we embark upon this landmark effort. 

The DOD/VA Interagency Program Office has been rechartered to give them more 

responsibility and authority as the program execution office for the iEHR. In addition, the VA has signed an agreement with the Defense Information Systems Agency to move the data centers for two of VA’s regions into DOD data centers. Most 

recently, this week we announced the selection for the Director of the Interagency 

Program Office. 

As we expand the amount of health care information that we collect and share, 

we remain vigilant about the security of this sensitive health information. In the 

last year, a DOD contractor responsible for the maintenance of aspects of our electronic health record experienced a serious security breach in which 4.9 million medical records were potentially compromised. In the wake of that incident, we have 

conducted a critical review of the contractor’s performance, as well as a review of 

our existing policies and procedures, and we have strengthened our guidance and 

future contract requirements for a number of security and encryption standards. 

Our work with the VA on the iEHR is only one element of a comprehensive strategy to further partner with the Department of Veterans Affairs. We have successful 

45 

joint ventures or fully integrated operations at ten locations in the United States, 

and, in addition, we are pursuing other opportunities for joint purchasing, shared 

education and training opportunities, and joint construction, where feasible. 

The Military Construction (MILCON) program continues to recapitalize our inventory of MTFs. Our current investment program was substantially increased 5 years 

ago and has been essential in facilitating the BRAC transition and continued improvement of our MTFs. Both the Walter Reed National Military Medical Center in 

Bethesda, MD, and the Fort Belvoir Community Hospital in Fort Belvoir, VA, have 

opened their doors, showcasing the investments made, using evidence-based design 

standards. Construction and renovation of medical facilities in San Antonio is also 

complete. Along with other military medical facility projects in the United States 

over the last 7 years, with the support of Congress we have just completed one of 

the most transformative periods in the history of our military medicine infrastructure. 

As budgets and force structure are reduced in the Department, we recognize that 

there is a need to reassess the size and scope of major construction projects, as we 

are currently doing with the Landstuhl Regional Medical Center in Germany. We 

will, however, sustain our commitment to the operational mission, patient-centered 

design and clinical quality, even if sizing issues are reconsidered. The recapitalization of military medical facilities is essential to our efforts to recapture health care 

that has migrated to the civilian sector. 

RESPONSIBLY MANAGING COST

We are proud of our achievements in combat and peacetime medicine. We offer 

a superb benefit to our 9.7 million beneficiaries, no matter where they live, through 

our direct health care system and through our managed care support contracts. This 

health care benefit is justifiably one of the finest and most generous in the county 

and is an appropriate benefit for those who serve our country. However, the costs 

of providing this care continue to increase more rapidly than overall inflation. For 

a number of years, and through several administrations, there have been continuous, incremental steps taken to reduce the rate of growth in the costs of 

healthcare. 

In addition, the requirements of the Budget Control Act of 2011 compelled the De- partment to identify $487 billion in budget reductions over the next 10 years. The 

process of identifying these budget cuts was developed by the senior civilian, military officer and enlisted leadership from throughout the Department. Difficult 

choices were made. Over 90 percent of the cost reductions were external to personnel compensation and benefits. Still, health care was not exempt from this process. The proposals being put forward in this budget appropriately balance the need 

for a superb benefit that assists with both recruitment and retention of an All-Volunteer Force with our need to sustain a cost-effective approach for the long-term. 

This administration is pursuing a four-pronged approach by which all stakeholders share responsibility for improving the health of our population and the financial stability of the system of care. 

Our four approaches—moving from a system of healthcare to one of health; continuing to improve our internal efficiencies; implementing provider payment reform; 

and rebalancing cost-sharing—are further described below. In some instances, they 

reflect efforts already underway, or new initiatives that the Department is implementing within existing legislative and regulatory authorities. 

Moving from Healthcare to Health 

The Department of Defense’s military medical leaders are leading a strategic effort to move our system to one that promotes and sustains the optimal health of 

those we serve, while providing world-class healthcare when and where it is needed. 

Central to this effort are the Department’s investments in initiatives that keep 

our people well; that promote healthy lifestyles; and that reduce inappropriate 

emergency room visits and unnecessary hospitalizations. These initiatives have been 

addressed in earlier parts of my testimony and include the Patient-Centered Medical Home (PCMH) initiative; the embedding of behavioral health staff within these 

medical homes; the introduction of a 24/7 nurse advice line; and our many population health initiatives. We have also taken a number of steps to support preventive services. Our TRICARE beneficiaries—whether enrolled to TRICARE Prime or 

in TRICARE Standard—have no copayments for recommended preventive services, 

such as influenza immunizations. 

The ‘‘Healthcare to Health’’ element of our strategy will not produce immediate 

cost savings. Nonetheless, based on knowledge of well-constructed wellness programs in the private sector, we are confident that these, and other ongoing enhancements to the TRICARE program, will produce improvements to health that also 

46 

‘‘bend the cost curve.’’ In the longer term, it is the strategy most likely to produce 

the greatest amount of savings to our system. 

Internal Efficiencies 

The Department has instituted internal cost reduction efforts by decreasing headquarters administrative overhead; jointly purchasing medical supplies and equipment; and directing patients to lower cost venues for medications. The cumulative 

savings from all of these internal efforts for fiscal year 2013 are estimated at $259 

million. 

I have also previously noted the proposed reorganization of the MHS, following 

the work of the Task Force on Military Health System (MHS) Governance, which 

evaluated options for the long-term governance of the MHS as a whole; governance 

in those areas where more than one Service operates medical treatment facilities— 

referred to as multi-service markets, and governance for the National Capital Region (NCR). 

Implementation of any organizational efficiencies resulting from this Task Force 

has been placed on hold at the direction of Congress, subject to a review by Congress and by the Comptroller General. We will provide congressional committees 

with the information requested regarding the Task Force work and will develop 

more detailed cost and savings estimates for any eventual governance model. After 

the Deputy Secretary of Defense approves the ‘‘way ahead,’’ we will be prepared to 

answer any additional questions that you have. We believe that further integration 

of health services across the Services and with the TMA are needed in order to provide a continued high quality of care in an environment of diminishing resources 

while ensuring the preservation of the health benefit for future generations. 

Provider Payment Reform 

We are committed to identifying greater efficiencies and cost savings in all areas 

of our operations. In addition to internal efficiencies, we are also seeing significant 

savings through a number of provider payment reforms that we have introduced in 

the last several years. These include the implementation of the outpatient prospective payment system; the policy changes we made for reimbursement to select hospitals and health plans in the TRICARE network; and further use of Federal ceiling 

prices for acquisition of pharmaceuticals. 

The Department has undertaken a broad-based, multi-year effort to ensure all aspects of our provider payments for care purchased from the civilian sector are 

aligned with best practices in Medicare and in private sector health plans. The most 

notable efforts have included implementation of changes to the outpatient prospective payment system (OPPS) and reform of payment to Sole Community Hospitals. 

OPPS is modeled after the payment process that Medicare uses for similar health 

care services—setting a fixed fee per procedure, inclusive of provider and institutional charges for care. In order to allow medical facilities to transition to this new 

method of payment, TRICARE phased in the reimbursement levels over 4 years, 

with the full implementation of this policy set to occur in 2013. In fiscal year 2012, 

we project $840 million in savings, and $5.5 billion over the fiscal years 2012–2017. 

Our provider payment reform for Sole Community Hospitals (SCH) was also phased-in over time, and will provide a projected $31 million in savings in the first 

year, and will grow to about $100 million in savings through 2017. 

In the area of purchasing prescription drugs, in 2009 we instituted a process for 

obtaining discounts on drugs distributed through retail network pharmacies, pursuant to authority provided in the 2008 National Defense Authorization Act. Known 

as Federal Ceiling Prices (FCP), prescriptions purchased under FCP are at least 24 

percent less than non-Federal Average Manufacturer prices. In 2012, the FCP program will save the Department over $1.6 billion, and will grow to over $2 billion 

in savings by 2017. 

Beneficiary Cost-Shares 

In addition to the focus on internal and external efficiencies, our proposed budget 

introduces changes to the health care out-of-pocket costs for our beneficiaries. 

I want to make three critical points related to these proposals. First, even accounting for these proposed fee changes, the TRICARE benefit will remain one of 

the finest and most generous health benefits available in the country, with among 

the lowest beneficiary out-of-pocket costs available to anyone—and certainly lower 

than costs by other Federal Government employees. We believe that is appropriate 

and properly recognizes the special sacrifices of our men and women in uniform, 

past and present. 

Second, as mentioned earlier in my testimony, these proposals were developed 

within the Department, and represent the input and consensus of our uniformed 

leadership, both officer and enlisted. 

47 

Third, we recognize that some beneficiary groups should be insulated from increases in out-of-pocket costs. We propose to exempt those servicemembers, and 

their families, who were medically retired from military service, as well as the families of servicemembers who died on active duty. We also propose to establish costsharing tiers, with lower increases for retirees based on their military retirement 

pay. More junior enlisted retirees, for example, will experience the lowest dollar increases in out-of-pocket costs. Finally, we have also avoided any changes in costsharing for active duty families with the exception of prescription drug copayments 

obtained outside of our MTFs. Prescription drugs distributed within MTFs will continue to be free of charge for all beneficiaries. 

For over 15 years, the Department had not increased patient out-of-pocket costs 

for any beneficiary. In fact, the TRICARE benefit was enhanced in many ways, and 

a number of out-of-pocket costs were decreased. A few of these enhancements include: active duty family members enrolled in TRICARE Prime had their copays 

eliminated; retirees and their families using TRICARE Prime had their catastrophic 

cap reduced from $7,500 to $3,000 per year; Medicare-eligible retirees and their 

families received TRICARE For Life coverage, and a TRICARE pharmacy benefit. 

Last year, we introduced very modest changes in one segment of our population— 

increasing TRICARE Prime enrollment fees for retiree families by $5/month, and indexed these fees so that future increases continue to be modest and beneficiaries 

can plan for them. We greatly appreciate Congress’ support for these proposals in 

the fiscal year 2012 budget, and have implemented those fee changes in the current 

year. 

Although last year’s changes were a necessary step, the Department has proposed 

further cost reduction efforts in 2013 as an element of our strategy to meet the requirements of the 2011 Budget Control Act. All of these changes are phased in over 

time. For select fees the Department has proposed ‘‘tiers’’ of copays based on the 

retirement pay of the beneficiary. Fee changes are distributed across the various 

TRICARE programs, so that no one beneficiary group bears the entire burden for 

these changes in cost-sharing. Retirees in TRICARE Prime, TRICARE Standard and 

TRICARE For Life each have a share of the increases; all beneficiaries (except uniformed personnel) have additional costs for prescription drugs outside of MTFs. The 

following sections provide a high-level overview of the proposed changes in beneficiary out-of-pocket costs. Figure 2 summarizes the proposed fees: 

• Fee increases for TRICARE programs. The following proposed changes represent increases from existing patient out-of-pocket costs. 

• TRICARE Prime Enrollment Fees. We propose to raise the enrollment 

fees in 2013 for retired servicemembers and their families from between 

$80–$300 per year, based on the retirement pay of the servicemember, and 

continue to provide similar increases through 2016. 

• TRICARE Deductibles. We propose to increase deductibles for the 

TRICARE Standard program for retired servicemembers and their families 

beginning in fiscal year 2013. TRICARE deductibles have not been changed 

since before the TRICARE program was introduced, having last been adjusted over 20 years ago. 

• TRICARE Pharmacy Copays. We propose to increase pharmacy copayments for generic, brand name and non-formulary prescriptions in both the 

retail and mail order settings, although we will continue to offer significant 

incentives for beneficiaries to elect mail order over retail pharmacy networks. Additionally, non-formulary prescription drugs will no longer be 

available in the retail network. These changes are proposed for all non-active duty beneficiaries, to include active duty family members. Prescription 

drugs obtained in military hospitals and clinics will continue to be provided 

without copay for any beneficiaries. 

• New fees for TRICARE programs. Our proposed budget also calls for the introduction of new fees not previously part of the TRICARE program. 

• TRICARE Standard/Extra Enrollment Fee. We propose to introduce an 

annual enrollment fee in TRICARE Standard for retired servicemembers 

and their families. The proposed fee for 2013 will be $70/year for an individual retired beneficiary, or $140 per retired family. 

• TRICARE For Life (TFL) Enrollment Fee. When TFL was introduced in 

2002, there was no enrollment fee in the program, only a requirement that 

beneficiaries be enrolled in Medicare Part B to enjoy their TFL benefit. 

Medicare Part B was always a step that we recommended our retirees elect, 

and prior to 2002, over 95 percent of eligible military retirees were enrolled 

in Medicare Part B. The TFL benefit has reduced beneficiary out-of-pocket 

costs by thousands of dollars per year in copayments or Medicare suppleVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00053 Fmt 6633 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
48 

mental health insurance plan payments. The proposed TFL enrollment fees, 

similar to the TRICARE Prime enrollment fees, are tiered, based on an individual’s retirement pay—and range from $35 to $115 per beneficiary per 

year in fiscal year 2013. 

• Exclusion of Enrollment Fees from the Catastrophic Cap. We propose 

that enrollment fees, which had previously accumulated toward a retiree’s 

catastrophic cap limit, will not be counted toward the cap beginning in 

2013. 

• In addition to the indexing of the TRICARE Prime enrollment fee, which 

is already indexed, we propose to index other beneficiary out-of-pocket costs 

identified in this set of proposals, to include the TRICARE Standard deductible, TRICARE Standard enrollment fee, TRICARE For Life enrollment 

fees, pharmacy copayments, and catastrophic caps. 


328pe121.eps
49 

These proposed changes continue to be modest by historic standards of cost-sharing in the TRICARE program. In 1996, when TRICARE was implemented, a working age retiree’s family of three contributed approximately 27 percent towards the 

total cost of their care; today that percentage has dropped to just over 10 percent. 

Even with these proposed changes, the percentage would still remain below the percentage originally set by Congress, averaging approximately 14 percent of range of 

overall health care costs in 2017—and stabilizing at that level for the out-years. 

These adjustments are an important step to setting the TRICARE benefit on a 

more sustainable path that maintains the quality of the medical benefit for future 

generations. Moreover, the overwhelming majority of these adjustments will be 

phased in over a 4- to 10-year period and will be appropriately indexed to ensure 

future sustainability and guarantee transparency. These proposals—one element of 

a four-pronged effort at cost control—will help shift us toward more effective and 

cost-efficient processes that will allow us to provide better care while meeting our 

obligations to help reduce our budgets. 

We are cognizant of the strains placed on our economy and the government by 

Federal budget deficits and long-term debt. We recognize that the Department of 

Defense must shoulder its share of responsibility and that we must tighten our belts 

just as so many Americans have been forced to do in recent years. We have not 

taken any proposed change lightly. The health benefit exemplifies the Department’s 

gratitude to veterans for their service and acts as an integral part of recruiting, retaining, and maintaining a healthy force. We worked to ensure that cost changes 


328pe122.eps
50 

would be minimized and that any reforms would not degrade the quality of the benefit. We are confident that this is the case. 

I am honored to represent the men and women of the Military Health System before you today, and I look forward to answering any questions you may have. 

Senator WEBB. Thank you very much, Secretary Woodson. 

Secretary McGinnis, welcome. 

STATEMENT OF DAVID L. MCGINNIS, ACTING ASSISTANT 

SECRETARY OF DEFENSE FOR RESERVE AFFAIRS 

Mr. MCGINNIS. Chairman Webb, Senator Graham, distinguished 

members of the subcommittee, thank you for the opportunity to appear before you today and discuss the Reserve and our National 

Guard. 

Today, I can report to you that we have over 72,000 members of 

the Guard and Reserve on involuntary orders for mobilization supporting operations in U.S. Central Command (CENTCOM). In addition, we have another 86,000 on a snapshot. At the end of the 

month, we provided to the Secretary, 86,000 guardsmen and reservists deployed on 6 continents supporting our regional commanders in various duty statuses from annual training to mobilization. This is reflective of the emerging new role of our Reserve components described by many as the operational reserve. 

The President’s fiscal year 2013 budget supports this operational 

reserve providing funding and programmatic support to three key 

readiness imperatives: training, equipping, and recruiting and retention. 

Training is focused on, first of all, maintaining capability and capacity identified within DOD for the particular organizations and 

leveraging available training technologies so we can make the maximum use of available time of our guardsmen and reservists when 

they are in training. We are focused on developing a common readiness standard across the components of each Service so we have 

standardized expectations on what we are looking for the Guard 

and Reserve to do. 

Equipping within my office first focuses on transparency. That is 

a bumper sticker for assuring that the equipment that you authorize for the Reserve components gets to those Reserve components 

you expected in a timely manner. We have also expanded this program to now develop a life cycle view of that equipment and track 

it throughout the system. 

We are also working very hard to ensure that the Guard and Reserve organizations have the right equipment to train with, including command and control and communications equipment, so they 

can integrate within the Total Force. 

Recruiting and retention are obviously an essential element of a 

ready force, and our recruit quality remains high. We expect some 

shifts in that as we move forward with individuals leaving the Active component, as we mentioned earlier, and we are working very 

strongly to come up with ways to integrate them into the Reserve 

components as they leave Active service. 

Retention currently is very solid, and we know that while we recruit the servicemember, we must maintain the family and retain 

the family. The Yellow Ribbon Reintegration Program (YRRP) is a 

wonderful tool that you provided us, that helps us do that. The use 

51 

of the Reserve components in an operational role is necessitating 

that we begin to move the YRRP, or at least portions of it, into the 

base budget. With Secretary Hale’s help and the help of others, we 

have started to do that in 2013, and we are working on doing that 

as we develop the future defense program. 

Continuing evolving requirements now also include employment 

programs, employment assistance, and training. We are working 

very hard at that. I will talk about that in a minute. 

As we learned from our members and their families on multiple 

deployments, we are finding that the tension to pre-enduring deployment activities within the YRRP really enhances the post-deployment period. We are putting a lot of emphasis on that. 

Hero2Hired (H2H) is a joint initiative between the YRRP and the 

National Committee on Employer Support to the Guard and Reserve which is focused on unemployment and under-employment of 

this distinct category of servicemembers within the Reserve components. 

Second, this focuses on the reality that is really, unemployment 

of our guardsmen and reservists is a key element of individual 

military readiness. Successful guardsmen and reservists are established in the community and have good jobs. We know that. 

Finally, sir, I could not appear before you without highlighting 

the 20-year history of the building of enduring international partnerships with the National Guard State Partnership Program. We 

currently have a total of 63 partnerships, but I would like to focus 

on the 22 in Eastern Europe and the 5 in CENTCOM. The 22 in 

Eastern Europe have helped us build the North Atlantic Treaty Organization (NATO) and expand NATO and also account today, as 

we speak, for about 9,500 Eastern European military members as 

part of the International Security Assistance Force (ISAF); and the 

5 CENTCOM programs give us expanded access and understanding 

of the CENTCOM theater. 

I thank you very much again. I look forward to your questions. 

[The prepared statement of Mr. McGinnis follows:] 

PREPARED STATEMENT BY DAVID L. MCGINNIS

INTRODUCTION

Chairman Webb, Ranking Member Graham, and members of the subcommittee; 

I thank you for your invitation to participate in this hearing. I welcome the opportunity to give you an overview of the issues we are addressing in the Reserve components. 

The fiscal year 2013 budget supports the National Defense Strategy and will enable our Reserve components to continue to fulfill their vital national security role. 

The budget provides funding and programmatic support for the training, equipping, 

recruiting and retaining of the Guard and Reserve. 

The Department’s Ready Reserve totaling about 1.1 million members contributes 

43 percent of total military end strength at a cost of 9 percent of the total base 

budget. The National Guard and Reserve provide trained, ready and cost-effective 

forces that can be employed on a regular operational basis, while also ensuring strategic depth for large-scale contingencies or other unanticipated national crises. Reserve component forces can: 

• Provide critical capabilities for meeting national defense objectives 

• Enable mitigation of strategic risk at lower cost than a large standing 

full-time force 

• Provide cost effective returns on significant Department of Defense 

(DOD) investment 

• Reduce stress on the Total Force 

52 

• Provide the capability to rapidly ‘‘reverse’’ given a change in our national 

strategic objectives 

Prior to 2001, the Reserve components were primarily a strategic reserve with occasional operational missions as needed to augment Active Forces. Since 2001, Reserve component units and individuals have been heavily employed across the full 

spectrum of military operations ranging from combat missions overseas, to homeland emergencies, to National Special Security Events and have demonstrated their 

readiness and utility. The current National Guard and Reserve is, arguably, the 

most combat seasoned Reserve Force ever, and the Department seeks to capitalize 

on this significant investment to provide needed military capacity during current 

austere economic times. 

To ensure the Reserve component can continue to provide both operational and 

strategic forces, the Department included funding and programs in its fiscal year 

2013 budget request for their training, equipping, recruiting and retention. 

TRAINING AND UTILIZATION OPPORTUNITIES FOR THE MILITARY DEPARTMENTS

After a decade of sustained engagement in combat operations, the Reserve components of our Armed Forces continue to transform into a dependable operational force 

that provides full-spectrum capability to the Nation. As of 31 December 2011, 

835,689 Reserve component members (809,913 Selected Reserve and 25,776 Individual Ready Reserve) have served in support of contingency operations since September 11, 2001 and 80 percent of those service men and women have deployed in 

the U.S. Central Command area of responsibility. Today there are over 85,000 National Guard and Reserve men and women on active duty around the world and at 

home, serving in missions ranging from combat in Afghanistan to defending the air 

space here in Washington and our borders in the southwest. 

RC Utilization 

The contribution of the Reserve components has increased dramatically in the last 

two decades, and during that time the Reserve component has become an integral 

part of the Nation’s military force participating in nearly every mission worldwide. 

The increased utilization of the Reserve components supports the recent Strategic 

Guidance, and the Department has managed the use of the Reserve component to 

help mitigate the stress on the Total Force. 

Today’s Reserve component is a force multiplier which provides access and flexibility at an incredible value allowing the Services to utilize full capabilities in an 

operational capacity while retaining strategic depth. An optimal Active component/ 

Reserve component force mix will allow the department to not only preserve previous investments in readiness, capability, and capacity, but also protect the operational expertise of the force for future use while ensuring a rapidly expandable, 

trained, and ready military. 


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Innovative Readiness Training 

The Innovative Readiness Training (IRT) Program is an outstanding volunteer 

training opportunity for our National Guard and Reserve. IRT’s focus is to provide 

a varied and challenging menu of training opportunities that exercise the Mission 

Essential Task List (METL) requirements of combat support and combat service 

support units and individuals. Each year, new training opportunities are presented 

by Federal, State, or local government agencies or nonprofit organizations to the 

Services for their selection. Military units are provided METL training in a realistic, 

hands-on setting while providing quality services to communities throughout the 

United States and U.S. territories. 

Examples of IRT activities include infrastructure development, constructing rural 

roads and runways, small building and warehouse construction and providing medical and dental care to medically underserved communities. These opportunities result in interoperability and readiness training ensuring our Nation always has a 

fully capable National Guard and Reserve. Historically, this office’s IRT program 

budgets for, and executes a $20 million fiscal year training program. 

Cyber Workforce 

Operating effectively in Cyberspace is vital to DOD and the Nation. ‘‘Cyber’’ as 

a Warfare Domain is newly organized and rapidly expanding. The need for personnel with cyber skills, the limited number of workers with those skills, and increasing competition within U.S. Government and the private sector for the same 

set of skills require a long-term and robust cyber workforce strategy. The Secretary 

of Defense has stressed the need for a flexible approach to attract, develop, and retain Cyber, and specifically Cybersecurity, professionals along with endorsing innovative use of the Reserve component for cyber missions. 

Innovative use of the Reserve component as proposed by the Secretary is well underway, with forces assigned to the National Security Agency, U.S. Cyber Command 

(CYBERCOM), the Defense Information Systems Agency and to each of the four 

Service component commands supporting CYBERCOM. There are multiple Air and 

Army Guard units engaged in the cyberspace mission and Computer Network Defense teams are authorized in all 54 States and territories. The Reserve component 

offers very highly qualified individuals from the private sectors whose civilian skills 

may be maximized when supporting DOD. 

State Partnership Program 

The National Guard State Partnership Program (SPP) mission is to establish and 

sustain enduring relationships with partner nations of strategic value in conjunction 

with the National Security Strategy, National Military Strategy, Department of 

State and Combatant Command Theater Security Cooperation guidance to promote 

national objectives, stability, partner capacity, better understanding and trust. 

Program partners engage in security cooperation activities to include homeland 

defense and security, disaster response/mitigation, consequence/crisis management, 

interagency cooperation, border/port/aviation security, combat medical, fellowshipstyle internships, and bilateral familiarization events that create training and exercise opportunities. SPP provides the ability to focus a part of DOD, a State’s National Guard, with a single country or region in support of U.S. and partner country 

objectives. Currently, 48 States, 2 territories, and the District of Columbia are 

partnered with 63 countries around the world. 

This program directly supports the Secretary’s strategic goal of building innovative partnerships. The program has been funded at $13.36 million for fiscal year 

2012 and the President’s fiscal year 2013 budget includes a request for $16.5 million. Many of these partnerships have resulted in collaborative working relationships through police and military operational mentoring and liaison teams with our 

new NATO partners who are part of the effort in Afghanistan. 

EQUIPPING THE RESERVE COMPONENTS

Equipment Procurement 

There currently is no specific appropriation that provides equipment directly to 

the Reserve components. The Reserve component relies on the active procurement 

account to meet equipment requirements and provide adequate capabilities. Congress has been generous in providing additional support through the National 

Guard and Reserve Equipment Appropriation ($1 billion for fiscal year 2012), which 

provides funding for Reserve component equipment modernization and critical dualuse equipment. 

54 

P–1R 

We thank Congress for their continued generous support of the Guard and Re- serve equipping (P1R fiscal year 2012 - $4.6 billion/fiscal year 2013 - $3 billion). The 

current challenge is that the P–1R has historically been treated as a non-binding 

projected subset of the Procurement Programs (P–1). In my view it is time to make 

the National Guard and Reserve equipment a sub-line within the P–1 and eliminate 

the P–1R. This will better ensure that Guard and Reserve component equipment is 

part of the Service plans throughout the entire procurement process. 

Resetting 

Currently, funding for reset of equipment returning from theatre for the Guard 

and Reserve comes from overseas contingency operations appropriations. As we prepare to move away from reliance on these supplemental funds, it is important to 

have a continued source of funding built into the base budget for Reserve component 

equipment reset. It is critical that the Guard and Reserves are able to continue to 

train on high quality equipment for which funds have already been allocated. 

RC Equipment Transparency 

Full transparency and accountability can only be achieved through a full life cycle, 

enterprise approach to reserve equipping. The life cycle includes requirements determination, budget requests, appropriation, purchase, and delivery of hundreds of 

thousands of pieces of equipment. The importance of transparency doesn’t stop when 

an item is delivered to a Reserve component unit; the value of transparency in the 

life cycle approach to equipping continues beyond delivery. Plans to return borrowed 

Reserve component equipment are included as key deliverables in this process. 

Military Construction 

The fiscal year 2013 Reserve component budget includes $1.02 billion, $21 million 

less than fiscal year 2012, for military construction which will meet both current 

and new mission requirements for Reserve component operations, readiness, and 

training facilities. The budget also funds sustainment, which is essential to maintaining facilities at a level that supports readiness and preserves the substantial investment the country has made in infrastructure. However, with urgent Reserve 

component facilities deficiencies and funding constraints, we must work to exploit 

opportunities to utilize existing DOD facilities and continue to pursue the efficiencies of joint use construction opportunities. The benefits of doing this go far beyond cost savings by promoting cooperation, building trust, and providing opportunities for joint training. 

Regional Integrated Training Environment 

The Regional Integrated Training Environment (RITE) concept is a joint effort 

that identifies and matches Services’ training requirements to a vast network of 

local training facilities and resources. The purpose of the RITE initiative is to help 

sustain the total force readiness posture and surge capability as determined by service rotational readiness models while reducing overhead training costs through innovative management of facilities, training assets, advance simulators and Joint Live 

Virtual and Constructive capability, pooled, shared equipment, and coordinated 

through a web-based scheduling/visibility program. As the concept matures, collaboration will expand with key internal and external DOD stakeholders. 

RECRUITING AND RETAINING THE RESERVE COMPONENT FORCE

In approximate numbers, as of December 31, 2011, the Ready Reserve currently 

consists of the following end-strengths: 

• Selected Reserve: 844,400 

• Individual Ready Reserve: 220,000 

• Inactive National Guard: 3,700 

Continuum of Service, End Strength and Readiness Management 

Meeting Reserve component end strength objectives is a priority of the Department. The following table depicts the current prescribed and actual end strengths 

for the Reserve components as of December 2011. The Department’s Continuum of 

Service efforts have contributed to all six DOD Reserve components remaining within the variance allowed for their congressionally-mandated end strength objective. 

The Services have implemented recruiting, retention, and force shaping policies and 

programs to achieve end strengths for fiscal year 2012. We appreciate the congressional support of the fiscal year 2012 end strength levels and the legislative initiatives that assist in recruiting and retaining Reserve component servicemembers. 

Fiscal year 2013 end strength levels will provide the Reserve components with the 

55 

forces necessary to meet strategic and operational demands while maintaining a 

dwell consistent with Departmental policy. 

Recruit Operational Ready Reserve Strength 

Thus far, for 2012, Reserve recruiting efforts show continued success. Through 

January, five of the six Reserve Services are within tolerance for recruit quantity 

objectives. Also, all Reserve components have met recruit quality objectives. The Reserve components continue to exceed the DOD Benchmark of 90 percent of new recruits being High School Diploma Graduates, with 97 percent of Reserve component 

recruits holding that credential. 

It is important that we have a military that reflects the society it defends, both 

in the enlisted ranks and our commissioned officers. This is particularly important 

as less than 1 percent of the American public serves in uniform. 


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We continually review our recruiting programs to align funding and policies with 

current realities. Each of the Services has made significant adjustments to recruiting programs in light of our austere fiscal environment and draw-downs, and continues to look for additional cost savings but we must be cautious and resist the 

temptation to cut too deeply and too fast. Stable adequate investments in recruiting 

resources are necessary to maintain long-term success. Although enlistment incentives can be adjusted quickly to meet market fluctuations and force management 

needs, history has shown that the time required to redeploy advertising/marketing 

campaigns and/or qualified recruiters is significant. 

Acknowledging and understanding these factors and the need to expand our recruiting areas for the Reserve components, we continue to enhance DOD influence 

in underserved communities by working with local school administrators, specifically from Title I school districts, and implementing programs like the DOD 

STARBASE Program that have potential long-term impacts on students’ on-time 

high school graduation; college enrollment; and interest in learning science, technology, engineering and mathematics. DOD STARBASE is an outreach and educational program that focuses on science, technology, engineering, and mathematics 

(STEM). STARBASE provides students underrepresented in the STEM areas of 

study and careers with 25 hours of instruction through an inquiry-based curriculum 

with ‘‘hands-on, minds-on’’ experiential activities and exposing them to military’s 

technological environment to solidify their attachment to and engagement with 

learning. The program’s influence has resulted in former DOD STARBASE students 

being invited to attend and participate in the White House Science Fairs for the last 

2 years. 

My staff and I have been working with the Office of Management and Budget to 

challenge States, industries, and nonprofits to invest in intervention programs like 

the National Guard Youth Challenge Program. I am also working with General 

McKinley, Chief of the National Guard Bureau, to provide oversight and management of the Program by collaborating with Governors to eliminate State resident 

issues; and to ensure every qualified high school dropout has an opportunity to attend the program. The Challenge program is currently operating in 27 States and 

Puerto Rico. Its goal is to improve the education, life skills and employment potential of America’s high school dropouts. We provide quasi-military based training, supervised work experience to advance the program’s core components. The core components include obtaining a high school diploma or equivalent, developing leadership, citizenship, life coping and job skills and improving physical fitness, health 

and hygiene. Since the program’s inception over 100,000 students have successfully 

graduated from the program. The average cost per Challenge student is approximately $16,000. The fiscal year 2013 budget will support increasing annual enrollment and/or start up new programs in States that have the fiscal resources to match 

the cost-share funding requirements and to sustain the program’s viability in States 

that have budget limitations. 

These two successful DOD youth outreach programs provide the Department a 

unique connection to the American public and working with our most valued resource—our young people. 

The Montgomery GI Bill-Selected Reserve (MGIB–SR) has been a cornerstone of 

our military recruiting efforts since 1985, and a major contributor to the success of 

the All-Volunteer Force. The new Post-9/11 GI Bill appears to enhance our recruiting efforts even more especially after signing the Post-9/11 Veterans Educational Assistance Improvements Act of 2010—providing additional benefit options that include the eligibility of National Guard and Reserve members who were inadvertently omitted from the original Bill, vocational and other non-college degree training, and living stipends for those enrolled in distance learning programs. 

Individual Readiness 

We understand that maintaining the highest level of individual readiness for our 

military manpower and civilian employees is a requirement for continuing to be utilized as a viable part of the operational force. Employing the Reserve components 

as operational forces requires modifications to training schedules and funding requirements. Ancillary training must be properly managed and prioritized in order 

to allow our members to focus on training for the skills that will be required of them 

when deployed or activated. Before DOD operationalized the Reserve component, 

the normal minimum training profiles consisted of training 2 days per month plus 

14–15 days of active duty for training annually. While that training profile remains 

in-place for some types of units, current Department policy states that for those 

with planned deployments, training days prior to mobilization increases. This training profile, with more training pre-deployment and less post-deployment, minimizes 

mobilized time away from families and civilian. Increasing individual readiness by 

57 

modifying training profiles with resources and policies is a major focus area that 

will allow the Guard and Reserve to capitalize on the gains made during the last 

decade and enable the continued use of the Reserve component as an operational 

force. 

Individual Medical Readiness 

The Individual Medical Readiness of the National Guard and Reserve continues 

to be a priority for the Department to ensure availability of Ready Reserve component members for deployment. As of the fourth quarter of fiscal year 2011, the Reserve component has increased its Fully and Partially Medically Ready rate 5 percent over first quarter fiscal year 2011 rates, and reduced the Indeterminate population by 6 percent. Most notably, the Marine Corps Reserves improved their Fully 

Medically Ready status by 16 percent and reduced the Partially Medical Ready rate 

by 14 percent, over half of the fiscal year 2011 first quarter rates. The U.S. Coast 

Guard Reserve also made great improvements increasing their Fully Medically 

Ready rate by 9 percent, and reducing their Indeterminate and Not Medically Ready 

population by 4 percent and 6 percent respectively. While we continue to face challenges with Dental Readiness, all Services are over the 75 percent goal except Army 

Reserve and Army National Guard which are at 71 percent and 73 percent respectively. My office is working within P&R and across the Services to improve access 

to medical and dental services for Reserve component members. For example, the 

Army Reserve now budgets additional medical and dental services into their readiness accounts for Reserve component members. 

TRICARE for the Reserve Components 

The Department offers various health and dental coverage options to eligible 

members of the Reserve components and their families. Members of the Selected Reserve (SELRES) who actively participate in the Reserve component may purchase 

individual or family TRICARE Standard/Extra coverage under TRICARE Reserve 

Select (TRS). Members pay premiums that reflect 28 percent of the total cost of the 

coverage and incur cost shares after meeting an annual deductible (a government 

subsidy covers 72 percent of premium cost). 

For Reserve component members who have been activated in support of a contingency operation, premium-free TRICARE coverage may begin up to 180 days before 

the member is activated (Early Identification) and continues for 180 days after the 

member is deactivated (Transitional Assistance Management Program (TAMP)) for 

the member and his/her family. After this period, qualified SELRES members may 

re-enroll and purchase TRS coverage again if desired. As of December 2011, there 

were a total of 81,465 TRS plans in effect: 29,204 TRS member-only plans and 

52,261 TRS member and family plans with a total of 215,545 beneficiaries covered 

by TRS. Additionally, the Continued Health Care Benefit Program (CHCBP) is a 

premium-based health care program that offers temporary transitional health coverage for 18–36 months after TRICARE eligibility ends. CHCBP acts as a bridge between military health benefits and civilian health plans. Qualified members may 

purchase CHCBP within 60 days of loss of eligibility for either regular TRICARE 

or TAMP coverage. 

TRICARE Retired Reserve (TRR) is a full cost (no government subsidy) premiumbased, worldwide health plan that qualified retired Reserve members and survivors 

may purchase. TRR offers comprehensive health coverage from any TRICARE-authorized network or non-network provider. TRR members may receive care in military treatment facilities on a space-available basis. TRICARE Young Adult is a premium-based health care plan that qualified dependents may purchase. TRICARE 

Young Adult provides medical and pharmacy benefits, but dental coverage is excluded. TRICARE Young Adult allows dependent adult children to purchase 

TRICARE coverage after eligibility for ‘‘regular’’ TRICARE coverage ends at age 21 

(or 23 if enrolled in a full course of study at an approved institution of higher learning) and are not yet age 26. 

Collectively, these options for health care coverage provide a comprehensive and 

affordable health care plan for Reserve component servicemembers and their families. TRICARE insurance has provided servicemembers the opportunity to maintain 

their individual medical readiness requirements, increasing the overall readiness of 

our Reserve component units. 

Yellow Ribbon Reintegration Program 

The Yellow Ribbon Reintegration Program (YRRP) is a statutorily created, joint 

effort to support the Services in providing National Guard and Reserve servicemembers and their families with critical support, information, services, and referrals throughout the entire deployment cycle (pre, during, and post) to maximize successful transitions as servicemembers move between their military and civilian roles 

58 

and to create strong, resilient military families. The YRRP is also responsible for 

providing Reserve component members and those who support them with training 

in suicide prevention and community healing. In fiscal year 2013, the YRRP will 

continue collaborating with suicide prevention experts to develop a strategic approach in identifying promising practices, strengths, challenges and gaps. We in Reserve Affairs continue to work with the Services as well as the newly created Defense Suicide Protection Office within the Office of the Under Secretary of Defense 

for Personnel and Readiness to address this important issue. The Services, along 

with Reserve Affairs, have taken current suicide rates very seriously and have committed resources to significantly reduce this trend. 

Guard and Reserve, Federal and State employees, volunteers and nonprofit organizations have worked tirelessly to ensure our servicemembers and those who support them have access to resources as they transition back into their communities. 

During the past 3 years, the YRRP has evolved into a successful, forward-leaning 

program providing essential readiness and resiliency training and resources to over 

800,000 servicemembers and designees through direct-contact YRRP events. In fiscal year 2011, the Services conducted a total of 2,151 YRRP events across the country, providing vital information and resources to 309,753 servicemembers, their families and/or designated representatives. To support the use of the operational reserve 

in the future, we need to work towards YRRP funding in the base budgets to ensure 

continuation of these important programs. 

In fiscal year 2011, Congress appropriated an additional $16 million to the YRRP 

for enhanced outreach and reintegration activities which allowed the department to 

provide one-time support to various State led initiatives. Our Center of Excellence 

is working to collect data and metrics from these various programs to ensure we 

are funding the most effective outreach. 

Employer Support of the Guard and Reserve (ESGR) 

Employer Support of the Guard and Reserve engagement has grown significantly 

in recent years. The vision is ‘‘to develop and promote a culture in which all American employers support and value the military service of their employees with ESGR 

as the principal advocate within DOD.’’ ESGR has a footprint in all 50 States, U.S. 

Territories, and DC with over 4,800 volunteers assisting employers and servicemembers on a daily basis. The support of employers and families has never been 

more critical to our national defense. Through its network ESGR accomplished the 

following during the past year: 

• Through Employer Outreach, ESGR volunteers briefed 153,062 employers 

regarding their rights and responsibilities in accordance with Uniformed 

Services Employment and Reemployment Rights Act (USERRA). Also, 

ESGR attained 45,140 Statements of Support. Employers signing a Statement of Support pledged support for their employees serving in the Guard 

and Reserve, while also focusing on opportunities to hire guardsmen, reservists, and veterans. 

• Through Military Outreach efforts, ESGR volunteers briefed 473,891 

servicemembers regarding their rights and responsibilities under USERRA. 

In turn, servicemembers recognized supportive employers with 4,049 nominations for the 2011 Secretary of Defense Employer Support Freedom 

Award and acknowledged 16,559 supervisors with ESGR’s Patriot Award. 

• ESGR’s Ombudsman services are supported by over 600 trained USERRA 

experts spread across the country and by a National Customer Service Center. Together, the Ombudsmen fielded 29,727 USERRA inquiries and handled 2,884 cases. ESGR Ombudsmen provided free, neutral mediation to resolve nearly 80 percent of all cases, in less than 9 calendar days. For cases 

that cannot be resolved by the Ombudsman, servicemembers are informed 

of their option to file a complaint with the Department of Labor, where a 

formal investigation will be conducted as to the merits of the complaint. 

Reserve Component Unemployment and Underemployment 

The Department knows that civilian employment is an important piece of a Reserve component servicemember’s readiness, and the current high unemployment 

rate is a clear threat to the readiness of our force. The Bureau of Labor Statistics 

January 2012 report showed that the unemployment rate for all Veterans (including 

Guardsmen and reservists who previously served on active duty) was 7.5 percent 

nationwide. The unemployment rate among Gulf War era II veterans (those serving 

since September 11) was 9.1 percent. For reservists and guardsmen, the January 

2011 Status of Forces Survey of Reserve Component Members shows a self-reported 

23 percent unemployment rate among junior enlisted members in the grades of E– 

1 to E–4. 

59 

As a result of these unemployment rates, ESGR and YRRP launched an Employment Initiatives Program (EIP) in January 2011. Under the Office of the Assistant 

Secretary of Defense for Reserve Affairs (OASD (RA)) our ESGR volunteers increased their focused activities to address the unique unemployment needs of Reserve component servicemembers. Our ESGR Committees, representing the 54 

States, Territories. and District, began focused efforts such as employment assistance workshops, job fairs, employment summits, and many other local community 

programs. ESGR conducted numerous workshops whereby servicemembers were 

trained on how to create civilian resumes, undergo mock interviews, dress for success, and received career counseling. 

Beginning in March 2011, ESGR volunteers assisted the U.S. Chamber of Commerce in the launch of their mega-hiring fairs around the country. As of the latest 

Chamber report, there have been 88 events, connecting more than 84,000 Veterans, 

Reserve component members and military spouses, to over 4,300 different employers. As a result of the combined effort, the National Chamber reports that more 

than 7,300 veterans, servicemembers, military spouses, and 50 wounded warriors 

have gained employment. 

This past December 2011, our office launched a comprehensive, multi-faceted program called ‘‘Hero2Hired’’, better known as H2H, using lessons learned from our 

own efforts this past year and from the U.S. Army Reserve Employer Partnership 

of the Armed Forces program, H2H was developed to address the gap in employment assistance services and support for Reserve component servicemembers who 

are not considered veterans in law and so are ineligible for VA employment programs. H2H focuses on helping Reserve component servicemembers connect to and 

find jobs with military-friendly companies that seek employees with specific training 

and skills. H2H is a powerful, comprehensive employment program with a powerful 

job search site (www.H2H.jobs) and online community that is made available at no 

cost to servicemembers and employers. It contains all the tools a job seeker needs 

to find a job: job listings, career exploration tools, education and training resources, 

advice and tips, hiring events, virtual career fairs, mobile phone app, and networking opportunities. In 2012, H2H is sponsoring and participating with the U.S. 

Chamber of Commerce in 40 job fairs in high Reserve component unemployment 

areas. H2H booths will be available and staffed by H2H, YRRP, and ESGR State 

Committee volunteers. 

Together, YRRP and ESGR are delivering meaningful services to assist Reserve 

component servicemembers to transition and reintegrate into their civilian community through full spectrum assistance with employment and by promoting positive 

employer relations through USERRA education. 

Individual and Family Support Policy (IFSP) is participating in DOD studies on 

Child Care Subsidy, Military Family Life Consultants, Effectiveness Tracking, Resilience Programs, Websites and Help-lines, State Liaisons, and Communication with 

Families. OSD Reserve Affairs will continue to be an active partner in the DOD 

process to ensure that as family support resources are realigned, the 1.1 million National Guard and Reserve members and their families are considered in the decisionmaking process and that family support functions at a level that sustains full 

mission readiness. 

CONCLUSION

Secretary Panetta has recently testified on the need to maintain the tremendous 

expertise that has been developed in the Reserve components during the last decade 

of sustained engagement. The Department’s recently released strategic guidance 

highlights the need for our National Guard and Reserves’ continued capabilities and 

contributions as an agile, flexible and ready force in our national security. It is wise 

to build on the success and capitalize on these investments as we continue to develop the Reserve components to provide full-spectrum capability to the Nation. The 

Quadrennial Defense Review directed Comprehensive Review of the Future Role of 

the Reserve Component, released last year, provides a foundation upon which to 

build a cohesive execution strategy that preserves current Total Force competencies, 

efficiently integrates multiple capabilities, and leverages Reserve component value. 

Additionally, the 2012 National Defense Authorization Act requires an assessment 

of Reserve component force structure and end strengths in total force structure, and 

we are working within the Department to complete this requirement. These analyses and others that are ongoing will support the Department’s strategic guidance 

to examine the mix of Active component and Reserve component elements best suited to support the strategy while maintaining a balance between the available resources and our security needs for the next decade. 

60 

The fiscal year 2013 budget anticipates the Department will continue to use the 

Guard and Reserve as a vital part of the operational force, and where it makes 

sense, as a force of first choice. Today’s Citizen Warriors have made a conscious decision to serve since September 11, with full knowledge that their decisions mean 

periodic recalls to active duty under arduous and hazardous conditions. To keep 

faith with their commitment, we will need your continued support of the funding 

requested for their training, equipping, recruiting, and retention. Thank you again 

for allowing me an opportunity to give you an overview of the issues we are addressing in the Reserve components. 

Senator WEBB. Thank you, Secretary McGinnis. 

I will start and I will also adhere to the 7-minute rule that I 

asked everyone else to adhere to at the beginning of my statement. 

Actually, Secretary McGinnis, I would like to start with just 

where you ended up because when we look at the unemployment 

figures for those who served, we essentially, in my view, have three 

different groupings of people who have served. We have the oneterm or non-career enlistees, which I think a lot of people up here 

misunderstand in terms of the size of that group. We tend to think 

if you have an all-volunteer system, you have an all-career system, 

and in truth and particularly in the Marine Corps and the Army, 

the majority of people leave before they enter their first enlistment. 

That group has one set of challenges in order to reassimilate into 

the civilian society. 

Then we have the Guard and Reserve as a particularly difficult 

problem right now, and I want to get back to it. 

Then third, we have the retirees who have another different set 

of circumstances when they leave. 

But with respect to the Guard and Reserve, I had the position 

that you are acting in right now for 3 years and responsibility for 

the oversight of these programs. We never could have comprehended the rate that they are being called to Active Duty and 

the percentage of their professional career that they are actually 

spending in uniform. We are seeing some really disturbing data in 

terms of the unemployment rates. I understand there are a lot of 

complexities that go into the fact that the employment numbers are 

down, but could you give us a better description of what the challenges are? 

Mr. MCGINNIS. Yes, sir. The first challenge is the group that has 

the biggest unemployment, going as high as 24 to 26 percent, depending on when you measured it, and that is junior enlisted personnel. We have increased the number of non-prior service enlistments over the last decade in the Guard and Reserves, especially 

Army components, and of course the Marine Corps has always had 

a high percentage. But in the Guard and Reserve, particularly in 

the Army Guard and Army Reserve, the numbers are now up to 

about 55 percent or more. They used to be lower than that by about 

10 or 15 percent. We used to rely a lot more on prior service before 

stop-loss. 

A lot of those individuals enlisted directly out of high school, 

came into the Guard, and went through their initial entry training 

and then deployed. Now they are coming back, and they have never 

been in the workforce before. So that is one unique group we are 

focusing on. That is why I mentioned in my opening statement that 

this is a unique group that we have to segment, as you explained, 

because then we have the individuals coming back who, because of 

61 

the economy and other reasons, may have lost their jobs for reasons that their employer could not help and that number is running about 12 percent. 

So we are working with the Employer Support Committee in 

each State and their 4,800 volunteers with the Chamber and their 

effort and with H2H, which we have joined with the Army and the 

Army Reserve to focus on both of these groups in different ways. 

So we are getting a lot of momentum, and we have been working 

on it for about 18 months. 

The initial problem we looked at was under-employment. We had 

some momentum working on under-employment for people coming 

back who were looking for better jobs based on their experience in 

theater. We did have some momentum. 

But those are the two areas that we are focused on and they are 

two distinct areas. 

Senator WEBB. Do you see any indication of a resistance in the 

employer community because of the deployment cycles? 

Mr. MCGINNIS. No, sir. We have just completed a survey which 

is now being assessed of employers. The Employers Support Committee did that, and when it is available, we will make it available 

to you. But initial indications are while if you look at the groups 

who have to support us, the individual themselves, the families, 

the employers, the employers have the lowest level of support, but 

it is not below 50 percent. The employers on par have been very 

patriotic and very supportive of the efforts. We do not see a reluctance to hire. In fact, we see people who are coming to us who want 

to hire. The biggest issue we have—and it has been the issue since 

the program started—is the small employer and in some cases the 

medium employer. We need to continue to work with them. Hopefully from the survey we will figure out some ways that we can 

bring to you on how we can help them. But that is a large group 

of employers. 

Senator WEBB. Secretary Hale, you mentioned the cross section 

of the Total Force when it comes to the reductions that we are 

looking at. Could you give us a comparative examination or a statement on the civilian employees and contractor employment? 

Mr. HALE. The civilians are down slightly, roughly similar to the 

military from 2012 to 2013, down about 2 percent. In the out-years, 

our civilian employment drops not very much, just a couple more 

percent. In fact, we are looking at that now. I believe what happened is we were pretty busy in the last program budget review, 

and, I think, we did not have a chance to look at support personnel 

as much as we could or should beyond 2013. So I know it will be 

an issue as we look at the 2014 to 2018 program. 

Regarding contractors, we struggle with good information. They 

are down in dollar terms from 2012 to 2013. Frankly, in the outyears, we do not have reliable data on contractors because we just 

do not formulate it in the same way. We are working to do that 

and I hope we will have better information, but they are down 

slightly from 2012 to 2013. 

Does that answer your question? 

Senator WEBB. Roughly, what would the percentages look like 

compared to the Active Force? 

62 

Mr. HALE. Similar. From 2012 to 2013, down 1 to 2 percent for 

both Active and civilians. Let me correct the details for the record. 

Similar for contractors in dollar terms, which is the best data I 

have. 

Senator WEBB. Are the out-years the same? 

Mr. HALE. Well, no. For Active Duty personnel, including Guard 

and Reserve together, about 5 percent over the FYDP period. More 

like 2 for civilians. As I said, I think we need to relook at that 

issue. I do not have contractor data beyond 2013. We keep track 

of how much we are going to spend in operation and maintenance 

buckets. We do not in the contractors, and we are trying to do a 

better job, but we are not there. 

Senator WEBB. We may ask you a follow-on question on that. 

Senator Graham. 

Senator GRAHAM. Thank you, Mr. Chairman. 

Just to pick up with where the chairman left off, I think it is 

very important before we make a decision how to get to $87 billion, 

that the civilian workforce, if it is going to be reduced just a fraction of the Active-Duty Forces and Reserve folks who wear the uniform, I would like to know more about how we could maybe shift 

some of this reduction, look at the civilian side a little bit harder, 

and make sure that we get to $87 billion with as many people that 

are available to go to war if we have to have a war. So I just want 

to echo what the chairman said there. 

Dr. Woodson, in 1996, I think you said the amount of money collected from people on the program through premiums for TRICARE 

was about 26 percent? 

Dr. WOODSON. Sir, the cost share was about 27 percent. 

Senator GRAHAM. 27 percent. So 27 cents of every dollar of cost 

came from the people on the program, right? 

Dr. WOODSON. Correct. 

Senator GRAHAM. It is down to 10 now. Is that right? 

Dr. WOODSON. Correct. 

Senator GRAHAM. Is that just because we have never adjusted 

the premiums and the costs have gone up? 

Dr. WOODSON. Correct, and also remember we have added substantial benefits to the program over the last decade. 

Senator GRAHAM. So what you are proposing is to try to get the 

premium cost share up to 14 percent? 

Dr. WOODSON. Correct, on average. 

Senator GRAHAM. Based on retirement benefits reschedules, 

based on how much money you make in retirement? 

Dr. WOODSON. Correct. 

Senator GRAHAM. In terms of overall budget, if it continues on 

the course that it is now, what percentage of DOD’s budget would 

be consumed by health care? 

Dr. WOODSON. Sir, that is a great question, Senator. If you look 

at the numbers right now and you look at a base budget of $525 

billion, our unified medical plan this year was $53 billion. So we 

are at 10 percent now. If you look at the issue of a modest 5.3 percent growth in health care—and you can do the calculations—particularly the top line of DOD comes down. The implications of this, 

of course, are that health care will consume a greater percentage 

of the DOD budget, but it also produces a palpable tension, if you 

63 

will, between providing health care and training, manning, and 

equipping the force. I think that is what Secretary Hale was alluding to before. 

Senator GRAHAM. I would just like to be on the record saying I 

would like to work with the administration to find some way to 

change this dynamic because the BCA requires $87 billion. I do not 

know if that is set in stone. If we can change that number, I would 

be willing to. But we have to balance the budget. We are $15 trillion in debt. Everything has to be on the table. 

When it comes to the Guard and Reserve, Mr. McGinnis, the Air 

Guard seems to get hit pretty hard here. Are you familiar with the 

proposed cuts in the Air Guard? 

Mr. MCGINNIS. Yes, sir. The Secretary of the Air Force is in the 

process of reorganizing his force and has presented this to DOD. 

I have made my recommendations to the Secretary, and the Secretary is in the process of reviewing that now. 

Senator GRAHAM. I appreciate it. 

Mr. MCGINNIS. Secretary Hale is very much a part of that, and 

hopefully in the near future, we will have a decision. 

Senator GRAHAM. Secretary Rooney, if you allowed people who 

were 50 percent disabled to access commissaries and exchanges, 

could you get back to us later on and see what impact that would 

have? Because I think the rule is now that only 100 percent disabled people have commissary and exchange privileges. Is that correct? 

Dr. ROONEY. I believe you are correct, sir. 

Senator GRAHAM. Okay, if you could look at that. What I am getting at is our commissaries and exchanges are good deals for the 

members and their families, and we want to make it sustainable. 

If we are going to draw down the force, then you lose customers, 

and this might be one way of getting a larger customer base and 

reward people who have sacrificed for the country. I just want you 

to look at that and I will talk with Senator Webb about it. 

Thank you all for your service, and we will see what we can do 

to work through this. 

Mr. HALE. Senator Graham, could I add briefly to your opening, 

underscoring the chairman’s point on civilian personnel? I agree we 

need to look at them. We need to look at contractors as well. But 

we need to remember that civilians run our acquisition, they run 

logistics, they run finance, they fix our ships and planes. We cannot fight effectively without them. So we need to be a little careful, 

in my view, about damning our civilian workforce which we sometimes, I think, lean toward doing. We just cannot work without 

them. 

Senator GRAHAM. They are a very valuable part of the team, cannot do the job without them. But again, we are going to have to 

set our priorities in this country and figure out where we go. 

Mr. HALE. We need to be careful. 

Senator WEBB. Before I call on Senator Blumenthal, just let me 

first of all say I am looking for data here when it comes to civilian 

numbers and Active numbers. There is a reality that I think we all 

acknowledge that when you end a long period of sustained ground 

combat, you reduce your ground forces. So, it is not necessarily an 

64 

apples-to-apples comparison when you look at the civilian side. But 

my question really was to get the numbers. 

Another thing, just from my own experience, Senator Graham, I 

was talking to staff on your question as to the percentage disability 

being able to use commissary and exchanges. 

Senator GRAHAM. Am I wrong? 

Senator WEBB. If you are medically retired from the military, it 

is 30 percent or above where you can use commissary and exchange. There is a different system if you go to the VA for a percentage. But I wanted to clarify that if you are retired, which is 

30 percent or higher, then you are able to use those benefits. 

Dr. ROONEY. Correct. 

Senator WEBB. Senator Blumenthal? 

Senator BLUMENTHAL. Thank you, Mr. Chairman, and thank you 

for your leadership and Senator Graham’s on this subcommittee. 

Thank you to the witnesses for the excellent work that you are 

doing in a very difficult time, perhaps more difficult than any within recent memory. 

Many of the issues that have been raised both by my colleagues 

and by you in your testimony are of very great interest to me. I 

want to focus on one, though, that may not be directly related to 

the budget. I know the budget consumes a lot of time. You have 

discussed in your testimony, Secretary Rooney, the issue of sexual 

assault, which I know troubles you and the Secretary greatly, a 

great concern to you, and there is a zero tolerance policy. It is a 

leadership issue. 

You say in your testimony that the estimates now are about 

19,000 sexual assaults a year, which is down from the estimate of 

34,000 in 2006. Are you suggesting that the rates or numbers of 

sexual assaults have been reduced over the last 6 years? 

Dr. ROONEY. Sir, the way we get to that number is we look at 

the number of reported sexual assaults as a percentage of the overall force and then actually multiply it. The number appears to 

come down, but quite frankly, as you indicated, our concern is that 

there are any at all. 19,000 are 19,000 too many, or whatever the 

exact number is, because again, that was extrapolated from actual 

reported numbers. So while we believe that the attention being focused, the programs being put in place, and frankly the leadership 

taking this on as such a critical area to be able to address because 

it goes right to the heart of what our military believes in terms of 

their work and their respect for each other, that that number will 

come down. But we realize we have a great deal of work to do, sir. 

Senator BLUMENTHAL. But it may not have come down in the last 

6 years. Obviously, your objective is to make it come down. But I 

am just asking whether you have confidence in that number because, quite honestly, I am not sure that I do. 

Dr. ROONEY. I believe that number indicates that we have a substantial problem. But again, it is not a specific number. It is extrapolated from those reports we have. 

Senator BLUMENTHAL. Of the defendants who are reported—and 

in those incidents, 3,192 in fiscal year 2011—what percentage faced 

court martial? 

Dr. ROONEY. Sir, I will take that question for the record and get 

back to you on the specifics. 

65 

Senator BLUMENTHAL. The information I have is fewer than 21 

percent. 

Dr. ROONEY. That percentage is correct. 

Senator BLUMENTHAL. What is the reason that they are not 

brought to court martial? 

Dr. ROONEY. Often, sir, it is many of the same challenges that 

we see on the civilian side, which is in order to go through the 

court martial, obviously, we need to be able to get the evidence and 

make sure that our folks are trained to be able to take and prosecute those particular cases. Those are specific areas we are working on now to make sure people are trained in the specific areas 

of how to be able to not only get the evidence, but to present that 

forward. That is often the roadblock. 

Senator BLUMENTHAL. So you are upgrading the procedures for 

collection of evidence, and what about retention of evidence? 

Dr. ROONEY. Yes, sir. We actually are retaining the evidence at 

this point, if it is an unrestricted report, for 50 years. 

Senator BLUMENTHAL. Are you making efforts to speed up the 

process? In one instance that has been reported to me—and I can 

get you the name and perhaps you can get me more details—there 

was a 3-year gap. By the way, I am very familiar with the defects 

in the civilian area since I was involved in it. 

Dr. ROONEY. I know you are, sir. 

Senator BLUMENTHAL. So this is by no means to say that you 

should use it as a model necessarily, but I know the military sets 

its own standards for what excellence is and you have your own 

goals. 

But that 3-year gap makes evidence, even if it is collected—that 

is, the eyewitness testimony that may be provided—more difficult 

to get. I just wonder what steps are being taken to make sure that 

these cases are brought to court martial and brought, in effect, to 

trial more quickly. 

Dr. ROONEY. Actually, we are working directly with the Services 

on this, and the Joint Chiefs have been actively involved in looking 

at how do we not only streamline the actual court process, but also 

streamline from the point of reporting, we have such things in 

place as expedited transfers. So all through the process, making 

sure that we are able to still protect due process, if you will, for 

the accused, but move that through the system from the first report through. So that is something we are actually engaged, right 

now, with the Services to do. 

Senator BLUMENTHAL. Do you have numbers as to the median or 

average length of time it has taken and what percentage involve 

eventual findings of guilt, culpability, and also what the eventual 

penalties are in those cases? 

Dr. ROONEY. Sir, we do have those numbers, but if I could take 

that for the record and give them to you as opposed to trying to 

get them from memory, we do have them. I have seen them, sir. 

Senator BLUMENTHAL. I would appreciate that. 

Dr. ROONEY. We will. 

[The information referred to follows:] 

The length of time for the investigation and adjudication of sexual assault reports 

varies greatly with the facts of each case. Of the 2,439 Unrestricted Reports opened 

and investigated in fiscal year 2011, 66 percent (1,612) of investigations were comVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00071 Fmt 6633 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
66 

pleted by the end of the fiscal year. Based on past case flow, we would expect that 

the investigations and subject dispositions for over 90 percent of the remaining 827 

Unrestricted Reports received in fiscal year 2011 should be completed in time for 

reporting in the fiscal year 2012 Annual Report on Sexual Assault in the Military. 

In fiscal year 2011, 1,518 subjects investigated for sexual assault were military 

servicemembers. However, legal factors sometimes prevent disciplinary action from 

being taken against some subjects. For example, commanders were precluded from 

taking disciplinary action against 482 of these military subjects because there was 

insufficient evidence of an offense to prosecute, the victim declined to participate in 

the military justice process, or the statute of limitations had expired. These factors 

do not fall under the discretion of a military commander to remedy and precluded 

these military subjects from receiving disciplinary action. Commanders declined taking action against 47 military subjects because they determined the sexual assault 

allegations against those subjects were unfounded. 

Of the 1,518 subjects investigated, commanders had sufficient evidence and the 

legal authority to support some form of disciplinary action against 989 subjects. Of 

the 989 subjects, 791 subjects had command actions taken against them for sexual 

assault: 62 percent (489 subjects) had courts-martial charges preferred (initiated) 

against them, 24 percent (187 subjects) received nonjudicial punishment under Article 15 of the UCMJ, and 14 percent (115 subjects) received a discharge or another 

adverse administrative action. For 198 subjects, evidence supported command action 

for other misconduct that came to light during the sexual assault investigation (such 

as making a false official statement, adultery, and other crimes under the UCMJ) 

but not a sexual assault offense. Of these, another 198 military: 9 percent (17 subjects) had court-martial charges preferred against them; 46 percent (92 subjects) received nonjudicial punishment; and 43 percent (85 subjects) received some form of 

adverse administrative action or discharge (no data was available for the remaining 

2 percent of subjects). 

As noted previously, of the 791 military subjects who had disciplinary action initiated on a sexual assault offense, 489 had court-martial charges preferred against 

them. The dispositions and the sentences imposed by courts-martial are for those 

subjects with at least one sexual assault charge adjudicated in fiscal year 2011. Of 

the 489 subjects who had courts-martial charges preferred against them in fiscal 

year 2011, 370 subjects’ court-martial outcomes were completed by the end of the 

fiscal year. Of the 240 subjects whose cases proceeded to trial, 80 percent were convicted, and most convicted servicemembers received at least four kinds of punishment: confinement, reduction in rank, fines or forfeitures, and discharge (enlisted) 

or dismissal (officers) from service. Thirty-nine subjects were allowed to resign or 

were discharged instead of court-martial. Court-martial charges were dismissed 

against 91 subjects. However, commanders used evidence gathered during the sexual assault investigation to take nonjudicial punishment against 25 of the 91 subjects. Most of the 25 subjects who received nonjudicial punishment received three 

kinds of punishment: reductions in rank, fines or forfeitures, and restrictions on liberty. 

Of the 791 military subjects who received disciplinary action on a sexual assault 

offense, 187 received nonjudicial punishment. Of the 168 subjects whose nonjudicial 

punishments were completed in fiscal year 2011, 93 percent of subjects were found 

guilty by the commander. Most subjects who received nonjudicial punishment received at least three kinds of punishment: reduction in grade, a fine or forfeiture 

of pay, and restriction of their liberty for a period of time. In addition, almost half 

of these subjects received extra duty or hard labor as part of their punishment. For 

6 percent of subjects, the nonjudicial punishment served as ground for a subsequent 

administrative discharge. 

Commanders administratively discharged 48 subjects investigated for a sexual assault offense. There are three types of administrative discharges: Honorable, General, and Under Other Than Honorable Conditions (UOTHC). Most of these 48 subjects received either a General or a UOTHC discharge. 

In fiscal year 2011, commanders took adverse administrative actions against 67 

subjects investigated for a sexual assault offense. These actions may consist of Letters of Reprimand, Letters of Admonishment, and Letters of Counseling. These actions may also include but are not limited to denial of reenlistment, the cancellation 

of a promotion, and the cancellation of new assignment orders. Adverse administrative actions are typically used when the misconduct alleged is of a lesser degree or 

when available evidence does not support more serious disciplinary action. 

The sexual assault investigations conducted by the Military Criminal Investigative Organizations sometimes do not find sufficient evidence to support disciplinary 

action against the subject on a sexual assault charge. However, the investigations 

sometimes uncover other forms of chargeable misconduct. When this occurs, DOD 

67 

holds those servicemembers who have committed other misconduct appropriately accountable based on the available evidence. 

DOD released the fiscal year 2011 Annual Report on Sexual Assault in the Military on April 13, 2012. The preceding information and supplementary charts and 

graphs detailing the subject case dispositions and punishments imposed are available on pages 42 through 49. The report is available at: http://www.sapr.mil. 


328pe129.eps
68 


328pe130.eps

FISCAL YEAR 2011 DEPARTMENT OF DEFENSE 

ANNUAL REPORT ON SEXUAL ASSAULT IN THE MILITAR Y 

". 1",, 1 '''' 

i .... 1 sy __ COllrta·m~rtill chargl f J 40"'" 1--36-. 38'" ~ j>NlerTe<lllnitlated) 

H "" "~'" .... ~~!!I 

(Miele 15l1CMJ) 

lib ~ 30'" ............ "" ". " _Ad!ron/$Ir_ar;IO:)n$ Ii m I -2 . .. 

r- ;aod doscharges , .. 

.. "" ~oo "" ~" ~" ,-

Exhlb ~ 9. Breakdown 01 dlse;pbnary actions taken against subJe<:.ta for se~oal assau~ offenses. 

FY07-FYll 

Noles: 

f. PefCltnl~s _ 01 SlJbie<;ts foutld to wamllll rJJscipllnary &<;liM for a wxuai aS$Bull otrenw 

otI/y OIIlfN ~>duc/ (false oIfrcial slalelUenl. edulrery. 61c,j IS no/ shown 

2. PefcrN1teges lisl9d for FYog excood 101)% dUf) 10 rounding of p&rCf#l19g6S/0 Iha nooms! 

wilde . I. 

Courts-Martial 

As noted previously, of the 791 military 

subjects who had disciplinary action 

initialed on a sexual assault offense, 489 

had court-martial charges preferred 

against them (ElI:hlblt 1, Point R). ElI:hibit 

10 illustrates what happened to these 

subjects after their commanders preferred 

court-martial charges. The dispositions 

and the sentences imposed by courtsmartial are for those subjects with at least 

one sexual assault charge adjudicated in 

What percentage of Se ..... tcll member 

subjeds tried 10. S6~ual assault charges Wflm conviCled In FY11, and what kind 01 

punishment did they re<:.elv8? 

60% 01 S.rvic. memOO/$ ... ,e conVICled 

01 ... 1 /ott,.1 Oml '''Mg' .. ,II"i.' of." o""",e 

<¥!fIglng ffOm Rape to Wrongful Slm,., 

Conracl ,."//w,, rhe Depart",.",I's <JeIi"l"on 

III s!!JIII"I assault 

Mosr SUOjecfS ~v«I Iourklnd$ of 

pl/nlslrm"",: 

FY,1 . Of the 489 subjects who had court- _ Co,,''''emen! 

martial charges preferred against them in 

FY11 , 370 subjects' court-martial 

outcomes were completed by the end of 

the FY. Of the 240 subjects whose cases 

proceeded to trial. 800A. were convicted, 

_ A Fin. or Forfe;rure ofPIIY 

- Rflducrlon In Rank 

- A Plm/rNe Discharge or DIsmissal 

and most convicted Service members received at least four kinds of punishment: 

confinement, reduction in rank , fines or forfeitures, and discharge (enlisted) or dismissal 

(officers) from service. Thirty-nine subjects were allowed to resign or were discharged 

instead of court-martial. Court-martial charges were dismissed against 91 subjects. 

APRIL 2012 
69 


328pe131.eps

FISCAL YEAR 2011 DEPARTMENT OF DEFENSE 

ANNUAL REPORT ON SEXUAL ASSAULT IN THE MILITARY 

However, commanders used evidence gathered during the sexual assault investigation 

to take nonjudicial punishment against 25 of the 91 subjects. Most of the 25 subjects 

who received nonjudicial punishment received three kindS of punishment: reductions in 

rank. fines or forfeitures. and restrictions on liberty. 

APRIL 2012 
70 


328pe132.eps

FISCAL YEAR 2011 OEPARTMENT OF O€FENSE 

AN NU REPORT ON SEXUAl ASSAULT IN THE M LlTARY " , 

~.- - I Chi_ 

Cou/U·1IaI1Io1 w_ P",",;" r;;; ---a._ R 

\::; - J Co<wI<IeCI"C~..,.. ~.-

P_.IOTtiol 

20.0Suqot!lI&i9'llj '" _.- -

_.- ~- "_(J)'W _ - . ---;1 ".,~- "" . ":~~ 

~- om......-o,- I .'J K._ ~-- _ ...... - j "" 9I5.qo<o. ~'''I 

r.~!,-a_ :!:r."~ ~- -...... .- ---.- .. - ,- --- ~- H-"- .- ~--

--_.- -.. 

- ----

_. ~.- .. - --~ ~.-

_.-.- Elcllib~ 10· Oitpos~ions 0( Subjects Against WIIom Court&-Martial Cllarges Were Preferred. FYI' 

Notes: 

, The M"~ary Serv.ces reported Ihal 489 wbj6cIS oI_ual assaulf irMJsllgallQ(l~ had court-mllltlal 

charges pmfefTDd ag8m51 lhem for II sexual IISsauIt oIfense 

, Of the 489 subjecls who hlK1 court·m8f1iBl o:harpf!s prefrmed againsllhflm. I 17 4UIJjecIS were 41i11 

pending coon 1IC/icv1 a/lite 6IId of FYI 1 CMposiIion dara WI'S ncI available lot 2IWbjecl . 

, Of/he 370 subjects whosll ooorts·marIJai were compJellld ill FYII, Z40subjects ptoCIIfIded /0 

lrial. 39 subjects were allowed /0 resign or received II d~ /nsltJiKI of trial. IJIId 91 subiecls 

hlld oour1.mert,aI C/IlIrges dism!S5fid againstlhOm BI some paml '" thfl jUstice prex:eedmgs. 

• In C8SfIS in whlc/l a ffI~nal.oon or discharge dl lioo 01 court-man~ is requesrlld and approved • 

/he cf1aracllllilatioo of the discharge is UOO&r Olllllr Tllan HooorIIbIe Conditions, unless a higher 

cf1Bff/C/erlzllt;"n IS justified (See alsO thfl <Iist:ussJon 01 lJdmirIislrBlNe discharge cl1iJllJCI.arilailOr).'l 

in lhe -AdminlSlfBfil'fl OischllrrIBS IIlid Adverse AdmirbslffllNO Ac/iolls" secticv1 of the repotf) Of 

thfl 9 I subjecls wllh dISmissed charges, commandam imposed notlJUdiCial PUtlls/lmllnl 00 Z5 

subjects. Most oJ/hese 25 subjects ffICI1iv8d thrw "'lids of fWrn9Jment: II /l1IIk roducllOtl, II r!llll 

or forieituffl. and ffl51r1C1IOn of IfIf/If hbetfy for B penod 01 /N7Ie , Of IhfI Z40 subjects whose C8SfIJ proceeded 10 lrial, HII (8O'If.) WIlle COfIv;cled ConvlC/Jon by 

coor1s·m8f1ie1 may resu/l in II combinatiofJ of fWlI'5hments. CooseqIl6I1t1y. COIlVicIed Slnvic6 

members could be 8IJJudQfId DnfI or more oIt/ifl fW"'s/lffIfIIl/s /lsted, Howev8I, In IfIO.5I CIIS9S. 

!hey fflCfINed at least four kNlds 0' p<1mshmen/; oonfillfllOOlI~ a reduct;oo iIIl&lIk. II r!OO/fol1eilul&. 

811d a discf181fJf1 o.:::S adjudged by COliffS-martial Wi!re lIither Bild Conduct DIscharges or 

Dishonomble Disclla s. 

" APRIL 2012 
71 


328pe133.eps

FISCAL YEAR 201 1 DEPARTMENT OF DEFENSE 

ANNUAl. REPORT ON SEXUALASSAUL T IN THE MIUTARY 

Nonjudicial PunishmQnt 

Nonjudicial punishment is administered in 

accordance with Article 15 of \ne UCMJ and 

empowers commanding officers to impose 

penalties on Service members when there is 

sufficient evidence of minor UCMJ violation. The 

member may demand trial by court·martial instead 

of accepting punishment by the commander, 

Nonjudicial punishment allows commanders to 

address some types of se)(ual assault and other 

misconduct by Service members that may not 

warrant proseculion in a military or civilian court 

Tne DoD definition of se)(ual assault includes a 

wide range of offenses ranging from unwanted 

Do mililary commanders use 

Ilonjudicial punlshm"nl as their 

p.imary means of discipline fOf s uua! as~aull crimes? 

No. 

LUs Ih"n a qu"ne, 01 sunjectt 

who ~el~ disciplinary IJCli0n 

fo •• su",,1 "5s ... 11 crl.,." 

rfI<:eN.d "onJud~tal pumllllmll<u 

I" FV1f, ltIosrsub}KI.$ (em) 

had coun'lNn,,,' ,halV6S 

prete",,,,1 "9"'''$1 thllm. 

sexual contact to rape. With nonjudicial punishment a commander can take a variety of 

corrective actions, including demotions, fines, and res trictions on liberty. Nonjudicial 

punishment often serves as the grounds for discharging military subjects with a less 

than an honorable discharge. 

Of the 791 military subjects wno received disciplinary action on a seKual assault 

offense, 187 received nonjUdicial punishment (Exhibit 1, Point R). Exhibit 11 denotes 

the outcomes of nonjudicial punishment actions taken against subjects on a sexual 

assault charge in FYll . Of the 168 subjects whose nonjudicla! punishments were 

completed in FYll, 93% of subjects were found guilty by the commander and issued 

punishment. Most subjects who received nonjudicial punishment received at least three 

kinds of punishment: reduction In rank, a fine or forfeiture of pay, and restriction of their 

liberty for a period of time. In addition , ahnost half of these subjects received extra duty 

or hard labor as part of their punishment. For 6% of subjects. the 110njudicial 

punishment served as grounds for a subsequent administrative discharge. 

" APRll2012 
72 


328pe134.eps

FISCAL YEAR 2011 OEPARTMENT OF DEFENSE 

ANNUAL REPORT ON SEXUAL ASSAULT IN THE MILITARY 

1Io<1"<kIoI,,",,~ rl C_c6on .. CiI ... "" ~ 1niI1,,"'''' FYI' I"'of~ 

'81~_ R H Ae~<1IOI\"n Itri- ~ 13%01 Si.qoeQ 

H ~.tE.rldUlU r Oiodlq, 

NonjulliclJl ~,'" 1~'" or 5ouqo<I. SUMI<\U'''HO -,- II......,''' .. Aclion I~S;; j9l"4) H ~o 

R."rI<Il.. ~ RopOllH'" to.ploltd _.,~. ,. ......... <1 .. 1'1"'10_'" S'lhfS\A>r<ct1 

Ilioml .. ." 

P 

.... 

.. <linv 

'2s.t+>;lt11l'1 H H.nllIbor.EdnOUly r m .. o(~c<I • .. 

.~.] Y """fl'''M r I~"'" ",.,,<d. ']~ I 

Exhib~ 11. Disposiliorl$ of SIlbjac1$ ReceMnIl NOfIj'ldiaal Pynistvnenl, FYl1. 

NOI": , Tho Mi hary S&Mices ffj{XJlfrKJ lhal 187 S<Jbj8Cls or SeKu81 asSllun InYesl/gal.oos dispossd in 

FY11 W8ffj ronsiderod frK noo}Udicisi punishmelli. 

, Of /00 168 subj6ds who ... "'" coosidiJtHd (fJf noojudicia/ putlishmool. 6 subjecls WIJIlI sbJJ 

wilding action allh6 end or FY11. Non{Ud/r:Ja1 punisllmfJlII OIJlcome data ..... s nolavailable frK 

13subjCe/$ ,. Of IIIe 168 S<Jbjecls WfIOstIlIOtyudicl8i pumshmellis W{lffj CI)IIop/fJled in FYll. 156 S<Jbjac/J; (93%) 

W{lffj found gu;ny by IIIe oomrrnrnder alld issl1«1 pUI!!shmellt. The ffjmajlWlg 12 sub/eClsl7%1 

were found rKJl guilty 

• NfJf1jlldiciai pUflishmenl may,",," in 8 combination 01 pen8llios. Cof\seqIJOtl/ly, SoNIce membe~ 

found guilly CIIn bo adminislfil9d 0fI9 or IOOf8 kinds 01 puflis/lmenls. Howowr, fa( mosl or II'a 

CaSfls, comlctfJd S8IYice f1IfImIKj,s receNed alloosllhtee kinds 01 punishm&nl; a rfJduclion in 

ran/(, B ~utfJ. and 8 IlJS/tfclion fJfI r/IIIir IIlJfHtY for a penoC1 01111116. AlrrIOIIl hair 01 me 

S<JlJiecIs ewlJl{Jed fIO/IjOOtcl81 purush",en/ WfJIe gMm I,ard labor fJf , .. I", duly, , Fot 6" 01 SUbjacls, Ilia nonjudicial PUrlmhmllf>l CMlnlJullKl ro 1l1li IlIlfonaia SUPpoftlllfl an 

edmlllislra!Na dischlll 

AdminIstrative Discharges aud Adverse Administrative Actions 

Commanders administratively discharged 48 subjects investigated for a sexual assault 

offense (Exhibit 1, Point R). Thele are three types of administrative discharges: 

Honorable, General, and Under Other Than Honorable Conditions (UOTHC). Gene181 

and UOTHC discharges may limit those discharged flom receiving full entiUements and 

benefits from the OVA. Most of these 48 subjects received either a Genelal or a 

UOTHC discharge. 

In FY11. oommandelS took adverse administrative actions against El7 subjects 

investigated fOI a sexual assault offense (Exhibit 1, Point R). These actions consist of 

Leltels of Reprimand. LeltelS of Admonishment, and Leltels of Counseling. These 

actions may also include but are not limited to denial of re·en!istment, the cancellation of 

APRIL 2012 
73 


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FISCAL YEAR 20\ \ DEPARTMENT OF DEFENSE 

ANNUAL REPORT ON SEXUAL ASSAULT IN THE MILITARY 

a promolion, and the cancellation of new assignment orders. Adverse administrative 

actions are typically used when the misconduct alleged is of a lesser degree or when 

available evidence does not support more serious disciplinary action. 

Probable Cause Only for a Nonsexual Assault Offense 

The sexual assault investigations conducled by Ihe MelOs sometimes do not find 

sufficient evH::lence to support disciplinary action against the subject on a sexual assault 

charge. However, the investigations sometimes uncover other forms of chargeable 

misconduct. When this occurs, the Department holds those Service members who 

have committed other misconduct appropriately accountable based on the available 

evidence. In FYI t , commanders took action against 198 subjects who were originally 

investigated for sexual assault allegations, but evidence only supported action on 

nonsexual assault misconduct. such as making a false official statement. adultery, 

assault. or other crimes (Exhibit 1, Point 5). Exhibit 12 denotes the outcomes of the 

disciplinary actions taken against subjects for nonsexual assault offenses in FYll . 

•• APRIL 2012 
74 

Senator BLUMENTHAL. Can you also provide percentages as to 

what numbers or in what rate you give defendants the option of 

a discharge or a resignation in lieu of court martial? 

Dr. ROONEY. I will get the information as to what the eventual 

resolution was as to whether that was a negotiated plea or something in that regard. That will be a little harder, but I can certainly tell you article 15 and various steps of penalties. 


328pe136.eps
75 

[The information referred to follows:] 

Of the 370 military subjects whose courts-martial action was completed in fiscal 

year 2011, 39 subjects (or 10.5 percent) were discharged (enlisted) or allowed to resign (officer) in lieu of court-martial. In cases in which a resignation or discharge 

in lieu of court-martial is requested and approved, the characterization of the discharge is usually Under Other Than Honorable Conditions, unless a higher characterization is justified. 

Senator BLUMENTHAL. Finally on this subject, can you tell me 

when Secretary Panetta is going to be releasing the recommendations he is going to be having both administrative and legislative? 

Do you know? 

Dr. ROONEY. Actually, we have been working on the possible legislative proposals as recently as today. So I am expecting those to 

be coming up soon, and within the next 3 to 6 months, we will also 

have some additional ways forward on specific recommendations 

coming out from the Services, as well as follow-up on the ones we 

mentioned with the expedited transfer and the document retention. 

Senator BLUMENTHAL. Thank you. 

On the issue—and you raise it in your testimony—concerning 

suicides, can you talk a little bit about what steps are being taken 

to address this issue more effectively? 

Dr. ROONEY. Absolutely, and you are right that the numbers 

right now, despite many of our efforts, have not shown a significant 

decrease. But what we have done, in fact, is taken the task force 

that had their report forward. One of the recommendations was to 

create a specific suicide prevention office, which we have done in 

the last few months. The purpose of that office is not to create yet 

another layer, but it is to look across all of the Services and actually be the conduit for what are best practices, where are we missing some potential opportunities, getting rid of the redundancies. 

That has at this point a temporary staff, but in the fiscal year 2013 

budget, we have the full appropriations we are requesting on that 

to have that staff stand up. 

In addition to that, we are working directly with the Services in 

each of their component areas to see what practices they have in 

place. 

The next thing—and I think you have seen it also from the medical side—is we are embedding behavioral health not only within 

the units but also making it available to the families through a 

number of our family programs. Again, we are continuing to monitor what has been the outreach and where have we seen some successes or not as it were. 

Those are the steps at this point with many more coming forward. 

Also, collecting data has been a big challenge that we have had, 

contemporaneous data. So we are working closely with the Department of Veterans Affairs (VA) in particular at this point to share 

information not only from the DOD side but also what the VA is 

getting. We are doing a lot of joint work with them. So we are getting data that is within 30 to 60 days old as opposed to a year or 

2, which is what we had been getting, as the way the States are 

gathering it, and sharing that information and trying to trend directly with the VA. 

76 

Senator BLUMENTHAL. Thank you, thank you very much. My 

time has expired. 

Thank you, Mr. Chairman. 

We hear a lot and I profoundly agree with the statement that we 

have heard again and again that our most important asset is our 

people, and you are the folks who are dealing with that asset. So 

I want to thank you for your great work. Thank you for being here. 

Thank you. 

Senator WEBB. Thank you, Senator Blumenthal. 

Senator Begich. 

Senator BEGICH. Thank you very much, Mr. Chairman. 

Thank you all for being here. I appreciate it. 

Let me start with a couple of questions, but first, Mr. McGinnis, 

there is a piece of legislation that Senator Graham and I have 

sponsored on space availability for widows of combat veterans, as 

well as Guard and Reserves. To be very frank with you, we are not 

changing any of the prioritization. We are just making sure if there 

is a seat open and all the prioritization has occurred, then there 

is opportunity. The response we got informally was not very 

thoughtful in my view. I will not belabor it here, but I would like 

you, if you could, to take a look at that legislation and give your 

thoughts on it. 

We have a lot of bipartisan support. As a matter of fact, a lot 

of people on this committee have sponsored it. We think it is a fair 

way to approach. It is like an airline industry. When there is a seat 

empty, there is no value to it, and if there is an opportunity, we 

should explore that. I think what we have tried to do is recognize 

the rules and regulations of prioritization of utilization of space 

available and recognizing that, but not overtaking that and leaving 

a lot of authority to DOD. 

So if you could take a look at that bill, that would be great. 

Mr. MCGINNIS. I will, sir. 

Senator BEGICH. My staff will be happy to talk with your staff 

about that. 

I will not belabor it more than that, to say the response was not 

as thoughtful as I thought it would be. I will leave it at that. 

Mr. MCGINNIS. I will look at it. 

Senator BEGICH. Thank you very much. 

Secretary Hale, this might be to you and to Secretary Rooney 

also. I want to understand the process. You have to understand 

where I come from. I come from being a former mayor where if I 

have a CFO, they know all, and at the end of the day, they have 

to sign off on money things. No department can go do their own 

stuff, and even when personnel has stuff, someone has to sign off 

their savings or costs. So I do not necessarily say that is the way 

it all works in the military. I am not suggesting that. 

But let me walk through an example and help me understand 

how you would be engaged in this or in your case, Secretary Rooney. 

I am dealing with, and a lot of folks are dealing with, this 

around the country with bases that are being reviewed for potential 

reductions or reductions of services or personnel, may they be military and/or civilian. We are dealing with this at Eielson Air Force 

Base right now. Here is the scenario. The proposal was laid out. 

77 

It will save X amount of dollars. We then, of course, questioned 

this. Now they are sending a team up to analyze what the savings 

will be, which seems odd that you would propose a savings and 

then analyze it later, but I will leave that for a second. 

First of all, I will start with you, Secretary Hale. When the Secretary of the Air Force—I am using them as an example, I do not 

mean to pick on them, but they are the ones we are dealing with 

with Eielson. They propose these savings that recognize a certain 

amount of money that will be saved. What is your interaction with 

those activities? Do you accept those based on that information? 

Then holding that thought, the question I would have for you, Secretary Rooney, is when they propose this—and it is basically a bulk 

of personnel savings—how are you engaged in that, in analyzing 

that number, may they be civilian and/or personnel or military active personnel? Secretary Hale, to the first question. What is that 

engagement? 

Mr. HALE. We are dealing with one of the world’s largest organizations, Senator Begich, and many of these proposals do work up 

through our Military Services and departments which have cost analysts and staff similar. They are not formally CFOs, but they have 

assistant secretaries for financial management and comptroller. My 

staff tends to review the ones that are in contention or perhaps cut 

across all the Services. 

I do not know for sure on the Eielson one, but my guess is it was 

an Air Force estimate and reviewed by them. 

Senator BEGICH. So you accept because they go through this kind 

of chain, to a certain extent, I am not saying all the time. 

Mr. HALE. If we have reason to question it, no, but we do not review every single proposal that comes forward. I do not know on 

the particular one you are referring whether we did. I would need 

to find out. 

Senator BEGICH. Let me ask then on the personnel. So when they 

recommend or suggest that it will save this amount of military personnel and X amount of civilian personnel, again recognizing they 

go through this chain, what happens at your level, if anything? I 

do not know. 

Dr. ROONEY. Actually, it would. Two of the areas within personnel and readiness deal with military personnel policy and civilian personnel policy, but embedded in that is this idea of Total 

Force. Our role typically at that point is working with the Services 

to ask them what, in fact, are they going to use as tools, specific 

drawdown tools available potentially for the military, if they are 

seeing that the reduction would come from the personnel side, and 

walk through with them from a policy standpoint what exact shaping tools are they using and making sure they are understanding 

the costs or the implication of those. 

The same with the civilian side. We have set processes and procedures to, hopefully, reintegrate the civilians within the workforce, and walk through whether, in fact, they are following those 

procedures and have considered that in cost estimates. 

Senator BEGICH. I appreciate that answer. But I would have expected that from our personnel department in the city would have 

done that. The departments do their thing and then the personnel 

walks through it because sometimes departments will over-estiVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00083 Fmt 6633 Sfmt 6602 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
78 

mate for the benefit of getting past the Office of Management and 

Budget (OMB). Getting past OMB, life is better. But in the mayor’s 

office we always had to say, well, are these real, what does it 

mean? 

In this situation, I am assuming they then submit to you something that says here is what we guess, here is how much civilian, 

here is how much Active, and then you walk through this process. 

Sometimes it is easy because it is clear, but sometimes more complicated. Is that a fair statement? Depending on what it is, is that 

fair? 

Dr. ROONEY. A fair statement. 

Senator BEGICH. Can I ask for the record—and again, I do not 

expect you to have it off the top of your head here—what role, 

maybe limited or extensive, that you might have had in this review 

within your area with regard to this redirection? It is a lot of people. Actually, they do not know how many. That is the challenge, 

to be very frank with you. They have estimated Active military, but 

they cannot give us an answer to this day on civilian. We have 

asked them four times. I know there is a document that exists that 

says here is what we anticipate because someone had to review it 

to say here is what it will save. I have not seen it. We have asked 

for it over and over and over again. 

So is that something you could look at and respond? If your answer is, well, we did not get anything, okay. Or we did, and we 

cannot give it to you yet, okay. Or, yes, we have it, here it is. I 

would prefer the latter, to be very frank with you. I am hoping it 

is the latter. 

Dr. ROONEY. What we will do is look at it. Based on what you 

are indicating, it is very possible it has not reached the level yet 

where we would see it fleshed out to the point to be able to give 

some feedback. But what I will do is check with our team, if they 

have been involved to this point, and if not, be able to check and 

see what work has been done, and then we can give you a better 

idea when it would, in fact, come to us for a review. But it usually 

has a little more detail than what you described before we would 

actually see it to be able to give some reaction. 

[The information referred to follows:] 

The fiscal year 2013 budget reflects a balanced workforce that decreases spending 

on military personnel, civilian full-time equivalents, and contracted services. It reflects our best judgment today, representing a carefully coordinated approach based 

on our strategy and policy, balancing operational needs and fiscal reality. Furthermore, we must budget for a future where we face a decreasing top line, and in order 

to help components do so, the Department of Defense (DOD) established civilian 

manpower targets at fiscal year 2010 levels, with certain exemptions and exceptions 

in critical growth areas. Individual components develop their workforces to meet 

their missions, tasks, and functions based on their operational requirements, workload needs, and available funding. At the departmental level, we do not prioritize 

the components’ missions for them or tell them how to size their workforces. As 

such, we do not require the components to submit a report estimating civilian drawdown. 

However, we are committed to ensuring the components have a balanced, flexible, 

responsive workforce that is the appropriate mix of military, civilian, and contracted 

support; efficiently mitigates risks, ensures continuity of operations, and promotes 

an organic knowledge base; and ensures mission requirements are met most cost effectively and efficiently. 

In developing budget requests and making manpower determinations, Personnel 

and Readiness works together with other elements of the Secretary’s and DOD’s 

79 

leadership team to ensure that risk mitigation, continuity of operations, and mission 

attainment shall take precedence over cost of performance. 

Senator BEGICH. My time is up. 

I would have anticipated even the kind of detail you are talking 

about that you would expect I would expect when they make a reduction to a military base to shift 600-plus people plus more civilians, which we do not know of, that you would have more information to make those judgments because we have to make the decision that, okay, this is an okay budget and we have to check off. 

But if we do not understand how they got there, we cannot make 

a rational decision. So that is why I am in this quandary. 

I will tell you there has been a lot of this—pointing—and I know 

the way it works, especially within the military. There are more 

forms about forms to have more forms. So somewhere in this mix 

someone wrote down in 2013 and 2014 and 2015 we anticipate this 

civilian reduction, this military reduction for the savings of X so 

that we can then get past OMB and the CFO. Someone did it somewhere. If they did not, then to be very frank with you, that is incompetency. But somewhere it is done. I just know it. That is how 

DOD works here, more reams of paper than paper can be produced 

every day, is my view. So that is just a thought there. 

I have some other questions which I will submit for the record 

for generally all of you. They are broader in the sense of some policy issues, and I will submit those. 

I thank you for you letting me have my rant. Thank you, Mr. 

Chairman, for letting me rant. 

Senator WEBB. Thank you, Senator Begich. Actually, we will 

have another round if you want to come back and ask more questions. 

Senator BEGICH. I will submit them. 

Senator WEBB. Having spent 5 years in the Pentagon, I can say 

a lot of the reams of paper that grow around the Pentagon have 

been produced at the behest of the Senate and the House of Representatives. [Laughter.] 

Senator BEGICH. The good news is I am not asking for more 

paper. I am just looking for a piece of paper that they produced. 

Senator WEBB. Senator Ayotte? 

Senator AYOTTE. Thank you, Mr. Chairman. 

Speaking of paper, I wanted to ask Secretary Hale about where 

we are on audit because I was able to ask the Chief of the Air 

Force. I know that the Air Force may have the most difficulty in 

meeting Secretary Panetta’s goal of a 2014 statement of budgetary 

resources. This is something I have been very interested in. In fact, 

I introduced an amendment to the National Defense Authorization 

Act (NDAA) in this past go-around wanting to codify that you meet 

the audit requirements. 

Just wondering where we are. Are we going to meet the 2014 

deadline for a statement of budgetary resources in each of our 

Services and within the overall DOD? 

Mr. HALE. I am reasonably confident. This is a tough problem, 

tougher frankly than I anticipated. But we have several things 

going for us. 

The first is the strong endorsement by Secretary Panetta which 

has opened doors wider than I expected, and we are doing everyVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00085 Fmt 6633 Sfmt 6602 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
80 

thing we can to leverage it. In particular, I think what we are 

doing that we have not been able to do in the past is get this out 

of being a comptroller issue and into being a commander issue. We 

absolutely have to do that because we have to change business 

processes, and only the commander can do that. We have the 

money. We have the governance process. We have interim goals 

which are critical. You probably heard me say before no one wakes 

up thinking, I really got to work hard today for a 2014, let alone 

a 2017, goal. So we have interim dates. 

The Secretary convened a meeting of all the Service Secretaries 

and Service Chiefs. We had everyone there. Amazing to me. They 

get it that it is important now. 

Senator AYOTTE. It is important. This is not just any paperwork. 

Mr. HALE. So I am going to stop with reasonably confident. 

Senator AYOTTE. Okay. I appreciate that. 

We did talk about a lot of paperwork, but this is really important 

particularly when we are asked to make some very difficult decisions about DOD in terms of it being a management tool as well 

as an information tool for Congress. Would you agree with me on 

that? 

Mr. HALE. I would. We have over-promised and under-delivered 

for a long time. So that is why the best you get is reasonably confident, Senator. 

Senator AYOTTE. Reasonably confident. I will take it. How is 

that? 

I wanted to ask Secretary Rooney, yesterday you and I had a 

chance to meet and talk about New Hampshire’s deployment cycle 

support program within our Guard. It is one of the challenges that 

we have had that our guardsmen and women and our Reserves— 

we have really used them in these conflicts in Iraq and Afghanistan. They have been part of our Total Force. We would not be able 

to have fought in Iraq and Afghanistan without our Guard or Reserve. Yet, often the whole deployment cycle support is not there 

for them. 

So, New Hampshire came up with a very strong public/private 

partnership. We partnered Federal Government resources with 

State government, as well as private organizations like Easter 

Seals. We have been keeping metrics on it so that we can measure 

the results, and, in fact, the results have been getting our veterans 

to work, reintegrated into work. We have actually saved someone’s 

life in a suicide, which we are very proud of, and really serving our 

families. 

So, I wondered Secretary Rooney, if you have had a chance to 

look at that after we talked yesterday, what are your impressions 

of it. I would also ask Mr. McGinnis as well, and then I would also 

love to invite both of you to New Hampshire to see firsthand how 

this program works. 

Dr. ROONEY. Thank you, Senator. Starting with your last point, 

as I indicated to you yesterday, I would welcome the opportunity, 

particularly if I am back home in New England on the weekend, 

to join you and actually see the program. 

I appreciate the additional information you did send over. 

You hit upon a key aspect. When we talk about the challenges 

that we have in managing to leverage resources and be efficient, 

81 

it is how do we not only extend what we are doing in DOD, but 

reach out and form more of these public/private partnerships. It is 

going to be a way that we have to be very diligent about looking 

for those opportunities, finding those situations that work the best, 

and how can we replicate them. 

After I left you, I was meeting with the senior enlisted, and we 

started talking about this, about how do we successful transition, 

and whether it is Guard and Reserve or Active, it is just how do 

we transition our folks from the military and reach out. They indicated to me too that they were aware of the New Hampshire program and also possibly another one in Oregon and maybe another 

State. 

I think what all of us need the responsibility for doing, myself 

and Mr. McGinnis, is to look for those opportunities, learn more 

about how they work, and see if we can duplicate them so that we 

are addressing the issues, as we heard of, suicide and unemployment and transition. Our job can be to more tightly align with how 

do we translate military skills into skills that the civilian workforce 

can use. We can do a good job about that, but then really rely on 

those public/private partnerships. We are seeing in several cases 

that they work. 

Senator AYOTTE. I think one of the reasons it works in New 

Hampshire is because we know there are limited resources, but we 

are leveraging those with the State and with the nonprofit community to take advantage of all the services in a way that is very 

proactive for those that return from overseas or return from deployment. 

I do not know if you wanted to add anything, Mr. McGinnis? 

Mr. MCGINNIS. Yes, ma’am. The funding that has been provided 

for these programs in the past has been congressional adds. There 

has been a number of State programs that have been supported. 

The appropriated dollars both to the Services and to DOD—and 

YRRP is focused on the long list of mandated requirements I have 

to make sure happens within the YRRP. We are focused on that. 

However, our YRRP Center for Excellence (CFE) is putting together a process to be able to evaluate all these programs, as Dr. 

Rooney mentioned. We share a very similar problem with my colleague in military communities and families, Secretary Gordon, 

and we are working with him to put together a process where we 

can evaluate these programs. But like Secretary Rooney, I would 

very much want to come up and see your program. 

Senator AYOTTE. We would love it. Come in the fall. It is gorgeous. We will have you sooner too. 

Mr. MCGINNIS. Thank you. 

Senator AYOTTE. I wanted to ask Dr. Rooney, certainly Secretary 

Woodson, where we are. Our All-Volunteer Force—I think you 

would all agree that our troops have done everything we have 

asked of them and more. 

So last year, did we not increase TRICARE enrollment fees? 

Dr. ROONEY. Modestly we did, yes. 

Senator AYOTTE. But we did. 

We tied it to cost-of-living adjustments, correct? Now you are 

back before us—I know, Secretary Hale, you certainly have an 

82 

opinion on this—to ask for additional TRICARE increases. These 

increases are very significant. 

I know my time is up here, but I think this is a really important 

issue. So I will wait for another round. 

But for some individuals, these are not trivial. For example, a retiree receiving between $22,000 and $45,000 a year—their annual 

fees will go from $500 to $1,500 a year, threefold in only about 4 

years. So this is a pretty significant issue. 

I think we have a duty, given what our servicemen and women 

have done, to really have a very hard discussion about this. I am 

really concerned about it. 

I know my time is up. I will stick around to ask more questions 

and turn it back to the chairman. 

Senator WEBB. Thank you, Senator Ayotte. 

Actually, I am going to get into that. So I welcome your participating when I do. 

I have one other little item that I would like to raise now, and 

there may be other questions that I or other members will submit 

for the record. They will have until close of business tomorrow in 

order to do so. 

I want to follow on what Senator Ayotte just said. 

Before I do that, Dr. Rooney, last year Secretary of Defense 

Gates made a decision to eliminate, reduce, or reallocate 140 general and flag officer positions. We held a hearing on that issue, as 

you may recall. Can you give us an update on the status of that? 

Dr. ROONEY. Yes, sir. As of now, we have eliminated 49 of the 

positions. As you are aware, this is a process that we expect between now and 2016 to reach the number that you indicated. But 

right now we are at 49. We are expecting, as we continue the drawdown in our overseas operations, that we will continue to actually 

increase that number of those that have been eliminated or reduced. 

Senator WEBB. So you are continuing the process that was begun 

when Secretary Gates initiated it? 

Dr. ROONEY. Yes. In fact, Secretary Panetta was affirmative in 

his support for continuing that process. 

Senator WEBB. All right. 

Now, I would like to follow on to what Senator Ayotte said and 

add some of my own concerns here, as I did in the full committee 

hearing about a week ago. 

First, I have said many times—I think all of you know that I believe whether there is a specific contractual obligation or not, when 

someone has served a full career, we have a moral obligation to 

provide them with lifetime medical care. Would you agree or disagree? 

Dr. ROONEY. Sir, I believe we have to offer the best medical care 

possible in respect of their service, yes. 

Senator WEBB. Secretary Woodson? 

Dr. WOODSON. Yes, I do believe we have a responsibility, particularly for the wounded, ill, and injured, to provide long-term lifetime 

medical care. 

Senator WEBB. What about for those who serve a career? 

83 

Dr. WOODSON. I think we have an obligation to provide them 

with a benefit package that is very generous and reflects their sacrifice and service. 

Senator WEBB. Thank you. That defines the struggle that we all 

have here. I know how difficult it has been to put together these 

numbers. 

Secretary Woodson, I want to go back and examine the percentage that you raise with respect to 1996 versus today. I want to just 

have my staff take a look at that and get back to you. I may have 

some further questions about how that number was arrived at. 

I would like to put up a chart that you had in your written testimony over here because this is another piece of the reality, and 

that is that if you look at cost per enrollee in the system, that cost 

has grown at pretty much the same pace as civilian health care. 

As I have said many times, our health care difficulties, as we have 

seen from the last 3 days in the Supreme Court, is a national problem. It is not a DOD problem. It is a challenge for all of us. But 

we are pretty much seeing the same percentage increase if you use 

2005 as a baseline as we have seen nationally. Is that a correct 

statement? 

Dr. WOODSON. That is correct. Thank you for putting up that 

chart because I have the very same chart. 

[The chart referred to follows:] 

Senator WEBB. I think it is a great starting point for this discussion. 

Another clarification is, as far as I know, when we summarize 

the costs even for TRICARE For Life, we do not take the costs of 

Medicare Part B and apply it when you are looking at the health 

care costs inside DOD. Right? 


328pe123.eps
84 

Dr. WOODSON. Let me make sure I understand your question. 

Senator WEBB. Let me be clearer. When a retired servicemember 

reaches the age of 65, they are required to sign up for Medicare 

Part B before they can get TRICARE For Life. 

Dr. WOODSON. That is correct. 

Senator WEBB. The cost of Medicare Part B—just to summarize, 

when you reach the age of 65, you are automatically entitled to 

Medicare Part A. But you have to elect to get Medicare Part B. It 

is wider coverage. But for a retired servicemember who wants 

TRICARE For Life, the DOD benefit, they are required to sign up 

for Medicare Part B. 

Dr. WOODSON. That is correct. 

Senator WEBB. When we look at the increase in the costs or the 

percentage increase in the costs inside DOD, we do not factor in 

Medicare Part B. That is a total separate account. Correct? 

Dr. WOODSON. That is correct, but remember 90 percent of folks 

will and have taken Part B. TRICARE For Life represents that 

wraparound insurance for that other 20 percent, which includes a 

Part D, which is a pharmacy benefit. Remember prior to 2001 

when TRICARE For Life came on board, many folks were paying 

independently for that wraparound insurance. So you are correct in 

your statement about Part B, but most folks will be paying Part 

B anyway. 

Senator WEBB. Medicare Part B is a very expensive program, 

and we do not count that when we look at the cost of TRICARE 

in terms of DOD funding. Correct? 

Dr. WOODSON. That is correct. 

Senator WEBB. Can you put up this other chart? 

[The chart referred to follows:] 

85 

Senator WEBB. If you are looking at this from the perspective of 

a retired servicemember—I spoke to this in a full committee hearing. But when you are on Active Duty, obviously all your medical 

care is provided for. When you retire before the age of 65, presently 

you are at where the red marks are on this line. You hit 65. You 

are where that far right bar is in terms of how much you are required to pay in. The blue represents the proposal from DOD for 

the increases in TRICARE fees. 

So if you are somebody out there, having retired, looking at what 

it is going to cost you for health care, you are seeing, first of all, 

as Senator Ayotte pointed out, a significant jump with the proposals from DOD, but if you are over here past 65, you are seeing 

just a really large, sudden expenditure. 


328pe124.eps
86 

Dr. WOODSON. Yes. Thanks for bringing this up because this is 

an interesting chart. First of all, it does not include the average 

out-of-pocket costs. The figures you have given there, where you 

are looking at a premium of $7,000 or a cost $7,672, represents the 

upper tier of folks who pay Part B. They would have to be making 

$428,000 a year in order to pay that premium. 

Senator WEBB. The couple, not the individual. Actually, if you 

will see the first line there, that is the lowest tier. Also, let us remember if somebody is on that upper tier, they are also paying 

Medicare again for the money that they are making. They are paying three times. They are paying Medicare Part B. They are going 

to be paying TRICARE, and they are going to be paying for Medicare on the income that they are making. 

Dr. WOODSON. Yes, but the important issue, in terms of the optics relative proportion, is that Medicare Part B—they do not start 

tiering until about $170,000 a year. So you are really talking about 

an upper echelon. 

The other thing about the chart is, again, you are not talking 

about total out-of-pocket costs. That is why the differential looks so 

wide there. If you looked at the other out-of-pocket costs, you would 

see that it would not be as—— 

Senator WEBB. Actually, that goes to another point, and then I 

am going to let Senator Ayotte follow on here, and that is that people who think that the TRICARE fee by itself is all that somebody 

is paying is not correct. For instance, if you are talking about 

TRICARE standard, you pay a 25 percent cost share after you pay 

your fee. So when people are talking about the notion that the 

amount that our retirees are paying for health care is very small, 

I agree with you that is not reflective of the amount that they are 

paying. 

Dr. WOODSON. That is exactly why we talk about cost share because that takes into account the relative out-of-pocket costs, and 

so the statistics I gave you before were correct, that in 1996 the 

relative contribution cost share was 27 percent. It has dropped to 

about 10 percent, even less if you look at prime. What we are talking about is a rebalancing so that even in 2017 and beyond, the relative cost share is only going to be about 14 percent, which is about 

half of what it was originally. So you have to talk about out-ofpocket costs. 

Senator WEBB. Right. We will look at your figures. 

Dr. WOODSON. Oh, absolutely. We can provide you details on 

that. 

Mr. HALE. Could I just add one more point that I think is important to this comparison? Although we should not copy the civilian 

system, we need to keep it in mind. Good Medigap coverage for a 

couple is probably $4,000 a year. We are talking TRICARE For Life 

at the highest tier of $900, at the lowest tier for $22,000 and less, 

more junior retirees, $300. It is meant to be generous. I think that 

is right. But I think we have to keep this in mind. This is a dynamic health care system, and we have to make some of those 

or—— 

Senator WEBB. Look, that is in addition and in addition to—— 

Mr. HALE. Yes, but it would be in addition for the civilians as 

well. They would be paying that $2,000—— 

87 

Senator WEBB. What we are talking about is an obligation to provide them medical care for the rest of their life based on a compensation package that begins the day that they enlist and is amortized over the rest of their life. It is not a direct comparison, in 

my view. 

Now, we are going to continue this probably for the next 4 or 5 

months. But I appreciate your views and you have heard mine. 

Mr. HALE. Okay. I understand. May I add one more thought? 

That is, you keep this in the context that we owe them not only 

good medical care, we have to provide training and equipment for 

them, as you know a lot better than I do given your military service. We have to have a balanced package as we respond to the—— 

Senator WEBB. I totally agree with that, but what I am saying 

to you is you cannot renegotiate the front end once the back end 

is done. This is an obligation that has been made to people whose 

military careers are now done. If you want to reexamine the whole 

compensation package, that is something that actually is on the 

table. 

Senator Ayotte. 

Senator AYOTTE. I would agree very much with the chairman on 

this. Just in terms of what we are talking about, as far as a comparison, there is a reason that in President Lincoln’s second inaugural address he said that we have a duty. Really, we have to ‘‘bind 

up our Nation’s wounds to care for him who shall have borne the 

battle and for his widow and his orphan.’’ This is different than the 

rest of the population in terms of what they have sacrificed and 

what they have put on the line for us and what they were promised. What is it that they expected in all this? So I think that that 

is what we are talking about here. 

What bothers me about this is that the reason that you are here 

in this position is that—let’s face it. Something like the BCA—you 

came with us last year to ask for TRICARE increases, and that was 

not easy, was it, Secretary Hale? That was a difficult question. I 

know you did not get everything you wanted. 

Mr. HALE. We appreciate your support. 

Senator AYOTTE. No, exactly. We supported you on that, and you 

are back before us this year. 

In the context of what we are looking at with something like the 

BCA, you have been handed a number. You are under additional 

budgetary pressures. Health care costs are rising in every sector. 

But we have not, as a Congress, dealt with the 60 percent of the 

spending that is going up in Federal spending that includes Medicare, that includes Medicaid, that includes the mandatory programs. I understand why you are here before us. 

I do not think, though, that we should put that, if we do not 

show the courage to deal with the entire budget—to really put a 

significant increase and burden after we just did an increase last 

year on this group of individuals who have served our Nation, 

given what they had as anticipation when they came into Service, 

as Senator Webb has said, and where we are making these 

changes. So that is one of the overall concerns I have about this. 

I understand that you were handed a number in the BCA. Would 

you be here asking for these increases immediately after you got 

some last year but for the BCA? 

88 

Mr. HALE. I suspect the answer to that is no, but the BCA is a 

law that you passed and we do need to be consistent with it. My 

worry is that if we choose not to make these decisions, we will have 

to take it out of force structure and investment, and I believe that 

we have already, consistent with the strategy, done what we should 

there. It is actually quite disproportionate toward the investment 

side and very disproportionate on the low side for personnel. So if 

you do not support this, I am not sure where we go. 

Senator AYOTTE. But my point in the bigger picture in all this, 

which is really not your fault that you are put in this position— 

is that because in Congress we are not looking at the whole picture, that you are in a position where you are handed the BCA, you 

are coming before us, you are going to ask for these health care increases after just having increased TRICARE last year. I think 

that we also on our end, to put this a little bit on us, that we have 

to take on the big picture here or we are going to be in a place like 

sequestration. We are going to be in a place where there is no question, reductions are going to happen to our military with withdrawal from Iraq and drawdown in Afghanistan. But you are here. 

It is troubling to me that we are going to take it out of that group 

first instead of dealing with the big picture of our budget problem. 

Mr. HALE. I would love a grand budget deal. 

Dr. WOODSON. But the truth of the matter is we are not taking 

it out of that group first. As Secretary Hale said in his opening 

statement, while personnel costs at 30 percent—when the Secretary laid out the policies and procedures for looking at the budget, 90 percent came from troops, weapons programs, ships, planes. 

10 percent came from personnel costs, and the truth of the matter 

is these TRICARE fee adjustments represent only slightly less than 

5 percent. 

Senator AYOTTE. I do have one substantive question. You received the Government Accountability Office (GAO) report which 

recommended a consolidation among the Services of health care as 

a way of a significant cost saving measure. I do not see that in all 

of this. I do not see a significant move in terms of changing and 

consolidation in trying to look at other ways where we could save 

money in health care. In fact, GAO recommended that you could 

achieve between $281 million and $460 million in annual savings 

from that. Have we gone down that road at all? 

Dr. WOODSON. Yes. So you may be aware that we delivered to 

Congress the required report to Congress in the NDAA looking at 

the restructuring of the military health system. We were ready to 

move out on that last fall when at the 11th hour, we got a prohibition in the NDAA saying that we could not make any changes in 

the military health system. So we have gone down that path in 

terms of analyzing what we need to get the greatest amount of efficiencies by looking at common business practices and common service orientation. 

I would suggest to you again that as much as we are bringing 

focus and energy to reorganizing the structure of the military 

health system—can we put up chart 1 please? 

[The chart referred to follows:] 

89 

Dr. WOODSON. You need to understand that headquarters functions actually represent only about 2 percent of budget, and we affectionately call this slide ‘‘the planet slide’’ because it shows the 

relative amounts of money in the budget. If you look to the far 

right, that really represents headquarters function, and where we 

spend the bulk of the money is actually in delivery of care and private sector care and maintenance—— 

Senator AYOTTE. I apologize. I will grab that report and look at 

it right away. So is this something you would still want to do? 

Dr. WOODSON. Absolutely. 

Senator AYOTTE. If you did it, could you also not have to ask for 

the increases that you are asking for? 

Dr. WOODSON. The answer is no because if you look at that slide, 

again headquarters function, while we want to squeeze that lemon 

very hard, only represents about 2 percent of really our costs. So 

the headquarters function is not going to get us to where we need 

to go. 

The other thing that you have to remember is that it is about 

putting the program on a sustainable course so that it will be there 

for future generations and men and women who stand up and raise 

their right hand and say I will protect and defend, that a benefit 

will be there, a generous benefit will be there, to take care of their 

lifelong needs and medical care. The issue is that because we have 

had prohibitions for 16 years, we actually are far behind the curve 

and not on a sustainable course. 

Put up number 4 there, please. 

[The chart referred to follows:] 


328pe125.eps
90 

Dr. WOODSON. I want to show to you how dramatic this is. If you 

look at particularly the private sector—and I know we do not want 

to talk about comparisons—over the course of the last decade or so, 

contributions to premium costs in health care have gone up 168 

percent. Premium costs have gone up 160 percent. If you look at 

the blue line at the bottom, you can see that there has been no increase until last year when we had these very modest increases of 

$2.50 per month for singles and $5 a month for families. 

The issue is that we have not been on a sustainable course, and 

we need to certainly slightly rebalance it. With all of the proposals, 

we will not go back to what was the original agreed upon cost 

share. We will only be at half of that, but we will be on a more 

sustainable course. This is about a national security issue that goes 

on for decades. 

Senator AYOTTE. This in my view—with all respect to the private 

sector, they do not endure what our soldiers do in battle—— 

Dr. WOODSON. I understand. 

Senator AYOTTE.—or shot at—the things that they have to experience. So I do not find the comparison good. 

I think that if we as Congress would actually say that this is a 

commitment we want to follow through on, that we could find a 

way to do it if we are willing to take on entitlements, if we are willing to take on the rest of the budget rather than you all trying to 

find a way to pass this on to our veterans in the first instance. 

That is my big-picture concern here. 

But I understand that health care is going up everywhere, but 

I do not find the comparison the same. 

Senator WEBB. Let me just have the final word here, seeing as 

I have the gavel. [Laughter.] 


328pe126.eps
91 

Just a couple of things. This is almost going the way that the 

lawyer hearing went when we had all the Judge Advocates General 

up here. It is going for another half hour. 

We will have further discussion about this and we will actually 

want to come back to you again, Secretary Woodson. There are 

some data that I may want. 

But let me just make three final points here in terms of where 

our concerns are. 

First, I understand the hand that you are dealt. I spent 5 years 

in the building. I was on the Defense Resources Board for 4 years. 

I understand the hand you are dealt. 

Second, I understand the notion of getting a sustainable course. 

The difficulty here is if you are going to look at the back end after 

someone has completed their career, that is a different situation 

than analyzing the whole context of the moral contract that goes 

into service. That is a concern. 

Then third, the reason I put that chart up there with Medicare 

Part B is I do not think there are very many members up here who 

understand that a military retiree has to buy into Medicare Part 

B before they get TRICARE For Life. They do not understand that. 

They see the little bar at the very top, the red part of the bar. They 

do not understand the blue part. I think I got that right. So it is 

an important part of the decision process up here when people look 

at that because it does not show up in the DOD budget, but it does 

show up in somebody’s bank account. 

So we will continue this discussion. Again, I very much appreciate your all coming to testify today. 

This hearing is adjourned. 

[Questions for the record with answers supplied follow:] 

QUESTIONS SUBMITTED BY SENATOR MARK BEGICH

TRICARE WEST

1. Senator BEGICH. Dr. Woodson, I understand you made a decision recently on 

the TRICARE contract in the West Region, which serves my home State of Alaska. 

As you know, Alaska is just beginning to move towards delivering military care in 

a somewhat similar manner as is done in the lower 48 States. It’s been a long and 

challenging process. So, the decision on the contract award will have a substantial 

impact on my constituents. I understand this award went to the higher price bidder. 

The contract award process is more detailed than simply price, but price is pretty 

important these days. Is it accurate that the contract was awarded to a higher bidder? 

Dr. WOODSON. Yes, the contract was awarded to the higher priced offeror. The 

source selection factors for this solicitation gave greater weight to technical and performance-related factors than to cost and price-related factors. The Source Selection 

Authority compared offers and, within the parameters of this authority, determined 

that the higher price was more than offset by the added value offered. 

2. Senator BEGICH. Dr. Woodson, will you provide me with a full briefing on the 

decision from the Department of Defense (DOD) so I may better understand it, as 

it will have a tremendous impact on all men and women in uniform, but especially 

on constituents in Alaska, as we don’t want to go backwards with progress that has 

been made in the State. 

Dr. WOODSON. I would be happy to arrange for a briefing once this protest is settled. The decision in the West is under protest and a briefing prior to the outcome 

of that proceeding would be guide limited. 

92 

TRICARE INCREASES

3. Senator BEGICH. Secretary Hale and Dr. Woodson, in years past, DOD has proposed to increase TRICARE fees, and thereby achieve savings, that were based in 

part on the principle that beneficiaries would either opt out of TRICARE completely, 

or decrease the amount of health care they used. This year DOD’s proposal for 

TRICARE Prime enrollment fees is for a first-year increase of 30 percent to 78 percent. That, plus other increases in health care costs to retirees, will result in $12 

billion in savings to DOD over 5 years. How much revenue does DOD expect to generate from the proposed fee increases? 

Mr. HALE and Dr. WOODSON. The fiscal year 2013 health reform proposals are expected to save DOD a total of $12.9 billion through fiscal year 2017. These savings 

are derived from four effects: 

• First, we project some savings from stopping and reversing the increase 

in the number of retirees who use TRICARE as their primary health insurance vice using their employer-sponsored insurance. In fiscal year 2000, approximately 60 percent of retirees relied on TRICARE. Today, it is roughly 

84 percent with projections that it will reach 90 percent by fiscal year 2017. 

Our estimate is that these proposals will reduce this reliance to 79 percent, 

roughly what it was in fiscal year 2008. For fiscal year 2013, these savings 

amount to $201 million. 

• Second, we project a minor decrease in health care utilization due to the 

higher fees. 

• Third, we project that beneficiaries will use health care options that are 

less costly for DOD. We project more beneficiaries will use TRICARE 

Standard vice Prime, that they will use more generic prescriptions vice 

brand, and that they will use military treatment facility (MTF) and mail 

order vice retail pharmacies. 

• Finally, there is the direct savings from increased fees that will offset 

DOD’s cost of health care. 

For fiscal year 2013–fiscal year 2021, we project that 25 percent of the savings 

will come from the increased reliance on employer-sponsored health care, 7 percent 

of the savings will come from the decrease in utilization, 28 percent will come from 

the use of less costly options, and that 40 percent will come directly from the increased fees. 

4. Senator BEGICH. Secretary Hale and Dr. Woodson, how much does DOD expect 

to save from beneficiaries changing their behavior with regard to health care use? 

Mr. HALE and Dr. WOODSON. The fiscal year 2013 health reform proposals are expected to save DOD a total of $12.9 billion through fiscal year 2017. These savings 

are derived from four effects: 

• First, we project some savings from stopping and reversing the increase 

in the number of retirees who use TRICARE as their primary health insurance vice using their employer-sponsored insurance. In fiscal year 2000, approximately 60 percent of retirees relied on TRICARE. Today, it is roughly 

84 percent with projections that it will reach 90 percent by fiscal year 2017. 

Our estimate is that these proposals will reduce this reliance to 79 percent, 

roughly what it was in fiscal year 2008. For fiscal year 2013, these savings 

amount to $201 million. 

• Second, we project a minor decrease in health care utilization due to the 

higher fees. 

• Third, we project that beneficiaries will use health care options that are 

less costly for DOD. We project more beneficiaries will use TRICARE 

Standard vice Prime, that they will use more generic prescriptions vice 

brand, and that they will use MTF and mail order vice retail pharmacies. 

• Finally, there is the direct savings from increased fees that will offset 

DOD’s cost of health care. 

For fiscal year 2013–fiscal year 2021, we project that 25 percent of the savings 

will come from the increased reliance on employer sponsored health care, 7 percent 

of the savings will come from the decrease in utilization, 28 percent will come from 

the use of less costly options, and that 40 percent will come directly from the increased fees. 

93 

PERSONNEL DECREASES

5. Senator BEGICH. Secretary Rooney, DOD is proposing a decrease of 8,000 personnel in fiscal year 2013. How did DOD determine 8,000 personnel decreases were 

feasible and will not undermine the workforce? 

Dr. ROONEY. DOD’s fiscal year 2013 budget request, including the proposed reduction in personnel, reflects a balanced workforce that decreases overall spending on 

military end strength and DOD’s Federal civilian workforce, as well as on contract 

services. It reflects our best judgment today and represents a carefully coordinated 

approach based on DOD’s strategy and policy that balances operational needs and 

fiscal reality without placing national security and our overall defense posture at 

risk. Proposed reductions in the military personnel levels reflect declines in our current overseas commitments; revised strategy, posture, and operational planning; 

and changes to our force structure. Reductions in civilian personnel are predominantly associated with ongoing organizational assessments and mission/function 

prioritization in an effort to reduce administrative workload. These reductions preserve DOD’s civilian workforce’s capability to perform key enabling functions for the 

operating forces, such as critical training and preparation to ensure readiness, 

equipment modernization and reset, medical care, family support, and base operating and infrastructure services—all vital services that support our men and 

women in uniform and help meet the Nation’s security needs. 

6. Senator BEGICH. Secretary Rooney, what assessment was conducted? 

Dr. ROONEY. The reductions in the workforce reflect, in part, a continuation of 

DOD’s efficiency initiative, directed by Secretary Gates and first included in the fiscal year 2012 budget. Specifically, they reflect the direction given to complete organizational assessments and mission/function prioritization, reflecting DOD’s commitment to challenge workload requirements and more appropriately size the workforce 

to meet the most pressing and critical priorities with a focus on reducing administrative functions associated with headquarters staffs. Additional reductions planned 

and reflected in the fiscal year 2013 budget correlate to changes in DOD’s force 

structure, strategy, posture, and operational tempo. 

7. Senator BEGICH. Secretary Rooney, of the 8,000 civilian personnel reduction, 

please provide how many each Service will have to decrease by and in what areas— 

base support, et cetera. 

Dr. ROONEY. Total U.S. Direct Hire (USDH) full-time equivalents (FTE) decreased 

by 7,367 from the fiscal year 2012 level of 751,172 to the fiscal year 2013 level of 

743,805. There was a net decrease of USDH (reimbursable) FTEs of 12,194 (see 

charts by Service component and appropriation below), which were offset by a net 

growth of 4,827 USDH (direct) FTEs, resulting in the overall decrease of 7,367. 

• The decrease in USDH reimbursable FTEs is primarily in the Military 

Departments’ Operation and Maintenance and Revolving Funds accounts, 

as shown in the chart attached. Reimbursable functions include logistical 

support functions such as depot-level equipment/aircraft repair and maintenance and ship maintenance and operations. 

• Of the Defense-wide reductions, 306 USDH reimbursable FTEs were converted to USDH direct FTEs. The remaining Defense-wide reductions were 

in the drug demand reduction and intelligence programs. 


328pe127.eps
94 

JOINT BASING

8. Senator BEGICH. Secretary Rooney, you mention in your written testimony submitted for the record that there have been some exceptions for growth and increases 

to the civilian workforce—to include joint basing requirements for the Navy and Air 

Force. Why have these exemptions not also been extended to Air Force and Army 

joint bases—such as Joint Base Elmendorf-Richardson (JBER)? 

Dr. ROONEY. When DOD directed its components to hold civilian funding to fiscal 

year 2010 levels, we recognized that some allowances had to be made for new missions or legislative requirements. One such allowance, as needed, was for implementing certain Base Realignment and Closure (BRAC) 2005 directed initiatives associated with selected joint basing agreements. 

Joint basing generated civilian workforce transfers between the Services. As a result, both the Air Force and Navy increased, while the Army saw its civilian workforce decrease as joint basing was implemented. Therefore, the Army did not require 

a growth exception for joint basing. Based on workforce shifts of installation support 

realignments, the Navy and Air Force requested exceptions to their overall civilian 

workforce levels. Based on overall joint basing requirements, the Army did not request an exception. 


328pe128.eps
95 

9. Senator BEGICH. Secretary Rooney, I am concerned the Air Force, as the installation’s executive agent, is not meeting joint basing requirements at JBER. JBER 

lost more than 220 civilian personnel billets previously identified as necessary to accommodate joint basing and the increase in Army end strength at the installation. 

Has the Air Force sought exceptions for joint bases where they are the lead or just 

the tenant? Why or why not? 

Dr. ROONEY. The Air Force actively sought exceptions to protect civilian growth 

associated with joint basing, acquisition excellence, plus operations and maintenance in-sourcing. While some exceptions were granted, DOD had to also respond 

to the Budget Control Act (BCA) of 2011. As such, the Air Force focused on reductions in overhead and support areas while minimizing the impact to functions tied 

to joint basing, acquisition excellence, the nuclear enterprise, and its flying missions. 

BRAC 2005 created joint basing as a means to identify, capture, and continue significant savings through consolidation thus freeing resources for other priorities. 

The joint bases for which the Air Force is the last Service are now in the process 

of reducing some of its previously planned growth by consolidating and centralizing 

many base support functions; examples include the ‘‘Tailoring Installation Support’’ 

and ‘‘Civil Engineer Transformation’’ initiatives. Their joint base commanders have 

the authority to, and will, reallocate manpower and dollars across their functions 

to maximize capabilities while mitigating impact to the services they provide. In 

spite of these fiscal challenges, Air Force remains committed to joint basing while 

meeting or exceeding the needs of our mission customers. 

BASE SERVICES

10. Senator BEGICH. Secretary Rooney, as you know, to meet the fiscal year 2010 

cap, the Services decreased civilian personnel primarily in base support services. Do 

you have any concerns the Services will take the additional reductions in base support services and thereby compromise quality of life and installation support? 

Dr. ROONEY. No, I am not concerned that quality of life and installation support 

will suffer. The reductions in DOD’s civilian workforce, including those in base support services, are correlated to workload and based on mission/function 

prioritization, reflecting the changes in DOD’s strategy and force structure. DOD 

has established an internal, multi-level governance process for monitoring implementation of all efficiencies and associated budget reductions. Through such governance processes, the Service and Department’s leadership ensures that base operating and infrastructure services, critical training to ensure readiness, equipment 

modernization and reset, medical care, and family support are delivered in a manner and with sufficient personnel to maintain quality of life and warfighting capabilities. 

SEPARATION

11. Senator BEGICH. Secretary Rooney, I understand it is DOD’s intent to utilize 

voluntary separation measures when implementing civilian personnel reductions. 

Yet, most applicants are being turned down when they apply for voluntary separation or retirement. In these economic times, a lay-off is unacceptable. Does DOD 

have the flexibility it needs to utilize voluntary incentives to the fullest? 

Dr. ROONEY. Yes, these incentives have served DOD well in avoiding involuntary 

separations. In accordance with the governing statute, Voluntary Separation Incentive Pay (VSIP) and/or Voluntary Early Retirement Authority (VERA) can only be 

granted when a voluntary separation would avert an involuntary separation, or 

when the vacated position can be restructured to meet organizational needs. It is 

management’s responsibility to determine when it is necessary to use these authorities and to determine who is in the eligible population. As a result, employees who 

do not work in areas targeted for VSIP/VERA are not eligible and they generally 

represent the group of applicants who claim they are being turned down. 

To minimize involuntary separations, DOD has a statutory limit of 25,000 VSIP 

payments annually. We do not anticipate exceeding the statutory limit in the current environment. There is no ceiling on VERA, but the number may be limited by 

the 25,000 VSIP limit because most employees who apply for VERA also apply for 

VSIP. In fiscal year 2011, DOD approved 3,854 VSIPs and 712 VERAs (649 with 

VSIP). As of March 31, 2012, DOD has approved approximately the same number 

of VSIPs and VERAs as it did in fiscal year 2011. 

If the use of voluntary separation incentives does not avoid the need for involuntary separations, DOD relies on the DOD Priority Placement Program (PPP), DOD’s 

96 

civilian career transition assistance program. When employees are scheduled for displacement due to downsizing or organizational restructuring, they receive hiring 

preference for DOD job vacancies through the PPP. Almost 260,000 civilians have 

been successfully placed through this program, and it remains the centerpiece of 

DOD’s overall efforts to maintain a stable workforce. 

Voluntary Separation Incentive Pay Approved 

Fiscal Year 

2009 2010 2011 2012 (1st and 2nd qtr) 

Army ...................................................... 820 790 2,143 1,679 

Navy ...................................................... 364 540 812 265 

Air Force ................................................ 496 236 247 1,107 

Other DOD ............................................. 313 463 652 427 

Total ................................................. 1,993 2,029 3,854 3,496 

Voluntary Early Retirement Authorities Approved 

Fiscal Year 

2009 2010 2011 2012 (1st and 2nd qtr) 

Army ...................................................... 280 

(241 with VSIP) 

250 

(197 with VSIP) 

250 

(234 with VSIP) 

399 

(381 with VSIP) 

Navy ...................................................... 149 

(102 with VSIP) 

150 

(125 with VSIP) 

186 

(175 with VSIP) 

71 

(60 with VSIP) 

Air Force ................................................ 157 

(151 with VSIP) 

107 

(99 with VSIP) 

142 

(136 with VSIP) 

247 

(241 with VSIP) 

Other DOD ............................................. 173 

(108 with VSIP) 

293 

(157 with VSIP) 

134 

114 with VSIP) 

77 

(74 with VSIP) 

Total ................................................. 759 

(602 with VSIP) 

800 

(578 with VSIP) 

712 

(659 with VSIP) 

794 

(794 with VSIP) 

12. Senator BEGICH. Secretary Rooney, are there legal restrictions or barriers to 

more lenient use to avoid a reduction in force? 

Dr. ROONEY. Yes. As explained in my previous response, VSIP and the VERA are 

governed by law. Section 9902 of Title 5 of the U.S. Code, imposes limits on the Secretary’s independent authority to use these separation incentives. These tools may 

only be used for two purposes: 

1. To reduce involuntary separations that would otherwise occur. 

2. To restructure the workforce to meet mission objectives without reducing the 

overall number of personnel. We cannot approve VSIP or VERA requests unless the voluntary separations would achieve one of the two specified purposes. 

FAMILY SUPPORT

13. Senator BEGICH. Secretary Rooney, family support programs are protected in 

the budget but indications are they will not see any growth in budget in the outyears. How does DOD intend to ensure funding of family support programs keeps 

pace with inflation? 

Dr. ROONEY. To ensure that funding of family support programs keeps pace with 

inflation and family programs are not reduced, I emphasized the need for Services 

to safeguard and sustain funding levels for their family programs. This resulted in 

implementation of a Comptroller-mandated, in-depth, mid-year review of the Services’ budgets. The Services are in the process of scrutinizing their budgets, tracking 

program funding, and disclosing discrepancies that could indicate diversion of funds 

from programs for which the funds were originally intended. Ongoing tracking of 

budgets and reporting on status of budgets supports the Secretary’s position of 

‘‘keeping faith’’ with servicemembers and their families to protect family assistance 

programs. Additionally, resourcing plans must maximize leveraging communitybased organizations that offer legitimate resources to support and empower our 

97 

military families. DOD’s ability to adapt programs and establish partnerships that 

more effectively and efficiently meet the needs of our military families are key to 

DOD’s continued success in an ever more fiscally-constrained environment. 

ASSIGNMENTS FOR WOMEN

14. Senator BEGICH. Secretary Rooney, I’ve long been an advocate for eliminating 

assignment restrictions for women in the military. Please describe the recent DOD 

changes with respect to women serving in the military. 

Dr. ROONEY. On February 9, the Secretary of Defense notified Congress of his intention to remove the co-location restriction and permit an exception to policy that 

allows women to be assigned to the battalion-level of specific direct ground combat 

units. Co-located positions are not part of ground combat units, but by virtue of the 

duties or missions involved, must be co-located with the ground combat units. In 

addition, positions opened under an exception to the existing DOD policy permit assignment of women to specific direct ground combat battalions in select occupations 

open to women. The experience gained by assigning women to these select positions 

will help assess the suitability and contemporary relevance of the direct ground 

combat unit assignment prohibition and inform future policy decisions. In total, 

14,325 positions are opening as a result of these changes. The Services will begin 

implementing these changes effective May 14, 2012. 

15. Senator BEGICH. Secretary Rooney, what more is DOD doing to give women 

a larger role in the Services? 

Dr. ROONEY. See response to question #14. 

RESERVE COMPONENT

16. Senator BEGICH. Mr. McGinnis, I was pleased in your opening statement that 

you mention the Innovative Readiness Training (IRT) program. I am pleased to see 

this program’s funding remained stable in the budget request at $20 million. Please 

elaborate on the benefits of the program to our Reserve component and civilian and 

military partnerships. 

Mr. MCGINNIS. The IRT program provides real world training opportunities for 

DOD servicemembers, which prepares them for wartime missions while supporting 

the needs of America’s underserved communities, many in rural areas. Through this 

program, the National Guard and Reserve and various Active component military 

units refine their planning, logistical, engineering, health care, driving, and transportation skills by performing services and developing projects in and for communities that otherwise would not have the resources to conduct them on their own. 

In many cases, the community provides the materials and the military provides the 

manpower, equipment, and training to sustain the improvements. 

This year, along with significant training in logistics, joint operational planning, 

coordination, and communication, Navy Seabees, Marine Combat Engineers, Army 

Reserve, and Air Force Red Horse teams will gain vertical and horizontal engineering experience. In West Virginia, over 1,300 Reserve component engineers and support personnel will build roads and helipads. In New Mexico, houses for homeless 

Navajos will be constructed, and in Arizona, a school for exceptional children will 

expand. 

In Arkansas last year, 5 communities were provided much needed medical, dental, 

optometry, and veterinary care; over 6,000 residents received direct medical care. 

Just last month, over 10,000 residents of Kauai, HI received similar medical services and 3,500 pairs of glasses were fabricated. Currently, the Arctic Care mission 

is underway in 16 villages in partnership with the Norton Sound Health Corporation in Nome, AK. Next month, three rural communities in Alabama will provide 

the back drop for medical training and many residents will receive much needed 

health care. Over 300 military medical personnel train at each of these health care 

missions. 

As overseas military operations wind down in the coming years, it is imperative 

to have sustainment training opportunities available to the Guard and Reserve. 

This program provides that unique niche of high-value mission essential training in 

support of the Nation’s underserved and remote communities. 

17. Senator BEGICH. Mr. McGinnis, you highlight the alarming Reserve component unemployment rate in your testimony. I understand the Army Reserves has 

a program called the Employer Partnership of the Armed Forces (EPAF). This program is having tremendous success ensuring members are trained and receive creVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00103 Fmt 6633 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
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dentials for civilian work while staying qualified for their military work. The Army 

Reserves is working hand-in-hand with employers to understand what credentials 

and skill sets are required for employment, training the force, and then placing 

members into jobs. Are you familiar with this program? 

Mr. MCGINNIS. Yes, my office is very familiar with this program. The EPAF was 

developed by the Office of the Chief, Army Reserve to work with employers to facilitate employment opportunities for Army reservists. After careful review of the success of EPAF, and with the concurrence of the Chief, Army Reserve, EPAF has 

transitioned to a multi-Service program known as ‘‘Hero2Hired (H2H)’’, which is administered by my office, and is available for use by servicemembers in all seven Reserve components. H2H, with a web site H2H.jobs, retains many of the great features and lessons learned in EPAF and has expanded tools designed to provide outreach, support, and mentorship to the unique Reserve component population. The 

tools help all unemployed and under-employed Reserve component servicemembers 

and spouses with employment assistance. 

18. Senator BEGICH. Mr. McGinnis, how is DOD leveraging the lessons learned 

from successful initiatives such as this one? 

Mr. MCGINNIS. The Yellow Ribbon Reintegration Program (YRRP) applies lessons 

learned to its operations on a continuous basis, constantly improving the quality of 

curriculum, materials, and resources provided to the Service components. H2H is a 

program provided by YRRP to address the needs of unemployed and under-employed 

Reserve component servicemembers. YRRP also made significant enhancements to 

the DOD YRRP Center for Excellence whose primary mission is to gather lessons 

learned, conduct analysis, and propagate the end results throughout the Services for 

their use. 

19. Senator BEGICH. Mr. McGinnis, the 168th Air National Guard Wing at Eielson 

Air Force Base has a critical need for a communications facility. Unfortunately, 

funding for this facility has not been provided and funding for it continues to slip 

into the future years. Without construction and modifications to the existing facility, 

communications will fail for this wing. Would you please look into this issue and 

provide an update? 

Mr. MCGINNIS. While my office provides policy oversight of the Reserve components, any final decisions on construction and funding for National Guard facilities 

falls within the purview of the Services. As such, my office did not play a direct role 

in any ultimate decisions related to the 168th. However, upon reviewing the matter, 

I was informed of the following information: 

The communications facility is scheduled for design and subsequent construction 

in fiscal years 2012 and 2013. This facility requirement was reviewed and found to 

be better suited for accomplishment using a combination of minor construction and 

sustainment, restoration, and modernization (SRM) funds instead of military construction (MILCON) funds. 

The project calls for a repair of the existing roof, construction of an addition, and 

renovation of the existing space. The roof was repaired in 2011. Construction of a 

3,650-square-foot addition for $2 million is under design for the fiscal year 2012 program and will be executed using minor construction funding. A companion project 

renovating 5,504 square feet for $1.85 million is under design for the fiscal year 

2013 program. 

20. Senator BEGICH. Mr. McGinnis, I am especially concerned with the decreases 

proposed by the Air Force in Air Guard equipment and manning. What role did you 

play in the deliberations this year and what role did the States play? 

Mr. MCGINNIS. The Assistant Secretary of Defense for Reserve Affairs serves as 

an advisor to the Secretary of Defense through the Under Secretary of Defense for 

Personnel and Readiness on all matters pertaining to the planning, programming, 

budgeting, and execution system for the Reserve components within DOD. 

The budgets are developed by the Secretaries of the Services based on their views 

of the future of their Services. The role of Reserve Affairs is to advise the Secretary 

of Defense, but we do not play a direct role in development of these budgets. However, we did participate in the Office of the Secretary of Defense review of the Services’ budget submissions. 

I am not aware of whether the States Adjutants General were involved in the development of this budget. It is the responsibility of the Service Secretaries to communicate, through the National Guard Bureau, with the State Governors and representatives, and I fully support that interaction and communication. If that was 

done this year, my office would not necessarily have played a role. 

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QUESTIONS SUBMITTED BY SENATOR LINDSEY GRAHAM

SEQUESTRATION

21. Senator GRAHAM. Secretary Hale, the BCA requires DOD to reduce all major 

accounts by a total of $492 billion over 10 years. Secretary of Defense Panetta has 

said that this would have a catastrophic impact on our military and its ability to 

protect this country. What is the impact on military readiness, equipment, and 

training? 

Mr. HALE. The initial impact of these reductions would come from a potential sequestration in January 2013. DOD is concerned that the sequestration process 

would have significant consequences due to the uncertainty surrounding the process 

and the rigid formula which Congress has prescribed for its application. Assuming 

the Fiscal Year 2013 Defense Appropriations Act Conference Report contains language similar to the Joint Explanatory Statement of the Committee of Conference 

accompanying Division A—Department of Defense Appropriations Act, 2012, DOD 

would be forced to reduce each line item within each procurement appropriation by 

the same percentage and each program element within each research and development appropriation by the same percentage. This percentage would be calculated 

based on the budgetary resources, primarily the enacted fiscal year 2013 appropriation and any unobligated balances carried forward at the end of fiscal year 2012. 

Some examples of the problems this method would cause are found in line items 

such as those for a ship, where it is not feasible to buy a fraction of a ship, or in 

a line item funding a multiyear contract where a fraction of the funding would not 

be sufficient to pay the negotiated cost of the multiyear contract. With over 1,500 

individual line items in these accounts, DOD could not fix all of these issues with 

the transfer authority that Congress typically provides; this would leave broken programs across all of these accounts within DOD. Finally, sequestration would force 

an immediate percentage reduction in our operation and maintenance accounts 

which would impact readiness. Funding provided for overseas contingency operations is not excluded from sequestration. 

The fiscal year 2014 and subsequent budgets will be developed using DOD’s planning, programming, budgeting, and execution process. Changes to our budget required by revised caps on the defense budget will be managed through this process 

to best allocate potential reductions to the currently planned funding to protect our 

highest priorities. As changes of this magnitude will impact all aspects of DOD’s 

budget, the process will be implemented in coordination with the White House and 

the Office of Management and Budget (OMB). 

22. Senator GRAHAM. Secretary Rooney, if sequestration is allowed to go forward, 

are we creating a hollow force and diminished support for military families and 

schools? 

Dr. ROONEY. I share your concerns about the devastating impact of further automatic cuts should Congress fail to enact additional deficit reduction measures. 

As the Secretary testified on February 29 to the House Budget Committee, sequester would subject DOD to another roughly $500 billion in additional cuts over 

the next 9 years. In fiscal year 2013, these cuts would have to be implemented with 

limited flexibility. These changes could hollow out the force and inflict severe damage to our national defense and programs that are vital to our quality of life. 

23. Senator GRAHAM. Mr. McGinnis, I am concerned about the current cuts in the 

Reserve and National Guard. What greater catastrophe looms in the event of sequestration for the Reserve component? 

Mr. MCGINNIS. The fiscal year 2013 budget submission supports the National Defense Strategy and will enable our Reserve components to continue to fulfill their 

vital national security role. The current budget provides funding and programmatic 

support for the training, equipping, recruiting, and retaining of the Guard and Reserve. Sequestration will have a direct impact on the operations, maintenance, and 

training of our Reserve components and can run the risk of preventing the ability 

of the National Guard and Reserve to provide trained, ready, and cost-effective 

forces that can be employed not only for unanticipated national crises, but also on 

a regular operational basis, providing strategic depth for large-scale contingencies. 

The extent of the impacts of sequestration will depend on congressional action or 

inaction, OMB guidance, and the measures each Service employs to implement 

those measures. 

24. Senator GRAHAM. Dr. Woodson, will access and quality of medical care decline 

in the event of sequestration? 

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Dr. WOODSON. See response to question #22. 

25. Senator GRAHAM. Secretary Rooney, Secretary Hale, Mr. McGinnis, and Dr. 

Woodson, are you currently conducting any planning in your areas of responsibility 

(AOR) for the impact of sequestration, and if so, how are you assessing and mitigating the risk of the potential cuts beginning in January 2013? 

Dr. ROONEY, Mr. MCGINNIS, and Dr. WOODSON. The President’s budget makes the 

necessary budget adjustments to avoid devastating DOD through sequestration. If 

sequestration becomes an inevitability, DOD will evaluate all options available to 

comply with the law. 

Mr. HALE. Consistent with direction from OMB, DOD did not reflect the effects 

of the sequestration in its fiscal year 2013 budget submission. The President’s budget proposes over $4 trillion in balanced deficit reduction, which Congress could enact 

and avoid sequestration. DOD is not currently planning for sequestration. OMB has 

not directed agencies, including DOD, to initiate any plans for sequestration. 

REDUCTIONS IN ACTIVE DUTY END STRENGTH

26. Senator GRAHAM. Secretary Rooney, despite ongoing combat operations, it 

seems clear that budgetary pressures are going to force reductions in the number 

of Active Duty military personnel: Army down 49,000; Navy down 9,000; and Marine Corps down 16,000. The Air Force will downsize to prevent exceeding its end 

strength limit, due to high retention. I am concerned about the need for advance 

planning to implement cuts like these, and particularly with respect to the ground 

forces, the effect this may have on morale and readiness in the present. How will 

cuts in the Army and Marine Corps affect dwell time, assuming we are still deploying units to Afghanistan? 

Dr. ROONEY. In the near-term, the pace of the reductions will account for the completion of our mission in Afghanistan and provide the resiliency that comes with 

sufficient dwell times. 

In the long-term, these reductions are consistent with our plan to transition to 

the new strategic guidance—to build a force that is smaller, more agile, and able 

to adapt to an uncertain future security environment. 

The Services are shaping their future force structure in ways that protect their 

ability to maintain and regenerate capabilities needed to meet future, unforeseen 

demands, maintaining intellectual capital and rank structure that could be called 

upon to expand key elements of the force. For those critical skill sets, there will be 

a need to keep on hand some of the specialized infrastructure (people, facilities, 

training curricula), or seed corn, that will enable a new capability to be developed 

in a timely manner. Keeping experienced mid-grade officers and noncommissioned 

officers will also be key. The seed corn and the experience will need to be properly 

balanced between the Active and the Reserve components. 

27. Senator GRAHAM. Secretary Rooney, if we are unable to find the mandatory 

spending authority for the force shaping legislation you would like to have (such as 

early retirement authority and more Selective Early Retirement authority), what 

measures would you have to use to achieve these reductions? 

Dr. ROONEY. We currently have a limited number of force management tools we 

can use to achieve these reductions. They include, but are not limited to: Selective 

Early Retirement Board (SERB), Temporary Early Retirement Authority (TERA), 

Voluntary Retirement Incentive (VRI), and Voluntary Separation Pay (VSP). 

The reinstatement of Enhanced SERB authority, the extension of Early Discharge 

or Reduction in Force (RIF) authority, and expanded Time-in-Grade waiver authority, combined with the use of the current authorities, will allow the Services to execute a very balanced drawdown. These additional authorities allow us to shape the 

force with greater flexibility and fidelity. 

ARMY AND AIR NATIONAL GUARD

28. Senator GRAHAM. Mr. McGinnis, I’m interested in your views on the role of 

the Army and Air National Guard. There is no question that Guardsmen have been 

essential contributors in Iraq and Afghanistan. In the future, in an era of tight 

budgets, we need to have a clear understanding from the Army and Air Force about 

how the National Guard will and should best be employed. What is your view of 

the appropriate role of the National Guard? Stated differently, what does the term 

‘‘operational reserve’’ look like for the National Guard as it’s implemented over the 

Future Year Defense Program (FYDP)? 

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Mr. MCGINNIS. Missions that are predictable and long-lasting are particularly 

well suited to the Guard and Reserve. This was clearly established in the Comprehensive Review of the Future Roles of the Reserve Component approved by Secretary Gates on April 27, 2011. The legislation expanding authority in title 10, section 12304, that was passed last year, facilitates this type of utilization. The Guard 

and Reserve have proven themselves over the last 10 years. From a cost and readiness point of view, their continued use makes good sense. Placing Reserve component units and individuals in service force generation models with appropriate levels 

of resourcing makes full use of the Total Force. It also relieves stress on the Active 

Force, permits the Active Force to train for full spectrum operations, and maintains 

the readiness levels of the Reserve component. 

29. Senator GRAHAM. Mr. McGinnis, data from the Air National Guard suggests 

that operating under today’s deployment constraints, the Air Guard costs only 53 

percent of an equivalent Active Duty Air Force Major Command. In light of the cost 

effectiveness of the Guard and Reserve, why do you support cutting the Reserve capability in the Navy and the Air Force? 

Mr. MCGINNIS. The current National Guard and Reserve is, arguably, the most 

combat seasoned Reserve Force ever, and DOD seeks to capitalize on this significant 

investment to provide needed military capacity during current austere economic 

times. Since 2001, Reserve component units and individuals have been heavily employed across the full spectrum of military operations ranging from combat missions 

overseas to Homeland emergencies and national special security events. They have 

consistently demonstrated their readiness and enduring value. 

To ensure the Reserve component can continue to provide operational reserve and 

strategic capabilities, DOD included funding and programs in its fiscal year 2013 

budget request for their training, equipping, recruiting, and retention. I believe the 

service force generation models provide the best mechanism to maintain a ready Reserve component force that can routinely contribute to the operational force. As discussed in the recently released Comprehensive Review of the Future Role of the Reserve Component, I continue to strongly advocate for the value that the Guard and 

Reserve can bring to the force mix equation; value that leverage cost differentials, 

attainable readiness, and inherent strategic depth. I intend to continue to work 

closely with the Services and Joint Staff to ensure a ready Reserve component that 

contributes to the most efficient delivery of required capabilities of the Total Force. 

30. Senator GRAHAM. Mr. McGinnis, why is this the correct strategy, either from 

a fiscal or readiness point of view? 

Mr. MCGINNIS. Even as the pace of operations declines, placing the Reserve components in the Service rotational models expands readiness, permits the Active 

Force to reset and train, and provides an efficient use of the Total Force. There are 

currently ongoing studies that will provide further guidance on the appropriate force 

mix to achieve the right balance of Active and Reserve components to provide the 

necessary capabilities across the spectrum of operations to effectively support the 

national defense strategy. 

CYBERSECURITY

31. Senator GRAHAM. Secretary Rooney, defense against cyberattacks is on every 

American’s mind and DOD obviously has a big role to play and much at stake in 

this threat. What policies are being implemented to increase the skills and numbers 

of civilian and military personnel with cybersecurity skills? 

Dr. ROONEY. To increase the cybersecurity skills of civilian and military personnel, DOD is updating its current information technology (IT) and information assurance workforce management guidance and enhancing training and education offerings. DOD is in the process of establishing policy and procedural requirements 

for the cyberspace workforce, leveraging the basic concepts of previous issuances, 

DOD Directive 8570.01, ‘‘Information Assurance Training, Certification and Workforce Management,’’ and DOD 8570.01–M, ‘‘Information Assurance Workforce Improvement Program.’’ In addition, under oversight of the DOD CIO, the Information 

Resources Management College (iCollege) of the National Defense University has restructured its cybersecurity certificate program and recently introduced a cyber 

leadership program. 

DOD continues to explore optimal tools for recruitment and retention. Efforts include establishing a 2-year pilot program to use the DOD Information Assurance 

Scholarship Program to develop IT acquisition personnel with cybersecurity skill 

sets; working with the Office of Personnel Management to extend and enhance the 

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Cybersecurity Schedule A Hiring Authority (currently due to expire in December 

2012); and developing a new cyberaptitude test to support military recruiting efforts. 

32. Senator GRAHAM. Secretary Rooney, how are you avoiding duplication of efforts to train and recruit these specialists across the Federal Government as cited 

by the Government Accountability Office (GAO)? 

Dr. ROONEY. In light of emerging cyberthreats, cyberworkforce roles, responsibilities, and skill requirements continue to evolve, not only in DOD, but across the 

Federal Government. DOD is working on Federal-wide efforts through the National 

Initiative for Cybersecurity Education (NICE) and Federal CIO Council to establish 

a common lexicon across government and the private sector; identify current and 

emerging cyberskill requirements; and develop relevant education, training, and recruitment strategies. Also, DOD is developing a directive to establish policy and 

guidance for the management of the workforce in the cyberspace domain which will 

include an American National Standards Institute (ANSI) accredited, commercial 

certification requirement, as appropriate. Collaborations with other Federal Government entities and the use of commercial certification providers reduce duplication 

by establishing a baseline that can be applied across the Government, while still 

allowing DOD, or component-specific training based on relevant threat or mission 

profiles. 

33. Senator GRAHAM. Mr. McGinnis, how can the Reserve components be used creatively to enhance DOD’s strength in this important area? 

Mr. MCGINNIS. Many cybersecurity personnel in the Reserves are at the forefront 

of that industry in their employment as civilians. Within this evolving domain, Reserve components offer DOD the wide range of opportunity, flexibility, and depth 

of expertise that is difficult to capture within Active Forces. The Active component 

cyberworkforce and Active Duty missions are focused and scoped to meet the dayto-day Service-specific needs, limiting the ability to maneuver or plus-up in a crisis 

or a shift in threat. 

This originates from the depth and currency of expertise that individual reservists 

bring from their civilian positions that is not now captured in the training and development of the Active component cyberforces. Changes in the cyberindustry are 

rapid and the capacity for those changes to be reflected in Service cyberschools is 

slower than it is in industry. Reservists bring to the fight depth and up-to-date information which is then rapidly shared and infused into the Active component mission. 

DISABILITY EVALUATION SYSTEM

34. Senator GRAHAM. Secretary Rooney, do you agree that we have a large and 

growing problem for wounded and ill servicemembers who are in need of disability 

evaluation? 

Dr. ROONEY. More than a decade of war has increased DOD’s disability caseload 

but we are committed to ensuring that the evaluation and compensation of our 

wounded and ill servicemembers is fair, correct, and thorough. Many of these 

wounded and ill servicemembers suffer from highly complex injuries that take time 

to manifest, properly diagnose, and evaluate. DOD evaluated 18,393 servicemembers for disability during 2011, about the same number as in 2010 and about 

22 percent more than in 2001. More than 50 percent of those DOD evaluated in 

2011 went through the legacy process. Since November 2007, 49,478 servicemembers have entered and 19,518 have completed the Integrated Disability Evaluation System (IDES). Today, fewer than 2,000 servicemembers remain in the legacy 

process. At the same time, the inventory of servicemembers in the IDES has grown 

rapidly as installations complete their older, legacy cases and enter new cases in 

IDES. As of early May 2012, 27,371 servicemembers were in the IDES process (68 

percent Army, 12 percent Marine Corps, 9 percent Navy, and 12 percent Air Force). 

DOD’s number of servicemembers undergoing disability evaluation has grown since 

the beginning of the conflicts in Iraq and Afghanistan, and we project that it will 

continue to grow as servicemembers redeploy from Afghanistan and the Military 

Services reduce their end strength. Unfortunately, predicting the exact number of 

referrals into the IDES is complicated because many injuries and illnesses may take 

weeks, months, and years to manifest to the point where they prevent a 

servicemember from performing their duties. Nevertheless, we are committed to providing the necessary resources to accelerate IDES timeliness and improving all aspects of the Disability Evaluation System (DES) for our wounded and ill serviceVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00108 Fmt 6633 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
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members who are in need of disability evaluation. We are confident that we have 

the right measures in place to adequately staff and accelerate the IDES so it remains manageable for recovering servicemembers and the Military Services as they 

draw down and refit their forces. 

35. Senator GRAHAM. Secretary Rooney, what is the solution to this problem? 

Dr. ROONEY. DOD leadership is focused on improving the integrated disability 

evaluation process. DOD and the Department of Veterans Affairs (VA) leaders meet 

regularly to review progress toward that end. The Secretaries of DOD and VA have 

met to review progress multiple times in the last year and will receive monthly updates on progress toward this priority goal. Within DOD, the Military Services’ disability agencies and medical and personnel communities are expected to execute the 

DOD portion of IDES in 175 days and do so in accordance with their 10 U.S.C. 

Chapter 61 responsibilities and authorities. 

Under the IDES in March 2012, servicemembers averaged 395 days to complete 

both DOD and VA systems, significantly less than in the previous legacy system, 

but still short of our goal to have 60 percent of servicemembers complete the IDES 

in 295 days by the end of 2012. DOD is concentrating on accelerating the IDES to 

meet that goal and will not rest until all referred servicemembers experience the 

most efficient IDES possible, even in times of increased caseloads. DOD plans to accelerate the IDES by emphasizing the following themes. 

Proper Staffing 

The Services have planned their budgets to ensure proper staffing of the IDES. 

Their efforts are underway with the Army completing 1,218 of 1,400 (87 percent) 

hiring actions for additional IDES staff. The Navy has increased its Informal Physical Evaluation Board staffing by 47 percent and has reduced processing time from 

50 days in January to 11 days in March 2012, well within the goal of 15 days. It 

is noteworthy that there has been growth in the number of soldiers in the IDES. 

Although the number of servicemembers in the IDES has grown since 2007, that 

growth is mainly a result of the transition between the prior legacy processes and 

the IDES. Although DOD expects some increase in the number of servicemembers 

requiring disability evaluation as servicemembers redeploy from Afghanistan and 

the Services reduce end strength, DOD believes the right measures are in place to 

staff and accelerate the IDES so the situation remains manageable. 

Improving System Execution 

DOD and the Services are focused on fine-tuning the IDES by identifying and implementing best practices in training and execution. For example, the Navy has 

made significant gains in accelerating their medical evaluation boards (MEB) at 

Camp Lejeune by using existing technology in DOD’s Armed Forces Health Longitudinal Technology Application (AHLTA) to streamline the medical summaries. The 

Navy is now preparing to implement this improvement at all locations. The Air 

Force has improved their initial IDES referral screening process to prevent unnecessary referrals and added workload. The Army recently completed a review of its 

IDES process and is implementing an Execution Order (EXORD) to streamline and 

standardize their IDES operations. Each of the Services is taking positive steps to 

improve execution. 

Senior Leadership Involvement 

DOD and VA leaders meet regularly to ensure they oversee and drive progress 

within their commands. The Secretaries of DOD and VA meet quarterly to discuss 

IDES progress. The Vice Chief of Staff of the Army and the Navy’s Bureau of Medicine leadership both meet monthly with VA senior staff to review IDES processes 

and direct attention to areas needing improvement. Recently, these top leaders convened joint VA and DOD teams to examine existing capabilities and implement by 

this summer an electronic, paperless, searchable IDES case file transfer system. 

This work is on track and will significantly reduce workload, accelerate the process 

by about 20 days, and save about $600,000 in annual mailing costs. 

DOD’s goal is to continue to improve the IDES so that servicemembers will benefit from a process that is faster, fairer, and reduces the benefits gap. While this 

is appropriate, lasting improvement in disability evaluation requires a national dialogue and significant legislative work. DOD is in the beginning stages of exploring 

this strategic reform and envisions this to be a long-term project that will span several legislative and budgeting cycles. Any large-scale effort to revolutionize the DES 

would eventually require your leadership and we look forward to working with you 

when and if we reach that point. Because soldiers comprise approximately 67 percent of the current IDES caseload, the Army bears most of that operational burden. 

To accelerate disability processing, the Army issued execution and operation orders 

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in the first half of fiscal year 2012. The orders direct staffing, standardization, and 

execution improvements. We are confident this effort will produce results for the 

Army and the DOD as a whole. 

On the joint technology front, VA plans to release an improved version of the software DOD and VA use for disability evaluation in the third quarter of fiscal year 

2012. These improvements will enhance case management capability and add electronic interfaces that will reduce labor-intensive data-entry requirements and free 

staff to focus on one core VA IT system. In the fourth quarter of fiscal year 2012, 

VA plans to implement an electronic case file transfer capability or paperless claim 

file to the available IDES IT support tools. VA, in partnership with DOD, is planning future veterans tracking application improvements, including synchronization 

of disability IT improvements with efforts to develop an integrated electronic health 

record and the planned virtual lifetime electronic health care record. 

My Wounded Warrior Care and Transition Policy staff is also preparing updated 

IDES program guidance that will streamline and consolidate policy. DOD anticipates that this publication will ease execution of the IDES policy and procedural 

guidance and accelerate disability evaluation. 

36. Senator GRAHAM. Secretary Rooney, what will this situation look like in a year 

or 2 if we don’t come up with a solution? 

Dr. ROONEY. Predicting the exact number of referrals into the IDES is complicated because many injuries and illnesses may take weeks, months, and years to 

manifest to the point where a member’s fitness for duty maybe called into question. 

We project that DOD’s number of servicemembers undergoing disability evaluation 

will grow as servicemembers redeploy from Afghanistan and the Services reduce 

their end strength. But, we are also confident we have the right measures in place 

to adequately staff and improve the process so the situation remains manageable 

for servicemembers as they recover from their wounds and prepare to transition 

back to their communities and the Services as they drawdown and refit their forces. 

TRICARE REFORMS

37. Senator GRAHAM. Secretary Hale and Dr. Woodson, I’ve said that I support 

health care reform in DOD. Do you agree with me that if we don’t control the 

growth in health care costs, we will pay for it through decreased personnel and 

readiness? 

Mr. HALE and Dr. WOODSON. Absolutely. We project that the total medical care 

budget will grow to 10.7 percent of the DOD topline by fiscal year 2017 if we do 

not take additional measures to slow the growth in health care costs. 

If Congress does not provide us with needed support for the health reform proposals included in the fiscal year 2013 budget, DOD will have to find about $12.9 

billion from other defense programs to meet its health care obligations. Such action 

would place the new defense strategy at risk. Without needed authority, DOD will 

face further cuts in forces and investment to be consistent with the BCA. DOD’s 

budget proposal already makes substantial reductions in the investment accounts so 

further cuts might fall mostly on forces. This could mean cutting additional Active 

Duty and Reserve Forces by fiscal year 2017 at a magnitude that could jeopardize 

DOD’s ability to pursue the new defense strategy. 

38. Senator GRAHAM. Secretary Hale and Dr. Woodson, we received a 32-star letter embracing these proposals, so among the senior military leaders, there is no dissent, is that correct? 

Mr. HALE and Dr. WOODSON. That is correct; these proposals have the full support 

of DOD’s senior military leaders. 

39. Senator GRAHAM. Secretary Hale and Dr. Woodson, how does this administration’s proposal for fee increases compare with the proposal put forward in 2006, 

which we all felt was too much, too fast? 

Mr. HALE and Dr. WOODSON. While there are some similarities between the 2006 

and 2013 proposals, there are also significant differences. The 2006 proposal for 

Prime enrollment fees also involved three tiers and the enrollment fees for 2017 for 

each of the tiers are roughly the same as the 2006 proposals. However, the 2006 

proposal was based on retired rank vice retired pay. In 2006, the tiers were split 

by junior enlisted (E–6 and below), senior enlisted (E–7 and above), and officers. 

Based on current data, roughly 24 percent of retired beneficiaries under the age of 

65 would fall into the lowest category and 28 percent would fall into the highest 

category. With the 2013 proposal, 48 percent will fall into the lowest category and 

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only 12 percent will fall into the highest category. The 2006 proposals for Standard 

also involved implementing an enrollment fee and raising the deductible. The 2006 

proposals had tiers with the lowest tier having a 2017 enrollment fee of $410 and 

the highest tier, $820. The 2013 proposal has no tiers for Standard and the proposed 

2017 enrollment fee is $250. The deductibles proposed in 2006 were also tiered with 

the lowest tier having a $542 deductible in fiscal year 2007 and the highest tier having an $820 deductible. The 2013 proposal, with no tiers, is for a 2017 deductible 

of $580. There was no TRICARE For Life enrollment fee proposed in 2006. Finally, 

the 2006 pharmacy proposed copays were similar to the copays implemented in fiscal year 2012. 

40. Senator GRAHAM. Secretary Hale and Dr. Woodson, from what I have heard, 

one of the most controversial elements of the reforms that you are seeking in health 

care is a three-tiered system that links the amount of the fee a retiree pays to his 

or her military retired pay. What is DOD’s rationale in moving to means testing for 

military retiree health care benefits and why is it the right approach? 

Mr. HALE and Dr. WOODSON. Where feasible, the proposed fee increases were 

tiered by military retirement pay, based on the principles of the December 2007 

Task Force on the Future of Military Health Care. In its deliberations, the Task 

Force recognized that military retirement is not like most civilian retirement systems and that the entire military compensation system differs from the typical civilian salary system because much of the compensation is in-kind or deferred. Thus, 

changes in the health care benefit were examined in the context of this unique system and its compensation laws, policies, and programs. The Task Force believed 

that, for equity reasons, military retirees who earn more military retired pay should 

pay a higher enrollment fee than those who earn less. While this tiering approach 

is not commonly used in the private sector for enrollment fees, the Task Force believed that it made sense in a military environment. 

41. Senator GRAHAM. Dr. Woodson, under current law, the TRICARE Prime benefit is supposed to be cost neutral—that is, the government costs for Prime should 

not exceed the government costs for Standard. Does the cost of TRICARE Prime 

today comply with this requirement? If not, what is the difference in government 

costs between TRICARE Prime and TRICARE Standard for retirees? 

Dr. WOODSON. The Prime benefit is no longer cost neutral compared to Standard/ 

Extra plans. 

Section 731(c) of the National Defense Authorization Act (NDAA) for Fiscal Year 

1994 required that the benefit that became known as TRICARE Prime ‘‘shall be administered so that the costs incurred by the Secretary under the TRICARE program 

are no greater than the costs that would otherwise be incurred to provide health 

care to the members of the uniformed services and covered beneficiaries who participate in the TRICARE program.’’ When TRICARE was implemented in 1996, the 

Prime enrollment fee was set to: (1) offset the substantially reduced out-of-pocket 

costs, including the elimination of the Standard deductible, the near-total elimination of the 25 percent Standard inpatient copay, and the substantial reduction of 

outpatient copays; and (2) make Prime cost neutral to the government. Subsequent 

enactments regarding TRICARE for Active Duty family members have superseded 

the NDAA for Fiscal Year 1994 requirement for Active Duty family members, but 

not for Prime-eligible retirees. 

For a working retiree family of three, the cost to DOD of providing health care 

in fiscal year 2011: Prime—$13,442; Standard—$11,267. The disparity between 

Prime and Standard/Extra was recognized in 2005 and resulted in proposals to adjust cost shares to both Prime and Standard/Extra. DOD was largely prohibited 

from changing fees and copays until fiscal year 2012. The net result is that Prime 

is not cost neutral to the Standard/Extra plans. 

42. Senator GRAHAM. Dr. Woodson, is cost neutrality of a managed care option 

like Prime compared to fee for service still desirable, still achievable? 

Dr. WOODSON. Cost neutrality is a laudable goal and our efforts should try to 

move in that direction. However, we cannot get to complete cost neutrality without 

significantly increasing the cost shares under Prime above the levels proposed in the 

President’s budget. The proposed increases in the Prime enrollment fee are one part. 

We also believe that increases in utilization management envisioned under the Patient Centered Medical Home concept that we are implementing will bring the cost 

of Prime closer to Standard/Extra. 

43. Senator GRAHAM. Dr. Woodson, if you want to encourage more people to move 

from Prime to Standard, why make Standard more expensive? 

106 

Dr. WOODSON. DOD took a balanced approach to benefit reform with increases in 

cost shares for Prime, Standard, and to TRICARE For Life. Each program has not 

kept pace with the cost of medical care and thus DOD has been faced with funding 

a larger share of the total health care expenses. While Prime, with the fixed enrollment fee and relatively modest outpatient visit copay, saw the more significant 

change in the beneficiary share of the cost, Standard/Extra with no enrollment fee, 

fixed deductible, and especially the relatively low catastrophic cap also saw significant change. Both had to be adjusted and indexed so that the relationship between 

what DOD pays and what the beneficiary pays moves closer to what was originally 

intended and remains there. 

44. Senator GRAHAM. Dr. Woodson, your reform proposals to TRICARE pharmacy 

will likely cause people to use mail order pharmacy instead of their local pharmacy, 

is that correct? 

Dr. WOODSON. The copay changes included in the President’s fiscal year 2013 

budget proposal are intended to encourage beneficiaries to use the most cost-effective venue. Costs to both the government and to beneficiaries are lower in the military treatment facilities and the mail order pharmacy program than in the retail 

network pharmacy program. For example, review of recent DOD pharmacy data 

(fourth quarter of fiscal year 2011) show that moving 1 percent of the retail market 

of maintenance medication over to mail order would save approximately $1 million 

in fourth quarter of fiscal year 2011 or $4 million per year. It is worth noting that 

this 1 percent decrease in the retail market would have been a 1.8 percent increase 

in use at mail order pharmacies during the fourth quarter of fiscal year 2011 (because the retail market was larger than mail order). Also, these savings estimates 

assume the 1 percent moving over from retail to mail exactly matches the mix of 

maintenance medications that make up the retail market basket used in the study. 

45. Senator GRAHAM. Dr. Woodson, can you explain the cost difference for DOD 

for prescriptions obtained at a local pharmacy versus those that come from mail 

order? 

Dr. WOODSON. Based on DOD analysis of maintenance medications, which was 

comprised of 19.9 million prescriptions filled during the fourth quarter of fiscal year 

2011 at all three points of service (military treatment facilities, retail, and mail 

order), the data show that the mail order and military treatment facility venues to 

be more cost-effective points of service. The results showed the mean cost per 90- 

day supply of a market basket of maintenance medications was 19 percent lower 

through either the mail order program or military pharmacies, compared to the retail pharmacy network. 

46. Senator GRAHAM. Dr. Woodson, how much does DOD spend in pharmacy costs 

every year and where do you see that cost going in the future? 

Dr. WOODSON. The table below highlights actual pharmacy costs for fiscal years 

2009 through 2011. The table shows current projected costs for fiscal years 2012 and 

2013. We have assumed slower growth in the future due to proposed copay changes 

and project that pharmacy expenses will increase at roughly the Consumer Price 

Index, Medical (3 to 5 percent per year). Failure to increase pharmacy copayments 

may result in higher actual expense. 

[In millions of dollars] 

Fiscal Year 

2009 2010 2011 2012 2013 

Under 65 Pharmacy Expense ......................................... $3.42 $3.82 $4.32 $3.95 $3.76 

Medicare Eligible Pharmacy Expense ............................ 4.19 4.06 3.71 4.32 4.72 

Total Pharmaceutical Expense ............................. 7.61 7.88 8.03 8.27 8.48 

47. Senator GRAHAM. Dr. Woodson, what initiatives are underway, other than adjustments to cost sharing, to reduce the costs of the TRICARE pharmacy program? 

Dr. WOODSON. Over the last several years, DOD has made significant efforts to 

control rising pharmacy benefit costs. The strategies and efforts pursued have been 

drawn from private sector best business practices, national trends, congressional 

mandates, professional consultants, and independent studies. Each effort has had 

an effect in controlling the rise in pharmacy costs. Many programs and policies surVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00112 Fmt 6633 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
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rounding formulary management within TRICARE closely mirror what commercial 

plans do to manage drug benefits. 

Implementation of section 703 of the NDAA for Fiscal Year 2008 granting DOD 

authority to obtain Federal discounts in the retail pharmacy venue has collected 

over $3.5 billion in refunds as of March 30, 2012. 

Publication of an Interim Final Rule in December 2009 covering seasonal flu, 

H1N1 flu, and pneumococcal vaccines followed by a final rule in August 2011 provided the authority for the TRICARE pharmacy benefit to cover all TRICARE-allowed vaccines within the retail pharmacy setting, significantly increasing accessibility of vaccines for the prevention of diseases. Over 700,000 vaccines have been 

administered through 45,000 retail pharmacies under this program since December 

2009 at no copay for beneficiaries. In addition to the increased accessibility of vaccines for beneficiaries, the discounted price to the government was a factor in the 

decision for this effort. 

The TRICARE Management Activity Beneficiary Education and Support Division 

in conjunction with the Pharmaceutical Operations Directorate implemented a comprehensive home delivery (mail order) marketing program in 2010. Over the course 

of 2 years this initiative has contributed to an overall increase of 23 percent in home 

delivery. In 2011, home delivery prescriptions totaled over 12 million. At the same 

time that the home delivery use increased, the growth in the more expensive retail 

use has slowed, declining for the first time in 2011. In the first quarter of fiscal year 

2012 the government cost savings associated with this enhanced communication effort totaled $17.2 million. 

Substantial additional cost avoidance (over and above the standard retail rebate) 

is realized as a result of the ongoing clinical and cost effectiveness evaluations of 

drugs and drug classes for the TRICARE Uniform Formulary (first implemented 

mid-2005), which allowed for tiered formulary copays and the ability to negotiate 

with manufacturers for better pricing based on formulary status. As an example, the 

additional first-year cost avoidance for drug classes reviewed in fiscal year 2010 was 

estimated to be $131 million. In fiscal year 2011, approximately $161 million in cost 

avoidance was obtained over and above the mandatory retail refund. The recent 

copay changes have also added to our negotiation leverage with the pharmaceutical 

manufacturers. 

Step therapy, requiring a trial of a preferred agent prior to covering a non-preferred agent—is among the formulary tools used to promote evidence-based and 

cost-effective drug therapy and to negotiate better pricing with manufacturers. We 

estimate that over 4 years (August 2007–June 2011), formulary decisions in four 

major drug classes with step therapy programs resulted in at least $786 million in 

voluntary rebates over and above the mandatory retail rebate. 

The NDAA for Fiscal Year 2007 directed implementation of an over-the-counter 

(OTC) demonstration project to allow selected OTC drugs to be included on the DOD 

Uniform Formulary thereby allowing access to less costly medications in place of the 

more expensive prescription products. The success of the program from both the 

beneficiary and government perspective has resulted in preparation of a legislative 

proposal requesting permanent authority for this program. Through November 30, 

2011 the program has saved DOD $48.5 million. 

48. Senator GRAHAM. Dr. Woodson, TRICARE is a complex program that includes 

many benefit options. The administration’s proposals will add to its complexity by 

creating a three-tiered copayment structure based on retired income. Did you take 

into consideration the increasing complexity of administering TRICARE in the development of your reform proposals? 

Dr. WOODSON. Yes, we did consider the complexity in administering a pharmaceutical copayment structure based on retired income. For that reason, DOD’s pharmacy copayment increase proposal is not linked to retirement pay. The proposed 

fees will be tiered, as they are today, based on the drug class status (i.e. generic, 

brand, or non-formulary). For Prime and TRICARE For Life enrollment fees, DOD’s 

decision was to tier the premiums. This will add some complexity, which was taken 

into consideration, but it was determined to be achievable and worth the effort. 

49. Senator GRAHAM. Dr. Woodson, what are the costs associated with the administration of the new benefit structure in fiscal year 2013 through fiscal year 2017? 

Dr. WOODSON. The fiscal year 2013 fee proposals included an implementation cost 

of $33 million in fiscal year 2012. The model assumed these costs in fiscal year 2012 

on the assumption that contract modifications would need to be issued in fiscal year 

2012 in order for the benefit changes to go into effect for fiscal year 2013. For subsequent years, starting fiscal year 2013, the budget also included annual administrative costs of $16 million for ongoing administration of the enrollment fee process in 

108 

TRICARE Standard. All of these amounts should be viewed as rough order-of-magnitude placeholders, pending development and analysis of actual implementation details, timelines, et cetera. 

50. Senator GRAHAM. Secretary Hale and Dr. Woodson, you and the military leadership have described the fiscal year 2013 budget request as an interconnected 

whole. What is the budgetary and programmatic impact on that whole if Congress 

fails to enact the reforms you have requested? 

Mr. HALE. The reforms we requested are an essential element in meeting the fiscal controls mandated by the BCA of 2011. Therefore, any reduced savings from failure to implement DOD’s TRICARE reform proposals will have to be replaced with 

commensurate reductions in other DOD accounts. This will undermine DOD’s attempt to execute the new strategy as stated and raises the risk that readiness will 

suffer. 

Dr. WOODSON. If Congress fails to enact the proposed health care reforms, DOD 

will be forced to shoulder the increasing cost of military health care, likely at the 

expense of force structure and in modernization. DOD’s budget proposal already 

makes substantial reductions in the investment accounts, so further cuts could 

mean cutting additional Active Duty and Reserve Forces, which would impact 

DOD’s ability to pursue the new defense strategy. 

51. Senator GRAHAM. Secretary Hale and Dr. Woodson, how realistic are your 

health care savings targets for fiscal year 2013 in light of the timetable for completion of legislation for fiscal year 2013? 

Mr. HALE and Dr. WOODSON. DOD will continue dialogue with Congress to identify options to achieve savings in fiscal year 2013. Our budget estimates are predicated on fee changes going into effect on October 1, 2012. DOD requires several 

months of lead time to make the appropriate contract and system changes to meet 

this timeline. Delays in the timetable for the completion of legislation will result in 

reduced savings in fiscal year 2013. 

52. Senator GRAHAM. Secretary Hale and Dr. Woodson, what options does DOD 

have to achieve savings in fiscal year 2013 if the NDAA becomes law late in fiscal 

year 2012? 

Mr. HALE. The fiscal year 2013 budget request assumes implementation of the 

TRICARE reform proposals on or about October 1, 2012. The projected fiscal year 

2013 TRICARE savings are $0.7 billion. Should the NDAA for Fiscal Year 2013 preclude the TRICARE reform proposals, DOD will most likely have to find commensurate savings in operational accounts with potential negative impact on readiness. 

Dr. WOODSON. Our budget estimates are predicated on fee changes going into effect on October 1, 2012. DOD requires several months of lead time to make the appropriate contract and system changes to meet this timeline. Delays in the timetable for the completion of legislation will result in reduced savings in fiscal year 

2013. DOD will continue dialogue with Congress to determine the appropriate 

course of action and implementation timelines. 

INTERNAL EFFICIENCIES IN HEALTH CARE

53. Senator GRAHAM. Dr. Woodson, military family and veterans groups have 

urged that you exhaust internal efficiencies in health care before increasing fees. 

What progress are you making in internal reforms and how much money have they 

saved prior to going ahead with this year’s proposal? 

Dr. WOODSON. We completely agree. We have been working aggressively to reduce 

the administrative overhead of the military health system by reducing reliance on 

contract support; reducing the number of government staff; reducing the number of 

boards and studies conducted; implementing leading purchasing practices for buying 

the best medical products at the lowest cost; and simply doing more with less. 

Health care savings initiatives—other than beneficiary cost sharing proposals— 

continue to be proposed and implemented, resulting in real cost savings. However, 

it is important to note that because the vast majority of the health care budget is 

spent on providing direct patient care, there is a limit on the amount of savings that 

can be achieved through internal efficiencies alone. As a result, changes in beneficiary cost sharing represent only one of the key steps that we are taking to improve health care and reduce the rate of growth in health care costs. We are also 

employing other approaches, including: (1) Moving from Healthcare to Health; investing in initiatives that keep our people well while promoting healthy lifestyle; (2) 

Maximizing Internal Efficiencies; that reduce the administrative overhead of our 

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1 $1.5 billion in collections since 2009, based on data ending 31 January 2012; discretionary 

savings (DHP) and the reductions in outlays from the Medicare-Eligible Retiree Health Care 

Fund (MERHCF) since 2009 were approximately $3.5 billion. 

military health system; and (3) Reforming Provider Payments; by responsibly paying 

private care providers and aligning with Medicare reimbursement levels, as required by law. 

Over the past several years, we have made great progress in implementing 

changes that have resulted in real cost savings. Below is a summary of these efforts: 

• Federal Ceiling Price: In 2008, with the support of Congress, DOD championed changes in law (known as Federal Ceiling Price) that require pharmaceutical manufacturers to provide DOD about $800 million annually in 

discounts for drugs provided to TRICARE beneficiaries through retail network pharmacies. This authority will provide DOD over $4 billion in collections over the next 5 years, representing substantial savings.1

• Outpatient Prospective Payment System: In 2009, by aligning its payments with Medicare rates (known as the Outpatient Prospective Payment 

System), DOD instituted changes in the way it reimburses private hospitals 

for outpatient services provided to TRICARE beneficiaries. When fully implemented, these changes will save DOD over $900 million annually. This 

new system will result in over $4.6 billion in savings over the next 5 years. 

• Sole Community Hospital: DOD is in the process of revising its payment 

rules to reimburse inpatient care claims at sole community hospitals by 

using Medicare rates; when fully implemented, this action will result in 

savings of about $100 million annually. 

• Medical Supply Chain Optimization and Standardization: To further reduce costs, DOD is changing the way it buys medical products, by 

leveraging the bulk buying power of the military health system. A series 

of strategic price reduction initiatives are being implemented, saving DOD 

on average $60 million annually. 

• Reducing Administrative Overhead: DOD is reducing administrative overhead in the military health system by streamlining its processes; reducing 

the number of unnecessary reports, studies, and commissions; and initiating other actions which will result in over $200 million in reduced personnel and contract costs annually. 

• Reducing Fraud, Waste, and Abuse: DOD is stepping up its efforts to detect fraud, waste, and abuse from fraudulent providers and institutions, 

and to recover overpayments. We expect these efforts will save DOD on average $35 million annually over the next 5 years. 

• Investing in Health: Finally, in effort to control long-term costs, DOD is 

pursuing a multifaceted strategy to invest in initiatives that keep beneficiaries well, promote healthy lifestyles, and reduce inappropriate emergency room visits and unnecessary hospitalizations while improving patient 

satisfaction. In the short term, we expect savings on average of over $25 

million over the next 5 years. 

54. Senator GRAHAM. Dr. Woodson, how can Congress help you achieve them? 

Dr. WOODSON. We appreciate Congress’ support for past efficiency efforts. DOD 

continues to reduce the administrative overhead of its military health system by reducing reliance on contract support; reducing the number of government staff; reducing the number of boards and studies being conducted; implementing leading 

purchasing practices for buying the best medical products at the lowest cost; and 

simply doing more with less. 

More is achievable with changes in the organizational structure of military medicine (report submitted to congressional committees). We look forward to Congress’ 

support for these proposed changes. 

TRANSITIONAL HEALTH BENEFITS

55. Senator GRAHAM. Dr. Woodson and Mr. McGinnis, if the administration’s plan 

to reduce military personnel goes forward, some who have served may be involuntarily separated. What health benefits will those involuntarily separated from Active 

Duty receive? 

110 

2 Eligibility for the TAMP for sponsors and family members is determined by the sponsor’s 

Service branch and information in the Defense Enrollment Eligibility Reporting System. TAMP 

categories are: members involuntarily separated from Active Duty and their eligible family 

members; National Guard and Reserve members, collectively known as the Reserve component, 

separated from Active Duty after being called up or ordered in support of a contingency operation for an Active Duty period of more than 30 days and their family members; members separated from Active Duty after being involuntarily retained in support of a contingency operation 

and their family members; and members separated from Active Duty following a voluntary 

agreement to stay on Active Duty for less than 1 year in support of a contingency mission and 

their family members. 3 Ibid. 

Dr. WOODSON and Mr. MCGINNIS. Active Duty servicemembers who are involuntarily separated from the Active component may 2 qualify for 180 days of premium 

free TRICARE coverage under the Transition Assistance Management Program 

(TAMP); (10 U.S.C. 1145(a)(2)(A)). TAMP offers comprehensive, premium-free 

TRICARE coverage to both the sponsor and eligible family members on the same 

basis as an Active Duty family member. At the conclusion of this transition period 

the individual and or his family is also eligible to purchase the Continued Health 

Care Benefit Program (CHCBP) plan, which is a premium based, temporary health 

care coverage program (18 months of eligibility) similar to better known COBRA 

program. It provides the Basic program benefits generally offered under the 

TRICARE Standard program. The premium rates are based on the Federal Employees Health Benefits program employee and agency contributions for a plan with 

similar benefits. 

56. Senator GRAHAM. Dr. Woodson and Mr. McGinnis, what about for those involuntarily separated from the Reserve components? 

Dr. WOODSON and Mr. MCGINNIS. ‘‘A member of a Reserve component who is separated from Active Duty to which called or ordered in support of a contingency operation if the Active Duty is Active Duty for a period of more than 30 days’’ may 3

qualify for 180 days of premium free TRICARE coverage under the TAMP (10 

U.S.C. 1145(a)(2)(B)). TAMP offers comprehensive, TRICARE coverage to both the 

sponsor and eligible family members on the same basis as an Active Duty family 

member. 

If the Reserve component member is involuntarily disaffiliated from the Armed 

Forces altogether and the member had TAMP, TRICARE Reserve Select, or 

TRICARE Retired Reserve coverage at the time, the member and eligible family 

members may purchase premium-based coverage under the CHCBP. 

57. Senator GRAHAM. Dr. Woodson and Mr. McGinnis, are these benefits fair and 

reasonable or should Congress consider some enhancement, particularly for the Reserve and Guard? 

Dr. WOODSON and Mr. MCGINNIS. Congress recently enhanced the transitional 

health benefits for Reserve component members. Section 703 of the NDAA for Fiscal 

Year 2010 (P.L. 111–84) amended law and offered Active Duty dental coverage to 

the Reserve component sponsor (and sponsor only) in TAMP. This provision was implemented by the Final Rule published in the Federal Register December 28, 2011 

(76 FR 81366–81368) and is fully operational as reported in the TRICARE news release http://www.tricare.mil/mediacenter/news.aspx?fid=742. 

Comprehensive coverage under the CHCBP is now available for purchase by all 

individuals who lose coverage under TAMP or any TRICARE program under Chapter 55 of Title 10, U.S. Code. 

This is further bolstered by the enhanced health care benefits eligibility from the 

VA enjoyed by combat veterans. This enrollment period was extended from 2 years 

to 5 years by section 1707 of the NDAA for Fiscal Year 2008 (P.L. 110–181, January 

28, 2008), which amended 38 U.S.C. 1710(e)(3). 

DOD has proposed a legislative change to extend eligibility for TRICARE Reserve 

Select and TRICARE dental coverage for a period of 180 days for members of the 

Selected Reserve who are involuntarily separated. 

FAMILY SUPPORT PROGRAMS

58. Senator GRAHAM. Secretary Rooney, Secretary of Defense Panetta has assured 

Congress that support for family support programs is protected throughout DOD 

even in this austere budget. Yet, testimony provided by the National Military Family Association argues that ‘‘family programs are being short-changed,’’ by reductions in child care and family support. 

111 

Our expectation is that the Secretary’s pledge will be fulfilled. What are you doing 

in your oversight capacity to ensure that family programs are not reduced during 

this time of war? 

Dr. ROONEY. To ensure that family programs are not reduced during this time of 

war, I emphasized the need for the Services to safeguard and sustain current funding levels for their family programs. This resulted in implementation of a comptroller-mandated, in-depth, mid-year review of the Services’ budgets. The Services 

are in the process of scrutinizing their budgets, tracking program funding, and disclosing discrepancies that could indicate diversion of funds from programs for which 

the funds were originally intended. Ongoing tracking of budgets and reporting on 

status of budgets supports the Secretary’s position of keeping faith with servicemembers and their families to protect family assistance programs. 

QUESTION SUBMITTED BY SENATOR SAXBY CHAMBLISS

UNIFORMED SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT

59. Senator CHAMBLISS. Secretary Rooney and Mr. McGinnis, the Uniformed Services Employment and Reemployment Rights Act (USERRA) protects millions of people, largely National Guard and Reserve members, as they transition between their 

Federal duties and civilian employment. USERRA is intended to eliminate or minimize civilian employment disadvantages resulting from service in the Reserve components and protect the rights of those members when they deploy. Since September 

11, 2001, over 835,000 citizen soldiers have mobilized to fight the war on terrorism. 

Many American soldiers have served more than one tour of duty and may be required to serve more. As we downsize the Active Force and operationalize the Reserve Force, it is likely that Reserve soldiers will continue to mobilize to fill the gaps 

of the smaller Active Force. In light of this stress on the Reserve components, do 

you see the need for any changes to USERRA to provide additional protection to our 

Guard and Reserve members? 

Dr. ROONEY and Mr. MCGINNIS. No changes to USERRA are required at this 

time. On balance, our Nation’s employers have proven to be full partners in the 21st 

century Total Force. Moving forward, as we believe civilian employment is a key 

part of individual readiness, we are committed to ensuring strong protections for Reserve component servicemembers. As such, we will continue to review existing laws 

to ensure that they are keeping up with the needs of the servicemembers. 

QUESTIONS SUBMITTED BY SENATOR KELLY AYOTTE

MEDICARE AND TRICARE

60. Senator AYOTTE. Dr. Woodson, the Centers for Medicare and Medicaid Services (CMS) are engaged with a number of States in seeking ways to enhance care 

and reduce costs for Medicare/Medicaid dual-eligible beneficiaries. The nearly 2 million TRICARE For Life beneficiaries are another large population that is dually entitled—to Medicare and TRICARE in this case. Have you explored with Medicare 

leadership the possibilities for interagency cooperation to evaluate potential approaches to coordinating benefits and enhancing care for TRICARE For Life beneficiaries? 

Dr. WOODSON. TRICARE For Life provides Medicare wraparound coverage when 

health care is a benefit under both programs, as long as the beneficiary is enrolled 

in Medicare Part B. Medicare pays 80 percent of their allowed amount, and claims 

automatically cross over to TRICARE where TRICARE processes the remainder for 

payment. 

Recently, TRICARE Management Activity staff met with representatives from the 

CMS’ Innovation Center to discuss the Comprehensive Primary Care Initiative that 

CMS is developing. This initiative will use a managed care approach to providing 

preventive care and disease management for Medicare and other patients. It will 

reward providers when costs are reduced as participants in the initiative achieve 

desired health outcomes. Many TRICARE For Life beneficiaries are likely participants in the initiative, and TRICARE intends to monitor progress and results of the 

initiative to assess how and whether to apply the care approach to a broader segment of our TRICARE For Life population. 

We have also instituted new management controls that are applicable when 

TRICARE becomes primary payer for a TRICARE For Life beneficiary’s stay in a 

skilled nursing facility (SNF). This occurs after exhaustion of the 100-day SNF care 

coverage provided by Medicare. We have found that bills for SNF care are among 

112 

the largest of any that TRICARE For Life must cover. Now we require that SNF 

care beyond 100 days be preauthorized and base the decision upon review of medical 

records to ensure: (a) that skilled care truly is required; and (b) if skilled care is 

required, that it is of such intensity that it cannot be safely provided at a lower, 

less expensive, level than in a SNF. 

61. Senator AYOTTE. Dr. Woodson, would this be a way to provide better care at 

a lower cost to the taxpayers for TRICARE For Life beneficiaries? 

Dr. WOODSON. There is potential that Medicare’s Comprehensive Primary Care 

Initiative will demonstrate an improvement in outcomes and will lower cost. That 

is why we are supportive of the initiative and intend to monitor its progress and 

results closely to determine if the approach is one that would have application to 

a broader set of our TRICARE For Life beneficiaries. 

DEFENSE HEALTH PROGRAM

62. Senator AYOTTE. Secretary Hale, I understand that in their 2007 report, the 

Task Force on the Future of Military Health Care called on DOD to conduct an 

audit of financial controls on the DHP, to include establishment of a common cost 

accounting system. Did you serve on this task force? 

Mr. HALE. Yes, I did serve on the Task Force on the Future of Military Health 

Care before assuming my current position. As noted above, the Task Force recommended: (1) the conduct of an external audit to ensure the proper financial controls with respect to health care eligibility and coverage, and (2) the establishment 

of a common cost accounting system to provide a more accurate level of accounting 

for costs across the Military Health System (MHS). 

The Defense Manpower Data Center (DMDC), a component of the Defense Human 

Resources Activity (DHRA), provides the beneficiary data upon which eligibility for 

health care benefits is determined. The data is maintained in the Defense Enrollment and Eligibility Reporting System (DEERS) database. Both DMDC and DHRA 

understand and support the value of an independent, external audit of financial controls on the DHP. 

DMDC is audited twice yearly by auditors external to the DHRA and the DHP. 

In that regard, the DOD Inspector General conducted an Audit of Beneficiary Data 

in the DEERS database (Project No. D2010–D000FR–0149.000) ‘‘to assess the completeness and accuracy of beneficiary data contained in DEERS used to estimate 

health care liabilities on DOD financial statements,’’ and actions are underway to 

address the findings of the audit. 

With respect to the establishment of a common cost accounting system, DOD is 

in the process of developing a statement of work to seek expert assistance in evaluating a set of alternatives for creating a common cost accounting structure and universal application across MHS. More specifically, DOD will evaluate the feasibility 

of overlaying a common cost accounting structure across the various disparate financial systems of the Service Medical Departments and the TRICARE Management 

Activity. In addition, DOD will evaluate the option of adopting a single financial 

system across the MHS, with special consideration to Service or Department systems further along in their development. We strongly believe that having a common 

cost accounting structure is a key component for improving financial transparency 

across the MHS and we are working on an aggressive schedule to accomplish this 

critical evaluation. 

63. Senator AYOTTE. Secretary Hale, is that recommendation still valid today? 

Mr. HALE. Yes, the recommendation is still valid today. As mentioned previously, 

both the DMDC and the DHRA understand and support the value of an independent, external audit of financial controls on the DHP, to include the establishment of a common cost accounting system. In addition, DOD is working aggressively 

to evaluate options for improving financial transparency across the MHS. 

64. Senator AYOTTE. Secretary Hale, what actions are underway to achieve greater accountability and additional savings for the DHP, to include protection against 

fraud and recovery of payments from other health insurance? 

Mr. HALE. DOD is employing a multi-prong approach for achieving greater accountability and additional savings for the DHP, to include: (1) Moving from 

Healthcare to Health; investing in initiatives that keep our people well while promoting healthy lifestyle; (2) Maximizing Internal Efficiencies; that reduce the administrative overhead of our MHS; and (3) Reforming Provider Payments; by responsibly paying private care providers. We are also stepping up our efforts to reVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00118 Fmt 6633 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
113 

duce fraud, waste and abuse and increase our recovery of payments from other 

health insurance. Specific strategies include utilizing third party entities to detect 

other health insurance coverage and prepare these cases for recovery; educating 

beneficiaries about legal requirements to disclose other health insurance coverage; 

and training MTF staff in proper patient intake procedures and tools available to 

increase recovery of payments. 

[Appendices A through F follow:] 

APPENDIX A


328pe115.eps
114 


328per4.eps

MR. CHAIRMAN AND DISTINGUISHED MEMBERS OF THE SUBCOMMITTEE. On behalf of 

The Military Coalition (TMC), a consortium of nationally prominent unifonned services and veterans' 

organizations, we are grateful to the committee for this opportunity to express our views concerning 

issues affecting the unifonned services community. This testimony provides the collective views of the 

following military and veterans' organizations, which represent approximately 5.5 million current and 

fonner members of the seven unifonned services, plus their families and survivors. 

Air Force Association 

Air Force Sergeants Association 

Air Force Women Officers Associated 

Aimy Aviation Association of America 

Association of Military Surgeons of the United States 

Association of the United States Anny 

Association of the United States Navy 

Chief Warrant Officer and Warrant Officer Association, U.S. Coast Guard 

Commissioned Officers Association of the U.S. Public Health Service, Inc. 

Enlisted Association of the National Guard of the United States 

Fleet Reserve Association 

Gold Star Wives of America, Inc. 

Iraq and Afghanistan Veterans of America 

Jewish War Veterans ofthe United States of America 

Marine Corps League 

Marine Corps Reserve Association 

Military Chaplains Association ofthe United States of America 

Military Officers Association of America 

Military Order ofthe Purple Heart 

National Association for Unifonned Services 

National Guard Association of the United States 

National Military Family Association 

Naval Enlisted Reserve Association 

Non Commissioned Officers Association 

Reserve Enlisted Association 

Reserve Officers Association 

Society of Medical Consultants to the Anned Forces 

The Retired Enlisted Association 

United States Anny Warrant Officers Association 

United States Coast Guard Chief Petty Officers Association 

Veterans of Foreign Wars 

Wounded Warrior Project 

The Military Coalition, Inc. does not receive any grants or contracts from the federal government. 
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Executive Summary 

FY2013 Budget Submission on TRICARE Fees 

The Coalition believes DoD's proposals for dramatic TRICARE fee hikes constitute a serious breach of 

faith with currently serving troops and families by cutting their future healthcare benefits. And if 

breaking faith with the currently serving is wrong, so is imposing a major "bait and switch" change on 

those who already completed 20-30 year careers, induced by promises of current benefits. 

TRICARE Prime Fees: Reject any increase in TRICARE Prime fees that exceeds the COLA-based 

standard established in the FY2012 Defense Authorization Act. 

TRICARE Standard Fees: 

The Coalition urges rejection of any TRICARE Standard enrollment fee unless and until the 

government provides guaranteed access to care for Standard beneficiaries 

The Coalition urges the Subcommittee to reject DoD's proposal to nearly double the TRICARE 

Standard deductible over the next five years. 

TRICARE For Life Enrollment Fee: Sustain current law that avoids any enrollment fee for TRICARE 

For Life, consistent with Congress' determination in 2001 that the service and sacrifices extracted from 

military retirees and families over the course of their careers constituted a pre-paid premium for their 

TFL coverage as a Medicare supplement. 

TRICARE Pharmacy Copays: Reject Administration-proposed pharmacy copayment increases that 

would inappropriately "civilianize" the military pharmacy benefit, dramatically raise costs for both 

retired and currently serving families, and deter beneficiaries from adhering to medication regimens that 

are essential to their long-term health as well as DoD's long-term cost containment. 

TRICARE Proposals Raise New Inequities: The extremely limited categories of exemptions for 

survivors and disabled retirees disregard the similar or more severe situations of other survivors and 

disabled. The Coalition does not propose expanding the exemption, because that would imply a level of 

Coalition concurrence with the proposed fee hikes that does not exist. We raise this inequity issue as 

another reason why the proposed fee increases are grossly inappropriate for all grades and categories of 

beneficiaries. 

TRICARE Fee "Tiering": Strongly oppose means-testing of military benefits, under which longer and 

more successful service would be penalized by progressive reduction of military healthcare benefits. The 

Coalition believes all retired servicemembers earned equal health care coverage by virtue of their service 

and that the proposed dramatic fee increases are inappropriate for servicemembers of all grades. 

TRICARE Fee Indexing: Reject the DoD-proposed tying of annual increases in military health care fees 

to an index of health cost growth which would dramatically and disproportionally accelerate military 

healthcare fees over time. 

Military Health Care Principles: The Coalition believes the law should be changed to explicitly 

acknowledge that: 

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The healthcare benefit provided for members and families who endure to complete a military career 

should be among the very best available to any American; 

The decades of service and sacrifice rendered by career military personnel constitute a significant 

pre-paid premium toward their healthcare in retirement; and 

The large value of this pre-paid premium should be accounted for by minimizing fees payable in 

retirement and avoiding significant and arbitrary increases from year to year. 

Leadership Accountability 

The Coalition urges the Subcommittee to hold Defense leaders accountable for their own management, 

oversight, and efficiency failures before seeking to shift more costs to beneficiaries. Congress should 

direct DoD to pursue any and all options to constrain the growth of health care spending in ways that do 

not disadvantage beneficiaries. 

Wounded, Ill, and Injured Servicemember Issues 

The Coalition urges: 

Joint hearings by the Armed Services and Veterans Affairs Committees addressing the Joint 

Executive Council's (JEC) effectiveness in daily oversight, management, collaboration, and 

coordination of the Departments' wounded, ill, and injured servicemember programs. 

Permanent funding, staffing, and accountability for congressionally mandated Defense Centers 

of Excellence and associated mental-behavioral health, suicide prevention, caregiver, respite, and 

other medical and non-medical programs. 

Continued aggressive oversight of the Integrated Disability Evaluation and legacy disability 

evaluations systems to ensure preservation of the 30-percent threshold for medical retirement, 

consistency and uniformity of policies, ratings, legal assistance, benefits, and transitional 

services Defense-wide. 

DoD - VA SeamJess Transition 

The Coalition urges: 

Joint hearings by the Armed Services and Veterans Affairs Committees to assess the 

effectiveness of current seamless transition oversight efforts and systems and to solicit views and 

recommendations from DoD, VA, the military services, and non-governmental organizations 

concerning how joint communication, cooperation, and oversight could be improved. 

Authorizing service-disabled members and their families to receive active-duty-Ievel TRICARE 

benefits, independent of availability of VA care for three years after medical retirement to help 

ease their transition from DoD to VA. 

Ensuring Guard and Reserve members have adequate access and treatment in the DoD and VA 

health systems for Post Traumatic Stress Disorder and Traumatic Brain Injury following 

separation from active duty service in a theatre of operations. 

DoD-VA Integrated Disability Evaluation System (IDES) 

The Coalition recommends: 

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Preserving the statutory 30 percent disability threshold for medical retirement in order to provide 

lifetime TRICARE coverage for those who are injured while on active duty. 

Reforming the 000 disability retirement system to require inclusion of all unfitting conditions 

and accepting the VA's "service-connected" rating. 

Ensuring any restructure of the 000 and VA disability and compensation systems does not 

inadvertently reduce compensation levels for disabled service members. 

Eliminating distinctions between disabilities incurred in combat vs. non-combat when 

determining benefits eligibility for retirement. 

Revision of the VA schedule for rating disabilities (V ASRD) to improve the care and treatment 

of those wounded, ill and injured, especially those diagnosed with PTSD and TBI. 

Barring designation of disabling conditions as "existing prior to service" for servicemembers 

who have been deployed to a combat zone. 

Directing 000 to re-engineer and redesign the front end of IDES to (I) better ensure medical 

evaluations are consistently based on a fully developed, accurate medical summary; (2) permint 

the servicemember's full participation; (3) afford each individual consistent, effective 

representation throughout the process; and (4) streamline the system by eliminating the 

redundancy of dual adjudication of disability. 

Caregiver/Family Support Services 

The Coalition recommends: 

Providing enhanced training of 000 and VA medical and support staff on the vital importance of 

involving and informing designated caregivers in treatment of and communication with severely 

ill and injured personnel. 

Providing health and respite care for non-dependent caregivers (e.g., parents and siblings) who 

have had to sacrifice their own employment and health coverage while the injured member 

remains on active duty, commensurate with what the VA authorizes for medically retired or 

separated members' caregivers. 

Extending eligibility for residence in on-base facilities for up to one year to medically retired or 

severely wounded servicemembers and their families (or until the medically retired or severely 

injured service member receives a VA compensation rating, whichever is longer). 

Guard and Reserve Healthcare 

The Coalition recommends: 

Authorizing TRICARE for early Reserve retirees who are in receipt of retired pay prior to age 60 

Authorizing premium-based TRICARE coverage for members of the Individual Ready Reserve after 

being called to active service for a cumulative period of at least 12 months 

Permitting employers to pay TRS premiums for reservist-employees as a bottom-line incentive for 

hiring and retaining them. 

Authorizing an option for the govenunent to subsidize continuation of a civilian employer's family 

coverage during periods of activation, similar to FEHBP coverage for activated Guard-Reserve 

employees of Federal agencies. 

Extending corrective dental care following return from a call-up to ensure G-R members meet dental 

readiness standards. 

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Allowing eligibility in Continued Health Care Benefits Program (CHCBP) for Selected Reservists 

who are voluntarily separating and subject to dis enrollment from TRS. 

Allowing beneficiaries ofthe FEHBP who are Selected Reservists the option of participating in 

TRICARE Reserve Select. 

Additional TRICARE Prime Issues 

The Coalition urges the Subcommittee to: 

Require reports from DoD and the managed care support contractors on actions being taken to 

improve Prime patient satisfaction, provide assured appointments within Prime access standards, 

reduce delays in preauthorization and referral appointments, and provide quality information to 

assist beneficiaries in making informed decisions. 

Require increased DoD efforts to ensure consistency between both the MTFs and purchased care 

sectors in meeting Prime access standards. 

Ensure timely notification of and support for beneficiaries affected by elimination of Prime service 

areas. 

Additional TRICARE Standard Issues 

The Coalition urges the Subcommittee to: 

Bar any further increase in the TRICARE Standard inpatient copay for the foreseeable future.Insist 

on immediate delivery of an adequacy threshold for provider participation, below which additional 

action is required to improve such participation to meet the threshold. 

Require a specific report on provider participation adequacy in the localities where Prime Service 

Areas will be discontinued under the new TRICARE contracts. 

Increase locator support to TRICARE Standard beneficiaries seeking providers who will accept new 

Standard patients, particularly for mental health specialties. 

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Mr. Chairman and distinguished members of the Subcommittee, The Military Coalition extends our 

thanks to you for your strong support of our active duty, Guard, Reserve, retired members, and veterans 

of the uniformed services and their families and survivors. 

Congress has improved retention and readiness by addressing a number of quality of life issues for the 

military community over the last decade including enactment ofTRICARE For Life, TRICARE Senior 

Pharmacy coverage, and health coverage for the Guard and Reserve community, among many other 

important initiatives. 

Now, ironically, critics decry the growth in health care spending over the last decade, ignoring that 

much of that cost was driven by wartime requirements and service organizational and readiness 

priorities rather than cost-efficient delivery of beneficiary care. 

As Congress assesses how to fairly allocate necessary sacrifices among the various segments of the 

population, the Coalition urges that you bear in mind that: 

Assertions about personnel and health cost growth over the last decade are highly misleading, 

because 2001 (when nearly all older beneficiaries had been pushed out of military health coverage) 

is not an appropriate or reasonable baseline for comparison - 2001 was the "bottom~' as far as 

military benefits were concerned. Congressional spending to fix that problem since then was a 

necessary thing, not a bad thing. 

000 health costs remain well below the 16% share health care comprises of the national GOP. 

Assertions that cutbacks for retirees don't affect the currently serving force are a delusion. 

Significant benefit cutbacks for retirees reduce incentives for the currently serving to complete a 

career. A currently serving member who will retire next month, next year, or next decade is 

definitely affected by such cutbacks. 

Retired servicemembers, their families and survivors have been no stranger to sacrifice. Nearly 

600,000 of to day's retirees served on active duty during the current Iraq/Afghanistan wars. 

Hundreds of thousands more saw service in multiple hot and cold conflicts. Older retirees endured 

years when the govemment provided them no military health coverage, and those retired between 

1985 and 2005 have forfeited an average 10% of earned retired pay because they retired under pay 

tables depressed by decades of budget-driven capping of military raises below civilian pay growth. 

Pentagon leaders' insensitivity to this situation is perfectly illustrated by Secretary Panetta's answer 

at a recent Senate Budget Committee hearing. When asked why the proposal focuses so much on 

raising fees for military retirees, he answered they would accept the changes because they're used to 

doing what they're told and used to a culture of sacrifice. In other words, they're used to abuse so 

we can - and plan - to abuse them again. 

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Military members' and families' sacrifices must not be taken for granted by assuming they will 

continue to accept the extraordinary personal and family sacrifices inherent in a multi-decade service 

career regardless of significant changes in their career incentive package. 

At a time when Congress is focused on lowering payroll taxes and avoiding any tax increases for 

other Americans, including millionaires and billionaires, it's grossly inappropriate to impose a 

$1,000-$2,000 new annual tax on the one group of citizens who already have sacrificed more for 

their country than any other. 

The Coalition is appalled that fully 60% of the projected savings associated with the proposed 

TRICARE fee increases accrue from the assumption that the fee increases will be so onerous as to 

drive many thousands of military beneficiaries away from using their service-earned coverage. 

When similar assumptions were highlighted about earlier 000 TRICARE fee proposals, Congress 

rightly deemed it grossly inappropriate to entice members to career service with promises of care 

and then consciously implement plans to drive them away from using that hard-earned care. That's 

no less true in 2012 than it was in 2007 and 2008. 

History shows clearly that there are unacceptable retention and readiness consequences for shortsighted budget decisions that cause servicemembers to believe their steadfast commitment to 

protecting their nation's interests is poorly reciprocated. 

FY2013 Budget Submission 

The President's proposed FY2013 budget has embraced the concept put forth by the Defense 

Department in past years that TRICARE benefits for retired beneficiaries should "trend toward market 

rates" by significantly increasing fees for retired beneficiaries and family members under 65. 

The proposal would shift $35 billion in costs to retired and some currently serving mili"tary families over 

the next 10 years through dramatic and disproportional healthcare fee increases. These fee levels are 

similar to those recommended by the Defense Department in past years, which the Subcommittee and 

Congress rejected as excessive on the basis that: 

Pentagon leaders need to demonstrate more effective cost management of their own before shifting 

significant additional costs to beneficiaries. 

Achieving savings by seeking to deter beneficiaries from using their service-earned benefits is 

inappropriate. 

The budget proposes to raise beneficiary costs over the next ten years by: 

Raising annual fees by as much as $1,500 or more for retired families under age 65. 

Establishing new annual enrollment fees of up to $950 for retired couples over age 65. 

Imposing means-testing of military retiree health benefits - which no other federal employee 

experiences. 

Dramatically increasing pharmacy co-pays to approach or surpass the median of civilian plans. 

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Tying future annual increases to an unspecified health cost index estimated to average 6.2% per 

year. 

DoD leaders have made a great point of their intent to "keep faith with currently serving troops" by 

avoiding any retirement changes that would affect the current force. 

But their concept of "keeping faith on retirement" doesn't extend to retirement health care benefits, as 

the proposed changes would affect any currently serving member who retires the day after they were 

implemented. This has the same. effect as reducing their retired pay by up to $2,000 a year or more. 

Further, the pharmacy changes would affect hundreds of thousands of currently serving Guard/Reserve 

members and families, as well as the family members of currently serving personnel who don't have 

access to military pharmacies. 

The Coalition believes DoD's proposals for dramatic TRICARE fee hikes constitute a serious breach 

offaith with currently serving troops and families by cutting their future health care benefits. And if 

breaking faith with the currently serving is wrong, so is imposing a major "bait and switch" change 

on those who already completed 20-30 year careers, induced by promises of current benefits. 

TRICARE Prime Fees. The Administration's TRICARE Prime Fee proposal for FY2013 is a radical 

departure from the new fee structure the Administration proposed and Congress accepted for FY2012. 

Last year, finally acknowledging Congress' long-standing concerns about the inappropriateness of 

dramatic increases in beneficiary fees, the Administration proposed a 13 % increase in TRICARE Prime 

fees. In the absence of congressional objection, the increase was implemented as of October I, 2011. 

The new proposal for FY2013-2017 is a dramatic dcparture, proposing to triple or quadruple fees over 

the next five years, as indicated in the chart below. 

Retired Pay** 

$0-22,589 

$22,590-

$45,178 

$45,179 

or more 

DoD-Proposed TRICARE Prime Enrollment Fee for 

Retired Beneficiaries Under Age 65 (Family Rate)* 

FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 

""'$520 $600 $680 $760 $850 

$520 $720 $920 $1,185 $1,450 

$520 $820 $1,120 $1,535 $1,950 

'Single rate is 50% of family rate 

•• Retired pay thresholds to be indexed to COLA increases .*. Fees for FYI8 and out years to be indexed to health cost inflation 

FY2017*** 

$893 

$1,523 

$2,048 

This proposal flies in the face of the specific language of the FY2012 Defense Authorization Actsigned into law less than three months ago - requiring that the percentage increase in TRICARE Prime 

fees for FY2013 and later years shall not exceed the percentage growth in military retired pay. 

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The logic behind the COLA cap has not changed in the last three months. Its purpose was to protect 

retirees against arbitrary, budget-driven initiatives to impose dramatic new fee increases. 

The COLA cap was intended to help recognize that: 

Military retirees already pre-paid very large premiums for their health care in retirement through 

their decades of service and sacrifice in uniform, and that 

They shouldn't be subjected to a double penalty by having their fees raised dramatically after 

they've already rendered a career of service induced by long-standing government retirement and 

health care promises. 

The Coalition urges the Subcommittee to reject any increase in TRlCARE Prime fees that exceeds the 

COLA-based standard established in the FY2012 Defense Authorization Act 

TRICARE Standard Fees. The Administration proposes two changes to TRICARE Standard that are 

not authorized under current law: a new enrollment fee that would increase significantly over time, and 

a significant adjustment to the Standard deductible, which is set by current law at $150 for a single 

person and $300 for a family. 

Enrollment Fee 

Deductible 

DoD-Proposed TRICARE Standard Annual Fees for 

Retired Beneficiaries Under Age 65 (Family Rate)* 

FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 

-$-0- $l4O $i7O $200 $230 

$300 $320 $400 $460 $520 

'Single rate is 50% offamily rate 

•• Fees for FYl8 and out years to be indexed to health cost inflation 

FY2017** 

$250 

$580 

The Coalition strongly opposes any enrollment fee for TRICARE Standard. An enrollment fee is only 

appropriate when the beneficiary is guaranteed a certain level of care. While the Defense Department 

has specified standards for TRICARE Prime, it's definitely not the case with TRICARE Standard. 

According to DoD's own surveys, there are localities where finding a provider who will accept Standard 

patients is very difficult. This is particularly true for some high·demand specialties such as psychiatry. 

In the absence of guaranteed access to care, there should be no enrollment fee. 

Establishing an explicit enrollment requirement also would change the fundamental character of this 

service-earned healthcare benefit by forcing a choice between military health coverage and other 

available coverage. Many use TRICARE as a contingent coverage that is there as a fallback if they lose 

their civilian job, if their civilian insurance offers limited coverage, etc. Throughout their careers, they 

were told they would have this coverage. The Coalition objects to a system that backs them into a 

situation that implies it's a reasonable decision to forfeit that earned protection because they have other 

insurance that mayor may not endure. In other words, their military ID card is and should continue to 

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represent their automatic emollment in the default military healthcare option unless they choose to emoll 

in Prime or age into TRICARE For Life. 

The Coalition also objects strongly to the proposal to nearly double the annual Standard deductible over 

the next 5 years. Standard-eligible retired beneficiaries who are able to find a participating provider 

already are absorbing a 25% copay, and so their costs have risen as allowable charges have risen. 

The Coalition urges the Subcommittee to reject any TRICARE Standard enrollment fee unless and 

until the government provides guaranteed access to care for Standard beneficiaries 

The Coalition urges the Subcommittee to reject DoD's proposal to nearly double the TRICARE 

Standard deductible over the next five years. 

TRICARE For Life Fees. The Administration proposes a new TRICARE For Life (TFL) emollment 

fee for beneficiaries age 65 and older, with successive annual increases as indicated in the chart below: 

Retired Pay* 

$0-22,589 

$22,590-

$45,178 

$45,179 

or more 

DoD-Proposed TRICARE-for-Life Annual Enrollment Fee 

(Per Individual Beneficiary Age 65+) 

FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY2017** 

$0 $35 $75 $115 $150 $158 

$0 $75 $150 $225 $300 $317 

$0 $115 $225 $335 $450 $475 

•• Retired pay thresholds to be indexed to COLA increases 

••• Fees for FY18 and out years to be indexed to health cost inflation 

Again, the Coalition believes strongly that an emollment fee is only appropriate when there is a 

guarantee oftirnely access to quality healthcare. While that is the case with TRICARE Prime, there is 

no such guarantee for TFL beneficiaries. 

Because TFL is available only if the benefIciary enrolls in Medicare Part B and acts as second-payer to 

Medicare, it provides coverage only in the case of providers who accept Medicare patients. 

In many localities around the country, more and more providers are limiting the number of Medicare 

patients they serve. In some localities, providers are refusing to accept any new Medicare patients. 

In the event a provider refuses to accept Medicare, the beneficiary must absorb the full cost of the care, 

as Medicare will not reimburse the beneficiary for any share of the charges. 

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The reality is that Medicare patients already pay significantly more for their care than beneficiaries 

under 6S do because of the statutory requirement to enroll in Medicare Part B to be eligible for TFL. 

Thls means a TFL-eligible couple already is paying premiums of at least $2,400 per year in 2012. 

Couples in higher income brackets may pay up to $7,680 per year in Part B premiums alone. 

Further, large numbers of these retired members already suffer severe and permanent financial penalties 

as a result of past government budget crises that caused depression of their annual pay raises while on 

active duty. Depression of military pay over time caused military pay scales to lag up to 13.5% behind 

private sector pay. Members who retired under those depressed pay scales already are being made to 

forfeit thousands of dollars per year, and those penalties will last through their lifetimes. Adding a TFL 

enrollment fee would add further financial insult to that grievous injury. 

TFL was enacted in 2001 to rectify the previous decade's disenfranchisement of older military 

beneficiaries from virtually all military healthcare coverage in the wake of the BRAC-driven closure and 

downsizing of hundreds of military hospitals and clinics. 

When Congress enacted TFL, it did so with the explicit acknowledgement that an enrollment fee for this 

program is inappropriate. 

In passing the new law, Congress acknowledged that the premium for this Medicare-supplemental 

coverage already had been paid in full through decades of service and sacrifice. 

The Coalition believes strongly that the experience of the last decade - during which the military 

community has been required to bear 100% of the nation's wartime sacrifice - only reinforces the 

rightness of Congress' 2001 acknowledgement that imposing an enrollment fee for TFL is inappropriate. 

The Coalition urges strongly against imposing any enrollment fee for TRICARE For Life. 

Proposed Fees Raise New Series ofInequities 

The Coalition appreciates that some modest effort was made to accommodate human concerns by 

exempting medical (Chapter 61) retirees and survivors of members who died on active duty. 

However, these very restricted exemptions create a whole new series of inequities that demonstrate a 

gross lack of appreciation for the circumstances of various beneficiary populations. 

Limiting survivor exemption to cases of deaths on active duty ignores that other categories of survivors, 

most of whom are older, typically have far less resources than survivors of recent active duty deaths. 

Thousands ofthese older survivors have no income at all from the military or the VA, and received 

dramatically lower Servicemen's Group Life Insurance settlements than are available today -- yet they 

would be subjected to the higher TRICARE fees. 

Among retirees, the sole exemption of chapter 61 (medical retirement) cases similarly ignores the 

realities of the disabled retiree population. 

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Medical retirees include not only the severely disabled, but also many with disability ratings of30% (or 

lower in some cases, since members with 20+ years of service can be medically retired under chapter 61 

with disability ratings as low as zero). 

As the Subcommittee is only too well aware in the wake of multiple recent reviews and commissions in 

recent years, far larger numbers with significant disabilities were denied medical retirement under 

service policies and told to "see the VA for any disability issues." 

So a 20-year retiree with a zero-to-30% medical retirement would be exempted from the higher 

TRICARE fees that would be imposed on a similar 20-year non-medical retiree who is immediately 

acknowledged by the VA as 100% disabled. 

The Coalition does not raise these inequity issues in order to propose expanding the exemption, 

because that would imply a level of Coalition concurrence with the proposedfee hikes that does not 

exist- We raise them as another reason why the proposed fee increases are grossly inappropriate for 

all grades and categories of beneficiaries. 

Pharmacy Co-Payments_ The Administration proposes dramatic increases in retail and other pharmacy 

copays, as shown in the chart below. 

DoD-Proposed Pharmacy Co-Payments 

(For All Retirees, Survivors, GuardlReserve and Active Duty Family Members) 

FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY2017 

Retail (1 mo fill) 

Generic $5 $5 $6 $7 $8 $9 

Brand $12 $26 $28 $30 $32 $34 

Non-Formulary' $25 N/A N/A N/A N/A N/A 

Mail-Order (3 mo fill) FY 2012 FY 2013 FY 2014 FY2015 FY 2016 FY2017 

Generic $0 -$0-- $0 $0 $0 -$-9-

Brand $9 $26 $28 $30 $32 $34 

Non-Formulary $25 $51 $54 $58 $62 $66 

• Non-Formulary pharmaceuticals will have limited availability in retail pharmacies 

Again, these are dramatic increases from the copayment rates the Administration proposed for FY2012, 

and implemented on Oct 1,2011 in the absence of congressional objection. 

For FY2012, the Administration imposed increases of$2 to $3 (e.g., from $9 to $12 for retail brandname drugs and from $3 to $5 for retail generics.) 

Now, only a year later, the proposal would mOre than double the new retail rates and triple the mailorder rates for brand-name medications. 

In subsequent years, copays would rise for generics in the retail venue, and the copay the Administration 

just eliminated for mail-order generic drugs last year would not only be restored, but tripled. 

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These purely budget-driven proposals are inappropriate on several levels. 

The current $5 retail generic copay already exceeds the $4 generic copay widely available to any 

civilian who walks through the door at dozens of retail pharmacies. Proposed further increases in 

the out years only exacerbate the relative disadvantage for military beneficiaries. 

The proposed brand-name and non-formulary copays would make the TRICARE pharmacy benefit 

little or no better than the median of civilian employer plans. In 2011, for example, 56% of civilian 

plans provide brand-name medications for a copay of $25 or less, compared to the DoD-proposed 

$26. 

Contrary to 000 assertions about exempting currently serving personnel from fee hikes, the 

pharmacy copay increases would apply to hundreds of thousands of drilling Guard and Reserve 

personnel, as well as to active duty, Guard and Reserve family members who don't have access to 

military pharmacies. 

000 has expended relatively little substantive effort to increase use of the mail order system other 

than seeking to impose an ever-bigger "stick" of higher fees on those who use other venues. The 

Coalition has urged 000 to create positive incentives such as eliminating copays for maintenance 

medications (see next paragraph) and work with the Coalition to develop better communication 

materials to address real-world concerns that deter beneficiaries from mail-order use, and will 

continue to do so even with higher copays. These initiatives could save 000 hundreds of millions a 

year, but Coalition offers to partner on such efforts have been rebuffed. 

Such dramatic pharmacy copay increases will only discourage adherence to medication regimens for 

chronic conditions like asthma, diabetes, and more. Studies show that even modest copayment 

increases deter use of maintenance medications that are essential to preserving wellness and holding 

down far more expensive care when the conditions deteriorate. The Coalition has endorsed reducing 

or eliminating copays for maintenance medications to hold down long-term costs. This new 

proposal would fly in the face of that objective, sacrificing long-term beneficiary health for shortterm cost savings. 

The Coalition believes strongly that the TRICARE pharmacy benefit should be a top-tier benefit, not 

merely one that approaches the median of plans offered by civilian employers, and that it should 

enhance wellness goals rather than posing a new impediment to them. 

The Coalition urges the Subcommittee to reject Administration-proposed pharmacy copayment 

increases that would inappropriately "civilianize" the military pharmacy benefit, dramatically raise 

costs for both retired and currently serving families, and deter beneficiaries from adhering to 

medication regimens that are essential to their long-term health as well as DoD's long-term cost 

containment 

Means-Testing Plan Discriminates Against Military Retirees. The Administration proposal 

envisions establishing graduated enrollment fees for TRICARE Prime and TFL, based on the amount of 

the retired servicemember's retired pay, as indicated in the charts previously shown. 

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This proposal would impose blatant and dramatic discrimination against military retirees. 

No other federal employee or retiree pays income-based fees for service-earned health coverage. The 

President, the Secretary of Defense, and the Speaker of the House pay the same premiums as the lowestpaid federal civilian retiree. 

Means-tested fees also are rare in the private sector. This is because healthcare has long been 

recognized as a service-earned benefit. 

Means-testing healthcare as DoD proposes would tum the concept of service-based benefits on its head, 

so that the longer and more productive the service, the less the earned benefit. 

This need-based mentality may be appropriate for social welfare programs, but its application to benefits 

that are earned by service and sacrifice is inappropriate and counterproductive. 

The proposal also discriminates against the military by failing to apply the same protections provided to 

VA healthcare programs and beneficiaries. 

No such fee increases are envisioned for VA care, and Congress expressly exempted VA healthcare and 

other programs from any reduction under sequestration. 

In past years, Congress has strongly rejected far smaller V A fee increases proposed for non-disabled 

veterans who had served as few as two years. 

In those contexts, imposing fee hikes of up to $2,000 a year for those who have served and sacrificed for 

two or three decades is grossly inconsistent and inappropriate. 

The Coalition urges the Subcommittee to oppose means-testing of military benefits, under which 

longer and more successful service would be penalized by progressive reduction of military healthcare 

benefits. The Coalition believes all retired servicemembers earned equal health care coverage by 

virtue of their service and that the proposed dramatic fee increases are inappropriate for 

servicemembers of all grades. 

Indexing of TRICARE Fees. The Administration's FY2013 budget request proposes to index, either 

immediately or following some transition period, a variety of TRICARE fees to a health care cost index. 

The specifics of how that cost index would be calculated, what beneficiary population it would account 

for, and who would be responsible for calculating it, have not yet been revealed to us. 

Last year, DoD sources indicated an expectation that such an index would yield annual adjustments on 

the order of 6.2% per year. 

The Coalition objects strongly to tying TRICARE fee growth for military beneficiaries to any measure 

of health care cost changes. 

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Indexing fees to healthcare cost growth would far outstrip annual retired pay increases and greatly erode 

retired compensation value. 

During congressional debate on this topic last year, Congress rejected the health cost growth index and 

capped year-to-year percentage increases in TRICARE Prime fees at the percentage growth in military 

retired pay, reflecting the belief that the latter measure was fairer considering the very large, up-front 

premium already extracted from career military personnel over decades of service and sacrifice. 

The chart below shows how DoD-proposed increases in TRICARE Prime enrollment fees, tied in the 

out years to the proposed health cost index, would vastly exceed the COLA-based standard approved by 

Congress last year, imposing large beneficiary losses that would continue and accelerate with each 

passing year. 

Monetary Impact of DoD-Proposed Fee Adjustment Methodology 

2015 $568 

2016 $585 

2017 S603 $1,523 

$621 $1,617 ."-"~-'-"-~---

$640 $1,718 

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2027' $810 $2,779 ~-~+- .. ~.~ .. ~.-. 

2028 $834 $2,952 

• Uses 000 actuaries' 3% long-term COLA assumption for military retirement trust fund 

""DoD proposal assumes a 6.2% annual health cost inflation factor 

The Coalition urges the Subcommittee to reject the DoD proposal to index military health care fees to 

an index of health cost growth. 

Annual Financial Impact of Fee Hikes on Military Families 

The following chart highlights how the cumulative impact of the DoD-proposed fee changes would 

roughly double or triple annual health costs for the bulk of the affected force (grades E· 7 to 0-4). Cost 

growth would be significantly larger for grades WA and 0-5 and above. 

This chart assumes average use of medications. Many older families and those with disabled or 

otherwise at-risk children require significantly more medications, and the proposed doubling and tripling 

of pharmacy copays would increase those families' annual expenses substantially above those shown in 

the chart. 

The chart also highlights what many overlook - that Medicare-eligibles already are required to pay 

significant Medicare Part B premiums in addition to the proposed new TFL and pharmacy fees. 

Impact of DoD-Proposed FY2013 TRICARE Fees on Military Families (E-7 to 0-4) 

(Recommended by DoD in the President's Budget) 

E-7 J 0-4 Retiree* Under Age 65, Family of Three 

TRICARE Prime** Current FY 2013 Proposed FY2017 

Enrollment Fee $520 $720 $1,523 

Doctor Visit Copays $60 $60 $60 

Rx Cost Shares'" $408 $744 $1,032 

Yearly Cost $988 $ 1,524 $2,615 

Retiree Under Age 65, Family of Three 

TRICARE Standard Current FY2013 FY2017 

Proposed 

Enrollment Fee $0 $140 $250 

Deductible $300 $320 $580 

Rx Cost Shares""" $408 $744 $1,032 

Yearly Cost $708 $1,204 $1,862 

* Enrolled m 2 Retirement Income Tier (W-4s, 0-5s and higher grades would pay even more) 

"'Enrolled to the network and assumes 5 doctor visits per year. 

u*Assumes 2 generic and 2 brand name prescriptions per month in retail pharmacy 

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E-7 I 0-4 Retiree* Over Age 65 and Spouse 

TRICARE For Life** Current FY 13 Proposed FY 2017 

Medicare Part B $2,398 $2,494···· $2,917···· 

Enrollment Fee' $0 $150 $634 

Rx Cost Shares'" $756 $1,428 $1,956 

Yearly Cost $3,154 $4,072 $5,507 . Enrolled m '" 2 Retrrement Income Tter (W 45,0 55 and hIgher grades would pay even more) 

"Assumes lowest tier Medicare Part B premium for new eruollee in 2012. 

**"'3 generic and 4 brand name prescriptions per month purchased at retail pharmacy 

* ... Assumes Part B increases of 4% per year 

Currently Serving Family of Four 

TRICARE Standard* Current FY 13 Proposed FY 2017 

Enrollment Fee $0 $0 $0 

Deductible $300 $300 $300 

Rx Cost Shares'" $264 $432 $624 

YearlyCost $564 $732 $924 

>Ie Spouse and 2 chIldren use Standard. 

'" '" Assumes 2 generic and 1 brand name prescriptions per month at retail pharmacy. 

Military vs. Civilian Cash Fees Is "Apple to Orange" Comparison 

The Coalition continues to object strongly to simple comparisons of military vs. civilian cash fees. Such 

"apple to orange" comparisons ignore most of the very great price career military members and families 

pay for their coverage in retirement. 

The unique package of military retirement benefits - of which a key component is a superior health care 

benefit - is the primary offset provided uniformed service members for enduring a career of unique and 

extraordinary sacrifices that few Americans are willing to accept for one year, let alone 20 or 30. It is an 

unusual and essential compensation package a grateful Nation provides to the small fraction of the 

population who agree to subordinate their personal and family lives to protecting our national interests 

for so many years. 

For all practical purposes, those who wear the uniform oftheir country are enrolled in a 20- to 30·year 

pre-payment plan that must be completed to earn lifetime health coverage. Once that pre-payment is 

already rendered, the governrnent cannot simply ignore it and focus only on post-service cash payments 

- as if the past service, sacrifice, and commitroents had no value. 

DoD and the Nation - as good-faith employers of the trusting members from whom they demand such 

extraordinary commitroent and sacrifice - have a reciprocal health care obligation to retired service 

members and \'heir families and survivors that far exceeds any civilian employer's. 

The Coalition believes the TRICARE fee controversy is caused in part by the lack of any statutory 

record of the purpose of military health care benefits and the specific benefit levels earned by a career of 

service in unifonn. 

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Current law gives the Secretary of Defense broad latitude to adjust fees for TRICARE Prime and the 

phannacy systems. Absent congressional intervention, the Secretary can choose not to increase fees for 

years at a time or to triple or quadruple fees, as in this year's budget proposal. 

Until a few years ago, this was not a particular matter of concern, as no Secretary had previously 

proposed dramatic fee increases. 

The experience of the recent past - during which several Secretaries proposed no increases and then a 

new Secretary proposed doubling, tripling, and quadrupling various fees - has convinced the Coalition 

that current law leaves military beneficiaries excessively vulnerable to the varying budgetary 

inclinations of the incumbent Secretary of Defense. 

It's true that many private sector employers are choosing to shift more healthcare costs to their 

employees and retirees, and that's causing many still-working military retirees to fall back on their 

service-earned TRICARE coverage. Fallout from the recession has reinforced this trend. 

Efforts to paint this in a negative light (i.e., implying that working-age military retirees with access to 

civilian employer plans should be expected to use those instead of military coverage) belie both the 

service-earned nature of the military coverage and the long-standing healthcare promises the 

government aggressively employed to induce their career service. 

The Coalition believes the law should be changed to explicitly acknowledge that: 

The health care benefit provided for members and families who complete a military career should 

be among the very best available to any American; 

The decades of service and sacrifice rendered by career military personnel constitute a significant 

pre-paid premium toward their healthcare in retirement; and 

The large value of this pre-paid premium should be accounted for by minimizing fees payable in 

retirement and avoiding significant and arbitrary increases from year to year. 

DoD Should Fix Inefficiencies, Not Punish Beneficiaries 

Unlike civilian healthcare systems, the military health system is built mainly to meet military readiness 

requirements rather than to deliver needed care efficiently to beneficiaries. 

Each Service maintains its unique facilities and systems to meet its unique needs, and its primary 

mission is to sustain readiness by keeping a healthy force and sustaining capacity to treat casualties from 

military actions. That model is built neither for cost efficiency nor beneficiary welfare. 

When military forces deploy, the military medical force goes with them, and that forces families, retirees 

and survivors to use the more expensive civilian health care system in the absence of so many uniformed 

health care providers. This shift in the venue of care and the associated costs are completely out of 

beneficiary control. 

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These military-unique requirements have significantly increased readiness costs. But those added costs 

were incurred for the convenience of the military, not for any beneficiary consideration, and 

beneficiaries should not be expected to bear any share of military-driven costs - particularly in wartime. 

The Coalition strongly rejects Defense leaders' efforts to seek dramatic beneficiary cost increases as a 

first cost-containment option rather than meeting their own responsibilities to manage military 

healthcare programs in a more cost-effective manner. 

Instead of imposing higher fees on beneficiaries as the first budget option, DoD leaders should be 

held accountable for fixing their own management and oversight failures that add billions to defense 

health costs. 

• Decades of GAO and other reports demonstrate DoD cost accounting systems are broken and 

unauditable. 

More than a dozen reports have recommended consolidated oversight of three separate service 

medical systems, four major contractors, and innumerable subcontractors that now compete for 

budget share in counterproductive ways. 

DoD-sponsored reviews indicate more efficient organization could cut health costs 30% without 

affecting care or beneficiary costs 

DoD's inexplicable refusal to partner with associations to expand mail-order pharmacy above the 

current low level has cost hundreds of millions per year (each prescription switched from retail to 

mail saves DoD $125). 

Improve and expand focus on management of chronic diseases. 

Reduce inappropriate and costly emergency room use by expanding clinic hours, urgent care 

venues, open access appointing, and phone/web-based access to providers after hours. 

Reform the TRICARE contracting and acquisition process. 

Base incentives to providers on quality-driven clinical outcomes that reward efficiency and value. 

Eliminate referral requirements that add complexity and inhibit timely delivery of needed care. 

Fix broken appointing system that inhibits beneficiary access to care. 

These are only some of the examples demonstrating that more effective management, oversight and 

reorganization of military healthcare delivery could dramatically reduce defense health costs without 

affecting care or costs for beneficiaries. 

The Coalition urges the Subcommittee to hold Defense leaders accountable for their own 

management, oversight, and efficiency failures before seeking to shift more costs to beneficiaries. 

Congress should direct DoD to pursue any and all options to constrain the growth of health care 

spending in ways that do not disadvantage beneficiaries. 

Wounded. IlL and Injured Servicemember Care 

Though the war in Iraq has officially ended and the country seeks an exit strategy in Afghanistan, the 

Coalition has great and continuing concerns about the longer-term stability and viability of the policies, 

programs, and services intended to care and support our wounded, ill, and injured and their familiescaregivers. 

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As the Pentagon marks a decade at war, seamless transition between the Departments of Defense (000) 

and Veterans Affairs (VA) continues to be problematic in many cases for our wounded, ill, and injured 

troops; disabled veterans; and their family caregivers. 

Since 2007, every National Defense Authorization Act has built upon institutionalizing a seamless and 

unified approach to caring and supporting America's wounded, ill, and injured and their familiescaregivers. 

TMC acknowledges the significant progress that has been made in caring for our nation's heroes and 

thanks the Subcommittee for its leadership and oversight on these pressing issues, particularly in the last 

four years since the Walter Reed scandal that brought to light the flaws and inadequacies of both 000 

and VA health care and benefits systems. 

But complex challenges remain in overseeing and validating massive policy and program changes 

among the military services; the 000; the VA; several Centers of Excellence; a multitude of civilian 

contractors and non-governmental agencies; and at least six congressional oversight committees. 

The Coalition looks forward to continued work with the Subcommittee to address the remaining issues 

and fully establish systems of seamless care and benefits that support our transitioning wounded 

warriors and family members. 

TMC strongly urges: 

Joint hearings by the Armed Services and Veterans Affairs Committees addressing the Joint 

Executive Council's (JEC) effectiveness in daily oversight, management, collaboration, and 

coordination of the Departments' wounded warrior programs. 

Permanent funding, staffing, and accountability for congressionally mandated Defense 

Centers of Excellence and associated mental-behavioral health, suicide prevention, caregiver, 

respite, and other medical and non-medical programs. 

Continued aggressive oversight of the Integrated Disability Evaluation and legacy disability 

evaluations systems to ensure preservation of the 30-percent threshold for medical retirement, 

consistency and uniformity of policies, ratings, legal assistance, benefits, and transitional 

services Defense-wide. 

DoD - VA Seamless Transition 

Institutional Oversight - While many legislative changes have improved the care and support of our 

wounded, ill, and injured servicemembers, the Coalition is concerned that the sunset in law of the 000-

VA Senior Oversight Committee (SOC) poses significant risks for effective day-to-day leadership and 

coordination of DoD and VA seamless transition efforts. While an informal SOC exists, the Pentagon 

has relegated responsibility and authority to lower levels ofthe agency, making it difficult for senior 

official involvement and oversight on these matters and limiting the Department's ability to fully 

establish a synchronized, uniform and seamless approach to care and services. 

Previously, the Coalition has expressed concern that the change of Administration posed a significant 

challenge to the two departments' continuity of joint effort, as senior leaders whose personal 

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involvement had put interdepartmental efforts back on track left their positions and were replaced by 

new appointees who had no experience with past problems and no personal stake in ongoing initiatives. 

Unfortunately, those concerns were realized, as many appointive positions in both departments went 

unfilled for long periods, requiring reorganization of responsibilities and entry of new people with little 

or no background or authority to engage systems and continue to move forward. 

While many well-meaning and hard working military and civilians are doing their best to keep pushing 

progress forward, leadership, organization, and mission changes have left many leaders frustrated with 

the process. 

The Coalition urges joint hearings by the Armed Services and Veterans Affairs Committees to assess 

the effectiveness of current seamless transition oversight efforts and systems and to solicit views and 

recommendations from DoD, VA, the military services, and non-governmental organizations 

concerning how joint communication, cooperation, and oversight could be improved. 

In addition, the hearings should focus on implementation progress concerning: 

Single separation physical; 

Single, integrated disability evaluation system; 

Bi-directional electronic medical and personnel records data transfer; 

Medical centers of excellence responsibilities vs. authority, operations, and research projects; 

Coordination of care and treatment, including DoD-VAfederallrecovery care coordinator clinical 

and non-clinical services and case management programs; and 

Consolidated government agency support services, programs, and benefits. 

Continuity of Health Care - Transitioning between DoD and V A health care systems remains 

challenging and confusing to those trying to navigate and use these systems. Systemic, cultural, and 

bureaucratic barriers often prevent the service member or veteran from receiving the continuity of care 

they need to heal and have productive and a high level of quality oflife they so desperately need and 

desire. 

Service members and their families repeatedly tell us that DoD has done much to address trauma care, 

acute rehabilitation, and basic short-term rehabilitation. They are less satisfied with their transition from 

the military health care systems to longer-term care and support in military and V A medical systems. 

We hear regularly from members who have experienced significant disruptions of care upon separation 

or medical retirement from service. 

One is in the area of cognitive therapy, which is available to retired members under TRICARE only if it 

is not available through the VA. Unfortunately, members are caught in the middle because of 

differences between DoD and V A authorities on what constitutes cognitive therapy and the degree to 

which effective, evidenced-based therapy is available. 

Action is needed to further protect the wounded, ill, injured, and disabled. The Subcommittee has acted 

previously to authorize three years of active-duty-level TRICARE coverage for the family members of 

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those who die on active duty. The Coalition believes we owe equal transition care continuity to those 

whose service-caused illnesses or injuries force their retirement from service. 

The Coalition recommends: 

Authorizing service-disabled members and their families to receive active-duty-level TRICARE 

benefits, independent of availability of VA care for three years after medical retirement to help 

ease their transition from DoD to VA. 

Ensuring Guard and Reserve members have adequate acce.'.' and treatment in the DoD and VA 

health systems for Post Traumatic Stress Disorder and Traumatic Brain Injury following 

separation from active duty service in a theatre of operations. 

DoD-VA Integrated Disability Evaluation System (IDES) - One of the most emotional issues that 

emerged from the Walter Reed scandal was the finding that services were "low-balling" disabled 

servicemembers' disability ratings, with the result that many significantly disabled members were being 

separated and turned over to the VA rather than being medically retired (which requires a 30% or higher 

disability rating}-a trend that continues today, especially for those in the Guard and Reserves. 

Congress has taken positive steps to address this situation, including establishment of the Physical 

Disability Board of Review (PDBR) to give previously separated servicemembers an opportunity to 

appeal too-low disability ratings. 

A jointly executed DoD-VA IDES pilot has been implemented and expanded, but experience under 

IDES has shown that the fundamental goals it was to achieve - to be more streamlined, faster, less 

complex, and non-adversarial -- have for the most part yet to be realized. The service member, 

typically without effective assistance, must navigate a still-complex adversarial system that is 

compromised by incomplete medical evaluations, overlooked conditions, and examinations omitting 

diagnoses - resulting in gaps in care, delays in decision-making, and lack of timely adjudication. 

TMC was further encouraged that wounded, ill, and injured members would benefit from the Dec. 19, 

2007 Under Secretary of Defense (Personnel and Readiness) Directive Type Memorandum (DTM) 

which added "deployability" as a consideration in the DES decision process - permitting medical 

separation/retirement based on a medical condition that renders a member non-deployable. 

Unfortunately, several cases surfaced indicating the Services failed to incorporate the DTM in their DES 

process. In this regard, many members found "fit" by the PEB have been deemed by the service to be 

"unsuitable" for continued service - and administratively separated - because the member's medical 

condition prevents them from being able to deploy or maintain their current occupational skill. 

The Coalition is grateful to the subcommittee for including provisions in both the FY20l1 and FY2012 

Defense Authorization Act prohibiting this practice. 

Unfortunately, some services still use other loopholes, such as designating disorders as "existing prior to 

service" - even though the V A rated the condition as "service-connected" and the member was deemed 

fit enough to serve in a combat zone. The Coalition believes strongly that once we have sent a soldier, 

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sailor, ainnan or marine to war, the member should be given the benefit of the doubt that any condition 

subsequently found should not be considered as existing prior to service. 

The Coalition believes strongly that all unfitting "service-connected" conditions as rated by the VA 

should be included in the DoD disability rating, and any member detennined by the parent service to be 

30 percent or more disabled should continue to be eligible for a military disability retirement with all 

attendant benefits, including lifetime TRICARE eligibility for the member and hislher family. We do 

not support efforts to disconnect health care eligibility from disability retired pay eligibility. 

The Coalition also agrees with the opinion expressed by fonner Secretary Gates that a member forced 

from service for wartime injuries should not be separated, but should be awarded a high enough rating to 

be retired for disability. 

The Coalition recommends: 

Preserving the statutory 30 percent disability thresholdfor medical retirement in order to provide 

lifetime TRICARE coverage for those who are injured while on active duty. 

Reforming the DoD disability retirement system to require inclusion of all unfitting conditions 

and accepting the VA's "service-connected" rating. 

Ensuring any restructure of the DoD and VA disability and compensation systems does not 

inadvertently reduce compensation levels for disabled service members. 

Eliminating distinctions between disabilities incurred in combat vs. non-combat when 

determining benefits eligibility for retirement 

Revision of the VA schedule for rating disabilities (VASRD) to improve the care and treatment of 

those wounded, ill, and injured, especialiy thoSi!diagiiosed With ptSD and TB1. 

Barring designation of disabling conditions as "existing prior to service" for servicemembers who 

have been deployed to a combat zone. 

Directing DoD to re-engineer and redesign the front end of IDES to (1) better ensure medical 

evaluations are consistently based on a fully developed, accurate medical summary; (2) permint 

the servicemember's full participation; (3) afford each individual consistent, effective 

representation throughout the process; and (4) streamline the system by eliminating the 

redundancy of dual adjudication of disability. 

Caregiver/Family Support Services - The sad reality is that, for the most severely injured 

servicemembers, family members or other loved ones are often required to become full-time caregivers. 

Many have lost their jobs, homes, and savings' in order to meet caregiver needs of a servicemember who 

has become incapacitated due to service-caused wounds, injuries or illness. 

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The Coalition believes the government has an obligation to provide reasonable compensation and 

training for such caregivers, who never dreamed that their own well-being, careers, and futures would be 

devastated by military-caused injuries to their servicemembers. 

In 2009, the Subcommittee authorized a special payment to an active duty servicemember to allow 

compensation of a family member or professional caregiver. The authorized payment was in the same 

amount authorized by the V A for veterans' aid-and-attendance needs, reflecting the Subcommittee's 

thinking that caregiver compensation should be seamless when the member transitions from active duty 

to V A care, as long as the caregiver requirements remain the same. 

The Coalition appreciates the Subcommittee's effort to sustain that principle in the FY20ll Defense 

Authorization Act in terms of caregiver support, and urges additional steps to ensure that non-dependent 

caregivers (e.g., parents and siblings) who have had to sacrifice their own employment and health 

coverage are provided health and respite care while the injured member remains on active duty, 

commensurate with what the VA authorizes for caregivers of wounded, ill, and injured veterans. 

In a similar vein, many wounded or otherwise-disabled members experience significant difficulty 

transitioning to medical retirement status. To assist in this process, consideration should be given to 

authorizing medically retired members and their families to remain in on-base housing for up to one year 

after retirement, in the same way that families are allowed to do when a member dies on active duty. 

Another important care continuity issue for the severely wounded, ill and injured is the failure to keep 

caregivers of these persOJillel involved in every step of the care and follow-up process. Again and again, 

we are told of clinicians and administrative people who seek to exclude caregiver participation and talk 

only to the injured member - despite the reality that the injured member may not be capable of 

remembering instructions or managing their appointments and courses of care. In many cases, this 

occurs even when the caregiver has a medical power of attorney and other authorities documented in the 

member's records. 

Congress, DoD and the V A have worked to get essential information to the wounded, ill, and injured 

and their caregivers. Similar efforts are urgently needed to educate medical providers and 

administrative staff at all levels that the final responsibility for ensuring execution of prescribed 

regimens of care for severely wounded, ill and injured servicemembers typically rests with the 

caregivers, who must be kept involved and informed on all aspects of these members' treatment, 

appointments, and medical evaluations. 

The Coalition recommends: 

Providing enhanced training of DoD and VA medical and support staff on the vital importance of 

involving and informing designated caregivers in treatment of and communication with severely 

wounded, ill, and injured personneL 

Providing health and respite care for non-dependent caregivers (e.g., parents and siblings) who 

have had to sacrifice their own employment and health coverage while the injured member 

remains on active duty, commensurate with what the VA authorizes for eligible caregivers of 

medically retired or separated members. 

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Extending eligibility for residence in on-base facilities for up to one year to medically retired 

or severely wounded, ill, and injured servicemembers and their families (or until the 

servicemember receives a VA compensation rating, whichever is longer). 

Guard and Reserve Health Care issues - The Coalition is very grateful for sustained progress in 

providing reservists' families a continuum of government-sponsored health care coverage options 

throughout their military careers into retirement, but key gaps remain. 

For years, TMC has recommended continuous government health care coverage options for Guard and 

Reserve (G-R) families. Operational reserve policy during two protracted wars has only magnified that 

need. 

000 took the first step in the 1990s by establishing a policy to pay the Federal Health Benefits Program 

(FEHB) premiums for G-R employees of the Department during periods of their active duty service. 

Thanks to this subcommittee's efforts, considerable additional progress has been made in subsequent 

years to provide at least some form of military health coverage at each stage of a Reserve Component 

member's life, including TRICARE Reserve Select for actively drilling GuardlReserve families and 

TRICARE Retired Reserve for "gray area" retirees. 

But some deserving segments of the Guard and Reserve population remain without needed coverage, 

including post-deployed members of the Individual Ready Reserve and early Reserve retirees who are in 

receipt of non-regular retired pay before age 60. 

In other cases, the Coalition believes it would serve GuardlReserve members' and DoD's COmmon 

interests to explore additional options for delivery of care to Guard and Reserve families. As 

deployment rates decline, for example, it would be cost-effective to establish an option under which 

000 would subsidize continuation of employer coverage for family members during (hopefully lessfrequent) periods of activation rather than funding year-round TRS coverage. 

TMC continues to support closing the remaining gaps to establish a continuum of health coverage for 

operational reserve families. 

The Coalition recommends: 

Authorizing TRICARE for early Reserve retirees who are in receipt of retired pay prior to age 60 

Authorizing premium-based TRICARE coverage for members of the Individual Ready Reserve 

after being called to active service for a cumulative period of at least 12 months 

Permitting employers to pay TRS premiums for reservist-employees as a bottom-line incentive for 

hiring and retaining them. 

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Authorizing an option for the government to subsidize continuation of a civilian employer's 

family coverage during periods of activation, similar to FEHBP coverage for activated GuardReserve employees of Federal agencies. 

Extending corrective dental care following return from a call-up to ensure G-R members meet 

dental readiness standards. 

Allowing eligibility in Continued Health Care Benefits Program (CHCBP) for Selected Reservists 

who are voluntarily separating and subject to disenrollment from TRS. 

Allowing beneficiaries of the FEHBP who are Selected Reservists the option of participating in 

TRICARE Reserve Select 

Additional TRICARE Prime Issues - The Coalition is very concerned about growing dissatisfaction 

among TRICARE Prime enrollees - which is actually higher among active duty families than among 

retired families. The dissatisfaction arises from increasing difficulties experienced by beneficiaries in 

getting appointments, referrals to specialists, and sustaining continuity of care from specific providers. 

Increasingly, beneficiaries with a primary care manager in a military treatment facility find they are 

unable to get appointments because so many providers have deployed, have been gone PCS, or are 

otherwise understaffed or unavailable. 

The Coalition supports implementation of a pilot study by TMA in each of the three TRICARE Regions 

to study the efficacy of revitalizing the resource sharing program used prior to the implementation of the 

TRICARE-Third Generation (T-3) contracts under the current Managed Care Support contract program. 

The Coalition strongly advocates the transparency of health care information via the patient electronic 

record between both the MTF provider and network providers. Additionally, institutional and provider 

healthcare quality information should be available to all beneficiaries so that they can make better 

informed decisions. 

We are concerned about the impact on beneficiaries ofthe elimination of some Prime service areas 

under the new contract. This will entail a substantive change in health care delivery for thousands of 

beneficiaries, may require many to find new providers, and will change the support system for 

beneficiaries who have difficulty accessing care. 

To date, largely because ofthe delay in award of the new contracts, beneficiaries who live in the areas 

where Prime service will be terminated have not received any information on this and how it may affect 

them. 

The Military Coalition urges the Subcommittee to: 

Require reports from DoD and the managed care support contractors on actions being taken to 

improve Prime patient satisfaction, provide assured appointments within Prime access standards, 

reduce delays in preauthorization and referral appointments, and provide quality information to 

assist beneficiaries in making informed decisions. 

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Require increased DoD efforts to ensure consistency between both the MTFs and purchased care 

sectors in meeting Prime access standards. 

Ensure timely notification of and support for beneficiaries affected by elimination of Prime 

service areas. 

Additional TRICARE Standard Issues - The Coalition appreciates the Subcommittee's continuing 

interest in the specific problems unique to TRlCARE Standard beneficiaries. TRICARE Standard 

beneficiaries need assistance in finding participating providers within a reasonable time and distance 

from their home. This is particularly important with the expansion ofTRICARE Reserve Select and the 

upcoming change in the Prime Service Areas, which will place thousands more beneficiaries into 

TRICARE Standard. 

The Coalition is grateful that the FY2012 Defense Authorization Act extended through 2015 the 

requirement for DoD to survey participation of providers in TRICARE Standard. 

However, we are concerned that DoD has not yet established benchmarks for adequacy of provider 

participation, as required by section 71 I (a)(2) of the FY2008 NDAA. Participation by half of the 

providers in a locality may suffice ifthere is not a large Standard beneficiary population, but could 

severely constrain access in other areas with higher beneficiary density. 

The Coalition hopes to see an objective participation standard (perhaps based on the number of 

beneficiaries per provider) that would help shed more light on which locations have participation 

shortfalls of Primary Care Managers and Specialists that require intervention. 

Further, the Coalition believes the Department should be required to take action to increase provider 

participation in localities where participation falls short of the standard. 

A source of continuing concern is the TRICARE Standard inpatient copay for retired members, which 

now stands at $708 per day or 25% of billed charges. The Coalition believes this amount already is 

excessive, and should be capped at that rate for the foreseeable future. 

The Coalition urges the Subcommittee to: 

Bar any further increase in the TRICARE Standard inpatient copay for the foreseeable future. 

Insist on immediate delivery of an adequacy threshold for provider participation, below which 

additional action is required to improve such participation to meet the threshold. 

Require a specific report on provider participation adequacy in the localities where Prime Service 

Areas will be discontinued under the new TRICARE contracts. 

Increase locator support to TRICARE Standard beneficiaries seeking providers who will accept 

new Standard patients, particularly for mental health specialties. 

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APPENDIX B


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THE 

., 

MILITARY COALITION 

201 North l1I'asbington Sln:et 

A1c::andr12, V1rgJnla 22314 

(703) 83!H1113 

STATEMENT OF 

THE MILITARY COALITION (TMC) 

before the 

SENA TE ARMED SERVICES 

SUBCOMMITTEE ON PERSONNEL 

concerning 

Military Personnel and Compensation Issues 
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MR. CHAIRMAN AND DISTINGUISHED MEMBERS OF THE SUBCOMMITTEE. On behalf of 

The Military Coalition (fMC). a consortium of nationally prominent uniformed services and veterans' 

organizations, we are grateful to the committee for this opportunity to express our views concerning 

issues affecting the uniformed services community. This statement for the record provides the collective 

views of the following military and veterans' organizations, which represent approximately 5.5 million 

current and former members of the seven uniformed services, plus their families and survivors. 

Air Force Association 

Air Force Sergeants Association 

Air Force Women Officers Associated 

AMVETS (American Veterans) 

Army Aviation Association of America 

Association of Military Surgeons of the United States 

Association of the United States Army 

Association of the United States Navy 

Chief Warrant Officer and Warrant Officer Association, U.S. Coast Guard 

Commissioned Officers Association of the U.S. Public Health Service, Inc. 

Fleet Reserve Association 

Gold Star Wives of America, Inc. 

Iraq and Afghanistan Veterans of America 

Jewish War Veterans of the United States of America 

Marine Corps League 

Marine Corps Reserve Association 

Military Chaplains Association of the United States of America 

Military Officers Association of America 

Military Order of the Purple Heart 

National Association for Uniformed Services 

National Guard Association of the United States 

National Military Family Association 

Naval Enlisted Reserve Association 

Non Commissioned Officers Association 

Reserve Enlisted Association 

Reserve Officers Association 

Society of Medical Consultants to the Armed Forces 

The Retired Enlisted Association 

United States Army Warrant Officers Association 

United States Coast Guard Chief Petty Officers Association 

Veterans of Foreign Wars 

Vietnam Veterans of America 

Wounded Warrior Project 

The Military Coalition, Inc. does not receive any grants or contracts from the federal government. 
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Executive Summary 

Force Levels 

Over the past several years, Congress has addressed the greater than anticipated requirements and 

resources to support the operational requirements and the resulting negative impact on the quality of life 

of uniformed servicemembers by boosting the Services' end strength resulting in increasing dwell time. 

TMC remains concerned about the adequacy of strength levels in light of stress indicators including 

increased divorces, alarming suicide rates, and other symptoms. 

Therefore, the Coalition urges the Subcommittee to: 

Ensure that the drawdown does not proceed at a rate which would adversely impact the required 

dwell time for the troops; that is, sustain force levels which are consistent with the mission. 

Ensure that the Services maximize the use of voluntary draw down tools (including the temporary 

early retirement authority included in the FY2012 National Defense Authorization Act) before 

resorting to involuntary measures. 

Sustain adequate recruiting and retention resources to enable the uniformed services to sustain their 

continuing needs for top-quality personnel. 

Support a defense budget that funds both people and weapons needs. 

Military Retirement 

The purpose of the unique military retirement package is to offset the extraordinary demands and 

sacrifices inherent in a service career. These benefits provide a powerful incentive for top-quality 

people to serve 20-30 years in uniform. 

The Administration's budget submission calls for a BRAC-like study to review the retirement system 

which has proven to be so critical to sustaining long-term retention and readiness. The program must 

not be subject to a short-circuited legislative process that denies due diligence and leaves this crucial 

program subject to the whims of a small group tasked to meet a political deadline. 

The Coalition urges the Subcommittee to: 

Oppose initiatives that would "civilianize" the military retirement system, ignore the lessons of the 

ill-fated REDUX initiative, and inadequately recognize the unique and extraordinary demands and 

sacrifices inherent in a military career. 

Oppose a BRAC-like legislative process for military retirement reform that would short-circuit the 

opportunity for thorough Armed Services Committee deliberation. 

Currently Serving Issues 

Compensation - Congress has made great strides to restore military pay comparability over the past 12 

years, including a statutory change that explicitly ties military pay raises to Employment Cost Index 

(ECI) growth. 

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Despite significant progress and retention problems associated with the "erosion of pay and benefits" 

abated, there are renewed calJs to cut back on military raises, create a new comparability standard or 

substitute more bonuses for pay raises in the interests of deficit reduction. 

The Coalition believes such proposals are exceptionally short-sighted in view of the extensive negative 

experience with military pay raise caps. 

The Coalition urges the Subcommittee to sustain fully-comparable annual military pay raises based on 

the Employment Cost Index as specified in current law. 

Wounded, Ill, and Injured Servicemember Compensation - Complex challenges remain in 

overseeing and validating massive policy and program changes among the military services; the DoD; 

the VA; several Centers of Excellence; a multitude of civilian contractors and non-governmental 

agencies; and at least six congressional oversight committees. 

The Coalition urges the Subcommittee to: 

Ensure any restructure of the DoD and VA disability and compensation systems does not 

inadvertently reduce compensation levels for disabled servicemembers. 

Oppose distinguishing between disabilities incurred in combat versus non-combat service when 

determining benefits eligibility for retirement. 

Support extending eligibility for residence in on-base facilities for up to one year to medically 

retired, severely wounded servicemembers and their families. 

DoD Resale Operations -1MC strongly believes military commissary, exchange and Morale Welfare 

and Recreation (MWR) programs contribute significantly to a strong national defense by sustaining 

morale and quality of life for military beneficiaries both within the United States and around the globe. 

The Coalition urges the Subcommittee to resist initiatives to civilianize or consolidate DoD resale 

systems in ways that would reduce their value to patrons. 

Family Readiness and Support - A fully funded, robust family readiness program is crucial to military 

readiness, especially given the continuing demands of deployments and the uncertainty of the legacy of 

the effects of 10 years of war on servicemembers and their families. 

The Coalition urges the Subcommittee to: 

Continue much-needed supplemental funding authority to schools impacted by large populations of 

military students. 

Direct DoD to report on MWR category programs. 

Fully fund effective programs. 

Ensure all National Guard and Reserve Yellow Ribbon Programs meet a standard level of family 

support within each State. 

Continue support for child care needs of the highly deployable, operational total force co~unity. 

Encourage greater military spouse educational and career opportunities, and ensure existing 

programs are accessible and effecti ve. 

Continue pressing the Defense Department to implement flexible spending accounts to enable 

military families to pay health care and child care expenses with pre-tax dollars. 

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Base Realignment and Closure (BRAC) Rounds - The Administration's budget calls for two 

additional rounds ofBRAC in order to garner savings. The Coalition is very concerned that these 

decisions are driven solely to save money. 

The Coalition urges the subcommittee to proceed cautiously with additional BRAC rounds and verify 

DoD has accounted for all the implementing costs of their proposals. 

National Guard and Reserve Issues 

Operational Reserve Retention and Retirement Reform - The current law that credits only active 

service since January 28, 2008 disenfranchises and devalues the service of hundreds of thousands of 

GuardlReserve members who served combat tours (multiple tours, in thousands of cases) between 2001 

and 2008. 

The Coalition urges the Subcomrrrittee to: 

Elirrrinate the fiscal year lirrritation which effectively denies full early retirement credit for active 

duty tours that span the October 1 start date of a fiscal year. 

Modernize the reserve retirement system to incentivize continued service beyond 20 years and 

provide fair recognition of increased requirements for active duty service. 

Authorize early retirement credit for all Guard and Reserve members who have served on active 

duty tours of at least 90 days retroactive to September 11, 200!. 

Yellow Ribbon Reintegration Program - Congress has provided increased resources to support the 

transition of warrior-citizens back into the community; however, program execution remains spotty from 

state to state and falls short for returning Federal Reserve warriors in widely dispersed regional 

commands. 

The Military Coalition urges Congress to hold oversight hearings and direct additional improvements in 

coordination, collaboration and consistency of Yellow Ribbon services between States. 

Reserve Compensation System - Related to this are demands on qualifications, mental skills, physical 

fitness, and training in conjunction with national security rrrissions at home and abroad. The 

compensation system needs to be improved to attract and retain individuals into the GuardlReserve. 

The Coalition recommends Congress authorize: 

Credit for all inactive duty training points earned annually toward reserve retirement. 

Parity in special incentive pay for career enlisted/officer special aviation incentive pay, diving 

special duty pay, and pro-pay for reserve component medical professionals. 

Recalculation of retirement points after one year of activation. A recent law change allowed certain 

flag and general officers to recalculate retirement pay after one year of active duty. TMC believes 

this opportunity should be made available to all ranks. 

GuardJReserve GI Bill - Benefits for joining the Selected Reserve were not upgraded or integrated in 

the Post-9fIl OI Bill as TMC has long recommended. However, the Budget request proposes to reduce 

contributions into the DoD Educational Benefit Trust Fund. 

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The Coalition recommends the Subcommittee: 

Restore basic reserve MGm benefits for initially joining the Selected Reserve to the historic 

benchmark of 47-50% of active duty benefits, 

Integrate reserve and active duty MGm laws in Title 38. 

Enact academic protections for mobilized Guard and Reserve students, including refund guarantees 

and exemption of Federal student loan payments during activation. 

GuardlReserve Family Support Programs - We have seen considerable progress in outreach 

programs and services for returning Guard and Reserve warriors and their families. Family support 

programs promote better communication with servicemembers. Specialized support and training for 

geographically separated Guard and Reserve families and volunteers are needed. 

The Coalition urges the Subcommittee to: 

Ensure programs are in place to meet the special information and support needs of families of 

individual augmentees or those who are geographically dispersed, 

Fund joint programs among military and community leaders to support servicemembers and families 

during all phases of deployments, 

Provide preventive counseling services for servicemembers and families, 

Authorize child care, respite care, family readiness group meetings and drill time, 

Improve the joint family readiness program to facilitate understanding and sharing of information 

between all family members, 

Retiree Issues 

Cost-or-Living Adjustments (COLAs) - COLAs are particularly important to military retirees, 

disabled retirees, and survivors because they start drawing their annuities at younger ages than most 

other COLA-eligibles and thus experience the compounding effects over a greater number of years, To 

the extent that COLAs fail to keep up with living costs, real purchasing power declines dramatically as 

long the longer a retiree lives, 

The Coalition urges the Subcommittee to ensure continued fulfillment of congressional COLA intent, as 

expressed in House National Security (HNSC) Committee Print of Title 37, USC: "to provide every 

military retired member the same purchasing power of the retired pay to which he was entitled at the 

time of retirement [and ensure it is] not, at any time in the future .. ,eroded by subsequent increases in 

consumer prices." 

Concurrent Receipt - The Coalition strongly believes that career military members earn their retired 

pay by service alone, and that those who suffer a service-caused disability in the process should have 

any V A disability compensation from the V A added to, not subtracted from, their service-earned 

military retired pay and this remains a key goal in 2012, 

The Coalition urges the Subcommittee to continue to seek options to: 

Expand Concurrent Retirement and Disability Payments (CRDP) to disabled retirees not eligible 

under the current statute, to include vesting of earned retirement credit for Chapter 61 retirees with 

less than 20 years of service, 

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Resolve the so-called Combat Related Special Compensation (CRSC) "glitch" that causes combatdisabled members' compensation to decline when their V A disability rating is increased; or as an 

interim step. 

Pursue legislation specifying that a disabled retiree's CRSC disability compensation cannot be 

reduced when his or her VA disability rating increases until the retiree is afforded the opportunity to 

elect between CRSC and CRDP. 

Fair Treatment for Servicemembers Affected by Force Reductions - Over the next five years, over 

100,000 additional servicemembers will transition from wearing a uniform into the private sector as part 

of the force drawdown. 

During any force reduction, servicemembers who intend to make the service a career are forced out. We 

believe the Nation should recognize their service and provide a "transportable" benefit for those that 

have their careers curtailed involuntarily short of 20 years. 

The Coalition recommends enacting temporary legislation that would allow members separated during 

periods of significant force reductions to deposit part or all of their involuntary separation payor VSP 

into their TSP account. 

Survivor Issues 

SBP-DIC Offset - The Coalition believes widows whose sponsors' deaths were caused by military 

service should not be last in line for redress. 

The Coalition urges the Subcommittee to: 

Continue its leadership in seeking to eliminate the SBP-DIC offset. 

Authorize SBP annuities to be placed into a Special Needs Trust for disabled survivors who 

otherwise lose eligibility for Supplemental Security Income (SSI) and Medicaid. 

Reduce the age for paid-up SBP to age 67 to be fairer to those who joined the military at age 17, 18 

or 19. 

Reinstate SBP annuities to survivors who transfer benefits to their children when the children reach 

majority, or when a second marriage ends. 

Exempt SBP-eligible children from being inadvertently penalized by the Alternative Minimum Tax 

(AMT), which treats SBP as unearned income and taxes it at the higher 26% AMT rate. 

Final Retired Pay Check - Under current law, DFAS recoups from military widows'/widowers' bank 

accounts all retired pay for the month in which a retiree dies. 

TMC urges the Subcommittee to authorize survivors of retired members to retain the final month's 

retired pay for the month in which the retiree dies. 

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Mr. Chairman, The Military Coalition thanks you and the entire Subcommittee for your strong support 

of our active duty, Guard, Reserve, retired members, and veterans of the uniformed services and their 

families and survivors. Your efforts have had a significant and positive impact in the lives of the entire 

uniformed services community. 

Presently, the Coalition has three major concerns with the Administration's proposed FY2013 

Department of Defense (DoD) budget: health care fee increases, force level reductions, and the 

establishment of a commission to examine military retirement. This statement will focus on two of 

these areas as well as provide our collective perspective on other issues concenting the entire uniformed 

service community. We will address health care issues in a separate statement for the March 22 hearing. 

The past few years have been exceptionally arduous, with our military winding down operations in Iraq 

while continuing operations in Afghanistan, all as the nation recovers slowly from the economic crisis. 

Congress and the Administration have had difficult choices to make as they worked to bolster the weak 

economy while facing record-breaking budget deficits. 

We are grateful that DoD and Congress have given personnel issues top priority in the past few years. 

However, as we enter the eleventh year of intense wartime operations, the Coalition believes that critical 

personnel issues are being marginalized in the proposed FY2013 DoD budget. 

Despi te extraordinary demands, men and women in uniform are still answering the call- thanks in no 

small measure to the Subcommittee's strong and consistent support- but only at the cost of ever-greater 

personal sacrifices. 

As you know, we have seen dramatic increases in suicide rates which reflect the long-term effects of 

requiring the same people to return to a combat theater again and again. In addition, there are reports 

that the military divorce rates are at the highest level since 1999. 

In these times of growing political and economic pressures, the Coalition relies on the continued good 

judgment of the Armed Services Committees to ensure the Nation allocates the required resources to 

sustain a strong national defense, and in particular, to properly meet the pressing needs of the less than 

one percent of the American population - our men and women in uniform - who protect the freedoms of 

the remaining 99 percent. 

In this statement, The Coalition offers our collective recommendations on what must be done to meet 

these essential needs. 

Force Levels 

Personnel Strength and Associated Funding - The Pentagon's budget submission includes a 

significant drawdown of over 100,000 troops, predominately affecting troops on the ground - the same 

troops that have endured repeated deployments over the past decade. 

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We understand that the Services are looking to reduce force levels as our troops return from the Middle 

East and the Coalition's primary concern is that the Pentagon's plan does not force additional burdens 

on our servicemernbers and their families by continuing to fall short of dwell time goals. 

For the last decade, servicemembers and their families have endured unprecedented sacrifices often 

having less than a year at home before returning for another year in combat. 

Both Defense and Service leaders have acknowledged that minimum dwell time should be at least two 

years at home after a year deployment. That minimum goal has yet to be attained for all deploying 

servicemembers. 

We are also concerned about sustaining a surge capacity for unexpected contingencies (as of Sept 10, 

2011, no one anticipated the following decade-plus of war) and retaining combat experience by 

encouraging departing veterans to join the Guard and Reserve. 

Cutting GuardlReserve as well as active forces will make achieving these goals even more difficult. 

The Coalition urges the Subcommittee to ensure adequate personnel strengths and funding are 

authorized to meet national security strategy requirements and dwell time goals. 

TMC remains concerned about the adequacy of strength levels in light of stress indicators including 

increased divorces, alarming suicide rates, and other symptoms. 

Therefore, the Coalition urges the Subcommittee to: 

Ensure that the drawdown does not proceed at a rate which would adversely impact the required 

dwell time for the troops; that is, sustain force levels which are consistent with the mission. 

Ensure that the Services maximize the use of voluntary drawdown tools (including the temporary 

early retirement authority included in the FY2012 Defense Authorization Act) before resorting to 

involuntary measures. 

Sustain adequate recruiting and retention resources to enable the uniformed services to sustain 

the continuing needs for top-quality personneL 

Support a defense budget that funds both people and weapons needs. 

Military Retirement 

Uniformed Services Retirement System - The entire military compensation system, to include the 

retirement benefit, is based on principles outlined in the DoD's Military Compensation Background 

Papers and "should be designed to foster and maintain the concept of the profession of arms as a 

dignified, respected, sought after, and honorable career." 

The purpose of the unique military retirement package is to offset the extraordinary demands and 

sacrifices inherent in a service career. Benefits provide a powerful incentive for top-quality people to 

serve 20-30 years in uniform, despite the burden of sacrifices as eloquently articulated by the Secretary 

of the Air Force during his January 18, 1978 testimony before the President's Commission on Military 

Compensation: 

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"The military services are unique callings. The demands we place on our military men and 

women are unlike those of any other country. Our worldwide interests and commitments place 

heavy burdens and responsibilities on their shoulders. They must be prepared to live 

anywhere, fight anywhere, and maintain high morale and combat efficiency under frequently 

adverse and uncomfortable conditions. They are asked to undergo frequent exposure to risk, 

long hours, periodic relocation and family separation. They accept abridgement of freedom of 

speech, political and organizational activity, and control over living and working conditions. 

They are all part of the very personal price our military people pay. 

"Yet all of this must be done in the light of - and in comparison to - a civilian sector that is 

considerably different. We ask military people to be highly disciplined when society places a 

heavy premium on individual freedom, to maintain a steady and acute sense of purpose when 

some in society question the value of our institutions and debate our national goals. In short, 

we ask them to surrender elements of their freedom in order to serve and defend a society that 

has the highest degree of liberty and independence in the world. And, I might add, a society 

with the highest standard of living and an unmatched quality of life. 

"Implicit in this concept of military service must be long-term security and a system of 

institutional supports for the serviceman and his family which are beyond the level of 

compensation commonly offered in the private, industrial sector." 

There is no better illustration of that reality than the experience of the past decade of war. Absent the 

career drawing power of the current 20-year retirement system and its promised benefits, the Coalition 

asserts that sustaining anything approaching needed retention rates over such an extended period of 

constant combat deployments would have been impossible. 

The crucial element to sustaining a high-quality, career military force is establishing a strong bond of 

reciprocal commitment between the servicemember and the government. If that reciprocity is not 

fulfilled, if we "break faith" with those that serve, retention and readiness will inevitably suffer. 

The Coalition believes the government has a unique employer's responsibility to the small segment of 

Americans it actively induces to subordinate their interests to the America's for 20 to 30 years that goes 

far beyond any civilian employer's obligation to its employees. 

The uniformed services retirement system has had its critics since the 1970s and even earlier. 

In the 1980s, budget pressures led to amending retirement rules twice for new service entrants: 

Basing retired pay calculations on the high-36-month average of basic pay instead of final basic pay 

(1980), and 

Enacting the REDUX system that cut 20-year retired pay value by more than 25% (1986). 

At the time the REDUX plan was being considered, then-Secretary of Defense Caspar Weinberger 

strongly (but unsuccessfully) opposed it (see attached letter), arguing the change would harm retention 

and degrade readiness. "It says in absolute terms," said Weinberger, "that the unique, dangerous, and 

vital sacrifices they routinely make are not worth the taxpayer dollars they receive." 

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When his prediction of adverse retention consequences proved all too accurate in the 1990s, Congress 

had to repeal REDUX in 1999 at the urging of the Joint Chiefs of Staff. 

Subsequently, innumerable studies and task forces have recommended further dramatic changeS, usually 

either to save money, to make the system more like those offered under civilian programs, or both. 

Most recently, groups such as the National Commission on Fiscal Responsibility and Reform, the Debt 

Reduction Task Force, the Sustainable Defense Task Force, and the Defense Business Board's 

"Modernizing the Military Retirement" Task Group have all recommended dramatically revamping the 

system more on civilian lines, with significantly reduced and delayed military retirement compensaUon. 

All too aware of the lessons of REDUX, Congress has wisely ignored and dismissed these ivory-tower 

recommendations, which propose far greater retirement cuts than REDUX entailed. 

The existing retirement system is often characterized as "inflexible", limiting the ability of Service 

personnel managers to more precisely and effectively manage the force. The Coalition strongly 

disagrees. 

The Services already have substantial authority to adjust high-year-of-tenure limits to enforce the unique 

military "up-or-out" promotion system. Other authorities exist, and the Services are currently exerclsmg 

them, to incentivize voluntary separations and voluntary or mandatory early retirements. 

The Services routinely tighten retention and reenlistment incentives and other restrictions when budget 

or other considerations create a need for additional separations and retirements. And when necessary, 

Congress has provided additional special drawdown authorities. 

But the practical reality is that precisely planned force management initiatives are regularly tossed aside 

in the wake of world events which force dramatic reversals of those planned actions. Plans whIch 

envision delaying retirement eligibility until age 57 or 60 belie the reality that the Services don't want 

the vast majority of members to stay in uniform that long. 

Service desires for unlimited flexibility to shape the force may be appropriate for management of 

hardware and other non-sentient resources. However, the Services are dependent upon attracting and 

retaining smart people who understand all too well when their leaders put no limits on the sacrifices that 

may be demanded of them, but also wish to reserve the right to kick them out at will .... even while 

building a system that assumes they will be willing to serve under these conditions until age 60. 

Servicemembers from whom we demand so much deserve some stability of career expectations in 

return, 

We believe that "civilianizing" the military benefit package would dramatically undermine the primary 

military career retention incentive and would be disastrous for retention and readiness, as they increase 

the incentives to 1eave and reduce the incentives for career service. 

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Moreover, we believe it is irresponsible to focus on budget and "civilian equity" concerns while 

ignoring the primary purpose of the retirement system - to ensure a strong and top-quality career force 

in spite of arduous service conditions that no civilians experience and few are willing to accept. 

The Coalition is particularly concerned that the Administration's budget submission calls for a BRAClike legislative strategy under which Congress would have to give a retirement study commission's 

recommendations an "up or down" vote with only limited debate and no opportunity for amendments. 

The Coalition is not opposed to a review of retirement pay, but we adamantly oppose a BRAC-like 

consideration process that would subvert thorough review, consideration, and determinations of 

propriety by the Armed Services Committees. 

The military retirement program that has proven to be so critical to sustaining long-term retention and 

readiness, must not be subject to a short-circuited legislative process that denies due diligence and leaves 

this crucial program subject to the whims of a small group tasked to meet a political deadline. 

The Coalition urges the Subcommittee to: 

Oppose initiatives that wouM "civilianize" the military retirement system, ignore the lessons of the 

ill-fated REDUX initiative, and inadequately recognize the unique and extraordinary demands 

and sacrifices inherent in a military career. 

Oppose a BRAC-like legislative process for military retirement reform that wouM shorl-circuit the 

opportunity for thorough Armed Services Committee deliberation. 

Currently Serving Issues 

Compensation - The Coalition is pleased that the Administration's budget plan envisions proposes 

military pay raises for 2013 and 2014 that reflect the growth in private sector pay, as measured by the 

Bureau of Labor Statistics' Employment Cost Index (ECI). 

But we are very concerned that the proposal includes plans to break the tie to civilian pay growth by 

limiting military raises to .5%, 1 %, and 1.5% for 2015, 2016, and 2017, respectively. 

History has shown that capping military raises is an exceptionally slippery slope that has never ended 

well. 

In the 1970s, a succession of annual pay raise caps contributed to serious retention problems that had to 

be addressed by two large "catch-up" raises in 1981 and 1982. But that lesson was quickly forgotten. 

Throughout the 1980s and '90s, budget problems led to regular capping of military pay raises below 

private sector pay growth, eventually accumulating a "pay comparability gap" which peaked at 13.5% in 

1998-99, and again contributed Significantly to serious retention problems. 

Congress has made great strides to restore military pay comparability over the intervening 12 years, 

including a statutory change that explicitly ties military pay raises to ECI growth. 

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Now that significant progress has been made and the "erosion of pay and benefits" retention-related 

problems have abated, there have been renewed calls to cut back on military raises, create a new 

comparability standard or substitute more bonuses for pay raises in the interests of deficit reduction. 

The Coalition believes such proposals are exceptionally short-sighted in view of the extensive negative 

experience with military pay raise caps. 

The Coalition is concerned that many in the Administration and some members of Congress are unaware 

of the history of past compensation changes and their unforeseen outcomes. Moreover, some view these 

vital programs simply as a source of savings without regard to the impact they may have on long term 

readiness in the All-Volunteer Force. 

History indicates that, once military pay raise caps start, they tend to continue until they cause retention 

problems that then have to be addressed through significant pay raise plus-ups. 

This is a significant irony, in that the whole purpose of sustaining pay comparability through good times 

and bad is to prevent retention and readiness problems from occurring, rather than going through an 

endless cycle of causing problems and then repairing them. 

Additionally, the Pentagon has been advocating a new comparability standard under which each pay and 

longevity cell would represent the 70th percentile of compensation for Similarly-educated civilians. 

A 2010 Congressional Budget Office report asserted that, considering adjustments in housing 

allowances, many military people actually are paid somewhat more than their civilian counterparts in 

terms of Regular Military Compensation (RMC), composed of basic pay, food and housing allowances, 

and the tax advantage that accrues because the allowances are tax-free. 

The Coalition believes such assertions are fundamentally flawed for three distinct reasons. 

First, the RMC concept was developed in the 1960s, when all servicemembers received the same 

allowances, regardless of location, and the allowances were arbitrarily established. Congress has since 

transformed the allowances into reimbursements for actual food costs and median locality-based housing 

costs. Under the RMC comparability concept, a year in which taxes increase and average housing 

allowances rise (e.g., based on growth in high-cost areas) would yield a perverse requirement to cut 

basic pay to restore comparability. 

Second, the Coalition is not convinced that the civilian comparison cohort or percentile comparison 

points as proposed by DoD are appropriate given that the military: 

Recruits from the top half of the civilian aptitude population; 

Finds that only about 25% of America's youth qualify for entry; 

Requires career-long education and training advancement; and 

Enforces a competitive "up-or-out" promotion system to ensure progressive quality enhancements 

among those with longer service. 

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Third, the Coalition believes it is essential to recognize that compensation is not simply the amount one 

is paid. It is pay divided by what's required of the recipient to earn that pay. If we increase pay 25% 

but require 100% more sacrifice to earn it, that's not a pay raise. 

In that context, today's conditions of service are far more arduous than anything envisioned 40 years ago 

by the creators of the All-Volunteer Force, who believed a protracted war would require reinstitution of 

the draft. 

Moreover, a fundamental requirement for any pay comparability standard is that it should be transparent 

and understandable by all. The Coalition has sought, but has never been provided by DoD, any data on 

what civilian comparison cohort was selected and why, and what rationale was used to establish a 

specific percentile comparison point. 

The Coalition agrees with the approach the Congress has consistently taken - that the best comparability 

measure is a comparison of the ntilitary basic pay raise percentage with the percentage growth private 

sector pay, as measured by the Bureau of Labor Statistics' Employment Cost Index (ECI). The 

government uses the ECI for every other measure of private pay growth, and it's transparent to 

government leaders and servicemembers alike. 

The Coalition urges the Subcommittee to sustain fully-comparable annual military pay raises based 

on the Employment Cost Index as specified in current law. 

Wounded, III, and Injured Servicemember Compensation - As the Pentagon enters the 11th year of 

war, the seamless transition between DoD and the Department of Veterans Affairs (VA) continues to be 

problematic in many cases for our wounded, ill, injured troops; disabled veterans; and their fantily 

caregivers. 

TMC acknowledges the significant progress that has been made in caring for our nation's heroes and 

thanks the Subcommittee for its leadership and oversight on these pressing issues, particularly in the last 

five years since the Walter Reed scandal that brought to light the flaws and inadequacies of both DoD 

and VA health care and benefits systems. 

But complex challenges remain in overseeing and validating massive policy and program changes 

among the ntilitary services; the DoD; the VA; several Centers of Excellence; a multitude of civilian 

contractors and non-governmental agencies; and at least six congressional oversight committees. 

There still exists a need to further streamline the Integrated Disability Evaluation System (IDES) and to 

improve the operational efficiency, effectiveness, consistency, and timeliness of the medical retirement 

process and DoD-VA coordination in the evaluation of disabilities. We also urge a greater alignment 

and correlation of federal programs such as TRICARE, Medicare, and Social Security Disability 

Insurance (SSDI) to ensure that severely wounded warriors who do not enroll in Medicare Part B do not 

lose TRICARE coverage. 

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The Coalition looks forward to continued work with the Subcommittee to address the remaining issues 

and fully establish systems of seamless care and benefits that support our transitioning wounded 

warriors and family members. 

The Coalition urges the Subcommittee to: 

Ensure any restructure of the DoD and VA disability and compensation systems does not 

inadvertently reduce compensation levels for disabled servicemembers. 

Oppose distinguishing between disabilities incurred in combat versus non-combat when 

determining benefits eligibility for retirement. 

Support extending eligibility for residence in on-base facilities for up to one year to medically 

retired, severely wounded servicemembers and their families. 

DoD Resale Operations - The Military Coalition strongly believes military commissary, exchange and 

Morale Welfare and Recreation (MWR) programs contribute significantly to a strong national defense 

by sustaining morale and quality of life for military beneficiaries both within the United States and 

around the globe. 

The Coalition is very concerned about initiatives to curtail appropriated fund support for these activities. 

Repeated studies have shown that military commissaries provide $2 in compensation value to 

beneficiaries for each $1 of appropriated funding. That constitutes a very significant retention "bang for 

the buck." 

Initiatives to civilianize commissaries or consolidate commissaries and exchanges to achieve budget 

savings would come only at the expense of devaluing their compensation and retention importance value 

for military patrons. 

In order to be the best steward of our funds, we recommend that Congress direct the Pentagon to provide 

a report on all DoD and Service MWR Category A, B, and C Programs and Family SupportlReadiness 

(Quality of Life [QoL] Programs). The report should include: 

A current listing of individual program funding levels by category, actual program expenditures vs. 

program requirement; 

An assessment of the effectiveness of each program including program standards and metrics; and 

A list of recommended changes to policy, including revisions in the current category program 

listings to more accurately support current war-time mission requirements and meet the needs of the 

21st Century all-volunteer force. 

The Coalition urges the Subcommittee to resist initiatives to civilianize or consolidate DoD resale 

systems in ways that would reduce their value to patrons. 

Family Readiness and Support - A fully funded, robust family readiness program continues to be 

crucial to overall readiness of our military, especially with the demands of frequent and extended 

deployments. 

Resource issues continue to plague basic installation support programs. At a time when families are 

dealing with continuing deployments, they often are being asked to do without in other important areas. 

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The Coalition urges the Subcommittee to continue to press the Defense Department to exercise its 

authority to establish flexible spending accounts (FSAs) for servicemembers so they can participate in 

the same pre-tax program available to all other federal employees for their out-of-pocket health and 

dependent care expenses. 

Quality education is a top priority for military families. Servicemembers are assigned all across the 

United States and the world. Providing appropriate and timely funding of Impact Aid through the 

Department of Education with supplemental funding for highly impacted schools in the annual Defense 

Authorization Bill is critical to ensuring quality education military children deserve, regardless of where 

they live. 

The Coalition urges the Subcommittee to: 

Continue much-needed supplemental funding authority to schools impacted by large populations 

of military students. 

Direct DoD to report on MWR category programs. 

Fully fund effective programs. 

Ensure all Narwnal Guard and Reserve Yellow Ribbon Programs meet a standard level of family 

support within each State. 

Continue supportfor child care needs of the highly deployable, operational total force community. 

Encourage greater military spouse and surviving spouse educational and career opportunities, 

and ensure existing programs are accessible and effective. 

Continue pressing the Defense Department to implement flexible spending accounts to enable 

military families to pay health care and child care expenses with pre-tax dollars. 

Base Realignment and Closure (BRAe) Rounds - The Administration's budget calls for two 

additional rounds of BRAC in order to garner savings. The Coalition is very concerned that these 

decisions are driven solely to save money. 

Since the implementation of the 2005 BRAC, every GAO report has highlighted significant concerns 

about the process citing "concerns with DoD under reporting BRAC costs/savings and using non-BRAC 

accounts to fund requirements." In fact, the long term impact of the 2005 BRAC has yet to be seen, as 

the deadline ended less than six months ago. 

Therefore, the Coalition urges the subcommittee to proceed cautiously with additional BRAC rounds 

and verify DoD has accounted for all the implementing costs of their proposals. 

National Guard and Reserve Forces 

Since Sept. 11,2001, more than 842,000 Guard and Reserve servicemembers have been called up, 

including over 300,000 who have served multiple tours. There is no precedent in American history for 

this sustained reliance on citizen-soldiers and their families. To their credit, Guard and Reserve combat 

veterans continue to reenlist, but the ongoing pace of routine, recurring activations and deployments 

cannot be sustained indefinitely. 

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Guard and Reserve members and families face unique challenges in their readjustment following active 

duty service. Unlike active duty personnel, many Guard and Reserve members return to employers who 

question their contributions in the civilian workplace, especially as multiple deployments have become 

the norm. Many Guard-Reserve troops return with varying degrees of combat-related injuries and stress 

disorders, and encounter additional difficulties after they return that can cost them their jobs, careers and 

families. 

Despite the continuing efforts of the Services and Congress, most Guard and Reserve families do not 

have access to the same level of counseling and support that active duty members have. In short, the 

Reserve components face increasing challenges virtually across the board, including major equipment 

shortages, end-strength requirements, wounded-warrior health care, and pre- and post-deployment 

assistance and counseling. 

Operational Reserve Retention and Retirement Reform - Congress took the first step in modernizing 

the reserve compensation system with enactment of early retirement eligibility for certain reservists 

actiVated for at least 90 continuous days served since January 28, 2008. 

Congress authorized a historic expansion of operational reserve policy in the 2012 NDAA. Now up to 

60,000 reservists may be called up for up to one year to perform non-emergency missions that are preplanned and budgeted by the Services. 

The Coalition believes this change only further underscores the need to ensure'Guard and Reserve 

members' compensation keeps pace with the increased service expectations being imposed on them. 

The greater the demands placed on them, the greater the need to enhance inducements that are essential 

to sustain the operational reserve force over the long term. 

Repeated, extended activations make it more difficult to sustain a full civilian career and impede 

Reservists' ability to build a full civilian retirement, 401(k), etc. Regardless of statutory protections, 

periodic long-term absences from the civilian workplace can only limit GuardlReserve members' upward 

mobility, employability and financial security. Further, strengthening the reserve retirement system will 

serve as an incentive to retaining critical mid-career officers and NCOs for continued service and 

thereby enhance readiness. 

As a minimum, the next step in moderniZing the reserve retirement system is to eliminate the inequity 

inherent in the current fiscal year retirement calculation, which only credits 90 days of active service for 

early retirement purposes if it occurs within the same fiscal year. The current rule significantly 

penalizes members who deploy in July or August vs. those deploying earlier in the fiscal year to provide 

equal retirement-age-reduction credit for all activated service rendered since Sept. 11,2001. 

The current law that credits only active service since January 28, 2008 disenfranchises and devalues the 

service,of hundreds of thousands of GuardlReserve members who served combat tours (multiple tours, 

in thousands of cases) between 2001 and 2008. -

Operational Reservists contributions to national security is demeaned by crediting a 90-day tour served 

from January through March, but only half credit for a l20-day tour served from August through 

November (because the latter covers 60 days in each of two fiscal years). 

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Moreover, the law-change authorizing early reserve retirement creillt for qualifying active duty served 

after 28 Jan 2008 severed eligibility for TRrCARE coverage until the reservist reaches age 60. 

The Coalition urges the Subcommittee to: 

Eliminate the fiscal year limitation which effectively denies full early retirement credit for active 

duty tours that span the Oct 1 start date of a fiscal year. 

Modernize the reserve retirement system to incentivize continued service beyond 20 years and 

provide fair recognition of increased requirements for active duty service. 

Authorize early retirement credit for all Guard and Reserve members who have served on active 

duty tours of at least 90 days retroactive to September 11, 2001. 

Yellow Ribbon Reintegration Program - Congress has provided increased resources to support the 

transition of warnor-citizens back into the community. But program execution remains spotty from 

state to state and falls short for returning Federal Reserve warnor>; in widely dispersed regional 

commands. Programs should meet a standard level of family support within each state. Military and 

civilian leaders at all levels must improve the coordination and delivery of services for the entire 

operational reserve force. Many communities are eager to provide support and do it well. But Yellow 

Ribbon efforts in a number of locations amount to little more than PowerPoint slides and little or no 

actual implementation. 

DoD must ensure that state-level best practices - such as those in Maryland, Minnesota and New 

Hampshire - are applied for all operational reserve force members and their families, and that Federal 

Reserve veterans have equal access to services and support available to National Guard veterans. 

Community groups, employers and service organization efforts need to be encouraged and better 

coordinated to supplement unit, component, Service and V A outreach and services. 

The Military Coalition urges Congress to hold oversight hearings and direct additional improvements 

in coordination, collaboration and consistency of Yellow Ribbon services between States. 

Reserve Compensation System - The increasing demands of qualifications, mental skills, physical 

fitness, and training reaillness on the Guard and Reserve to perform national security missions at home 

and abroad and increased training requirements indicate that the compensation system needs to be 

improved to attract and retain individuals into the GuardlReserve. The added responsibility of returning 

to active duty multiple times over the course of a reserve career requires improvements to the 

compensation package and to make it more equitable with the active component. 

The Coalition recommends Congress authorize: 

Credit for all inactive duty training points earned annually toward reserve retirement. 

Parity in special incentive pay for career enlisted/officer special aviation incentive pay, diving 

special duty pay, and pro-pay for reserve component medical professionals. 

Recalculation of retirement points after 1 year of activation. A recent law change allowed certain 

flag and general officers to recalculate retirement pay after one year of active duty. TMC believes 

this opportunity should be made available to all ranks. 

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GuardIReserve GI BilI- The Coalition is most grateful to Congress for passage of the Post-9/11 GI 

Bill, which incorporates a number of major Coalition goals including benefits that match the cost of 

education, extension of the post-service usage period to 15 years, and cumulative credit for GuardReserve service on active duty. However, volunteers who join the Selected Reserve were left behind in 

this legislation. 

Benefits for joining the Selected Reserve were not upgraded or integrated in the Post-9/ll GI Bill as 

TMC has long recommended. However, the Budget request proposes to reduce contributions into the 

DoD Educational Benefit Trust Fund. This could result in future cuts to this program. 

The Coalition recommends the Subcommittee to: 

Restore basic reserve MGIB benefits for initially joining the Selected Reserve to the historic 

benchmark of 47-50% of active duty benefits. 

Integrate reserVe and active duty MGIB laws in Title 38. 

Enact academic protections for mobilized Guard and Reserve students, including refund 

guarantees and exemption of Federal student loan payments during activation. 

GuardlReserve Family Support Programs - We have seen considerable progress in outreach 

programs and services for returning Guard-Reserve warriors and their families. Family support 

programs promote better communication with servicemembers. Specialized support and training for 

geographically separated Guard and Reserve families and volunteers are needed. 

The Coalition urges the Subcommittee to: 

Ensure programs are in place to meet the special information and support needs offamilies of 

individual augmentees or those who are geographically dispersed. 

Fund joint programs among military and community leaders to support servicemembers and 

families during all phases of deployments. 

Provide preventive counseling services for servicemembers and families. 

Authorize child care, including respite care, family readiness group meetings and drill time. 

Improve the joint family readiness program to facilitote understanding and sharing of 

information between allfamily members. 

Retiree Issues 

Cost-of-Living Adjustments (COLAs) - In recent years, several commissions have proposed adjusting 

the Consumer Price Index (CPI) methodology to the so-called "chained CPI" calculation as a means of 

holding down COLA growth for military and federal civilian retired pay, Social Security and all other 

federal annuities over time. 

Proponents of the chained CPI say it more accurately reflects changes in annuitants' cost of living by 

recognizing that their purchasing behavior changes as prices change. If the price of beef rises, for 

example, consumers may purchase more chicken and less beef. 

The real issue with the chained CPI is whether one is measuring changes in prices or changes in quality 

of life. If one continues the logical progression of the argument, consumers might find themselves 

substituting hot dogs or pasta for chicken, etc. 

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The Bureau of Labor Statistics has estimated that implementation of the chained CPI would depress 

COLAs by about one-quarter of a percentage point per year. 

The DoD actuary estimates that inflation will average 3 percent per year over the long term. 

Using those two estimates, applying chained-CPI COLAs for a servicemember retiring at age 42 would 

yield about 10 percent less in his or her retired pay check at age 80 relative to the current COLA system. 

Additionally, some commissions have proposed delaying any COLAs on military retired pay until age 

60 or later, barring COLAs on annuity levels above some set dollar amount, or reducing the CPI by onehalf percent or a full percentage point per year. 

The Coalition believes such initiatives would constitute a breach of faith with military people and 

constitute a disproportional penalty. 

COLAs are particularly important to military retirees, disabled retirees, and survivors because they start 

drawing their annuities at younger ages than most other COLA-eligibles and thus experience the 

compounding effects over a greater number of years. To the extent that COLAs fail to keep up with 

living costs, real purchasing power continues to decline ever more dramatically as long as one lives. 

The Coalition urges the Subcommittee to ensure continuedfulfulment of congressional COIA intent, 

as expressed in House National Security (HNSC) Committee Print of Title 37, USC: "to provide every 

mi'itary retired member the same purchasing power of the retired pay to which he was entitled at the 

time of retirement [and ensure it is] not, at any time in thefuture ... eroded by subsequent increases in 

consumer prices. " 

Concurrent Receipt - In the FY2003 and FY2004 NDAA, Congress acknowledged the inequity of the 

disability offset to eamed retired pay and established a process to end or phase out the offset for many 

disabled retirees. The Coalition is extremely grateful for the Subcommittee's efforts to continue 

progress in easing the adverse effects of the offset. 

We were very optimistic in 2009 and 2010 that another very deserving group of disabled retirees would 

become eligible for concurrent receipt when the White House included a concurrent receipt proposal in 

the Budget Resolution - the first time in history any Administration had ever proposed such a fix. 

The Administration's proposal would have expanded concurrent receipt eligibility over a five year 

period to all those forced to retire early from Service due to a disability, injury, or illness that was 

service-connected (chapter 61 retirees). 

The Coalition is dismayed that, despite the Subcommittee's leadership efforts and White House support, 

the provision has not yet been enacted - an extremely disappointing outcome for a most deserving group 

of disabled retirees. 

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We recognize only too well the challenges associated with adding new mandatory spending provisions 

in this difficult budget environment. But making at least some progress to address this grievous inequity 

(e.g., covering all100-percent disabled retirees with less than 20 years of service) is an important goal. 

Additionally, the Coalition is concerned that an inadvertent problem persists in the statutory CombatRelated Special Compensation (CRSC) computation formula causes many seriously disabled and clearly 

eligible members to receive little or nothing in the way of CRSC. The Defense Department has 

acknowledged the problem in discussions with the Subcommittee staff, and the Coalition urges the 

Subcommittee to correct this technical problem. 

The Coalition believes strongly in the principle that career military members eam their retired pay by 

service alone, and that those unfortunate enough to suffer a service-caused disability in the process 

should have any VA disability compensation from the VA added to, not subtracted from, their serviceearned military retired pay and this remains a key goal in 2012. 

The Coalition urges the Subcommittee to continue to seek options to: 

Expand Concurrent Retirement and Disability Payments (CRDP) to disabled retirees not eligible 

under the current statute, to include vesting of earned retirement creditfor Chapter 61 retirees 

with less than 20 years of service. 

Resolve the so-called Combat Related Special Compensation (CRSC) "glitch" that causes combatdisabled members' compensation to decline when their VA disability rating is increased; or as an 

interim step. 

Pursue legislation specifying that a disabled retiree's CRSC disability compensation cannot be 

reduced when his or her VA disability rating increases until the retiree is afforded the opportunity 

to elect between CRSC and CRDP. 

Fair Treatment for Servicemembers Affected by Force Reductions - Over the next five years, over 

100,000 additional servicemembers will transition from wearing a uniform into the private sector as part 

of the force draw down. 

Even though the President's budget includes additional funding for transition assistance for the 

Department of Labor, the Coalition remains concern over the adequacy of funding for DoD and the 

services based on what will be an ever increasing demand on transition services. 

In addition, throughout the 1990s the services had several drawdown tools at their disposal to incentivize 

members to voluntarily leave the service: Voluntary Separation Incentive (VSI), Special Separation 

Benefit (SSB), and Temporary Early Retirement Authority (TERA). Voluntary Separation Pay (VSP) 

still exists and a recently reauthorized TERA will greatly aid the Services over the next five years. 

During any force reduction, servicemembers who intend to make the service a career are forced out. We 

believe the Nation should recognize their service and pr<lVide a "transportable" benefit for those that 

have their careers curtailed involuntarily short of 20 years. 

The Coalition emphasizes that this limited "vesting" initiative should be applied only during periods of 

significant force reductions and funding for it should not come at the expense of those who serve 20 

years or more. 

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Authorizing separated servicemembers the ability to contribute part or all of their involuntary or 

voluntary separation pay into their Thrift Savings Plan (TSP) account would appropriately recognize 

their past service and provide a level of "transportable" career benefit under these difficult times. 

The Coalition recommends enacting temporary legislation that would allow members separated 

during periods of significant force reductions to deposit parl or all of their involuntary separation pay 

or VSP into their TSP account. 

Survivor Issues 

The Coalition is grateful to the Subcommittee for its significant efforts in recent years to improve the 

Survivor Benefit Plan (SBP), especially its major achievement in eliminating the significant benefit 

reduction previously experienced by SBP survivors upon attaining age 62. 

SBp·DIC Offset - The Coalition believes strongly that current law is unfair in reducing military SBP 

annuities by the amount of any survivor benefits payable from the DIC program. 

If the surviving spouse of a retiree who dies of a service-connected cause is entitled to DIC from the 

Department of Veterans Affairs and if the retiree was also enrolled in SBP, the surviving spouse's SBP 

annuity is reduced by the amount of DIC. A pro-rata share of the SBP premiums is refunded to the 

widow upon the member's death in a lump sum, but with no interest. This offset also affects all 

survivors of members who are killed on active duty. 

The Coalition believes SBP and DIC payments are paid for different reasons. SBP is insurance 

purchased by the retiree and is intended to provide a portion of retired pay to the survivor. DIC is a 

special indemnity compensation paid to the survivor when a member's service causes his or her 

premature death. In such cases, the V A indemnity compensation should be added to the SBP annuity 

the retiree paid for, not substituted for it. 

It should be noted as a matter of equity that surviving spouses of federal civilian retirees who are 

disabled veterans and die of military-service-connected causes can receive DIC without losing any of 

their federal ci vilian SBP benefits. 

The reality is that, in every SBP-DIC case, active duty or retired, the true premium extracted by the 

service from both the member and the survivor was the ultimate one - the very life of the member. This 

reality was underscored by the August 2009 Federal Court of Appeals ruling in Sharp v. U.S. which 

found, "After all, the servicemember paid for both benefits: SBP with premiums; DIC with his life." 

The Veterans Disability Benefits Commission (VDBC) was tasked to review the SBP-DIC issue, among 

other DoDN A benefit topics. The VDBC's final report to Congress agreed with the Coalition in finding 

that the offset is inappropriate and should be eliminated. 

In 2005 then-Speaker Pelosi and other House leaders made repeal of the SBP-DIC offset a centerpiece 

of their GI Bill of Rights for the 21" Century. Leadership has made great progress in delivering on other 

elements of that plan, but the only progress to date on the SBP-DIC offset has been the enactment a 

small monthly Special Survivor Indemnity Allowance (SSIA). 

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The Coalition recognizes that the Subcommittee's initiative in the FY2008 defense bill to establish the 

Special Survivor Indemnity Allowance (SSIA) was intended as a first, admittedly very modest, step in a 

longer-term effort to phase out the Dependency and Indemnity Compensation (DIC) offset to SBP. 

We're very grateful for the Subcommittee's subsequent efforts to increase SSIA amounts as additional 

steps toward the goal of eliminating the offset. 

While fully acknowledging the Subcommittee's good-faith efforts to win more substantive progress, the 

Coalition shares the extreme disappointment and sense of abandonment of the SBP-DIC widows who 

are forced to sacrifice up to $1,195 each month and being asked to be satisfied with a $80 monthly 

rebate. 

The Coalition understands the mandatory-spending constraints the Subcommittee has faced in seeking 

redress, but also points out that those constraints have been waived for many, many far more expensive 

initiatives, including the recent extension of civilian unemployment benefits. 

The Coalition believes widows whose sponsors' deaths were caused by military service should not be 

last in line for redress. 

The Coalition urges the Subcommittee to: 

Continue its lea4ership in seeking to eliminate the SBP-DIC offset. 

Authorize SBP annuities to be placed into a Special Needs Trust for disabled survivors who 

otherwise lose eligibility for Supplemental Security Income (SSI) and Medicaid. 

Reduce age for paid-up SBP to age 67 to be fairer to those who joined the military at age 17,18 or 

19. 

Reinstate SBP annuities to survivors who transfer it to their children when the children reach 

majority, or when a second marriage ends. 

Exempt SBP-eligible children from being ina4vertently penalized by the Alternative Minimum 

Tar (AMT), which treats SBP as unearned income and tares it at the higher 26% AMT rate. 

Final Retired Pay Check - Under current law, DFAS recoups from military widows' Iwidowers' bank 

accounts all retired pay for the month in which a retiree dies. Subsequently, DFAS pays the survivor a 

pro-rated amount for the number of days of that month in which the retiree was alive. This often creates 

hardships for survivors who have already spent that pay on rent, food, etc., and who routinely are 

required to wait several months for DFAS to start paying SBP benefits. 

The Coalition believes this is an extremely insensitive policy imposed by the government at the most 

traumatic time for a deceased member's next of kin. Unlike his or her active duty counterpart, a 

retiree's survivor receives no death gratuity. Many older retirees do not have adequate insurance to 

provide even a moderate financial cushion for surviving spouses. 

In contrast to the law governing military retired pay treatment of survivors, the title 38 statute requires 

the VA to make full payment of the final month's VA disability compensation to the survivor of a 

disabled veteran. 

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The disparity between DoD and VA policy on this matter is indefensible. Congress should do for 

retirees' widows the same thing it did ten years ago to protect veterans' widows. 

TMC urges the Subcommittee to authorize survivors of retired members to retain the./inal month's 

retired pay for the month in which the retiree dies. 

Summary 

The Military Coalition again thanks the Subcommittee for your unfailing support of the entire uniformed 

service community and for taking our concerns and priorities into consideration as you deliberate on the 

future of the one weapon system that has never let our Nation down - the men and women who wear 

and ha ve worn the uniform and their families. 

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24 
166 

APPENDIX C


328per56.eps

Not for Publication 

Until Released by 

The Committee 

Statement for the Record 

ofthe 

NATIONAL MILITARY FAMILY ASSOCIATION 

Before the 

Subcommittee on 

Personnel 

ofthe 

UNITED STATES SENATE 

ARMED SERVICES COMMITTEE 

NATIONAL 

MILITARY FAMILY 

ASSOCIATION 

Together we're stronger 
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The National Military Family Association is the leading nonprofit organization committed to strengthening 

and protecting 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, and the Commissioned Corps 

of the Public Health Service and the National Oceanic and Atmospheric Administration. 

Association Volunteers in military communities worldwide provide a direct link between military 

families and the Association staff in the Nation's capital. These volunteers are our Heyes and ears," bringing 

shared local concerns to national attention. 

The Association does not have or receive federal grants or contracts. 

Our website is: www.MilitaryFamily.org. 
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328per58.eps

Chairman Webb, Ranking Member Graham, and Distinguished Members of the Subcommittee, the 

National Military Family Association thanks you for the opportunity to present testimony for the record 

concerning the quality aflife of military families - the Nation's families. After almost 11 years 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 and ever-changing need for support has resulted in programs and poHcies that 

have helped sustain our families through these difficult times. 

We recognize the emphasis the Administration is placing on supporting military families. The work 

of Mrs. Obama and Dr. Biden in raising awareness of the sacrifices military families make has been wellreceived by the Nation and appreciated by our families. The Joining Forces initiative calls the American 

people to action in supporting military service members and their families. It is helping more Americans 

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. But all Americans must also understand 

that military service members and their families are still serving, in Afghanistan, in contingency operations 

throughout the world, and by maintaining readiness for unknown contingencies in the furore. 

We endorse the recommendations contained in the statement submitted by The Military Coalition 

on personnel issues and health care. 

Our Nation's military is facing challenges after II years of war. As some of the troops come home, 

many will find realigning the work/life balance as a family may not be easy. Military families worry that 

budget cuts will affect the service member and erode the foundation of support they have relied on. Our 

Association believes that the Federal government has an inherent responsibility to provide support for 

military families and to ensure the readiness of the service member. 

To address the challenges facing our Nation and its military families this year, our Association 

has identified critical priorities and will address them in the first pages of this statement. We also feel 

we have an obligation, as the only organization that speaks for the families of all components, retirees 

and survivors, to bring to your attention other issues of concern and, in some cases, let you know how 

legislation you have championed in the past has made an impact on their lives. We know our statement 

is lengthy. Military families love to share their stories. We want to share their stories with you. 

Family Readiness 

We remain a Nation at war. The readiness of service members and the families that support them 

needs to be at the forefront. Families rely on a foundation of support: accessible quality health care, 

responsive behavioral health support, spouse employment options, quality children's education. 

comprehensive child care, a secure retirement, and unwavering support when wounded, widowed. or 

orphaned. Military families should be able to access some level of this support no matter where they live - in 

the United States or overseas. 

With the change in mission and expected reduction of forces, some families will be forced to make 

unexpected transitions. Some may enter a world filled with uncertainties, especially in the area of 

employment. Those who make the military a career also face uncertainties as they perceive threats to their 

retirement benefits. A review of the military retirement system must be made within the context of the 

entire military compensation package. It should recognize the service of those who don't or can't make the 

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Our Nation's warriors are returning to their families after multiple deployments and frequent 

separations. Our research shows children are especially affected by repeated separations from their mom or 

dad, and by how well their parent/caregiver has handled deployments. We cannot begin to anticipate the 

long-term impact on our families. The ability to achieve and maintain a work/life balance needs to include 

time for reintegration for all families, including those of the wounded, ill, and injured. 

Reintegration Support 

Military families have been living a revolving door existence for the past 11 years. They have 

experienced repeated deployments, each the same with the strains of separation, but unique with the 

dynamic of their family at that moment in time. They have had repeated reunions, honeymoons followed by 

the hard work of rebuilding their family. As they rebuilt, nagging in the back of their mind was the thought 

that soon their family would be doing this again. Family members of single service members can find 

themselves experiencing reintegration with their families long distance. 

The Services have addressed reintegration needs by providing service members with resilience 

training through programs like the Army Comprehensive Soldier Fitness program, presently being adopted 

by the Air Force as well. The establishment of resilience centers on installation serves as a one-stop shop for 

access to counseling, chaplains and other wellness programs. The Army and Air Force are encouraging 

spouses to participate in the online evaluation and training sessions and have master trainers available at 

Family Support Centers. This may prove to be a good tool for the long term. 

Reintegration programs become a key ingredient in the family's success. Our Association believes we 

need to focus on treating the whole family with programs offering readjustment information, education on 

identifying stress, substance abuse, suicide, and traumatic brain injury, and encouraging them to seek 

assistance when having financial, relationship, legal, and occupational difficulties. We appreciate the 

inclusion in the National Defense Authorization Act Fiscal Year 2010 (NDAA FYIO) for education programs 

targeting pain management and su bstance abuse for families, especially as the Department of Defense (DoD) 

reports an increase in medication-related deaths and prescription-related substance use. We recommend 

Congress request DoD report on its outreach and the effectiveness of its educational programs in addressing 

this issue. 

Successful reintegration programs will require attention over the long term, as well as a strong 

partnership at all levels between the various mental health arms of DoD, Veterans Affairs (VA), and State 

agencies. DoD and VA need to provide family and individual counseling to address these unique issues. 

Opportunities for the entire family, and for the couple to reconnect and bond must also be provided. Our 

Association has recognized this need and established family retreats under our Operation Purple· program 

in the National Parks, promoting family reintegration following deployment. 

Expand and support strong and effective reintegration programs for families of all Services and 

Components. 

Recommend Congress request DoD report on its outreach and the effectiveness of its educational 

programs in addressing readjustment information and services. 

National Guard and Reserve 

During the past 11 years of war, our Nation has relied on the services of the National Guard and 

Reserve more than ever before. Our Association appreciates the great strides made by both Congress and the 

Services to help support our Reserve Component families. We believe sustaining effective support programs 

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for our "Citizen Soldiers" and their families is essential at every stage of deployment. We ask Congress to 

provide funding for preventive and follow-up counseling and behavioral health services for mobilized 

Reserve Component members and their families. 

Our Association also appreciates Congress authorizing travel and transportation for Uniformed 

Services members and up to three designees to attend Yellow Ribbon events. We appreciate the provision 

enhancing the Yellow Ribbon Program by authorizing Service and state-based programs to provide access to 

all service members and their families. We ask you continue funding this quality of life program for Reserve 

Component families. 

Our Association has long recognized the unique challenges our National Guard and Reserve families 

face. They are geographically dispersed, live in rural areas, and have service members deployed as individual 

augmentees. Although family support programs have been strengthened, these programs may not be close 

enough to access. These families need more education on leveraging community resources with available 

military resources. 

Provide funding for preventive andfollow-up counseling and behavioral health services for mobilized 

Reserve Component members and their families. 

Continue funding the Yellow Ribbon program and stress the need for greater coordination of resources 

supporting our Reserve Component families. 

Behavioral Health Care 

Our Nation must help returning service members and their families cope with the aftermath of war. 

DoD, VA, and State agencies must partner in order to address behavioral health issues early in the process 

and provide transitional mental health programs, especially during transition from active duty to veteran 

status (voluntary or involuntary) and Permanent Change of Station (PCS) moves. Partnering will also capture 

the National Guard and Reserve member population, who often straddle these agencies' health care systems. 

Full Spectrum of Care 

As the war continues, the call from families who need a full spectrum of behavioral health servicesfrom preventative care and stress reduction techniques, to counseling and medical managed behavioral 

health services-is growing louder. The military offers a variety of psychological health services, both 

preventative and treatment, across Services, agencies, and a variety of programs. However, as service 

members and families experience numerous lengthy and dangerous deployments, we believe the need for 

confidential, preventative, and psychological health services will continue to rise. More importantly, this 

need will remain high even after military operations scale down. 

Our Association applauds DoD and Senior leadership initiatives in addressing stigma around seeking 

behavioral health services for service members, Guardsmen, and Reserves. However, stigma still exists for 

spouses and their children. At a recent military spouse symposium, several spouses described their concerns 

with seeking treatment. They feared it would negatively impact their service member's promotion. Two 

spouses stated the Command was called by the counselor after they sought care at their Service's family 

support center. Spouses frequently tell us they don't know what is out there for help even though there are 

so many available programs. It is hard to find support when military families are having emotional 

difficulties or substance abuse issues because they live so far away from their loved ones who can assist with 

interventions. Stigma about seeking treatment is not openly discussed, but it exists and DoD needs to address 

it. 

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In the research they conducted for us, RAND found military children reported higher anxiety signs 

and symptoms than their civilian counterparts. A recent study by Gormanl et. al (2010), Wartime Military 

Deployment and Increased Pediatric Mental and Behavioral Health Complaints, found an 11 percent increase 

in outpatient mental health and behavioral health visits for children from the ages of 3-8 during 2006-2007. 

Researchers found an 18 percent increase in pediatric behavioral health visits and a 19 percent increase in 

stress disorders when a parent was deployed. Additional research has found an increase in mental health 

services by non-deployed spouses during deployment. A study ofTRICARE claims data from 2003-2006 

published last year by the New England Journal ofMedieine showed an increase in mental health diagnoses 

among Army spouses, especially for those whose service members had deployed for more than one year. 

Our research also found the mental health of the caregiver directly affects the overall well-being of 

the children. Therefore, we need to treat the family as a unit as well as individuals. Communication is key in 

maintaining family unit balance. Our study also found a direct correlation between decreased 

communication and an increase in child and/or caregiver issues during deployment. Research is beginning to 

validate the high level of stress and mental strain our military families are experiencing. The answer is 

making sure our families have access to behavioral health providers. 

Recommend an extended outreach program to service members, veterans, and their families of available 

psychological health resources, such as DoD, VA, and State agencies. 

Encourage DoD to include families in its Psychological Health Support survey and perform a pre and 

post-deployment mental health screening on family members (similar to the PDHA and PDHRA currently 

being done for service members). 

Suicide 

Our Association recognizes the action being taken by the Services and the VA to address the rising 

number of suicides in active duty, National Guard and Reserve members, and veterans. We appreciate the 

Army's suicide report and the DoD Suicide Prevention Task Force report. However, we are concerned that 

military and veteran families were not included when examining suicides. We have no data showing whether 

families are also experiencing a rise in suicides and outpacing their civilian counterparts. Therefore, we 

recommend Congress require a DoD report on the number of family members who committed suicide, made 

a suicide attempt, or reported suicidal thoughts. 

We encourage Congress to direct DoD to include a brief mental health assessment of military 

families each time they visit their primary health care provider. Providers should inquire about whether or 

not the family is experiencing a loved one's deployment. We also recommend DoD offer a type of pre and 

post-deployment mental health screening on family members (similar to the PDHA and PDHRA currently 

being done for service members). 

Recommend Congress require Q DoD report on the number of family members who have committed or 

attempted suicide. 

Downsizing 

While we are aware that the downsizing of the force has already begun, we want to highlight the 

effect on service members and their families whether they leave the service or stay. The editors of the March 

19m editions of the various Military Times newspapers emphasized the toll these 11 years of war have taken 

on families. Quoting from their most recent Military Times Poll, active duty troops who say they are satisfied 

with their marriages, dropped 9 points since 2011 to 85%. The editorial also stated 

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Tile Marine Corps is shedding 20,000 people and fanning out to more deployment locations in the 

Pacific. The Navy is moving to longer sea tours. places like the Philippines and Africa loom a new 

deployment destinations. 

To their credit, military leaders are trying to address dwell times between deployments and the needfor 

stronger family support programs .... A shrinking force will be a busier force - and that could prove 

tough onfamilies. 

OUT Association agrees. It is another reminder that family support programs need to be sustained to 

support readiness. As the Army takes on a more expeditionary role to Europe and Korea, families left behind 

will need to rely on Family Readiness Groups (FRGs) and other support services. While service members will 

not be at war, they will be away from their families. The need for support programs will remain. 

And what of those who are being asked to leave? While DoD and the Services talk about an upgraded 

Transition Assistance Program (TAP), more emphasis should be placed on attendance by the spouse of the 

separating service member at these sessions. Military spouses should be encouraged to take advantage of 

programs like the Military Spouse Employment Partnership to help with their employment planning. We 

hope that an appropriate lead time will be given to separating service members to help with planning. We 

also recommend that transitional compensation and health care coverage be made available to help ease the 

cross over to civilian life. 

Provide compensation and transitional health care coverage for service members who are being released 

from service due to downsizing. 

Encourage the Services to make TAPS training more accessible for military spouses. 

TRICARE Cost Saving Strategies in the 2013 Budget 

DoD's proposed TRICARE changes include a change in enrollment fees for TRICARE Prime for 

under age 65 retirees and the implementation of a first-ever enrollment requirement along with a fee for 

TRICARE Standard/Extra and TRICARE for Life (TFL). DoD also proposed additional changes to pharmacy 

co-pays and limited access to non-formulary retail medications. DoD states it will incur savings through 

better management of health care costs, but also highlights the "savings" it will gain through beneficiary fee 

increases. We believe, however, that the dramatic fee increases proposed for TRICARE Prime and the new 

fees for TRICARE Standard/Extra and TFL are not real "savings" at all, but simply a cost shifting to 

beneficiaries. 

Moreover, as evidenced by last year's GAO Report "'Prohibition on Financial Incentives That May 

Influence Health Insurance Choices for Retirees and Their Dependents under Age 65" (GAO-ll-160R, Feb 16, 

2011) and a February 22, 2012 report from the Congressional Budget Office, DoD has no clear indicator of 

what drives beneficiaries away from using their TRICARE benefit and choosing other insurance. When 

faced with increased costs to their employee health care and an ineligibility to use TRICARE standard as a 

second payer, both reports infer that many under age 65 retirees migrated to TRlCARE Prime, resulting in 

higher costs to DoD. A TRICARE Standard enrollment fee combined with the cost of employer provided care 

or private TRICARE supplemental insurance and no managed care or guaranteed access to care, may drive 

more beneficiaries in this age category to Prime .. 

OUT 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/Extra and TFL. We have never 

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supported an enrollment fee for TRICARE Standard/Extr. or TFL because these programs lack the same 

guarantees attached to TRlCARE Prime. There is no added benefit to the beneficiary, just an added cost. It 

appears this is strictly a financial decision in order to bring in more revenue. 

We oppose DoD's is proposed tiered enrollment fees for TRICARE Prime and TFL based on retiree 

income. Civilian health care plans offer a variety of options at different premium levels. However in the 

civilian market, higher premium fees are tied to added benefits or coverage. DoD's proposal calls for 

TRICARE beneficiaries to pay a higher enrollment fee tied to their retirement income for identical 

TRICARE coverage. Again, it appears DoD's proposed tiered fees are simply a financial decision. 

We appreciate that DoD did not propose any changes to the TRICARE benefit for active duty 

members, did not include a TRICARE enrollment fee for active duty family members, and ensures FY13 

TRICARE enrollment fee changes will not apply to medically retired service members and survivors of 

active duty service member deaths. 

While we have always supported a mechanism for modest TRICARE Prime increases, we have 

concerns regarding DoD's selection of a civilian-based index in determining TRICARE enrollment fee 

increases after October 2012. We object to DoD's proposed use of a civilian index because we believe health 

care experts cannot agree on an accurate index on which to base civilian health care yearly cost increases. 

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. If DoD had used COLA from the beginning to increase TRICARE Prime enrollment fee for retirees 

and tbeir families, it would have been $339 for individual and $678 for family in 2012, more than DoD's 

proposed Tier 1 fee. We applaud the Congressional mandate in NDAA FYll to tie TRICARE Prime fees to 

COLA. We believe increases tied to COLA are the most fair to beneficiaries and predictable for DoD. 

Recommend Juture increases to TRICARE Prime enrollment fees for working age retirees be indexed to 

retired pay cost of living adjustments as it is currently required by law. 

Oppose an enrollment fee for TRICARE Standard/Extra for working age retirees and Medicare eligible 

TFL beneficiaries. 

Recommend that Medicare-eligible beneficiaries using the USFHP be allowed to remain in the program. 

Include consideration of health care cost adjustments as part of a larger study of overall military 

compensation. 

Other Cost Saving Proposals 

We ask Congress to establish better oversight for DoD's accountability in becoming more costefficient. We recommend: 

Require the Comptroller General to audit MTFs on a random basis until all have been examined for 

tbeir ability to provide quality health care in a cost-effective manner 

Create a committee, similar in nature to the Medicare Payment Advisory Commission, to provide 

oversight of the DoD Military Healtb 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 time frame in which they were commissioned to 

examine the issues. This Commission would have the time to examine every issue in an unbiased 

manner. 

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Reform the Governance Structure ofMHS. The Defense Health Board in 2006 and 2009 and the 

U.S. House Armed Service Committee's NDAA FYI! and FY12 proposed the establishment of a 

Unified "Joint" Medical Command, which our Association has supported as well. 

OUT Association believes right-sizing to optimize MTF capabilities through innovative 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. We support the TaskForce on the 

Future a/Military Health Care recommendations to make the DoD MHS more cost-efficient. They conclude 

the MRS must be appropriately sized, resourced, stabilized, and make changes in its business and health care 

practices. We encourage Congress to include the recommendations of the Task Force in the year NDAA 

FY13. These include: 

Restructure TMA to place greater emphasis on its acquisition role 

Examine and implement strategies to ensure compliance with the principles of value-driven health 

care 

Incorporate health information technology systems and implement transparency of quality 

measures and pricing information throughout the MRS (This is also a civilian health care 

requirement in the recently passed Patient Protection and Affordable Care Act.) 

Reassess requirements for purchased care contracts to determine whether more cost effective 

strategies can be implemented 

We support TMA's movement toward a medical home model of patient and family-centered care 

within the direct and purchase care systems. An integrated health care model, where beneficiaries will be 

seen by the same health care team focused on well-being and prevention, is a well-known cost saver for 

health care 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. 

We support DoD's interest to reform the governance structure of MHS. The establishment of a 

Defense Health Agency and its ability to provide efficiencies is still being evaluated by the Government 

Accountability Office. However, we have some concerns with the governance reform chosen by DoD. We 

believe it has not gone far enough to include all of the needed changes to capture maximum efficiencies 

across the MHS. We look forward to discussing potential options with Members of Congress. 

Military Compensation 

In their recent testimony before the House Appropriations Committee's Military Construction, 

Veterans Affairs and Related Agencies Subcommittee, the Senior Enlisted Advisors of all Services spoke of a 

recent phenomenon they had all experienced. The Defense Business Board's presentation on Modernizing 

the Military Retirement System had prompted concerns among all levels of the enlisted and noncommissioned officer ranks. What they heard was "what's going on with my retirement?" They heard it 

everywhere they traveled. The Senior Enlisted Advisors passed that concern on to the members of the 

Subcommittee, stressing that the force did not need the added distraction in the field about whether the 

retirement system would be there for them after 11 years of war. 

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The Defense Business Board, which advises the Secretary of Defense, recommends eliminating the 

current retirement system that awards half of base pay for life to a service member who retires after 20 years 

of active service. Instead, the Board recommends a new defined-contribution plan for currently-serving and 

future service members, which would require service member and DoD contributions to the Federal Thrift 

Savings plan (TSP). DoD contributions per service member could vary, with the prospect of larger 

contributions for personnel in risky assignments. on hardship tOUTS, or in critical specialties. Under the 

Board's proposal, service members would be vested in the plan after 3 to 5 years and could take their TSP 

savings with them when leaving the military. But they would not be able to receive payouts from the TSP 

until age 60 or 65. Current retirees would not be affected by this proposal. 

In an environment of defense budget cuts, military families wonder how soon this plan might be 

implemented and how they might be affected given their service member's time in the military. Among the 

most worried are the currently-serving members who've built their retirement planning on expectations 

about the existing system. We've heard several references to "promises broken" from members of the 

military community. 

This reaction underlines the need for a broad review of the military retirement system. Our 

Association believes retirement is only one part of what must be a complex and comprehensive review of the 

military compensation system. That system and the benefits it provides must reflect the demands of service 

on service members and their families and enable DoD to recruit and retain the highly-skilled, dedicated 

people it needs to fight our Nation's wars and protect our security. We appreciate the Defense Business 

Board's recognition that most service members do not stay long enough to retire. Service members who have 

served five, ten, or 15 years should be able to leave service with some kind of start on their retirement 

savings, especially in times like the past II years of war with repeated deployments. With the plans to 

downsize, personnel who may want to stay to retirement may not be able to do so. Having a flexible 

compensation system that includes the option to provide retirement savings to people forced out because of 

periodic force strength reductions may provide a welcome retirement nest egg to these former service 

members and their families who must start over in another job. 

This review will be complex. We disagree with the proposed BRAC-like legislative process proposed 

by the Administration. This would not allow the opportunity for thorough consideration by the Armed 

Services Committees. 

Call for a comprehensive review of the military compensation system, including health care benefits. 

Family Readiness and Support 

Family Support 

During deployments and often between deployments, military spouses have come to rely on the 

support from Family Support Centers. They've come to understand and make better use of benefits when 

they attend family support programs. In talking with the Services, we have heard of cuts in child care for 

volunteers, reduced curriculum materials for marriage enrichment programs, and significant reductions to 

chapel program budgets. We hear of other ways that family programs are being short-changed. Installation 

commanders may try to make up for budget shortfalls, either because of the Continuing Budget Resolutions 

oflast year or in anticipation of cuts for FYI3. Staff members have been cut from family service centers, 

causing reduction in services. Family members who have been trained and participate in family support 

programs have better experiences with deployment and have fewer problems. DoD and the Services talk of 

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eliminating the programs that are redundant and keeping the ones that work. without a staff to run them, 

how will families access any of them? 

Cuts to installation budgets affect the quality of life of service members and families in other ways. 

We are hearing from families and program staff that some families who have been waiting on housing lists 

for months must now pay for their own moving expenses when their turn finally comes up. This type of 

move had previously been provided through installation funds. Living an hour away from the installation, 

with added expenses for a short while, seemed a good trade-off for the opportunity to live in installation 

housing for the majority of their tour. The cost of moving may make it prohibitive to make the move to the 

installation. Will those families fall behind financially? 

Installation commanders need to make the difficult choice of reducing hours or closing valued 

services such as libraries and gyms. These are services that consistently show up as highly valued by service 

members and their families. 

Senior leadership recognizes family support is extremely important but continually reminds families 

of the need to "tighten our belts". Families do not feel valued when their programs are cut. We know it will 

take time to fine tune the right mix of programs and the expectations of the families. We ask for funding to 

sustain effective family support programs critical to family readiness. 

Fund family support programs to address the changing needs of military families. 

Child Care 

Our Association appreciates the efforts of Congress and the Department of Defense (DoD) to ensure 

that military families have access to high quality child care. Child care concerns used to be the number one 

complaint we heard from families. This is no longer true. Our military families enjoy a plethora of choices 

including drop-in and 24-hour care, and choose between care in Child Development Centers or in Family 

Care homes. We also have several services available to help us find child care in our local communities 

through the National Association of Child Care Resource and Referral Agencies (NACCRRA) and SitterCity. 

The Department of Defense (DoD) and the Services continue to take innovative steps to address concerns as 

they arise. 

The Department of Defense is running a pilot initiative in thirteen states aimed at improving the 

quality of child care within communities. This investment translates into increased child care capacity for 

military families living in geographically dispersed areas. DoD is contracting with SitterCity.com to help 

military families find caregivers and military subsidized child care providers. The military Services and 

NACCRRA continue to partner to provide subsidized child care to families who cannot access installation 

based child development centers. 

In February, the GAO released the report required by the National Defense Authorization Act 

(NDAA) Fiscal Year 2010 (FYIO) 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. The 

report details the steps DoD and the Services are taking to address family concerns with regards to 

accessibility and quality. 

The Mental Health Needs of Military Children 

Our Association is concerned about the impact of deployment and/or the injury of the service 

member is having on our most vulnerable population, children of our military service members and veterans. 

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Our study on the impact of the war on caregivers and children found deployments are creating layers of 

stressors, which families are experiencing at different stages. Teens especially carry a burden of care they are 

reluctant to share with the non-deployed parent in order to not "rock the boat." They are often encumbered 

by the feeling of trying to keep the family going, along with anger over changes in their schedules, increased 

responsibility, and fear for their deployed parent. Children of the National Guard and Reserve members face 

unique challenges since most do not live near a military installation. Our research finds they have more 

difficulty with deployments and reintegration than their active duty counterpart. 

Our study respondents stated their communities did not understand what it was like to be military, 

and youth reported feeHng misunderstood by people in their schools. We hear that school systems are 

generally unaware of this change in focus within these family units and are ill prepared to spot potential 

problems caused by these deployments or when an injury occurs. The National Guard and Reserve must 

partner with their deployed families' schools and educate them about available services and programs. 

We appreciate the inclusion of a study on the mental health needs of military children in the NDAA 

FYIO. However, we are still waiting for the study's findings. 

Prompt DoD to release the study on the mental health needs of military children calledfor in NDAA 

FYlO. 

Education of Military Children 

We strongly urge Congress to ensure 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, to 

apply for Impact Aid funds using current student enrollment numbers rather than the previous year. In 

addition, we thank Congress for authorizing and funding DoD Impact Aid annually. We ask you to authorize 

$50 million for schools educating large numbers of military connected students. These funds help local 

school districts to meet the education needs of our military children in an era of declining state budgets. Our 

Association has long believed that both Impact Aid programs are critical to ensuring school districts can 

provide quality education for our military children. 

Our Association wishes to thank Congress for providing additional funding to civilian school 

districts educating military children through DoDEA's Educational Partnership Grant Program. We are very 

pleased the National Defense Authorization Act for Fiscal Year 2012 provided a three-year extension to the 

DoD authority that was set to expire in 2013. Since 2008, DoDEA has awarded 146 grants, totaling $167 

million to school districts, for more than 900 schools. We believe DoDEA's expanded authority to provide 

grant assistance to local education agencies is an important step in strengthening education for all of the 1.2 

million school-aged children. 

We also thank Congress for appropriating additional funding to construct, renovate, repair, or 

expand elementary and secondary public schools on military installations. We appreciate that schools with 

the most serious capacity or facility condition deficiencies will be given priority consideration. 

Ensure appropriate and timely funding ofJmpact Aid through the Department of Education. 

Allow school districts experiencing high growth to apply for Impact Aidfunds using current student 

enrol1ment numbers. 

Authorize and appropriate $50 million in DoD Impact Aidfunding for schools educating large numbers of 

military connected students. 

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Support for Special Needs Families 

The Office of Community Support for Military Families with Special Needs (OSN) was created in 

the NDAA FYIO to enhance and improve DoD support around the world for military families with special 

needs, whether medical or educational. Last year our Association expressed concern that the needs of our 

special needs families were not being addressed in a holistic manner. Our Association is pleased OSN is now 

regularly meeting with the Department of Defense Office of Health Affairs to address the medical resources 

our special needs families require. We are also pleased the OSN has twice convened the Advisory Panel on 

Community Support for Military Families with Special Needs created in the NDAA FY 11 to get input from 

families on the medical, educational, relocation, and family support resources our special needs families 

require. Progress has been made, but our Association still has some concerns. 

Case management for military beneficiaries with special needs is not consistent across the Services 

or the TRICARE Regions because the coordination of care for the military family is being done by a noosynergistic health care system. Beneficiaries try to obtain an appointment and then find themselves getting 

partial health care within the MTF, while other health care 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 requires not only medical intervention, but non-medical care as well. 

Each TruCARE Managed Care Support Contractor (MCSC) has created different case management 

processes. Families need a seamless transition and a warm hand-off between and within TRICARE Regions 

and a universal case management process across the MHS. TruCARE 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, as well as health care. 

We applaud the attention Congress and DoD have given to our special needs family members in the 

past three years and their desire to create robust health care, 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 one 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 studying Medicaid availability for special needs military family 

members. Our Association is anxiously awaiting this srudy'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 

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needs to receive additional services to offset their lack of eligibility for state or federally provided services 

due to 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 the population it was intended to serve. We 

also hear from our ECHO eligible families that they could benefit from additional programs and health care 

services to address their special needs. We request a DoD pilot study to identify what additional services, 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 in the pilot have access to $3,000 above what is provided 

by ECHO 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. This pilot study could identify gaps in coverage and provide DoD and Congress with a list of 

possible extra ECHO benefits for special needs families. More information is needed so the correct solutions 

can be applied to meet the needs of these families. 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. 

The Reserve Component (RC) has unique challenges with their special needs family members. They 

only qualify for ECHO when they are on active duty status. The population is relatively small, but our 

Association is concerned with the coordination of care and seamless transition of services as the special 

needs family member becomes eligible to receive ECHO benefits and then losses them when the member is 

deactivated. We request Congress ask GAO to examine ECHO benefits during the activation and deactivation 

cycle, and its impact on the RC family and the special needs family member. 

Require GAO reports to determine if the ECHO program is working as it was originally designed, and to 

examine the impact of almost 11 years of war on our special needs families. 

Create a DoD pilot study to identify what additional service(s), if any, our special needs families need to 

improve their quality of life. 

Ask GAO to examine the impact of ECHO benefits during the activation and deactivation cycle on the RC 

family and the special needs family member and if it has been effective in addressing the needs of this 

population. 

Spouse Education and Employment 

In February 2012, the First Lady and Dr. Biden urged state action to support military spouses with 

state licenses by unveiling the joint report from the Departments of Defense and Treasury. Supporting our 

Military Families: Best Practices for Streaming Occupational Licensing Across State Lines outlines best 

practices that states can adopt to support military spouse employment and license portability. We believe 

Congress can also support military spouse license portability. We recommend Congress pass the Military 

Spouse Job Continuity Act, (H.R. 3046 or S. 697) or similar legislation. This legislation provides a tax credit to 

a military spouse to offset the cost of a new state-required license after a government ordered move. 

Military spouses who require a state license for their profession are financially disadvantaged by 

Permanent Change of Station (PCS) orders. Many military spouses maintain career licenses 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 

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state. State legislation can expedite the employment process and Congress can alleviate the financial burden 

with a tax credit. 

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 thank you for your strong support of military spouse education by continuing to fund the 

Military Spouse Career Advance Account (MyCAA) program. We are disappointed DoD has not reopened 

the program to all military spouses. 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. 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. In 2012, there were nearly 9,000 applicants and 40 percent were not 

eligible for the MyCAA program. Military spouses remain committed to their education and need assistance 

from Congress to fulfill their educational pursuits. 

In FYII, DoD did not use all of the funds allocated for the MyCAA program. We ask Congress to 

push DoD to reinstate the MyCAA program to include all military spouses, regardless of their service 

member's rank. 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. 

We look forward to the military spouse employmeut report required by the NDAA FY12. This report 

will complement the Congressional mandated military spouse education report released in 2011. 

Recognize the value of military spouses with a tax credit to offset state license and credential fees (H.R. 

3046/S. 697) and expand the Work Opportunity tax credit (H.R. 687). 

Fully fund the MyCAA program for all military spouses. 

Commissary and Exchange 

Our Association is committed to protecting the Commissary and Exchange benefits vital to the 

quality of life of our military families. This past year, our Association worked tirelessly to defeat attacks to 

the Commissary and Exchange benefits: 

The Senate Veterans' Affairs Committee voted to eliminate the federal subsidy for military 

commissaries and recommended the Department of Defense (DoD) consolidate the operations of 

the commissaries and exchanges in order to pay for the Caring/or Camp Lejeune Veterans Act 0/2011 

(S.277). 

An amendment proposed to the NDAA FY12 to consolidate commissaries and exchanges and 

increase prices. 

Senator Tom Coburn's (R-OK) "Back to Black" report recommended consolidation of commissaries 

and exchanges into a single, nonsubsidized retail system over five years. 

The Congressional Budget Office continues to recommend consolidation of commissaries and 

exchanges, price increases, and commercially redeemable vouchers for only certain commissary 

patrons. 

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Our Association is very pleased that the DoD FY13 Budget does not call for additional reductions to the 

Defense Commissary Agency (DeCAl. We believe 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. Military 

families consistently tell us that they consider the commissary one of their most important benefits. Here are 

just a few of the many comments we received: 

"The commissary is a great benefit that helps us stretch our paycheck while helping us put food on 

the table. I was in shock recently when I went to a grocery store and saw the prices! I know that it 

would be much harder to feed my family within our budget if there wasn't a commissary." 

OIMaking it on junior enlisted pay means we have a strict budget and there isn't a lot left over. Every 

penny counts and living in an overseas location makes things even tighter. One of the ways we are 

able to make ends meet is shopping at the commissary. We simply cannot afford to shop off post. 

Taking away the savings we get at the commissary would catastrophically hurt our standard of 

living." 

"Our family chooses to shop at the commissary and the PX because so many of the items are less 

expensive than retail. It is hard to feed a family of 4 boys on retail rates. My husband and I figured 

out we save approx. $300.00 a month. The other reason why we shop at the PX and the Commissary 

is that the money that is made is put back into military programs via MWR. .. " 

Commissaries provide an average savings of more than 32 percent over local supermarkets. They also 

employ military family members. According to the Honorable JoAnn Rooney, Acting Under Secretary of 

Defense for Personnel and Readiness, in her statement before the House Armed Services Committee Military 

Personnel Subcommittee, "Last fiscal year. 39 percent of DeC A employees in the United States were military 

spouses or other family members; and the total rises to 63 percent when including military retirees, other 

veterans, and members of the Guard and Reserve." 

Commissaries also provide military families 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. Commissary patrons also receive nutritional information through commissary 

promotions and campaigns. as well as the opportunity for educational scholarships for their children. 

In addition to commissary benefits, military families also save over 20 percent by shopping in the 

Exchanges. The $300 million in annual dividends are used to support essential Moral. Welfare and 

Recreation (MVVR) programs that support service members and their families. Our Association strongly 

believes that every effort must be made to ensure this important benefit and MWR revenue is preserved, 

especially as facilities are down-sized or closed overseas. 

According to this year's American Customer Satisfaction Index (ACSI) survey, the Exchange scored 

higher than ever before as its operations equaled the industry of excellence. The Exchange also relies on a 

Customer Service Index (CSI) to provide feedback on how well facilities improve the value of support 

provided to Soldiers, Airmen, and their families. The CSI score for 2011 was a 77, another all-time high score 

for the Exchange. These customer satisfaction indexes prove that military families value the benefit of the 

Exchange more than ever. 

Protect the Commissary and Exchange benefits from future budget cutting measures. 

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Military Housing 

Privatized housing expands the opportunity for families to live on the installation and is a value for 

military families. With mOTe joint basing, the Services must work together to create consistent policies not 

only within their Service, but across the Services. 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. We ask Congress to push the Services to develop joint basing policies. 

The Government Accountability Office (GAO) report, Military Housing: Enhancements Needed to 

Housing Allowance Process and Information Sharing among the Sendces identified four key areas of 

improvement. Our Association is especially concerned with the lack of available housing at growth 

installations. As service members return from deployments and families move back to installations, we will 

have a housing shortage. According to the GAO Military Housing report there is a housing shortage at DoD 

installations impacted by growth. Further, instal1ation officials expect such housing challenges to continue 

or worsen. 

Congress must look for solutions to provide housing to growth impacted installations. The Services 

need flexibility to enter into housing partnerships in local communities and to adjust aJlowances for families 

who may need to live in temporary housing for longer periods of time as they wait for housing to become 

available. 

Adopt the recommendatiomfrom the GAO Military Housing report. 

Find additional flexible solutiom for housing needs at growth instal/atiom. 

Voting Support for Military Service Members and their Families 

The passage of the Military and Overseas Voter Empowerment (MOVE) Act of2009 was a significant 

step toward alleviating many of the voting issues faced by military service members and their families. Our 

Association greatly appreciates Congress passing this important legislation and holding subsequent hearings 

to evaluate its effectiveness. Many improvements have been made to strengthen the absentee voting process 

for military families. However, according to DoD's 2010 Post Election Survey Report to Congress, 29 percent 

of military voters still did not receive their ballots in the 2010 election. In light of this fact, we urge you to 

continue your oversight of the MOVE Act implementation. 

Our Association is proud of the role we played in helping to pass the MOVE Act. We work with the 

000 State Liaison Office to support the passage of the Uniform Military and Overseas Voters Act (UMOVA). 

This legislation would assist states in meeting the statutory mandates ofthe MOVE Act and expand these 

important protections and benefits to cover state and local elections. To date, forty-seven states and the 

District of Columbia have passed state-specific laws resulting in better protection for military and overseas 

voters. Our Association remains committed to advocating for military families' right to vote wherever they 

are stationed, and to have their vote counted. 

Continue oversight of the MOVE Act implementation to improve voting rights for military service 

members and their families. 

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Financial Readiness 

We applaud the efforts of the DoD Financial Readiness Campaign and recommend it continue. 

Ongoing financial literacy and education is critically important for todays 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 DoD financial literacy program should be expanded to transitioning service members and their 

families. The program currently focuses on new and junior service members. Transitioning families must be 

financial prepared for life outside the military and the financial literacy program is the right resource to 

provide this training. 

Our Association is pleased the Office of Servicemember Affairs (OSMA) within the Consumer 

Financial Protection Bureau (CFPB) elevated financial concerns of military families and connected 

government and nongovernment organizations. We look forward to the further development of the 

complaint process. 

We remain concerned about the impact of the housing crisis on military families. The funds from the 

expanded Homeowners Assistance Program (HAP) are gone and other solutions are limited. In September 

2011, Members of Congress sent letters to Departments of Treasury and Housing and Urban Development, 

the Federal Housing Finance Agency, and the Securities and Exchange Commission, after hearing concerns 

from service members about the difficulties they face when receiving Permanent Change of Station (PCS) 

orders and attempting to qualify for home foreclosure prevention programs. Service members and their 

families are often unable to sell their homes quickly at prices that will enable them to payoff their mortgages, 

and they cannot generate enough rental income to cover their mortgage payments or retain their homes until 

housing prices return to normal values. 

The Department of Treasury responded by providing updated guidance to its Home Affordable 

Foreclosure Alternatives (HAFA) Program. Under the new guidance, service members who cite a Permanent 

Change of Station (PCS) order as a basis for their financial hardship under HAF A are now eligible even if 

their income has not decreased. Unfortunately, the new guidance does not address a military homeowner 

who is a landlord and is underwater. Government agencies must continue to provide solutions to assist 

underwater military homeowners. Service members must relocate where ordered and cannot ride out the 

housing market. 

We remain a Nation at war and must continue to support the families of our forward deployed war 

fighters. The Family Separation Allowance (FSA) has not increased in more than ten years. We ask that the 

Family Separation Allowance be indexed to the Cost of Living Allowance (COLA) to better reflect rising 

costs for services. 

Press federal agencies to fonnulate solutions to assist underwater military homeowners. 

Increase the Family Separation Allowance by indexing it to COLA. 

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 

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key issue presented to the Army Family Action Plan at their 2011 Department of the Army level conference. 

FSAs would be especiaJly helpful for families with out-of-pocket dependent care and health care expenses. 

Civilians who work for the Department of Defense have access to FSAs, it is time for service members to 

have access to a similar benefit. 

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 thatthe flexibility of a rollover or transfer of funds to the next year 

be considered. 

Require DoD to create Flexible Spending Accounts for uniformed service members that account for the 

unique aspects of military life including deployments and Pennanent Change of Station moves. 

Healthcare 

When considering changes to the health care 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, ill, and injured, and the stress of uncertainty 

create a need for greater access to professional behavioral health care for all military family members. 

Family readiness calls for access to quality health care 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 MTFs and the purchased care segment of civilian providers under the 

TRlCARE contracts must work in tandem to meet military readiness requirements and ensure they meet 

access standards for all military beneficiaries. 

Improving Access to Care 

Our Association continues to monitor the experience of military families with accessing care within 

both the direct care and purchased care segments of the MRS. We are concerned our MTFs are stressed 

from 11 years of provider deployments, which directly affects the quality, access, and cost of health care. We 

consistently hear from families that their greatest health care challenge is getting timely care in both the 

direct and the purchased care systems. Their main challenges with the direct care system are: 

access to their Primary Care Managers (PCM) 

availability of after-hours and weekend routine care 

availability of urgent care and additional same-day appointments 

having appointments available in MTFs for next day or week, along with 60, 90, or l20-day followups recommended by their providers 

Beneficiaries' main challenges with the purchased care system, according to TRICARE's Health Care Survey 

of DoD Beneficiaries 2009 Annual Report, are difficulty in accessing personal doctors and specialty care. 

Our Association hears frequent complaints by families regarding the referral process. Families are 

often unfamiliar with the process at their MTF and in their TRICARE region. They frequently report 

difficulties in obtaining an appointment within access standards. Families often find that a provider on the 

TRICARE Managed Care Support Contractor's (MCSC) list is no longer taking TRICARE or taking new 

patients. The difficulties sometimes cause the beneficiary to give up on the referral process and never obtain 

the specialty appointment their PCM believes they need. Our Association is concerned with the impact these 

delays or the lack of even getting the referral is having on the quality of care and beneficiary outcome. We 

cannot stress enough how continuity of care is important to maintain our families' quality of care. We 

recommend Congress require a DoD report on the management of the referral process-both within the 

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direct care system and between the direct care and purchased care sectors~and the impact on beneficiaries' 

access to care. 

We see even more issues ahead that could affect beneficiary access. The TRICARE Management 

Activity (TMA) has rolled out the new TRICARE Third Generation (T3) contract in the TRICARE North 

Region and will be rolling out T3 in the TRICARE South Region beginning April201L At that time, the 

remaining TRICARE West Region will still be operating under the existing TRICARE Next Generation (TNex) contract. Full T3 implementation will remain in a holding pattern, preventing contractors' 

renegotiation with approximately 33 percent of our civilian TRICARE providers. With the demands and 

uncertainties to providers in regards to health care reform's added requirements and expenses along with 

looming Medicare reimbursement rate changes, we are beginning to hear from providers their lack of a longterm willingness to remain in the TRICARE network and impact TRICARE MCSCs' ability to recruit new 

providers. Thus, the combination of factors may result in a decreased access to care for military families, 

especially mental health. 

We applaud DoD building "world class" MTFs that utilize ev'idence-based design. Ft. Belvoir 

Community Hospital and the National Military Medical Center Bethesda are two examples. Ten more MTFs 

are being built using similar design concepts. Our Association wants to make sure that the inner workings of 

the hospital are also "world class." Reasonable pharmacy wait times, professional attitudes with a customer 

focus, medical home designed clinics, quality care, and access standards met for all appointments are 

hallmarks of a "world class" system. Given the recent discussion of high health care costs and budget 

concerns, beneficiaries are going to wonder why DoD spent so much money on facilities that look great, but 

conduct business as usual. Congress needs to make sure that DoD's new facilities meet "world class" 

definitions both in brick and mortar and in customer services and policies and procedures. 

Require a DoD report on the impact on beneficiaries of the MHS referral process. 

National Guard and Reserve Member Family Access to Care 

We remain especially concerned about access to care for National Guard and Reserve families. 

These families also need increased education about the multiple types of TRICARE health care benefits in 

which they are eligible to participate. We recommend Congress request a report to assess the coordination 

and continuity of health care services for National Guard and Reserve families as they frequently move from 

activated TRICARE Prime coverage to non-activated status and TRICARE Reserve Select (TRS) or their 

employer civilian health care insurance plans. We continue to believe that paying a stipend to a mobilized 

National Guard or Reserve member for their family's coverage under their employer-sponsored insurance 

plan while the service member is mobilized may work out better for many families in areas where the 

TRICARE network may not be robust. This will hold true as well when the beneficiary population in remote 

areas decreases as mobilizations decline with the end of conflicts. 

Require a report assessing the coordination and continuity of health care services for National Guard and 

Reserve families as they transition from one TRICARE status to another. 

Allow reserve component families to be given the choice of a stipend to continue their employer-provided 

care during the deployment of the service member. 

TRICARE Reimbursement 

Our Association is concerned that continuing pressure to lower Medicare reimbursement rates will 

create a hollow benefit for TRICARE beneficiaries. We are pleased Congress passed the Temporary Payroll 

Tax Cut Continuation Act of2011 (P.L.1l2-78), which provided a one-year extension of current Medicare 

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physician payment rates until December 31, 2012. When Congress takes up Medicare legislation this year, we 

ask you to consider how this legislation will impact military health care. We are especially concerned about 

our most vulnerable population, military 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 MCSCs are making in 

adding providers, especially mental health providers, to the networks, we believe more must be done to 

persuade health care and mental health care providers to participate and remain in the TRICARE network, 

even if that means DoD must raise reimbursement rates. We still hear from providers they will not 

participate in TRICARE because of their belief in 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 and TRICARE rules. Military-unique 

geographic challenges, such as large military beneficiary populations in rural or traditionally-underserved 

areas, also contribute to providers' unwillingness to accept TRICARE low reimbursement rates. Many 

mental health providers are willing to see miHtary beneficiaries on a voluntary status; therefore, we need to 

do more to attract these providers to join the TRICARE network. Increasing TRICARE reimbursement rates 

is just one way of enticing them. 

Pharmacy 

For several years, our Association has cautioned about DoD generalizing findings of certain civilian 

pharmacy plans changing beneficiary behaviors and automatically applying them to the military population. 

As part of the President's FYl3 Budget proposal, DoD recently announced it would adjust certain pharmacy 

co-payments. DoD's intent is to drive beneficiaries away from retail pharmacies and toward TRICARE Mail 

Order Pharmacy (TMOP) utilization, which should lower government costs and increase DoD savings. Our 

Association long championed a zero co-payment for generic Tier 1 medications in TMOP and we applaud 

DoD's proposal and Congressional approval to implement this measure as one of their cost-saving measures. 

The rationale behind DoD's recent proposed pharmacy changes is concerning. The proposed 

increase in co-payments and the loss of access to retail non-formulary medications starting in 2013 will have 

the biggest impact on beneficiaries who have no choice but to rely on the retail pharmacy for urgent 

formulary and non-formulary non-maintenance medications. For example, young families of deployed 

National Guard, Reserve members and recruiters usually do not live close to an MTF pharmacy. When their 

child needs an antibiotic for an urgent medical condition, such as pneumonia, they have no other option than 

the retail pharmacy. Beneficiaries who need certain medications not suited for TMOP, such as a narcotic or 

a chemical compound not suitable for home delivery, would find themselves paying more or not able to even 

fill the non-formulary prescription without first acquiring a Prior Authoriz:ation (PA) or Medical Necessity 

(MN) from their provider. We fear this requirement of a PAor MN will become so confusing and difficult to 

achieve by everyone involved (beneficiary, provider, and pharmacist), the beneficiary will simply walk out 

without the needed medications. The end result will impact beneficiary compliance and decrease desired 

quality outcomes. If this is implemented, DoD will need to educate the beneficiary and TRICARE network 

providers on the PA and MN requirement process to ensure the process is seamless and successfuL 

We are also concerned about the effect-of the proposed co-pay changes and access to non-formulary 

medication at retail will have on our wounded, ill, and injured service members and those already medically 

retired. This population may be adversely affected because of the frequent alteration to their medication 

protocols by their health care providers in order to achieve optimum medical benefits for their oftenchanging medical conditions. Their medications may appear to be maintenance drugs, but are actually 

intended to be used only for short-term relief. Sending them to TMOP for a 90-day supply just because the 

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co-payment is less may in fact cost the beneficiary and the government more because of frequent changes in 

doses. Many of the prescriptions needed by the wounded, ill, and injured are for newly FDA-approved 

medications, which wi1l most likely place them in non-Formulary Tier 3 status. This may place an unfair 

financial burden and lack of access to these medications on this population because they tend to utilize a 

higher number of formulary and non-formulary medications. 

Beneficiaries who have no choice in where they must obtain their medications should not be 

subjected to co-payment increases and barriers to non-formulary retail access simply aimed at changing the 

behavior of those who do have choices. DoD must consider the possible effects of its co-payment changes 

and access barriers as it plans for implementation and may need to devise alternative co-payment 

adjustments to protect beneficiaries during these sihlations. We look forward to discussing potential options 

with Members of Congress and DoD. 

include: 

We believe there are additional ways DoD could experience increased pharmacy savings. These 

Provide medications treating chronic conditions, such as asthma, diabetes, and hypertension, at the 

lowest level of co-payment regardless of brand or generic status 

Implement The Task Force on the Future of Military Health Care recommendation to include overthe-counter (OTC) drugs as a covered pharmacy benefit, thus eliminating the need for more costly 

pharmaceuticals that have the same efficacy as over-the-counter options 

Make all newly FDA approved medications non-formulary status until reviewed by DoD's Pharmacy 

and Therapeutics Committee's (P&T Committee) within 9 months of approval. 

The new T3 contract will provide TRICARE MCSCs and the pharmacy contractor with the ability to 

link pharmacy data with disease management. This will allow for better case management, increase 

adherence/compliance, and decrease cost, especially for beneficiaries suffering from chronic illness, comorbidities, and multiple conditions. However, this valuable tool is only available starting April of this year 

in the TRICARE North and South Regions because the T3 contract still remains under protest in the 

remaining TRICARE West Region. 

Require DoD to report on how proposed pharmacy changes may impact beneficiary behavior and health 

care quality outcomes. 

u.s. Family Health Plan (USFHP) 

We remain opposed to last year's change to the U.S. Family Health plan (USFHP) eligibility, 

requiring newly enrolled beneficiaries to transition from USFHP once they become Medicare/TFL eligible. 

Our Association believes USFHP is already providing TMA's medical home model of care, maintaining 

efficiencies, caphlring savings, and improving patient outcomes. 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 health care experts and should be used by DoD as a method to test best-practices 

that can be implemented within the direct care system. 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 health care plan-and thus to the governmentbut to the improvement in the quality of life for the beneficiary. Removing beneficiaries from USFHP at a 

time when they and DoD will benefit the most from their preventative and disease management programs 

will greatly impact the continuity and quality of care to our beneficiaries and only shift the cost of their care 

from one government agency to another. Almost all USFHP enrollees already purchase Medicare Part Bin 

case they decide to leave the plan or spend long periods of time in warmer parts of the country. There must 

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be another mechanism in which beneficiaries would be allowed to continue in this patient-centered program 

after becoming Medicare eligible. 

Recommend that Medicare-eligible beneficiaries using the USFHP be allowed to remain in the program. 

National Health Care Reform 

Our Association is cautious about the changes contained in the Patient Protection and Affordable 

Care Act (P.L. 111-148) and their potential impact on TRICARE and CHAMPVA. We thank Congress for 

including a provision in the NDAA FYII to allow TRICARE Standard/Extra and Prime coverage for 

TRlCARE eligible young adult beneficiaries up to the age of 26. Military families had been asking for this 

added benefit. However, we still need Congressional action to allow CHAMPVA coverage for eligible young 

adults up to the age of 26. This lack of coverage for eligible survivor dependents is causing an unnecessary 

financial burden on a population already economically challenged. 

Provide health care coverage to young adults, up to the age of26, who are eligible for CHAMPVA. 

Access to Behavioral Health Care 

The body of research focusing on the increased levels of anxiety and utilization of mental health 

services and medication causes our Association to be even more concerned about the overall shortage of 

mental health providers in TRlCARE's direct and purchased care network. 

While TMA reports significant progress by the TRICARE contractors in adding to the numbers of 

mental health providers in the networks, these numbers do not automatically translate into a corresponding 

increase in access. A recently published report in the March 2011 issue of Military Medicine, "Access to 

Mental Health Services for active duty and National Guard TRICARE Enrollees in Indiana," found that only 

25 percent of mental health providers listed in the TRICARE contractor's provider list were accepting new 

TRICARE beneficiaries. Researchers stated the number one barrier to active duty and reserve component 

service members and their families, in obtaining mental health care in Indiana, was the accuracy of the 

TRlCARE mental health provider list. Our Association hears from families about the number of times they 

contact network providers using the TRICARE provider list only to find the providers cannot meet access 

standards, are no longer taking TRICARE, or are not taking new TRICARE patients. Provider lists must be 

up-to-date in order to handle real time demands by military families. 

While families are pleased more military mental health providers are available in theater to assist 

their service members. they are disappointed with the resulting limited access to providers at home. Families 

report they are being turned away from obtaining appointments at their MTFs and clinics and told to seek 

services elsewhere. The military fuels the shortage by deploying its mental health providers, even its child 

and adolescent psychology providers, to combat zones. 

Families want to be able to access care with a mental health provider who understands or is 

sympathetic to the issues they face. We recommend an extended outreach program to service members, 

veterans, and their families of available mental health resources through DoD and VA with providers who 

inherently understand military culture. We appreciate the VA allowing family member access to Vet Centers; 

however, we encourage them to develop more family-oriented programs and offer internet based chat and 

Skype grouped meetings. DoD must also look beyond its own resources to increase mental health access by 

working with other government agencies, such as the Substance Abuse and Mental Health Services 

Administration (SAMHSA), especially SAMHSA's Military Families Strategic Initiative and Service member, 

veteran, and family Policy Academy States and Territories, and encourage State agencies to provide their 

already established services and programs to service members, veterans, and family members. Our 

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Association has been actively working with SAMHSA, providing valuable input on military families and 

military culture to these initiatives. DoD must also educate these other agencies about military culture to 

make the providers more effective in their support. 

Frequent and lengthy deployments create a sharp need in mental health services by family members 

and service members as they get ready to deploy and after they return. There is also an increase in demand in 

the wake of natural disasters, such as hurricanes and fires. Embedding mental health providers in medical 

home modeled clinics will allow easier access for our families. DoD must maintain a flexible pool of mental 

health providers that can increase or decrease rapidly in numbers depending on demand on the MHS side. 

Currently, Military Family Life Consultants (MFLC) and Military OneSource counseling are providing this 

type of preventative and entry-level service for military families. The web-based TRICARE Assistance 

Program (TRIAP) has been offering another vehicle for non-medical counseling, especially for those who 

live far from counselors. The TRIAP program will be absorbed by Military OneSource beginning 30 March. 

Project FOCUS (Families Over Coming Under Stress) is a family psychological health and resiliency building 

program to help families deal with deployment(s) and high-operational tempo. The military Services, along 

with military fami1y members, need to be more aware of resources along the continuum of mental health 

support. Families need the flexibility of support in both the MHS and Service family support arenas, as well 

as coordination of support between these two entities. 

There are other barriers to access for some in our population. Many already live in rural areas, such 

as our National Guard and Reserve members, or they will choose to relocate to rural areas lacking available 

mental health providers. We need to address the distance issues families face in finding mental health 

resources and obtaining appropriate care. Isolated service members, National Guard and Reserve, veterans, 

and their families do not have the benefit of the safety net of services and programs provided by MTFs, 

military installation based support programs, VA facilities, Community-Based Outpatient Centers, and Vet 

Centers. The National Guard Bureau's Psychological Health Services (PHS) has been established to address 

mental health issues. We applaud the provision in NDAA FYll promoting the use of telemental health and 

removing geographic practice barriers that prevent mental health providers from participating in telemental 

health services. Our Association looks forward to wor~ing wi~ DoD on implementation ,of this ne~ policy. 

However, we encourage Congress to do more by: increasing mental health reimbursement rates for rural 

areas; developing a standardized military culture curriculum; and educating civilian network mental hea1th 

providers about our military culture. 

The Defense Centers of Excellence (DCoE) is providing a transition benefit for mental health 

services for active duty service members, called in Transition. 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 pes. This program will not only provide a warm 

hand-off between mental health providers when moving between and within TRICARE Regions, but more 

importantly enable mental health services to begin during the move, when families are between duty stations 

and most venerable. 

Recommend the "in Transition" program be erpanded to provide the same benefit to active duty family 

members. 

Recommend the use of alternative treatment methods, such as increasing mental health reimbursement 

rates for rural areas; developing a standardized curriculum; and educating civilian network mental health 

providers about our military culture. 

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TRICARE Policy Barriers to Behavioral Health Care 

TRICARE's policies contribute to a lack of adequate access to behavioral health care. TRICARE is 

not part of the Mental Health Parity and Addiction Equity Act of 2008 (P.L.1!0-343); therefore, our families 

have a yearly cap on how many days they can receive inpatient behavioral health services. Some families try 

to enroll their child into Medicaid in order to continue receiving treatment. TRICARE should meet the 

provisions of the Mental Health Parity law. TRICARE requires Partial Hospitalization Programs (PHP) and 

Substance Use Disorder Rehabilitation Facilities (SUDRFs) to become a National Quality Monitoring 

contractor (NQMC). There is no incentive for PHP and SUDRFs to comply since it is not required by 

commercial programs. TRICARE's policy excludes the utilization of Intensive Outpatient Program (lOP), 

which is considered a best clinical and business practice that allows for the continuum of care. Also, DoD 

needs to incorporate clinical best practices across the Services. 

Caregiver Burnout 

Many health care and behavioral health providers have just returned home after completing a 

combat tour, only to be overwhelmed by treating active duty members, retirees, and their families. It can lead 

to provider compassion fatigue and create burnout. Our Association would like to be assured DoD is allowing 

these providers adequate dwell time and time to reintegrate with their families before returning to work. 

Beneficiaries rely heavily on MTF providers for their care, especially mental health, and need them to be 

fully ready to care for them. Providers must also be provided the opportunity to sharpen their practice skills, 

which may have not been used while serving in a combat zone. If they are not adequately addressed, this 

situation has the potential to negatively impact both the provider's ability to provide quality care and the 

beneficiary to receive quality care. We recommend Congress ask for a study to examine the impact the war is 

having on our MHS active duty providers and their families. 

Ask for a study to examine the impact the war is having on our MHS active duty providers and their 

families. 

Educating Those Who Care for Service Members and Families 

The families of service members and veterans must be educated 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 "pointy 

end of the spear" and are more likely to pick up on changes attributed to either condition and relay this 

information to their health care providers. Programs are being developed by each Service. However, they are 

narrow in focus, targeting line leaders and health care 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 include our families, communities, and support personnel. 

The DoD, VA, and State agencies must educate their health care and mental health professionals of 

the effects of mild Traumatic Brain Injury (mTBI) in order to help accurately diagnose and treat the service 

member's condition. They must be able to deal with polytrauma~PTS and PTSD in combination with mTBI 

and multiple physical injuries. 

DoD, working with the TRICARE Managed Care Support Contractors (MCSC) and Service medical 

leadership, must reach out to educate civilian health care providers on how to identify signs and symptoms 

of mTBI, PTS, and PTSD. They must also educate them about our military culture. We recommend a course 

on military culture be required in all health care and behavioral health care college curriculums and to offer 

a standardized DoD approved military culture Continuing Education Unit (CEU) for providers who have 

already graduated. TMA should incentivize providers to take these courseS. 

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Recommend a course on military culture be required in all health care and behavioral health care college 

curriculums and a standardized DoD approved military culture Continuing Education Unit (CEU) for 

providers who have already graduated. TMA should incentivize providers to take these courses. 

Transition 

Families on the Move 

Travel allowances and reimbursement rates have not kept pace with the out-of-pocket costs 

associated with today's moves. In a recent pes survey conducted by our Association, more than 50% of 

survey respondents identified uncovered expenses related to the move as their top moving challenge. 

Military families are authorized 10 days for a house hunting trip, but the cost for the trip is the responsibility 

of the service member. Families with two vehicles may ship one vehic1e 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 actual 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. 

Address the out-aI-pocket expenses military families bear for government ordered moves. 

Wounded Service Members Have Wounded Families 

OUT Association asserts that behind every wounded service member and veteran is a wounded 

family. It is our belief the government, especially DoD and VA, must take a more inclusive view of military 

and veterans' famiHes. 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 address problems and implementing initiatives upstream while the service member is still on 

active duty status. 

DoD and VA are working together on the Integrated Disability Evaluation System (IDES). Our 

Association applauds this cooperation. Many of our wounded, ill, and injured are members of the Reserve 

Component. They often do not reside where the IDES is taking place. We recommend DoD and VA pilot the 

IDES using a Community Based Warrior Transition Unit (CBWTU). This would allow the wounded, ill, and 

injured Guardsman or Reservist to be home with their family while going through the IDES process. 

Currently, they are held at the demobilization site, assigned to the MTF, and proceed through the IDES. This 

recommendation is also supported by the National Guard Association of the United States (NGAUS), The 

Retired Enlisted Association (TREA), and Association of United States Navy (AUSN). 

Reintegration programs become a key ingredient in the family's success. For the past three years, we 

have held 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 that 

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/illness. Each member needs to understand the unique aspects the injury/illness 

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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 everyone 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 senrice member or 

veteran. Family members are a key component to a service member's psychological well-being. They must be 

included in mental health counseling and treatment programs for service members, reserve component, and 

veterans. 

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 of active duty service members, 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 threeyear transition period in which medically-retired service members and their families would be treated as 

active duty family members in terms ofTRICARE 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 and financial 

requirement. 

Wounded, ill, and injured service members and their families should be allowed to remain enrolled 

in their MTF when they are medically retired. Our Association has been hearing from families that this is not 

always the case. The family may be re-enrolled, but the medically retired service member is not and told to 

enroll in the VA health system of care instead. Many are having difficulty obtaining timely specialty care for 

service connected disability medical conditions, such as PTS. Medical retirees are using their TRICARE 

benefit to receive their care, paying co-pays, and having to navigate the TRICARE purchased care network 

for specialty providers without the assistance of a case manager. This can be a daunting task for a medically 

retired service member with a mild to moderate Traumatic Brain Injury and PTSD. We request Congress 

ask the GAO to design and conduct a study to determine the accessibility and timelessness of VA primary and 

specialty care, particularly for those conditions most prevalent among returning veterans. The study should 

take into account of such factors as waiting times relative to patient acuity, travel times, barriers to 

provisions of fee basis care and variability among VA networks; should identify what alternative treatment 

avenues veterans/medically retirees are using when confronting barriers at VA; and should provide not only 

a quantitative analysis but an analysis of other factors that account for or contribute to lack of access and 

timeless, where it exists. This Congressional request is also supported by Iraq and Afghanistan Veterans of 

America (lAVA), Wounded Warrior Project (WWP), AMVETS, and Veterans of Foreign Wars (VFW). 

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Allow medically-retired service members and their families to maintain the active duty family TRICARE 

benefit for a transition period of three years following the date of medical retirement, comparable to the 

benefit for surviving spouses. 

Allow service members medically discharged from service and their family members to continue for one 

year as active duty for TRICARE and then start the Continued Health Care Benefit Program (CHCBP) if 

needed. 

Case Management 

OUT Association still finds families trying to navigate a variety of complex health care systems alone, 

trying to find the right combination of care. Our most seriously wounded, ill, and injured service members, 

veterans 1 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 

members are still on active duty and meet the Federal Recovery Coordinator (FRC) requirement, who have 

not been told FRCs exist or that they qualify for one. The GAO FRC report found there were many areas of 

concern, one being limitations on sharing of information between the Services' case managers and the VA's 

FRCs, which impacts care coordination. The Congressionally mandated Recovering Warrior Task Force 

(RWTF) has also been looking into the issue around case management. We look forward to their report to 

determine how case management is working within each Service and government agency caring for our 

wounded, ill, and injured service members, veterans, and their families. 

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, psychosocial, and mental health, would be significantly compromised. They are viewed as an invaluable resource to 

DoD and VA health care providers because they tend to the needs of the service members and the veterans 

on a regular basis. Their daily involvement saves DoD, VA, and State agency health care 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. 

We have observed from our own Healing Adventure Camps the lack of support and assistance to the 

spouse/caregiver of our wounded, ill, and injured. Many feel frustrated with not being considered part of the 

care team and not included in long-term care decisions. The level of frustration displayed by the 

spouses/caregivers at our recent Healing Adventure Camp at Ft. Carson about lack of information and 

support was disturbing. Even the RWTF discovered the same level of frustration during their site visit and 

raised their concerns to the MTF and Warrior Transition Unit (WTU) Commanders. DoD needs to make 

sure the spouse/caregiver and the family are also cared for and provided them the support they need to 

perform their role as a caregiver and provide them with the tools to care for themselves as well. WTU 

Commanders need to establish spouse/caregiver support groups and mentoring opportunities. 

Spouses/caregivers need a platform where they can voice their concerns without the fear of retribution. 

Evoking HIPAA (Health Insurance Portability and.Accountability Act of1996) privacy is not an excuse to limit 

spouses/caregivers from receiving health care information about their loved one. Wounded warrior 

commands must remember that they are an integral part of the health care team and their input is invaluable. 

The VA has made a strong effort in supporting veterans' caregivers. Our Association still has several 

concerns with the VA's interpretation ofp.L.111-163. The VA's eligibility definition does not include illness, 

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which means it does not align with DoD's Special Compensation for Service. We believe the VA is waiting too 

long to provide valuable resources to caregivers of our wounded, ill, and injured service members and 

veterans who served in Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn 

COIF /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. Another 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 vaJidation process appear to be very time intensive. The DoD Special Compensation benefit expires 

at 90 days following separation from active duty. We recommend DoD's remove the 90-day limit and allow 

the Special Compensation benefit to be extended until the VA's caregiver benefit is instituted. 

The VA's decision to delay access to valuable training may force each Service to begin its own 

caregiver 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 care and receive benefits. 

Our Association also beHeves 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. 

The VA piloted eight caregiver assistance programs to expand and improve health care 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. 

Spouses/caregivers of the wounded, ill, and injured Reserve Component face unique challenges. 

They are often not located where their loved one is assigned by their Services' wounded warrior commands. 

They must travel using their own money to visit them while they are receiving medical treatment for service 

connected conditions or going through the Medical Evaluation Board process. DoD should pay for their 

travel and lodging during this timeframe. If the family decides to relocate in order to be closer to their loved 

ones treatment at the MTF, DoD should pay for their move. Services should allow wounded, ill, and injured 

Reserve Component the opportunity to receive treatment as close to home as possible. When they receive 

care in TRICARE's purchase care network for service connected conditions, TRICARE MCSC should case 

manage their treatment. 

Encourage DoD to establish spouse/caregiver support groups and mentoring opportunities. 

Recommend DoD remove the 90-day limit and allow the Special Compensation benefit to be extended 

until the VA's caTegiver benefit is instituted. 

Relocation Allowance and Housing for Medically-Retired Single Service Members 

A'ctive 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. 

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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, ill, and 

injured service member and the caregiver's family (if warranted), such as a sibHng 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 Jives may not be able to 

provide all the health care 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 assistance of their 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 health care, 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 hisjher caregiver. 

The consideration for a temporary partial shipment of caregiver's household goods may also be 

allowed if deemed necessary by the care management tearn. 

Authorize medically retired single service members to have their caregiver~s household goods moved as a 

part of their final pes move. 

Medical Power of Attorney 

We have heard from caregivers of the difficult decisions they have to make over their loved one's 

bedside following an injury. We support the Traumatic Brain Injury Task Force recommendation for DoD to 

require each deploying service member to execute a Medical Power of Attorney and a Living will. 

Require each deploying service member to execute a Medical Power of Attorney and a Living Will. 

Senior Oversight Committee 

The Recovering Warrior Task Force report recommended the Senior Oversight Committee 

functions be consolidated into the Joint Executive Council (JEC). Even though the Services have stated to 

the RWTF that SOC initiatives are progressing, there are still frequent instances where processes are 

working at cross-purposes, resulting in misaligned DoD and VA benefits and programs. The JEC has a 

history of not getting things done, which is why the SOC was created in the first place. Pushing 

responsibilities of creating seamless transition of benefits and programs back onto the JEC in our minds is 

moving the process backward rather than forward. DoD and VA senior leaders must play an active role, 

which means meeting on a regular basis, developing goals, and implementing strategies to address issues at 

every meeting. We request Congress hold DoD and VA Secretaries accountable for getting the job done right. 

Office of Wounded Warrior Care and Transition Policy 

DoD established the Office of Wounded Warrior Care and Transition Policy to take over 

responsibility for three SOC Line of Action items for wounded ill, and ill service members. The Office has 

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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 the Office creates 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. Other Centers of Excellence have 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. 

Encourage 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. 

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 

appreciate the special consideration, sensitivity, and outreach to the families whose service members have 

committed suicide. We do have some concerns about the effect federal civilian employee downsizing will 

have on this program when certain expectations for survivors have been established. 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 hold 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. 

We are grateful the extended TRICARE Active Duty Dental benefit for survivors has finally been 

implemented. We were disappointed that TRICARE chose to use the date of implementation instead of the 

date the legislation was passed as the effective date for these families. 

The need for designated bereavement leave has been brought to our attention. Service members, 

especially those married to other service members, many times are not allowed the administrative leave 

necessary to finalize paperwork and other operations that may be required after the loss of a loved one, never 

mind the need to grieve. While this should seem to be straightforward, the recent introduction of nonchargeable adoption and paternity leave demonstrates the gentle nudge that some commanders need to 

allow their service members the time to complete administrative tasks. The service member may then return 

to duty without the distraction of important tasks left undone. This leave would be at the discretion of the 

commander, as are the other two designated leaves. 

Recommend that grief counseling be more readily available to survivors as a TRICARE benefit. 

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Establish a designated bereavement leave policy to allow the surviving service member to complete 

required administrative tasks in a timely manner and fully return to duty more quickly. 

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 ofloss 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 

$1,195 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% of 

VA Disability Compensation. We are pleased that the requirement for a report to assess the adequacy ofDIC 

payments was included in the NDAA FY09. We are awaiting the overdue report We support raising DIC 

payments to 55% 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 3P\ a retiree receives retired pay for the month of June. 

Presently, the government has the authority to take back the full month's pay ftom the retiree's checking 

account when that retiree die~. Payment for ~e nu~ber 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. 

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Eliminate the DIC offset to SBP 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. 

A/low SBP benefits to be paid to a Special Needs Trust in cases of disabled family members. 

Increase DIC to 55 percent of VA Disability Compensation. 

Provide for forgiveness of overpayments of retired pay paid to deceased retired members of the Armed 

Forces fo/lowing their death. We support H.R. 493, "The Military Retiree Survivor Comfort Act,' which 

provides for that forgiveness. 

Former Spouses, Abandoned Spouses 

On September 10, 2001, DoD released a report containing recommendations for improvements to 

the Uniformed Services Former Spouse Protection Act (USFSPA). While Congress has addressed one or two 

of the recommendations from the report in the ensuing 11 years, none of them have been passed. We endorse 

the TMC recommendation for a hearing on this important issue. 

We have also heard from a number of spouses who have been abandoned physically and financially. 

There can be many reasons for this, some related to behavioral health, some to inability of the families to 

reintegrate after many deployments. We intend to pursue this issue with DoD and the Services since it 

appears not to need a legislative fix. However, we do feel it is important enough to mention as a symptom of 

how our families and marriages are suffering after 11 years of war. 

OUT Association recommends that legislative action be taken to implement recommendations 0/ the DoD 

Report on the Uniformed Services Former Spouse Protection Act including: 

Base the award amount to the former spouse on the grade and years of service of the member at 

time of divorce (not time of retirement); 

Prohibit the award of imputed income while on active duty, which effectively forces active duty 

members into retirement; 

Extend 20/20/20 benefits to 20/20/15 former spouses; 

Permit the designation of multiple Survivor Benefit plan (SBP) beneficiaries with the 

presumption that SBP benefits must be proportionate to the aIlocation of retired pay; 

Eliminate the "1O-year Rule" for the direct payment of retired pay aIlocations by the Defense 

Finance and Accounting Service (DFAS); 

Permit SBP premiums to be withheld from the former spouse's share of retired pay if directed by 

court order; 

Permit a former spouse to waive SBP coverage; 

Repeal the one-year deemed election requirement for SBP; and 

Assist DoD and the Services with greater outreach and expanded awareness to members and former 

spouses of their rights, responsibilities, and benefits upon divorce. 

Implementation of the Repeal of "Don't Ask, Don't Tell" 

We are very pleased with the implementation of the repeal of "Don't Ask, Don't Tell". We have 

heard from many gay and lesbian service members and their families about how accepted and welcomed 

they have felt by the military community. They are participating in support activities and accessing resources 

where they can. Our Association is pleased at the ongoing efforts by the DoD and the Services to monitor the 

implementation. We were heartened to read in the recent statement by Dr. Jo Ann Rooney, Acting Under 

Secretary of Defense for Personnel and Readiness about the formal monitoring process and the feedback 

they continue to get back from all service members. We are pleased DoD is engaged in a comprehensive 

review of the possibility of extending eligibility for additional benefits, when legally permitted, to same-sex 

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partners. The success of this implementation underlines the importance of careful planning and training 

when instituting controversial new policies. We congratulate DoD and the Services on its success. 

Military Families - Our Nation's Families 

Bringing the troops home does not end our military's mission or the necessity to support military families, 

especially their children, dealing with the long-term effects of more than a decade at war. Downsizing and 

budget cuts will present new challenges. The government should ensure military families have the tools to 

remain ready. Effective support for military families must involve a broad network of government agencies. 

community groups, businesses, and concerned citizens. 

Our Nation must continue to fund what works to support military families, protect the most vulnerable, and, 

above all, value their service. 

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NACDS NATIONAL ASSOCIATION OF 

CHAIN DRUG STORES 

Statement 

Of 

The National Association of Chain Drug Stores 

For 

U.S. Senate 

Armed Services Committee 

Personnel Subcommittee 

Hearing on 

FY2013 Defense Authorization 

232-A Russell Senate Office Building 

National Association of Chain Drug Stores (NACDS) 

413 North Lee Street 

Alexandria, VA 22314 
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NACDS Statement for the Record 

Military Personnel Subcommittee 

Hearing on FY20 13 Defense Authorization 

Page 2 of6 

Introduction 

Chainnan Webb, Ranking Member Graham, and members of the Military Personnel 

Subcommittee. The National Association of Chain Drug Stores (NACDS) thanks the 

committee for the opportunity to submit a statement for today's hearing on the FY2013 

Defense Authorization. 

NACDS represents traditional drug stores, supermarkets, and mass merchants with 

pharmacies - from regional chains with four stores to national companies. Chains 

operate more than 40,000 pharmacies and employ more than 3.5 million employees, 

including 130,000 pharmacists. They fill over 2.6 billion prescriptions annually, which is 

more than 72 percent of annual prescriptions in the United States. 

Community Pharmacies are the Most Readily Accessible Healthcare Providers 

Ninety-two percent of Americans live within five miles of a community pharmacy, 

making pharmacies among the most accessible healthcare providers. Local pharmacists 

playa key role in helping patients to take their medications as prescribed and offer a 

variety of pharmacist-delivered services to improve health quality and outcomes. With 

preventive immunizations and appropriate medication use, it is possible to reduce 

utilization of costly medical services such as emergency department visits and 

unnecessary physician visits. The proximity of community pharmacies to each and every 

American and pharmacists' exceptional knowledge and training renders pharmacies 

uniquely positions to provide care for the American public. 

Pharmacist-Administered Vaccinations Improve Public Health 

Increasingly, local pharmacies are not only a reliable, convenient source for obtaining 

prescription drugs, but also a healthcare destination. For example, retail network 
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NACDS Statement for the Record 

Military Personnel Subcommittee 

Hearing on FY20l3 Defense Authorization 

Page 3 of6 

pharmacies now provide vaccinations to TRICARE beneficiaries. Recognizing the cost 

effectiveness of pharmacist-provided vaccinations, the Department of Defense (DoD) 

authorizes TRICARE beneficiaries to obtain vaccinations at a retail network pharmacy 

for a $0 co-payment. In its final rule expanding the authority of retail pharmacies to 

provide vaccinations, DoD estimated that in the first six month of the immunization 

program, it had saved over $1.5 million by having vaccinations provided through the 

pharmacy rather than the medical benefit (Federal Register, Vol. 76, No. 134, p. 41064). 

This cost savinss did not take into consideration the savings from medical costs that 

would have been incurred in treating influenza and other illnesses, if TRICARE 

beneficiaries had not been vaccinated. In addition, DoD also noted in the final rule that 

"adding immunizations to the pharmacy benefits program is an important public health 

initiative for TRICARE, making immunizations more readily available to beneficiaries. 

It is especially important as part of the Nation's public health preparations for a potential 

pandemic, such as was threatened last fall and winter by a novel HINI virus strain. 

Ensuring that TRICARE beneficiaries have ready access to vaccine supplies allocated to 

private sector pharmacies will facilitate making vaccines appropriately available to high 

risk groups ofTRICARE beneficiaries" (Federal Register, Vol. 76, No. 134, p. 41063). 

Medication Therapy Management Improves Health Outcomes and Reduces Spending 

Medication therapy management (MTM) is a distinct service or group of services that 

optimize therapeutic outcomes of medications for individuals based on their unique 

needs. MTM services increase medication adherence, enhance communication and 

collaboration among providers and patients, optimize medication use, and reduce overall 

healthcare costs. Increasingly, MTM services provided face-to-face by retail pharmacists 

is proving to be the most effective. For example, a recent study published in the January 

2012 edition of Health Affairs demonstrated the key role retail pharmacies play in 

providing MTM services to patients with diabetes. The study found that a pharmacybased intervention program increased patient adherence and that the benefits were greater 
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NACDS Statement for the Record 

Military Personnel Subcommittee 

Hearing on FY20I3 Defense Authorization 

Page 4 of6 

for those who received counseling in a retail, face-to-face setting as opposed to a phone 

call from a mail order pharmacist. The study also suggested that an integrated, 

pharmacy-based program, including interventions such as in-person, face-to-face 

interaction between the retail pharmacist and the patient, contributed to improved 

behavior with a return on investment of 3 to 1. 

Preserving Patient Access and Choice in the TRiCARE Program 

As the Congress considers FY2013 Defense Authorization, NACDS urges consideration 

of policies that control spending while protecting patient choice and preserving access to 

local pharmacies. 

NACDS was disappointed to learn that the President's Budget proposed further changes 

to co-payments and other policies that would further drive TRICARE beneficiaries out of 

their local pharmacies and to the TRICAREMail Order Pharmacy (TMOP). There are 

strong incentives in place to encourage beneficiaries to use mail order. Additional 

changes were put in place in October 2011. Currently TRICARE beneficiaries can 

receive a 30-day supply of medication at a local pharmacy for co-payments of $5 

(generic), $12 (brand) or $25 (non-formulary brand), versus co-payments of $0 (generic), 

$9 (brand) or $25 (non-formulary brand) for a 90-day supply of medication from TMOP. 

The President's FY2013 budget includes even more draconian changes. In most cases, 

TRICARE beneficiaries will be unable to obtain non-formulary medications at their local 

pharmacy. Furthermore, cost sharing will increase to as much as $34 for a 30-day supply 

of a formulary medication at retail, and as much as $66 for a 90-day supply of a nonformulary medication at TMOP. 

In addition to unfairly penalizing TRICARE beneficiaries who prefer to use local 

pharmacies, NACDS believes this proposal is penny wise and pound foolish. Failure to 

take medications as prescribed costs the U.S. health system $290 billion annually, or 13% 
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NACDS Statement for the Record 

Military Personnel Subcommittee 

Hearing on FY2013 Defense Authorization 

Page 5 of6 

of total health expenditures. Threatening beneficiary access to prescription medications 

and their preferred healthcare provider will only increase the use of more costly medical 

interventions, such as physician and emergency room visits and hospitalizations. 

NACDS supports cost savings initiatives that preserve patient choice. For example, the 

utilization of generic medications by TRICARE beneficiaries is low in comparison with 

other plans. According to Wolters Kluwer Health, in 2010, generic drugs were dispensed 

71.2% of the time by community pharmacies, compared with 56.1 % by mail order. In 

contrast, for the TRICARE program, generic medications were dispensed 69.7% by 

community pharmacies, and 51 % by TMOP. Modest increases in generic utilization by 

TRICARE beneficiaries would have a dramatic impact on the DoD budget. 

We also urge DoD to conduct a demonstration project on the effectiveness of medication 

therapy management (MTM) in improving patient medication adherence and reducing 

healthcare costs. The demo should target TRICARE beneficiaries with at least one 

chronic condition that accounts for high spending in TRICARE. Targeted beneficiaries 

should be eligible for MTM services at a TRICARE retail network pharmacy. Services 

should include a face-to-face comprehensive medication review as well as quarterly 

follow-up reviews as deemed necessary. Beneficiaries may opt-out of the MTM 

program, but those who elect to participate and comply with program recommendations 

will have cost sharing for maintenance medications waived while participating. 

Finally, we encourage Congress to consider the use of a "drug-stock replacement" 

program for retail pharmacies, similar to the program currently in use by the TRICARE 

mail order pharmacy. NACDS believes using depot pricing for covered prescription 

drugs provided through the retail pharmacy network would assist DoD in negotiating 

addition discounts from drug manufacturers, beyond the Federal Ceiling Price (FCP) 

discounts currently required by law. 
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NACDS Statement for the Record 

Military Personnel Subcommittee 

Hearing on FY2013 Defense Authorization 

Page 6 of 6 

Potential savings for the TRICARE program through these initiatives are significant. For 

example, use of a drug stock replacement program using depot pricing for retail 

prescriptions could result in savings of up to 30%. Since the Department of Defense 

spends an estimated $5 billion annually on prescription medications dispensed by retail 

pharmacies, the resulting savings could be as much as $1.5 billion. 

Conclusion 

Thank you for the opportunity to share our views. We look forward to working with you 

on policies that control costs and preserve access to local pharmacies. 
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APPENDIX E


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Reserve Officers Association of the United States 

And 

Reserve Enlisted Association 

Written Testimony on Health Care 

for the 

Senate Armed Services Committee 

Subcommittee on Personnel 

March 28, 2012 

IROA 

RESERVE OFFICERS 

ASSOCIATION 

"Serving Citizen Warriors through Advocacy and Education since 1922. "TM 

J ~~~~ ASSOCIATION 

Reserve Officers Association 

1 Constitution Avenue, N.E. 

Washington, DC 20002-5618 

(202) 646-7719 

Reserve Enlisted Association 

1501 Lee Highway, Suite 200 

Arlington, VA 22209 

(202) 646-7715 
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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 ofROA to: 

" ... support and promote the development and execution ofa military policy for the United States that 

will provide adequate National Security." The mission ofROA is to advocate strong Reserve 

Components and national security, and to support Reserve officers in their military and civilian lives. 

The Association's 58,000 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. ROA is represented in each state 

plus departments in Latin America, the District of Columbia, Europe, the Far East, and Puerto Rico. 

Each department has several chapters throughout the state. ROA has more than 450 chapters 

worldwide. 

ROA is a member of The Military Coalition where it co-chairs the Tax and Social Security 

Committee. ROA is also a member of the National MilitaryNeterans Alliance. Overall, ROA works 

with 75 military, veterans and family support organizations. 

President: 

Colonel Walker M. Williams III, USAF (Ret.) 

Staff Contacts: 

Executive Director: 

Major General Andrew B. Davis, USMC (Ret.) 

Legislative Director, Health Care: 

CAPT Marshall Hanson, USNR (Ret.) 

Air Force Director, 

To be filled 

Army and Strategic Defense Education Director: 

Mr. "Bob" Feidler 

USNR, USMCR, USCGR, Retirement: 

CAPT Marshall Hanson, USNR (Ret.) 

202-646-7706 

202-646-7706 

202-646-7713 

202-646-7758 

202-646-7717 

202-646-7713 

The Reserve Enlisted Association (REA) 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. 

Executive Director 

CMSgt Lani Burnett, USAF (Ret) 202-646-7715 

DISCLOSURE OF FEDERAL GRANTS OR CONTRACTS 

The Reserve Officers and Reserve Enlisted Associations are member-supported organizations. Neither 

ROA nor REA have received grants, sub-grants, contracts, or subcontracts from the federal 

government in the past three years. All other activities and services of the associations are 

accomplished free of any direct federal funding. 

R RESERVE STRENGTH. 

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INTRODUCTION 

The Reserve Officers Association and the Reserve Enlisted Association thank the Personnel 

subcommittee for the chance to present written testimony on behalf of the 1.1 million Ready 

Reservists affected by medical readiness, and for the retirees of the National Guard and Reserve 

who continue to be entitled to health care. The Associations also thank the Senate Armed 

Services committee as a whole for limiting adjustments to TRlCARE Prime enrollment to only an 

increase at the same percentage as the retiree's cost-of-living (COLA) rate. 

Yet, the Department of Defense (DoD) was not satisfied with last year's increase to TRICARE, 

and has revisited this topic by proposing further increases. The challenge this year is reviewing 

these increases to TRlCARE fees, prescription co-payments and the catastrophic caps, and the 

establishment of new enrollment structures for TRlCARE Standard, and TRlCARE for Life at a 

time when there is also a proposal to cut defense budgets. 

Both ROA and REA are disappointed that the Pentagon continues to make these 

recommendations unilaterally and to neither discuss cost sharing with the beneficiary 

associations, nor heed the sense of Congress as to what direction to take in making adjustments. 

We commend your committee on proactively working these health care issues ahead of proposed 

DoD language. Open communication is key to reducing the angst felt by the beneficiaries that 

would be directly affected. Further, the serving force is watching how the retirees are being 

treated to see how this or any administration "keeps the faith" with those who serve. 

ROA and REA also appreciate the reassurances that the serving members of the Reserve and 

National Guard who are TRlCARE Reserve Select beneficiaries are excluded from any fee 

increases being consideredjust the same as active duty members and their families. 

Increasing the cost-share of DoD health care beneficiaries is admittedly an emotional issue. The 

nation and the Department of Defense are faced with ever increasing health care costs, but this is 

not simply a budgeting exercise. Because of the dynamics involved, this is an issue that should 

be resolved by involving all those who are concerned. Here is a summary of the key points as 

seen by the Reserve Officers Association (ROA) and the Reserve Enlisted Association (REA). 

Congress must maintain an oversight over DoD health care, preventing capricious fee 

increases to beneficiaries. 

TRICARE: 

Do not change the Catastrophic Cap of $3000. 

o If indexed, at no more than COLA adjustments. 

TRICARE Prime: 

Continue any adjustment to Prime enrollment based on COLA rates. 

Independently verifY the current total cost of DoD health care benefits. Such an audit will 

permit Congress to validate proposals based on cost-sharing percentages. 

Do not link annual increases to the market-driven national health costs inflation rate, nor 

Federal Employee Health Benefits Plan (FEHBP). 

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On Pharmacy Co-payments: 

Any higher retail pharmacy co-payment should not apply on initial prescriptions, but on 

maintenance refills only. 

To keep co-payments lower, ROA and REA support a mandatory mail-order prescription 

refill, if an opt-out is permitted. 

TRICARE Standard: 

No annual enrollment fee for DoD beneficiaries. 

o Should an enrollment fee be instituted - limit such an enrollment to only a onetime nominal administrative fee. 

No increase to Standard deductible. 

o Higher cost share is already being made by automatic increases to TRICARE 

Standard through the 25 % copayment as health care costs increase. 

o For individuals or families relying on Standard for medical treatment, it is a more 

expensive health plan than TRICARE Prime. 

o Should the Standard deductible be increased; by no more than COLA. 

Do not link annual increases to the market-driven national health costs inflation rate, nor 

Federal Employee Health Benefits Plan (FEHBP). 

Decouple changes to TRICARE Standard deductible from TRS as Reservists pay more 

upfront. 

Reserve Health Care Initiatives: 

Improve continuity of health care for all drilling Reservists and their families by: 

o Permitting active members in the Individual Ready Reserve (IRR) to buy-into 

TRICARE Reserve Select. 

o Allowing demobilized Retirees and Reservists involuntarily returning to IRR to 

qualify for subsidized TRS coverage. 

o Providing TRS coverage to mobilization ready IRR members; levels of subsidy 

would vary for different levels of readiness. 

o Improving post deployment medical and mental health evaluations and access to 

care for returning Reserve Component members. 

o Providing an option for Reservists where DoD pays a stipend to employers. 

Extend military coverage for restorative dental care following deployment to 90 days. 

Permit beneficiaries of Federal Employee Health Benefit plan the option of subscribing to 

TRICARE Reserve Select. 

Should any TRICARE fees be "tiered" do so by annual military retirement, as 

o Reserve Component member are paid about 113 less than active duty. 

TRICARE Retired Reserve (TRR) 

Premiums are too high; to keep TRR viable, premiums must be reduced. 

GAO should audit the assumptions used for TRICARE Retired Reserve premiums. 

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TRICARE for Life: 

Implement no enrollment fee. 

Do not link annual increases to the market-driven national health costs inflation rate, nor 

Federal Employee Health Benefits Plan (FEHBP). 

TFL beneficiaries are already paying Medicare Part "B", which adds up to more than any 

other TRICARE beneficiary pays (except for gray area Reservists). In addition, there is 

means testing, which increase the expense for a number of retirees over age 65. 

I DISCUSSION 

MILITARY HEALTH CARE - a shaky foundation. 

For a number of years, the Pentagon has spoken out about the rising costs of health care and the 

need for refonn. This can be noted by statements illustrating that military health costs have 

increased such as "DoD medical costs have shot up from $19 billion in FY 2001 to $52.5 billion 

in FY 2012," as made by Deputy Secretary of Defense William J. Lynn, III at a Senate Budget 

hearing last year. 

Health care costs now consume about nine percent of the 000 budget. Yet comparisons of health 

care costs are distorted by beginning with a peacetime starting point followed by a decade of war. 

Still judging from what has been said to both Congress and the press, it wou,ld seem that many in 

the Pentagon are attributing the increases in military health care to its retirees, especially those 

working second careers. A break out of beneficiary medical expense totals have not been 

provided by the Pentagon. 

This is why 000 needs to publish a breakdown of its OCO and baseline health care costs. The 

department has said it will cost a billion dollars to perfonn such an audit and won't have anything 

before 2014. 

Congress needs to continue to ask the Pentagon for a financial breakdown. An independent audit 

by the Government Accountability Office (GAO) or another agency would allow Congress an 

opportuoity to validate proposals based on financial benchmarks rather than 000 speculation. 

DoD officials continue to tout that "working-age retirees" (those younger than 65) should use 

their employer's health care. The Congressional Budget Office predicts that ifTRlCARE fees go 

up, 60 percent of the savings would be from beneficiaries leaving TRICARE, providing the 

Pentagon with long sought after savings. There is fallacy in this argument. Recent changes to the 

TRICARE structure have only driven beneficiaries to TRlCARE Prime which is more expensive 

for the Government. 

The Pentagon's public campaign for health care refonn has undercut its credibility with serving 

members, retirees and beneficiary associations in what has been said, what has been budgeted, 

and what still might be planned. 

The Reserve Officers Association was among the first associations to be open to a relook on cost 

sharing for TRICARE beneficiaries. Unfortunately, ROA's position has grown less flexible as 

DoD demands have grown more costly to beneficiaries. 

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IHEAL TH CARE COST DISCUSSION 

The Reserve Officers Association and the Reserve Enlisted Association would like to thank 

Congress for its continued involvement on 000 health care issues and hope it remain a leading 

partner on these issues. 

ROA and REA applaud the efforts by Congress to address the issue of increasing Department of 

Defense health care costs and its interest to initiate dialogue and work with both the Pentagon and 

the beneficiary associations to find the best solution. The time has come to examine the cost of 

TRICARE and the level of beneficiary contribution. 

It is important to sustain the 000 health care as a deferred benefit for our serving Active and 

Reserve Component members and their families. While retired, these beneficiaries have accepted 

risks and made sacrifices in their earlier military careers that have not been asked of the 

remaining 99 percent of the nation's population. TRICARE fulfills an on-going promise by the 

government for continued health care to those who have served or are serving. 

ROA and REA are committed to our membership to sustain this health care benefit. 000, 

Congress and the beneficiary associations need to work together to find a fair and equitable 

solution that protects our beneficiaries and ensures the financial viability of the military health 

care system for the future. ROA and REA remain open to discussions on cost-sharing. 

Of concern is a proposal to index future increases. 000 suggests that cost indexing be based 

on the national health costs inflation rate. Military retirees face different health issues than the 

national average. Twenty to thirty years of physical training requirements makes it a healthier 

population than the nation as a whole. 

ROA and other associations are advocating that no change be made to the adj ustments of the 

annual TRICARE Prime enrollment fee, allowing only an increase at the same percentage as the 

retiree's cost-of-living (COLA). Cost ofliving is actually rising higher than what COLA adjusts 

for. 

The actual inflation rate is higher than how COLA is calculated. While COLA adjustment 

increased by 3.6 percent, everyday prices rose 7.2 percent in past year, according to the 

independent American Institute for Economic Research. The annuity pay for military retirees 

continues to fall behind inflation. 

Another proposal has been to adjust annual fees to what they would be if COLA adjustments had 

been made annually since 1996. While this would make it almost 22 percent higher in FY-2012 

than the adjusted $560, it should be remembered that 000 did not seek fee increases for almost 

ten years, which is why ROA and REA don't support such an adjustment. Retired beneficiaries 

should not be penalized for 000' s inaction. 

Congress has already agreed to a COLA increase concept. It should not be tempted, as 000 did 

in the past, by a one year catch-up. Any retroactive COLA "catch-up" would need to be done 

over a period of years, but should also be adjusted for those years when COLA did not keep up 

with inflation. Taking all factors into account, Congress should seek a quick fix. 

ROA and REA share the concern that any process used should be a fair and equitable approach 

where retiree's won't be overburdened. 

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RESERVE COMPONENT HEALTH CARE DISCUSSION 

The Pentagon views TRlCARE as a health care plan, and Reserve TRlCARE as a health care 

insurance. Because words create paradigm, Reserve health care is treated by DoD entirely 

different than active duty health care. The differences are easily noted: Active duty members 

enroll in a benefit with deductibles and co-payments; Guard and Reserve members "purchase" a 

premium based health plan. The following are suggested improvements. 

1. ROA and REA still hold concerns over the implementation ofTRlCARE for gray area 

retirees. Because DoD treated Reserve gray area retirees as a separate health care risk group, 

health care premiums proved higher than expected. Because of the expense, enrollment is low. It 

is likely just being used by those with health care problems, who can't afford health care from 

other sources. If the program is not changed it will have a similar success to mobilization 

insurance. 

ROA and REA hope that the committee will request a Government Accountability Office 

review of the process that determined the published premium levels. 

2. Seamless Transition. Service members should not have to navigate through bureaucracy to 

receive care or benefits. Every time a Reserve Component member transitions into a new 

category of health care, he or she is required to reenroll in the new program. Even those who are 

beneficiaries of TRlCARE Reserve Select (TRS) need to do an administrative transition between 

TRS, TRlCARE once mobilized, into Transitional Assistance Management Program (TAMP) and 

back onto TRS. And once retired, there is additional transition into TRlCARE Retired Reserve, 

and the latter TRlCARE retiree health care. Add to this the additional health care provided by the 

Department of Veteran Affairs, and there are gaps in health care as a Reserve Component or 

family member moves between programs. 

3. Employer health care option: DoD could pay a stipend to employers of deployed Guard and 

Reserve members to continue employer health care during deployment. G-R family members are 

eligible for TRlCARE if the members' orders to Active Duty are for more than 30 days; but some 

families would prefer to preserve the continuity of their own health insurance. Being dropped 

from private sector coverage as a consequence of extended activation adversely affects family 

morale and military readiness and discourages some from reenlisting. Many G-R families live in 

locations where it is difficult or impossible to find providers who will accept new TRlCARE 

patients. This stipend would be equal to DoD's contribution to Active Duty TRlCARE. 

ROA and REA continue to support an option for individnal Reservists where DoD pays a 

stipend to employers 

4. Dental Readiness. Currently, dental readiness has one of the largest impacts on mobilization. 

The action by Congress in the FY-2010 NDAA was a good step forward, but still more needs to 

be done. 

The services require a minimum of Class 2 (where treatment is needed, however no dental 

emergency is likely within six months) for deployment. Current policy relies on voluntary dental 

care by the Guard or Reserve member. Once alerted, dental treatment can be done by the 

military, but often there isn't adequate time for proper restorative remedy. 

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ROA and REA continues to suggest that the services are responsible to restore a 

demobilized Guard or Reserve member to a Class 2 status to ensure the member maintains 

deployment eligibility. 

Because there are inadequate dental assets at Military Treatment Facilities for active members, 

active families, and reservists, ROA and REA further recommend that dental restoration be 

included as part of the six month TAMP period following demobilization. DoD should cover 

full costs for restoration, but it could be tied into the TRICARE Dental program for cost and 

quality assurance. 

5. IRR Access to TRS: Not everyone who drills is eligible for TRS. All services offer drilling 

for points without pay. These members are in the IRR. The Navy has Voluntary Training Units 

that drill monthly. The Air Force and Army have non-paid Individual Mobilization Augrnentees 

(IMA). The Army also has a group within the IRR body that has agreed to mobilization during 

their first two years. 

The Army, the Marine Corps and the Navy have mobilized Reservists out of the Individual Ready 

Reserve. Under current law, unless these RC members are given an opportunity to join the 

Selected Reserve, they are not eligible to purchase TRS. 

ROA and REA feel that IRR members should be eligible for TRS (not TRR.) They could qualify 

ifthey sign an agreement of continued service and complete a satisfactory year of training and 

satisfy physical standards. A satisfactory year could be defined either by points or by training 

requirements, as defined by each Reserve Chief. 

ROA and REA recommend legislation to allow IRR buy-in to TRICARE Reserve Select. 

CONCLUSION 

ROA an REA reiterate their profound gratitude to the personnel subcommittee for addressing the 

health care issues. The process that we develop and what we decide upon this year for TRICARE 

fees and sustained benefits reflects not only our recognition of retired members for their service 

to the nation, but is a dedication to the warriors of the future. 

Service members deserve the best medical care that the nation can offer. Health care services are 

vital to keeping the nation's military force strong and ready. As a deferred benefit, it serves as a 

recruiting as well as a retention tool, as the willingness of the young to serve will depend on how 

they perceive the treatment and appreciation given to earlier veterans. 

When a nation puts members of its military at physical risk from disease and traumatic injury, it 

absolutely owes them health care not health insurance. 

ROA and REA strongly urge that when all cost-sharing is finally taken into account, our 

beneficiaries must receive the DoD provided health care for which they are entitled. 

R RESERVE STRENGTH. RESERVE UFE. 
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APPENDIX F


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Statement of 

The Fleet Reserve Association 

on 

Military Personnel Policy, Benefits, and Compensation 

Submitted to: 

Senate Armed Services Committee 

Personnel Subcommittee 

by 

Master Chief Joseph L. Barnes, USN (Ret.) 

National Executive Director 

Fleet Reserve Association 

March 28,2012 
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THEFRA 

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 (V A) 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 Navy. 

FRA's mission is to act as the premier "watch dog" organization on Capitol Hill in maintaining 

and improving the quality of life for Sea Service personnel and their families. The Association 

also sponsors a National Americanism Essay Program and other recognition and relief programs. 

In addition, the FRA Education Foundation oversees the Association's scholarship program that 

presented awards totaling over $120,000 to deserving students last year. 

The Association is also a founding member of The Military Coalition (TMC), a 34-member consortium of 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 87 years of service in November 2011. For nearly nine decades, dedication to its 

members has resulted in legislation enhancing quality oflife 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 Standard) 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." 

CERTIFICATION OF NON-RECEIPT 

OF FEDERAL FUNDS 

Pursuant to the requirements of House Rule XI, the Fleet Reserve Association has not received 

any federal grant or contract during the current fiscal year or either of the two previous fiscal 

years. 
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SYNOPSIS 

The Fleet Reserve Association (FRA) is an active participant and leading organization in The 

Military Coalition (TMC) and strongly supports the recommendations addressed in the more extensive TMC testimony prepared for this hearing. The intent of this statement is to address other 

issues of particular importance to FRA's membership and the Sea Services enlisted communities. 

INTRODUCTION 

Mr. Chairman, the Fleet Reserve Association salutes you, members of the Subcommittee, and 

your staff for the strong and unwavering support of programs essential to active duty, Reserve 

Component, and retired members of the uniformed services, their families, and survivors. The 

Subcommittee's work has greatly enhanced care and support for our wounded warriors and significantly improved military pay, and other benefits and enhanced other personnel, retirement 

and survivor programs. This support is critical in maintaining readiness and is invaluable to our 

uniformed services engaged throughout the world fighting the global War on Terror, sustaining 

other operational requirements and fulfilling commitments to those who've served in the past. 

STOP DOD SEQUESTRATION 

As mandated by the 2011 Budget Control Act, failure of the Super Committee in 2011 to develop a bipartisan plan to contain the growth of the national debt will force implementation of 

"sequestration" in January 2013 unless Congress intervenes. Failure to act will trigger acrossthe-board cuts with half coming from the Defense budget. FRA agrees with Secretary of Defense, Leon Panetta, who said these cuts "would do catastrophic damage to our military, hollowing out the force and degrading its ability to protect the country." Defense counts for 17 percent 

of the federal budget but will receive 50 percent of the Sequestration cuts. 

With the American military out of Iraq and the conflict in Afghanistan winding down, some are 

suggesting the possibility of a "peace dividend." Although there have been victories in the War 

on Terror, there has been no peace treaty with terrorism and the additional $500 billion defense 

cuts beyond the cuts in the FY 2013 budget request could jeopardize essential military pay and 

benefit programs, which would negatively impact recruiting, retention and overall military readiness. For these reasons, FRA strongly supports the "Down Payment to Protect National Security 

Act" (S. 2065) sponsored by Senator Jon Kyl and a House bill (H.R. 3662) sponsored by HASC 

Chairman, Rep. Howard P. "Buck" McKeon. These proposals would amend the Budget Control 

Act by excluding the DoD budget from the first year of sequestration (2013). 

DoD has already identified over $450 billion in budget cuts over the next 10 years. While operations are winding down in Iraq and Afghanistan, the Nation however, is still at war and slashing 

DoD's budget further will not reduce the associated threats. 

Less than one percent of the population is shouldering 100 percent of the burden of maintaining 

our national security, and the punitive reductions mandated by sequestration would force major 

across-the-board cuts to all programs and could potentially threaten the All-Volunteer Force. 
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BUDGET DEVALUES MILITARY SERVICE 

FRA's membership is especially concerned about the Administration proposed FY 2013 budget 

which includes plans to drastically increase existing TRICARE Prime enrollment fees, implement new fees for TRICARE Standard and TRICARE-for-Life beneficiaries, and increase pharmacy co-pays. If approved, fees would be tiered based on the beneficiary's retired pay. These 

increases are a major concern to the entire military retiree community and since mid-February 

that concern has prompted nearly 11,000 messages to Capitol Hill via FRA's web site Action 

Center. Our members are also concerned that the budget calls for the fees to be increased based 

on health care inflation after FY 2017. 

The budget also calls for a commission to study and propose changes to the military retirement 

system. This BRAC-Iike process would bypass the expertise of the Senate and House Armed 

Services Committees and only allow Congress an up-or-down vote on the commission's recommendations. All Reservists responding to a recent FRA survey, and 97 percent of active duty participants ranked retirement benefits as a very important benefit. More than 1,000 current and former service members participated in the survey. As Congress considers plans to reduce 000 

costs by revamping the military retirement program, that benefit is particularly relevant to active 

duty and Reserve component personnel. Many current service members have expressed concern 

about the future of the retired pay and healthcare benefits they've been promised after they complete a career of military service. FRA appreciates SecDef Panetta assuring those currently serving that they will come under the current retirement system, but wonders why there is no similar 

commitment for those who served in the past? 

The budget also requests an active duty and Reserve pay hike that is equal to the Employment 

Cost Index (ECI) only for FY 2013 and FY 2014, and makes deep cuts in Army and Marine 

Corps end strengths. 

FRA supports a defense budget of at least five percent of GOP that will adequately fund both 

people and weapons programs, and is concerned that the Administration's spending plan is not 

enough to support both, particularly given ongoing operational commitments associated with the 

new defense strategy. 

Future spending on national defense as a percentage of Gross Domestic Product (GOP) will be 

reduced despite significant continuing war related expenses and extensi ve operational and national security commitments. Wall Street Journal editorial writers noted, "Taken altogether, the 

(defense) budget could shrink by over 30% in the next decade. The Administration projects outlays at 2.7% of GOP in 2021, down from 4.5% last year (which included the cost of Iraq and Afghanistan). That would put U.S. outlays at 1940 levels - a bad year. As recently as 1986, a better 

year, the U.S. spent 6.2% of GOP on defense with no detrimental economic impact. What's different now? The growing entitlement state. The Administration is making a political choice and 

sparing Social Security, Medicare and Medicaid, which are set to hit nearly 11 % of GOP (without health care reform costs) by 2020." 

2 
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Make no mistake about the importance of these entitlement programs, however, DoD and VA 

benefits are also important and essential to maintaining that All Volunteer Force and our national 

security. 

TruCARE FEE INCREASES 

Health care benefits are important to every segment ofFRA's membership. The continued 

growth in health care costs is not just a military challenge but a challenge for the entire country. 

FRA believes that military service is a unique profession and notes minimal projected savings 

associated with DoD management efficiencies and other initiatives in FY 2013 and beyond, 

while retirees are targeted for major fee hikes. These proposed hikes follow the 13-percent military retiree TRlCARE Prime increase imposed this year. 

Our members are also very conccrncd about a proposed new TRlCARE-for-Life (TFL) emollment fee beginning in FY 2013. This is viewed as another failure to honor commitments to those 

who served past careers in the military. These personnel pay Medicare Part B premiums and 

have not benefited from the significant pay and benefit enhancements enacted since 2000. 

The Association believes that military retirees have earned their TRlCARE benefits with twenty 

or more years of arduous military service with low pay. As you know, many retirees believe that 

they were promised free health care for life. 

FRA strongly opposes premium increases for TRlCARE beneficiaries' based on health care inflation. The Consumer Price Index (CPl) is the basis for military retiree annual cost-of-livingadjustments (COLAs), the purpose of which is to maintain purchasing power for the beneficiary. 

Deputy Secretary of Defense Ashton B. Carter recently announced a plan to reform the Department of Defense's (DoD) governance structure of the Military Health System (MHS) in an effort 

to improve efficiency and reduce costs, per provisions of the FY 2012 National Defense Authorization Act. This is a step in the right direction, however, FRA continues to advocate for 

more extensive management reform and other department efficiencies as alternatives to shifting 

costs to retired TRlCARE beneficiaries. 

RETIREMENT COMMISSION 

The Administration has proposed the creation of a BRAC-like commission to review and "reform" the current military retirement system. Numerous studies and commissions have focused 

on the military retirement as an opportunity to reduce overhead costs for the Pentagon. The latest 

is the Defense Business Board (DBB) proposal to replace the current system with a 401(k) plan 

similar to what corporations offer their employees. This concept has created significant anxiety 

in the career active duty community as noted above per a recent FRA online survey. As Congress 

considers plans to reduce DoD costs by revamping the military retirement program, that benefit 

is particularly relevant to active duty and Reserve component personnel. Many current service 

members have expressed concern about the future of the retired pay and healthcare benefits 

they've been promised after they complete a career of military service. 
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Since last October, FRA has noted strong opposition responses to its survey regarding proposals 

to "civilianize" the current military retirement system. More than 1,700 current and former service members responded and nearly 95 percent believe retiree benefits offer the most appeal if 

they were joining today. More than 80 percent of active duty and Reserve component respondents said they'd shorten their term of service if retirement benefits were changed to conform 

with the recommendations. 

FRA believes that military service is unlike any other career or occupation, and requires a unique 

retirement system. Career senior NCOs are the backbone of our military and their leadership and 

guidance are invaluable and a result of many years of training and experience. 

WOUNDED WARRIORS 

FRA believes post traumatic stress should not be referred to as a "disorder." This terminology 

adds to the stigma of this condition, and the Association believes it is critical that the military do 

all it can to reduce the stigma associated with PTS and TBl. 

FRA also believes the Armed Services and Veterans Affairs Committees should remain vigilant 

regarding their oversight responsibilities associated with ensuring a "seamless transition" for 

wounded warriors transitioning from DoD's Military Health System (MHS) to the Department of 

Veterans Affairs (VA). FRA strongly supports efforts to create a Joint Virtual Lifetime Electronic Record (VLER) for every service member and believes this would be a major step towards 

the long-standing goal of a troly seamless transition from military to veteran status for all service 

members and would permit a DoD, V A, or private health care provider immediate access to a 

veteran's health data. 

According to Navy Times editors, "Even before sequestration takes effect budget cuts have impacted the Office of Wounded Warrior Care and Transition Policy with the elimination of 40 

percent (44 positions) of the staff, and all 15 contract employees in the transition policy section 

that leaves only two full-time civilian employees.") Budget cuts have also resulted in the cancellation ofthe Virtual Transition Assistance Program (VT AP) website that was scheduled to replace the current Turbo TAP website. FRA is concerned that these cuts could negatively impact 

transitioning wounded warriors. 

The Association also notes the importance of the Navy's Safe Harbor Program and the Marine 

Corps Wounded Warrior Regiment (WWR) that are providing invaluable support for these personnel. 

SUICIDE RATES 

Suicide in the military is a serious concern for FRA and the Association notes that active duty 

suicides have been reduced or at least leveled off, but suicides for non-active duty Reserve Component personnel are increasing. "More than 2,000 service members killed themselves in the past 

decade, including 295 in 2010 compared with 153 in 2001.,,2 

I Navy Times Editorial, January 16,2012, Page 4 

2 ABC News, Rising Suicides Stump Military Leaders, September 27,2011, Kristina Wong 

4 
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Master Chief Petty Officer of the Navy (MCPON) Rick West testified on February 16,2012 before the House Military Construction, Veterans Affairs Appropriations Subcommittee (MilConlY A) and stated that in 20 II there were 51 Navy active duty suicides and seven Navy Reserve suicides which represents an increase from 39 active duty suicides and six Reserve suicides 

in 2010. To reduce the suicide rate the Navy has implemented a multi-faceted approach with 

communication, training, and command support, designed to reduce individual stress and 

strengthen psychological health of Sailors. The Navy efforts fall within the scope of their broader 

family readiness programs. 

At the same hearing, Sergeant Major of the Marine Corps Micheal Barrett stated that in 20 II 

there were 33 Marine suicides and 171 failed suicide attempts. During the previous year, 37 Marines committed suicide and there were 172 failed attempts. The Marines have deployed peer-topeer suicide prevention training and are working with the 000 Suicide Prevention Office to implement the recommendations of the 000 Joint Task Force on the Prevention of Suicide. Despite 

these initiatives, suicides continue and efforts to address the reasons for suicides must continue 

to be a top priority. FRA appreciates the provision in the FY 2012 Defense Authorization Act 

that requires pre-separation counseling for Reservists returning from successful deployments. In 

addition, FRA supports Rep. Thomas Rooney's bill (H.R. 208) that authorizes reimbursement for 

mental health counseling under TRICARE. 

COLA ADJUSTMENTS 

Under current law, military retired pay cost of living adjustments are rounded down to the next 

lowest dollar. For many of these personnel, particularly enlisted retirees, their retired pay is 

sometimes the sole source of income for them and their dependents. Over time, the effect of 

rounding down can be substantial for these personnel and FRA supports a policy change to 

rounding up retiree COLAs to the next highest dollar. 

RESERVE EARLY RETIREMENT 

A provision of the FY 2008 NOAA reduces the Reserve retirement age requirement by three 

months for each cumulative 90-days ordered to active duty. This is effective upon the enactment 

of the legislation (January 28, 2008) and NOT retroactive to October 7, 2001 and the Association 

supports "The National Guardsmen and Reservists Parity for Patriots Act" (H.R. 181) sponsored 

by the House Personnel Subcommittee Chairman, Rep. Joe Wilson, to authorize Reservists mobilized since October 7, 2001, to receive credit in determining eligibility for receipt of early retired pay. Since 09/1112001 the Reserve Component has changed from a strategic Reserve to an 

operational Reserve that now plays a vital role in prosecuting the war efforts and other operational commitments. This has resulted in more frequent and longer deployments impacting individual Reservist's careers. Changing the effective date of the Reserve early retirement would 

help partially offset lost salary increases, promotions, 401 (k) and other benefit contributions. The 

Association urges support for this important legislation. 
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RETENTION OF FINAL FULL MONTH'S RETIRED PAY 

FRA urges the Subcommittee to authorize the retention of the full final month's retired pay by 

the surviving spouse (or other designated survivor) of a military retiree for the month in which 

the member was alive for at least 24 hours. FRA strongly supports "The Military Retiree Survivor Comfort Act" (H.R. 493), introduced by Rep. Walter Jones. 

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 month 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 Department's financial arm (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. 

The measure is related to a similar pay policy enacted by the VA. Congress passed a law in 1996 

that allows a surviving spouse to retain the veteran's disability and V A pension payments issued 

for the month of the veteran's death. FRA believes military retired pay should be no different. 

CONCURRENT RECEIPT 

FRA supports legislation authorizing the immediate payment of concurrent receipt of full military retired pay and veterans' disability compensation for all disabled retirees. The Association 

strongly supports Senate Majority Leader, Harry Reid's "Retired Pay Restoration Act" (S. 344) 

and Rep. Sanford Bishop's "Disabled Veterans Tax Termination Act" (H.R. 333). Both proposals would authorize comprehensive concurrent receipt reform, and Rep. Gus Bilirakis' "Retired 

Pay Restoration Act" (H.R. 303) would authorize current receipt for retirees receiving CROP 

with a disability rating of 50 percent or less. 

FRA also strongly supports House Personnel Subcommittee Chairman Joe Wilson's bill (H.R. 

186), that expands concurrent receipt for service members who were medically retired with less 

than 20 years of service (Chapter 61 retirees) and would be phased-in over five years. This proposal mirrors the Administration's proposal from the 110th Congress. In 2008, Congress voted to 

expand eligibility for Combat-Related Special Compensation (CRSC) coverage to Chapter 61 

retirees and the proposed legislation would, in effect, extend eligibility for Concurrent Retirement and Disability Pay (CROP) to all Chapter 61 retirees over five years. A less costly improvement to pursue in an austere budget year would be fixing the so-called "glitch" for CRSC 

that result in compensation declining when the V A disability rating increases. 

CHILD CARE 

Access to affordable, quality child care must be a high priority for all the military services. Adequate and reliable child care helps reduce stress on a military family that has one of the parents 

deployed. Sergeant Major ofthe Marine Corps Micheal Barrett testified before the House Mil-
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ConIV A Appropriations Subcommittee on February 16,2012 and stated that child care remains a 

high priority for that service. The Marine Corps provided 15,927 child care spaces in FY 2011, 

which reflects an 18 percent increase in capacity from FY 2010. The service developed a Child 

Development Program and Facility Master Plan, which reviewed child care capabilities and 

costs. The report will assist the Marine Corps in providing this benefit in a more efficient manner. MCPON Rick West stated at the same hearing that at the end of this year the Navy will 

complete its expansion efforts by adding 7,000 new child care spaces to meet the Office of Secretary of Defense (OSD) guidance to provide 80 percent of potential child care needs. This expansion has reduced waiting times to three-months or less. 

UNIFORMED SERVICES FORMER SPOUSES PROTECTION ACT (USFSP A) 

According to USA Today, "At the end ofFY 2011, the military divorce rate reached its highest 

level since 1999, as nearly 30,000 marriages were dissolved. The overall military divorce rate of 

3.7 percent edged out the most recent civilian (divorce) rate.,,3 FRA urges Congress to review the 

USFSPA with the intent to amend the language so that the Federal government is required to 

protect its service members against State courts that ignore the Act. 

The USFSPA was enacted 30 years ago; the result of Congressional maneuvering that denied the 

opposition an opportunity to express its position in open public hearings. The last hearing, in 

1999, was conducted by the House Veterans' Affairs Committee rather than the Armed Services 

Committee which has oversight authority for USFSPA. 

Few provisions of the USFSPA protect the rights of the service member, and none are enforceable by the Department of Justice or DoD. If a State court violates the right of the service member under the provisions ofUSFSPA, the Solicitor General will make no move to reverse the error. Why? Because the Act fails to have the enforceable language required for Justice or the Defense Department to react. The only recourse is for the service member to appeal to the court, 

which in many cases gives that court jurisdiction over the member. Another infraction is committed by some State courts awarding a percentage of veterans' compensation to ex -spouses, a 

clear violation ofU. S. law; yet, the Federal government does nothing to stop this transgression. 

There are other provisions that weigh heavily in favor of former spouses. For example, when a 

divorce is granted and the former spouse is awarded a percentage of the service member's retired 

pay, the amount should be based on the member's pay grade at the time of the divorce and not at 

a higher grade that may be held upon retirement. 

FRA believes that the Pentagon's USFSPA study recommendations are a good starting point for 

reform. 

HOUSING 

FRA supports reform of enlisted housing standards by allowing E-7s and above to reside in separate homes, track the Basic Allowance for Housing (BAH) to ensure it is commensurate with ac3 USA Today, Dec. 14,2011, Military Divorce Rate at Highest Level Since 1999, Gregg loroya 
223 

[Whereupon, at 3:39 p.m., the subcommittee adjourned.] 


328pe113.eps

tual housing costs, ensure adequate housing inventory and that housing privatization programs 

are beneficial to service membe~ and their families. 

The Marines are the youngest and least married of the four services. FY 2012 was the last year of 

a five year barracks construction effort to replace and update faculties. The FRA notes that Marines have 100,000 bachelor enlisted housing units. These projects were developed to meet 90 

percent of the housing requirements of 202,000 and will meet just less than 100 percent of the 

projected reduced end strength force. 

According to MCPON West during the above referenced testimony, the Navy is continuing to 

invest in Homeport Ashore Program to provide off-ship housing for junior Sailo~ who would 

otherwise live aboard ships. Despite multi-year efforts to address this issue, there are stilI 5,400 

single Sailo~ E-I through E-4living abroad ships while at their home ports. This program will 

finally eliminate aboard ship living at home port by FY 2016. . 

The Navy has 3,500 family housing units that are inadequate and the service plans to reduce inadequate housing from the current 36 percent to 10 percent by FY 2017. The Marines have 

24,000 family homes (including PPV) and the FY 2013 budget provides $20 million to restore 44 

family homes. The Navy and the Marines have privatized 97 percent of their family housing and 

when their Public Private Venture (PPV) is complete the Navy will own less than 100 homes. 

MILITARY REsALE SYSTEM 

FRA strongly supports adequate funding for the Defense Commissary Agency (DeCA) to ensure 

access to the commissary benefit for all beneficiaries. Since 2000, DeCA's budget bas remained 

flat in real dollars, meaning the agency has done more with less for the past 11 years. The Association also strong supports the military exchange systems (AAFES, NEXCOM and MCX), and 

urges against revisiting the concept of consolidation. FRA instead urges a thorough review of the 

findings of an extensive and costly ($17 million) mUlti-year study which found that this is not a 

cost-effective approach to running these important systems 

MILITARY VOTING 

In the past two years, 47 states and the District of Columbia enacted laws to protect the voting 

rights of military and ove~eas citizens, according to a report recently released by the Pew Center 

on the States. These changes are associated with a provision in the FY 20 I 0 NDAA that requires 

all states to provide military voters with ballots no later than 45 days prior to each election, to 

ensure adequate time to complete and return them. The provision also allowed stales and D.C. to 

transmit ballots to vote~ electronically and eliminated requirements for notarization and witnesses. FRA wants to express its appreciation for helping all deployed service members to be 

afforded the opportunity to vote. The Association recommends that this distinguished Subcommittee periodically conduct ove~ight hearings to ensure that deployed service members are not 

being disenfranchised. 

CONCLUSION 

FRA is grateful for the opportunity to provide these recommendations to this distinguished Suhcommittee. 
(225) 

DEPARTMENT OF DEFENSE AUTHORIZATION 

FOR APPROPRIATIONS FOR FISCAL YEAR 

2013 AND THE FUTURE YEARS DEFENSE 

PROGRAM 

WEDNESDAY, APRIL 25, 2012 

U.S. SENATE, SUBCOMMITTEE ON PERSONNEL, COMMITTEE ON ARMED SERVICES, Washington, DC. 

CONTINUATION OF TESTIMONY ON THE ACTIVE, 

GUARD, RESERVE, AND CIVILIAN PERSONNEL PROGRAMS 

The subcommittee met, pursuant to notice, at 1:07 p.m. in room 

SR–232A, Russell Senate Office Building, Senator Jim Webb (chairman of the subcommittee) presiding. 

Committee members present: Senators Webb, Blumenthal, 

Graham, Brown, Ayotte, and Vitter. 

Committee staff member present: Leah C. Brewer, nominations 

and hearings clerk. 

Majority staff members present: Jonathan D. Clark, counsel; 

Gabriella E. Fahrer, counsel; and Gerald J. Leeling, counsel. 

Minority staff member present: Richard F. Walsh, minority counsel. 

Staff assistant present: Jennifer R. Knowles. 

Committee members’ assistants present: Gordon Peterson, assistant to Senator Webb; Ethan Saxon, assistant to Senator 

Blumenthal; Brad Bowman, assistant to Senator Ayotte; Sergio 

Sarkany, assistant to Senator Graham; and Joshua Hodges, assistant to Senator Vitter. 

OPENING STATEMENT OF SENATOR JIM WEBB, CHAIRMAN 

Senator WEBB. The hearing will come to order. 

The subcommittee meets today to continue to receive testimony 

from the military Services on military and civilian personnel programs contained in the administration’s Defense Authorization Request for Fiscal Year 2013 and the Future Years Defense Program 

(FYDP). 

I would like to begin this hearing by thanking everybody for adjusting their schedules. As you have been informed, we have a series of votes that will begin in approximately 1 hour. So I am going 

to summarize my statement, at the end of which I will have my 

full statement entered into the record. Then I think we previously 

226 

asked that the civilian assistant secretaries give a brief overview 

of theirs. All of the written statements will be entered into the 

record, and hopefully we can allow enough time for members who 

wish to ask questions to use this next hour in a fruitful manner. 

As always, the hearing record will be open until close of business 

tomorrow if there are written questions for the record for any of 

those of you who are here today. 

We have today the senior leaders responsible for military and civilian personnel matters within the Services. We will discuss, as always, the plans and programs for fiscal year 2013 and also specific 

budget items in furtherance of this subcommittee’s oversight responsibilities. 

We have Hon. Thomas R. Lamont, Assistant Secretary of the 

Army for Manpower and Reserve Affairs; Hon. Juan M. Garcia III, 

Assistant Secretary of the Navy for Manpower and Reserve Affairs; 

Hon. Daniel B. Ginsburg, Assistant Secretary of the Air Force for 

Manpower and Reserve Affairs; Lieutenant General Thomas P. 

Bostick, USA, Deputy Chief of Staff G–1, U.S. Army; Vice Admiral 

Scott R. Van Buskirk, USN, Chief of Naval Personnel, U.S. Navy; 

Lieutenant General Robert E. Milstead, Jr., USMC, Assistant Commandant for Manpower and Reserve Affairs, U.S. Marine Corps; 

and Lieutenant General Darrell D. Jones, USAF, Deputy Chief of 

Staff for Manpower, Personnel and Services, U.S. Air Force. 

We had originally scheduled this hearing for a few weeks ago. At 

that time, General Milstead was recovering from some very serious 

surgery. We are pleased that you have successfully recuperated, although you might have been better off being able to avoid this 

hearing a couple of weeks ago. But we are very happy to have you 

with us today, General. 

As I stated at our oversight hearing with the Office of the Secretary of Defense (OSD) witnesses in March, we have some very serious challenges here. General Schwartz, Air Force Chief of Staff, 

called these challenges with personnel programs ‘‘the monumental 

defense issue of our time.’’ These challenges, as everyone knows, 

have been made more difficult by the Budget Control Act (BCA). 

Much of the subcommittee hearing last month was devoted to the 

TRICARE fee issue. I am not going to go into that in any detail 

today. Just suffice it to say that it is an issue of great concern to 

me and some other members on this subcommittee. 

We are concerned about the planned reduction of large numbers 

of military personnel, more than 120,000 across Service components. I have been able to have personal discussions with a number 

of you about that issue. It may come up again today. 

The Integrated Disability Evaluation System does not seem to be 

working. I have been able to have discussions again out of this 

hearing room with people about that. It is being implemented 

worldwide. There are some 23,000 servicemembers in the system, 

that at least by our count, are still awaiting some sort of resolution. 

We are interested in examining the roles and opportunities for 

service by women. The Marine Corps, particularly, has had an interesting week in that regard. We will have a discussion about 

that. 

227 

Sexual assault prevention and response remain a priority, as always, for our subcommittee. 

Another priority is the many discussions we have had regarding 

total force mix of military personnel, Department of Defense (DOD) 

civilian personnel, and contractors. This has come up a number of 

different times. It was a major part of our hearing last year. It will 

come up again today. 

Lastly, we continue to be interested in the DOD’s and the Services’ efforts to eliminate, reduce, and reallocate 140 general flag officer positions and 150 Senior Executive Service positions. 

At the outset of the hearing, I think it is important for those of 

us who are on this end of the table to express our great appreciation to all of you for what you and the people who serve alongside 

you do every day to make our country more secure and also to 

make DOD a better functioning place. 

At this time, I will enter my full statement for the record. 

[The prepared statement of Senator Webb follows:] 

PREPARED STATEMENT BY SENATOR JIM WEBB

The subcommittee meets today to receive testimony from the Military Services on 

military and civilian personnel programs contained in the administration’s Defense 

Authorization Request for Fiscal Year 2013 and the Future Years Defense Program. 

With us today are the senior leaders responsible for military and civilian personnel matters within the Services. We will discuss not only their plans and programs for fiscal year 2013, but also specific budget items in furtherance of this subcommittee’s oversight responsibilities. We will begin marking up the 2013 defense 

bill in the next few weeks. Your statements and testimony today are extremely important as we prepare for that important activity. 

Our witnesses today are: 

• The Honorable Thomas R. Lamont, Assistant Secretary of the Army for 

Manpower and Reserve Affairs; 

• The Honorable Juan M. Garcia III, Assistant Secretary of the Navy for 

Manpower and Reserve Affairs; 

• The Honorable Daniel B. Ginsberg, Assistant Secretary of the Air Force 

for Manpower and Reserve Affairs; 

• Lieutenant General Thomas P. Bostick, USA, Deputy Chief of Staff G– 

1, U.S. Army; 

• Vice Admiral Scott R. Van Buskirk, USN, Chief of Naval Personnel, U.S. 

Navy; 

• Lieutenant General Robert E. Milstead, Jr., USMC, Assistant Commandant for Manpower and Reserve Affairs, U.S. Marine Corps; and 

• Lieutenant General Darrell D. Jones, USAF, Deputy Chief of Staff for 

Manpower, Personnel and Services, U.S. Air Force. 

Lieutenant General Milstead, I understand you tried to avoid this hearing the 

first time by scheduling surgery. I am pleased that your plan failed, and we are 

happy to see you back in good health. 

As I stated at our oversight hearing with the Office of the Secretary of Defense 

witnesses in March, this subcommittee faces a very clear challenge this year as we 

address the need to control the increasing costs of personnel programs. General 

Schwartz, the Air Force Chief of Staff, called this challenge ‘‘the monumental defense issue of our time.’’ 

This challenge is made more difficult by the funding limitations imposed by the 

Budget Control Act. To comply with the discretionary funding caps, the administration has made several proposals to reduce military personnel costs, including end 

strength reductions of more than 120,000 military personnel, limiting pay raises beginning in 2015, establishing a BRAC-like commission to conduct a comprehensive 

review of military retirement, and increasing TRICARE fees for military retirees 

and their families. 

Much of this subcommittee’s hearing last month was devoted to the TRICARE fee 

issue, and I won’t rehash that here. Suffice to say, I believe we have made a moral 

contract with servicemembers past and present to provide them a lifetime of medical 

care in exchange for a career of military service. The Department’s proposal to instiVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00233 Fmt 6601 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
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tute fees for TRICARE for Life, in my view, does not fully take into account other 

fee requirements that already are in place. 

We are also very concerned about the planned reduction of large numbers of military personnel—more than 120,000—across all Service components. I want to hear 

from the personnel chiefs in particular about their plans to reduce the size of their 

forces, how they will ensure adequate dwell time, and how they will avoid the need 

to involuntarily separate soldiers, sailors, airmen, and marines. Our witnesses today 

are well aware that our men and women in uniform have sacrificed much on behalf 

of our Nation during the past decade. I specifically would like to know what forceshaping tools the Services must have in place to achieve force reductions in a compassionate and sustainable manner. 

In a related issue, the Integrated Disability Evaluation System (IDES) does not 

seem to be working as initially planned. It is bureaucratic and timeconsuming. It 

has been fully implemented worldwide for some 15 months, and yet there are more 

than 23,000 servicemembers in the system according to the latest data provided to 

the committee. For the Army alone, its IDES population would equal six brigade 

combat teams. I would like to hear from the personnel chiefs their view of how this 

new evaluation system is progressing and what we can do to make it more efficient 

and fair. 

Many of us on the committee continue to be interested in examining the roles and 

opportunities for service by women. The Department recently proposed to Congress 

policy changes that would open more than 14,000 positions to women. Additionally, 

last week the Marine Corps announced opening a limited number of training slots 

in combat specialties to women, a significant departure from current restrictions. As 

our witnesses know better than anyone, for a variety of reasons, more than 75 percent of the Nation’s youth do not qualify for enlistment in the military. Maintaining 

unnecessary barriers to service of those who are qualified and motivated to serve 

magnifies the challenge in recruiting the most qualified individuals for service in 

the All-Volunteer Force. At the same time, this subcommittee has an obligation to 

ensure policy changes continue to move us in the right direction. I look forward to 

learning more from our witness today. 

Sexual assault prevention and response remain a priority for this subcommittee. 

Last year, we enacted a number of legislative provisions to assist victims of sexual 

assault. Additionally, Secretary Panetta recently announced several initiatives in 

this area, some of which may require legislation. I would like to hear what the Services are doing to reduce incidents of sexual assault in the military, prosecute offenders, and provide greater assistance to victims of such crimes. 

Another continuing priority is accounting for the total force mix of military personnel, DOD civilian personnel, and contractors. At last year’s hearing, with all the 

same witnesses except for Admiral Van Buskirk, I asked how you account for civilian contractors when you build your manpower models. There was a good deal of 

difficulty in pinning down actual numbers. I would like to know how we have progressed on addressing this issue since last year. 

Lastly, this subcommittee continues to be interested in the Department of Defense 

and the Services’ efforts to eliminate, reduce, and reallocate 140 general and flag 

officer positions and 150 Senior Executive Service positions. I would like to know 

what progress has been made in executing these reductions. 

I’m sure that we all agree that there is no greater responsibility for Congress and 

our military leaders than to care and provide for our servicemembers and their families. That includes making careful, deliberate, and sometimes painful budget 

choices necessary to protect the viability of the All-Volunteer Force and to ensure 

our military remains the finest in the world. Tradeoffs must be made between what 

is nice to have and what we must have—not just in terms of weapons, planes, and 

ships, but most importantly in terms of our people. We must have the right number 

with the right qualifications and skills. 

I look forward to hearing your testimony about the health of your Services, military personnel and their families, and your assessment and counsel concerning the 

difficult choices ahead. As always, I encourage you to express your views candidly. 

Let us know how we can best assist our servicemembers and their families to ensure that our military remains steadfast and strong. 

We will now hear opening statements from our witnesses. Given the number of 

witnesses, I ask that the witnesses keep their oral statements to 3 to 5 minutes. 

Their complete prepared statements will be included in the record. Following the 

opening statements, we will limit our questions to 7 minutes per round. I am going 

to call witness by Service, starting with the Army. 

Finally, I would like to note that this will be the last subcommittee hearing for 

Dick Walsh, minority counsel to the committee. Dick has been with the committee 

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for over 10 years and has made innumerable contributions always in a bipartisan 

fashion. We will miss him, and we wish him luck. 

We have received a statement from the Reserve Officers Association. If there is 

no objection, it will be entered into the record. 

Senator WEBB. With that, Senator Graham, welcome. 

Senator GRAHAM. Thank you, Mr. Chairman. I will just forgo an 

opening statement and look forward to receiving the testimony. 

Senator WEBB. Thank you. 

We have received a statement from the Reserve Officers Association, and if there is no objection, that will be entered into the 

record. 

[The information referred to can be found at Appendix A:] 

Senator WEBB. With that, we will start with Secretary Lamont. 

Hopefully, you can summarize your statement in about 3 minutes 

or so. 

STATEMENT OF HON. THOMAS R. LAMONT, ASSISTANT SECRETARY OF THE ARMY FOR MANPOWER AND RESERVE AFFAIRS; ACCOMPANIED BY LTG THOMAS P. BOSTICK, USA, 

DEPUTY CHIEF OF STAFF G–1, U.S. ARMY 

Mr. LAMONT. I will try to do it in half of that, if you do not mind. 

I have truncated my lofty words and will rely upon our written 

statement. 

Senator WEBB. Your written statement in full will be entered 

into the record. 

Mr. LAMONT. Thank you. 

Chairman Webb, Senator Graham, and members of this subcommittee, thank you for taking the time to explore the issues that 

are so critical to the men and women in our All-Volunteer Army 

and to our national defense both today and in the future. 

It is an honor to serve as the Army’s Assistant Secretary for 

Manpower and Reserve Affairs. 

After a decade of war, the Army is poised to draw down both our 

military and civilian forces. We must do this smartly and compassionately. Thousands of individuals will transition out of military 

and civil service after serving faithfully and honorably. They will 

need the support of the Nation and deserve quality transition assistance. 

Wartime experiences over the past decade have taught us that 

we must have a total Army. The Army National Guard and Army 

Reserve provide 51 percent of the Army’s military end strength for 

around 16 percent of the base budget. We look forward to working 

with you to transform the Army National Guard and Army Reserve 

into an operational force that provides not only ready access to 1 

million trained soldiers but also an historic opportunity for our Nation to achieve the most cost-effective use of its Army. 

We are increasingly aware of the physical and emotional toll a 

decade of war has taken on our force, and we are committed to providing quality assistance to soldiers and family members who are 

struggling with issues such as substance abuse, depression, posttraumatic stress disorder (PTSD), and sexual harassment and 

abuse. These issues affect readiness and weaken our force. The 

Army continues to take aggressive action to promote health, identify and reduce risky behaviors, and prevent suicides. Further, at 

230 

all levels of the Army, we are reinforcing the Army value of respect 

in order to establish a climate where sexual harassment, sexual assault, and hazing will not be tolerated. 

While we transform to a smaller Army, we remain dedicated to 

improving readiness and building resilience in our soldiers, civilians, and families. The Army must not and will not sacrifice readiness as it draws down. We will emerge from the forthcoming budget reductions a leaner force but one still capable of and committed 

to meeting our obligations to the Nation, the American people, and 

the dedicated men and women who serve. Although our Army will 

become smaller in the coming months and years, we will preserve 

the quality of our All-Volunteer Force. This fighting force will retain the confidence and pride of the American people as it has for 

more than 236 years. 

I appreciate the support of the committee and your commitment 

to taking care of our soldiers, civilians, and families. The well-being 

of our force, regardless of its size, is absolutely dependent upon 

your tremendous support. 

Thank you very much. I look forward to your questions. 

Senator WEBB. Thank you, Secretary Lamont. General Bostick, 

your written statement will be entered into the record as well. I 

know you will be receiving some questions during the question period. 

[The joint prepared statement of Mr. Lamont and General 

Bostick follows:] 

JOINT PREPARED STATEMENT BY HON. THOMAS R. LAMONT AND LTG THOMAS P. 

BOSTICK, USA 

INTRODUCTION

Chairman Webb, Senator Graham, distinguished members of this committee, 

thank you for the opportunity to appear before you on behalf of America’s Army. 

The U.S. Army is a values-based organization that exists to serve the American people, to defend the Nation, to protect vital national interests, and to fulfill national 

military responsibilities. We are now poised to execute an historic drawdown of both 

our military and civilian personnel, and we are proposing to do it in a deliberate 

and careful manner. Thousands of individuals will transition out of military and 

civil service and deserve quality transition assistance. 

While the future Army will be smaller, the Army is implementing a number of 

improvements in force structure and other capabilities to ensure it remains the best 

led, best-trained, and best-equipped land force in the world today and in the future. 

Our soldiers have performed superbly over the last 10 years of war, displaying the 

values, character and competence that make our Army second to none. We must not 

waver on our commitment to support all those who have served with courage, pride, 

and honor. 

Thank you for your steadfast commitment to ensuring that the needs of our soldiers, their families, and our civilian workforce are met by supporting our personnel 

initiatives to ensure growth, sustainment and well being of our All-Volunteer Force. 

STRATEGIC OVERVIEW

America’s Army, our soldiers, families, and civilians are strained by nearly a decade of persistent conflict. More than 1.1 million soldiers have deployed to combat, 

impacting not only the soldiers, but their families as well. Additionally, Army civilians shoulder a majority of the Generating Force mission, and 30,000 civilians have 

deployed into harm’s way. Now we will transition to a smaller force, while continuing to remain vigilant of new threats and prepare for new capabilities and requirements. 

To maintain an All-Volunteer Force of the highest quality soldiers and achieve our 

end-strength goal, the Army must responsibly balance force shaping across accessions, retention, promotions, voluntary and involuntary separations, and natural 

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losses. We should assist our soldiers and civilians who will transition from their 

military and civil service careers to employment in the private sector. 

One of the challenges we face is the nondeployable population. The disability system is not effective and we must continue to work on an efficient solution between 

the Services, DOD, and the Veterans Administration to streamline the disability 

system and improve coordination for health care, compensation, and benefits. The 

Army also continues to focus on assisting our soldiers and family members struggling with depression, substance abuse, and other Health of the Force issues. 

With the continued support of the American people and Congress, we remain committed to the readiness, health and well being of our soldiers, civilians, and family 

members. As part of this effort the Army is also focused on wisely managing our 

resources in the health care arena. The Department of Defense (DOD) has also put 

forward a set of proposals to further reduce the rate of growth in health care costs— 

proposals that are aligned with our priorities. TRICARE is a superb health benefit— 

one of the best in the country—and appropriately so. Just as in all areas of the defense budget, we need to make decisions that preserve a strong benefit yet reflect 

the fiscal realities of the times. The proposals take care to exempt populations who 

have made the greatest sacrifices—those who are medically retired, and those families who have lost their loved one while serving on active duty. The changes proposed are also adjusted to reflect lower adjustments for those retirees with lower 

retirement pay. Most importantly, DOD continues to provide resources that improve 

the overall health system for our soldiers and their families. 

The American soldier is the centerpiece of everything we do in the Army. Our efforts must remain focused on the preservation of our most precious resource, our 

people. 

DRAWDOWN/END STRENGTH

In keeping with the National Defense Strategy, the Army is building our future 

force to meet the Nation’s requirements. The Army is reducing its Active component 

end strength to 490,000 soldiers by fiscal year 2017. Based on Total Army Analysis 

of future requirements, the force structure effective in fiscal year 2017 requires an 

additional decrease of ∼24,000 enlisted soldiers and ∼5,000 officers beyond our current rate of attrition over this same period. The Army continues to reduce the additional temporary end strength increase (TESI) of 22,000 soldiers, approved in 2009 

by the Secretary of Defense, and is on target to be at an Active component end 

strength of 552,100 by the end of fiscal year 2013. In fiscal year 2014, the Army 

will begin to take further steps to significantly shape the force toward the 490,000 

fiscal year 2017 goal. 

Our projected drawdown ramp allows for funding 490,000 of end strength in the 

base budget starting in fiscal year 2014 and beyond, with all other end strength 

supported by Overseas Contingency Operations (OCO) funding. This ramp allows for 

a steady enlisted accession mission of ∼57,000 and an Active Competitive Category 

officer mission of ∼4,300. Our strength projections incorporate additional soldier inventory, Temporary Endstrength Army Medical (TEAM), to mitigate impact of the 

Disability Evaluation System (DES) nondeployable soldiers. This TEAM end 

strength is assumed in fiscal year 2013 and fiscal year 2014 and fully eliminated 

by end of fiscal year 2015. 

In order to achieve expected end strength reductions, the Army expects to use various types of separation authorities across all elements of the force (officer, enlisted, 

and civilian). In order to maintain America’s Army as an All-Volunteer Force of the 

highest quality, we are planning to execute the upcoming force reductions in a responsible and targeted fashion while maintaining a ready force. Our soldiers have 

performed superbly over the last 10 years of war and have displayed the values, 

character and competence that made us successful. We value their service and sacrifices, and will use precision, care, and compassion in achieving the end strength 

goal without jeopardizing combat operations. Under current loss rates, the Army 

will not be able to reach its end strength goal over the fiscal year 2013–2017 period. 

We are making use of reduced accession levels, promotion selectivity and tightened 

retention standards to help shape our force naturally. Through these processes, we 

expect to lose combat seasoned soldiers and leaders, but our focus will be on retaining the best individuals in the right grades and skills. 

The National Defense Authorization Act (NDAA) for Fiscal Year 2012 provides 

several incentive authorities that will help the Army encourage soldiers to separate 

over the drawdown period, along with the flexibility to apply them to meet specific 

grade and skill needs. We are developing cost data for potential use of Voluntary 

Separation Pay (VSP), Temporary Early Retirement Authority (TERA), and Voluntary Retirment Incentive (VRI) pay, but will need to realign or request reVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00237 Fmt 6601 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
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programming of funds to support execution of these now existing authorities. Unfortunately, there is no single force shaping method among the choices of accessions, 

retention and separations, that will achieve the Army’s end strength goals, and 

there will be good soldiers who we will not be able to retain. As soldiers depart our 

active duty formations, the Army is committed to assisting them and their families 

as they transition to the Army Reserve, National Guard, or civilian life. 

To maintain an All-Volunteer Force of the highest quality soldiers and achieve our 

end strength, the Army must responsibly balance force shaping across accessions, 

retention, promotions, voluntary separations, involuntary separations, and natural 

losses. 

TRANSITION ASSISTANCE STRATEGY

Our Nation entrusts its best and brightest to the Army to support the All-Volunteer force. Therefore, the Army has a responsibility to help our transitioning personnel prepare for post-Army life by providing the training and tools to enable their 

success. We must help them use their Army training, education and experience to 

successfully return to civilian life and to become gainfully employed. Support 

through this transition process demonstrates the Army’s commitment to its soldiers 

and their families beyond their years of service. 

Some of the more than 130,000 soldiers who transition from the Army annually 

have difficulty finding employment. As of January 2012, 21 percent of our Gulf War 

II Veterans between the ages of 20 and 24 are unemployed while the national unemployment average for the same age group is 14 percent. Since 2001, the Army’s annual unemployment compensation costs have increased from $90 million to $574.5 

million in fiscal year 2011. As the Army executes force shaping in the 2014–2017 

timeframe, the number of personnel requiring transition training and counseling is 

expected to increase. 

Consequently, the Army is transforming the way we transition soldiers in order 

to give them the greatest opportunity for success after their military service. On August 29, 2011, the Army published a new Transition Policy, which encompasses 

transitions throughout the entire lifecycle of Service (e.g. permanent change of station, component change, promotion, schooling, deployment, demobilization and separation/retirement). In particular, this policy establishes Transition as a commander’s 

program; ensures every soldier begins mandatory transition counseling and planning no later than 12 months before separating or demobilizing; mandates building 

a tailored plan for an individual’s needs which will have measurable outcomes; and 

expands virtual services for career and education counseling before, during, and 

after deployment. On December 29, 2011, the Army published an Execution Order 

focused on transition policy actions which will have an immediate and positive impact on soldiers preparing to separate from Active Duty, demobilizing Reserve component soldiers, and their families. 

The Army supports the White House Employment Initiative and the DOD/Department of Veterans Affairs (VA) Veterans Employment Initiative Task Force to develop reforms to ensure all transitioning servicemembers maximize their career 

readiness prior to separation in line with the newly enacted Veterans Opportunity 

to Work to Hire Heroes Act of 2011. With the Army’s new proactive approach to 

transition, we are connecting soldiers and veterans with career private industry employment opportunities. The Army is working with the DOD/VA Task Force to help 

identify the best information technology application and functional capability to support this employment initiative. 


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CIVILIAN REDUCTIONS AND HUMAN CAPITAL MANAGEMENT

The Army is reducing civilian on-board strength, where necessary and appropriate, in order to meet funded targets. This reduction will draw down civilian onboard strength in order to hold to fiscal year 2010 civilian funding levels. Headquarters, Department of the Army Staff and all Army commands and agencies have 

conducted exhaustive reviews of programs and functions in order to identify specific 

functions, activities, and workload for elimination and/or reduction. 

On February 2, 2011, the Department of the Army suspended civilian employment 

offers for Operation and Maintenance, Army (OMA)-funded positions, with exceptions for positions related to medical, law enforcement, safety, health, welfare, and 

contingency operations. Other exceptions to fill vacancies were approved at the Department of the Army headquarters level. The suspension was lifted on April 29, 

2011, and commands and agencies were directed to manage civilian and contracted 

workload within their targeted fiscal constraints. 

The Secretary of the Army issued implementation guidance to Army commands 

on July 11, 2011, informing them of their funded civilian authorization levels and 

an implementation order was issued on August 3, 2011. The $834 million reduction 

in OMA funding is associated with 8,741 reductions in direct hire civilian authorizations. Commands and agencies will take immediate action to reduce civilian onboard strength as rapidly as possible, but no later than the end of fiscal year 2012. 

Our reshaping efforts are already assisting commanders and directors with reshaping efforts. 

The Assistant Secretary of the Army (Manpower and Reserve Affairs) and the Assistant Secretary of the Army (Financial Management and Comptroller) have established business processes and reporting mechanisms to effectively align requirements, authorizations, on-board strength and associated funding execution for the 

civilian workforce. Commands and agencies report monthly on the status of their 

civilian workforce reduction plans, the number of civilian reductions effected each 

month, the total number of reductions to date and the amount of OMA funding expended on civilian payroll. In accordance with statutory restrictions and the Secretary of the Army’s instructions, service contracts will not be initiated in lieu of 

reduced civilian manpower, nor will existing contracts be modified to accommodate 

work formerly performed by civilian employees. 

To the maximum extent possible, the Army is relying on voluntary departures and 

attrition to achieve the personnel reductions. Reshaping tools to effect voluntary departures include Voluntary Early Retirement Authority (VERA) and Voluntary Separation Incentive Pay (VSIP). Other non-voluntary reshaping tools short of Reduction In Force (RIF) may include release of temporary employees, separation of Highly Qualified Experts (HQE), separation of re-employed annuitants, management-directed reassignments and furloughs. If these measures do not achieve the required 

civilian personnel levels, then a RIF may be considered. 

Several commands are releasing temporary employees, re-employed annuitants 

and HQEs. Many have also instituted internal hiring freezes, with recruitment outside of the command requiring higher headquarters approval. Commands have offered VERA to employees willing to retire and/or VSIP to those willing to separate 

from the Federal Government. If further reductions are necessary, a RIF will be the 

last resort. As conditions change with regard to the size of the workforce, marginal 

adjustments will be made to these planned reductions at installations where such 

adjustments are warranted. 


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RECRUITING AND RETENTION (OFFICER AND ENLISTED)

Our soldiers are the Army’s most important resource, and our ability to meet the 

challenges of the current and future operational environment depends on our ability 

to sustain the All-Volunteer Force. Even as we drawdown the Army, we must continue to bring high quality men and women into the force to grow our future leaders. We must also ensure that the Army retains the most talented soldiers with the 

skills necessary to meet our future needs. 

Despite the challenges of an ongoing conflict, the active Army and the Army Reserve once again exceeded their enlisted recruiting and retention missions in fiscal 

year 2011. The Army National Guard intentionally under accessed in fiscal year 

2011 to avoid exceeding their congressionally mandated end strength limits. The active Army accessed the highest percentage of high school diploma graduates since 

fiscal year 1992—increasing from 94.7 percent in fiscal year 2009 to 98.7 percent 

in fiscal year 2011. The Army met its skill-set needs, achieving over 99 percent Military Occupational Specialty (MOS) precision. The Army’s percentage of new enlisted 

soldiers with a high school diploma was well above historic rates for all three components. In addition, recruits scoring (50–99 percent) exceeded the DOD standard 

of 60 percent, while recruits who scored in the lower range (30 and below) on the 

Armed Forces Qualification Test decreased by 30 percent (from 281 to 199). Ineligibility waivers granted for enlistment and appointments declined by 4.45 percent 

from fiscal year 2010 to fiscal year 2011 as a result of being more selective and the 

improved recruiting environment. We are currently on track to achieve our fiscal 

year 2012 mission and expect to recruit half of the fiscal year 2013 annual mission 

into the entry pool by the end of fiscal year 2012. 

In fiscal year 2011, Combined Active Army (AC) and Army Reserve Component 

(RC) enlistment and reenlistment incentives (bonuses and education), totaled slightly over $1.39 billion. Entering fiscal year 2012, the combined Active and Reserve 

components will spend slightly over $1.19 billion (AC recruiting; $406 million), AC 

retention ($231 million), Army National Guard recruiting and retention ($455 million), USAR recruiting and retention ($274 million). A large part of the fiscal year 

2012 incentives budget is a result of obligations for enlistment bonuses occurring 

from fiscal years 2007–2010. As a result of lower recruiting missions and the favorable recruiting environment, average Regular Army recruiting bonuses dropped 

from over $13,000 in fiscal year 2009 to $2,500 in fiscal year 2012. Enlistment and 

reenlistment bonuses are only used to incentivize longer-term enlistments in a small 

percentage of critical skills. These incentives ensure the success of the total Army 

recruiting and retention missions and shape the force to meet specific grade and 

skill requirements. The amount budgeted for contractual payments is anticipated to 

decrease until at least fiscal year 2015. 

Over the years through research, the Army has improved personnel assessment 

measures to more fully assess an individual’s potential to serve and predict a soldier’s success in job performance, attitudes, and career intentions. One valuable 

measure is the Tailored Adaptive Personality Assessment System (TAPAS). TAPAS 

was developed to enhance the selection of soldiers with Tier 1 credentials by screening out low motivated, high attrition risk applicants. To date, more than 320,000 

Army and 96,000 Air Force applicants have tested on TAPAS. The Navy also started 

testing their applicants in late fiscal year 2011. Preliminary results in operational 

testing indicate that soldiers who pass the TAPAS screen have better retention and 

training outcomes than soldiers in the same Test Score Category who fail the 

TAPAS screen. 

Recruiting success is expected to continue in fiscal year 2012; however, the Army 

and the Nation still face challenges such as rising obesity rates and decreasing high 

school graduation rates as we recruit the All-Volunteer Force. As the pool of qualified 17–24 year old Americans continues to decline due to growing rates of obesity 

and decreasing rates of high school graduation, it will become more important for 

parents, teachers and business leaders to support a youth’s decision to join the 

Army. In today’s environment fewer than one in four 17–24 year-olds are eligible 


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to serve in the Army. More than 20 percent of high school students fail to graduate 

and 1 in 5 youths, 12–19 years old, are currently overweight, compared to 1 in 20 

in the 1960s. This trend is projected to grow to 1 in 4 by 2015. 

The Army must retain the flexibility to offer incentives to attract and retain talent. The continued funding of these programs by Congress is absolutely critical to 

the Army. These incentives assist in shaping the force for both quality and specific 

talent required. 

The Army continues to retain soldiers at unprecedented levels, while engaged in 

the longest period of conflict for our All-Volunteer Force. The Army has surpassed 

its retention goal, every year since 2002. Soldiers reenlist for three top reasons: current command climate, job satisfaction, and the quality of life in the Service. Additionally, retention rates within the last 24 months have been slightly higher than 

anticipated. 

In fiscal year 2011, the Active Army reenlisted 43,626 soldiers towards an annual 

mission of no less than 40,000 and no more than 45,000. Soldiers extending to complete deployments with their units represented an additional 7,346 extended contracts. The Army Reserve reenlisted 12,934 soldiers, exceeding their annual goals 

by 11 percent. The Army National Guard accomplished their mission as well by 

achieving 116 percent of their assigned mission, reenlisting 39,750 soldiers. 

During fiscal year 2011 and into fiscal year 2012, retention bonuses were carefully 

monitored and adjusted to ensure that the Army met its retention goals while remaining fiscally responsible. As we posture for future reductions in the size of our 

force, the Army is using lessons learned from past reductions to ensure that today’s 

decisions maintain the viability of tomorrow’s All-Volunteer Force. Retention policies 

will emphasize retention of soldiers with high potential coupled with appropriate 

force alignment and structure. 

The Army’s programs to recruit and retain both officers and enlisted soldiers with 

critical skills have been effective. For enlisted soldiers, the Enlistment Bonus, the 

Selective Reenlistment Bonus, Critical Skills Retention Bonus, and the Student 

Loan Repayment Program are proven tools that remain effective for filling critical 

skills. 

DIVERSITY

The diversity of our Army is a continuous source of strength as we recruit soldiers 

and Army civilians from an increasingly diverse America. We must take full advantage of opportunities to bring new ideas and expanded capabilities to the mission 

by reaching out to communities and building relationships that will support the 

Army’s human resource requirements. To this end, we have developed and implemented our first strategy for conducting outreach activities on an Army-wide basis. 

In this first year of execution, 9 commands are responsible for coordinating 25 outreach events for the Total Army. The Army staff will coordinate an additional 10 

events for a total of 35 during 2012. Additional organizations and events will be 

added to the strategy in the future. 

Our ability to be inclusive of the Nation’s diverse citizenry while sustaining a high 

performance Army requires the engagement of senior leaders and continuous diversity education throughout the Force. The Army Diversity Roadmap, published in December 2010, outlines a unique approach to an enterprise-wide diversity initiative 

over the coming years and will guide our actions in the areas of leadership, people, 

structure and resources, training and education, and inclusive work environments. 

Within the Roadmap, we are implementing an intra-Army council of senior leaders 

to advise the Secretary and provide a forum for collaboration and sharing ideas in 

connection with implementation of the Army Diversity Roadmap and execution of 

related initiatives. In addition, the Council will facilitate delivering the diversity 

and inclusion message throughout the Army. 

Our initial diversity training and education efforts have focused on practitioners 

who support our commanders and other leaders. We have completed initial training 

for 560 Military Equal Opportunity (MEO) and Equal Employment Opportunity professionals, and followed up with materials to support unit-level instruction. Over the 

past 2 years, 300 general officers and civilian senior executives have completed a 

diversity education program. In this program Senior executives are presented with 

Army demographics and participate in experiential exercises that facilitate awareness and perspective. 

We will continue to invest in diversity education and inclusive leadership by 

seamlessly integrating the training for senior leaders into their initial leader development programs. Ultimately, we will also reach every soldier and Army civilian 

through the Army’s institutional professional development system. 

236 

We must position the Army to recruit, develop and retain the most talented people our Nation has to offer. Critical to our global mission is an understanding of 

the cultures, languages and social norms of the people in locations where we deploy 

as well as in our own ranks. This diversity initiative is integral to the Army’s longterm vision for human capital and our understanding of the human dimension of 

leadership and global engagements. 

OPERATIONALIZING THE RESERVES

The wartime experiences of the past decade validate the need to institutionalize 

the policies, procedures and legal authorities conducive to achieving the most efficient utilization of the Total Force through maintaining the Army’s Reserve components as an ‘‘operational force.’’ Additionally, recent DOD strategic guidance advocates maintaining key capabilities within the Total Force by shifting certain capabilities to the Reserve components where they can be maintained at a high readiness level at lower overall cost. This strategy requires we continue to regularly employ National Guard and Reserve Forces in support of our national strategy. 

To support an Operational Reserve, the Army included resources for the National 

Guard and Army Reserve within the fiscal year 2013 base budget, including additional resources for collective training, full-time manning and medical/dental readiness. This required investment in readiness ultimately allows the Army to manage 

our Reserve components as an operational force. 

Towards that end, the NDAA for Fiscal Year 2012 provided the authority for 

Service Secretaries to place limited numbers of their Reserve component units on 

active duty as an operational force for certain preplanned missions in support of the 

combatant commands where the costs associated with such usage are contained in 

that year’s Defense budget. Additionally, the Secretary of the Army promulgated the 

Army’s Deployment Period Policy which established a common, 9-month period of 

deployment for General Purpose Forces at division-level and below. The policy also 

mandates common processes and procedures for validating pre-deployment readiness across the Total Force with a view towards integrating Active and Reserve 

Forces at the tactical level consistent with the Secretary of Defense’s policies for utilization of the Total Force. 

The Army National Guard and Army Reserve provide 51 percent of the Army’s 

military end-strength for around 16 percent of the base budget. Transforming the 

Army National Guard and Army Reserve into an operational force provides not only 

ready access to 1 million trained soldiers, but also an historic opportunity for our 

Nation to achieve the most cost-effective use of its Army. 

NONDEPLOYABLE CAMPAIGN PLAN

As a result of more than a decade of war, the Army has experienced a dramatic 

increase in the number of soldiers who are unable to deploy. During the 4-year period from 2007 through 2011, the nondeployable rate for Brigade Combat Teams 

(BCTs) increased by nearly 60 percent, from ∼10 percent in fiscal year 2007 to greater than 16 percent in fiscal year 2011. The corresponding decrease in the overall 

deployable rate has required us to over-man deploying units so that BCTs deploy 

with the required combat strength. This has directly impacted the Army’s ability to 

properly man the generating force. As a result, the Army developed a comprehensive 

nondeployable campaign plan to analyze the three categories representing the highest percentage of nondeployable soldiers: Medical, Separations [Expiration Term of 

Service/retirements], and Legal Processing. 

With the support of this Congress, we made significant strides this past year in 

the administrative categories; driving the overall rate down to 14 percent. Legislation passed in 2011 authorizing 365-day early separation will enable the Army to 

increase the readiness of our deploying units as we backfill those separating with 

deployable soldiers. Soldiers with medical conditions remain a challenge, comprising 

nearly half of our nondeployable population. This population will continue to grow 

as we draw down, decreasing the overall population while retaining these nondeployable soldiers as they undergo medical evaluation. Our soldiers continue to be 

the cornerstone of our combat formations and as we draw down the force, we remain 

committed to providing top quality service to our soldiers and their families. Therefore, we have focused our efforts to reduce the number of medically nondeployable 

soldiers by creating a Disability Evaluation System (DES) Task Force that will represent both medical non-deployable and DES initiatives. Through the collaboration 

of this multi-faceted Task Force, we can continue to man an expeditionary Army 

with soldiers who are deployable, while preserving the All-Volunteer Force. 

237 

THE ARMY DISABILITY EVALUATION SYSTEM

The DES has made improvement over the last 4 years, as legislative changes and 

the new Army Disability Evaluation System (DES) have made the system less adversarial; provided greater consistency between Military and VA ratings; and reduced the time it takes to start receiving VA benefits after separation. However, we 

are committed to improving the complex process. 

The current process takes almost 400 days to complete. Even if the Army were 

meeting DOD’s goal of 295 days, 10 months is simply too long for our soldiers and 

their families to wait while their future hangs in the balance. Currently the Army 

has more than 19,000 soldiers tied up in this process of disability adjudication; the 

equivalent of 5 Brigade Combat Teams sitting on the bench, not available or 

deployable, who must be replaced from other elements to meet operational and tactical requirements. As a result of the lengthy processing times, the DES continues 

to have a significant impact on Army readiness. More than 95 percent of these soldiers depart from the Army once through the process. 

The Army is committed to doing everything it can to improve the current process. 

Our Senior Leadership meets monthly with our partners in the Department of Veterans Affairs to focus on the execution of the Army DES down to the installation 

level, identify performance issues, and share best practices in order to streamline 

the process. More recently the Army completed a Senior Leader assessment of the 

execution of the Army DES at installations across the Army. This assessment identified specific actions required to enhance and standardize performance across the 

Army. Combined, these actions and standards will ensure our soldiers receive the 

needed support in a timely manner; provide the leadership at all levels visibility in 

order to adjust resourcing and assess efficiency; and help us improve Army Readiness by moving soldiers through the Army DES more expeditiously. 

We are working with DOD leadership, the other Services, and our partners in the 

Department of Veterans Affairs on improving the system and look forward to collaborating with Congress on this issue. 

QUALITY OF LIFE/FAMILY PROGRAMS

The strength of our Nation is our Army. The strength of our Army is our soldiers. 

The strength of our soldiers is our Families. Because of the tremendous sacrifices 

soldiers and families make every day, the Army is resolute in sustaining the important programs that enhance their strength, readiness, and resilience. 

The Army Family Covenant institutionalized the Army’s commitment to provide 

soldiers and their families with a quality of life commensurate with their level of 

service to the Nation. Army Senior Leadership signed the first Family Covenant in 

October 2007 and reaffirmed its tenets in October 2011. The Covenant represents 

our commitment to provide programs and services to soldiers, both single and married, and their families, regardless of component or geographic location. The Covenant recognizes the strength and commitment of soldiers and their families and establishes a lasting partnership with Army families to enhance their strength, readiness, and resilience. 

We are committed to improving soldier and family readiness by continuing to 

build resiliency through strengthened soldier and family programs that are simple 

and easier to access; maintaining accessibility and quality of health care; sustaining 

high-quality housing for soldiers and families; maintaining excellence in school support, youth services, and child care; promoting education and employment opportunities for family members; sustaining recreation, travel, and quality of life opportunities for single soldiers; and joining forces with communities to inspire support for 

soldiers and families. 

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ARMY MILITARY EQUAL OPPORTUNITY POLICY

The Army is the leader in MEO policy and practice. Commanders at all levels are 

responsible for sustaining positive MEO climates within their organizations, thus 

enhancing Army Readiness. To remain relevant within the ever-changing environment in which we operate, the Army is revising its MEO policy by integrating and 

institutionalizing equal opportunity goals, objectives and training practices. This effort will strengthen the foundation of the Army’s Human Capital Strategy. Since fiscal year 2009, the Army has invested $3.2 million to include $0.8 million in fiscal 

year 2011, and expects to invest another $2.1 million in fiscal year 2012 for MEO 

personnel services support, database and survey systems, outreach support, and 

training for implementation. 

WOMEN IN THE ARMY

On January 13, 1994, the Secretary of Defense issued the Direct Ground Combat 

Definition and Assignment Rule. The rule remains in effect today and prohibits the 

assignment of women to units below the brigade level whose primary mission is to 

engage in direct combat on the ground. 

The Army’s current assignment policy (Army Regulation 600–13, 27 Mar 92) allows women to serve in any officer or enlisted specialty or position except in those 

specialties, positions, or units (battalion size or smaller) which are assigned a routine mission to engage in direct combat, or which collocate routinely with units assigned a direct combat mission. 

On March 2, 2010, in the context of a changing operational environment, with 

emerging requirements and missions, the Army initiated a routine cyclic review of 

its assignment policy for female soldiers. The purpose of the review was to assess 

the current Army policy alignment with DOD policy. The Army completed the cyclic 

review in March 2011 and submitted the results and recommendations to Army 

Senior Leadership for decision. Prior to making that decision, the NDAA for Fiscal 

Year 2011, section 535, directed the Secretary of Defense, in coordination with the 

Services, to review laws, policies, and regulations that restrict female 

servicemembers an opportunity to excel in the Armed Forces. 

The DOD review was completed in late January 2012 and released February 9, 

2012. The Army concurred with the other Services in the revision of the Direct 

Ground Combat Assignment Rule that eliminates gender-based assignment restrictions to units and positions that are required to physically colocate and remain with 

direct ground combat units that are closed to women and to further align Army assignment policy with that of DOD. In doing so, the Army opened approximately 

13,139 positions for the assignment of women. Additionally, we opened six MOS: 

three in Field Artillery and the remaining three closed specialties in the Logistics 

career field. We also requested and were granted a DOD exception to the Direct 

Ground Combat Assignment Rule that will authorize the Army to assign females 

to direct ground combat units below the brigade level. This limited exception allows 

assignment of female soldiers in select open specialties to serve in the battalion 

headquarters of select direct ground combat units. Each of these activities will take 

effect in late spring 2012. 

Women in the Army have and continue to serve this Nation with honor and distinction in the roles, positions, units, and specialties in which they are allowed to 

serve. They have proven their ability to serve in expanded roles throughout the 

Army both on and off the battlefield. This review marks the beginning of a careful 

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ade of persistent conflict. The Army will continue to review positions and requirements to ensure that all soldiers are provided opportunities to reach their full potential and that we accomplish our missions with the most capable and qualified soldiers. 

SEXUAL HARASSMENT/ASSAULT RESPONSE AND PREVENTION PROGRAM (SHARP)

The Army’s goal is to eliminate sexual assault and sexual harassment through 

cultural change, thereby, creating a professional climate where every member of the 

Army family (soldiers, civilians, family members, and contractors) trusts their leaders to treat them with dignity and respect. 

The Army SHARP Program reinforces the Army’s commitment to reducing incidents of sexual violence while promoting sensitive care and confidential reporting 

for victims of sexual assault, and accountability for those who commit these crimes. 

The Army continues to implement a comprehensive ‘‘I. A.M. (Intervene, Act, and 

Motivate) Strong’’ Sexual Harassment/Assault Prevention Strategy and Campaign. 

The campaign is based on the same strategic framework and guiding principles 

used to execute a successful military initiative—Prevent, Shape and Win. The 

Army’s goal is to ‘‘Prevent’’ sexual assault and harassment before it occurs; ‘‘Shape’’ 

an Army culture that promotes dignity and respect; and ‘‘Win’’ an environment that 

improves prevention, investigation, and prosecution while reducing the stigma of reporting. 

The program consists of a comprehensive policy that centers on awareness and 

prevention; training and education; victim advocacy; and response, reporting, accountability and program assessment. 

The Secretary of the Army and the Chief of Staff of the Army are strong advocates for the implementation of the SHARP Program. They consider SHARP an integral part of the ‘‘Profession of Arms’’ in developing individual character and supporting the Warrior Ethos. 

In 2008 the Army launched a comprehensive sexual assault prevention strategy, 

which incorporates the ethical principles of the ‘‘Profession of Arms’’ and requires 

leaders to establish a positive command climate that clearly communicates sexual 

assault’s negative impact on the force and family members. The strategy further encourages soldiers to engage in peer-to-peer intervention, and not tolerate behavior 

that could lead to sexual assault. 

This strategy consists of four integrated, cyclical phases that are designed 

to achieve true cultural change as we work to be the Nation’s leader in sexual harassment and sexual assault prevention: 

Phase I (Committed Army Leadership) provides training on best practices 

and allows commands the opportunity to develop prevention plans to support the Army strategy. 

Phase II (Army-wide Conviction) includes educating soldiers to understand their moral responsibility to intervene and stop sexual assault and 

harassment. 

Phase III, which launched April 2011, is dedicated to ‘‘Achieving Cultural 

Change’’ and fosters an environment free from sexual harassment and sexual assault 

Phase IV, the final phase is ‘‘Sustainment, Refinement and Sharing.’’ 

This phase will be implemented beginning April 2013. Here, the prevention 

program will continue to grow while motivating national partners—governmental and nongovernmental organizations—to support our efforts in 

changing generally accepted negative social behaviors. 

The goal will be the reduction of sexual assault through primary prevention by 

creating an environment where people are not afraid to intervene as soon as conditions exist that could lead to sexual misconduct if left unchecked. 

The Army’s campaign commitment includes integrating sexual harassment and 

sexual assault prevention efforts; executing the SHARP transformation plan; providing policies; training and education support to commands; and establishing prevention partnerships. 

The SHARP Program transition is occurring throughout the Army. Building on 

previous training, SHARP Mobile Training Teams (MTTs) have trained approximately 7,900 of 17,000 command-selected program personnel on a prevention-focused 80-Hour Program Certification Course. The course was approved by the National Organization for Victim Assistance in December 2011 and credentialed under 

the National Advocacy Credentialing Program. 

The Army applied $40 million from fiscal year 2009–fiscal year 2011 to increase 

investigative and prosecutorial capabilities by hiring 12 highly qualified experts in 

the field of prosecution and investigations and 23 additional special investigators. 

240 

The Judge Advocate General designated 16 special victim prosecutors and 5 Trial 

Counsel Assistance Program attorneys. Additionally, there are plans to add another 

seven Special Victim Prosecutors in fiscal year 2012. 

The U.S. Army Military Police School Special Victims Unit Course, Fort Leonard 

Wood, MO, has been selected as the DOD school house. In essence, the Army will 

serve as the DOD executive agent for sexual assault investigator training and the 

U.S. Army Military Police School will serve as the proponent for sexual assault investigations training for DOD. 

The Army’s school house employs a unique advanced interview technique in its 

Special Victims Unit (SVU) Training Course. This technique is called the Forensic 

Experiential Trauma Interview, or FETI, which was developed by the Army SVU 

lead instructor. This new interview technique combines the best of child forensic 

interview techniques along with the principles of critical incident stress debriefings 

and new neurobiology research to obtain not just the who, what, why, when, where, 

and how of the incident, but also the three dimensional experiential aspect of the 

crime. This process solicits and documents critical forensic physiological evidence. 

Based on feedback from the field this new technique has already shown to be substantially more effective in obtaining information and substantially more beneficial 

evidence which enhances our ability to prosecute sexual assault cases. The FETI 

technique is also being trained by our Army trainers to Federal, State, and local 

civilian agencies and has been embraced as a promising best practice. 

The SVU course is not only taught by USAMPS and USACIDC experts, but is also 

augmented by other nationally recognized experts as well as legal instructors from 

the Army Trial Counsel Assistance Program. Agents from DOD Inspector General, 

Naval Criminal Investigative Service, and Air Force Office of Special Investigations 

have already begun training at the SVU course. Army prosecutors will also begin 

attending the SVU course in April of this year to foster additional synergy and understanding between our CID Special Agents and prosecutors. We have developed 

a plan to include prosecutors from other DOD Services beginning in fiscal year 2013. 

Additionally, the Army is continuing in its efforts to ensure attorneys in the 

Judge Advocate community are receiving the most up-to-date training so they are 

properly equipped to investigate/prosecute sexual assault cases. Judge Advocates 

who are selected to serve as Special Victims Prosecutors based on their skill and 

experience in the courtroom, are required to attend a 2-week Career Prosecutors 

Course at the National District Attorneys Association in South Carolina; a 1-week 

Essential Strategies for Sexual Assault Prosecutions; and 2-weeks of on-the-jobtraining with a designated civilian district attorney’s office, special victims in various other locations. 

The Army is currently providing $3.5 million to support Judge Advocate prosecution and defense capability improvements, to include policy development, case management, training and education. DOD is supporting the Army’s investigation/prosecution training efforts with an additional $1.3 million in funding. 

Based on recent congressional, Office of the Secretary of Defense, and Army directives, the Army is revising its policy and program requirements to effectively expand 

the program to additional beneficiaries such as family members 18 years of age or 

older, DOD civilians serving overseas and Deployed DOD contractors deployed into 

combat zones, while finalizing a plan to meet the NDAA for Fiscal Year 2012 requirements. Concurrently, the Army is revising its comprehensive training and education program that began in fiscal year 2004 and remains flexible to meet new legislative and military direction. 

The Army is working with DOD leadership to ensure the manpower and funding 

required to address the programmatic changes stipulated in the NDAA are adequately addressed. 

HEALTH PROMOTION, RISK REDUCTION AND SUICIDE PREVENTION

The Army continues to take aggressive actions to promote health, identify and reduce risky behaviors, and prevent suicides. Utilizing a holistic approach, increased 

emphasis has been placed on developing and implementing targeted training programs as well as funding for support programs that impact the entire Army Family. 

The key elements of the Army’s approach are: ensuring that all soldiers have 

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mentation of mild traumatic brain injuries; and improved leader awareness of highrisk behavior. As conclusions are derived from ongoing studies, such as the Army 

Study to Assess Risk and Resilience in Servicemembers (Army STARRS), the largest 

BH epidemiological study that the Armed Forces has ever undertaken, appropriate 

leadership decisions will follow to capitalize on the outcomes. The Army has increased screening efforts to improve diagnosis and treatment for soldiers through 

the Post-Deployment Health Assessments, standardized screening protocols for 

those exposed to concussive events and implemented the ‘‘Pain Management Task 

Force’’ to appropriately manage the use of pain medications and adopt best practices 

Army-wide. 

The dramatic increases in suicides experienced from 2006 to 2010 leveled off in 

calendar year 2011 and were down slightly from their record year in 2010. It is important to note, however, that suicides by soldiers on Active Duty increased while 

those by soldiers not on Active Duty decreased. There were 165 suicides by ActiveDuty soldiers during 2011, an increase from 159 suicides in 2010. However, a significant decrease was observed for Not-on-Active Duty members of the Army Reserve and National Guard, with 115 suicides during 2011 compared to 146 in 2010. 

This represents a decrease of 25 suicides over the 2010 report. 

The Army released the Army 2020 Generating Health and Discipline in the Force 

Ahead of the Strategic Reset Report 2012. Referred to as the Army Gold Book, the 

report is an update to the Army Health Promotion, Risk Reduction, Suicide Prevention Report, 2010. It summarizes the progress made in enhancing the health, discipline and readiness of the Force and it represents the next phase in the Army’s 

ongoing campaign to counter the stress associated with more than a decade of war. 

The Gold Book is designed to educate leaders, illuminate critical issues that still 

must be addressed, and provide guidance to those grappling with these issues on 

a day-to-day basis. It candidly addresses the challenges that leaders, soldiers and 

families currently face, while providing a thorough assessment of what the Army 

has learned with respect to physical and behavioral health conditions, disciplinary 

problems, and gaps in Army policy and policy implementation. The Army is committed to ensuring the entire Army Family has access to the training and resources 

necessary. 

ARMY SUBSTANCE ABUSE PROGRAM

More than a decade of war has created symptoms of stress for our soldiers, including an increase in alcohol and drug abuse. The Army Substance Abuse Program 

(ASAP) is a commander’s program that uses prevention, education, deterrence, detection, and rehabilitation, to reduce and eliminate alcohol and drug abuse. It is 

based on the expectations of readiness and personal responsibility. 

In March 2010, the Army conducted a counselor requirements analysis based on 

each installation’s average daily client census with a ratio of 1 counselor for 30 patients. Patient caseload was as high as 60 patients per counselor at some installations. The 1:30 ratio is an accepted ratio based on literature and counselor input. 

Applying this ratio yielded a requirement of 563 counselors assuming a 20 percent 

growth in number of patients. 

An Army priority in this area includes the hiring of more counselors. There is a 

finite pool of qualified substance abuse counselors nationwide and the Army is competing for this scarce talent with private industry, the Veteran’s Administration and 

State and local governments. As of January 1, 2012, the Army has hired 500 of the 

563 counselors needed. The Army is increasing the use of recruiting, relocation, and 

student loan reimbursement incentives to attract more qualified candidates, and is 

developing a ASAP Counselor Internship Program which will allow students with 

Masters degrees to work in a supervised internship for up to 2 years as they attain 

their licenses and substance abuse counselor certifications. 

The Confidential Alcohol Treatment and Education Program (CATEP), began in 

July 2009 and offers confidential alcohol treatment to qualified soldiers. For these 

soldiers, the chain of command is not informed of the soldiers enrollment as was 

previously customary. This pilot program was initially offered at Fort Lewis, Fort 

Richardson, and Schofield Barracks. An initial assessment was conducted in March 

2010, and the Secretary of the Army directed that the pilot be expanded to include 

Forts Carson, Riley, and Leonard Wood. 


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The initial assessment showed moderate success in attracting soldiers and placed 

more career NCOs and younger officers into treatment. Soldiers who participated 

in CATEP were very positive about the opportunity to take care of their issues without commander knowledge and were more motivated as patients. Some soldiers informed their commanders about their enrollment and these commanders had a high 

acceptance of the program. The program was assessed again during July 2011. The 

results showed that many soldiers with an alcohol abuse or dependency diagnosis 

had walked away from treatment when asked to change their behaviors. After careful consideration, the VCSA directed implementation of several improvements to the 

pilot and consideration of the use of a contract for soldiers interested in CATEP, 

with the proviso that non-compliance with treatment would result in mandatory 

placement in the Command ASAP. The pilot will be assessed again in April and 

May 2012, after which the Secretary will decide whether to expand the CATEP to 

the remainder of the Army. To date 1,129 soldiers sought CATEP treatment and 

784 were/are enrolled. 

CONGRESSIONAL ASSISTANCE

As the Army prepares for reductions in the force, we will need congressional support to drawdown accurately and efficiently while maintaining readiness. The Army 

continues to work with the various parties to improve the physical disability system, 

so that our servicemembers receive the transition they deserve. The continued support of Congress for competitive military benefits and compensation, along with incentives and bonuses for soldiers, their families, and for the civilian workforce is 

critical in helping the All-Volunteer Army contine to recruit, retain, and support the 

highest caliber of individuals. 

CONCLUSION

We have invested a tremendous amount of resources and deliberate planning to 

preserve the All-Volunteer Force. People are the Army, and our enduring priority 

is to preserve the high quality, All-Volunteer Force—the essential element of our 

strength. 

While we transform to a smaller Army, we remain dedicated to improving readiness, and building resilience in our soldiers, civilians, and their families. The Army 

will not sacrifice readiness as it draws down. We must draw down wisely to preserve the health of the force or prevent breaking faith with the brave men and 

women who serve our Nation. The Army has gained the trust of the American public more now than at any other time in recent history, while fulfilling our responsibilities toward those who serve. 

The well-being of our force, regardless of its size, is absolutely dependent upon 

your tremendous support. The Army is proud of the high caliber men and women 

whose willingness to serve, is a credit to this great nation. To conclude, I wish to 

thank all of you for your continued support, which has been vital in sustaining our 

All-Volunteer Army through an unprecedented period of continuous combat operations and will continue to be vital to ensure the future of our Army. 

Chairman Webb, and members of the subcommittee, I thank you again for your 

generous and unwavering support of our outstanding soldiers, civilian professionals, 

and their families. 

Senator WEBB. Secretary Garcia, welcome. 

STATEMENT OF HON. JUAN M. GARCIA III, ASSISTANT SECRETARY OF THE NAVY FOR MANPOWER AND RESERVE AFFAIRS; ACCOMPANIED BY VADM SCOTT R. VAN BUSKIRK, 

USN, CHIEF OF NAVAL PERSONNEL, U.S. NAVY; AND LT.GEN. 

ROBERT E. MILSTEAD, JR., USMC, ASSISTANT COMMANDANT 

FOR MANPOWER AND RESERVE AFFAIRS, U.S. MARINE 

CORPS 

Mr. GARCIA. Thank you, Senator. I also will be short. 


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Chairman Webb, Senator Graham, and distinguished members of 

the subcommittee, thank you for the opportunity to speak about 

the sailors, marines, and civilians who comprise the Department of 

the Navy. 

There have been many successful changes in the Department of 

the Navy since I testified before you last spring. We have 23 female 

officers assigned to submarines, with more being assigned in the 

very near future. 

Last year I spoke of new Navy Reserve Officers Training Corp 

(ROTC) units at Arizona State University and Rutgers. This year 

I am pleased to report that we are expanding our ROTC presence 

at Harvard, Yale, and Columbia as part of our goal to make naval 

service a viable option for the young men and women from all regions and all segments of society. 

In addition to ensuring our manpower and personnel policies 

meet our country’s security requirements, it is my honor and privilege to represent and advocate for the more than 800,000 sailors, 

marines, and civilian employees. We are always prepared to respond to the needs of our Nation. 

Both sea services will strive to meet their operational requirements with as an efficient a force as possible. For the Navy, this 

means continuing to move sailors from shore support functions to 

sea duty to enhance operational readiness. Such a shift not only 

means fewer sailors will be available for important work ashore, 

but also that sailors will, on average, spend more time at sea away 

from their families. For the Marine Corps, the reduction of nearly 

20,000 in end strength coincides with the planned withdrawal from 

Afghanistan. 

Our highest priority remains the care and recovery of our wounded, ill, and injured servicemembers. The Department of the Navy 

is leading the way in innovative, therapeutic treatments of our 

wounded warriors. At the National Intrepid Center of Excellence, 

the Department of the Navy is pioneering research into diagnosis 

and treatment of traumatic brain injury and PTSD, but more work 

remains in this area. 

I wish to thank the subcommittee members for your continuous 

and unwavering commitment to support the Navy and Marine 

Corps and the brave men and women who as sailors and marines 

serve bravely in Afghanistan, spend months at sea apart from their 

families, combat pirates in the Indian Ocean, board drug runners 

in the Caribbean, guard embassies throughout the world, conduct 

humanitarian missions whenever and wherever needed, and perform countless other missions, often under unimaginably demanding conditions and circumstances. Thank you. 

Senator WEBB. Thank you, Secretary Garcia. 

[The prepared statement of Secretary Garcia follows:] 

PREPARED STATEMENT BY HON. JUAN M. GARCIA

Chairman Webb, Senator Graham, and distinguished members of the subcommittee, thank you for the opportunity to speak about the Department of the 

Navy’s personnel programs and about the sailors, marines, and civilians who comprise the Department of the Navy. 

There have been many successful changes in the Department of the Navy since 

I testified before you last spring. By the end of March we will have 23 to 25 female 

officers assigned to submarines, with more being assigned in the very near future. 

The repeal of ‘‘Don’t Ask, Don’t Tell’’ is fully implemented across the force with no 

244 

significant problems or incidents. National Naval Medical Center, Bethesda, has 

transformed into the new joint Walter Reed National Military Medical Center. Navy 

personnel comprise 27 percent of the hospital’s staff. 

In addition to ensuring our manpower and personnel policies meet our country’s 

security requirements, it is my honor and privilege to represent and advocate for 

the more than 800,000 sailors, marines, and civilian employees who are always prepared to respond to whatever our Nation demands. 

Vice Admiral Van Buskirk and Lieutenant General Milstead will address their respective Service’s personnel plans in detail, but I would like to touch on some common challenges the Department of the Navy faces as a whole. 

Recently, the Secretary of the Navy unveiled the 21st Century Sailor and Marine 

Initiative, which is designed to place an increased focus on the resiliency and fitness 

of our servicemembers. With so much of our defense strategy dependent upon our 

Navy and Marine Corps, we must ensure that our resources support the most combat effective and the most resilient force in our history. We must set high standards, 

but at the same time provide individuals with the services and training needed to 

meet those standards. The 21st Century Sailor and Marine Initiative consists of five 

‘‘pillars’’: readiness, safety, physical fitness, inclusion and continuum of service. 

Readiness will ensure sailors, marines, and their families are prepared to handle 

the mental and emotional rigors of military service. Both Services are introducing 

campaigns this year to deglamorize use, and treat and track alcohol abuse. We will 

also develop new means to deter Spice use, reduce suicides and increase our family 

and personal preparedness programs. This includes zero tolerance for sexual assault. We are continually working to improve the reporting, investigation and disposition of sexual assault cases, ensuring that commanders, investigators, and prosecutors receive sufficient training and appropriate resources. 

We will also increase our efforts to ensure the safest and most secure force in the 

Department’s history, including a reinvigoration of our efforts to encourage the safe 

use of motor vehicles and motorcycles. 

Physical fitness is an important central pillar that resonates throughout the 21st 

Century Sailor and Marine Initiative. Personal fitness standards throughout the 

force will be emphasized. We will also improve nutrition standards at our dining facilities with the introduction of ‘‘Fueled to Fight’’, which ensures that healthy food 

items will be available at every meal. 

The Department of the Navy will be inclusive and consist of a force that reflects 

the Nation it defends in a manner consistent with military efficiency and effectiveness as it serves its primary function of defending the Nation. The Department will 

also reduce restrictions to military assignments for personnel to the greatest extent 

possible consistent with our mission and military requirements. 

The final pillar, continuum of service, will provide the most robust transition support in the Department’s history. Individuals selected for either separation or retirement will be afforded myriad of assistance programs and benefits that are available 

to them as they transition to civilian life. These programs, which include education 

benefits, transition assistance, career management training, counseling, life-work 

balance programs, and morale, welfare and recreation programs have been recognized by human resource experts as some of the best corporate level personnel support mechanisms in the Nation. 

The budget process requires a careful balancing of resources and assessment of 

risk. Within in the President’s fiscal year 2013 budget and the Future Years Defense Plan are the results of several other difficult decisions and tradeoffs. The final 

product meets mission requirements while providing appropriate compensation and 

benefits for our Active Duty, Reserves, civilian employees, and military retirees. 

Both sea services will strive to meet their operational requirements with as efficient a force as possible. For the Navy this means continuing to move sailors from 

shore support functions to sea duty to enhance operational readiness. Such a shift 

not only means fewer sailors will be available for important work ashore, but also 

that sailors will, on average, spend more time at sea away from their families. For 

the marines, the reduction of nearly 20,000 end-strength coincides with the planned 

withdrawal from Afghanistan. 

Our highest priority remains the care and the recovery of our wounded, ill, and 

injured servicemembers. The Department of the Navy is leading the way in innovative therapeutic treatments of our Wounded Warriors. At the National Intrepid Center of Excellence the Department of the Navy is pioneering research into diagnosis 

and treatment of Traumatic Brain Injury and Post-Traumatic Stress Disorder, but 

more work remains in this area. 

There are other initiatives that deserve mention. We continue to emphasize civilian hiring of veterans and of wounded warriors in particular, through both competitive and non-competitive hiring authorities. Similarly, the Department is continuing 

245 

our participation in the Military Spouse Employment Partnership both as a resource 

for our members’ spouses and as an employer. 

Last year I spoke of new Navy Reserve Officers’ Training Corps (ROTC) units at 

Arizona State University and Rutgers. This year I am pleased to report that we are 

expanding our ROTC presence to Harvard, Yale, and Columbia as part of our goal 

to make naval service a viable option for young men and women from all regions 

and all segments of society. 

As many of you are aware, the Navy has recently closed a number of Junior 

ROTC programs at units that failed to meet the statutorily required participation 

numbers. To minimize the effects of these closings, I authorized the creation of National Navy Defense Cadet Corps (NNDCC) units at a number of these schools. The 

NNDCC program is virtually identical to Navy Junior ROTC, except there is only 

a 50 student minimum enrollment requirement and the schools must provide the 

majority of the funding. 

We continue to search for innovative ways to improve the efficiency and capability 

of our forces as well as the quality of life of our members and their families. Modernization of the military retirement system could provide greater fairness and equity to servicemembers with, perhaps, some savings to the defense budget. 

We wish to thank the committee members for your continuous and unwavering 

commitment to support the Navy and Marine Corps and the brave men and women 

who, as sailors and marines, serve bravely in Afghanistan, spend months at sea 

apart from their families, combat pirates in the Indian Ocean, thwart drug runners 

in the Caribbean, guard embassies throughout the world, conduct humanitarian 

missions whenever and wherever needed, and perform countless other missions, 

often under unimaginably demanding conditions and circumstances. 

The following service specific information is provided for the committee. We look 

forward to your questions. 

246 

Senator WEBB. Admiral Van Buskirk and General Milstead, your 

full statements will be entered into the record at this time. We will 

also get back to you during questioning. 

[The prepared statements of Admiral Van Buskirk and General 

Milstead follow:] 

PREPARED STATEMENT BY VADM SCOTT R. VAN BUSKIRK, USN 

I. INTRODUCTION

Chairman Webb, Ranking Member Graham, and distinguished members of the 

Senate Armed Services Committee, thank you for the opportunity to review Navy’s 

fiscal year 2013 manpower, personnel, training, and education budget request. I am 

honored to be here to represent the outstanding men and women of the U.S. Navy, 

and their families, in this my inaugural appearance before the committee as the 

56th Chief of Naval Personnel. 


425per19.eps
247 

In developing our budget request, we recognized that our Nation is at an historic 

inflection point, that we are shaping a Navy that will be more agile, flexible, ready 

and technologically advanced. As we continue our presence in the Middle East, 

maintain our commitments in Europe, add emphasis and focus in the Asia-Pacific 

region, Navy has continued to prove itself in providing a truly adaptive force capability and capacity, at sea, on land and in the air. While Navy’s operations in Iraq 

and Afghanistan have been both sea and land based, the shift in focus toward the 

Asia-Pacific region will likely increase demands upon Navy’s maritime role, even as 

the Nation works to address the national security imperative of deficit reduction 

through a lower level of defense spending. 

As we move into this new era, Navy is well positioned to recruit, develop, retain, 

and provide the American people the best and most capable maritime fighting force 

in history. Navy has worked to become a ‘‘Top 50’’ organization, an employer of 

choice, providing world-class benefits and opportunities. Moreover, as an All-Volunteer Force, we must adapt to changing economic times, while continuing to implement force management policies focused on incentivizing, encouraging and rewarding high performance. We will continue to strive for a Navy that attracts and retains top-performing sailors who possess the critical skills necessary for our mission. 

Further, we are making hard choices on sailor retention as Navy continues to transition, but we are committed to doing so in a fair, transparent and compassionate 

manner using performance as our benchmark. 

Our fiscal year 2013 budget request enables us to continue to meet the operational demands of the Fleet and the Joint Force while optimizing personnel readiness. As we look to the future, Navy is mindful that: 

• The All-Volunteer Force is the foundation of our Navy and vital to the 

security of our Nation. 

• Navy life involves unique challenges and stresses as a global, full spectrum sea service. 

• War related deployments since September 11 have placed extraordinary 

demands on many sailors and their families. 

We believe our request appropriately balances risk in supporting the readiness requirements of the Fleet and Joint Force, changing strategic mission focus, and essential programs that provide for the care of our sailors and their families. 

II. A READY AND CAPABLE GLOBAL NAVY

Shortly after assuming office as the Nation’s 30th Chief of Naval Operations 

(CNO) last September, Admiral Greenert issued his inaugural guidance to the Fleet, 

the CNO’s Sailing Directions. Coupled with our Navy Total Force Strategy for the 

21st Century, it charts a course for Navy to deter aggression, and, when necessary, 

decisively win our Nation’s wars. We will employ global reach and persistent presence through forward-stationed and rotational Forces to protect our Nation against 

direct attack, assure Joint Operational Access, and retain global freedom of action. 

With our global partners, we will protect the maritime freedom that is the basis for 

global prosperity. We will foster and sustain cooperative relationships with our allies and international partners as we enhance global security in a constantly changing environment. 

Informed by the Sailing Directions and our Navy Total Force Strategy for 

the 21st Century, we have crafted our focus areas . . . 

Warfighting First: We will manage military personnel strength to deliver an affordable, sustainable and resilient force that meets mission needs. We will deliver 

a Force that is operationally ready—assignable and deployable. To remain operationally effective, we will deliver a career-continuum of technical training and advanced education. 

Operate Forward: We will deliver ‘‘fit’’ and balance to the Fleet—not only the 

right number of sailors, but also the right skills and experience for the job. We must 

also anticipate fleet and combatant commander priorities to meet operational needs 

and provide the regional skills required for theater security and cooperation of our 

Joint and coalition partners. 

Be Ready: We will attract, recruit, and retain a high-quality Force through recruiting and outreach efforts—we must be competitive for the best talent in the Nation. Most importantly, we will continue to care for sailors and their families . . . the 

foundation upon which our Navy is built. 

III. END STRENGTH

Our fiscal year 2013 Navy budget request appropriately balances risk, preserves 

capabilities to meet current fleet and joint requirements, fosters growth in emerging 

248 

mission areas, and provides vital support to sailors and Navy families. The request 

supports active end strength of 322,700, and selected Reserve end strength of 

62,500. These levels will allow us to meet Fleet and the Joint Force operational demands while optimizing personnel readiness as articulated in the recently released 

Sustaining U.S. Global Leadership: Priorities for 21st Century Defense. The President’s $28.9 billion request for Active Navy Manpower, Personnel, Training and 

Education seeks $27.1 billion in Military Personnel, Navy (MPN) appropriations and 

$1.8 billion in related Operation and Maintenance, Navy (O&MN). The Reserve request includes $1.9 billion for Reserve Personnel, Navy (RPN) and $24.7 million in 

related Operation and Maintenance, Navy Reserve (O&MNR). 

In fiscal year 2013, there is no OCO funding requested for Active component end 

strength in support of non-core Individual Augmentee (IA) mission. Following an assessment of the Reserve component’s funding, and ability to cover previous Active 

component-sourced non-core IA requirements, 5,900 man-years of OCO funding was 

requested to support 4,500 Reserve IA billets throughout the fiscal year. We will 

continue to fill IA requirements, when possible, with Reserve component personnel 

funded through OCO appropriations. 

As we work to stabilize Navy end strength with emphasis on achieving 

warfighting wholeness, we continue to shift billets from shore duty to sea duty while 

preserving nearly 600 critical shore billets in sea-centric ratings, including regional 

maintenance centers, afloat training groups, Fleet electronic warfare training and 

Ballistic Missile Defense AEGIS billets. We expect last year’s sea/shore-flow requirements changes to result in reduced at-sea gaps this year and in fiscal year 2013. 

We continue to apply Sea Duty Incentive Pay to encourage and reward sailors for 

extended or repeat sea duty service to help further mitigate our gaps at sea. 

Navy will continue to size, shape, and stabilize the Force while carefully monitoring personnel and Fleet readiness. As required, we will apply, evaluate and adjust existing and new force-shaping tools designed to retain the right skills, pay 

grade, and experience-mix necessary to provide mission-ready Naval Forces, as required. 

IV. FORCE MANAGEMENT: ACHIEVING BALANCE, MAXIMIZING INVESTMENTS

We must always remember that the men and women of the All-Volunteer Force 

in our Navy have remained versatile, adaptable and committed to the Nation during 

a time of unprecedented, sustained combat operations, and at tremendous personal 

sacrifice. As we take the necessary steps to properly size and shape the Navy to 

meet current and emerging requirements, we must be vigilant to ensure the readiness of the All-Volunteer Force, while maintaining trust with those who serve in our 

Navy. 

We expect to finish fiscal year 2012 below end strength controls, largely due to 

effective force management policies within the enlisted force. At the same time, we 

are over-executing our officer strength. To remedy this imbalance, we plan to stabilize enlisted strength while gradually reducing officer strength. Our strategy focuses on rebalancing the Force to achieve the right mix of officers and enlisted personnel by increasing enlisted accessions over time, reducing officer accessions in a 

controlled manner through judicious application of force management tools to address officer overages in specific skills. We will achieve proper force balance while 

respecting the sacrifices of sailors and their families by using voluntary measures 

to the extent possible before resorting to involuntary actions. Through careful combination of both, we will meet dynamic force management challenges and maximize 

investments in our people. 

Our use of force management tools will be continuously evaluated as end strength 

and force structure is reduced. We will keep a watchful eye on indicators of shifting 

behavior and on economic trends and act quickly to preserve our ability to attract 

and retain the highest-quality sailors while achieving and then maintaining the 

right balance of seniority, skills, performance, and experience to deliver optimum 

military personnel readiness to the Fleet. 

Perform-to-Serve (PTS) remains our primary, and most effective, enlisted forcebalancing tool, allowing us to manage enlisted continuation behavior by rating. 

Based on performance ranking, PTS identifies sailors at career decision points, up 

to 14 years of service, who are best qualified for in-rate reenlistment, conversion 

from overmanned to undermanned specialties, or separation from the Navy. In fiscal 

year 2011, we converted 1,052 sailors, narrowing critical manning gaps, while 6,765 

sailors identified by PTS separated at their End of Active Obligated Service. We 

plan to separate another 6,650 sailors through PTS in fiscal year 2012, and fewer 

in fiscal year 2013. PTS has significantly improved enlisted manning balance perVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00254 Fmt 6601 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
249 

mitting us to offer in-rate reenlistment to significantly more sailors while returning 

advancement opportunity to historic norms. 

To further assist in rebalancing the Force and relieve pressure on sailors in a PTS 

reenlistment window, Enlisted Retention Boards (ERB) were implemented as an additional force management tool. The ERB was necessary to ensure we could reduce 

inventory within overmanned ratings in cases in which converting sailors to undermanned ratings was not a viable option. Unlike PTS, the ERB looked at all eligible 

sailors in 31 overmanned ratings, not just the ones in a PTS window. This past 

summer, ERB examined the records of approximately 16,000 sailors in pay grades 

E4–E8, with at least 7 and less than 15 years of service, who are serving in overmanned ratings, and identified 2,947 for separation in fiscal year 2012. Approximately 300 of these sailors, who will have at least 15 years of service by September 

1, 2012, are being offered the opportunity to apply for early retirement under Temporary Early Retirement Authority (TERA) enacted in the National Defense Authorization Act for Fiscal Year 2012. We do not intend to use ERB authority in fiscal 

year 2013. 

We have used, and continue to use, a host of other tools to contribute to ongoing 

force management efforts for both officer and enlisted sailors, including: 

• High-Year Tenure separations in select pay grades and years of service. 

We separated 912 sailors in fiscal year 2011, and plan an additional 909 

in fiscal year 2012, and slightly more in fiscal year 2013, through recent 

changes to High Year Tenure policy. 

• Early Transition. In fiscal year 2011, we allowed 1,541 sailors to separate 

up to 24 months before the end of their enlistments, and anticipate authorizing a similar number of separations in fiscal year 2012, but fewer in fiscal 

year 2013. 

• Annual performance-based continuation boards. We reduced the number 

of active duty sailors in pay grades E7–E9 with over 20 years of service by 

187 and expect an additional 50 losses in fiscal year 2012 and fiscal year 

2013. 

• One-year time-in-grade (TIG) retirement waivers for select senior enlisted 

and officers. We executed 37 officer TIG waivers in fiscal year 2011 and expect approximately 45 for fiscal year 2012 and fiscal year 2013. 

• Monthly probationary officer continuation and redesignation boards. 

These boards authorize release or redesignation of probationary officers 

(with <6 years commissioned service). We separated 242 officers in fiscal 

year 2011 and anticipate separating 270 in fiscal year 2012. 

• Permitting voluntary retirement of officers with prior enlisted service 

after 8, vice 10, years commissioned service. Enacted in the NDAA for Fiscal Year 2011, we expect to authorize approximately 60 retirements in fiscal 

year 2012 and fiscal year 2013. 

• Selective Early Retirement (SER). SER Boards selected 124 unrestricted 

line captains and commanders for early retirement in fiscal year 2012. In 

fiscal year 2013, we may select approximately 40 Restricted Line and Staff 

Corps officers for early retirement. 

• Voluntary Retirement Incentive (VRI). An authority that allows Navy to 

precisely target specific commanders (O–5) and captains (O–6) with between 20–29 years of service in certain specialties and warfare areas to separate and retire voluntarily. 

• Temporary Early Retirement Authority (TERA). In fiscal year 2012, we 

are offering early retirement to approximately 300 sailors as an alternative 

to early separation required by Enlisted Retention Boards. We are evaluating options for further targeted use of TERA in fiscal year 2013. 

Despite significant progress, additional force management actions are necessary 

to maintain mandated end strength and officer levels with the right mix of skills 

and experience due to high retention and low attrition. For example, we will soon 

implement two new policies to facilitate further enlisted force management: 

• In fiscal year 2012 and fiscal year 2013, we will apply Initial Training 

Separation Authority to separate fewer than 500 sailors per year who do 

not satisfactorily complete their training pipeline, but for whom no suitable 

vacancy exists. 

• We will adjust High Year Tenure thresholds to separate fewer than 1,000 

sailors in pay grades E2–E3 in fiscal year 2013. 

We are contemplating whether additional authorities may be necessary to enhance our ability to properly shape and balance the Force. A range of broad, flexible, 

options to properly size and shape the Force remains vital to Navy military personnel readiness. We appreciate Congress enacting flexible authorities that provide 

250 

voluntary means to effectively manage the Force in a way that preserves a positive 

tone across the Navy. 

V. SAILOR AND FAMILY SUPPORT

Our fiscal year 2013 budget request of $131.7 million for sailor and family care 

coupled with the items in the Secretary of Defense and Defense Health Care budgets sustains or enhances our comprehensive continuum of care. The health care proposals in the President’s budget are consistent with our efforts in identifying processes that are more efficient, incentivizing positive health behaviors, promoting 

overall wellness and keeping our sailors fit and ready to deploy on a moment’s notice. This budget keeps faith with those who serve and those who have served, and 

responsibly meets the demands dictated by the Federal budget crisis. With continued congressional support, Navy is committed to retaining funding levels necessary 

to address the medical, physical, psychological, and family readiness needs of sailors 

and their families. I hope you will agree, and support our efforts. 

Comprehensive Continuum of Care 

Through a comprehensive continuum of care, we place the highest priority on the 

medical, physical, psychological, spiritual and family readiness needs of sailors and 

families. Navy’s Operational Stress Control Program, Navy Reserve Psychological 

Health Outreach Program, Warrior Transition Program, Returning Warrior Workshop, Navy Safe Harbor, and our Medical Home Port Program are critical continuum of care elements. 

• The Operational Stress Control (OSC) program is our proactive approach 

to address the personal readiness of our sailors and their families. OSC is 

comprised of training, assessment, policy, and tools to support and build 

sailor, family, and unit resilience. It enables leaders to foster a climate in 

which sailors use available resources to stay fit and ready without stigma. 

OSC, with complementary and integrated support from the Navy Chaplain 

Corps, provides assistance for stress reactions before they become stress 

problems. A 2011 Behavioral Health Quick Poll found most sailors reported 

using positive methods to cope with stress. 

• The Navy Reserve Psychological Health Outreach program improves the 

psychological health and resiliency of Reserve Component (RC) sailors and 

families. Teams of psychological health outreach coordinators and outreach 

team members, located at the five regional Reserve commands, provide psychological health assessments, education, and referrals to mental health 

specialists. 

• The Warrior Transition program provides Individual Augmentees the opportunity to decompress and transition to life back home. Through small 

group discussions, chaplains and medical personnel prepare sailors to resume family and social obligations, return to civilian places of employment, 

and reintegrate into the community. 

• Returning Warrior Workshops help remove stigma that may prevent sailors from seeking support during demobilization and reintegration. 

• Navy Safe Harbor supports the non-medical needs of wounded, ill, and 

injured sailors, coast guardsmen, and their families. This network of recovery care coordinators and non-medical care managers, at 18 locations across 

the country, provides individually tailored assistance to 748 enrolled sailors, 43 enrolled coast guardsmen, and an additional 777 sailors considered 

assist cases. The fiscal year 2013 budget request supports our enduring goal 

to provide the highest quality care to our wounded, ill, and injured. 

• Medical Home Port program is a team-based primary care model focused 

on optimizing relationships between patients, primary care providers and 

other health care professionals to enhance health and readiness. Beginning 

this year, mental health providers will be embedded within Medical Home 

Ports alongside the rest of the care team, and will facilitate regular assessment and early behavioral intervention for sailors and families. This will 

enable treatment in settings in which patients feel most comfortable and 

will reduce stigma associated with seeking care. Early detection and intervention in the primary care setting reduces the demand for time-intensive 

intervention in behavioral health specialty clinics. The presence of behavioral health within the Medical Home Port promotes increased comfort 

among primary care providers in treatment of behavioral health issues 

within their scope of practice in collaboration with the embedded specialists. 

251 

Behavioral Health 

The Navy Behavioral Health program goal is to develop an organizational climate 

that encourages psychologically healthy, resilient and mission-effective sailors. It 

provides Navy-wide resources for suicide awareness and prevention, intervention 

skills, and risk mitigation procedures. We track and analyze data on suicide-related 

behaviors and deaths to identify trends and develop additional policy, training and 

outreach to prevent suicide risk. A 2011 Behavioral Health Quick Poll reflects positive trends in the percentage of sailors attending Suicide Prevention Training and 

who recognize proactive suicide-prevention efforts occurring at their commands. 

Suicide Prevention: All Hands, All of the Time 

Every Navy suicide represents a tragedy that affects command cohesiveness and 

the loss of a valued shipmate; a loss the Navy is determined not to accept. Our comprehensive strategy to combat suicide incorporates four pillars: Education and 

awareness; Operational Stress Control; Intervention; and Post-intervention support; 

a leadership-led effort with a foundation built on a comprehensive array of education and outreach. 

Navy’s suicide prevention approach builds combined sailor, family, and command 

resilience with a goal of changing behavior through personal resilience; peer to peer 

support; leadership intervention throughout the chain of command; enhancing family support; and fostering a command climate where help-seeking behaviors, when 

required, are expected in order to restore personal readiness. 

We have implemented a year-round strategic communication plan focused on 

Navy’s ‘‘Ask-Care-Treat’’ model, or ACT, which emphasizes the value of peer-to-peer 

support. Additionally, targeted suicide assessment training is provided for primary 

care providers at large Medical Treatment Facilities as another viable means to 

identify at-risk sailors. 

The Suicide Prevention Coordinator network is growing with the addition of 

webinar training that has trained more than 500 new suicide prevention coordinators in 18 webinars since December 2011 and additional webinar training is planned 

for members of the Public Affairs community. We are also continuing to make 

progress in implementing recommendations of the DOD Task Force on Prevention 

of Suicides Among Members of the Armed Forces. Moreover, in fiscal year 2013, we 

will provide targeted chaplain training, guidance and tools for leaders, to facilitate 

successful reintegration of sailors into their units following behavioral health or 

other medical treatment. We will improve integration of suicide prevention into the 

broader array of resilience and prevention efforts to provide a coherent approach to 

comprehensive wellness, resilience and prevention. 

Sexual Assault: Not in my Navy 

There is no place for sexual assault in the U.S. Navy. We are committed to eliminating sexual assault completely; to ensuring compassionate support for sexual assault victims; to investigating all cases thoroughly; and to holding perpetrators accountable within the full extent of the law. Since 2005, we have worked to build 

a robust Sexual Assault Prevention and Response (SAPR) program, and we are already engaged in a number of new initiatives to combat sexual assault. These collectively are critical investments in both individual sailors and in Force readiness. In 

addition to other direct measures, we will use a proven process of tiered training 

for sexual assault prevention and response and provide Navy’s SAPR-Leadership 

training to all E–7 and above leaders and every sailor through SAPR-Fleet training. 

This process served us well in the repeal of Don’t Ask Don’t Tell and we anticipate 

this will resonate in our campaign to eliminate sexual assault from our Navy. 

Our immediate goal is to measurably reduce the frequency of sexual assaults involving sailors. Our first and perhaps most important tool has been a strong, consistent, top-down leadership message of intolerance for sexual assault. We are 

pleased to already be seeing Department-level leadership forums translating into 

special workshops and other sessions conducted by regional commanders and commanding officers. Our second core strategy involves updated training tools for Navywide use. We have already worked with civilian experts to review relevant content 

in a broad range of Navy training curricula spanning the full continuum of leadership development. We are developing special new video programs for all sailors to 

emphasize the criticality of sexual assault issues, and the responsibly of every sailor 

to actively intervene in protecting shipmates in vulnerable situations. In addition, 

we have undertaken special initiatives focused on those most at risk—our youngest 

sailors just out of recruit training. Our ‘‘Bystander Intervention’’ program uses locally trained instructors in small-group sessions to educate and mentor sailors at 

‘‘A-Schools’’ Navy-wide. At TSC Great Lakes, we have combined this effort with a 

number of simultaneous other initiatives—and we have developed a process of periVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00257 Fmt 6601 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
252 

odic anonymous surveys to assess our impact. After a year of progressive effort, it 

is still too early to speak of definitive outcomes, but the initial signs are encouraging. In 2011, over 67,000 sailors participated in an anonymous, web-based sexual 

assault survey conducted by the Navy Secretariat. We plan to repeat that process 

every 2–3 years worldwide to help us understand issues and trends in the underlying incidence of sexual assault. If it is necessary along the way, we will use our 

best accumulated data and insight to adjust course in combating sexual assault. Civilian experts, including researchers at the Centers for Disease Control, tell us this 

kind of approach is cutting-edge and breaking new ground. However, that is not all 

we are doing. 

In just the past 2 years, we have conducted site visits and special training at 

Navy sites worldwide. We have talked to stakeholders including senior commanders, 

SAPR program mangers, sailor focus groups, and even individual sexual assault victims. We have brought Sexual Assault Response Coordinators and installation commanders together from across the Navy for programs civilian experts on sexual assault prevention summits. We have given special training to NCIS agents and JAG 

lawyers on the unique aspects of sexual assault cases. NCIS recently hired new 

criminal investigators with extensive civilian backgrounds in sexual assault cases 

for every major Navy (and Marine Corps) installation. We are working on tool kits 

for commanding officers to help them make the right decisions in complex cases. 

In summary, there is no place for sexual assault in the U.S. Navy. We take the 

challenge seriously, we are engaged on numerous fronts, and we are committed to 

a sustained effort. 

VI. RECRUITING

Navy has worked hard to achieve strong recruiting success over the past 4 years 

by projecting the Navy as an employer of choice and attracting the Nation’s very 

best men and women for America’s Navy. Our brand, ‘‘America’s Navy—A global 

force for good’’, captures the diversity of our Navy missions while also appealing to 

our target recruiting market. In fiscal year 2011 and through fiscal year 2012 to 

date, Navy’s ‘‘total force’’ recruiting achieved accession recruiting goals for officers 

in the Active component (AC) and enlisted recruiting goals in both the Active and 

Reserve components (RC). Additionally, we attained the best quality future sailors 

in history with 98.7 percent of accessions entering as high school diploma graduates 

(HSDG) and 88.2 percent of accessions scoring in the upper 50th percentile on the 

Armed Services Vocational Aptitude Battery (ASVAB). 

Adapting to the current challenges of the recruiting environment and in anticipation of an improving economy, Navy recruiting is investing in the future with improvement of its Information Technology (IT) systems and streamlining its processes 

as part of its innovative Recruiting Force 2020 strategy. This strategy will provide 

an agile, mobile and highly responsive capable recruiting force. 

Looking ahead, we will continue to aggressively attack specific recruiting areas, 

particularly in the healthcare profession where all military services have had difficulty in attaining specialized medical professionals. An additional challenge is RC 

General Medical Officer recruiting where we achieved nearly 80 percent of our fiscal 

year 2011 goal primarily due to the high retention of active duty officers in the unrestricted line communities. We continue to work closely with the Office Chief of 

Naval Reserve (OCNR) and BUMED on several aggressive initiatives to address 

both challenges as we keep Medical and RC General Medical Officer recruiting as 

our top officer recruiting priorities. 

The fiscal year 2013 budget requests $276.0 million for recruiting programs including accession incentives, advertising, and support for our Active and Reserve recruiters. This represents a reduction of $34.1 million from fiscal year 2012 mainly 

due to adjustments in marketing and advertising. Our budget request ensures that 

the recruiting force remains appropriately sized and resourced for success. 

Accession bonuses remain critical to meeting our goals for recruiting health professionals, nuclear operators, and special warfare/special operations personnel. We 

maintained bonus levels for nuclear officers and health professionals, and continue 

to offer enlisted accession bonuses to special warfare/special operations and other 

critical ratings to meet increased demand. A favorable recruiting environment has 

enabled us to reduce the number of ratings eligible for an accession bonus from 67 

in 2008 to 6 in 2012. The fiscal year 2013 active budget request for bonuses, special 

pays, and incentives, represents a $22.1 million reduction from fiscal year 2012. 

An integral component of achieving our force management goals include competing for the best talent in our Nation’s colleges and universities. Our Naval Reserve Officers Training Corps (NROTC) program has 61 units located at 75 host institutions with 87 cross-town institution agreements. While the NROTC program 

253 

has more than sufficient capacity for our current requirements, Navy recognizes the 

value of engagement and presence on the campuses of America’s elite colleges and 

universities and appreciates the high quality educational experience provided to future military leaders at these institutions. The highest quality applicants ever for 

our NROTC program in fiscal year 2011 further reflected Navy’s recruiting success. 

To broaden outreach efforts and generate recruiting leads, and to offset reductions 

in paid media advertising, we are expanding our use of social media and other technologies. Navy Recruiting Command has over 100,000 active followers across 19 

prominent social media sites, including 15 Facebook communities of interest. However, face-to-face contact with recruits in the field remains the cornerstone of our 

sustained success in attracting high quality, diverse individuals. 

VII. RETENTION

We continue to closely monitor retention behavior across the Force and project we 

will meet our fiscal year 2012 overall officer and enlisted retention goals. While we 

have been able to make selected reductions in retention bonuses, sailor retention behavior indicates we must continue to apply bonus programs to critical skill areas 

that are less responsive to changes in the economic environment and which require 

significant investments in training and education. 

Enlisted Retention 

Despite a decade at war, Navy continues to experience high levels of retention 

among enlisted personnel across the force, due in large part to Navy’s efforts to provide a quality lifework experience, increases in basic pay and housing allowances, 

and contributing economic conditions. Additionally, we experienced higher retention 

among female servicemembers, especially within critical technical and warfighting 

skilled areas. fiscal year 2011 aggregate enlisted retention was 63.9 percent, which 

is elevated relative to historical norms, even though we utilized several force management tools to suppress reenlistments. 

Active Navy Retention 

Fiscal Year 2011 

Achievement 

Reenlisted 

(Percent) 

Expected 

(Percent) 

Zone A (0–6 yrs) ................................................................................................................................. 66.0 59.0 

Zone B (6–10 yrs) .............................................................................................................................. 67.0 66.0 

Zone C (10–14 yrs) ............................................................................................................................. 72.7 72.0 

Our new and existing policies encourage longer-term career behavior as sailors 

commit sooner to stay for longer periods. While affording increased predictability of 

future personnel readiness, higher retention also contributes to increased competition for reenlistment. 

This past year, 14,544 sailors were discharged before the end of their contracts, 

slightly above the projected attrition of 14,300; we project similar attrition in fiscal 

year 2012. Misconduct-related discharges this year are within 1 percent of misconduct discharges in fiscal year 2011. Reserve enlisted attrition rates continue to 

trend lower than the historical average, evidence of the high quality Force we have 

recruited. 

Demand in civilian industry for highly trained nuclear-qualified sailors challenges 

our ability to meet nuclear retention goals. We are committed to retaining sailors 

with critical skills in high demand in the civilian sector, as well as sailors in specialties that continue to experience high operational tempo in support of OCO, such as 

special warfare/special operations and independent duty corpsmen. Selective Reenlistment Bonus (SRB) remains the most important tool in our efforts to retain these 

highly-skilled sailors. 

By our close monitoring of retention behavior, we apply adjustments to SRB levels 

on a semi-annual basis, or as required. We have adjusted SRB levels five times in 

the past 18 months, reducing the number of eligible skill areas by 26 percent compared to fiscal year 2011. In fiscal year 2012, 33 of 84 ratings will receive SRB; the 

pool of eligible sailors is 2.3 percent of our Active Enlisted Force, representing a 60 

percent reduction compared to fiscal year 2011. Our SRB plan targets high-demand 

skill sets unaffected by slowing or down economy, to include special warfare/special 

operations, information technology, medical, cryptology, and nuclear ratings. The fiscal year 2013 budget request includes $107.3 million for new SRB contracts for Active Duty sailors, a slight reduction from fiscal year 2012. The fiscal year 2013 SRB 

budget for selected Reserve sailors is 13 percent less than fiscal year 2012, a reducVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00259 Fmt 6601 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
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1 Because Minimum Service Requirement (MSR) is different for Surface Warfare (5 years) and 

Aviation (7 years), 2 comparable year groups (i.e., includes women who are past their initial 

service obligation) were examined to more accurately capture overall URL female retention. YGs 

98 and 01 which both had only 7 year MSRs for prop/helo and 8 years for jets (10 U.S.C. 653). 

tion achieved by realignment of resources within the Navy Reserve Comprehensive 

Bonus Strategy to target the most critical specialties. 

Officer Retention 

Active and Reserve officer retention rates remain high due, in large part, to targeted incentive pays, improved mentoring, flexible career options, and increased emphasis on lifework integration initiatives and current economic conditions. Retention 

of female unrestricted line (URL) officers beyond initial minimum service requirement (MSR) has increased in the last 4 years in both the surface warfare community (19 percent for Year Group 2001 to 33 percent for Year Group 2004) and aviation community (14 percent for Year Group 1998 to 27 percent for Year Group 

2001).1 Initiatives to improve retention of Selected Reserve (SELRES) officer communities by 2014 include targeted officer affiliation and retention bonuses, increased accession goals, and Continuum of Service programs. 

Although the overall loss rate for junior officers increased slightly from fiscal year 

2009 to fiscal year 2010, economic conditions have contributed to surface and submarine communities meeting retention goals for the third consecutive year. With 

signs of an improving economy, we are closely watching junior officer retention since 

retention through the operational department head tour is a critical metric for monitoring the health of these communities. 

After a decade of war, we are seeing signs of increased operational stress on 

Naval Special Warfare (SEAL), Special Warfare Combatant-Craft Crewmen 

(SWCC), Combat Support and Combat Service Support personnel; increased operational tempo, decreased dwell time, and deployment unpredictability have contributed to a decrease in junior officer retention, particularly at the lieutenant commander (O–4) level. Mentorship and increased access to family support programs 

and operational stress control resources are primary tools to mitigate the effects of 

stress on these officers and their families. The fiscal year 2013 budget request includes $7.6 million for targeted incentive pays to retain these critical officers. 

We have experienced slight improvement in medical community retention, largely 

due to competitive incentives and bonuses. Select subspecialties; including dentistry, 

psychiatry, clinical psychology, clinical social work, physician assistants, general 

surgery, preventive medicine, family medicine, mental health nurse practitioner, 

perioperative, and nurse anesthetists, continue to require attention. The fiscal year 

2013 budget request includes $76.4 million for special and incentive pays to retain 

these critical medical professionals. 

Retention and Compensation Going Forward 

The Budget Control Act of 2011 mandates reductions in Federal spending at levels that require every area of the budget to be scrutinized for efficiencies to produce 

cost savings. With the current budget situation, the Navy believes that every area 

of the budget, to include personnel costs, should be examined for efficiencies that 

could lead to cost savings. However, before any changes are made, complete understanding of the impact those changes might have on the servicemember and the 

Navy should be understood. The current compensation system, to include incentive 

pay, retirement and other benefits, is a major factor in retention for 

servicemembers. Any changes to this compensation package must be examined to 

ensure that Navy retention requirements are met. 

We routinely review special and incentive pay and bonus programs, adjusting 

bonus levels and eligibility in response to manning levels, in addition to reducing 

enlisted accession bonuses, Assignment Incentive Pay (AIP) and SRB. Over the past 

year, we have reduced officer bonuses in the aviation, and intelligence communities. 

Additionally, we restructured the Submarine Support Incentive Pay program to efficiently address shortfalls at specific career points and reduced total program costs 

by over 58 percent since fiscal year 2009. We will continue monitoring retention 

rates in fiscal year 2012 to determine the need for further adjustments for select 

officer communities. 

The current military compensation system, including retired pay and other monetary and non-monetary benefits, is a major factor in the success and quality of the 

All Volunteer Force. Navy strongly supports protecting the retirement benefits of 

those who currently serve by grandfathering their benefits; Navy is working closely 

with the Office of the Secretary of Defense (OSD) and other Services on this effort. 

Any changes to compensation, especially the retirement system, must be fair to the 

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sailor and suitably reward the individual and their family for their service. As we 

examine the personnel budget, we must carefully consider, before imposing any cuts, 

the potential impact on sailors and Navy military personnel readiness. 

VIII. LEARNING AND DEVELOPMENT

Education and training are strategic investments that enable our highly-skilled 

force to meet the demands of CNO’s Sailing Directions and the Navy Total Force 

Strategy for the 21st Century. In response to the demands of our increasingly diverse and technologically complex world, we have increased our focus on Science, 

Technology, Engineering and Math (STEM) in our accessions and education programs. The $1.5 billion fiscal year 2013 education and training budget invests in 

innovative training technologies and increases our investment in simulators, curricula, and instructors targeted at critical mission areas. 

Accessions Training and Education 

We continue to invest in the Navy’s ROTC program as an essential contributor 

to a diverse work force and diversity of thought and, in concert with appropriatelysized U.S. Naval Academy and Officer Training Command accessions, we have the 

officer accessions capacity we need to meet USN and USMC requirements. New investments in cyber education at USNA will ensure our flagship institution produces 

officers with the technical education and core competencies necessary to excel in this 

area as 21st century warriors. 

We have no plans to close Navy ROTC units, and in fact have recently restored 

the historic Navy ROTC presence at Harvard, Yale, and Columbia, and have opened 

host units at Arizona State University and Rutgers. Although the Navy’s Junior 

ROTC program has included closures, they have occurred in accordance with Federal guidelines, and the bulk of the affected units have substituted Navy National 

Defense Cadet Corps (NNDCC) units in their stead. We are evaluating re-opening 

some JROTC units previously closed under Federal guidelines, but which have restored student enrollment above the statutory minimum enrollment threshold. Recruit Training Command (RTC) is appropriately sized to support current enlisted accession requirements and prepared to meet the increases associated with economic 

changes. 

Technical Training and Skills Development 

The Navy continues to adjust staffing and student throughput of our accessions 

pipeline schools in response to the changing size, missions, and make-up of the 

Force. We have initiatives in progress to optimize the efficiency and responsiveness 

of the supply chain that takes a sailor from ‘‘the street to the fleet’’. For 2013 we 

made critical targeted investments in our technical training schoolhouses focused on 

improving readiness in key mission capabilities areas including Integrated Air & 

Missile Defense; Anti-Submarine & Surface Warfare; Command, Control, Communications, Computers, Combat Systems, and Intelligence; and Ballistic Missile Defense. 

The fiscal year 2013 budget request supports additional investments in simulators, trainers, and new technologies that allow us to deliver sailors to their commands with the skills needed to perform their missions faster and at reduced cost. 

Coupled with training aboard ships, simulators increase training opportunities and 

effectiveness across the Fleet while minimizing stress on equipment, operating costs 

and risk to our sailors. Examples of our fiscal year 2013 simulator investments include the Integrated Air & Missile Defense Advanced Warfare Trainer for our Ballistic Missile Defense platforms and the Aegis Ashore Team Trainer for shore based 

Ballistic Missile Defense. The Littoral Combat Ship (LCS) training program is based 

on the Virtual Ship Centric Training Strategy, which uses virtual simulators in the 

ashore LCS Training Facility to cover the full breadth and depth of ship operations 

and maintenance training. 

We continue to invest in the development and application of innovative training 

technologies that offer tremendous potential to provide our sailors the best technical 

training in less time with improved understanding and retention. The field of intelligent tutoring is a focus area for the Future Naval Capabilities Capable Manpower 

science and technology program, and our enlisted cyber-warriors are currently participating in a very promising Digital Tutor pilot course that combines classroom, 

instructor led training with advanced computer-based one-on-one tutoring to increase a student’s motivation and problem solving skills. 

Joint and Professional Military Education 

In the past year, the Navy has held education summits to examine the role of 

joint education, professional education and technical education in the career paths 

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of our unrestricted line, restricted line and staff officer communities. The results of 

these summits, combined with a thorough review of the education requirements 

coded to all Navy officer billets, are informing an ongoing review of the Navy’s education strategy. A review of Naval Post Graduate School (NPS) curricula is underway to examine ways to reduce time required to complete in-residence degrees, 

which, in conjunction with expanded distance learning opportunities, will better 

align with our officer career tracks and allow greater flexibility in meeting the 

Navy’s Joint, and professional education requirements. In the past year, we have 

also begun new masters degree programs at the NPS for cyber operations and for 

energy management. 

A progressive continuum of professional military education, including degree opportunities, also exists for enlisted personnel. Junior enlisted pursue professional 

military education through distance learning hosted by the Naval War College, 

while senior enlisted personnel are afforded the opportunity to attend the Senior 

Enlisted Academy (SEA), which graduated 505 senior enlisted sailors from its 6- 

week resident course in fiscal year 2011. 

Voluntary Education 

The Navy’s on-line Virtual Education Center (VEC) website and counseling service has proven very successful in providing centralized management of Tuition Assistance (TA) requests, sailors’ academic transcripts and virtual counseling. The 

VEC has enabled the Navy to reduce operating costs by downsizing or eliminating 

local Navy College Offices at some bases while also reducing paperwork and processing time and increasing accessibility to educational opportunities for our sailors. 

Navy continues to maximize education opportunities through programs specifically tailored to meet the needs of our sailors and their families. The Navy College 

Program for Afloat College Education (NCPACE) makes college courses available to 

sailors assigned to ships and submarines deployed around the world. The Navy College Program Distance Learning Partners (NCPDLP) program offers both associate 

and bachelor degree programs through partnerships with accredited civilian institutions. These institutions provide maximum credit for military training and experience for every Navy rating and combine those credits with courses they offer to meet 

degree requirements. Sailors may use Tuition Assistance to offset their education 

costs in both NCPACE and NCPDLP. 

The Tuition Assistance (TA) program is the primary means for Navy personnel 

to pursue their off-duty education goals. The TA program management controls we 

implemented in 2010 require sailors to have a plan with clear educational goals to 

emphasize both professional development and academic success. These controls have 

helped us remain within our established funding limitations while providing a more 

equitable opportunity to use the program. Our management controls have improved 

academic success as evidenced by the reduction in the non-completion rate of TAfunded courses from 16 percent in fiscal year 2009 to 7.5 percent in fiscal year 2011. 

Credentialing 

The demand for credentialing examinations continues to be very high, indicating 

the significant value sailors place on gaining professional recognition for their training and experience. In fiscal year 2011, we funded 19,762 certification exams, a 43 

percent increase over fiscal year 2010. The Navy Credentialing Opportunities Online 

(COOL) website experienced 497,002 visits, a 65 percent increase over fiscal year 

2010, and 30,460,627 hits, an 11 percent increase. Sailors in all 83 ratings have applied for funding, and 94.2 percent of those completing voluntary certification examinations via Navy COOL funding passed, far exceeding the national average pass 

rate of 75–85 percent, and represents a positive return on investment. In 2011, 

Navy COOL and Navy’s Credentialing Program was awarded ‘‘Best Workforce Development Program‘‘ by Human Capital Management Defense, and the Navy COOL 

program was recognized through the Training Top 125 Award for the second consecutive year. 

In 2012, work has already begun to implement several improvement recommendations from the President’s Employment Initiatives DOD/VA Veterans Employment 

Task Force and to develop Navy COOL pages to display credentialing opportunities 

for Navy’s 198,000+ civilian employees. In addition, we will waive the time-in-service prerequisites to make COOL available to all sailors affected by the ERB to help 

posture them for success as they transition to the civilian workforce. 

Navy Language, Regional Expertise, and Culture (LREC) 

Cultural, historical, and linguistic expertise remains essential to fostering strong 

relationships with global partners and to enhance our ability to execute missions in 

multinational environments. Over the past year, LREC efforts paid dividends in 

every geographic area of operations, including support for Operation Tomodachi in 

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the Far East, Operation Odyssey Dawn in the Mediterranean, and Operation Continuing Promise in Latin America. Navy’s LREC program in fiscal year 2011 provided language and cultural training and products to over 67,000 sailors and officers, 49 flag officers and 46 senior leaders heading to overseas assignments. 

We recently expanded the Navy Reserve Language Culture and Pilot Program to 

include all selected Reserve personnel. In fiscal year 2012, we are increasing opportunities for overseas study, language and cultural immersion, as well as professional 

exchanges with foreign navies for U.S. Naval Academy midshipmen. We are also 

pursuing full implementation of in-country language immersion training for Foreign 

Area Officers (FAOs), and transitioning the Personnel Exchange Program (PEP) to 

redefine long-standing agreements with traditional allies and partners, while realigning towards nations in regions of increasing strategic importance. In anticipation of the shift in focus outlined in Secretary Panetta’s Sustaining U.S. Global 

Leadership: Priorities for 21st Century Defense, LREC product development emphasis is transitioning from Central Command (CENTCOM) to the Asia-Pacific region, 

Indian Ocean perimeter, and West Africa. 

This past year we participated in Maritime Security Cooperation activities and 

supported the Joint Force in Afghanistan and Pakistan with enhanced language and 

cultural capabilities through the Afghanistan-Pakistan (AFPAK) Hands Program. 

We also provided timely, tailored language, and Afghanistan/Pakistan training and 

culture products to 3,695 Navy Individual Augmentees (IAs) and to sailors assigned 

to units deploying to the CENTCOM Area of Responsibility. 

IX. BUILDING FOR THE FUTURE

As we navigate through a period of change, Navy must take action now to posture 

itself for success in the future. Evolving missions, shifting workforce demographics, 

and increased competition for skills will require new and innovative approaches to 

attracting, recruiting, and retaining the Nation’s best talent. Mission success starts 

and ends with a highly skilled, highly capable workforce. To build an effective future force, we remain focused on developing and sustaining a diverse workforce, providing our sailors with opportunities for greater work-life balance, and promoting 

open, frequent communication with families. 

Diversity Initiatives 

Diversity is a Navy strategic imperative. By 2020, demographic projections indicate that minorities will comprise nearly 40 percent of the Navy’s recruitable market, with minority representation continuing to increase over time. Navy’s ability to 

access and retain the talents of varied sectors in our society has a direct impact on 

mission success at home and abroad. 

We recognize the value of diverse ideas, perspectives, and experiences to remaining competitive in an increasingly global environment; our Navy draws strength and 

innovation from this diversity. Navy continues to effectively execute our accession 

strategy of ‘‘moving the needles,’’ maintaining a high number of diverse applicants 

and enrollments in both NROTC and U.S. Naval Academy class of 2015. In recognition of our efforts, Navy received the 2011 Diversity MBA Magazine’s Best Places 

for Diverse Managers to Work, ranking number 26 on the list of the top 50 organizations for Diversity Leadership, and the only government organization included on 

the list of Fortune 500 companies. Additionally, the Association of Diversity Councils recognized the Navy’s Strategic Diversity Working Group (SDWG) as the nation’s number one diversity council for 2011. 

Expanding Opportunities for Women 

Gender diversity remains an important focus area for Navy, 23 percent of our enlisted accessions were women in fiscal year 2010 and fiscal year 2011, and we are 

on-track to bring in a similar number of women in fiscal year 2012. We are exploring ways to further increase the number of women in the Navy in the future. With 

few exceptions in which the combat exclusion applies, the vast majority of billets 

(93 percent) are available to women, including ship, aviation squadron, afloat staff, 

naval construction force units and most recently, specific submarine platform billets. 

In fiscal year 2011, Navy began the integration of female officers into the submarine force. Five of the eight crews being integrated during the first round are successfully integrated and the remaining three will be by the end of March 2012. Our 

second round will include one additional SSGN and SSBN (i.e., four additional 

crews); women are currently in the training pipeline for integration in November 

2012. We will continue to integrate women on submarines in a brisk yet responsible 

manner, while leveraging the insights from the studies and the lessons learned from 

initial integration efforts. 

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Life-Work Integration 

In an All-Volunteer Force, life-work integration and flexible career options are key 

to attracting, recruiting, and retaining the talent of a new generation just entering 

the workplace. With 75 percent of Fortune 500 companies reporting a chronic ‘‘talent shortage’’ among mid-level employers, Navy continues to address the imperative 

to retain talent and provide a work environment that is personally and professionally rewarding. Navy’s ability to recruit and retain the talents of varied demographics has a direct impact on mission success. We are actively creating programs 

to enhance personal and professional development while providing life-work balance. 

Sailors and their families continue to benefit from comprehensive parental support programs including paternity and adoption leave, extended operational 

deferment for new mothers, and expanded childcare. We continue to support lifework integration while meeting mission requirements through initiatives such as 

Career Intermission, telework, and other flexible work options. 

Communication with Navy Families 

Navy recognizes that social networking and the Internet can greatly facilitate 

communication efforts with sailors and their families. We continue to promote open, 

frequent communication with our sailors and their families and encourage development of social networking accounts, mobile applications, public websites, and publishing newsletters to sailors and their families via email. 

The Navy Recruiting Command ‘‘Navy for Moms’’ website received a 2011 Workforce Management Magazine Optimas Award for ‘‘Service.’’ Through this award-winning website, families of current sailors can share information with families of future sailors and answer many questions about Navy life. Since its establishment in 

March 2008, more than 36,000 members have used the website to discuss issues 

with others who share common concerns. ‘‘Military OneSource’’ provides information 

on many topics, including parenting and childcare, educational services, financial information and counseling, civilian legal advice, crisis support, and relocation information. This free, 24/7 information and referral service offers practical solutions, 

background information and advice via the telephone, email, or the web to all Active 

Duty and Reserve sailors, and their families. 

Social media venues such as Facebook have quickly become a primary and effective means of communicating with a wide audience, including family members. Additionally, in cooperation with Navy’s Chief of Information’s social media team, we 

are able to connect to a much broader audience by taking advantage of the U.S. 

Navy official Facebook page, which currently has more than 400,000 fans. 

Recognized for Results 

Our efforts have culminated in Navy’s recognition as a Top 50 organization. Top 

50 organizations encourage innovation and focus on performance, while taking care 

of their people through programs and policies that support a culture of trust, respect, and collaboration. In October 2011, Navy received several awards for Business Excellence in Workplace Flexibility from the Alfred P. Sloan Foundation. These 

awards recognize initiatives introduced at six different organizations across the 

Navy that promote flexible work options while still achieving business goals. For the 

third year in a row, Navy received the prestigious Workforce Management Magazine’s Optimas Award. This marked the first time in the award’s 21-year history an 

organization has won 3 consecutive years. 

Navy continues to earn recognition for its high quality training and development 

programs. In the 3 years since Navy began participating in the American Society 

for Training and Development (ASTD) awards program, no other organization has 

won more awards for ‘‘Excellence in Practice.’’ Most recently, Navy was honored 

with an ASTD BEST Award, ranking third out of 32 best training organizations 

from a prestigious list of recipients from 6 nations. For the second year, Training 

Magazine recognized Navy as one of the premier training organizations in the country, ranking seventh out of 125 organizations recognized. We remain committed to 

seeking out best practices across industry and benchmarking our programs against 

the best in the Nation. 

X. CONCLUSION

The President’s fiscal year 2013 budget request supports critical programs that 

will ensure Navy’s continued success in delivering the personal component of CNO’s 

Sailing Directions, the Navy Total Force Strategy for the 21st Century, and key capabilities in support of Sustaining U.S. Global Leadership: Priorities for 21st Century Defense. I look forward to working with you as we continue to shape the Navy 

to meet current and emerging requirements, while confronting the challenges that 

lie ahead. On behalf of the men and women of the U.S. Navy, and their families, 

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I extend our sincere appreciation for your leadership, commitment and unwavering 

support. Thank you. 

PREPARED STATEMENT BY LT. GEN. ROBERT E. MILSTEAD, JR., USMC 

Chairman Webb, Ranking Member Graham, and distinguished members of the 

subcommittee, it is my privilege to appear before you today to provide an overview 

on Marine Corps personnel. 

I. YOUR MARINES

The Marine Corps is our Nation’s expeditionary force in readiness. We are ready 

to respond to today’s crisis—with today’s force—TODAY! Currently, approximately 

27,000 marines are forward-deployed in operations supporting our Nation’s defense. 

Our individual marines are the Corps’ most sacred resource, and the quality of our 

force has never been better. 

II. END STRENGTH

New strategic guidance issued by the President and the Secretary of Defense provides the framework by which the Marine Corps will balance the demands of the 

future security environment with the realities of our current fiscal environment and 

the lessons learned from 10 years of combat. The new strategy includes a reduction 

in our Active component end strength from 202,100 to 182,100 by the end of fiscal 

year 2016, while maintaining our Reserve component at 39,600 marines. Although 

reshaping the Marine Corps to a force of approximately 182,100 marines entails 

some risk relative to current and anticipated capacity requirements, we believe that 

it is manageable. Your new Corps will have fewer infantry battalions, fixed wing, 

aviation squadrons, and general support combat logistics battalions than we had 

prior to September 11. However, it adds cyber warfare capability, special operators, 

wartime enablers and higher unit manning levels—all lessons gleaned from recent 

combat operations. 

Our intent will be to conduct our drawdown in a measured way beginning in fiscal 

year 2013. Our plan is to reduce our end strength by approximately 5,000 marines 

per year and will be accomplished by some accession cuts, natural attrition, and voluntary separation and retirement authorities. The drawdown cannot be accomplished by accession cuts alone—that is a lesson learned from the last drawdown 

in the 1990s. In addition, we have no plan to conduct a reduction-in-force (RIF) of 

our marines; they will be allowed to complete their current period of service. Our 

all-volunteer system is built upon a reasonable opportunity for retention and advancement; wholesale cuts undermine the faith and confidence in service leadership 

and create long-term experience deficits with negative operational impacts. Such an 

approach would no doubt do significant long-term damage to our ability to recruit 

and maintain a quality force. 

Our overarching goal must be to keep faith with our marines and their families. 

III. MARINE CORPS RESERVE

Our Reserve component continues to make essential contributions to Total Force 

efforts in Overseas Contingency Operations. In 2011, we continued to refocus our 

recruiting and retention efforts on meeting our Reserve component authorized end 

strength. These efforts included increases to the non-prior service recruiting mission, lowering rates of attrition, and discreet targeting of those marines eligible to 

receive an incentive. As a result, we achieved over 99.8 percent—39,527—of authorized end strength in fiscal year 2011 (not including reservists who served on active 

duty at least 3 of the prior 4 years). 

Our incentives budget is $5.4 million in fiscal year 2012, and we project an end 

strength of 39,249, approximately 1 percent below our authorized level. For fiscal 

year 2012 and beyond, we have refined the use of incentives to strengthen manning 

in specialties and grades where we remain critically short. In particular, the recruitment of company grade officers and aviators remains most challenging. Targeted incentives and transition assistance outreach programs help us to attract junior officers who are leaving the Active component. While transitioning officers from the Active component provide the majority of our company grade officer leadership, we 

have had considerable success commissioning officers directly into the Reserve. The 

Reserve Officer Commissioning Program, which includes Officer Candidate CourseReserve (OCC–R)—has produced a total of 431 lieutenants for the Marine Corps 

since its creation in 2006 and has increased company grade officer fills from 21 to 

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46 percent. More importantly, it enables the Marine Corps Reserve to place officers 

in critical small unit leadership positions at the platoon and company level. 

To complement outreach efforts and the use of incentives, and to address the challenges of geographic constraints, we offer occupational specialty retraining. The 

Prior Service Military Occupational Specialty Retraining Program is crucial in our 

efforts to join enlisted marines to units that are located in areas of the country 

where it is geographically challenging to recruit. This training has helped us to 

build positive trends with respect to recruiting and retention and are integral to our 

future success. 

This year we increased efforts to fully staff Reserve aviation squadrons. To 

achieve this goal, we developed a number of Reserve aviation manpower initiatives 

designed to encourage transitioning Active component aviators to affiliate with Reserve units. Since there are a limited number of Reserve squadrons, the use of travel reimbursement, incentives, and aviator retraining programs are critical to achieving our staffing goals. Altogether, these programs, combined with our prior service 

recruiting efforts, should provide for at least 90 percent manning of critical combat 

arms and company grade officer billets by the end of fiscal year 2014, with Reserve 

squadrons reaching this mark 1 year later. 

IV. RECRUITING

The Marine Corps is unique in that all recruiting efforts (officer, enlisted, regular, 

Reserve, and prior-service) fall under the direction of the Marine Corps Recruiting 

Command. Operationally, this provides us with tremendous flexibility and unity of 

command, allowing us to meet accession requirements. 

To meet future challenges in the recruiting environment, it is imperative that we 

maintain our high standards both for our recruiters and those who volunteer to 

serve in our Corps. Recruiting quality youth ultimately translates into higher performance, reduced attrition, increased retention, and improved readiness for the operating forces. Our actions, commitment, and investments today in recruiting ensure 

a high state of readiness in our Corps tomorrow. 

In fiscal year 2011, we achieved over 100 percent of our enlisted and officer recruiting goals for both the Active and Reserve components. On the enlisted side, we 

accessed over 99 percent Tier 1 high school diploma graduates and over 74 percent 

in the upper Mental Groups of I–IIIAs, both exceeding Department of Defense quality standards. Our fiscal year 2012 Mission for enlisted marines is 28,500 regulars 

(Active component) and 5,450 reservists. In fiscal year 2012, we expect to meet our 

annual recruiting mission to include all quality goals. Additionally, we expect to 

have a strong population of qualified individuals ready to ship to recruit training 

as we enter fiscal year 2013. The fiscal year 2013 mission forecast is 28,500 regulars 

and 5,800 reservists. 

The Marine Corps seeks to reflect the diversity of the Nation and be representative of those we serve. Diversity remains a strategic issue that raises our total capability by leveraging the strengths and talents of all marines. In fiscal year 2011, a 

tremendous amount of effort and resources was placed into communicating the Marine Corps diversity message through community outreach, recruit marketing, training and education. This enduring challenge requires the Corps to strategically 

evaluate our current efforts in order to drive toward improved capabilities. 

Our officer accessions mission for fiscal year 2012 is 1,450 Active Duty and 125 

Reserve officers. Historically, the Active component has been the exclusive source 

of lieutenants and captains for the Reserves. As previously noted, filling company 

grade officer billets for our Selected Marine Corps Reserve units is traditionally our 

greatest challenge, but the success from the OCC–R program is proving to help in 

remedying this shortfall. 

Our recruiting command is taking a hard look at its advertising budget. It is imperative that we maintain the momentum within a competitive media environment 

and still provide the basic awareness level when reaching out to an increasing number of critical audiences (prospects and their influencers, officer candidates, and 

multicultural audiences) to include our diversity outreach. It is important that we 

acknowledge that today’s successes are dividends from the investments made in recruiting and advertising 4 to 5 years ago. 

Our greatest asset is the individual marine and recruiting remains the lifeblood 

to the Corps and our bedrock to ‘‘Make Marines, Win Battles, and Return Quality 

Citizens.’’ We thank you for the generous support you have provided to us and look 

forward to working with you to ensure continued success in the future. 

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V. RETENTION

In fiscal year 2011, the Marine Corps achieved both its accession and retention 

missions and completed the year with a 201,497 Active component end strength (including 340 reservists who served on active duty at least 3 of the prior 4 years). 

For fiscal year 2012, we will continue to assess all recruiting and retention missions, 

enabling the Marine Corps to successfully meet our mission requirements and poise 

the force for the impending drawdown. 

Even with our successes in recruiting, retention, and overall end strength, the 

Marine Corps must continue to shape our force to meet continuing mission requirements and fill critical military occupational specialties (MOSs) with the most qualified marines. Incentive pays remain critical to this effort, allowing the Marine Corps 

to fill hard to recruit positions, such as crypto linguists and reconnaissance. Enlistment bonuses also allow us to ship new recruits at critical times to balance recruit 

loads at the depots and meet school seat requirements. It is important to note that 

only 8 percent of new Marine Corps recruits receive an enlistment bonus; the Marine Corps budget for enlistment bonuses has decreased from $75 million in fiscal 

year 2008 to $14.7 million in fiscal year 2012. 

Selective Reenlistment Bonuses (SRBs) similarly allow us to shape our career 

force. SRBs target critical MOSs and allow us to laterally move marines to these 

MOSs. There are currently 6 of 205 occupational specialties where the on-hand 

number of marines is less than 80 percent of what is required. Our SRB funding 

has decreased from $468 million in fiscal year 2009 to $108.6 million in fiscal year 

2012. 

VI. WOMEN IN SERVICE REVIEW

As directed by the National Defense Authorization Act for Fiscal Year 2011, the 

Marine Corps, alongside the other Services, conducted a review of the laws, policies 

and regulations regarding the service of female members. The findings were delivered to Congress in February 2012. The Marine Corps requested an exception to policy that would allow for the assignment of Active component female company grade 

officers and staff noncommissioned officers (E–6 and E–7) into select Ground Combat Element (GCE) units (Artillery, Tanks, Assault Amphibian, Low Altitude Air 

Defense, Combat Engineer and Combat Assault) down to the battalion level, in military occupational specialties (MOSs) already open to female marines. This will open 

97 officer billets and 274 staff noncommissioned officer billets for assignment of female marines during 2012. 

Concurrent with the exception to policy, the Marine Corps will conduct responsible research to generate data that can be used to make informed decisions and 

potentially develop appropriate gender neutral tests to screen males and females 

prior to assignment to the GCE. We must ensure that all marines assigned to the 

GCE have the required physical aptitude. This research will include a force survey 

and a research study that will assess the potential impact on recruiting, MOS classification, entry level training, and promotions in order to inform future assignment 

decisions. We will report back to the Secretary of Defense with an initial assessment 

in November 2012. 

The Marine Corps is committed to utilizing the skills and abilities of our marines 

to achieve the highest levels of unit readiness and focus on mission accomplishment. 

We are proud of the contributions that women make across the Marine Corps and 

want to ensure female marines continue to have opportunities to be successful. 

VII. DIVERSITY

The Marine Corps is committed to attracting, mentoring and retaining the most 

talented men and women who bring a diversity of background, culture and skill in 

service to our Nation. In both representation and assignment of marines, diversity 

remains a strategic issue. Our diversity effort is structured with the understanding 

that the objective of diversity is not merely to strive for a force that reflects a representational connectedness with the rich fabric of all the American people, but to 

raise total capability through leveraging the strengths and talents of all marines. 

We are near completion of a new comprehensive campaign plan to focus our diversity effort in areas where improvement is most needed and anticipate release of this 

roadmap this year. This is an effort facilitated through our standing Diversity Review Board and a Diversity Executive Steering Committee chartered to establish the 

foundations for diversity success in the Total Force. In addition, since 2010, we have 

conducted leadership seminars that introduce diverse college undergraduates to Marine leadership traits and leadership opportunities in the Marine Corps; we are actively seeking new communities within which to continue this effort. 

262 

The Marine Corps has established minority officer recruiting and mentoring as 

the highest priority in our recruiting efforts. Because we acknowledge the accession 

and retention of minority officers has been a challenge for our Corps, we are committed to taking steps to further facilitate the mentoring and career development 

of all our officers with emphasis on our minority officers in order to encourage the 

retention of our best officers no matter their background. 

Overall, we seek to communicate the Marine Corps diversity mission through 

community outreach and recruit marketing; to ensure continued opportunities for 

merit based development and advancement; and to optimize training and education 

to increase the understanding for all marines of the value that diversity brings to 

the Total Force. 

VIII. TAKING CARE OF MARINES, SAILORS, AND FAMILIES

Marine families are America’s families and a model for the Nation. The Marine 

Corps will continue to take care of its marines and families through enhanced family readiness and family care programs. Marine communities are a team, and our 

programs promote increased socialization and community connection through official 

unit communication, readiness preparation and information, and referral opportunities. These programs seek to improve resiliency by training marines and families 

how to cope with the rigors of life in the Marine Corps, whether at home or deployed. 

Family Readiness 

The Marine Corps has 380 Family Readiness Officers, who connect marines and 

families at the grassroots level to critical information and referrals and assist families during all phases of deployments. We recently completed an overhaul of our Marine Corps Family Team Building Training to ensure we are providing relevant, 

standardized and timely support and information to our families. In fiscal year 

2011, we provided 5,869 Marine Corps Family Team Building training sessions. 

Family readiness also benefits from dependable yet innovative communication 

tools that help families effectively manage their lives in times of stress. eMarine, 

a secure website, delivers readiness information to marines and their families 

whether they are on active duty stationed at large installations or in the Reserves 

living in remote locations. It gives family members access to documents, photos and 

videos, discussion forums, and vital information about their marine’s unit from anywhere in the world, 24/7. 

The Marine Corps conducted a full review during fiscal year 2011 of its Family 

Readiness programs to ensure they adequately support the mission and operational 

requirements of the Marine Corps. While our programs conform to the Commandant’s guidance and congressional direction, we are developing program plans 

and supporting resource requirements to maintain capabilities at appropriate levels. 

Family Care 

Family care programs support the care and development continuum of Marine 

Corps children from birth into their teens. Family care includes our school liaisons, 

who provide approximately 70 school districts with information about the needs of 

Marine Corps families and access to beneficial training and counseling services to 

support teachers and students. Marine parents are comforted by the support of a 

local education expert, who provides meaningful insight to new transfers and those 

with questions on local education policies. 

Child care services remain a high priority. In fiscal year 2011, we provided 15,927 

child care spaces, which reflects an 18 percent increase in capacity from fiscal year 

2010. The Marine Corps opened five new child development centers in fiscal year 

2011 and plans to open eight more in fiscal year 2012. The Marine Corps has completed a Child Development Program and Facility Master Plan, which reviewed 

child care capabilities and costs across the Marine Corps. This plan will facilitate 

efforts to build multi-capable, adaptable services, reexamine structure, and ensure 

that our programs are prepared to deliver child care in an efficient manner. We will 

continue to standardize our processes in fiscal year 2012 and will work to enhance 

child care for marines and families serving on independent duty or at locations that 

are isolated from military bases and stations. We are also expanding our staffing 

model to include nurses at our Child Development Centers and behavioral health 

specialists at our installations across our family programs. 

Families enrolled in our Exceptional Family Member Program (EFMP) strongly 

endorse our focus on providing a continuum of care and the improvements made to 

their level of support. Two years of increasing enrollments and a reduction in issues 

experienced by families relocating to new duty stations demonstrate this approval. 

EFMP had only 4,500 enrolled family members in fiscal year 2008; it has over 

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10,000 today. The Marine Corps continues to underwrite the cost of up to 40 hours 

of short-term respite care per month for enrolled families, providing more than 

450,000 hours of respite care in fiscal year 2011. We continue to transform our program, which the Department of Defense (DOD) and our sister services continue to 

recognize as a premier program. Marine Corps policy ensures that the assignment 

and relocation process is sensitive to EFMP family needs and allows marines to remain competitive for promotion while maintaining a continuum of care for exceptional family members. 

Personal and Professional Development 

We recognize and encourage all marines and their spouses to pursue and achieve 

their life goals while serving in the Marine Corps or beyond as veteran marines. 

Our Personal and Professional Development (P&PD) program supports marines and 

their spouses with their education, employment, financial fitness, and transition 

readiness goals. This program integrates the efforts of several formerly-disparate 

programs (education services, transition assistance, spouse employment support, 

personal financial management, relocation assistance, library programs and the Marine For Life network) to ensure we provide our marines and spouses holistic education and support. 

One of our most significant initiatives is to revise and improve our Transition Assistance Management Program (TAMP) to better meet the needs of our transitioning 

marines and their families. TAMP is being integrated and mapped into the lifecycle 

of a marine from recruitment, through separation or retirement, and beyond as veteran marines. The Marine Corps efforts will comply with the multi-agency initiative, 

led by OSD and VA, to help improve employment prospects of veterans, as well as 

with implementing the provisions of the recently enacted Veterans Opportunity to 

Work (VOW) Act. 

The integration of our Marine For Life program in the P&PD Program has improved our ability to work with the civilian community to find opportunities for our 

transitioning marines and their spouses. Marine For Life also provides an avenue 

for marine veterans to reach back for assistance or to volunteer their services to assist transitioning or veteran marines in their communities. 

Regarding spouse employment opportunities, we see that tying these programs 

more closely with formerly marine-focused programs, such as transition assistance 

and on-base education, creates significant synergy. Many of the same employers who 

seek marine veterans are also interested in employing marine spouses. We look forward to working with the Joining Forces Initiative, which seeks to streamline certification and licensure procedures for marine spouses. We also support parallel efforts to qualify marines for certifications based upon military training and experience. 

Our P&PD Program includes personal finance counseling efforts to help marines 

make responsible financial decisions. We have created a new personal financial 

management curriculum that covers 34 major topics including saving and investing, 

credit and debt management, and smart home buying, selling and renting. These 

efforts help ensure that we are not focusing solely on those in financial distress but 

also on preparing marines and their families to be financially stable and prepared. 

Bringing all of these programs together to offer an integrated set of personal and 

professional development services will enable marines and their families to be more 

effective, and more ready. At the same time, these services will help marines be better prepared to make the transition back to civilian life whether it be after a 4-year 

enlistment or a 30-year career. 

Behavioral Health Integration 

The integration of our behavioral health programs seamlessly weaves our efforts 

in sexual assault, suicide, combat and operational stress, substance abuse and family advocacy/domestic violence into the larger support network of command structures and the health and human services across the Marine Corps. We focus on evidence-based practices to ensure we are providing effective support in these critical 

areas and utilize our Behavioral Health Information Network, which is a web-based 

clearinghouse, for the latest information on behavioral health. This integration further benefits from our Behavioral Health Advisory Committee, a committee chartered for the purposes of examining promising practices and making recommendations on our behavioral health programs. A universal prevention training module, 

which is in development, will reduce redundancy in our training efforts by integrating all behavioral health program information. This training will discuss common risk and protective factors across all behavioral health programs. 

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Sexual Assault Prevention and Response 

Our Sexual Assault Prevention and Response Program follows a holistic approach 

to prevention and response, utilizing a top-down leadership message of support and 

an emphasis on bystander intervention. Marines have an inherent responsibility to 

step up and step in to prevent sexual assault. Our priority is to reduce the number 

of incidents as well as reduce the number of unreported sexual assaults by utilizing 

a consistent and focused emphasis on command climate. The Marine Corps has revitalized our curriculum for noncommissioned officers to include a new video-based 

bystander training, entitled ‘‘Take a Stand,’’ designed to reduce stigma by stimulating conversation and engaging marines with a more personalized message about 

sexual assault prevention. 

We are revitalizing our Command Team training module, updating our annual 

training and enhancing our training for all first responders. We have staffed our installations with subject matter experts, positioned to have the greatest impact on 

victims and victim care. In addition, 24/7 Helplines are available at all major installations and Reserve headquarters to provide resources and advocacy for victims. 

These Helplines are answered by victim advocates who are trained to provide immediate services to victims of sexual assault. 

We continue our focus on accountability for those who violate the Uniform Code 

of Military Justice. The Marine Corps Trial Counsel Assistance Program (TCAP) 

trained 118 Judge Advocates in sexual assault investigation and prosecution best 

practices in fiscal year 2011. TCAP will continue this training in fiscal year 2012 

and plans to train approximately 125 Judge Advocates and 75 enlisted paralegals. 

The DOD-wide release of the Defense Sexual Assault Incident Reporting Database 

will enhance current case management capabilities. 

Suicide Prevention 

In calendar year 2011, we lost 33 marines to suicide, and we preliminarily recorded 171 suicide attempts. While we have seen 2 consecutive years of decreased 

suicides and evidence of change in marine attitudes toward behavioral health, we 

still have much work to do. Leaders prevent suicide by strengthening all marines 

and encouraging marines to engage helping services early, when problems are most 

manageable. We continually encourage marines to recognize, acknowledge and seek 

help for stress reactions, and we deploy evidence-based prevention practices such as 

peer-to-peer suicide prevention training. The Marine Corps will work closely with 

the DOD Suicide Prevention Office to implement recommendations of its Joint Task 

Force on the Prevention of Suicide. Our award-winning ‘‘Never Leave a Marine Behind’’ suicide prevention program, which is peer-led and continually updated to reflect emerging evidence-based practices, is tailored to reflect the culture and values 

of the Marine Corps. We will continue to forge strong relationships with Federal 

agencies, academia, and private industry in order to further our understanding of 

suicide prevention. 

Combat and Operational Stress Control 

Combat and Operational Stress Control (COSC) helps Marine leaders maintain 

their warfighting capabilities by addressing the negative impacts of stress. COSC 

enhances force preservation, readiness and the long-term health and well-being of 

marines and their families. Every battalion or equivalent unit across the Total Force 

will have an Operational Stress Control and Readiness (OSCAR) team by mid-2012. 

OSCAR teams are comprised of mentors (selected unit marines and leaders), extenders (unit medical and religious personnel), and mental health professionals, who 

provide a network of support. As of March 2012, the Marine Corps had trained over 

10,000 marines as OSCAR mentors, who help reduce stigma and act as sensors for 

the commander by noticing small changes in behavior and taking action early before 

stress becomes a medical issue. COSC is incorporating lessons learned into new 

courses in COSC fundamentals for all levels of enlisted professional military education. 

Our DSTRESS Line, which will have a global capacity by mid-2012, addresses the 

full spectrum of behavioral health needs, whether they are problems arising from 

the everyday stressors of life or a suicidal crisis. DSTRESS Line is a ‘‘by Marine/ 

for Marine’’ counseling center for marines, attached Sailors, and families, who can 

call, chat online, or Skype with a veteran marine, Fleet Marine Force corpsman, or 

Marine Corps family member. 

Substance Abuse 

Our Substance Abuse Program works to reduce substance abuse and dependency 

disorders that negatively affect the operational readiness and health of the force. 

The program’s tenets are prevention, treatment and drug demand reduction. We are 

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executing an Alcohol Abuse Prevention Campaign throughout the Marine Corps this 

year to reduce the negative impact that alcohol abuse and misuse has on the Marine 

Corps’ readiness and health. 

Marine Total Fitness 

In fiscal year 2012, we will also continue to develop our Marine Total Fitness concept to develop marines of exemplary physical, psychological, spiritual and social 

character. Marine Total Fitness, which will support the Department of the Navy’s 

21st Century Sailor and Marine Initiative will infuse resilience-based information 

and concepts into all aspects of a marine’s training and readiness. A totally fit marine exhibits exemplary physical, mental, spiritual, and social character and is prepared to successfully operate in and respond to the rigors, demands, and stressors 

of both combat and garrison. The four pillars of Marine Total Fitness—physical, psychological, social, and spiritual—provide an avenue to deliver programs, initiatives 

and resources. 

Casualty Assistance 

The Marine Corps Casualty Assistance Program is committed to ensuring that 

families of our fallen marines are treated with the utmost compassion, dignity, and 

honor. Always seeking to improve survivor assistance and demonstrating a record 

of quick, effective action, our Casualty Assistance Program is a 24-hour-per-day operation manned by marines and civilians trained in casualty reporting, notification 

and casualty-assistance procedures. Casualty Assistance Calls Officers assist the 

next-of-kin with burial arrangements, applications for benefits and entitlements, 

contact with benevolent and philanthropic organizations, and obtaining reports of 

investigation. Within days of the incident, families are connected to representatives 

from the Tragedy Assistance Program for Survivors, a nationally-recognized provider of comfort and care to those who have suffered the loss of a military loved 

one. The Marine Corps reaches out to the next-of-kin approximately 60 days after 

the loss to help resolve any remaining issues and to let the families know that they 

are still part of the Marine Corps family. We will remain steadfast in our support 

of our Marine Corps families who have paid so much in service to our Nation. 

IX. SEMPER FIT & EXCHANGE SERVICES

I want to thank Congress, especially this subcommittee, for your continued support for our Marine Corps Semper Fit and Exchange programs. In the National Defense Authorization Act for Fiscal Year 2012, you and your colleagues included a 

provision which allows us to access credit for business operations through the Federal Financing Bank and thereby lock-in the best possible interest rates. Thank you 

for your hard work on that bill. 

The Commandant continues to stress that the Marine Corps will keep faith with 

our marines, our sailors, and our families. We repeat this theme in all that we do 

as we strive to deliver capability-based programs all the way down to the unit level. 

Semper Fit & Recreation 

Our Semper Fit and Recreation programs support the readiness, resiliency, and 

retention goals of your Marine Corps. Our efforts are primarily focused on the areas 

of fitness, sports, health promotion, and recreation, as they are essential in maintaining a fit marine. We recently introduced High Intensity Tactical Training 

(HITT), a comprehensive strength and conditioning program geared towards optimizing physical performance and combat readiness. HITT is designed to reduce the 

likelihood of injury while in theater; initial feedback from marines is positive and 

Corps-wide rollout of the program, including use in Afghanistan, began in February 

and will be completed at all installations by June 2012. 

Social resilience is linked with unit cohesion and we are identifying unit-driven 

recreational activities to provide at Marine Corps installations. Operation Adrenaline Rush, currently offered at two installations, assists marines in reintegration by 

empowering small unit leaders, maintaining combat readiness, and reinforcing unit 

cohesion. The program offers opportunities for outdoor recreation activities such as 

whitewater rafting and deep sea fishing. 

Overall, Semper Fit makes every effort to deliver high quality programs and services to marines and their families. Our programs are vital to the continued success 

and development of your marines and your Corps. 

Marine Corps Exchange and Temporary Lodging Facilities 

The Marine Corps Exchange (MCX) is inextricably linked to our mission of taking 

care of marines and their families and is an important part of the overall non-monetary benefits package. Our success is measured on the program’s value and conVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00271 Fmt 6601 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
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tributions to the readiness and retention of our marines, as well as our ability to 

provide unparalleled customer service, premier facilities, and valued goods and services at a savings. With MCX, unlike any other retail store, marines can rely upon 

a high quality product at a fair price and know that the proceeds are returned to 

their community, creating a stronger Marine Corps. Like other Marine Corps Community Services (MCCS) facility master planning efforts, MCX is executing branding strategies, and our aggressive re-investment into our main stores is near completion. We are also expanding the branding strategies to focus on our Marine Marts 

and Temporary Lodging Facilities. All Marine Corps design standards are focused 

on energy efficiency and sustainability. 

Deployed Support 

Deployed support is one of the most important services we provide. Our Exchange, 

Recreation and Fitness, Communication, and MCCS Amenity Wi-Fi services not 

only boost and maintain morale, but also help to reduce mission-related stress. 

Exchange 

Ongoing missions in Afghanistan include the operation of two Direct Operation 

Exchanges Tactical at Camps Leatherneck and Dwyer, one Tactical Field Exchange 

at Camp Delaram II, one Imprest Fund Site at Forward Operating Base (FOB) Edinburgh, and numerous Warfighter Express Services Teams operating out of Camps 

Leatherneck, Dwyer, and FOB Edinburgh. 

Recreation and Fitness 

We assist in providing sports, recreational, and fitness equipment to units 

throughout Helmand Province. This transportable equipment includes sports/recreation cooler kits filled with sports gear and board games, electronic game kits, Theater-in-a-Box kits, and functional fitness equipment for use in austere environments. Reading materials, both electronic and paperback, are also available. 

Communication 

Morale Satellite services are available to forward operating bases, combat outposts, and other austere locations. We have delivered 13 satellite communications 

systems to units in Afghanistan. Each system has 2 phones which each provide 

6,000 free minutes per month and 5 laptops that allow internet access, social networking, and chat/video capabilities to deployed marines. In 2011, we provided over 

a half-million minutes of telephone air time. In addition, approximately 23,683 marines were able to use the Morale Satellite services at several different FOBs, including over 2,100 telephone calls over the Thanksgiving and Christmas holidays. 

MotoMail, supported by Marine and Family Programs and first offered in December 2004, is another form of communications support which continues to serve marines and families. MotoMail allows friends and family members to submit letters 

and pictures online to deployed marines. A marine will receive their letter within 

24 hours of submission. Since implementing this free service, over 4.1 million letters 

have been created and delivered. 

MCCS Amenity Wi-Fi Solution 

The Marine Corps Community Services Amenity Wireless Fidelity (Wi-Fi) Solution program deploys Wi-Fi capability at no cost to marines and families. This morale and welfare initiative helps marines stay in contact while separated from their 

families. The Wi-Fi is conveniently located at temporary lodging facilities, exchange 

food courts, libraries, education centers, child and youth centers, clubs, and Wounded Warrior Program facilities. Since its inception, our Wi-Fi program has been popular with marines and their families. As of the first of this year, the program is 

available on 19 Marine Corps installations with 240 buildings receiving Wi-Fi coverage. 

X. WOUNDED WARRIOR REGIMENT

The Marine Corps is grateful for this subcommittee’s recognition of the service 

and sacrifices of wounded, ill, and injured (WII) marines and their families. Your 

marines continue to sustain wounds on the battlefield, including catastrophic injuries that present significant quality of life challenges. Marines also continue to be 

injured in training accidents, become ill, and experience other tragedies that require 

a wide range of interconnected non-medical care. Through our Wounded Warrior 

Regiment (WWR), we provide this care—from the point of injury or illness through 

return to duty or reintegration to civilian communities. 

Our WWR is a single command with a strategic reach that provides non-medical 

care to the total Marine force. The Regimental Headquarters in Quantico, VA, commands the operation of two Wounded Warrior Battalions (at Camp Lejeune, NC, 

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and Camp Pendleton, CA) and multiple detachments in locations around the globe, 

including at major Military Treatment Facilities and Department of Veterans Affairs Polytrauma Centers. All WWR elements function as a cohesive team to allow 

for consistent, top-notch services for WII marines, their family members, and caregivers. 

The Marine Corps approach to wounded warrior care is to return recovering marines to their parent units as quickly as their medical conditions permit. Allowing 

marines to ‘‘stay in the fight’’ is what makes our care model unique and successful. 

When WII marines remain with their parent units, they are supported by their regular command structure with the full assistance of our WWR’s comprehensive assets. WII marines with medically acute cases (typically when their recoveries are 

more complex and medical treatment or rehabilitation is expected to exceed 90 days) 

are joined to a WWR element where they are enrolled in programs to not only heal 

them medically, but also strengthen their mind, body, spirit, and family during recovery and rehabilitation. 

There is no one-size-fits-all approach to warrior care. Each case is unique based 

upon the marine’s phase of recovery, their location and family situation. Care does 

not lend itself to a process, but rather, it is a relationship between the WWR and 

the WII marine. As leadership is an integral part of the healing process, our WWR 

assigns specially-trained Marine Section Leaders to various locations where WII marines are joined to maintain good order and discipline and ensure that these WII 

marines are provided leadership, mentorship, and encouragement on a daily basis. 

Assets and Capabilities 

Now in its fifth year of operation, our WWR continues to refine its programs and 

services. Many program improvements are based upon sound feedback from WII 

marines, their family members and caregivers. Our fundamental assets and capabilities are available to WII marines whether they are joined to the WWR or remain 

with their parent command. 

Recovery Care Coordinators (RCCs) 

We currently provide 49 RCCs to approximately 1,220 WII marines, 60 percent 

of whom are joined to the WWR and 40 percent remain with their parent command. 

Our RCCs are located at 14 sites and serve as the WII marine’s central point of 

contact to help them set and meet their recovery and transition goals. RCCs work 

in coordination with other members of the marine’s recovery team (Marine leadership, medical case managers, non-medical case managers, and others) to ensure recovery and transition actions are fully coordinated. Recent improvements to the 

RCC program include standardizing Comprehensive Recovery Plans (CRPs), the WII 

marine’s ‘‘life map,’’ by implementing a quality assurance program for consistent 

CRP development and documentation. We have also developed a robust training 

program that provides RCCs with the critical skills necessary to identify WII marines’ needs, translate those needs into concrete goals, and then provide actionable 

steps to help the marine meet their goals. To facilitate a smooth transition process, 

the RCCs have instituted a practice whereby they hand-off cases of marines who 

leave the Marine Corps to other WWR assets for post-transition monitoring and to 

provide for any ongoing or residual care coordination requirements. Our RCCs coordinate with the Department of Veterans Affairs’ Federal Recovery Coordinators 

(FRC) on cases where WII marines have been assigned an FRC to ensure a smooth 

transition to VA services. 

Warrior Athlete Reconditioning Program 

When a marine is wounded, ill, or injured, our WWR helps focus them on their 

abilities through the Warrior Athlete Reconditioning Program (WAR–P). WAR–P 

provides activities and opportunities for marines to train as athletes, to increase 

their strength so they can continue with military service or develop healthy habits 

for life outside of the Marine Corps. WAR–P, which is mandatory for marines joined 

to the WWR, does more than help WII marines maintain a healthy body; it counters 

declining self-perception, depression and stress that may be associated with their injury. Under WAR–P, WII marines have more than 20 activities to choose from, including swimming, cycling, running, wheelchair basketball, and strength and conditioning. 

Sergeant Merlin German Wounded Warrior Call Center 

The Marine Corps continues to honor its commitment to keep faith with WII marines through our WWR’s Call Center, a Department of Defense Best Practice, 

which renders resource and referral assistance to WII marines and Marine veterans. 

Our trained Call Center staff includes retired marines, other Marine veterans, and 

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fessionals. They not only receive calls on a 24/7 basis, but also conduct outreach efforts to check on the well-being of WII marines. Combat-wounded marines who remain with their parent units are contacted at prescribed intervals to determine if 

they have any needs or issues. If needs are identified, the marine is referred to a 

non-medical care manager for resolution. These calls can result in assignment to a 

Wounded Warrior Battalion or the assignment of a Recovery Care Coordinator, or 

both. This Call Center also serves as the WWR’s hub for its new social media efforts, which includes Facebook, Twitter, and a new WWR App that can provide fact 

sheets, news updates, and other WWR-specific information. 

Strategic Communication 

Clear, consistent, and accurate information regarding services and eligibility must 

reliably reach WII marines, their family members, and caregivers. To address this 

need, the WWR continually disseminates information on its programs and services 

to various audiences, including Marine Corps leaders, to ensure the Marine Corps 

total force, including all wounded warriors and commanders are aware of the 

WWR’s services. 

Community Reintegration 

As the vast majority of WII marines reintegrate to their communities, our WWR 

has taken steps to ensure they are highly competitive in a difficult job market. We 

provide specialized transition support through Transition Cells, located at WWR 

Headquarters and Wounded Warrior Battalions. Transition coordinators, both Marine Corps and civilian employees (including representatives from the Departments 

of Labor and Veterans Affairs), work closely with marines to reach their employment and education goals. Based on the WII marine’s ultimate goals, the transition 

coordinators determine their needs, develop pathways, provide coaching and resources, and help network for employment and careers. For WII marines who are 

joined to the WWR, their transition to civilian life begins as soon as their medical 

conditions allow (typically at outpatient status). They must start an education program, participate in an internship, or return to work (ideally in a military occupational field commensurate with their established goals). 

Integrated Disability Evaluation System Support 

The Marine Corps supports the current Integrated Disability Evaluation System 

(IDES) process as it enables the recovering servicemember and family to continue 

to receive our support and transition smoothly to VA benefits from active duty status. While not a universal concern, some marines have expressed dissatisfaction 

with the IDES process due to the variance in their final DOD compensation package 

and their VA compensation based on the same VA disability rating determination. 

This is because DOD compensates for medical conditions that are determined to be 

military unfitting by the service Physical Evaluation Board (PEB), whereas VA compensates for all disabling medical conditions incurred or aggravated during a period 

of active duty. Although the Marine Corps does not own the IDES process, we own 

the marine and it is our responsibility to be their advocate. Over the past year, we 

have taken several actions to improve IDES performance. These actions include: 

• providing Marine Corps leadership with detailed IDES case processing information, resulting in their ability to work closer with the Regional Medical Commanders on specific issues impacting IDES performance; 

• enhancing the PEB administrative staff and bolstering manning to perform field-level counseling and case processing assistance; 

• providing Marine Corps disability evaluation attorneys with a list of marines entering the IDES process for proactive advocacy prior to the Medical 

Evaluation Board (MEB) referral; and 

• ensuring all marines referred into the IDES receive a pocket-sized information pamphlet on the IDES process which provides detailed information 

on the establishment of the DOD and VA compensation based on the VA 

determined disability rating. It also identifies all actors (PEBLOs, VA Military Service Coordinators, DES Attorneys, and Independent Medical Reviewers) in the IDES process and describes how the marine can work with 

that actor to achieve a better outcome. 

These initiatives have reduced case backlogs and improved case processing timeliness in the MEB and improved customer satisfaction. 

Program Assessment 

The WWR recognizes the importance of sound data to measure program effectiveness and inform changes in the way we serve WII marines and their families. Since 

the WWR was established in 2007, several surveys have been conducted. The most 

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recent survey was administered to WII marines joined to or supported by the WWR 

and posed questions relating to our various care coordination assets: Section Leaders, Recovery Care Coordinators, the Wounded Warrior Call Center and Battalion 

Contact Cells, Family Readiness Staff, and District Injured Support Coordinators. 

Findings reveal that satisfaction levels have increased for marines injured prior to 

2007 and are now consistent with WII marines injured post 2007. Much of this 

equalization can be attributed to the reach-back capability that the Call Center possesses, conducting outreach calls to offer assistance. There was also an increase in 

satisfaction levels in the following areas: WWR personnel; the level of information 

provided/ability to provide information; and ability to provide support to family 

members. One of the most important data points from the survey: 81 percent of respondents agreed or strongly agreed that WWR personnel do a good job of coordination with each other to make things easier. 

Our WWR has also been assessed by the Department of Defense Task Force on 

the Care, Management, and Transition of Recovering Wounded, Ill, and Injured 

Members of the Armed Services. We are pleased to point out that we were recognized for several best practices, including our Hope and Care Centers, customization 

and delivery of the Keeping It All Together Handbook to families at detachments, 

and our IDES Pocket Guide for Marines. 

WII marines and their family members and caregivers have sacrificed much and 

I can assure this subcommittee and Congress that we will fully honor their sacrifices by continuing to provide them quality care and support to posture them for 

success, whether they return to duty or transition back to civilian life. 

XI. CIVILIAN MARINES

Our civilian marines support the mission and daily functions of the Marine Corps 

and are an integral part of our Total Force. 

In recognition of the need to study and clearly define our civilian workforce requirements in light of civilian labor budget reductions, we proactively conducted a 

full review of the civilian workforce in late 2010. This measure resulted in a selfimposed hiring freeze from December 2010 to December 2011, but allowed time to 

prioritize requirements within affordable levels and align resources with capabilities. It also ensured the civilian labor force was shaped to support the mission of 

the Corps today and for the future. As a result of our efforts, the Marine Corps 

avoided drastic reductions of civilian personnel and was able to reduce from a 

planned level of 21,000 personnel in direct funded Full-Time Equivalencies to 

17,501. 

Our fiscal year 2013 civilian personnel budget reflects efforts to restrain growth 

in direct funded personnel. By establishing budgetary targets consistent with current fiscal realities, we will be able to hold our civilian labor force at fiscal year 

2010 end-of-year levels, with some exceptions for critical workforce growth areas 

such as acquisition, intelligence (National Intelligence Professionals), information 

technology, security (Marine Corps Civilian Law Enforcement Personnel), and cyber. 

The civilian labor budget represents less than 5 percent of the Marine Corps’ fiscal year 2012 budgetary submission, demonstrating that our ‘‘best value’’ for the defense dollar applies to our civilians as well as our marines. 

XII. HEALTH CARE EFFICIENCIES

The Marine Corps supports the reforms in military compensation programs included in the President’s fiscal year 2013 budget. The President’s budget acknowledges the reality that military pay, allowances, and health care costs cannot be ignored in our comprehensive effort to achieve savings. The compensation reforms are 

sensible. Modest pay raises continue—no reductions, no freezes. TRICARE care enrollment and deductibles fees increase for retirees, but they are comparatively moderate and tiered based on retirement income. Pharmacy co-pays trend toward market rates and encourage the use of generic drugs and mail-order delivery. In all 

cases, costs remain substantially less than those in the private sector. 

XIII. CONCLUSION

To continue to be successful, we must always remember that our individual marines are our most precious asset, and we must continue to attract and retain the 

best and brightest into our ranks. Marines are proud of what they do. They are 

proud of the ‘‘Eagle, Globe, and Anchor’’ and what it represents to our country. With 

your support, a vibrant Marine Corps will continue to meet our Nation’s call. 

Thank you for the opportunity to present this testimony. 

Senator WEBB. Secretary Ginsberg, welcome. 

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STATEMENT OF HON. DANIEL B. GINSBERG, ASSISTANT SECRETARY OF THE AIR FORCE FOR MANPOWER AND RESERVE 

AFFAIRS; ACCOMPANIED BY LT. GEN. DARRELL D. JONES, 

USAF, DEPUTY CHIEF OF STAFF FOR MANPOWER, PERSONNEL AND SERVICES, U.S. AIR FORCE 

Mr. GINSBERG. Thank you very much, Mr. Chairman. 

Chairman Webb, Ranking Member Graham, and members of the 

subcommittee, General Jones and I would like to thank you for the 

opportunity to testify today on behalf of more than 700,000 airmen—Active, Guard and Reserve, and civilian, who make up the 

most capable aerospace and cyberspace force the world has ever 

known. We know that you and members of the subcommittee are 

keenly interested in the well-being and support of our airmen. We 

must start by thanking you all for everything that you have done 

to support them each and every day. 

In the past year, our Nation’s airmen have performed magnificently, carrying out operations precipitated by Arab Spring, major 

natural disasters, Homeland defense missions, and ongoing overseas contingencies in Afghanistan and the conclusion of our Iraq 

operations. 

It is vital to visit our airmen firsthand and see their contributions and challenges they face every day, and we can assure you 

that from Japan to Florida, from Wyoming to Kandahar, your 

members of the U.S. Air Force are laying it on the line for the Nation every single day. 

It is due to the quality of our All-Volunteer Force that your Air 

Force can project focused military power to achieve strategic, operational, and tactical objectives globally in support of our national 

security interests. 

We have no higher priority than taking care of our airmen and 

ensuring that they have the resources and support that they and 

their families need to stay focused and ready to perform the demanding missions we assign to them. 

As this subcommittee already is well aware, the Air Force had 

to make very hard choices in this year’s budget submission. We had 

to reconcile top-line reductions with our requirement to fulfill our 

global commitments and maintain acceptable levels of readiness 

while still sustaining key quality of life and core services for our 

people. Despite a difficult budget situation, the Air Force is committed to providing cost-effective medical care services and programs to maintain a healthy and resilient force. We must support 

our people to meet the demands of high operational tempo and persistent conflict. Developing and caring for our airmen will remain 

a key focus as we continue to become more efficient and develop 

smarter and more agile approaches to our achieving security objectives. 

Again, on behalf of Secretary Donley and General Schwartz and 

all of our airmen, we thank you for your commitment and support 

to our Air Force. We look forward to answering your questions. 

Senator WEBB. Thank you very much, Secretary Ginsberg. 

General Jones, both of your full statements will be entered into 

the record at this time. 

[The joint prepared statement of Mr. Ginsberg and General 

Jones follows:] 

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JOINT PREPARED STATEMENT BY HON. DANIEL B. GINSBERG AND LT. GEN. DARRELL

D. JONES, USAF 

The airmen of our great Air Force serve the Nation with distinction. They have 

performed valiantly during more than 20 continuous years of combat operations dating back to Operation Desert Storm, while simultaneously supporting multiple 

broad-spectrum operations across the globe. Committed to meeting the requirements 

of the President’s Defense Strategic Guidance, while confronting the realities of the 

current and future constrained fiscal environment facing our Nation, the Air Force 

remains committed to recruiting, developing and delivering to the battlefield innovative airmen who can smartly and skillfully meet any task or mission. Our commitment as the Air Force’s Assistant Secretary for Manpower and Reserve Affairs and 

Deputy Chief of Staff for Manpower, Personnel and Services is to align the Air 

Force’s greatest resource, our airmen, to support the national security strategy. We 

must do so with fiscal responsibility, making extremely difficult resource priority decisions while at the same time demonstrating that we fully support our airmen and 

their families. As we prioritize missions, it is critical we balance capabilities between our Active and Reserve components to maintain a robust national security 

posture in a dynamic global environment. 

CONTINGENCY OPERATIONS

Our airmen remain at the forefront of today’s conflicts and contingency operations 

around the globe, serving proudly alongside our soldier, sailor, and marine counterparts. Today there are more than 80,000 airmen either forward deployed or stationed abroad worldwide in our Nation’s defense with an additional 134,000 airmen 

providing direct support to our joint warfighters from the continental United States 

on a daily basis. That means 43 percent of our Total Force is directly supporting 

combatant commander requirements every day. In late 2010, the Air Force began 

a transition to a 6-month baseline deployment length. This will increase at-home 

time for airmen between deployments and use pre-deployment training resources 

more efficiently. We are on track to complete this transition by October 2012. At 

the same time, Air Force 365-day deployment taskings have increased to 2,300, up 

from 689 in 2005, and now represent 7 percent of the Air Force’s total deployments. 

MILITARY AND CIVILIAN PERSONNEL BUDGETS

The Air Force is committed to maintaining and sustaining the appropriate size 

and force mix to align with the new defense strategy, ensuring we meet mission requirements with acceptable personnel tempo and associated stress on the force. Detailed assessments of future conflict scenarios and deployment rotation requirements drove force structure adjustments resulting in the corresponding personnel 

reductions. By the end of fiscal year 2013, end strength will be reduced a further 

9,900 from 510,900 to 501,000. This will result in an Active Duty military end 

strength reduction from 332,800 to 328,900. Our Air Force Reserve (AFR) military 

end strength will decrease by 900 (increase in 200 full-time; decrease in 1,100 parttime, including 700 associated technician positions) to 70,500, and Air National 

Guard (ANG) military end strength will decrease by 5,100 (500 full-time; 4,600 parttime, including 1,400 associated technician positions) to 101,600. Approximately 80 

percent of these reductions were driven by force structure changes. 

During the development of the fiscal year 2012 President’s budget, the Secretary 

of Defense released efficiency guidance to improve the effectiveness and efficiency 

of business operations. As part of this guidance, the Department of Defense (DOD) 

civilian end strength funding was targeted at fiscal year 2010 levels. For the Air 

Force, this action effectively removed funding for 16,500 civilian positions that were 

planned growth between fiscal year 2010 and fiscal year 2012. To meet the DODdirected civilian funded targets, the Air Force conducted an enterprise-wide review 

of efficiency initiatives, reducing overhead and eliminating redundancies, while protecting areas of strategic importance such as the nuclear enterprise, intelligence, reconnaissance and surveillance. The reductions ultimately resulted in the Air Force 

divesting 3,000 positions of planned civilian growth and approximately 13,500 established positions, primarily from management and support staff areas. 

The fiscal year 2013 budget includes a total budget authority request of $34.2 billion for Active Duty, ANG and AFR military personnel. Included in this budget is 

a 1.7 percent military base pay increase, a 4.2 percent increase in the housing allowance and a 3.4 percent increase in subsistence allowance. We also project an 11.4 

percent decrease in Overseas Contingency Operations (OCO) funds. In addition, the 

civilian personnel budget requested for fiscal year 2013 is $12.4 billion for a proVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00277 Fmt 6601 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
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grammed total force civilian strength of 185,900, and includes a 0.5 percent pay 

raise following a 2-year pay freeze. 

COMPENSATION REFORM

We support the President’s plan to establish a military retirement commission, 

undertaking a thorough review of the current retirement system and make recommendations to modernize that system with input from the Department We also 

support the recommendation that any changes be grandfathered. The costs for military pay, allowances and health care have risen significantly in the last decade. As 

part of a DOD-wide effort, we are participating in the development of multiple proposals to meet deficit reduction targets and slow cost growth. The adjustments to 

the TRICARE benefits included in the budget reflect the proper balance and the 

right priorities necessary to sustain the benefit over the long term. National health 

care costs continue to rise at rates above general inflation and DOD is not insulated 

from this growth as we purchase over 60 percent of our care from private sector. 

DOD beneficiaries’ out-of-pocket costs with the proposed changes remain far below 

the cost-sharing percentage they experienced in 1995. 

MILITARY FORCE MANAGEMENT

The Air Force will continue to sustain excellence with a smaller, more agile and 

modernized force. We continue to realize record high retention and remain focused 

on tailored force management efforts as we continue to size and shape the force to 

meet congressionally mandated end strength. The Force Management Program is a 

targeted, multi-year program managing the force along the 30-year continuum of 

service, which leverages voluntary measures first, incentivized programs where 

needed, and implements involuntary measures as required to yield sustained support for combatant commanders across the globe. 

The fiscal year 2012 voluntary force management programs include active duty 

service commitment waivers; time-in-grade waivers; reduced enlistment contract 

waivers; 8 versus 10 commissioned years of service waivers for prior-service officer 

retirement, as granted in the National Defense Authorization Act (NDAA) for Fiscal 

Year 2011; voluntary separation pay; and Palace Chase transfers to the Air Reserve 

components. We plan to utilize the Temporary Early Retirement Authority granted 

in the NDAA for Fiscal Year 2012 by targeting a very limited and specific number 

of enlisted airmen in selected skills. 

The fiscal year 2012 officer involuntary force management program resulted in 

610 losses through use of a force shaping board for probationary officers with less 

than 6 years Total Active Federal Commissioned Service (TAFCS), a reduction in 

force board for captains and majors, and lieutenant colonel and colonel selective 

early retirement boards. The fiscal year 2012 enlisted involuntary force management program currently only calls for date of separation rollbacks. 

In fiscal year 2013, the Air Force’s voluntary programs are similar to those in fiscal year 2012 and the only involuntary action is a projected force shaping board for 

probationary officers with less than 6 years TAFCS. Additionally, the Air Force will 

continue use of limited selective continuation and reduced promotion opportunities 

to captain (95 percent) and major (90 percent). 

While we must take proactive measures to manage the force to remain within end 

strength, the Air Force is also committed to ensuring an effective transition to civilian life for our airmen. We have increased our focus on improving Transition Assistance Programs and are actively participating with the White House Veterans Employment Initiative Task Force, in an effort to reduce veteran unemployment. We 

are committed to providing appropriate resources towards increased transition assistance and veteran employment efforts as we continue to collaborate with the Office of the Secretary of Defense (OSD), the Department of Veterans Affairs (VA), the 

Department of Labor, the Department of Education, and other government partners. 

CIVILIAN FORCE MANAGEMENT

The Air Force has initiated programs to achieve the necessary civilian force reductions while ensuring mission continuity to comply with the fiscal year 2010 funding 

levels as directed by DOD. The Air Force has implemented force management programs such as hiring controls, a 90-day hiring freeze, and two rounds of voluntary 

separation initiatives (Voluntary Early Retirement Authority (VERA) and the Voluntary Separation Incentive Pay (VSIP)). More than 2,900 civilian employees have 

accepted VERA/VSIP incentives. A third round of voluntary separation initiatives 

are planned to begin 1 May and conclude on 31 August. During this time of reductions and reshaping the force, the Air Force’s primary goal is to minimize the number of involuntary separations to the greatest extent possible. 

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RETENTION, RECRUITMENT, BONUSES, AND INCENTIVE PAYS

The Air Force accesses, retains and grows motivated and uniquely qualified airmen to meet the security threats of today and the future. We must carefully tailor 

accessions to meet current needs, while also considering the future, as not bringing 

in enough new recruits can impact the force for 30 years to follow. Therefore, while 

our force management plan includes reducing some officer and enlisted accessions, 

those reductions are considered against future requirements. We project reducing 

enlisted accessions for fiscal year 2012 and fiscal year 2013 by 1,030 and 1,232, respectively, and reducing officer accessions by 30 in fiscal year 2012, but no planned 

reductions in fiscal year 2013. 

The Air Force seeks the highest quality recruits to fill our ranks as current airmen retire or separate through programmed attrition. To support these efforts, we 

have included $82 million in the budget for the Air Force Recruiting Service to support Total Force recruiting operations, and an additional $97 million for fiscal year 

2013 advertising, a slight reduction in the total recruiting budget from fiscal year 

2012. In 2011, the Air Force experienced great recruiting success, meeting all enlisted and officer recruitment goals for the Active Duty and Reserve components. 

Just as notably, the quality of recruits entering the Air Force greatly increased. For 

our CAT I to IIIA recruits, the average score on the Armed Services Vocational Aptitude Battery increased from 90.5 percent in 2010 to 98.5 percent thus far in fiscal 

year 2012, and we anticipate continued overall recruiting success in fiscal year 2012 

and fiscal year 2013. However, there are nine Air Force career fields, to include linguist, special operations, and explosive ordnance disposal specialties where critical 

shortages remain due to high operational demand, manning shortages, or lengthy 

training pipelines. We budgeted $14.5 million in Initial Enlistment Bonuses in fiscal 

year 2013 to attract airmen into these critical skill areas. Active duty, non-line officer recruiters met 99 percent of their 2011 goal. We increased our efforts to recruit 

Fully Qualified Health Professionals (FQHP), meeting the goal of 25 FQHP officers 

in fiscal year 2011 while increasing our fiscal year 2012 goal to 55. 

The ANG met their fiscal year 2011 enlisted recruiting goal and are on track for 

fiscal year 2012. However, ANG officer recruitment fell short in fiscal year 2011 in 

both line officer and health professional areas. In response, the ANG is executing 

precision recruitment efforts in fiscal year 2012 towards officer candidates using a 

standardized processing system, focused lead generation, and a heightened advertising campaign to help meet officer recruiting goals by fiscal year 2013. 

The Air Force Reserve continues to attract and retain qualified prior service and 

nonprior service recruits. For the 11th straight year, the AFRC Recruiting Service 

has led DOD in meeting recruiting goals. The Air Force’s ability to attract and retain trained Active component airmen into the AFR greatly reduces training costs, 

and enhances the repository of talent and expertise available to meet the Air Force’s 

surge and steady state requirements. 

Retention remains at an all-time high in the Air Force as a whole, contributing 

to the need for multi-year force management programs to remain within authorized 

end strength. However, retention is still problematic for some skill sets and year 

groups, and we need investment to counter low accession year groups of the past 

and to retain critical warfighting skills for the future. Bonuses have proven the 

most effective, responsive, and measurable tool for retention to encourage airmen 

to remain in or retrain into career fields with high demand requirements. Training 

and replacement costs far exceed the amount invested in bonus programs, so the 

Air Force has allocated $420.4 million in fiscal year 2013 for Special and Incentive 

bonus pay. The Air Force has portioned $232 million of this amount for Selective 

Reenlistment Bonuses (SRB) for 78 Air Force specialties, down from 89 in fiscal 

year 2011. SRB investments have shown to improve retention up to 1 to 8 percent 

per SRB increment, depending on the enlistment zone, and have proven to be a critical tool in retaining our needed specialties for the future. Retention of senior noncommissioned officers (SNCO) in certain high-demand specialties such as combat 

control and pararescue is also challenging. critical skills retention bonuses (CSRB) 

remain a vital tool to target specific year groups within specialties experiencing low 

retention, manning shortfalls, and high operational demand. Therefore, the Air 

Force targeted $2.9 million in enlisted CSRB towards retaining these SNCOs beyond retirement eligibility. Additionally, we are investing $10 million in CSRB towards officer specialties with retention and manning problems including contracting, special tactics, combat rescue officers and health professionals. 

AIRMAN DEVELOPMENT

One of our primary initiatives in developing the force is an effort to better define, 

identify, and track institutional, occupational, and cross-functional competencies. 

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During fiscal year 2013, we will continue to institutionalize a process allowing force 

development stakeholders at all levels to quantify and measure specific skills on 

both an individual and aggregate basis. Doing so will allow us to develop our Total 

Force airmen more deliberately by matching training, education, and experiential 

opportunities to real-world requirements. The Air Force is developing cross-cultural 

competence for all airmen, in order to prepare them to deliver the global vigilance, 

global reach and global power our Nation expects. To support this requirement, we 

will focus our efforts on: (1) building expertise in foreign language, regional, and cultural skills; (2) recognizing joint experience in an airman’s career; and (3) ensuring 

our educational offerings address current and anticipated requirements for language 

and regional expertise. 

SUPPORT TO AIRMEN AND THEIR FAMILIES

Quality-of-life programs continue as one of our highest priorities. As our force 

changes, we must adapt our programs and services to ensure we meet the needs 

of today’s airmen and families. Additionally, we must tailor our offerings based on 

the utilization of services and the availability of suitable alternatives. 

We recently completed the second generation of our Caring for People Survey. 

More than 100,000 Total Force airmen voiced their opinions in this online survey 

conducted from December 1, 2010 to January 3, 2011. The survey measured satisfaction with quality of life across the Air Force community, to include airmen, 

spouses, Air Force civilians, and retirees across multiple areas like medical care, 

housing and support for families. The respondents expressed satisfaction with housing, installation schools, military benefits, dining facilities, fitness centers, child development centers and youth programs. Information, Tickets and Travel, along with 

the Air Force Food Transformation Initiative were standouts, competing with comparable industry leaders in the travel and food service industries. Some areas of 

concern include a sense of Air Force community, financial issues, medical care for 

families and job satisfaction. 

We have a project team developing base prototypes, technological innovations and 

efficiencies to address concerns not just from the Caring for People Survey, but a 

variety of other surveys and focus groups as well. The team will provide installation 

commanders with tools to help them determine how to shape quality of life programs according to the needs of their local Air Force community. In that vein, another key focus area is strengthening partnerships within local communities to take 

advantage of the services they provide. In the end, we will consolidate or divest 

quality of life activities that are not financially viable or not well utilized in order 

to redirect resources to the places where they matter most to airmen, their families 

and the mission. 

Our successful Food Transformation Initiative (FTI) continues as a high priority 

through fiscal year 2012 and fiscal year 2013. A customer satisfaction rating of 75 

at the 6 FTI installations, compared to 67 at other facilities, indicates we are on 

the right path as we work to improve the delivery of meal choices, food quality, 

speed of service, and the overall dining experience for our personnel. As another indicator of success in our first year, we served an additional 530,000 customers and 

provided 133,000 more meals to our junior enlisted members at FTI installations as 

compared to the previous year. Based on the initial success of this program and 

with congressional support, we anticipate expanding FTI to seven additional installations in fiscal year 2013. 

It is important to recognize the contributions of non-pay programs in enhancing 

the quality of life for our airmen and their families. The Defense Commissary Agency operates as a nonprofit organization and can save a family of four an estimated 

$4,500 a year. Providing groceries and household items .at cost. saved patrons a 

total of $2.7 billion last fiscal year. Additionally, the Army Air Force Exchange Service (AAFES) provides merchandise and services to military members and their families at competitively low prices. The 3,100 facilities located in over 30 countries provided an average 24 percent savings to customers compared to comparable retail 

stores. Additionally, AAFES gives back to the military community through significant dividend contributions, which amounted to $90.6 million going back to the Air 

Force communities AAFES serves in fiscal year 2010. AAFES also offers employment benefits as 31 percent of employees are military family members. 

We continue to strengthen our Air Force community by meeting childcare needs 

through a robust construction effort to increase the number of available childcare 

spaces and reduce our shortfall by the end of fiscal year 2012. We are also adding 

74 accessible childcare playgrounds and 26 community nature parks in support of 

Air Force families with special needs. The Air Force Expanded Child Care program 

assists airmen who need child care for unusual shifts, extended duty hours and drill 

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weekends. Additionally, we funded our new respite childcare program for special 

needs children at seven bases and we will expand it to other locations throughout 

the upcoming year. 

We are also expanding our Exceptional Family Member Program (EFMP) to support more than 18,400 Air Force families with special needs members, a 10 percent 

increase since the end of fiscal year 2010. To do so, we placed 35 EFMP Family Coordinators at installations with the highest concentrations of families enrolled in the 

program. We are also adding 36 EFMP Medical Coordinators through fiscal year 

2016 to support families needing specialized medical care and included $3 million 

starting in fiscal year 2013 to fund respite care and other EFMP related programs. 

The Air Force also recognizes the important role and sacrifices of our ANG and 

AFR airmen and their family members. While many of the same family support programs are offered to our Reserve components, we realize that ANG and AFR families have difficulty sometimes accessing those available resources. As a result, we 

have supported ANG and AFR unique programs such as the Home Community Care 

program, which provides fee-assisted, in-home quality childcare during scheduled 

drill weekends. Returning Home Childcare for deployed personnel is another ANG/ 

AFR family program benefit, funding 16-hours of no-cost care per child following deployments of 30 days or more. Finally, a Defense Management Data Center survey 

administered to ANG/AFR families highlighted the high satisfaction with the congressionally-supported Yellow Ribbon Reintegration Program (YRRP), with 83 percent of respondents expressing high satisfaction with the YRRP events. Additionally, 

77 percent said the information presented increased their confidence in their ability 

to find and utilize vital resources that would prepare them and their loved ones for 

continued military service. 

MILITARY HEALTH SYSTEM (MHS) GOVERNANCE

The Air Force fully supports the MHS Governance Task Force recommendations. 

They are important because they represent the intense and informed deliberation 

of both line and medical professionals who were seeking the best solutions to maintain exceptional care for our servicemembers while finding more effective and efficient ways to deliver that care. 

The Air Force believes implementation of the task force recommendations will ensure the sustainment of this high level of mission success. We agree that a more 

effective and efficient joint medical solution can be attained without the expense of 

establishing a unified medical command. The Services should—and will—continue 

integrating common medical platforms to reduce redundancy and lower costs. The 

task force recommendations will move us quickly to a construct that curtails expenses and achieves savings to the greatest extent possible while meeting our deeply important mission; providing quality health care to the military member and 

their families, while being good stewards of American taxpayer dollars. 

AIRMAN AND FAMILY RESILIENCY

A key factor in maintaining the health of our Air Force is to increase the resiliency of our airmen. Our efforts include a number of programs in the Comprehensive Airman Fitness (CAF) model designed on four pillars of resilience: Mental, 

Physical, Social and Spiritual. This program provides tools to help Total Force airmen and their families withstand, recover or grow in the face of stressors and 

changing demands. It is our goal to expand education and training of the CAF 

model to our accession and professional military education units first. Next, we will 

provide Master Resilience training Air Force-wide to individuals who provide faceto-face resilience skills training at the installation level. Further, the Leadership 

Pathway is a program incorporating basic resilience and life skills for airmen and 

family members in utilizing existing resources offered at the Airman and Family 

Readiness Center, Health and Wellness Center, Air Force clinics/hospitals and base 

chapels. 

The Deployment Transition Center (DTC) at Ramstein Air Base, Germany, was 

established to provide valuable decompression, reintegration and resilience training 

for returning servicemembers who were exposed to significant danger and stress in 

combat zones. Since calendar year 2010, over 3,000 airmen have completed the center’s 2-day program and have reintegrated with their home units and families. The 

Air Force fiscal year 2012 budget includes $7 million for DTC operations, research, 

curriculum development, materials and intervention training. 

SUICIDE PREVENTION

Suicide prevention remains a top Air Force leadership priority. The Air Force uses 

an integrated public health approach to suicide prevention, emphasizing leadership 

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involvement, a supportive Wingman culture, and access to evidence-based care provided by Air Force helping agencies. The Air Force Suicide Prevention Program is 

one of only 15 evidence-based programs listed by The Substance Abuse and Mental 

Health Services Administration. Recent suicide prevention initiatives include requiring face-to-face suicide prevention training for all frontline supervisors in the three 

career fields with the highest suicide rates in 2010. Since implementation in November 2010, the suicide rates in these career fields dropped significantly. 

Other initiatives include developing the Airman’s Guide for Assisting Personnel 

in Distress, a new web-based resource to assist all airmen with strategies and resources for a variety of behavioral concerns. We are also sponsoring a RAND study 

on the use of social media and its impact on relationships and emotional wellbeing, 

as well as research by the University of Rochester on specific clusters of risk factors 

associated with suicide. The Air Force Community Action Information Board/Integrated Delivery System (CAIB/IDS) links leaders and helping professionals at every 

level of the Air Force organization and monitors all our suicide prevention initiatives for continuity and completeness. An audit of its effectiveness will provide guidance on enhancing the functioning of these organizations and provide areas of further improvement in our evidence-based program. 

Proper public messaging on suicide prevention is important. Public messages 

must avoid the impression that suicide is common, so the Air Force has revised memorial service and public affairs guidance shifting the focus toward the positive 

message of resilience, stressing the benefits of early help-seeking and effective 

Wingmanship. 

Finally, the Air Force is working closely with our sister Services to implement recommendations made by the Defense Health Board’s Task Force on Suicide Prevention and to clarify roles and responsibilities within the Department regarding suicide prevention. 

SEXUAL ASSAULT PREVENTION AND RESPONSE

The Air Force strongly supports the Secretary of Defense’s commitment, focus, 

and initiatives aimed at eradicating sexual assault. Eliminating sexual violence is 

everyone’s responsibility. Leaders, commanders and supervisors set the tone and 

must model zero tolerance and behaviors supporting zero tolerance. The goal of our 

Air Force Sexual Assault Prevention and Response (SAPR) program is to prevent 

and respond to sexual assault through a balance of focused education, compassionate advocacy and accountability, promoting respect and dignity throughout the 

Air Force. 

Prevention of sexual assault continues to be a high priority. Career long education 

and training creates a foundation for prevention. This education begins with accessions, continues through all phases of professional military education, and is refreshed during annual training. In February, we released a wing commander guide, 

An Opportunity to Lead, containing five core elements to help commanders provide 

immediate impact. The guide addresses personal leadership, climate and environment, community leadership, victim response, and offender accountability. In addition, Bystander Intervention Training has been established as a requirement for all 

airmen, focusing on the importance of recognizing signs of inappropriate or unsafe 

situations and intervening appropriately. 

The NDAA for Fiscal Year 2012 contained significant mandates addressing sexual 

assault including a requirement for full time Sexual Assault Response Coordinators 

(SARCs) and victim advocates at brigade or equivalent level. The Air Force SAPR 

program has included full time SARCs at installation level since 2005, including the 

six primary U.S. Central Command area of responsibility AF locations. Air Force 

SARCs receive training that meets national advocacy credentialing standards. Victim advocates are military and Air Force civilian volunteers who receive comparable 

training. Currently, 3,159 fully trained volunteers are available to assist victims. 

The Air Force projected $31.8 million to execute the SAPR program in fiscal year 

2013. The budget funds full-time SARCs, 24 dedicated investigative agents specializing in sexual assault investigations, and operational program expenses for all firstresponder agencies and field level activities. To meet the new NDAA for Fiscal Year 

2012 requirement for full time Sexual Assault victim advocates at brigade or equivalent level, the Air Force will need to add 89 new positions (60 DOD civilians and 

18 officers from the Active Duty component, and 11 traditional Reserve officers from 

the Air Reserve component). The associated cost is $7.5 million in fiscal year 2013, 

increasing to $8.4 million by fiscal year 2017. 

Prevention and response are critical elements of the SAPR program. Holding 

those who commit the crime of sexual assault accountable is equally important. The 

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able staff judge advocate advice, and strong commander and senior enlisted support. 

The Air Force has 24 Air Force Office of Special Investigations investigators dedicated to sexual assault investigations and funds 10 DNA analyst salaries at the U.S. 

Army Criminal Investigations Laboratory to analyze Air Force sexual assault case 

evidence. Investigators and judge advocates participate in combined training and attend courses specifically addressing sexual assault crimes. The recent Air Force 

Judge Advocate General Keystone annual leader summit provided a 4-hour session 

for staff judge advocates facilitated by subject matter experts on investigation and 

evaluation of sexual assault cases. Executive Order MRE 514 provides victim advocate privilege against disclosure of certain communications by victims, SAPR victim 

advocates and family advocacy program victim advocates, and we feel certain this 

provision will encourage more victims to come forward and report sexual assaults 

and incidents of domestic violence. 

In March, the Air Force launched the Defense Sexual Assault Incident Database 

(DSAID). The Air Force has worked closely with OSD from concept development to 

DSAID system design, so we look forward to implementing this valuable tool for enhanced reporting to Congress and to our leaders and commanders and we appreciate 

Congress’s continued support in addressing this crime. 

WOUNDED WARRIORS

The Air Force continues to strengthen its support for our wounded, ill and injured 

population through our Warrior and Survivor Care Division. Our wounded, ill and 

injured airmen deserve our very best and the Warrior and Survivor Care Division 

is committed to providing them individualized and focused non-clinical support. 

Through the Recovery Care Coordinator (RCC) program, we have strategically 

placed 33 non-clinical care managers around the country and in Germany. This RCC 

network provides dedicated support and coverage from the moment Air Force Casualty reports that an airman is placed in a seriously or very seriously ill or injured 

status; serving as independent advocates for each airman and working to ease the 

burden of administrative and personal requirements as they navigate through their 

continuum of care. 

Our Family Liaison Officers (FLO) also provide an invaluable service to the families of our seriously or very seriously wounded, ill and injured airmen. The Air Force 

has taken the concept used to support families of the fallen and applied it to our 

wounded warrior families as well. The FLO coordinates all logistical support for 

family members to include arranging lodging, securing transportation, and seeing 

to the comfort and other arising needs of the family. 

While we provide excellent care for all our wounded, ill, and injured with RCCs 

and FLOs, the Air Force Wounded Warrior Program (AFW2) focuses exclusively on 

our combat wounded airmen. This program provides long-term, non-clinical care 

management for combat wounded who must meet a Medical Evaluation Board or 

Physical Evaluation Board to determine whether they are fit for duty. Focused, personal care from AFW2 allows our combat wounded airmen the opportunity to make 

informed decisions when their future career path changes due to their injuries. 

INTEGRATED DISABILITY EVALUATION SYSTEM

The Air Force has collaborated with OSD and the VA to simplify the Integrated 

Disability Evaluation System (IDES) process for servicemembers by increasing 

transparency and reducing processing time to improve the transition for 

servicemembers from DOD to VA. Overall, the IDES monthly progress report for 

February 2012 indicates Air Force Active component case processing is averaging 

360 days, down from an average of 540 days in recent years. 

The Air Force Medical Evaluation Board (MEB) and Physical Evaluation Board 

(PEB) are working diligently to meet timeliness goals and ensure quality outcomes. 

We have directed considerable leadership attention and resources targeting improved MEB and PEB decision timeliness and are on target to meet review and decision guidelines by October 2012. These focused efforts will ensure our wounded, 

ill and injured personnel receive timely reviews and adjudications of their cases. 

Along with the Army and the Navy, the Air Force is working with the Wounded 

Warrior Care and Transition Policy Office to identify a methodology for accurately 

tracking each step associated with the transition phase. 

Another venue of disability appeals administered by the Air Force is the DOD 

Physical Disability Board of Review (PDBR). As the lead component operating this 

Wounded Warrior Board, the Air Force recently partnered with the VA in its outreach efforts to ensure every PDBR-eligible veteran is made aware of their opportunity to have their service assigned disability ratings reviewed. The goal of this 

interdepartmental effort is to reach all 77,000 eligible veterans within the year. 

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OPERATIONAL RESERVE

We appreciate the opportunity to also share information about the highest quality, 

most cost efficient Reserve component in history. As the new DOD strategy is implemented and planning occurs to conform with an increasingly austere budget environment, the Air Force Reserve and Air National Guard will continue to maximize 

the advantages of Associations. Associate units have proven themselves as a solid 

solution that exploits the strengths each component offers. They ensure that the experience and cost effectiveness of the Air Force Reserve and Air National Guard 

reach their full potential. This effort is critical to mission success in an environment 

wrought with fiscal challenges. 

Recently, Congress passed much-needed legislation allowing Service Secretaries to 

involuntarily mobilize up to 60,000 members of the Reserve component without a 

national emergency. The use of this authority still needs to be planned, programmed 

and budgeted before it can be implemented. The Air Force is working with OSD to 

develop the policies and procedures to offer the fastest, most enduring support to 

not only the combatant commanders around the world, but to all our members; balancing their time between service to our country, their families, and their employers. 

The Air Force Reserve and Air National Guard are currently sustaining combat 

operations in conjunction with our active duty colleagues on five continents— 

lengthy operations which have produced strains on our airmen and our equipment. 

We will continue to define the most efficient mix of Active, Air Force Reserve, and 

Air National Guard forces best suited to the strategy in terms of cost, operational 

requirements, surge or regeneration capability, and employment of Total Force assets. By ensuring optimal mix between the Regular Air Force, the Air Force Reserve, and the Air National Guard the Total Force will not only preserve previous 

investments in readiness, capability, and capacity, but also protect the operational 

expertise of the force for future use while ensuring a rapidly expandable, trained 

and ready military. 

MILITARY PERSONNEL APPROPRIATION (MPA) MAN–DAYS

The MPA man-day resource enables the Air Force to leverage Air Reserve Component capabilities supporting military missions beyond the Active component’s level 

of capability. In late 2009, a decision was made to implement a requirements-based 

MPA man-day process as part of the Air Force Corporate Structure (AFCS) fiscal 

year 2012 Program Objective Memorandum (POM) development process. Since the 

fiscal year 2012 POM build, Air Force Major Commands have worked closely with 

the combatant commanders to identify requirements. Once submitted, requirements 

are staffed, verified and vetted through the AFCS based on priorities established in 

the Annual Planning and Programming Guidance. Additional criteria such as mission impact, critical skills, active duty manning and level of support are also weighted to finalize the prioritization. The Air Force is committed to continuing this transparent process, which is designed to ensure appropriate deployment of Reserve Component forces, enabling the Total Force to properly respond to combatant command 

requirements. 

INTEGRATION OF AIR FORCE COMPONENT PERSONNEL MANAGEMENT

We are committed to fully integrating personnel management policies, organizations, systems and processes across the Air Force enterprise, with the outcome of 

providing more effective and improved service to our airmen, reducing barriers to 

continuum of service, and increasing emphasis on unified Total Force decisionmaking. This is not only the right thing to do for our Air Force; it will drive greater 

operational efficiencies and allow transfer of resources from tail to tooth. 

Since the Secretary of the Air Force directed the integration of the three Air Force 

Component Personnel Management Systems into one, personnel from across the Air 

Force headquarters have been working to facilitate the integration and standardization of human resource management with Total Force directives and instructions. 

As of this date, analysis is underway on more than two dozen human resource activities, with the high-level policy analysis phase on track for completion in May 

2012. We are looking closely at existing policy guidance to standardize or consolidate management across components wherever practical and where allowed by law. 

This effort has a targeted implementation work plan of calendar year 2012, with follow-on actions through the Future Years Defense Plan (FYDP). 

279 

DIVERSITY

Diversity remains a top priority of Air Force senior leadership. The Air Force recognizes that a diverse force is a military necessity, and we continue on a strategic 

path to attract, recruit, develop and retain a diverse and inclusive workforce of highly qualified individuals who reflect the rich tapestry of the Nation we serve. In October 2011, a Declaration on Diversity signed by the Secretary of the Air Force, Chief 

of Staff of the Air Force and Chief Master Sergeant of the Air Force was distributed 

across the Air Force to highlight the importance of diversity to the mission. Additionally, we increased senior leader involvement in the Air Force Diversity Committee by adding the Major Command Vice Commanders, who provide invaluable 

insight on best practices throughout their respective commands. We are well on the 

way to institutionalizing our Strategic Diversity Roadmap, A Journey to Excellence 

throughout the Total Force. 

Results from our 2011 Internal Communication Assessment Group Diversity survey indicated 75 percent of airmen agreed it is important for the Air Force to attract, recruit, develop, and retain a qualified, diverse workforce as a way to maintain our edge as a superior military organization. Furthermore, 88 percent of airmen surveyed believe the Air Force is doing a good or excellent job creating diversity within the Total Force. 

Focus on Air Force outreach programs remains central to attracting and recruiting diverse talent. To that end, in partnership with OSD’s Office of Diversity Management and Equal Opportunity, the Air Force plans, coordinates and oversees national-level diversity outreach programs supporting our diversity goals and objectives. Further, to maximize resources, we utilize a Total Force perspective to determine which events and opportunities provide the best return on investment. We 

have 80 outreach events planned for 2012, including the Black Engineer of the Year 

Awards, Joint Women’s Leadership Symposium and the Hispanic Engineer National 

Achievements Award Corporation Conference. We continue to place emphasis on 

education, health, and mentoring in the Science, Technology, Engineering, and 

Mathematics disciplines through our community engagements, and feedback from 

community influencers has proven very positive thus far. 

Finally, the Air Force supports the Military Leadership Diversity Commission recommendations and is poised to support Executive Order 13583, Establishing a Coordinated Government-wide Initiative to Promote Diversity and Inclusion in the 

Federal Workforce. Upon OPM’s release of the government-wide Diversity and Inclusion Strategic Plan, we will work with OSD to develop a plan of action and milestones to support the President’s goal of using the talents of all segments of society 

by enhancing our ability to recruit, hire, promote, and retain a more diverse workforce and creating a culture that encourages collaboration, flexibility, and fairness 

to enable individuals to participate to their full potential. 

U.S. AIR FORCE ACADEMY

The U.S. Air Force Academy (USAFA) continues to provide an exceptional environment for educating, training and inspiring men and women to become outstanding officers, motivated to lead the U.S. Air Force in service to our Nation in 

a challenging global environment. Senior Air Force leadership continues to energetically engage in the Academy’s oversight, ensuring cadet train, study and live in 

a safe and productive environment. We continue our close working relationship with 

the USAFA Board of Visitors (BOV), enjoying frequent interactions with Ambassador Susan Schwab, USAFA BOV Chair, who is keeping the BOV vitalized and actively engaged in providing external Academy oversight. 

In the past year, USAFA cadets received numerous accolades for their undergraduate work, including one Rhodes scholar and two Marshall scholars, recognition 

by U.S. News & World Report as having the #2 Aerospace/Aeronautical/Astronautical Program in the Nation and #1 undergraduate-only institution in research funding-over $70 million, and being ranked by Forbes #10 of 610 of America’s Best Colleges. In addition to outstanding academics, the cadets have also excelled in athletics, being #2 of 120 NCAA Division I football programs in academic progress 

rates, #1 of 9 academically in the Mountain West Conference, and for the second 

consecutive year, the Academy’s football team will visit the White House to receive 

the Commander in Chief’s Trophy from the President. The President will also give 

this year’s commencement address at the Academy. 

Respect for human dignity is at the core of the USAFA environment. USAFA is 

a leader in developing programs for the prevention of and responding to incidents 

of sexual assault and sexual harassment, gender relations issues, and religious tolerance. The Academy is currently conducting Religious Respect Training, which involves cadets, faculty and staff, using training scenarios designed to spur critical 

280 

thinking on religious tolerance and actions. While the Academy had an uneventful 

‘‘Don’t-Ask/Don’t-Tell’’ transition, it is unfortunately in the midst of investigating 

several cases of alleged sexual assault and illegal drug use. 

USAFA is working hard to preserve an outstanding training and educational environment in a fiscally challenging environment. As part of the AF response to the 

requirements of the Secretary of Defense’s August 2010 Efficiency Memorandum, 

USAFA is reducing its civilian workforce by 67 positions (∼4 percent of its current 

workforce). The Academy is currently in the process of selecting members for the 

Class of 2016 while focusing efforts to ensure the size of that class supports the 1 

Oct 2012 cadet wing end strength target of 4,000. 

CONCLUSION

The hallmark of the U.S. Air Force’s success has always been, and will remain, 

our people. Nearly 2 decades of sustained combat, humanitarian, and stability operations have imposed extraordinary demands on our forces. Yet our airmen continue 

to contribute significant capabilities to the joint team and do so with the integrity 

and excellence familiar to the global community. We will continue to size and shape 

the force through all necessary means while retaining an intrinsic value that attracts and keeps the highest quality airmen. We are a smaller force, but a ready 

force. By sustaining accessions for the long-term and balancing the total force to 

meet operational requirements, your U.S. Air Force, with its joint partners, provides 

unmatched capabilities across the spectrum of operations. 

Senator WEBB. Thank you very much, Secretary Ginsberg, 

I am going to ask three questions, and then I am going to move 

along to whichever other Senators on the subcommittee wish to ask 

questions. 

First, Secretary Ginsberg, let me ask for your clarification on 

something. When I was in the Pentagon, the way the budget process worked was, first, the Services got together with their different 

components. They got the budget submissions. They argued against 

a top line. They figured out their budget. Then the different Services presented their budgets to OSD, and I sat on the Defense Resources Board (DRB) for 4 years. The DRB would examine the 

Service budgets. They would challenge different components of it. 

You came up with a DOD budget signed off by the Deputy Secretary of Defense and eventually by the Secretary. That was then 

brought to the Office of Management and Budget (OMB). OMB 

scrubbed it. Then you had a DOD budget, and it came over here 

to Congress. Once it came over to Congress, DOD as a whole was 

expected to support that budget. 

Is that the way things work? 

Mr. GINSBERG. Yes, sir. I think that is fundamentally the basic 

outline of the way it works today. We develop our budgets through 

what we call the corporate process. What that really does is bring 

together every component of the Air Force, every office that has equity in the budget, and we develop a program that is, of course, 

meeting the strategic guidance the President lays out then within 

the fiscal realities and we submit it to OSD. The other Services 

have a chance to look at it. We develop a program and then we 

submit it up through OMB. 

Senator WEBB. It is a corporate process? 

Mr. GINSBERG. Yes, sir. 

Senator WEBB. For instance, a little more than 20 years ago, 

there was an Air Force Chief of Staff named Larry Welch who I 

had served with in the Pentagon and who was widely expected to 

become Chairman of the Joint Chiefs of Staff. He went over to the 

House side and had a discussion with Les Aspin about a tradeoff 

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grams, how much money would go into one or the other. He made 

a statement that he would personally support—in his opinion, he 

could personally support something that had not been in the budget. By the time he got back to the Pentagon, he was reprimanded 

by the Secretary of Defense. 

There was an article in the New York Times yesterday about the 

Air National Guard lobbying the Hill against budget cuts that were 

in a scrubbed budget. Are you aware of that effort? 

Mr. GINSBERG. No, sir. I read that article. I do not know specifically what that was referring to. No, sir. 

Senator WEBB. It said for 2 months the Air National Guard, with 

the help of Governors from every State, has been battling the Active Duty Air Force over proposed budget cuts. I can hear Senator 

Graham wanting to get to the mic here. [Laughter.] 

What do you think about that? 

Mr. GINSBERG. Sir, I do not know exactly what that is referring 

to again. So, of course, there you have the adjutants general of the 

States who are the chief military advisors in the State role to their 

Governors. When they are the adjutants general, they are—— 

Senator WEBB. What if they are over here in uniform? 

Mr. GINSBERG. What is that? 

Senator WEBB. What if they are over here in uniform? 

Mr. GINSBERG. It depends on what business they are carrying 

out, sir. 

Senator WEBB. If they are carrying out this particular business 

mentioned in this particular article. 

General Jones, do you have a thought on that? 

Mr. GINSBERG. I cannot comment on a specific hypothetical. Sir, 

I do not know exactly again specifically the specific situation. 

Senator WEBB. General Jones, do you have a comment on that? 

General JONES. Senator, I am familiar with the article you are 

speaking of. When we prepared the budget, it was a budget that 

was designed to look at the new strategy, a balanced approach, and 

that is certainly what the Chief and the Secretary feel like they 

need to bring forward that balances the requirement for the Guard, 

the Reserve, and the Active Duty to coexist to support each other 

in a role that allows us to use each to their strengths. I feel like 

that is the proposal that was laid out by the Chief. Obviously, some 

people have opinions of the proposals and the details of it. But I 

really feel like the budget was something that was put together. 

The proposals were vetted. They were discussed, and it was a collaborative effort or a cooperative effort. Not every decision was 

agreed upon 100 percent, but when you have to make decisions, 

they will not all be agreed upon. 

Senator WEBB. We may end up coming back to that or someone 

may end up coming back to that. 

General Milstead, you and I had a discussion about this. This is 

the front page of the Marine Corps Times this week. Grunt training for women starting now, infantry school admissions, new combat tests, et cetera. The Internet is abuzz with this decision. There 

are a lot of people wondering what the inception of it was, what 

the plan is. I think this is an opportunity maybe for you to explain 

how this decision took place, how you project this moving into the 

future as well. 

282 

General MILSTEAD. Yes, sir. It is important to put that story and 

the story that was in the New York Times as well in context. It 

is also important to make sure that folks understand what it is 

and, more importantly, what it is not. 

Assignment policy for women has not changed. We are not training women to be infantry officers. We do not have that authority. 

That authority resides with Congress. 

What we are doing is deliberate research. If I may, the National 

Defense Authorization Act (NDAA) for Fiscal Year 2011 directed 

OSD and the Services to review the policies and the laws and the 

regulations that pertain to women in the Service and to report 

back. They stood up a working group with members from all the 

Services and they reported back in February. That report included 

a request from Congress to conduct an exception to policy and what 

we call a pilot program. It also asked for the authorities. It stated 

that they were removing the collocation restriction, and then the 

Secretary further directed—— 

Senator WEBB. Just for clarification, what was that request? 

What was the nature of that request when you said the report included a request for a pilot program? All Military Occupational 

Specialists (MOS)? 

General MILSTEAD. Thank you, a request to take open MOSs and 

to establish them at a lower level. For instance, in the Marine 

Corps, we did not have women below the division level in certain 

MOSs. So it was a request for an exception to policy to take a 

woman in an MOS that she is already authorized to serve in and 

put her down to the battalion level. We intend to do that as part 

of the research. 

The Secretary further tasked the Commandant and the other 

Service Chiefs to come back to him in 6 months and give him their 

personal recommendation. So what we are doing is we are doing a 

measured, responsible, and deliberate research, a comprehensive 

plan, so that the Commandant, when he does give his recommendation to Secretary Panetta, it will be based on an analyses. It will 

be based on quantitative information and on research, and it will 

be an informed recommendation. 

Senator WEBB. To clarify the record, because there are a lot of 

people who are following this, what I understand that you are saying is that this is pursuant to a request by the Secretary of Defense. The opening up of infantry schools, et cetera, is pursuant to 

a request by the Secretary of Defense for the Commandant to give 

him a report in 6 months on feasibility. 

General MILSTEAD. That decision was ours. We felt that we could 

take volunteers—and they are volunteers. They have to be volunteers under the protocols—take women officers when they come out 

of the basic school, women volunteers, subsequent to the MOS that 

they will be going to, to attend the Infantry Officer Course (IOC), 

not to become infantry officers, but to see how they do and to capture data which will be given to the Commandant which will allow 

him to make an informed recommendation to the Secretary how we 

proceed. 

Senator WEBB. We need to understand the origins of this experiment. That is why I am trying to get it clear for the record. The 

NDAA gave a broad recommendation, as I understand what you 

283 

are saying. Then the Secretary of Defense gave a further request 

that within 6 months certain recommendations from the Services 

come to the Secretary of Defense? 

General MILSTEAD. That is correct. 

Senator WEBB. This is pursuant to that request? 

General MILSTEAD. The decision being within our own wire. It is 

the Marine Corps. He did not tell us to open IOC. The Commandant—we came to him with a research plan and said we want 

to push people down to the battalion level, assess that. We want 

to take some women. We want to put them into IOC, see how that 

comes up. We want to come up with common gender-neutral standards. We want to do a test based on physical fitness for both men 

and women to see what the level playing field is. It is all to come 

to the Commandant and allow him to make an informed recommendation to the Secretary of Defense on the way he thinks 

that we should proceed. 

Senator WEBB. So when a male officer finishes IOC, is he automatically entitled to one of two MOSs? Right? 

General MILSTEAD. Yes, sir. That is correct. 

Senator WEBB. So, if a female officer finishes IOC? 

General MILSTEAD. If a female volunteer attends IOC, it is not 

for the purpose of getting the 03, 02, or 02, 03 MOS. She will not 

receive that MOS. 

Senator WEBB. But if she successfully concludes—— 

General MILSTEAD. Even if she successfully completes. This is 

not to make female infantry officers. 

Senator WEBB. You are going to get a lot of comment on that. 

General MILSTEAD. Yes, sir. 

Senator WEBB. Secretary Lamont, very quickly, because I wanted 

to ask a question of each of your Service representatives. Eight 

years ago this week, I spoke at the Army Infantry School on a lessons-learned package that they had talking about my experiences 

in Vietnam. That night, we had a reception at the commanding 

general’s house, and they informed us that Pat Tillman had been 

killed. I think, first of all, it is a little sad that we are not remembering what this individual did for the respect of the military, leaving millions of dollars behind and voluntarily enlisting and going 

over and serving. 

But what happened after that, the way that his death wrongly 

characterized, apparently even when the Army knew it was a 

friendly fire incident, and the existence of private communication 

inside the general officer corps warning the Army that this was a 

friendly fire incident—even his family did not know it—was a really tragic circumstance for the family, and I think a stain on the 

Army’s reputation. 

We then had an incident at Wanat where certain commanding officers were held accountable by a U.S. Central Command 

(CENTCOM) investigation and then their accountability was removed by the Department of the Army subsequently. 

We just had an incident not too long ago with a soldier who apparently was shot by his own platoon leader accidentally during a 

night engagement but was left on the battlefield when others were 

evacuated, and there does not seem to have been a lot of accountability. 

284 

Maybe, General Bostick, you would like to comment on it, either 

or both of you. What is the Army doing in terms of reinforcing the 

notions of the accountability of senior leadership? 

Mr. LAMONT. I am certainly aware of the situation with that captain, as I recall. Actually, I think he may have been a 1st lieutenant at the time. As I understand it, it was at night. They did not 

have awareness of where the fallen victim was until later. I do 

know he was reprimanded. Unfortunately, I also understand he 

was subsequently promoted. But I do recall that there was a significant review, and, in fact, the Secretary, as recently as 3 weeks 

ago, I think, met with the father of the young victim. 

General BOSTICK. First, our heart goes out to all of the loved 

ones that have lost soldiers on the battlefield. 

We realize that in our Army and the way we fight, we place huge 

responsibilities on the shoulders of young sergeants and lieutenants and captains. They have to make on-the-spot decisions that 

sometimes are life-threatening-type decisions. We count on them to 

do that every day. 

We also count on leaders to train them and to be accountable for 

their behaviors. When things go wrong—and they always will in 

war—then we expect to thoroughly investigate each one of these incidents. That is what happened in each of these. 

I can tell you in the case of Wanat, my wife taught that young 

man when he was in elementary school. So for us, it had special 

meaning, and I know the parents very well. I know Hondo Campbell, who was asked to review the situation by the senior leadership of the Army, took in the new evidence that came on board, 

and he made his decisions, and the Secretary of the Army stood by 

those decisions. 

But I think in each one of these cases, our responsibility is to 

make sure that if an investigation is due, it is thorough, it is proper, and that we report back to the families and we provide the care 

and compassion that they need to get through it. 

Senator WEBB. Thank you. 

Senator Graham. 

Senator GRAHAM. Thank you, Mr. Chairman. 

Secretary Lamont, you mentioned efforts to deal with sexual harassment and sexual assaults in the Army and the military, in general. Is there anything this subcommittee can do or tools we can 

provide or money we can appropriate or recommend to be appropriated that we are not doing? 

Mr. LAMONT. I would hesitate ever to say you do not need to give 

us any more money. But on the whole—— 

Senator GRAHAM. You do not have to give a definitive answer 

today. 

Mr. LAMONT. Right, and I appreciate the opportunity to do that. 

I think we are making every effort, frankly, to create the kind 

of professional climate that gives to every soldier the dignity and 

respect that he or she deserves. I do not know that it is a money 

question. Although under the new NDAA requirements that we 

shall have sexual assault counselors and victim advocates at the 

brigade level, we understand that our numbers would suggest 

roughly 980 personnel. The fact that we are under a civilian cap 

now at OSD will in itself create some problems because we will 

285 

have to have a mix of both civilian and military to meet those requirements. I think right now that is the only thing that I would 

suggest that we would need from this committee. 

Senator GRAHAM. Can I ask the same question of the Navy and 

the Air Force? 

Mr. GARCIA. Senator, I would say that we believe we have the 

resources and the commitment and the emphasis on the issue, that 

we do not need any extra tools. You asked this question. At the end 

of our ‘‘sexual assault awareness month’’ where every unit in the 

Department of the Navy has just had four separate stand-downs 

over the course of this month to emphasize the priority that our 

leadership has in ending this scourge of sexual assault and harassment across the force. 

I am certain you are familiar with the Secrtary of Defense’s new 

guidance on convening special courts martial at the 06 level. 

Prior to this across the Navy, we have trained our Naval Criminal Investigation Service personnel to be dedicated field experts in 

capturing and sustaining and protecting evidence in crime scenes. 

Our Judge Advocates General and our Staff Judge Advocates are 

trained in the most effective prosecution strategies where appropriate, expedited transfer for members who request it within 72 

hours. That is all on the response side. 

If I could take one more second to speak to the prevention side. 

Every new sailor or marine in our department right now, when 

they go to their A school, their first training school, will receive bystander training, bystander intervention training. Every leader, enlisted leader and officer leader, will be trained in ensuring their 

command environment eliminates the stigma for an individual, preventing an individual from being willing to report such an incident. 

You may have followed—I guess it has been about 3 weeks now. 

Our Secretary, our Commandant, our Chief of Naval Operations 

rolled out our new 21st Century Sailor and Marine Initiative, and 

a key cornerstone of that, the readiness piece, includes an effort to 

end sexual assault and acknowledge the undeniable correlation, the 

link between irresponsible alcohol use—close to 50 percent of our 

sexual assaults involve it in some way or another, and that is why 

we are introducing the use of breathalyzers that I suspect you are 

familiar with. 

So I think we have the tools to combat this. 

Mr. GINSBERG. Senator, there is absolutely no place in the Air 

Force for sexual assault. This is really everyone’s responsibility. It 

is a command responsibility. It is every airman’s responsibility to 

not just go after those who perpetrate this action but also to create 

a climate that reduces the likelihood of this occurring. We are not 

just following up the direction, of course, that of Secretary Panetta 

who has, as Secretary Garcia laid out, mentioned later a whole series of actions from elevating the level for a disposition of case to 

the 06 level, but we are also taking a number of steps on our own, 

including putting $2.4 million for additional Office of Special Investigations investigators. 

As Secretary Lamont mentioned, though, there is going to be an 

additional resource requirement with the additional full-time victim advocates, and we are going to address that in the fiscal year 

2014 budget. 

286 

Senator GRAHAM. I think the committee would appreciate in 

writing anything that you need from us, Uniform Code of Military 

Justice changes, regulatory changes, funding requirements, new 

positions, so that we can say in Congress we have done everything 

within our power to help you do a job that needs to be done and, 

quite frankly, has to be dealt with more seriously. So if you could 

do that in the next week or 2, we would appreciate it. 

Senator Webb brought up the conflict between the Reserve component and Active Duty component in the Air Force. I just want 

to say I have not been visited by anybody from the Air Guard to 

tell me what to do or not do about the proposed force structure. I 

have decided that on my own, right or wrong, that 5,000 out of the 

Air Guard and Air Reserve and less than 1,000 out of the ActiveDuty Force is probably not the right mix. Some of the airframes 

that we will be retiring—I am not so sure that is wise. In a downsized world, you have to have the right mix of Active Duty, Air Reserve, and Air Guard personnel. 

The Council of Governors entity—what is the latest on that? 

Mr. GINSBERG. Sir, I think you have received—— 

Senator GRAHAM. Yes, I think we got it yesterday. 

Mr. GINSBERG.—some correspondence, but their proposal from 

Secretary Panetta is basically to put back 24 C–130 and about 

2,200—— 

Senator GRAHAM. Right. 

Mr. GINSBERG. Sir, if I could just talk about that. Obviously, we 

talked about hard choices in my opening statement. This is, of 

course, one of the many hard decisions that the Air Force had to 

make. We had a new Strategic Guidance that came from the President that talked about being more flexible, agile, told the Air Force 

that we were going to have a very high operational tempo over the 

long term. At the same time, we had the BCA, $487 billion off the DOD top line over 10 years. For the Air Force, that meant about $54 billion 

over a 5-year period over our FYDP. 

So in order to meet the strategy and to be responsive with the 

limited resources, we had to feed in overseas presence. We had to 

maintain rotational demand and make sure that the operational 

tempo was manageable across not just the Guard and Reserve and 

Active. So we were really concerned about balancing the budgets on 

the backs of our people. 

Senator GRAHAM. I got you. I met with General Breedlove and 

Secretary Donley and had a real good discussion about what went 

into the decisionmaking process. 

The question for me and I think Members of Congress is $487 

billion, given the threats we face—is that too much? I think certainly we need to do north of $400 billion, but when it comes to 

the Air Force, the Reserve component got hit pretty hard. 

This Council of Governors negotiation, I think, is an appropriate 

thing for you to be doing because they are affected by the decisions. 

Hopefully, we can find some compromise that people will feel comfortable that we have the right mix particularly in the Air Force. 

I do not think it is really a concern in the other Services. 

But my final question is as we go forward in a down-sized environment of having to reduce the military, the Army by 80,000, 

287 

what should the Nation know about future conflicts in terms of 

how we meet future land engagements? Hopefully we do not have 

another Iraq, Afghanistan war anytime soon, but the possibility of 

a large land force being deployed is not unheard of or impossible 

to imagine in the future. 

General Odierno told the Appropriations Committee that if we 

had another Iraq-like conflict where you had a large number of 

forces deployed over a fairly significant period of time, that with 

the reduction of Active-Duty Forces of 80,000, that 50 percent of 

that combat power and support power, personnel, would have to 

come from the Reserves and the Guard. Does that surprise you, 

Secretary Lamont? 

Mr. LAMONT. Not greatly. Clearly we are going to be in need of 

a significant operational Reserve. To the extent that we have the 

trained and ready forces to support a smaller Active component, it 

is absolutely essential. 

Senator GRAHAM. The only reason I mentioned that is, I think, 

that probably is true, and that does mean the Air Guard and the 

Air Reserve who do the fighting and the refueling and the transport—we have to look at the Guard and Reserve anew. If our Active Duty component is going to be reduced to the point, at least 

on the Army side and probably to the Air Force side too, where the 

next major engagement will be one out of two people will be a 

Guard member or a reservist for a very long period of time, we will 

have to come to grips with that as a Nation. Is that where we want 

to go? If we want to go, we will have to plan for it because I do 

not think anyone has ever planned for that before. 

Mr. LAMONT. I think we have to be very careful because as we 

reduce the Active component of the Army, we may very well find 

it necessary to shift further capabilities into the Guard and Reserve. If we are going to do that, then we better make sure they 

are trained and ready to go. So as we get into the budget process, 

we have to ensure from our standpoint that we have sufficient 

funds for not only full-time support to assist the Guard and Reserve, but to also have the training monies. We are very good right 

now on the equipping level, but we are a little concerned that we 

have sufficient and adequate funding to train them at the readiness level that we know we will need to do. 

Senator GRAHAM. Thank you. Mr. Chairman. 

Senator WEBB. Thank you, Senator Graham. 

Just as an aside on your very important question, when I was 

responsible for the Guard and Reserve programs in the 1980s before this current evolution that we see in Iraq and Afghanistan, the 

way that the total force was designed at that time was approximately half of the combat support and about two-thirds of the combat service support, as I recall, in the Army was in the Guard and 

Reserve. They wanted to keep the immediate deployers, the combat 

units, fully manned up to, I think, 18 divisions at the time. We are 

probably going to end up with a similar formula as we draw down. 

General Bostick, what was the Army’s Active Duty strength on 

September 11? Do you recall? The point being, just to get to it, is 

that the number you are going down to now is slightly above where 

it was on September 11. Is that not correct? 

288 

General BOSTICK. Yes, Senator. It was about 482,000–483,000. 

We are going to come down to 490,000. 

Senator WEBB. Are you comfortable with that number? Is the 

Army comfortable with that number? 

General BOSTICK. I think, Senator, given the strategy that has 

been laid out, we are comfortable given the assumptions that we 

can make. We are never very good in the assumptions that we 

make about the future, but given the assumptions that we have 

made, given the strategy that we have outlined, we are comfortable 

that if we stay on the ramp that we are on in terms of drawing 

down the Army end strength, that we can do this in a reasonable 

way and take care of soldiers and families as we come down and 

still meet the missions that we have been asked to do. 

Senator WEBB. Thank you. 

Senator Ayotte. 

Senator AYOTTE. Thank you, Mr. Chairman. 

General Bostick, if I can just follow up on the end strength reductions on a couple of different fronts. First of all, with the 72,000 

in end strength reductions in the Army, how much—call it what 

you want, how much latitude did you build in there? How much 

contingency did you build in there? Where are we in terms of being 

on the edge of a position where we could put ourselves in a place 

where we would hollow out our force? As we think about 72,000, 

how much did we build in there that we may have made a mistake 

in terms of future contingencies that we are asked to respond to? 

General BOSTICK. From an operational standpoint, Senator, I 

would say again, given the strategy that has been outlined from 

the President, we look at that strategy, develop a force structure, 

and then our job is to man that force structure. So based on the 

strategy and the assumptions that go into that strategy, if we can 

stay on the ramp that the Secretary and the Chief have asked us 

to stay on through the end of 2017, there will be risks there but 

we believe we have mitigated the risk as best we can. 

Where we can get hollow is in a number of areas. A lot of folks 

think about hollowness of a force in terms of people. But the Chief 

and the Secretary have said that they need a balanced force, and 

we are not going to retain force structure to hurt ourselves in readiness, and readiness could be in training readiness, it could be in 

the quality of life for our soldiers and families, it could be in modernization. So currently the biggest portion of our budget, 45–46 

percent of our budget, is in personnel and it is in manning. So we 

have put the risk in other areas beyond personnel. 

Senator AYOTTE. What are our current dwell times and where 

would the end strength reductions—where will we be with dwell 

times? Also, can you tell me what the dwell times are in particular 

for the military occupational specialties? 

If what you have told us thinking about we have an unanticipated contingency because, as you have noted, we have been particularly bad at predicting our next conflict, where does that bring 

us in terms of needing to reverse the Army’s end strength reductions? 

I know that is a series of questions, but if you can help me where 

we are with dwell times, where does this bring us with the end 

289 

strength reductions. It is one of the concerns I have about the readiness of our forces. 

General BOSTICK. The dwell times—and it is a difficult question 

to answer simply because dwell is an individual metric. If you add 

it all up, when I testified last year, the dwell was about 1 to 1.5. 

Today it is about 1 to 2. But there are MOSs like our aviators, our 

infantry, and those low-density MOSs that have much lower dwell 

times. It varies on grade. So if you are a young junior enlisted, 

then your OPTEMPO and your dwell is lower than a senior officer 

or a senior non-commissioned officer (NCO). But if you add it up 

across the Army, it has been a long time that it has taken a reach 

of 1 to 2 dwell, but we are there now except for some of the key 

MOSs that I talked about later. 

We are very concerned on end strength as we come down. If we 

come out of Afghanistan as planned in 2014, that is when the majority of—our bigger end strength reductions will happen in 2014 

and beyond. So the temporary end strength increase of 22,000 that 

Congress and the Secretary of Defense have authorized us to have 

is helping us meet the demands of our deployers. So we have no 

issues with meeting our deployer strengths at their late arrival 

dates, have had no issues with ensuring that they are able to have 

end strength in addition to compensate for their disability evaluation system, the soldiers that are involved in that. So from an end 

strength perspective and the glide path that we are on, I feel fairly 

comfortable as long as we are able to maintain the Overseas Contingency Operations (OCO) dollars. Everything above 490,000 is 

not in our base. It is an OCO. So that is something that we have 

to fight for each year. 

In terms of your last point on reversibility, we have asked Congress for the ability to increase the affiliation bonus from Active 

component to Reserve component from $10,000 to $20,000, and we 

think that will allow us to put more of our NCOs and officers that 

are leaving the Active Force into the Reserves. What the Chief and 

the Secretary have asked us to do is put some of our young captains and senior NCOs in drill sergeant status and recruiting, more 

of them in those positions and more on the platform in our institutional Army, if you will, so that if we had to grow the Army quickly, the part that we cannot grow is our mid-grade officers, our midgrade NCOs. So if we have them in some of our school locations 

where we have pulled them out or converted it to civilian positions, 

we would have some flexibility to grow the Army. 

Senator AYOTTE. How many are going to receive involuntary termination in terms of officers and NCOs with the drawdown, the 

72,000 drawdown? 

General BOSTICK. I do not have a specific number on that. We 

have asked Congress for the authorities to have involuntary separations. There will be some officers and there will be some very 

good NCOs that will want to stay in the Army and will probably 

not. 

What the Secretary of the Army and the Chief have said is that 

is our last resort. They want to do this without involuntary separations. Also on the voluntary separations like we had in the 1990s, 

we open it up to everyone, and a lot of our very best folks would 

leave. 

290 

We think we can manage it, but there will be some especially in 

the 2014–2015 timeframe that on this ramp will have to leave by 

other than natural causes. 

Senator AYOTTE. General, I would really very much appreciate if 

you could get us an estimate of how many involuntary terminations 

there will be both in the commissioned and then the NCOs. 

Also, I think it is really important for people to understand, as 

I understand it, that some of those people that are going to get involuntary terminations have done multiple tours for us in these 

conflicts that we have been fighting. 

Mr. LAMONT. Could I just very quickly address a couple of your 

issues? You have mentioned the dwell time, but I want to let you 

know, we are moving our deployment cycle down to a 9-month 

cycle. So we hope that will help reduce some of our stress on the 

force and maybe even eventually, as we reduce in Afghanistan, our 

dwell time will then rise. 

As you say on the hollowing out of the force and our concern with 

our assumptions, the problem is the enemy always gets a vote. We 

never know what the enemy is going to do. We do not know what 

contingencies are going to arise, and we must be extremely careful 

in how we plan for reversibility and expandability as necessary. 

Just on some of the numbers, I hate to throw out numbers, but 

I have seen numbers that will approach in the enlisted category 

perhaps as high as the mid-20s, 23,000, 24,000, and on the officer 

contingent—again, these are very rough numbers and all based 

gain on assumptions and attrition rates, but officers may go up to 

4.5 to maybe 5,000. 

Senator AYOTTE. That is a very significant number for many who 

have done multiple tours for us. So I think the American people 

need to understand that in terms of some of the choices that we 

are making. 

I very much appreciate all of your being here. I have some followup questions that I will probably submit for the record on other 

issues. Thank you. 

Senator WEBB. Thank you, Senator Ayotte. 

Senator Blumenthal. 

Senator BLUMENTHAL. Thank you, Mr. Chairman. 

Thank you all for your excellent work in a time of great challenge, and thanks to all the men and women who serve under you. 

I have some questions that really relate to the responsibilities 

that will be increasingly important placed on our Reserve and National Guard and in particular on the transition assistance that we 

give them as they come, many of them, off Active Duty to go into 

the Reserve, which has been a focus of mine, and also on the employment opportunities once they return to civilian life. 

I am troubled by reports—and you may want to comment on 

them—that there are instances of discrimination. I do not know 

how to put it any more politely, but discrimination against reservists or National Guard because of the possibility that they may be 

deployed and therefore unavailable in their workplaces, number 

one. 

Number two, whatever transition assistance we can give them 

while they are in the military but also afterward when they are in 

civilian life, a Transition Assistance Program (TAP) type of assistVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00296 Fmt 6601 Sfmt 6602 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
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ance. I know that many of the Services—I am most familiar probably with the Marine Corps and what it is doing to expand the 

TAP. 

I would ask you to comment on those areas of transition assistance and employment opportunity when our Reserves and National 

Guard come off Active Duty and also the kinds of help we are giving to our veteran services. 

Secretary Ginsberg? 

Mr. GINSBERG. Senator, thank you. There are a couple issues 

there that you really raised that are very critical for our Air Force 

and our future. There is a very key readiness concern there that 

if our Guard and Reserve airmen do not feel like they have the 

support of their employers, they are not going to be raising their 

hands to volunteer for the missions, whether a pop-up contingency 

or some type of steady state action. So we need to make sure, in 

addition to the family support and the direct support we provide 

them, that we have the backing of their employers. So this is absolutely vital for our Air Force, and what we have been trying to do 

is communicate across the force to the families, to the employer 

partners that we are going to really need our Guard and Reserve 

over the long term. 

Of course, if an airman does have a problem, we encourage them 

to file a real complaint, obviously, to be investigated by the Department of Labor. So very vital there. 

But the other issue there, sir, is the one you mentioned about the 

transition support, and that is a realm where the President has 

made it a very top priority. We are going to be working to make 

TAP available to our Guard and Reserve in a way that really has 

not been available to them over the long term. So any Guard and 

Reserve member who goes on a deployment over 180 days is going 

to be eligible for a full range of transition programs, counseling, resource databases. That is all going to be put at their fingertips. But 

we are moving out on that and it is a key concern to us. 

Senator BLUMENTHAL. Thank you. 

Secretary Garcia? 

Mr. GARCIA. Senator, thank you for your question. 

We too have heard anecdotally accounts of our reservists having 

difficulty in employment and coming back to returning employers. 

We have run each case to ground. 

But I think I would have to point out as well the other side of 

that coin, that on the Navy side alone, we have mobilized 67,000 

reservists for year-long mobilizations over the course of this war. 

The Navy reservist model is a little bit different. They tend to follow their Active Duty service. They tend to be a little bit older demographic. The overwhelming evidence is that supporters, especially against the backdrop of a struggling economy, with these 

Navy personnel have accommodated in many cases voluntarily paying the differential between their mobilized salary and that which 

they have made in their civilian capacity, and it is real patriotism. 

Our Marine Reserve model is a little bit different. Those cases 

that have run up against the regulations and the law, and those 

cases—we have run each one to ground. 

Secretary Ginsberg mentioned the work we are doing with our 

counterparts at Labor, OMB, and the Department of Veterans AfVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00297 Fmt 6601 Sfmt 6602 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
292 

fairs (VA) in fleshing out the details of the Veterans Opportunity 

to Work to Hire Heros Act of 2011, known as the ‘‘VOW to Hire 

Heroes Act.’’ 

But above and beyond that, the TAP reform that both Services 

are doing, initiatives like the American Corporate Partners, where 

heads of a stunning number of companies across America have 

reached out to serve as mentors for our separating personnel as 

they go through TAP. Within the Department of the Navy, every 

separating member, to keep them on the team to the maximum extent possible—for example, at Naval Sea Systems Command which 

is our largest civilian hiring entity, we set a goal of hiring 365 departing members last year, one a day, and we have hired 500. We 

have set a goal for 300 this year. 

So the transition process is receiving full priority. 

Senator BLUMENTHAL. I do not mean to disparage employers in 

general. I think that the instances of alleged discrimination or nonhiring are a small minority, but as Secretary Ginsberg said, they 

create disincentives that may have a ripple effect or ramifications 

beyond that. I agree with you. My impression is the vast majority 

of employers want to do the right thing. 

I am very interested, I know Senator Graham has asked about 

sexual assault, and I commend the Secretary of Defense and all of 

you who have taken a really increasingly hard line on that issue. 

But I want to ask about an unrelated issue—and I would like to 

follow up in questions because I want to give my colleagues a 

chance to ask some questions and that is, suicide prevention. How 

are we doing? Any progress to report? Any comments for us? 

Mr. GARCIA. I had the opportunity to respond to Senator Graham’s question earlier. General, do you want to start this one off? 

General MILSTEAD. Of course, one is too many, and nobody is 

dancing in the end zone, but we are doing better. If you look at the 

numbers, calendar year 2009 was the dark year for us. We were 

at 52. The next year we came down to 37, and this past year we 

were at 33. So the glide slope is right, but again, until you get a 

zero—and so far this year we are at 12, a little bit ahead of where 

we were last year, but I am not sure what that means. 

We continue to work this. In the Marine Corps, we have given 

this to our NCOs. We continue with our training. Now we have a 

training program for our junior marines, for our NCOs, and then 

for our young officers and staff NCOs, our platoon sergeants and 

our platoon commanders. But the NCOs—those are the guys that 

have their fingerprints all over the guys and gals, where we see 

this, the young ranks. 

So we are optimistically hopeful, but this is something that we 

will continue to work at until we have zero. As you are well aware, 

Senator, this is a national problem. It is just not within the military. But it has the Commandant’s attention. It has all the Services’ attention. 

Admiral VAN BUSKIRK. Senator, I would like to add we are also 

putting more resources towards it, and just recently we have 

added—we have operational stress training teams out in the fleet 

concentration areas that can be out there among our sailors, our 

men and women, out there so they can help train our leadership 

to identify the signs of increased stress with our servicemembers 

293 

and then additionally be a resource that they can actually go on 

board the ships to help counsel our people as well. 

24/7 hotlines as well that we are manning to ensure we have the 

people available to counsel at any time a person has some indication that they may have some problems. 

So I think adding that and adding additional leadership focus to 

this is critical. But certainly we do not like the trends we are seeing across the Services and we want to continue to combat and put 

the resources against it, sir. 

Senator BLUMENTHAL. Thank you. 

Mr. GARCIA. If I could just punctuate that point, Senator. I think 

in some part what makes this such an agonizing problem, each of 

us reviews the operations reports each morning from the night before, and to try to discern a pattern in these cases is so difficult. 

Across the Department of the Navy, we will typically see about five 

and a half suicide events per day, that is, ideation, attempts, or in 

the worst case, the act. It is not rare to have days, five and a half 

more incidents, where the members involved have never deployed. 

It is difficult to make the correlation, the formal link, between the 

operational tempo and the deployment piece. 

It took me a while to get to this point. What I take some comfort 

in is that an ideation event, if it does not culminate in an attempt, 

or, God forbid, the actual act, I want to believe is a sign that we 

are making progress in that a sailor or marine knows the resources 

to go to. His shipmates, his fellow marines, are recognizing the telltale signs and are reaching out and getting information to the right 

people. 

Senator BLUMENTHAL. Thank you, all. I really appreciate your 

excellent answers. Thank you. 

Thank you, Mr. Chairman. 

Senator WEBB. Thank you, Senator Blumenthal. 

Senator Vitter. 

Senator VITTER. Thank you, Mr. Chairman, and thanks to all of 

you for your service. In that vein, by the way, we just had Navy 

Week in New Orleans associated with commemoration of the War 

of 1812, and I got to meet a number of servicemembers. They happened to all be Navy. But I tell you what. We have a lot of problems and a lot of challenges, but it is not the young people in the 

military. So thanks for your leadership and thanks for them. 

I have some questions focused on some concerns I have with the 

cuts and proposals as it affects Louisiana. Let me put it in context. 

Look, these are very tough budget times. There are going to be a 

lot of decisions that are not popular to different States, and we all 

get that. 

I think what frustrates me and some other Members are two 

things. 

Number one, in a lot of these cases, we are not given and we do 

not see, even after digging, a clear metric and a clear justification 

and rationale. 

Number two, in a lot of these cases, I see jointness going out the 

window at a time when greater jointness, including greater efficiency, is more necessary than ever. In some of these decisions, I 

personally see the stovepipes hunkering down and sacrificing 

jointness and through it, greater efficiency. 

294 

So that is the context of some of these concerns and questions. 

Specifically the Air Force—and I will ask you, Mr. Secretary—is 

recommending to cut out the 917th Fighter Group at Barksdale, 

the A–10s there. Now, when we looked into that, when we asked 

the folks on the ground in Louisiana, including the Army folks at 

Fort Polk who they help train, those folks on the ground said that 

about 70 percent of all of the joint Air Force/Army training at Joint 

Readiness Training Center (JRTC) at Fort Polk use that 917th 

Fighter Group during the Green Flag East exercises. So there was 

tremendous appreciation of that participation in that joint training. 

When we asked the Air Force—I just got a letter from the Secretary, and his response was that the same 197th group has only 

fulfilled its requirement, meaning that training, once over the last 

3 fiscal years. 

Now, this is not a 10 percent difference of opinion. This is different planets, and so it is very concerning to me when you get 

wildly different statistics and numbers behind a decision. How am 

I to reconcile those wildly different statistics? 

Mr. GINSBERG. Senator, I certainly will reconcile the numbers for 

you. We will go back and validate and we will certainly get back 

to you on that. 

I will say a couple of things. One is on the decision to retire the 

A–10s, that was based on our force planners’ assessment of what 

the future demand was going to look like, what was the range of 

scenarios that the Department of the Air Force would have to support the joint war fight in and what was the overall capacity of aircraft that were needed for that. A decision was made to take down 

more A–10s than F–16s because the F–16 is a multi-role aircraft 

versus the A–10 which is more single purpose. So that was the decision to take down—that was the approach to take down the capacity. 

In terms of where the specific units were in the distribution 

among the Guard and Reserve, it was similar to what I talked 

about. The thought was similar to what I mentioned before, that 

in order to maintain the overseas presence and to maintain an acceptable level of operational tempo across our force, to do more of 

those reductions in the National Guard and Reserve. So that was 

the overall thought process there. 

Sir, I would just like to highlight that. If there is a unit at JRTC 

that is in the box, ready to go deploy, whether it is the 917th or 

an A–10 unit from Moody Air Force Base in Georgia, that is a valid 

requirement, and in the same way that the Air Force plugs in with 

its Service counterparts down range, it will do so here in order to 

make sure that our comrades are ready to go and that we can train 

like we fight every day. So that is something we will be working 

through. 

But, sir, I do want to make sure we are providing you all the information that you need. 

Senator VITTER. Certainly, I would like that follow-up and reconciliation. 

More broadly we have asked for specific savings numbers and 

analysis for that, as well as Louisiana National Guard 259th Air 

Traffic Control Squadron from DOD. The only thing we have gotten 

are conclusory statements or the decision or a letter with a paraVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00300 Fmt 6601 Sfmt 6602 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
295 

graph explanation. We have constantly, many times over, asked for 

a specific cost savings assessment. If you can get that to us more 

broadly. 

[The information referred to follows:] 

The new Defense Strategic Guidance states that U.S. forces will no longer be sized 

to conduct large-scale, prolonged stability operations. Analysis based on scenarios 

consistent with the Strategic Guidance resulted in a reduced requirement for tactical combat aircraft and a preference for multi-role fighters to provide the most 

flexible capability within each scenario. As a result, A–10 retirements were selected 

in lieu of other combat aircraft and the Air Force made the difficult choice to retire 

five A–10 squadrons comprised of 102 A–10 aircraft. Previous reductions in fighter 

force structure shifted the Total Force ratio toward Reserve component forces, and 

Air Force decisions in the fiscal year 2013 President’s budget request (20 A–10s 

from Active Duty, 61 from the Air National Guard, and 21 from the Air Force Reserves) rebalanced that ratio to create a more sustainable force structure over the 

long term. 

Before I explain how we determined where to take the A–10 reductions out of the 

Air Force Reserve, I’d like to clarify the discrepancies you noted in the A–10 

taskings for the 917th Fighter Group and their support of the Joint Readiness 

Training Center (JRTC) at Fort Polk. The Air Force has formally tasked the 917th 

Fighter Group one time through the Air Combat Command Consolidated Planning 

Schedule. However, due to their proximity to Fort Polk, the 917th Fighter Group 

routinely accepts ad-hoc requests from the JRTC for close air support training outside of Air Combat Command Consolidated Planning Schedule. 

The Air Force Reserve reduction of 21 A–10 aircraft required a decision between 

two unit-equipped bases, Barksdale and Whiteman AFB. The Air Force Reserve employed four realignment strategy principles that influenced the selection of specific 

locations for aircraft reductions. It first ensured aircraft reductions would not negatively impact operational support to the combatant commands. Second, it considered 

if force structure movements would create any new Air Force bills. Third, it attempted to minimize risk by optimizing crew ratios to exploit expected increase in 

mission capability rates. The final principle considered locations that continued to 

have an Air Force mission due to the presence of another Air Force component. In 

addition, although not stated as one of the four guiding principles, our sphere of influence also factored in and allowed for maximum reversibility at minimum cost. 

The decision between Barksdale and Whiteman Air Force Base (AFB) Reserve A– 

10 units was difficult, as both units are tenant organizations on Active Air Force 

installations, have excellent recruiting capabilities, sound track records of performance, and provide support to joint warfighting and training. Ultimately, the Air 

Force Reserve determined that the B–52 classic association at Barksdale AFB would 

be best positioned to absorb some of the adverse impact of closing the A–10 squadron at Barksdale. Conversely, the A–10 unit at Whiteman AFB is a stand-alone tenant unit. Closing the Whiteman unit would make it difficult to absorb the personnel. 

The Air Force will continue to provide support to joint warfighters at the JRTC 

through the Air Combat Command Consolidated Planning Schedule system. 

By divesting the A–10 squadron at Barksdale AFB, the Air Force expects to save 

approximately $336 million over the Future Years Defense Program. The savings 

account for operations and maintenance personnel, flying hours, aircraft modifications such as wing replacements, and depot sustainment funding. 

The decision to divest the 259th Air Traffic Control Squadron (ATCS) was based 

on the lack of an Air National Guard flying mission assigned to the Alexandria 

International Airport. The cost savings to the Air Force will include cost avoidance 

for the purchase of a next generation deployable radar and deployable instrument 

landing system as well as non-flying and depot level repair cost savings that exceed 

$500,000 per year. Additionally, the manpower saved by divesting the ATCS allowed 

the Air National Guard to realign the corresponding end strength towards bolstering readiness in areas such as aircraft maintenance, intelligence, surveillance, 

and reconnaissance, and domestic operations. 

Senator VITTER. On the 917th, if it is true that they have participated in a big number, a majority—folks on the ground say 7 percent of that training at Fort Polk—what will be the replacement for 

that type of training? 

General JONES. Senator, I think it is important that when they 

talk about what will be the replacement, not that they ask for what 

296 

type, what specific aircraft, but what capability. That is where we 

were stuck with the tough decision to have to eliminate single capability aircraft to go with multi-role aircraft so we could bring in 

something that could do more than just one thing. So what we 

would be providing them is a multi-role aircraft that could perform 

the same function the A–10 was performing. 

Sir, if I could just go back and comment on one thing you said 

earlier about jointness, the question of Services hunkering down 

and trying to back away from jointness—I really do not agree with 

that. I would have to tell you that having served in the U.S. European Command when I was a younger officer, having been the

J–1 at CENTCOM during much of the conflict when General 

Abizaid was the commander, we are all so bought into jointness 

that it would be impossible for us as a department to walk away 

from how we fight now. We fight as a joint, integrated team. Our 

leadership teams are integrated. Our relationships across the Services have been solidified, and that is the only way we will be going 

to war in the future. 

Senator VITTER. Okay. To follow up on that thought, regarding 

this A–10 decision, let me ask your Army colleagues when in the 

process was the Army consulted regarding the impact of this A–10 

decision? How early or late and who was consulted about that on 

the Army side? 

Mr. LAMONT. I frankly cannot respond to that. I will have to take 

that for the record and find out. I assume it would be within our 

G–3 staff, our training and operational concerns. 

General BOSTICK. Senator, we will go back and find out, but I 

would agree with my Air Force colleague. We will never walk away 

from jointness, and any opportunity that we have to train is going 

to be a good opportunity for the country. So just like we cannot 

walk away from the Reserve component, we cannot walk away 

from jointness and the combined nature of how we fight is the only 

way that we can do this. 

Senator VITTER. If you would follow up because I think it would 

be an interesting test of this debate to see when in time and at 

what level the Army was actively in a meaningful way consulted 

on this decision. 

Mr. LAMONT. We will find out. 

Senator VITTER. Okay. I will look for that follow-up, and I appreciate it. 

[The information referred to follows:] 

The Air Force did not consult with the Army regarding moving the A–10 mission 

out of Barksdale. The Air Force made difficult choices to closely align with the new 

Department of Defense strategy. In doing so, it favored aircraft with multi-role capabilities versus those focused on niche missions. The Air Force Reserve was faced 

with a fair share reduction of A–10 fleet and had to make a decision between two 

unit-equipped bases, Barksdale and Whiteman Air Force Base (AFB), to reduce 21 

A–10s. Both units are tenant organizations on Active Air Force installations, have 

excellent recruiting capabilities, sound track records of performance, and provide 

support to joint warfighting and training. The Air Force Reserve determined that 

the B–52 classic association at Barksdale AFB would be best positioned to absorb 

some of the adverse impact of closing the A–10 squadron at Barksdale. Conversely, 

the A–10 unit is a stand-alone tenant unit on Whiteman AFB. Closing the unit 

would make it difficult to absorb the personnel. 

Mr. GINSBERG. Senator, could I just say that during the development of our budgets, each Service’s plan is vetted through the 

297 

other Services, and of course through our Office of Secretary of Defense overseers. So there are smaller forums and larger forums. We 

have our programmers, plans, and programs. We call them the 

‘‘eights.’’ They regularly review the budget submissions towards the 

tail end, once each Service is developed, and then our budgets go 

through something they call the Defense Management Action 

Group, and that is where the Services can look before it is submitted to Congress, before it goes to OMB. Every Service gets to 

peer into what each other Service is doing. Also, there are lots of 

communications back and forth where we highlight some of the big 

issues that are going to be coming forward in the year ahead. 

Senator VITTER. Secretary Ginsberg, again on the Air Force side, 

Global Strike Command is a relatively new command at Barksdale. 

Senator WEBB. Senator Vitter, I am going to have to interrupt 

you because we are on a 7-minute clock, and a vote has been called. 

I know Senator Brown wants to ask a question. You could submit 

that question for the record as can anyone else on the subcommittee before close of business tomorrow night. 

Senator VITTER. I will submit that for the record. Thank you, Mr. 

Chairman. 

Senator WEBB. Senator Brown. 

Senator BROWN. Thank you. I will be brief. Thank you. 

How much time do we have before the vote? 

Senator WEBB. The vote has been called. 

Senator BROWN. I will be done long before then. Thank you. 

General Milstead, first of all, I am encouraged to hear that General Amos is opening up some slots for the training of women at 

Marine Corps Infantry School right down the road in Quantico. I 

want to commend him for that. 

I read a quote from General Gray who said every marine is first 

and foremost a rifleman. All other conditions are secondary. I agree 

with that also. I am a strong proponent of women in combat, providing they fit the qualifications. 

Where do you think the perception comes from that somehow female servicemembers could, ‘‘compromise the mission’’? Have you 

heard that? Do you think it is relevant? Do you think it is something that is being handled appropriately? 

General MILSTEAD. Sir, again, I do not believe the Senator was 

in here when I first responded to Senator Webb’s response that this 

is research so that the Commandant can make an informed recommendation to the Secretary. 

But we have approximately a little over 13,000 women marines. 

I have been in combat twice with them. They are in combat. That 

is a misunderstanding of a lot of people. Our women are in combat. 

I am a Cobra pilot. We have women Cobra pilots. But we are talking a difference between closed and open MOSs. Our women marines, just like our women sailors and our women soldiers and our 

women airmen, make a great contribution and have made a great 

contribution, and we have no inclination at all in turning our back 

on that. 

Senator BROWN. It means a lot. I appreciate the effort and I will 

convey that to General Amos. 

I know that Senator Graham and I and others are deeply concerned about the Air Force, and I think the Army has struck a good 

298 

balance between Guard and Reserves and regular Army. The Air 

Force—I have to tell you I am not quite happy with the way things 

are shaking out. I feel that the Guard and Reserves are getting the 

short end of the stick. A lot of the input that has been given, I feel, 

has fallen on deaf ears. 

I am deeply concerned about the fact that the Air Force has 

taken all the toys and is holding them and then really having a difficult time sharing and especially because I feel we get a very good 

value for the dollar in the Guard and Reserves especially in Massachusetts. Some of the units are at 70–80 percent mission-capable 

and yet we are going to take away that—destroy some of those 

teams and shift and adjust. It is deeply, deeply concerning to me. 

So if we were to make these irreversible cuts to the Guard based 

on disputable facts or flawed assumptions, could that be reversed? 

Could those actions be reversed, do you think? 

Mr. GINSBERG. Senator, we really have struck a balance, given 

again the strategic demands—— 

Senator BROWN. You have been given guidance from Secretary 

Panetta, but then you have gone and done it how you felt it was 

appropriate. Is that a fair statement? 

Mr. GINSBERG. Yes, sir. 

Senator BROWN. The Army has done the same thing, but they 

have a different model. 

Mr. GINSBERG. Sir, we just looked at what the demands were 

going to look like over the future, what were the war plans that 

we would have to fulfill, what are the rotational requirements, and 

then we had to, again, balance those considerations with the fact 

that there was a very significant change in our resourcing over the 

fiscal year plan. 

Senator BROWN. Yes, but you are going to get a better value for 

your dollar with the Guard and Reserves. You know that the OSD 

Reserve Affairs report basically said the method of calculating the 

baseline costs and capabilities of the Guard and Reserves—without 

having the appropriate information, is it possible the Service Chiefs 

are assuming key data that would show how to preserve the greatest amount of military capability at the lowest cost or not? 

Mr. GINSBERG. Sir, there has been a lot of discussion about the 

costs, of course. If there is a way to do a mission more cheaply and 

to get it done, we are going to do that, sir. The challenge has been 

when you are using the Guard and Reserve in a very high operational intensity, that some of the cost benefits become more ambiguous. 

Senator BROWN. But if you shift some of the Active components 

to some of the Reserve bases like has been done in the past, you 

are going to get that good value for the dollar and also stretching 

out the mission. 

Mr. GINSBERG. We foresee a very intense deployment schedule 

for the Guard, Reserve, and the entire force, and like I said, as you 

are using them more intensely, again the cost differences among 

the various components become more ambiguous. 

In the meantime, sir, we also have to be, of course, concerned 

about what is the demand that is placed on the force and what is 

the stress level that we put on everybody. We are concerned that 

if we get these balances wrong, that a member of the Guard or ReVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00304 Fmt 6601 Sfmt 6602 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
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serve is going to have to deploy at an intensity that will just be 

unacceptable to them, and our airmen are going to walk with their 

feet not just on the regular Air Force side but across our entire 

force. 

Senator BROWN. I do not know if I agree with that assumption. 

I have been in 32 years. I have met with all the Guard and Reserve 

air components in Massachusetts and throughout, and I will tell 

you what, this conversation is not over. If it is not going to be addressed by you guys keeping and staying at the table, we will handle it in committee and we will do it for you. I do not know how 

else to say it. We will make sure we play a very active role. 

Unfortunately, we do have to go vote, but I do have a question 

or two for the record I will submit. 

Thank you, Mr. Chairman. 

Senator WEBB. Thank you, Senator Brown. 

Again, all members of the subcommittee will have until the close 

of business tomorrow to submit any further questions for the 

record. 

I thank all of you for your testimony and for your continued service to our country. 

This hearing is adjourned. 

[Questions for the record with answers supplied follow:] 

QUESTIONS SUBMITTED BY SENATOR KELLY AYOTTE

INTEGRATED DISABILITY EVALUATION SYSTEM

1. Senator AYOTTE. Secretary Lamont and General Bostick, while speaking at the 

Warrior Care and Transition Program Training Conference in Orlando, Florida, in 

2011, the former Vice Chief of Staff for the Army, General Chiarelli, said that the 

current Army Disability Evaluation System (DES) is ‘‘complex, disjointed, hard to 

understand, and it takes too long to complete.’’ How long does it take for the average soldier to complete the DES process? 

Secretary LAMONT and General BOSTICK. Active component soldiers who completed the Integrated Disability Evaluation System (IDES) in April 2012 averaged 

396 days from referral through notification of the Department of Veterans Affairs 

(VA) benefits decision, Reserve component soldiers averaged 401 days. 

2. Senator AYOTTE. Secretary Lamont and General Bostick, what is the Department of Defense’s (DOD) goal for completing the DES process? 

Secretary LAMONT and General BOSTICK. The goal for completing the IDES is 295 

days for Active component soldiers and 305 days for Reserve component soldiers, 

measured from date of referral to the IDES through notification of the VA benefits 

decision. 

3. Senator AYOTTE. Secretary Lamont and General Bostick, how long does this 

process take and why is it taking so long? 

Secretary LAMONT and General BOSTICK. Active component soldiers who completed the process in April 2012 averaged 396 days and Reserve component soldiers 

averaged 401 days. The Army is enduring the effects of 10 years of war and lacks 

sufficient capacity to efficiently process the increasing number of soldiers now in the 

IDES. 

4. Senator AYOTTE. Secretary Lamont and General Bostick, how many soldiers are 

currently enrolled in the Army’s DES? 

Secretary LAMONT and General BOSTICK. As of April 23, 2102, there were more 

than 24,000 soldiers enrolled in the DES, including over 18,800 who are enrolled 

in the IDES and over 5,100 who are enrolled in the legacy DES. 

5. Senator AYOTTE. Secretary Lamont and General Bostick, would it be correct to 

say that as these soldiers progress through the 400-day process, they are obviously 

nondeployable and count toward the Army’s overall end strength? 

300 

Secretary LAMONT and General BOSTICK. Yes, these soldiers are nondeployable 

and do count against the overall Army end strength. The purpose of the DES is to 

maintain a fit and ready force. Soldiers going through that process are being evaluated to see if they are fit enough to continue to serve in the Army. Approximately 

5 percent of those who begin the process are deemed fit and continue to serve. The 

remainder are evaluated for disability ratings and are separated. 

6. Senator AYOTTE. Secretary Lamont and General Bostick, what can we do to fix 

this? 

Secretary LAMONT and General BOSTICK. The Army is aggressively working to improve performance of the DES. We are currently implementing a number of initiatives designed to improve the performance, including: adding over 1,100 in staffing; 

publishing guidance to standardize the process across the Army; enhancing our 

training; and establishing procedures that will enhance the sharing of information 

with the VA. However, the Army believes we need to fundamentally change the 

DES; and remain convinced statutory reform is the only way we can achieve a sustainable system worthy of the sacrifices of our volunteer force in this era of persistent conflict. 

The Army is looking at several different options to improve the DES—one of 

which would be a process where DOD determines a disabled servicemember’s fitness 

for duty, and if found unfit, provide a lifetime annuity based on the member’s rank 

and years of service. The VA would then establish compensation for service-connected injuries, disease, or wounds. We believe this type of system would achieve 

an average disability process outcome in less than 90 days: improved readiness; reduced complexity; decreased impact on limited medical resources; and less adversarial. 

7. Senator AYOTTE. Secretary Lamont and General Bostick, is part of the problem 

the dual DOD/VA adjudication systems? 

Secretary LAMONT and General BOSTICK. The IDES was designed to eliminate the 

duplicative elements of the separate disability processes previously operated by VA 

and the military. It employs a model that features a streamlined exam process using 

VA protocols and a single disability rating to be issued by VA. One of the principal 

goals of the new system was to ease servicemembers’ transition to veteran status 

so they can quickly access VA benefits to reduce the risk of financial hardship. From 

this perspective IDES was successful. 

IDES allowed for a move toward a single process with a single examination and 

a single source for all disability ratings. However, soldiers continue to receive two 

ratings. The Services can only compensate for military unfitting (fit for duty) service-connected conditions, while the VA compensates for all service-connected conditions. This duality creates confusion, and the belief the Services are not being loyal 

to or fair with servicemembers; it is also wasteful and time consuming. 

We need to move to a system where the Services determine a disabled servicemember’s fitness for duty, and if found unfit, provides benefits based on the member’s rank and years of service and let VA establish compensation for disabling service-connected conditions. We believe this type of system would achieve an average 

disability process outcome in less than 90 days, improve readiness, while decreasing 

the impact the system currently has on our limited medical resources. It would be 

a less adversarial system. 

8. Senator AYOTTE. Secretary Lamont and General Bostick, could these two systems be combined into one in order to streamline the process, help our troops, and 

save taxpayers’ money? 

Secretary LAMONT and General BOSTICK. The Army believes there is a need to 

clarify the objectives of each respective system. The current DES is over 60 years 

old and was designed for a draft-based military, in an industrial/agricultural economy. Its focus on disability and compensation reduces incentives or creates conflicting incentives to participate in rehabilitation or to return to work and is not 

adequate for the needs of today’s professional all volunteer military. 

The Army believes the system requires reform. We recommend a simpler process 

where DOD determines a disabled servicemember’s fitness for duty, and provides 

benefits based on the member’s rank and years of service. VA continues to determine disability benefits as it does now using one of its predischarge programs. We 

believe this type of system would achieve an average disability process outcome in 

less than 90 days and ensure that VA benefits were available to soldiers immediately after separation. 

301 

DWELL TIME

9. Senator AYOTTE. General Bostick, what is the impact on readiness when there 

is insufficient time at home between deployments? 

General BOSTICK. Over the past 11 years, the Army has successfully satisfied the 

high demand for conventional ground forces throughout two conflicts. The Army 

works hard at ensuring that our deploying units are adequately manned and ready 

to meet operational demands. The price of meeting the increase in the operational 

demand has significantly stressed our military personnel and their families. To fully 

reconstitute our units, soldiers and their families must be given the time and resources they need to reintegrate and reverse the effects of the sustained operational 

tempo. A study completed in 2009 confirmed what we already intuitively knew: soldiers require more than 2 years to fully recover, both mentally and physically, from 

the rigors of combat deployment. The Army’s goal is to achieve and maintain a dwell 

time of at least 2 months at home for every month deployed for the Active component soldier and 4 months at home for every month mobilized for the Reserve component soldier. 

The withdrawal of forces from Iraq will assist the Army with restoring its operational depth and returning strategic flexibility in our formations and among our 

leaders. In the second quarter of fiscal year 2012, the median Active component 

Army individual boots-on-the-ground (BOG):dwell reached the goal ratio of 1:2. The 

ongoing drawdown of forces in Afghanistan will continue to improve the BOG:dwell 

ratio of the force, and as dwell times increase, the Army will be able to focus on 

sustaining the rotation rates of 1:2 as envisioned. This will ensure the force’s longterm health, and will, once again, allow the necessary time to train units to perform 

missions across the full spectrum of operations. 

10. Senator AYOTTE. General Bostick, what impact does insufficient dwell time 

have on families? 

General BOSTICK. Most families focus on the quality of the dwell time rather than 

the length. But it does take time to adjust and become reacquainted with what it’s 

like to be together again. Soldiers’ reintegration with their families is an individual 

process. It is important for soldiers to spend quality time with their families in the 

reset period following deployment. With less dwell time, returning members may 

not have enough time to reconnect with their families and fit back into the home 

routine before they have to deploy again. Children worry about the next deployment, 

which impacts their ability to get to know their parent again. To help families with 

this process, the Army is educating family members about reintegration, helping 

them recognize changes in family structure and functioning, and the importance of 

establishing expectations before the soldier returns. 

11. Senator AYOTTE. General Bostick, what impact does insufficient dwell time 

have on the Army’s ability to train for full spectrum operations, including major 

combat operations? 

General BOSTICK. The amount of dwell time required for a redeploying unit to 

progressively build readiness for a broad range of military operations (including 

major combat operations) depends on complexity of the unit’s design, functions, 

interaction with external organizations, and degree the unit will be employed in 

harm’s way or employ deadly force. Whether or not dwell time is sufficient depends 

on a number of factors, primarily how quickly the Army is able to reset the unit 

with personnel and equipment and how much training resources and venues are 

available to support the unit’s progressive training strategy. If dwell time proves insufficient for the unit to fully prepare before expected to be available for contingency 

operations, then the Army must accept either more training time or risk before deploying the unit, as allowed by exigencies of the situation. 

Risk associated with insufficient dwell time is somewhat mitigated by developing 

unit leaders throughout their career in professional military education and through 

participation in Army training venues like Combat Training Centers; by providing 

training support capabilities that allow unit components to sharpen skills using virtual/constructive/gaming venues through iterative execution of increasingly complex 

tasks, conditions, and enabler integration—complexity which is simply infeasible to 

create for live training at the unit’s home station due to constraints on maneuver 

space, airspace, joint/interagency/multinational availability; by training on fundamentals first and progressively building the proficiency of individuals, crews, sections, small units, then larger formations; and by integrating adaptability into training, which enables a professionally disciplined force to apply their mastery of fundamentals to any assigned mission and adapt to circumstances. Units deploying 

with insufficient dwell may not have had opportunity to perform as a large formaVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00307 Fmt 6601 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
302 

tion, to fully integrate external enablers required of unified operations, or to practice 

against the full arrange of threats presented by contemporary operating environments. 

12. Senator AYOTTE. General Bostick, what are the Army’s current goals for dwell 

time between deployments for the Active and Reserve components? 

General BOSTICK. Because individuals follow a variety of deployment patterns, we 

measure dwell as a ratio of time spent deployed (boots-on-the-ground (BOG)) to time 

spent not deployed (dwell). Our near-term goals are for Active component soldiers 

to have 2 months of dwell for every 1 month deployed (a 1:2 BOG:dwell ratio) and 

for Reserve component soldiers to have 4 months of dwell for every month deployed 

(1:4 ratio). 

13. Senator AYOTTE. General Bostick, what military occupational specialties and 

types of units are receiving the least time at home between deployments? 

General BOSTICK. Because individuals and units follow a variety of deployment 

patterns, we measure dwell as a ratio of time spent deployed BOG to time spent 

not deployed following the deployment (dwell). In terms of this ratio, aviation units 

and aviation-related specialties have been the most taxed. This is especially true 

among junior enlisted soldiers and warrant officers, who have seen slightly more 

than 3 months of dwell for every 2 months deployed. Other units such as civil affairs, intelligence, military police, psychological operations, engineers, and special 

forces have also been heavily taxed and remain just above the mandated 1:1 

BOG:dwell ratio for units. However, the soldiers in these units tend to have better 

median individual BOG:dwell ratios than aviation soldiers, suggesting a wider variety of assignment opportunities or partial-unit deployments. 

14. Senator AYOTTE. General Bostick, what are the current dwell times for individuals with these specialties and for these types of units? 

General BOSTICK. Because individuals and units follow a variety of deployment 

patterns, we measure dwell as a ratio of time spent deployed BOG to time spent 

not deployed following the deployment (dwell). As previously stated, aviation units 

and aviation-related specialties have been the most taxed. This is especially true 

among junior enlisted soldiers and warrant officers, who have seen slightly more 

than 3 months of dwell for every 2 months deployed, a 1:1.5 ratio. This ratio is highly correlated with the unit ratios, as these soldiers do not have many assignment 

opportunities outside of these units. More senior noncommissioned officers and commissioned officers have been experiencing ratios better than 1:1.8, largely because 

they have more assignment opportunities. 

15. Senator AYOTTE. General Bostick, do you believe the Army should be reducing 

its end strength before achieving its dwell time goals? 

General BOSTICK. For the last several years, the Active Army has enjoyed the benefits of a temporary end strength increase that was as much as 22,000 soldiers 

above its 547,000 permanent end strength. Because of this increase, the Active component was able to achieve its median 1:2 individual BOG:dwell goal in second quarter of fiscal year 2012. With the expected decrease in demand for deployed forces, 

we do not anticipate that the median individual BOG:dwell will worsen. 

16. Senator AYOTTE. General Bostick, if future unanticipated contingency operations emerge and the Army’s dwell time predictions turn out to be too optimistic, 

at what point would you recommend pausing or reversing the Army’s end strength 

reductions? 

General BOSTICK. Once the Army is no longer able to sustain the 1:2 BOG:dwell 

ratio assigned to it in the Guidance for Employment of the Force, the senior Army 

leadership would need to assess the risk to the force and recommend to the Secretary of Defense that he pause or reverse the end strength reductions. 

TRAUMATIC BRAIN INJURY

17. Senator AYOTTE. Secretary Lamont, Secretary Garcia, Secretary Ginsberg, 

General Bostick, Admiral Van Buskirk, General Milstead, and General Jones, can 

you give me a sense as to how many of your servicemembers have suffered from 

a traumatic brain injury (TBI)? 

Secretary LAMONT and General BOSTICK. Since 2000, there have been 233,425 

DOD servicemembers including 134,938 U.S. Army soldiers diagnosed with TBI. 

303 

Secretary GARCIA and Admiral VAN BUSKIRK. From 2000 through 2011, Navy has 

had 32,379 TBI cases among Active and Reserve sailors while Marine Corps has had 

33,989 such cases among Active and Reserve marines. In 2011 alone, Navy had 

2,825 instances of TBI while Marine Corps had 4,747. Mild TBI accounts for approximately 77 percent of TBI cases documented across the Services since 2000, and 

84 percent of all TBIs occur in garrison. 

Secretary GINSBERG and General JONES. The Air Force accounts for 14 percent 

of the total TBI cases in the military, with 32,119 cases from 2000 through 2011 

(deployed and nondeployed, all severity). There are approximately 2,500–3,500 total 

cases per year, with the majority not being associated with deployment. According 

to the Medical Surveillance Monthly Report, there were 242 cases of deploymentassociated TBI in airmen in calendar year 2010 (0.56 percent of Air Force deployments). Of the total cases, 81.8 percent were mild, defined by the duration of alteration of consciousness, loss of consciousness, or post-traumatic amnesia at the time 

of injury. As reported in the civilian TBI literature, 85–90 percent of those who sustain mild TBI recover fully within 3 months, often sooner. Early identification, education, rest, and symptom management facilitate recovery. Those who sustain recurrent concussions and/or have co-morbid conditions such as Post-Traumatic Stress 

Disorder (PTSD) may take longer to recover. 

General MILSTEAD. The official TBI data for DOD is reported through the Defense 

and Veterans Brain Injury Center (DVBIC). Current DVBIC data indicate 233,425 

total TBI cases throughout DOD from 2000 through 2011. In that same time period, 

the Navy has had 32,379 TBI cases within Active and Reserve components, while 

the Marine Corps, Active and Reserve components, has had 33,989 such cases. In 

2011, the Navy had a total of 2,825 TBIs while the Marine Corps had 4,747. Mild 

TBI accounts for approximately 77 percent of TBI cases documented across the 

Services since 2000, and 84 percent of all TBIs occur in garrison. 

18. Senator AYOTTE. Secretary Lamont, Secretary Garcia, Secretary Ginsberg, 

General Bostick, Admiral Van Buskirk, General Milstead, and General Jones, what 

is your Service doing to address this problem and care for our servicemembers who 

have sustained a TBI? 

Secretary LAMONT and General BOSTICK. The Army has instituted a comprehensive program to better detect, diagnose, treat, and track TBI. This program contains 

four essential elements: (1) baseline neurocognitive testing of all deploying soldiers; 

(2) a comprehensive in-theater policy for assessing and treating soldiers exposed to 

potentially concussive events, who may have been exposed to a traumatic event; (3) 

establishment of an expansive garrison clinical care program to meet the medical 

and rehabilitation needs of patients with all severities of TBI; and (4) an aggressive 

research program looking at ways to better diagnose and treat TBI. 

Army policy directs that all soldiers who have been exposed to possible concussive 

events are screened for TBI and are given mandatory recovery time. The Army has 

improved provider education and training with regard to screening, evaluation, and 

management of concussion in both the deployed setting and the garrison environment. Research is being conducted to find possible biomarkers of TBI, to improve 

accurate and timely diagnosis of TBI, and to increase the treatment options for individuals with a positive diagnosis of TBI. 

Secretary GARCIA, Admiral VAN BUSKIRK, and General MILSTEAD. TBI care on the 

battlefield has improved significantly since the beginning of Operations Enduring 

Freedom and Iraqi Freedom. Most improvements have targeted early screening and 

diagnosis followed by definitive treatment. In 2010, the Deputy Secretary of Defense 

issued Directive-type Memorandum 09–033, ‘‘Policy Guidance for Management of 

Concussion/Mild Traumatic Brain Injury in the Deployed Setting,’’ which has resulted in improved diagnosis and treatment of battlefield concussion. 

For Navy and Marine Corps, the primary treatment site for concussed servicemembers has been the Concussion Care Restoration Center (CRCC) at Camp Leatherneck in Afghanistan. Since its opening in 2010, the CRCC has treated over 964 

servicemembers, resulting in a greater than 98 percent return-to-duty (RTD) rate 

and an average of 10.3 days of duty lost from point-of-injury to symptom-free RTD. 

There is also a Concussion Specialty Care Center (CSCC) at the North Atlantic 

Treaty Organization (NATO) Role III Hospital in Kandahar, with a neurologist on 

staff. 

Upon return from deployment, enhanced screening methods for TBI and mental 

health conditions are being piloted at several Navy and Marine Corps sites. These 

efforts include additional screening and follow-up for any servicemember noted to 

have sustained a concussion in theater. Efforts are underway to increase use of the 

National Intrepid Center of Excellence (NICoE) across DOD, and development of 

304 

NICoE satellite sites, to provide state-of-the-art evaluation and treatment for patients who do not improve with routine clinical care. 

Secretary GINSBERG and General JONES. Of the total TBI cases from 2000 to 2011, 

81.8 percent were mild, defined by the duration of alteration of consciousness, loss 

of consciousness, or post-traumatic amnesia at the time of injury. As reported in the 

civilian TBI literature, 85–90 percent of those who sustain mild TBI recover fully 

within 3 months, or often sooner. Early identification, education, rest, and symptom 

management facilitate recovery. Those who sustain recurrent concussions, and/or 

have co-morbid conditions such as PTSD may take longer to recover. 

As outlined in the 2009 Department of Veterans Affairs/Department of Defense 

Clinical Practice Guideline (CPG) for Management of concussion/mild TBI, most of 

the initial management of mild TBI can be accomplished by primary care in the patient-centered medical home, with referral to specialty services when needed. In addition to the CPGs, providers also have tools produced by the Defense Centers of 

Excellence for Psychological Health and TBI, such as the Pocket Guide for Management of TBI and the Co-Occurring Disorders Toolkit. The Air Force has one standalone multidisciplinary TBI clinic at Joint Base Elmendorf-Richardson. This TBI 

clinic stood up in 2008 and was started to support the local Army units who account 

for over 90 percent of the patients treated. Additional efforts to standardize mild 

TBI care are in place for higher risk units in the Air Force, such as explosive ordnance disposal. One example is a provider-to-provider video teleconsult pilot project 

that brings together primary care providers with a TBI team of experts using video 

teleconference capability to allow exchange of knowledge and de-identified case discussion. 

A theater system of TBI care has evolved since the release of Directive Type 

Memorandum (DTM) 09–033: ‘‘Management of Concussion of mild TBI in the Deployed Setting.’’ Leadership’s responsibility to identify and report servicemembers 

involved in mandatory events (within 50M of blast, direct blow to head, and motor 

vehicle crash) ensures early identification of TBI. Medics and providers standardize 

care by using clinical algorithms for evaluation and management of mild TBI, including mandatory rest periods. Located throughout Afghanistan, 11 concussions 

care centers, which are overseen by the theater neurology consultant, allow 

servicemembers sufficient time to rest and recover, resulting in an over 95 percent 

return to duty rate. Clinical history and examination, together with post-injury 

neurocognitve testing in theater, aids in return to duty decisionmaking. 

19. Senator AYOTTE. Secretary Lamont, Secretary Garcia, Secretary Ginsberg, 

General Bostick, Admiral Van Buskirk, General Milstead, and General Jones, do 

you have all of the resources and authorities you need to care for our servicemembers with TBI? 

Secretary LAMONT and General BOSTICK. While resources are adequate for current 

efforts, continued congressional support of the Army’s TBI clinical and research efforts will ensure improved screening and delivery of care. 

Secretary GARCIA, Admiral VAN BUSKIRK, and General MILSTEAD. Caring for sailors and marines who have sustained a TBI remains a top priority. While we are 

making progress, we recognize that there is much work ahead of us to determine 

the acute and long-term impacts of TBI on our servicemembers. Our strategy must 

be both collaborative and inclusive, by actively partnering with the other Services, 

our Centers of Excellence, the VA, and leading academic medical and research centers, to make the best care available to warriors afflicted with TBI. 

We are grateful to you and your colleagues for your outstanding support of our 

efforts in improving the care of our sailors and marines and their families. We believe we have both the resources and authorities required for the diagnosis, treatment, and recovery of our servicemembers who have sustained a TBI. While we are 

resourced well, we should continue our vigilance in the area of TBI policies that 

support tracking and surveillance efforts. We need to ensure sailors and marines receive the optimal care at all points in the continuum from point of injury to reintegration. 

Secretary GINSBERG and General JONES. At this time, the Air Force has sufficient 

resources and authority to provide care for airmen who sustain TBI. In addition to 

the steps taken to identify and care for airmen with TBI, the Air Force has support 

from our sister Services, the Defense Centers of Excellence for Psychological Health 

and TBI, the Defense and Veterans Brain Injury Center, and the NICoE. 

[The prepared statement of the Reserve Officers Association follows:] 

305 

APPENDIX A 


425per1.eps

Statement for the Record 

Reserve Officers Association of the United States 

And 

Reserve Enlisted Association 

for the 

Senate Armed Services Committee 

Subcommittee on Personnel 

ACTIVE AND RESERVE COMPONENT 

PERSONNEL ISSUES 

April 25, 2012 

ROA 

RESERVE OFFICERS 

ASSOCIATION 

"Serving Citizen Warriors through Advocacy and Education since 1922. "TM 

Reserve Officers Association 

1 Constitution Avenue, N.E. 

Washington, DC 20002-5618 

(202) 646-7719 

REA 

RESERVE EN LISTED 

ASSO CIATIO N 

Reserve Enlisted Association 

1501 Lee Highway, Suite 200 

Arlington, VA 22209 

(202) 646-7715 

IR~RESERVE STRENGTH. 

I:'ft.RESERVE LIFE. 
306 


425per2.eps

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 1. 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 ofROA to: 

" ... support and promote the development and execution of a military policy for the United States that 

will provide adequate National Security." The mission ofROA is to advocate strong Reserve 

Components and national security, and to support Reserve officers in their military and civilian lives. 

The Association's 58,000 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. ROA is represented in each state 

with 54 departments plus departments in Latin America, the District of Columbia, Europe, the Far 

East, and Puerto Rico. Each department has several chapters throughout the state. ROA has more than 

450 chapters worldwide. 

ROA is a member of The Military Coalition, where it co-chairs the Guard and Reserve Committee. 

ROA is also a member of the National Mi1itaryNeterans Alliance. Overall, ROA works with 75 

military, veterans, and family support organizations. 

President: 

Colonel Walker M. Williams III, USAF (Ret.) 

Staff Contacts: 

Executive Director: 

Major General Andrew B. Davis, USMC (Ret.) 

Legislative Director, Health Care: 

CAPT Marshall Hanson, USNR (Ret.) 

Air Force Director, 

To be filled 

Army and Strategic Defense Education Director: 

Mr. "Bob" Feidler 

USNR, USMCR, USCGR, Retirement: 

CAPT Marshall Hanson, USNR (Ret.) 

202-646-7706 

202-646-7705 

202-646-7713 

202-646-7758 

202-646-7717 

202-646-7713 

The Reserve Enlisted Association (REA) 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. 

Executive Director 

CMSgt Lani Burnett, USAF (Ret.) 202-646-7715 

DISCLOSURE OF FEDERAL GRANTS OR CONTRACTS 

The Reserve Officers Association and Reserve Enlisted Association are member-supported 

organizations. Neither ROA nor REA have received grants, sub-grants, contracts, or subcontracts from 

the federal government in the past three years. All other activities and services ofthe associations are 

accomplished free of any direct federal funding. 

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I INTRODUCTION 

On behalf of Our members, the Reserve Officers Association and the Reserve Enlisted Association thank 

the committee for the opportunity to submit testimony on personnel issues affecting serving members, 

retirees, their families, and survivors. 

The Title 10 Reserve and National Guard are no longer just a part-time strategic force but are an integral 

contributor to our nation's operational ability to defend itself, assist other countries in maintaining global 

peace, and fight against overseas threats. They are an integrated part of the Total Force, yet remain a 

surge capability as well. At a time that the Pentagon and Congress are examining our nation's security, it 

would be incorrect to discount the Reserve Components' abilities and cost efficiencies. Instead, these 

part-time warriors provide a cost savings solution and an area to retain competencies for missions not 

directly embodied in the administration's new strategic policy, Sustaining Us. Global Leadership: 

Priorities for a 21st Century Defense." 

ROA and REA are concerned that as the Pentagon strives to achieve the administration's goals for this 

new strategic policy, it is not seriously considering the available assets and cost efficiencies of the 

Reserve Component, and that it views the Reserve and National Guard as a bill payer instead. Congress, 

starting with the leadership of this subcomrriittee, should insist on a methodical analysis of suggested 

reductions in missions and bases before authorizing such changes. Haste creates mistakes. 

Each association would like to thank Congress and this committee for amending Title 10 USC, Chapter 

1209 of section 12304a that allows Title 10 Reservists to provide assistance during a time of major 

disaster or emergency, and for amending Section 5 I 5 of Chapter 1209 that now authorizes service 

secretaries to activate Guard and Reserve members at times other than war or emergencies to augment the 

Active component. These two provisions should help prevent the Reserve Component from being placed 

back into Armories and Reserve Centers as just a strategic asset. ROA and REA hope that the 

administration makes use of these new authorities by providing necessary funding. 

I PROVIDE AND EXECUTE AN ADEQUATE NATIONAL SECURITY 

The Reserve Officers Association is chartered by Congress "to support and promote the development and 

execution of a military policy for the United States that will provide adequate national security." 

Requested Action 

Hold Congressional hearings on the new policy of "Sustaining U.S. Glohal Leadership: 

Priorities for the 21" Century Defense." 

Seek exemption or delay in Defense Sequestration hudget cuts. 

Study the impact of manpower cuts to Army and Marine Corps on National Security. 

Avoid parity cuts ofhoth Active and Reserve Components without analyzing rehalance. 

Maintain a rohust and versatile all-volunteer armed forces that can accomplish its mission 

to defend the homeland and U.S. interests overseas. 

The Defense Budget, including current war expenses, is close to 5 percent of the Gross Domestic Product, 

yet as a percentage of the overall Federal budget it continues to decline. With defense expenses 

representing less than 20 percent of the federal budget, it seems inappropriate to take half of the budget 

reduction from National Security. 

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ROA and REA question the current spending priorities that place more importance on the 

immediate future, rather than first doing a short and long term threat analysis. The result of such a 

budget-centric policy could again lead to a hollow force whose readiness and effectiveness is degraded. 

The administration proposes cutting 100,000 troops. End strength cuts need to be made cautiously. The 

deployment of troops to Iraq and Afghanistan proved that the pre·91l1 end strengths left the Army and 

US Marine Corps undermanned, which stressed the force. 

ROA and REA share concerns about reductions in the Department of Defense, while budgets for 

other federal agencies increase. An example of this is the $13.4 billion budget increase for the 

Department of Veteran Affairs. Of this, $10.6 billion is an increase in mandatory funding. When ROA 

asked the V A's Chief Financial Officer, Todd Grams, what offset is being made to allow this increase, his 

response was that no offset was needed as all but $1 billion were for existing programs. 

While some V A increase is obviously needed with the ever increasing number of service-connected 

veterans who are disabled, injured, or ill, every agency should be fiscally responsible to help balance the 

budget and reduce the ever growing deficit. 

Serving members, retirees, families, and survivors are in effect being taxed by defense reductions to be 

the dollar offsets for other departments. Not only is this unfair, but by making cuts to national security, it 

puts future warriors at a greater risk. 

I BASE CLOSURE OR DEFENSE REALIGNMENT? 

The President's Budget recommends two more rounds of base closures. ROA and REA don't support 

such a BRAC recommendation. 

1) BRAC savings are faux savings as these savings are outside the accounting cycle; with a lot of 

additional dollar expenses front loaded into the defense budget for infrastructure improvements to support 

transferred personnel. 

2) Too much base reduction eliminates facilities needed to support surge capability. Some surplus is 

good. 

Instead, ROA and REA recommend that Congress consider an independent Defense Realignment 

Commission that would examine the aggregate national security structure. It could examine: 

1) Emerging Threats. 

2) Foreign defense treaties and alliance obligations. 

3) Overseas and forward deployment requirements. 

4) Foreign Defense Aid. 

5) Defense partnerships with the State Department and other agencies, as well as NGO's. 

6) Requisite missions and elimination of duplicity between the Services. 

7) Current and Future weapon procurement and development. 

8) Critical Industrial base. 

9) Surge capability and contingency repository. 

10) Best utilization and force structure of Active and Reserve Components. 

II) Regional or centralized training, and dual purpose equipment availability. 

12) Compensation, recruiting and retention; trends and solutions. 

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 take precedence over budget 

reductions. 

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I MILITARY RETIREMENT MODERNIZATION 

Another recommendation in the President's budget is a commission to review deferred compensation. As 

structured, ROA and REA do not support this proposal eitber, but if considered: 

1) This should not be a BRAC-like commission. Congress should not give up its authority. 

2) In one section of the President's Budget, it suggests that the President will appoint all of the members 

on the commission. Congress should share in appointments. 

3) While alternatives to current military retirement should be explored, ROA and REA don't support a 

two tiered system where two generations of warriors have different benefit packages. 

3.1) An incentivized retirement option could be offered, rather than making any new mandatory system. 

4) Should a task force be appointed, ROA and REA recommend that individuals with experience in 

Reserve Component compensation be among those appointed, as the administration has suggested that 

both regular and non-regular (reserve) retirement should be the same. 

I RESERVE STRENGTH 

"The challenges DoD has to face are not going to be handled by circling the wagons here at home," 

Dennis McCarthy, then-Assistant Secretary of Defense for Reserve Affairs told ROA at its national 

meeting in 2011. "We're going to continue to need a force that can deploy worldwide ... for the full 

spectrum of missions." 

"With roughly 1.4 [million 1 active-duty service members, 1.2 million reserve-component members and 

likely future missions worldwide," McCarthy added, "the military will need to continue to rely on reserve 

strength." 

The Reserve forces are no longer a part-time strategic force but are an integral contributor to our nation's 

operational ability to defend our soil, assist other countries in maintaining global peace, and fight in 

overseas contingency operations. 

Yet, as discussions occur in both Congress and the Pentagon on how to reduce the budget and the deficit, 

the peril of lowering defense spending is that the Reserve Components will become a bill payer. The Air 

Force and the Navy are already making drastic cuts to their Reserve Components. 

A further 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 by underfunding 

training. In the 2005 BRAC, Reserve and National Guard facilities were closed, reducing the risk of 

closure to active duty facilities. 

Rather than be limited by historical thinking, and parochial protections, creative approaches should be 

explored. The Reserve Component needs to continue in an operational capacity because of cost 

efficiency and added value. The cost of the Reserve and National Guard should not be confused with 

their value, as their value to national defense is incalculable. 

Tbe Reserve Components remain a cost-efficient and valued force. It isjust a small percentage of the 

total services budget: 

Army Reserve - 7 percent of the Army budget; 18 percent of the force 

Army National Guard - 14 percent of the Army budget; 32 percent of the force 

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Marine Forces Reserve - 6 percent of the USMC budget; 16.5 percent of the force 

Navy Reserve - 7 percent of the USN budget; 17 percent of the force 

Air Force Reserve - 4 percent of the AF budget, 14 percent of the force, and 20 percent of the capability 

Air National Guard - 6 percent of the AF Budget and 21 percent of the force. 

"Differences in the cost of the active and reserve components relate primarily to three factors," writes 

Jennifer Buck, former Director, Programs and Budgets, Reserve Affairs at Office of the Secretary of 

Defense. "First, the guard and reserve have lower operating and training tempo. Second, they receive 

part-time pay and benefits, [and only accrue personal leave when mobilized.] Third, the guard and reserve 

incur smaller infrastructure costs-such as, for example, in family housing." 

Admittedly a member of the reserve who is engaged in operational missions will cost more than one who 

is used strategically, but even in an operational mode, the tempo for a reservist will be less frequent, 

bringing down the costs. With a dwell time of four years at home and one year activated, that reflects a 

cost of abou"t 23 percent when compared to a full time active duty member. 

If it assumed that members of the Reserve components mobilize four times during the course 

of a career, and members ofthe active component are sent to an operational conflict seven times during 

the course of a career a career cost per deployment can be calculated. In The Cost of the Reserves, 

Chapter 10, Jennifer Buck determined that based on differences in pay and follow-on retirement, an 

active member "costs" the government almost $2.4 million over a lifetime of service while reserve 

members cost about $790,000. In terms of "usage," it can be calculated at $336,000 per deployment 

"opportunity" for the active member and $198,000 for a member of the reserves. 

Value, on the other hand, is more intangible to calculate. The Reserve Component fills an ongoing need 

for a surge capability as an insurance policy against worse-case scenario's. Reserve and National Guard 

members give the armed forces access to civilian skills that would prove too expensive for the uniformed 

services to train and maintain. With less than one percent of the U.S. population serving in uniform, the 

Reserve Component also provides a critical link to American communities. 

Tbe Reserve and National Guard sbould also be viewed as a repository for missions and equipment 

that aren't addressed in tbe administration's new Strategic Policy. They can sustain special 

capabilities not normally needed in peacetime. 

Part of the President's budget includes planned end-strength reductions for both the Army and Marine 

Corps, by 80,000and 20,000, respectively. It should be remembered that individuals cannot be brought 

quickly on to active duty on a temporary basis, as it is an accumulation of experience and training that is 

acquired over years that becomes an asset for the military. The Reserve is also a repository for these 

skills. 

A strong Reserve is needed for a strong national defense. For the last 73 years, America hasn't gone 

to war without its Reserves. According to the Congressional Research Service, Reserve and Guard 

members were involuntarily ordered to active duty for military operations 10 times since World War II: 

Korean War (1950-1953) 857,877 

Berlin Crisis (1961-62) 48,034 

Cuban Missile Crisis (1962) 14,200 

Vietnam War (1968-1969) 37,643' 

Persian Gulf War (1990-91) 238,729 

Haiti (1994-1996) 3,680 

Bosnian peacekeeping mission (1995-2000) 19,324 

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Iraqi [Operation Northern Watch]conflict (1998-2000) 2,038 

Kosovo conflict, peacekeeping mission (1999-2000) 5,933 

o Iraq and Afghanistan (2001-present) over 843,000 activations 

• As in many conflicts, newly affiliated Reserve Component members on their initial a.ctive duty tour served in Vietnam, but 

were not included in the above statistics. In Vietnam, 5,857 reservists were killed, which extrapolates to about 260,000 Reserve 

Component members in theater. 

The Reserve Component also contributed to ending the Cold War, because Soviet war planners had to 

account for the U.S. Reserve strength as well as its Active Duty numbers. The added military costs to 

prepare for all contingencies against the U.S. proved overwhelming to Soviet war planners. 

To maintain a strong, relevant, and responsive Reserve Force, the nation must commit the 

reSOurces necessary to do so. Reserve strength is predicated on assuring the necessary resourcesfunding for personnel and training, equipment reconstitution, and horizontal fielding of new technology to 

the RC, coupled with defining roles and missions to achieve a strategic/operational Reserve balance. 

National Guard and Reserve Equipment Allowance (NGREA) 

The Reserve and National Guard are faced with ongoing challenges on how to replace worn out 

equipment, equipment lost due to combat operations and legacy equipment that is becoming irrelevant or 

obsolete. The National Guard and Reserve Equipment Allowance provide critical funds to the Reserve 

Chiefs and National Guard Directors to improve readiness throughout procurement of new and 

modernized equipment. Continued receipt ofNGREA and congressionally added funding will allow the 

Reserve Components (RC) to continue to close the ActivelReserve Component modernization and 

interoperability gap. 

I Air Force - An Example of a Rush to Make Cuts 

The Air Force has recommended cuts in personnel and equipment, with disproportionate cuts taken from 

the Reserve Components. Proposed budget cuts has the Air Force planning to retire 286 aircraft as part of 

the president's new defense strategy over the next 10 years. A large number of these aircraft will be cut 

from the Reserve Component with most of the cuts "upfront" between Fiscal Years (FY) 2013 and 2017. 

The proposed cuts heavily impact the Reserve Component, affecting 32 states and one territory, 75 

reserve component units, and the military careers of thousands of Air Force Reserve and Air National 

Guard members. 

There is only a 35 percent savings when a Reserve Component officer or enlisted is cut when compared to 

the cost of keeping an individual on active duty. Certain missions can be performed by either the 

National Guard or the Reserve for much less than maintaining a fully staffed active duty unit. 

Air Force Chief of Staff, General Norton A. Schwartz has said that the Air Force is going to get smaller, 

and all of the components, Active, Guard and Reserve, are going to get smaller. An earlier statement by 

the Department of the Air Force indicated that the reductions would be balanced. Unfortunately, under 

the Air Forces plan, the majority ofthe end strengtbs cuts will come from the Reserve Components. 

The Air Force announced at the beginning of March that FY \3 manpower cuts would be: 

3,900 Active Air Force 

S,IOO Air National Guard 

900 Air Force Reserve' 

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It should be also noted that the Air Force ended fiscal year 2011 about 1,200 Airmen over active duty end 

strength. The net reduction would be 2,700 from authorized active duty end strength. The Reserve 

Component is be reduced by 2.2 times that ofthe active force. 

• Even though the AF announced that the Air Force Reserve will be reduced by 900 personnel in FY2013 over 3000 jobs will be realigned. There will be a risk of further reductions at some locations not 

shown on the chart attached to this testimony. There are 2,093 Reserve and 734 full time staff (FTS) 

reductions shown in Air Force announcements at six Air Force Reserve flying locations. These include: 

-563 Lackland, Texas (-385 reserve/-178 FTS in C-5s) 

-580 Barksdale, La. (-4091-171 closing AFR A-IO unit) 

-53 Homestead, Fla. (-401-13 reducing F-16s) 

-1448 Pittsburgh, Penn. (-1122/-326 closing Wing and Base) 

-53 Fort Worth, Texas (-40/-13 from the NAF) 

-130 Youngstown, Ohio (-971-33 reducing C-130s). 

Then in FY 14 and out, the plan to close the entire C-130 wing at Maxwell, Ala. ; the entire C-130 

winglbase at Minneapolis-St Paul, Minn.; a C-130 flying squadron at Keesler, Miss.; and the C-130 

winglbase at Niagara, N.Y. 

While some billets may not be lost, but simply transferred to other locations, individuals will be impacted 

by these changes .. Some Air Force reservists will have to move or travel to new jobs. Career choices will 

be aggravated by a poor economy and civilian job availability, and will push attrition rates higher. In 

these proposed reductions, the Air Force does not seem to understand the importance of 

populationlreserve demographics to cost-effective reserve unit locations. 

Some question the basis of the Air Force analysis. For example the Air Force identified Pittsburgh Joint 

Air Reserve Station for closure, claiming that the ARS is below the BRAC threshold of 300 full time 

civilian jobs enabling them to close the ARS unilaterally. Locals disagree, demonstrating that 317 DoD 

personnel are employed at Pittsburgh. Rebuttal position papers suggest that the Air Force is purposely 

misinterpreting Title 10 USC, "disregarding" DoD publications, and OPM definitions. This paper further 

suggests that the Air Force disregards infrastructure savings by having an Air Reserve Station at a shared 

civilian facility such as Pittsburgh International Airport. 

The Council of Governors also question the Air Force'S proposal, suggesting that the new budget "shift 

the Active DutylReserve Component mix back to the Cold War ration of the early 1990's when reserve 

components were strategic rather than combat-tested operational reserve forces." The report also 

highlights a shift of a 4 percent of combat aircraft and 3 percent of mobility aircraft into the active force. 

This actually raises the operational expense. The Council of Governors recommending returning the 

ACIRC mix to near the Fiscal Year 2012 ratio. 

The Council of Governors report includes offsets and recommendations for end strength cuts, but the 

report is National Guard centric, again highlighting that it would be ill-advised to react without a 

comprehensive review of the Active, Reserve and National Guard missions and assets for true budget 

savings. 

This risk is parochial infighting as active and reserve components "lobby" for dwindling financial 

resources. It didn't help when Air Force Chief of Staff Gen. Norton Schwartz General said, "The active 

component has been cut to the point at which capacity cannot be reduced further without harmful effects 

to ... readiness, increased capacity and the ability to surge and rotate at a sustainable tempo," while 

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speaking at the Air Force Association's annual air warfare symposium, seeming to justify cuts to the Air 

National Guard and drilling Air Force Reserve. 

There needs to be a referee to keep the armed forces focused on emerging threats rather than squabbling 

amongst ourselves. ROA and REA are confident that Congress will remind the Pentagon what is 

important. 

I RESERVE LIFE 

Reserve and Guard members have provided unprecedented service and sacrifice for the past decade. 

Congress should make a commitment to them to provide lifelong support for them through career growth, 

civilian employment, seamless health care, family support and deferred compensation that has been 

promised to them upon retirement. This will be an incentive to continue to serve. 

Continuum of Service 

A continuum of service influences the way the nation uses individual service members and the way it 

employs its Active and Reserve forces. It enables an effective use of our most important national security 

asset: the men and women who are willing to serve in the armed forces. It allows them and their families 

to continue to serve throughout predictable life-status changes, and leverages their skills throughout a 

career that is unencumbered with unnecessary barriers. 

By consolidating Active and Reserve personnel procedures and policies, and permitting seamless 

transition between the Active and Reserve components, individuals can gain better control of their own 

careers, while the services maximize the efficiency of force structure. A continuum would allow for a 

flexibility and optimization ofthe Total Force by allowing special skills and functions to be activated as 

needed and returned to the Reserve Component when not. 

Continuum of service is a human capital strategy that views active (full-time) and reserve (part-time) 

military service not as two elements of valuable service but as a continuation of service where a qualified 

individual can serve in different capacities and durations during his or her career. A continuum of service 

strategy recognizes the tremendous cost of accessing and training each service member and seeks to avoid 

unnecessary replication of such costs by accessing those skills rather than replacing them. 

Taken to its full potential, a continuum of service would require a re-examination of how service is 

credited and compensated, but would also allow for a more efficient management of our forces in a 

resource constrained environment. 

Reserve Life Issues supported by the Reserve Officers and Reserve Enlisted Associations include: 

Changes to retention policies: 

Permit service beyond current mandatory retirement limitations. 

Retain serving members for skill sets, even when passed over for promotion. 

Support incentives for affiliation, reenlistment, retention and continuation in the Reserve 

Component. 

Advocate against cuts in Reserve Component; support Reserve commissioning programs 

Reauthorize yellow ribbon program to support demobilized Guard and Reserve members. 

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Pay and Compensation: 

Reimburse a Reserve Component member for expenses incurred in connection with round-trip 

travel in excess of 50 miles to an inactive training location, including mileage traveled, lodging 

and subsistence. 

Eliminate the 1/30'h rule for Aviation Career Incentive Pay, Career Enlisted Flyers Incentive Pay, 

and Diving Special Duty Pay. 

Simplify the Reserve duty order system without compromising drill compensation. 

Education: 

Include Title 14 Coast Guard Reserve duty in eligibility for the Post 911 I GI Bill. 

Exempt earned benefit from GI Bill from being considered income in need based aid calculations. 

Increase MGIB-Selected Reserve (MGffi-SR) to 47 percent ofMGffi-Active. 

Include 4-year reenlistment contracts to qualify for MGffi-SR. 

Spouse Support: 

Expand eligibility of surviving spouses to receive Survivor Benefit Plan (SBP)-Dependency 

Indemnity Clause (DIC) payments with no offset. 

Provide family leave for spouses and family care-givers of mobilized Guard and Reserve for a 

period oftime prior to or following the deployment of the military member. 

Deferred Benefits and Retirement: 

Voting: 

Extend current early retirement legislation retroactively to Sept. II, 200 I. 

Change US Code to eliminate the Fiscal Year barrier toward full credit toward early retirement. 

Promote improved legislation on reducing the Reserve Component retirement age. 

Permit mobilized retirees to earn additional retirement points with less than two years of activated 

service, and codify retirement credit for serving members over age 60. 

Modify US Code that requires repayment of separation bonuses if an individual receives a 

Uniformed Service retirement annuity. 

Continue to protect and sustain existing retirement benefits for currently retired. 

Ensure that every deployed service member has an opportunity to vote by: 

o Working with the Federal Voting Assistance Program. 

o Supporting electronic voting. 

Ensure that every military absentee ballot is counted. 

I Joint Military Professional Education - a need to expand. 

A deep bench of Joint Qualified Officers (JQO) is essential to military planning and operations in today's 

national security environment. The architects of the Goldwater-Nichols Act recognized this and 

attempted to codify standards and career milestones to build a robust cadre of Joint officers. Although 

this act makes no di.stinction between the Services' Active and Reserve Components, obtaining Joint 

Qualified Officer (JQO) Level III status, which requires both joint experience and education, has proven 

much more challenging for members of the Reserve Components (RC) to achieve. 

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The primary reason is that opportunities for members of the RC to attain JPME Phase II credit or attend 

Senior-Level Education in residence are more limited than for the Active Component (AC). Members of 

the RC typically complete Senior-Level Service School through their respective services' distance 

education program. 

However, graduates of the Distance Education Programs (DEP) do not receive the JPME Phase II credit 

required to achieve the coveted JQO Level III status. So, in addition to completing a 12 to 24 month 

DEP, RC members aspiring to achieve JQO status must complete the Advanced Joint Professional 

Military Education (AJPME), a 10-month blended course, through Joint Forces Staff College. Altogether 

this can potentially add up to 34 months of education to achieve what most members of the AC do in 10 

months at in-residence programs--despite the fact that nearly the same curricula standards apply to both 

the DEP and the resident education program (REP). To both provide equal access to achieve Level III 

status, and to better position the RC to continue to function as an Operational Force, barriers to 

educational achievement must be creatively addressed while not lowering standards. 

Solution - Amend Title 10 USC and adjust policy to provide that nonresident graduates of accredited 

senior-level service school programs receive the same JPME credit as resident graduates. It is acceptable 

to also require that a certain amount of the non-resident curricula also deal with joint issues. Further, the 

laws should be amended that provide that graduates of the Joint Forces Staff College (JFSC) Advanced 

JPME course receive Phase II credit. 

Permit flexibility.in the student and faculty ratios now required by Title 10 USC to permit the nonresident 

programs to adjust and validate other ratios that would still yield a proper joint education. The waiving 

of the current ratios would be solely within the control of the Secretary of Defense although his discretion 

should be limited to permitting a maximum ratio of 80% faculty and students coming from the host 

institution to ensure cross-culturalization. 

ROA has suggested language to amend Title 10 USC, and will work with the committee to make these 

improvements. 

I CONCLUSION 

ROA and REA reiterate our profound gratitude for the bipartisan success achieved by this committee by 

improving parity on pay, compensation and benefits between the Active and Reserve Components. The 

challenges being faced with proposed budget cuts are going to make this committee's job that much 

harder. 

ROA and REA look forward to working with the personnel sub-committee where we can present 

solutions to these' challenges and other issues, and offers our support in anyway. 

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DEPARTMENT OF DEFENSE AUTHORIZATION 

FOR APPROPRIATIONS FOR FISCAL YEAR 

2013 AND THE FUTURE YEARS DEFENSE 

PROGRAM 

THURSDAY, JUNE 21, 2012 

U.S. SENATE, SUBCOMMITTEE ON PERSONNEL, COMMITTEE ON ARMED SERVICES, Washington, DC. 

DEPARTMENT OF DEFENSE PROGRAMS AND POLICIES 

TO SUPPORT MILITARY FAMILIES WITH SPECIAL NEEDS 

The subcommittee met, pursuant to notice, at 2:35 p.m. in room 

SD–106, Dirksen Senate Office Building, Senator Jim Webb (chairman of the subcommittee) presiding. 

Committee members present: Senators Webb, Begich, Gillibrand, 

and Blumenthal. 

Committee staff member present: Leah C. Brewer, nominations 

and hearings clerk. 

Majority staff members present: Jonathan D. Clark, counsel; 

Gabriella E. Fahrer, counsel; and Gerald J. Leeling, counsel. 

Minority staff member present: Diana G. Tabler, professional 

staff member. 

Staff assistants present: Jennifer R. Knowles and Brian F. 

Sebold. 

Committee members’ assistants present: Brian Burton, assistant 

to Senator Lieberman; Lindsay Kavanaugh, assistant to Senator 

Begich; Elana Broitman, assistant to Senator Gillibrand; Ethan 

Saxon, assistant to Senator Blumenthal; and Lenwood Landrum, 

assistant to Senator Sessions. 

OPENING STATEMENT OF SENATOR JIM WEBB, CHAIRMAN 

Senator WEBB. The subcommittee will come to order. The subcommittee meets today to receive testimony on the Department of 

Defense (DOD) programs and policies to support military families 

with special needs in review of the National Defense Authorization 

Act (NDAA) for Fiscal Year 2013 and the Future Years Defense 

Program. 

At the outset, let me say a few things. First, I know that this 

is a hearing that was supposed to have been held yesterday. Some 

of you have been required to stay over a day in order to testify. I 

want you to know I appreciate that, and I think everybody here is 

aware of what we have been doing on the Senate floor for the past 

318 

3 days. We had the Farm Bill up and we entertained more than 

70 amendments in 3 days. 

Having spent 4 years as a committee counsel on the House side, 

I can tell you it is a lot different on the Senate side in terms of 

how we address amendments because each of these amendments is 

debated. There is a time for a vote, and each senator has to personally present themselves when they vote. It is a very timeconsuming 

process, and I think there is actually a pretty good bipartisan feeling right now that we were able to get through such a complex 

piece of legislation, nearly a $1 trillion piece of legislation during 

that time period. 

But I do apologize for not having been able to have held this 

hearing yesterday. We thought about trying it, but quite frankly, 

we would have been in and out of here constantly, and I do not 

think it would have been the best use of the time of the people who 

have come here to testify. 

I would also like to acknowledge Senator Gillibrand, who is, I 

have heard, on her way, for having expressed an interest in a couple of these issues, which resulted in Senator Levin and Senator 

McCain suggesting that we hold a hearing on these issues. So this 

is what we are doing. This was during the recent markup of the 

Defense Authorization bill. She requested that some specific special 

needs programs be examined in an open subcommittee hearing. We 

are doing that today and very pleased to be doing that today. 

We are fortunate to have with us today a diverse panel. Our witnesses are Dr. Karen S. Guice, Principal Deputy Assistant Secretary of Defense for Health Affairs, and Principal Deputy Director 

of TRICARE Management Activity; Dr. Rebecca L. Posante, Deputy 

Director of DOD’s Office of Community Support for Military Families with Special Needs; Dr. Vera F. Tait, Associate Executive Director, and Director of the Department of Community and Specialty 

Pediatrics of the American Academy of Pediatrics; Mr. Jeremy L. 

Hilton, a military spouse, a veteran, and a military family advocate, as well as the 2012 Armed Forces Insurance Military Spouse 

of the Year as voted by his fellow military peers in Military Spouse 

Magazine; Dr. Geraldine Dawson, Chief Science Officer of Autism 

Speaks, and Professor of Psychiatry at the University of North 

Carolina at Chapel Hill; and Mr. John O’Brien, Director of 

Healthcare and Insurance for the U.S. Office of Personnel Management (OPM). 

This panel represents a variety of interests and viewpoints: the 

Federal Government, clinicians, the military family community, 

non-profit organizations, and academia. We look forward to hearing 

from each of you today. 

I have said in many previous hearings that ensuring that our 

uniformed personnel and their families receive first-rate healthcare 

is one of the critical elements in what I view as the military’s 

moral contract with those who volunteer to serve our Nation. I say 

that as someone who grew up in the military, who had the honor 

of serving as a marine rifle platoon and company commander during Vietnam, whose son served as a marine infantryman in Iraq, 

whose brother served, and both my sisters married military professionals. I care deeply about this, as I am sure everybody on this 

panel does also. 

319 

Families play a significant role in maintaining our volunteer 

force, and this is true now more than ever. Our servicemembers 

must know that their families are receiving timely and professional 

medical care, especially when they are so frequently deployed. This 

can be even more imperative in cases where military family members have special needs. 

We are mindful that the term ‘‘special needs’’ is very broad. For 

some families, ‘‘special needs’’ may mean obtaining necessary care 

and treatment for complex medical issues. For others, it means 

gaining access to resources necessary to accomplish goals set out in 

a child’s individual education program at school. For many, it can 

mean a combination of medical treatment, educational services, 

and systems of support for caregivers. 

Given the unique challenges inherent to military life, including 

frequent relocations to new homes and schools, and having a new 

team of medical providers with each permanent change of station 

(PCS), not to mention deployments, it is no wonder that DOD felt 

it necessary to establish the Exceptional Family Member Program 

(EFMP). This program provides support to our military families 

with special medical and educational needs through identification 

and enrollment, assignment coordination, and family support. Currently, more than 120,000 servicemembers are enrolled in this program. 

Beyond support through EFMP, DOD reports that in fiscal year 

2011, more than 10,000 beneficiaries were enrolled in the Extended 

Care Health Option (ECHO) program, which supplements basic 

TRICARE coverage. This program provides eligible Active Duty 

families with up to $36,000 a year to help cover the costs of services and supplies necessary for qualifying medical and physical conditions. 

Data for the ECHO program provides us with a sense of the 

scope of conditions that some military families face today. For example, DOD tells us that more than 6,000 dependents have been 

diagnosed with autism. More than 1,000 have infantile cerebral 

palsy. Another 2,700 have disorders including epilepsy, hearing 

loss, digestive disorders, spina bifida, or muscular dystrophy. These 

are just the major categories of medical conditions military families 

with special needs must address. 

Today, we aim to increase our awareness of the challenges facing 

our military special needs families. Some examples: we recently 

heard of the need for better outreach to military families with special needs, some of whom may be unaware of resources that are 

available to them, continued effort to provide more uniform support 

through EFMP from installation to installation, and assisting our 

servicemembers and their families to navigate the various medical 

and educational services available from State to State. 

We have also been informed that OPM recently determined that 

applied behavior analysis (ABA) therapy for autism spectrum disorders is considered medical therapy for purposes of offering it to 

beneficiaries under the Federal Employees Health Benefits (FEHB) 

program. DOD has been offering ABA therapy for several years, 

but not under its basic TRICARE program as it has determined 

that ABA is an educational intervention and not a medical therapy. 

320 

We are interested in hearing the thoughts of today’s witnesses 

about this distinction. 

We appreciate the breadth of knowledge the panel before us 

today possesses. I hope that our witnesses can help us to identify 

the key issues and concerns facing military families with special 

needs, the steps DOD has taken to address those concerns, and 

where DOD and Congress can do a better job. 

We look forward to your testimony. I encourage all of you to express your views candidly, to tell us what is working and what is 

not, and to raise any concerns and issues you may want to bring 

to this subcommittee’s attention. 

I would also point out at this time that we have received written 

statements from the National Military Family Association and the 

National Council on Disability. These statements will be included 

in the record at the end of the testimony of the witnesses that we 

have today. 

[See Annexes A and B] 

Senator WEBB. We will now hear brief opening statements from 

each of our witnesses. I would like to say to each of our witnesses 

that your full prepared statements will be entered into the record 

in their entirety at the end of your opening statements. I would ask 

that you look to keeping your opening statements to about 5 minutes. 

We have six witnesses, so that is going to take us probably a little more than a half hour to do that. 

Please proceed. Dr. Guice, welcome. 

STATEMENT OF DR. KAREN S. GUICE, PRINCIPAL DEPUTY ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS 

AND PRINCIPAL DEPUTY DIRECTOR, TRICARE MANAGEMENT ACTIVITY 

Dr. GUICE. Mr. Chairman, members of the subcommittee, as you 

can tell, I have laryngitis. I would like to beg your indulgence in 

letting me talk a little over the 5 minutes, if I have to. 

Thank you for the invitation to discuss the military health system—— 

Senator WEBB. Very convenient, Dr. Guice, that you would have 

laryngitis when we have called you to this hearing. [Laughter.] 

You are getting a lot of empathy right now, so if you want to 

make your statement briefer, that is fine. We can do it any way 

possible to accommodate you. 

Dr. GUICE. Thank you. Military service brings unique challenges 

to anyone who wears the uniform. Those servicemembers who have 

special needs children have additional challenges. 

DOD is proud of the programs and services we offer to these families in conjunction with other support services provided by State 

and local governments and the private sector. Dr. Rebecca L. 

Posante will talk about those services provided by the Office of 

Community Support for Military Families with Special Needs. I 

will briefly touch on the health benefits and supplemental services 

we provide through our basic medical plan and the ECHO program. 

DOD offers a comprehensive and uniform medical benefit for 

military beneficiaries delivered worldwide through our military 

treatment facilities or purchased care. For our beneficiaries, these 

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medical benefits include access to a variety of providers, including 

specialists, inpatient and outpatient care, as well as prescription 

medication. 

In addition to the basic health plan, the military health system 

offers the ECHO program. This program provides additional beneficiaries not otherwise available under the basic health plan to eligible Active Duty servicemembers with special needs. By ensuring 

our Active members have access to these services, we support military retention and readiness for DOD. 

One example of the services covered under the ECHO program 

is ABA treatment for patients with autism spectrum disorders 

(ASD). Since 2001, DOD has covered ABA services for qualifying 

members. Because many of our Active Duty families found it difficult to access certified ABA providers under the traditional ECHO 

program’s criteria, we implemented a demonstration project in 

2008, to determine if we could expand the availability of providers. 

Under the demonstration program, we cover ABA services when 

provided by tutors who are under the direct supervision of certified 

ABA therapists. This demonstration project has succeeded in expanding access to services, and participation in the demonstration 

project has grown by average of 3 to 5 percent per month per year. 

We are now in the process of converting the demonstration project 

into a permanent part of the ECHO program. 

Military families also asked us to help sustain continuity of care 

and service during reassignments and relocations. We work closely 

with our TRICARE regional offices and TRICARE contractors to 

ensure that there is a smooth transition for families with children 

who have special needs when they relocate. 

I understand that one of the primary purposes of this hearing is 

to address medical coverage decisions by OPM for the FEHB Plan 

and TRICARE relative to ABA for patients with ASD. In 2010, 

DOD conducted an assessment to determine if ABA qualified as 

medically necessary and appropriate under existing TRICARE law 

and regulation. Through robust analysis, peer review literature, 

and independent technical analyses, ABA was determined to be an 

educational intervention, and as such, did not meet the criteria for 

coverage under the basic medical program. 

Our determination is consistent with the 2011 Agency for 

Healthcare Research and Quality’s Comparative Effectiveness Review, Therapies for Children with Autism Spectrum Disorders. In 

this review, the investigators found the literature to be highly variable in quality, limited in those specific areas, and inconclusive. 

They identified the need for more research to determine which children benefit from a particular intervention or combination of interventions. 

In the same report, the investigators clearly separated education 

and behavioral interventions for medical interventions. They did 

not consider ABA to be a medical intervention, which is consistent 

with DOD’s 2010 review. However, we also understand that OPM 

has recently reviewed evidence that they believe now meets their 

threshold for determining ABA as a covered medical service. We 

have formally requested that OPM provide us this evidence so we 

can evaluate it against our coverage criteria. 

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Medical care evolves over time, and we continuously evaluate 

new medical interventions or treatments for effectiveness and safety prior to a coverage determination. Our coverage determinations 

are strictly governed by statute and regulations, and require an extensive assessment of reliable medical evidence. Our determinations are also based on what is medically or psychologically necessary to diagnose and treat disease or injury. 

DOD is committed to providing comprehensive services for military families who have children with special needs. By providing 

robust medical care for our Active Duty members and their families, along with supplemental services to further support those with 

special needs, we contribute to a stronger warfighter. 

I am proud to be here with you today to represent the military 

health system and our exceptional health providers who provide exceptional service to exceptional people. I look forward to answering 

your questions. 

[The joint prepared statement of Dr. Guice and Dr. Posante follows:] 

JOINT PREPARED STATEMENT BY DR. KAREN S. GUICE AND DR. REBECCA L. POSANTE

Mr. Chairman, members of the subcommittee, it is a privilege for both of us to 

appear before you today, and we appreciate the opportunity to testify on our efforts 

to support military families that include a member with special medical or educational needs. 

The Department of Defense is proud of the programs and services we provide to 

military families with special needs. We have been providing specialized services to 

families for decades. In response to the landmark legislation for military families 

with special needs (Sec. 563 of the National Defense Authorization Act, Pub. L. No. 

111–84), the Secretary of Defense established the Office of Community Support for 

Military Families with Special Needs (OSN) in October 2010. This office is leading 

efforts to streamline processes that can be improved, to develop policies that guide 

the provision of support by the military departments, and to generally help families 

identify, understand and navigate the systems they will encounter. This office is 

closely linked with our colleagues in the Office of the Assistant Secretary of Defense 

(Health Affairs) and the TRICARE Management Activity (TMA) within the Office 

of the Under Secretary of Defense (Personnel & Readiness). 

Support to military families with special needs is an especially important task for 

the Department. Military families with special needs are first military families. 

They have the same challenges any other military family may encounter in the face 

of periodic moves, deployments, and separation from family. Further, they face additional challenges, navigating often complex systems to obtain the services and benefits their families need to help their loved one function to their maximum potential. 

Each time a military family moves the process starts over, and they face questions 

such as: Who provides early intervention services in this State? Am I going to the 

local school system, public health or a regional board to get help? What do they call 

their programs here? Is there a waiting list for Medicaid, or perhaps, how long is 

the waiting list? Where do I sign up for the women, infants, and children program, 

and will they accept the certification from my current state? What will we do when 

we can no longer take our non-verbal child to the dentist who has finally achieved 

his trust? Will there be anyone at the new location who will understand what we 

need? What school district can best meet the needs of my child? 

We recognize that these military families need assistance with these questions, 

and we have worked to make this process less challenging wherever possible. 

THE CURRENT STATE OF THE EXCEPTIONAL FAMILY MEMBER PROGRAM

For over 30 years, the Military Services have administered the Exceptional Family Member Program (EFMP), which identifies family members who have special 

medical or educational needs, documents their needs and ensures they are considered when the servicemember is being considered for the next assignment. Since the 

NDAA for Fiscal Year 2010, the EFMP has been expanded to include a requirement 

for family support and to extend the coordination of assignments based on the famVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00328 Fmt 6601 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
323 

ily member’s special needs to permanent change of station (PCS) moves within the 

United States as well as overseas. 

Currently, over 400 EFMP family support personnel serve military families with 

special needs. All installations have either a full- or part-time staff person, or (in 

smaller locations) a point of contact for military families with special needs. Installations with greater numbers of families with special needs may have multiple 

EFMP family support personnel. All providers have been trained in their roles, the 

agencies with which they will work, and the requirements of supporting military 

families with special needs. 

The OSN developed an EFMP Family Support Reference Guide and disseminated 

it to all EFMP family support providers (to include Reserve and Guard Components) 

as a guide to providing family support and networking with community support systems. Through a Memorandum of Understanding with the U.S. Department of Agriculture (USDA), the OSN partnered with Cornell University and the University of 

Kansas to conduct a benchmark study identifying the concerns of military families 

with special needs, the support they require, and the systems that have been effective in providing services. The research team conducted focus groups with military 

families from all branches of Service and with civilian populations. This study will 

generate recommendations for the military in refining our support programs including staffing models, metrics, evaluation standards, and a family satisfaction scale. 

The OSN is working closely with the Military Services to standardize the EFMP 

across Services. Military families want consistency, and we are improving their ability to navigate internal processes more easily by having standard forms, terms, and 

procedures. The OSN embarked on a multi-year project to analyze current systems 

(medical, personnel and family support) that make up the EFMP (identification/enrollment, assignment coordination and family support) to even more closely integrate service delivery. We have concluded the first year of the functional analysis. 

Over the longer term, we will create an integrated, longitudinal electronic record 

that works across all military departments. This system will prevent families from 

reinventing paperwork with every PCS, allow the medical command to alert the personnel command about availability of medical services, and regardless of Service affiliation the family will receive a warm handoff to the receiving location. This is a 

detailed, iterative process involving multiple data and case management systems. 

The end result, however, will offer an important enhancement to the families we 

serve. 

LISTENING TO OUR MILITARY FAMILIES

In the last 2 years, we have held two EFMP family panels representing military 

families of all ranks, Service affiliation, Active Duty and Reserve components, and 

ages and disabilities of the family member with special needs. We have conducted 

three studies on access to special education in the public schools, access to Medicaid, 

and a benchmark study on what makes a support system work. The lack of State 

and local data identifying military-connected families who use public sector programs, including special education, remains a gap. 

We have also consulted with non-governmental agencies on their knowledge of the 

relevant issues regarding special needs families, and participated in several of the 

Military Family Caucus sessions. These Caucus sessions pertained to special needs, 

and military family members who advocate for families with special needs were invited to discuss issues in our office. We have read the National Council on Disability’s report, How to Improve Access to Health Care, Special Education, and LongTerm Support and Services for Family Members with Disabilities, and met with the 

researchers who developed the report. The same issues for our families emerge in 

each forum: access to special education, access to Medicaid, transition problems with 

access to TRICARE when families change locations, and a request for inclusion of 

applied behavior analysis as a medical benefit within TRICARE rather than through 

the Extended Care Health Option. 

We have focused on providing the information military families with special needs 

members need, particularly during critical transition moments; we work to educate 

them about what is available to them and assist them with obtaining resources and 

benefits within the scope of the law. Our efforts have been directed at identifying 

the problems families encounter, addressing those we have the authority to address 

(such as consistency across the military departments) and collaborating with the 

agencies/programs responsible for services not within our control. 

EDUCATING OUR FAMILIES

While the Department does not have authority over programs in other governmental agencies or programs administered by the States, we have the responsibility 

324 

to educate our families on how to identify resources available to any American citizen and obtain benefits. We can provide information about special education and 

the Individuals with Disabilities Education Act (IDEA) and all its requirements and 

protections. Many military family children benefit from special education and the 

families must know how these systems work. Our military families need and benefit 

from programs such as Medicaid, Supplemental Security Income, and early intervention, too. 

The OSN has created a wealth of information for military families available on 

line at the MilitaryOneSource.mil website or by calling Military OneSource. These 

include written guides for families whose children have disabilities and a new guide 

for families where there is an adult family member with special needs. Both guides 

will be accompanied by a facilitator’s manual, which can be used by EFMP staff (or 

families) to conduct training sessions on special education, early intervention, 

TRICARE, and much more. We conduct monthly webinars utilizing the talents of 

leaders in our field on such subjects as care giving, assistive technology, guardianship and estate planning, and advocacy. We have produced a series of podcasts 

available on smart phones and a mobile website that allows families to access 

EFMP providers, EFMP enrollment forms, and all of our online content. Several elearning modules have been developed to increase parents’ knowledge about special 

education and how to collaborate with school personnel, about the EFMP and about 

other Federal and State programs. 

We are in the process of revising the content and presentation on the Military 

OneSource website and anticipate completion of this revision by September 1. From 

one landing page families with special needs will be able to learn about military and 

community programs, access an EFMP provider, sign up for a webinar or view 

archived webinars, request materials, or make an appointment for a specialty consultation with a Military OneSource consultant who is a professional in special 

needs. 

SUPPORTING DOD PROGRAMS TO SERVE FAMILY MEMBERS WITH SPECIAL NEEDS

OSN has created an internal coalition of Defense organizations to address issues 

of access for our military families with special needs. Through effective collaboration 

with the military departments, the EFMP and Morale, Welfare and Recreation, we 

have built over 200 accessible playgrounds for children with disabilities and installed pool lifts in all military swimming pools. We have developed online tools for 

families who are moving with a special needs family member to help them plan 

their move. For the past 2 years in cooperation with the military children and youth 

programs, we have funded ongoing training and support to enable those programs 

to integrate children and youth with disabilities. The OSN purchased and distributed books and electronic subscriptions to all military departments’ installation libraries and family centers to create an EFMP library. The set of references is intended to assist professionals and family members in accessing materials on disability-related topics. In addition, special education law resources were provided to 

military department legal offices and selected medical offices. We work closely with 

the DOD Education Activity to ensure the 9,700 children with special needs attending a DOD schools receive appropriate special education services. 

ACCESS TO SPECIAL EDUCATION

Military families are concerned about access to special education services. Obtaining comparable services from one assignment to the next is the most consistently 

reported obstacle for military families and often reflects differences in eligibility and 

services between States. For example, the American Association for Employment in 

Education (AAEE) has reported shortages of special education teachers, speech-language pathologists, school psychologists, vision and hearing specialists, school 

nurses, physical therapists and occupational therapists, with many regions of the 

country reporting considerable shortages for several years in a row (AAEE, 1996– 

2010). There are wide disparities in school nurse staffing ratios; some exceed 1: 

4,000. Only 75 percent of schools have a full or part time nurse; 25 percent have 

no registered nurse. Seventeen percent of schools with more than 750 students have 

no registered nurse on duty (National Association of School Nurses (NASN)). Fortyeight States and the District of Columbia identified special education teaching and/ 

or at least one of the related service provider categories as an official ‘‘shortage 

area’’ for the 2011–2012 school year (Teacher Shortage Areas Nationwide Listing, 

U.S. Department of Education, Office of Postsecondary Education, March 2011). 

Given well-documented fiscal pressures on State budgets, it is likely that discrepancies in which resources are available between school districts and among States 

will persist. 

325 

To address family member information needs in this area, OSN has initiated multiple efforts including establishing a resource clearinghouse to help families with relocation; identifying and promulgating effective support practices among service 

branches; and sponsoring research studies on evidenced-based educational practices. 

OSN developed an online Education Directory to inform families of points of contact, 

resources, and procedures in public school districts in the States with the highest 

number of military assignments. The project continues and by the end of fiscal year 

2014, we will publish a directory that includes all 50 States and the District of Columbia. 

Through the USDA MOU previously mentioned, we are partnering with Ohio 

State University and Pennsylvania State University to collect more detailed data 

about the extent and types of issues impacting families as they attempt to access 

comparable special education services in their new duty station. This project will 

support the identification of special education issues for which parents and family 

support providers need additional training and assist in determining if a formal 

military complaint documentation system should be explored in collaboration with 

the U.S. Department of Education. 

ACCESS TO MEDICAL SERVICES—TRICARE, EXTENDED HEALTH CARE OPTION (ECHO) AND

MEDICAID

In managing health and health benefit issues, we first ensure we are faithfully 

following public law regarding what is a covered medical benefit. We also seek to 

align our initiatives to the Military Health System (MHS) strategic plan, the Quadruple Aim, which is comprised of four interrelated missions—Assure Readiness; Improve Population Health; Enhance the Patient Experience of Care; and Responsibly 

Manage the Cost of Care. We consider ‘‘family readiness’’ as an essential element 

of our Readiness strategy. 

The MHS has long been a leader in offering benefits and services to military families with special needs. We have directed considerable effort in formulating policy 

for coverage of effective therapies under the TRICARE Basic Program and the Extended Care Health Option (ECHO) program. 

TRICARE Basic Program 

The TRICARE Basic Program—whether TRICARE Prime, TRICARE Extra, or 

TRICARE Standard—offers a comprehensive health benefit that covers any medically or psychologically necessary care for special needs beneficiaries, to include physician visits, immunizations, psychological testing and medical interventions such as 

speech therapy, physical therapy and occupational therapy. TRICARE offers exceptionally comprehensive coverage with very low out of pocket costs to our beneficiaries. For active duty families enrolled in TRICARE Prime, the out of pocket 

costs are almost non-existent, and families are further protected by a $1,000 out of 

pocket catastrophic cap, after which DOD pays 100 percent of allowable costs. By 

law, the TRICARE Basic Program may not cover non-medical services such as Applied Behavior Analysis (ABA). 

Extended Care Health Option 

The ECHO program, established under Title 10 U.S.C. Code 1079, provides additional benefits not otherwise available under the TRICARE Basic Program to certain eligible active duty family members with special needs. As established by law 

(National Defense Authorization Act for Fiscal Year 2009, Public Law 110–417), the 

government will cover up to $36,000 per beneficiary per year in ECHO benefits. 

As we noted at the beginning of our testimony, similar to other military families, 

our active duty families with special needs members must move frequently from one 

location to another. To ensure continuity of care for ECHO participants when they 

move, our TRICARE contractors have established case management hand-off processes so that the receiving contractor will be prepared to maintain for a family the 

set of ECHO services it had been receiving before moving. Because of the complexity 

and diversity of the services required to effectively address the special needs of 

many participants in ECHO, TRICARE requires its regional managed care support 

contractors to provide case management services to ECHO participants. Applied 

case management ensures access to a comprehensive, coordinated set of required 

treatments and services. 

Each of the three TRICARE contractors is required to deliver a uniform TRICARE 

benefit. Consequently, a family can expect to receive the same ECHO services upon 

arrival at the new duty station. However, families may notice some differences in 

the administration of these services by our regional contractors. The Department 

does permit some variation in administrative practices in order to permit the use 

of contractor best practices. In the unlikely event a family should be denied coverage 

326 

under either TRICARE Basic or ECHO it had been receiving in another TRICARE 

region, there is a well-designed appeal process beneficiaries may use, and the contractors are required to assist them in understanding and exercising their appeal 

rights. 

Examples of benefits not available through the TRICARE Basic Program, but 

available through ECHO include: assistive services, expanded in-home medical services, institutional care when a residential environment is required, and other services that the Director of TMA determines are capable of reducing the disabling effects of a qualifying condition. These ‘‘qualifying conditions’’ include Autism Spectrum Disorders (ASD). At the end of fiscal year 2011, DOD had over 10,000 

TRICARE beneficiaries registered in the ECHO program. 

The Department has worked to ensure our special needs families with ASD have 

access to the most widely-accepted educational intervention, known as ABA. Since 

2001, the Department of Defense has covered ABA services for eligible active duty 

family members under the ECHO program (and its predecessor, the Program for 

Persons with Disabilities). Originally, we covered ABA services only if provided by 

a Board Certified Behavior Analyst (BCBA). We found there were not enough of 

them available to satisfy the demand from Active Duty family members for services. 

So, in 2008 we constructed a demonstration to increase access to ABA services by 

permitting tutors, under the supervision of BCBAs, to provide the services. Even 

today, ECHO enrollees with an ASD who want ABA services but who do not want 

to participate in the demonstration may obtain the services directly from a BCBA, 

if available from that source. 

This demonstration has succeeded in expanding access to services—and we continue to witness increased participation by ABA supervisors, tutors and TRICARE 

beneficiaries. As of March 31, 2012, there were 3,783 beneficiaries enrolled in the 

demonstration—a number that has grown by 3–5 percent annually, on average, 

since the program was first introduced in 2008. Just as importantly, a recent DOD 

survey of military parents of dependent children with autism reported that the improved access to ABA services contributed to improved military family readiness 

and retention. 

The Department is now moving beyond a demonstration program and seeking to 

embed the supervisor-tutor model of ABA provision as a permanent element of the 

ECHO program. We published a proposed rule in the Federal Register on December 

29, 2011, to establish coverage of this ABA provision under ECHO for eligible beneficiaries with ASD. Upon final implementation of this rule, we intend to categorize 

ABA as an ‘‘Other Service’’ under the ECHO statute and permanently adopt a more 

robust ABA services delivery and reimbursement methodology. 

While we are pleased that we have been able to broaden access to these services, 

we do recognize that some families experience additional out-of-pocket costs when 

needed services exceed the government’s statutory limit of $36,000. Based on our 

own claims data from 2011, 207 beneficiaries using the ECHO program had expenditures above $35,000 per year. Another 489 beneficiaries had expenditures between 

$30,000 and $35,000. Thus, in 2012, we estimate that approximately 86 percent of 

TRICARE beneficiaries with an ASD diagnosis and using the ECHO program have 

had 100 percent of their expenses covered within the $36,000 government maximum. 

Several Members of Congress have inquired about the feasibility of categorizing 

ABA services as a medical benefit covered under the TRICARE Basic Program. The 

Department conducted a thorough technical assessment of ABA in 2010 to determine whether ABA met the requirements for inclusion as a TRICARE covered service. 

Our technical assessment looked at the following: Does the reliable evidence, as 

that standard is defined in law and regulations for TRICARE Basic Program coverage determinations, support a conclusion that ABA is medically or psychologically 

necessary and that it is appropriate medical care for Autism Spectrum Disorders 

(ASD)? (2) Does the reliable evidence support a conclusion that ABA is proven as 

medically or psychologically necessary and that it is appropriate medical care for 

ASD in accordance with the requirements of 32 Code of Federal Regulations Sec. 

199.4. Can ABA be covered as a TRICARE benefit under Chapter 55 of Title 10, 

U.S.C. if it is concluded that ABA is not medically or psychologically necessary and 

that it is not appropriate medical care for ASD, or that it is not proven as medically 

or psychologically necessary or that it is not appropriate medical care for ASD? 

We found that ABA is an ‘‘educational intervention’’ and does not meet the 

TRICARE definition of medically or psychologically necessary care. The majority of 

the reliable evidence characterizes ABA as not being a medical treatment, as that 

standard is defined in law and regulations for TRICARE Basic Program coverage 

327 

determinations, but instead as involving non-medical, behavioral intervention services. 

Consequently, the Director, TRICARE Management Activity has concluded that 

ABA is not medically or psychologically necessary or appropriate medical care within the meaning of the law and regulations governing coverage of medical benefits 

under the TRICARE Basic Program. However, the assessment indicates that 

TRICARE has authority to pay for ABA to reduce the disabling effects of ASD for 

ECHO-registered dependents with an ASD diagnosis, and this assessment helped 

guide our decision to make ABA services a permanent part of the ECHO program. 

The assessment and Director’s conclusion serve as the administrative record of the 

agency’s decision and is reflected in the proposed rule. The TMA’s Medical Benefit 

& Reimbursement Branch reviews information about Medicare’s and other payers’ 

coverage, regular medical technology updates available through a subscription to 

Hayes, Inc. reports (a medical technology assessment firm), data/evidence submitted 

by beneficiaries and providers on appeal, evolving practice information from the Office of the Chief Medical Officer, and TRICARE Managed Care Support Contractors’ 

evolving practice reports. TMA decides on the basis of these information sources 

whether it is warranted to conduct a formal review to determine if a medical technology can be confirmed by the hierarchy of evidence specified in 32 CFR 199.2 to 

be considered medically safe and efficacious. 

Medicaid. Some military families with special needs beneficiaries also qualify for 

Medicaid. There are select services that TRICARE does not cover that are available 

through this Federal-State medical program. Example of items and services that 

TRICARE (and most civilian health insurance) does not cover includes long-term 

care, custodial care (assistance with daily living), adult day services, or expendable 

items such as diapers. 

Because Medicaid is State-administered, military families that include member(s) 

with special needs face difficulties each time they move and they are required to 

reapply for Medicaid eligibility. In some cases, this includes placement on waiting 

lists. Because of the frequency of military rotations, some families do not move off 

the waiting list before they once again relocate. 

The Department has contracted with West Virginia University to study the problems military families face with accessing Medicaid. Preliminary findings of the 

West Virginia study indicate that families and EFMP providers need more training 

on how to access Medicaid. The final report from this study will be available in fall 

2012. 

The DOD State Liaison Office held an open meeting recently to discuss adopting 

this as one of the issues to address with States much as they have addressed the 

transition of school-aged children. We will provide an update on the outcome of this 

recommendation in the near future. 

The Department recognizes the enormous challenges that military families with 

special needs beneficiaries experience, and we have aggressively sought to meet 

their needs with targeted programs and services. As we stated earlier—family readiness is a military readiness issue. We have made tremendous progress over the past 

several years, consistent with the law that Congress has established. 

In the case of military children with special needs, we have crafted programs that 

have only been enhanced and improved over the last 10 years—in the areas of education, special education, community wide information and education. In the medical arena, we have successfully expanded programs that allow for the delivery of 

services beyond the traditional medical services authorized under TRICARE. We 

have continuously worked to expand both service delivery and reduce their out of 

pocket expanses. Congress has also expanded the government’s maximum cost-share 

for the ECHO program from $2,500 monthly maximum to $36,000 annually. 

We are committed to maintaining our passion for excellence and service to these 

very special families. We are proud of what we have accomplished to date, and we 

are optimistic about our ability to continue to meet family member needs for the 

long-term. 

Again, we thank you for inviting us to be here today, and we look forward to your 

questions. 

328 

Senator WEBB. Thank you very much, Dr. Guice. 

Dr. Posante, welcome. 

STATEMENT OF DR. REBECCA L. POSANTE, DEPUTY DIRECTOR, OFFICE OF COMMUNITY SUPPORT FOR MILITARY FAMILIES WITH SPECIAL NEEDS, DEPARTMENT OF DEFENSE 

Dr. POSANTE. Thank you, Senator Webb, for inviting me to testify 

today. Supporting individuals and families with special needs has 

been a passion of mine for over 30 years. I really appreciate the 

attention being paid to this topic today. 

When I brief the NDAA for Fiscal Year 2010 to military audiences, I always refer to it as landmark legislation. It established 

the Office of Community Support for Military Families with Special 

Needs, for which it has been my pleasure to serve as the Deputy 

Director for nearly 2 years. It served as a catalyst for our efforts 

to streamline processes that can be improved, to raise issues that 

need to be raised, to develop policies that guide the provision of 

support by the military departments, and to generally help families 

identify, understand, and navigate the systems they will encounter. 

Military families with special needs are military families first. 

They face the same challenges that other military families face due 

to periodic moves, deployments, and separation from their extended 

families. But in addition, our families with special needs face the 

challenge of navigating often complex, stovepiped, and confusing 

educational, medical, and community support systems. Our families have children with intellectual, physical, communication, and 

emotional disabilities. In about a third of our families, it is the 

adult member that has a special need. 

The good news is that there are a myriad of systems, military, 

State, and local community systems, available to support them. 

The bad news is there are a myriad of systems. Our office has been 

charged with bringing order to this chaos and helping our families 

access the support they need. 

Currently, over 400 family support personnel serve military families with special needs. All of our installations, depending on their 

sizes, have a full or part-time staff person or, in some very small 

locations, a point of contact for military families with special needs. 

Over the last 2 years, all of our providers have been trained on 

their roles, on the agencies with which they should be working, and 

on the requirements of supporting military families with special 

needs. 

Communicating with our families is important. Educating them 

on programs, benefits, and resources is crucial. Working jointly 

with the military departments, we have provided a wealth of information to military families with special needs, including materials 

available online and through Military OneSource. 

My written testimony outlines our ongoing work in greater detail, where we are succeeding, and where we have more work to do. 

Thank you so much for your support. 

Senator WEBB. Thank you, Dr. Posante. Again, I would remind 

the witnesses that your full written statements will be entered into 

the record at the end of your opening statements. Also, just for the 

subcommittee, that the hearing record will remain open until close 

329 

of business tomorrow in case there are written questions that anyone would like to present to you. 

Senator WEBB. Dr. Tait, welcome. 

STATEMENT OF DR. VERA F. TAIT, ASSOCIATE EXECUTIVE DIRECTOR, DEPARTMENT OF COMMUNITY AND SPECIALTY PEDIATRICS, AMERICAN ACADEMY OF PEDIATRICS 

Dr. TAIT. Thank you. Chairman Webb and members of the subcommittee, thank you for holding today’s hearing on such an important topic: military families who have children with special 

healthcare needs. I am Dr. Vera Fan Tait, and I represent the 

American Academy of Pediatrics (AAP), a professional organization 

of more than 60,000 primary care pediatricians and pediatric subspecialists. I am honored to join this panel, which includes such extraordinary advocates and experts. 

I am a pediatric neurologist and an Associate Executive Director 

at the AAP. Prior to joining the AAP, I was in practice for more 

than 25 years with my major areas of expertise including children 

and youth with special healthcare needs, traumatic brain injury, 

neurodevelopmental disabilities, and neurologic rehabilitation. Caring for our Nation’s military families and their children has always 

been of paramount importance for AAP. I am proud to say that one 

of the oldest sections in our academy is the section on uniform 

services. 

The impacts of long or multiple deployments on all military families can be significant. For families with children who have 

neurodevelopmental disabilities or disorders, these impacts are 

often significantly exacerbated. The AAP believes that the optimal 

health and well-being of all infants, children, adolescents, and 

young adults, including those in military families, is best achieved 

with access to appropriate and comprehensive health insurance 

benefits. These benefits must be available through public health insurance plans, like Medicaid, the Children’s Health Insurance Program (CHIP), and TRICARE, as well as the private health insurance plans. 

AAP policy recommends that minimum health benefits for infants, children, and youth should provide all medically necessary 

care within the medical home. We believe that medical and other 

services must be delivered and coordinated, as you said, Senator 

Webb, in a comprehensive patient- and family-centered medical 

home, which is the quality setting where physicians who are known 

to the family and to the child have developed a partnership of mutual responsibility and mutual trust. 

The health insurance plan that most military families use is 

TRICARE, and services, as we have heard, covered by TRICARE 

provided by pediatricians who are Active Duty military, but also 

community pediatricians and pediatric sub-specialists, who provide 

care near military facilities. Military families often face challenges 

navigating the TRICARE program, many times struggling to find 

the appropriate pediatric providers or have certain pediatric services covered. 

One area of particular concern among military families, and the 

reason we are here today, is to look at children with special 

healthcare needs and the coverage of services for children with 

330 

neurologic disorders, especially the ASD. Unfortunately, there is 

often no simple solution for families whose children must receive 

care often from numerous providers. A coordinated approach to 

intervention and treatment among the medical home, the educational institutions, and the family is really critical for success. 

One demonstrated effective treatment for autism is ABA. The 

symptoms associated with autism are directly addressed by ABA 

methods, which have proven effective in addressing the core symptoms of autism, as well as helping children develop skills and improve and enhance functioning in other areas that affect health 

and well-being. 

The effectiveness of ABA-based interventions and autism has 

been well-documented through a long history of research. Children 

who receive early intensive treatment have been shown to make 

substantial gains in cognition, language, academic performance, 

and adaptive behavior, as well as social behavior. Their outcomes 

have been significantly better than those of children who have no 

access to these interventions. Though more research and ongoing 

research is needed, ABA has both long-term empirical and research 

data to demonstrate its effectiveness in helping children who are 

diagnosed with ASD. 

The AAP has endorsed the use of ABA treatments when determined appropriate by physicians within a medical home in close 

consultation with families. 

Thank you for allowing me to testify before the subcommittee 

today. We must do all that we can to support our military families, 

but especially those who have the added challenge of raising children with special healthcare needs. Thank you, and I look forward 

to the questions. 

[The prepared statement of Dr. Tait follows:] 

PREPARED STATEMENT BY DR. VERA F. TAIT MD, FAAP 

Chairman Webb and Ranking Member Graham, thank you for holding today’s 

hearing on such an important topic—the programs and policies that the Department 

of Defense has in place to support military families with children with special needs. 

My name is Vera Fan Tait, MD, FAAP, and I am representing the American Academy of Pediatrics (AAP), a nonprofit professional organization of more than 60,000 

primary care pediatricians, pediatric medical subspecialists, and pediatric surgical 

specialists dedicated to the health, safety, and well-being of infants, children, adolescents, and young adults. 

I am a pediatr—ic neurologist and am an Associate Executive Director at AAP, 

as well as the Director of AAP’s Department of Community and Specialty Pediatrics. 

In addition to my role with the American Academy of Pediatrics, I am also a member of the Child Neurology Society and the Association of Maternal and Child 

Health Programs. Prior to joining the AAP, I was in practice for more than 25 years 

and my major areas of expertise include children and youth with special health care 

needs, traumatic brain injury, neurodevelopmental disabilities, and neurological rehabilitation. It was my privilege to care for families with children with autism spectrum disorders and other neurodevelopmental disabilities. 

I have personally experienced the struggle that many pediatricians face every day 

when trying to access needed medical, educational and other services for children 

with special health care needs. Finding needed services can be difficult even when 

they are adequately covered by health insurance. It is only more difficult when a 

primary care pediatrician or subspecialist can locate care only to find it is not covered by a family’s insurance. 

Caring for our Nation’s military families and their children has always been of 

paramount importance for the Academy. I am proud to say that one of the oldest 

sections we have at the Academy is the Section on Uniformed Services. Created in 

1959, the AAP’s Section on Uniformed Services has helped direct the Academy’s 

leadership on the health and well-being of our Nation’s military children and adolesVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00336 Fmt 6601 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
331 

cents. The Section is comprised of over 900 members who are active duty or retired 

military, as well as civilian pediatricians who serve military beneficiaries. The section works closely with the pediatric consultants to the surgeon general of each 

branch of the military. 

An example of one of the Section’s most recent accomplishments is the development of the Military Youth Deployment Support Video Program, which is designed 

to help children and adolescents cope with the deployment of one, or sometimes 

even both, of their parents or guardians to other countries around the world. The 

video was initially designed by the Section on Uniformed Services and was subsequently utilized by the U.S. Army Medical Command. So far more than 20,000 copies of the program have been distributed worldwide to military families, various 

military youth serving professional agencies, and primary care offices. 

The health and well-being of children in America’s military families ranks as one 

of the top priorities of the Academy, and that is why I am honored to represent AAP 

here today. The impacts of long or multiple deployments on all military families can 

be significant and for families with children with autism spectrum disorders, 

neurodevelopmental disorders or other disabilities, these impacts are often significantly exacerbated. 

The American Academy of Pediatrics believes that the optimal health and wellbeing of all infants, children, adolescents and young adults through 26 years of ageincluding those in military families-is best achieved with access to appropriate and 

comprehensive health care insurance benefits. These benefits must be available 

through public insurance plans like Medicaid, the Children’s Health Insurance Program and TRICARE, as well as private health insurance plans. 

AAP policy recommends that minimum health benefits for all infants, children, 

and youth should provide all medically necessary care, and include such services as: 

• preventive care • hospitalization • ambulatory patient services • emergency medical services • maternity and newborn care, and • mental health and substance abuse disorder services. 

Also included in the set of benefits should be: 

• behavioral health • rehabilitative and habilitative services and devices • laboratory services • chronic disease management, and • oral, hearing and vision care. 

In short, all children must have a medical home. AAP believes that medical and 

other services should be delivered and coordinated in a comprehensive, patient and 

family-centered, physician-led medical home—the quality setting for primary care 

delivered or directed by well-trained physicians who are known to the child and 

family, who have developed a partnership of mutual responsibility and trust with 

them, and who provide accessible, continuous, coordinated, and comprehensive care. 

The health insurance plan that most military families use is TRICARE. Services 

covered by TRICARE are provided by pediatricians who are active duty military but 

also community pediatricians and pediatric subspecialists who provide care near 

military bases and other military facilities. AAP members providing care to children 

and families covered by TRICARE face unique challenges compared to other public 

and private programs and plans. For example, one of the challenges that military 

families with children face is that the TRICARE program is largely based on Medicare, a health system designed to provide coverage for senior adults. Because of this 

program alignment, military families often face challenges navigating the TRICARE 

program, many times struggling to find appropriate pediatric providers or have certain pediatric services covered.This is especially true for parents of children with 

special health care needs. AAP has worked closely with TRICARE programs to ensure needed services are available from routine immunizations to highly specialized 

and acute pediatric care. 

One area of particular concern among military parents of children with special 

needs is the coverage of services for children with autism spectrum disorders or 

other neurological disorders. Recently released data from the Centers for Disease 

Control and Prevention confirms that the prevalence of children with autism spectrum disorder (ASD) is growing, as is the need for effective services to help children 

with ASD maximize their potential. 

Autism spectrum disorders, similar to other neurodevelopmental disabilities, are 

generally not ‘‘curable,’’ and complex care is required for the child along with services for the family. Unfortunately, there is often no simple solution for families and 

332 

1 ‘‘Habilitative or rehabilitative care’’ means professional, counseling, and guidance services 

and treatment programs that are necessary to develop, maintain, and restore, to the maximum 

extent practicable, the functioning of an individual. 2 ‘‘Management of Children With Autism Spectrum Disorders,’’ Scott M. Myers and Chris 

Plauche Johnson, Pediatrics 2007; 120; 1162; originally published online October 29, 2007; DOI: 

10.1542/peds.2007–2362 3The TRICARE for Kids Act was subsequently included as an amendment to the House’s National Defense Authorization Act for Fiscal Year 2013. 

effective, family-centered care will include numerous providers. A coordinated approach to intervention and treatment among the medical home, educational institutions and the family is critical for success. 

Optimizing medical care and therapy can have a positive impact on the 

habilitative1 progress and quality of life for the child. Medically necessary treatments ameliorate or manage symptoms, improve functioning, and/or prevent deterioration. Thus, in addition to routine preventive care and treatment of acute illnesses, 

children with ASD also require management of sleep problems, obsessive behaviors, 

hygiene and self-care skills, eating a healthy diet, and limiting self-injurious behaviors. 

Effective medical care and treatment may also allow a child with ASD to benefit 

more optimally from therapeutic interventions. Therapeutic interventions, including 

behavioral strategies and habilitative therapies, are the cornerstones of care for 

ASD. These interventions address communication, social skills, daily-living skills, 

play and leisure skills, academic achievement, and behavior. 

An example of a demonstrated, effective treatment for ASD is Applied Behavior 

Analysis (ABA). ABA uses behavioral health principles to increase and maintain 

positive adaptive behavior and reduce negative behaviors or narrow the conditions 

under which they occur. ABA can teach new skills, and generalize them to new environments or situations. ABA focuses on the measurement and objective evaluation 

of observed behavior in the home, school, and community. 

ASD is a medical/neurodevelopmental condition with behavioral symptoms that 

are directly addressed by applied behavior analysis methods. ABA has proved effective in addressing the core symptoms of autism as well as developing skills and improving and enhancing functioning in numerous areas that affect the health and 

well-being of people with ASD. 

The effectiveness of ABA-based interventions in ASD has been well documented 

through a long history of research in university and community settings.2 Children 

who receive early intensive behavioral treatment have been shown to make substantial gains in cognition, language, academic performance, and adaptive behavior as 

well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups. 

Late last year, TRICARE proposed to extend coverage under the Extended Care 

Health Option for Applied Behavior Analysis interventions for Active Duty 

servicemembers who have family members with autism spectrum disorders. AAP 

commented on the proposed rule and commended the Department of Defense for undertaking the important task of proposing measures to make it easier for Active 

Duty servicemembers with children with ASD to better access needed health care 

services for their children. 

In short, though more research is needed, ABA has both long-term empirical and 

research data to demonstrate its effectiveness in helping children who are diagnosed 

with ASD, and AAP has endorsed the use of ABA treatments when determined appropriate by physicians within a medical home, in close consultation with families. 

ABA remains an active subject of research and we encourage the Department of Defense to maintain flexibility in the provision of ABA services as new data may 

emerge. 

Beyond just ABA services, one way to make it easier for military parents with 

special needs children would be to examine how TRICARE currently works for its 

beneficiaries. The Academy supports legislation introduced in the House-the 

TRICARE for Kids Act,3 which could begin the process of making TRICARE work 

better for all parents, but especially those with children with ASD or other special 

health care needs. 

TRICARE for Kids would require TRICARE to establish a working group of relevant stakeholders to review TRICARE policies and practices and develop a plan to 

ensure that TRICARE meets the pediatric-specific needs of military families, including those children with chronic and special health care needs. We believe this is an 

excellent collaborative model to ensure that TRICARE polices work for all children 

in military families. 

333 

Thank you for allowing me to testify before the subcommittee today. As I said earlier, caring for our Nation’s military families and their children has always been of 

paramount importance for the American Academy of Pediatrics. We must do all that 

we can to support our military families, especially those who have the added challenge of raising children with special health care needs. 

I look forward to your questions. 

Senator WEBB. Thank you very much, Dr. Tait. 

Mr. Hilton, welcome. 

STATEMENT OF MR. JEREMY L. HILTON, MILITARY SPOUSE, 

VETERAN, AND MILITARY FAMILY ADVOCATE 

Mr. HILTON. Mr. Chairman and distinguished subcommittee 

members, thank you for allowing me to discuss our military families impacted by disabilities. 

I am a Navy veteran. My wife is Active Duty Air Force. When 

our daughter, Kate, was born in 2002 with significant disabilities, 

I resigned my commission to take care of her. This year I was honored as Military Spouse of the Year by my peers in Military Spouse 

Magazine. It is an amazing privilege to be able to represent a million-plus military spouses and their families. 

A recent National Council on Disability Military Families study 

concluded, ‘‘Far reaching systemic changes are needed in our Nation’s health, education, and long-term service systems to address 

the significant barriers faced by exceptional family members.’’ This 

hearing is a critical step in addressing and acting on these extraordinarily important issues to our military families. 

Caring for a child with a disability can be exceptionally expensive and remarkably stressful. We have higher medical bills, therapy bills, home modification and equipment bills, and other large 

expenses. Many families will need Medicaid waiver assistance for 

their children, but State Medicaid waiver wait-lists are very long, 

lasting for years. Every time a military family moves, they go to 

the bottom of the next State’s wait-list. They rarely reach the top 

before moving again. Those that do lose their Medicaid when the 

military moves them. 

There are a variety of ways in which this problem could be rectified, including a military Medicaid waiver, an interstate compact 

addressing Medicaid portability, allowing servicemembers to maintain wait-list eligibility based on their home of record, or extending 

the ECHO benefit into retirement. In the end, we ask that our children are not penalized for the service their mother or father renders to the Nation. 

The extended care health option was created to bridge the needs 

of families unable to access the State Medicaid waiver programs. 

But experience shows it fails to come close to replacing Medicaid 

waiver benefits. We are grateful for this benefit, but we would like 

to see it updated and made more flexible so it better fulfills its purpose. 

We support the Senate report language directing DOD to explore 

more flexible ECHO options. We respectfully ask that EFMP families are included on any working groups considering this and other 

issues that impact our families. 

While we look forward to enhanced functionality and flexibility 

of the ECHO program, the treatment of autism for our military 

children is one area that I do not believe requires further study. 

334 

It requires action. TRICARE currently segregates ABA, the standard of care, and the treatment of autism into ECHO as a non-medical educational service. TRICARE’s classification of ABA as nonmedical allows TRICARE to limit care to dependents of Active Duty 

servicemembers, and places a financial cap on treatment services 

which fall far below recommended standards. There is no other disease, disability, or chronic health condition which is treated similarly as autism and its segregation of treatment outside the basic 

TRICARE benefit. 

Because the ECHO benefit is only available for dependents of Active servicemembers, dependents of our retirees are not able to access ABA treatments under TRICARE. Prior to the hearing, we 

supplied 80-plus stories to the subcommittee. Many are heartbreaking, but inspiring at the same time. I am going to read from 

a letter written by Lance Corporal Hardy Mills, U.S. Marine Corps, 

Retired. 

‘‘In 2004 while serving with the 1st Marine Expeditionary Force 

in Fallujah, Iraq, I was wounded severely by a rocket propelled grenade. Because of my injuries, I retired medically from the Marine 

Corps in 2006 with full disability benefits. I am blessed with a supportive wife, and we have two beautiful children. 

Our son, Shane, has autism. As a retired Marine and disabled 

veteran, my family depends on the military healthcare system, 

TRICARE, for coverage of medical services and interventions. Unfortunately because of my retired status, Shane’s medically recommended autism treatment, ABA, is not covered by TRICARE. 

My family faces out-of-pocket costs of $4,600 a month associated 

with this vital service because of current TRICARE policy deficits. 

We have sold our home to provide Shane the care he requires, but 

we are running out of funding and ask for your intervention.’’ 

The other letters are no less important and show the struggles 

our military families have gone through to be able to provide therapy to their children. In the end, many of these families are still 

coming up significantly short, particularly those with younger children and our retirees. 

You will hear Dr. Tait and Dr. Dawson testify on the scientific 

evidence that proves ABA is effective. Many other reputable organizations and members of the medical community have endorsed 

ABA therapy as the standard of care for autism. I sincerely hope 

that the Senate Armed Services Committee will take this into consideration and support an amendment to the 2013 NDAA to help 

our military kids impacted by autism. 

These military families are remarkable Americans who endure 

exceptionally trying circumstances in addition to their service in an 

already stressful military lifestyle. I would encourage you to take 

a moment and get to know each of them. As I am certain you realize after reading these stories, we have much work left to do in 

order to provide the appropriate level of medical care, services, and 

support these military families deserve. 

I would like to personally thank the subcommittee members and 

the professional staff for their leadership in providing much-needed 

oversight to these issues. Thank you to this subcommittee for not 

forgetting our military families. I look forward to your questions. 

[The prepared statement of Mr. Hilton follows:] 

335 

PREPARED STATEMENT BY MR. JEREMY L. HILTON

Mr. Chairman, Senator Graham, and distinguished members of the subcommittee, 

thank you for the opportunity to discuss the issues facing our military families impacted by disabilities and your consideration of actions and initiatives that I submit 

need to be accomplished to ensure our Nation honors its obligations to our military 

families. By doing so, I believe we enhance the readiness of our All-Volunteer Force 

and improve the lives of our military children. 

INTRODUCTION

I am a 1995 U.S. Air Force Academy graduate that cross-commissioned into the 

Navy and served 8 years in the submarine force. In 2002, while on shore duty at 

the Washington Navy Yard, our daughter, Kate, was born with a number of significant disabilities. Seven months later, I resigned my commission and have been taking care of our children ever since. Since Kate’s birth we have moved six times, five 

of those within a 5-year timeframe due to deployments, training, and military Permanent Changes of Station (PCS). Kate has undergone nine surgeries and received 

thousands of hours oftherapy, provided by our family and outside therapists. Our 

primary goal is to ensure she lives life to her fullest and is educated and lives in 

the community to the greatest degree possible. My wife remains Active Duty Air 

Force, and we are currently stationed at Andrews AFB where she is the commander 

of an AFOSI squadron. We have a 1-year-old son, Jackson. 

In May 2012, I had the distinct honor of being selected as the Military Spouse 

of the Year, based on my advocacy for military families. I started as an advocate 

for our daughter. That advocacy expanded within the Air Force, then the Department of Defense (DOD), and then to the larger disability population. I quickly discovered there are so many unruet needs in the disability world. Our families are 

overwhelmed. There is little to no time to be advocates because many families are 

simply surviving. We don’t have the defense industry or unions to ensure our programs receive the funding they require. We have a very small group of volunteer 

parents that do their best to raise these tough issues when they happen to be stationed in the DC Metro area. What I have learned from being part of this process 

is that our families do have a voice, but many times it is very quiet, at least relative 

to the normal buzz in DC. However, what we lack in volume, we make up for with 

passion. In the short amount of time we’ve had since the hearing was announced, 

these amazing families have provided me the most astonishing and personal insights into their lives and the hope they have for their children. I hope the Committee finds their stories instructive (see attachments after written testimony). 

This committee plays an integral role in both legislation and oversight on the 

issues that enable our families to support our servicemembers while they protect 

our country. Your support continues to be instrumental in making needed changes 

to the DOD infrastructure, policy, and procedures which will allow our special needs 

military families to deal with the significant stresses associated with service; PCS, 

multiple deployments, and the high operational tempo that has marked these past 

10 years of war. 

There are a number of areas that I will be discussing today: Medicaid Waivers, 

the Extended Care Health Option (ECHO), TRICARE, Autism, Education, the Exceptional Family Member Program (EFMP), Survivor Benefits, and Legal Issnes. 

Each of these programs and issues has a substantial impact on the health and 

wellbeing of our military families with disabilities and it is critical that the Committee understand what areas require improvement. 

Many of these areas were considered in a recent National Council on Disability 

(NCD) study on Marine Corps EFMP families (transmittal letter included as Attachment A). In the preamble to the study, the NCD Chairman, Jonathan Young stated: 

‘‘However, many of the changes necessary to improve the supports available to military families with [Exceptional Family Members] are beyond the 

control of the Marine Corps and may require statutory and regulatory 

changes to meet these needs. 

NCD has concluded that far-reaching systemic changes are needed in our 

Nation’s health, education, and long-term service systems to address the 

significant barriers faced by EFMs. NCD thus seeks support from Congress, 

the military, and the administration to build the critical Federal partnerships necessary to effect systemic change and ensure that the men and 

women serving our country can do so knowing their family members with 

disabilities will have the supports and services they need.’’ 

This hearing is the first step in addressing these extraordinarily important issues 

to our military families. 

336 

MEDICAID WAIVERS

Caring for a child with a disability can be exceptionally expensive and remarkably 

stressful. We have higher medical bills, therapy bills, home modification, equipment 

and supply bills, and other large expenses. Many, if not most, families impacted by 

disabilities will come to rely on public assistance programs in some fashion for our 

children who are disabled. The majority of such programs relate to State-run Medicaid waiver programs which provide short and long term benefits that TRICARE 

does not. Examples of such supports include incontinence supplies, respite, employment supports, housing, and more flexible medical coverage. Most of the Medicaid 

waiver programs run by the States have significant waiting lists for citizens to access these benefits because the need is simply much greater than the available benefits. It is not uncommon for a family to place a 1-year-old on the State Medicaid 

waiver waitlist with the hope the child will receive benefits by the time they are 

a teenager or an adult, depending on the type of waiver and the State in which they 

reside. For our highly mobile military families, that means our children constantly 

remain at the bottom of any given State’s waitlist. If by chance they get off the 

waitlist and receive services in one State, they will lose their eligibility once they 

PCS, and they will find themselves back on the bottom of the next State’s waitlist. 

Upon retirement after a career of service, our children, yet again, find themselves 

on the bottom of waitlist at their new and final home. 

There are a variety of ways in which this problem could be rectified, including 

a military Medicaid waiver, an Interstate Compact addressing Medicaid portability, 

allowing servicemembers to maintain list-eligibility based on their home of record, 

or extending the ECHO benefit into retirement. Given the cross-committee jurisdictional nature of this issue, Medicaid reform may seem like a bridge too far, but it 

is one that will have a significant impact on our families. 

Parent advocates are currently working with a variety of partners on finding a 

fix that addresses the problem. The DOD has funded a grant for West Virginia University to study this issue and we expect findings this summer. We would ask that 

this committee remain engaged on this issue moving forward to ensure State Medicaid services for our military children are provided for equally in comparison to 

their civilian counterparts. 

EXTENDED CARE HEALTH OPTION PROGRAM

The ECHO, created in 2005, was originally designed to bridge the needs of families due to the inability to access State-run Medicaid programs. Our experience has 

been that it does not replicate those benefits because of the lack of flexibility in the 

ECHO program. Military families strongly support the Senate report language that 

directs the DOD: 

‘‘to assess participation in the ECHO program by eligible dependents with 

special needs, and to explore options to provide more flexible benefits.’’ [sec. 

703] 

Our families are grateful for the ECHO benefit. However, it is time to reassess 

its effectiveness to meet the requirements for which it was created. As one is considering the benefits typical families might need, it is imperative that DOD consider 

best practices as applied by the States. Please understand that while these studies 

are taking place, children may be very well going without necessary items or therapy. We would hope for an aggressive timeline for dissemination and prompt action 

on the basis of the results from the study. 

There are two helpful resources when considering both Medicaid and ECHO 

issues: 

• United Cerebral Palsy’s annual ‘‘Case for Inclusion’’ which ranks the 50 

States and DC on its Medicaid waiver programs: http://www.ucp.org/thecase-for-inclusion/2011/ 

• Medicaid’s Web based resources: http://www.medicaid.gov/MedicaidCHIP-Program-Information/By-Topics/Waivers/Waivers.html?filterBy=1915%28c%29#waivers 

One striking item included in the Medicaid website highlights that there are 423 

different Medicaid waiver programs and demonstration projects throughout all 50 

States and the District of Columbia. There must be a way we can find to serve the 

military family appropriately. 

TRICARE

As most parents are quite aware, children are not simply little adults. It is why 

the children’s hospital model exists, to provide for a child’s unique health care 

337 

needs. This is why TRICARE, being based on Medicare, sometimes doesn’t provide 

the best possible care for our military children, particularly those who have special 

health care needs. It is also why military families support the TRICARE for Kids 

Amendment (Attachment B) included in the National Defense Authorization Act 

(NDAA) for Fiscal Year 2013 recently passed by the House. This bi-partisan amendment was co-sponsored by Representative Steve Stivers (R–OH15), Representative 

Susan Davis (D–CA53), and Representative Bobby Schilling (R–IL17) and has been 

endorsed by the Military Officers Association of America (MOAA), the National Association of Children’s Hospitals (NACH), the National Military Family Association 

(NMFA), and the March of Dimes. 

From a recent endorsement letter by the March of Dimes (Attachment C), they 

noted: 

• ‘‘Unfortunately, because TRICARE utilizes a reimbursement structure 

based on Medicare, it often adopts policies and practices from Medicare that 

do not address the unique health care needs of children. Moreover, despite 

the best efforts of the Department of Defense, military families with children with special health care needs and chronic conditions often have difficulty accessing resources and services from local or regionally specialized 

providers. This problem is further exacerbated by the mobility of military 

families, who must repeatedly locate and obtain specialized health care 

service in unfamiliar geographic regions as their assignments change or 

they are deployed. 

• The TRlCARE for Kids Act seeks to better shape the policies and practices of TRICARE to meet the needs of children, including those with special health care needs or chronic illnesses.’’ 

Our hope is to ensure that the final NDAA includes the Tricare for Kids amendment, section 723 in the House bill, and that the conference committee report will 

mirror the Section 703 report language provided by the Senate, thus providing a 

specific panel to address children’s health needs, and adding ECHO to DOD’s ongoing evaluation and reporting of cost, access, and quality. 

AUTISM

While we look forward to enhanced functionality of the TRICARE program, the 

treatment of autism for our military children is one area that I do not believe requires further study; it requires action. 

TRICARE currently segregates Applied Behavioral Analysis (ABA), the standard 

of care in the treatment of autism, into ECHO, which is an entirely separate arm 

of TRICARE, as a ‘‘non-medical educational’’ service. TRICARE’s classification of 

ABA as ‘‘non-medical’’ allows TRICARE to limit care to dependents of Active Duty 

servicemembers and places a financial cap on treatment services which falls far 

below recommended standards. There is no other disease, disability or chronic 

health condition which is treated similarly as autism in its segregation of treatment 

outside the basic TRICARE benefit. Families are forced to make the difficult decision of paying thousands of dollars out of pocket to address these deficits or forgo 

medically recommended care. Because the ECHO benefit is only available for dependents of active-duty servicemembers, dependents of our retirees (including 

Wounded Warriors retired due to injuries sustained in combat) are not able to access ABA treatments under TRICARE and Guard/Reserve families receive intermittent care. 

Contrary to DOD’s stated position, in April of this year, the U.S. Office of Personnel Management (OPM) concluded that ABA treatment for autism is a ‘‘medical 

therapy.’’ In a letter dated 19 April 2012 (Attachment D), OPM stated [bottom of 

page 5] 

• ‘‘The OPM Benefit Review Panel recently evalnated the status of Applied 

Behavior Analysis (ABA) for children with autism. Previously, ABA was 

considered to be an educational intervention and not covered under the 

FEHB Program. The Panel conclnded that there is now sufficient evidence 

to categorize ABA as medical therapy.’’ 

The previous findings are instructive as well as they point to what level of evidence was required to overcome OPM’s original objection. In a 2006 letter to Representative Christopher Smith (R–NJ4) (Attachment E), the Director of OPM, Linda 

Springer, stated 

• ‘‘It is OPM’s most sincere hope that one day randomized trials will demonstrate ABA to be an effective course of treatment for autism and no 

longer be considered investigational. OPM has great empathy for the famiVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00343 Fmt 6601 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
338 

lies affected by this tragic disorder, and regret our decision could not be 

more favorable’’. 

Coverage of ABA care in the civilian sector also exceeds that of TRICARE. Currently, 30 States have laws requiring private insurers to cover autism-related therapies, including ABA, as a medically necessary service. TRICARE’s position that ABA 

therapy is ‘‘non-medical’’ is now contrary to the Federal Government and laws in 

30 States. 

We now stand at a point where, without action by Congress, we will soon see Federal workers provided medically prescribed autism therapy for their children while 

military families receive either an inferior level of care or, as in the case of the retired veteran’s child, receive no care. Our families simply cannot imagine that Congress would find that appropriate. 

With strong bipartisan leadership, the House’s 2013 version of the NDAA includes 

important language clarifying that military dependents with autism, regardless of 

duty status, have access to medically necessary behavioral health treatments including ABA through the TRICARE basic program. Our military families ask that you 

work to ensure comparable language is included with the Senate version of the 

NDAA. 

EDUCATION

Special education as a career is truly a calling and the vast majority of teachers 

who instruct our children are competent professionals whose greatest desire is to 

see our children succeed. However, with the pace, length, and number of deployments over the past 10 years, as well as the normal structure of the military lifestyle, military families whose children require special education have struggled to 

receive a free appropriate public education. 

According to the Military Child Education Coalition, the average military child 

will transfer schools 6 to 9 times between grades K to 12. For the special needs military family, the frequent moves present additional challenges: reestablishment of 

medical care, educational services, and necessary therapies each time they move to 

a new location. For many of our families, this means the primary caretaker parent 

will devote countless hours ensuring their child’s needs are met. In the event the 

spouse is employed outside the home, or in the case of a dual active duty couple, 

there is little time to digest the changing special education laws and regulations required to ensure a child receives a free, appropriate public education. In many situations, military families either go into debt to hire advocates or lawyers to ensure 

their child is receiving an appropriate education or they go without and watch their 

child regress in an inappropriate placement without proper supports. 

In the event that a school district does not provide appropriate services for a military child, the family must weigh the following before attempting to hold a school 

district accountable under the Individuals with Disabilities Education Act (IDEA): 

1. Legal fees, many lawyers no longer will take a case on contingency 

2. Expert witness fees (not reimbursable even if you win your case) 

3. Length of time left in the current assignment 

4. Family and life considerations (financial and medical stress, spouse deployed, 

wounded, or otherwise unavailable). 

Military families have little control over where they will be stationed, sometimes 

as part of a normal base reassignment, and sometimes when a spouse and child(ren) 

have to live close to family when a member deploys for a year or more. 

Some school districts take advantage of military families, calculating how long 

they will likely spend at a current base, and the families’ emotional, physical, and 

financial abilities to utilize their procedural safeguards under IDEA. 

The average due process case to hold a school district accountable lasts a number 

of years, making IDEA’s procedural safeguards essentially meaningless for the large 

maj ority of military families, particularly when confronted with an aggressive, costcutting school administration. Most school districts have law firms retained from 

taxpayer funds with unlimited time to run out the clock against a military family. 

Military families have few resources to hire lawyers or retain experts to ensure our 

children receive an appropriate education. 

Included in the 2011 NDAA was a directive to DOD to consider these issues for 

study (sec 583). The DOD’s response was that the evidence was anecdotal therefore 

they could not make any conclusions without appropriate data. This lack of data has 

been a consistent issue for all military connected children as evidenced by the DOD 

report as well as two GAO reports sparming over the last 5 years (GAO study entitled ‘‘Military Personnel: Medical, Family Support, and Educational Services Are 

Available for Exceptional Family members’’ (2007) and GAO study entitled ‘‘Education of Military Dependent Students, Better Information Needed to Assess StuVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00344 Fmt 6601 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
339 

dent Performance’’ (2011)). Over the last 5 years, we could have been collecting data 

to take action, but for some reason, we haven’t. It seems clear to me that a data 

element is needed to identify our military connected students so we can access and 

evaluate their needs. 

In August 2011, four Service representatives wrote a letter to the Assistant Secretary for Special Education and Rehabilitative Services, Ms. Alexa Posny, for clarification and guidance on issues specifically related to military families (Attachment 

F). To date, no response has been provided. While many of the educational challenges facing our military connected special needs students involve cross jurisdictional issues, we desperately need this committee’s strong leadership to ensure our 

children our appropriately take care of. 

Finally, the new Post-September 11 or Bill offers a terrific option to transfer educational benefits to dependents; expanding these benefits to cover more options beyond traditional degree-granting education would be a welcome improvement for our 

special needs dependents. 

EXCEPTIONAL FAMILY MEMBER PROGRAM

DOD support for families with special needs has been a work in progress for 

many years. The 2010 NDAA included the creation of the Office of Special Needs 

(OSN) within the Military Community and Family Policy Office. The next year’s 

NDAA provided for the creation of the Military Exceptional Family Member Panel, 

which includes military family members and adults impacted by disability. The goal 

of the panel is to provide specific real world input to the OSN on issues facing our 

families. Each of these has been a forward step in improving our family member’s 

ability to access a life that any parent would want for their child. We thank the 

committee for taking legislative action to improve DOD support for military families 

with special needs. However, the proof is in the implementation of these directives. 

The specific mandate provided to the OSN included ‘‘The development and implementation of a comprehensive policy on support for military families with special 

needs’’. Two years later, this hasn’t been completed. Without appropriate policy to 

review, it is not clear where we stand with many of the other mandates assigned 

to the OSN. 

Our families ask that appropriate oversight be provided to ensure that the Office 

of Special Needs has the funding and personnel to carry out its mandates and then 

ensure that they are completed in a reasonable amount of time. 

To consider best practices within DOD, one need look no further than the Marine 

Corps, which is universally lauded as providing the best care for its exceptional family members. Attached you will find a recent brief provided by the head of the 

USMC Family Programs branch, Rhonda LaPorte, which provides an immediate 

overview of the current EFM Program as well as future direction. (Attachment G). 

We believe the other Services should follow the lead of the Marine Corps as they 

review their EFMP programs. 

SURVIVOR BENEFITS

Today, servicemembers with permanently disabled children face an unfortunate 

dilemma. Under current law, the servicemember can only direct survivor benefits 

to that child, and not a trust of any sort. Because the Survivor Benefits Plan (SBP) 

annuity cannot be placed into a special needs trust this survivor benefit ironically 

will make the beneficiary ineligible to receive the Medicaid waiver which allows 

many individuals with a disability to survive. One example of a consequence includes a disabled adult being removed from a group home or other long-term care 

facility provided by Medicaid because the SBP amount exceeds State income thresholds for Medicaid waiver programs and disqualifies the individual from that program. Please see Attachment H for a more detailed analysis of this issue by a lawyer who specializes in special needs trusts. 

Civilian families are able to create special needs trusts for their pennanently disabled children that preserve their access to Medicaid while providing them additional supports that enable them to live in their communities. We believe that members of the military should have the assurance that their surviving family members 

with disabilities will have the same opportunities after they are gone. 

The Disabled Military Child Protection Act, H.R. 4329, was introduced in this 

Congress to correct this disparity. Unfortunately, because of a very modest cost and 

lack of a means to pay for it, the measure was not included in the House version 

of the NDAA. We request the Committee to file an amendment to be added to the 

Senate NDAA in order to resolve this issue. 

340 

LEGAL ISSUES

There are a whole host of issues our military families face when trying to access 

the legal system. For military families with special needs, these primarily include 

issues related to guardianship, wills, trusts, and special education. Each one of 

these issues create significant out of pocket expenses above and beyond that of a 

typical military family. The issues are not ones that the on-base JAG officers are 

qualified to provide counsel on, and most JAG officers do not have the connections 

required to even provide a referral. 

Our families are encouraged by the Senate language regarding its support for the 

American Bar Association’s Military Pro Bono Project. We would encourage the Secretary of Defense and the DOD’s General Counsel to consider the unique issues of 

our military families impacted by special needs as they are investigating the report 

request by the Senate (detailed in Senate Report 112–173). 

DISABILITY ISSUES

There are a variety of issues which impact the disability community as a whole, 

including our active duty military families, our veterans and retirees, and particularly our Wounded Warrior community. The Senate will soon consider the Convention on the Rights of Persons with Disabilities. The Senate Health, Education, 

Labor, and Pensions Committee will hold a hearing on restraint and seclusion in 

our publics chools on June 30. While the Senate Armed Services Committee does 

not specifically play a role in these issues, please appreciate the fact that these 

issues are ones that our families care about and your support in ensuring these 

issues are resolved significantly impacts our military community. 

CONCLUSION

• ‘‘Disability is a natural part of the human experience and in no way diminishes the right of individuals to participate in or contribute to society.’’ 

These are the congressional findings from the IDEA, the Federal law that ensures 

children with disabilities are provided a public education. If the concept that having 

a disability is a natural part of our world is foreign to you, you are not alone. But 

like so many things in our world, your perception can change in a millisecond. For 

some of us, this will happen in a split second, whether that is an IED explosion or 

from the doctor telling you something is wrong with your baby. For others, it will 

be the shocking realization of the road you are about to travel as you deal with your 

MS, cancer, or Alzheimers. Smart disability policy is the right thing to do, both for 

our military families and for its positive impacts on our force’s readiness. Short-term 

thinking and budgeting will in fact have significant long term cost, whether we are 

talking about the rehabilitation of a young airmen with traumatic brain injury or 

a child with cerebral palsy or autism. Our entire society as a whole has made significant strides in the last four decades in supporting people with disabilities. The 

strides our society as a whole has made have been mirrored in many of the programs within the Department of Defense and the VA. However, there continue to 

be significant stovepipes within DOD, the VA, Tricare, the individual services as 

well as individual States as opposed to an appropriate sharing of best practices and 

implementing changes needed. What we need is leadership at all levels of the chain 

of command, within Congress, and within our local communities to make change reality. 

I’ve attached a number of stories of individual military families immediately after 

this written testimony. [See Attachment I]. These are amazing Americans, who endure exceptionally trying circumstances and somehow find ways to serve their nation and many times try to help others. I would encourage you to take a moment 

and get to know each of them. If you look ‘‘hero’’ up in the dictionary, you’d see the 

faces of these moms, dads, and their children. 

We don’t pretend to think that there are any easy tasks in front of us as a nation. 

How we deal with these tough issues will define us as a Nation. Our families appreciate the opportunity and leadership demonstrated by holding this hearing. Thank 

you to this committee for not forgetting our military families. 

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Attachment A 

Attachment B 

Attachment C 

Attachment D 

Attachment E 

Attachment F 

Attachment G 

Attachment H 

Attachment I 

List of Attachments 

NCD Transmittal Letter on USMC EFMP Study 

TRlCARE for Kids Amendment 

March of Dimes Endorsement Letter 

OPM FEHB Program Carrier Letter 

2006 OPM Ltr to Rep. Christopher Smith 

2011 Ltr to Assistant Secretary Posny 

USMC Family Programs Briefing 

SBP Legal Analysis 

Stories ofIndividual Military Families, Provided 

by Mr. Jeremy L. Hilton 
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Attachment A 

NeD Transmittal Letter on USMC EF1v1P Study 
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~ ·.' National Council on Disability 

An independent federal agency making recommendations to the President and 

Congress to enhance the quality of life for all Americans with disabilities and their 

families, 

November 28,2011 

The President 

The White House 

Washington, DC 20500 

Dear Mr, Pnesident 

Letter of Transmittal 

The National Council on Disability (NCO) is pleased to submit the enclosed report, 

'United stat,es Marine Corps Exceptional Family Members: How to Improve Access to 

Health Care, Special Education, and Long-Term Supports and Services fur Family 

Members with Disabilities.' NCO conducted this study at the request of the Marine 

Corps, which has a longstanding commitment to providing support for its Families with 

disabifities, This report is based on a study conducted within the Marine Corps 

interviewing Marines and Families that have dependents that meet the requirements to 

qualify for the Exceptional Family Member Program (EFMP), 

The lifestyle of the Maline Corps Family is chaUenging under the best of circumstances. 

Among the challenges that military Families face are separation from their extended 

famifies, Service Member absences, penmanent changes of station moves, and the stresses 

of combat and noncombat deployments. These challenges are compounded for Families 

with disabilities, referred to in the Marine Corps as 'Exceptional Family Members' (EFMs). 

The Services have recently passed the marker of 10 plus years of armed conflict across 

the wond, but most specifically in Afghanistan and Iraq. Multiple deployments to these 

theaters have increased stress on all military Families, but even more on those with EFMs, 

The objectives for this study were to: 

1) Document the experiences of USMC EFMP participants in accessing 

appropriate and effective services in health care, special education, related 

services, long-term suppcrts, and services; 

2) Identify barriers impeding access to appropriate resources and services; and 

3) Develop recommendations to improve access. 

NCD condu~ focus groups and interviews of Caregivers, Family Members with 

disabiITties, and service providers between January 2010 and March 2010 at Marine 

Corps Base Quantico, Camp Lejeune, and Camp Pendleton, 

NCO findings indicate that EFMs and their FamtIies face barriers that span the domains 

of health care, education, and long-term supports and services. Key findings include: 

• For CaregiVers, navigattng the health, education, long-tenm services 

systems, and obtaining and maintaining disability-related services require 
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relentless hard work-a process they have to start over every time the 

Family moves. For so~arficularty young parents, Families with more 

than one EFM, Families With a dependent With significant disabmtfes, parents 

who are themselves EFMs, and Families with a deployed sponSDr-it can be 

an overwhelming prospect and can be so time-consuming that it becomes 

. impossible for the spouse of an active-duty Marine to work outside the home. 

• Many Famines lamented the lack of qualified health care specialists near 

their installations, and they struggle to obtain timely referrals and 

appOintments and make long trips to medical specialists. 

• For Family Members in need of special education services, having to make 

frequent moves to a new school system results in substantial gaps in critical 

education and therapeutic services: 

The lack of Medicaid portability across states is a Significant barrier to obtaining 

necessary long-term supports and services for Families with EFM dependents. 

Each time the Family moves, they have to start over on a Medicaid waiver 

waiting list and often do not tive in one place long enough to qualify. Tricare 

(loes not cover the same services provided under a Medicaid waiver. 

• Many families are dependent on the disabUity-related services typically 

covered by ECHO, a Tricare supplemental insurance, and they worry about 

. how they will pay for these services when they retire and ECHO is no longer 

available to them. 

These findings reveal that prompt action must be taken to improve health, education, 

and long-term services for Marine Corps Families with EFMs. NCO commends the 

Marine Corps for making significant improvements to their EFM program during the time 

this study was being conducted (many of which are highlighted in this report). However, 

many of the changes necessary to improve the supports available to military Families 

with EFMs are beyond the control of the Marine Corps and may require statutory and 

regulatory changes to meet !hese needs. 

NCO has concluded that far-reaching systemic changes are needed in our nation's 

health, education, and long-term service systems to address the significant barriers 

faced by EFMs. NCO thus seeks support !Tom Congress, the military, and the 

Mministratil?n to build the critical federal partnerships necessary to effect systemic 

change and ensure that the men and women serving our country can do so knowing 

their Family Members with disabHities will have the supports and services they need. 

NCO commends your Administration for focusing on the needs of miUtary Families, 

particuiarly the launch of Joining Forces, and ~Id welcome the opportunity to work 

with you on behalf of military Families with EFMs. 

Sincerely, 

/ /,~/,:/ ,.~/~F_~,._ 

( JofiaJ;han-M:Ya1:Jng, J.D., Ph.D. . 

-~hairman, National Council on DiSability 

2 
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Attachment B 

TRICARE for Kids Amendment 
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mm 2D CONGRESS SSSSlQlf H R •• 4341 . 

To direct Iht 8ec .. tary of Dr.t...... to IIlIahlish • 'iI'O<'kiDc iI'\IUP to ~ 

TRlClARE poli<::l' 'I'fitb l"I:IIpeet to ~ I>Mlth ...,." to chiJ(Ira> and 

dotermilll! ""'" to imp"""," IIUI:h polky. I.IId for athc!r 'JI'U1I08"L 

rn THE HOUSE OF REPRESENTATIVES 

MARt:n 29, 2012 

J.fr. !'l'J:m:1\S (foe him<elt, Mr. SC'mL.t.!J<G, &lid Ml"$_ D.o.VIS 0' 0ali!0mlI) inuodc lBl. t.ht rollowing bill; whiM W&lI rdmed til tile Committee (Ill 

Azmed Sel"l~ 

A BILL 

To direct the Secretary of Defenoo to establish a working 

group to review TRlCARE policy with respwt to pro. 

vidirig health care to children and determine how to 

improve such policy, and for other purposes. 

Be it eMCUd by the Senat4 and House of Rep~ta2 tives oj'/ks United Skltes of A.merioo 171 ~ assembled, 

3 SECTION I. SENSE OF CONGRESS. 

4 It is the sense ofCongres.'l that.-

5 (1) children of rnemhen! of the .Armed FOn)e8 

6 desernl health-csre practices and policies that--

7 (A) are designed to meet their pedlatrio.. 

8 specific need!!; 
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2 

(B) are deyeloped and determined 

2 proactively and comprehensiveJjl; and 

3 (0) ensure and maintain their access to pe4 diatric-specific treatments, providers, and facili5 ties; 

6 (2) children's health-care needs and standards 

7 of care are different and distinct from those of 

8 adults, therefore the TRJOARE program should un9 dcrtakc a proaetiye, comprehensive al)proach t() re10 view Rnd analyze its policies and praCtices to IDeet 

11 the needs of children to ensure that children and 

12 their families receive appropriate care in proper set13 tings and avoid mmecessary challenges in seeking Dr 

14 obtaining proper health care; 

15 (3) a proactive and comprehensive TC'view is 

16 llecessary because the reill1bUl'semerit structure of 

17 the TruCARE program is patterned upon Medicare 

18 and the resulting policies and practices of the 

19 TRICARE program do not always properly reflect 

20 appropriate stariJards for pediatric eare; 

21 (4) one distinct aspect of children's health care 

22 is the need for specialty care and services for chil23 clren . with special-health-care needs 8Jld chronic24 health conditions; 
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3 

I (5) the requirement for specialized health care 

2 and developmental support is an ongoing and serious 

3 matter of day-to-day life for families with children 

4 with special or chrocic-health-ca.re needs; 

5 (6) the Department of Defense and the 

6 TRICARE program, recognizing the special needs of 

7 certain children, have instituted special-needs proS grams, including the ECIIO program, but there are 

9 collateral needs that are not being met, generally belD cause the services are provided in the local co=u11 city rather than by the Department of Defense, who 

12 may not always have the best tools or knowledge to 

13 access these State and local resourceS; 

14 (7) despite wholehearted efforts by the Depart15 ment of Defense, a gap exists between linking mili16 tary families with children with special-health-care 

17 needs and chrol1ic conditions with the resources and 

18 services available from local or regional highly spe19 cialized providers and the communities and States in 

20 which they reside; 

21 (8} the gap is especially exacerbated by the mo22 bility of military families, who often move from 

23 State to State, because special-needs -health care, 

24 educational, and social services are very specific to 
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4 

1· eaeh loeal oommunity and St8te and such services 

2 often have lengthy wailing Ii.sta; and 

3 (9) the Deputment of Defense will be ~r 

4 able to assist military families with children wiih 

5 special·health-eare needs 6ll the gIlP by eollaborating 

6 with special-heAlth-care needs providers and those 

7 knowledgeable !!.bout the opportunities tor such chiI8 ~n that are provided by States and local oommu9 nities. 

10 SEC. 2. EST .... BI f5BM1lNT OJj' nuCABB WOR,JING GROUP. 

11 (a) ESTABJ..:rsmLEN"l'.-

12 (1) IN OR}.'ERAI •. -Tb.e Se<:rctary of Defense 

13 sh.alJ. establish a working group to <:any ou~ a reriew 

14 of the TRJCARE program with respeet to15 tAl pediAtrie health care needs 1lllder para16 grapb (2); and 

17 (B) pediatric special and chronie health 

18 care needs under paragraph (3). 

19 (2) PEDUTRlC BEALTH CARE NRKD8.-

20 (Al DtrrtES.-Tbe wilTling grtIup shall21 (il eomprehensively review the poliey 

22 and prMtiees of the TRIOARE progl'a(D 

23 with respect to providing pediatrie health 

24 eart'; 
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5 

(ii) recommend changes to such poli2 cies and practices to ensure that3. (1) children receive appropriate 

4 care in an appropriate manner, at the 

5 appropriate time, and in an appro6 priate setting; and 

7 (II) access to care and treatment 

8 provided by pediatric' providers and 

9 children's hospitals remains available 

10 for families with children; and 

11 (iii) develop a plan to implement meh 

1£ changes. 

13 (B) REVIEW.-In carrying out the duties 

14 under subparagraph (A), the working group 

15 shall--

16 (i) identitr improvements in policies, 

17 

18 

19 

20 

2f 

22 

23 

24 

25 

practices, and administration of the 

TRICARE program with respect to pediatric-specific health care and pediatric-specific healtheare settings; 

(li) analyze the direct and indirect effects of the reimbursement policies and 

practices of the TRICARE program with 

respeet to pediatric care and care provided 

in pediatric settings; 
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6 

(ill) oonsider ease ~t pro2 gnuns with respeet. to pediatric complex 

3 atld chronie care, including whether pedi4 airie tpecili:e programs are llOOeSSII.rY; 

5 (N) df:!Vclop II. plan to = that the 

6 TRICARE program addTesses pedia.trie7 SP,Ccific health care needs OIl 8.il on-going 

8 basia beyond the life of the WtIrkiog group; 

9 (v) eonsider how the TRllliRE prolO gram ean work with the pediatric provider 

11 commnnity W e1lSW"ll access, promote com12 munication and collaboration, 8.Dd optinUre 

13 e:xperieneet; of military t'a.mili.es seeking IUld 

14 reeciving bealtb care senices for children; 

15 ""' 

16 (vi) review matters that further the 

17 mission of the worlcing group. 

18 (3) PKDLlTRlC SPECU.L .wn CHR01'o,C e:&..u.TB: 

19 (:ARB Nl:EDS.-

20 (A) DUTlES.-The wm-lriDg group shall21 (i) review the methods in whlch Cami22 lies in the TRICARE program who b4ve 

23 ebildnn with speci.al-health-eare needs all24 eess oolIlItUl1lity re8Olll"CeII and health-ea.re 

25 """""'" 
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2 

1 

, 

S 

, 

7 

• 

, 

10 

11 

12 

" I' 

IS 

I' 

17 

I. 

I' 

20 

21' 

22 

23 

24 

7 

(ll) review bo'If bariag aaoe&I to, II.!ld 

a better nn.derst.aDdini ot, community resourc:es may improre aooesa to health ea.re 

I!.lld aupport serrioes; 

(ill) rooommend metliods to a.coompliah improved acoe&II by such children and 

families to community reIO\I.l"C.eII and 

heaJth-care , including through 

colla.bor&tWn with ebildrtn's hospitals and 

other providers ot pediatric specialty eare, 

kleal agencies., Ioea1 communities, and 

States; 

(ivJ oon&ider approaches &Ild mab 

reeommendatioD.ll for the impro'\led integration of iDdividu.alir.e or oompa.rtmentaliud 

lI1edica1 and f.:amiIy lrupport ~ fur 

miliwy families; 

(v) work eJoseJy wiib the Qmce of 

Community Support for Military Fa.wilies 

with Special Needs of the Deparlment of 

Defen!Je and other reJe\'&Dt. otflcea to a;oid 

redund&neiel and t.a.rget ah.a.rod a.rea.s of 

concer:n Cor children with spetiaI ()(' chron· 

io-he&J.th-eue needs; and 
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8 

(rij ~ew any ~ant information 

1 leanied and. findings made by the wtlrking 

1 group under this p&ragrepb that may be 

4 considered or adopted ixl A consistent man· 

S net "With T't:!Ipf!et. to iJ:IIJ'f'CI'UIg IlIXleSS, reo 

6 IOW'CleI, and serrieee tor adulta with spe7 cia! netdB. 

8 (B) lbmEw.-ln carrying out the dtltiea 

9 under rubpll.t8gl"aPb (A), the l\"Orkiog gt"(IUp 

10 shall--

I I (i) disco.ss impitm:ments to special 

12 neeck bealth care pollee. and praeticea; 

1.1 (ii) determine how to &'IlppOt't and 'Pro14 teel I'amilies of members of the National 

1.5 Guard or Reserve Compolll!Jlbl lIS the 

16 membtl1l b-ansition into aud oot of the . 

11 evant EDleptional Family Member Pro18 gram at the ECHO p~ 

19 (iii) lIII&lyze caae lIl8Jl4ge:meot services 

20 Ul impf'OVl: oonsi.f;teIlty, oo=unication, 

.21 knowledge, e.nd undem&Dding ot retilOllI"CIIl8 

22 and eommunity conta.elll; 

Z3 (iv) identif,y are&II in whieh a Staie 

24 may oi!er services that Ill'1!: not wvered by 
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2 

3 

4 

5 

6 

7 

• 

9 

JO 

11 

12 

". 

14 

15 I. 

17 

18 

19 

20 

21 

22 

23 

24 

25 

9 

the TRICARE program or the ECHO pro. 

gram !lIld haw to ooord.inAte such services; 

(v) identify steps th&t States and 

communitiea ea.v. take to improve support 

for military families of i!hildren with special health care needs; 

(vi) «Insider how the TRlCARE pl'O+ 

gram and other progr-ams of the Depart. 

ment of Defense .... can work with apeclalty 

pediatric providers &Od resou.roe oommu· 

nities to et1S\1n! access, promote oommu· 

uication and collaboratioll, fUld optimi.r.e 

experiences of military families seeking and 

receiving health care 5ervi~ for their children wifh special or chronio bealth care 

(vii) con.&ider special and chronic 

health care iII II. comprehensive ll18JlIler 

without focus on one or more conditions or 

diagnoses til thi! uclusioll of others; 

(Wi) focus on ways to create innava.. 

eve pa.rtnerships, linkages; and access to 

information and resoun::es for military 

families across the &peCtrWn of th& specialneeds commtmity and between the medical 
355 


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IO 

eoIlllll.llnity IUld the !.e.Inily snpport OOIl'lmll.· 

2 nilyj IUld 

3 Ca) review matterT; that turtbec the 

4 ~on ot the wo~ group. 

S (b) MEHBI!:RSlIIP.-

6 (1) AJ>ron,.'TY1UiTS.-The working group I!.ball 

1 be eompoeed of not \es;; than 14 members as rouows: 

8 (Al The Chief Medjea1 Officer ot the 

9 TRICARE progra.m, wilp shall eerve II chair10 penolL 

11 (B) The Chief MedieeJ Offieen of the 

12 Nonh, Sooth, and West regional office.s of the 

13 TRJOARE prognt.Jll. 

14 (el One iJ:IdividuaJ repNl6en1ini the !Imy 

15 appointed by the Surgeon GeDeral of the Army. 

16 (D) One indmdual representing the Na'ry' 

17 appointed by the Snrgoon Geoera.i ot the Navy. 

18 (E) One individual representing the Air 

19 Force appointed by the Surgeon General of the 

20 .Air Force. 

21 (F) Oce individual representing t.be re22 glow managed eare support oontracUlr ot the 

23 North region at lobe TRlCARE progtMl ap24 poinUd by such oonb"act.or. 
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11 

(G) One indiVidual representing t.ht re2, gional mAllIlged care support oontraeWr of the 

3 South region or tbe TRlillRE program ap4 pointed by!1llcil eontracl.or. 

5 (H) One individual representing thf. re6 gional In!IllIIged care 1SI1Pport eontractcr ot: the 

7 West region of tbe TRICARE progra.ro apS pointed by such oon1rllctor. 

9" (I) Not more thlll. three .individuals rep10 resenting the non-profit organization the Mill· 

11 tary Coalition appointed by such organU.ation. 

12 (J) One indIvidual representmg the A.mer--

13. iCIIII Ac&demy of Pediat.l"ics appointed by such 

14 organixation. 

IS (K) One indmdu81 representing the Na16 tiona! Association of Children's B:ospital.s apt7 pointed by such organization. 

18 eL) One individual I'l!presenting mllit.ary 

19 families wbo is not !Ill empl~ of an orga.nira20 lion rep~ such iamilies. 

2 1 (M) Any otha individual as deterrni.oed by 

22 the Chief Medical Officer o( the TRICARE pro23 gram. 

24 (2) TElws.-Each member shall be appoitlted 

2S for tbe life of the worlting gn:nrp. A VllCIIIley in the 
357 


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12 

working group shall be filled in the manner in which 

2 the original appointment was made. 

3 (3) TRAVEL EXPEXsEs.-Each member shall 

4 receive travel el..-pen.~es, including per diem in lieu of 

5 subsistence,in ac~ordance with applicable provisions 

6 under subchapter I of chapter 57 of title 5, United 

7 .states Code. 

8 (4) STAFF.-The Secretary of Defense shall en9 sure that employees of the TRICARE program proW "ide the working group witll the necessary SUppOl1: 

11- to carry out this section. 

12 (e) :MEETTh'GS.-

13 (1) &HEDDLE.-The working group shall14 (A) convene it.s first meet.ing not later than 

15 60 days after the date of tlle enactment of this, 

16 Act; and 

17 (Bl convene not less than four other times. 

18 (2) FOR1Ii.-Any meeting of tile working group 

19 lllay be conducted in-person or throngh the use of 

20 video conferencing. 

21 (3) QDORUM.-Sevell members of the working 

22 group shall constitute a qnorum but a lesser nurober 

23 may hold hearings. 

24 (d) POVl'ERS.-
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13 

(1) HEARI:-IGS !u'm TESTIMOl'>~.-The working 

2 group may, for the purpose of carrying out this Act, 

3: hold public or priva.te hearings, sit alld act at times 

4 WId places, take written or oral comments or testiS many, alld receive evidence as the wor1.ing group 

6 considers appropriate .. 

7 (2) OFFICIAL D-<"'FORlliATION.-The "'orking 

8 group may secure directly from any department or 

9 agency of the United States information necessary 

10 to enable it to CBJ~"y out thls Act. 

11 . (3) MAILs.-The working group may use the 

12- United States mails in the same manner and under 

13 the same conditions M other department~ and ageu14 cies of the United States. 

15 (e) CONSTILTATION.-

16 (1) AnvrcE.-With respect to canj'ing out the 

17 revielY of the TRJClIl{E program and pediatric spe18 cia] and chronic health care needs Ullder subsection 

19 (a)(3), the working group shall seek counsel from 

20 the fonowing indil~duals acting as an el:pert advisory 

21" group: 

22 (AlOne indhi.dual representing the Excep23 tional Family Member Program of the Army. 

24 (BJ One individual representing ilie Excep25 tionaJ Family Member Program of the Navy. 
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14 

.(C) One individual representing the Excep2 tional Family :Member Program of the .Air 

3 Force. 

4 (D) One individual representing the Excep5 tional Family Member Program of the Marine 

6 Corps. 

7 (El One individual representing the Office 

8 of Community Support for Military Families 

~ with Special Needs. 

10 (F) One individual who is not 811 employee 

11 of au organization representing military families 

12 shall represent a military family with a child 

13 with special health care needs. 

14 (G) Not more than tbree individuala rep15 resenting organizations that16 (i) are not otherwise represented in 

17 tills paragraph or in the working group; 

18 and 

19 (ii) possess eJ.-pertise needed to carry 

20 out the goals of the working group. 

21 (2) ComfENTs.-With respect t{) carrying out 

22 the review of the TBlCARE program and pediatric. 

23 special and chronic health care needs under sub24 section (al(3), the working group shall invite and ac25 cept comments and testimony from States, local 
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15 

communities, national special needs advocacy 

2 groups, educators, pediatric-health-care providers, 

J and military family advocates. 

4 (f) REPoRTS REQUIRED.-

5 (1) REPOR'l'.-Not later than 12 months after 

6 the date on which the working group convenes its 

7_ first meeting, the working group shall submit to the 

8 congressional defense committees a report includ9 

10 

ing-

(A) any changes described in subsection 

11 (a)(2)(A)(iiJ identified by the workiug group 

12 that13 (i) require legislation to carry out, in14 eluding proposed legislative language for 

15 such changes; 

16_ (ii) require regulations to carry out, 

17 including proposed regulatory language for 

18 such changes; and 

19 (Ui) may be can-ied out without legis20 lation or regulations, including a time line 

21 for such changes; and. 

22 (B) -steps that States and local oommu23 nities may take -to improve the experiences of 

24 military families with special-needs children in 
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16 

1 interacting with and accessing State and local 

2 community resources. 

3 (2) FlNAL REPORT.-Not later than 18 months 

4 after the date on which the report is submitted 

5 under paragraph (1), the working group shall sub6 mit to the congre~sional defense committees a final 

7 report includulg8 (A) any additional information and up9 dates to the report submitted nuder paragraph 

10 (1); 

11 (B) information with respect to how the 

12 Secretary of Defense is implementing the 

13 changes identified in tile report submitted 

14' under pa.ragraph (1); and. 

15 (e) information with respect to any steps 

16 described in subparagraph (B) of such para17 graph that were taken by States and local com18. munities after the date on which snch report 

19 was submitted. 

20 (g) TERMTNATION.-The 'Working group shall termi21 nate on the date that is 30 days after the date on which 

22 the worhing. group submits the final report pursuant to 

23 subsection (f) (2). 

24 (h) DEFI:\TITOXR.-Iu this Act: 
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17 

(1) The term "children" means dependents of a 

2 member of the .Armed Forces who are3 (A) individuals who have p.ot yet attained 

4 the age of 21; or 

5 (B) individuals who have not yet attained 

6 the age of 27 if the inclusion of such depend7 ents is applic.a.ble and relevant to a program or 

8 poliey being reviewed under- this Act. 

9 (3) The term "congressional defem;e OOIIll1lit10 tee~" has the nleaning given that term in section 

11 101(a)(16)of title 10, United States Code. 

Ii (3) The term "ECHO program" means the pro13 gram established pursuant -to subsections (d) 

i4 through (e) of section 1079 of title 10, United 

15 States Code (commonTy referred to as the "Extended 

16 Care Health Option program"). 

17 (4) The term "TRICARE program" meallS the 

18 managed health care program that is established by 

19 the Department of Defense 1IDder chapter 55 of title 

20 10, United States Code. 

o 
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Attachment C 

March of Dimes Endorsement Letter 
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June 13, 2012 

The Honorable Steve Stivers 

US. House of Representatives 

Washington, DC 2Q515 

The Honorable Susan Davis 

U.s. House of Representatives 

Washington, DC 20515 

Dear Representatives Stivers, Davis, and SchaUng: 

Marc!' of Di1\1~5 FCl.lnd"tion 

Office 01 Govl;!mmen! t>-.ffairs 

m.::rd'lofdH'h'·S.ccm 

naceorsano.org 

" The H<lOorable Bobby SchiUing 

U.S. House of Representatives 

Washington, DC 20515 

The March of Dimes, a unique collaboration of scientists, clinicians, parents, members of the business 

community, and other volunteers affiliated with 51 chapters representing every state, the District of 

Cclumbia and i>uerto Rico, is pleased to endorse H.R. 4341, the TRfCAREfor Kids Act, a bill to ensure that 

a~ military families and children receive the essential health care services they need. 

The TRICARE program covers 9.6 million lives, including children and families of active duty soldiers. 

Unfortunately, because TRICARE utilizes a reimbursement structure based on Medicare, it often adopts 

policies and practices from Medicare that do oot address the unique health care needs of children. 

Moreover, despite the best efforts of the Department of Defense, military families with children with 

spedal health care needs and chronic conditions often have difficulty accessing resources and services 

from local or regionalty specialized providers. This problem is further exacerbated by the mobility of 

military families, who must repeatedly locate and obtain specialized "health care service in unfamiliar 

geographic regions as their assignments change arthey are deployed. 

The TRfCARE for Kids Act seeks to better shape the polities and practices of TRICARE to meet the needs 

of children, including those with special health care needs or chronic nlnesses. If enacted, the bill would 

convene a working group with a wide range of expertise in children's health and health care to 

systematically review TRICARE's policies and practices and make recommendatIons for improvements. 

The working group would also work With specialty providers of children's health care and support 

services to better connect military families to state resources for children with special and chronic 

health care needs. " 

Our nation's sold'1ers and their families have made tremendous sacrifices for the sake ofour coUntry. It Is 

our duty to ensure that these families receive the health care that best meets their needs. The TRfCARf 

for Kids Act will help make this possible. We look forward to passage of this important bill. 

Sincerely, 

Cynthia Pellegrini 

Senior Vice President, Public Policy & Govemment Affairs 

march of dimes 
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Attachment D 

OPM FEHB Program Carrier Letter 
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FEHB Program Carrier Letter 

All Fee For Service Carriers 

Letter No. 20ll-12(c) 

Fee-for-service [11] Experience-rated HMO [n/a] 

D..S. Office of Personnel Management 

Healtb ..... and lDAmm .. 

Date: April 1.9, ZD12 

Community-rated HMO [nla] 

Subject: 2013 Technical Gnidance and Instructions for Preparing Proposals fur 

Fee-For-Service Carriers 

Enclosed are the technical guidance and instructions for preparing your benefit proposals fur the 

contractterm January I. 2013 through December 31, 2013. Please refer to our annual Call Letter 

(Carrier Letter 2012- 09) dated March 29, 2012 for policy guidance. Benefit policies from prior 

years remain in effect unless otherwise noted. 

This year's deadlines are as follows: 

• No later than May 31, 2012: Please send your complete proposal fur benefit changes 

and clarifications to your contniCt specialist on a CD-ROM (or other electromc means) in 

addition to a hard copy. Your proposal should include corresponding language descnbing 

all proposed brochure changes. Your OPM contract specialist will discuss your proposed 

benefits and finalize negotiations in a close-out letter. 

• Wrtbin five business days following receipt of close-out letter or by date set by your 

contract specialist: Please send him/her an electronic version of your fully revised 2013 

brochure. See Attachment VI: Preparing Your 2013 Brochure. 

Carriers are strongly encouraged, as always, to follow our guiding principles of affordability and 

value based benefit design when preparing proposals. This year you will see an increased focus 

on quant:itative data which we need to measure each plan's overall performance. For some items, 

we ask for historical data to establish a baseline for perfonnance reviews. In addition, we 

appreciate' your continued timely efforts to submit benefit and rate proposals and to produce and 

distribute brochures. . 

Enclosed is a checklist (Attachment XVI) showing all the information to include with your 

benefit and rate proposals. Please return a COlllFleted checklist with your submission. 

We look forward to working closely with you on these essential activities to ensure a snccessful 

Open Season again this year. 

Sincerely, . 

John O'Brien 

Director 

Hea1thcare and Insurance 
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Preparing Your 2013 Benefit PI:oposaJ 

Your benefit proposal must be complete. Tirneframes to conclude benefit negotiations are finn 

and we cannot consider late proposals. Your benefit proposal should include: 

Asigned contracting official's fonn (Attachment I); 

.. A plain language description of each proposed change (Attachment II) and revised 

language fur yeur 20 13 brochure; and 

• A plain language description of each proposed clarification (Attachment III) and revised 

language for your 2013 brochure. 

If you anticipate significant changes to your benefit package, please discuss them with your 

OPM Contract Specialist before preparing your submission. 

As stated in the 2013 Call Letter, our three primary initiatives this year are: 

.. Implementing additional requirements under the Affordable Care Act; 

Improving the delivery and cost efficiency of prescription drugs; and 

• Advancing quality of care principles. 

I. CALL LETTER INITIATIVES 

A. Implementing the Affordable Care Act 

1. Lifetime and Annual Limits on Essential Healtb Benefits 

FEHB plans have historically not imposed lifetime limits and we will continue to enforce this 

requirement. 

In addition, FEHB plans BIe expected to eliminate annuallimifs on essential health benefits 

(EHB), regardless of grandfathered plan status. 

On December 16,20 I t, the Department of Health and Human Services (HHS) released a Bulletin 

01tlo://cciio,cms,oo,lresources/files/FileQI12 16')Olllessential health benetits bulletin.pdD 

describing its approach to define EHB under the Affordable Care Act. On February 17,2012, HHS 

issued a FAQ Qlt\p:ilcciiO,CJns.nov!resourceslflles/Files2/021 no 12iehb-faq-508.pdD to provide 

additional guidance on the subject. 

Information Required for Proposal: Attachment IV-Lifetime and Annual Limits on 

Essential Health Benefits 

2. Clinical Trial Coverage 

FEHB plans are expected to comply with certain coverage requirements for clinical trials next 

year, in advance ofrequired implementation for 2014, regardless of grand fathered status. The 

requirements are described in detail in Attachment V. 

2 
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InfunnatioD Required fur Proposal: Attachment V-Clinical Trial Coverage 

3. PreveJltive Services 

Last year, we requested FEHB plans to eliminate cost-sharing for all recommended in-network 

preventive services, immunizations, screenings, tobacco cessation services and medications. 

Please check the latest posting by the Advisory Committee on Immunization Practices (ACIP) at 

http://wwi, .cdc.!!ov/vaccinesfpubs/ACIP-list-bv-date.htm for the full list of required vaccinations 

as some have changed. Note that, unless otherwise specified, plans must cover these 

requirements no later than the start of the plan year which follows the year in which the 

recommendation becomes effective. 

Plans must submit proposals that cover preventive services, including birth control, with no costsharing, regardless of grandfathered status. The Affurdable Care Act adds new preventive 

services requIrements for 2013 that go beyond recommendations of the, United States Preventive 

Services Task Force. See hnp:II\,ww.hrsa.[!ov/womensf!uidelines/. 

lnfonnation Required for Proposal: Attachment VI- Preventive Services 

4. 2013 Brochure 

FEHB plans are required to provide a "Summary of Benefits" for 2013, in advance of required 

implementation for 2014, regardless of grandfathered status. To evaluate our "Going Green" 

goals to help reduce FEHB administrative costs, please provide your cost savings information on 

the worksheet provided. You will receive additional guidance In a forthcoming carrier letter. 

Infonnation Required for Proposal: Attachment Vll-Preparing Your 2013 Brochure 

5. Grandfathered Plans 

You only need to complete the certification for options that you anticipate will remain 

grandfathered for plan year 2013, based on benefit changes. Please read the certification 

carefully as it lists specific regulatory requirements that allow a plan to nemain grandfathered 

under the Affordable Care Act. We will confirm requested grandfather status once final benefits 

and rates are negotiated. 

Note:'!f one 'Or more of your plan options was grandfutbered in 2012, but will uo longer 

meet regulatory reqnirements for 2013 then all Affordable Care Act reqnirements for nongrandfathered plans must be met in 2013. 

Informatio'n Required for Proposal: Attachment VTII-Grandfathered Status Certification 

3 
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B. Improving the Delivery & Cost Efficlepg oIPrescription Medications 

OPM continues to explore innovative methods to reduce pharmacy spending rmd to 

develop effective prescription drug management without cost sbifting or burdening 

members. The rate proposal, wbich you will receive separately, has our phannacy data 

request. 

Information Required for Proposal: 

• Describe effective prescription drug management without cost shifting or 

burdening enrollees; 

• Describe proposals to implement specialty drug programs that manage these 

costs; 

• Describe how you are managing the control of drug administrative costs such as 

dispensing fees; and 

• Complete Attachment TX for four issues below. 

(1) Generic Medications 

OPM's target for 2013 is to achieve an overall FEHB average generic dispensing rate of at least 

75 percent The Generic Dispensing Rate (GDR) is defined as the percentage cftotal 

prescriptions filled with generic drugs. 

(2) Specialty Pharmaev 

OPM's target is to stabilize the growth and cost of specialty drugs by keeping cost trends below 

the industry average of 14 to 20 percent. 

(3) Pharmacy Benefit Managers Accreditation 

FEHB plans should provide the highest quality pharmacy services to Federal employees, retirees 

and their families as demonstrated by the accreditation status of their pharmacy benefit managers 

(PBMs) or pharmacy components. 

(4) Control of Dispensing Fees 

Carriers will provide OPM with baseline data on the administrative fees in their current PBM 

contracts and describe how they intend to mitigate inflation in those fees. Examples are 

dispensing fees for generic drugs, brand name drugs, and for specialty drugs. 

C. Advancing Quality of Care 

OPM supports enhanced care coordination and the principles underlying patient centered 

medical homes (PCMH). To the greatest extent possible, we encourage participation in pilots 

offered by states or other Federal agencies, including the Comprehensive Primary Care (CPC) 

initiative sponsored by the Centers for Medicare and Medicaid Innovation Center. Read about 

this important initiative at 

4 
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h n p ://\ \ ww. in nov alions.c m s. gOY lin itiati" cslCom prch ens i ve-Prim ar.v-Care-l ni tia! i ,eli ndex .htm I 

We invite you to propose arrangements through which your FEHB members can participate in 

the new CPC activities. 

Information Required for Proposal: Attachment X-QuaIity of Care: PCMH 

Additionally, we support the goals of the HHS' Partnership for Patients, Better Care, Lower 

Costs to reduce hospital readmissions by 20 percent and decrease preventable hospital acquired 

conditions by 40 percent when compared with 2010. We expect that you will make concerted 

efforts to improve the quality and safety of health care by addressing both those concerns. 

Nate: Plans will receive s~arate guidance in a forthcoming Carrier Letter describing how 

to measure applicable rates for FEHB populations. 

We seek to eliminate elective deliveries before 39 weeks' gestation to reduce prematurity and 

adverse neonatal outcomes. We encourage you to deScribe initiatives supporting this goal in 

your benefit proposal, including those in place through your plan, participating hospitals or 

network providers. 

NOte: The forthcoming Carrier Letter regarding readmission and preventable conditions 

will include data requests reflecting maternity care and prematurity. 

In your proposal, please describe all wellness programs you intend to offer - including any 

quantitative data or other measures of their effectiveness - that can improve employee 

productivity, enhance healthy lifestyles and lower long-term healtheare costs. 

FEHB plans are expected 10 continue programs to mana"oe obesity as part of their focus on 

members' health and wellness. Your 2013 benefit proposal should update weight management 

coverage to ensure that enro !lees receive all appropriate support to achieve and sustain a 

healthier weight. . 

Information Required for Proposal: Nanative information on all wellness programs with 

outcome data IlIld Attachment XI-Weight Management 

II. BENEFITS & SERVICES 

A. New Gtddance: Coverage of Applied Behavior Analysili (ABA) 

The OPM Benefit Review Panel recently evaluated the stBtns of Applied Behavior Analysis 

(ABA) for children with autism. Previously, ABA was considered to be an educational 

inrervention and not covered under the FEHB Program. The Panel concluded that there is now 

sufficient evidence to categorize ABA as medical therapy. Accordingly, plans may propose 

benefit packages which include ABA. 

Information Required for Proposal: Describe what benefit package you intend to offer and 

describe how you WIll deliver these services through appropriate providers. 
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B. Benefit Changes 

Your proposal must include a narrfltive description of each proposed benefit cl!angll. Please use 

Attachment II as the template to submit benefit changes; You must show all changes, however 

small, thatresultin an increase or decrease in benefits, even ifthere is no rate chBIlge. 

We expect you to answec each of the fullowin g questions in worksheet format for each proposed 

benefit change. Indicate if a particular question does not apply and use Ii separate page for each 

change you propose. We will return any incorrectly formatted submissions. 

Information Reqnired for Proposal: 

• Describe the benefit ehBIlge completely. Show the proposed brochure language, 

inciuding the KHow we change for 2013~ section in "plain language" using the active 

voice and written from the member's perspective. Show clearly how the change will 

affect members and the complete range of the change. For instaoce, if you propose to 

add inpatient hospital copays, indicate whether the change will also apply to inpatient 

hospitalizations under the emergency benefit. U there are two or more changes to tbe 

same benefit, please show each change clearly. 

• Describe the rationale or reasoning for the proposed benefit changll. 

• State the actuarial value of the change and if it change represents an increase or decrease 

in (a) the existing benefit and (b) your overall benefit package. If an increase, describe 

whether any other benefit offsets your proposal. Include the cost impact of the change as 

a biweekly amount for the Self Only and Self and Family rates. If there is ''no cost 

impact" or if the proposal involves a "cost trade-of!" with another benefit, indicate which 

result is applicable, i.e. no cost or trade-off. 

C. Benefit Clarificatiolls 

Clarifications are not benefit changes. Please use Attachment III as the template to 

submit an clarifications that better explain to members how a benefit is covered. 

Information Required fur Proposal: 

• Show 1he: current and proposed language fur each proposed clarification and 

reference all portions oftbe brochure it affects. Prepare a separate worksheet 

far each proposed clarification. You roay com bine more than one clarification 

for.the same benefit, but you must present each one clearly on the worksheet. 

Remember to use plain language. 

Exp lain the reason for the proposed clarification. 

D. Continned Focus from Previons Years 

1. Health & Wellness 

6 
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We continue to encourage you to offer financial incentives to enrollees who (a) complete a 

health risk assessment or biometric assessment or (b) participate in wellness activities or 

treatment plans to improve their health status. 

Information Required for Proposal: Attachment XII-Health & We1Iness 

2. Increase FEHB providers 

We ccmtinue to encoumge you to increase the number of health care providers inFEHB plan 

networks who are board certified or have training in geriatrics. 

Infonnation Required. fur Proposal: Attachment XID-Geriatric Providers 

3. Affinity Products 

We encourage you to add products on the "non-FEHB" page of your, plan brochure that may be 

of interest to members and ineligible family members, especially individual policies for domestic 

partners as wen as for members who may seek additional insurance products, such as short-term 

disability. 

Information Required. for Proposal: Attachment XIV -Affinity Products 

4. OrganlTissne Transplants 

We have updated the guidance on organ/tissue transplants which we provided in last year's 

technical guidance. When a carrier determines that a transplant service is no longer 

experimental, but is medically accepted, you may begin providing benefits coverage at that time. 

Carriers are not obligated to wait for the next contract year before they begin providing such 

benefits. We have updated the fullowing table in Attachment XV: 

• Table J- OPM's required list of covered organ/tissue transplants. Although we no longer 

require coverage fur autologous transp \ants for breast cancer, plans may continue to offer 

it. 

Information Required for Proposal: Attachment XV: 2013 OrganfI"Issue Transplants and 

Diagnoses 

5. DescribingPrescriptiOli Drug Co-Pays in tbe Gnide to Federal BenefitS 

Plans that use levels or tiers to denote different prescription drug co-pays must clearly describe 

the coverage and difference between each level or tier in the 2013 brochure. The 2013 Guide to 

Federal Benefits will Ulustrate the prescription drug co-pays at the following levels. 

• Level I - generally includes generic drags, but may include some brand formulary or 

preferred brands. Usually represents the lowest co-pays. 

• Level II - generally includes brand formulary and preferred brands, but may include 

some generics and brands not included in Levell. Usually represents brand or middlerange co-pays. 
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• Leyel lIT - may include all other covered drugs not on Levels I and II, Le. non-formulary 

or non-preferred and some specialty drugs. 

If your plan has more than three co-pay levels for prescription drug coverage, please work with 

your OPM Contract Specialist to ensure that we accurately reflect your coverage in the 2013 

Guide to Federal Benefits. 
374 


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Attachment E 

2006 OPM Ltr to Rep Christopher Smith 
375 


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UNITED STATES 

OFFICE OF PERSONNEL MANAGEMENT 

Of"f'ICt:' OF 11lE: DIllEcrOR 

'The llonomhlc Christopher Smith 

U.S. House ofReprescntativos 

Washington. DC 20515 

Dear Representative Smith: 

JMi 2 7 20C5 

. Thank yL1U for y()ur recent communication C()lleenling applied behavior analysis (AliA) for 

autism. You asked th"tthe Office of Personnel Management (OPM) direct the Federal 

Employccs Health &ndiL< (FEHB) Program carrier.; to prol-ide information on the extent or 

their Cllvt'm~e for therapies such us ABA. 

OPi'\'f has cunductcd an extensive literaturc re,-iew on AliA and consulleU v>'ilh medical experts 

in this jjeld. V;11ilc it appears thaI ABA is considered a promising behavior,,1 inteIV'couon 

themp), for autism. there is no strong scientilie evidence ofits benefit A ~ational Library of 

Medicine "Medline" so'areh ofrhc scientific literature from 1966 to present revealed no 

evidellccd-based articles on hehaviorallhC!1ljlY ofautism. The cw-rent evidence rests 011 small 

numbers or children with autism treated over se"'eral years. ABA has not yet been proven ill 

randomized e,perim~ntal trials and is <;:onsidered 10 be experimental or investigational. 

Dlcrefore, benefits c(,vcrag.; under the FEHEl Program is not availabk. 

The American Academy or Pediatrics and the National Research Council indicate that more 

n'plicativc studies with improved methodology arc needed before ABA can be necommt:JldeJ for 

all autistic cbildren. The 01ational InsliltLlc o[:vtental Health reported in April 2004: "Research 

is beginning to sbow that spt.'Cific medical and behavil1r~J lreauncnts. and combinations of these 

treatments, aTe erkClive in ameliorating various problems thaI are oft"n a<sociated witb autism, 

Further research is needed to fully evaluate the efficacy and effectiveness of such lreatmenL~."l 

In May 2004, tile National Institutes of Health', Inlera~cocy Autism Coordinating Comminee 

reportL'<i that "Randomized controlled trials orbebavioral interven!.ions arc also nceded. as well 

Il!/ oulcume' measures for behavioral treatment studies:,2 

Cnder its mental health coverage. Ihe Federal Employees Health Benefits (FEHB) Program 

provides benefits for sen-ices related to aulism as it does for medical conditions. For example. if 

a specific service (c. g., speech therapy) is covered by a FEHB Plan, the >;en-ice C'mnot be 

e"c1uued if it is prescribed to treal autism. These mental health benefits, along with prea\lthorization requirements, limitalions, and exclusiuns of services considered experimental or 

invc,tigatiDI)al are described in eaeh carrier's plan brochure available during open season. As 

with any type of service (medical or mental). regardless of the condition. OPM cannot authorize 

bcnc!its for services that are considered to be experimental or investigational. 
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The Hooofahle Christopher Smith 2 

It is OPM's most sincere hope that one day!"ll1'ldomized trials \frill demonstrate ABA to be !Ill 

effective course of treatment for autism and no longer be considered investigationaL OPM has 

great empathy for the fmnilies affected by this tragicdisorlier, and regret our decision could not 

be morc fa"orable. 

I apPreciate the opporiunityto respond to yourintercst in this matter. 

Sincerely. 

~ Director 

I Depar1me;nl ,,[Health and ffum:m SeT"ic., I'.lional fnstiNte> of Health. 1''''100.1 Institute ofML"Iltal Health, 

Congressional Appropriations lrunmitlee Report on the State: of Autism R~arch, April 2004, Pg. 16. 

" Defli3rtrncn[ of Health and Hwnan Services., 111f'CTilgcncy Autism Coordinating Committee, Mec[ing Hightig.h~s.,. 

\1a~' 11.1004. Nalion.lln!ctituu: of Health. Pg. 3. 
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Attachment F 

2011 Ltr to Assistant Secretary Posny 
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Dr. Alexa Posny 

Assistant Secretary for Special Education and Rehabilitative Services 

United States Department of Education 

400 Maryland Avenue, S.W. 

Washington, D.C. 20202 

Dear Assistant Secretary Posny; 

We are active duty members and/or their spouses who have a child with a 

disability who receives special education services under the Individuals with 

Disabilities Education Act (IDEA). We request that the Department of Education 

via your office investigate a number of serious issues related to the ability of 

military children to receive appropriate services in our nation's public schools. 

There are over 150,000 military children impacted by a disability (many more if 

you count ReserVes and Guard families). The root of our problem is that military 

orders and requirements cause military families to move more often than the 

general public. We move both due to short term training and deployments (6 

months to 1 year) and normal military transfers (every three years on average). It 

is not uncommon for military families to relocate 15 or more times in a 20 year 

career, generally across state lines. When we move, our children with disabilities 

are impacted and they often fall behind at school. FllJIlilies and children must 

adjust to new IEPs, new staff and new programs. At a time when they need more 

services due to the transition, a number of families find that the new school district 

significantly cuts their child's services or alters them to the child's detriment. 

Some districts deny the child accommodations they had through their previous 

school district Some oftbese districts seem to be aware that families will move 

soon again, and have little ability to protect themselves (once a family moves, it 

may be difficult to bring due process). We wish to reco~ that there are school 

districts that provide excellent services to military children with disabilities and 

many individual teachers and staff who go above and beyond in providing 

effective educations to military cbildten. These staff and schools are heroes to the 

families they serve. But still these problems persist with a number of school 

districts. 

There are five significant issues for your consideration. 

First, contrary to IDEA 2004, children who move into new school districts do 

not necessarily receive services comparable to those in their prior IEP. 20 

U.S.C. 1414 (d)(2)(C)(i)(II) of IDEA states "the local edllcational agency shall 

provide such child with a free appropriate public education, including services 

comparable to those described in the previously held IEP." Regulatory 

Co=entary states that "comparable" was intended to mean "similar or 

equivalent" to the old IEP [71 Fed Reg. 46681 (2006)]. But, it has been our 
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experience that some school districts ignore the COInmentary. This is because the 

commentary is not legally binding, and school districts have told parents this when 

they cite it But regulations are binding and making the commentary part of the 

regulation would be a significant step toward solving the problem. A number of 

families find that their child's services are cut significantly and accommodations 

and modifications are not provided. Assistive technology needs may not be 

recognized across districts, forcing students to learn new programs and 

computerized devices with each move. As one example, military parents of a 

child with hydrocephalus and associated issues moved from Texas to Alabama for 

a required 10 month military training program. The new Alabama district reduced 

the child's services by half, effectively ignoring the Department of Educa.tion's 

commentary. Since the family was in Alabama for such a short period, they had 

little recourse. Their story is included from the September 2009 edition of 

Exceptional Parent Magazine. We ask for three things with regard to this section 

of IDEA 2004. 

We ask that the regulatory commentary should be made part of the regulations. 

There are school districts that ignore the commentary because it is not binding. 

Regulations are legally binding and everyone must follow them. Most families do 

not even know about the Commentary or that they need to go find an August 2006 

Federal Register notice to access it Most schools and families simply focus on 

the regulations. Military families, often with a family member deployed or 

otherwise serving their country, often find it difficult to take on advocacy for their 

child on top of everything else. Consequently, we would be grateful for clearer 

regulations. 

Pending this regulatory reform, we would request focused, clear guidance be 

issued to school districts and State Educational Agencies. It would be most 

helpful if the new school district fully understood the requirement to provide 

sii:nilar or equivalent services, per the previously agreed to lEP from the losing 

school district. 

Third, we hope that guidance can be developed around evaluation needs related to 

this part of IDEA.. IDEA 2004 appears to suggest that an LEA needs to conduct 

an evaluation before writing an lEP. 20 U.S.C. §1414 (d)(2)(C)(i)(ll). This further 

delays services, as states go through the evaluation period. Districts get 60 days to 

write IEPs unless states set their own deadlines, and some deadlines exceed 60 

clays. After this, there is a delay before the IEP is written, and then a slight delay 

again for implementation. It seems that districts should be urged to adopt 

assessments that have already been conducted, which would save LEAs money. It 

wastes resources to conduct fue same assessment twice in a year, merely because a 

child moves. 
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Second, military families moving school districts face difficulty with 

evaluations. As mentioned previously, state evaluation periods can vary from 60 

days to much longer. For military children who move in the middle of the 

evaluation, the delay in services can become appalling. One military family noted 

that they notified Child Find in late March in one state, only to eventually be 

provided a IEP and services in another state in late October. We would ask that 

you clarify in regulations and in guidance that 20 U.S.C. 1414(a)(J)(C) requires 

the evaluation timeline to begin from when the child is first evaluated in the old 

district, Some districts take the position that it does not. 

Third, the protections in IDEA for moving families are limited to moves 

during tbe "scbool year." Because military families move during the summer, 

LEAs refuse to implement their old IEP or provide similar or equivalent services. 

They simply read IDEA 2004 's protections for families which move as 

inapplicable, since the family moved in the summer. We urge you. to clarify that 

the intent of IDEA, even with summer moves, is for school districts to implement 

comparable, meaning similar or equivalent, IEPs. 

Fourth, we'd request tbat coordination be conducted between the 

Departm~nt of Education and tbe Department of Defense rega.rding the above 

investigation. Many times, a military child who needs to access special education 

will transition from a public school to a DoDEA school or vice versa. OUI' 

families need both entities to be on the same page to ensure OUI' children receive 

an appropriate education. 

Flftb. school districts know that military families are a transient population 

and that the large majority are unable to effectively access IDEA's 

procedural safeguards (most notably the dne bearing process), dne to cost 

and timeliness issues. This creates incentives for some school districts to deny 

services and ret'wie to negotiate. Many times, families who move give up certain 

due process rights, except those related to compensatory education. Moreover, 

military families, with one spouse deployed or otherwise serving the country, are 

already stretched to the breaking point without considering the extensive time and 

energy required to advocate for OUI' children who access special education. We 

would request that the Department of Education, in accordance with Presidential 

Directive No.9 "Strengthening our Military Families", consider regulations and 

guidance on ways to help military families impacted by their child's disability, 

particularly related to transitions and procedural safeguards. It is directly in line 

with the Directive's "Priority #2: Ensure excellence in military children's 

education and their development" that clear guidance should be provided on the 

requirements that schools must implement for military families and their children 

who access special eduCaJion. 
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We would request you consider the following documents as supportive of om: 

commenjs: 

• GAO Study: Education of Military Dependent Students: Better 

Information Needed to Assess Student Performance 

(bffp:l!vn'l'w.gao.gov!DroductsIGAO-11-231) 

• RAND Study on Effects of Deployments on Military Child's Education 

(http:/h'fww.rand.org/Dubs/monograDbs/MG 1 095.h tm!) 

An upcommg study provided by the National Council on Disability is expected to 

also validate om: complaints above. 

Thaok you very much for considering our concerns. We are providing our names 

and contact information below, if you need further information or to follow up. 

Sincerely, 

Mike Bari-ett 

US Army 

barrettfamilvri/lhotmail.com 

Karen Driscoll 

USMC Spouse 

Karen062201aol.com 

Laura Blair 

US Navy 

laura.blair!Wnavv.mil 

Jeremy Hilton 

USAF Spouse 

ktp1995fal.gmajl.~om 

Please note that our signatures in no way imply endors=ents by the Department 

of Defense or our individual branches of services. The views expressed are our 

own. 
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Attachment G 

USMC Family Programs Briefing 
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r' "'i<~ ,,·~.w·.·<e 

i SCHOOL UAISDN" I 

PROGRAM I 

FArv1ILY CARE BRANCH 

For HQMC Contact Information 

http.s::/Iwww.manpDwer.usmc.mil/portaJloagelportaIlM RA HOME/MF/F Fsmily%2DCare 

"Keeping Faith" 

FAMILY CARE BRANCH 

I 

EXCEPTIONAL II 

FAM!LY MEMBER, 

PROGRAMS! 

--. 

I "'oi~ 

;-- -___ ~"_I_" __ -: . J-~IiiiiiiIiiiiiii'" " .. ~--~ ~i 

'~ 

MKeeping Faith" 

TRICARE UAISON 
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~FAMllY CARE PROGRAMS (MFYj Strategic Concepts 

~ '~: 1!!!!!!!ii!!!!f!linih!ilanai!ii.rrg!!!!!liM!lia!lirl!ilni!!esitmi!!!!dith!!!!!e!i!ir!i!famii!!iii~iiesi,i!!qiua!i!Ii!i!.ty!i!iof!i!illfe!i!ithiroiiuighiip!i!roig!!iro~m!i!is !i!r,,!i!at!i!i!i 

prDvide, support. or facilitate, core and seIVices for chUdren. youth and teens 

and exceptional family members 

·fUll fN'OLUslON IN 

CHUJ)REN, YoUTH AN-D TEEN 

PROGRAM 

eiNCREASE CHiLo CARE 

CAPABtUTlES 

-REVi'EW AND ",-PROVE 

CAPABfUTtES Of SCHOOL 

UAlSON PROGRAM 

·tNCREASE CAPABIUTIES OF 

EXCEPTlONAl- FAMILY 

MEMSERPROGRAM 

The FamIly Care B"",M was emr/Jilshed to align mrtural worIdng grolJ/>S. Family Ca,.. is 

integrating and reorganirlrtg to- exploit al/, 

capabilities and elimInate redundanciu. 

"Keeping Faith" 

..fNCREASE EFFICIEHCfES 

"DO THE RlGKTTHING 

~. CYTP - Inclusion Services 

-~£i:·li!i !iiiiii!il!!!ii!!!!!iiiiA!!iIiP I!!lri !.imjjaiirY~Fol!iciiuisi!ifiio!iir iiM!!!!ciiciiiyi!ir·p!!!!i!i!!!iii!!i!i!i!i!!!!i!i!!!!i!i!!l 

CDC Nurse, hired to serve CYTP at ~ 70% of Me installations with 

100% goal. The Millrine COrps CYTP benefitted from training and 

technical assistance offered through a ((ids Included Together {ICIT] 

program, contracted by DoD to provide installation staff with . 

professional technical assistance and partnership with the Exceptional 

Family Member Program and the School Liaison Program to meet the 

indtvldual needs of children with specific disabilities and challenging 

behaviors. 

A Diabetes Management Pilot Program was ",so successfully 

Implemented at three pilot sttes to promote and ensure safety and 

support for children wlth dlabetes in CYTl'. C\'TP mil ... were hired to 

support the special medical needs of chfldren enrolled In and to provide 

increased awareness and trainine fur CYTP staff. 

BebaviorSpecialists. During 2012, the Marine COrps is .ddlng another 

critical capabDlty to support the Inclusion of all children. Behavior 

SpeciaIlsts will be added at each installation to support service to 

chHdren with soda~ emotional or behmora! concerns. 

"K"" .. "i"a Faith" 
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EFMP Enrollment 

Enrollment. EFMP support ro enrolled families is provided by both HQMC and installotion EFMP 

persooneL Since FYOs, EFMP has experienced a steady increase In enroHment from 4,500 Marines 

to 8,404 Marin", to over 11,000 EI'Ms. EFMP enrolled Marines account for 4.1 % of the Marine 

Corps population. A myriad of diagnoses may lead to EFMP enrollmen~ 

"Keeping Faith" 

THE USMC EFMP 

CONTINUUM OF CARE 

Assignment Coordlnation. HQMC EFMP 

Assignment Coordimrtcm: reviewed 3,125 orders 

to ensure availability, ac;cessibiHty and reasonable 

travel time to TRICARE"'pproved medical 

provide",. Familv case Workers (FeW) ot the 

installation has provided over 80,000 hours of 

direct and indirect support to enrolled families. 

An improved assignment process and rnvestigative 

protocols, results in HQMe EFMP endorsement of 

90% of ft1Sl identified assignments for enrolled 

Marines, aUowing Marines to remain competftive 

for promotion while ensuring the continuum of 

care for EFMs .. On-going analyses of declines have 

resulted in conversations with OSC Office of 

Special Needs and Navy Medical which could resu1t 

in gap resoh.rtion. 

HKeeping Faith'" 

USMC 

Continuum 

ofeare / 

/ 
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.~ NCO Research 

"~~~~~~~~J 

"Keeping Faith" 

NCD Research 

• Ajoint undertaking of the USMC and the National Council on Disability (NCD) 

• NCO is an independent federal agency " ... to promote policies, programs, practices, 

and procedures that guarantee equal opportunity for all individuals with 

disabilities, and that empower individuals with disabilities to achieve economic selfsufficiency, independent living, and inclusion and integration into all aspects of 

society:' (www.ncd.gov) 

• NCD contracted ICf International, a professional research firm with extensive 

background in military community research, to conduct the Research. 

• The Research took place fall 2009 through fall 2010. 
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Research Purpose 

He\'! to Improve Access to Health.;,;are, Special 

Ed,lcation, and Long-Term Supports and Senrices to 

~::Cari1liy r/;embers v,Iith Disabmtfes 

• Document the experiences of USMC families with member.; with disabilities in 

accessing appropriate and effective healthcare, special education and related 

services, and long-term supports and services in the U.S. 

• Identify barriers impeding access to appropriate supports and services 

• Develop recommendations to improve access to healthcare, special education and 

related services, and long-term supports and services for Marine Corps family 

m~mbers with disabilities. 

"Keeping Faith" 

Research Approach 

• Data collection period/sites: 

- MCB Quantico [January 2010) 

- Camp Lejeune (February 2010) 

- camp Pen{fleton (March 20io) 

• Data collection methods: Focus groups and interviews 

• Instrumentation: Discussion guides and demographic sheets 

• Research participants: EFMs, their caretakers, and service providers 

• Research outputs: Aggregated findings, NCO recommendations, final report. 
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• USMC reijes on EFMP as the primary USMC resource forfamifies with spedal 

needs 

Participants almost unanimously recognized that EFMP is a program in 

transition that has grown significantly in reeentyears 

• Many families and providers affillated with other base and off-base programs 

p~i5ed EFMP and described a number of EFMP providers as exceptional. 

"Keeping Faith" Findings 

Barriers to EFMP program entry: 

Lack of awareness among potential enrollees about EFMP 

Misinformation regarding who is eligible to enroll and benefits of 

enrollment 

Ungering stigma associated with EFMP and its impact on a Marine's 

career 

Inconsistent referral of appropriate candidates by providers (inel 

physicians) 

Communications barriers: 

. - Inconsistent communication between lOsing and gaining EFMP offices 

about PC5ing families. 

-----_ .. _ ... _-------------- "Keeping Faith" Findings 
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EFMP-Areas for Improvement 

Barriers to delivery of quality service: 

- Absence of outreach contact from EFMP [reported by many families) 

- Large t:i!seioads 

- Under-qualified caseworkers 

- Perception of limited services (assIgnment coordination., Information & referral) 

Dist.rust of assignment process.; 

- Skepticism about the capabilities of assignment monitors to make appropriate assignment 

-decisions on behalf of Marines and their EFMs 

- Concem about impact af enrollment on the Martnels assignment o-ptions., deployabTIity, and 

advancement. 

"Keeping Faith" Findings 

Key Recommendatlons-Short-Term 

Conduct accessibility review of human service programs and facilities on USMC 

bases (incl base housing). Deve[op plans for each base to make programs and 

fadnties llccessib[e, as necessary, i.e., ADA compliant. Execute plans. (USMC) 

Increase accuracy and timeliness of information EFMP families receive from Tricare 

by instructing Tricare case manager; to assist families in accessing services, 

assigning Tricare case manager; to a larger proportion of theEFMP population, 

.and establishing mUltiple communication mechanisms (ind. a 24/7 Tricare 

telephone hotline for EFMP families, similar to the Medicare hotline. (Tricare) 

Disseminate to Loca[ Education Agencies (LEAs) and EFM families detailed 

guidance for implementing initiatives included [n the Interstate Compact on 

Educationa[ Opportunity for Military Children. ([nterstate Commission, Federal and 

State DoEs, LEAs, DoDEA) 
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Key Recomendations-Long-Term 

Implement mechanisms to enable military EFMs to maintain Medicaid waiver 

services when they move from state to state, rather than requiring them to go 

to th~ bottom of the waitlists each time they pcs: 

Place Incoming EFMs on the new state's waitlist based on their position 

an the previous state's waitlist (i.e., based on "time served"). If 

individuals have a Medicaid waiver in the previous state, they should 

automatically receive ane in the new state. (Congress and state agencies) 

For EFMs who lase Medicaid waiver services as a result ofa PCS, provide 

the same benefrt:S the EFM received in the previous state until eligibility 

can be established in the new state. (Congress and state agencies, DaD, 

Trlcare) 

Increase the flexibility of services covered by ECHO to closely mirror the. 

services available through a Medicaid waiver. (Congress, 000, Trlcare). 

"Keeping Faith" 

FAMILY CARE PROGRAMS {MFY} Strategic Concepts 

Enhancing Marines and their families' quality of Tife thraugh programs that 

provide, support. or facilitate, care and services for cluldren, youth and teens 

STBAIEGICENAAGEMfNI 

..fULL ItiCL.USIOK IN 

CHILDREN, Y01JT1-i AND TEEN 

PROGRAM 

oINCReASE CHIlD CARE 

CAPABlunES 

oREVlEW AND tMPROYE CAPAarunes-OFSCHOOL 

l.II\ISONPROGRAM 

·lNCREASECAPMIUTlES OF 

EXCEPilOf\lAl FAMPly 

MEMBER PROGRAM 

and exceptional farrrfty members 

r

-

""")18' : .. 

'! ' 

'K~=:=:RPS FAMIULIES 

. -aRANCHANOOMSlON 

INTEGRAnON 

The Fitml/y care Branch ..... esIabIisbed to aligtr __ 911""/PS- _car.1$ 

IrHegm/iDg _ reotpaDfdtIgfu erpJait..n ~atJd_aflt_ 

oQO THE RtGHTTHING 
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Attachment H 

SBP Legal Analysis 
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The Dilemma for Military Parents 

of Children with Disabilities B-1' KELLY A. THOMPSOI't 

M iHta:ry parents of chITdren wtth disabilities fa.ce a seriou-s dilemma at retirement-wh.ether Of' not to 

choose the m Hitary SurvIVor Benefits Plans (SBP) 

retirement o-ptlon ror cheir children. SayiRg ~yesW to a monthly 

income for YO!If child seems the obvious choiCe, BUT it may 

weH be the wrong one under current law! 

Let's explore the differences between miHtary SBP and 

Medicaid benefirs. the usefulness of combintng eligibi1!ty f-or 

bath progra.mi, and me unfair dilemma thaI miHmry families 

now face when ptanr1ing Fo-r the future of then- special ctu1dren. 

(ssn and Medicaid. Although S5l pays only $"674 month.fj1 (2011 

maximum benefit) and Medicaid may seem to dupUcare 

TRJCA.RE's health benefics, Medkald "waiver" programs pay for 

a wide variety of programs and services thaI TPJCAiU!. does not 

If the chl1d wilh a disability is livi(lg inde-pendendy. Sst is 

intended to pay for the child's food and. shelter. while Medicaid 

may pay for supported living programs, day program!t job 

toaching and OIDe( !>e:rvices. Thus. TRlCARE and Medkaid provide a complementary m1X ofhea:1th care beneftrs and support 

services needed by many adults with disabUitie!l 

THE DIlEMMA SBP BENt:FITS 8. SSI{Mt:DICAIO Bt:NEFITS COMPARED 

The SBP will pay up ttl 55% of the milita.ry member's ret1re· 

ment pay to a spouse andIor dependent child when the retiree 

dies. ThIS: member can also select a lesser benefit at a lesser 

COst. The military member can select co"erage ror a spouse 

onty. a spouse and children. or chHdren only. The member 

takes a reduction of about 6.5 % in redrement 

The dilemma is mal the SBP inrome payments after a military 

parent's deam paid. ID a chlfd wro, a disability may cause the loss 

of the child's sSt and e5sentiaJ MecUcaid benef"ltS. sst payments 

are offset by other income recehied (inclumng SBP payments') by 

the recipient. ANY unearned income over S2D offsets SSl income. 

pay for SBP for a spouse and only about 

$20/month fOT dependent children. 

In addition to (or in place 01) the survivor 

benefit. a miiita.ty member can provlde an. 

array ofben.eftts fbra chUd witl1 ad!sabiUry.ln 

mosr cases, a disabled ch}ld over a~ 18 can be 

designated 115 a.rL Incapacfta.red Dependent (DO 

Form 137·5) aC'ld be p-tmllanent1y eligible for 

miliwy post: privileges as- well as TRlCARB 

heald1 ben~ However, these mllitary benl;lfits do not include supportive Ifvihg progI'i!1l\S 

or vocational opportunities. Unfortunately, the 

SSP and TRICARE beneflts are often not 

en.ough to pay privatelY,for all the help that 

may be needed by an ad",lt child with. a disability. So, me mililiiry family must often look to 

ather programs [0 provide for a child's needs. 

If the child with a disability who has 

reached age 18 has assets less than 52.000 

and mintmal income, he or she wnl usually 

be eligible fOT Supplemental Se..cu:rity Incom-e 

House 

Resolutions 

2059 and 3324 

were introduced 

in 2009, 

allowing assignment of 

theSBP to a 

special needs 

trust that 

provides for 

payback to 

Medicaid at the 

death of the SBP 

recipient. 

doi1at-for-doUar. Once SSI income reaches 

zero, SSI I!: lost and, In the maJority of cases. 

Medicaid is lost alSQ. [f the mfittary member 

d1es having masen s:B~ for his or her chUd. 

with a di5abtlity. that child will rec:eive asmuch as 55% of thl;l retiree's incorne. If that 

SBP payment [-0 me child amounts to more 

than $674 monthly. the child with a d.ls.abillty 

will 10m SSl and Medlcatd health. care wd 

community' support benefits. In my home 

stat!! ofV!r&inia and In many StateS, if the S8,P 

exceeds $2,.()22 per maruh. Itlen all supported 

Hving assi5tiince. job ~aching, respite care 

afld Other servic:es proVided. under Medicaid 

"WaNer" programs are lost.. 

A recent eDmple concerns a S·year-old 

man whh an intellectual disability who had 

rIVed in a group home Ibt 18ycarsand~od 

• dB}' program for individuals with l!!sabifiOos, 

His only lncomewasSSI of$674:permonth.HIs 

SSI benefits and Medicold paid for hiS prog""'. and services. However. when his f'aIher.a retired 
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Navy officer. died his adult SOil began to 

recetve military SBP in ~he ampunr of $2,030 

per mon tho This SSP payment made him inel· 

igIble fOl' Medicaid waiVer serv\'ces. The private 

pay cos[ of the programs and services he was 

receiving prior 10 his fal!ier's dearh is $8,000 

per month, more than fonr times his SBP pay· 

rnent He lost his group h·ome placement. as 

well as hls day program. and 'WaS transferred to 

a S!al'e -nainfng centerH~a Ia-rge Instirutlonal 

setting isolated from the c6mrnuni[j'. 

A military family 

may spend years 

on a waiting list 

payment may only be paJd ro a "penion.-

When interpreted lite;[afiy by the mnitary. tlris 

means thar SSP payments cannot be assigned 

to a trust for the benefit of that "person." 

SUppott is growing for a leglslative fix to 

this problem. by a:lIowing the SBP payment 

fur a child wtth a disability to be asiigned to a 

~ecial needs trust House Resolutions 2059 

and 3324 were introduced Tn 2009, allOWing 

assignment of the SBP lO a special needs trust 

thai provides: for payback to Medicaid at the 

death of the SS-P recipient. Identical provl. 

SiOM were introduced by Senaror James 

Webb {D-VA} as amendments to the Natfonal 

Defense Aulhortxation Act Unfortunirtety, the 

2009·2010 initiadves were unsccces:rl'ui and, 

in the recent political climate. it is dlfficulr. to 

get attention Focused on: thls issue. 

for Medicaid 

I'lANNING OPTIONS? 

What about just cancelin.g the SBP beneficlary 

payments? If tile mlilre.ry retiree has already 

made a.n SBP election that includes a benefit 

faT chitdren. and he or she has a. child with a 

disability. then the reriree can apply m 'the 

Board for Correction of M illtary Reconis to 

mOdiFy the 55P election. This option mm;t be 

completed while the retiree is itHt wive. since 

SSP benefi,c1a.ry paymems ro the disabled 

waiver services in 

one state and 

finally receive 

benefits, only to 

be transferred to 

another state and 

start the waiting 

list process all 

over again, YOU CAN HELP 

The MUitary Coalition has placed mls SBP issue 

on i.ts legislative agenda and has actively 

chfld start upon death. The member must 

complete DD Fann 149. Just\fYing why the SBP selection option 

must not Include c"i1dren (i.e. spouse only). For example. [he 

retiree might ~I [he Beam thar he or she did not und:ersm:nd 

when the retiree originally made the election including children 

how the S6P benefit would negatively impact tl1e disahted Chilt:1'S" 

other benefi[5. The individual services have seParate Boards for 

[he Correction of Milirary Records thar will consider such requests. 

UnfortUnately, once- the retiree has. djed and p.aymBflts begin, 

there is no way to srop them. Medicaid wiD not anow the 

renunciation or the SBP payment and wilt continue to couht it 

as income even jfnot co~lected. and the child with a disability 

will lose Medicaid. The only true option under current law is 

NOT to elect the SSP benefit when the miUrary member retires. 

PlANNING OPTIONS UNFAIRLY UMITED 

FOR MILITARY FAMILIES 

Most of my miiiW)' clientS feel thai: this SBP Isrue as it effects !heir 

children with disabiHties: is blacaIII:ly discriminBlDT)' and unfair: Non· 

mllltBry parentS can easfly assign their pension and Ufe Insuran:ce 

benefits to a special needs p:ust l'or their child with a disabruty. This 

allO\VS the child to ~elve SSI and Medlcaid and to sapplement 

those benefits wi1il distrlb.utions from a specia1 needs trUSt. corrta.ir1· 

Ing the paren[S other assets. The rules for mrutary famflies are dlf· 

ferent, however. Defonse Pinance and Accou:ntlng regulations 

(based on a prevision of the United States Code) pl'OV'idetharmeSRP 

sought an amendment ro the United st:nr:s 

Code to allow assignment t>fSB:P payments to aspedal [leeds t:rUSl 

1.lleAmericanBarAssociadon and Thel\rCoftheUrticedS!ates have 

alsa endor.!led such.an amendment. As of August 1, Z01I, SenalOr 

Webb has agreed ID intrOduce [tie measttte agatn. Meanwhile. the 

coalitton contlnues to look fur a sponsor on the House stde. 

Military families who have a member w1tl'1 a disabtlicy face 

numeroUS c"allenges not faced by most: families. Frequent trans· 

fers make meeting the educational needs of their clilldren a moving mrget. These same transfers mean that applytng for Medicaid 

and other benefits for theirchildren Is repeated often as the rami- lies.move from Slate to state. A mWtary family may spend years on 

a waiting list for MedkaJd waiver services in one state and finally 

receive benefits, Oll Iy to be cansferred to another smte ann startrhe 

waiting list process all aver again" The inabitity to assign SBP pay_ 

ments to a special needs trust: is OF'le challenge facing mnttary faIn· 

flies th.EIl can a.nd should be fixed. Mel yom mice [0 this effort. • 

Kell¥ A. Thompson has been a 1!IN')'ef for 32 years. ptadiciDg law in Arington, 

Virginia for the last 16 ~ Her d"1elrti ind\Jde many mDlliry famIlies and her 

practice foctl5es on planning for irldivl:dua/s. with disdities and the el:lerlr, sptdaI need.$ tn.tsts. tntrt administration MId ~1:E: planning. SM has been hem0lE!d as II. Super lilW)'M, and i!i fISted as o~ of A.mericas' Best ~$l/II'Id as a 

Wadllngton!"n Magazine Top lz.Nyef. Ms. Thompson is' II member of the 

Special Needs Alliana. iii national. non-profrt organization committed to hf!1pin; 

individuals V'lith disabilities, their tamiliM, a~d thl!! professional!> who r!:p~sent 

them. Contact information for a member in yout nate cilin b!! ob[ained ~ callingtolHree 1-877·572HS472. or by visiting: www.specialneemalfian::e..org 
394 


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Attachment I 

Stories of Individual Military Families, 

Provided by Mr. Jeremy L. Hilton 
395 


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John P. Wilson 

497 Candlebark Drive 

Jacksonville, Florida 32225 

Dear Sir or Ma'am, 

June 17, 2012 

I'm writing to you pleading to make the current TRICARE ECHO benefi~ a permanent benefit for all 

military service members who are active, retired due to disability, or retired after serving 20 plus years. 

After reaching High Year Tenure, I transfer to the Fleet Reserves after 26 years of Honorable service in 

the Navy on 30 June 2012, and that's the day my benefits expire for my autistic 10 year old son, Adam, 

who will still'be autistic. We were very excited when TRICARE announced ECHO and we were enrolled 

and receiving benefits two months after it started as well as respite care. 

Due to all of his therapies, school, etc., I have to be a stay at home dad' once I retire and do side jobs 

when I can. His mother served 10 years active duty NavY, got out while I was on active duty to raise two 

boys and is now a RN. 

Adam was a non-verbal and totally dependent child before starting ABA therapy and now talks in fourto 

five word sentences, can go to the bathroom, sit in his chair at school, dress himself, starting to socialize 

with his peers, etc. I contribute all ofthese milestones to ABA therapy. 

Even though Florida has mandated that insurance carriers offer ABA therapy, there are loop holes that I 

can't seem to get through. The main loop hole is the companies insurance has to be fully funded, 

whereas most are self funded. I have exhausted all avenues in search of insurance to cover his ABA and 

we have applied to many programs to assist with 'no avail. 

With all of his medical expenses and our limited income we have to reduce his ABA in half (which was 

half of the recommended treatment to begin with), reduce his speech and OT therapies from four times 

a week each to one, and are still out $1884.00 a month with TRICARE Prime for Retirees, who doesn't 

cover any ABA. We are going to do everything we can to give Adam a chance in life and will do this until 

our savings is depleted and credit cards are maxed out, after that we are on our own ... unless this bill 

passes. 

I have read that treating autism early is much less expensive then dealing with it later in life. 

Thank you for your time and consideration, and thank you so much in advance for approving this bill. 

621per72.eps

Bo Brown 

Military Support System Struggles: 

* The Browns pays $25,000 per year for ABA 

therapy not covered by Tricare. This comes as 

huge financial burden to the family. 

* Because of the funds being applied to ABA the

there is no money left over for normal family 

experiences like a simple vaccation 

* The Brown family has moved seven times in th

last fourteen years. they have three more mov

coming up in the next four years. 
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The McClenney Family 

Branch: US Navy Duty Station: VFC-12, Oceana Naval Air Station 

Carsun McGlenney, son of P02 Cecil McClenney and Brenna McClenney of VFC-12 Oceana Naval Air 

Station, was bom with Cerebral Palsy (CP). Now almost 5 years old, he, is unable to walk independently 

without medical eqUipment. Although still very young, Carsun has already endured a bilateral femur osteotomy 

(surgical reshaping of the femur and pelvis) in hopes that would help make walking easier. Unfortunately the 

surgery was unsuccessful, and it has actually made walking harder for Carsun. He will be undergoing a second 

surgery July 19th to remove plates from previous surgery. 

While the McClenneys feel they have been more fortunate than most in America to have health insurance, they 

have still faced many trials at trying to make life better for Carsun. One of the many difficulties the McClenneys 

have encountered is finding ou1 what kind of medical equipment is best for their son, and then locating 

companies to purchase the equipment They do extensive research, only to be faced with a brick wall when it 

comes to TRICARE. The McClenneys are paying extensive out of pocket expenses for the equipment, while 

they wait significantly long times to even be seen by specialists at their Military Treatment Facilities. It has 

created a financial burden on the McClenneys to have to pay for equipment upfront, when it is TRICARE that is 

holding up the process. For example, the family ordered Carsun a pediatric wheelchair on March 1,2012, and 

to date, they are still fighting with TRICARE and the equipment has yet to be ordered. 

Petty Officer McClenney decided to move his family back to their hometown so they could have a larger 

support networK. Unfortunately, their new home could not accommodate Carsun, so they ",quested for a ramp 

through TRICARE. Unfortunately, neither TRICARE nor ECHO covers any type of ramp, even when it is a 

necessity. Fortunately, through the love of a close-knit community, the townsfolk built the McClenneys a ramp, 

at no expense to the family. 

Medical and equipment needs will always be a necessity for Carsun. As he gets larger, the McClenneys will 

need a vehicle lift, which is also NOT covered by insurance. Bu1 the McClenneys will continue to fight and 

advocate for their son's needs, no matter what. 

Above are some pictures of Carsun: some of Carsun in his equipment, one of him right after surgery, him in his 

temporary wheelchair on his new ramp, and also a picture of him participating in the Specials Olympics for 

Young Athletes. This will show you how happy and full of life he is, despite his disabilities. 

Thanks, 

P02 Cecil McClenney and Brenna McClenney 
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The Adams' Family consists of John, Kathy, Brent (14) and Oaire (12). John is an actlve duty Marine stationed at Quantico 

with 21 years of service. Our daughter Claire was referred to the developmental center at 15 months. She regressed in 

health and developmentally sometime after turning one. 

She began Occupational and Speech therapy at 18 months. At that time there were no providers in the Cherry Point area 

accepting Tricare, and the family had to commute 45 minutes to Jacksonville, NC for 30 minutes of therapy. Claire's mother 

noticed that children ofthe same age and 'With less noticeable delays with Medicaid insurance were receiving 1 hour of 

therapy. 

At 2, Claire was diagnosed with Cerebral Palsy and Physical therapy was added. At 34 months, daire was diagnosed with 

Pervasive Developmental Disorder-Not Otherwise Specified by Dr. Gretchen Meyer at Portsmouth Naval Hospital. 

In October 2002, Claire began ABA services after filling out extensive paperwork to get $1000 covered under the Person's 

with Disabilities Program under Tricare. $1000 did not cover the recommended 40 hours of intensive therapy that is 

recommended and the family deCided to pay the overages. The family was able to hire "tutors" to work directly with daire, 

while being supervised by a Board Certified Behavior Analyst. 

In 2006, daire's mother began inquiring about respite options for daire thru the state and inSUrance. She was told she 

could only get respite t~ru insurance if receiving ABA services. After clo~e to a year wait (paperwork misplaced) she started 

receiving respite thru North Carolina's Intellectual Disability Waiver and was allotted 9 hours a week. In 2010, the respite 

hours were taken away due to budgetary cuts.' 

In 2008, Caire's mother pursued respite thru the new Exceptional Family Program. She was told she could get reimbursed 

up to 10 hours per,week at the rate of $18 an hour, but that she would need to find her own provider. Rnding a qualified 

provider, was difficult and they did not receive respite for some time. Then the rates dropped to $15, to $10 and after 

major cuts to $6. 

In 2010, the family dea-ded it was in Claire's best interests to move to Northern Vi~.ginia for better serVices (ABA,. schools, 

respite). In VA. there ar~ more ABA providers but many do not accept the new Autism Demo ECHO guidelines which 

reimburse up to $3000 a month; this witl typically cover 10-15 hours a week of superVised ABA programming. She is 

currently getting tutoring thru Cuuriculum Autism Services: and is making quick progress with the communication program 

Proloquo to Go with the iPad. 

In early 2011, daire's mother applied for Medicaid as was told the wait in VA was 10-15 years, especially if the child was 

under 18 and the parents were In good health. She was referred to the I D waiVer for respite. In March 2011 she was 

meeting with the 10 respite caseworker, w~o told her they reimburse at a $6 an hc:>ur r:ate, when daire fell out of chair Into 

a grand mal seizure. She was hospitalized for 6 days. ' 

After the seizure, daire's health status made her eligible for services under the Elderly and Disabled Waiver, reimbursing at 

$11.37 per hour. daire began receiving up to 30 hours per week of respite in the Spring of 2011. 

·Oaire's father is approaching retirement and they are concerned about services for Oaire. ABA ~as been integral for Oaire 

and is opening a world to her, but these services will no longer be covered after retirement and few states provide coverage 

for older children. Please re-consider extending the services to retireesl Also consider the difficulty milita'r'/ families have 

obtaining services and have to re-start the wait in each state when they move ... tliis should not be the case! Furthermore, 

states receiving Federal bailouts should not have been allowed to make employee cuts (does not help stimulate the 

economy) which led to respite services being discontinued. It is disconcerting, that Tricare Is not universally accepted by 

civilian providers; our soldiers are putting their "lives on the line" in service and their families deserve the best. Our country 

is not prep~red for the epidemic rates in which the disabled children are approaching adulthood, 

John and Kathy Adams 10800 Park Road, Lorton VA 22079 703-339-{)729 jkandkb@vahoo.com 
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400 


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To the Senate Armed Services Subcommittee on Personnel: 

My name is MSgt Melinda Burts, and I have been an active duty member of the United States Air Force for 15 

years. My oldest son, Simon, was diagnosed with autism at 20 months old In 2006. My husband and I were 

devastated. He was completely non-verbal and behaviorally was nearly Impossible to control. I cannot express 

how thankfui my husband and I are that Simon was able to receive ABA Therapy beginning at age 2, and that this 

therapy was covered under my Tricare Insurance. Although the road has been frustrating and challenging at times, 

Simon's progress has been truly astounding. He has been receiving ABA Therapy now for Over 5 years. He just 

completed first grade In a mainstream classroom. He still has plenty of academiC and behavioral issues to work on, 

but he was able to handle the kindergarten and first grade academic curriculum with some spedal education 

support. He was even identified by the Advanced Academics Teacher for being gifted in math, and received 

weekly group instruction in advanced math concepts. He is a success story (yet still a work in progress) and I truly 

believe he would not have made these strides without years of intensive ABA Therapy. 

My husband and I wa~hed our younger son, Alex, very closely for signs of autism throughout his infant and 

toddler years. His language, cognitive, and social skills seemed to be on track ·for a while. But at age 4, we started 

to notice delays in some of these areas and also a few familiar autism behaviors. Alex was diagnosed with autism 

in November of 2011 at age 4. His condition is milder than his older brother's, but he has issues that definitely 

need to be addressed. Again, my husband and I are relieved that we have access to ABA Therapy that is covered 

by Tricarel and Alex has already made progress in many areas in the few months he has been receiving therapy. 

I cannot imagine how my family could have survived finanCially if I had been paying for this therapy without the 

help of insurance. The going rate for a BCBA (Board Certified Behavior Analyst) is $150 per hour, and the going 

rate for an ABA Tutor is $50 per hour. If I add up the services that my children currently receive in a typical month, 

at these rates it comes to $3800 for Simon and $2400 for Alex, for a total of $6200 per month. But because each 

child with autism is differentl the service.s that each child needs can vary. Also, the services that a child needs can 

vary at different times in his life. For example, Simon was having some behavioral difficulties at school this year, 

and our BCBA spent a lot of time at his school working with his teachers to create a behavior plan for him. It was 

extremely successful and all of his teachers agree that his behaviors improved drastically after the plan was put in 

place. But this required our BCBA to spend as much as 15 hours a week at his school for several weeks. This 

comes to an extra $2250 per week (or an extra $9000 per month) for a temporary period of time. I am an enlisted 

member of the U.S. military and my husband is a public school teacher. There is just no way that our family would 

have been able to afford this level of ABA services without help. 

I strongly believe that all medical insurance plans should cover ABA Therapy. I have seen with my own eyes how 

incredibly beneficial ABA Therapy is for all children with autism, both the mildly impaired children and the severely 

impaired children, and all of those in between. And as I approach 20 years of service in the military, i must admit 

that I am nervous about how I will pay for ABA Therapy for 2 children after I retire. I cannot impress enough how 

important I believe it is for ABA Th erapy to be covered for Active Duty Members, Federai Employees, and Retired 

Military Members alike. Please consider taking the action necessary to make this happen for your service 

members. 

Sincerely, 

Melinda M. Burts 

Autism Blog: WNW.placesonthespectnJm.wordpress.com 

621per77.eps

Drake Anlb.-ews 

Military Support System Struggles

* System is hard to navigate, easy t

get lost in the shuffle 

* Lack of coverage of sensory 

equipment and communication 

devices like iPads. 

* Tricare continuing to refer patien

to companies that have histories 

fraud and neglect. 

* Financial burden of paying for 

durable equipment that TRICARdoes not cover for disabilities, su

as SPIO vests, Iycra swings. 
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.Senate Armed Services Subcommittee on Personnel 

Russell Senate Office Building 

WaShington, DC 20510 

Dear Ladies and Gentlemen, 

14 June 2012 

I am an active-duty Army officer who has served for thirty years and am currently 

tmdergoing a Medical Evaluation Board for my injuries and illnesses incurred during that 

time. I also have a fourteen year-old son with profound autism. He has never said a 

single word in his life, has to use diapers, has had his· own struggle with many medical 

issues; but I consider him one of the happiest kids that I have ever met. A large part of 

that happiness can be attributed to the Applied Behavior Analysis (ABA) therapy that he 

has receive4 through the TRICARE Extended Care Health Option (ECHO) Program. His 

increasing ability to understand his environment and the verbal commands of others can 

be directly related to this therapy. In one instance, his ability to understand my verbal 

command of STOP prevented him from walking in front of a car which he was unaware 

of. When he stopped, the car was literally inches froiD. his nose and the front ofhis shoe 

was actually touching the tire of the car, but he was completely unaware that there was 

even a car in front of him due to his autism and his fixation on the object that he was 

running towards. Unfortunately, his ABA therapy is due to end 'When I retire after thirty 

years and with my own set of significant medical issues. 

The TRlCARE ECHO Program and its predecessor prograins have provided ABA 

therapy to a very small percentage of affected dependents of active-duty service members 

since the late 1990's under a supplemental program to the lRlCARE Basic Program for 

special education purposes. Since that time, ABA therapy has been deemed medically 

necessary by the Office of Personnel Management for Federal employees and by the 

legislatures of thirty states. It is time for the Department of Defense to similarly declare 

this crucial therapy to be medically neCessary, so that it is also available to the affected 

dependents of retirees and applicable Guard and Reserve families that can benefit from 

this life-saving therapy. . . 

If you would like any further information, please feel free to contact me at (703) 

241-2640 or at carnpbellsservices@gmail.com. Thanks very much for considering this 

information in your deliberations. 

Respectfully, 

Scott A. Campbell· . 

Lieutenant Colonel, United States Army 

3537 Devon Drive . 

Falls Ch)lfCh, VA 22042 
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The Chen Family US Army 

In March of20 1 0, Casey Chen was diagnosed with PDD-NOS, ADHD, and an adjustment 

disorder with arixiety, while his family was stationed in Germany. At the time, he was 

significantly behind his peers in all areas, and would not speak above a whisper in the presence 

of unknown people. He was profoundly afraid of other kids his age, and would avoid interaction. 

In December of 2010, the Chen family was granted a compassionate reassignment to JBLM due 

to lack of services and his inability to access ABA. Within 3 months of arrivlng, Casey began 

receiving ABA, in addition to private speech and OT. Within 5 months of beginning ABA, 

Casey be'gan speaking with his regular volume of speech, starting, interacting with his peers, and 

had almost caught up with his peers in schooL His teacher and ABA therapist have worked 

closely together to help him. 

Casey's father is currently deployed. The above picture was their last hug. Under the current 

regulations, Casey will lose his much needed ABA benefits if his father is injured to the point 

that he is no longer able to serve or worse. ECHO is only for active duty fumilies. Ling's father 

will be eligible to retire in 3 years. However, if he chooses to retire, Casey will lose his ABA 

benefits. If ABA is made a benefit directly under TRlCARE, he can continue receiving it. 

Casey continues to make huge strides and is now ending the school year on grade level, and is 

continuing to make friends. We fear that he may not do as well in the future withoui this much 

needed therapy. His father is willing to serve as long as he can to enable his son to continue to 

receive ABA. However, after 20 years of deployments to Iraq and AfghaniStan, peace keeping 

missions inBosnia, TDYs to Korea, and countless training exercises, Ling would like to retire 

and physically be able to help his son more. He is currently on a path that will lead to an 

independent life as an aduh. Please allow our son to continue receiving this amazing therapy. 
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Aurora - Age 3 

Panhypopituitarism 

Survivor 

Adrenal Insufficiency 

Autism Spectrum 

Sensory Issues 

-Non-Verbal 

-High Wandering Risk 

The Cunliffe Family 

Averie - Age 11 

Extreme Prematurity 

Ulnar Club Hand 

Autism Spectrum/ 

Aspergers 

Sensory Issues 

Struggles with Barriers to Care: 

Serena- Age 44 

Brain Tumor. 

Neurological Issues 

Sensory Issues 

PTS, Depression 

-Unable to Drive 

• Varying Educational Support Eligibility across State lines - Autism 

diagnoses does not guarantee school services 

• Denied ECHO coverage for our oldest daughter without an I EP 

• Limited coverage for ABA therapy does not meet recommended hours 

• Need for specialized equipment covered under same cap 

• Access to needed medical specialties not available at MTF and limited 

locally. Waiting times are up to two years under some circumstances. 

• System does not accommodate or assist caregivers/spouses with 

authentic transportation issues. This results in care being simply 

inaccessible independent of the service member 

• Complementary therapies such as Speech/Language Therapy and 

Occupational Therapy are not available to take place in the home after 

the age of three 
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June 18, 2012 

To the Senate Armed Services Subcommittee on Personnel: 

I write this letter, hopefu~ as Tricare's stance on ABA coverage and the financial aid for mi1itary 

retirees' dependents is being reviewed. On April 11, 2007, my son, at the age of two, was diagnosed with 

one of medicine's greatest and most frustrating mysteries: Autism. Upon his diagnoses, my heart broke. 

My every desire became giving my son the best chance for a narmallife that I could. At his initiaJ 

diagnosis and the recommendation of Developmental Pediatrician, Lt. Col. Dr. James P. Vandercar, my 

husband and I enrolled Zachary in ABA Therapy. It was ltrged by the doctor that Zachary receive the 

maximum number ofholtrs (40) of therapy. Unaware of exactly what we were dealing with, as parents 

new to having a child with disability, we beganZach's therapy one month later in May of 2007. Our son 

initially received ABA therapy 3 hours/week, progressing to 12 hours/week and now is receiving 24 

hours/week. This increase in therapy holtrs is still far less that what is prescribed for the best outcome of a 

child on the AutiSm Spectrum as severe as my son, but it is what our income could afford financially. 

Since this process began, five long years ago, I have ba1tled insurance companies, filing claim 

after claim with Tricare fur ABA Therapy to be paid for. Repeatedly, I was denied. Their representatives 

stated that "military retirees' were exempt from ECHO, and Tricare would not cover ABA therapy." 

Frustrated, but persevering, I continue this battle. 

After months of disheartening attempts, I was blatantly told one day, by a Tricare Representative, 

that if I did not like the way the law was written I could contact my Congressman, Jeff Miller (FL). 

Again, I plead my case. Although my Congressman has sympathy, and has tried, the bills enacted to 

revoke the present statute denying military retirees' dependents ABA coverage, were not passed. What 

could I do? Here I stood, doing everything in my power to get treatment for my son, and lmding myself 

useless in this battle. It was then, that a fellow autism mom, Karen DriscoR whose husband serves in the 

Marine Corps, provided me with a spark of promise. A lawyer in Michigan, Dave Honigman, had joined 

the fight for families just like mine. His firm had recently WOl,1 a case against Blue Cross Blue Shield, 

regarding the coverage of ABA therapy. Somehow renewed and hopeful, in December of 20 I 0, I 

contacted Mr. Honigrnan and joined the class action lawsuit to change the present ruling. Regrettably, the 

case is still waiting to be heard. 

As I continue the battle offmding a way to financially give my son the tools he needs, he is 

fighting his own battle. Zachary is enrolled at the Emerald Coast AutisIJ,1 Center in Niceville, Florida, 

where he receives 24 hours per week of ABA therapy. In the past quarter, Zach has made the largest gains 

on the Verbal Behavior MAPP, an assessment used to chart knowledge acquisition, since beginning 

treatment. I could not be more proud or a stronger believer in ABA. When he first began, his vocabulary 

consisted of about 20 words. He noW has over 200! He is able to functionally communicate with 2-3 word 

requests, and is able to understand 2 word commands. He has learned self-control and is more personable 

with therapists and family. While Zachary is still considered an early-learner, with the mental capacity of 

a 3-year old (he is now 7), I am confident that his gains are a direct result of ABA therapy. Sadly, at a cost 

of$53,000 per year, my family is financially tapped and may soon have to dis-enroll my son from the 

Center. I am beyond words at the thought of stopping treatment and doing this disservice to Zachary. I 

fear for a loss of what progress he has made and worry that once the ball stops rolling, we may never be 

able to start it again. 

I fervently plead that you assist military retirees in ABA coverage for their dependents. My 

husband served in the USAF for 22 years, and put his life on the line for our country. He chose to remain 

in the military not only out of a love for his country, but a love for his family, )IIlderstanding that 

medically, his family would be provided for in exchange for his service. It is ludicrous to deny our son the 

therapy he desperately needs, because my·husband is retired. It is a daily challenge for any family to raise 

a child with Autism Spectrum Disorder, but the trial becomes infinitely.larger as the battle with insurance 

companies to obtain coverage, is constant. I appeal to each of you to help us change this legislation, not 

ouly for my family, but for each family that bears this same cross. 

Thank you for your time and consideration in this vita.I matter. 

Dawn L. Berge (wife to Ret. MSGT. Kenneth Berge, mom to Carson and Zachary) 
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My name is Dr. lois-lynn S. Deuel and I am a proud military spouse. My husband, lTC George L Deuel, 

U.S. Army, is currently stationed at the Pentagon, Headquarters, Department of the Army. We live with 

our son, lance, 8, in Arlington, VA. lance is an EFM. We have been stationed at multiple locations 

throughout CONUS, Germany and Italy over 20+ years of service. We are honored to serve and are 

grateful for the comprehensive health care that Tricare provides. With few exceptions, we believe that 

the military system takes good cate of services members and their families. This note is to inform of you 

of two areas where policy changes, with respect to medical care, can and should be made to improve 

care for service members in EFMP. 

As both a psychologist and parent of a child with special needs, I have always found it curious as to why 

Tricare ECHO would require a medical doctor to provide a prescription for something that they consider 

an "educational modality." We don't ask our pediatricians to write prescriptions for Social Studies or 

Science. Outside of military medicine, other medical, psychological and educational professionals view. 

Applied Behavior Analysis (ABA) as an evidence-based medical therapy (not an educational one) that is 

considered the standard of care for indiViduals with autism spectrum disorders. In addition, the arbitrary 

rationing of ABA through Tricare ECHO falls short of the standard of care (25-40 hours/week), as military 

families can only receive 3 to 5 hours of ABA therapy per week. Indeed, the effectiveness of delivering 

ABA in such small, rationed amounts is questionable and there is absolutely no scientific evidence 

supporting delivery in the manner used by Tricare ECHO. I ask you to: 1) eliminate Tricare ECHO which 

only serves as a barrierto military families, 2) provide ABA as an ordinary medical therapy through 

Tricare prime or standard, 3) provide an appropriate number of ABA therapeutic hours that adheres to 

the standard of care, and 4) ensure that ABA therapy continues for families of all retirees, including 

wounded warriors who are medically retired. 

The military currently has many avenues that accommodate the extra special needs of families that are 

in the EFMP program. Commanders and career managers routinely consider assignments that ease the 

burdens for se rvice members and their families. Please commend them for this! We are grateful for the 

effective supports provided by EFM P and associated efforts. Frequent moves and deployments are the 

new normal and all military families understand this. However, the structure of Tricare into three 

regions detrimentally affects the continuity of care for families with special needs. Every PCS between 

regions results in a complete cessation, often for several months, of a II critical medical therapies for 

special needs families. Until a service member signs into a new unit, and the family is entered into the 

system for the new Tricare region, families cannot make any medical appointments, cannot get any 

referrals for speciality care and cannot get on any waiting lists for therapies. For example, your current 

PCM in California cannot make a single refenral for you in your new duty station in Virginia. I ask you to 

either 1) eliminate Tricare regions or 2) streamline the PCS process and make it seamless so that special 

needs family members can get medical referrals, make medical appointments and set up therapeutic 

services at the new duty station BEFORE/DURING their PCS. 

Please contact me directly at (703) 340.0585 or Isdeuel@hotmail.com if you have any questions about 

issues facing military families with special needs. Thank you for your interest and concern. 
407 


621per83.eps

My husband is an active duty Army officer. He has served 21 years so far. We have a 16 year old, 

autistic, mentally. challenged, daughter named Shaylin. In the sixteen years we have moved 5 times. 

Each move caused a set back in Shaylin's behavior. We are now dealing with a very aggressive, irritable, 

159 Ib, 5'11" child. 

With each move we have to reestablish Shaylin in a self contained, autism specific, classroom. During 

our last tour (my husband was at the Pentagon & the Natl. War College) we spent $15,000 in legal fees. 

The IEP team wanted to admit Shaylin into Key Center which was not appropriate for Shaylin for several 

reasons. We ended up with a questionably suitable placement at a district middle school. 

In the previous duty station, Hawaii, we had to obtain an attorney to force the local elementary-school 

to establish an autism· specific classroom. After it was established we struggled for 4 years to keep the 

setting and the services related to it. When our daughter was transitioned into middle school the prior 

elementary school did away with the autism program. And yes, there were still autistic children there in 

need of such a program. 

We now have a very serious problem on our hands. Since my husband is training to deploy for the 

fourth time, we opted to move me & our three daughters near family for supportUnfortunately, 

Shaylin's behaviors have escalated to a level that it is not safe at times to have her live in our home. Not 

safe for us nor Shaylin as she is self injurious & lashes out at us with no regard to her own safety. For 

almost a year we have attempted to get support services for Shaylin. A!; I write this note, we still have no 

services .. There is no ABA therapist in our area that works with adolescents. And there are no respite 

caregivers that provide that service in our area either. Attempts to have Shaylin admitted into 

psychiatric clinics for evaluations have failed as well as our attempts to have her placed into residential 

settings designed to treat autistic children. 

Our military, normal-functioning, children have issues with the frequent PCS's and deployments much 

of the time. When you have a special-needs child those issues are compounded tenfold. Autism is a very 

complex disorder that can be improved. These improvements are only seen with constant training and 

oversight by individuals highly trained to provide therapy. A care-over support system is imperative for a 

family dealing with an autistic child in their home. When needed, residential schools designed for 

autistic children should be a viable option. This is especially true if the ~ctive duty service member (or 

reservist) is on deployment. These schools and services are expensive. They are nowhere near as 

expensive as government financial support needed to sustain these children once they become adults. 

Our military children and their families have to fight for services for their children. This is outrageous 

when it is those same families that are already sacrificing so much to support our military. 

Thank you for listening to a parent of a special child that is very much loved. 

Shawn Diaz 

240 TIdewater Road 

Hattiesburg, MS. 39402 
408 


621per84.eps

My husband and I both served in the Army when our older two children were bom. We began·to realize 

something wasn't quite right with our children. I was medically discharged from the service fairly soon 

after that and began looking for answers as to what was going on with our children. Eventually the heart 

stopping answer came, autism. After our initial shock wore off, we began researching treatments. Our 

children have been very lucky to have all the services they needed paid for through the Tricare system 

and excellent service providers. These amazing children have gone from the possibility of being declared 

moderately mentally retarded to children whom most people cannot tell have autism. They no longer 

need IEP's or behavioral modification plans at school and are academically equal with their peers. 

These successes would not have been possible without the support of Tricare. They still see specialists 

··on a weekly basis. I cannot imagine, after serving for so many years and retiring, losing those benefits or 

having to shoulder the financial burden of paying out of pocket on a reduced retirement budget. 

Jeremy, let me know if this is what you were looking for. I'd be happy to make any modifications. 

VIR, Maureen 
409 


621per85.eps

Hello, my name is Sheila L AJmendras-FIaherty and I am an Active Duty Navy Nurse. I have 4 beautiful 

children Dakota Skye Flaherty age 6, Chase Robert Flaherty age 8, Sheila Renee Velasco age 16 and Desiree 

Jasmine Velasco age 17. And as the years wentby my husband, Robert Joseph Flaherty, and I noticed changes 

in our children·and had them evaluated like any good parents. The providers provided us multiple diagnoses 

for our children ranging from mild reflux to ADHD and Autism. Needless to say our world was turned upside 

down and our family went through all the stages of grief. I wish I could tell you more about all the issues we 

had to go through .. as a family with each of our children, but that would take up your Whole day. Please know 

that Our Family has and continues to meet all the challenges that come along with having a special needs 

family, especially one that has 3 out of 4 children with Special Needs. It has not been easy an easy transition 

for our family but I can tell you !hal our paIn and struggle were made a lot easier by the support and dedication 

of those in the Exceptional Family Member Program (EFMP) especially in the Marine Corps. We established 

stability and sense of normalcy through the information and opportunities we were given through EFMP. 

Even with their guidance, I can tell you from my own experiences as a Medical Professional and a Mother of 

Special Needs Children !hal the Military still has much opportunity to grow and improve on regarding the 

issues that affect their Military Members' Families with disabilities. 

I would like to give you a few bullets on the issues Our Family has experienced to .give you a better 

understanding. 

Not having the Specialists needed to provide the care needed either by none in the Network or not 

avallable in the area where the fanrlly resides even after the Detailer and EFMP cleared family for area 

according to Category. (i.e. Developmental Pediatricians) 

Traveling 2-4 hours in each direction for One Specialist Appointment Active Duty Member needed as 

Medical Escort to provide support to Spouse. (i.e. so child didn't hurt himself or jump out of car)! 

Not having an EFMP Case Manager like the Marines Corps have. EFMP Case Managers knows the 

fanrlly, offers assistance the entire time the family is enrolled and direct them to local co=unity 

programs and services. Navy only offers EFMP Coordinators who basically·assist with the application 

process that is it and families ar~ left out in the cold wondering ''Now What?", "What do I do next?", "So 

I'm a Category X, what does that mean for the Active Duty Member and the family?". 

Issues with Schools especialJy when moving since many times the Individual Education Plan (lEP) is from 

another state .. The new receiving school may not offer similar programs or may just refuse since they 

know the family may not be aware of their rights because state or city laws may be different Need More 

Local Military Special Needs Advocates and continuation of School Liaison Officers. Large need for 

Military Special Needs Lawyers so families don't have to spend their own money flghting the School 

System each time they move. This is especially important because the schools that educate children from 

base housing know the families don't have much of a choice and many families choose to stop fighting 

because of money, time and energy. 

Continue and expand the Navy EFMP Respite Care. It has helped my family plan and deal with alJ the 

struggles of having Special Needs Children especialJy when geographically separated from any type of 

social support and the Military Member is away 50-80 hours a week or deployed in harms way serving 

their country. 

Continue the ECHO Services as this has supplemented other needed services and treatments not covered 

under Tricare-Prime. This service has made a huge positive impact not only to my child but the family 

because of alJ the progress made. 
410 


621per86.eps

I am an ArrnyVeteran, spouse to a retired 1st Sergeant, mom to 3 fabulous children and advocate for 

my son with autism. 

Currently, "TRICAREH military healthcare provides less than halfthe recommended treatments for 

autism, and only to children of active duty service members. Service members who retire after more 

than twenty years and Wou nded Warriors forced to medically retire are stripped of what little 

treatment TRICARE allows via the Extended care Health Option (ECHO). 

Our son was the lucky recipient of such services. He received these services known as ABA, Applied 

Behavior Analysis. This is a scientifically proven medical treatment for children with autism. Scott 

received these services for nearly 6 years. During this time of treatment, we have seen marked 

improvement with his behavior and educational assessments. With the support of ABA, Scott was able 

to learn how to talk, write and even go potty. This one-on-one therapy'played a major part of his 

development and overall well being. Since his father retired from the Army after serving 2S years, this 

service was no longer available to Scott. 

Congress and the Department of Defense have been denying what our military children need, what my 

child needs all in the name of saving money and trimming the budget. 

Scott stopped receiving ABA therapy 6 months prior to my husband's retirement in April. Those 6 

months and the months up to today, without ABA have been met with 'great challenges for our son. His 

behavior has dramatically worsened and he no longer participates i~ school activities, He refuses to 

complete simple tasks he once mastered such as going potty or brushing his teeth. Everyday we are met 

with temper tantrums and rage. His behavior has changed so much that he has recently begun, 

treatment through medications. Drugs he never needed prior to the absence of ABA therapy. 

In late 2003 my husband purchased a vintage hobby car, a 1969 Mercury Cougar Convertible. He loved 

that car! It was to be the kind of thing that every father dreams about doing with their only son. ' 

Father/son bonding while rebuilding a classic car only to pass it on to his son when he becomes a 

teenage driver. That was until 6 months later when Scott was diagnosed with autism at the age of 4. 

That dream of rebuilding the car became a memory as we were thrust into the world of disabilities. 

Then in 2006 Scott started to receive ABA therapy. Once Scott started to gain skills through the work of 

his ABA therapistS, that dream started to look more like a reality. Scott started to learn. He was 

beginning to talk and learn how to communicate his needs to his father and me. We were so excited 

with his develo,pment, After 6 years oftherapy and progress, Scott was denied access to these 

remarkable services. All because his father served his country and retired from active duty. Now that car 

sits collecting dust, never to be worked on by this father/son team. 

My husband served his country, your country for 25 years. He earned most of his stripes and 

commendations as a Special Forces Soldier. He served in Operation Desert Storm-Iraq, Operation Joint 

Guardian-Kosovo, Operation Silent Warrior-Turkey and Operation Iraqi Freedom-Iraq. He has missed 

most ofthe important ~ilestones each of our 3 children reached during his service. He has watched his 

children grow up from the battlefield. 
411 


621per87.eps

My husband has faced many enemies over the years battling for his country and other countries in 

support of honor and duty. Now he has to stand up and fight against the very same government he 

fought for, all so ~is son is able to have the same opportunities as others and to learn and BE a citizen of 

this country he loves. 

Each day, month that passes our son looses a little more of himself. Without the ABA Therapy that was 

denied him when his father retired, Scott's future no longer looks as bright as it once did. We worry 

more everyday what his future may include. Unfortunately one of the topics has included the "what iPs" 

and the possibility ofan institution. 

It is time to do the rightthing here. 

It is not too late for Scott. Approve this funding to all military Children, active and retired, for a better life 

of these children and for the brighter future of our community. More funding and therapy NOW will 

mean less funding and institutionalization when these children become adults 

Our brave service members never leave a fallen soldier behind. Can our government say the same? 

Thankyou. 

Retired lSG Brian & Christine Garton, 

Shay lynn, 16 

Scott, 12 

Laura, 8 

Moore County, NC 
412 


621per88.eps

HeHo and thank you for taking time to read our story. We are the Geraghty's, a proud 

Marine Corps family with two sons, Caden and Cole, and a baby girl on the way. I have the 

honor of serving as Military Spouse Magaz.ine's 2012 Marine Corps Spouse of the Year and 

my platform revolves around Stroller Warriors Running dub. This nonprofit organization 

encourage military wives to live happier healthier lives through running, goal·setting, 

networkIng, family-building, and community outreach. These women have been a source of 

joy, inspiration, and support for me, especially during our son's diagnosis. Cole has a genetic 

neuromuscular disorder called Spinal Muscular Atrophy (SMA). He may never gain the 

ability to walk and the nature of the disease is to worsen. There is no cure but growing 

attention for the disease has supported research. 

Our military community and Brian's unit have supported us throughout testing, diagnosis, 

and treatment. TRICARE, Extended Care Health Option (EG-IO), and the Exceptional Family 

Member Program {EFMP) have also been a huge asset. Without them, we· would not have the care and equipment that Cole needs. 

TRIU\RE and EGIO have been extremely prompt in authorizing referrals and the coverage far exceeds other insurance companies. 

However, THESE PROGRAMS MUST RETAIN FUNDING AND NEED EVEN MORE AmN110N In order to continue accommodating our 

needs and those of many o~her military families. Despite the positives, our experience has not been without trials and tribulations 

and I would like to share with you ~ome areas that need attention and revision, from our perspective as a special needs family. 

TRICARE: 

We were unable to pursue testing for Cole before he turned 18 months. Until a child misses a milestone, they are 

discouraged to pursue testing. The entire process should have been accelerated so Cole cou.ld receive the physical therapy 

he needed earlier. MILITARY DOCTORS SHoUW NOT BE FORCED TO ADHERE TO STANDARDS WHEN PROFESSIONAL 

OPINION OVERRULES. 

Every time I call the TRICARE Benefits Department and ask for clarification on coverage, they supply ambiguous answers or 

no information Clt all. I have called numerous times so this is not an isolated occurrence. THE BENEFITS 

DEPARTMENTSHoULD BE KNOWLEDGEABLE ABOUT COVERAGE AND WILLING TO HELP CUSTOMERS. 

• TRICARE refuses to cover transportation for necessary durable medical equipment. It can cort up to $25,000 to modif( a 

vehicle to accommodate a wheelchair and several thousand dollars to purchase a trailer. Cole needs his wheelchair 1.OQOA. 

of the time but they deem transportation "not medically necessary. U TRANSPORTATION FOR NECESSARY DURABLE 

MEDICAL EQUIPMENT MUST BE COVERED TO ACCOMMODATE PATIENTS' NEEDS. 

Spedalists are too far away for remote military locations. We drive 4 hours each way for each of Cole's neurology 

appointments. They authorize 1 night of hotel rtay, even if the appointment is mid·day. That means we leave the house 

obscenely early or drive into the night. I have paid for rooms out of pocket for our own health and safety. TRICARE NEEDS 

TO ACQUIRE MORE SPECIALTY DOCTORS SO PATIENTS DO NOT NEED TO TRAVEL GREAT DISTANCES. 

Extended care Health Option (ECHO) 

ECHO possesses the same policy as TRICA.RE and will not cover transportation for necessary durable medical equipment. 

TRANSPORTATION FOR NECESSARY DURABLE MEDICAL EQUIPMENT MUST BE COVERED TO ACCOMMODATE PATIENTS' 

NEEDS. 

Exceptional Family Memb~ Program: 

• The staff at our base does not show concern for our family. The case manager and staff contact ~s only to correct 

paperwork. During these numerous calls, they never once inquired about Cole's progress, nor offered assistance. EFMP 

EXISTS TO HELP FAMIUES AND STAFF SHOULD BE TRAINED TO PAY ATTENTION TO CUENT NEEDS. 

The child care respite program Is a wonderful resource but the paperwork is excessive. They change formats frequently and 

require periection. I personally know of several families that would use the prOgram but do not because of the time, effort, 

and turmoil. EXCESSIVE PAPERWORK SHOULD NOT PREVENT CLIENTS FROM WANTING TO USE THE PROGRAM. 

Once again, we are th"an!dtl\ for the benefits we have and these shortfalls can be remedied with more attention and a retaining 

budget. Thank again for your time and consideration for our needs. We appreQate your concern and advocacy. 

Regards, Stephanie and Brian Geraghty of Camp Lejeune, NC 
413 


621per89.eps

Gerwig Family 

USN - Active Duty stationed at NIOC Mo.and living on Ft Meade 

Our son, four years old, was diagnosed with autism at age 2.5. He receives ABA services through ECHO., 

attends speech and behavior management therapy through TriCare and Eel services through the county 

under IDEA. We also anticipate an upcoming appointment with a Developmental Pediatrician will result 

in our 2.5 year old son also being diagnosed. 

We have had a huge problem with the county school on post not complying with federal and state laws 

in regards to special education children. It is a huge disservice to send military families into a school 

district that does not comply with existing laws and makes families work to get some semblance of these 

protections for their children. I recently filed an Dfficial Complaint with the Maryland State Board of 

Education and their Letter of Findings has been issued. Df the four violations they investigated, the 

school was found in violation for each item. There is no reason military families should have to invest so 

much time, energy and sanity exhausting all resources when it comes to special education. No family 

should have to truthfully, but when you are known to be transient members of a community and dealing 

with a II that comes with military life as well as whatever comes with your special needs family 

member(s) - there should be some way to ensure Commands are aware of existing issues and willing 

and able to address the family readiness issue SpEd noncompliance is. Especially when the school is 

located on post. 

We look forward to the EFMP program being run as one rather than by branches. Having things 

separate can be especially confusing and disjointed at joint commands. 

I very much support the efforts Mr Hilton and so many others to have ABA therapy rolled into regular 

TriCare in recognition of its true function for our ASD children and with full regard given to those retired 

servicemembers who have a family member on the spectrum. 

Atthe top of my list ofthings that should exist in the EFMP is a JAG Dfficer stationed at all major. 

bases/posts whose specialty is SpEd, or who is tasked with becoming meaningfully well versed in the 

Federal and State laws regarding SpEd. This Dfficer would hold some form of periodic town halls 

(virtual or not) or- meetings with parents to pin point any possible areas needing their attention. While 

they would not become a laWyer to be involved in Due Process complaints or anything, they could meet 

with families and give them educated and on point advice re: their situation. They could also draft 

letters to the school refenencing the specific applicable laws and asking for clarification on specific 

situations in the expectation that knowing families have a SpEd lawyer available to guide them on their 

issues many schools will stop looking at our families as ignorant or overcommitted and unlikely to tackle 

systemic problems in local school systems. 
414 


621per90.eps

The Gorman Family 

Active duty Marine Corps for 12 years 

5 year old child Madeline survived leukemi\l, now suffers from multiple 

seizures daily with severe delay in all areas 

Challenges with Tricare/ECHO/EFMP 

Inconsistent policies regarding coverage of medical equipment 

In our region, the Tricare Management Authority refuses coverage of certain items 

like a seizure safety-proofed bed. Other areas of the country allow coverage of these 

beds. This was an extremely large out of pocket expense for our family and it seems 

unfaJr that it is being covered without issue in other places, forcing us to question if 

we should just wait until we get transferred elsewhere to get it covered. 

Inadequate EFMP Respite program 

For families like ours with children who cannot do anything independently and who 

are extreme safety risks, respite care is extremely important to give the parent or 

caregiver a break. Service members work long hours and deploy often. Forty hours 

per month is not enough, especially during deployment Respite hourly pay 

coverage and time allotted should be on a scale that more accurately reflects the 

disability and needs of the child. 

Medicaid Portability 

This affects families both military and civilian with special needs children, but the 

greater burden is on military families who move every 2- 3 years on average. "It puts 

great stress on families at an already stressful time (relocation) not knowing if their 

child will be able to receive similar services in the next are"a. 
415 


621per91.eps

HA~SFANITLYSTORY 

. ~:-......- .... 

Aly Hawkins was born at 35-weela;' gestation with a rare birth defect called esophageal atresia tracheoesophageal fistula (EA!IEF), 

which means that her esophagus was not attached to her stomach., while her trachea and esophagus were connectecL .After a traumatic 

birth. Aly was transferred to the local Children's Hospital, where she endured painful PICe lines with no sedation and was denied any 

nutriticm for over a week. During the operation, the surgeon damaged nerves and paralyzed her stomach and intestines, as well as 

caused respiratory problems and heart rate and pulse issues. The physicians released her after two weeks, although her heahh 

cantinued to decline. She began turning blue. She screamed every time I would feed her. We would nm. her to the emergency room 

only to be told there was nothing wroog. The physicians refused to treat my baby. 

I immersed myself into resear.ch and fmm.d a doctor in Boston that specialized in EAfI'EF and we hopped an the next flight, carrying 

an infant who was so dehydrated, she was on the verge of seizing. She spent three months in-patient at Boston Children's Hospital. 

enduring six surgeries, hundreds of x-rays and studies, and finally found the issues: not only was her esophagus barely opening, but 

scar tissue had developed- She also had two heart defects and a severe tracheomalcia that callied her airy.ray to collapse almost 100% 

'Nith every respiratory cycle. She had developed clonus and tremors in het extremities because of the previous surgeon's damage 

during hcr first operation. Aly weot hame wee month, later wi1h a GJ tube, feeding pump, puIse oxymetcr, and referrals to every 

specialist tmder the sun. 

TRICARE and ECHO were great \\'hile we were stationed in California. She received 40 hours a week nursing services, a special lift 

reflux bed, and approved the Synagis vaccine 1hat helps prevent RSV virus, which cotJId have been fatal to our baby girl. All of her 

therapies and specialists were approved quickly, even 1hough we were TRlCARE Standard. 

Then we transferred to Virginia, whc:::re healthcare for Aly is awful. It is a 6~week or longer wait to see a pediatrician and eve;n longer 

to see a specialist We have to see a civilian pediatrician now because we just can't put her care on hold like that TRICARE has 

denied the referral fur Aly to see a dietician, I!Ild as a result, my child, who is 100"10 G-tube fi:d has not seen a dietary specialist since 

we moved here twelve months ago! Therapies are nm-existent, as their waiting lists are extensive. We have been fightingtooth and 

nail to get the OCCUjlational and Speech therapies that she desperately needs, hut they are only able to provide for h", sporadically 

tbrough the month. ECHO has been a nightmare, too. They have repeatedly denied nursing care here, stating "We are a different 

regiOIl, and you do not qualify here in Vrrgjnia. .. "Why isn't there consistency in ~ervices? 

We have been on tJ::J.e -waiting list far much needed respite care services for two years. We pay out-of-poCket expense of $852 for the 

Synagis vaccine, because in Vrrginia, it's not covered. either. The:re is no available ADA milit:ar)r hOUSing for us in Virginia, and the 

local housing office seems to be very conupt. 

AIy has fhll'" through the cracks in Virginia, and health care here is a joke. Why aren't services wough TRICARE and ECHO 

uniform tbroughout the regions? I feel hopeless thBt 1he services thBt my daughter desperately needs and deserves are not being taken 

care ot: Please help our fimillymd oth"" like us. Ourmilitlly children deserve better! 

Kris Hawkins, wife ofLT Rlldolf A. Hawkins, Pilot, US Navy 
416 


621per92.eps

This is kuo:. He "''U bomlmppylLlld beahhy If Blazx.hl:ield 

Ann, Conmllltlil;y HD$pUl If Fort c.mpbell, K=uc:ky. TMl 

IWIllht aft~ his secolld binbday.}z ""'as cIi.:IgDo~ with lIUlism 

aod I Vo'IIlI told that hi: r:n.y DeVl:t uJIr. or be 1lffectio1l41e. I wu 

1!l::::~ promised !hal eatly ioIervention II aiticall-lld - W~ lucky to 

\: have him diagDose.d Jo YDlJIl&. Our pediatrician stressed !be 

imporWIcc ofspcccb therapy, occupatioaal therapy, mel Applied 

Bella\'KlnJ Aaalysil(ABA) UJQapy if_ wamcd S-to pin 

=ial.skillJ. With my husband Ikpb)'ed aDd OD family wil.hiD 2,000 miles - I immc:ned mY'l=if 

iI'Ilo his world tQ do 1M:l)'lhing I could.. Weecro1led in the ExccptioIW Family Mo:mben 

Ptogram so that we wuld then apply ill ECHO &lid be eligible fOr ABA ~y. 

II ~ktd. Jesse wiU be.sUe this September aDd will be emcriog a uWnstrcam kindclpn.cn 

classroom. NotooJy doe3 be speak, be _ Slops rpeakiDglHe has S'lories to teU abow 

dioo-. to anybody tba15tmU stillloni enoup i:lr b.if!I to !.Ilk to. He isn'l without hill 

Slt\IUles. we ,nu IIIb ABA Iht:npy a.nd are oollSWllly wo • .ti.Dg on behavior mel IiOCiaJ mues 

lhatpop up. 

N of[)ec.etnber I, 2012 mylmsbaDdwill mbtafla- 20)'C!ln ofhooonlbic servi~Md we will 

Jose oW"covaqe fur ABA tlJenl.py OoIIlPJeteJy. Please doo.'llet this happen. !'ben are c:hiI<Irc:o 

OUi tbm Iba% Deed this - DDI jUst to IlICC.ced but IO!DC DOed it just lO mae il through daily wU 

that ~ aD tab for ~ We don't julI ~ ABA tbmp)' fOr our SOD, we need it. He occds it. 

WeMed )'Our~ 
417 


621per93.eps

16 June 2012 

1. My san was diagnosed with autism while we were stationed in Gormany. 'He was 15 months old. As 

overwhelming as the diagnosis was, it was even more overwhelming to get all the nw"sary care he needed. There 

was speech, occupational and physical therapy, allergy and immunology, etc .... and there was ABA. Stateside 

military members had already worked hard to have ABA =gnized as a need but only under Tricare ECHO 

(Extended Health Care Option), which still denied it as MEDICALLY NECESSARY for children with a diagnosis 

on the autism. There was only one American operated ABA company available in G=any. It was very expensive, 

and we were constantly struggling with Tricare to receive reimbursement By time we left Germany, private ABA 

and his medical necessities, that we refused to wait for months for in the system, had depleted our savings and 

investment accounts. 

2. We fought with the Ak Force assignments team. explaining that they needed to send us to a location that had 

available ABA for our son. With patience and persistence, we arrived at Andrews AFB. Because we had heard 

about schools that offered self-contained classrooms for children with autism, we decided to live in VIrginia. In the 

meantime, we begie> our journey trying to find him ABA services. There were several companies, but they had 8 -12 

month waiting lists. When we finally did find a company that Tricare would cover, they left billing to us. The 

company billed us, and we would walt for Tricare to reimburse us. At times, our credits cards were maxed well 

(upwards of $20,000) while we waited for reimbursement And the interest was not low. So we are now, broke. 

3. Before my son started receiving up to 12 hours a week of ABA, he did not speak, had tremendous behaviors that 

included hitting himself, spinning, crying constantly, and lived in constant frustration. After only one month of 

ABA, he began to sign then steadily began his journey to beginning to communicate. I will save the complicated 

details, but I will tell you that he legitimately passed the 2'"'grade recently. He still however cannot leave a self 

contained c1assroo~, and we long for him to be mainstreamed. ABA works. It's been proven to work. It is also 

MEDICALLY NECESSARY. 

4. We arefrustrated. Upset. Tired. Wehave the weight of the worJdon our shoulders. Any parent knows the pain 

of watching your child go through something that you just can't seem to fix. But how about knowing there is 

something lhat will benefit your child is out there, but you only get access to a SMALL portion of it You don't 

only give a "little bit ofchemo" if you have cancer, or a ''little bit of physical therapy" to someone who was in a car 

accident and broke their legs. You give them what will benefit them completely. I feel like SOmeone has dangled 

that carrot on • stick we continue to chase. I feel as if someone is saying to us, "There is.this scientifically proven, 

medically necessary therapy that can benefit your child, but we are only going to give you a quarter of it" 

4. Currently, my husband is stationed in Dover, Delaware and commutes home on weekends. Because he was force 

to move, we lost nearly $1,000 in a month in housing allow.mce and now have to maintain two households. Ther. 

are no ABA services in Delaware. And even ifther. was there would be waiting lists. So, we separate our finnily 

so that my SOD can contioue to receive his ABA services. And my husband continues his service faifufully in hopes 

that the military will do due diligence and take care of his finnily in his sbsence. 

5. ABA should be given to us as it was found to be the most beneficial, at 40+'hours per week. It should also be 

made to avallable to military retirees. Cutting these services at retirement from active duty is a travesty. Our men & 

women who serve our country deserve peace of mind that their:filmily is taken care of both during and after the 

completion of their military service. They earned it and our children deserve it 

MELISSA A. HENDRIX, 

Military Spouse 
418 


621per94.eps

BRANCH: US Navy 

DUTY STATION: NAS Fort Worth JRB 

EFMP CATEGORY: 5 

Kaitlyn Samuels was bom with severe brain abnormalities which resulted in severe global developmental 

delays, cerebral palsy, scoliosis and a seizure disorder. The family's biggest hurdle in caring for Kaitlyn has 

been gaining access to the Medicaid Waiver. They are entitled to this, however, Mark's military service has 

made this impossible at every duty station except for one. Here is their experience: 

Due to Mark's career we nave moved five times since Kaitlyn's birth in 1996. While we have managed to make 

every move successful for Kaitlyn in terms of medical care (by being on Tricare Standard rather than the more 

cost effective Prime) and school (by living within the best available school districts) one area that is 

frustratingly difficult is access is the Medicaid Waiver program. As you are aware each state handles its own 

program, therefore military families must start over with each move. Ofthe six locations we have lived with 

Kaitlyn, only the state of Maine did not have a waiting list fortheir Medicaid Waiver (the Katie Beckett Waiver 

in Maine). OUT current waiting time here in Texas is over 4 years for one waiver and over 10 years for another. 

This is the typical wait time we have encountered in each of the other locations in which we have lived. As you 

know, military orders are rarely longer than 2-3 years, therefore, in niost states military families never make it 

off the waiting list befo're being put at the bottom of the list in their new state when relocating. 

One of the most helpful benefits of the Medicaid waiver is access to respite care. Military families rarely live 

near extended family and very often the active duty parent is gone. Therefore respite care is an even greater 

need for military families than most ·others. My daughter is '15, but requires the care of an infant. I must dress, 

feed, bathe and diaper her. Having respite care when we lived in Maine gave me a chance to do things with 

my other two children that are hard to do with Kaitlyn. It gave me time to catch my breath both physically and 

emotionally. And it gave me an extra set of hands when my husband was gone. There must be some way to 

address this problem. Possibly some type of waiver program for military families that is not tied to a particular 

state. I am not seeking help for something special for military families. I am asking for help for what we are 

already entitled to, but our family member's service denies us. 

Jennifer Samuels 

Navy wife of 19 years 
419 


621per95.eps

SirlMa.am: 

We are an active duty family with an autistic 6 year old daughter and an 8 year old 

daughter that is recovering from difficult leukemia treatment and currently receiving her 

treatment at the- New Walter Reed hospital in Bethesda, MD. I have over 20 years in the 

military on active duty and as I am nearing retirement, we are very concemed on how we are 

going to continue Haynah's Applied Behavior Analysis (ABA) therapy. 

My autistic daughter's treatment plan for autism includes a wide variety of treatment 

aside from the ABA therapy to include but not limited to speech, occupational therapy, 

hypotherapy, glutenfcasein-free diet, LOA shots, and attendance at a Fairfax Country Public 

School autism elementary program. The ABA therapy has and continues to be a critical part of 

her treatment as we cannot even imagine where my daughter would be without it. The financial 

burden is already very significant as we pay out-of-pocket expenses not covered by TRICARE. 

Even though the ABA therapy benefits are a true blessing, my daughter still requires more hours 

than allocated, therefore, we also pay out-of-pocket for these additional hours. However, with 

the current ABA poliCies for retirees, her treatment plan will be seriously affected by our inability 

to support her financially. 

Please consider our huge challenges and that of many other military families that have 

Similar circumstances. Treatment of autism is a huge financial and emotional undertaking for 

the families and all involved, and your help would be greatly appreciated by all, but mosUy by 

these autistic children. 

Sincerely, 

Theo Kang and Family 

7981 Viola St. 

Springfield, VA 22152 

Kang.theo@gmail.com 
420 


621per96.eps

16June 2012 

I am the proud father of twin sons who were both diagnosed with autism while 

I was on active duty in the Army with more than 28 years of military service; Both 

sons received Applied Behavior Analysis (ABA) medical care while I was on actiVe 

duty. But when I reached mandatory retirement at 30 years of military service, 

DOD TRICARE would no longer pay for any ABA treatment. Does my retirement 

change anything about my children's condition? 

One of my twin sons is non-verbal and requires OT as well as speech therapy in 

addition to ABA therapy. Military readiness and the fair treatment of all 

categories of military personnel, active duty as well as retired, are important 

considerations for DoD health care. I have many out of pocket medical expenses 

reSUlting from the autism spectrum disorder diagnosis of my two sons .. 

I hope this unfair policy, in which retired military family members are excluded 

from reimbursement of ABA medical treatment by DOD Tricare, is finally 

corrected. 

Kenneth D. Shive 

COL (ret) US Army 
421 


621per97.eps

McIntyre-Brewer Family, US ARMY 

Pediatric Needs: Lorelei, 7 years, hypoplastic left heart syndrome (BLHS), PTSD, 

OCD, Harlequin Syndrome, seizures, tics, extensive pulmonary 

scarring 

JoJo, 5 years, cerebral palsy, plagiocephaly, residual PDA, BAV, 

insufficient aorta, tricuspid prolapse, endocarditis, multiple tumors 

Primary Issues Relative to Access to Care: 

1. Continuity of care from one permanent change of station (PCS) to next was 

denied despite proof of history with in-network providers through the Children's 

Hospital of Philadelphia (CHOP) was denied in the referral process by a doctor 

who wiShed to retain children within the Military Treatment Facility (MTF) and a 

written care plan previously established through the Exceptional Family Member 

Program (EFMP). Recourse protocol was followed and ended with a switch to 

Tricare Standard despite contacting the central EFMP office at the Pentagon, 

advocacy from CHOP, and proof that adequate care was not being provided by 

clinician who tagged referral fur Right of First Refusal. Review of files was done 

in-house, rather than a third party review, and limited patient advocate recourse 

for proper advocacy. 

2. Continued reductions in payout for services to civilian providers have caused 

various specialists and hospitals to refuse Tricare patients, limiting qualified care. 

The financial crisis has been sited as reason for limiting distance travel to viSit 

facility used since birth and denying referriU despite proven patient history with 

institution, willingness to furfeit travel reimbursement expenses, and limited 

availability 0 f specialized services for patient. 

3. MTF medical records have been lost multiple times or· NOT recorded, including 

the entire first years of our daughter's life. MTFs also regularly ignore requests 

from civilian providers for infurmation, despite using correct channels fur 

acquisition of information. Loss of records has led clinicians to request 

procedures that were unnecessary and redundant, including sedated MRIs, 

echo cardiograms, labs, and other interventions that proved a waste to taxpayer 

dollars and trauma to pediatric patient. 

4. COlIlPlunication and appointment collaboration for children with complex medical 

needs is disjointed and very seldom followed through.' The disconnect between 

front desk services and inability to contact clinicians bas created various instances 

of ignored medical requests, situations where hospitalization could have been 

easily prevented with early intervention, and inability to access care. 

S. Right of First Refusal ultimately compromises the health and well-being of 

chronically and severely disabled children as it retains children who should be 

routinely monitored by the same team of experts who have the ability to establish 

adequate protocol, limit the misfiling of information, and ensure longevity of 

health fur patient. While useful in healthy patient circumstances with temporary 

medical needs, it is inappropriate fur life-long medical iSsues with established 

care protocol in place already. 
422 


621per98.eps

My name is Jennifer Lockwood and I'm writing to you today to ask for 

your support of HR 2288, the Caring for Military Kids with Autism Act. 

I've been married to military since before I was married. My father is a 

veteran who retired with 20+ years in the Navy; my husband is in US 

Army, with close to 25 years active dnty. 

In July of 2008, at the age of 4 my son was diagnosed with Autism. My 

husband and I were highly encouraged by my son's Developmental 

Pediatrician to enroll in both ilie Exceptional Family Member Program 

(EFMP) and the Extended Care Health Option (ECHO) Program, which 

would enable us to start Applied Behavior Analysis (ABA) inunediately. 

My husband submitted all the required paperwork for my son's enrollment into EFMP by mid-July and in 

September I was told that there was no paperwork and my son was not in the system. Essentially we had to 

start the process over again. My son was not authorized to begin ABA therapy until he was processed 

through EFMP and enrolled in ECHO. For children with Autism, it is imperative to start early intervention 

as soon as possible to ensure the most benefit and the greatest positive impact. Because of the lengthy 

enrollment process and the lost applications, it was January 2009 before my son was fully enrolled and 

approved. Due to the demand for ABA therapy, my son did not receive his first session until April 2009. 

Had ABA been an approved medically necessary therapy under Tricare, 1 suspect we would not have lost 

close to a year of my son's precious time. 

Although the reco=ended amount of ABA therapy is 30 - 40 hours/week, my son only receives 10 

hours/week, not near what is recomniended, but absolutely better than nothing. Due in part because of 

these services, my son has gone from functioning as an 18 month old to functioning of a 6 year old; and 

this would not have been so had these services not been available through ECHO. 

Because of where my husband is currently stationed, I live thousands of miles away from my family and 

have no family support. When my husband was deployed, there were many days when·I was so tired and 

exhausted from being mother, father, and therapist to my son, that I just needed a few hours to myself. I 

called to inquire about respite care, which is a benefit that the EFMP and ECHO program provides for their 

families of deployed soldiers. I was told that any respite care that was provided would be deducted from 

my son's already minimal ABA therapy hours. Respite for a deployed soldier's family should not be 

provided at the expense of a child's medically necessary ABA therapy hours. I chose to furego respite; 

because my son's medically necessary therapy was more important than his mother's well-being. 

As I stated earlier, my husband has over 25 year's active duty Army Special Forces. He has deployed 

multiple times throughout his military career, potentially risking his life each time. He recently returned 

from a yearlong combat deployment in Afghanistan and is scheduled to deploy again in August, for what 

will most likely be another year. Although my husband has more thao enough years to retire from military 

service, he cannot for fear of losing all medically necessary autism therapies for our son; retirees are not 

eligible for ECHO services. 

My husband has made many sacrifices for this county, so I ask you to do what is right and offer your 

support to him by supporting HR2288. The medically necessary therapies that our son requires should 

... ,..+ ~rln.-:l,.. nllT son from having a father present in his life. 
423 


621per99.eps

The MaId Family 

USAF 

Caleb,S years old 

Diagnoses: 

Autism, Celiac disease, Apraxia of Speech, Sensory Integration Disorder 

Our current base is 45 minutes from the nearest city that provides the necessary services, 

such as, Speech, Occupational and Physical therapies. Our in-home ABA therapists 

travel 45 minutes each way 3-4 days a week to work with him and our BCBA drives over 

2 hours each way when she comes up to supervise. Caleb received some additional ABA 

services through our state programs, but that has now ceased due to a health bill that was 

passed mandating insurance coverage. The gains made in the "last 6 months when he 

received a total of25 hours per week in ABA therapy are now threatened without those 

additional hours and Tricare cannot fill that void leaving us with the cost of maintaining 

those additional hours that he so desperately needs. In future months we will bave to 

choose between providing that much needed bebavioral support and continuing to 

provide him with the specific nutrition that he needs due to Celiac and various other 

allergies and sensitivities. 

Struggles: 

• Remote base location and limited resources available locally 

• Limited amount of ABA therapy funds 

• High cost of maintaining gluten free diet and nutritional supplements 
424 


621pe100.eps 621pe101.eps

Hello CommIttee Members, 

Thank you for the opportunity to share the ooncem that my husband and I have regarding Autism care. We sincerely 

appredate this forum ill pruvide our family's sillry. 

We live in Eagle River, Alaska. Dave is an active duty member of the Alaska Air National Guard. His active duty status 

allows us the benefits of the Tricare insurance coverage. He has met the time requirements for retirement. and one 

month ago we had ill make the difficult decision to submit retirement paperwork. Last year Dave had ill have surgery on 

both feet to repair severe arthritis that has developed, over the course of his military career, due to oombat training 

injuries frum when he was in the Amny. Because of these surgeries, he is on a waiver for the physical fitness tests. He 

was told that there was a. very strung chance of him being forced to retire due to these medical issues. This Is so scary 

for us because the Tricare benefits for OUr son will change. He will no longer be eligible for his Applied Behavioral Analysis 

therapy. 

Cole, our sb< year old son, is an absolutely precious boy who loves Star Wars. He can create the most fasdnating things 

wlth Legos. He loves In snuggle with us and read sillries. If you had an opportunity to meet Cole, his sweet smile would 

melt your heart. 

Cole has high functioning autism, with hOnrific meltdowns that threatened to tear our family apart. For years these 

oa:unred several times a day, and required that my husband or I wrap him up and hold him tight for over 30 minutes to 

an hour while he screamed and raged and fought us. Our family was held hostage by these behaviors. 

Over the oourse of two years, we sought help from a psychologist. two psychiatrists, and our son's pediatridan. While 

these professionals were empathetic and supportive, they were unable to help us. We were told by our psychologist that 

most families would not have been able to maintain as long as we had, and they would have had to place their child in 

residential treatment 

As horrifying as the thought was to have to put our 4 year old into such a restrictive setting outside of our home, we 

understood families who had to make that choice. With the exception of strung psychotropiC medication, and weekly 

counseling, there was not the intensive support available that we needed. ThaUs until we found out about Applied 

Behavioral Analysis (ABA) therapy. 

Our family was so fortunate because we found out that we were eligible for this therapy due to Dave's active duty status. 

This therapy was a God's send to our family. Our son is progressing and learning the necessary skills to interact 

apprupriately without defaulting into explosive rages. His therapists are highly trained, amazing people. They come into 

our home and work with him for three hours, four days each week. 

This last school year, Cole was only able to attend Kindergarten half of the day. He becomes.overwhelmed very quickly, 

and can only handle a few hours of the incredible sensory stimulation that oocurs at school. He struggles during play 

dates, and usuaUy leaves crying or angry after a short amount of time. He is so very aware of how others perceiVe himJ 

and desperately wants to fit in and have friends and be 'normal" as he says. His ABA therapists are trained to work 

thruugh several goals at a time, and when he aliains each goal, they tackle another area of need. It is a slow process, 

but IT WORKS! It is amazing to see the difference in our child after the last year and a half of ABA therapy. 

I would like to make an Important point that many people may not understand. ABA is NOT provided in the dassruom for 

most children who have autism in this ODuntry. Perhaps severely autistic children who do not speak will be piaoed in the 

intensive needs dassrooms with spedal education teachers who may use parts of ABA to get them thnough the day. 

However, this is not the case j'or the high functioning child who has the greatest chance of being able to function 

independently wlth this therapy. . 

As we think of Cole gruwing older, we ha~e great hope for him. He is an extremely smart boy, and has the pOtential for a 

life that indudes friends, a ODIIege education, and a self-SUstaining career. ABA therapy Is a critical resource for Cole 

during this important developmental time In h~ life. 

Once Dave retires, although we will be able to retain our Triwest insurance, the EO-IO program under Tnwest that 

pruvides for the ABA therapy changes. Cole will no longer be eligible for this vital therapy that is helping him become the 

person he is meant to be. Our family desperately NEEDS this therapy In continue. 

Thank you for taking the time to review this extremely Important matter to thousands of families. 
425 


621pe102.eps

The Mendiola Family' 

Our son, Michael, was diagnosed with autism on his 

third birthday, November 23, 1994. At the time we were 

stationed in Yokosuka, Japan, and the doctor informed us 

that we would need to return to the states ASAP because 

appropriate therapies were not available in Japan. It took six 

months for the Navy to finally get us transferred to the 

states. 

Atthattime, ABA was not covered by CHAMPUS 

(which has since been replaced byTRICARE), butwe tried 

multiple times to get our son approved for speech therapy. 

We were finally approved for speech therapy and 

occupational therapy when he was in third grade, age 8 or 9. 

By then a great deal oftime had been lost that we couldn't 

recover. 

When ABA became a covered therapy under ECHO in 

2005, we were preparing to transfer, so we waited until we had moved before we pursued it. 

After the transfer, it took over 18 months to find an ABA provider with space on her schedule 

for our son. During that time, we saw much regression, as we had no therapy for our son. 

Once ABA started, we were very pleased with the progress we saw. Language progressed 

impressively, independent·living skills were becoming a reality, and his interaction with those in 

the community was becorT)ing more age-appropriate. Through all of this great progress, the 

dark cloud hanging over our heads was the knowledge that upon retirement from the military, 

ABA therapy would no longer be covered by our insurance, and we would likely have to 

discontinue it. . 

My husband retired from the US Navy with over 30 years of service to our country on 

August 31,2011. We could not afford to continue ABA therapy for our son as private-pay 

clients, so we had to discontinue it. Since that time, our son has visibly regressed. Affirst we 

thought it was just our perception, but everyone (bus drivers, school teachers, friends in the 

community) has noticed and mentioned it to us; It is very difficult to get him to speak with 

people anymore. His ability to focus and complete a task is almost non-existent. He is 

retreating into "his own little world", and we are finding this heartbreaking to watch. We do 

everything we can to encourage progress, using techniques we learned from his therapists over 

the years, but it just isn't enough. 

The only change in services he has had in the past year is the loss of ABA therapy; we 

therefore believe that this has to be the reason for his regression. At this age (20 years old) his 

options are very few. He will age out of public school in 18 months and will then have no 

services whatsoever, as the waiting list in our state for medwaiver services is decades-long. 

ABA therapy is the only proven method to treat autism. Our son needs this therapy to make 

progress and be.come a happy, productive, independent adult. Please make the changes 

necessary to include ABA therapy under regular TRICARE coverage so that families of retirees 

are able to provide this therapy for their children on the autism spectrum. This is the right 

thing to do for these families who have sacrificed so much to serve our nation. 

621pe103.eps

The Mills Family 

• Dad was wounded severely in 

Fallujah Iraq by an RPG and forced to 

retire because of the severity of his 

injuries 

• As a retired Marine and disabled 

veteran, the family relies on TRlCARE 

for coverage of medical services 

• Son Shane has autism 

• Because Dad is retiree, Shane's ABA 

care is not covered by TRlCARE 

• Family faces out of pocket costs of 

nearly $5,OOO/month 

• Family has sold their home to pay for 

the medically recommended ABA treatments for Shane 
427 


621pe104.eps

From the Mosser Family; Jim (dad), Trish (mom), Jesse James (age 7) and Wyatt (age 5) 

Hi and thank you for taking the time to read my letter about our family. 

I am a Military spouse, my husband Jim is in the Army and has served Our Country for almost 29 years. 

He has been deployed twice and received two Bronze Stars, one for Desert Storm and one for 

Afghanistan. He has had various other tours stateside and has served over seven years overseas with 

about 15 moves in total. 

In February of 2009, Jesse James was diagnosed with Autism. To add, a Genetics Test revealed he has a 

lOp1S Chromosome Deletion. Also, he has asthma and a seizure disorder. Wyatt was diagnosed with 

Autism in July of 2009. To add, he has asthma and sensory processing disorder and multiple allergies to 

antibiotics which, if taken, can cause febrile seizures. 

Jesse and Wyatt have been in early intervention with Occupational Therapy (011 and Speech Therapy 

since they were 18 months old. Jesse and Wyatt sta<:ted Applied Behavioral Therapy (ABA) in February 

of 2010 and we have seen a tremendous change for the positive for both our boys in spite of their 

health issues, including three more moves in total. Actually, the learning curve they have achieved has 

far surpassed our expectations and has made our life so much more fulfilling. We can now dothings as a 

family! I! Had we relied on ONLY Speech and OT we know our boys' progress would have been much 

slower and their ~ives much more challenging. 

My hUSband is eligible to retire and it scares the LIVING DAYLIGHTS out of both of us. Even having faith, 

we are still very concerned about retirement because we know the boys will no longer receive ABA 

therapy. To finanCially afford ABA therapy is completely out of our realm to achieve which no parent 

should ~ave to bear that burden knowing we are unable to pay for a life changing and lifesaving therapy 

we know will save our chilcjren's lives and give them a better future. A future we dream of for them. My 

husband is also a wounded warrior and we are fortunate he is still able to remain in the Military yet I see 

that he struggles to do the things he used to do and I know why he put,s those bootS on everyday and his 

uniform because he knows that Jesse and Wyatt count on him to have the best possible medical care 

and he is proud to Serve His Country. We appreciate your time and we have faith that you will give our 

kids a hopeful and bright future by passing this bill. 
428 


621pe105.eps

17 June 2012 

Dear Senate Armed Services Subcommittee on Personnel, 

My husband was a dedicated solider, who dreamed of a lifelong career in the Army. He devoted his time to 

serving his country well. Unfortunately, he was injured in a training accident, which has permanently deteriorated his 

knees. Things might have been different had his unit at the time allowed him to seek proper medical attention 

immediately. but he was told to work through the pain. He did and working through that pain cost him his career. He 

was medically retired in Julyof 2007. 

We have a five year old daughter, 

Samara, who we tried so long to get. We went 

through a lot of heartache before we were 

blessed with our miracle littie girl. Although things 

on the civilian side of life were more challenging 

than we had hoped we were and are thankful for 

our Trica're Standard. When our daughter was 

diagnosed with Autism we were confident that 

because we had such amazing insurance we 

would be fine. Much to my dismay it has been a 

repeated no. It was even suggested that my child 

be adopted by someone on active duty so that 

she could have the therapy she needs. 

We are grateful for the Occupational and 

Speech therapies she receives as a beneficiary, 

but everyone knows she will flourish with also 

having ABA therapy. It is dumbfounding that 

through our medical insurance our country has 

turned their backs on our child, and countless others like her with autism. He father fought and served honorably, for 

our country. Being retirees with a child,with Autism is like a slap in the face. You cannot provide the therapy they need, 

and no one seems to think your sacrifice to your beloved country maters anymore. 

We are respectfu'lIy asking that you make ABA therapy available to all Tricare recipients, and to make it 

affordable. We need to give kids with autism the best life possible, without ABA it isn't the best possible. Her father gave 

his best; show some appreciation and allow his daughter to possibly achieve her best too. 

• Samara is a five year old with Autism, whose father is a disabled Army Veteran. 

• She needs 2Q.4() hours of ABA therapy a week to help her achieve the best life possible. 

• If ABA becomes a benefit for all Tricare recipients. Please somehow make it affordable for us. Currently our 

Tricare has 80/2Q coverage. However, even with a 20% co-pay it may place it out of our and many others 

financial reach due to the sheer amount of therapy involved. Please ke'ep this is mind, and make the out of 

pocket costs zero to minimal for all recipients. 

Her disability is pr.eventing her from joining her peers in Kindergarten in the falll with ABA therapy we are 

hoping she will "catch up" to her peers academically, and soCially. 

• We have a 9 month old son, Sabastian, who is already showing developmental delays, and has started early 

intervention therapies. If we receive the diagnosis of Autism we would need him to receive ABA therapy as well. 

Respectfully, 

Travis, Tami, Samara & Sabastian (Booth) Or!. US Anmy Retired family 
429 


621pe106.eps

16 Jun 2012 

1 have served 14 years as an Air Force Dental Corps officer. 1 am the mother of three children. My second child, 

Peter, is 9 years old and is autistic. He does not speak or read, has minimal imitation skills, does not understand many 

social concepts, and lacks many life skills. We have been fortunate to be able to utilize Tricare Extended Care Health 

Option (ECHO) for services when needed at various bases. However, I believe that these benefits have concerning 

limits. The present $36,000 per year allotted by Tricare ECHO may cover 9 hours a week of Applied Behaviof Analysis 

(ABA) therapy-far short of recommended intensive therapy. 

Presently, Peter, his siblings, their father, and my mother-in-law live near Joint Base MCGuire-Dix-lakehurst, NJ 

where 1 was assigned. Peter is receiving year-round schooling at an ABA-based school paid by the Pemberton, NJ Public 

School District. Since May, I am living in San Antonio stationed atJoint Base San Antonio where 11m now assigned. I am 

anticipating my family will remain in NJ for the two years that I will be here. The public school systems in San Antonio do 

not use ABA therapYI has, higher studentto teacher ratios, and will not provide summer school for Peter. If we move 

Peter, his ABA therapy will be reduced from 25 hours per week in school to 10 hours a week using Tricare ECHO funds in 

a center-based or home-based program. He has lost skills with inadequately trained DODEA teachers when we were 

overseas and when he was living in San Antonio using the public school system. If we move him back to San Antonia, he 

would most likely not continue with the same progression of learning. 

Our family separation i~ our solution for now, but we are concerned what will happen to Peter when I retire 

and when he is no longer eligible to use the public' school system. Peter makes consistent but very slow progreSs 

learning important life skills. In order to become as independent as reasonably possible and less ofa burden on sOeiety, 

Peter will need continued teaching beyond my permitted active duty time. These skills are being taught through his ABA 

education and not through medical therapies. We are fortunate for now. But other families with special needs family 

members are not as fortunate due to military status and cannot use services funded through Tricare ECHO. Shouldn't 

these vital benefits be considered basic medical needs for all-active duty, retirees, guard, and reservists? Shouldn't 

these special needs dependents be given the opportunity to learn in a way effective to them? 

If you have any questions, please contact me via phone (609) 845-7689 or e-mail ccgarin@hotmail.com. 

Very respectively, 

Cecilia I. Garin 
430 


621pe107.eps

My name is Linda Reilly and my husband, Shane, is a Major in the US 

Army. We have 2 kids: Charlotte, who is 7 and Alexander, 5. He is on the 

Autism Spectrum and has been diagnosed since he was 2. Shane was on 

Active duty when Alexander was diagnosed so we were enrolled in EFMP 

and Alexander received ABA therapy through the ECHO benefit. This has 

helped him tremendously where he went from not even looking at us to 

speaking in full sentences. We are enrolling him in regular Kindergarten 

this year because of the progress he' has made. 

My main concern is continuing benefits once my husband's duty status 

changes. He has actually taken an assignment overseas to Kuwait to stay 

in Active duty so we can keep Alexander's benefits. With the upcoming 

transition to school, it would be devastating to lose these benefits. The 

company we work with only deals with military benefits and our therapists 

and ABA has been vital to his growth. 

So we are sacrificing our kids' time with their Father for the benefit of 

Alexander. Why can't ECHO coverage be extended to Guard and Reserve 

families? It is not fair to just cut off these life-changing therapies. 

I hope the current legislation will extend these benefits to ALL military 

families regardless of status. We need to honor the sacrifice our troops 

have made for their families and help our kids succeed. 

Thank you! 
431 


621pe108.eps

The Reyna Family 

Our daughter Karsyn was diagnosed on the Autism Spectrum with POD-NOS. My husband is currently 

on Active Duty and we are enrolled in the ECHO program in order to receive ABA benefits. My daughter 

has made tremendous improvements with that I'm not sure she would have otherwise made without 

this therapy. Unfortunately, due to the dollar amount $36,000, Karsyn only receives 6 hours per week. 

Furthermore, this coverage is only available while my husband is on Active Duty. If he were to get 

injured in combat, die on active duty, or just retire not only would my daughter face significant 

difficulties coping with the loss of her father or permanent disability (excluding retirement) but she 

would also lose the therapy that has will most help her become an independent functioning member of 

society. Please consider making ABA coverage available for all military, active duty, retired, and 

medically retired/discharged. It will make a significant difference in many lives of the military members 

that have sacrificed so much for the United States. 
432 


621pe109.eps

My name is Susan Reynolds and I am married to AF TSgt )eremy Reynolds. We have a son named Ian 

who is 22 months. My family is currently assigned to Fort Bragg, NC which is home to the 820' Akborne 

Division, and the 18th Airborne Corp. My husband is a Combat Weatherman also known as a Battlefield 

Weather Airman. Jeremy has deployed twice both to Iraq and Afghanistan and we are now preparing 

for him to deploy again sometime next year. 

lan, our son was born at 36 weeks and 6 days weighing only Sibs and 100z and was only 19 Y. inches 

long. Within a few weeks of having Ian home we noticed a flat spot on the back of his head. With our 

upcoming move, '1 didn't push the flat spot issue until we settled into our new clinic at Fort Bragg. On 

April 16'h, our rental home was hit by the tornadoes that came through NC. My husband also left for 

Afghanistan and my son and I moved into my parents' home over an hour away from post. 

Ian started having ear infections around that time, and I was pushing more and more about the flat spot 

and getting a referral. I was told by his pediatrician that Tricare policy stated that Ian had to be a year 

hold and have head x-rays oompleted before a consult for a pediatric neurologist oould be given. I have 

now discovered that thatTricare policy is not true nor does it exist. I got lan's x-rays and "kept pushing 

for a consult. Finally in August for lan's 12 month check up, I was given a consult. 

Helmets are most effective for children under the age of 12 months. By the time Ian was in his helmet, 

he was 14 months old. I was informed that Tricare does not provide coverage for helmets and he 

recommended another company in Cary that would provide a SO% discount to active duty military 

families. Ian went to Level 4 Orthotics in Cary (http:Uwww.levelfour.us.comf). I chose to pay for my 

son's helmet because the potential long-term negative effects were unacceptable. 

The lack of education on plagiocephaly is ridiculous and the made up policies from my base clinic made 

the situation worse. 

My group is called: Cranial Helmets: Re-Shaping Our Children's Future By Using Our Heads. My son is 

my inspiration and when I see that he wasn't able to get the best possible care afforded to him, I 

became upset. Instead of complaining though, I decided to be a part of a solution. That solution is to 

change the policy and ensure that our military children are receiving the best possible care. 

My husband has served his country and been deployed twice. He will be gone again next year. I hear a 

lot oftalk about the sacrifices of military families. When my husband comes home trom a deployment 

or training my son experiences horrifying nightmares because Ian is un"able to understand that his father 

is home. Our lives are dictated to us and our military serves this great nation without question. The 

least that we can do as a nation is to have the best medical care for the family member. 
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Congress, help us! 

Our son's ABA coverage stops in one week! 

" My name is Jesus Rodriguez, and I have recently retired from the U.s. Navy after 

faithfully serving 20 years of active duty. My wife and I "have a 9-year-old boy with 

Autism. Alex is a remarkable success story of the effectiveness of early 

intervention, specifically applied behavior analysis (ABA). He has been receiving 

ABA therapy for the past 5 years, and it has made a significant impact in his 

communication and self-care skills. 

Unfortunately, my TRICARE ECHO benefits are due to expire on 28 June 2012 and 

cannot be renewed because I am no longer active duty. Our son will cease to 

have any insurance coverage for this crucial therapy that has made a difference in 

our family's life. Although Alex has made great strides, Autism is a life-long 

disorder that did not go away upon my retirement. We are very worried that we 

will not be able to afford the amount of ABA therapy hours that my son currently 

receives and will no doubt need in the future. This type of therapy is most 

effective when consistently applied in childhood, but it is ineffective when it is not 

provided or is severely limited in hours provided. 

I have never asked Congress to take specific action on an issue as important as 

this. Similar to many in my situation, it is absolutely personal. Just put yourself in 

our shoes. We retirees have served our country to the best of our abilities, 

enduring military life in peacetime and during war. Our spouses have supported 

us and made numerous sacrifices. Don't we deserve some help when we need it? 

Alii am asking for is to give my child the support he needs to learn and grow. He 

may one day thank you himself. I implore Congress to help our children 

immediately. 

Sincerely, 

Jesus A. Rodriguez 

United States Navy (retired) 
434 


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The ROUTHIER Family 

On November 3, 2009 our oldest son, William, was diagnosed with PDD-NOS,_ 

an autism spectrum disordeL 

- 7 days later, David deployed for Afghanistan leaving Michelie with 2 year old, 

William and 7 month old, Benjamin, who was diagnosed with GERD and failure 

to thrive. David spent his last days before deployment NOT spending time with 

his sons and wife, but on base, trying to get William enrolled in EFMP and gather 

the steps for Michelle to complete the process for ECHO. 

- With no. help from anyone of base and conflicting answers, it was January 2010 

before Michelle managed to find out that Liam had been successfully enrolled in 

EFMP and then several weeks to complete the ECHO process. 

In terms of therapy, that meant William lost 2 months of potential therapy. 

Since starting ABA therapy under the ECHO program, William has shown 

significant improvement gone from not communicating and 35% delayed in 

social skills to near age level in both language and social skills. 

- The Routhier family is about to make their second pes since David's return 

home in June 2010, which means more months of waiting list and lost therapy. 
435 


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The Schuchs-Gopaul Family 

BRANCH: US Air Force 

DUTY STATION: Davis-Monthan AFB, Arizona (355th 

Fighter Wing) 

The Schuchs-Gopaul family is a dual-military family 

with two children. In 2008, while stationed at Maxwell 

AFB, Alabama, they began to suspect that their 16-

month old son, Evan, was different. He did not speak 

at all. This is their story: 

In 2006, after 3% years of being 'stationed apart, my husband and I 

were both assigned to Maxwell AFB, Nabama. It was a wonderful 

assignment that reunited our family, but introduced us to 

challenges we never could have imagined. Our son, Evan, was bom in May 2007 v.11i1e his father was 

deployed to Afghanistan. Evan. was a happy, healthy and quiet child. He never talked. While other 

children in his pre-school class were singing songs at circle time, Evan was mute and becoming hard to 

control. By 16 months, we decided that something was wrong. We found ourselves With few places to 

turn for help. As EFMP assistance for Nr Force families was in its infancy, we were referred by the Air 

Force to the State of Alabama (Department for Retarded Citizens) as Evan was viewed has having an 

"educational problem: The state of Alabama tested him, determined that he was delayed, and then 

provided speech therapy for him once a week. 

In 2009, we were.assigned to the Pentagon. The State of Virginia accepted Evan's IFSP, provided him 

even more therapy, and then provided us the bill. While services for an IFSP in Alabama had been paid 

for by the state, Virginia required parents to cost-share. While we absorbed this increaSing and 

unexpected cos~ we were finally given a referral to a developmental pediatrician at Walter Reed Hospital. 

Evan was diagnosed with autism spectrum disorder (POD/NOS) and we were told that he needed 20+ 

hours a week of ABA therapy to progress. Facing thousands of dollars in therapy costs,'we finally 

discovered TRICARElECHO. While it would not fully cover the 20+ hours of ABA therapy prescribed by 

the military doctor, it would help us provide 15 hours a week. At 30 months old, and atter only a few 

months of ABA, Evan said his first word. 

Evan is now five years old. Our move to Arizona was challenging. With a different view of POD/Autism 

than we found in Virginia, the first thing the school system did was slash Evan's speech therapy services 

(IEP) by over 50%. With ECHO-provided ABA therapy helping to fill the gap, Evan Still progressed. In 

May, he graduated from an inclusive preschool program and he will start kindergarten with his peers next 

fall. Evan talks, Sings, and loves to pretend he is a pirate; each new step representing a tremendous 

victory. 

We are, and continue to be, g.rateful for the TRICARElECHO program. While every state we mOVe to redefines "free appropriate public education" for Evan, the ECHO-provided ABA services have given this 

military child a chance to progress - no matter v.11ere we live. We will lose this benefit upon retirement 

from the military. As parents, we worry if our nomadic lifestyle has affected Evan's ability to succeed - a 

worry that will not end upon retirement from active duty. We ask that ECHO benefits continue to be 

available to our military child v.110 has served along With us - even after we retire from active duty. 

621pe113.eps

The Stones 

'Branch: Air Force 'Status: Both Active Duty (Join Spouse) 

'Awesome Warrior Kiddos: 

'Anna, 2 Y, 

-Katie, 3 months 

'Anna's Diagnosis: Angelman Syndrome 

-Severe neuro-genetic condition 

'Lack of speech 

'Slgnlficant developmental delays 

'Feeding difficulty (feeding tube) 

-Ufe threatening seizures 

'Lifelong care required 

'Our experience thus far 

'Alr Force works hard to accommodate our 

complex situation 

'Our concerns 

'ECHO benefits after retirement (including 

ABA for non-Autism diagnosis) 

-Childcare that can handle significant special 

needs 

'Post 9/11 GI bill transferability for special 

needs dependents 

-IEP transfer across states 
437 


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The Tarwater Family 

Bob, Adreanna, Nathan (12), . 

Currently stationed at Lackland Air Force Base, Texas 

Nathan was born with a rare chromosome disorder that has made him dependent on us for all of his care. He is 

medically fragile, nonverball uses a g-tube and is not able to walk or sit on his own. Addison and (aden were both born 

with cleft lip and palates. Both of them face a lifetime of surgeries and speech therapy. 

Concerns: 

Continuity of health care services for our children. 

o Nathan is followed by 17 spedalists and every time we move we have to start over with his health care. 

The nature of his medical needs makes it very difficult for a new phYSician to understand his needs 

quickly. We have moved three times since Nathan was born and each time, his health declined because 

of lack of continuity of services. 

Nursing services. 

o Through TRICARE, we receive 12 hours, nightly. However the remaining 40 hours are provided by the 

Texas Med icaid Waiver program. Nathan will continue to have the extra nursing support as long as we 

remain in Texas. Once we move we will be placed on the bottom of a waiting list for a waiVer program 

and potentially not receive services during a tour. It would be very detrimental for our family, as 

Nathan's.care is so intensive that we really couldn't keep him at home with us without the support. Our 

other children's lives would be impacted greater since our ability to leave the house or do anything as a 

family would be compromised. 

Ease of finding new resources In a new community. 

o Most EFMP workers do not have the knowledge of physicians, hospitals, nursing services, Medicaid 

waivers, SChools, organizations, etc. Each time we have moved, mo.st information we have obtained has 

come from other parents, and Adreanna has done the majority ofthe legwork in getting services set up. 

Respite care 

o Finding a.caregiver who can provide respite for all three of our children's' speCial needs has been 

extremely difficult. 

Diapers 

o Thankfully the Texas Medicaid waiver covers our diapers but, if we move from Texas, again, we are at 

the bottom of a waiting list. TRICARE should be covering them. 
438 


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The Babiarz Family 

Diagnoses: 

Our 9 year old son has Autism and our other son has Processing Deficits and Inattentive ADHD. 

Military Support System Struggles: 

ABA therapy is only covered under the ECHO program while service member is Active Duty. 

We are eligible to retire, but must stay active duty as long as possible to receive the needed ABA 

therapy for our Autistic child. This therapy has allowed our son to engage others in 

conversation and attempt to relate to the world. This therapy has lowered the frequency of 

violent outbursts, setting fires, and running away. We cannot do without it. 

Limited local service providers result in long waiting lists for Occupational Therapy, Speech 

Therapy, Pediatric Psychiatrists, and ABA Therapy. Appointments are often located at least one 

hour away from our horne. This means it is nearly impossible for the active duty spouse to be 

employed and maintain the medical appointment schedule. 
439 


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The Batchelor Family 

Branch: US Air Force 

Duty Station: Nellis AFB, Las Vegas, NV 

EFMJ> Category: Q coded Assignment 

Deferment' 

Children on EFMJ> program: Age 12, bipolar and 

ADHD; Age 10,' Severe autism, Mental 

Retardation,Silent Seizures, and No 

communication disorder; Age 4, reactive a.ilvvay 

disease, currently being tested for Behavioral 

Issues; Age 2, Pervasive developmental disorderNOS, traumatic birth injury among multiple health conditions. 

Nearly five years ago [joined the Air Force after a lengthy wait on the surgeon general to clear me for 

active duty because [had open heart surgery at three years old. After going through basic training and technical 

school, it was time to go to our first duty station. The day before it was time to leave we were told that we 

could not go to our projected assigriment at Moody AFB because they did not have the capability to care for our 

children. It took two months and countless times of telling me [ may have to retrain or possibly be 

administratively discharged to find a base for us. This was our first and sour taste of the EFMP program. 

Eventually we were assigned to Nellis AFB, NV and shortly after visited the EFMP office. This visit 

also left a sour taste in our mouth as we asked for local resources and were told, "Go ogle is your best friend." 

The EFMP program has improved very little over the past four years ofus being here but still does not provide 

resources, only a basic package with general information is available, and very little "Family Support is" 

offered here at Nellis. 

Tricare ECHO does provide applied behavioral analysis therapy for our 10 year old who is severely autistic 

and our 2 year old recently diagnosed with pervasive developmental disorder-NOS. However, they will not pay 

for a wheel chair or car sear for our 10 year old who has silent seizures that send him into fits of rage and he 

experiences loss of control ofhis bodily movements( in short he sometimes falls to the floor like dead weight 

hitting whatever limb is headed down first.) Also in crowded environments he becomes over stimulated and 

lashes out at anyone around him, restraints are needed in both of these scenarios and we had to buy one, paying 

out of pocket. We also tried to use ECHO funds or regular tricare to buy a car seat for our son which was also 

denied due to beirig considered a form of restraint Well our son got out of the back seat walked up to the fron! 

of our van and grabbed ,my wife by her hair while she was driving and she almost wrecked with ALL of our 

children in tow. We had to get one on our own as well. [also get aggravated that children the Autism ' 

Demonstration Program is not case by case. My son who is VERY severe gets the same as our 2 yr old who is 

NOT as bad. Why can't this be fixed and it be case by case to determine how many units/funding a child can 

get? Also why can't it be a service covered under Tricare instead of ECHO? Why can't ABA be extended (case 

by case) to ALL special needs children if determined it's needed? 

We have been able to get respite care for twelve weeks through the Airman and Family Readiness 

Center (because if we use the ECHO for respite then it takes a huge chunk of ABA funds awaY),after the 10 

year old was no longer allowed to go to give parents a break because he is not completely toilet trained "which 

is silly after they made a class just for him and a couple of other special needs kids." The problem is after the 

twelve weeks is over, we have to provide financial hardship in oroer to receive this service any longet. Another 

losing battle for us, and it seems like we are being punished because we have special needs children. Please take 

into consideration these issues not just for our family but all our past, present, and future members oftheArmed 

Forces. . 

621pe117.eps

loses: 

les and Earnesto have 

m. 

The Beattie Family 

Military Support System Struggles: 

* After 28 years combined service i

Navy, the Beatties no longer look 

forward to retirement. They lmow 

left worrying about how their son

lose services when they need them 

most, when they become school a
441 


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~g~~t~~~!:f:Jt~~~ a~~=i~~~;, ,::.;.:,: 

.~vlOL"er:'.""llicb~ncerned it waS rriore thm '. ~'OIID utciiti:d ·'.:Spe~thari,dtm~age .... , .•• ,'. : .·:qiJrrently a_happy, thriving, weUa<ljJSied 

! i':ReaChedoui to Stanford UniverSitY when ,'. :iGh<krg2rtep~':fuIry-~~ed:':';'-

(;""~ci':;IWai\3V-2·~' . ,', ,~. _.';'~~.;_/ 

621pe119.eps

Our hearts sank when Sara was 

diagnosed with Autism January . 

2011. 

For our little girl to reach her 

potential, the Developmental 

Specialist recommended 25 hours 

of therapy per week. 

We were shocked when we found 

out Trlcare does not cover ABA 

Therapy for Sara because we are 

a ReUred Military F am lIy. 

1 

I 

--:'"'i 

. i 

The Bryan Family 

Colorado Springs,. Colorado 

Jeff Retired Air Force 

Lisa Stay At Home Mom 

Sara 5 year old with Autism 

Our greatest wish Is' for Sara to 

happy and productive member 

society some day. 

The OPM recently confirmed w

medical team has told us all alo

ABA Is a proven medical therap

Autism. 

Our daughter deserves to have 

to prescribed therapies for her A

Including Applied Behavior Ana

Plaase help us give Sara and all military children with Autism every opportunity to "be all 

they can be" by saying yes to Senator Gillebrand's Amendment. 
443 


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The Cartwright Family 

BRANCH: us Army (retired) 

In 2006, Julia, age 2, was diagnosed with autism. She was 

. completely non verbal and had virtually no cognitive abilities. The 

diagoosing doctor, who was from the National Naval Medical 

Center, presc;nbed intense therapy targeting commllllicatioo and 

social sldlls development of 15 hours per week of ABA therapy. 

This is their story. 

We requested authorization from TRICARE to cover the expense 

of the ABA therapy the diagnosing doctor had ordered for our 

daughter. That's when we discovered that ABA therapy was not 

available through the basic TRICARE prime program we bad. ABA therapy was available to active duty military through 

the TRICARE ECHO program but r, as a military retiree, was not eligible for ECHO and thns coverage fur my daughter for 

ABA therapy was doni.ed by TRICARE. 

We had to foot the entire ABA therapy program. For the last six years, we have paid from $35,000 t~ $50,000 per year out 

of our pocket for Julia's ABA therapy. This huge outlay for our daughter's therapy has forced our family into a financial 

crisis and curtailment of all of our family plans - at the same time we have had to deal with the tramna of having a child 

who suffers from the devastating effects ofautism. As devastating as the financial effect of paying for ABA therapy is, 

there are other effects of having ao autistic child in the family which are indescribable to any fumily who has not 

experienced it personally. Autism is worry. Autism is despair. Autism isfear for the future of your child 

Julia has or had a number of symptoms of autism in addition to not being able to talk. Julia engages in frequent tantnnns. 

Often the tantnnns are minutes, or seconds apart and can last 20 minutes or longer. Julia's tantrums are characterized by 

crying and shouting at the top ofhee luogs, accompanied by hitting, kicking and spitting. 

We have to watch Julia constantly becallile she picks at wouods on lIerself-and on other people. If Julia secs or feels a 

wound of any kind on herself - or on anyone else, she will quickly lance and dig at the wound. We have had put socks on 

hee hands at bed time to prevent her from doing damage to herself 

In the past, Julia frequently ran away from us. In spite of our best efforts to watch her every second; there have been times 

when we turned our heads for a mom';"t. On one occasion. at a mall, Julia was completely oot of the sight ofher desperate 

mother fur 20 minutes. Her mother finally found the Julia 7'. of a mile from where she first ran away, and she was still 

running. Real fear is losing sight of your beloved child who has no means to protect herself 

The results of ABA therapy which we paid for out of pocket are noth.ing short of dramatic. Since kiodergarteo, she has been 

in !)pica1 classes aodjustpassed seccnd grede. She scores at or in advance of her grade level in all subjects and reads at an 

advanced level. She still has communication, social and cognitive problems associated with her autism fur which she 

continues to receive ABA therapy but now, at age eight, Julia limctions near that of a nenrologically typical child. 

Julia's progress would ·not have happened without ABA We are members of several autism organizations and have regu1ar 

contact with many other families which have autistic children. The children we know who have autism and have had no 

ABA have made little or no progress in being able to commllllicate, relate to their family or peers .and have few if any life 

sIdJ.1s or cognitive abilities. 00 the other hand, if they had ABA theraPy at an early age, they, like our daoghter have 

demonstrated reIllllIkable progress. 

It my fervent hope you will reccgnize the medical necessity of ABA which is supported by the Surgeon Gen..-aI, Nlli, 

OPM and professional associations such as the American Academy of Child and Adolescent Psychiatry. 
444 


621pe121.eps

the Chafoses and our Zachary: 

We are a military family living on Fort Meade in Maryland. We are blessed 

with three beautiful boys: Andrew, age 12, Zachary, age 10, and Anthony, 

age 2. My husband, Colonel Timothy Olafos, is an active duty Army officer 

who graduated from the Army War College last weekend and is deploying in 

two weeks to Afghanistan for one year. We enjoy serving our nation as a 

military family and we feel fortunate to give our children the fantastic 

opportunities we have experienced with the Army. 

Our middle son, Zachary, was diagnosed with autism at the age of two in 2004. We struggled to understand 

what he needed when we" began our journey. Shortly after Zachary started Early Childhood Intervention 

services, my husband deployed to Iraq for one year. I.had to navigate the complicated world of autism 

alone. Through lots of research and phone calls, I started Zachary on an intenSe schedule of speech therapy, 

occupatlonal therapy, and behavior therapy in addition to educational services. OVer the years, my husband 

has been able to manage his Career so we have been able to stay in the D.C. area to keep our family" 

stable. Zachary has flOUrished and thrived and we are happy with his progress. I believe a lot of his progress 

is from Applied Behavior Analysis (ABA) therapy. Although we have had to navigate a very complicated 

TRICARE system and have had numerous therapists over the years, Zachary has done very well with intensive 

ABA therapy after school each day. 

Achieving the proper educational services for Zachary is one of the most significant struggles we have 

faced. Our local schools have failed to provide appropriate modifications and services required under Zachary's 

Individual Educational Plan. We had so much trouble in our school on Fort Meade that we hired an advocate to 

attend all of our meetings and fight for our son. This past school year, after Zachary was forced out of our 

local school we had the gQod fortune to place him in a fantastic non-pUblic setting where the teachers are 

specifically trained for autism and he is doing very well. Zachary attends the Kennedy Krieger School in 

Baltimore. We know of many military families around the country with autistic children who have faced similar 

challenges. The militarY provides little help in navigating the complex world of autism, education, and therapy. 

When my husband returns next summer from Afghanistan, we will be moving to San Antonio, Texas so he can 

command a brigade there for two years. While we are excited for this great career opportunity, I am very 

nervous about moving our son. We have Significant COncerns about achieving appropriate school placement 

and support, as well as delivering the therapies Zachary needs. 

We clearly see the benefits of ABA therapy and pray it remains covered under TRICARE. My husband's tlme 

left in the military is limited; our son will almost certainly require continued ABA therapy after his retirement. I 

request that you make ABA therapy available to active and retired families so we can provide our son with 

continued care after my husband finishes his military career. I am not sure what we can do about the 

" struggles we face with our children and their educational needs, but there is definitely a lot of room for 

improvement in educational policies, approaches, and resourcing for children with autism. Our schools are 

failing our children miserably, the scale of the problem is growing. Military families face particular challenges, 

as continuity of serviceS is extremely difficult to maintain and detailed knowledge of local school services and 

systems is difficult to attain. 

Thank you for your time. Cheryl Chafos, Army Wife 
445 


621pe122.eps

I am Rebeka Edge the mother of4 and a Board Certified Behavior Analyst. My Husband is an Lt Col and 

a Pilot in the USAF and we are the proud parents of 4 beautiful children, all with developmental 

disabilities. Our oldest, Corbin is diagnosed with High functioning autism. Magnola has a learning 

disorder, dyslexia. Uly-Anne had a significant language delay and our youngest son, lett, is severely 

dyslexic and was recently diagnosed with PDD-NOS, a pervasive developmental delay, which is on the 

autism spectrum. 

I am the owner of Behavior Matters, a company that provides Behavior Analytic Services. We work to 

improve the lives of children and young adults using this behavioral science. Between my 12 therapists, 

and myself we are privileged to serve 28 families in the state of Alaska. We work with individuals up to 

12 hours 1:1 weekly to teach functional skills that reduce aversive behaviors including injurious ones to 

themselves and others while teaching life improving skills such as functional communication, daily living 

skills and social skills. Another facet of this program is to collaborate with the parents so that programs 

and interventions continue after therapy. 

Every week I receive calls from veteranfamilies inquiring about Applied Behavior Analysis ABA and 

funding options. I have talked with families as to how these services can be extended to children. At this 

time there are no funding options for families that are not active duty military dependents. 

By providing training and consultation to families, we will improve the quality of life for the individual, 

the families and ultimately the community. The training will also significantly reduce the risk of moving 

to a more restrictive and more costly environment. 

These children and adults, ir'cluding my own, are counting-on- you to provide our children with ABA 

services after we retire. Our country needs a program that provides individual-specific training and 

ongoing consultation. It will enrich the country and provide for our veterans, in that it will return dignity 

to individual, provide hope for the family, and help to build a work force that will have specialized 

training in developing and implementing programs to effectively deal with challenging behaviors. 

Sincerely, Lt. Col.Jarrett and Rebeka Edge 

621pe123.eps

THE FISHE' FAMILY 

Good afternoon. My name Is Katja Kox-Fishe' and I've been an Army wife for 15 years. When our son 

was 3, he was not really speaking yet and had many meltqowns. At the time we were stationed In 

Germany, my husband Charles was in Iraq and I was pregnant with our daughter Kinzey. I can tell you 

this was a very trying time for-our family. It took me about a year to get Quinn 'an autism diagnosis, en

in the Exceptional Family Member Program and the military insurance Tricare Echo which pays for ou

son's ABA therapy. ABA therapy, also known as Applied Behavioral Analysis, is the only scientifically 

researched and proven therapy for children with autism and is recommended by the American Assoc

of Pediatrics. Quinn is now 7. He is able to have a conversation, has no meltdowns and is on grade level with some 

special education support In a 1st grade inclusion classroom. We still have a way to go to overcome h

language and social delays but he has also come such a long way which I can only credit to ABA. 

In a year my husband will have 20 years of service. Being faced with the fact that once we retire we w

lose Trlcare Echo, retiring is not an option for us. We are proud to be an Army family' and feel very taken care of by the Army. It is a life unli

any and we accept the challenges, the separation, the uncertainty, the deployments. But when our children are affected that is not a sacrif

should be expected to have to make. 

Unlike civilian special needs families, military families are at a disadvantage with a lack of continuity for their special needs children faced w

waltllsts for specialists and therapists, varying levels of support from different school districts, years long waitlists for Medicaid waiver serv

for ABA. Military special needs children have to start all over again with every move with new therapists, new schools, new teachers and 

hopefully new friends. If teachers were trained in ABA then we could rely on schools to provide this service but until a law Is passed to train 

teacher in autism best teaching practices we are thankful to have Tricare Echo to provide ABA. So I ask to please close this loophole for ou

military special needs kids and extend ABA coverage to our Wounded Warriors and other military retired and Guard/Reserves families. Tha

you for your attention to this important issue. 

Katja Kox-Fishe' 

katjaworld@hotmail.com757-6036903 
447 


621pe124.eps

My Autistic daughter Morgan 'is high functioning, and like other Idds on the spectrum she has several other diagnosis' in 

addition to Autism. She is learning disabled, dyslexic, has an expressive language delay, suffers from anxiety and severe 

·ADHD. Ufe with Morgan is filled with challenges that add to the already unique lifestyle of a Navy family. 

Morgan was always'different She didn't have the "normaln Autistic symptoms. W~ went thru several physicians In 

Central Califomia trying to discover what was going on with our little girl.. At age 6, captain carol Forrsell, a 

Developmental & Behavioral Pediatrician from Portsmouth VirgiIJ1a, was temporarily assigned to Naval H?spital 

lemoore, We were luck enough to get a highly coveted appointment After listening to our concerns, reading the 

reports from school testing, and examining Morgan, she changed our lives forever with the diagn~sis of Autism. 

I expected Autism to change our lives. What I didn't expect was the many hats rd have to wear to ensure Morgan's 

equal treatment and appropriate education •. , have had to become a lawyer, a teacher, a therapis~ an advocate. 

In 2009, I had to leave my job after Morgan was diagnosed as the CDC and Youth Center at NAS Lemoore do not have 

staff specifically qualified or trained to care for special needs childr~n. We travel 80 to 800 miles round trip for medical 

care. Sometimes severa! times a week. There are no Behavioral Pediatricians at the Naval Hospital. The nearest one is in 

San Diego. Our Occupational and Speech Therapy providers are located in Fresno, 47 miles away. Our Applied Behavior 

therapist travels from over 30 miles away. Our pediatrician has recommended we leave califomia's Centra! Valley as they 

are considered to BR 10-15 years behind other areas in providing services for Autism. 

The schools here on station, while state distinguished schools, lack the funding and knowledge needed to teach Morgan. 

Her dyslexla is ignor'ed and last year she was struck in the head by a substitute tea~cher, in an attempt to redirect her 

attention~ t have been asked to provide solutions for problem behaviors, ratherthan the trained district Psychologist and 

I must keep abreast of new legislation and law, to ensure the school provides Morgan1

s accommodations. 

I've had to do all of this in addition to caring for my other daughter and my disabled spouse, who is currently recovering 

from back fusion surgery, a result of injuries he sustained as a F/A .. ,1S mechanic, and has suffered from for almost 10 

years. This year we are faced with the possibility that his career may be over. What is mostfrighteni~g is not an end to 

his military career, but the fact that ifhe is medically retired from the military, oyr daughter will lose our ABA therapy. 

This therapy has changed our lives for the better and the chance of losing this life altering therapy keeps me awake at 

night. 

ladies and Gentiemen~1 urge you to make the necessary changes for our Military families. Our men and women in 

uniform puttheir lives on the line to defend this great nation. Knowing that their family members at home are receiving 

the needed care and support. allows them to fully focus on the mission. Most importan~IYI the diagnosis of Autism does 

not disappear when the military,member leaves service. Ending ABA is a crushing blow to these families. I implore you to 

cOl")tinue to improve the quality of life for military families with special needs and to extend ABA coverage to all military 

families and retire~, not just Active Duty. 

Health & Happiness, 

""Sara Gain-
448 


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6-17-2012 

Information for the Senate Armed Services Subcommittee on Personnel: 

We discovered ABA therapy for our autistic son, Andrew in 2000. By the time we were 

approved for services, it was 2010. This benefit provided some amazing therapy for our SOD, 

even at the age of 18! We observed encouraging progress. Sadly, that summer my husband 

retired from active duty and we lost the ABA benefit. We were so discouraged to learn that 

being retired meant the end of ABA therapy for our son. Families should not have to fuce that 

reality. A child receiving a proven and effective therapy, should be able to receive that therapy 

regardless oflocation or his parents' military status. 

We ask that you approve ABA therapy as a medically necessary therapy for all service members, 

whether active duty or retired. Our children deserve the best the medical profession has to offer. 

Sincerely, 

Mary Beth Geringer 
449 


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June 17, 2012 

To Whom It May Concern: 

We are a military family living near Eglin APE. My husband is an active duty soldier 

in the Army and prior to having children I worked as an ABA tutor for individuals 

with disabilities, primarily Autism; however I gave up that roll to become a full time 

mom.. Marissa is our 3 year old daughter and happens to have Down Syndrome. In 

addition to Marissa we have twin boys (Ben and Brayden) that are 19 months old, 

one of which has a speech delay. We had no idea that Marissa was going to be born 

with something extra special, but we have been blessed beyond measure having her 

in our lives. Due to her being born with a heart condition we were re-routed to Fort 

Bragg North Carolina, which was a location better equipped with a variety of service 

providers to help care for Marissa. 

We immediately enrolled Marissa in North Carolina's early intervention program, 

which included a developmental therapist, speech, occupational, and physical 

therapy. Not all the services begin upon our arrival, each happened in their own 

time. Given my background with ABA, I wanted to get her connected with an ABA 

tutor and I was elated to learn that Tricare offered a supplemental insurance for 

individuals .with special needs that approved ABA services. I had no previous 

experience with Tricare Echo, but found that Marissa's enrollment into the program 

was fairly easy once all the necessary paperwork was gathered and submitted. The 

case managers took their time to explain the program and ensure I felt comfortable 

with the information 

Roughly, by the time Marissa was 20 months old, she was receiving ABA therapy 

through and incredible provider, Creative Consultants, whom we were referred to 

through Tri'care Echo. Our provider took great care in developing and implementing 

a plan using an approach to increase verbal and communication skills. Sign 

language, PECS, and verbal skills were taught to increase my daughter's ability to 

communicate with her family and people within the community. Although we have 

be reassigned to Eglin AFB, we continue to receive ABA services through another 

provider, which continues to work on improving Marissa's verbal skills. 

Marissa is an amazing little girl. She has a spirited personality and a smile that can 

light up any room. Although each targeted therapy has played a role in her 

continued success, I strongly·believe that much.of the credit is due to our ABA 

providers and their constant diligence in updating her goals and plans to ensure 

continued growth and success for her long term future. There is not a doubt in my 

mind, as a parent and a professional, that Marissa would not be as far along as she is 

without the services that have been available to us through Tricare Echo and the 

offering of ABA services. I can only hope. these services continue to be offered. 

Very sincerely, 

Patricia Heath 
450 


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621pe128.eps

The Love Family 

u.s. Army Special Forces 

.. ' .. Cl Have 2 Children with Autism 

fJ; Patrick age 10 

" Conner age 3 

o North Carolina Does Not Recognize Educational or Medical 

ABA Therapies 

r.I Patrick regressed In the public school environment 

n ABA is the ONLY treatment that both LO'le boys 

respond to 

o Significant Debt Incurred to Cover ABA Therapies Not 

Covered by TRICARE 

1;1 Patrick medically prescribed 30·40 hours per week 

El Parents mortgaged home to save Patrick from being 

institutionalized 

DAfter 9 Years at Ft Bragg, the Loves are currently in the 

process of a PCS to Camp Blanding, FL 

o Medicaid Waiver is NOT portable across state lines 

1::1 Patrick will loose a crucial component that he has 

had for almost 6 years 

;:l Parents told that Florida's Medicaid Waiver waitlist is 

apprOXimately 10 years . 
452 


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The McCall Family 

Branch: U.S. Anny 

Stationed: Ft. leavenworth, KS 

• Eldest son, Kyle (6), diagnosed with POD-NOS and ADHD. 

• ABA provider is headquartered in Missouri and has difficulty fulfilUng our 

recommended weekly therapy hours. 

• Respite tare has become Impossible to coordinate since December 31, 2011 

with new stringent requirements and reduced wages for our previous 

respIte care providers. Under the current circumstances, they are no longer 

wliUng to w.ork. As a result, we have not had respite care since the New 

Year. During this time, my husband had extended TOY for 6+ weeks. 

• SodalskJl1s groups are non-exlstent in our area yet these skills afe altlcal 

building blocks that my son needs to practice frequently and master in 

order to be successful ilnd accepted In society. 
453 


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The MeDon Family 

CDR Frank. Mellott, USN Ret., Sheri Dyas Mellott and children 

Alex, Nathaniel and Francesca 

During our last Z4 months at Naval Air Station Lemoore (CA) ••• my 

husband's last Z4 months on active duty ••• all three oi our children 

were diagnosed with special needs. It was a blow to the family like we 

have never experienced nor ever could have imagin~. Our dreams for 

the future began unraveling faster than we could anticipate. 

• July :&007 - Alex (age 10) diagnosed with Aspt:'rger Syndrome 

and with severe OCD U months later, now also suHers from 

PTSD due to " years of bullying in public schools, no early 

intervention and no behavioral therapies like ABA 

• February :&009 - Nathaniel (age 10) diagnosed as going blind in 

one eye, due to amblyopia. Eye doctors missed the diagnosis at 

age ~, 4 and 5 when surgery would have been recommended 

• June :&009 - Franc:esea (age 5) diagnosed with Autism after 

many other diagnoses to include phonologic:al disorder and 

severe verbal apraxia. A year later, OCD diagnosis was added. 

Between March 2008 and September 2008, we spent more than $80,000 

oi our :&0+ years oi retirement savings in a Due Process fight to acquire 

spec:ial education services for Alex in the public school system. 

My husband retired in June :&009, one week after Francesca's 

diagnosis, and after Z3 years in the Navy, so that our fami1y could find 

appropriate educational and medic:al services lor aU three 01 our 

children. 

621pe131.eps

The Nielsen Family 

Diagnosis: Robyn has Sheldon Hall 

Syndrome - a variant of Arthrogryposis 

Difficulties within the Military Treatment 

System: 

Therapies and equipment approved in one 

Tricare region then denied in a different Tricare 

region. 

Equipment that is necessary for Robyn to be 

mobile took 8 months to be delivered. Parts of 

that equipment necessary for function (wheels) 

were denied and a work"around had to be 

found. 

Positives with Military Treatment System: 

Our Pediatric Orthopedist, Major Jefferson Jex 

has fought for us every step of the way for 

everything Robyn needs to be successful in her" 

treatment, including getting her to see the 

premier Dr in the Country for consultation on 

her treatment. 

621pe132.eps

The Nielsen Family 

Branch: US Navy 

Duty Station: Branch Health Clinic Washington Navy Yard 

EFMP Category: 5 

Our story: Robyn was born at Tripier Medical Center, Honolulu, HI. She 

was immediately diagnosed with Arthrogryposis. We met with Major 

Jefferson Jex to determine a treatment plan. He has been with us ever ste

of the way. When he needed a second opinion about our treatment plan h

fought to have us sent from Hawaii to Shriner's Hospital Philadelphia to se

the expert in Arthrogryposis, over all of the hurdles the Military put in fro

of us. 

When he was transferred here to Walter Reed National Medical Center, he 

made sure we were able to transfer with him to continue her care as 

Arthrogryposis is a very rare disorder effecting 1 in 10,000 children. Here 

the Capitol Region we have started having trouble getting the braces and 

equipment we need to continue her care. These braces and equipment w

know would have been approved had we stayed in Tricare West. 

There is a large difference between Regions within the Tricare system for 

what is approved from Region to Region. What we would like to see if the 

same set of rules across all Regions so when a family PCS's we know the 

care our family members are receiving will be available. 
456 


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Jeremy and Scott: My wife Julie forwarded me your email- you'll see below that I'm writing this from 

Afghanistan. Here's my input - hope you use it. I've also cc'd Ms Jean Winegardner, Washington TImes 

writer and advocate for military families rights; CSM(USA ret) Jim Hussey and Nancy Bobbitt, military 

assistants to US Senators Chambliss and Isackson. I'll keep the prayers going. Lastly, Scott, I hope that 

your treatments go well and you're given a clean bill of health. r/ OJ Reyes 

TO THE SENATE ARMED SERVICES COMMITTEE FOR PERSONNEL: 

I am honored to ~ndorse your·passage of this most important piece of legislation that ultimately and 

positively impacts the morale and health of our military force and their families. 

For context, I am currently on a one year deployment to Kabul ~fghanistan and will complete my tour 

next month. Prior to deployment, I commanded the National Security Agency - Georgia (NSAG) which 

continues to provide critical intelligence support to the·Global Fight against Terrorism. I've briefed 

Senators S·axby Chambliss and Johnny Isackson several times on the great accomplishments ofthis 3.5K 

military, civilian, DoD contractor, and allied (UK, AUS, NZ, CAN) force. 

I attached a picture of my family the day after I relinquished brigade command in Georgia. My wife Julie 

and I were blessed with triplets - they were born in Cambridge, UK, while I was commanding the US 

European Command Joint Analysis Center, circa 2005-2007. Immediately upon relinquishing command, 

I redeployed to Iraq for another 1 year combat tour. 

I shate these facts with you because in addition to the "normal" stress of constant deployments while 

managing multiples, my wife notified me that our son Christian was diagnosed with autismwhile I was 

deployed in Iraq in 2007. Long story short, through persistent education, networking, advocacy, and 

Faith, my wife has been thus far able to 'cobble together' a program oftherapeutic support for my son. 

It has not been easy - at times it has been downright difficult and emotionally turbulent - but like any 

military family, we persevere, we adapt, we overcome. 

I won't lie to you. Statistically, autism appears to be more than just an nuance issue. There's something 

terribly wrong and it's permeating through our military families. It's putting a tremendous stress on our 

troops, both deproyed and at home station. It's affecting morale. I saw it as a former brigade 

commander running the Unit Exceptional Family Member Program, and as an active member of the local 

Autism Now Chapters in Georgia. And more importantly, as a parent of an autistic child. 

The next issue you're confronting is that of military servicemembers who are retiring or are retired with 

children who desperately require continuing autism therapeutic support programs. I strongly support 

your approval of support that continues through active duty service in into retirement. In addition to 

the obvious finan.cial aspects of support, I believe that it sends the right strategic message to our troops 

- we never leave a fallen comrade on the battlefield, and we will never leave a fallen comrade's family in 

their time of need. 
457 


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621pe135.eps

The Serna Family - A retired military family 

Nicholas Anthony Serna retired after 20 years of service in the U.S. Army In-2007. Our son Bryson was born In 2003 and diagnosed with 

autism when he was 6 years of age in 2009. Bryson lost all his speech between 18-24 months of age and was non-verbal until he was nearly 6 

years old .. Life as an active duty family can be challenging with deployments, international moves and stress, but nothing prepared us for the 

stress and hardship our family faces daily. Ourfamily receives NO support because we are a retired military family. We need our son Bryson to 

be eligible to receive ABA therapy, a medical necessity, through Tricare. Don't let Bryson's smiling face in the pictures Iielow paint the wrong 

picture. Beneath the smile is a lot of hurt and sadness because he can't communicate very well, because he doesn't have the abilities to make 

and maintain friendships, and because he has to spend countless hours working hard to achieve things that come very easy to others. Bryson 

needs ABA therapy to improve his speech / communication skills, his social skills, his self-help skills and his academic abilities. Bryson needs ABA 

tlierapy in order to be able to live independently one day. Retired CW4 Nicholas A. Serna served his country for 20 years; now his family needs 

help and support. Please suPpo.rt our retired military family and please support Bryson and all the other military children affected by Autism 

who will need support past the active duty days. 

Sincerely, 

Retired CW4 Serna, Fabienne Serna, Bryson Serna and Sarah Serna 
459 


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The Stockwell Family 

We are an active duty Air Force Family living in Colorado Springs, CO. 

Our son Tom was diagnosed with moderate-severe autism in 2009, one month before a PCS. 

Almost had last competitive in-re,sidence school opportunity cancelled because of lack of 

services at Air University location. 

PCS'd to CO in 2010. PCS initially medically declined because of 'lack of services' (one month 

prior to p.CS), but information held by SGH was Incorrect. Denied because of lack of '25 hours of 

ABA per week', medically recommended for our son. Tricare covers approximately 12 hrs per 

week. Using this rationale, we could not have PCS'd anywhere. Eventually got decision 

overturned and PCS'd. 

Services don't share information -Colorado Springs is a Compassionate Reassignment location 

for Army. AF were denying clearance. 

Our family did EFMP/SGH work for them - they had incorrect information and were unhelpful, 

as we we.re preparing to PCS from IDE at Maxwell to a competitive leadership assignmentVERY STRESSFUL 

Our son is now thriving. With ABA therapy and great schools in Colorado he is preparing to 

transition to kindergarten and will be mainstreamed. 

ABA therapy has been a huge part of his improvement, giving us hope for his future and 

independence. 

621pe137.eps

The Wales 

oBranch: Air Force· 

°Status: Husband, retired (22 years), wife forced to 

get out of USAF after 14 years to care for son 

oAwesome Warrior Kiddo's: 

-Zachary, 15 

-Alexander. 12 

oAlex/Zach's Diagnosis: X-linked 

Adrenoleukodystrophy 

-Rare brain disease, destroys myelJn sheath In the brain -No cure-after 6 years of age, bone marrow transplant 

will slow the progre!islon 

-High doses of Cherno pre-transplant 

-Disease speeds up until transplant takes hold 

-Eyesight, speech, mobility affected 

-Alex recelved transplant In July 2009-105t the above 

attributes and Is now quadriplegic 

-Requires nurses In home to monItor at night 

-lifelong care required 

oOur experience thus far 

-Dept of the Air Force works hard to accommodate our 

complex situation 

-Our concerns 

·Trlcare Prime Benefits at risk-medicaid benefits at 

risk 

-Schooling that can handle special needs, specialized 

clinical services not available In mmt m11ltary areas 

·Post 9/11 GI blll transferablllty for special needs 

dependents 

-IEP transfer across states-need forTrlcare to provide 

better long-term benefits for chronic patients and their 

families 
461 


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The Walker Family 

Branch: US Army 

Duty Station: The Pentagon 

Eighteen years of active duty service, eight duty stations; six with our 13 year old 

daughter, Madeline and five with our 11 year old son, Ethan. Both children are enrolled 

in the Exceptional Family Member Program (EFMP). Madeline was diagnosed at the 

age of four with severe ADHD, GAD, Allergic Rhinitis; and at the age of nine 

Eosinophilic Esophagitis. Ethan was diagnosed at the age of 20 months with severe 

Autism, Sensory Integration Dysfunction Disorder, Auditory Processing Disorder,severe 

Allergic Rhinitis and Environmental Allergies. 

Our 'daughter is doing well a~d our primary focus is our son and his services. Ethan is 

mostly non-verbal and requires 24 hour supervision. Ethan requires a specialized diet 

(gluten, casein and soy free), HFCS free, peanut free and no artificial colors; flavors or 

preservatives. He requires specialized classrooms to include ABA, OT and Speech. 

Ethan currently has a military PCM, an autism clinic and a pediatric allergist and 

immunology specialist that is non-network (not covered by Tri-Care). Ethan is treated 

with allergen extracts for his environmental allergies which subdues inflammation and 

greatly improves his behavior. Inflammation is a direct cause that leads to violent 

outbursts and self-injurious actions in Ethan. Ethan has been receiving home ABA since 

2008. We cannot express enough the positive impact the home ABA services have had 

on Ethan's quality of life. 

Our Concerns: 

• Our greatest concern is the loss of ABA services after retiring from the military 

• Better coverage from Tri-Care for non-traditional treatments that have proven effective 

• MEDICAID services that transfer from State to State for active duty family members 

• Enrollment in EFMP programs such as Respite Care that transfers from duty station to 

duty station without requiring reapplying and being put on a "wait-list" 
462 


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The Samuels Family 

BRANCH: us Navy 

DU1Y STATION: NAS Fort Worth JRB 

EFMP CATEGORY: 5 

Kaitlyn Samuels was bo"rn with severe brain abnormalities which resulte~ in severe global developmental 

delays, cerebral palsy, scoliosis and a seizure disorder. The family has recently experienced a long and costly 

battle with Tricare regarding physical therapy coverage for their daughter. Kaitlyn is now 15 years old. Here is 

their experience: 

Kaitlyn has received physical therapy utilizing a horse as a therapy tool since 2005. These services were 

covered by Tricare until 2009. All physical therapy notes documented the use ofthe horse. These notes were 

requested and received by Tricare prior to claim approval. In 2010 Humana Military determined Kaitlyn was 

receiving "hippotherapy" and not physical therapy. It is important to note Tricare does not exclude 

hippotherapy. in fact, the term is nowhere in the Tricare manual or website. Given this fact, plus the previous 

payment of services., we had no reason to question coverage. In 20010 Humana Military began denying claims 

and subsequently recouped all funds they had previously paid. We returned the funds to Humana Military, 

paid the therapy center for all outstanding therapy sessions and appealed the decision of Humana and later 

TMA. After lOSing those appeals we hired an attorney and were granted a hearing on February 10,2012. 

Kaitlyn's physical therapist and neurologist both testified on our behalf. Our attorney was told by the judge, 

Claude Heiny, that he liad turned his decision over to TMA on March 30th. Today is June 14, 2012 and we still 

do not know the outcome. According to Judge Heiny, DOD policy is for his deciSion to be released with TMA's 

final decision. There is no regulation requiring TMA to release its decision within a certain time frame. TMA is 

accountable to no one. TMA makes the rules and TMA enforces the rules. This is a disturbing situation. We 

followed the proper procedure required of us as beneficiaries, but there are no procedures to ensure TMA 

meets its responsibilities. Unlike Tricare1 private insurance companies are regulated. The situation we 

experienced would not have been possible with a private insurance company due to those regulations. This 

situation has cost us a great deal of stress and money and a loss of services for our daughter. At the very least 

we deserve to know the judge's findings. The fact that TMA is taking such a great deal oftime to come to a 

final decision suggests that the judge may have likely found in our favor. If not, their delay is only exacerbating 

a very stressful situation for our family. 

Jennifer Samuels 

.,,£ _ _ L 1n ........... ... 

621pe140.eps

ut Ryan: 

gnosed at 26 months 

I PDD-NOS 

'ifferent Addresses with 

. different schools in 8 

"s- 3 of those schools all 

lin the last 3 years 

month regression with 

1 move 

The Vetter Family 

Struggles: 

-Constant moving has 

disrupted development, and caused significant 

regressions 

-Husband's career has 

been affected by limited bases we can go to. 

-Continuing legal battles 

. with various school 

districts to get my son 

appropriate support in 

. school. 

Ryan (8, Autism), Jodi (36, AspergersjDisabled Veteran), 

Sophie (6, gifted), Shane (Active Duty) 
464 


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The Vitaliano Family 

Branc.h: us Air Force (Active Duty) 

DUty Assignment: Joint Base McGuire-Dix-Lakehurst 

Advocacy Initiative: 

1. Common bench-marked EFMP support services across a!lservices of the DOD. A family should not have to' consider 

leaving their chosen servi!;e to get better service in another branch of the military for their EFMP dependant. 

2. Benchmark of successful.EFMP programs. Why re-invent the wheel when we h"ave programs out there that work? Lets 

capture those successful methods/programs and replace failing programs with them across the DOD. 

3. Modification ofTR1CARE ECHO to continue supporting into retirement. Our children never asked for their disabilities but 

they are demanding the best care possible especially considering the sacrifices their military sponsor's have made over a 

20+ year military career. 

Our son Spence was born prematurely at 26 weeks gestation while stationed at Kadena AB, Japan on 22 December 2006. The cause 

of his prematurity was a genetic defect (chrQmo~omal deletion) which went undetected during his prenatal care. Following his birth 

he Was admitted to the NICU at lester Naval Hospital in Okinawa, Japan where he experienced a severe hemorrhage to his brain on 

his 3rd day of life. The bleed damaged his pituitary, hypothalamus, and optical nerve resulting in a diagnosis of Cerebral Palsy, 

Central Diabetes Insipidus, and Cortical VIsual Blindness to name a few. During his stay at lester I worked diligently with the Kadena 

EFMP staff to get a reassignment for Spence's long term care. Prior to his birth we had an assignment In-hand to Hurlburt Field, FL 

however, they were unable-to support his needs. We submitted EFMP Facility Determinations to Kirtland AFB and Little Rock AFB 

both of which were denied. 

After being stabilized at Okinawa for approximately a month he was transported by an NICU transport team via C-17 to Tripier Army 

Medical Center in Hawaii where he received laser eye surgery for his Retinopathy of Prematurity and continued care. During his stay 

at Tripier I continued to work with the AF EFMP Division at AFPC (Randolph AFB, TX) through my close friend and AF Functional 

Manager (SMSgt (ret) Ian Wightman). Since I was presently assigned to AF Special Operations Command they worked feverishlY to 

keep me within the command due to.my special qualifications & experience level however, it was,to no avail. It was later 

determine~ after direct consultation with little Rock AFB that they could in fact accommodate Spence's medical needs through the 

Arkansas Children's Hospital in UttJe Rock. At this point I received formal EFMP orders'to the 314 AW at Uttle Rock AFB. 

Two months into his stay at the Tripier N1CU, Spence experienced a severe medication overdose at the hands of one of his NICU 

nurses. I petitioned the chief phYSician to transport my son to our follow-on assignment in Arkansas, where he could get civilian 

care and we could prepare a home for his eventual discharge. Wtth his approval, they coordinated another NICU team to transport 

Spence via C-$ through Travis AFB and then transferred him on to a civilian Gulfstream aircraft where a dvilian team completed his 

transport to The Arkansas Children's Hospttal (ACH). Upon arrival his quality of care improved by 3-fold. The staff was immediately 

able to diagnosis him with Diabetes Insipidus {this had eluded all of his previous neonatologists}, established a nutrition plan, and . • • , - _~L ____ .. , _____ +-h , .... ·HIlt- "'''''' ..I .. .,. .......... i ... c. ... +h .. + "h. In'" n\"rpmpnt w::tc; 
465 


621pe142.eps

necessary to control his worsening hydrocephalus. After the shunt placement, his condition improved substantially and he was 

discharged 2 months after a·rrival and approximately 5 months after his traumatic birth in Oldnawa, Japan. 

During Spence's course oftreatment in all ofthe various hospital, I have consistently received amazing support from my 

commanders, supervisors and coworkers at each location. I was afforded a great deal of leeway with duty status and permitted to 

remain with my son daily in lieu of reporting for duty. I without a doubt, am deeply grateful to the commanders and supervisors 

who allowed me to be a part of my sons ongoing care. It's because of my ability to provide continuity of care, remain actively 

involved, and advocate daily for my son that he continues·to receive some of the best care in the world. 

Unfortunately our story is not without its share of problems mostly due to the shortcoming of the Air Force EFMP Program and my 

sons overall condition. Many months after our arrival to Arkansas, we determined that the EFMP paperwork completed by the 

neonatologist in Okinawa was inaccurate and failed to identify the complete medical needs of our son. As a result we were assigned 

to a location that did not have the ability to provide the full range of services required for a medically compl~x child such as Spence. 

It's unfortunate that when I reflect back on all the rushed coordination I did before leaving Kadena to get the EFMP process started, I 

recall being very alone and without any guidance. I recall the Kadena EFMP office telling me they're EFMP Coordinator has PCS'd 

and that the new guy wasn't trained. I also recall repeatedly being advised of how difficult the process would be and how I couldn't 

get the paclcage completed in less than two weeks (it was done in 6 days). While we were in Hawaii, I called back to the Kadena 

EFMP office for support and they refused to assist me stating.. I was no longer within their area {how horrible of a person can you be 

to leave a family such as ours stranded in the system, without any support or semblance of guidance}. Unfortunately this continues 

to be a constant experience in the AF EFMP program even to this day. I continue to advocate for change in our current AF EFMP 

polley and program overall. 

The single most beneficial source for my family's journey has been the parents, Specialized Training of Military Parents (STOMP) 

staff, JBMDL Military 360 Project and other professionals communicating through the STOMP Ustserver. It Was through these 

refre5hing resources that I was able to educate myself on policies, processes, and methods to get the best care possible for my 

special boy. As a result I submitted a 33S page request to AFPC for EFMP reassignment due to lack of medical services with enough 

justification to make your eyes water. I prioritized McGuire AFB, NJ as our #1 location of choice due to its proximity to the Children's 

Hospital of Philadelphia (CHOP) and the abundance of medical Sl.!pport in the community. t opted to completely erase any thoughts 

of Spence receiving care or support from the military medical community and focused .on finding the best civilian care in the country. 

We were of course denied; denied because the inexperienced/newly assigned Chief of Medical Staff (SGH) at McGuire felt the drive 

time to CHOP was excessive and his pediatricians were unable to get specialty appointments in a timely manner. 

I was floored by his response, but I refused to give up. I'm accustomed to dealing with government bureaucracy and receiving the 

easy answer of no when the hard but correct response often times is yes. So I contacted a very kind and sincere doctor at the Uttle 

Rock MDG who coordinated a teleconference betwe~n us and the McGuire SGH on Spence's behatf. During the course of the 

conversation we came to the realization that this was a battle of might - the McGuire SGH was flexing his muscles without concern 

for the truth. In the end we closed the discussion with a challenge on my part. I informed him I could prove his reasons for denial 

regarding timeliness of acquiring appointment could be overcome and would prove it i.n writing; he chuckled and said if I gave him 

something proving my side he would approve the request (he had no doubts I would be unable to prove this). So I coordinated with 

the CHOP Complex Scheduling Department and within a week was able to acquire a list of appointments for Spence showing all of 

them scheduled within a 3 month period follOWing his expect arrival as well as a back-up plan should he need to get in sooner. The 

doctor was of course floored and then requested I sign a statement that my son would not receive any medical care in the McGuire 

MDG -I signed and we had orders 3 days later. It just amazes me that this doctor who runs an entire medical staff couldn't. 

understand the impact oftrlage on appointment scheduling; anyone with any semblance of medical experience knows that those 

who are more severe get seen faster (it's just a fact of life). 

We arrived at McGuire about two weeks after receiving orders and immediately thing~ began to improve. Spence now receives 

home nursing 16 hours/day to include on the bus and during school. He also received therapy services (OT, PT, Speech, vision, etc) 

at his school and are working on getting him additional therapies after school in an outpatient environment. Overall the relotation 

to McGuire AFB has been the best choice for Spence & our family. We've had some hard times since we moved here and theAF 

EFMP program has been of no help to us however, STOMP & theJBMDL Military 360 Project continues to be our sounding board and 

the bedrock of our success. I remain deeply grateful to those families/professionals that have and continue to support my family in 

our journey with Spence. 
466 


621pe143.eps

Hi there! 

My name is Abby and I am ten years old. I have an extremelY rare genetic condition called . 

Aicardi Goutieres S'Yndrome, or AGS·l. I can't tall", waif'( or hOld my head up, but I can . 

smile real big! There are onlY about 300 f'(ids worldwide with AGS and less than 30 that are 

JUSt liKe me! MY daddy, DaVid, is a pOlice OfFicer with the 

Uni1:ed StateS Air Force, and he has served our country For 19 

years on aCtive dutY. My mommy, Stephanie, is a Kindergarten 

teacher at a church in St. Mary's CountY. My big siSter, Riley, 

is in seventh grade and is the beSt siSter eVer! 

"Because of my condition, I am WheelChair bound and 10091. 

dependent on my Fami[Y For my care 2q hours a daY. My daddy 

has to go away a lot For his job and that leaves Mommy and 

"Ri[eY to taKe care Of me. Because my Family moves so much 

with the military, we get no State or Federa[ help to get me a 

van and the modiFications I need. 

'fricare does cover monthlY Feeding supplies, an 

wheelchairs For AbbY. With 'Papa retiring in a Few 

months, all Of Abby's beneFits will increase our OUt Of 

POCf'(et expenses. This will include monthlY Feeding 

supplies, incontinence supplies, specialty care 

appointments, and therapy treatments. 
467 


621pe144.eps

June 12, 2012 

Dear Members of Congress, 

I am writing to you on behalf of military dependents with autism, and specifically, my two daughters 

Caragh and Camille. 

At five and six years old, Caragh and Camille are two AMA2ING little girls who would light up any room 

you enter. They laugh, they play, they dress like princesses, and they have autism spectrum disorder. 

Both were diagnosed very young, which has changed their lives. Howeyer, there is a long road and life 

ahead of them and our family. 

Our girls started intensive ABA therapy when they were two and three years old. It has changed their 

lives. Because of caps in coverage through the EFMP program we have had to work to juggle hours, take 

fewer hours than prescribed, and cancel sessions at the end of the ~scal year-aka beginning of school 

year. This is hard on the girls and certainly hard on our family. 

The realitY now is that I will retire. Autism for my two girls will never retire. They will need ABA for years 

to come; and we can only ask for it to become part of Tricare coverage so we can continue to give ou~ 

children the services they need to function as adults. 

Autism is hard. Helping families living with autism is not hard. Just help us help our children. 

Again, thank you for all you do, 

The Zeigler Family 

Branch: US Navy NAS Jacksonville, FL 

EFMP Cat: Caragh 5 Camille 4 
468 


621pe145.eps

June 18, 2012 

Dear Sir or Ma'am, 

Margaret Stubbs 

6631 Hazel Lane 

Mclean VA 22101 

My husband is an active-duty Naval Officer, afTd we have a nine year old son named Wilton who is 

diagnosed with autism. Over the years, Wilton has greatly benefited from Applied Behavior Analysis 

(ABA) after school. ABA helps him to mitigate his aggressive behaviors (like biting, spitting, hitting, and 

kicking) and his anti-social behaviors (like screaming and removing his clothes public). In addition, his 

ABA therapists have been able to teach him self-help skills such as dressing himseff, brushing his teeth, 

and using utensils when eating. If it were not fur ABA, Wilton would be guaranteed to have absolutely no 

ability to care for himself as an adult However, because of the skills he has leamed from ABA, Wilton 

may be able to live in a gnoup home as an adult with minimal to moderate assistance and supervision. It 

is also possible that he may be able to have a low-skill job, making him less of a burden to the tax payers 

in the long run. 

We are concerned because my husband has served for 27 years in the military, and is now at the end of 

his career. When he retires, Tricare will no longer cover the cost of ABA This is a pnoblem because we 

will not be able to payout of pocket as it costs $3000 a month for the 15 hours a week he receives 

outside of school. If Wilton no longer does ABA, I fear that he will never have to skills to live outside of a 

heavily staffed medical facility once his father and I pass away. 

In my view ABA is a good investment Although it is a weighty initial expense, it will benefit society in the 

long run. If my son can live a semi-independent life, he is far less likely to end up in jail, prison, or a 

mental hospital. 

Thank you for your attention to my concems. 

Sincerely, Margaret Stubbs 
469 


621pe146.eps

The Rupe Family Home of Record: Pearland, Texas 

Current Duty Station: Norfolk, Virginia 

Kyle, 11 years old, EFMP category 4, Autism 

Michael, 7 years old, EFMP category 2, congenital limb defect (no special services) 

EXPERIENCED EDUCA nON ADVOCATES: Kyle has attended 8 schools in 4 public school districts. Advocating 

for appropriate services for a military child can often be difficult because the school often assumes he will 

not be attending long enough to fight the system. Experienced advocates in highly populated EFMP areas 

like Virginia Beach and San Diego would be beneficial to many families. 

MEDICAID WAIVERS: Kyle received a Medicaid waiver slot for ABA therapy in one state. He made 

considerable progress with 25 hours of Applied Behavior Anaiysis (ABA) therapy a week, which is the 

minimum recommended by the American Academy of Pediatrics. Now he will be at the bottom of another 

Medicaid Waiver waiting list and will likely never see the top. Allowing military families to move with their 

waivers would help so many children-even keeping their spot on a waiting list would help. 

ECHO - LIMITED ABA: The TRICARE ECHO program pays for ONLY 6 hours of ABA perweekon the Demo 

program. This is less than 25% of the recommended minimum hours. Moving the ABA benefit to TRICARE 

Basic would remove the limit and make it available to retirees who still have children with autism ·when 

they retire. 

CONTINUITY OF CARE: Finding qualified private therapists even in a large city is difficult. Waiting lists are 

often months long. if you can even get on a list. Contracting with more therapists may help. 

NO RESPITE: Our area of the country has a Navy Respite program, but the waiting list is aimost ONE YEAR 

long! ECHO has a respite program, but if you use your ECHO dollars on ABA you don't have any left for 

respite. It is necessary to fund existing programs and provide respite for all EFMP families. 

LIMITED MEDICAL KNOWLEDGE OF AUTISM: Autism is being treated medically with great results all over 

the world, yet military doctors remain untrained and pass this sense of hopelessness on to the parents of 

children with autism. Children with autism are entitled to proper non-discriminatory medical care. 
470 


621pe147.eps

The Jamesons 

Navy SEAL Reservist activated - March 2012; Mobilized and deployed - May 2012 

Our son Ronan has several diagnoses - mitochondrial diseases, autism, non-verbal, developmental delays; his siblings 

are being screened for mite disease as well 

Local schools wouldn't provide ABA and civilian doctors gave us little hope. 

We found a private ABA school-based program; he thrived, gained skms and transitioned to a pu bUc school special 

needs classroom upon a move to a "new community 

With the private school and private therapies we paid for out-af-pocket, we were knee-deep in medical, educational, 

therapeutic and emotional debt. 

Becoming a Reservist presented itself; the benefit of a sign-on bonus as well as a second income was welcomed to 

offset debt incurred to care for ourson 

We are now an active-duty family and Ronan qualify for Exceptional Family Membe'r Program (category 5). Through 

the Au,tism Demo Program we aer awaiting approval for Applied Behavior Analysis (ABA), the same therapy that made 

an consistent difference for Ronan 

But, as with all things go~ernment-military related, it has been an exhausting, paperwork-ridden maze trying to figure 

out how to correctly apply, who to go to to get questions answered, and then knowing when that entire the process is 

cample,te. 

What, we had hoped would be a simple process has become labored. 4.5 months later, we are still jumping through 

hoops to Secure ABA ther:apy. Now we hear that these benefits might be in jeopardy even before Ronan has the 

chance to usetheml 

Funding for Ronan's ABA will end when my husband returns to reservist status in 2013. Ronan has yet to start specific 

therapy for his needs. Ronan might not lose his autism diagnosis when my husband returns home from deployment, 

but sadly the ABA benefits will. 
471 

Senator WEBB. Thank you very much, Mr. Hilton. 

Dr. Dawson, welcome. 

STATEMENT OF DR. GERALDINE DAWSON, CHIEF SCIENCE OFFICER, AUTISM SPEAKS, AND PROFESSOR OF PSYCHIATRY, 

UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL 

Dr. DAWSON. Good afternoon, Chairman Webb, and members of 

the subcommittee. I am Dr. Geraldine Dawson. I am the Chief 

Science Officer at Autism Speaks, and I serve as Professor of Psychiatry at the University of North Carolina at Chapel Hill. Prior 

to joining Autism Speaks, I directed the University of Washington 

Autism Treatment and Research Center for close to two decades. 

Autism Speaks is the world’s leading autism science and advocacy organization. We are dedicated to funding research into the 

causes, prevention, treatments, and cure of autism, and to increasing awareness and advocating for individuals with autism and 

their families. 

I am honored to appear before the Senate Armed Services Subcommittee on Personnel, and to participate in this hearing on 

issues facing military families who have dependents with special 

needs. 

Like their counterparts in civilian life, many military families 

face challenges in providing proper treatment for their child with 

autism. I am here today to talk about those challenges and how the 

military healthcare system can lessen their effect on families. 

But first some information about autism. Autism is a development disorder that affects a person’s ability to form social relationships and communicate with others. People with autism also exhibit repetitive behaviors, some of which can interfere with their 

ability to learn and function. Autism is caused by a combination of 

genetic and environmental risk factors. 

But autism is no longer considered a rare condition. It affects 1 

in 88 children in the United States, 1 in 54 boys. This year, more 

children will be diagnosed with an ASD than AIDS, diabetes, and 

cancer combined. The prevalence of autism has risen dramatically 

over the last several decades. In fact, statistics show a tenfold increase in the past 40 years. Many in the autism community use the 

word ‘‘epidemic’’ when describing autism. 

Fortunately, there are effective treatments for autism that can 

change a person’s course and outcome. Numerous controlled clinical 

trials have shown that early intensive behavioral treatment significantly increases IQ, language abilities, daily living skills, while reducing the symptoms of autism. 

In fact, a 2010 randomized control trial, funded by the National 

Institutes of Health and published in the prestigious Journal of Pediatrics, found that 50 percent of children with autism who received early intensive behavioral treatment for 2 years had a 15- 

point increase in IQ. One-third of the children showed an increase 

in IQ of greater than 30 points. This means that early treatment 

changed these children’s life trajectories, setting them on a course 

that increases their chance of living productive and satisfying lives. 

These children will likely attend a regular classroom, develop 

spoken language, and make friendships. This is not only good for 

these individuals, it results in significant cost-savings, as fewer 

472 

services will be needed in the long-run, and these individuals now 

can become more productive members of our society. 

Behavioral health treatments that are based on ABA have become widely accepted among healthcare professionals as an effective treatment for autism. These treatments are provided by highly-trained licensed and certified professionals. Early-in-life treatment involves working one-on-one with a child typically for 25 to 

40 hours per week. 

Thirty States now require coverage of ABA treatment as part of 

medical care. Employers, such as Microsoft and Home Depot, universities, such a Ohio State, Harvard, and Princeton, and 

healthcare facilities, such as the Mayo Clinic, do so as well. 

Earlier this year, OPM concluded that there is enough evidence 

to classify ABA as a medical therapy. In contrast to the benefits 

covering ABA treatment that now will be made available to the 

Federal civilian workforce, the healthcare program for uniform 

servicemembers and their families, TRICARE, provides only limited coverage for ABA treatment. 

TRICARE classifies ABA treatment as an educational intervention, and makes it available only through ECHO, and caps coverage at $36,000 a year. 

Furthermore, ABA treatment is restricted to dependents of Active Duty servicemembers. Dependents of retirees, including dependents of wounded warriors who were retired due to their injuries sustained in combat, are unable to access ABA treatment for 

their child with autism. Guard and Reserve families receive intermittent care as they move between Active and Reserve status. $36,000 a year pays for about 11 hours of ABA treatment per 

week. Many children with autism, particularly early in life, and 

some who face severe challenges, need more treatment hours in 

order to fully benefit from the treatment. 

Given all that our military families have shouldered for the past 

decade, they deserve better. On behalf of thousands of military 

families affected by autism, I strongly urge Congress to require 

TRICARE to provide behavior health treatment, including ABA, to 

military families regardless of duty status, and at the level of care 

prescribed. 

Thank you, Chairman Webb and members of the subcommittee, 

for this opportunity to speak about this important issue affecting 

military families. I look forward to your questions. 

[The prepared statement of Dr. Dawson follows:] 

PREPARED STATEMENT BY DR. GERALDINE DAWSON, PH.D. 

Good afternoon, Chairman Webb, Ranking Member Graham, and members of the 

subcommittee. I am Dr. Geraldine Dawson, Chief Science Officer of Autism Speaks. 

I also serve as Professor of Psychiatry at the University of North Carolina at Chapel 

Hill. 

Autism Speaks was founded in February 2005 by Bob and Suzanne Wright, 

grandparents of a child with autism. Since then, Autism Speaks has grown into the 

world’s largest autism science and advocacy organization, dedicated to funding research into the causes, prevention, treatments and cures for autism; increasing 

awareness of autism spectrum disorders; and advocating for the needs of individuals 

with autism and their families. We are proud of what we’ve been able to accomplish 

and look forward to continued success in the years ahead. 

I am honored to appear before the Senate Armed Services Subcommittee on Personnel at this hearing on issues facing military families with dependents who have 

special needs. Like their counterparts in civilian life, many military families face the 

473 

challenge of providing proper treatment for a child on the autism spectrum. I am 

here to talk about those challenges and how the military health care system can 

lessen their effect on families. 

THE CHALLENGES OF AUTISM

I will begin by providing an overview of autism. Autism is a developmental disorder that affects a person’s ability to form social relationships and communicate 

with others. People with autism also exhibit repetitive behaviors, some of which can 

interfere with their ability to learn and function. Most scientists agree that autism 

is caused by a combination of genetic susceptibilities that interact with environmental risk factors. 

Autism is no longer considered a rare condition. It affects about 1 in 88 children, 

including 1 in 54 boys. Let’s compare autism’s prevalence to that of some other conditions: 

• Pediatric AIDS – 1 in 300; • Type 1 diabetes – 1 in 400; and • Childhood cancer – 1 in 2,000 

This year, more children will be diagnosed with an autism spectrum disorder than 

AIDS, diabetes, and cancer combined. The prevalence of autism has risen dramatically over the past several decades; in fact, statistics show a ten-fold increase in 40 

years. Although broadening of the diagnostic criteria for autism and increased 

awareness account for some of this increase, experts estimate that approximately 

50 percent of the increase remains unexplained. Many in the autism community use 

the word ‘‘epidemic’’ when describing autism. 

Based on metrics used by the World Health Organization, autism represents a 

significant public health challenge. It is a highly prevalent and chronic condition 

with an early onset and is associated with significant functional impairments and 

costs. Its burden is higher than childhood leukemia, cystic fibrosis, and type 1 diabetes—an estimated $137 billion per year. 

Of course, the impact of autism cannot be measured in dollars alone. Autism 

takes a significant toll on families. Compared to the families of children with special 

health care needs other than autism, the families of children with autism are more 

likely to: 

• cut back or stop working; 

• spend 11 or more hours per week providing care; 

• pay more than $1,000 annually in out-of-pocket medical expenses; 

• experience financial problems; and 

• avoid changing jobs in order to maintain health insurance. 

According to a national survey, only one in five children with autism has adequate 

health insurance coverage, receives coordinated, ongoing, comprehensive care within 

a medical home, and had at least one preventive medical visit in the past 12 

months. 

Military families with a child on the autism spectrum face the added burdens of 

stress associated with their service. Relocating to a new duty station can cause gaps 

in care with lifelong consequences. When one parent is deployed, the other may bear 

the full responsibilities of child care. When a parent returns from deployment, the 

family may have the additional challenge of combat-related mental or physical 

health problems. 

SCREENING, DIAGNOSIS, AND TREATMENT

The care of a child with autism often begins with a sense by a family member 

or health care professional that the child’s development is not typical. It is now possible to screen for autism at 12 months of age, and autism can be reliably diagnosed 

by 18 to 24 months of age. In 2007, the American Academy of Pediatrics recommended that all children be screened for autism at 18 and 24 months of age and 

that appropriate referrals be made if autism is suspected. Yet, the average age of 

diagnosis in the United States remains close to 5 years. Children from ethnic minority backgrounds are at a particular disadvantage. Research shows that these families have to go to the doctor many more times before receiving a diagnosis, and the 

age of diagnosis is much older. 

Fortunately, there are effective treatments for autism that can change a person’s 

course and outcome. Controlled clinical trials have shown that early intensive behavioral treatment significantly increases IQ, language abilities and daily living 

skills, while reducing the symptoms of autism. In fact, a 2010 randomized controlled 

trial funded by the NIH and published in Pediatrics reported that 50 percent of children with autism who received early treatment for 2 years had a 15 point increase 

474 

in IQ (1 standard deviation). One third of the children showed an increase in IQ 

of greater than 30 points (2 standard deviations). This means that treatment 

changed these children’s life trajectories, setting them on a course that increased 

their chances of living productive and satisfying lives. This is not only good for the 

individual; it results in significant cost-savings for society as children and adults 

need fewer services and can become productive members of society. 

Among the many treatment methods available, behavioral treatments that use 

the methods of applied behavior analysis (ABA) have become widely accepted among 

health care professionals as an effective treatment for autism. Mental Health: A Report of the Surgeon General states, ‘‘Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior.’’ Study after 

study has provided evidence for the efficacy of early intensive behavioral treatment 

based for improving outcomes of children with autism. 

Let me say a little more about ABA. Treatments based on behavior analysis use 

a scientifically validated approach to understanding behavior and how it is affected 

by the environment. Through decades of research, the field of behavior analysis has 

developed many techniques for increasing useful behaviors and reducing those that 

may cause harm or interfere with learning. These techniques bring about meaningful and positive changes in behavior. Success in an ABA program is measured by 

direct observation and data collection and analysis. Early behavioral treatment 

based on ABA is provided by highly trained licensed/certified professionals with expertise in ABA and involves one-on-one treatment with the child typically for 25– 

40 hours per week for at least 2 years. This early intensive investment in treatment 

results in significant cost savings in the long run, as many children with autism 

who receive such treatments can now carry on a normal conversation, enter a regular classroom, and form friendships with their peers. 

THE GROWING TREND TOWARDS COMPREHENSIVE AUTISM COVERAGE

Autism Speaks is committed to passing insurance legislation that provides access 

to behavioral health treatments for people with autism. Back in 2001, only the State 

of Indiana required insurance coverage of effective therapies like ABA. Now 30 

States (representing over 70 percent of the country’s population) require coverage 

of ABA treatment as a medical care. 

Large employers like Microsoft and Home Depot provide coverage for autism 

therapies, as do universities such as Ohio State, Harvard, and Princeton and health 

care facilities like the Mayo Clinic. 

After conducting an internal review earlier this year, the U.S Office of Personnel 

Management (OPM) concluded there is enough evidence for OPM to classify ABA 

as a medical therapy. This means that Federal Employees Health Benefits Program 

(FEHBP) carriers may propose 2013 benefit packages that offer behavioral treatments based on ABA. In communicating this decision to Autism Speaks, OPM stated, ‘‘This decision reflects our perspective that families covered under the FEHBP 

should have access to medical treatment that is safe, effective for their individual 

diagnosis, supported by sound medical evidence, and delivered by appropriate providers.’’ 

In contrast to the benefits that will be made available to the Federal civilian 

workforce, TRICARE—the health care program for uniformed servicemembers and 

their families—currently provides only limited coverage for ABA treatment. 

TRICARE classifies ABA as an educational intervention and makes it available only 

through the Extended Care Health Option (ECHO), a supplement to the basic 

TRICARE program. ECHO benefits are cumulatively capped at $36,000 per year 

which may not adequately cover the early years when intensive treatment is needed. ECHO is restricted to dependents of active-duty servicemembers. Dependents of 

retirees—including dependents of wounded warriors retired due to injuries sustained in combat—are unable to access ABA treatment under TRICARE. Guard/Reserve families receive intermittent care as they move between active and non-active 

duty status. 

Families report that the ECHO $36,000 limit on care does not address the need 

for intensive ABA services. Using TRICARE billing rates, $36,000 pays for an average of 11 hours of ABA therapy per week, whereas the recommended number of 

hours is between 25 and 40. Many children with autism, especially those who are 

newly diagnosed or who face severe challenges, need this level of initial treatment. 

The out-of-pocket costs associated with this additional medical care are unaffordable 

to the military family. Even the limited available benefit is difficult to access for 

some eligible families, who report significant enrollment delays and a lack of 

TRICARE authorized providers. 

475 

Without access to needed services, many military families depend on State Medicaid waiver programs. A change in duty station, however, may move a family to 

the bottom of a long waiting list and force a stark choice: incur significant debt or 

do without treatment for their child. 

Given all our military families have shouldered for the last decade, they deserve 

better. The warfighter in Afghanistan should not have health care inferior to that 

of the civilian employee working within the Pentagon. We owe more than this to 

the families who are making tremendous sacrifices for our country. 

This is not a matter for further study. Action is needed to provide the quality of 

care our military families deserve and have earned. On behalf of the thousands of 

military families affected by autism, we ask that Congress require TRICARE to provide behavioral health treatment, including ABA, to military families regardless of 

duty status and without a dollar cap. 

Thank you, Chairman Webb, Ranking Member Graham, and members of the subcommittee, for your time, for your commitment, and for your leadership. 

Senator WEBB. Thank you very much, Dr. Dawson. 

Mr. O’Brien, welcome. 

STATEMENT OF MR. JOHN O’BRIEN, DIRECTOR OF 

HEALTHCARE AND INSURANCE, U.S. OFFICE OF PERSONNEL 

MANAGEMENT 

Mr. O’BRIEN. Chairman Webb, members of the subcommittee, 

thank you very much. Thank you for the opportunity to make a 

statement on behalf of the FEHB program administered by OPM. 

We appreciate the subcommittee’s interest in our program and its 

support of families whose children have special needs, specifically 

those with ASD. 

We understand that the subcommittee seeks information on our 

recent reclassification of ABA as a medical therapy. In contrast to 

the single provider model of TRICARE, the FEHB program contracts with 91 separate insurance carriers to offer health plans to 

over 8 million Federal employees, annuitants, and families. All 

plans are required to provide basic services, and may propose and 

negotiate to offer a range of additional benefits. All FEHB plans 

are required to provide children with autism access to pediatric 

care, physical therapy, occupational therapy, speech therapy, mental health treatment, and medications. 

However, during the current 2012 contract year, the FEHB benefit—ABA is not an FEHB benefit because it is classified for the 

FEHB as an investigational or educational intervention, and, therefore, is subject to a blanket exclusion. That means that children of 

a Federal employee cannot access ABA services through their 

health insurance regardless of whether the plan they have selected 

would have normally considered such a treatment as medically necessary and provide it to its non-Federal subscribers. 

Beginning in 2010, Members of Congress, families, and other 

stakeholders asked OPM to reexamine this blanket exclusion. The 

OPM Benefit Review Panel evaluated the status of ABA for children with autism. Previously, ABA was considered to be an educational intervention and not covered under the FEHB program. 

The Benefit Review Panel concluded that there is now sufficient 

evidence to categorize ABA as a medical therapy. Accordingly, 

plans may propose a benefit package that include ABA. 

The insurance marketplace in which the FEHB operates is 

changing rapidly with regard to ABA therapy. At present, 30 

States require some health insurance coverage of ABA. In a week, 

that number will be 31. Had I been before this subcommittee in 

476 

June 2010, the number of States requiring ABA would have been 

14. In June 2008, just 4 years ago, the number would have been 

two. 

OPM has made the decision to reclassify ABA as a medical therapy rather than as an educational service based on the evolving 

body of clinical research and the maturing provider infrastructure 

to deliver this modality under a medical model. This reclassification does not presume medical necessity, and does not specifically 

require FEHB plans to add ABA service to their basic benefits 

package. Rather, it allows plans to propose ABA as an additional 

benefit under conditions where medical necessity is satisfied and 

appropriate and qualified providers are available. 

Medical necessity criteria are evaluated by each health plan in 

FEHB, not by OPM. Plans assess whether a proposed treatment is 

safe, supported by sound medical evidence, effective for an individual, more effective than alternative treatments, and conforms to 

relevant standards of medical practice. Our decision only applies to 

the FEHB and not to TRICARE programs, and accordingly, was 

published as technical guidance to our carriers. 

The evidence is not yet sufficient to support an official OPM position requiring coverage by all FEHB carriers. In the interval, our 

administrative change will allow FEHB plans that choose to make 

ABA services available as the research and provider base matures. 

OPM will periodically re-review ABA as the research develops. 

We are grateful for the subcommittee’s support of Federal employees and their families. Thank you for this opportunity. I am 

happy to answer any questions you may have. 

[The prepared statement of Mr. O’Brien follows:] 

PREPARED STATEMENT BY MR. JOHN O’BRIEN

Chairman Webb, Ranking Member Graham, and members of the subcommittee, 

thank you for the opportunity to make a statement on behalf of the Federal Employees Health Benefit (FEHB) Program, administered by the U.S. Office of Personnel 

Management (OPM). We appreciate the subcommittee’s interest in our program and 

its support of families whose children have special needs, specifically those with Autism Spectrum Disorders. 

We understand the subcommittee seeks information about our recent classification of Applied Behavior Analysis (ABA) as medical therapy. In contrast to the single provider model of TRICARE, the FEHB program contracts with 91 insurance 

carriers to offer health plans to over 8 million Federal employees, annuitants, and 

families. All plans are required to provide basic services, and may negotiate to offer 

a range of additional benefits. All FEHB plans are required to provide children with 

autism access to pediatric care, physical therapy, occupational therapy, speech therapy, mental health treatment, and medications. However, in 2012, ABA is not an 

FEHB benefit because it is classified as an investigational or educational intervention. This means that the child of a Federal employee cannot access ABA through 

their health insurance regardless of whether the plan would normally consider such 

treatment medically necessary and provide it to its non-Federal subscribers. 

Beginning in 2010, Members of Congress, families, and other stakeholders asked 

OPM to re-examine this blanket exclusion. The OPM Benefit Review Panel evaluated the status of ABA for children with autism. Previously, ABA was considered 

to be an educational intervention and not covered under the FEHB Program. The 

Benefit Review Panel concluded that there is now sufficient evidence to categorize 

ABA as medical therapy. Accordingly, plans may propose benefit packages which include ABA. 

Over the last 2 years, the infrastructure to support the delivery of ABA has matured rapidly. Today 30 States require at least some health insurance coverage of 

ABA, and 14 have licensure procedures for ABA providers. ABA providers most frequently have a graduate degree in Psychology with additional training in ABA, leading to formal Board Certification in Behavior Analysis. States often exercise their 

477 

supervision of certified or licensed providers through the same pathway which oversees other health care practitioners, such as a Board of Medicine or Psychological 

Examiners. It is also common practice to require a physician’s or Psychologist’s prescription before a health plan will approve ABA for a specific child. 

OPM made a decision to reclassify ABA as a medical therapy rather than an educational service based on the evolving body of clinical research and the maturing 

provider infrastructure to deliver this modality under a medical model. This reclassification does not presume medical necessity and does not specifically require 

FEHB plans to add ABA services to their basic benefits package. Rather, it allows 

families of Federal employees to receive the same treatment as families of non-Federal employees by allowing plans to propose ABA as an additional benefit, under 

conditions where medical necessity is satisfied and appropriate, qualified providers 

are available. Medical necessity criteria are evaluated by each health plan in FEHB, 

not by OPM. Plans assess whether a proposed treatment is safe, supported by sound 

medical evidence, effective for an individual, more effective than alternative treatments, and conforms to relevant standards of medical practice. Our decision applies 

only to FEHB, and not to TRICARE programs, and accordingly, was published as 

technical guidance to our carriers. 

The evidence is not yet sufficient to support an official OPM position requiring 

coverage by all FEHB carriers. In the interval, our administrative change will allow 

FEHB plans that chose to do so to make ABA services available as the research and 

provider base mature. OPM will periodically re-review ABA as the research develops. We are grateful for the subcommittee’s support of Federal employees and their 

families. 

Thank you for this opportunity, I am happy to address any questions that you 

may have. 

Senator WEBB. Thank you very much, Mr. O’Brien. Let me begin 

by thanking all of you for your extraordinary breadth of experience 

that has been reflected in your testimony today, both written and 

oral. 

Just as an immediate reaction, before we get into some of these 

more complex issues that are being addressed with respect to ABA 

therapy, I think that, Mr. Hilton and some of the others, you raised 

some very valid points about inconsistencies in the ability to get 

treatment, and the eligibility requirements when people move. I 

think that is something I am going to right now encourage staff to 

pursue further. These are things that could be handled administratively perhaps working with DOD on these sorts of issues. 

I remember what it was like to move around when I was a kid. 

I remember at one point I went to nine different schools in 5 years 

between the 5th and the 10th grade. We were in England, Missouri, Texas, Alabama, California, and Nebraska. I remember what 

it was like to be at the bottom of the pile in these types of things. 

We did not have Medicaid waiver programs when I was a kid. I do 

not think we had Medicaid when I was a kid. I do not remember 

any of it. 

But certainly there are issues that have been raised that could 

be dealt with in a more immediate sense just by working with DOD 

to see if we cannot iron out some of those matters that have been 

raised. 

As I mentioned in my opening statement, let me begin with this. 

There is a lot of debate with respect to the OPM determination 

that you, Mr. O’Brien, discussed. I would like to start by getting 

a better understanding of the factual nature, the specific nature of 

the treatments. Maybe the best place to start would be with Dr. 

Tait and Dr. Dawson. If you could help us understand the difference in current practices that are regarded as medical therapy 

in these cases as opposed to what have been educational intervenVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00483 Fmt 6601 Sfmt 6602 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
478 

tions. Just in basic terms, what are the differences? Dr. Tait, 

maybe we will start with you. 

Dr. TAIT. Thank you. When I am thinking about and when we 

are talking in terms of whether this is medical versus educational, 

unfortunately, when we are looking at any therapy, whether it is 

occupational therapy, physical therapy, speech, ABA, it has both 

educational and medical effects. I think maybe the best way that 

if I could give some examples of that. 

If you are looking at ABA, as I mentioned in the testimony, it 

certainly affects cognition or thinking. It affects language. It affects 

academics. That is the school piece of it. But if you look at children 

who have ASD, many of them have specific medical issues that 

have to be dealt with through a behavioral approach. Examples of 

that would be self-injury. Many of the children actually are involved in self-injurious behaviors. 

Another example would be eating. One of the things that we look 

at, some children at the extreme of ASD really have such very specific eating habits that unless you look at it behaviorally, they can 

be malnourished. That is the medical piece of it. They can have 

what we call Pica disorder, which is eating other objects that you 

should not be eating, and then you go to the doctors for that. 

Another piece of that is, behavior can be such a part of what we 

are talking about that they cannot get the basic needs they need, 

like going to a dentist, or getting the medical needs that they have 

addressed unless they are sedated. 

All of those are behavioral in one sense, Senator, but they are 

also educational. When I am thinking in terms of ABA, I think that 

it certainly is medically-based. It is also educationally-based. 

Senator WEBB. Just for clarification here, in terms of programmatically what is now funded and what is considered educational 

intervention, what type of program is now funded that does not 

reach the ABA area? Programmatically, when we say there are certain practices that are acceptable, and at the same time we are 

saying that the ABA is educational intervention and, as a result, 

not funded, what are we treating and what are we not? 

Dr. TAIT. The way that I look at this is if you look at therapies 

that are funded—maybe that is the best way to approach it. The 

therapies that we know that are funded are things like occupational therapy, physical therapy, speech language pathology. If you 

look at those therapies, they are very specific and individualized 

with respect to the children that need them. 

Those therapies are not as behaviorally-based where you set up 

a specific behavior program that has to be carried through at home, 

at school, by the family. You are looking at different, what we call, 

trials, where you look at behavior changes and trials. I think that 

is why when we are looking at this, you are saying it is educational 

because it is looking at the cognition, language, academic performance, and adaptive behavior. But all of that rolls into the medical 

piece of it too. 

Not all children need 40 hours of ABA per week that have autism, and that is why we were saying it has to be individualized. 

You look at the therapy that is appropriate. 

Senator WEBB. Dr. Dawson? 

479 

Dr. DAWSON. One way to look at it has to do with who delivers 

the treatment and the scope of the treatment. When we think 

about an educational service, it is typically provided in an educational context by educators. When we think about ABA treatment, early intensive behavioral intervention, first of all, it is often 

prescribed by a physician. Second, it is delivered by either a licensed clinical psychologist or a board certified behavior analyst, 

not necessarily a special educator. Then, third, it requires many 

hours of intensive intervention that is not accommodated within an 

educational program. Educational programs simply do not offer either the level of expertise in this area or the number of hours and 

intensity. It really goes beyond the scope of a typical educational 

program that we might offer. Even a child with special needs would 

not be offered these kinds of services typically in an educational 

program. So it really goes beyond the scope of what we think of is 

education. 

The other thing to point out is that it has an impact on brain 

development. In fact, there is study in press right now that shows 

that it not only impacts things like IQ and language ability, but 

can change the pattern of brain activity in these children to normalize them over time. It is much more of a whole medical intervention than we think of as restricted specifically to an educational 

activity. 

Senator WEBB. I want to finish this thought with Mr. Hilton. In 

your own experience with the program, what does it cover, and 

what does it need to be covered? How does the $36,000 annual cap 

fit into that? 

Mr. HILTON. Sir, I am just going to back up for a second and piggyback on something that the lady said and give you an example. 

A lot of these children, for whatever reason, are runners, meaning 

they run and run. Another thing, they like water for a reason I do 

not understand. 

We lost a little girl, a little Army girl, 7 years old in May, who 

had autism. She ran and they ended up finding her in a pond not 

far from the family. This is documented in a variety of different circumstances. So from our perspective, for a lot of our families, this 

is life or death. I do not think that qualifies educational. That 

qualifies as medical. 

To answer your specific question, what my friends and what I 

have seen is that particularly when you are talking about younger 

children, 2- to 5-year range, or the children who need much more 

intensive therapy, that $36,000 simply is not enough to cover their 

costs. I have a friend who is a Navy commander. I served with him 

a long time ago. He has a child with autism, and this is an 05 that 

you would think might be able to cover this therapy. He has had 

to take out a second mortgage on his house. That just gives you an 

example of what an 05 has to deal with. Imagine an E3 or E4. 

They are simply just going without the therapy. 

Senator WEBB. Mr. O’Brien, we have been told that DOD has 

asked OPM to see the studies and the basis for OPM’s decision. Is 

OPM going to share that study with DOD? 

Mr. O’BRIEN. Yes. 

Senator WEBB. Good. Senator Begich. 

Senator BEGICH. Thank you very much, Mr. Chairman. 

480 

First, Mr. Hilton, congratulations again on your award as Military Spouse of the Year. I know you corresponded off and on with 

my wife by e-mail. I thank you. We really appreciate your effort 

and your lead and your leadership today in representing families 

in a very succinct way. I will have some questions for you in a second, but I just wanted to acknowledge that I really appreciate your 

being here today. 

I am actually going to take the question that the chairman just 

asked. If the answer is yes, the question is obviously how long will 

it take you to review it? When will you do it? That, to me, is very 

simple. 

Dr. GUICE. When we get the information, we will put it in our 

normal review process and evaluate it according to our requirements by statute and by regulation as to whether or not it serves 

as medical care according to our criteria. 

It may take us very little time, 6 months. It just depends on all 

the information that we get. We invite others to submit information as well if they have credible evidence, peer review publication 

of studies, that would help us, inform us about a better or a different coverage decision, we would be delighted to receive those as 

well, sir. 

Senator BEGICH. Can you do that administratively? In other 

words, once you review and if you determine you can move it to 

medical therapy, can you then do it? 

Dr. GUICE. Yes, sir. If it is deemed to be appropriate according 

to our criteria, and statute and regulations that we evaluate evidence by, then it can be made a coverage decision. 

Senator BEGICH. Okay. Here is the question I have. I guess if I 

am able to do it right, because I am under one of your policies 

somewhere in the mix because I pay a bunch of money. I know that 

despite what people think, we actually have lots of premiums as 

senators. I think I had my co-payment premiums at $6,000 last 

year. So if I wanted to buy additional coverage for one of my policyholders or one of the folks I have under Federal insurance, that is 

covered as additional, I can get it, correct? 

Mr. O’BRIEN. Assuming the plan offers service. 

Senator BEGICH. Right. 

Mr. O’BRIEN. But it is not a required part of our basic benefit 

plan. We are offering plans the opportunity to propose this benefit. 

So this does not guarantee anyone would get this benefit. 

Senator BEGICH. I understand that. I understand, but it is now 

offered where several years ago we had a couple only that offered 

it, correct? 

Mr. O’BRIEN. Right. As of today for the 2012 contract year, there 

is no child in the FEHB program who is receiving ABA. It is under 

a blanket exclusion as we have identified it as an educational service. We have removed that blanket exclusion. 

Senator BEGICH. Because the evidence is telling you something, 

and it is worthwhile to ask the question for policyholders to consider, correct? 

Mr. O’BRIEN. In our benefit review panel, we went back there. 

We considered the evidence, and the evidence has said this is a 

promising therapy. There is also a wiggle around it. Additionally, 

481 

we looked at the costs and we looked at what the evolution of the 

provider infrastructure and the insurance market. 

Senator BEGICH. Let me ask you. What have you done there, do 

you do that frequently? 

Mr. O’BRIEN. We have other services we are going to be doing in 

the future. This is a relatively new process we are doing. 

Senator BEGICH. That helps me because you have a standard. 

You are not just doing it for anything. You are reviewing it, and 

then you are moving it to the next stage. Then it could move to the 

next stage. Is that fair to say? 

Mr. O’BRIEN. Yes, that is fair to say. 

Senator BEGICH. Okay. Your process, once this information and 

other information may come in, you may have 6 months or so to 

review. Then at that point, you will determine if it fits your criteria. If not, you will identify what those gaps are. Is that fair to 

say? 

Dr. GUICE. Yes, sir. 

Senator BEGICH. Okay. You will keep, I am assuming, the chairman, the subcommittee informed on that process? 

Dr. GUICE. We will be happy to. 

Senator BEGICH. Great. Mr. Hilton, you brought up a lot of good 

questions. I am going to take one which the chairman mentioned 

that I want to follow up on, and that is the Medicaid waiver. 

It is interesting. We do not know what the Supreme Court is 

going to do in the next 4 or 5 days, but under that new program, 

we pay—when I say ‘‘we,’’ I mean the Federal Government—when 

it is all done and said, all new entrees into Medicaid at a certain 

level, we pay 90 percent to any State. So it seems logical to me that 

there should be probably a veteran or an Active Duty military Medicaid program because we are going to pay 90 percent of it anyway, 

that is portable. 

So you serve in one community, because the way it is going to 

work—I think this is the way it is going to work. Let us say you 

are in Alaska. You serve a year or 2. You get transferred. You go 

to another State. You are going to be a new member on their Medicaid roll. You are going to be a new entry. So, therefore, we are 

going to pick you up at 90 percent. So, do we not just figure this 

out now because within a 2- or 3-year period, every military person 

who needs a service and a Medicaid waiver will be actually a new 

entry onto States’ rolls, which we pay 90 percent of. So why not 

just cut through it all and create a Medicaid waiver program for 

military that will actually go into play anyway? Your thoughts on 

that? 

Mr. HILTON. Sir, I think I would be obviously supportive of that. 

Senator BEGICH. Yes, I thought that would be the case. 

Mr. HILTON. In my written testimony, I list the Medicaid waiver 

website. There are 423 different Medicaid waiver programs in the 

Federal Government at the various States. So you can see why we 

sometimes get confused as we move from State to State. However, 

as I note in my testimony, there has to be a way to figure out how 

to serve our military families. 

Senator BEGICH. Just sitting here listening to you and thinking 

about the law by the example I just gave, every military person 

who needs the Medicaid waiver will automatically become a MedVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00487 Fmt 6601 Sfmt 6602 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
482 

icaid new entry in the State they go to. Those are people we are 

going to be covering 90 percent of under the new law. So why not 

just do it? That is just a thought that I wanted to share. 

I am giving it through the chairman and the staff, and maybe 

some thought there because I think you bring up, if I can in my 

last minute here, Mr. Hilton, what other things do you think we 

in the Federal Government can do? You mentioned a couple in your 

testimony, and I appreciate that—that we can do to better really 

serve families that have children with disabilities and special 

needs? 

Mr. HILTON. Sure. If I had to prioritize the variety of things I 

put in my written testimony—it was pretty lengthy—I would obviously put high on the top of the list the ABA issue. We have been 

admiring this problem—— 

Senator BEGICH. To get it classified as a medical—— 

Mr. HILTON. Yes, sir, as medically necessary. I will be honest 

with you. I hear medical therapy, but not medically necessary. I 

hear educational. I hear sea lawyer combined with insurance adjuster, to be honest. That is what our families hear, and that would 

be at the top of the priority list for me. 

Obviously, getting in place appropriate policy to standardize the 

EFMP process such that, exactly as the chairman said, as we move 

from base to base, it is consistent. From my perspective, disabilities 

do not care what uniform you wear, and it is one of those things 

where we all scratch our head and wonder why are we receiving 

different services. 

Senator BEGICH. Very good. Thank you very much. Thank you, 

Mr. Chairman. 

Senator WEBB. Thank you, Senator Begich. Before I call on Senator Gillibrand, let me just say to her that I was talking well about 

her before she got here. She was really one of the principal motivating forces behind having this hearing. So we welcome her, and 

she is now recognized. 

Senator GILLIBRAND. Thank you, Mr. Chairman, and thank you 

so much for holding this hearing. Thank you to each of the witnesses. This is so helpful because this is not an issue that I think 

gets enough sunlight, enough discussion, and one that so urgently 

does for families that have children that are suffering. That is what 

I am really worried about. 

I am worried that this would take 6 months; 6 months is a long 

time. That could be a whole half year for a 1-year-old or a 2-yearold where those therapies are the difference between whether they 

will ever reach their God-given potential. I think that is too long. 

I am very concerned because the prevalence is so high. One in 

54 boys today are being diagnosed with autism. The fact that these 

therapies actually work is the greatest hope that we have. We 

should not be denying them to any child, certainly not children of 

military families, certainly not children of wounded warriors or veterans. We have to do better, in my view. 

Now, I was very interested in both of the doctors’ testimonies because what you described to me sounded very much like psychological therapies that are similar to what we do for post traumatic 

stress disorder (PTSD). So I want to go to our first witness, Dr. 

483 

Guice. Could you tell us, when we look at PTSD, are those therapies covered as medically necessary? 

Dr. GUICE. Those are covered as medically necessary, yes. 

Senator GILLIBRAND. What is the difference between the types of 

therapies, because as Dr. Dawson described, she described them 

being administered by psychologists, by people who have specific 

training for these needs, very similar to PTSD. 

Dr. GUICE. The difference is when we looked at providing ABA 

back in 2010, the evidence at that point in time convinced us it was 

still considered a behavioral intervention, and as such could not be 

covered under our statutory and regulatory requirements for determining medical care that is medically and psychologically necessary to treat a disease or an illness. 

Senator GILLIBRAND. So, even as you just described it, that perfectly describes PTSD therapy, something that is behaviorally necessary that actually is an intervention that actually does help these 

men and women in life and death situations. 

Dr. GUICE. The treatment actually treats the underlying condition of PTSD. It is designed to treat PTSD. 

Senator GILLIBRAND. Exactly. That sounds exactly what behavioral therapies for ABA are. So I feel that if you did reexamine it, 

where the literature is today, and since studies are being published 

every month that show that it is scientifically and medically necessary, that it actually affects the brain and the development of the 

brain, I think every criteria that you have been using for all these 

other diseases and disorders and treatments, it will match up perfectly just from the testimony I have heard today. 

My question is, how can we do this more quickly? Is there a way 

for us as the Senate Armed Services Committee, as we do this authorization legislation, to write something that allows you to do 

this immediately, and to have the resources put in place to understand the literature immediately, to be able to say this is a psychologist offering medical treatment so children can develop their 

brains, their behavior, their abilities properly? 

Dr. GUICE. We have it separate. We have a very defined process 

through which we look at these potential coverage decisions, and 

we use that routinely and standardly. It is about getting information and assessing it according to our criteria. We will do it as expeditiously as we possibly can. 

Senator GILLIBRAND. I would like to turn my attention now to 

Mr. Hilton. I want to thank you, sir, for your service. The men and 

women who serve and their families are the greatest Americans we 

have. They are some of our best and brightest, and certainly sacrifice more than anyone else. So I want to thank you for coming 

to this panel to tell us about what the lives of these families are 

actually like. 

Can you describe to me, to the extent you know, and if Dr. Dawson or Dr. Tait can amplify this, I would be grateful. Explain what 

happens when a child is newly diagnosed? How do they navigate 

the current system? Please tell me how they navigate whether you 

are Active Duty or whether you are recently separated or whether 

you are injured and in wounded warrior status. What are the differences for each of those types of members of our military families, 

and what needs to be addressed for each person? 

484 

Mr. HILTON. That is a pretty big question. 

Senator GILLIBRAND. Take your time. 

Mr. HILTON. I will just tell you part of our experience from our 

daughter being in born in 2002. In 2004 to 2008, we moved five 

times. That was due to deployments, regular PCS. My wife was in 

training. During that period of time, every time you move, I would 

start preparing for the next move 6 months prior to. I can consider 

myself a pretty decent advocate for my daughter, and we only had 

one daughter at the time. As you are going through the normal 

PCS process and you are dealing with the deployment, it takes 

probably 6 months from getting to the next duty station for you to 

get all the pieces of the puzzle back in play. 

Reading through some of the testimony or some of the notes from 

the parents, and you are talking about the retirees or the veterans 

or the wounded warriors particularly, I cannot even imagine frankly dealing with those situations and having a child with autism or 

another developmental disorder. 

Senator GILLIBRAND. Because they are not eligible at all? 

Mr. HILTON. Correct. If you think about that, going from something to nothing is like hitting a brick wall for these families. For 

that child, and again, I would really encourage everyone to read 

their stories. You read again and again how devastating that is for 

the family and the child. 

Senator GILLIBRAND. Dr. Dawson, could you speak a little bit to 

what is the difference for a child that you are treating that they 

have now 11 hours covered a week. Imagine it is a child that you 

have actually prescribed 40 hours a week. What is the difference 

for that child’s future to the extent you can describe it? 

Dr. DAWSON. First of all, it is important to keep in mind that the 

National Academy of Sciences did convene a group. It has been a 

while now, but they convened a group to look at how many hours 

should be standard of care. At that point, and this was actually a 

number of years ago, 2001, it could have even changed now. But 

standard of care was a minimum of 25 hours a week for a child 

during the pre-school period. 

Senator GILLIBRAND. That was a decade ago. 

Dr. DAWSON. That was a decade ago, and the difference is really 

in IQ points, language ability, and adaptive behavior. So even in 

the last few years, there have been studies that have examined the 

difference in IQ, language, and adapted behavior of a child who 

gets fewer hours versus more, and it does make a difference. 

If we want children to have the best possible outcome, then they 

need to have access to the number of prescribed hours. It is important to keep in mind that that can vary, and it should be looked 

at by each physician working with a family, as Dr. Tait has said. 

For some children, it is going to be 40 hours, particularly early on. 

Other children may only need 10 hours, and that needs to be an 

individual decision so that that child has the best outcome. 

Senator GILLIBRAND. Thank you, Mr. Chairman. 

May I submit a statement for the record that Senator Lieberman 

asked me to submit? 

Senator WEBB. That will be entered into the record at this point. 

[The prepared statement of Senator Lieberman follows:] 

485 

PREPARED STATEMENT BY SENATOR JOSEPH I. LIEBERMAN

I would like to lend my strong support for expanded coverage for military families 

affected by autism. I am struck by the figures provided by our witnesses that show 

how autism has reached near-epidemic levels in our country: one out of every 88 

children, including one out of every 54 boys, is affected, far beyond the rates of 

childhood AIDS, diabetes, and cancer combined. The Department of Defense estimates that 23,000 military dependents have an autism diagnosis, and I have heard 

the deeply moving personal stories of but a few of them. It is clear that this is a 

growing problem that we as a country have yet to address. 

Studies have shown that early diagnosis and intensive therapy are the keys to 

effectively mitigating the effects of autism in children. Therapies informed by applied behavior analysis (ABA) can significantly help the development of life skills 

for those affected. The efficacy of these methods has been recognized by the U.S. 

Surgeon General, and 30 States recognize ABA as a medical treatment that should 

be covered by private insurance. Most notably, the Office of Personnel Management 

has concluded that ABA is a medical therapy that can be covered in Federal Employees Health Benefits programs. 

Unfortunately, TRICARE is behind the curve in this critical area. Unlike the rest 

of the Federal workforce and a growing majority of the private sector, 

servicemembers, veterans, and their families continue to face restrictions on these 

effective autism treatments under TRICARE’s Extended Health Care Option 

(ECHO) program, which I believe place an undue burden on our military families 

with autistic dependents and thereby affect overall readiness. TRICARE classifies 

ABA as a nonmedical educational service. Under TRICARE’s current allowances for 

nonmedical services, members can receive limited financial help that is capped annually at $36,000, sharply limiting the allotment of behavioral analysis hours to less 

than half what it recommended to make a real difference in the life of an autistic 

child. Furthermore, the classification of ABA as a nonmedical service limits provision of even this limited support to Active Duty members, leaving retirees and even 

those who have been separated due to combat wounds. 

I believe that our military families should be provided with the best available 

care, and it is clear to me that behavioral analysis-based therapies constitute the 

best available means to address autism. The time to address this critical gap in 

TRICARE is now. I look forward to supporting legislation to address this issue when 

the Senate takes up the National Defense Authorization Act for Fiscal Year 2013. 

Senator GILLIBRAND. Thank you, Mr. Chairman. Thank you, witnesses. 

Senator WEBB. Thank you, Senator Gillibrand. 

Let me make one point, if I may, just as a follow-on to Senator 

Gillibrand’s comments about PTSD. I was committee counsel on 

the House Veterans Committee many years ago when we did the 

initial studies on PTSD. If I were to see a parallel here—first of 

all, let me be careful. I know there are a lot of frustrated people 

out here, but I do not think this is a sea lawyer syndrome. I do 

not think that is fair to the people who have the burden of having 

to make these determinations. 

I think it is more that the process of trying to figure out how to 

take care of people is an evolutionary process. We went through 

this back in the late 1970s and early 1980s with respect to PTSD. 

I think the question is a legitimate one in terms of evaluating the 

methodology in order to determine whether a particular therapy is 

medically effective. That is what our challenge is here. I think Senator Gillibrand has given our subcommittee a great shot in the arm 

in terms of putting this issue in front of the subcommittee. 

With that, Senator Blumenthal. 

Senator BLUMENTHAL. Thank you, Mr. Chairman, and thank you 

for having this hearing, and to all our witnesses for being here, and 

all who have been such effective advocates for families in this situation. 

486 

Dr. Dawson, I have read a lot of materials and witness testimony 

regarding ABA. My impression is that ABA is a widely accepted, 

successful set of tools that can be used in assisting people who are 

facing the challenges of being diagnosed with autism and other developmental disorders. You have immensely impressive background 

experience, as do all of our witnesses here today. I would like to 

ask you to describe how ABA is being used to assist in the treatment and the effectiveness of this treatment in relation to autism. 

If you could highlight the differences between the TRICARE coverage of ABA and the coverage in the civilian sector. 

Dr. DAWSON. Let us first look at the evidence in terms of what 

is the impact of ABA on children’s outcomes. There have been numerous clinical trials that have been conducted and published. 

There was a study that was funded by the National Institutes of 

Health. It was published in the Journal of Pediatrics. This is the 

flagship journal of the American Academy of Pediatrics, and it was 

published in 2010, that showed that the impact of the early intervention for 50 percent of the children, they had a 15-point IQ gain, 

and for 30 percent of the children, they had a 30-point IQ gain. 

That is to standard deviation. 

So the majority of children who received this treatment actually 

moved from a status of intellectual disability into the normal range 

of cognitive functioning. We know that in terms of predicting longterm outcome, that IQ is the strongest predictor. 

Also, let us think about the cost to society. The current estimates, based on an analysis that was conducted this year, are that 

the costs are $137 billion annually to care for people with autism 

in the United States. Most of that cost is based on adult care. The 

average cost per individual is reduced by about half if they do not 

have intellectual disability. 

Imagine now that we provide this early intervention. You change 

the life course. This individual has either less severe intellectual 

disability or none at all, and they have a chance now to go to a regular classroom, form friendships, have language, go on to have a 

job, and be productive members of society. From a cost benefit 

analysis, it saves taxpayers a tremendous amount of money. 

In terms of TRICARE, the issues are several. One is the fact that 

they limit the amount of coverage to cover about 11 hours of ABA. 

For some children, particularly in that early period, they need 

more than that in order to get the kind of gains that I am talking 

about. The parents are not getting adequate medically prescribed 

treatment, what the physician would recommend. 

The second has to do with the status, and this has to do with 

when you retire, you no longer have access to treatment. Or if you 

are in the National Guard, you are going to have intermittent access to treatment. So if you can imagine your child is doing well 

and they are in intervention, and then you change your status, and 

suddenly the treatment program is gone. What happens is that 

families will do anything. They will mortgage their home. They will 

give up their other children’s college savings in order to get treatment because they know that these are effective. They are aware 

of the literature. The idea of a parent, after learning about a diagnosis and then rising to the challenge, and then finding that the 

treatments that we know are effective and that can make a difVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00492 Fmt 6601 Sfmt 6602 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
487 

ference for their child are not available to them, it is just not something that we should be doing. We really need to do better by these 

families. 

Senator BLUMENTHAL. It strikes me as I listen to you Dr. Dawson, and I want to thank you for your service, this hearing room 

is a very colorless, antiseptic, majestic, but still very abstract setting to talk about what a parent faces in this situation. Since many 

of us—I have four children—are parents, if we were called in the 

middle of a family emergency out of the most important hearing in 

this room or the most important vote ever, we would all be gone 

in a flash. 

The instinctive reaction that you have described to disregard cost 

and to sacrifice almost anything to mortgage homes, to, in effect, 

put a family’s future under a severe financial cloud, is one that I 

think we need to understand. We as a Nation, we as a Congress, 

need to understand. 

The hopes offered by ABA, I think, are very impressive. Maybe 

I can ask others who are on this panel whether they have any comments on what we have just heard. 

Dr. TAIT. If I may comment for just a moment, thank you so 

much. I was just keying off of some of the things that have been 

said thus far, and I think whether you are looking at PTSD or 

whatever we are talking about here. We spend a lot of time not 

separating our head from our body. So when we are talking about 

health of children, that includes the behavioral health. That includes the physical health. 

For a child to be healthy and learn and grow, we have to look 

at all of those issues, and that is exactly what parents want. They 

just want their kids to have the services that they need to be able 

to have them fulfill their potential. I know that is what you all 

want too. 

I just wanted to comment on the navigation of families within 

systems. I can remember when I have talked to families, and one 

mother said to me, I want you to know that I spend all my day 

trying to navigate the payment system and nine care coordinators. 

I coordinate the care coordinators. They do that willingly, and dayin and day-out so that their children can receive the services that 

they need. 

From the perspective of this hearing, what we want is to make 

that as successful and easy to the families as we can make it. If 

they have to worry about what is getting paid or what is not getting paid and not concentrate on the children and the families, 

then that just puts extra stress on a family that is already stressed 

for a number of reasons. Thank you. 

Mr. HILTON. Sir, if I could offer one other thought. Looking 

through these 80-plus testimonies of individual military families, I 

realize it is not a scientific study, so you cannot rely on it exactly. 

But there is no one in here in this enormous population that says, 

‘‘oh, we tried ABA and it did not work out.’’ Literally in every story, 

they say ABA—and it has been beneficial through the ECHO program, and we are thankful, I will admit. It is an amazing program, 

and it has been helpful to a lot of families. 

Every one of them then says, ‘‘what we are worried about is retirement,’’ and retirement is one of the stories. It is literally a week 

488 

away for this family, and they are looking forward to retirement 

after multiple deployments, after many, many years. I know families that have put off retirement for a variety of reasons when they 

would like to, and they simply cannot. 

Senator BLUMENTHAL. Thank you. Again, thank you, Mr. Chairman. My time has expired, but I am going to continue my interest. 

I would like to, again, thank the chairman for being very much attuned to this issue, and my colleagues, especially Senator 

Gillibrand, for being so active and attentive to it. Thank you. 

Senator WEBB. Thank you, Senator Blumenthal. Again, let me 

emphasize that I do not think there is any disagreement in this 

room about wanting to help the people who are in need, and particularly for us at this moment, family members and people who 

are serving and who have served. 

Our question, our burden, is evaluating the methodology in order 

to determine whether this therapy is medically effective. If it is, in 

those cases where it should be applied, there should not be any 

question about what we do. But that is the question that is before 

us. 

I understand there are people who would like a second round. 

Senator Begich? 

Senator BEGICH. No, I am good. 

Senator WEBB. Okay. Senator Gillibrand, I know you want to ask 

questions or have other comments. 

Senator GILLIBRAND. I would like to go back to the conversation 

about specifically what we can do to hasten the re-review process. 

I would like guidance to this subcommittee about how we can help 

you legislatively. 

Dr. GUICE. I do not believe at this point that we would require 

additional legislation to do it. I think it is just getting the evidence 

and having the time to sift through it. 

I would like to add, though, I think one of the witnesses said 

that TRICARE limits the ECHO or the payment available for ABA 

therapy to the $36,000 per year. That limit is set by Congress. 

Senator GILLIBRAND. We could change that. What would the 

limit have to be to cover the prescribed ABA therapies, Dr. Dawson 

or Dr. Tait? 

Dr. TAIT. We have looked at some of those costs, and they run anywhere from $30,000 to $50,000 depending on where you are and 

whether you need the 40 hours versus the 20 hours. I believe that 

it is in that range, and that is generally what we are asking at the 

State level per child, of course. 

Dr. DAWSON. I think that is the way to look at it. Think about 

it from the point of view of a physician making a prescription, and 

I do not think many children would go above 40 hours. One would 

look at the range that would cap at 40 hours a week and what that 

would cost, particularly during that early intensive period. Obviously, when children are entered into school and they are spending 

the majority of their time in school, they are not going to require 

40 hours. So it would over time, that amount would be lessened. 

But to have that option during the early period is what is critical. 

Senator GILLIBRAND. Is there a way to facilitate, both Dr. Dawson and Dr. Tait, getting the studies that you mentioned today to 

DOD so that you can have immediate answers on trying to prove 

489 

the case to DOD so when they do their re-review, they have those 

studies on hand and those peer review studies? 

Dr. DAWSON. Absolutely. In fact, just to point out, since the evaluation was done, which I think was based on 2010, there have been 

well over a dozen studies that have been published since then. I 

can certainly provide that literature. Even the Agency for 

Healthcare Research and Quality (AHRQ) report, which I think 

was referred to in the testimony, is historically already out of date, 

and also very limited in its scope. It only looked at 10 years worth 

of literature, and the literature now that actually began in 1987 

was the first clinical trial that was published. None of those studies 

were included in that particular report. 

I think we really need to include the breadth of knowledge in the 

review that is available today. 

Senator WEBB. If I may, as chairman, if there are studies that 

have not been provided to our staff along those lines, I think we 

would appreciate being able to look at them as well. 

Senator GILLIBRAND. I have at least an informal commitment of 

this group of people to be a working group to coordinate data, coordinate studies, get it done. To the extent this subcommittee asks 

for a recommendation in the near future from DOD, that might be 

a way to formally, at least, request that this process continue as 

quickly as possible. We could either do that by letter or put something as an amendment into the authorization bill. I would like to 

work with you on how that should be requested in the way most 

effective to help your team apply the proper resources to do it now. 

Dr. GUICE. We would appreciate that. Thank you. 

Senator GILLIBRAND. Thank you very much. Thank you, Mr. 

Chairman. 

Senator WEBB. Thank you, Senator Gillibrand. Again, I appreciate all of the testimony from a very wide breadth of knowledge 

and experience, and it has been extremely useful to us. 

Your written testimony will be reviewed in very thorough detail 

as well. Thank you, Senator Gillibrand, for being the motivating 

factor in having this hearing. I think it has been very useful for 

us. 

This hearing is now adjourned. 

[Questions for the record with answers supplied follow:] 

QUESTIONS SUBMITTED BY SENATOR SCOTT P. BROWN

APPLIED BEHAVIOR ANALYSIS

1. Senator BROWN. Dr. Guice and Dr. Posante, recently the Office of Personnel 

Management (OPM) stated there is enough evidence to classify Applied Behavior 

Analysis (ABA) as a medical therapy rather than an educational service. Can you 

please explain how the TRICARE Management Activity continues to rely upon information regarding ABA that it gathered in 2010? 

Dr. GUICE and Dr. POSANTE. The TRICARE program medical benefit coverage determinations are governed by separate statutory and regulatory mandates not applicable to the insurance plans that participate in the Federal Employees Health Benefits (FEHB) Plan. Currently, the TRICARE program has no authority to provide coverage of educational services, behavior modification modalities, or other nonmedical 

services under the Basic Medical Program. The authority and scope of the TRICARE 

program to cover medical treatments under the Basic Medical Program are defined 

by statute. 

In addition, any proposed TRICARE Basic Medical Program benefit characterized 

as a drug, device, medical treatment, diagnostic, or therapeutic procedure must be 

determined to be safe and effective in accordance with the longstanding, reliable eviVerDate Aug 31 2005 15:51 Jan 31, 2013 Jkt 000000 PO 00000 Frm 00495 Fmt 6601 Sfmt 6621 Y:\BORAWSKI\DOCS\76542.TXT JUNE PsN: JUNEB
490 

1 ECHO is a supplemental program to the basic TRICARE program. ECHO provides financial 

assistance for an integrated set of services and supplies to eligible Active Duty family members 

(including family members of activated National Guard or Reserve members). There is no enrollment fee for ECHO; however, family members must have an ECHO-qualifying condition, enroll 

in the Exceptional Family Member Program (EFMP) as provided by the sponsor’s branch of 

Service, and register in ECHO through ECHO case managers in each TRICARE region. 

dence criteria set forth at Title 32, Code of Federal Regulations Part 199.4(g)(15). 

The Department of Defense (DOD) has used this published ‘‘reliable evidence’’ 

standard for the TRICARE Basic Medical Program benefit coverage determinations 

since 1997 (see 62 Federal Register 625, 629, January 6, 1997). The requirement 

to use peer-reviewed evidence of safety and efficacy allows DOD to ensure the benefits our beneficiaries receive are tested and proven safe and effective in either the 

diagnosis or treatment of an injury, illness, or disease. 

It should be noted that apart from the medical benefits provided under the 

TRICARE Basic Medical Program, DOD is authorized to provide additional nonmedical services to dependents of Active Duty servicemembers eligible for and enrolled in the Extended Care Health Option 1 (ECHO) to reduce the disabling effects 

of a qualifying condition. This program was created to support the readiness of Active Duty members who might have a dependent with special needs not otherwise 

covered under the health plan ECHO supplements other public resources for Active 

Duty dependents that are subject to geographic relocations based on their sponsor’s 

duty assignment. 

2. Senator BROWN. Dr. Guice and Dr. Posante, how is TRICARE Management Activity able to rely upon dated information regarding ABA? 

Dr. GUICE and Dr. POSANTE. The TRICARE program medical benefit coverage determinations are governed by separate statutory and regulatory mandates not applicable to the insurance plans that participate in the FEHB Plan. Currently, the 

TRICARE program has no authority to provide coverage of educational services, behavior modification modalities, or other non-medical services under the Basic Medical Program. The authority and scope of the TRICARE program to cover medical 

treatments under the Basic Medical Program are defined by statute. 

In addition, any proposed TRICARE Basic Medical Program benefit characterized 

as a drug, device, medical treatment, diagnostic, or therapeutic procedure must be 

determined to be safe and effective in accordance with the longstanding, reliable evidence criteria set forth at Title 32, Code of Federal Regulations Part 199.4(g)(15). 

DOD has used this published ‘‘reliable evidence’’ standard for the TRICARE Basic 

Medical Program benefit coverage determinations since 1997 (see 62 Federal Register 625, 629, January 6, 1997). The requirement to use peer-reviewed evidence of 

safety and efficacy allows DOD to ensure the benefits our beneficiaries receive are 

tested and proven safe and effective in either the diagnosis or treatment of an injury, illness, or disease. 

It should be noted that apart from the medical benefits provided under the 

TRICARE Basic Medical Program, DOD is authorized to provide additional nonmedical services to dependents of Active Duty servicemembers eligible for and enrolled in ECHO to reduce the disabling effects of a qualifying condition. This program was created to support the readiness of Active Duty members who might have 

a dependent with special needs not otherwise covered under the health plan ECHO 

supplements other public resources for Active Duty dependents that are subject to 

geographic relocations based on their sponsor’s duty assignment. 

3. Senator BROWN. Dr. Guice and Dr. Posante, can you please explain the reasons 

behind why children of DOD civilians have greater access to ABA rather than children of the men and women we send off to war? 

Dr. GUICE and Dr. POSANTE. For DOD civilians, OPM’s reclassification of ABA as 

a medical therapy rather than an educational service is an administrative decision 

and does not require FEHB plans to add ABA services to their basic benefits package. Rather, it allows plans to propose ABA as an additional benefit, under conditions where medical necessity is satisfied and appropriate, qualified providers are 

available. Those plans that include ABA may adjust their premiums accordingly. 

The ECHO program for Active Duty servicemembers that allows DOD to help our 

beneficiaries minimize the disabling effects of Autism Spectrum Disorder (ASD). Importantly, the ECHO program exists to supplement other public resources for Active 

Duty dependents who are subject to geographic relocations based on their sponsor’s 

duty assignment. Beneficiaries are required by law to first seek services from the 

State in which they reside, but DOD realizes the requirements of military service 

are demanding and may, at times, place a family in a State with more limited State 

491 

benefits. The ECHO program allows us to augment public services to assist special 

needs dependents of our Active Duty servicemembers. 

To increase access to ABA services, DOD implemented, within ECHO, the Enhanced Access to Autism Services Demonstration in March 2008. The demonstration 

expands the opportunity for access to ABA through a variety of provider types, including tutors. TRICARE extended the demonstration to March 2014, pending inclusion of the demonstration model as a permanent benefit within ECHO. 

• As of May 31, 2012, there were 3,793 beneficiaries enrolled in the demonstration, 1,881 ABA supervisors, and 9,201 ABA tutors across all three 

TRICARE regions. 

• DOD’s evaluation of the results of the demonstration concluded that it increased the number of and access to the services of authorized ABA providers, as evidenced by the sustained 3 to 5 percent monthly growth in the 

number of demonstration enrollees since implementation in 2008. 

• Parents of dependent children with autism who responded to a DOD survey reported that improved access to ABA contributed to improved military 

family readiness and retention. 

• A proposed rule to establish TRICARE coverage under ECHO of ABA for 

the Assistant Secretary of Defense was published in the Federal Register, 

Vol. 76, No. 250 on December 29, 2011. Upon final implementation of this 

rule, DOD intends to categorize ABA as an ‘‘Other Service’’ and adopt a 

tiered ABA services delivery and reimbursement methodology. 

4. Senator BROWN. Dr. Guice and Dr. Posante, with the eventuality that ABA is 

considered a medical therapy, I realize there may be some challenges that will need 

to be worked through to make this change a reality. One is the possible shortage 

of qualified professionals available to provide. How do you suggest this issue be addressed? 

Dr. GUICE and Dr. POSANTE. The National Defense Authorization Act for Fiscal 

Year 2007 directed the Secretary of Defense to develop a plan within the authority 

of the ECHO program to provide services to military dependent children with autism. The legislation mandated that DOD develop: (1) requirements for the education, training, and supervision of autism service providers; (2) the ability to identify the availability and distribution of those providers; and (3) procedures to ensure 

that such services provided by DOD supplement those available through other public sources. In response to Section 717, DOD submitted the required plan (DOD 

2007) to Congress in July 2007. In addition to meeting the requirements of Section 

717, the report outlined a proposed demonstration that would test the feasibility of 

expanding the types of providers authorized to deliver autism treatment services to 

include those not meeting the strict requirements of the then-current departmental 

regulations. However, the requirements for establishing TRICARE-authorized providers coupled with the relative newness of the Behavior Analyst Certification 

Board (BACB) and the ABA profession resulted in a shortage of qualified providers 

available to TRICARE beneficiaries with autism. To mitigate this shortfall, 

TRICARE has used its authority in ECHO to use non-professional ‘‘tutors’’ to provide ABA through the Enhanced Access to Autism Services Demonstration. The 

demonstration has been extended to March 14, 2014. The demonstration expands 

the provider model by including tutors under the supervision of a TRICARE-authorized ABA provider to deliver the hands-on therapy. The supervisor retains all of his/ 

her other responsibilities. 

To be eligible for the demonstration, the Active Duty family member must be registered in ECHO. Eligible beneficiaries can receive ABA services under ECHO but 

that program recognizes only ABA providers who are State-licensed or certified or 

are certified by the BACB. Under ECHO, those providers are responsible for developing a behavior plan, providing periodic beneficiary assessments, and delivering 

ABA therapy. 

TRICARE continues to increase access to ABA services and is leading the Nation 

in fielding an effective ABA provision model that overcomes the national shortfall 

in available BACB credentialed providers. Regular reports to Congress demonstrate 

increasing participation by ABA supervisors, tutors, and TRICARE beneficiaries. 

Based on positive results from the demonstration (as noted in the response to Question #3), a proposed rule to establish TRICARE coverage under ECHO of ABA for 

Assistant Secretary of Defense was published in the Federal Register, Vol. 76, No. 

250 on December 29, 2011. Upon final implementation of this rule, DOD intends 

to categorize ABA as an ‘‘Other Service’’ and adopt a tiered ABA services delivery 

and reimbursement methodology. However, reducing or eliminating the national 

shortfall of board-certified providers of ABA will require a concerted national effort 

492 

that falls outside of DOD’s mission area and might best be led by other departments. 

Appendix A 

[The prepared statement of the National Military Family Association follows:] 


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The National Military Family Association is the leading nonprofit organization committed to 

strengthening and protecting 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 oflife for active duty, National Guard, Reserve, retired service 

l11elTI_bers, their families and survivors from the seven uniformed services: Army, Navy, Air Force, 

Marine Corps, Coast Guard, and the Commissioned Corps of the Public Health Service and the 

National Oceanic and Atmospheric Administration. 

Association Volunteers in military communities worldwide provide a direct link between 

military families and the Association staff in the Nation's capital. These volunteers are our "eyes 

and ears," bringing shared local concerns to national attention. 

The Association does not have or receive federal grants or contracts. 

Our website is: www.MilitaryFamiiy.org. 
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Chairman Webb, Ranking Member Graham, and Distinguished Members of the 

Subcommittee, the National Military Family Association thanks you for the opportunity to present 

testimony for the record concerning the quality oflife of military special needs families, After 11 

years 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, as well as the unique challenges facing families who have a child or other family 

member with special needs. Your response through legislation to the increased and ever-changing 

need for support has resulted in programs and policies that have helped sustain these families 

through difficult times. 

Support for Special Needs Families 

Military families tell our Association the issues they face in caring for a special needs family 

member while simultaneously supporting the service of the military member are complex. Most 

often, meeting these needs requires the coordination of many distinct military and community 

entities, with the responsibility for that coordination too often falling to the already-burdened 

family. Military families caring for a special needs family member need not just medical and 

educational support. They also need assistance from state and local agencies, relocation help, 

respite, and family support, especially if they are also dealing with the deployment of their service 

members. 

True support for these families must be designed and delivered holistically, but with the 

understanding that diagnoses and the severity of conditions vary from one special needs family 

member to another. No "one-size-fits-all" solution exists to solve the problems these families face. 

The military support systems guided through Department of Defense (000) offices, such as Health 

Affairs and Military Community and Family Policy, and the programs implemented by the 

individual Services and installations must be coordinated and flexible enough to meet the variety 

of needs in the military community. The military must lead an outreach to schools; other federal, 

state, and local government agencies; and charitable service-delivery organizations to ensure 

families know about and have access to the full range of support for which they are eligible. 

To engage in this outreach and to support these families, and thus the service member, 

000 must have the resources. We encourage you, in this time of scarce resources, to direct the 

Services to maintain robust Exceptional Family Member Programs al1d to provide enough School 

Liaisol1 Officers to assist ALL families with issues they experience transitioning from school to 

school. While installation School Liaison Officers are available to assist all transitioning military 

families, special needs families especially benefit from their assistance as part of the installation 

support team in ensuring proper, timely placement, and delivery of educational services. Respite 

and family support programs provided by the Services for special needs families payoff in greater 

family capacity to meet the challenges of military life and deployment. Unfortunately, funding and 

availability for these programs has varied among the Services and among installations. We believe 

the support for the family and assistance with their special needs family member make these 

programs crucial in enabling the service member to focus on the mission. 

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While many issues remain for families caring for their special needs member, we are 

encouraged by the progress made at the installation, Service, and Department levels when 

adequate resources and the proper focus are provided. Your creation of the Office of Community 

Support for Military Families with Special Needs (OSN) in the National Defense Authorization Act 

for Fiscal Year 2010 (NDAA FYIO) is one sign of progress. OSN's mission is to enhance and 

improve DoD support around the world for military families with special needs, whether medical, 

educational, relocation, or family support. Last year when discussing the OSN in testimony, our 

Association expressed concern about a lack of coordination on these issues between the various 

DoD program and agency stovepipes. Our Association is pleased OSN now regularly meets with the 

Department of Defense Office of Health Affairs to address the medical resources our special needs 

families require. We are also pleased the OSN has twice convened the Advisory Panel on 

Community Support for Military Families with Special Needs created in the NDAA FY 11 to get 

input from families on medical, educational, relocation, and family support resources our special 

needs families require. 

Despite the progress, a holistic approach to supporting these families still remains the goal 

and not the reality for many. Case management for military beneficiaries with special needs is not 

consistent across the Services or the TRICARE Regions because the coordination of care for the 

military family is being done by a health care system whose individual elements do not always 

work in synergy. BenefIciaries try to obtain an appointment and then find themselves getting 

partial health care within the Military Treatment Facility (MTF), while other health care 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 move, not just from one TRICARE Region to another, but often even when transferring 

within the same TRICARE Region. This incongruence is further exacerbated when a special needs 

family member requires not only medical intervention, but non-medical care as well. Each 

TRICARE Managed Care Support Contractor (MCSC) has created different case management 

processes. 

Families need a seamless transition and a warm hand-off between and within TRICARE 

Regions and a universal case management process across the Military Health System. We believe 

TRICARE leaders must be more engaged with their family support counterparts both through the 

Office of Community Support for Military Families with Special Needs and at the local level to 

develop a coordinated case management system that takes into account other military and 

community resources, as well as health care. We recommend a Government Accountability Office 

(GAO) report to examine the case management process for special needs families. 

ECHO 

The Extended Health Care Option (ECHO) program, the primary benefit enhancement for 

special needs military families, has been the topic of a great deal of debate among military families 

and by Congress. Congress created the ECHO program to allow active duty families with special 

needs to receive additional services to offset their lack of eligibility for state or federally provided 

services due to frequent moves. We assert that this focus on supporting currently-serving families 

is appropriate and should remain the priority for DoD. We suggest that, before making any more 

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adjustments to the ECHO program or to other benefits, Congress should request a GAO report to 

determine if the ECHO program has been effective in addressing the needs of the population it was 

intended to serve in the way it was intended. The report should also address ECHO coordination 

with other benefits, both the regular TRICARE benefit and state and local resources. 

Special needs families come in all demographics and diagnoses. It is important to note that 

the TRICARE ECHO program provides services for all types of diagnoses. A military spouse 

eligible for ECHO can be diagnosed with multiple sclerosis, an adolescent with psychosis, or a 

child with Down's Syndrome. Recent focus on TRICARE ECHO has been on supporting military 

children diagnosed with autism spectrum disorder. However, family members with other 

diagnoses are also enrolled in the ECHO program and benefit from its services. As the conversation 

on changing ECHO or TRICARE benefits continues, we ask Congress to recognize that special 

needs family members enrolled in ECHO with diagnoses other than autism spectrum are also 

benefiting from Applied Behavior Analysis (ABA) therapy. These diagnoses include, but are not 

limited to, Down's Syndrome, Mental Retardation, Angelman Syndrome, Cerebral Palsy, 

developmental delays, and Fragile X. 

Under the ECHO benefit, the TRICARE Management Activity established an Autism 

Demonstration, known to beneficiaries as the "Demo." The Demo provides beneficiaries with an 

autism spectrum diagnosis the ability to purchase more ABA therapy through the use of tutors. 

ECHO-enrollees who cannot qualify for the demo based on diagnosis, but who would benefit from 

ABA, cannot use the tutors and thus their benefit would not cover as many hours. Our Association 

recommends any changes made to the TRICARE ECHO benefit or related demonstration 

programs need to incorporate the needs of ALL diagnoses among program-eligible family 

members. 

We also hear from our ECHO-eligible families that they could benefit from additional 

programs and health care services to address their special needs. We request a DoD pilot study to 

identify what additional services, if any, our special needs families need to improve their quality of 

life, such as cooling vests, cranial helmets, diapers, or nutritional supplements. We recommend 

families in the pilot have access to $3,000 annually above what is provided by ECHO to purchase 

self-selected items, programs, and/or services not already covered by ECHO. DoD would be 

required to authorize each type of purchase to verify the requested item, program, or service is 

appropriate. This pilot study could identify gaps in coverage and provide DoD and Congress with a 

list of possible extra ECHO benefits for special needs families. 

The Reserve Component eRC) has unique challenges with their special needs family 

members. They only qualify for ECHO when they are on active duty status. The population is 

relatively small, but our Association is concerned with the coordination of care and seamless 

transition of services as the special needs family member becomes eligible to receive ECHO 

benefits and then loses them when the member is deactivated. We request that Congress direct 

GAO to examine ECHO benefits during the activation and deactivation cycle, and the impact on 

the RC family and the special needs family member. 

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Transitions 

We applaud the attention Congress and 000 have given to our special needs family 

members in recent years and the desire to create robust health care, educational, and family 

support services for special needs family members. However, these robust services do not follow 

the family members when the service member retires from the military. When ECHO was created 

as an active duty support program, its creators believed families in retirement would be able to 

access similar services through other federal, state, or community programs. 

We know the transition to retirement can be difficult for many families, however, because 

of the immediate loss of ECHO benefits upon retirement. Both TRICARE and civilian insurers face 

growing pressure to incorporate coverage of services currently available for military families only 

through ECHO into their basic benefit package, even though only certain special needs family 

members may benefit. As you review possible TRICARE changes, we ask you to ensure that 

benefits changes balance the needs of all members of our community 

We remain concerned about the transition of wounded, injured, or ill service members and 

their families from active duty status to that of medically-retired, especially when the family 

includes a special needs family member. We support DoD's proposal to exempt medically-retired 

service members, survivors of active duty service members, and their families from the TRICARE 

Prime enrollment fee increases. However, we believe wounded, ill, or injured service members 

need even more assistance in their transition. We continue to recommend that a legislative change 

be made to create a three-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, increased costs, and the immediate loss of ECHO benefits 

for their special needs family member. 

Our Association has always recommended that special needs families be allowed to pick 

their last duty station, preferably in the state where they will reside after they retire from the 

military. This additional time would give them a head start on establishing themselves in their 

communities, enrolling in state Medicaid Waiver programs, and receiving local services. As our 

military downsizes, the preparation for transition and establishing eligibility for needed services 

before entering civilian status could become more difficult. We recommend the Services allow 

special needs families enrolled in EFMP the opportunity to choose their final duty station before 

retirement. Because such a move is not always possible, we recommend legislation be passed to 

extend ECHO eligibility for one year after retirement for enrolled family members to provide 

more time for families to transition to state and local services or employer-sponsored insurance. 

We also encourage you to use your Congressional bully pulpit to stimulate more awareness 

in the states aboutthe needs of military families. We believe one of the most critical issues at the 

state level for our special needs families is the availability of and military family eligibility for 

Medicaid waivers. The Office of Community Support is studying Medicaid availability for special 

needs military family members. Our Association is anxiously awaiting tbis study'S findings. We will 

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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 harder 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 corresponding inability to qualify for these additional value-added benefits in a 

timely manner. 

We have also asked the 000 State Liaison Office to consider exploring ways to stimulate 

state discussions on how to provide portability for military family members' enrollment in 

Medicaid waivers. Too often, military families arrive in at a new duty station, put their special 

needs family member on a waiting list for a waiver, and finally start receiving services under the 

waiver not long before it is time for another military move to a different state, where they must 

start the process to obtain a waiver all over again. We know achieving portability may be difficult 

because each waiver program has its own set of eligibility requirements, services determined, and 

funding provided by the states, but believe it is important to raise awareness about the issue and 

stimulate discussions at the state level. 

Recommendations 

To meet the needs of all our special needs military families, we need a coordinated 

approach to both service-delivery and information gathering. We encourage Congress and DoD to 

seek more information from a variety of sources: 

military families representing the full range of diagnoses and conditions 

DoD service providers in the Service and installation Exceptional Family Member 

Programs 

civilian and military health care providers and case managers, including those working for 

the TRICARE contractors 

educators in DoD and civilian school districts 

state and local agencies, such as Medicaid 

representatives of the national disability organizations 

Only with the right information can DoD apply correct solutions to meet the needs of these 

families. Our Association believes the Medicaid waiver report, a GAO report on the ECHO 

program, along with our recommended pilot study will provide DoD and Congress with necessary 

information 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 wartime deployments on special needs military families. 

In conclusion, we ask Congress to: 

Ensure any changes made to the ECHO benefit incorporate the needs of families with 

ALL diagnoses. 

Direct DoD to expand the Autism Demo's coverage of Applied Behavioral Analysis 

therapy to all eligible ECHO-enrolled beneficiaries when therapy is deemed necessary by 

their physicians. 

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Create a DoD pilot study to identify what additional service(s) special needs families 

need to improve their quality oflife. 

Allow medically-retired service members and their families to maintain the active duty 

family TRICARE benefit for a transition period of three years following the date of 

medical retirement, comparable to the benefit for surviving spouses. 

Allow already-enrolled family members in ECHO to remain eligible for one year 

following the service member's retirement from the military. 

Require GAO reports 

o to evaluate DoD's existing case management programs and program 

coordination for special needsfamily members 

o to evaluate how well ECHO coordinates with other benefits: with the regular 

TRICARE benefit and those offered by other federal, state, and local government 

agencies and community resources. 

o to examine the impact of almost 11 years of war on our special needs families. 

o to examine the impact of ECHO benefits during the activation and deactivation 

cycle on the RC family and the special needs family member and if the program 

has been effective in addressing the needs of this population. 

Direct the Services to maintain robust Exceptional Family Member Programs 

Military Families - Our Nation's Families 

Bringing the troops home does not end our military's mission or the necessity to support military 

families, especially their children, dealing with the long-term effects of more than a decade at war. 

Downsizing and budget cuts will present new challenges. The government should ensure military 

families have the tools to remain ready. Effective support for military families with special needs 

must involve a broad network of government agencies, community groups, businesses, and 

concerned citizens. Our Nation must continue to fund what works to support military families, 

protect the most vulnerable, and, above all, value their service. 

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Appendix B 

[The prepared statement of the National Council on Disability 

follows:] 


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parents, Families with more than one EFM, parents who are themselves EFMs, 

and Families with a deployed sponsor-it is an overwhelming prospect. Despite 

having health insurance, some Families experience substantial unreimbursed 

costs if not financial hardship, and the demands of caring for the Family member 

with a disability can make it impossible for the caretaker to work outside the 

home. EFMP Families who live off base, which describes the majority, are apt to 

be less Familiar with base services, and to be ineligible to use them. 

Access to Health Care 

Many Families who were more successful than others at navigating the complex 

health care service and reimbursement systems attributed their success, in large 

part, to the assistance of case managers through EFMP, Tricare, and ECHO. 

Most Families, however, reported not having been assigned a case manager, not 

being able to access their case manager, or not knowing whether they were 

eligible for case manager services. Certain individual healthcare providers were 

described as exemplary in assisting Families to navigate the health care system. 

Participants consistently said there is a dearth of nearby specialists (especially in 

behavioral health), requiring them to routinely travel long distances to obtain 

specialty care. Some Families also described cumbersome Tricare processes 

and a protracted system for obtaining healthcare referrals, which are particularly 

burdensome for those that rely heavily on the healthcare system. Many 

lamented the limitations of Tricare coverage-particularly Tricare coverage of 

Applied Behavior Analysis (ABA) therapy, offered under the Tricare Extended 

Care Health Option (ECHO), which falls well short of the recommended standard 

of care. 

Access to Special Education 

USMC students frequently attend public schools, because bases with 

Department of Defense Education Activity (DoDEA) schools are the exception 

rather than the rule. Parents described DoDEA schools as well-resourced and 

praised DoDEA's inclusive model for students with disabilities. Similarly positive 

remarks were made about EDIS (Early Development Intervention Services), a 

base program that feeds into the DoDEA system. Participants also mentioned 

valuable national-level civilian resources for advocacy and advocacy training 

within the educational environment-most notably Specialized Training of Military 

Parents (STOMP) and Task.Mil. Despite these resources, EFMP Families 

encounter a number of obstacles to special education-related services. With 

great regularity, parents described feeling that they must fight schools to secure 

disability-related resources for their children - a lengthy process that may not be 

resolved before a Family has another permanent change of station (PCS). 

Several parents and providers observed that schools and other educational 

facilities (including on- and off-base) are not fully accessible to students with 

disabilities. 

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Access to Long-Term Supports and Services 

Relatively few of the focus group participants had experience in this arena. For 

the most part, unlike healthcare and education, the military is not involved in the 

delivery of long-term supports and services, and USMC EFMs who need such 

resources must look to the civilian sector. The greatest barrier to long-term 

services raised by the study participants is the absence of Medicaid portability 

when USMC Families PCS from state to state. It was also noted that adult EFMs 

currently lack access to services such as transportation for medical appointments 

and personal care attendants. Many Families do not live on the same base long 

enough to qualify for Medicaid waivers, which provide these services for families 

that meet state residency and other requirements. 

Pennanent Change of Station and Access to Disability-Related Services 

The requirement to move, or PCS, regularly, often to destinations not of one's 

choosing, is a constant in military life that entails logistical, emotional, and 

financial stressors. The focus group results reinforce that PCS challenges can 

be significantly more arduous for Families with EFMs, especially if the Families 

are young and/or the EFM's disability is severe. Every time a Family PCSes, 

they must re-educate themselves about the resources available to them and the 

process for accessing them. They must also reassemble their EFM's continuum 

of care-i.e., request, coordinate, and potentially fight for the services their EFM 

needs. Families often PCS without knowing exactly where they will be living 

(e.g., on-base/off-base, school district) which significantly hinders their ability to 

plan in advance and can result in substantial delays in services. On arrival, there 

may be a wait for housing (on-base or off-base), necessitating a difficult if not 

costly stay in temporary lodging. A number of resources can potentially facilitate 

the PCS move. The EFMP assignment policy, for example, is intended to ensure 

that Families are assigned to locations where their EFMs' needs can be met. 

However, in practice, this often is not the case. Priority on-base housing is a 

significant resource for PCSing EFMP Families. Some Families were concerned 

that the current elimination of the EFMP category system, which grades level of 

need based on disability severity, may jeopardize continued access to priority 

housing. Families and providers also described EFMP caseworkers as PCS 

resources, at least for Families who are Familiar with EFMP services and have 

an EFMP caseworker. Caretakers mentioned additional resources for all PCSing 

Families, e.g., Family Readiness Officers (FROs), Military OneSource, the PCS 

planning tool on the Military Homefront website, and the Interstate Compact on 

Educational Opportunity for Military Children. 

Permanent Change of Station and Access to Healthcare 

The cycle of interrupting and re-establishing healthcare is part and parcel of the 

PCS experience. The more severe and involved the Family member's condition, 

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the more challenging the process of re-establishing the continuum of care. Many 

Families noted that the process of finding new providers is time-consuming and 

prolongs the lag in healthcare services. The new location may fall under a 

different Tricare region, necessitating burdensome re-enrollment. EFMs lose 

momentum and ground in progress toward their treatment goals. There can be 

problems accessing healthcare, including prescriptions, while in transit and 

before meeting with the new Primary Care Manager (PCM). Although the 

obstacles to healthcare during PCS are substantial, there are resources to help 

Families deal with them. Notwithstanding limitations in community awareness, 

EFMP is available to help coordinate the healthcare transition. Various medical 

and non-medical case managers, including EFMP caseworkers, can help 

Families with the healthcare transition, although it is not clear which, if any, is 

specifically assigned this responsibility. Some individual physicians go out of 

their way to suggest or talk with specialists at the new location, although a "warm 

handoff' from doctor to doctor is not the norm. Military OneSource and Tricare 

websites offer listings of health care providers by geographic area, although it 

was noted that the Tricare lists are not always accurate or easy to navigate. 

Permanent Change of Station and Access to Special Education 

Many PCSing Families are dealing with the public schools, rather than DoDEA 

schools, on one or both ends of the PCS. The primary difficulty that parents 

encounter is inconsistency across states and installations in education policies 

and resources, which often leads to a lack of continuity and gaps in the special 

education services offered to their child. The perception of degradation in 

services, real or otherwise, causes parents great frustration, which both 

educators and parents said contributes to an adversarial dynamic between 

parents and the schools. Participants noted that a number of base resources are 

in place to facilitate EFMs' educational transition. EFMP and the School Liaison 

(SL) office are two prime examples; however, many suggested that both are 

under-utilized by PCSing EFMP Families due to a lack of awareness of the PCSrelated services these programs offer. It also should be noted that EFMP and SL 

staff couldn't provide Families specific school support until the Families can tell 

them where they will be living-information that frequently is unavailable before 

the Family's departure. Educational and Developmental Intervention Services 

(EDIS) was touted as another reliable base resource for facilitating the 

educational transition of early-intervention clients. Although the participants 

acknowledged that the public schools, and public schoollDoDEA Directors of 

Special Education, have the potential to play meaningful roles in the educational 

transition of military students with disabilities, it does not appear that there are 

systems in place to support this. 

Permanent Change of Station and Access to Long-Term Supports and 

Services 

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EFMs must start anew each time they move, learning the services and policies of 

the new jurisdiction and complying with often complex application procedures. 

State to state differences in services and eligibility criteria create the risk of 

privation for PCSing EFMs-Le., gaps in services-and potentially expose the 

Family to financial hardship. The lack of Medicaid waiver portability, specifically, 

is a significant obstacle to obtaining and keeping long-term supports and services 

for PCSing EFMs, because there are long waiting lists for the waivers and the 

EFM's name starts at the bottom of the wait-list each time the Family moves to a 

new state. Study participants identified no resources that facilitate access to 

long-term supports and services during PCS; they did, however, call out the 

absence of a mechanism to help individuals retain Medicaid benefits. 

Additionally, although the current study did not target EFMs of retirees, it was 

evident that some currently serving EFMP Families are concerned about 

continuity of care for their EFM upon retirement, e.g., how access to services will 

be affected by the loss of ECHO. 

EFMP and Other Base Programs 

The USMC relies on the EFMP as the primary USMC resource for Families with 

special needs. Participants almost unanimously recognized that EFMP is a 

program in transition that has grown significantly in the past few years and is 

continuing to increase its capacity to serve EFMs and their Families. Many 

Families and providers affiliated with other base and off-base programs praised 

the work EFMP is doing, and described a number of EFMP providers as 

exceptional. EFMs, caretakers, and providers also identified areas for 

improvement within EFMP. 

EFMP Program Entry 

Several factors potentially interfere with entry of eligible Families into the 

program. There continues to be a lack of awareness among potential enrollees 

about EFMP, as mentioned earlier, as well as misinformation regarding who is 

eligible to enroll and what the benefits of enrollment are. A lingering stigma 

associated with EFMP, and its impact on a Marine's career, may affect a Family's 

willingness to enroll. Finally, providers-including physicians--do not 

consistently refer appropriate candidates to EFMP, which needlessly delays 

some Families' enrollment and timely receipt of invaluable services (e.g., respite 

care, services covered by ECHO). 

EFMP Communications 

Communication among base-level EFMP proponents about PCSing Families 

apparently is inconsistent, and sometimes EFMP offices are unaware of 

incoming Families. Shortfalls in communication between local programs and 

enrollees also were identified, with many Families saying they do not receive the 

information from the local EFMP office that they should. Many Families voiced 

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frustration that the EFMP office frequently sends communications only to the 

Marine, rather than directly to the spouse, who typically is the primary caretaker 

of the EFM or the EFM herself (or himself). 

EFMP Service Delivery 

Providers and enrollees identified opportunities for improvement related to quality 

of service delivery. A large number of enrollees said they were not receiving 

outreach contact from EFMP. Many participants, including providers, indicated 

there are too few caseworkers to meet enrollees' needs; some suggested that 

there are existing EFMP caseworkers who lack the req~isite knowledge and 

background. Additionally, some enrollees characterized EFMP as an assignment 

program and an information and referral operation, and suggested that EFMP 

should offer a broader scope of services. 

EFMP Assignment Process 

Families expressed skepticism about the capability of assignment monitors to 

make appropriate assignment decisions on behalf of Marines and their EFMs. 

There also was considerable discussion about how enrollment impacts 

assignment options, deployability, and advancement. As noted previously, there 

seems to be lingering concern within the USMC community regarding a potential 

adverse impact of EFMP enrollment on the Marine's career advancement. 

Other Base Resources 

A number of base entities other than EFMP play an important role in supporting 

the needs of EFMP Families. Providers and enrollees frequently lauded the 

EFMP respite care program, often describing it as the greatest benefit of EFMP 

enrollment. Caretakers and providers also mentioned EDIS and the New Parent 

Support program as other good sources of base-level support for EFMP 

Families. Caretakers expressed concern about the disability-accessibility of base 

housing, describing it as "adaptable" rather than "accessible"; many indicated the 

quarters to which their Family was aSSigned did not adequately accommodate 

their EFM's disability. In several instances, participants also identified 

accessibility problems with public spaces on base. Lastly, a number of 

participants suggested that Families are not sufficiently aware of the base 

resources available to them. 

It should be noted that Significant improvements were made to the EFM program 

during the time this study was being conducted. However, the need for EFMP 

services still far exceeds program capacity, and many Families remain unaware 

of program improvements. 

NATIONAL COUNCIL ON DISABILITY STUDY RECOMMENDATIONS 

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Based on the study findings, and drawing upon decades worth of experience 

working with people with disabilities, NCD formulated recommendations for 

improving USMC EFM access to disability-related services. Many of these 

recommendations echo or build upon suggestions made by the study 

participants. Chapter IV of the report contains a comprehensive list of 

recommendations, followed by the entity or entities to which each 

recommendation is targeted (e.g., Congress, DoD, Department of Navy, USMC, 

Tricare, EFMP). The complete list of recommendations is presented in Appendix 

H according to which entity or entities each recommendation is directed. 

For purposes of this summary statement, ten recommendations, five short-term 

and five long-term, are being called out for immediate attention, as having the 

potential to have the greatest impact on Families with members with disabilities. 

Short-Term Recommendations 

1. Conduct an accessibility review of human service programs and facilities, 

including base housing, on USMC bases. Develop plans for each base to 

make programs and facilities accessible, Le., ADA compliant, if they are 

not already. Execute plans as appropriate. (USMC) 

2. Increase the accuracy and timeliness of information EFMP Families 

receive from Tricare by assigning Tricare case managers to a larger 

proportion of the EFMP population and/or establishing a dedicated Tricare 

telephone hotline (staffed 24/7) for EFMP Families, similar to the Medicare 

hotline. (Tricare) 

3. Disseminate to Local Education Agencies (LEAs) detailed guidance for 

implementing initiatives included in the Interstate Compact on Educational 

Opportunity for Military Children. (Interstate Commission, Federal and 

State DoEs, LEAs, DoDEA) 

4. Educate the military and civilian community about EFMP (Le., base and 

unit leadership, military and civilian healthcare providers, relevant base 

and community agencies/providers, including LEAs, and members of the 

USMC community at large) by designing and implementing a robust, 

ongoing, multi-faceted public relations (PR) campaign to educate 

stakeholders and the USMC community as a whole to: 

a. Raise their awareness of today's EFMP and sensitivity to EFM 

issues 

b. Publicize the specific benefits of enrollment 

c. Mitigate myths, concerns about stigma, and resulting resistance to 

enrollment 

d. Increase the capacity of the entire cornmunity (Le., military leaders, 

military and civilian healthcare providers, base and community 

agencies, LEAs, USMC community members) to inform USMC 

Families about EFMP and to be a supportive presence in the lives 

of USMC Families with members with disabilities. 

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e. Promote the Medical Home concept, particularly within the military 

and civilian health care communities. 

(EFMP, USMC, Department of Navy, Tricare) 

5. Ensure EFMP offices systematically gather, maintain, and update contact 

information from caretaker/EFM spouses and consistently direct all 

communications-whether by email, telephone, or US mail-to them. 

(EFMP) 

Long Term Recommendations 

1. Address the implications of retirement for continued access to disabilityrelated services, including considering the extension of ECHO coverage. 

(000, Tricare) 

2. For EFMs who are prescribed ABA therapy, continue to work toward full 

coverage, consistent with the recommended standard of care and healthcare 

reform. (Congress, Department of Defense, Tricare). (Tricare) 

3. Minimize the gaps in healthcare services related to PCS: 

a. Adjust Tricare procedures to provide EFMs referrals for routine 

specialty care without needing to be seen by their new Primary Care 

Manager. (Tricare) 

b. Facilitate transfer of medical records between bases and between 

off-base and on-base providers by digitizing EFM medical records. 

(EFMP) 

c. With the help of a Medical Home, establish a mechanism to ensure 

EFM Families have sufficient prescription medications while in transit 

between installations. (Tricare, EFMP) 

d. For recipients of ABA therapy, provide linkage to ABA therapist 

trainees in the vicinity of the gaining installation (who must complete 

volunteer hours for their ABA certification) until a longer-term solution 

can be implemented. (EFMP, Tricare, local health care providers, 

certifying authorities such as colleges and universities) 

4. Implement mechanisms to enable military EFMs to maintain Medicaid 

waiver services when they move from state to state, rather than requiring 

them to go to the bottom of the waitlists each time they PCS: 

a. Place incoming EFMs on the new state's waitlist based on their 

position on the previous state's waitlist (i.e., based on "time served"). If 

individuals have a Medicaid waiver in the previous state, they should 

automatically receive one in the new state. (Congress and state 

agencies) 

b. For EFMs who lose Medicaid waiver services as a result of a PCS, 

provide the same benefits the EFM received in the previous state until 

eligibility can be established in the new state. (Congress and state 

agencies, 000, Tricare) 

5. Increase the flexibility of services covered by ECHO to closely mirror the 

services available through a Medicaid waiver. (Congress, 000, Tricare) 

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NCD appreciates the opportunity to provide this Statement for the Record, 

and would welcome the opportunity to work collaboratively with others to 

facilitate implementation of the report recommendations and improve 

supports and services for military Families with disabilities. 

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[Whereupon, at 3:55 p.m., the subcommittee adjourned.] 

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