DEPARTMENT OF DEFENSE APPROPRIATIONS 

FOR 2011 

HEARINGS 

BEFORE A 

SUBCOMMITTEE OF THE 

COMMITTEE ON APPROPRIATIONS 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

SUBCOMMITTEE ON DEFENSE 

NORMAN D. DICKS, Washington, Chairman 

PETER J. VISCLOSKY, Indiana 

JAMES P. MORAN, Virginia 

MARCY KAPTUR, Ohio 

ALLEN BOYD, Florida 

STEVEN R. ROTHMAN, New Jersey 

SANFORD D. BISHOP, JR., Georgia 

MAURICE D. HINCHEY, New York 

CAROLYN C. KILPATRICK, Michigan 

TIM RYAN, Ohio 

C. W. BILL YOUNG, Florida 

RODNEY P. FRELINGHUYSEN, New Jersey 

TODD TIAHRT, Kansas 

JACK KINGSTON, Georgia 

KAY GRANGER, Texas 

HAROLD ROGERS, Kentucky 

NOTE: Under Committee Rules, Mr. Obey, as Chairman of the Full Committee, and Mr. Lewis, as Ranking 

Minority Member of the Full Committee, are authorized to sit as Members of all Subcommittees. 

PAUL JUOLA, GREG LANKLER, SARAH YOUNG, PAUL TERRY, KRIS MALLARD, ADAM HARRIS, 

ANN REESE, BROOKE BOYER, TIM PRINCE, B G WRIGHT, CHRIS WHITE, 

CELES HUGHES, and ADRIENNE RAMSAY, Staff Assistants 

SHERRY L. YOUNG, and TRACEY LATURNER, Administrative Aides 

PART 4 

Page 

Defense Health Program / Wounded Warrior .................... 1 

Missile Defense Agency .......................................................... 125 

Public Witnesses ...................................................................... 179 

Printed for the use of the Committee on Appropriations 


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PART 4—DEPARTMENT OF DEFENSE APPROPRIATIONS FOR 2011 


sroberts on DSK5SPTVN1PROD with HEARING
DEPARTMENT OF DEFENSE APPROPRIATIONS 

FOR 2011 

HEARINGS 

BEFORE A 

SUBCOMMITTEE OF THE 

COMMITTEE ON APPROPRIATIONS 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

SUBCOMMITTEE ON DEFENSE 

NORMAN D. DICKS, Washington, Chairman 

PETER J. VISCLOSKY, Indiana 

JAMES P. MORAN, Virginia 

MARCY KAPTUR, Ohio 

ALLEN BOYD, Florida 

STEVEN R. ROTHMAN, New Jersey 

SANFORD D. BISHOP, JR., Georgia 

MAURICE D. HINCHEY, New York 

CAROLYN C. KILPATRICK, Michigan 

TIM RYAN, Ohio 

C. W. BILL YOUNG, Florida 

RODNEY P. FRELINGHUYSEN, New Jersey 

TODD TIAHRT, Kansas 

JACK KINGSTON, Georgia 

KAY GRANGER, Texas 

HAROLD ROGERS, Kentucky 

NOTE: Under Committee Rules, Mr. Obey, as Chairman of the Full Committee, and Mr. Lewis, as Ranking 

Minority Member of the Full Committee, are authorized to sit as Members of all Subcommittees. 

PAUL JUOLA, GREG LANKLER, SARAH YOUNG, PAUL TERRY, KRIS MALLARD, ADAM HARRIS, 

ANN REESE, BROOKE BOYER, TIM PRINCE, B G WRIGHT, CHRIS WHITE, 

CELES HUGHES, and ADRIENNE RAMSAY, Staff Assistants 

SHERRY L. YOUNG, and TRACEY LATURNER, Administrative Aides 

PART 4 

Page 

Defense Health Program / Wounded Warrior .................... 1 

Missile Defense Agency .......................................................... 125 

Public Witnesses ...................................................................... 179 

U.S. GOVERNMENT PRINTING OFFICE 

66–611 WASHINGTON : 2011 


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COMMITTEE ON APPROPRIATIONS 

DAVID R. OBEY, Wisconsin, Chairman 

NORMAN D. DICKS, Washington 

ALAN B. MOLLOHAN, West Virginia 

MARCY KAPTUR, Ohio 

PETER J. VISCLOSKY, Indiana 

NITA M. LOWEY, New York 

JOSE ́ E. SERRANO, New York 

ROSA L. DELAURO, Connecticut 

JAMES P. MORAN, Virginia 

JOHN W. OLVER, Massachusetts 

ED PASTOR, Arizona 

DAVID E. PRICE, North Carolina 

CHET EDWARDS, Texas 

PATRICK J. KENNEDY, Rhode Island 

MAURICE D. HINCHEY, New York 

LUCILLE ROYBAL-ALLARD, California 

SAM FARR, California 

JESSE L. JACKSON, JR., Illinois 

CAROLYN C. KILPATRICK, Michigan 

ALLEN BOYD, Florida 

CHAKA FATTAH, Pennsylvania 

STEVEN R. ROTHMAN, New Jersey 

SANFORD D. BISHOP, JR., Georgia 

MARION BERRY, Arkansas 

BARBARA LEE, California 

ADAM SCHIFF, California 

MICHAEL HONDA, California 

BETTY MCCOLLUM, Minnesota 

STEVE ISRAEL, New York 

TIM RYAN, Ohio 

C.A. ‘‘DUTCH’’ RUPPERSBERGER, Maryland 

BEN CHANDLER, Kentucky 

DEBBIE WASSERMAN SCHULTZ, Florida 

CIRO RODRIGUEZ, Texas 

LINCOLN DAVIS, Tennessee 

JOHN T. SALAZAR, Colorado 

PATRICK J. MURPHY, Pennsylvania 

JERRY LEWIS, California 

C. W. BILL YOUNG, Florida 

HAROLD ROGERS, Kentucky 

FRANK R. WOLF, Virginia 

JACK KINGSTON, Georgia 

RODNEY P. FRELINGHUYSEN, New 

Jersey 

TODD TIAHRT, Kansas 

ZACH WAMP, Tennessee 

TOM LATHAM, Iowa 

ROBERT B. ADERHOLT, Alabama 

JO ANN EMERSON, Missouri 

KAY GRANGER, Texas 

MICHAEL K. SIMPSON, Idaho 

JOHN ABNEY CULBERSON, Texas 

MARK STEVEN KIRK, Illinois 

ANDER CRENSHAW, Florida 

DENNIS R. REHBERG, Montana 

JOHN R. CARTER, Texas 

RODNEY ALEXANDER, Louisiana 

KEN CALVERT, California 

JO BONNER, Alabama 

STEVEN C. LATOURETTE, Ohio 

TOM COLE, Oklahoma 

BEVERLY PHETO, Clerk and Staff Director 

(II)


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DEPARTMENT OF DEFENSE APPROPRIATIONS 

FOR 2011 

THURSDAY, APRIL 22, 2010. 

DEFENSE HEALTH PROGRAM/WOUNDED WARRIOR 

WITNESSES 

DR. CHARLES L. RICE, PRESIDENT, UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES, PERFORMING THE DUTIES OF THE 

ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS, AND 

ACTING DIRECTOR, TRICARE MANAGEMENT ACTIVITY 

LIEUTENANT GENERAL ERIC SCHOOMAKER, ARMY SURGEON GENERAL AND COMMANDER, U.S. MEDICAL COMMAND 

VICE ADMIRAL ADAM M. ROBINSON, JR., MC, USN, SURGEON GENERAL 

OF THE NAVY 

LIEUTENANT GENERAL (DR.) CHARLES B. GREEN, AIR FORCE SURGEON GENERAL 

OPENING STATEMENT OF CHAIRMAN DICKS

Mr. DICKS. The Committee will come to order. Today, the committee will receive testimony regarding the Defense Health Program and the Wounded Warrior Program. This hearing will cover 

the fiscal year 2011 budget request and various medical treatment 

issues pertaining to Soldiers and their family members. 

The Department faces a tremendous challenge with the growing 

cost and long-term sustainability of the military health system. The 

military health system has taken several important steps to prepare our military forces and our military medical forces for the future. For the first time, the Department of Defense has fully funded the Defense Health Program in the fiscal year 2011 budget submission. The request also includes $2.5 billion for the wounded, ill, 

and injured. The request includes $30.9 billion for operations and 

maintenance, procurement, research and development. The total 

military health program is $49.6 billion for 2011. This includes the 

payment of $9.3 billion to the Department of Defense Medicare-eligible Retiree Health Care Fund and $9.3 billion in personnel, Base 

Closure and Realignment Commission (BRAC), and military construction costs. 

The Department continues to focus on the need for mental health 

counseling and readjustment support for our servicemembers returning from deployments. It is important for the Department to 

get to the heart of the issues that soldiers and their families face 

during and after lengthy deployments. The Department is making 

strides with improvements to psychological health screening, but 

much more still needs to be done. 


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The Defense Health Program’s cost continues to grow at a similar rate to that experienced in the United States health-care system at large. In addition, it is likely that benefits for members, 

their families, and military retirees are likely to expand over the 

coming years. As such, one of the themes from this hearing is what 

initiatives should Congress consider that would sustain health-care 

benefits, support the needs of troops and their family members, 

and improve care, yet control cost growth. 

We look forward to your testimony and to a spirited and informative question-and-answer session. 

Now, before we hear your testimony, I would like to call on the 

ranking member, my good friend, Mr. Young, who was formerly 

Chairman of this subcommittee. 

Mr. Young. 

REMARKS OF MR. YOUNG

Mr. YOUNG. Mr. Chairman, thank you very much. I want to add 

my welcome to our distinguished witnesses today. I think no one 

is going to be surprised when I say that it is the opinion—my opinion and the opinion of most of this committee—that this is one of 

the most important hearings that we will have this year. 

As the Chairman has said, the well-being and health of our 

troops, their families, is something that Mr. Murtha took very seriously, something that Mr. Dicks, the present chairman takes very 

seriously, and I and the rest of this subcommittee. And we have 

been stressing for years that it is essential that we take care of our 

Soldiers, Sailors, Marines, Airmen, Air women, and their families. 

They deserve the best and most affordable health care we can provide them, as do our veterans. 

Just yesterday morning, in a similar hearing, we discussed the 

consolidation of medical facilities in the National Capital Region 

and what will it take to ensure a world-class health care system. 

If it is not already, that world-class standard should be the goal 

across all of medical treatment facilities, not just those in the capital region. 

It is our job, your job, to make sure we take care of our injured 

heroes, and there is perhaps no job more important to the subcommittee than that. I know that you take this very seriously, and 

I appreciate your commitment to providing them the best care possible. 

So welcome, again. I look forward to your testimony. Just be assured that whatever it is that you need to guarantee the proper 

care of our wounded warriors, our heroes, this subcommittee is interested in providing that. So let us know what it is. Thank you 

very much. 

Thank you, Mr. Chairman. 

Mr. DICKS. Thank you, Mr. Young. 

Dr. Rice, would you like to start first? 

Dr. RICE. Yes, sir. 

Mr. DICKS. We will put all the statements in the record and you 

may proceed as you wish. 


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SUMMARY STATEMENT OF DR. RICE

Dr. RICE. Thank you, sir. 

Thank you, Mr. Chairman and distinguished members of the 

committee, for the opportunity to come before you today. I am honored to be able to testify on behalf of the men and women who 

serve in our Military Health System, and deeply appreciative of the 

support that this committee has always provided military medicine. 

I have, as you note, submitted my written comments to the committee. I would like to make a few very brief opening remarks. 

I approach my role as the Senior Medical Advisor to Secretary 

Gates and Secretary Stanley, at least on a temporary basis, with 

the advantages of multiple perspectives: as a trauma surgeon, as 

an educator, as a retired Navy medical officer, and as the father 

of an Active Duty naval aviator. 

The performance of our military medics in combat remains nothing short of remarkable. In addition to the lifesaving care on the 

battlefield, we are continuously improving the medical readiness of 

the total force. We monitor and record the health of 

servicemembers in the most comprehensive manner ever witnessed 

throughout the cycle of deployment: before, during, and after their 

service in the combat theaters. Despite the breakneck pace of combat, most recently our medical personnel have responded heroically 

to the natural disasters in Haiti and Chile. I know that you share 

this pride in the people who serve in our system. 

Today I want to focus on those areas where greater attention is 

required for me, during the hopefully short time I serve in this capacity, so that you will understand where I am focusing my energies. First, our deepest obligations are reserved for the casualties 

returning to the United States, and to the families and other caregivers who support them. 

Substantial progress has been made since the problems with 

Wounded Warrior first came to light in 2007. More needs to happen on our end to ensure that the programs, services, health information, and communication are knitted together more tightly, so 

that we can provide clearer and more cohesive services to the families who continue to sacrifice so much. 

Second, I am intently focused on the performance and the perception of the electronic health record. My intention is not to micromanage the many technological issues, but to determine whether 

our proposed solutions will result in a better capability for our providers, nurses, physicians, pharmacists, and all the other key members of the health care team, and deliver value for patients. The 

only real test for a successful electronic health record is whether 

it leads to higher-quality care and the improvement of the health 

of the population that it serves. It must not and cannot fail that 

test. 

Third, the Department continues to implement the broad 

changes required by the 2005 BRAC Commission. Our approach to 

the right organizational construct and how we build medical facilities design must result in better services, better quality, and better 

access for our patients. Investments in evidence-based design concepts for our new facilities are critically important. They offer a 

better healing environment for patients and their families. Belvoir 


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will be a showcase for this new approach, a truly dazzling design 

that will create an unmatched healing environment. 

Fourth, we are working to resolve the serious matters identified 

in the protests that were upheld by the General Accountability Office regarding the T3 contract awards. While the issues that we 

must address are serious, I am reassured and want to reassure you 

that the internal issues affecting these awards have not affected 

the day-to-day service for our beneficiaries. 

Nonetheless, our efforts to control TRICARE cost growth are 

closely linked to the effective implementation of new contracts, and 

it is in the best interest of the government and of the organizations 

involved in these contract decisions to move toward a definitive 

conclusion. 

Finally, I want to briefly comment on the larger issue of national 

health care reform that has been the focus of so much recent attention. Although the military health care system is a unique system 

of care, we do not function apart from the civilian health care system used by the American people. In fact, almost 70 percent of the 

care our beneficiaries receive is delivered by our civilian colleagues. 

TRICARE benefits are administered separately from the new 

health-care reform law. We know that the DOD medical benefit is, 

appropriately, one of the most comprehensive benefits of any employer. One visit to the Walter Reed or the National Naval Medical 

Center or Wilford Hall or Brooke, demonstrates why this should be 

so, more than any words I can offer here. 

Yet there are other potential benefits that will accrue to the military services when more Americans are covered by insurance. This 

includes a more medically fit recruiting pool, greater investments 

in comparative effectiveness research that will help all practitioners of care with developing scientifically validated approaches 

to medicine, and a more secure transition for those members of our 

Armed Forces who decide to separate prior to full retirement. 

I will be working with my health care colleagues at Health and 

Human Services and elsewhere to ensure that we are appropriately 

involved in the implementation of health care reform initiatives 

that both reassure our beneficiaries and promote the goals of reform. 

One area in which legislation has been proposed to match 

TRICARE to the new health insurance requirements is the extension of health insurance coverage to children of eligible beneficiaries to the age of 26. Our staff is performing preliminary actuarial work to determine the anticipated additional cost to the Department for this coverage expansion and to develop an equitable 

premium for this expanded coverage as directed by legislation. 

Mr. Chairman, I want to thank you again for your leadership 

and for your steadfast support of the military health system, and 

I look forward to answering your questions. 

Mr. DICKS. Thank you, Dr. Rice. 

[The statement of Dr. Rice follows:] 


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Mr. DICKS. General Schoomaker. 

SUMMARY STATEMENT OF GENERAL SCHOOMAKER

General SCHOOMAKER. Chairman Dicks, Representative Young, 

distinguished members of the Defense Subcommittee, thank you for 

inviting us to discuss the Defense Health Programs and our respective service medical programs. I am now in my third congressional 

hearing cycle as the Army Surgeon General and the Commanding 

General of the Army Medical Command. I can tell you that these 

hearings are valuable opportunities for me to talk about the accomplishments of Army medicine and to hear your collective perspectives regarding military health promotion and health care. 

I, and I know my colleagues as well, are saddened to be in this 

hearing today without one of military medicine’s strongest supporters. Chairman Jack Murtha was a friend of the Military Health 

System, of Army medicine, and a soldier on point for the Nation. 

I extend my personal sympathies to his family and to those with 

whom he worked closely, to those in his district he represented so 

faithfully, and to those he inspired. He is deeply missed. 

Chairman Dicks, I certainly look forward to working with you in 

your new role and to continue the great support and guidance this 

committee has provided for the Military Health System. 

I am pleased to tell you that the President’s budget submission 

for fiscal year 2011 fully funds the Army Medical Department’s 

needs. Your support of the President’s proposed budget will be 

greatly appreciated. 

One area of special interest to this subcommittee is our comprehensive effort to improve warrior care, from the point of injury 

through evacuation and inpatient treatment to rehabilitation and 

return to duty. This is really a tri-service effort and done very cooperatively with my colleagues to the left. There is nothing more 

gratifying than to care for these wounded or injured heroes. 

We in Army medicine continue to focus our effort on wounded, 

ill, and injured warriors, and I want to thank Congress for your unwavering support. You all have been very, very instrumental in the 

improvements that Army medicine has made in this regard and 

across the Joint force. The support of this committee has allowed 

us to hire additional providers to staff our Warrior Transition 

Units, to conduct relevant medical research, and to build the healing campuses, the first of which will be opened at Fort Riley, Kansas in late May. 

I am convinced that Army has made some lasting improvements. 

The most improvement may be a change in the mindset from a 

focus on disability to an emphasis on ability and achievement. 

Each of these warriors has an opportunity and the resources to create their own future as soldiers or as productive private citizens. 

In fulfilling our moral obligation to our soldiers, we have established a comprehensive program of world-class medical care, of rehabilitation, professional development, and personal goal setting. 

Today, we have 29 Warrior Transition Units and nine community-based Warrior Transition Units out in individual States, 

staffed by more than 3,900 personnel who manage the care and 

support for approximately 9,000 soldiers and their families who are 

currently in the program. 


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The cornerstone of any warrior’s successful transition is what we 

call the Army’s Comprehensive Transition Plan. It is the warrior’s 

holistic plan for his or her future. As detailed in my written testimony, the Comprehensive Transition Plan is tailored to a warrior’s 

individual situation. It takes account of six demands: career, physical, social, emotional, spiritual, and family support needs. 

A second area of special interest for this committee is psychological health. Army Medicine, under the direction of our new Deputy Surgeon General, Major General Patty Horoho, most recently 

the Commanding General of the Western Regional Medical Command—and, sir, I know that you know her very well—at Fort 

Lewis, is finalizing a comprehensive behavioral health system of 

care plan. This comprehensive system of care is intended to standardize and to synchronize the vast array of behavioral health activities that occur across the Medical Command and throughout the 

Army’s force generation cycle—this iterative cycle of deployment, of 

support for families and the soldier, while they are in deployment, 

and reintegrating them when they return from deployment. I look 

forward to sharing more information with you over the next 

months as we roll out this exciting initiative. 

In keeping with our focus on preventing injury and illness, Army 

Medicine and Army leadership is currently engaged in an all-out 

effort to change the military mindset regarding traumatic brain injury, especially the milder form, or concussion. Our goal is nothing 

less than a cultural change in fighter management after potential 

concussive events on the battlefield. To achieve this goal, we are 

educating the force so as to have trained and prepared soldiers, 

leaders, and medical personnel to provide early recognition, treatment, and tracking of concussive injuries, ultimately designed to 

protect the warrior’s health—no different than what would occur on 

a sports field in America today. 

I brought with me today a packet. It is called ‘‘The Brain Injury 

Awareness Tool Kit.’’ I ask that we be permitted to share this with 

you and your staffs. It contains patient information materials as 

well as an informative DVD—a kind of concussive brain injury 101, 

that is used to educate soldiers before they deploy overseas. This 

further highlights strong efforts by Army’s leadership and the DOD 

leadership to reduce the stigma associated with seeking help for 

this injury and for any behavioral health problem that may occur 

jointly or separately from the brain injury. 

The end state of these efforts is that every servicemember sustaining a possible concussion will receive early detection, state-ofthe-art treatment, and a return-to-duty evaluation in the long-term 

digital health record that Dr. Rice referred to earlier, to track their 

management. I truly believe our evidence-based directive approach 

to concussion management will change the military culture regarding head injuries and impact the well-being of the force. 

In closing, I am very optimistic about the future of Army Medicine. I feel very privileged to serve the men and women of Army 

Medicine as soldiers, Americans, and as global citizens. Thanks for 

holding this hearing and for your steadfast support of the Military 

Health System and Army Medicine. 

[The statement of General Schoomaker follows:] 


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Mr. DICKS. Admiral Robinson. 

SUMMARY STATEMENT OF ADMIRAL ROBINSON

Admiral ROBINSON. Good morning, Chairman Dicks, distinguished members of the subcommittee. I want to thank you for 

your unwavering support of Navy Medicine, particularly as we continue to care for those who go in harm’s way, their families, and 

all beneficiaries. 

I am honored to be with you today to provide an update on Navy 

Medicine. Navy Medicine: World-Class Care Anytime, Anywhere. 

This poignant phrase is arguably the most telling description of 

Navy Medicine’s accomplishments in 2009, and continues to drive 

our operational tempo and priorities for the coming year and beyond. 

Throughout the last year, we saw challenges and opportunities. 

And moving forward, I anticipate the pace of operations and demands will continue to increase. We have been stretched in our 

ability to meet our increasing operational and humanitarian assistance requirements as well as maintain our commitment to provide 

care to a growing number of beneficiaries. However, I am proud to 

say that we are responding to this demand with flexibility and agility more so than ever before. 

The foundation of Navy Medicine is force health protection. Nowhere is this more evident than in Iraq and Afghanistan. During 

my October 2009 trip to theater, I again saw the outstanding work 

of our medical personnel. The Navy Medicine team is working side 

by side with Army and Air Force, medical personnel and coalition 

forces to deliver outstanding health care to our troops and civilians 

alike. As our Wounded Warriors return from combat and begin the 

healing process, they deserve a seamless and comprehensive approach to their recovery. We want them to mend in body, mind, 

and spirit. 

Our patient- and family-centered concept of care brings together 

medical treatment providers, social workers, case managers, behavioral health providers, and chaplains. We are working closely with 

our line counterparts in the Marine Corps Wounded Warrior Regiments and the Navy’s Safe Harbor program to support the process 

for Sailors, Marines, and for their families. 

An important focus area for all of us continues to be traumatic 

brain injury. We are expanding TBI training to health care providers throughout the Fleet and Marine Corps. We are also implementing a new in-theater traumatic surveillance system and conducting important research. Our strategy is both collaborative and 

integrative, by actively partnering with the other services, the Defense Center of Excellence for Psychological Health and Traumatic 

Brain Injury, the Department of Veterans Affairs, and leading academic medical and research centers to make the best care available 

to our warriors. 

We must act with a sense of urgency to continue to help build 

resiliency among our Sailors and Marines as well as the caregivers 

who support them. We are aggressively working to reduce the stigma surrounding psychological health and operational stress concerns. Programs such as the Navy’s Operational Stress Control, 

Marine Corps Combat Operational Stress Control, FOCUS (FamiVerDate Mar 15 2010 03:50 Jun 11, 2011 Jkt 066611 PO 00000 Frm 00036 Fmt 6633 Sfmt 6602 E:\HR\OC\A611P2.XXX A611P2

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lies Overcoming Under Stress) Caregiver Occupational Stress Control, and our suicide prevention programs are in place and maturing to provide support to personnel and their families. 

Mental health specialists are being placed in operational environments and forward-deployed to provide services where and when 

they are needed. The Marine Corps is sending more mental health 

teams to the front lines, and Operational Stress Control and Readiness teams, known as OSCAR, will soon be expanded to include the 

battalion level. A mobile care team of Navy Medicine mental health 

professionals is currently deployed to Afghanistan, conducting mental health surveillance, consulting with command leadership, and 

coordinating mental health care for Sailors throughout the Area of 

Responsibility (AOR). 

An integral part of Navy’s Maritime Strategy is humanitarian 

assistance and disaster relief. In support of Operation United Response-Haiti, we deployed USNS Comfort from her homeport in 

Baltimore within 77 hours of the order and ahead of schedule. She 

was on station in Port au Prince 5 days later. From the beginning, 

the operational tempo onboard Comfort was high, and our personnel were challenged both professionally and personally. For 

many, this was a career-defining experience. And I was proud to 

welcome the crew home last month and congratulate them for their 

outstanding performance. 

I am encouraged with our recruiting efforts within Navy Medicine and we are starting to see the results of new incentive programs. But while overall manning levels for both officer and enlisted personnel are relatively high, ensuring we have the proper 

specialty mix continues to be a challenge both in the Active and the 

Reserve components. Several wartime critical specialties as well as 

advanced practice nursing and physician assistants are in demand. 

We are facing shortfalls for general dentists, oral maxillofacial surgeons, and many of our mental health specialists, including clinical 

psychologists, and social workers. We continue to work hard to 

meet this demand, but fulfilling the requirement among these specialties is expected to present a continuing challenge. 

Research and development is critical to Navy Medicine’s success 

and our ability to remain agile to meet the evolving needs of our 

warfighters. It is where we find solutions to our most challenging 

problems and, at the same time, provide some of medicine’s most 

significant innovations and discoveries. 

Research efforts targeted at wound management, including enhanced wound repair and reconstruction, as well as extremity and 

internal hemorrhage control and phantom limb pain in amputees 

present definitive benefits. These efforts support our emerging expeditionary medical operation and aid in support of our Wounded 

Warriors. 

Clearly, one of the most important priorities for the leadership 

of all the services is the successful transition to the Walter Reed 

National Military Medical Center onboard the campus of the National Naval Medical Center Bethesda. We are working diligently 

with the lead DOD organization—Joint Task Force, National Capital Region Medical—to make sure that this significant and ambitious project is executed properly and without any disruption of 


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services to our Sailors, Marines, and their families, and all other 

beneficiaries for whom we are privileged to serve. 

In summary, I believe we are at an important crossroads for military medicine. Commitment to our Wounded Warriors and their 

families must never waver, and our programs of support and hope 

must be built and sustained for the long haul. And the long haul 

is the rest of the century, when the young Wounded Warriors of 

today mature into our aging heroes in the years to come. They will 

need our care and support, as will their families, for a lifetime. 

On behalf of the men and women of Navy Medicine, I want to 

thank the committee for your tremendous support, for your confidence, and for your leadership. It has been my pleasure to testify 

before you today, and I look forward to your questions. 

Mr. DICKS. Thank you, Admiral Robinson. 

[The statement of Admiral Robinson follows:] 


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Mr. DICKS. We want to welcome General Green. This is his first 

time testifying before our subcommittee. We welcome you. 

SUMMARY STATEMENT OF GENERAL GREEN

General GREEN. Thank you, sir. Chairman Dicks, Representative 

Young, and distinguished members of the committee, thank you for 

the opportunity to join you today and address our common goal of 

providing the best care to our warriors and families. The Air Force 

Medical Service does whatever it takes to get our Wounded Warriors home safely. 

Over 1,600 Air Force medics are currently deployed to 40 locations in 20 countries, delivering state-of-the-art preventive medicine, rapid lifesaving care, and critical care air evacuation. We 

have now moved over 70,000 patients safely from Iraq and Afghanistan. Air Force medics are responding globally in humanitarian 

missions as well as on the battlefield, and in the last 6 months we 

contributed significant support to the treatment and evacuation of 

Indonesian, Haitian, and Chilean earthquake victims. 

You may have heard or seen national news reports about an 

amazing operation that took place last month at Craig Joint-Theater Hospital in Bagram. Air Force Major Doctor John Bini is a 

seasoned theater hospital trauma surgeon stationed at Wilford Hall 

Medical Center who is deployed to Bagram. When the radiologist 

discovered a live explosive round in an Afghan patient’s head, there 

was no hesitation as Major Bini and his anesthesiologist, Major 

Doctor Jeffrey Rengel put on body armor and went to work. They 

evacuated the OR, leaving only the two of them and a bomb technician with a patient, and within 10 minutes removed the live round. 

Miraculously, the patient has been discharged and is recovering, 

able to walk, talk, and feed himself. 

At home, our health-care teams share patient-centered care to 

produce healthy and resilient airmen and provide families and retirees with full-spectrum health care. Our suicide and resiliency 

programs are targeting those at highest risk for interventions. We 

have embedded mental health in our family health clinics to increase access and reduce stigma. Family liaison officers and recovery care coordinators assist our Wounded Warriors and families 

with seamless transition and are the backbone of the Air Force 

Wounded Warrior and Survivor Care programs. 

This is what Air Force and Army medics, along with Navy corpsmen, are all about. We are trained and ready as a team to meet 

the mission wherever, whenever, and however needed, with cutting-edge techniques and equipment or the most basic of resources, 

if this is our only option. We have the lowest died-of-wounds rate 

in history because of well-trained, highly skilled, and extraordinary 

people. Our brave and dedicated men and women put service before 

self and demonstrate excellence in all they do. 

Thank you for your immeasurable contributions to the success of 

our mission. We deeply appreciate all that you do to ensure we recruit and retain these very special medics who are devoted to providing trusted care anywhere. We could not achieve our goals of 

better readiness, better health, and best value for our heroes and 

their families without your support. 


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I thank you and stand ready to take any questions from the committee. 

Mr. DICKS. Thank you for your statement. 

[The statement of General Green follows:] 


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IMPACT OF VOLCANIC ASH ON WOUNDED WARRIOR TRANSPORT

Mr. DICKS. It is very impressive to be at Ramstein and 

Landstuhl and see these planes fly in with these wounded warriors. 

Mr. Young. 

Mr. YOUNG. Mr. Chairman, I wanted to say we had a really good 

hearing yesterday. Dr. Rice pretty much led the discussions, and 

was very, very helpful. There were a couple of questions that we 

presented, and I am not sure we got the answers exactly accurately, so I want to go back to one or two of them. 

One, the Chairman mentioned about Landstuhl and Ramstein 

and the transporting of wounded heroes. We have both been there 

a number of times and experienced seeing this happen. But my 

question yesterday was—there was some kind of notice was published that said that we would be bypassing Landstuhl now and 

coming directly to Andrews. The response was that they think that 

was just temporary because of the volcanic ash. I would like to get 

confirmation on that; whether that is the case or whether—if in 

fact it is the practice now to bypass Landstuhl when you can. 

General GREEN. No, sir. That was done solely because of the restrictions on aircraft in Europe because of the volcanic ash. And so 

we basically rerouted the airplanes through Balad and rotated 

them up through Rota and then back into here. It is very temporary. We have had four or five airplanes do it. There has been 

no effect on the casualty evacuation. As of today, Ramstein and 

Landstuhl are back up again and the casualties will go through 

there again. 

WALTER REED/BETHESDA CONSOLIDATION

Mr. YOUNG. Well, I am amazed at how well that system works. 

These kids are getting good care immediately on the scene, at the 

battlefield, and on the way home. I have met a lot of those aircraft 

as they brought wounded heroes. I am just impressed with the care 

that they get. As a matter of fact, I get in trouble on occasion, because every time there is a little news story about something that 

went wrong with military medicine, my comments are brought 

back to haunt me. But I have seen miracles, what I consider miracles, at Walter Reed and at Bethesda. 

And, General Green, I am not that familiar with your medical facilities, just because of the proximity here. But I think that our 

Wounded Warriors get outstanding medical care and I think your 

medical professionals are outstanding. 

Having said that, also, again, yesterday we talked briefly about 

the merger of the medical facilities in the capital area. I get different responses when I talk to different people, those who are at 

the hospitals. How is that going? You all have a little different position than the witnesses that were here yesterday because each of 

you represent your service. But now we have this merger. What 

happens to the identity of your service, what happens to the chain 

of command? Who is really in charge of this consolidated medical 

facility? Let’s start with that. 

General SCHOOMAKER. Sir, I will take the first. We are the Army, 

and we are losing one of our major and most vulnerable instituVerDate Mar 15 2010 03:50 Jun 11, 2011 Jkt 066611 PO 00000 Frm 00084 Fmt 6633 Sfmt 6602 E:\HR\OC\A611P2.XXX A611P2

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tions. As you know, Walter Reed and the Walter Reed campus, 

which is 100 years old this year—or last year—I think, sir, it is 

going remarkably well. I think we already know, the three of us 

sitting here, that on a day-to-day basis at Walter Reed and Bethesda and Malcolm Grow, and at Fort Belvoir, for that matter, but 

to a lesser degree, the staffs are already integrated. Training programs are already integrated. 

I personally have undergone surgeries over the last several years 

at Walter Reed and at Bethesda. Frankly, the staffs are fully integrated. You have Navy surgeons working on soldiers, marines, and 

airmen in an Army hospital, and you have Army surgeons and dermatologists and OBs that are delivering services to the same mix 

at a Navy facility. 

And so I think what we are now doing is all the necessary steps 

at a granular level to make sure the civilian workforce from Walter 

Reed—which is the one most affected by this—is moved successfully; that they know where they are going and what jobs they are 

going to have. 

But as Admiral Robinson and his subordinate commander there, 

Admiral Nathan, points out, even 90 percent of the people currently working at Navy are going to go to different slots within different sites within a brand-new facility. So everybody is being affected, and I think it is being done in a very proactive way. 

I might say, sir, in reference to the earlier comment about the 

trip through Rota, correct me if I am wrong, but it is still an onerous trip. It adds considerably to the length of the evacuation. I 

would also comment that every time you see a patient at Walter 

Reed or Bethesda, you are seeing the results of Air Force Medicine, 

because they wouldn’t be there and they wouldn’t be alive and 

doing as well as they are, were it not for the intensive care that 

they receive in the air from the Air Force. 

Admiral ROBINSON. I would like to underscore what General 

Schoomaker said. I think he hit many of the major issues that are 

there. I would emphasize that in terms of care, the CCAT, Air 

Force, Army, and Navy, and the care of Wounded Warriors and 

trauma care, et cetera, there is no equal in the world. We have 

come together to give that care. And it shows in the interoperability and the ethos of all three services in making sure we get 

what we need for our Wounded Warriors. 

I think the same continues in the National Capital Area. I think 

that I am going to take my Chief of Naval Operation’s position here 

today to say the care that we give here must follow the rule of first 

principles. First principles say: Let us do what we have to do. So 

let us do the BRAC and let us at the same time take care of 

Wounded Warriors. And then, since our services are already integrated and we are joint from a medical-care perspective, then we 

can take on some of the challenges of the governance and the other 

things that we need to look at in terms of the long haul for medical 

care. 

But in terms of making sure that we are focused on patient care 

and on Wounded Warriors and care issues, which are the issues 

that we cannot leave behind, I think we are doing that. If we continue to do that, I think we are going to be very successful in the 

BRAC issue. 


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And just like the Army said that it is losing a venerable institution, the Navy is losing a venerable institution, too, in the National 

Naval Medical Center and the Bethesda Naval Hospital. Both of 

those institutions go away. There is a new institution called the 

Walter Reed National Military Medical Center. It may sit on a 

Navy base on Wisconsin Avenue, but it is no longer a Navy hospital in the tradition of Bethesda, nor will it be an Army hospital 

in the tradition of Walter Reed. And it will also include Air Force 

physicians, medics, nurses, and ancillary medical personnel from 

Malcolm Grow. It will be a joint hospital that will care for our 

Wounded Warriors into the future. 

JOINT MEDICAL FACILITIES

General GREEN. Malcolm Grow, which is the smaller of the medical centers here in town, was actually due to close about 2 years 

ago. Because of the BRAC and trying to ensure that we had extra 

capability as we saw all of the construction, we have kept the doors 

open in terms of the inpatient facility through the end of 2011. It 

will become an ambulatory surgical facility, and we are keeping 

roughly the same amount of manpower here, with nearly 172 of our 

staff that will be working up in the Walter Reed National Military 

Medical Center. We have also combined residencies with the Army 

down at Belvoir and have family practice residents in the residency 

at Belvoir. 

My response in terms of how it is going is, I think it is going 

well. We know how to execute a JTF. Air Force is simply one component of that JTF. We believe that they have the authorities that 

they need and that we are working closely with them. If you go to 

Bethesda campus today, you will find that roughly 55 of the 

nurses, the ICU nurses, are there. Those same nurses are the ones 

we trained to do Critical Care Air Transport Teams (CCATs) and 

also provide a lot of the work on aircraft when it is their turn to 

deploy. 

So I think it is a very good joint effort in terms of how we are 

bringing this together. There are still issues in terms of financing 

and guidance as we move into more joint operations back here at 

home. But we know how to do this. Our clinical care is very joint. 

And so I would say it is going well, sir. 

FORT HOOD

Mr. YOUNG. Well, I appreciate what you have said. If you recall, 

two of you were here last year for the hearing, and I expressed 

some concern about morale, because a lot of the medical professionals, the doctors, were wondering where do I go next; what is 

my next job; where is my next location? But having been in Walter 

Reed and Bethesda considerably, and recently, I see at Walter Reed 

a lot of Navy doctors and nurses. At Bethesda I see a lot of Army 

doctors and nurses. And I think the morale issue is basically dramatically improved because people didn’t—last year they didn’t 

really know what was happening. This year I think they have a 

pretty good idea of what is happening. I give you all credit for making sure that your services were identified, but that you have been 

able to make this merger. 


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I know I have taken an awful lot of time. Mr. Chairman, one 

more question I wanted to ask. We are concerned—many of us— 

many are concerned about the situation with Major Hasan and the 

shooting at Fort Hood. There has been some criticism that maybe 

his problem should have been detected before he ever got to Fort 

Hood. Are there any changes in watching something like this to 

make sure that if there is a suspicion, that we deal with it before 

it becomes a threat to life and limb? 

Dr. RICE. Congressman Young, I will speak with my hat on as 

the President of the Uniformed Services University. As you know, 

Major Hasan received his M.D. Degree at the Uniformed Services 

University and then came back to do a fellowship. I want to be 

careful in what I say because we have not yet sent our report on 

our analysis up to Secretary Gates. As you know, there is an ongoing criminal investigation. 

This touched the faculty, staff, students, and alumni of the Uniformed Services University very deeply. And we have undertaken 

a very thorough review. I have received a summary of that analysis 

just this morning, and I think we will be able to provide some recommendations to Secretary Gates very shortly. 

I will defer to General Schoomaker, who can discuss the Army 

side of that review. 

General SCHOOMAKER. Yes, sir. Again, mindful that this is an 

open investigation, the Army’s subsequent completion of the investigation that was begun by the Wes Clark Commission, the Army 

component of which was conducted by General Hamm, the Commanding General of the United States Army-Europe, is still ongoing and is about to be completed. But I would submit, sir, that 

there have been many lessons, all the way from the recognition of 

self-radicalization within the force, which is a real threat, and how 

we identify that—senior Army leadership, DOD leadership, is focused on that—to how we respond in the event of a calamity like 

this at a local installation like Fort Hood, to include its emergency 

response to how we manage subsequent consequences of that. 

We launched a fairly unique behavioral health response with the 

help of the Uniformed Services University and others, targeting 

subpopulations like children, like victims, family members, and 

other members of the community that would be affected by that. 

All of these have provided lessons to us. 

But to your point, I have been very clear with my Command and 

with those who have asked, I think although, again, it is an open 

investigation, we all agree there are many aspects of the training 

of Major Hasan that we are looking at very closely. But I will stand 

by my earlier comments that none of his behavior, I think, would 

have been predictive of a mass murderer. 

ACCESS TO PRIMARY CARE HEALTH CARE

Mr. YOUNG. Well, I think your comment ‘‘lessons learned’’ was a 

good comment. I am just happy that you are really paying attention to those lessons that we have learned from this incident, which 

was a calamity. 

Mr. Chairman, thank you very much. 

Mr. DICKS. Thank you, Mr. Young. Since we are talking about 

Fort Bragg, there was an article in the Fayetteville, North Carolina 


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Observer saying that General Casey had just visited Fort Bragg 

and officials at the Womack Army Medical Center said they are 

aware of problems with access, because the number of enrolled 

beneficiaries at Womack has exceeded the available primary care 

capacity; patients have at times experienced difficulty obtaining 

timely appointments, largely in the area of routine and wellness 

care, Shannon Lynch, a Womack spokesman, said in a written 

statement. 

How serious is this problem and what are you doing about it, 

General Schoomaker? 

General SCHOOMAKER. Sir, access to primary care I would say is 

a problem across the Army. The Chief of Staff of the Army, General 

Casey, and his wife, Mrs. Casey, have made this a very important 

focus of their leadership. For the last 18 months to 2 years, we 

have been working very hard across the Army with a series of initiatives, beginning with properly sizing our facilities and healthcare providers to accommodate reasonably the enrolled population 

of soldiers and Active Duty family members. Recognizing that the 

Army has grown by 65,000 soldiers and has brought on many, 

many more beneficiaries in the form of Reserve component soldiers, 

this continues to challenge us at a time that the Nation is challenged to provide primary care health care. 

We have a very aggressive program. We have been seeing steady 

improvements in overall patient satisfaction, overall ability of a patient to get to his or her primary care provider or the team. All 

three services have embraced the patient-centered medical home 

concept, which is a fundamental transformation of how we deliver 

care at the primary care level. And we have recently, with the help 

of the TRICARE Management Agency and Dr. Rice’s deputy, Rear 

Admiral Christine Hunter in the TRICARE Management Agency, 

have gotten consent for standing up in 14 different communities in 

the Army, to include Fort Bragg, the building of and leasing of 

community-based primary care clinics that are going to expand the 

capacity. 

So we are very aware of the problems that Fort Bragg especially 

has. It happens to be one of the hospitals that we continue to 

have—because of the size of the population and growth—some of 

the bigger problems with, but we are seeing steady improvements 

across the Army, sir. 

Mr. DICKS. They also mention behavioral health care to Active 

Duty soldiers and their families is on a space-available basis. Is 

that pretty much standard? 

General SCHOOMAKER. Sir, behavioral health care across the 

Army, and I think almost across the services—I don’t want to 

speak for the others—but across the Nation as well, is under challenge. We are about 86 percent of our estimated requirements for 

behavioral health specialists, uniformed and non-uniformed. 

Admiral Robinson in his opening statement alluded to the problems they are having with social workers and psychologists. We 

have a problem with psychiatrists, both civilians and, of course, 

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wards of 8 to 10 years. So these are tough nuts for the whole Nation to crack. 

I would have to say it is one of the reasons that we are really 

focusing a lot, as well, on building resiliency and trying to identify 

problems as close as possible to when they are first recognized and 

to use the primary care arena—our family medicine docs, our internal medicine docs, our PAs, our pediatricians—to be one of the first 

line of defense in treating behavioral health issues. 

SUICIDES

Mr. DICKS. One of the major issues of concern to the Defense Department and to the Congress is the suicide rate, particularly in 

the Army and Marine Corps. We had some discussion of this prior 

to the meeting. I thought some of the things that are being done 

we should put on the record. Dr. Rice, do you want to start on this? 

Dr. RICE. Yes, sir. Thank you, Mr. Chairman. Dr. Tom Insel, who 

is the Director of the National Institute of Mental Health, has identified suicide as a public health problem for the Nation as a whole. 

There are approximately 32,000 completed suicides in the United 

States each year. That is a number at or slightly above the number 

of fatalities related to motor vehicle collisions. 

In the military services for a number of years the suicide rate 

was lower than the population as a whole. But recently, over the 

last several years, that rate has gone up, so that it is now at or 

perhaps slightly above the rate for the country. 

The line leadership and the Service Secretary in all three Services have been very concerned about this. Particularly, I will let 

General Schoomaker speak in more detail about the Army’s approach. But the Vice Chief of Staff of the Army is personally engaged in this issue. In fact, I am attending one of his monthly reviews of suicides in the Army this afternoon. He does this every 

month with the commanding generals of the various military facilities where a suicide has occurred. 

He takes this personally and seriously. He identified a need for 

a detailed study on suicide and turned to the National Institute of 

Mental Health for assistance in developing a grant application. A 

number of academic institutions around the country responded to 

that application. And I am pleased to say Dr. Robert Ursano, Chair 

of the Department of Psychiatry at the Uniformed Services University, and his team—he is assisted by very experienced investigators 

from the University of Michigan, from Harvard University, and 

from Columbia—were the successful applicants for that grant. 

Mr. Chairman, you are familiar with the Framingham study in 

Massachusetts, which over a number of years has contributed enormously to our understanding of the risk factors associated with 

heart disease. What is intended with this study is a similar longitudinal study on a large number of individuals followed sequentially over a number of years that will similarly inform us about 

the risk factors associated with suicide. 

General Schoomaker, did you want to add? 

General SCHOOMAKER. What Dr. Rice has talked about is the 

program known as STARS, begun by our former Secretary of the 

Army Pete Geren, and is being maintained by Mr. McHugh, our 

current Secretary. It is a $50 million, 5-year study which promises 


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to be the largest longitudinal study that examines all the factors 

that are relevant to suicidal ideations and suicidal behavior. It follows about a year and a half’s worth of work led by Vice Chief of 

Army Pete Chiarelli himself to try to get inside the problem of suicide in the Army. We have seen over the last 5 to 6 years a doubling of suicide rates from what were roughly half of an age-andsex-adjusted population rate against our civilian colleagues, to one 

that is on par and may even exceed the current civilian population. 

It is hard to tell because civilian statistics are 2 years behind the 

military’s statistics. 

General Chiarelli is really focused hard on this. About a third of 

our suicides are from soldiers in their first year, before they have 

even been deployed; often, we think, due to problems that they 

bring into uniform with them; and it tracks with what we know 

from health behavior studies that have been conducted over the 

last several decades where 30 to 40 percent young soldiers, airmen, 

sailors, will admit to bringing significant psychological problems 

into uniform. About a third occurred in deployment, often with a 

weapon, and about a third from soldiers who have been deployed 

in the last 2 years. 

We are looking at all the factors. The one transcendent factor we 

see across the board is a correlation with fractured relationships— 

the loss of a spouse, a divorce, breakup with a girlfriend. As I explained to you, sir, before the meeting, even for marines and sailors 

and soldiers and airmen, the relationship they have with the service, they can forge a very close relationship with the Army and 

then get caught in misconduct, be administratively dealt with 

through the Uniform Code of Military Justice, leave the commander’s office and go out and kill themselves. 

So these are the things that we are dealing with. We are working 

very hard with the help of the STARS program to see what we can 

do to interrupt this. 

SUICIDE PREVENTION

Mr. DICKS. Admiral Robinson. 

Admiral ROBINSON. I would like to just also say that, in addition 

to everything being said, taking it to the individuals in question, 

this becomes a leadership issue. And it is a leadership issue not 

only at the highest ranks but also at the lowest ranks. It has to 

be taken to the level of the Soldier, of the Sailor, of the Marine, 

of the Airman, and there has to be an awareness of the people 

around you and how they are doing. That comes through education 

and that comes through training. That also comes through 

destigmatizing mental health issues so that people are not afraid 

and do not think their career will be hindered or harmed by seeking psychological help. 

It also calls for individuals to look at one another. Friends and 

buddies know each other better than anyone. When things aren’t 

right, then they have to institute those programs so that they can 

can ask, how are you doing, how are you sleeping? They can actually look into the eyes of individuals and see who they are and see 

whether they are hurting. And then they can take the appropriate 

action by getting them to counseling, getting them to a chaplain, 


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making sure they take responsibility for their shipmate. I think 

that is another important aspect of this. 

Another aspect is making sure that we have time between deployments so that we can reset from a social and a family and an 

emotional and psychological point of view, come back into a more 

regimented existence, and home, before going back into an operational and combat environment. 

General GREEN. Sir, for the Air Force, we have a 14-year history 

of effective suicide prevention program. We were able to drop our 

rates below 10 per 100,000 for nearly ten years. Since 2007, we 

have seen our rates also edging up. And so we are reemphasizing 

many of the things we put in place over those years. 

The newest thing is to target specific groups we have seen who 

are at higher risk, such as our security forces, our intel groups, and 

some of our aircraft maintenance, who have a much higher rate, 

perhaps related to operational tempo and dwell rates. Those things 

are not determined yet, but we are watching very closely. 

Our focus is on trying to get face-to-face training for those highrisk groups and have the training and get the experience to be 

wingmen, if you will; someone who will watch after those who are 

working with them. We think, like the other Services, if we can get 

the leadership and the people who are overseeing these folks to 

know what is going on with their troops, that we can make a difference in this. 

Like the other Services, we see relationship problems as number 

one in terms of risk factors; financial problems as a second area; 

and then UCMJ and disciplinary problems also can lead to issues. 

We have not seen any association with deployment. In fact, over 

the last 8 years, only two occurred while deployed. The only potential association has to do with relationship difficulties that may be 

caused by recurrent deployments. And so we are watching that 

very closely. 

We do see something that is in fourth category now in terms of 

things that are rising. We can’t yet tell you whether that is people 

who are depressed or who have other diagnostic categories, but we 

are seeing a larger number of the people who actually commit suicide who have been involved with mental health care, and we still 

have been unable to break the cycle that led to that impulsive decision. 

General SCHOOMAKER. If I could add real quickly to what both 

these gentlemen said, and especially the comment that Admiral 

Robinson made about the importance of small-unit leadership and 

fellow Soldiers, Sailors, Airmen, and Marines. You may have read 

a recent story of a hooch mate, a bunk mate of a soldier 

downrange, who knew that his fellow young enlisted soldier had 

just received a Dear John e-mail and was in distress. Took the firing pin out of his weapon without his knowing it. While he was out 

of his billets, his buddy, the suicidal one, tried to kill himself with 

his M–16. Of course, it didn’t go off. When he came back in he said, 

My weapon doesn’t fire. His bunkmate said, How do you know 

that? They got to talking about the fact that he was aware that his 

buddy was suffering a lot of problems. That soldier whose life was 

saved by his friend is still a soldier. He is continuing on Active 


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Duty. He has started a new relationship and he is going to be leaving sometime in the next year to marry her and start a new life. 

These things that Adam talked about are very, very important. 

Mr. DICKS. Thank you. Mr. Visclosky. 

IMPLANTED STIMULATORS

Mr. VISCLOSKY. Thank you, Mr. Chairman. Gentlemen, thank 

you for your service. 

Admiral, I usually take this opportunity to congratulate Naval 

witnesses on beating Notre Dame in football at home, twice. Now 

Mr. Moran is upset with me. But I also notice that you graduated 

from Indiana University Medical School. 

Admiral ROBINSON. I did. 

Mr. VISCLOSKY. You obviously know what you are talking about. 

I have got to get in a plug. 

Gentlemen, my understanding is the Department of Defense is 

doing research on implanted stimulators that would send impulses 

to reanimate limbs for people who have had strokes and traumatic 

injuries. I find the issue fascinating. If, one, you could bring me up 

to date as to where you are, and is there an ongoing study and is 

there progress being made? 

General SCHOOMAKER. Yes, sir, real briefly. We have a very, very 

robust program across the Services on amputee care and extremity 

injury, very heavily endorsed by the American orthopedic community at large, and the Congress has been generous by providing research funds for us. We are in our third generation of prostheses. 

The upper arm, the upper extremity prostheses, is the most demanding for an amputee. Lower extremity prostheses—of course, 

the loss of any limb or extremity is a problem. I don’t mean to 

trivialize that. But the advances in lower limb prostheses have resulted in now the ability to retain soldiers or marines or others 

who have lost a lower limb, especially below the knee, much more 

easily. 

We have retained about 140 amputees in the Army on Active 

Duty. Forty of them we have redeployed to combat. Three of the 

40 have gone back to combat, having lost their limbs not in combat, 

but in motor vehicle accidents or training accidents back here, and 

are being deployed as amputees for the first time. 

The upper extremity prosthesis is a challenge. We are in the 

third generation. And DARPA has been in the lead of much of this. 

Geoff Ling is the name associated with this, a neurosurgeon and 

neuroscientist who is working with linking brain thought—just as 

in your and my case, who have limbs—with the movement of the 

limb. Heretofore, we were reliant on the upper extremity prostheses to either retrain a muscle to flex and make a mechanical device in the hand or the arm move. Then we went to the advance 

of linking a sensor in the muscle on the remaining part of the body 

so when someone thought to move his thumb or close his hand, 

they thought, and began to move that muscle. 

We have gone to now the generation that eventually will allow 

people to move that prostheses because of a thought in their brain. 

That is the one I think that you are thinking about. 


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CLINICAL AND REHABILITATIVE MEDICINE RESEARCH PROGRAM

Mr. VISCLOSKY. Is there a funding request for 2011 for that? One 

of the other questions I was going to address—you had mentioned 

DARPA—is that it was our understanding the Department was 

going to ask for $125 million to DARPA for development of force 

enhancements. I assume that is a separate issue. 

General SCHOOMAKER. Yes, sir, I believe so. I can get back on the 

details of funding for the extremity research alone. 

Mr. VISCLOSKY. If you could, I would appreciate that very much. 

General SCHOOMAKER. Yes, sir. 

[The information follows:] 

Yes. For Fiscal Year 2011, the Clinical and Rehabilitative Medicine Research Program has requested, through the Defense Health Program, $30 million for the development, evaluation and optimization of extremity orthotics and prosthetic component research. The primary impetus is on the development of arm interface technology and the further development of upper extremity prosthetics. The requested 

funding will support upper extremity prosthetic clinical optimization studies and 

subsequent optimization of the devices. 

ORGANIZATIONS WORKING WITH WOUNDED WARRIORS

Mr. VISCLOSKY. I also understand that at a number of DOD facilities there are individual installations or not-for-profit organizations working with Wounded Warriors. Are there a fair number of 

these established, and how would I distinguish them from military 

programs for Wounded Warriors? Is there care given to make sure 

there is not duplication of services? 

Dr. RICE. Well, sir, there are two very prominent programs funded by Mr. Arnold Fisher and his foundation, the National Intrepid 

Foundation; one is at Brooke Army Medical Center at Fort Sam 

Houston in San Antonio, which General Schoomaker can describe; 

the other is under construction now at the new Walter Reed National Military Medical Center, the National Intrepid Center of Excellence, focused on traumatic brain injury and psychological 

health. In addition, there are a number of support activities around 

all military installations. USO is a good example. I am sure my colleagues can describe those in more detail. 

General SCHOOMAKER. I think all the services have very, very 

good relationships with a whole range of nonprofit groups out there 

that have leaned forward in assisting our wounded and injured soldiers, sailors, airmen, and marines in all our camps and stations 

where these are done. At all of those Warrior Transition units I described earlier, we have got relationships with a variety of local 

and national groups. 

One of the problems, I think, is how to focus and distribute those 

services. Recently, the USO has offered to serve as a kind of national clearinghouse to be able to provide that service for us. But 

I think, as Dr. Rice mentioned, we have a very large number of 

very generous nonprofit groups that have helped build facilities 

such as the National Intrepid Center at Fort Sam Houston, and is 

building right now the National Intrepid Center of Excellence for 

traumatic brain injury on the campus at Bethesda. 

Another good example is the Warrior and Family Support Center 

that is down—attached to Brooke Army Medical Center, which was 

built entirely by a very large number of private donors on land that 


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was given over by the Army. None of the donors, largely, were over 

about a hundred dollars apiece. So, like the National Intrepid Center, which is the amputee center down at Fort Sam Houston which 

was built by 600,000 donors, there has been a huge outpouring of 

support from the public. 

Mr. VISCLOSKY. Gentlemen, thank you. Thank you, Mr. Chairman. 

Mr. DICKS. Mr. Frelinghuysen. 

JOINT THEATER TRAUMA REGISTRY

Mr. FRELINGHUYSEN. Thank you, Mr. Chairman. Gentlemen, 

thank you for the extraordinary work you do. Since this is a public 

hearing, will one of you talk about the remarkable track record of 

survival rate for battlefield injuries? Would one of you just mention—the statistics are very high, this is like no other war—the 

things that your men and women have done? 

General SCHOOMAKER. I agree. This is a tri-service effort. It is 

probably best attributed to the Joint Trauma Theater System, the 

JTTS. It employs an electronic record, known as the Joint Theater 

Trauma Registry. It is maintained by the Army, Navy, Air Force, 

and Marines. 

This is a group that, for all intents and purposes, has built a 

trauma system comparable to what you would have in any large 

metropolitan area in the country, but it has done it across three 

continents and 8,000 miles. They meet virtually online and by 

video teleconferencing at least once a week to discuss cases. And 

they use evidence-based practices that literally follow almost from 

the point of injury back through evacuation and rehabilitation back 

in the States to make sure that any improvements that can be 

made in how a case is managed are being done, and then looks for 

evidence for improvement. And doing that has resulted in a case 

fatality rate that is unprecedented in past wars. 

Mr. FRELINGHUYSEN. Would you give that rate? 

General SCHOOMAKER. It is very high. The case fatality rate is 

less than 10 percent, meaning that over 90 percent of casualties in 

combat survive. If you make it to a forward surgical team or forward Marine unit or combat support hospital or the hospital at 

Balad or Bagram, then your survival rate is over 90 percent. 

MEDICAL RECORDS

Mr. FRELINGHUYSEN. All of us pay tribute to that—Medevac people, airlift people from Balad and Bagram, the hospital in the air. 

It truly is remarkable. 

The focus of my question is sort of on medical records. Can you 

talk about just the issue of medical records, the integrity of the 

medical records? Maybe it is anecdotal, but we do hear periodically 

that there are issues that medical records don’t often follow the patient. I sort of wondered where, generally, the services were. You 

do extraordinary work here, but obviously we have battlefield injuries and people are transported long distances, and done in a remarkably wonderful way, but some general comments about medical records. 

We talked about this with Dr. Rice yesterday, the integrity of 

those records and also the susceptibility in today’s world that someVerDate Mar 15 2010 03:50 Jun 11, 2011 Jkt 066611 PO 00000 Frm 00094 Fmt 6633 Sfmt 6602 E:\HR\OC\A611P2.XXX A611P2

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body could sort of bring down the whole damn system, as evil as 

people are. Can we have some general comments and reaction on 

the medical records issue? 

Dr. RICE. Happy to talk about that, sir. I bring, unfortunately, 

a very long perspective. I am considerably older than my colleagues 

here. So I was on Active Duty at the National Naval Medical Center during the Vietnam War, where casualties would come back, 

often 4 or 5 weeks after wounding, just because the Air-vac system 

was not anywhere close to what the sophistication level is today. 

They may have stopped at two or three hospitals along the way. 

And the likelihood that their record would actually accompany 

them back to us at Bethesda was relatively low. 

I am pleased to say that that is not the case now; that almost 

always an accurate record of the care that has been rendered both 

at the forward support hospital, the combat support hospital, the 

theater hospitals, and in the air at Landstuhl, makes it back. 

ELECTRONIC MEDICAL RECORDS

Mr. FRELINGHUYSEN. Is it indeed electronic or is it sort of a combination of paper and electronic? 

Dr. RICE. In some cases, it is. But by and large, it is electronic. 

The issue of security of the medical record is one of not just military, not just national, but actually international concern, as I 

know you are aware. The Department is working very hard towards our next generation of electronic health record. And the 

three pillars that must be there are security, stability, and 

scalability. The security issue is of paramount importance. We 

must protect the integrity of the record, and the Department is 

going to great lengths to make sure that that happens. 

Mr. FRELINGHUYSEN. So you think that is being well done. I 

know you each take pride in your service. I assume that all the 

services have the same high standards. 

Dr. RICE. We are taking a common approach to that across the 

Services, so that it will be a single system that serves all three of 

our Services and ultimately links with the VA system so we can 

seamlessly pass the relevant and important data from the DOD 

system into the VA. 

Mr. FRELINGHUYSEN. You said ‘‘ultimately.’’ I know around the 

table we have talked about the VA at one point was sort of in a 

crisis. They sort of are leading the way. It was the seamlessness 

they have now that they didn’t have. They had all the different 

hospitals, but records couldn’t be transferred from people in the 

Northeast to the South. So our Services, as represented here today, 

how are they doing in terms of linking medical records? 

Dr. RICE. We have a pilot project. 

Mr. FRELINGHUYSEN. We did hear yesterday that we couldn’t get 

I think from Walter Reed—from Bethesda to Fort Belvoir. Hopefully, that was an exception. 

Dr. RICE. Admiral Madison commented on that yesterday. I think 

by and large, the ability to transfer the relevant and important 

data across the systems from one military treatment facility to another is a problem that we have accomplished a great deal on. We 

don’t hear that as a major issue with our providers. 


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Mr. FRELINGHUYSEN. We are counting on it. We are the resource 

committee. So if there is anything lacking, we would love to hear 

about it. 

General SCHOOMAKER. No, sir. I think across the three services, 

that is not an issue. Bidirectional health information flow to the 

major polytrauma centers, the VA, is also not a problem. My own 

electronic health record began in about 2002 in the Southeast. I 

have moved four times and my record has moved with me each 

time without any problems. Saved a lot of money, saved a lot of unnecessary x-rays and shots. 

The one hole that we have in the electronic system is from the 

point of injury to the surgical site. That still is paper-dependent. 

We have tried electronics. We have given hand-held PDAs to medics and corpsmen. It is a problem and an issue, and we continue 

to try to penetrate that. Right now, it is still reliant on a handwritten record. 

Dr. RICE. Sir, if I could just add one comment to that. That is 

not different from the civilian world. If you look in emergency 

rooms, even in those hospitals that have electronic records, it is the 

ER that still is largely paper-dependent because of the press of 

time. 

Mr. FRELINGHUYSEN. Thank you, Mr. Chairman. 

Mr. DICKS. Thank you. Mr. Moran. 

TRAFFIC AT BETHESDA

Mr. MORAN. Thanks, Mr. Chairman. Actually, I am going to relate a little story. A few months ago, the retina in my left eye was 

peeling off. It is about 5:30 at night. 

Mr. DICKS. Free medical advice? 

Mr. MORAN. No. You will see the relevancy; it is going somewhere. So I drive to Bethesda through traffic and so on. Get there 

about 6:30 or so. They said, You’re about to lose your eyesight. This 

retina is going to be gone. They said, I don’t know what we are 

going to do about it because all our folks are gone; but perhaps the 

best guy to do this operation is over at Walter Reed, Dr. Chun. I 

am going to call him. We might as well start this coordination stuff 

now. 

So they call Dr. Chun. He was on his way home. He comes back 

to Bethesda. They put a couple of tables together to have me lie 

down at the top of it. He takes his hypodermic needle and sucked 

out all the liquid behind the eye, except it was probably the most 

excruciating thing, because there was no time for anesthesia. 

Then they broke into a room that was locked and got a machine 

that had this gas stuff and put gas in the eye and held it down. 

Anyway, they saved the eye. They said among themselves, you 

know, had we not been able to do this together, the Navy and the 

Army ophthalmologist, I would have lost my eyesight in my left 

eye. 

There was some relevance here, Mr. Chairman. So I really am 

a believer in this, that as we coordinate at Walter Reed—I know, 

as Admiral Robinson said, the Navy is also losing its principal 

medical care facility in terms of the public visibility, as is Walter 

Reed. They are both losing their identity, but we are going to have 


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something new that is even better, and the colocation is going to 

work for a lot of people. 

My concern, of course, is that both at Bethesda and at Walter 

Reed, the traffic is almost impossible. You know that. And I am 

wondering—I am not going to get into all the BRAC stuff—I am 

wondering the extent to which you were consulted in terms—I 

know it is a mundane issue, it would seem, but if your staff, if your 

physicians, let alone your patients, can’t get in there, that no matter how good the care is, it is moot if they can’t get to the hospital 

in some reasonable period of time when there is an emergency. 

So have you given any thought? Were you able to offer advice in 

this process of the logistics around the facility to have real adequate access? 

Dr. RICE. Congressman Moran, I experience this personally when 

I am back at the Uniformed Services University because, as you 

know, it sits on the Bethesda campus. I live about 10 minutes 

north. It is 10 minutes when I come into work at a little after 5:00 

in the morning. It is considerably longer than that going home in 

the evening because of the traffic on Wisconsin Avenue. 

Mr. MORAN. It could be as much as 40 minutes just to get out. 

Dr. RICE. It can be as much as 40 minutes to get from Jones 

Bridge Road to Cedar Lane. Admiral Robinson experiences it, because he lives on the base at Bethesda. It is a complex problem, 

and I know a number of people have given this issue serious 

thought. We are hoping that DARPA will shortly come up with a 

transporter beam so that we could move around without vehicles. 

But I think a large part of the effort that we are undertaking 

with the new Commander of the Naval Support Activity at Bethesda is to do everything we can to encourage staff, particularly 

staff and the students at the university, to use Metro to the maximum extent possible. It is a complex issue. 

General SCHOOMAKER. Congressman, first of all, we are glad to 

hear your eye was saved. I suspect the contributions of the soldiers 

involved was breaking down that door to let the Navy surgeons 

work. 

Admiral ROBINSON. At least we have solved that break-in now. 

Thank you. 

General SCHOOMAKER. Two comments I would make. First of all, 

many of you, after the 2007 February stories in the Washington 

Post about Walter Reed, came out and visited. I was then put in 

command of Walter Reed, and commented about whether there was 

reason to pause and think about the decision to close the old Walter Reed campus. My comment, in addition to the fact that we 

want to be in compliance with law, was that for the same reasons 

that you describe the problem at Bethesda, we have the same problem at Walter Reed. It is very tough to get there; patients don’t like 

to get there; and we don’t even have the benefit of the Bethesda 

or the National Institute of Health (NIH) Metro station. 

FT. BELVOIR

Mr. MORAN. Incidentally, you have got a similar problem at Fort 

Belvoir. It is a beautiful facility but there is no Metro there either. 

We are going to have trouble getting patients in emergency condition there. 


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General SCHOOMAKER. That brings up my second point; that 

often overlooked is that although the most proximate demand, as 

Adam has pointed out, is the merger of three hospitals into two, 

the larger plan of 37 facilities and 400,000 beneficiaries in a greater metropolitan area, which makes up the National Capital Region, 

is the real motherlode here. It is how do we integrate services 

across the three services for over 400,000 beneficiaries. 

This will be the 40th largest HMO in the country once it is completed, for 37 different military treatment facilities. Putting care 

close to where families and Soldiers, Sailors, Airmen, and Marines 

live is going to be important, which is why the Belvoir campus is 

so important to us. It is much closer to where people live. 

It is also why, as I said from the beginning with my colleagues 

here, that siting a lot of the high-intensity warrior care and accommodating their families on the Bethesda campus, which won’t necessitate trans-gate traffic, is so important. If you can provide care 

for an injured soldier or patient and amputees and intensely injured and ill Soldiers on that campus, then you reduce the necessity to move traffic in and out of the campus. 

Admiral ROBINSON. Representative Moran, I think that that is 

correct. I agree. I think that your comments are, we are consulted, 

and when I say ‘‘we,’’ as we have the Corps of Engineers and as 

the Navy’s NAVFAC, the Navy Facilities Command that builds, 

those things such as traffic loads and others are studied and taken 

into account. We need to attend to how the growth goes. 

I think that, as you stated, making sure that we can get staff 

into the hospital and—that is as important as the patients. One of 

the reasons we have a large number of barracks for our enlisted 

onboard the base, and have for years, is the fact that not only are 

we in a hugely expensive county, much more expensive than most 

of our junior enlisted can pay for, they also are within the skin of 

the ship, as it were. So snow days and traffic days, we can depend 

on those corpsmen to make sure they are with patients and doing 

those jobs. 

So yes, we are consulted; and yes, this is a major point. No way 

around it. 

Mr. MORAN. Thank you. Thanks, Mr. Chairman. 

Mr. DICKS. Thank you, Mr. Moran. I am very glad you had a 

positive outcome. 

Mr. MORAN. I wouldn’t have shared it if it hadn’t been positive. 

Mr. DICKS. I am glad you shared it. Thank you. Mr. Tiahrt. 

WARRIOR TRANSITION UNITS

Mr. TIAHRT. Thank you, Mr. Chairman. Welcome to the committee. I was recently in Fort Riley, where they have a Wounded 

Warrior transition unit that they are standing up. Even though 

they don’t have the facilities yet, they have the program in place. 

I have had the opportunity to pheasant hunt with some of the 

Soldiers that returned from the front lines and have suffered traumatic brain injury, and some are suffering from posttraumatic 

stress syndrome. They seem to have a pretty good way of helping 

them readjust back to life here in America. 

I was wondering if you are satisfied with the progress that they 

are having so far and if you can explain a little bit about the 


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uniqueness about the unit. Because they have a pretty good rate 

of success; at least that is what they have told me. 

General SCHOOMAKER. Yes, sir. The Fort Riley program is one of 

the 29 Warrior Transition Units that are in hospitals, major health 

centers, and medical centers across the Army. We have about 

9,000—about 7,000 Soldiers in that program and another 2,000 Soldiers in nine States that are centered around nine States—Arkansas, Utah, Virginia, Florida, and the like, and Massachusetts. 

These Warrior Transition Units have an Active Duty cadre made 

up of primary care managers, squad leaders, just like any other 

military unit, and nurse case managers that track the care. 

A very important part of our program is with comprehensive 

transition planning for vocational rehabilitation; for career development; for social, medical and emotional needs. And for programs 

like our posttraumatic stress program, we have got a fairly high 

rate of return to duty for those Soldiers. Overall, the WTUs are returning about 50 percent of Soldiers back into uniform to continue 

service or back into the Reserves to continue service. 

The campus associated with that program, the one at Fort Riley, 

will be our first physical campus that we are standing up with new 

construction on the 27th of May. That will be the first of about 20 

of these campuses that will be built across the country, including 

the one that we are building down at Fort Belvoir. 

POST TRAUMATIC STRESS DISORDER

Mr. TIAHRT. At what point do you sort of take the temperature 

of people as far as trying to find PTSD or some mental capability? 

When they are deployed, do you test them or talk with them before 

they return, and when they return and how long afterwards? What 

is your pattern now that you shoot for? 

General SCHOOMAKER. Sir, we do it whenever it is appropriate. 

Frankly—I am not being coy—what we are moving away from is 

a kind of arbitrary surveying of people at key points. Heretofore, 

we did it before they were deployed; the predeployment health assessment. Immediately upon redeployment—it was called the postdeployment health assessment, and then 90 to 180 days later, it 

was called the post-deployment health reassessment. 

What we are finding is it is more important to move in a direction of tracking the individual and their problems, because they 

frequently arise out of major events. For example, the last time I 

was in Afghanistan, there was some intense fighting on the eastern 

part of Afghanistan. The brigade commander told me that one of 

the unexpected findings was 30 to 60 days after they were deployed, some of the experienced young officers and noncommissioned officers who had deployed before and been in fights before 

were experiencing stress reactions to this new deployment. We 

didn’t expect that to occur 30 to 60 days after they had arrived in 

theater. 

So we are beginning to track longitudinally through this comprehensive program when care is provided. But, in general, what 

we look for most often was immediately before deployment to make 

sure people are sound, immediately after they return, and then the 

90 to 180 days later. 


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The last thing I will say is that part of the program that both 

the Marines and the Army are doing downrange is to find both concussive events—which we think have a high correlation with 

posttraumatic stress disorder—and overlap with that. That is, if 

you have had a concussion in combat, it predicts more often than 

not that you are going to have posttraumatic stress later, or possibly posttraumatic stress if it is enduring. So we are trying to find 

those problems as close to the actual incidents as possible and 

begin treatment in theater. 

Mr. TIAHRT. As you know, we have a lot of Guard and Reserve 

units that have gone forward, and they don’t have access to a permanent facility like Fort Riley or Fort Belvoir. How are you dealing 

with PTSD with the Reserve and the Guard units? 

Dr. RICE. Yes, sir. You are exactly right. There is a challenge for 

the Guard and Reserve in particular as they return to areas that 

are remote from military treatment facilities. With the support of 

this committee and under the leadership of Chairman Young, we 

established a program at the University, the Center for Deployment Psychology, which is focused on behavioral health providers, 

on the peculiar types of experiences that these servicemen and 

-women have experienced in theater, so that they can better provide behavioral health care for them. We have educated a substantial number of civilian providers now, and I am very pleased with 

the success of that program. 

Mr. DICKS. The gentleman’s time has expired. Mr. Boyd. 

SUPPLEMENTAL FUNDING

Mr. BOYD. Thank you, Mr. Chairman. And, gentlemen, thank you 

for being here today. 

Dr. Rice, I want to direct my question to you and talk a little bit 

about the budget side. Obviously, I think many of us have been 

concerned that over the last 8 or 10 years that we have relied on 

supplemental budgets for much of our funding. I wanted to pick 

your brain a little bit about the current supplemental that we have 

before us; what part of that will be for funding Active military personnel and dependents, and also what you might have in your current budget that you are talking about here today that might not 

be covered, we might have to cover in a supplemental later on. 

Dr. RICE. Congressman Boyd, thank you. First, let me say that 

I am relatively newly arrived in this position, and the preparation 

of this year’s budget happened before I got here. I do not think that 

any of the basic funding of the military health-care system was dependent on the supplemental budget. I think that the budget proposal that has come before you now fully funds the Military Health 

System. 

Mr. BOYD. Okay. Would any of the Surgeon Generals have any— 

do you have any knowledge about the current supplemental as it 

relates to any health funding that is in that? 

General SCHOOMAKER. Sir, in the past, the supplementals have 

helped us mainly with closing the gap in military medical construction, which had a very large hole in the program. You all very generously filled that for us, and we are building new hospitals, to include the one at Fort Riley and Fort Benning. 

Mr. BOYD. But not health services. 


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General SCHOOMAKER. Not direct health services, although there 

has been supplemental dollars attached to, for example, Army support of Grow the Army and the medical support that went into 

that. But I fully agree with what Dr. Rice said; that is, the President’s budget in the base provides the necessary dollars for health 

care. 

Admiral ROBINSON. For the Navy, as an example, I think the recent Unified Response-Haiti, there will be an additional amount of 

money that will be covered by the supplemental. And that is operational. I am not sure that is really in the definition of health services, but I agree, again, with what my colleagues have said. 

General GREEN. What my financial people tell me is beginning 

2010, there were dollars that were reprogrammed from previous 

supplementals into the baseline. The dollars for the Air Force were 

about just under $35 million. About $22 million of that was for TBI 

and psychological health, another $4.5 million for OCO tasks, and 

about $8.3 million for Wounded Warriors. 

If your question is whether we can get by without any supplemental in 2011, we are fully funded. The trick is with ongoing contingency operations, the dollars that come in that backfill some of 

our deployed people, we can’t absorb it; but actually a lot of that 

contract that fills in for care back home and ensures access does 

comes from OCO funds, which is part of the supplemental, if that 

answers your question. 

Mr. BOYD. Thank you. Thank you very much. Mr. Chairman, I 

brought that up because, obviously, as we enter this era where we 

have to begin to focus on budget deficits, it is going to be really important that we understand what the requirements are going to be. 

Dr. Rice, in your testimony you have laid out some very instructive information there about the rising health-care costs under your 

purview, both Active Duty and retirees. So I just wanted to bring 

that to the attention of the committee. I thank you, Mr. Chairman. 

Mr. DICKS. Thank you. 

Mr. Rogers. 

PRESCRIPTION DRUG ABUSE

Mr. ROGERS. On March 23, when we had Secretary McHugh and 

General Casey here, I brought up with them the prescription drug 

abuse problem that we have—and it is not limited, of course, to the 

military. It is a problem in the civilian world as well. But a recent 

USA Today article about it mentioned a Pentagon survey in 2008 

which showed that one in four soldiers admitted abusing prescribed 

drugs, mostly pain relievers, in the 12 months prior to the survey; 

15 percent said they had abused drugs in the 30 days before the 

survey. The records show that the abuse of prescription drugs is 

higher in the military than in the civilian world. 

I am wondering, A, what you think about this, and what are we 

doing about it, and what should we be doing about it? 

General SCHOOMAKER. Well, sir, I will speak for the Army. We 

are very concerned about prescription drug use. As you alluded 

to—and you and your district are experiencing as well—there is a 

nationwide problem of, first of all, accidental overdose from prescription drugs now leads or exceeds deaths or complications from 

illegal drugs in the country. The Centers for Disease Control tell 


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us that. The second is that diversion of drugs—that is, prescription 

drugs that are used for recreational purposes, not for what they 

were intended—is a major problem both outside the gate and inside 

the uniform. 

Last year, I stood up a task force within the Army for pain management oversight, working with the other services and the VA. 

And in anticipation of legislation that came out last year requiring 

that we have a DOD approach to pain management, we are starting to get our arms around the size, the magnitude of the problem 

of pain management, and the use of prescription pain-managing 

drugs. We are looking at all sources of care for pain management, 

to include alternative medical care practices like acupuncture and 

yoga and the like. 

At the same time, we are, especially in our Warrior Transition 

Units and in other clinical settings, taking a very aggressive approach to what we call sole provider programs, where only a single 

physician, nurse practitioner, or PA can prescribe drugs for a patient if they are at risk for abusing those drugs, and very careful 

programs of counting and watching the inventory of drugs that our 

soldiers might have. But we are very concerned about the problems 

that you address. 

Mr. ROGERS. Abuse of prescribed drugs is a huge problem in my 

district and, as you say, across the country. It is not limited to the 

military, obviously. However, the Pentagon survey said that the 

problem is higher in the military than civilian. I am told that Army 

Secretary Thomas Lamont, said that a multiservice task force is 

examining how the Army gives pain relief pills to its soldiers. 

Eventually, it will outline how to limit prescription medication use 

and ensure that Army hospitals all use the same procedure for dispensing medicine. He said, We found every Army medical center 

was dealing with pain in altogether different ways, all individual, 

but not an Army-wide program at all. There was no consistency. Do 

you agree with that? 

General SCHOOMAKER. Yes, sir, that is exactly what the pain 

management task force that I chartered has found. That is not 

unique to the services. Frankly, that is a national problem. It is a 

problem even within the Veterans Administration. We don’t have 

a standard kind of approach and we don’t necessarily leverage all 

techniques, to include nonpharmacological problems. We have had 

a problem of acute versus chronic pain. We have pain from a variety of sources. Pain is subjective. It is not objective in the sense of 

something measurable. 

What we are trying to do is standardize our approaches, leverage 

every technique that we can, in cooperation with the other services 

and the Veterans Administration and leading academics in the private sector and in the academic sector who can help us. But you 

have identified, sir, I think a problem that we recognize as a medical system. 

Mr. ROGERS. In the civilian world we have been pushing prescription drug monitoring drug programs; each State, with a grant 

from the Federal Government to require pharmacies, doctors, hospitals, anyone in the medical field, when a prescription is filled, to 

notify the central computer in our State capital so that a person 

will not be able to double-fill a single prescription. I think you have 


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† Does not include WT Soldiers 

* Psychotropic medications include the drugs in the following classes: anti-anxiety, anti-seizure, anti-psychotic, anti-depressant, or stimulant 

what is called a Pharmacy Data Transaction Service, a similar 

type. 

General SCHOOMAKER. In fact, we can track every prescription 

across not only our military facilities but also civilian pharmacies. 

Any time a military prescription electronically is used and any time 

the military system is billed, even if it is outside in the civilian sector, we can track. 

In fact, I can give you for the record a tabulation of exactly what 

the use of prescription drugs of various categories is right now for 

the entire force of 550,000 soldiers. 

Mr. ROGERS. I would like to see that. 

[The information follows:] 

We can query the comprehensive pharmacy database of all DoD pharmacies and 

contracted network pharmacies (provided the service member has the DoD pay for 

the prescription so it is recorded in the database). We can provide a summary of 

how many Soldiers have current, open and active prescriptions. 

Active Duty Soldier Prescription Data 

(March 2010) 

558,840 Active Duty Army Personnel (Includes 4,498 USMA Cadets): 

—200,255 (35.8%) Active Duty Army Soldiers with any medication 

prescription† 

—2,504 (0.4%) for combination (sleep, psychotropic*, narcotics) 

—43,578 (7.8%) for narcotics 

—20,027 (3.6%) for anti-depressants 

—11,448 (2.0%) for sleep medications 

—5,500 (1.0%) for anti-anxiety medications 

—5,119 (0.9%) for anti-seizure medications 

—2,671 (0.5%) for anti-psychotic medications 

—170 (0.03%) for fentanyl patch 

General GREEN. Sir, if I can add, the PTDS system also allows 

us to place restrictions, like the systems you are talking about, 

where people would not be able to get their prescriptions filled, 

even when written by another provider. So they can only get it 

from one source. 

PRESCRIPTION DRUG MONITORING PROGRAMS

Mr. ROGERS. I think that service works for all except medications 

in-theater. I think I can understand that, but explain that. 

General SCHOOMAKER. Sir, we don’t have—except in selected facilities such as Balad or Bagram, where we have an electronic 

record available—in the average or the usual combat outpost or forward operating base where we may not have that available and 

where things are done out of troop medical clinics or battalion aid 

stations—we don’t have the same oversight and ability to roll up 

the aggregate abuse of prescription drugs. 

Mr. ROGERS. I think, Admiral Robinson, the data from ships is 

also not a part of this. 

Admiral ROBINSON. It is not, but we have the data from ships 

rolled up into our SAMs program and to other electronic programs 

we use. But it is not a part of PTDS. 

Mr. ROGERS. Well, the problem has been growing. The abuse of 

prescription drugs in the military is growing rather dramatically, 

as a matter of fact; partly, of course, because of the wars. It seems 


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to me like we are dealing with a real problem here. Do you think 

it is a real problem? 

General SCHOOMAKER. Yes, sir, I think that is exactly what 

prompted me to charter the task force that I did for the Army, to 

try to get our arms around it, especially when it is related to pain 

use. We are doing the same thing with respect to drugs that are 

being given for behavioral health problems and can give you the 

same comprehensive tabulation of who is taking a psychotropic 

drug, a drug that influences mood or behavior. 

Mr. ROGERS. What do you expect out of the task force, and when? 

General SCHOOMAKER. Sir, I have the final draft in hand. Right 

now, I am reviewing that. We hope to present that to the leadership of DOD Medicine very shortly. 

Mr. DICKS. The gentleman’s time has expired. 

Mr. ROGERS. Mr. Chairman, I think Dr. Rice has something. 

Dr. RICE. Sir, if I may, Congressman Rogers, you have put your 

finger on a very complex problem. One of the challenges that we 

face is that for many, many years we in the medical profession 

undertreated pain. Through the efforts of a lot of people, including 

the Joint Commission, we have recognized that undertreatment, 

and now begun to take steps to make sure that patients are not 

needlessly enduring pain. 

I think the challenge for us all is to know what the appropriate 

treatment is, and while the use has undoubtedly gone up, that increased use is entirely appropriate. Pain is the most common reason that people seek medical attention. And, therefore, paying appropriate attention to pain relief is an important part of clinical 

practice. 

Mr. ROGERS. Thank you. 

Mr. DICKS. Thank you. Mr. Bishop. 

HYPERBARIC OXYGEN THERAPY

Mr. BISHOP. Thank you very much. Let me welcome you all back 

again. I would like to ask the panel to return to an issue that we 

visited last year, and that has to do with the related treatments 

for traumatic brain injury and the hyperbaric oxygen therapy. 

Lieutenant General Schoomaker, I have been informed that the 

hyperbaric oxygen therapy equipment and the medical personnel 

have been contracted by DOD for a 2-year, $20 million pilot program that was supposed to start up in January of this year. I am 

told that the equipment and the personnel are positioned at Camp 

Pendleton, Camp Lejeune, Fort Carson, and Fort Hood, but to date 

they haven’t been used to treat any injured personnel. 

I wanted to ask if you would just describe for the committee 

what the hyperbaric oxygen therapy is, and tell us about the situation with the equipment being available but not yet in use. 

General SCHOOMAKER. Yes, sir, I will do my best, and then I 

think my colleagues have even more visibility over it. But in a nutshell, hyperbaric oxygen is the delivery at a pressure above the sea 

level atmospheric pressure of air or oxygen, which then raises tissue levels of oxygen above the normal range. It is recognized as a 

treatment for a variety of things; for example, wound healing for 

resistant infections, especially by organisms that are sensitive to 

oxygen; or for reversal of complications of diving accidents, for exVerDate Mar 15 2010 03:50 Jun 11, 2011 Jkt 066611 PO 00000 Frm 00104 Fmt 6633 Sfmt 6602 E:\HR\OC\A611P2.XXX A611P2

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ample, and that is where the Navy and those who work with pressurized environments have some experience with them. 

There are some recognized medical indications for the use of 

hyperbaric oxygen. Its use in traumatic brain injury or for 

posttraumatic stress disorder is not currently recognized by the national groups that, in a sense, certify or authorize use for that clinical application. We are looking very, very hard for good scientific 

evidence that it adds value in those situations. We are compelled—— 

Mr. BISHOP. That was the status last year. I thought you told us 

last year that that was underway and that we would probably have 

some kind of indications soon. 

General SCHOOMAKER. My understanding is that we have two or 

three outstanding trials right now that are just about to report and 

give us some early indication whether there is some utility to it. 

There are some recently reported nonrandomized and noncontrolled 

studies, meaning that patients were given the treatment, but 

knowing they were getting the treatment, and there was no control 

arm that didn’t use that treatment mode to see if there was any 

real effect of the hyperbaric oxygen. So we are compelled to use 

randomized clinical trials. We have a good program now. Maybe 

Admiral Robinson would summarize. 

Admiral ROBINSON. Representative Bishop, last year, and actually for the last couple of years, we have been—there have been a 

number of reports by researchers and clinicians on hyperbaric oxygen therapy. As has already been summed up, hyperbaric oxygen 

therapy has a usefulness with evidence-based treatments and clinical protocols for a variety of different cases. 

There has never been one for brain injuries and for PTSD. There 

have been a number of anecdotal reports, a number of anecdotal reports that people benefit from hyperbaric oxygen therapy with 

traumatic brain injury and with PTSD. In those reports—and this 

is what General Schoomaker is referring to—they were not done in 

a randomized fashion. They were not done so we can take evidencebased scientific study and actually produce clinical protocols that 

we can give to the world and say, this is based upon clear evidence 

of working. 

Mr. BISHOP. Why have we not done that? 

Admiral ROBINSON. That is what I am getting to. Over the course 

of the last 3 months, and we have been working on this for well 

over a year—but working with Colonel Scott Miller, an Army internist researcher, infectious disease expert—and I will caveat now, 

he has no knowledge of hyperbaric oxygen therapy, but he is a 

master and a professional at designing prospective studies—has in 

fact helped us, through the Army Research Facility, to actually put 

together studies that we are conducting. He has included, at Camp 

Pendleton, Lejeune, Carson, and San Antonio, we now have more 

people enrolled in those studies and actually under investigation. 

So those sites, the Pendleton site and the San Antonio site, are 

working. And for sure the San Antonio site. We have more people 

enrolled than ever before. 

We will have a definitive result of does hyperbaric oxygen work 

over the course of the next 24 to 36 months. That seems like a lot 

of time, but in the world of research, to get that type of evidence 


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and then to put clinical guidelines together, clinical guidelines that 

are going to go forward and be the standard of care worldwide, that 

is not too long. 

Mr. DICKS. Will the gentleman yield? I may have missed this, 

but I think there are some situations where this is being prescribed 

now. 

Admiral ROBINSON. There are conditions treated with hyperbaric 

oxygen therapy today. 

Mr. DICKS. What have been the results of those? 

Admiral ROBINSON. The results have been phenomenal. Wonderful. They have been absolutely unable to base it on any objective 

criteria that we can produce. Since oxygen therapy is a device, it 

is being looked at by the FDA. In fact, the FDA has stepped in and 

asked for some of those studies to be stopped, because they are not 

sure whether this would be harmful to the patients, and there has 

been no objective evidence in a properly controlled study to prove 

that it works. 

General SCHOOMAKER. I think, Mr. Dicks and Congressman 

Bishop, one of the frustrations we all have up here is we want the 

very best treatment for our people. There are far more traumatic 

brain injuries generated and far more posttraumatic stress disorder 

generated in the civilian sector every year than there is in combat—on motor vehicle accidents, on sports fields. We have had decades and decades of brain injury and posttraumatic stress disorder 

and have asked the field to provide good scientific evidence that it 

works. 

We finally, as the Department of Defense, have come together 

and said, Okay, we can’t seem to get academics to do good trials 

for us, so we will do the trials. And, frankly, they are getting off 

the ground now. 

Mr. DICKS. How can the doctor, if this hasn’t been vetted or 

whatever you call it, how can they go ahead and make these prescriptions, and do it, and find out it works very well, and how does 

that happen? 

Admiral ROBINSON. Representative Dicks, I think that there have 

been all sorts of people who have sold all sorts of remedies in past 

years and centuries that have proclaimed the efficacy and effectiveness of things that have been really sham. 

Mr. DICKS. Yeah, but this works. 

Admiral ROBINSON. It hasn’t been proven to work scientifically. 

It works according to the anecdotal explanations of patients. 

General SCHOOMAKER. Legally, a licensed physician can prescribe 

so-called ‘‘off label.’’ 

Mr. DICKS. That is what I want to know. 

General SCHOOMAKER. You can take a drug which is not labeled 

for use in a particular way and try it ‘‘off label.’’ You are responsible for the outcome of that. But you can do that. About 90 percent 

of all pediatric drugs, for example, are prescribed to children ‘‘off 

label,’’ meaning that there isn’t a definitive trial to show its utility. 

It would be too expensive to do that. 

In the case of hyperbaric oxygen, a licensed and certified provider can do that as a trial. The problem we have there is what 

Admiral Robinson says: We don’t have definitive proof. 


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Mr. DICKS. Keep moving the trials ahead as best you can. We 

have to do it in a scientific way, I understand that. But there does 

seem to be some evidence that there are positive outcomes here. 

We have a vote underway. I am trying to wrap this up. Have you 

got anything? Can I go ahead to Mr. Hinchey? 

MEDICAL MALPRACTICE

Mr. HINCHEY. Thank you very much, Mr. Chairman. Thank you 

very much. I deeply appreciate everything you are doing and we all 

know how important it is. It is a very complex set of circumstances 

also, under some set of circumstances. What I want to ask you 

about is the medical malpractice situation. This is something that 

comes about as a result of a Supreme Court decision back in 1950, 

which has created a whole host of problems that really needs to be 

addressed. 

There are many cases of military medical malpractice which have 

been highlighted in the media recently, and a number seem to involve very preventable medical errors. One group reports 10,000 

veterans were exposed to HIV and hepatitis after at least three VA 

hospitals failed to sterilize colonoscopy equipment. This contamination is considered a ‘‘never’’ event, but it is completely preventable 

and it should never happen. So this is a situation that I think 

comes about as a result of this situation of medical malpractice 

under a set of circumstances that is not really overseen. 

My attention was drawn as a result of a former constituent of 

mine, a sergeant by the name of Carmella Rodriguez, who was repeatedly misdiagnosed by military doctors as having a wart when 

he actually had a melanoma. And that melanoma led to his death. 

So I am wondering a couple of things. Do the Armed Forces keep 

track of how much money is wasted yearly on preventable medical 

errors? And how can this rate be lowered if the military is immune 

from liability for the harm it causes? I think that the focus of that 

attention has to be on this, unfortunately, Active Duty military 

personnel who have no legal resources in the face of medical negligence, due to this 1950 Supreme Court decision that Justice 

Scalia says was a mistake. This is health care that comes about not 

in the context of military actions but it comes in the context of just 

normal life. So I wonder if you could focus a little attention on that. 

What do you think about that Supreme Court decision? It seems 

to me that Scalia is right; this is something that really needs to 

be dealt with. You have civilians that still have legal recourse, civilians that are members of military families. But you don’t have 

the military personnel themselves who have the recourse as a result of that 1950 decision. Can we afford to kill and injure our own 

soldiers through negligent medical care? 

General SCHOOMAKER. I think you are alluding to the Feres Doctrine, which was a law passed to protect uniformed commanders 

and members of the military from liability for decisions made in a 

military setting. That has been expanded to caregivers in a practice 

setting, in medical practice, and surgical practice. 

Just a point of information about the first cases you raised in the 

VA. The Veterans Administration, not being a part of the Department of Defense, I am not sure its relationship to the Feres Doctrine. But in that case—in fact, our practices in our hospitals would 


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have protected our patients from HIV because we do the necessary 

sterilization and check for it. 

Mr. HINCHEY. I appreciate the focus on that. There is no question 

about it. But there are cases where we have documented where 

they come up, where they weren’t paid attention to adequately. 

That is the one I am mentioning. 

General SCHOOMAKER. We look very carefully at medical errors. 

We look at those cases that either result in a claim against it; or, 

even when a claim is not filed, when an error has resulted in adverse outcome for a patient, or a near adverse outcome. I am, 

frankly, not aware of any connection between medical liability and 

improvements in medical error. 

Dr. RICE. Congressman Hinchey, I have never presumed to quarrel with Justice Scalia, particularly on an issue of legal doctrine. 

But I think General Schoomaker is exactly right. The government 

is liable under the Federal Tort Claims Act for an act committed 

by a uniformed practitioner acting within the scope of his duties 

and responsibilities. As General Schoomaker has pointed out, there 

is a standard-of-care investigation taken in the case of any assertion of medical malpractice or an unfortunate outcome. 

In my personal experience, having spent most of my career in the 

civilian academic world, I do not think that the threat of litigation 

is a particularly helpful way to improve practice. The judgment of 

one’s peers is profoundly effective. 

Mr. HINCHEY. That is something that I am going to disagree with 

you on, because I think that the liability is something that is going 

to focus attention on the health care that people need much more 

effectively than it is so often. Now, almost always in the vast majority of times, it is focused appropriately and people get appropriate health care. But if you have people who don’t care about it, 

and knowing they are not going to be held accountable as a result 

of it, then there can be a lot of negligence in some cases. 

I think that negligence comes about as a result of the fact that 

there is no accountability; that they don’t have to behave in the 

right way in the context of dealing with people who have normal 

health-care problems in the military. And if the people suffer as a 

result of that, well, they are not going to be held responsible. 

Dr. RICE. Sir, I guess I would take issue with your statement 

that there is no accountability. There may not be accountability in 

a civil court, but within the military system there is a lot of accountability. The behavior and performance of a military officer delivering health care is scrutinized very carefully, and there are profound implications. 

Mr. HINCHEY. I think that is right. I think that that is effective. 

But at the same time, there are a number of other people who are 

not subject to accountability, and they are not subject to accountability because there is no legal accountability that they have to 

deal with. They don’t have to deal with the legal accountability as 

a result of that 1950 Supreme Court decision. 

Dr. RICE. I think on this one we will have to agree to disagree. 

Mr. HINCHEY. All right. 

General SCHOOMAKER. I would echo that. All of our practitioners 

are fully accountable for their actions. Except for the Active Duty 

soldier who, through the Feres Doctrine, cannot raise a claim 


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under tort law, all family members, for example, are eligible for recourse. 

Mr. HINCHEY. Family members are eligible. 

General SCHOOMAKER. I don’t know any relationship between improvements in standard of care and the ability of patients to sue 

for that care. 

Mr. HINCHEY. The families are, but the military personnel are 

not. And that is something that I think really has to be dealt with. 

Frankly, I must say, candidly, I am disappointed in the way that 

you feel about it because it is going to, and has, clearly diminished 

the likelihood of the high quality, effective quality for health care 

for military personnel across the board. There are some number of 

military personnel who have suffered as a result of this. 

Mr. DICKS. The gentleman’s time has expired. Ms. Kaptur. 

VETERANS CLINIC

Ms. KAPTUR. Thank you, Mr. Chairman. Welcome, gentlemen. 

Thank you for the work that you do. In our region, we have no 

major bases that I represent that are Active Duty. But we have a 

lot of Guard and Reserve and returning soldiers. The Veterans Department has announced they want to rebuild this little veterans 

clinic we have in our area. If your advice—and knowing everything 

you know about what is occurring in theater and afterwards as 

these soldiers rotate out and they come back home, what would you 

advise them in terms of what to think about as they construct this 

clinic? Any considerations based on what you see happening to 

those in theater and in support of them compared to past wars? 

Dr. RICE. Congresswoman, if you are referring primarily to 

guardsmen and reservists, then I think a couple of things should 

be kept in mind by the VA, and I know the VA does a very good 

job of thinking through these issues. As my colleagues alluded to 

earlier, the biggest challenge that our beneficiaries face is access 

to primary care. So I think building a robust primary care system 

at such a clinic and then establishing referral relationships with a 

secondary and tertiary care facility in the nearby region is of paramount importance. 

Admiral ROBINSON. Additionally, with the comprehensive primary care, make sure that you have ready access, and I mean onsite access, to mental health capabilities—licensed clinical social 

workers, licensed occupational therapists that can do counseling. 

Psychologists, psychiatrists, of course. But it doesn’t have to be 

only professionals; it can be a lesser person that can still give adequate and good mental health counseling. 

General GREEN. The studies have clearly shown that if you establish what we call collaborative care, which is the integration of 

the mental health into the primary care area, that that decreases 

stigma, encourages use of mental healthcare, and aids the primary 

care folks as they take care of some of the issues that come up with 

veterans. 

Ms. KAPTUR. Your comments are very useful, because one of the 

challenges locally is, we have got veterans organizations, largely 

from past wars, they are more willing to participate than the current veterans—and one of the issues is mental health. And they 

are saying, We don’t want to go in the same door, because when 


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they call our number then everybody knows—if we go down the elevator they know who we are. So we want a door built in the back 

of the building and we are going to drive our car back there so we 

are not with those other veterans. Collaborative care. I hadn’t 

heard about that. 

Admiral ROBINSON. The deployment health clinics in Navy, we 

have about 17 now across the United States, are based exactly on 

the collaborative care model. It is helping to reduce stigma in 

terms of getting mental health care. So your veterans groups will 

be pleased because you go to the deployment health center for primary care. While you are there, you can also get mental health 

therapy, but no one knows where you are going to in the clinic. 

Ms. KAPTUR. Admiral, could you send me some sort of summary 

of that from places where it is working? I know that you don’t have 

responsibility for the VA. However, I have found in my career a 

huge gap between what happens at DOD and then when they come 

home at VA. It is a huge abyss in between. 

General SCHOOMAKER. If I might, ma’am, really quickly. In fact, 

a lot of the behavioral health services that can be provided at a primary care site were developed in conjunction with the Veterans Administration. Durham VA, for example, was very, very active in developing a program called Respect-Mil which teaches and trains 

primary care providers. 

Ms. KAPTUR. They probably have a big hospital there, right? 

When you get down to the hinterlands where you have got people 

coming home, and they are only going to clinics. 

General SCHOOMAKER. This is a training program that can be applied wherever it is. 

The other things that I would add real quickly in terms of this 

clinic is dental care; a robust alcohol and drug treatment program; 

and because they are a younger population of veterans now, and 

more females, we suggest having child care available for women 

veterans onsite so that they can attend their appointments. 

SINGLE-PLAYER PODCAST DEVICE FOR VETERANS

Ms. KAPTUR. Interesting. Thank you, gentlemen, very much. 

I wanted to mention something that I saw that I will try to get 

to each of you, because I have ordered extras, and that is a singleplayer podcast device that is just as big as a little, tiny telephone. 

And what it is, the current soldiers aren’t going to VFW posts and 

participating in veterans organizations when they are coming 

home. So especially where you don’t have a big hospital or big base, 

they go out into the counties, and they are out there, and if they 

have mental challenges, mental illness challenges, it is likely untreated. 

And I found this over at the VA in Cleveland. And working with 

some of the psychologists, they have developed this program that 

can be hand-held, where a veteran can just take it—and I don’t say 

it is self-administered care, but it works them through questions 

and so forth. We are finding it to be very effective. 

And so I wasn’t aware if you had seen these types of devices and 

were using them on a regular basis. If they are out in some rural 

county and they have nothing, it is better than nothing. If they are 

not going to come into the major urban clinic, it gives them a lot 


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of alternatives. A lot of people working with them in the Cleveland 

system seem to feel it provides a new way forward. And the new 

veterans are all independent. They don’t want to go to group sessions. A lot of them don’t do that. 

Have you ever seen these types of devices? 

General SCHOOMAKER. I am personally not familiar with it, but 

I have written it down. Maybe we can get some details. 

Ms. KAPTUR. We are trying to order you some cassettes. 

General SCHOOMAKER. I am going to be at the Cincinnati VA Friday or Saturday, talking to Kate Chard, one of the leading 

posttraumatic stress treaters. I will talk to her. 

DRUG ADDICTIONS

Ms. KAPTUR. I will make sure we get one of these to her so she 

can give it to you. Give me your evaluation of it, if you think it is 

as useful as we have been told. 

My final question has to do, sort of following on what Congressman Rogers was dealing with, I think about Vietnam. I remember 

that era and the numbers of our Soldiers that were addicted and 

what happened in theater and when they came home. We have got 

soldiers now over in Afghanistan, and we know what the primary 

crop in that country is. 

What are you seeing? Are you seeing any evidence of additional 

addiction as a result of where our Soldiers are deployed, and what 

is happening in those circumstances and what comes to you in the 

health field? 

General SCHOOMAKER. No, ma’am, not that we are aware. I am 

not aware through the drug screening programs that are applied 

to all Soldiers that there has been any increase as a consequence 

of those deployments. 

HEALTH CHALLENGES

Ms. KAPTUR. If each of you were, in summary, were to tick off 

a major health challenge you feel that you face in your branch or 

in your responsibility at the university, what would it be? 

Admiral ROBINSON. Just to name a major challenge, it would be 

smoking. 

General GREEN. I would say obesity. It mirrors what is going on 

with the country. 

Ms. KAPTUR. Obesity. In the Air Force. 

General GREEN. Obesity with our beneficiary population, not just 

Active Duty. It is a problem with Active Duty, retirees, family 

members. Our problems tend to mimic the general society. 

General SCHOOMAKER. We have the same problem in the Army. 

Army statistics show the Active Duty soldier on average is at lower 

body mass index, but as soon as they retire—and their family 

members are on par with the country. So we are targeting childhood obesity as one of the health improvement programs within 

Army Medicine. 

Ms. KAPTUR. Thank you. Thank you very much, Mr. Chairman. 


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TRICARE REGION NORTH AND SOUTH PROTESTS

Mr. DICKS. What is the basis for the protest in the TRICARE Region North? 

Dr. RICE. Chairman Dicks, the General Accountability Office reviewed the contract in the North and found evidence of an undue 

competitive advantage. That is a public report. And the Department is working through resolution of that issue. 

Mr. DICKS. UNDO competitive advantage. What does that mean? 

Dr. RICE. Unfair competitive advantage. The assertion is that the 

winning contractor had access to inside information. 

Mr. DICKS. What is the basis for the protest in TRICARE Region 

South? 

Dr. RICE. In the South region, one of the bidders offered discounts for services. The protest was based on the fact that even 

though the TRICARE Management Activity had indicated that it 

was not going to take discounts into consideration in the award of 

the contract because they could not be guaranteed, the General Accountability Office found that those should have been taken into 

account. 

So the technical evaluation of those two contracts, those two proposals, is now underway to define precisely how the proposed discounts can be factored in. 

Mr. DICKS. So what is the status? Are you redoing them? 

Dr. RICE. No, sir. The contracting office has reached a conclusion 

on those and on the one in the North, and that is now under legal 

review at the highest levels of the Department. We hope to be able 

to resolve that issue quickly. In the South, again, the technical reevaluation is underway or the technical standards are being redefined. 

We will give the two proposing organizations the opportunity to 

refine their proposals just within those narrow technical limits. We 

will then evaluate those. And we hope to be able to reach a conclusion on that issue within a month to 6 weeks. 

Mr. DICKS. What is the status of the award at the TRICARE Region West? 

Dr. RICE. Sir, that is an agency protest that did not go to the 

General Accountability Office. Under the rules of competition, a 

health-care or managed-care support contractor can win in only one 

of the three regions. One of the organizations that was apparently 

successful in the South region lodged an agency protest in the West 

region so that in the event they lost in the South, they would be 

able to reopen discussions in the West. 

Mr. DICKS. When will that be resolved? 

Dr. RICE. The resolution of the West is dependent on the resolution of the South. 

Mr. DICKS. So, interrelated. 

Dr. RICE. Yes, sir. 

Mr. DICKS. Is it possible to change the current contracts to reflect 

the enhancements of T3, the third-generation TRICARE contracts? 

Dr. RICE. No, sir. The existing TNEX contracts, which are the 

ones that we are operating under right now, they have run their 

course in the North. Where the contract has been extended with 

the existing contractor, that remains under the TNEX contract. 


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That is one of the reasons that we are eager to move ahead with 

the resolution of these awards, so that we can transition to T3. 

In the meantime, we will very shortly begin the development of 

the generation of—the characteristics of the generation to follow 

that one, which we have, very imaginatively, tentatively named T4, 

which we hope to be able to take into account some of the new 

thinking that may help us bend the curve so that health-care costs 

under TRICARE do not continue to escalate as rapidly as they 

have. 

Mr. DICKS. How fast have they been going up? What has been 

the percentage per year? 

Dr. RICE. Mr. Chairman, the MHS costs are projected to increase 

between about between 5 and 7 percent per year through the year 

2015. If that growth rate remains unchecked, they are projected to 

approach $64 billion in 2010 dollars in fiscal 2015. As the chairman 

knows, the subject of escalating health-care cost has been one that 

the Congress has been intently focused on for the country as a 

whole. The Military Health System is not immune from those same 

pressures. 

Mr. DICKS. At least this year, you set up a budget that had all 

your costs in it. 

Dr. RICE. Yes, sir. The budget proposal is fully funded. 

WARRIOR TRANSITION UNITS

Mr. DICKS. How many Warrior Transition Units currently exist 

to date? 

General SCHOOMAKER. Twenty-nine within the uniformed system 

associated with hospitals and clinics. And there are nine that are 

based in the Adjutants General for nine different States. They are 

more regional; as I said, at Utah, Virginia, Massachusetts, Florida, 

Arkansas. 

Mr. DICKS. There are nine of them? 

General SCHOOMAKER. Yes, sir. 

Mr. DICKS. Not one in Washington State, I take it. 

General SCHOOMAKER. Utah is the closest one. 

Mr. DICKS. We have a big one at Fort Lewis at Madigan. 

General SCHOOMAKER. Yes, sir. And there is one at Fort Richardson in Alaska. 

Mr. DICKS. The committee understands that the WTUs are not 

fully resourced. Why are the WTUs not fully resourced? 

General SCHOOMAKER. Sir, I am not aware that they aren’t. In 

what respect? 

Mr. DICKS. Well, why don’t you look into that? If you can just 

verify that. Our staff seems to think that there are some issues 

here. Are there funds in the 2011 budget to enhance Warrior Transition Units? 

General SCHOOMAKER. Yes, sir. Part of the funding is for fully 

funding the Warrior Transition Units. 

Mr. DICKS. Okay. I was just out to the one at Fort Lewis. I was 

very impressed. I was also impressed by the fact that the commander of the unit was a wounded veteran, who was very impressive. 

General SCHOOMAKER. It may be worth noting that the Army 

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tion Command that has oversight over all of these units, is going 

to be Lieutenant Colonel, promotable, Greg Gadson, the double amputee, who remained on Active Duty, and was the inspiration for 

the New York Giants to win the Super Bowl 2 years ago. 

Mr. DICKS. Is the Army Medical Action Plan fully resourced? 

General SCHOOMAKER. Yes, sir. The AMAP, the Army Medical 

Action Plan, that was stood up after an execution order in MayJune of that year of 2007, was the forerunner of the Warrior Transition Unit process. That led off the whole process of transforming 

wounded and injured warrior care. 

Mr. DICKS. How do the services differ in the provision of care in 

transitioning of Wounded Warriors? 

General SCHOOMAKER. Sir, I would say that the inpatient and 

outpatient care is identical across the services, independent of what 

the color of the uniform is. What we differ in is how we administer 

the programs, subtleties in the support of families and nonmedical 

attendants and the like—and I will let my colleagues address 

that—but use a more decentralized process and the like. In the 

main, what we are all aspiring to do, and our transition into the 

VA and the like, is very, very similar. 

Admiral ROBINSON. I think that from the Navy’s perspective, as 

General Schoomaker has said, the decentralized approach, all of 

the Warrior Transition Units and the men and women who may be 

there are still under the auspices of the Surgeon General of the 

Army; in the Navy, the Warrior Transition Units or Wounded Warrior regiments at Camp Lejeune and Camp Pendleton, and at 

Quantico in this particular region. The Marine Corps takes those— 

they are in charge of those particular units and the Marines are 

in control. Those units all have medical clinics or medical facilities 

that are with them, but we are there to provide medical care to 

them, but the line has control of those members. 

General GREEN. For the Air Force, we have a centralized program that oversees our warrior and survivor care, all overseen by 

our A1, so done by our personnel community. But we do decentralize in terms of the recovery care coordinators and the community readiness consultants, et cetera, that provide support. Our 

Wounded Warriors are all tracked centrally, so we know exactly 

what is happening with each of them, but they actually can receive 

their care locally and then have regional recovery care coordinators. 

Mr. DICKS. Does the budget cut provide adequate funding to take 

care of the Wounded Warrior Programs? As far as you know, is this 

fully funded? 

General SCHOOMAKER. Yes, sir. 

Admiral ROBINSON. Yes. 

General GREEN. Yes. 

Mr. DICKS. All right. The committee stands adjourned until May 

5th at 10 a.m. in H–140 when we will hold a hearing on the Missile 

Defense Agency programs. 

Thank you, gentlemen. I appreciate your testimony. 

[CLERK’S NOTE.—Questions submitted by Mr. Young and the answers thereto follow:] 

Question. VA and DOD medical facilities have improved markedly over the last 

several years, which is good for those people who live in close proximity to them. 


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However, a great many National Guardsmen and Reservists live in rural communities far removed from those types of support facilities. In the past I have championed efforts to provide telephonic psychological counseling services to mitigate 

those types of challenges. Though accomplished at a distance, the intent of these 

services is to have an active medical professional manage cases over a period of time 

in order to both treat and diagnose psychological issues that may also appear long 

after a veteran leaves the service. What other things can this committee do to ensure the welfare of servicemen and women in rural areas? 

Dr. Rice’s Answer. The Department appreciates the Committee’s support for telephonic counseling for the mental health needs of our Service members. As we review 

our options for best solutions, the Department will continue to work closely with the 

Committee on this important issue. 

General Schoomaker’s Answer. There are three actions I recommend to your committee in order to improve the welfare of servicemen and women in rural areas. 

First, continue to fully fund the Defense Health Program (DHP) budget. Eligible Reserve Component (RC) Soldiers and their Families use DHP-funded TRICARE medical and dental services before, during, and after mobilization. RC Soldiers who are 

issued delayed-effective-date active duty orders for more than 30 days in support of 

a contingency operation are covered as active duty service members and receive active duty medical and dental benefits generally from the time they receive their mobilization orders until six months after their demobilization. Eligible RC Soldiers 

living in rural areas use the TRICARE provider network in their local area to receive medical and dental care, and this benefit is critical to those Soldiers who lose 

employer-provided healthcare insurance while deployed. 

RC Soldiers are also eligible to purchase TRICARE Reserve Select (TRS) and the 

TRICARE Dental Program when not on active duty for more than 30 days. DHP 

funds subsidize a significant portion of both programs, making these plans affordable to RC members throughout the U.S. In some rural areas RC Soldiers may have 

few other affordable medical and dental insurance options, so your funding support 

for DHP enables TRICARE to continue to offer these beneficial programs. 

Second, continue to support and fund the Yellow Ribbon Reintegration Program. 

The Secretary of Defense initiated the Yellow Ribbon Reintegration Program to provide information, services, referral, and proactive outreach programs to RC Soldiers 

and their Families through all phases of the deployment cycle. The goal of the Yellow Ribbon Reintegration Program is to prepare Soldiers and Families for mobilization, sustain Families during mobilization, and reintegrate Soldiers with their Families, communities, and employers upon redeployment or release from active duty. 

The program includes information on current benefits and resources available to 

help overcome the challenges of reintegration. This program provides vital resources 

to rural-based Family members of deployed Soldiers as they are geographically dislocated from military installations that routinely provide similar services to Soldiers 

and Families in the immediate area. 

Third, the Army will need your continued support as we review statutory limitations that impact the provision of telemedicine across state lines. State laws governing contract providers vary regarding licensure reciprocity and/or other sharing 

arrangements, while Uniformed and Government civilian providers can practice 

across state lines as long as they have a valid state license and are working in their 

Federal capacity. The Army would like to remove barriers such as this in order to 

provide world-class telemedicine care to Soldiers and their Families regardless of 

proximity to the provider. We value your support of this issue as we continue to 

work with our Department of Defense partners to improve access to care for all Soldiers and their Families. 

Admiral Robinson’s Answer. The Committee can continue to support psychological 

health outreach and support activities such as those being provided by the Navy Reserve Psychological Health Outreach Program. This program was established by 

Navy Medicine in 2008 to provide a Psychological Health ‘‘safety net’’ for Navy Reservists and their families at risk for stress injuries. Five teams consisting of two 

Psychological Health Outreach Coordinators and two to four Psychological Health 

Outreach Team Members are located at each of the five Reserve Component Commands for a total of 25 personnel. The Psychological Health Outreach Team Members provide outreach phone calls to Navy Reservists, especially those returning 

from mobilization, to check on their psychological health status. Additionally, they 

provide referrals to mental health care providers (TRICARE, VA or civilian health 

care provider based on eligibility) as indicated and assist in arranging follow up care 

as needed. Finally, the Outreach Team Members make periodic visits to each of the 

Navy Operational Support Centers (NOSCs) in their respective regions where they 

provide the Operational Stress Control (OSC) and Suicide Prevention briefings and 


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have the opportunity to meet with individual Reservists. As of 1 April, 2010, the 

Navy Reserve Psychological Health Outreach Teams have: 

—Assessed over 2,000 Reservists; 975 required further services and follow-up 

—Provided outreach calls to an additional 2,100 returning Reservists 

—Made 225 visits to NOSCs providing OSC awareness brief to over 23,400 

Reservists and NOSC staff. 

This program was expanded to provide services to the Marine Corps Reserves in 

2009. There are six Psychological Health Outreach Teams (total of 30 licensed Social 

Workers) providing services to Marine Corps Reservists and their family members. 

General Green’s Answer: The Air Force Reserve Command provides the following 

suggestions: 

Air Force Reserve Command (AFRC) currently has no Director of Psychological 

Health (DPH) positions. AFRC wants to hire DPHs who will be in charge of coordinating access to mental health services for reservists. Defense Health Program 

(DHP) funds have been appropriated, but because of appropriation rules this money 

cannot be used to provide administrative oversight positions. Recommend committee 

investigate how long-term funding for the AFRC DPH program can be provided. 

Funding of DPHs will provide recourses to assist Reserve members having difficulty 

accessing care and assistance, especially in rural areas. 

The Air National Guard provides the following feedback: 

Regarding psychological health, the National Guard Bureau has contracted to 

have a Director of Psychological Health (DPH) in every State and Territory. These 

individuals are tasked with evaluating and providing case management for National 

Guard service members and their loved ones, regardless of their location. Unfortunately, there is only one allotted for each State and Territory. In addition, there are 

efforts to implement video teleconferencing for behavioral health consultation. At 

present, the Air National Guard has five sites where telemental health equipment 

has been placed. However, it is unknown how readily the systems are being used. 

The committee could investigate the possibility of expanding the availability of 

DPH’s at the State and Territory level. This would help ensure that service members, especially those in geographically remote areas can have rapid and convenient 

access to behavioral health care practitioners. 

Question: The Center for Deployed Psychology (CDP) has an excellent curriculum 

to train military and civilian psychologists and other mental health professionals to 

provide high quality deployment related service. Do you have any thoughts on how 

the CDP can appeal to a larger audience, to effectively expand the number of providers that are ‘‘deployment psychology’’ certified? Are certain incentives to attend 

the training the answer? 

Dr. Rice’s Answer: My thoughts of how CDP can appeal to a large audience is to 

address the three issues that currently limit participation: (1) costs in time and dollars associated with attending the programs, (2) lack of incentives making the programs a worthwhile endeavor for providers to attend, and (3) lack of awareness of 

the programs. 

To address these issues, we are offering certain incentives. With regard to costs, 

the CDP has made efforts to defray the costs associated with attending their programs (e.g., funding TDY costs for military providers, regional distribution of 1-week 

courses). Additional resources (i.e., TDY funds, funding for additional civilian 

courses, CDP staffing) would allow for larger audiences. The CDP generally offers 

free or low-cost Continuing Education Credits to provide incentives for attending its 

courses but there is some evidence that providing additional direct incentives might 

not attract providers who are likely to use these skills with Service members, veterans, or their families. We are considering additional incentives that target providers likely to treat these populations, such as contract providers working on military installations. 

General Schoomaker Answer. The Center for Deployment Psychology (CDP), a triService center, was established to promote the deployment-related training of behavioral health providers in support of service members and their Families. The 

CDP provides education to military and civilian behavioral health providers. This 

two-week training takes place quarterly, and is a mandated training requirement 

for all student interns completing their American Psychological Association Internship at every Military Treatment Facility within the Army, Navy, and Air Force. 

There are several ways that the CDP can appeal to a larger audience, including retaining central travel funding for attending the two-week course and not shifting 

this burden to the Services. When units fund the travel, they are less likely to send 

personnel. Also, adding programs for mobile training at Military Treatment Facilities, as well as for additional one-week civilian courses would mean CDP trainers 

could reach more providers. Military Treatment Facility training may be particularly important to reach contractors who can not travel as easily as military or govVerDate Mar 15 2010 03:50 Jun 11, 2011 Jkt 066611 PO 00000 Frm 00116 Fmt 6633 Sfmt 6621 E:\HR\OC\A611P2.XXX A611P2

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ernment service personnel. An advanced CDP training course has also been suggested specifically for providers who have already attended the two-week course and 

then deployed. The demand is unknown and although CDP is able to develop such 

a course, funding would be needed to cover additional costs. 

The Army also provides additional training to our behavioral health providers including Active and Reserves Components. All providers (e.g., psychiatrists, psychologists, social workers, psychiatric nurses, enlisted mental health specialists) are mandated to receive Combat and Operational Stress Control training prior to deploying 

for the first time. Providers who have not deployed within the previous 24 months 

are also required to attend this training, and those who are re-deploying to a different operational site are strongly encouraged to attend. This one-week training 

emphasizes the most current, cutting edge information, lessons-learned from combat 

operations, and tools to effectively deliver behavioral healthcare downrange. 

Our network providers who care for service members and families also have numerous opportunities for education and training related to deployment psychology. 

TriWest Healthcare Alliance offers extensive education for their network providers. 

At this year’s annual American Psychiatric Association Meeting, a number of presentations will be delivered by military and Department of Veterans Affairs (VA) providers to help civilian psychiatrists understand deployment psychology and the 

needs and strengths of Soldiers and their Families. In July, the Massachusetts General Hospital Psychiatric Academy is partnering with military and VA clinicians to 

provide an intense course on the management of complex post traumatic stress disorder and traumatic brain injury. 

Admiral Robinson’s Answer. Since 2008 Navy Medicine has coordinated closely 

with Dr. David Riggs and the Center for Deployment Psychology (CDP) to develop 

and provide evidence-based training programs for Navy mental health providers in 

the treatment of Post Traumatic Stress Disorder and other combat related stress illnesses. CDP training has been provided at Navy Military Treatment Facilities, 

Navy Psychology Internship training programs, and Navy Medicine Deployment 

Health Centers, with plans to expand to our growing Social Work community. 

Offering Continuing Medical Education (CME) and Continuing Education Units 

(CEUs) for CDP training would increase the appeal and participation in CDP 

trainings. 

General Green’s Answer. Currently Air Force psychologists, social workers, and 

psychiatry residents attend the Center for Deployed Psychology (CDP) during training. Adding courses/topics specific to psychiatry (e.g. medication use in Post Traumatic Stress Disorder, medication use in theater) will increase attendance by psychiatrists. We recommend advertising this to Mental Health Nurse Practitioners. In 

addition, we recommend CDP reach out to State and Territorial mental health departments or private sector clinicians, identifying additional clinicians treating 

Guard and Reserve Airmen, who would benefit from this training. We also recommend CDP certify their online educational resources for continuing education 

credit hours, giving providers an incentive to complete on-line trainings. We support 

CDP’s plan to conduct an ongoing series of workshops and seminars throughout the 

United States in an effort to disseminate information on deployment-related behavioral health. This is especially important for our Guard and Reserve members who 

may not have ready access to military or veteran’s medical services. 

Question. Battlefield medicine has come a long way and survival rates are the 

highest they have ever been, yet there is still room for improvement. During the 

past decade, the Army Surgeon General’s office has been supportive of developing 

the advanced life support technology known as LSTAT, which is essentially an automated life support trauma pod. It seems like promising technology and apparently 

lighter versions were developed, cleared by the FDA, with requests coming in from 

the field for them. Can you tell me why AMEDD has not fielded the FDA approved 

smaller versions of the system? Furthermore, can you tell me why AMEDD has 

stopped development of the next generation LSTAT and why it has withheld 

FY2009 and FY2010 Congressional dollars from the program? 

General Schoomaker’s Answer. The Army Medical Department has a long-standing interest along with the other Services in a portable, interoperable, and modular 

life support module which allows us to transfer seriously injured and ill patients 

from field hospitals to medical evacuation (MEDEVAC) ambulances, helicopters, and 

planes and through the MEDEVAC chain from far forward to hospitals in the continental United States. We have been working with industry on this for many years 

including current development of lighter weight LSTATS. Existing automated life 

support equipment demonstrates some critical deficiencies in operational testing 

and does not meet all functional capability requirements. The FY2010 congressional 

procurement funding is being reprogrammed to be used as Research, Development, 

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bility. The FY2009 procurement funding will not be expended for several months 

pending the result of current development efforts. If the outcome of these efforts is 

acceptable, we will invite vendors to compete for the procurement solicitation to provide the best currently available products to the battlefield. We are confident that 

this will give us the best solution and provide the Warrior and the taxpayer the best 

value. 

Question. Hyperbaric oxygen treatment appears to show some promise when it 

comes to the treatment of brain related injuries, burns, and certain medical conditions such as cerebral palsy and autism. Can you please describe the military’s position on the viability of this treatment option and how it is being assessed? Possible 

Follow-up: When do you expect to see results from any studies and how quickly 

could treatment options become available for the vast majority of patients? 

Dr. Rice’s Answer. The DoD position on the viability of the Hyperbaric oxygen 

(HBO2) treatment is that it has shown promise in randomized controlled trials in 

acute severe traumatic brain injury (TBI), and anecdotally has shown promise in 

case reports and case series in relief of symptoms in chronic mild TBI or concussion. 

The results in mild TBI are not outside the realm of a placebo response, however, 

and attribution of the observed improvement to the HBO2 cannot be determined due 

to the lack of rigorous scientific design. Moreover, no data on durability of any improvement has been reported. 

The viability of the treatment has been assessed by the required randomized clinical trials to generate this evidence through a program of clinical studies. Three preliminary randomized, double-blind, sham-controlled trials within DoD are underway 

or due to start shortly to look at the best doses of oxygen, sham procedures, and 

validation of measures to assess improvement in symptoms and objective neurologic 

function. To date, 34 warriors with chronic TBI have volunteered in the first trial 

and 25 have completed all testing. A second study is actively recruiting and a third 

is due to kick off soon. 

We expect to see more results from these pilot trials by early next calendar year. 

DoD plans for a definitive trial to kick off at that time, which will take approximately three years to complete. That study will enroll approximately 300 symptomatic warriors over two years, and follow the volunteers for the durability of any 

response for at least a year. 

General Schoomaker’s Answer. Hyperbaric oxygen (HBO2) is approved by the FDA 

for 13 medical conditions, but not brain injury. HBO2 has demonstrated promise in 

randomized controlled trials in acute severe traumatic brain injury (TBI), and 

anecdotally has shown promise in case reports and case series in relief of symptoms 

in chronic mild TBI or concussion. The results in concussion are not outside the 

realm of a placebo response, however, and attribution of the observed improvement 

to the hyperbaric oxygen cannot be determined due to the lack of rigorous scientific 

design. Moreover, no data on durability of any improvement has been reported. In 

summary, there remains no randomized controlled trial evidence to support the use 

of HBO2 for chronic TBI, and four independent reviews have failed to endorse its 

use for this purpose citing lack of strong evidence. 

The DoD response has been to support and to perform the required randomized 

clinical trials (RCT) to generate this evidence through a program of clinical studies, 

and then allow the data to guide policy decisions. These studies are in fact the only 

RCTs of HBO2 for chronic TBI ongoing in the United States. Furthermore, the Defense Centers of Excellence for Traumatic Brain Injury, along with the Army Medical Research and Materiel Command, has been awarded an investigational new 

drug application (IND) to study hyperbaric oxygen, and has established an independent data monitoring board to review the results of the data and make policy 

recommendations to senior leadership. Three preliminary or phase II randomized, 

double blind, sham-controlled trials within DoD are underway or due to start shortly to look at the best doses of oxygen, sham procedures, and validation of measures 

to assess improvement in symptoms and objective neurologic function. To date, 34 

warriors with chronic TBI have volunteered in the first trial and 25 have completed 

all testing. Two additional studies are due to kick off in the next couple months. 

We expect some data (∼100 volunteers) from these pilot trials by early next calendar 

year, and DoD plans for a definitive or Phase III trial to kick off at that time, which 

will take approximately three years to complete. 

Admiral Robinson’s Answer. Navy Medicine is committed to providing all available therapies to Service Members and their families as soon as there is sufficient 

evidence to ensure safety and efficacy of the therapy. The Department of Defense 

has three trials planned or in progress (two efficacy studies, one feasibility study) 

to assess the effects of hyperbaric oxygen therapy on the symptoms of mild and 

moderate traumatic brain injury. The two efficacy studies will have data available 

in January 2011. The feasibility study will have data available in 2014. 


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General Green’s Answer. At the present time, Air Force research on Hyperbaric 

oxygen treatment (HBOT) is centered on treatment of Traumatic Brain Injury (TBI). 

Although anecdotal case reports and small series of trials report benefit in TBI, it 

is an unproven therapy and is not accepted as a standard treatment. There are several prospective randomized clinical trials underway within the DoD and civilian institutions to provide more conclusive evidence regarding use for TBI. 

There are four major prospective randomized Phase II trials underway to evaluate 

HBOT. The first is being conducted by the United States Air Force at United States 

Air Force School of Aerospace Medicine and Wilford Hall Medical Center with initial 

results expected in August 2010. The second is being conducted jointly by Defense 

Advanced Research Projects Agency (DARPA), the U.S. Navy, and Virginia Commonwealth University. The third is sponsored by the Defense Centers of Excellence 

(DCoE) and the US Army Medical Research and Material Command (USAMRMC). 

And the fourth trial is sponsored by Intermountain Health Care. 

The definitive phase 3 clinical trial is being sponsored by DCoE and USAMRMC 

which will be a randomized, multi-center (DoD facilities only), double blind, definitive clinical trial to be conducted under the auspices of the Food and Drug Administration with an Investigational new Drug registration. This study will enroll 300 

participants across multiple military locations where TBI affected members reside 

and will use the outcome measures validated in the Phase 2 studies previously conducted. This Phase 3 trial is projected to start in the fall of 2010 under the supervision of Dr. Lindell Weaver, a critical care pulmonologist, hyperbaric physician, and 

Professor of Medicine at the University of Utah School of Medicine, and Director of 

Hyperbaric Medicine at Latter Day Saints Hospital and Intermountain Medical 

Center, Murray, Utah. 

To ensure that the data from these trials are rapidly and independently assessed, 

the DCoE has chartered an independent Data Safety Monitoring Board (DSMB) that 

will review the results of the Phase 2 and Phase 3 trials. They will ensure the safety 

of the study participants and will be authorized to stop the study early if it proves 

to be futile or if a conclusive benefit if found. 

If HBO therapy is found to be effective in the treatment of TBI, the evidence will 

be presented to the Undersea and Hyperbaric Medical Society for consideration as 

an accepted indication for use of HBO. This phase 3 study will likely take 2–3 years 

to get results. 

Question. For Admiral Robinson: In your written testimony, you mention the humanitarian missions the Navy is involved in as a ‘‘Force for Good.’’ You specifically 

mentioned Haiti and the roles the USNS Comfort and Mercy have played in that 

tragedy and elsewhere. Such expeditionary medical capabilities seem invaluable to 

me, both from a humanitarian standpoint and a diplomatic one. Please tell me what 

long term role you see in the Navy for ships like the Mercy and Comfort. Possible 

Follow-up: For the other services, how do you view your expeditionary medical capabilities? Is the humanitarian assistance mission an important one? 

Answer: 

CNO’s Sea Basing concept requires robust medical capability afloat to support the 

Chief of Naval Operations Maritime Strategy: A Cooperative Strategy for 21st Century Seapower. 

Both T-AHs (hospital ships) are assigned forces in DOD Forces for Unified Commands supporting their operational capability. 

• Through Disaster Response and Humanitarian and Civic Assistance missions, 

Theater Security Cooperation is achieved with international military partners, NonGovernmental Organizations and academic institutions. 

• The T–AH, as a national asset, provides a unique image of national resolve in 

the forward presence sea-basing strategy. 

USNS MERCY (T–AH 19) and USNS COMFORT (T–AH 20) continue to provide 

now, and in the future, a unique and flexible capacity with up to 12 operating rooms 

and associated medical support. This capability of the hospital ships includes 80 

beds for intensive care (including 11 isolation beds), 20 beds for recovery, 440 beds 

for intermediate care, and 440 beds for minimal care which allows them to treat 

a wide range of patients in partnership with the international community. Alliance 

with non-governmental organizations enhances capacity and enduring support in remote areas. 

The hospital ships serve as cornerstones for Shaping and Stability operations 

which help to address many of the root causes of conflict. To be effective in Overseas 

Contingency Operations, our Combatant Commanders need tools that are not only 

instruments of war, but implements of stability, security and reconstruction. Operating from the sea-base, the hospital ships provide a highly visible, positive, engaged, and reassuring presence when deployed for Theater Security Cooperation or 

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port of Civil Authorities (DSCA) missions. The hospital ships are part of the Navy’s 

proactive influence plans and partnerships-for-peace missions. 

The two hospital ships (USNS MERCY and USNS COMFORT) have a life expectancy to approximately 2020/21. Alterations to extend their service life beyond 2020, 

and to enhance their ship-to-shore patient transfer capabilities for shallow water 

coastal regions (such as larger, higher capacity, faster, and more seaworthy boats), 

may be considered. It is conceivable, subject to life extension studies being accomplished, that these ships might be capable of a life extension approaching 2030. Currently, there is no recapitalization plan for hospital ships, but possible smaller, more 

flexible alternative platforms are being examined. Continued studies are needed to 

define future capabilities for wartime and peacetime support and to develop an assessment of more effective, less costly, methods of providing health services support 

from the sea-base. Examining alternatives of sea-to-shore health services capabilities would expand the flexibility to meet a range of future missions with more agility. 

The hospital ships of the past, present, and the next generation ships, have a 

strong role in fostering the good will stemming from the contributions of our government and citizens towards meeting the humanitarian needs of the people from other 

nations, and of our own nation. While serving with an enormous medical benefit to 

the contingency purposes of our own country in times of war and disaster response, 

recent missions have won the hearts of countless people, not only from those who 

serve on them, both military and civilian, foreign and domestic, but also with the 

hearts and minds of those who received care and support from those ‘‘big white 

American ships with the red crosses on them.’’ Humanitarian missions are very important, and the future generation of T–AH hospital ships will remain a central contributor to that civic duty of our country. 

General Schoomaker’s Answer. I see humanitarian assistance and foreign disaster 

response missions as extremely important. The Army Medical Department has incredibly diverse and robust capabilities, both in our operating force forward deployed, and in our generating force here at home. We have statutory authority 

under Title 10 (U.S. Code, Section 401) to support a variety of peacetime engagement projects, of which humanitarian assistance missions are a subset, principally 

as training missions for our forces. In addition to the training benefits, we involve 

our forces in humanitarian activities for several other reasons, including, of course, 

the moral humanitarian imperative, but also because the Army has unique capabilities, we can foster goodwill through nonthreatening engagement with foreign governments, and because there are positive public affairs outcomes that influence recruiting. Few organizations outside of the military have the capacity to move materiel, establish secure routes for aid delivery, develop command and control mechanisms, and provide direct assistance at the levels often required especially in disasters such as the earthquake in Haiti. Humanitarian operations benefit the American 

political process by showing other countries the diverse American population working together to achieve common goals and thus improving global public relations. 

The deployment of military forces to assist with a foreign disaster is a very visible 

show of support for the affected government and people. It also helps develop skills 

in our forces that are necessary for successful civil-military operations. The knowledge of, and relationships with, civil authorities’ and non-governmental response organizations’ processes, needs, goals, and constraints foster increased capabilities 

within the Army medical force to respond within the context of the Combatant Commander’s theater engagement plans and within the scope of our federal responses 

to disasters within the United States. For these reasons, the Army Medical Department will continue to evolve our organizations, training, and equipment to ensure 

we can provide world class health care, any time, any place to meet our missions. 

We have to be able to apply the right mix of medical and public health expertise, 

knowledge and experience in civil military engagements, and cultural intelligence 

to successfully support the United States’ expeditionary medical missions anywhere 

on the globe. 

Army medical forces provided support in the aftermath of Hurricanes Andrew in 

1992, Mitch in 1998 and Katrina in 2005. With each of these opportunities to support our own citizens, we have evolved our processes and procedures to improve our 

response capabilities. Similarly, Army medical units were called on to provide disaster response medical support to earthquakes in Pakistan in 2006, and to both 

Haiti and Chile in 2010. The Army Medical Department is regularly engaged in 

Medical Readiness Training Exercises (MEDRETES) and Medical Civil Action Programs in support of the Combatant Commanders providing disease surveillance, remote clinical support and medical, veterinary and dental training. The Army Medical Department is presently involved in a MEDRETE in Honduras and is preparing 

for two additional exercises, one in the Dominican Republic and one in Paraguay. 


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We have gained from our experiences some key insights about the value of these 

programs. We are extremely aware that creating false expectations in a foreign 

country is sometimes as detrimental as doing nothing. That insight led us to the 

awareness that building or fostering capabilities as well as capacity creates better 

long term impacts. By training the host country’s providers, we enable them to continue programs and build medical capacity long after the Army departs. 

Finally, in alignment with this goal of building host nation capacity to improve 

health and provide healthcare to their citizens, the Army Medical Command 

through its subordinate Medical Research and Materiel Command has several pivotal foreign medical research laboratories—one in Germany, one in Kenya, and one 

in Thailand. These, in parallel with the Naval Medical Research Units in Indonesia, 

Egypt, and Peru, represent ‘‘intellectual power projection platforms’’ which foster 

host nation capacity and Combatant Command-centered theater health engagement. 

The laboratory in Thailand (the Armed Forces Research Institute of Medical 

Sciences, AFRIMS), working with the U.S. National Institute of Allergy and Infectious Disease and Thai government health officials recently completed an important 

HIV vaccine clinical trial that for the first time demonstrated modest protection 

against HIV infection. In the past, AFRIMS has helped develop—in partnership 

with host nation scientists and health officials—vaccines protective against hepatitis 

A and Japanese Encephalitis 2 in Thailand; rapid diagnostic tests for malaria; work 

on plague in Vietnam; and other related health initiatives in the Pacific Command 

area of responsibility. 

The Kenya laboratory (US Army Research Unit—Kenya, USAMRU–K) has done 

similar work with the Kenyans on malaria, leishmania, HIV, and trypanosomiasis 

(African sleeping sickness) and is a pivotal African regional asset for implementation of the President’s Emergency Plan For Aids Relief. Further, in partnership with 

the President’s Malaria Initiative, USAMRU–K has developed a regional center for 

the training of African laboratory technicians in the proper diagnosis of malaria. 

General Green’s Answer. Absolutely! The Air Force Medical System (AFMS) provides a Total Force contingency response capability, leveraging both our Active and 

Reserve (Air Reserve and Air National Guard) Components, to deliver world-class 

patient care on the ground and in the air. We are light, lean and are designed to 

move quickly to wherever needed. Our Expeditionary Medical System (EMEDS) is 

a time-tested and proven medical capability around which the AFMS has built its 

deployed operations over the past decade. It is extremely adaptive across all mission 

areas to include combat operations, homeland response, and humanitarian disaster 

relief. When linked with our highly developed patient movement system to include 

Critical Care Air Transport Teams (CCATT’s), we are able to stabilize and move 

even the most critical patients within hours of injury to the highest levels of care 

anywhere in the world, truly a good news story for our Wounded Warriors. This 

‘system’ of care is fast becoming the system of choice in responding to contingencies. 

A recent demonstration of the EMEDS success was in support of United States response to the 8.8 Chile earthquake. The United States Agency for International Development (USAID) specifically requested the EMEDS in their efforts to restore 

medical care and provide a temporary medical facility to the city of Angol. Within 

72 hours of notification, we deployed 84 medical personnel and 67 tons of cargo to 

Chile and within 48 hours of hitting the ground, our facility was fully operational. 

Over the course of the next 14 days our Air Force medics treated 276 patients, performed 38 surgeries, and integrated/transitioned the facility over to the local 

healthcare providers. The entire operation was well received, praised by both the 

Mayor of Angol and the U.S. Ambassador. We continue to perfect this expeditionary 

medical capability to solidify the EMEDS as the system of choice. Although the 

AFMS provides a vital niche capability to deploy rapidly with small modular personnel teams and equipment packages tailored to specific mission requirements, we 

recognize that we are still part of a much larger medical response effort that includes not only our sister Services, other U.S. governmental agencies, and coalition 

partners, but also a host of nongovernmental agencies specializing in providing support. Our humanitarian mission is an important one, as non-kinetic ‘soft power’ in 

the DoD arsenal to win today’s fight, and through partnership and partnership capacity building to enhance stability and cooperation around the globe. In conclusion, 

the AFMS, as always, stands ready, willing, and able to respond to our nation’s call, 

wherever that may be. 

Question. For General Schoomaker: I enjoyed reading your written testimony 

about the improvements the Army has made with its Warrior Transition Units and 

ensuring that our wounded warriors are being properly cared for throughout the entire process. The Comprehensive Transition Plan seems like a good idea and the 

Army Wounded Warrior (AW2) advocates also appear to be a prudent step in giving 

individual attention when it comes to navigating the many decisions that need to 


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be made by our wounded warriors. Are those advocate positions adequately manned 

and are there enough on hand now? Are there corresponding advocates in the VA 

if someone is transitioned into that system? Possible Follow-up for all services: How 

effective is the transition today from DoD to VA? 

Answer. Army Wounded Warrior (AW2) has 150 Advocates located at major Military Treatment Facilities (MTFs), Army Installations Warrior Transition Units 

(WTUs), and Department of Veterans Affairs Medical Centers (VAMCs) throughout 

the Continental United States, Alaska, Hawaii, 4 U.S. Territories and Germany. 

The current ratio of AW2 Soldiers and Veterans to Advocates is appropriately 45:1. 

The AW2 program has undertaken various innovative and cutting edge business 

protocols in an effort to continue providing its renowned first rate customer support 

and assistance to both the Service members and their Families. Over the past few 

months, the AW2 leadership has conducted a comprehensive assessment and has 

implemented a thorough growth management initiative that will ensure that every 

assigned Soldier and their Family members are adequately supported within the 

provisions of the AW2 program. The AW2 program is expanding its core of government personnel, who are augmented by a robust and flexible contract support vehicle. In addition to this initiative, the AW2 program has developed and is in the process of field testing new methodologies and processes for assessing, defining and 

managing assigned Soldiers under the Lifecycle Management Program (LCMP). 

LCMP allows Advocates, with the concurrence of assigned Soldiers, to more effectively provide assistance and support based on the needs and desires of the Wounded Warriors. The general premise is—as Soldiers and Families progress back to advanced levels of independence, the frequency of Advocate interactions and involvement can be tailored to meet the needs of our Soldiers and Families. This initiative 

has the benefit of providing AW2 with a resource tool to measure and develop a 

more efficient Wounded Warrior to Advocate ratio. 

The Army and the VA have made great strides in the development and integration of sound collaborative efforts in the realm of jointly managing, supporting and 

assisting our severely injured and ill Wounded Warriors. The Army currently has 

Advocates positioned in 75 VA facilities (VAMCs or Community Based Outpatient 

Clinics—(CBOCs)). This relationship, like other VA/DoD joint ventures in the area 

of support services to Wounded Warriors, is on the increase. By the end of this fiscal 

year, it is anticipated that this collaborative effort will witness the growth of approximately 15 new Advocates sharing and supporting dually-eligible beneficiaries 

from VA locations. The Army and the VA will continue to reach out to each other 

to explore all available options that are likely to enhance our mutual support to 

Wounded Warriors and their Families. 

The Army and the VA have integrated several procedures to ensure Soldiers and 

their Families have a successful transition. Since FY2008, both organizations use 

Senior Advisors to ensure coordination and open communication between departments. There are 27 VA liaisons (Social Workers) currently assigned to 15 military 

treatment facilities to coordinate the transition of Warriors in Transition (WTs) to 

VA medical facilities and VA polytrauma centers. VA liaisons register and enroll 

service members into the VA healthcare system, coordinate care with VA program 

managers, coordinate with the Veterans Benefits Administration (VBA) staff to provide Soldiers with benefit information, integrate with Army staff at MTFs, and educate veterans, service members and Families about VA benefits. 

To ensure severely wounded Soldiers have a plan covering all clinical and nonclinical issues, the VA has assigned 20 Federal Recovery Coordinators to major 

MTFs. The VA has also assigned VBA advisors (currently there are 58 VBA Military 

Service Coordinators assigned to WTUs and their supporting Soldier Family Assistance Centers) to educate wounded Soldiers and their Families about VA benefits 

and claims processing at all WTUs. VBA and Veterans Health Administration 

(VHA) personnel support the nine Community-Based WTUs in the same manner. 

There currently are 37 Vocational Rehabilitation and Employment (VR&E) counselors assigned to WTUs who provide employment, career and educational counseling to Soldiers separating from Active Duty. VBA and VHA personnel are learning about the Army’s Comprehensive Transition Plan (CTP) and how the plan supports WTs. Both VR&E counselors and VA liaisons will use the CTP to better understand Soldiers and their Families. 

The VA is assigning clinical and non-clinical personnel to support the ongoing Disability Evaluation System pilot at many major MTFs. At most Army installations, 

the VA has established ‘‘Benefits Delivery at Discharge’’ (BDD) sites to support the 

VA claims process, ensuring all Soldiers submit any necessary claims before discharge. By doing this, Soldiers can track the processing of their VA claim, and the 

VBA can start processing the claim before separation. In addition to the BDD sites, 

VA healthcare enrollment is supported at the 12 Army demobilization sites ensuring 


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all Army Reserve and Army National Guard Soldiers are enrolled in VA healthcare 

and understand VA benefit programs. Lastly, the VA is part of a team that supports 

the Army Career and Alumni Program (ACAP), providing a detailed benefits briefing under the Transition Assistance Program. ACAP has been a successful program 

since 1991, and continues to be one of the main ways to provide VA benefits to all 

Soldiers separating from the Army. 

Admiral Robinson’s Answer. The Departments of Defense (DoD) and Veterans Affairs (VA) work in a close and unified effort in support of Wounded Warriors. Transition support within the Navy consists of medical care case managers and non-medical care managers working collaboratively and with Recovery Care Coordinators 

(RCC) and VA Federal Recovery Coordinators and Case Managers. This close cooperation ensures a smooth and seamless handoff of each patient’s recovery needs 

as a member transitions between DoD care locations, or from DoD to the VA and/ 

or into the civilian sector. 

In support of this process, Navy Medicine has increased medical care case managers to over 190 individuals and tracks acuity to ensure that adequate staffing is 

available to meet the case management needs of our Wounded Warrior and beneficiary population. All Navy Medicine medical care case managers receive training 

on Post Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI) and other 

combat-related conditions/injuries. Navy Military Treatment Facilities and VA Poly 

Trauma Facilities hold multidisciplinary clinical case video teleconferences to discuss patient transition and care needs and to provide follow up information on previously transferred patients. 

Navy Safe Harbor has increased to 19 the number of non-medical care manager 

positions across a nation-wide network to facilitate close coordination during transition. Safe Harbor has also implemented the Anchor Program, assigning a Navy Reserve volunteer ‘‘near peer’’ mentor and senior mentor from community-based organizations such as the Navy League, Fleet Reserve Association, American Legion, Retired Affairs organizations and others, to support individual Sailors and their family 

members as they relocate to communities across the country. Safe Harbor non-medical care managers receive training on psychological health and traumatic brain injury as part of annual programmed training plans. 

General Green’s Answer. The Air Force Medical Service is committed to ensuring 

that our wounded, ill, and injured Airmen are provided effective and efficient transition from the military to the Department of Veterans Affairs (VA). There are multiple initiatives aimed at streamlining and standardizing a service member’s transition from DoD to VA. The Air Force created the Warrior and Survivor Care office 

(AF/1) to oversee the Air Force Survivor Assistance Program, the Air Force Recovery 

Coordination Program, and the Air Force Wounded Warrior program, to ensure continual contact with the wounded, ill or injured Airman and his or her family 

throughout the entire recovery, rehabilitation, and reintegration process. These efforts have resulted in significant improvements in the transition process from DoD 

to VA. 

The following are examples of DoD/VA programs and working groups to further 

enhance transitions and simplify processes for our warriors: 

The DES Pilot 

The Benefits Delivery and Discharge 

The Quick Start 

The Benefits Executive Council 

The Pre-Discharge Working 

The Disability Evaluation System Working 

The DoD/VA Benefits Communication Working 

The Medical Records Working 

The Information Sharing/Information Technology Working 

The AF Survivor Assistance Program (AFSAP) 

The Recovery Coordination Program 

The Air Force Wounded Warrior Program 

[CLERK’S NOTE.—End of questions submitted by Mr. Young. 

Questions submitted by Mr. Moran and the answers thereto follow:] 

Question. Over the past several years there has been an increasing burden on the 

civilian health care community to provide services to active duty members, their dependents and retirees that had previously been provided by military treatment facilities. For example, Ft Eustis, in my state of Virginia, recently closed its post hospital and now buses soldiers daily to the nearby Mary Immaculate Hospital Emergency Room to receive care. Because Tricare reimbursement rates to civilian hosVerDate Mar 15 2010 03:50 Jun 11, 2011 Jkt 066611 PO 00000 Frm 00123 Fmt 6633 Sfmt 6621 E:\HR\OC\A611P2.XXX A611P2

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pitals are often below the actual cost of care, these hospitals are incurring financial 

losses. Four areas in particular suffer the most due to a high concentration of military servicemembers: Hampton Roads, Virginia, Killeen, Texas, Colorado Springs, 

CO and the area surrounding Fr. Carson. 

Is the Department exploring alternative reimbursement solutions to hospitals that 

serve a high-volume of TRICARE enrollees? 

Answer. The Department is not exploring alternative reimbursement solutions to 

hospitals that serve a high-volume of TRICARE enrollees beyond what is already 

available through regulations and policy. After reviewing regulations and policies 

governing the TRICARE Outpatient Prospective Payment System (OPPS), we have 

found that the General Temporary Military Contingency Payment Adjustments 

(TMCPA) adequately reimburse hospitals that serve a high volume of TRICARE 

beneficiaries. 

[CLERK’S NOTE.—End of questions submitted by Mr. Moran. 

Questions submitted by Mr. Dicks and the answers thereto follow:] 

Question. Dr. Rice, you testified before HASC that DOD is facing a significant 

nurse shortage. 2010 NDAA included language (Section 525) authorizing OSD to 

take the lead on the establishment of an undergraduate nurse training program, 

and directed the Secretary to report to Congress within 180 days of passage on the 

plan for implementation of the program. Dr. Rice, can you talk about how you envision that program coming to fruition, and the status of the report to Congress? Do 

you intend to take an active role in the development of the undergraduate nursing 

program considering it is an OSD directive or defer it to the Services? If so, why 

do believe that is the appropriate course of action considering the clear congressional intent provided in Section 525? 

Answer. The way I envision this program is OSD and the Services collaborating 

to meet our need for nurses while ensuring that we are mindful of how we are using 

our resources. We should also ensure that establishment of this program does not 

adversely affect existing Service nursing accession programs (such as ROTC and enlisted to nurse educational programs) and that the Services address this new accession source in the context of their personnel management systems. The final report 

to Congress, with formal Service coordination, will be submitted by July 2010. 

Yes, I intend to take an active role in developing an undergraduate nursing program. For that reason, we have developed plans to establish a Tri-Service Academic 

Nursing Partnership program, which will meet the intent of the National Defense 

Authorization Act for Fiscal Year 2010, Section 525, to expand training programs 

aimed at increasing the number of nurses serving in the Armed Forces. We plan 

to establish partnerships with accredited schools of nursing near our largest military installations. The Department’s Office of the Assistant Secretary of Defense for 

Health Affairs will have program oversight for the development of consolidated 

budget and reporting requirements. However, the operational aspects required to 

implement and maintain this program will be at the Service level. 

We believe this is the most appropriate course of action because it will best support existing unique Service nursing accession programs and integration with existing personnel management programs. 

[CLERK’S NOTE.—End of questions submitted by Mr. Dicks.] 


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WEDNESDAY, MAY 5, 2010. 

MISSILE DEFENSE AGENCY 

WITNESS 

LIEUTENANT GENERAL PATRICK J. O’REILLY, USA DIRECTOR, DEFENSE MISSILE AGENCY 

OPENING STATEMENT OF CHAIRMAN DICKS

Chairman DICKS. The committee will come to order, Mr. Young 

has a motion. 

Mr. YOUNG. Mr. Chairman, I move that those portions of the 

hearing today, which involve classified material, be held in executive session because of the classification of the material to be discussed. 

Chairman DICKS. All those in favor of the motion say aye. 

Opposed, no. 

The ayes have it and the hearing is closed. 

The committee will come to order. Today the Defense Appropriations Subcommittee will receive testimony from Lieutenant General 

Patrick J. O’Reilly, Director of the Missile Defense Agency. Fiscal 

year 2010 was a year of significant transition and high operational 

tempo for the Ballistic Missile Defense program, and MDA participated in several warfighter activities in support of real-world 

events, tested new capabilities, and delivered hardware and software to the warfighter in defense of the Nation. 

MDA also restructured the test program and subsequently developed an Integrated Master Test Plan. The Agency supported the 

administration’s development of the Phased Adaptive Approach, 

formerly European capability, that can be used for defense of deployed U.S. forces, friends, new allies and allies in Europe. 

The fiscal year 2011 President’s budget request reflects significant new policies and initiatives in homeland and regional defense, 

enhanced testing, and technology development to adapt and respond to future threats. 

Restructuring of the Missile Defense Agency’s test program and 

plan was a significant accomplishment in fiscal year 2010. MDA 

worked with the services, operational test agencies, and the 

warfighter, represented by the Joint Forces Component Command 

for Integrated Missile Defense, with the support of the Director of 

Operational Test and Evaluation. 

MDA transitioned to test objectives to verify, validate, and accredit BMDS models in simulations and collected data to determine 

operational effectiveness, suitability and survivability of programs. 

The Integrated Master Test Plan, which extended through fiscal 

year 2015, focuses on proving system capabilities through the collection of identified flight test data to ensure adequate test investVerDate Mar 15 2010 03:50 Jun 11, 2011 Jkt 066611 PO 00000 Frm 00125 Fmt 6601 Sfmt 6601 E:\HR\OC\A611P2.XXX A611P2

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ments and a solid foundation to anchor BMDS models and simulations. 

We look forward to your testimony and a very spirited and informative question and answer. 

Now, before I go to Mr. Young, I just want to say that I had a 

chance to meet with General O’Reilly and a program that our committee has been strongly supportive of, the airborne laser, has had 

some very successful tests, and I think is really—we really moved 

forward dramatically, and we are going to have a demonstration 

after the General makes his statement of this so that the committee members and staff can see it. 

But first I want to turn to Mr. Young, the ranking member, and 

our former chairman. Mr. Young. 

OPENING STATEMENT OF MR. YOUNG

Mr. YOUNG. Mr. Chairman, thank you very much. And I want to 

add my welcome to yours, to our distinguished guest, General 

O’Reilly. 

Protecting our Nation, including our troops abroad and our interests abroad, is an extremely important job, especially as rogue nations and other less-than-friendly nations develop more and more 

ability to attack with their missiles. We spent a lot of money on 

the Missile Defense Program over the years; most of the money 

well spent, I hope, but that can only be determined by testing. 

Sometimes the committee has taken a few raps because we have 

supported programs that maybe weren’t quite as effective as they 

should have been, but we are prepared to do that. We just cannot 

overemphasize the importance of our missile defense to our Nation. 

General, your fiscal year 2011 budget builds upon your last 

year’s transition and I commend you for some significant accomplishes. I do remain concerned, however, about our test and targets 

program. Continued test schedule delays or test failures due to target malfunctions only make your job and our job a little more difficult. 

But as Chairman Dicks stated, you and I had an opportunity to 

meet at length earlier yesterday, and I found that meeting extremely interesting, and look forward to your testimony today. 

Again, welcome. 

Chairman DICKS. General, why don’t we go ahead with your 

statement and then we will take a look at the airborne laser tape. 

SUMMARY STATEMENT OF GENERAL O’REILLY

General O’REILLY. Good morning, Chairman Dicks, Congressman 

Young and other distinguished members of the committee. It is an 

honor to testify before you today on the Missile Defense Agency’s 

activities to continue developing and fielding an integrated, layered, Ballistic Missile Defense System to defend the United States, 

its deployed forces, allies and friends. 

Under the oversight and direction of the Department of Defense’s 

Missile Defense Executive Board, the Missile Defense Agency proposes an $8.4 billion fiscal year 2011 program that is balanced to 

achieve the six policy goals of the Ballistic Missile Defense Review 

report and the combatant commanders’ and the services’ missile deVerDate Mar 15 2010 03:50 Jun 11, 2011 Jkt 066611 PO 00000 Frm 00126 Fmt 6601 Sfmt 6602 E:\HR\OC\A611P2.XXX A611P2

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fense needs as stated in the latest U.S. Strategic Command’s 

prioritized capabilities list. 

First, defense of the homeland against limited missile attack. 

The Ground-based Midcourse Defense system, or GMD, will continue to be our primary defense against raids of Intercontinental 

Ballistic Missiles, or ICBMs, from regional threats for the next decade and beyond. The missile fields in Alaska and California are in 

an optimum location to intercept missiles from either Northeast 

Asia or the Middle East. We continue to upgrade GMD to increase 

its reliability, survivability and ability to leverage a new generation 

of missile defense sensors. We also continue more expansive testing 

of GMD to accredit our simulations. 

The purchase of five additional Ground-based Interceptors, or 

GBIs, and the production of components to support extensive reliability testing and missile refurbishment, will sustain our GBI production capability until 2016, and our critical component manufacturing beyond 2020.——— 

Additionally, the previous European Missile Defense program did 

not cover most of Southeastern Europe, which is exposed to today’s 

ballistic missile threats. It would not have been available till 2017 

and was not adaptable to changes in future missile threats to Europe. 

Therefore, instead of the previous program, we plan to deploy a 

larger number of SM–3 interceptors in Europe over the next decade, in four phases, as the missile threats from the Middle East 

evolve. The first two phases, in 2011 and 2015 respectively, provide 

protection against short- and medium-range ballistic missiles. The 

third phase in 2018 provides protection against intermediate-range 

ballistic missiles. And the fourth phase in 2020 provides capability 

to intercept ICMBs from the region in which they are launched. 

Third, prove the Ballistic Missile Defense System works. We 

have submitted a comprehensive Integrated Master Test Plan, 

signed by the Director of Operational Test and Evaluation, to service the operational test agencies and the Commander, U.S. Strategic Command, to ensure we comprehensively test our missiles before we buy them. 

The two greatest challenges we face in developing missile defense 

is acquiring cost-effective, reliable targets and improving quality 

control in all products. Over the past year, we have initiated a new 

target acquisition strategy to increase competition, improve quality 

control, reduce costs and provide backup targets starting in 2012. 

However, the precise performance of Missile Defense Systems requires stringent manufacturing standards. Until we complete 

planned competitions, including the greater use of firm fixed-price 

contracts and defect clauses, we have to motivate some senior industry management through intensive inspections, low award fees, 

issuing cure notices, stopping the funding of new-contract scope 

and documenting inadequate quality control to influence future 

contract awards. 

Fourth, hedging against the threat uncertainty. Due to the uncertainty in the intelligence estimates of a potential North Korean 

or Iranian ICBM threat over the next decade, we are augmenting 

our current capability today to destroy 8 to 15 simultaneously 

launched ICMBs using our 30 GBIs in Alaska and California, with 


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8 additional silos. We are also completing the development of a 

two-stage GBI which adds several minutes to our battle space. 

Additionally, in accordance with the warfighters’ priorities, we 

are focusing our future technologies to develop more accurate and 

faster tracking sensors on forward-deployed platforms to enable 

early intercepts, to enhance command and control networks, to rapidly fuse sensor data, to handle large-scale missile attacks, to develop a more agile SM–3 interceptor to destroy long-range missiles, 

to enhance the discrimination of reentry vehicles from other objects, and to develop a high-energy laser technology to destroy missiles while they are boosting at great ranges. 

Fifth, develop new fiscally sustainable capabilities over the long 

term. The Missile Defense Agency is complying with the Weapons 

Systems Acquisition Reform Act by establishing and managing six 

baselines—costs, schedule, technical, tests, contract and operational baselines—increasing service in COCOM participation and 

increasing emphasis on competition in all phases of a program’s acquisition life cycle. We are reviewing over $37 billion in contracts 

for competition over the next 2 years. 

Six, expand international missile defense cooperation. We are 

currently engaged in missile defense projects, studies and analysis 

in many countries, including Japan, Poland, the Czech Republic, 

Israel, Australia, the United Kingdom, Germany, South Korea, 

United Arab Emirates, Bahrain, Saudi Arabia, Kuwait and NATO. 

Additionally, Poland and Romania have agreed to host our Aegis 

ashore sites, and we are cooperatively developing the SM–3 2A interceptor with Japan. We also continue to support expert dialogue 

on cooperative efforts with the Russian Federation. 

Relative to the recently expired START treaty, the new START 

treaty actually reduces constraints on the development of missile 

defenses. For example, our targets are no longer subject to START 

constraints, which previously limited our use of air-to-surface and 

waterborne launches of targets. The new START treaty also does 

not constrain our plans to employ ballistic missile defenses. The 

treaty prohibits the conversion of ICBM silos to new missile defense silos. 

However, if more silos are needed in the future, they would be 

less expensive and more reliable if we built new silos—which are 

not prohibited from the treaty—than converting existing ICBM 

silos. 

In conclusion, MDA has teamed with the combatant commanders, services, other DOD agencies, academia, industry and 

other international partners to address the challenges of managing, 

developing, testing and fielding capabilities to deter the use of ballistic missiles and effectively destroy them, once launched. 

Thank you, Mr. Chairman, I look forward to answering the committee’s questions. 

[The statement of General O’Reilly follows:] 


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AL&B TESTING VIDEO

General O’REILLY. I have brought a 2-minute classified video, 

which I am prepared to show. 

Chairman DICKS. I just want to commend you, General O’Reilly, 

for your approach on this competition issue and your approach to 

dealing with these contractors. You and I had a discussion a year 

or so ago, where I complained, and I have been complaining, about 

the performance of many of our major companies. It is unfortunate, 

but the people, there is just a lack of performance. 

And I think what you have done here should be a model for the 

rest of the Department of Defense of aggressively going after those 

people who are not performing and, in essence, taking away their 

contracts and putting them out to bid and letting other people bid 

who will perform. And, somehow, you know, with the amount of 

programs in trouble and overruns at the Pentagon, I hope this 

works. And we are going to be watching very closely to see if this 

does work, because we have got to get this under control somehow. 

I am glad that you have taken this on so aggressively, and we 

look forward to seeing how it turns out. 

So why don’t we—and I know Mr. Tiahrt will—we are going to 

have a little 2-minute video on the airborne laser here. 

Mr. TIAHRT. Excellent. 

General O’REILLY. Sir, if it is okay with the committee: I am 

going to project it on the wall. I would recommend some of you may 

want to stand in a position where you can see it. It will be very 

quick. ——— 

Chairman DICKS. Now, weren’t there a lot of critics who just said 

this is impossible to do? 

General O’REILLY. Absolutely, sir. My background is in laser 

physics, and there was a lot of discussion, including previous directors of the Agency, that said this was impossible. The main difficulty I will show you is we actually fired through the atmosphere 

into space to destroy this missile. This is a scientific breakthrough 

in the area of anchoring our models and simulations, which is what 

some of the physicists were saying why it was impossible. ——— 

Chairman DICKS. One other thing, just one point. You will see 

the missile launch. And then when it breaks apart, it keeps alight, 

but it is only on the pieces of the thing as the debris goes away. 

So I would just point that out so you will understand it better. 

——— 

It was quite impressive. Let us go ahead and show the start of 

the video. ——— 

So at this point we adjusted the optics and we deformed the 

laser, the main laser, so that when it leaves the aircraft it is 

unfocused. Since we now know basically the prescription of the atmosphere, kind of like my glasses. We used the Earth’s atmosphere 

to focus the laser. When it arrives on the target it is perfectly focused. ——— 

Unfortunately, with the movies that have been out for the last 

20 years, this doesn’t impress. I show this to high school classes 

and others in an unclassified form. People are not reacting to it because they are saying, of course, you have got a laser beam. This 

has never happened before. This is the first one in history. 


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Chairman DICKS. It is easier to do it in Hollywood, right? 

General O’REILLY. Yes, sir. It does look like what you just saw 

in the movies. But what you just saw was real. ——— 

It is hard to see, but that is the destruction of the missile. Now 

the laser is irradiating the pieces. So that is what it actually looks 

like for the pilots. They actually see a gigantic beam leaving the 

front of the aircraft. 

Can you just show it one time in real-time without stopping? And 

what we are doing today, while this tees up again. Here is the 

launch. You are watching the entire flight test here. And that is 

the destruction of the missile. ——— 

We did this morning find a blemish on one of the mirrors. We 

are trying to clean it today. We have to change it out. It might take 

2 more weeks before we do the next test. 

Thank you, sir. 

ALTB DEVELOPMENT

Chairman DICKS. Well, I want to compliment you on this, because this subcommittee was one of the steadfast supporters of this 

program over many years, especially when, a few years ago, there 

was a funding issue whether this should go forward or not. 

And I must say that there were some in this body who are no 

longer serving here, but are serving at the State Department, who 

had great doubts about this. And I think the point you make about 

the fact that the refocusing of this laser was the critical issue: 

Could you go through the atmosphere and this thing, the beam, 

would come and hit where it is supposed to? 

But I just want to compliment you because a lot of us thought 

this could be done, and I like your new approach to the program. 

And I think it is also important to know that out at Lawrence 

Livermore, which has been one of the great places for the development of laser capability, there is now a—why don’t you tell them 

about this new laser that they are developing and how it relates 

to the aircraft and the fact that you can have two lasers on this 

plane? 

General O’REILLY. Sir, the Office of Secretary of Defense is executing a study right now on all high-energy laser programs. Last 

year there was over $325 million in laser programs across the 

Agency. They are reviewing them all in order to see if we can consolidate and get a better return on investment. 

But as part of that program, and under that review, they have 

identified the airborne laser to become the airborne laser test bed 

for most of these lasers. The aircraft actually has the mounting for 

two lasers. It had from the beginning. So you can actually put two 

different lasers on this aircraft. ——— 

Chairman DICKS. As I understand it, DDR&E is creating a report 

for Deputy Secretary Lynn on defense high-energy laser research 

to be completed in June. General O’Reilly, can you tell you about 

this report? 

General O’REILLY. Yes, sir. It is the one I referred to before. Last 

year, in all services and the Department of Defense, we spent $325 

million on various laser programs. They are reviewing all of those 

programs. By June they can make a recommendation on how the 

Department should move forward on high-energy laser research. 


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I will tell you that in all the other applications, it is about 150 

kilowatts. This is the only megawatt laser system or megawatt capability requirement that we have in the Department. And, sir, as 

you said, that will be done by the end of next month. 

Chairman DICKS. The committee would like a copy of the report 

when it is completed, General, if you could help arrange that. 

General O’REILLY. Yes, sir. I will pass that to the Office of the 

Secretary of Defense. 

Chairman DICKS. Thank you. Mr. Young. 

Mr. YOUNG. Well, Mr. Chairman, thank you very much. That 

was a very interesting video, General. 

Can you give us—look into the future and tell us when this system might be available to be used? 

General O’REILLY. ——— Chairman DICKS. And when might we anticipate that they would 

be actually an IOC, where we could actually put them into the 

war? 

General O’REILLY. Well, sir, the engineers themselves on this 

program have indicated they have learned so much—because this 

was a breakthrough technology—that if they were going to build a 

second aircraft, they would use what they have learned and design 

a different design. That is what the Secretary of Defense acknowledged last year when he said we will build one aircraft and we will 

test the aircraft and operate from them. ——— 

Mr. YOUNG. General, as you look at the world and you see so 

many rogue nations developing missiles of one type or another, how 

many airborne laser systems do you think that the United States 

will need to give us the type of protection that this demonstration 

shows that we could have? 

General O’REILLY. Sir, our budget is proposing the development 

of several different classes of missile defense systems. I think the 

combatant commanders, who I work with every day, are looking at 

a spectrum of capabilities. Airborne laser does serve us very well 

in certain capabilities where you can deploy for a limited period of 

time, like we surge aircraft today, because they would have to be 

on station. It is expensive to do that, operationally difficult to do 

it, but it can be done.——— 

Mr. YOUNG. General, one of the realistic points during the negotiations for the new START agreement had to do with missile defense. Does that new START treaty affect the airborne laser? 

General O’REILLY. No, sir. I have been to Moscow seven times in 

the last 21⁄2 years. One of the proposals we have had for cooperation on missile defense, besides sharing early-warning data and so 

forth, is development in laser technology with the Russians. 

They have world-class experts at the University of Moscow. 

There are some of the best theoretical physicists and optics and 

such, and they can contribute a lot. Previously the Russians have 

not responded. ——— 

Mr. YOUNG. So if they become unhappy with and withdraw from 

the treaty, which we have seen some suggestions that they might 

do that, you don’t think this would be one of the reasons that they 

might make that decision? 

General O’REILLY. No, sir. They are pursuing this technology, as 

we are, and as the Chinese are also. 


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Mr. YOUNG. Well, as Chairman Dicks has said, this committee 

has been involved with and supporting airborne laser for many 

years, and it is pretty exciting to see the success that you have 

showed us here today. Thank you very much. 

Thank you, Mr. Chairman. 

Chairman DICKS. Thank you. Mr. Moran. 

GROUND-BASED INTERCEPTOR TESTING

Mr. MORAN. Thank you, Mr. Chairman. 

I think we are all impressed by your laser capability that you 

showed in that video. But the General Accountability Office is less 

impressed with your Ground-Based Missile System and, in fact, according to the GAO—and I will quote—‘‘The Missile Defense Agency continues to put the Ground-Based Interceptor program at risk 

with cost growth and scheduled delays by buying and placing enhanced interceptors before this configuration has been demonstrated in a realistic environment. 

In January of this year, you attempted to intercept a target missile using the Ground-Based Interceptor with the—I will only use 

this full term once and then I will use the acronym—the capability 

enhancement 2 XO atmospheric kill vehicle. So we will just call it 

the CE–2. But it failed to intercept the target because of a failure 

of the X-Band Radar to track the target, as well as a failure of the 

CE–2 EKV. 

But about 40 percent of the EKVs have been delivered to date, 

notwithstanding the fact that in the first real-world test, the CE– 

2 EKV failed to intercept the target missile. 

What are the cost estimates for redesigning the EKV and when 

will a new functioning EKV be produced and fielded? 

General O’REILLY. Sir, as I testified last year and as I mentioned 

before, we have restructured our test program to more comprehensively test the GMD program. 

In the past, we have launched our targets out of Kodiak, Alaska, 

launched our targets. And our interceptors have come out of California. That is a 3,500-kilometer threat. 

What we have gone to now is testing against ICBM ranges. Our 

test in January was the first test to more thoroughly test the system out. It traveled—the test was over 8,500 kilometers. We 

launched the target out of Kwajalein, and we launched the interceptor out of Vandenberg. That is the equivalent of a type of defense if you had to launch out of Alaska and defend Miami. ——— 

AEGIS SM–3 PRODUCTION

Mr. MORAN. Well, the problem that the GAO has, as you know, 

is that you were 40 percent—you had gone 40 percent of the way 

into production, whereas the only test showed that it was not operable as yet. 

And with regard to the Aegis Ballistic Defense Missile System, 

the GAO said that it believes that four of the five critical technologies are immature and that there are no plans to intercept a 

target using a fully integrated prototype SM–3 Block 1B missile 

until the second quarter of fiscal year 2011. Yet production begins 

this year. It is not that we are not excited and we don’t want to 


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be supportive, but our job is to ask questions, particularly when 

GAO raises them. 

Given the fact that the SM–3 Block 1B production is set to begin 

before testing a fully integrated prototype in a relevant environment, what are the Department’s plans to employ design changes 

to that SM–3 Block 1B should problems be discovered down the 

line? That is our concern. You have moved ahead with production, 

and yet the testing raises issues that seem legitimate, certainly in 

the mind of the GAO. 

General O’REILLY. Sir, I do not agree with the characterization 

that the GAO made regarding the 1B because those missiles we 

have in production right now are the test missiles. 

We do not have a full production decision made. We are not 

going to make that decision until the flight tests. 

What the GAO was referring to was production of the missiles 

to go test them, and then we will go to a full production decision. 

We are following the prudent traditional path of thoroughly testing 

these systems before we put them into production. The GBIs in the 

past were not procured that way, as you said, sir. We have procured CE–2s. We are, as rapidly as we can, doing the types of tests 

I just referred to, but our policy from this point on is to test first 

and then go into production. 

So, again, what we are buying right now are the test missiles to 

go to production. They are not production missiles. 

Mr. MORAN. Okay, that is a good answer. And I won’t want to 

take up any more time. If we get into a second round, though—and 

I will just prepare you—I do want to better understand why we 

have to pay for Europe’s missile defense. But at this point I will 

yield to the next questioner. 

Thanks, Mr. Chairman. 

Chairman DICKS. Mr. Lewis. 

NATO AND MISSILE DEFENSE

Mr. LEWIS. Thank you, Mr. Chairman. 

General O’Reilly, thank you very much for being here. I am very 

much concerned about the point that Jim was just about to make, 

but perhaps we fall on a different side of this question. It is very 

clear that our European friends for some time now have been wallowing in their own resources because they spent a lot less money 

in defense. America, on the other hand, has been the strength providing defense for much of the world, certainly beyond the developing world. 

It is very important that we be willing to make sure we carefully 

measure where we are going in connection with those expenditures. 

If America doesn’t continue to commit itself to our national security 

and much of the world’s security, who will, is the question. 

If we decide to make, Mr. Chairman, a move in the other direction and continue to fund social programs here instead of defense, 

and Europe is not spending money on defense, who will? It is a 

pretty fundamental question in terms of our future. 

I am very concerned, General, about Iran and the testing that 

they are about and the implications of their future missile capability relative to the European theater and how that impacts our 

responsibilities in the world. 


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Would you enlighten us more about your thinking relative to 

Iran, especially as a major target? 

General O’REILLY. Yes, sir. Do you also want me to address the 

question on the contribution of the allies? 

Mr. LEWIS. Yes. We would like to hear it. Sure, if you want to. 

General O’REILLY. Sir, the most effective defense is not by looking at a map and see if it is covered or not. It is actually a side 

view. To have effective missile defense you need at least two shots 

at a target. You would like them to be from two different systems, 

so that if you have countermeasures in something and you can 

spoof one, you can’t spoof the other. 

If each missile system has, per se, a 60 percent probability of destroying the target that it is launched at, you put those two together and you now have an 88 percent probability of killing it as 

it comes in. You add a third layer and you get high into the 90s. 

Therefore, we want layered missile defenses. 

Our proposal for Europe is the upper tier where we have the capability, and the proposal is they would provide the lower tier. The 

lower-tier systems, you need more of them than you do upper-tier, 

so their net investment actually would be greater than ours if they 

were going to cover Europe themselves. 

Their current NATO policy is to protect their forward-deployed 

forces. 

They have just finished a NATO Ministerial where they are proposing to defend the soil of Europe itself with their NATO Missile 

Defense Systems. This proposal will go to a decision by NATO 

heads of state in Lisbon in November. 

My understanding—and I work with this every day—is we will 

provide the upper-tier defense. They are going to have to provide 

the lower-tier defense. Why do we do it in a classified session? 

——— 

Mr. LEWIS. General, as you responded to Congressman Young’s 

question about timing, when will this be available? I wasn’t— 

maybe I missed it. I didn’t quite get your response in terms of the 

actual time frame. You are in the process of development. You suggested, I think, that we would have this capability operable sometime near the end of the decade? 

General O’REILLY.——— Mr. LEWIS. General O’Reilly, the person who said this will go 

unnamed, but one of my colleagues has said he never saw a fourstar general with so little support behind him. Congratulations. I 

am talking about numbers of people in the audience. 

General O’REILLY. Well, yes, sir, I am a three-star; thank you, 

sir. 

Chairman DICKS. He doesn’t need as much. Mr. Rothmans. 

COOPERATION WITH COCOMS

Mr. ROTHMANS. Thank you, Mr. Chairman. 

Secretary, thank you for all your outstanding work throughout 

your career and in this matter in particular, and these matters in 

particular. Secretary Gates, it was revealed in the general press, 

had sent a memo back in January or February, I think, or maybe 

it was December, encouraging greater planning and coordination or 

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gency option against Iran should diplomacy and sanctions fail. And 

that got a lot of attention recently in the press. 

I actually had asked him that in this subcommittee’s hearing in 

April of 2009, in open session, and he and Admiral Mullen at the 

time said that they were confident they have the capabilities and 

were constantly working that offensive military option. 

But I would imagine that part of an offensive military operation 

would be a defensive capability, a simultaneous defensive operation 

to protect the homeland or our forces in the region or our allies in 

the region. 

Are you working, coordinated with the offensive military missile 

folks, in those kinds of contingency plans, Avis Iran? 

General O’REILLY. Yes, sir, we are. Both EUCOM, the U.S. 

Forces in Europe, under the command of Admiral Stauridis, and 

CENTCOM under General Petraeus are both—we are working with 

both of them to develop and modify and update their war plans 

against the protection of our assets from a strike from Iran and the 

offensive site. For example, our missile defense systems can, within 

seconds of identifying a missile being launched, determine where it 

came from. 

So we are providing that data, we are integrating it into our offensive command and control system. So they immediately know 

that while the missile is still in flight, we have already launched 

strike attacks against the point where it came from. 

Mr. ROTHMAN. And, of course, we want to make sure that there 

is not a conflict between our offensive and defensive systems. So 

have you done exercises so that your defense of launches are not 

misinterpreted by our offensive folks? I know in Operation Juniper 

Cobra—from what I have been told and read—that you had in 

Israel in 2009, where you coordinated that kind of informationsharing between the Israelis and the American forces so that they 

weren’t shooting at each other’s rockets, et cetera. Do we have 

that—have we done that with our own forces? 

General O’REILLY. Yes, sir; extensively with simulations supported BY MDA with EUCOM and CENTCOM. The same commanders that are in charge of the missile defense assets that we 

have employed in other commands are the same commanders that 

have the offensive capabilities. So at the top and their staffs, they 

are responsible for developing both plans so it is integrated. 

COOPERATION WITH ISRAEL

Mr. ROTHMAN. Right. And then regarding Operation Juniper 

Cobra, from what I understand it was at an unprecedented level 

of cooperation and showing of strength and commitment of resources and that it went well; but nothing goes perfectly, and that 

there were lessons to be learned and there is a review going on. 

There is some issue as to whether the U.S. is sharing the lessons 

learned and the mistakes with the Israelis and vice versa. 

Can you comment on that? 

General O’REILLY. ——— 

missile coming in, we immediately provide that data to the Israelis. 

Mr. ROTHMAN. Two last questions, and I will leave him with the 

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gest challenges you face—and this is from your written testimony— 

are reliable targets. 

General O’REILLY. Yes, sir. 

AEGIS INTERCEPTORS

Mr. ROTHMAN. And the last question would be, we need more of 

these Aegis ships and missiles. Are you comfortable with the budget for more ships and more Aegis missiles and your targets that 

you say are your number one priority? 

General O’REILLY. No, sir. I am not comfortable with the number 

of standard missiles. We need more today. It takes 2 years to build 

one, though. And the decision in 2008, the proposed budget, was to 

build a total of 105 standard missiles, total. Today we are asking 

for funding for 431. The problem is—— 

Chairman DICKS. Is that fiscal year 2011? 

General O’REILLY. It starts in fiscal year 2011; yes, sir. 

Chairman DICKS. Four hundred five? 

General O’REILLY. I think it is 435 SM–3s and 431 THAAD missiles across the FYDP. It starts the production line. The problem 

is it takes 2 years to build the first missile. 

So because of the decisions made in 2008, we could use many 

more missiles than we have today. The Joint Staff is conducting, 

with all the combatant commanders in the services, a capabilities 

mix study. The study will determine what the ultimate number is, 

so that our next year’s budget can have that in there. But we know 

we need to ramp up, and we are doing that under this budget as 

quickly as we can. 

But, again, we need to test first and then put into production 

these new missiles. 

STANDARD MISSILE

Chairman DICKS. On this point, why don’t you describe kind of 

in a general overall sense, how we are going to do this missile defense and where the standard missile fits into this? 

General O’REILLY. ——— That standard missile, we made the determination it works very 

well on an Aegis ship. If you just take it off the ship and put it 

on the land, you don’t have to do very much development. It is 

mainly the building itself and the structure. And if you put it on 

the land, now we have a land-based capability equivalent to a Navy 

capability and, more importantly, the sailors are trained. The logistics system, the worldwide logistics system, is there. There is a savings of billions of dollars to have this same missile system on the 

land as you do at sea. 

But more revolutionary is the Joint Chiefs approved earlier this 

year that the Navy would be the lead service for the land-based 

SM–3, which will be the first time that the Navy is operating and 

fully responsible for a land-based weapons system. The Army fully 

agreed with that. 

The problem the Navy had was, with all their sailors at sea for 

Aegis, they did not have the type of shore assignments where they 

could rotate them. The Chief of Naval Operations now has land assignments and sea assignments which will help retention, it helps 

training, it helps across the board. So we thought that this was a 


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very prudent way to move forward to have land- and sea-based capability, same command and control. Where the sailors walk into 

a room on a land-based SM–3, it looks identical to the way it does 

on a ship. 

And when we have remote locations such as Guam, Okinawa, 

Diego Garcia, and other places in the past that have been problematic to station a ship near them, we can now permanently put one 

of these land-based SM–3 sites—or, as the Navy calls them, Aegis 

ashore—and you have now that protection. ——— 

Mr. YOUNG. When will this global defense system be in place or 

be available to use in the event of an attack? 

General O’REILLY. Sir, the first capability is against mediumrange ballistic missiles, 3,000 kilometers or less, and that will be 

deployed in 2011. 

Mr. YOUNG. Is that worldwide? 

General O’REILLY. No, sir. Until this budget is requested, we are 

requesting at least 37 ships, and, between THAAD and Aegis, 

about 800 interceptors. By 2015, we should have the capability now 

that we can start deploying around the world against MRBMs. We 

need the Japanese missile that we are working with the Japanese 

by 2018. And by 2020, we will have had many independent reviews. We believe we will have the capability to develop a missile 

that can destroy ICBMs from a ship or one of these forward bases 

by 2020. 

Mr. DICKS. Mr. Frelinghuysen. 

CHINA AND BALLISTIC MISSILES

Mr. FRELINGHUYSEN. Thank you, Mr. Chairman. 

Just within the last week, for the first time we have revealed a 

lot about our nuclear stockpile. It will be interesting to see whether 

the Chinese and Russians will be willing to go through the same 

full measure of public disclosure. 

My question, sort of general question, is what do we know about 

the Russians’ and Chinese offensive ballistic capability? Do we 

know how many missiles they have? I assume we have done the 

intel on that? 

General O’REILLY. ——— 

Mr. FRELINGHUYSEN. The view here oftentimes is what the Chinese have is crude, and often we say that about the North Koreans. 

But some people sort of have a different take on it. It impacts their 

moving fairly rapidly with the development of their missile program, particularly the Chinese. There continue to be stories circulating in the media that China is working to modify their landbased B–21 ballistic missiles. 

General O’REILLY. Yes, sir. 

Mr. FRELINGHUYSEN. To potentially use against our carrier assets. Can you talk about that? I understand the idea is to have a 

satellite or over-the-horizon radar or maybe a UAV guide these 

heavy missiles towards our carrier groups at very high speeds. We 

have a range reportedly of about 2,000 kilometers, so that would 

make our fleet out there or our ships out there fairly vulnerable. 

And more importantly, do we have the ability to protect the carrier 

groups that are out there? 

General O’REILLY. ——— 


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Mr. FRELINGHUYSEN. This is idiocy. 

General O’REILLY. We have looked at that extensively in the 

past, us and the Navy. It is very cost-prohibitive. It is very complex. We are not looking at using submarines to launch GBIs. 

Mr. DICKS. Not offense. 

General O’REILLY. I was referring to defensive missiles. 

Mr. DICKS. I think what you are suggesting in the START agreement is that the number of launchers, you use some, but I know 

of no system that you would use off a submarine as a defensive system against—— 

General O’REILLY. We are not pursuing that. 

Mr. FRELINGHUYSEN. But we are limiting on the offensive side. 

Mr. DICKS. Both sides are coming down. I mean, to answer the 

gentleman’s points, any of these acts that you are talking about 

would be an act of war, and we have our whole, you know, strategic 

term that would—they are going to have to contemplate that they 

are going to be retaliated against, massively and overwhelmingly, 

if they were to launch such an attack. 

Mr. FRELINGHUYSEN. My point is that there is a degree of vulnerability. 

Mr. DICKS. One thing that wasn’t mentioned, at least for the carriers, our ships’ defense systems. I mean Phalanx is not anything 

to write home to mother about, but it is a final system that can 

shoot down these missiles. 

General O’REILLY. Yes, sir. 

Mr. DICKS. There are limits to its effectiveness. But there are 

ship defense systems. 

General O’REILLY. ——— 

Mr. DICKS. Mr. Visclosky. 

PHASED ADAPTIVE APPROACH

Mr. VISCLOSKY. General, I would like to talk about the phased 

adaptive approach, and part of this is just to clarify the program 

in my mind, if I could. 

You have the SM–3 block, and as I understand the relation of 

Block 1, Block 2, those can be launched from land or sea; am I correct? I want to make sure I am clear. 

General O’REILLY. That is our proposal, sir. We have tested the 

standard missiles before from the land at White Sands so it is not 

unprecedented. But that is what we plan to develop, the land-based 

launchers, so we can deploy them—so you can launch the same 

missiles at sea as you can on the land. 

Mr. VISCLOSKY. Are they launched today on land or sea? 

General O’REILLY. Today they are launched at sea on destroyers 

and cruisers. 

Mr. VISCLOSKY. And the proposal would be to have them also be 

adaptive—I guess that is the ‘‘adaptive’’ word there—on land as 

well. 

General O’REILLY. Yes, sir. The ‘‘adaptive’’ word is we can move 

them if we find a threat changes in the future. It takes a couple 

of months to disassemble the whole deployment and move it to another location if we see some in the future. 

Mr. VISCLOSKY. And also, obviously, there are multiple at sea. 

General O’REILLY. Yes, sir. 


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Mr. VISCLOSKY. On the Ground-Based Interceptor, that is land 

exclusively. That is not launching from sea. 

General O’REILLY. That is correct. 

Mr. VISCLOSKY. The SM–3 is for short and intermediate intercepts essentially? 

General O’REILLY. Sir, there are several variances of the SM–3. 

The SM–3 IA is for short—which is up to 1,000 kilometers—and 

medium range, which is up to 3,000 kilometers. 

So the SM–3 IA and IB will be to engage targets up to 3,000 kilometers, the range of the target, 3,000 kilometers. And the SM–2s 

would be able to handle targets of 5,000 kilometers, the IIA and 

the IIB ICBMs. 

Mr. VISCLOSKY. So the A and the B in Block II would be modified 

to be long-term interceptors as well; or would it be A is short and 

medium, and A is long term? 

General O’REILLY. The SM–3 I series is the short and medium 

range. The SM–3 IIA would be against IRBMs up to 5,500 kilometers, and the SM–3 IIB would be ICBMs, 12,000 kilometers. 

Mr. DICKS. Are these the ones that are under development with 

the Japanese? 

General O’REILLY. The IIA is. 

Mr. DICKS. But not the IIB. 

General O’REILLY. Not the IIB, sir. That is a new missile start. 

Mr. VISCLOSKY. That is not under development currently. It is a 

proposal? 

General O’REILLY. We are going through the technology today of 

verifying the high-risk parts which we believe we have in hand, the 

high-risk technologies for the next 2 years for the IIB, and then we 

would start a formal program start after that. 

Mr. VISCLOSKY. And the IIA would still be adaptable for short 

and intermediate intercepts? 

General O’REILLY. ——— 

Mr. VISCLOSKY. And B would be long? 

General O’REILLY. Yes, sir. 

Mr. VISCLOSKY. There is no further development or changes proposed for, then, the Ground-Based Interceptor, which is long range? 

General O’REILLY. ——— Mr. VISCLOSKY. What about the missile itself? 

General O’REILLY. ——— Mr. VISCLOSKY. General, if I could follow up. You are not in those 

upgrades looking to also make it a sea-launched system, though? 

General O’REILLY. No, sir. We have no plans for a sea-launched 

GBI. 

Mr. VISCLOSKY. Then the question in my mind, understanding 

that the Block IIB is not yet developmental—you are looking at 

it—why proceed with that if you are upgrading your current landbased system? 

General O’REILLY. Sir, it is a quantity. A GBI costs about $70 

million apiece. The estimate for a IIB would be on the order of $15 

million. 

Mr. VISCLOSKY. One-five, 15? 

General O’REILLY. One-five, yes, sir. 

And the difference is the GBIs, if we are going to add a new 

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pand a missile field. The ships at sea, we are building these new 

missiles so they fit in the existing launcher systems. So a cruiser 

has 120 launching cells on it. So we can put up to 120 missiles, 

four times as many as we have in Alaska—— 

Mr. VISCLOSKY. Short, intermediate, and long? 

General O’REILLY. Yes, sir. 

Mr. VISCLOSKY. On your land-based, that would also hold true, $15 million per copy? 

General O’REILLY. Yes, sir. That is the II—what we refer to as 

the IIB and IIA. They are about $15 million, is our estimate. 

Mr. VISCLOSKY. If you have a missile that is long-range and one copy—of course you haven’t built one yet—that is $15 million and 

the other $70 million, what is the cost disparity when I am comparing apples and apples; that is, land-based IIB and the landbased GBI? 

General O’REILLY. ——— Mr. VISCLOSKY. So the upgrade, then, to the GBI is not necessarily to increase their quantity but to make sure, as long as you 

have that investment in them, it is an effective investment, then 

you keep them effective. If you have additional quantities, you go 

with the IIB that you have in your proposal. 

General O’REILLY. Yes, sir. 

Mr. VISCLOSKY. I know I don’t have a lot of time. 

If the IIB, you have not started development but obviously you 

have a plan for and you have a cost assessment for it, will there 

be a time when you need more of—will you need at some point 

some of the additional GBI in the interim until all of this is built? 

General O’REILLY. Sir, there is a threat uncertainty. Our current 

plans, we are going to procure 52 missiles, GBIs, and five additional booster stacks. Now, that is what we are proposing. With 

those 52, we are going to be flight-testing some of them. By 2020 

when we have planned on fielding the newer missile, we should 

have 36 GBIs at that point. If we find we need more, we are going 

to be in production until 2016. So we have 5 more years to continue 

to assess the intel and determine if we need more. 

We don’t want to get into the situation I am in today. Our last 

time we bought a GBI was 2006. Our production is stopped on most 

of the vendor base, and I have to restart it next year, which I am. 

But we are trying to make—allow decisions to be made in the future before we shut down that production line again. 

Mr. VISCLOSKY. Which—industrial base would be a concern. But 

I know my time is up, and I thank the general and the chairman. 

Mr. DICKS. Mr. Tiahrt. 

ALT B FUNDING

Mr. TIAHRT. Thank you, Mr. Chairman, thank you for your support for the Missile Defense Program. I think you have been a 

great visionary. 

One of the things I would like to pick up on what Mr. Rothman 

talked about and the cooperation with Israel. They are developing 

great new technology over there. In fact, you can’t buy a new computer today without the incorporation of some ideas that originated 

in Israel on processing. And I think there is a great deal of synergism that we could gain by close cooperation. So if there are any 


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problems with that cooperation, I have got to join with Mr. Rothman in trying to smooth the bumps in the road, because I think 

it gives us an advantage on defense issues as well. 

There is something that happened last year that I want to point 

out to you. The ABL is about 12 years old. Last year, the optics 

needed to be recoded. It took 6 weeks to get a supplier up and running. So there was like a 6-week delay. It is an indication of how 

our national defense industry base is shrinking and making us 

more vulnerable. 

While this is occurring within the United States, our own Pentagon is looking outside the United States as a supplier. You have 

heard a lot about the tanker program where they are trying to buy 

a French tanker and put an American paint job on it and call it 

American. And even though this is a country that I don’t think we 

can fly over today to get our men and material to Iraq and Afghanistan, I am very concerned about this outsourcing of our national security. 

We are also doing it through a program called Imminent Fury, 

where we are going to Brazil for aircraft which have a competitor 

that is made right here in America. So again, we are outsourcing 

our national defense base, and I think it is very ill-advised. And 

this ABL program is an example. 

When you are in confrontation, you can’t afford a 6–week delay 

or 6-day delay. And we have seen this in the Gulf War, Japan disappointed us by delay. In Operation Iraqi Freedom, Belgium disappointed us with a delay in war materials. So we can’t make ourselves more vulnerable. And I think the committee needs to know 

that by diluting our defense industrial base, we are making ourselves more vulnerable. 

And I don’t think any of you are going to run for reelection on 

the platform that we are going to increase the employment in 

France when we have got almost 10-percent unemployment in 

America; or we are going to run on the platform of increasing the 

employment in Brazil when we have got almost 10-percent unemployment in America. So we need to be very concerned about this 

outsourcing of our national security, whether it is Imminent Fury 

or an air refueling tanker or the ABL program. ——— 

For us to now cut back the funding on this program concerns me 

greatly, especially in light of all of these advancements you have 

made in technology, in compressing the package carrying. 

If the Department was provided with the same level of funding 

as last year, which would be an additional hundred million, I believe, how would that money be spent and how would we use that 

to progress the program and the technology? 

General O’REILLY. ——— 

Mr. TIAHRT. Please explain to the committee what the 98 or 99 

million will buy in 2011 that we have in program now. Is that just 

the one test you are talking about? 

General O’REILLY. The one test, but the 1-year program. The one 

major test, but we have a lot of smaller tests. 

Mr. TIAHRT. The hundred million would get the smaller tests, the 

advanced? 

General O’REILLY. Yes. And a part of that does pay for the newer 

laser work going on at Lawrence Livermore. 


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Mr. TIAHRT. ——— 

General O’REILLY. ——— 

Mr. TIAHRT. I think I want to emphasize the need for increased 

testing because of the versatility of this weapon. And we just are 

thinking, you know, how many kilometers away and all of this. But 

by increasing the testing, I think the capability will dramatically 

increase. And if you take it to—you know, using my imagination, 

I can imagine the capability in the back of a Humvee, and it can 

protect a platoon, at the platoon level, from incoming objects like 

a handheld rocket. So it has great potential as we compress it further, and I think that can be revealed. ——— 

Mr. DICKS. Mr. Hinchey. 

COUNTERFEIT PARTS

Mr. HINCHEY. Thank you very much, Mr. Chairman. 

I think you made a very good point, as everybody else did here, 

but I want to express my agreement with you of the kinds of things 

that—what you were saying and why I think it needs to be done. 

So if there is anything I can do to work with you on that, I would 

be happy to do that. 

General O’Reilly, thank you very much. Thank you for everything you are doing and the opportunity that we have to understand this situation much more clearly. 

The safety and security on this planet is diminishing, and it is 

something that really has to be dealt with more effectively, including diplomatically. But that is another issue here that really has 

to be addressed. 

The safety and security issue with North Korea and Iran, it is 

just remarkable why they would be engaging in the capabilities 

they are engaged in, when, if they were to do anything militarily 

dramatic in the context of this, it would be a disaster for them. No 

question about it. 

And of course the safety and security issue was demonstrated in 

New York just a couple of days ago, and we know that kind of situation that we are likely to continue to see over time, and it is something that we have to be very, very careful about and very, very 

intensive about. 

I wanted to ask you a technical question. It has to do with a 

number of things, including a company in a district that I represent, Endicott Interconnect Technologies, working with the Department of Defense. 

The situation basically is this: Last year, the New York Times 

reported that despite a 6-year effort to build trusted computer 

chips for military systems, the Pentagon now manufacturers in secure facilities run by American companies only about 2 percent of 

the more than $3–1/2 billion of integrated circuits that are bought 

annually for use in military gear. And the effectiveness of that 

gear, the reliability of it, is something that is obviously very important. 

So recently the GAO released a report regarding counterfeit 

parts and the potential of such parts to potentially seriously disrupt the Department of Defense supply chain, do other things like 

delay missions and affect the integrity of weapons systems. 


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The report found that the Department of Defense is limited in its 

ability to determine the extent to which counterfeit parts exist in 

its supply chain because it does not have a Department-wide definition of the term ‘‘counterfeit’’ and a consistent means to identify 

instances of suspected counterfeit parts. 

Apparently, while some Department of Defense entities have developed their own definitions of ‘‘counterfeit,’’ these can—they vary 

on the context of the definitions that are being put out there. Two 

Department of Defense databases that track deficient parts—and 

they are those that do not conform to standards—are not designed 

to track counterfeit parts. A third database can track suspected 

counterfeit parts; but according to officials, reporting is low and 

that reporting is low due to the perceived legal implications of reporting prior to a full investigation, reporting something that you 

may not have all of the information about, so are you going to report it in any case before you know everything about it. Well, that 

is just one aspect of what is now a deeply complicated set of circumstances here. And it has to do a lot with security. 

So I am wondering to what extent you may have looked into this 

and may have understood this situation. 

Has the MDA been impacted by counterfeit parts? Does MDA 

have its own definition of counterfeit? And what anti-counterfeiting 

measures are being considered by MDA? 

General O’REILLY. Sir, first of all, that GAO report cites us as 

one of the organizations that is aggressively pursuing counterfeit 

parts. We do have a definition of counterfeit parts, and it is both 

not building the part to the exact design that was proposed in our 

approved designs for our components of our missile systems by our 

prime contractors, but also built by someone different than was 

originally identified when we approved the design. So that is our 

definition of counterfeit parts: change the part or been built by 

somebody differently. So we hold our prime contractors accountable 

for that. 

Yes, we have been affected. Yes, we have called in the FBI. Yes, 

the Justice Department has pursued them. And so yes, sir, we do 

see it as a growing problem. 

Mr. HINCHEY. So to what extent do we have or to what extent 

is the reliability of this situation increasing, do you think, over recent time? 

General O’REILLY. Sir, we have been aggressively pursuing them. 

I have inspectors in almost every one of the plants. So does the Defense Contracting Agency. A lot of our reporting, though, of this is 

actually coming from our prime contractors themselves or major 

subcontractors. These counterfeit parts are not coming from large 

companies, but it is the smaller ones. 

What we have added in is additional screening. So we test the 

first thing, to identify if something is not operating right, when you 

take the component. Years ago, we had—in order for acquisition reform and reducing the cost of acquisition, we had removed some of 

those tests. We have installed those tests back in to do more parts 

screening when they come in. 

And second of all, it is a crime and we do pursue that. 

So through inspection, making it a contract requirement, and our 

prime contractors themselves have been vigilant. ——— 


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Mr. HINCHEY. Is it generally considered to be a serious situation 

where you have essentially 98 percent of the products here that are 

being manufactured, apparently, in places outside of the country, 

and the reliability of the integrity of these operations comes into 

question? Is the situation concerned about; is it being looked into 

effectively? I know you just mentioned some of the ways in which 

it has been. 

General O’REILLY. Yes, sir. It is a concern. Screening is the first 

order we do to protect at the piece-part level to catch them when 

they are coming in, but more is needed. 

Mr. HINCHEY. Is there any potential for this operation, or is it 

significant enough to have it be focused in the context of being 

manufactured here in ways that can be seen more effectively? 

General O’REILLY. Sir, that obviously is a viable solution that 

would solve that. Some of our counterfeit parts, though, we have 

found in the past some of them are from U.S. entities, and the Justice Department has taken over at that point. We have had to redesign parts of a component and go procure them from somebody 

else. But it is not just overseas; it is U.S. too, where we have run 

into this problem. 

Mr. YOUNG. Will the gentleman yield? 

This is a field I have cared for for a long time. We all know the 

technology exists in the world to embed programs into certain types 

of electronics, certain types of technology that could cause a failure 

or a disruption of the system. 

And as Mr. Hinchey and Mr. Tiahrt have raised the issue of foreign producers or counterfeit producers, are we vulnerable to having that type of attack made against us by embedding something 

that we can detect but an enemy could disrupt our missile with one 

of those embedded programs? 

General O’REILLY. Sir, as far as a foreign component, we prohibit 

the use of foreign components by any of our contractors unless we 

provide them a waiver. And the waiver is not just the Department 

of Defense, but the Department of Commerce also. So we go 

through a process. It has to be a trusted source. We have trusted 

sources in the U.K. Obviously, this is something that we work very 

closely with the Japanese in our development with the SM–3 IIA. 

We do have processes to provide waivers, but without a waiver, 

they cannot use a foreign piece-part in any of our systems. 

Mr. DICKS. Mr. Kingston. 

Mr. KINGSTON. General, that just seems outrageous to me. And 

it would appear to me that within your Department that there 

would be equal outrage; in fact, that your outrage would be bigger 

than our outrage in terms of anybody selling counterfeit parts to 

a missile system so important. 

Do you feel it? You don’t strike me as a real emotional guy, 

which is good. But is anybody there pounding the desk and saying 

this is—somebody has got to go to jail? 

General O’REILLY. Sir, our process for that is, first of all, we turn 

it over to the Justice Department. Second of all, we prohibit them 

as a supplier to the Defense Department, immediately to MDA. We 

submit them to be a prohibited supplier in the future. So what we 

try to do is put it out of business. 

Mr. DICKS. Will the gentleman yield on this point? 


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Has anybody been put out of business? 

General O’REILLY. We have—sir, I know of several incidences a 

couple of years ago. I can provide you the data on that. 

Mr. DICKS. That would be good. 

[The information follows:] 

MDA has experienced several instances of counterfeit parts. For example, a counterfeit operational amplifier, which can be used on multiple MDA systems, was identified on MDA hardware during testing. The failed part was found on a circuit board 

supplied by a subcontractor. It was later determined that the subcontractor purchased these parts from a parts broker who was not authorized to distribute parts 

by the original component manufacturer. In another instance, a counterfeit microcircuit, which can be used on multiple MDA systems, was identified on MDA hardware. MDA’s visual inspection showed that the part was resurfaced and remarked, 

which prompted authenticity testing. Tests revealed surface scratches, inconsistencies in the part marking, and evidence of tampering. These parts were purchased 

from a parts broker who was not authorized to distribute parts by the original component manufacturer. 

MDA reports instances of counterfeit parts to the Department of Justice (DOJ) for 

criminal investigation and possible prosecution. In October 2009, DOJ announced 

that it had indicted three individuals in connection with sales of counterfeit electronic components through several distributors, including MVP Micro, Red Hat Distributors, Force-One Electronics, Becker Components, and Pentagon Components. In 

January 2010, one of the defendants pleaded guilty to charges of Conspiracy to Traffic in Counterfeit Goods and Defraud the United States and to the Trafficking in 

Counterfeit Goods. MDA also issued a formal advisory to its program offices to determine whether there had been any other parts procurements from these distributors and confirm that these entities had been removed from all Approved Vendor 

Lists at the contractor and subcontractor level. 

Counterfeit parts are addressed as part of MDA Parts, Materials, and Processes 

Mission Assurance Plan which includes instructions on part selection, procurement, 

receipt, testing, and use of parts. MDA further has applied DOD’s item-unique identification technology that provides for the marking of individual items. In addition, 

MDA issues formal bulletins that alert MDA staff of counterfeiting techniques and 

how to detect them. 

Mr. DICKS. Also, what is their excuse? What do they say when 

they are confronted with this? 

General O’REILLY. Sir, we deal with the prime contractor. I don’t 

know. It is a criminal act and we turn it over to the Justice Department. We then immediately find a new supplier and change the design if we have to avoid ever using those components again. 

Mr. DICKS. But you are not getting a new prime. You are just 

getting a new subcontractor. 

General O’REILLY. Yes, sir. 

Mr. KINGSTON. It would seem to me that the prime contractor 

would have some vulnerability. 

Mr. DICKS. He is the one that selected the prime—the subcontractor, right? 

General O’REILLY. That is right. Sir, this is a problem that we 

deal with in the Department; that is the use of cost-plus contract. 

A cost-plus contract is intended in order to say that there is a risky 

technology or something we are pursuing that is not mature. And 

instead of the contractor absorbing the whole risk, the government, 

for most risky technologies, like a lot of the missile defense ones, 

we share the risk of them proceeding in a risky development. It 

was never intended, but there is no distinction in our contracts 

today, our older contracts, to distinguish between a legitimate development risk and negligence or a defect. 

And so our new contracts that we are moving forward—and we 

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tracts, we are aggressively using fixed-price contracts where we 

can; which means when you spot counterfeit parts it is on the 

prime contractor to pay for the impact of that. 

And we are also adding in defects clauses. 

HOMELAND DEFENSE

Mr. KINGSTON. I want to move on a little bit. 

I want a Rotary Club takeaway here. When we move from agriculture to education to health care to ballistic missile defense, what 

would you say in terms of your number one goal, defending the 

homeland against a limited ballistic missile attack, where are we 

on the scale of 1 to 10, 10 being 100 percent secure? 

General O’REILLY. Sir, we have conducted three out of three successful tests of a geometry that shows missiles being launched from 

North Korea and our interceptors coming out of Alaska. That is the 

tests where we launch the interceptor—the target out of Kodiak 

and we launch out of Vandenberg. We have shown it is technically 

viable. 

The Director of Operational Tests and Evaluation has calculated 

that to have a statistical confidence you would need to repeat that 

test 17 times, and each test is over 200 million. 

So I think what is more critical is when we are going to complete 

the testing on these systems—and that is what our integrated master test plan does—to validate our models so we can run thousands 

of runs in order to get a high confidence level in this capability. 

We know we have capabilities, sir, but I can’t quantify like I 

would like to be able to of what that probability is. 

Mr. KINGSTON. Two hundred million dollars just for one test? 

General O’REILLY. For a GBI test, yes, sir. Again, we are now 

testing at greater ranges. The latest one was $279 million. We were 

launching out of the Marshall Islands and the intercepter out of 

Vandenberg. 

Mr. KINGSTON. If you were going to guess where our biggest 

threat is, what would you say, what could be—fast forward in the 

tape if you could make a prediction. 

General O’REILLY. In defense, sir? 

Mr. KINGSTON. Yes 

General O’REILLY. ——— 

Mr. KINGSTON. Would it come from a rogue nation or where 

would it come from? 

General O’REILLY. Sir, our concern is they are being sold on the 

arms market. So they do not discriminate. So nonstate actors do 

have a potential to have these. 

NATO BMD FUNDING

Mr. KINGSTON. Okay, then I have one more question, Mr. Chairman. 

I wanted to know on the European contribution, you had said 

they do the first level. 

General O’REILLY. That is the proposal, yes, sir. 

Mr. KINGSTON. And how much is that in terms of a percent of 

the total of their defense? What is their lift compared to American 

taxpayers? 


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General O’REILLY. Sir, our rough calculation of the value of the 

missile defense assets they own today, and several countries do, is 

about $2 billion that they already procured. 

Mr. KINGSTON. What would be the total defending Europe—and 

I understand it is not just defending Europe—but defending Europe, what is the total price tag for that? 

General O’REILLY. ——— 

Mr. KINGSTON. I am really worried about the dollars here. 

General O’REILLY. They need a lot more of them. 

Mr. KINGSTON. But we are spending $12 billion. What are we 

proposing that they spend? 

General O’REILLY. They would have to make a determination of 

what they want to protect at that lower level. And that is what is 

going to occur in the Lisbon Summit, between the heads of states 

of NATO. Today they haven’t declared that they will protect territory of Europe, and that is a first step. 

Then the second step—and NATO does have studies going on 

looking at what is the priority of what they are trying to protect 

and their investment strategy. 

Mr. KINGSTON. At Lisbon, if they vote not to participate, what do 

we do with the upper tier? 

General O’REILLY. ——— 

Congresswoman Kilpatrick. 

STRATEGY BALLISTIC MISSILES

Ms. KILPATRICK. Interesting discussion. I think I am trying to 

visualize. 

Let me ask you this: What missile system is the strongest defense system in the world? What countries? 

General O’REILLY. For missile systems? 

Mr. DICKS. Are you talking about offensive or defensive? 

Ms. KILPATRICK. How can you separate them? 

General O’REILLY. Offensive, the threat missiles, if you remove 

the United States—— 

Ms. KILPATRICK. I don’t want to remove them. 

General O’REILLY. The country that has the most missiles today 

is Russia; the second country is the United States; and the third 

is China. 

Ms. KILPATRICK. Do you base my question on the number of missiles they have or the best defense system that there is? 

General O’REILLY. Our intelligence estimates look at the effectiveness of the threat. So it is the most egregious threats are the 

ones that have the most potential. 

Ms. KILPATRICK. So which is the best system of the three that 

you named? 

General O’REILLY. ——— 

Ms. KILPATRICK. So U.S. in that regard. 

General O’REILLY. For offensive strategic accurate weapon. 

Ms. KILPATRICK. And Russia would be how in that same scenario? 

General O’REILLY. ——— 

Ms. KILPATRICK. And Russia is now our friends. We work with 

them. They are one of our allies, are they not? 


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General O’REILLY. They are not an ally, but we do work with 

them. We have agreements that we do surveillance on each other’s 

systems. So we do know—and they do inform us and they have 

done that—every time they move their systems. 

Ms. KILPATRICK. So we have a working relationship, say, not allies. What would they be to us? We use their parts. 

We meet with them. We discuss the security thing. 

General O’REILLY. We have an ongoing open dialogue for years, 

going back to the original STARTs. We exchange data back and 

forth on our systems. 

Ms. KILPATRICK. I am trying to move to Iran and North Korea 

and all of them. 

Is Iran—you didn’t name them in that top three. Do they have 

the capability that the other three that you mentioned have? 

General O’REILLY. No. They are pursuing it, is our intelligence 

estimate. So are the North Koreans. But, no, they don’t today. 

——— 

Ms. KILPATRICK. Okay, so that is good. They are still in testing, 

then. They are trying to get there. 

General O’REILLY. They are trying to get there. 

Ms. KILPATRICK. So between Syria, Iran, China, North Korea, we 

have better offensive and defensive missile defense systems than 

they at the current time? 

General O’REILLY. Yes. 

Ms. KILPATRICK. If we use some of our other partners—I guess 

Russia would be one of those—does Russia have the same relationship with Iran and North Korea that we have? Are they in that 

realm? They agree on some things and some things they don’t, or 

are they like our country? 

General O’REILLY. They do have ongoing dialogues and relationships with both North Korea and Iran. 

Ms. KILPATRICK. Then on the video that we saw, the laser. Does 

it operate in bad weather, in clouds? Is any of that interrupted? 

General O’REILLY. ——— 

Ms. KILPATRICK. How much is it going to cost to develop that 

testing? We want to get you what you need. Is it in addition to— 

in our Congress, everyone wants to cut the Defense budget because 

it is the money that we need to secure, and I am for securing as 

much as we need. 

Is the phase-in 2014 that you mentioned, 2015, going to mean 

that we can reprogram some old money, or is it all new money that 

we are talking? 

General O’REILLY. It is all new money that we are proposing in 

this budget. However, there are two reprogramming actions on the 

Hill here today right now; one to complete the missile field in Alaska to provide us the eight additional silos to give us some additional hedge for the future; and the other is to upgrade more Aegis 

ships to BMO capability sooner. So those actions are on the Hill 

today. 

STANDARD MISSILE–3 IIB DEVELOPMENT

Ms. KILPATRICK. I commend you for your knowledge, and the 

physics background that you have obviously helps that. 


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Lastly for me, if there was one thing that you would ask this 

committee to do or support in your capacity as Director of MDA, 

what would that be? 

General O’REILLY. I believe it is the support for the SM–3 IIB 

missile. And the reason for that is that regardless of the intelligence estimates, my concern is these technologies are out of the 

box. People are aggressively working on long-range mobile missiles 

and they have shown over and over again they are willing to sell 

them to anybody who will buy them. 

So it may not be this decade, but it would be hard to say it 

wouldn’t be the next decade that we could face threats from all directions. We have to convince these people it is not worth even pursuing. And therefore having missiles like an SM–3 II8 that could 

shoot down a missile over a country that is launching the missile 

would deter them and persuade them, like we have done with their 

air forces, to stop investing in these missiles. 

Ms. KILPATRICK. Thank you very much. 

Thank you, Mr. Chairman. 

Mr. DICKS. Now I want to recognize Mrs. Granger, and I notice 

that she has an apple there. 

And General, can you tell us why that apple is there? 

General O’REILLY. My mother taught me to always bring an 

apple and give it to your teacher. And believe it or not, I don’t 

know what the odds are of missile defense, but the odds here are 

pretty high. 

Should I say how long ago it was, ma’am? 

Mr. DICKS. That is one thing you don’t. Strike that from the 

record. If you were both much younger. 

General O’REILLY. A few years ago I was briefing Congresswoman Granger and she asked me where I was from, and I informed her I was from her district. And then she asked me where 

I went to high school and where my parents lived. And it became 

quickly apparent that we have known each other many years ago 

when I was 16, and I don’t know how old she was. 

Mr. DICKS. But she was the teacher, right? 

General O’REILLY. Yes, sir. Congresswoman Granger was my 

high school English teacher, I believe my junior year in high 

school. 

Mr. DICKS. You told us that she vigorously corrected your papers. 

General O’REILLY. You may think I am worried about these questions that committees ask. I am worried about having my former 

English teacher correcting my grammar. 

ARROW-3 DEVELOPMENT

Ms. GRANGER. When you were talking about the defense of Europe and you said, ‘‘We are going to have to propose,’’ and so I was 

going to come back to you and say, Does that mean they haven’t 

decided not to? Then you told us about the Lisbon Summit, so we 

will watch that very carefully. 

I want to ask you to go back to something that we have talked 

about, you and I talked about, and that is the critical importance 

of the relationship with the U.S. and Israel. And I want to ask you 

about the Arrow-3 program and how that is progressing and the 


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challenges it presents and how we are coming along with the 

project agreement. 

General O’REILLY. ——— So we have a program laid out with them that very systematically monitors their progress, and we do assist with them, and U.S. 

companies like Boeing are participating with them on this program. 

Ms. GRANGER. I was aware that it was more costly and going to 

take more time, but they are absolutely committed to it. So I thank 

you. 

I would suggest to anyone—I did, because I am his former teacher, and because I wanted more information. You gave me a briefing 

that was very helpful just generally on all of these missile programs and what they do. And it was very helpful to me in understanding and be able to then zero in on particular issues. 

Mr. KINGSTON. Was he still trying to get extra credit? Is that 

what this was about? 

General O’REILLY. When I briefed her, she gave me a gold star 

at the end. I was hoping there was no homework. 

PHASED ADAPTIVE APPROACH

Mr. DICKS. Mr. Rogers. 

Mr. ROGERS. General, some people are concerned that the new 

Nuclear Posture Review weakens our missile defense efforts. In 

2009, the administration scrapped the planned missile defense systems in Poland and the Czech Republic, coincidentally turning its 

back on two very staunch allies in the effort to, I think, appease 

Russia. Am I correct on that? 

General O’REILLY. No, sir. When I was advising the Secretary of 

Defense and others in this, our primary concern with the other program is it takes 5 years to build the missile field. And if we found 

we didn’t have enough missiles, we would be vulnerable for 5 more 

years until you can upgrade the missiles. ——— 

So the concern was not enough missile defense. We needed to 

procure or pursue a system that was more affordable, that could 

in fact—because GBI cost 70 million apiece, the missiles we are 

proposing now are between 10 to 15 million apiece. We project we 

are going to need hundreds—instead of 10, hundreds of interceptors in Europe if the threat emerges, as some of the intel predictions are. 

Mr. ROGERS. Why did we scrap Poland and the Czech Republic? 

General O’REILLY. Sir, I was part of the—Under Secretary 

Tauscher and Under Secretary Flournoy and I went to Poland the 

day the President made the announcement. 

When we landed at the airfield in Warsaw, the first thing we 

saw was a London Financial Times telling us how the meeting 

went that we hadn’t even held yet. There was a complete fabrication on what had occurred in the announcement. I was one of the 

three that announced this to the Polish Government. 

We listened for an hour respectively, as they were very upset 

that we had left them hanging. And at the end of the hour, we then 

explained to them we still want to put an intercepter system in Poland; and they looked at us and said, But that is not what we were 

told. 


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And myself and Secretary Flournoy and Secretary Tauscher said, 

‘‘We are here on behalf of the President. We do want to have missile defense here. We are continuing our agreements on the deployments of Patriot and to put the command and control system we 

had before.’’ And frankly, instead of having 10 interceptors in Poland, they could have as many as a hundred and—— 

Mr. ROGERS. Where do we stand now? Are we going to have missiles in Poland? 

General O’REILLY. Yes. And they have agreed to that, sir. 

Mr. ROGERS. And effectively, what will those missiles defend 

against and whom? 

General O’REILLY. ——— Mr. ROGERS. Well, again, the question is why are we paying for 

the protection of Europe, especially those areas where we do not 

have troops of our own or installations that we need to protect? 

Why are we doing this? Are they going to help us with the costs, 

the Europeans? 

General O’REILLY. Sir, that, again—NATO is reviewing that 

right now, and the first step is to agree to protect themselves. That 

is the Lisbon Summit. 

But, second of all, once you have this separate tier protection for 

ourselves, it does have zones of about 2,000 kilometers. With Article 5 and NATO, if we have a capability to defend NATO, we must 

under the article launch our interceptors to defend NATO, which 

is part of the indivisability of NATO that goes back to the very beginning. 

Mr. ROGERS. Well, will we be pushing NATO and/or the Europeans to help pay the costs of these deployments? 

General O’REILLY. Yes, sir. Two weeks, ago, I spent 4 hours, privately, with the Secretary General of NATO. He came to Colorado, 

and we showed him all of our demonstrations and our simulations 

and so forth, and we had very long discussions on what would be 

the cost to NATO and what would be the changes in the command 

and control and so forth, for them to have an Integrated Missile 

Defense System. ——— 

Mr. ROGERS. So the Lisbon Summit will, hopefully, decide the 

European defense posture; correct? Who pays for it, where the missiles will be? 

General O’REILLY. Yes, sir. Without their agreement to protect 

themselves, and it is a U.S. commitment only, or bilateral, with 

each of the countries. 

Mr. ROGERS. Well, in September of 2009, the President introduced what is called a Phased Adaptive Approach for missile defense in Europe. What is that and what does it have in relation to 

the Lisbon Summit? 

General O’REILLY. ——— 

The second step, then, would be the Phased Adaptive Approach. 

As we are developing new missile capabilities with the SM–3 and 

the THAAD and our forward-based radars, we will deploy the capability, as they are being tested and proven and accepted by the 

services, first deployment in 2011, the second deployment in 2015. 

And these deployments are geared by our intelligence estimates of 

what range the Iranians can reach if, in fact, they are successful 

in the development of their own systems. 


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Mr. ROGERS. So this will be a NATO-run program, do you think? 

General O’REILLY. ——— 

ALTB CONCEPT OF OPERATIONS

Mr. ROGERS. Now, in closing, a wholly different subject. In the 

video, what is the planned protocol for stationing the aircraft, the 

laser-armed aircraft, in a defensive situation? Obviously the plane 

has to be fairly close to the launch phase, right? How would you 

have those planes deployed on a routine basis? 

General O’REILLY. ——— Mr. ROGERS. Well, on a worldwide mission, you are going to need 

a lot of planes. 

General O’REILLY. Sir, that is why this would be a great capability to surge. That is why we are proposing to have many different missile defense systems so that the combatant commanders 

that I am working with today put the appropriate system against 

the appropriate threat. 

Chairman DICKS. Would the gentleman yield? 

Mr. ROGERS. Yes. 

Chairman DICKS. A possibility would be you would have planes 

off of North Korea. 

General O’REILLY. Yes, sir. 

Chairman DICKS. Or off of Iran as a possibility. So if tensions 

rose, we had some indication that they might do something, then 

you could deploy these airplanes and you could attack a missile in 

boost phase. 

Mr. ROGERS. Well, that is what I am talking about. And, like 

Iran, where to get close to a launch site that might be inside the 

middle of Iran, I don’t know how you would be able to patrol close 

enough to—— 

General O’REILLY. Well, again it is what we call goal-tending 

from hockey. If you know where the threat missiles are coming and 

you know what you are trying to defend, and you have a mobile 

defense, you can put the defense and put the aircraft between 

where they are being launched and where they are going. 

So we have an idea. We know what trajectories they would have 

to use if they were going to threaten the United States. So we are 

in their path, and we let them come towards us as well as shooting 

them. That would be part of the strategy. 

But, again, this would be more applicable to a system where, 

when tensions rise, like many of our defense systems, we surge 

them into an area and then you have, for a limited time, a very 

high capability. 

But to deploy them globally, constantly, we do not do that with 

any of our defense systems because of affordability. 

Mr. ROGERS. But I assume you would, for the moment. You 

would be patrolling around Iran and North Korea, would you not, 

if you had the capability? 

General O’REILLY. Sir, that is why we work with the combatant 

commanders, and they would determine that capability because of 

training and other things. That is why we went with an Aegis 

ashore, where you can have a semipermanent protection and then 

you have mobile systems, both sea and aircraft. They are not to act 

as—our proposal is they are not to act as a permanent defense. 


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They are surged when they are needed because it would be costprohibitive to keep them there constantly. 

Mr. ROGERS. Final question. In your realism talk, what do you 

think the distance, the range, will finally be of the airplane-borne 

laser capability? 

General O’REILLY. ——— Mr. ROGERS. Got you. Thanks, General. 

Chairman DICKS. Mr. Rothman then has a final question. 

Mr. ROTHMAN. Yes, sir, thank you, Mr. Chairman. I appreciate 

it. 

It is a two-part question. It is regarding the airborne laser and 

part one is, how high will it fly? My concern is countries objecting, 

certain countries to our overflying their territory, albeit at 400 kilometers out. But what countries would those be, and are they all 

friendlies who would permit to us overfly their countries, and how 

high would they be? 

Mr. ROTHMAN. Right. 

General O’REILLY. And you could actually use the defensive systems of Japan in order to assist our aircraft. So it really does depend on geometries, but what we are working for is to give the 

combatant commanders this capability so that they can determine 

the best use. 

Mr. ROTHMAN. And so you build in—the SAMs will have a longer 

range in the future, 

General O’REILLY. Yes, sir. 

Mr. ROTHMAN. So at 50,000 feet we don’t care about overflight 

rights? 

General O’REILLY. Yes, sir, we do. And that is an issue that we 

have today. But usually this is used in a time of war and when tensions have risen and those are—we are given those rights—— 

Mr. ROTHMAN. We have already identified those countries, the 

racetracks? 

General O’REILLY. No, sir. We actually work with that all the 

time. We have recently received overflight rights from the Russians 

but it is a continual diplomatic dialogue. 

Mr. ROTHMAN. Thank you, General. Thank you, 

Mr. Chairman. 

THAAD TESTING/PRODUCTION

Chairman DICKS. Let me just go through, give us a little update 

on THAAD. How is THAAD doing? 

General O’REILLY ——— 

The next two big decisions for THAAD is, number one, that the 

Army formally accepts it and it will be transferred, the first unit 

to the Army, and the Army will operate it, not MDA at that point. 

That will occur in January; it is scheduled upcoming January. 

Chairman DICKS. 2011. 

General O’REILLY. 2011. That will be the Army’s first fully operational THAAD unit. ——— 

I am requiring that they solve that before, in fact, we go to our 

first full-rate production decision. The United Arab Emirates have 

put in a request to purchase two THAAD units and a forward 

THAAD-based radar at the cost of $6.9 billion, and their request 

is to have a THAAD unit by 2014. 


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Chairman DICKS. Who is the contractor on THAAD? 

General O’REILLY. Lockheed Martin is the developer of the missile and the whole system, and Raytheon develops the fire-control 

system and the radar. 

Chairman DICKS. How is Raytheon performing? 

General O’REILLY. In the Raytheon area, they have performed 

very well with their radar and their fire-control system on this. 

PAC–3 INTEGRATION

Chairman DICKS. Okay, what about PAC–3? 

General O’REILLY. Sir, I currently do not have responsibilities for 

PAC–3. That is an Army program. The Army is looking at, in discussions today, and has been asking us about a possible transfer 

of PAC–3 back to MDA. And that is a decision that they are discussing at this time. 

Chairman DICKS. What is the reason for that? 

General O’REILLY. The approach to MDA used to be, back 5 years 

and beyond, was that we would develop the technologies and develop systems ready for production, and then we would hand them 

off to the services and we would produce the systems. The decision 

has been made since then, over the previous administration and 

this administration, is that due to the constant need to upgrade our 

missile defense systems as the threat keeps changing, I am now responsible for the lifetime of the systems, for the Navy systems, for 

all of them, and PAC–3 had just matured early, or matured at the 

point where it was transferred to the Army. Today it wouldn’t have 

been transferred to the Army; just like Aegis and THAAD, stay 

with the Missile Defense Agency. 

So because of that, they are going back and looking at should 

they revisit the decision on moving PAC–3 possibly back to MDA 

so that the Army then gets the benefits of the rest of our national 

effort that I lead. 

Chairman DICKS. How do you feel about it? 

General O’REILLY ——— 

Chairman DICKS. So who in the Army—this will go up to General 

Casey? 

General O’REILLY. Yes, sir—and the Secretary of the Army are 

currently reviewing this. At their request—it was their initiative, 

not MDA’s, to retook this decision. 

SBX TESTING

Chairman DICKS. We have discussed a lot of things today, but is 

there anything on the radars, again, that stands out in your mind 

that we need to—— 

General O’REILLY ——— 

When you are dealing with a solid rocket motor, it actually, what 

we call chuffs, it produces bits and pieces that are burning still, 

that come out of the back end of the missile and produce a lot of 

fiery hot objects, that are just part of the debris that comes out of 

the back of a missile, a solid missile, as it burning. ——— 

And as we said, the Iranians are working on a solid rocket motor 

missile, so we need this capability for the future, sir. 

Chairman DICKS. Okay. Well, thank you very much. 


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The committee stands adjourned until May 13 at 10:00 a.m., 

when we will hold a hearing on the United States Pacific Command and U.S. Forces-Korea. 

Thank you, General. You did a great job. 

[CLERK’S NOTE.—Questions submitted by Mr. Dicks and the answers thereto follow:] 

PRECISION TRACKING SPACE SYSTEM (PTSS) 

Question. Another new program in the FY2011 budget request is PTSS which is 

intended to track a missile after boost phase and cue Aegis. This is a follow on program to STSS however is still a demonstration satellite 

How is this new demonstration satellite different that STSS that was launched 

on September 25, 2009? 

Answer. The Space Tracking Surveillance System (STSS) was designed from preexisting work on the Space-Based Infrared System (SBIRS) program and will accomplish the following objectives: • Provide critical data on how a space-based sensor could be used to track 

missiles and their released mid-course objects to close the fire control loop from 

space; • Assess space layer performance in Launch-on/Engage-on Remote scenario of 

an intercept of a ballistic missile in flight; • Measure latency of BMDS communications and weapon system/Command 

and Control, Battle Management, Communications (C2BMC) integration and 

interfaces; • Assess user/warfighter (i.e., CONOPS gaps) in operating a Low Earth Orbit 

(LEO) space constellation in support of BMDS operations; • Familiarize the warfighter with precision space tracking; • Collect LEO based phenomenology, atmospheric and environmental data; 

and • Conduct observations and monitoring in support of other missions, not necessarily related to BMDS tracking. 

The objective of the Precision Tracking Space System (PTSS) program is to address the ascent-phase, midcourse tracking challenge facing the joint warfighter. 

PTSS is a simplified system with the minimum necessary functionality to cost effectively provide midcourse tracking data and is an integral part of the extended Aegis 

fire-control system and early intercept capability—a key focus of the Missile Defense 

Agency (MDA). PTSS will leverage high Technology Readiness Level (TRL) space 

system components and improvements in BMDS Command and Control, Battle 

Management, and Communications. This approach will minimize the need for new 

technology development that may drive up costs and increase development 

timelines. 

MDA is incorporating lessons learned from the STSS demonstration satellites to 

inform our decisions on the development of PTSS, specifically in the areas of phenomenology and fire control. STSS phenomenology data (i.e., infrared scene collections such as atmospheric GC 611 315 lot backgrounds, clouds, earth limb observations, etc.) will be used to anchor models essential to the missile tracking mission. 

In the case of PTSS, this category of collections is planned to be used in payload 

design, and validate the selection of optics, focal planes, wavebands of interest and 

data processing. STSS uses on-board processing to autonomously generate missile 

target tracks and pass that data to the ground control system. The PTSS program 

will analyze STSS processing performance to determine the level of on-board processing required, from a system- wide perspective for PTSS. 

PTSS program goals are to: 

• Develop an operational, end-to-end, missile tracking capability from space 

focusing on regional ballistic missiles; 

• Develop and test a space system prototype and integrated ground system 

with BMDS to precisely track missiles with sufficient accuracy and low enough 

latency to provide sensor data to BMDS interceptors to defeat large raids from 

regional threats; 

• Establish the technical and programmatic foundation for procuring the 

operational system; 

• Develop space qualified technology to hedge against future missile threat 

growth; and Fully integrate PTSS space and ground systems into the BMDS architecture. 

Question. Why is MDA pursuing another demonstration satellite that will not 

have the appropriate capabilities? 


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Answer. The objective of the Precision Tracking Space System (PTSS) program is 

to address the ascent-phase, midcourse tracking challenge facing the joint 

warfighter. PTSS is an integral part of the extended Aegis fire-control system and 

early intercept capability, which is a key focus of the Missile Defense Agency 

(MDA). 

Challenges and problems associated with past satellite development programs indicate that a stable baseline and risk reduction is necessary to improve development 

timelines. To that end, the Missile Defense Agency (MDA) will establish Precision 

Tracking Space System (PTSS) requirements baseline upfront and early and discourage future growth without operational necessity. The MDA also intends to leverage heritage, high TRL space system components for the PTSS. This approach focuses on component reuse and integration and minimizes the need for new technology development and custom design which will drive costs up and increase development timelines. 

Developing prototypes prior to making production decisions will ensure that proper Technology Readiness Levels (TRL) are achieved, thereby improving our development timelines. The PTSS acquisition strategy is to develop a prototype system with 

Johns Hopkins University’s Applied Physics Laboratory before awarding production 

development contracts to industry. Additionally, we will award contracts to several 

industry participants during concept development and exploration to insure the prototype can be readily produced by industry. Industry engagement during the prototyping phase will greatly improve the level of understanding by the contractors and 

reduce risk for PTSS production. This partnership between industry and the scientific community will ensure our understanding of requirements before we award 

production development contracts. 

The crawl-walk-run approach to space system development has shown great success in prior programs, such as the efforts that led to the Global Positioning System 

program. 

Question. How are the mission requirements different than those for STSS? 

Answer. The Precision Tracking Space System (PTSS) plan calls for simplification 

of STSS as much as possible and takes advantage of several improvements in capability over the past decade. PTSS will utilize MDA’s Command and Control, Battle 

Management, Communications (C2BMC), significantly reducing the requirements on 

PTSS for command, control, battle management, and communications as compared 

to those levied on Space Tracking Surveillance System (STSS). In addition, PTSS 

will receive missile launch cues from Overhead Persistent Infrared systems, reducing the sensor requirements on PTSS, again, as compared to those on STSS. PTSS 

will also be integrated as part of space layer leveraging external space systems with 

a common ground processing node that is interfaced to the battle manager. 

Question. Will PTSS have mid-course tracking capabilities? 

Answer. Yes. The requirement for Precision Tracking Space System (PTSS) is to 

enable mid-course tracking, closing the fire-control loop and enabling early intercept. 

TARGET ACQUISITION

Question. MDA is also addressing the need to have more reliable and less costly 

targets. The new target acquisition strategy, initiated in FY 2009, streamlines a set 

of target classes to increase quality control, account for intelligence uncertainties, 

control costs, and ensure the availability of backup targets. 

Since it takes about two years to build and deliver a high quality target, when 

do you expect to complete the new target acquisition strategy? 

Answer. Request for Proposal (RFP) was issued for the Intermediate Range Ballistic Missile (IRBM) targets in the second quarter of FY10. The draft RFP for the 

InterContinental Ballistic Missile (ICBM) target is anticipated for release 4QFY10. 

The IRBM contract award schedule is dependent on the volume/quantity of proposals received, but award is planned for 1QFY11. The ICBM contract award is 

planned for 4QFY11. 

Question. What is the timeframe the new strategy will be realized? 

Answer. Over the past year, the Agency has initiated steps to implement the new 

target acquisition strategy. The initial step was to streamline the current Lockheed 

Martin contract to provide the near term IRBM targets with the LV–2. Secondly, 

two classes of new targets are to be procured. 

• The IRBM class of targets is being acquired through the release of an RFP in 

2QFY10 with contract award 2QFY11 and first target delivery milestone in 

2QFY14. 

• The ICBM class of targets is being acquired by release of RFP in 4QFY10 with 

contract award 4QFY11 and first target delivery milestone in 3QFY14. 


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Question. What types of targets will you be acquiring? 

Answer. In accordance with the Targets and Countermeasures Acquisition Plan 

(3 November 2009), MDA will acquire targets in the following classes: • Intermediate Range Ballistic Missiles (3000–5500 km or 1620–2970 nm) • InterContinental Ballistic Missiles (greater than 5500 km or 2970km) 

GMD FLIGHT TEST DELAYS

Question. GMD has planned 11 flight tests and 14 ground tests in fiscal year 

2011. Many previous tests have been delayed or cancelled. This test schedule contained 9 additional tests compared to FY2010. 

The Committee understands that many test events scheduled in previous years 

have been delayed. Please outline the tests that have been delayed. 

Answer. In 2005 the Missile Defense Agency (MDA) Director established a Mission Readiness Task Force (MRTF) to address all issues contributing to flight test 

mission preparedness and strengthen systems engineering and quality. The new 

processes that were adopted greatly improved the success of Ground-based Midcourse Defense (GMD) testing. The attached ‘‘GMD Flight Test Delay History— 

FY06 to FY10’’ chart shows each flight test incurring delay since FY2006 and the 

reasons for the delay. 

In Fiscal Year 2009, MDA transitioned from an architecture-based approach to a 

Models and Simulations (M&S) Verification, Validation, and Accreditation parameters-based test objectives approach. The Integrated Master Test Plan (IMTP) is 

used to evaluate research and development milestones, technology maturity levels, 

and coverage and performance analysis. The IMTP establishes and documents test 

requirements of the GMD element with specific focus on collecting data needed for 

the Verification, Validation, and Accreditation (VV&A) of missile and threat models 

and simulations. Models and simulations permit repeated assessments of performance and provide a statistical determination of effectiveness of GMD capabilities. 

Ground tests using these high fidelity models and simulations test GMD capabilities 

across a range of threats and environments that cannot be affordably replicated in 

flight tests. 

The Missile Defense Agency remains committed to successfully executing and 

completing the IMTP. The development and testing schedule within the IMTP is realistic, accounts for the possibility of testing anomalies, and is updated semi-annually. The next update is expected to be complete by July 30, 2010. 

Question. Can you explain primary reasons behind the rescheduling of prior year 

test events? 

Answer. In Fiscal Year 2009, MDA transitioned from an architecture-based approach to a Models and Simulations (M&S) Verification, Validation, and Accreditation parameters-based test objectives approach. The Integrated Master Test Plan 

(IMTP) is used to evaluate research and development milestones, technology maturity levels, and coverage and performance analysis. The IMTP establishes and documents test requirements of the GMD element with specific focus on collecting data 

needed for the Verification, Validation, and Accreditation (VV&A) of missile and 

threat models and simulations. Models and simulations permit repeated assessments of performance and provide a statistical determination of effectiveness of 

GMD capabilities. Ground tests using these high fidelity models and simulations 

test GMD capabilities across a range of threats and environments that cannot be 

affordably replicated in flight tests. 

The Missile Defense Agency remains committed to successfully executing and 

completing the IMTP. The development and testing schedule within the IMTP is realistic, accounts for the possibility of testing anomalies, and is updated semi-annually. The next update is expected to be complete by July 30, 2010. 

Specific challenges in the Ground-based Midcourse Defense (GMD) flight test program include acquiring a cost effective set of reliable targets and Ground-Based Interceptor quality control issues. MDA has taken action to address both of the challenges. 

For example, as a result of a Short Range Air Launched Target (SRALT) failure 

during a THAAD flight test in December 2009 MDA issued a Cure-Notice and directive to cease air-launch operations to repair program deficiencies. This resulted in 

a delay to the BMDS test program impacting cost and schedule of multiple major 

BMDS weapon systems and capability delivery to the Warfighter. To bridge the time 

between the delivery of these targets and our new competitive target procurements 

next year, the MDA initiated a limited procurement of Air Launched Targets 

through its existing Lockheed Martin contract. Lockheed Martin is evaluating the 

target options to satisfy MDA’s requirements and have not made a final target solution decision. As with all of our target providers, MDA fully expects Lockheed MarVerDate Mar 15 2010 03:50 Jun 11, 2011 Jkt 066611 PO 00000 Frm 00176 Fmt 6601 Sfmt 6621 E:\HR\OC\A611P2.XXX A611P2

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tin to select and deliver a target solution that meets the performance specification 

thresholds within the cost and schedule parameters. 

Over the past year MDA also initiated steps to acquire a new set of targets for 

all ranges, including Foreign Material Acquisitions, needed to verify the performance of the BMDS. Our new target acquisition strategy, initiated in FY 2009, procures targets in production lots to increase competition, quality control, reduce costs, 

and ensures the availability of backup targets starting in 2012. Accordingly, MDA 

issued a Request for Proposal (RFP) for the Intermediate Range Ballistic Missile 

(IRBM) targets in the second quarter of FY10; a draft RFP for the InterContinental 

Ballistic Missile (ICBM) target is anticipated for release 4QFY10 with contract 

award planned for 4QFY11; the IRBM contract award is planned for 1QFY11, but 

the contract schedule is dependent on the volume/quantity of proposals received. 

Nevertheless, until backup targets are available starting in 2012, we will continue 

to rely on an intensive inspection and oversight process to enhance mission assurance. Quality issues are also a primary driver and a high focus area for GMD. Builtin-test software and test silo quality issues caused delays in 2005. Challenges in 

Exoatmospheric Kill Vehicle (EKV) development, hardware quality, and target 

availability and target development issues drove test schedule delays in 2007–2009 

affecting flight tests FTG–03, FTG–04, and FTG–05. 

MDA is committed to improving missile defense acquisition to overcome significant flight test delays, target and interceptor failures, cost growth, quality control, 

and program delays we have encountered in the past. Moving forward, MDA is implementing the Weapon Systems Acquisition Reform Act of 2009, including provisions related to contract competition, and it is our intent to use greater firm fixed 

price contracts and defect clauses as we complete planned competitions. We are increasing emphasis on competition at all phases of a program’s acquisition life cycle 

to ensure the highest performance and quality standards are sustained throughout 

development. 

However, until we complete planned competitions we will have to motivate some 

senior industry management through intensive inspections, low award fees, issuing 

cure notices, consideration of pending quality concerns during funding decisions for 

new contract scope, and documenting inadequate quality control performance to influence future contract awards by DoD. 

Question. What issues remain to be resolved to reschedule delayed test events? 

Answer. There are no current delayed test events that have not been rescheduled 

or are in the process of being rescheduled. FTG–06a is being added as an incremental step in correcting the shorts comings of FTG–06. FTG–06a scheduling is in 

work. FTG–09 is being deleted and the objectives are transitioning to FTG–08. 

FTG–06 was conducted on January 31, 2010 and resulted in a failed intercept. 

A Formal Independent Failure Investigation Team (FIT) was established to conduct 

Missile Defense Agency investigations into the failures to meet test objectives. The 

scope of the FIT included investigating all potential target, interceptor, ground systems, and any other area deemed relevant in the determination of root cause and 

contributing conditions associated with the failure; recommending corrective actions 

to preclude the reoccurrence of a similar event on future missions; and identifying 

design, integration, test, and readiness deficiencies discovered during the investigation that did not directly contribute to the failure. The FIT results will aid decisions 

on future GMD flight tests. 

The FTG–06 Failure Investigation Team final report and its effect on possible 

courses of action to ensure a successful FTG–06a follow-on flight test are driving 

final planning activities and the overall GMD test schedule. Decisions on the FTG– 

06a test design and schedule are expected in June 2010. The Integrated Master Test 

Plan is under semi-annual review and will be updated to capture all GMD test planning changes as well as other BMDS test planning. 

Question. How will this impact the current test plan for GMD? 

Answer. The FTG–06 Failure Investigation Team (FIT) final report and its effect 

on possible courses of action to ensure a successful FTG–06a follow-on flight test 

are driving final planning activities and the overall GMD test schedule. Decisions 

on the FTG–06a test design and schedule are expected in June 2010. The Integrated 

Master Test Plan is under semi-annual review and will be updated to capture all 

GMD test planning changes as well as other BMDS test planning. 

FTG–06a is an incremental step in correcting the short comings of the FTG–06 

mission. Once the FIT final report is complete modifications to the Ground Based 

Interceptor will be incorporated as needed. 

Question. How will the test plan review change the way MDA tests? 

Answer. In FY09, MDA transitioned from an architecture-based approach to a 

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eters-based test objectives approach. This new test approach focuses on collecting 

data needed for the Verification, Validation, and Accreditation of the BMDS Models 

and Simulations and identifies the specific data to be gathered and the circumstances in which to measure them. For example, Critical Engagement Conditions (CECs) and Empirical Measurement Events (EMEs) will examine the accuracy 

of GMD and BMDS models and simulation by measuring key factors affecting a kill 

vehicle’s ability to see a target and adequately maneuver in time to collide with it. 

Key factors include: solar and lunar backgrounds; low intercept altitudes; timing between salvo launches; long times of flight; high closing velocities (ICBM-class targets); correcting for varying booster burnout velocities; and responding to countermeasures. This test approach will establish confidence that the M&S used to evaluate the BMDS represents real world behavior and enable simulation based performance assessment to verify system functionality. DOT&E and the operational test 

communities are key partners in this effort. The Integrated Master Test Plan describes each CEC and EME and is updated semi-annually. The next update is expected to be completed by 30 July, 2010. 

TESTING AND LACK OF SUFFICIENT NUMBER OF TARGETS

Question. One of the key limiting factors of MDA’s test program has been the lack 

of sufficient number of missile defense targets and the inventory of foreign assets. 

Do you currently have a sufficient amount of targets to execute your testing program? For the current fiscal year? For fiscal year 2011? Does the FYDP provide for 

sufficient number of targets? 

Answer. Yes, we have sufficient quantity of primary targets on contract for the 

current fiscal year (FY10) and FY11; however, we do not have a sufficient number 

of spare targets in case of a target failure or other processing problems. Spare targets will be available starting in FY12. MDA plans to update the Integrated Master 

Test Plan (IMTP) twice a year ensuring executability within budget controls. For 

the remainder of the FYDP, we currently have the required targets on contract to 

support tests scheduled in FY12. The new Targets Acquisitions to be awarded in 

FY10 and FY11 will provide the remainder of the targets required across the FYDP 

in support of the IMTP Version 10.1, which was delivered to Congress in March 

2010. 

Question. If not, what can we do to improve the number of targets? 

Answer. We have sufficient primary targets to support the PB11 program, but due 

to the 18–24 month lead time to produce a target, there is no opportunity to improve 

the availability of spare targets till FY13. 

Question. Would additional funds in this area be helpful? 

Answer. The Targets and Countermeasures acquisition strategy for the new target 

procurements provides the opportunity to acquire flexible threat representative target configurations. The President’s budget request represents an appropriate balance of risk given competing priorities for resources. 

Question. Would having a procurement account be beneficial? 

Answer. No. The Targets and Countermeasures program will require RDT&E 

funding to perform non-recurring engineering activities associated with target development in the MRBM, IRBM, and ICBM classes against our new acquisition program in FY10 and FY11. Additionally, several on-going development activities in 

countermeasures along with improvements in existing target configurations require 

RDT&E funding. If procurement funding were provided it would be applied to the 

fixed price hardware Contract Line Item Numbers (CLINs) for targets procured on 

the new acquisition contracts only. The remaining CLINs for engineering services, 

modeling and simulation activities, or other related engineering activities would still 

require RDT&E funding. 

[CLERK’S NOTE.—End of questions submitted by Mr. Dicks.] 


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THURSDAY, MAY 20, 2010. 

TESTIMONY OF MEMBERS OF CONGRESS AND OTHER 

INTERESTED INDIVIDUALS AND ORGANIZATIONS 

AMERICAN MUSEUM OF NATURAL HISTORY/OHIO STATE 

UNIVERSITY 

WITNESSES 

WARD WHEELER, Ph.D., CURATOR AND CHAIR, DIVISION OF INVERTEBRATE ZOOLOGY, AND PROFESSOR, RICHARD GUILDER GRADUATE 

SCHOOL, AMERICAN MUSEUM OF NATURAL HISTORY 

DAN JANIES, Ph.D., ASSOCIATE PROFESSOR, THE OHIO STATE UNIVERSITY, DEPARTMENT OF BIOMEDICAL INFORMATICS, COLLEGE 

OF MEDICINE 

INTRODUCTION

Mr. DICKS. The committee will come to order. This morning the 

committee will hear testimony from witnesses outside of the executive branch. The committee is finishing its hearing process for the 

fiscal year 2011 period, and we have heard from all the Secretaries 

and Chiefs of each service. 

The committee held hearings regarding the military’s personnel 

programs, medical programs, intelligence programs, acquisition 

programs, the missile defense program. Now we are turning our attention to hear from 17 different public organizations which will 

highlight issues that the committee should consider as work continues on the 2011 base appropriations bill that we will fund in 

support of our men and women in uniform over the next year. 

This hearing will allow the committee to understand the unique 

capabilities that outside entities can contribute to the needs of our 

servicemembers. The committee is aware that many of you have an 

existing relationship with the Department of Defense as it relates 

to medical research in support of the unique needs of our 

warfighters. 

The structure of today’s hearing will follow a format that ensures 

all witnesses will have an opportunity to highlight their key points 

on the record. Further, each of your prepared statements will appear in full in the published hearing volume. 

We ask that you summarize your testimony in 5 minutes or less. 

Because President Calderon is speaking at 11 o’clock, the hearing 

has to end, so at 5 minutes you are going to hear the gavel. We 

don’t have the clock, do we? 

I would like to express my gratitude to each and every one of you 

for the work you do on behalf of our Armed Forces. We look forward to your testimony, and I now yield to Mr. Frelinghuysen for 

any comments that he would like to make. 


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Mr. FRELINGHUYSEN. I join the chairman and welcome you all 

this morning, and I commend him for having this hearing. Thank 

you very much. 

Mr. DICKS. Our first witness is Dr. Ward Wheeler, Ph.D., curator 

and chair, Division of Invertebrate Zoology, and Professor, Richard 

Guilder Graduate School, American Museum of Natural History; 

and Dr. Dan Janies, Ph.D., associate professor, the Ohio State University, Department of Biomedical Informatics, College of Medicine. 

We will start you at 5 minutes to 9:00. You may proceed. We will 

put your statement in the record. 

Mr. WHEELER. Good morning. Chairman Dicks, my name is 

Ward Wheeler, and as chair of the Invertebrate and Zoology Division and Professor at the American Museum of Natural History, it 

is a pleasure and honor to testify before you about the global 

spread of emergent infectious disease and human health implications of viral evolution. With me today is Dr. Megan Cevasco, a research scientist who is actively involved in the project. 

The recent emergence of a pandemic influenza and SARS has 

shown that new diseases can affect human populations without 

warning, presenting critical threats to our troops, public health and 

our economic welfare. Rapid genomic sequencing of these pathogens has become the primary method by which we understand, 

fight and infer their spread. 

Analysis of these data, however, is difficult, requiring new algorithmic approaches and high-performance computation. To provide 

an important basis for forecasting these outbreaks, the AMNH has 

been working over the past several years to apply our research expertise in evolution, geography and computation to the problems of 

the emergence and spread of pathogens. 

Recognizing the potential of this work to aid the Department of 

Defense in its goal to prepare for and respond to the full range of 

threats, the AMNH seeks $3.5 million in fiscal year 2011 to continue contributing our unique resources to the advancement of research in this area. By increasing the Nation’s capacity to infer 

where disease outbreaks might occur, and to effectively monitor 

disease-causing agents and their global spread, this research works 

directly to combat bioterrorism and to protect both troops in the 

field and civilian populations at home. 

While the AMNH has been a recognized leader in education, educating the public on complex scientific issues, many people may not 

realize that we are also an active research and training institution, 

much like a research university, with major innovative research 

programs that are positioned to advance the Nation’s capacity to 

prepare for and respond to security threats. 

AMNH research staff, who number over 200, publish nearly 450 

scientific articles each year and enjoy a success rate in competitive 

peer-reviewed scientific grants that is approximately double the national average. AMNH is also the only American museum authorized to grant the Ph.D. degree. Our Richard Guilder Graduate 

School encompasses both a doctoral program in comparative biology 

and long-standing graduate training partnerships with such universities as Columbia, Cornell and NYU. 

As our research on infectious disease requires biomedical expertise, as well as evolutionary and computational expertise, AMNH 


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has bonds with Dr. Dan Janies of The Ohio State University Medical Center in these efforts. Dr. Janies is here with me today and 

will testify in just a moment. 

First I would like to tell you what we have been able to accomplish with DOD support thus far. In fiscal year 2005, DOD and the 

AMNH launched a multifaceted research partnership via DARPA 

that leverages the AMNH’s unique expertise and capacity. The first 

phase of this project focused on the development and application of 

a high-performance computational system to study the complex 

conditions that underlie the evolution and spread of infectious diseases, specifically analyzing genetic and functional changes in 

hosts and pathogens across time and space. 

Concurrently we develop methods to visualize these data by projecting an evolutionary tree onto a virtual globe, such as Google 

Earth or NASA Whirlwind, and the resulting visualizations are 

akin to weather maps that show the spread of pathogens and their 

key mutations over time, space and various hosts. These maps provide not only situational awareness, but also diagnostic and inferential power. 

We are now able to track the global spread of any pathogen and 

can identify for any geographic region sources, destinations, 

mutations and host shifts by pathogens. 

Mr. DICKS. You have got 2 minutes left, so if you are going to 

share any time here, it is 5 minutes for the both of you. 

Mr. WHEELER. We continue work, particularly in influenza. And 

I appreciate the opportunity to speak to you today. I will now give 

the floor to my colleague Dan Janies. 

Mr. JANIES. Mr. Chairman, members of the subcommittee, I, too, 

am honored to have been invited to testify today. My name is Daniel Janies, and I am an associate professor of biomedical informatics at Ohio State. I bring biomedical expertise to the project. 

My efforts have focused on meeting deliverables, ensuring that the 

tools are highly interoperable, and communicating our results to 

military planners, public health scientists and policymakers. 

We have engaged in a variety of outreach programs. We have 

conducted workshops and symposia, have published results in peerreviewed scientific journals, results that have been covered by journalists in many media. We have testified on pandemic influenza before the U.S. Senate Committee on Homeland Security and have 

been invited to present our research to DHS. 

We have also worked with the Department of State on efforts to 

build capacity in public health abroad to foster data sharing. We 

have discussed the evolution of drug resistance and pandemic influenza with the White House Office of Medical Preparedness. 

Throughout our partnership, DARPA program managers have supported the AMNH’s work and made our research known to other 

DOD-supported scientists, have invited scientists from the AMNH 

and Ohio State to participate in today’s conferences for research, 

planning and force protection. 

Our work moves forward. We plan to continue our outreach efforts and plan to hold workshops and symposia annually, as well 

as to rapidly respond to requests for information, consultations and 

briefings. 


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As you know, the committee has supported our work over the 

last several years. Should the committee fully support our fiscal 

year 2011 requests, the AMNH will be able to advance to the next 

phase of the project, focusing on more complex pathogens and the 

host side of the infectious disease problem. 

Mr. DICKS. Thank you very much. We will take this under very 

serious consideration. 

[The statement of Mr. Wheeler and Dr. Janies follows:] 


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Mr. DICKS. Mr. Frelinghuysen. 

Mr. FRELINGHUYSEN. No comment. 

Mr. DICKS. Thank you. 

THURSDAY, MAY 20, 2010. 

HEART OF A CHAMPION 

WITNESS 

STEVE RIACH, FOUNDER AND BOARD MEMBER, HEART OF A CHAMPION FOUNDATION 

Mr. DICKS. Next is Mr. Steve Riach, founder and board member, 

Heart of a Champion Foundation. 

Mr. Riach, welcome. 

Mr. RIACH. Good morning. 

Mr. DICKS. You have 5 minutes. You understand the drill. 

Mr. RIACH. Chairman Dicks and distinguished Members, thank 

you. It is an honor for me to be here and provide testimony this 

morning regarding military families and the unique challenges that 

they face, and the unique challenges that we face in terms of educating our military families, and the role that character-development programs can play, such as our very successful Heart of a 

Champion Program, in meeting those challenges. 

We know that 1 million military-connected students today are 

living in what is called a ‘‘new normal’’ environment, dealing with 

multiple wartime deployments, lengthy parent-child separations, 

mental illness, injuries and even death. These unique stresses can 

create chaos in the lives of affected students and negatively impact 

their motivation, their grades, their behavior, their peer relations, 

family life and graduation rates in military-impacted schools and 

districts. And while each of our Nation’s military services has made 

strong covenants to assist families and students, much greater support and specialized programs are needed to follow those military 

students into DOD, DEA and non-DOD public school systems. Our 

research has proven that an important part of the solution must 

be character-development programs taught in these schools. 

During the past 9 years our Nation has been at war, DODEA 

schools have had to deal with special significant challenges to teach 

our military children. But more than just our military bases, 

schools in districts such as the Killeen Independent School District, 

which, of course, serves Fort Hood, Texas, where Active Duty military enrollment can be as much as 80 percent of that population, 

they struggle to meet those challenges. 

It is my view that character-development programs such as ours 

can be a vital, in fact, necessary, tool to help these young children 

of our servicemen and women deal with the many unique stresses 

they face on a daily basis. 

When we launched Heart of a Champion 14 years ago, started 

by business leaders around the United States who had a desire to 

impact the lives of children in any kind of environment, it was our 

goal to create the finest character-development program around 

that would deliver measurable results. We spent 4 years researching with educators around the United States to determine what 

would create the most efficient and effective program. And now, 


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since 2001, we have deployed our program in 24 States, to reaching 

about a half a million young people in any kind of environment you 

can imagine, public schools, after-school programs, partnering with 

people like the Big Brothers/Big Sisters, Boys and Girls Clubs, and 

in juvenile justice facilities, where we impact students who are— 

or young people who are the most hard-core teen offenders in the 

United States, as well as those who are in the probation system, 

and redirecting them out of the juvenile system. 

So we know that this program works and character education, 

character-development programs work to create change in the lives 

of young people in any type of population. We know it can be the 

same in the population of military families. 

We have seen results that are dramatic. We have seen not only 

attitudinal behavioral changes, we have seen increased graduation 

rates, in some cases as many of 100 percent of students in some 

areas graduating; decreased truancy; decreased dropouts; decreased 

drug and alcohol use, in some cases as much as 40 percent; increased grade average; increased test scores. 

We know that what has occurred is in changing the heart of the 

student. We have seen students perform better. We have seen them 

make better life choices. 

Mr. DICKS. The gentleman has 1 minute to summarize, or if you 

want us to ask a question or two. 

So how do you work this with the school? Are you doing this with 

the DOD schools? 

Mr. RIACH. Currently not in DOD schools; in public schools. 

Mr. DICKS. But you just do it in public schools that are near the 

bases? 

Mr. RIACH. Correct. 

Mr. DICKS. How do you get organized? How do you work it out 

with the local school district? 

Mr. RIACH. We work directly with the local school district and 

the individual schools. We train their teachers. Those teachers deploy the program in the school. We certify them. They deploy it 

during the class day, in class during the school day. And we work 

with them. We pre- and post-assess and deliver measurables, empirical data showing the results that I mentioned earlier. 

Mr. DICKS. And do they do after school, too? Is it after school as 

well? 

Mr. RIACH. Absolutely. Worked with Big Brothers/Big Sisters, 

Boys and Girls Clubs, a number of after-school programs, both on 

school campus and in the community. 

Mr. DICKS. Any other questions? 

Thank you very much. If you want to summarize. 

Mr. RIACH. Thank you. 

I just, in conclusion, would say that if there is anything this committee can do to look at the critical need with these families and 

these students, and the deployment of a character program that actually works and changes their hearts and helps them make better 

decisions, we will see a decrease in suicides, drug and alcohol use 

and those things that are plaguing young people who are military 

family members in this current day. 

Mr. DICKS. Thank you very much. 

Mr. RIACH. Thank you. 

[The statement of Mr. Riach follows:] 


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THURSDAY, MAY 20, 2010. 

LUNG CANCER ALLIANCE 

WITNESS 

LAURIE FENTON-AMBROSE, PRESIDENT AND CEO, LUNG CANCER ALLIANCE 

Mr. DICKS. Laurie Fenton-Ambrose, president and CEO, Lung 

Cancer Alliance. Welcome, Laurie. 

Ms. FENTON-AMBROSE. Thank you, Mr. Chairman. 

Mr. DICKS. You have 5 minutes. We will let you know when you 

have 1 minute so you can summarize. 

Ms. FENTON-AMBROSE. Thank you very much. 

Dave Hobson also says hello, who I also had the pleasure of seeing this morning. So he wanted me to say hello. 

Mr. DICKS. Thank you. 

Ms. FENTON-AMBROSE. I am delighted to be here, Mr. Chairman, 

members of the subcommittee. My name is Laurie Fenton Ambrose, 

and I am president and CEO of the Lung Cancer Alliance, which 

is the only national organization that is providing patient support 

and advocacy to those either living with or at risk for lung cancer. 

And it is my great privilege to be here to talk with you about a 

program that we had the great pleasure of working to see established, along with our former board chairman Admiral Phil Coady; 

and our current board members, former Secretary of Transportation Norman Mineta, who is a lung cancer survivor, and along 

with Joe Lopez; and certainly with the late chairman John Murtha, 

who saw the need to create this program to help our military men 

and women who are at greater risk for the disease. 

To summarize, lung cancer is a public health epidemic. It is the 

leading cause of cancer deaths among men, among women, in every 

ethnic group, and in our military, conservatively speaking, is at a 

25 percent higher risk for this disease not just because of smoking, 

but because of exposures to toxins, battlefield fuels and the like. It 

is a disease that, even with this proportion of deaths, has received 

the least amount of Federal funding. What we are doing today is 

to try to ensure that a very comprehensive plan of action is brought 

to bear on all of those who are either living with or at risk for this 

disease. 

It is important to note that today, based on CDC surveys, 60 percent of those with this disease are former smokers, most who quit 

decades ago. Another 20 percent are those who have never smoked 

at all. So what we are faced with is the fact that today, tomorrow—— 

Mr. DICKS. Is that a different kind of cancer; is that a different 

disease for the people who don’t have—who have never smoked? 

Ms. FENTON-AMBROSE. I wish I could say we knew. There are 

many variations to this disease. We don’t have enough research to 

understand why, for example, men and women have differences in 

the type of diagnosis and progression with the disease. But it is 

lung cancer. 

So if you think about the fact that 80 percent of those with this 

disease today, tomorrow and decades to come do not have the research to support earlier intervention or certainly to have a robust 


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treatment pipeline, no doubt we need tobacco control and prevention strategies, but that alone will not address those who actually 

heard the message and quit their addiction to ensure that we find 

it early or then have treatments best to manage it. 

This brings us really to why we are here today. Even last week 

the President’s Panel on Cancer produced a report about the environmental risk factors that highlighted among our military exposures that are putting them at greater risk. 

Lung Cancer Alliance has been advocating strongly and persistently for a greater focus on our military men and women who are 

at great risk. Whether it is Agent Orange, whether it is battlefield 

fuels, whether it is smoking, our military men and women do not 

deserve to have this disease, and we have worked to establish a 

program within the CDMRP that is focused on an early intervention program to help our at-risk military. 

Chairman Murtha was so quick to recognize the need. We are 

grateful that he helped us to establish this in 2007. This is a program not intended to duplicate, but rather supplement, the research programs under the National Cancer Institute. This has a 

particular focus on the patient and patient outcomes rather than 

the basic science which has been the purview of NCI. 

This patient-oriented, mission-oriented program, if properly implemented, will have an immediate impact on our high-risk military and quickly lead to other earlier detection and improvement 

of treatments for the entire civilian population. 

I have attached supporting documents—— 

Mr. DICKS. Thank you. 

Ms. FENTON-AMBROSE [continuing]. I am happy to present for 

you today. 

Mr. DICKS. Thank you. 

[The statement of Ms. Fenton-Ambrose follows:] 


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Mr. DICKS. Any questions? 

Mr. FRELINGHUYSEN. Good to have you back. 

Mr. DICKS. Thank you very much for your testimony. We appreciate it. Thank you very much. 

THURSDAY, MAY 20, 2010.

NEUROFIBROMATOSIS 

WITNESS 

KAREN GUNSUL, VICE PRESIDENT, WASHINGTON STATE NEUROFIBROMATOSIS FAMILIES—WSNF 

Mr. DICKS. Karen Gunsul. 

Ms. GUNSUL. Good morning. 

Mr. DICKS. Good morning, Karen, welcome. 

Ms. GUNSUL. Thank you. 

Mr. DICKS. We will put your statement in the record. You have 

5 minutes to summarize. 

Ms. GUNSUL. I understand. 

I am a business owner from Seattle, Washington. 

Mr. DICKS. Well, welcome. 

Ms. GUNSUL. Thank you. Your whole State said hello. 

I am representing the Washington State Neurofibromatosis Families and a national coalition of States under NF, Inc. We are asking for $20 million to continue the Army’s highly successful peerreviewed Neurofibromatosis Research Program. I am also the 

mother of a 17-year-old son Sam who has NF. 

Neurofibromatosis, if you don’t know, is a genetic disorder involving uncontrolled tumor growth along the nervous system, which 

can result in a variety of symptoms; disfigurement, deformity, deafness, blindness, brain tumors, cancer and/or death. NF is not rare. 

Mr. DICKS. Is it a lung disease, too? 

Ms. GUNSUL. No, not yet, but it does cause tumors to grow anywhere along nerve pathways, so it can be. You just don’t know 

when and where it is going to strike. It is more common than muscular dystrophy and cystic fibrosis times three. It is not as widely 

known because for years it has been poorly diagnosed, and approximately 100,000 Americans currently have NF, and it occurs in 1 in 

2,500 births. 

It strikes worldwide without regard to gender or race, and approximately 55 percent of those cases are spontaneous mutations 

of genes, such as my son’s. We have no history of NF in our family, 

and 50 percent of the cases are inherited. 

There are two types of NF, NF1, which is more common, that my 

son has, and NF2, which primarily causes deafness, tumors that affect the ears and balance problems. 

When my son was diagnosed in 1996, I learned as much as I possibly could about neurofibromatosis, and the one thing that stood 

out to me is that there are no known treatments and no known 

cure. And 14 years ago that was tough news to take. 

While there are broad implications for the general public, the 

Army can see direct military application. Research on NF stands 

to benefit the military because this disorder is closely linked to cancers, brain tumors, learning disabilities, brain tissue degeneration, 


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nervous system degeneration, deafness, memory loss and balance. 

And because NF manifests in the nervous system, findings generated by the Army-supported research on NF address peripheral 

nerve regeneration. This is very important to understand for 

wound healing and war-related illnesses. 

In recognizing NF’s importance to both the military and to the 

general population, Congress has given the Army’s NF program 

strong bipartisan support for years. After the initial 3-year grants 

were successfully completed, Congress appropriated continued 

funding for the Army NF research program on an annual basis. 

From fiscal year 1996 through now, this funding has amounted to 

$214 million in addition to the original $8 million, 3-year grant. 

These grants, through the Army program, reach across all 50 

States, and they are highly regarded in the medical community. 

There are currently five clinical trial sites located across the 

country, and they are all coordinated and monitored through the 

Huntsville, Alabama, central site. The Army program funds innovative, groundbreaking research which would not otherwise have 

been pursued. 

At our last meeting with Army officials administering the program, they indicated that they could easily fund more applications 

if funding were available because of the high quality of the applications received. They stated they felt they were turning away good 

science. 

In order to ensure maximum efficiency, the Army collaborates 

closely with other Federal agencies that are involved in NF research, National Institutes of Health. They have several members 

of the National Institute of Neurological Disorders and Stroke. The 

NINDS group sits on the Army’s NF Integration Panel—— 

Mr. DICKS. You have 1 minute. 

Ms. GUNSUL. Thanks—which sets the oversight and long-term vision strategies for the program. 

The results from this program have been fast, and we are right 

on the brink of some very exciting findings. 

The difference was brought home to me personally last month. 

After my son had three very large tumors removed from his left 

leg, I sat down with Sam’s surgeon, and we discussed potential 

therapies that are now right on the horizon for restricting tumor 

growth and stopping the formation of tumors. 

The science is real, and we are very excited by the potential. We 

are asking for $20 million to continue the Army’s important NF research. It is money well spent. Thank you. 

Mr. DICKS. Thank you very much. We appreciate your testimony. 

[The statement of Ms. Gunsul follows:] 


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Mr. DICKS. Any questions? Thank you. Thank you very much. 

THURSDAY, MAY 20, 2010. 

MELANOMA RESEARCH FOUNDATION (MRF) 

WITNESS 

MARTIN A. WEINSTOCK, M.D., PH.D., PROFESSOR OF DERMATOLOGY 

AND COMMUNITY HEALTH, BROWN UNIVERSITY ALPERT MEDICAL 

SCHOOL 

Mr. DICKS. Martin A. Weinstock, M.D., Ph.D., professor of dermatology and community health, Brown University. Welcome. 

Dr. WEINSTOCK. Thank you very much, Mr. Chairman, for the 

opportunity to testify before you. I am here representing melanoma 

research and the Melanoma Research Foundation, which is the 

largest independent national organization devoted to melanoma in 

the United States. 

Mr. Chairman, I am requesting $10 million for melanoma research in fiscal year 2011 defense appropriations bill through the 

Peer-Reviewed Cancer Research Program within the Defense 

Health Account. 

Melanoma, as you may know, is a type of cancer which nearly 

always arises in the skin. Invasive melanoma affects nearly 70,000 

Americans every year, and about 9,000 of those die every year. I 

met the sister of one of those people who succumbed to melanoma 

just last year about an hour ago, just coming to Washington, D.C. 

It is actually quite common. That is actually about one an hour 

dying from this disease. 

It has been increasing over time. At a time when most cancers 

are decreasing in incidence and mortality, melanoma is increasing. 

It is the most rapidly increasing of any of the common types of cancer. And, indeed, since about the 1930s, when we started collecting 

these data, melanoma had an incident rate that has increased 

twentyfold. That’s not 20 percent, that is 2,000 percent, twentyfold 

since that time. 

Melanoma also, compared to other cancers, tends to affect younger adults. So people in the 25- to 29-year age group, it is the most 

common cancer in the United States in that age group. 

We have learned in recent years through the various research 

that has gone that, in fact, melanoma is more than just one disease, it is multiple diseases. The most common types of melanoma 

are related to intense ultraviolet radiation exposure from the sun 

or from artificial sources either in childhood or in the early adult 

years. This is the type of exposure that our military has. 

Also, many people who are afflicted by melanoma are, indeed— 

have the type of melanoma that is related to cumulative ultraviolet 

exposure either from the sun or artificial sources over the course 

of their lives. So recent exposure is important. For many people, 

the most common type of melanoma, it is early adult life and childhood exposure. 

So the connection to the military, obviously, is obviously very important, because we put our military men and women in areas of 

intense sun exposure, and that has been linked to increased risk 

of melanoma. There are some recent publications to that effect, and 


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we know the etiology of melanoma, so that that is an important 

risk factor. 

In order to appropriately treat those people, we need to detect 

those melanomas early, and for those that aren’t detected early 

enough, we need to find a cure. 

So right now we have about 150,000 Army National Guard, 

Coast Guard, Air Force and Marines in Iraq where the intensity of 

sun exposure is quite great, and that is common, such as in Vietnam in years past, and it generates melanomas in these people 

years after their service. 

Mr. DICKS. You have 1 minute to summarize. 

Dr. WEINSTOCK. Okay. So basically the peer-review cancer research—— 

Mr. DICKS. Can I ask a question? 

Dr. WEINSTOCK. Sure. 

Mr. DICKS. Why hasn’t the National Cancer Institute funded 

this? I just don’t understand why melanoma, which is a very serious cancer, would not get more attention from the National Cancer 

Institute. Is there an answer to that? 

Dr. WEINSTOCK. Well, I can say that there is some funding from 

the National Cancer Institute, but more is needed. I can’t answer 

why in their wisdom they have decided not to increase levels. I can 

just say that the Peer-Reviewed Cancer Research Program established in fiscal year 2009 is specifically geared towards this purpose, which uniquely affects members who have served in the military, and so we respectfully request $10 million for melanoma research. 

Mr. DICKS. Thank you very much. We appreciate your testimony. 

[The statement of Dr. Weinstock follows:] 


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Mr. DICKS. Any questions? 

THURSDAY, MAY 20, 2010. 

THE NATIONAL ASSOCIATION TO PROTECT CHILDREN 

WITNESS 

DAVID KEITH, SPOKESPERSON 

Mr. DICKS. David Keith, National Association to PROTECT Children. 

Mr. KEITH. Thank you, Mr. Chairman and distinguished members, for giving me this opportunity to speak to you. 

Mr. Chairman, in 1980, when you and I were 26, I enjoyed filming An Officer and a Gentleman in your district. 

Mr. DICKS. Great movie, one of the best. Port Townsend. I was 

there last weekend. 

Mr. KEITH. It is a beautiful place. I understand that—— 

Mr. DICKS. Rhododendron Festival. 

Mr. KEITH. I understand that hotel, that motel room, tourists 

come to see where I hung myself in that thing. Pretty weird. 

I want to come and tell you about what I have decided to do with 

the final chapter of my life. The members of this committee remember how shocked and appalled Americans were to see the graphic 

photographs of cruelty and abuse in the Iraqi prison Abu Ghraib. 

I ask for your full attention now as I describe something much, 

much worse. Those Abu Ghraib photos are eclipsed in volume and 

savagery by the millions of images of little children being raped, 

tortured, sodomized and bleeding that flood the Internet to fill the 

bottomless appetite of a global pedophile marketplace. 

Child exploitation is the great blind spot to a homeland security 

focused on protecting our ports, financial assets and intellectual 

property, but is bafflingly oblivious to international criminal networks soliciting the filmed abuse of American children. Children in 

the U.S. military families are no exception. 

A 2008 investigation by the London Times delivered a stunning 

indictment to our cybersecurity response when it reported British 

officials had found secret coded messages between terrorists embedded in child pornographic images and pedophilic Web sites because this is ‘‘a secure way of passing information between terrorists.’’ 

Internet-facilitated child exploitation is investigated by four military criminal investigative organizations in each military branch, 

or MCIOs. These MCIOs do their best, but their capacity is a national disgrace. Only half a dozen of their investigators are trained 

and ready to conduct on-line investigations, about the size of the 

police force of Forks, Washington, Mr. Chairman, to protect the entire U.S. military. This small ghost patrol knows the locations of 

hundreds of child exploitation suspects and their victims in the 

U.S. right now, but they cannot take action due to sheer lack of resources. 

Last month PROTECT coordinated a meeting of the best and the 

brightest. At a table here in Washington were Federal and State 

law enforcement agents, computer scientists from Oak Ridge NaVerDate Mar 15 2010 03:50 Jun 11, 2011 Jkt 066611 PO 00000 Frm 00240 Fmt 6602 Sfmt 6602 E:\HR\OC\A611P2.XXX A611P2

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tional Laboratory and Cray Computer, makers of the world’s most 

powerful supercomputers. Since that meeting those partners began 

a research and development project that could dramatically change 

the game for law enforcement. 

The one indispensable partner not participating is the United 

States Government. In addition to underfunded MCIOs, the ICE 

Cyber Crimes Center, C3, took crippling budget cuts this year. DOJ 

lags far behind, leaving the National Internet Crimes Against Children Data System, NIDS, and the PROTECT Our Children Act, 

which reshaped our national child exploitation response, unfunded. 

Shame on us. 

Modest emergency funding from this Congress is a simple—— 

Mr. DICKS. This is in the Justice Department budget; is that 

what you are saying? 

Mr. KEITH. I realize that part of these things are outside of this 

committee. 

Mr. DICKS. No, no. We are not being critical of your pointing this 

out. We just want to get your ideas. 

Mr. KEITH. Yes, sir. I understand that. Thank you. 

A modest emergency funding from this Congress and a simple 

three-pronged attack will significantly advance the war against 

child predators in the military and those attacking our homeland; 

provide at least $2 million in defense funding to the four military 

criminal investigation organizations for investigation of child exploitation, the development and deployment of new technology; provide at least 10 million in Homeland Security funding to ICE Cyber 

Crimes Center for the specific purpose of research and development 

in high-speed computing and related technology; provide at least 2 

million in Justice funding for the implementation of the NIDS computer platform as authorized by the PROTECT Our Children Act 

of 2008. 

I understand that two of these proposals for funding are beyond 

the purview of this subcommittee; however, no piecemeal attack 

will be an effective or an efficient use of precious taxpayer dollars, 

and I ask each of you to champion this simple three-pronged solution with the full House Appropriations Committee. 

Finally, let me share one other project that PROTECT is working 

on that is gathering congressional momentum. The Hero to Hero 

bill will provide financial assistance and training to returning and 

disabled veterans, allowing them to transition into jobs combating 

child exploitation and abuse, allowing them literally to go from 

hero to hero. 

Since the dawn of history, men have gone off to war understanding that they were leaving behind what they held most dear. 

Protecting our children and our families are why we fight, and it 

is why we are all here today. Given our children face this clear and 

present danger, we cannot fund wars overseas without first funding 

this war at home. It will take your leadership right now to make 

that happen. 

Thank you. 

Mr. DICKS. Thank you. You make a very compelling statement. 

[The statement of Mr. Keith follows:] 


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Mr. DICKS. Mr. Frelinghuysen. 

Mr. FRELINGHUYSEN. Thank you. 

Mr. DICKS. Any of my colleagues have any questions? 

Mr. MORAN. I should be sitting down there. Nice to see you, 

David. 

He really has been working hard, and he is trying to get an 

across-the-board approach to this issue. It is very convincing testimony. 

Thank you. 

Mr. DICKS. Thank you. We appreciate your good work. I hope you 

get back to Port Townsend or Forks. 

THURSDAY, MAY 20, 2010. 

AMERICAN SOCIETY OF TROPICAL MEDICINE AND 

HYGIENE (ASTMH) 

WITNESS 

DR. BERMAN, AMERICAN SOCIETY OF TROPICAL MEDICINE AND HYGIENE (ASTMH) 

Mr. DICKS. Dr. Berman, American Society of Tropical Medicine 

and Hygiene. 

Thank you, Dr. Berman, you have 5 minutes to present your 

statement and summarize. 

Colonel BERMAN. Thank you, Mr. Chairman. I am Dr. Berman, 

Colonel, United States Army Medical Corps, Retired, representing 

the American Society of Tropical Medicine and Hygiene, which is 

the principal professional medical organization in the United 

States and actually in the world for tropical medicine and global 

health. ASTMH represents physicians, researchers, epidemiologists 

and other health professionals dedicated to the control and prevention of tropical diseases. 

Because the military operates in so many tropical regions, reducing the risk that tropical diseases present to service personnel is 

critical to mission success. Malaria and other insect-transmitted 

diseases, such as leishmaniasis and dengue, are particular examples of this. Antimalarial drugs have saved countless lives throughout the world, including troops serving in tropical regions during 

World War II, Korea and Vietnam. The U.S. military has taken a 

primary role in the development of antimalarial drugs, and nearly 

all antimalarial drugs and most promising vaccines to date were 

developed, at least in part, by U.S. military researchers. 

Three hundred fifty million people are at risk of leishmaniasis in 

88 countries; 12 million are currently infected. Leishmaniasis was 

a particular problem for Operation Iraqi Freedom as a result of 

which 700 American service personnel became infected. 

Because of leishmaniasis’s prevalence in Iraq and Southwest 

Asia in general, the DOD has spent large resources on this disease, 

and DOD personnel are the leaders in development of new 

antileishmanial drugs. I might add both for malaria and leishmaniasis, I count or did count am still counting as one of those leadership personnel. 

Dengue is the leading cause of illness and death in the—a leading cause in the tropics and subtropics. One hundred million people 


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are affected yearly. Although dengue rarely occurs in the continental United States, it is endemic in Puerto Rico, many tourist 

destinations, and periodic outbreaks occur in Samoa and Guam. 

The intersection of militarily important diseases and tropical 

medicine is the reason that 15 percent of ASTMH members are 

also members of the military. For this reason we respectfully request that the subcommittee expand funding for the DOD’s longstanding and successful efforts to develop new drugs, vaccines and 

diagnostics to protect servicemen and women from malaria and 

tropical diseases. 

Specifically we request that in fiscal year 2011 the subcommittee 

ensure 70 million to DOD to support its infectious disease research 

efforts through USAMRIID, WRAIR and NMRC. Presently DOD 

funding for this important research is about 47 million. To keep up 

with biomedical inflation, fiscal year 2011 funding needs to be 60 

million, and to fill the gaps that have been created by underfunding, ASTMH urges Congress to fund DOD ID research at 70 

million in fiscal year 2011. 

We very much appreciate the subcommittee’s consideration of our 

views. We stand ready to work with the committee and staff on 

these and other tropical disease matters. 

Thank you. 

Mr. DICKS. Thank you very much for your statement. 

[The statement of Ms. Finney follows:] 


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Mr. DICKS. Karen Mason, Ovarian Cancer National Alliance. 

Good morning, and you have 5 minutes to summarize. Your statement will be put in the record. 

Ms. MASON. Good morning, Mr. Chairman, ranking member and 

members of the subcommittee. I am honored to appear before you 

in support of the Ovarian Cancer National Alliance’s request of $30 

million for the Department of Defense Ovarian Cancer Research 

Program. 

My name is Karen Mason, and I am an intensive care nurse from 

Pitman, New Jersey. I also serve as an Integration Panel member 

of the Ovarian Cancer Research Program, which I will refer to as 

the OCRP for the rest of my testimony. 

As a 9-year survivor of late-stage ovarian cancer, I feel a strong 

sense of responsibility to my community and sit before you today 

as the voice of all women with this disease, past, present and future. It is my hope that today I can beseech you to share this responsibility to fund research conducted by the OCRP to find new 

treatments and an early detection for women with or at risk of 

ovarian cancer. 

This year approximately 20,000 women will be diagnosed with 

ovarian cancer; 15,000 women will die of this disease. Ovarian cancer has no tests, like the mammogram for breast cancer or the Pap 

test for cervical cancer. Because there is no reliable early detection 

test, women must rely on their and their doctors’s knowledge of 

ovarian cancer symptoms. However, most women and even their 

doctors do not know the symptoms of ovarian cancer, which are 

bloating, pelvic or abdominal pain, urinary urgency or frequency, 

difficulty eating or feeling full quickly. These symptoms are often 

confused with less threatening conditions. 

Unfortunately, even with symptom awareness, by the time a 

woman has symptoms, she will already have late-stage cancer. Two 

out of three women with ovarian cancer are diagnosed when their 

cancer is late stage, as mine was. 

Care and treatments are brutal and consist of long debulking 

surgeries followed by months of chemotherapies. Even when the 

initial treatment response seems positive, around 70 to 95 percent 

of women diagnosed at stages 3 or 4 will have a recurrence. 

During my 9 years of survivorship, I have befriended many 

women who also had late-stage ovarian cancer. One by one I have 

watched most of these women die. Today, in the Delaware Valley, 

I know of no other woman diagnosed at a late stage who has survived as long as I have. I still speak to women newly diagnosed to 

offer them hope, but now I must hold a piece of my heart in reserve. 

The OCRP has one bold aim, to eliminate ovarian cancer. Since 

1997, the OCRP has funded out-of-the-box, innovative research focused on detection, diagnosis, prevention and control of ovarian 

cancer. Many of the funded proposals can be characterized as high 

risk and high reward. Although we take risks in the research we 

fund, we believe that investing in innovative research will result in 

great breakthroughs in the fight against ovarian cancer. 

The OCRP is also special in that it involves patient advocates at 

all levels. I have volunteered my time for the past 3 years to serve 

as an Integration Panel member for the OCRP. I work alongside 


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physicians, scientists and other patient advocates, and together we 

select proposals we think merit funding. Patient advocates hold 

equal weight with the scientists and physicians when funding proposals and deciding the program’s vision for the future. 

Mr. DICKS. You have 1 minute. 

Ms. MASON. The OCRP needs increased funding. This spring we 

have received approximately 350 preapplications. In the end we 

will only be able to fund approximately 32 full proposals. The ovarian cancer community worries that the cure could be heading into 

the trash can. Only with increased funding can the OCRP grow 

and continue to contribute to the fight against ovarian cancer. 

The ovarian cancer community was very disappointed last year 

when our funding was cut from 20 million to 18.75 million for 

2010. This cut is shocking when you consider our mortality has not 

decreased, and new treatments and an early detection test are so 

desperately needed. By increasing our funding to 30 million for 

2011 so that more research can be carried out, we not only help 

women in battling the deadly beast, but the future generations of 

women at risk for having ovarian cancer. 

Thank you again for this opportunity. 

Mr. DICKS. Thank you for your statement. You make a very compelling case. 

Ms. Kilpatrick. 

Ms. KILPATRICK. Thank you, Mr. Chairman, and thank you for 

your testimony. I understand you are a registered nurse. 

Ms. MASON. Yes. 

Ms. KILPATRICK. You are 9 years—— 

Ms. MASON. Yes, of late stage. 

Ms. KILPATRICK. And I am sure you have seen in your career 

what procedures, medications allowed you to resist. 

Ms. MASON. I think that my initial surgery that was done in a 

major cancer center was just long and tedious, and the doctors 

stayed there and removed every bit of cancer. Ovarian cancer has 

a way of spreading like Rice Krispies throughout your abdomen 

and pelvis. And once the big tumors are removed, the physician 

then has to spend hours picking out all these little tiny pieces. 

Ms. KILPATRICK. So then the people who have this disease obviously are not getting the proper care? 

Ms. MASON. Well, my long surgery was followed by months of 

chemotherapy. I think that my own particular body was very sensitive to the chemotherapy drugs. There aren’t many women like 

me. I was extremely lucky, and I do feel a great sense of responsibility to help change, you know, the facts of this cancer. 

And although cancer survival rates have improved since the war 

on cancer was declared for ovarian cancer, that is not true. We are 

kind of basically where we were 40, 50 years ago. 

Ms. KILPATRICK. I am with you on that. I look forward to following up. 

Thank you, Mr. Chairman. 

Mr. DICKS. Mr. Frelinghuysen. 

Mr. FRELINGHUYSEN. I just wanted to thank you, Ms. Mason. I 

work pretty closely with Kaleidoscope of Hope and Paint the Town 

Teal, and there is a critical mass up there which I think is spreading the message. Thank you for being here. 


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Ms. MASON. Thank you. 

[The statement of Ms. Mason follows:] 


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THURSDAY, MAY 20, 2010. 

SOCIETY OF GYNECOLOGIC ONCOLOGISTS 

WITNESS 

DANIEL L. CLARKE-PEARSON, M.D., PRESIDENT, SOCIETY OF GYNECOLOGIC ONCOLOGISTS, PROFESSOR AND CHAIR, OBSTETRICS AND 

GYNECOLOGY, UNIVERSITY OF NORTH CAROLINA MEDICAL 

SCHOOL, CHAPEL HILL, NORTH CAROLINA 

Mr. DICKS. Our next witness is Daniel L. Clarke-Pearson, M.D., 

president, Society of Gynecologic Oncologists. Thank you, sir, welcome. 

Dr. CLARKE-PEARSON. Thank you. Good morning, Mr. Chairman 

and members of the subcommittee. Thank you for inviting me to 

testify at today’s hearing. 

My name is Daniel Clarke-Pearson. I am a physician and president of the Society of Gynecologic Oncologists. The Society of 

Gynecologic Oncologists is a national medical specialty organization 

of physicians who are trained in the comprehensive management 

of women with malignancies of the reproductive tracts, such as 

ovarian cancer. Our purpose is to improve the care of women with 

gynecologic cancers by encouraging research, raising the standards 

of practice, disseminating knowledge, and the prevention and treatment of gynecologic malignancies. 

I also practice medicine at the University of North Carolina in 

Chapel Hill, where I am a professor in the School of Medicine, and 

I am the chairman of the department of obstetrics and gynecology. 

A large part of my clinical practice is committed to the care of 

women with ovarian cancer. 

I am honored to be here and pleased that this subcommittee is 

focusing its attention on the Department of Defense Congressionally Directed Medical Research Program in Ovarian Cancer, OCRP. 

As this subcommittee may know, ovarian cancer causes more 

deaths than any other cancers of the female reproductive tract. 

One of our biggest challenges lies in the fact that only 19 percent 

of all ovarian cancers are detected in a localized stage when the 5- 

year survival rate is about 90 percent. 

Unfortunately, as Ms. Mason just said, most ovarian cancer is diagnosed at a late stage when the cancer is spread throughout the 

abdomen and pelvis. In these cases the 5-year survival is only 

about 30 percent. We, the members of SGO, along with out patients 

who are battling ovarian cancer, depend on the DOD OCRP research funding. It is through this research funding that a screening 

and early detection method for ovarian cancer can be identified. 

Therefore, the SGO respectfully recommends that the subcommittee provide DOD OCRP with a minimum of $30 million for 

Federal funding in fiscal year 2011. 

Since its inception, the DOD OCRP has funded 209 research 

grants totaling more than $140 million in funding. The common 

goal of these research grants has been to promote innovative, integrated and multidisciplinary research that will lead to prevention 

and early detection and ultimate control of ovarian cancer. 

Much has been accomplished in the last decade to move us forward. In my home State of North Carolina, DOD OCRP has funded 


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research on important questions such as the designing of personalized cancer treatments that may prolong survival based on individual cancer gene expression. We are also looking to adapt a radiology imaging technique used successfully in prostate cancer to potentially detect early ovarian cancers. 

Mr. Chairman, in your home State of Washington, the DOD 

OCRP has funded five grants in the last 5 years either at the University of Washington or at the Hutchinson Cancer Center, looking 

at questions such as the development of tests to detect new small 

molecules in blood that are present in high levels in early ovarian 

cancers that might be used for early ovarian cancer detection. 

Another research project is examining the entire human genome 

in women, searching for genes or other groups of genes that may 

cause ovarian cancer in a familial inheritance rather than just focusing just on BRCA genes, and also developing an infrastructure 

for the collection and storage and testing of new biomarker blood 

tests. 

In Ranking Member Young and Mr. Boyd’s State of Florida, nine 

grants have been funded since the inception of OCRP. These have 

contributed much to ovarian cancer research enterprise, specifically 

through the creation of a model of ovarian cancer in mice that allows the evaluation of the interaction of gene mutations in female 

hormones, and through studies to determine whether a gene, Bcl– 

2, which is expressed in ovarian cancer, can be used as a novel 

marker for early detection. 

Mr. DICKS. You have 1 minute to wrap it up. 

Dr. CLARKE-PEARSON. Yes, sir. 

Mr. DICKS. But you are doing very well. 

Dr. CLARKE-PEARSON. These examples of achievement are obscured to a great degree by opportunities that have been missed because of underfunding. 

The program’s success has been documented in numerous ways, 

including 469 publications in professional journals, 576 abstracts 

and presentations, and 24 patents and applications. 

The Society of Gynecologic Oncologists joins with the Ovarian 

Cancer National Alliance and the American Congress of Obstetricians and Gynecologists to urge this subcommittee to increase Federal funding at a minimum to $30 million in fiscal year 2011. I 

thank you for your leadership and the leadership of the subcommittee on this issue. 

Mr. DICKS. Thank you for your statement. We appreciate it very 

much. 

Ms. Kilpatrick. 

Ms. KILPATRICK. Thank you very much. 

How are you funded? How is the society funded? 

Dr. CLARKE-PEARSON. Mostly membership dues and fees for our 

annual meeting. 

Ms. KILPATRICK. And the OCRP is funded—— 

Dr. CLARKE-PEARSON. Yes, in terms of developing projects. Of 

course, the National Cancer Institute as well funds some research 

by our members. 

Ms. KILPATRICK. Thank you. 

Thank you, Mr. Chairman. 

Mr. DICKS. Thank you. 

[The statement of Dr. Clarke-Pearson follows:] 


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THURSDAY, MAY 20, 2010. 

AMERICAN COLLEGE OF OBSTETRICIANS AND 

GYNECOLOGISTS 

WITNESS 

MARY F. MITCHELL, SENIOR DIRECTOR OF PROFESSIONALISM AND 

GYNECOLOGIC PRACTICE, AMERICAN COLLEGE OF OBSTETRICIANS 

AND GYNECOLOGISTS 

Mr. DICKS. Mary F. Mitchell, American College of Obstetricians 

and Gynecologists. We will put your entire statement in the record, 

Mary, and you have 5 minutes to summarize. 

Ms. MITCHELL. Mr. Chairman, ranking member and members of 

the subcommittee, thank you for inviting me to testify at today’s 

hearing. My name is Mary Mitchell, and I am the Senior Director 

of Professionalism and Gynecologic Practice at the American College of Obstetricians and Gynecologists. I am here today on behalf 

of the college’s companion organization, the American Congress of 

Obstetricians and Gynecologists, or ACOG, representing more than 

54,000 physicians and partners in women’s health. The gynecologist is often the first health care provider a woman sees, and 

ACOG and its fellows are committed partners in the fight against 

gynecologic cancer. 

This morning I will outline the great need for research into all 

aspects of ovarian cancer and some of the important contributions 

made by the Department of Defense Congressionally Directed Medical Research Program in ovarian cancer, the OCRP. 

These needs and the contributions of the OCRP lead ACOG to respectfully request a minimum of $30 million in Federal funding for 

the OCRP in fiscal year 2011. We believe that the unique structure 

of the program and its success in funding innovation combine to 

yield a high return on the Federal financial investment. 

In the more than 30 years since passage of the National Cancer 

Act, ovarian cancer mortality rates have not significantly improved. 

In large part this is because we do not have a reliable screening 

test for ovarian cancer. Without this critical tool, ovarian cancer, 

as you have heard, is too often diagnosed in a late stage when the 

5-year survival rate is only 29 percent. And, as you have heard 

from Ms. Mason, 13,000 women die each year from ovarian cancer. 

In contrast, since the 1950s, we have had an effective screen for 

cervical cancer, the Pap test, which has reduced mortality from cervical cancer by over half in the past 30 years. We need a test like 

the Pap test for ovarian cancer, and the research supported by 

DOD’s OCRP can help us get there. 

Unfortunately, inadequate funding is a barrier to scientific 

progress. At the National Institutes of Health and the Centers for 

Disease Control and Prevention, funding for ovarian cancer research has not kept pace with inflation. Even in the DOD medical 

research program, ovarian cancer research is significantly underfunded relative to other cancers, and, as you have heard, funding 

was cut to $18.75 million in fiscal year 2010. 

We recognize the challenges of funding research, given so many 

competing demands, but we believe that the OCRP’s flexible and 

collaborative approach ensures that the maximum value is gained 


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for the dollars spent through Federal appropriations. Through the 

Integration Panel structure mentioned by Ms. Mason, the OCRP is 

able to actively manage and evaluate its current grant portfolio 

and fill gaps in ongoing research at other agencies. With seed 

money from the OCRP, possible research strategies are efficiently 

reviewed, and then the most promising can be funded by other 

agencies. Collaboration is one reason the OCRP is so effective. 

Mr. DICKS. You have 1 minute, ma’am. 

Ms. MITCHELL. The new Ovarian Cancer Academy for junior faculty will allow early career researchers to optimize the pace of their 

career development, and the Consortium Award will bring together 

researchers from multiple institutions to study the early signs of 

ovarian cancer. 

The OCRP has been an unqualified success, but as you have 

heard from other speakers, the current level of funding allows only 

a fraction of the approved proposals to actually receive a grant. 

ACOG joins with the American Society of Gynecologic Oncologists 

and Ovarian Cancer National Alliance to urge this subcommittee 

to increase Federal funding for the OCRP to at least $30 million 

in fiscal year 2011 and allow for the further development of discoveries and research breakthroughs achieved in the first 13 years of 

this program. 

We thank you very much for your leadership. 

Mr. DICKS. Thank you. Thank you for your testimony. 

[The statement of Ms. Mitchell follows:] 


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Mr. DICKS. Michelle Galvanek, The Leukemia & Lymphoma Society. Thank you, Michelle. We will put your statement in the record. 

You have 5 minutes to summarize. 

THURSDAY, MAY 20, 2010. 

THE LEUKEMIA & LYMPHOMA SOCIETY 

WITNESS 

MICHELLE GALVANEK 

Ms. GALVANEK. Thank you. Good morning, Mr. Chairman and 

members of the subcommittee. My name is Michelle Galvanek, and 

I am a volunteer with the Leukemia & Lymphoma Society. And I 

would like to thank you for allowing me to testify today on behalf 

of the LLS and the thousands of blood cancer patients we serve. 

Since 1949, the Society has been dedicated to finding a cure for 

blood cancers. To that end, in fiscal year 2009, the Society provided 

approximately $69 million in research grants. A number of our 

grant recipients also received funds from the National Institute of 

Health, private foundations and the Department of Defense. The 

funding from the Department of Defense is through the congressionally directed medical research program. 

For fiscal year 2011, the Leukemia & Lymphoma Society, along 

with other cancer groups, the C3 Colorectal Cancer Coalition, the 

Kidney Cancer Association, the International Myeloma Foundation, 

the Lymphoma Research Foundation, and the Vietnam Veterans of 

America support the peer reviewed cancer research program and 

request it to be funded at $50 million in fiscal year 2011. 

Additionally, we request that the program fund research into the 

same cancers it did in 2010, namely blood, kidney, colorectal, pediatric brain and melanoma. I know firsthand about the benefits of 

research as my husband is an 11-year leukemia survivor. The LOS 

supports the inclusion of all 5 cancers in the PRCR, and particularly blood cancer. The reasons for having a blood cancer research 

program at the DOD are the benefits such a program would have 

for military service members and the fact that blood cancer research has led to break throughs in the treatment of other cancers. 

Civil agencies in the Federal Government have recognized the importance of blood cancers to those who serve in our military. 

For example, the Department of Veterans Affairs has determined 

that service members who have been exposed to ionizing radiation 

and contract multiple myeloma, non-Hodgkin lymphoma or leukemia other than chronic lymphocytic leukemia are presumed to 

have contracted those diseases as a result of their military service. 

Secondly, in-country Vietnam veterans who contract Hodgkin’s disease, chronic lymphocytic leukemia, multiple myeloma or nonHodgkin’s lymphoma are presumed to have contracted these diseases as a result of their military service. Because these diseases 

are presumed to have been service connected in certain instances, 

VA benefits are available to affected veterans. 

Furthermore, the Institute of Medicine has found that Gulf War 

veterans are at risk for contracting a number of blood cancers due 

to exposure to Benzene, solvents and insecticides. One example is 


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IOM has found sufficient evidence of a causal relationship between 

exposure to Benzene and acute leukemias. In addition, the C.W. 

Bill Young Department of Defense Marrow Donor Program works 

to develop and apply bone marrow transplants to military casualties with marrow damage resulting from radiation or exposure to 

chemical warfare agents containing mustard. Bone marrow transplants are also a commonly used second-line therapy for blood cancers more so than other cancers. 

Finally, research into blood cancers have produced results that 

can help patients with other cancers too. The idea of combination 

chemotherapy was first developed to treat blood cancers in children 

and is now common among cancer treatments. Bone marrow transplants were first used as curative treatments for blood cancer patients, and these successes led the way to stem cell transplants and 

immune cell therapies for patients with other diseases. In general, 

blood cancer cells are easier to access themselves from solid tumors, making it easier to study cancer causing molecules in blood 

cancers and to measure the effects of new therapies that target 

these molecules that are frequently also found in other cancers. 

Mr. DICKS. You have 1 minute. 

Ms. GALVANEK. Thank you, sir. Several agents designed only to 

kill cancer cells and leave healthy cells undamaged were first developed for blood cancer patients and are already helping or being 

developed to help other cancer patients as well. In conclusion, because blood cancer research is relevant to our Nation’s military and 

because blood cancer research often leads to treatment in other 

cancers, I would urge the subcommittee to include $50 million for 

the Peer Reviewed Cancer Research Program for funding into 

blood, colon, skin and kidney cancer, as well as pediatric brain tumors. Thank you very much. 

Mr. DICKS. Thank you very much. I would just point out that Mr. 

Young, the ranking member and former chairman of the subcommittee, has been a leader on this particular form of cancer and 

has been a great advocate in this committee for more research in 

this area. Ms. Kaptur. 

Ms. KAPTUR. Mr. Chairman, just very quickly, I just wanted to 

ask whether your data provides you with any statistics that show 

for veterans from any of our conflicts—you mentioned Benzene. Do 

veterans contract these particular type of cancers, blood-related 

cancers at a higher rate than others? Can you provide that—you 

sort of mentioned some of it. 

Ms. GALVANEK. I don’t have that answer off the top of my head, 

but I can follow up with you and get that to you. 

Mr. DICKS. Her statement has a few examples. Thank you for 

being a volunteer. 

Ms. GALVANEK. Thank you. It is the best way I spend my time. 

Thank you. 

[The statement of Ms. Galvanek follows:] 


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Mr. DICKS. Thank you. We appreciate it. The National Breast 

Cancer Coalition, Fran Visco, J.D., president of the coalition. Hold 

on just a second. We are going to switch here. Mr. Moran has got 

a problem, and he wants to hear this witness. If you would just 

give us Carlea Bauman, President of the Colorectal Cancer Coalition. Welcome. 

THURSDAY, MAY 20, 2010. 

C3: COLORECTAL CANCER COALITION 

WITNESS 

CARLEA BAUMAN, PRESIDENT, C3: COLORECTAL CANCER COALITION 

Ms. BAUMAN. Good morning. Thank you. Mr. Chairman and 

members of the subcommittee, thank you for the opportunity to testify in support of the research that is being funded through the 

DOD’s Peer Reviewed Cancer Research Program. My name is 

Carlea Bauman. I am the president of the C3: Colorectal Cancer 

Coalition. C3 is a nonprofit, nonpartisan advocacy organization 

seeking to eliminate suffering and death due to colorectal cancer. 

Last year, our advocates asked Congress to include colorectal cancer in the DOD’s Peer Reviewed Cancer Research Program. Thank 

you for listening to them. We were thrilled that in the fiscal year 

2010 bill, for the first time, colorectal cancer research is being 

funded through the DOD’s PRCRP. Because when you fund research for a disease, people diagnosed without disease live longer 

and enjoy a higher quality of life. In 2010, there are $15 million for 8 research areas that includes 

colorectal cancer. C3 is working with other advocacy groups to increase that funding for fiscal year 2011. We hope we can count or 

your support. We respectfully ask that you increase the funding for 

this important program in fiscal year 2011. Specifically we ask that 

you fund the DOD’s PRCRP at $50 million. Although the cancers 

included in this program are diverse, the research on these disease 

types is often synergistic. Efforts to develop a genetic profile for pediatric brain tumors will direct research efforts and permit greater 

targeting of treatment options and molecular profiling of melanoma 

will permit better predictions of therapeutic response and informed 

research efforts. 

And researchers today working on colorectal cancer are producing biomarker tests that provide important information about 

which treatments will work and which will not. Today, treatment 

options for colorectal cancer have expanded to seven drugs, more 

precise surgery and radiation. Continuing to fund innovative research will result in more treatment option for colorectal cancer patients. 30 years ago, people diagnosed with metastatic colorectal 

cancer lived approximately 6 months after their diagnosis. Today 

they are living on average over 2 years past their diagnosis and 

some are even cured. 

In the general population, colorectal cancer is the third most 

commonly diagnosed cancer and the second most common cause of 

cancer deaths for men and women in the United States. Nearly 

147,000 people will be diagnosed with colorectal cancer and nearly 


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50,000 people will die this year. Funding for the DOD’s PRCRP is 

an opportunity to advance the best research to eradicate diseases 

and support the warfighter for the benefit of the American public. 

A continued investment by the subcommittee in research focusing 

on these cancers may yield benefits beyond the specific cancers. 

A study published in the Cancer Epidemiology Biomarkers and 

Prevention found differences in cancer incidence rates between 

military personnel and the general population. Rates were lower 

among military personnel than the general population for 

colorectal, lung and cervical cancers. However, for colorectal cancer, 

the difference in rates between the two populations was significant 

only among white males. Screening rates in the military for 

colorectal cancer like in the general population are much too low. 

In 2008, only about 58 percent of those in the military who 

should be screened for colorectal cancer had been screened. And 

every day precancerous polyps that could be detected through 

screening are not being found. Today only 39 percent of colorectal 

cancer patients have their cancers detected at an early stage. For 

many patients, a diagnosis of colorectal cancer means a diagnosis 

of late stage colorectal cancer. Not nearly enough research is being 

done into late stage colorectal cancer treatments. The PRCRP represents an opportunity to conduct such research. Areas of focus for 

colorectal cancer research in the PRCRP could be an inexpensive, 

noninvasive accurate screening test, predicted markers to identify 

who will benefit from which treatments and accurate diagnostics 

that can evaluate the markers. 

Mr. DICKS. You have 1 minute. 

Ms. BAUMAN. Thank you, sir. Discoveries resulting from investment in PRCRP research have the potential to transform the investigation of cancer through the development of new prevention strategies and therapies and some day cures. I thank you for your commitment to cancer research at the Department of Defense and efforts to improve the lives of Americans facing and living with a 

cancer diagnosis. I respectfully request that this subcommittee continue to support the important work of the DOD’s congressionally 

directed medical research programs by funding the PRCRP at $50 

million for fiscal year 2011. Once again, thank you for the opportunity to provide this testimony to this subcommittee. 

Mr. DICKS. Thank you. Thank you very much. 

Mr. MORAN. Mr. Chairman. 

Mr. DICKS. Yes, Mr. Moran. 

Mr. MORAN. If I could, the next speaker will represent the Breast 

Cancer Survivors Coalition, which all of these groups really have 

to thank for initiating medical research. I am glad we have been 

as robust in funding that. When you look at what the Lung Cancer 

Coalition has submitted, lung is the largest, then colorectal cancer, 

then, of course, breast cancer and then pancreatic cancer and then 

prostate cancer, which we have specific funding for. Colorectal cancer is in a larger group, including pediatric cancer and the like. But 

we made so much progress. 

Mr. Chairman, I want to thank you particularly for having this 

public hearing because otherwise we don’t really hear from the 

other side. It is just a line item. These folks are putting a face to 

it. But in colorectal cancer, so much of this is a matter of screening. 


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That is how you save lives. You have got to get it before it gets 

into the body and takes hold. And to think that only about half of 

our military are being adequately screened for colorectal cancer is 

just wrong when the incidence is over 50,000 deaths a year. Many 

of those are military folks. So I wanted to make that point and I 

appreciate, Ms. Bauman’s testimony. 

Ms. BAUMAN. Great. Thank you very much. 

[The statement of Ms. Bauman follows:] 


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Mr. DICKS. Thank you. Now we will go to Fran Visco, president 

of the National Breast Cancer Coalition. Thank you for being patient. 

THURSDAY, MAY 20, 2010. 

NATIONAL BREAST CANCER COALITION 

WITNESS 

FRAN VISCO, PRESIDENT, NATIONAL BREAST CANCER COALITION 

Ms. VISCO. You are welcome. Thank you for inviting me. So I am 

Fran Visco. I am a 22-year breast cancer survivor and head of the 

National Breast Cancer Coalition, which is a coalition and umbrella for over 600 groups from across the country. I want to begin 

by thanking you for your leadership over the years in support of 

this program. I am not going to talk to you about the details of 

what we funded and what the specific successes of the program 

have been. I give you some examples in my testimony and all of 

the information is available on the program’s Web site. What I do 

want to tell you is that this government program has been an incredible success on every level and it warrants level funding, this 

Competitive Peer Reviewed Biomedical Research Program. 

This program is a unique structure. It is a collaboration among 

scientists, trained consumers and the United States Army. Its vision is to eradicate breast cancer by funding innovative research. 

This program funds gaps. It doesn’t replicate or duplicate what 

other funding agencies and private funders do. This program can 

rapidly respond to what is happening in the world of breast cancer. 

Why? There is no bureaucracy. The United States Army has done 

an incredible job administering this program. It is streamlined, it 

is efficient. The administrative costs don’t even rise to 10 percent. 

And importantly for the public, this is a transparent program. It 

is accountable to the taxpayers. The public can go to the Web site 

and see where the money is going, where their tax dollars are 

being spent. Every other year at a meeting called the Era of Hope, 

everyone who has been funded by this program has to present the 

results of their research to the public. 

Mr. DICKS. When does that occur? 

Ms. VISCO. Every other year. It is going to happen again in August of 2011 will be the next Era of Hope meeting. 

Mr. DICKS. Can Members of Congress go? 

Ms. VISCO. Oh, yes. Absolutely. We would love to have you. This 

program has been successful because it has been free of outside influence and it has the strongest conflict of interest policy of any research funding entity within or without government. What this 

program does is it pushes science to new levels. It challenges the 

status quo. It creates new models, some of which you have heard 

from other programs that you have funded. We create new models 

of research. We don’t direct the research questions to be asked. We 

leave that to the scientific community. It has been replicated by 

other programs, by other countries, by breast cancer programs in 

other States from its mission to the mechanisms it creates to the 

structure of the program. 


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In fact, a number of years ago, the then general in charge of the 

program, General Martinez, told me that even the mechanisms and 

the way the integration panel works, he took that and used it elsewhere within the Department of the Army because he was so impressed with what we were able to do. So this works on every level. 

It doesn’t just save lives. It changes how research is done. I want 

you to know that this program is where the hope lies, the hope of 

the women and men across the country and actually around the 

world who are dedicated to ending breast cancer. This is the program they look to because they know this is the program that is 

responding to the needs of patients. And that is really making a 

difference for all of us. Thank you. 

Mr. DICKS. Thank you very much. Are there any questions? We 

have a little time here for anyone who has a question. Thank you. 

Let me ask you this. Do you think this is a better program than 

National Cancer Institute? 

Ms. VISCO. Yes, I do. Without question, I think this program for 

breast cancer is a better program than the National Cancer Institute. 

Mr. DICKS. Why is that? 

Ms. VISCO. For all the reasons I said. It is incredibly transparent, 

it is accountable, it is able to rapidly respond. There is no huge bureaucracy here that you have to try to overcome. It is looking at 

innovation. A couple of years ago, the then head of the National Institutes of Health testified to Congress. And he was talking about 

how proud he was of the four new innovations at NIH. And all four 

of them were copied from the DOD Breast Cancer Research Program. This is the program where the creativity and the innovation 

lie. This is the program that brings the public into it. The NCI, 

while it is doing very good work, does not rise to the level of the 

breast cancer research that the DOD program funds. 

Ms. KAPTUR. Mr. Chairman, since this witness is so articulate 

and though I won’t only focus on breast cancers, I have listened to 

the various witnesses come before us this morning whether it is 

colorectal or lung or breast cancer, we thank you so much for the 

great work you are doing. What I fail to understand from a scientific standpoint is knowing everything we know about genetics, 

knowing everything we know about blood typing and analysis, why 

isn’t it just a simple matter of genetic marking so that we can find 

better detection regimens. We spend so much money as a country. 

Ms. VISCO. I could answer that. I am not sure by 11:00, but I 

could answer that. I will be as quick as I can. But I would love to 

have the conversation with you outside the hearing. The problem 

is that this isn’t just an issue of early detection, nor is it an issue 

of genetic mutation. It isn’t. It is much more complicated than that. 

Cancer is more complicated than that. We can find a pathway or 

a gene that is mutated. We can find people who are at high risk, 

but we don’t know what to do with them. And when you find a mutated pathway or a mutated gene, there are some other pathways 

and genes and proteins that come into the story that it is not just 

one target that is going to make a difference, that is going to cure 

women or that is going to detect it early enough for everyone to 

make a difference. 


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We don’t understand enough about the biology of this disease or 

really any cancer. The question was asked about ovarian cancer. 

Why am I here? I am a 22-year survivor. I had a pretty difficult 

breast cancer. I had lymph node involvement. I had state-of-the-art 

treatment. I don’t think that is why I am here. We don’t know why 

I am here. There is something about my DNA, the biology of my 

disease that responded to therapy, maybe didn’t need therapy at 

all. We don’t know enough about these diseases. They are incredibly complicated. We can’t just focus on early detection because 

that is so far from the answer to these diseases. 

The same thing with ovarian cancer, that woman thankfully is 

alive 9 years later. I don’t know if it was her surgery or her treatment. It was probably something about the biology of her disease 

that we don’t know yet. Those are the kinds of questions that we 

have to answer to really get rid of these diseases. 

Mr. RYAN. Mr. Chairman, if I could just add something here. Of 

all of these diseases, I think there is an issue that I hope over time 

we can start focusing on and that is stress, especially in the military environment, military families, is how we can begin to reduce 

levels of stress, teach people how to cope with their levels of stress 

because it has been proven that over time stress will just accelerate 

cancer and other diseases. So I hope that we can continue that and 

make that a part of our focus. 

Ms. VISCO. Actually I mention in my submitted testimony we actually are funding looking at stress levels in the military and accelerated breast cancer. That is one of the concepts that was funded 

by the program. 

Mr. RYAN. It was just in the earlier testimony too on the schools 

with the kids and the families and everything else here. I think we 

are going to see a theme running through a lot of this stuff. I think 

if we really want to kind of focus on something that is a cause of 

or something that increases these problems, we are going to find 

out time and time again it is stress. So we need to figure out how 

to get to the root of the problem too at the same time. 

Mr. MORAN. Mr. Chairman, I hate to belabor this. But the other 

thing that would be helpful is that in terms of prevention, we hear 

so many conflicting things. Breast feeding is good or aggressive exercise, any number of things, vitamins and so on. But one day we 

will see that this is the secret and then several months later we 

will say no, they were absolutely wrong. It would be helpful for a 

group such as yours to provide the kind of consistent device because women are desperate for credible information that they can 

use to apply to their own lives. 

Ms. VISCO. Yes. And prevention research, of course, is one of the 

most underfunded areas of any disease but certainly in cancer. We 

really don’t know enough about how to prevent these diseases. You 

are absolutely right. 

Mr. MORAN. Thank you. 

Mr. DICKS. Thank you very much. 

Ms. VISCO. You are welcome. 

[The statement of Ms. Visco follows:] 


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Mr. DICKS. We appreciate it. Now we will have Kendra Sharp, 

associate professor of mechanical, industrial and manufacturing engineering at Oregon State University. A great northwest school. 

Ms. SHARP. Yeah. I just moved to the Pacific Northwest. 

Mr. DICKS. Some of my best friends went to Oregon State. Terry 

Baker played there. A great quarterback. 

Ms. SHARP. Okay. Great. I just moved there to the Pacific Northwest and I am quite pleased to have moved to that part of the 

country. 

Mr. DICKS. Corvallis? You are in Corvallis, right? 

Ms. SHARP. Yes. 

Mr. DICKS. Thank you. 

THURSDAY, MAY 20, 2010. 

ASME, DEPARTMENT OF DEFENSE TASK FORCE 

WITNESS 

KENDRA SHARP, ASSOCIATE PROFESSOR, MECHANICAL, INDUSTRIAL, 

AND MANUFACTURING ENGINEERING, OREGON STATE UNIVERSITY 

Ms. SHARP. Mr. Chairman, Mr. Ranking Member and members 

of the committee, I am Kendra Sharp, associate professor at Oregon State University’s mechanical, industrial, manufacturing and 

engineering. On behalf of the ASME Department of Defense task 

force, I am pleased to have the opportunity to testify on the fiscal 

year 2011 Department of Defense budget request. The American 

Society of Mechanical Engineers is a 120,000 member professional 

organization focused on technical, educational and research issues. 

Our Nation’s engineers play a critical role in national defense 

through research discoveries and technology development for military systems. Therefore, my comments will focus on the DOD’s 

science and technology budget. The administration has requested 

$76.7 billion for the RDT&E portion of the fiscal year 2011 DOD 

budget, a 5.1 percent decline from last year. Of concern to our task 

force, funds for operational tests and evaluation function are still 

at reduced levels by historical standards. 

And while the fiscal year 2011 request represents an improvement from recent years, even this amount does not represent the 

importance of OT&E as mandated by Congress. The administration’s request for defense S&T of $11 billion represents a 12.2 percent reduction from last year. Our task force strongly urges this 

committee to consider additional resources to maintain stable funding in the S&T portion of the DOD budget. 

We note that up to $16.4 billion would be needed for defense 

S&T funding to meet the 3 percent of total obligational authority 

guideline recommended by the National Academies and set in the 

2001 Quadrennial Defense Review, recommendations which were 

broadly supported in Congress only a few years ago. The basic research 6.1 account supports programs which are crucial to fundamental scientific advances and for maintaining a highly skilled 

science and engineering workforce. Maintaining a skilled workforce 

is critical given the large turnover that will occur in the next few 

years in key science and engineering industries. 


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The National Science Foundation’s 2010 Science and Engineering 

Indicators Report shows that the U.S. severely lags the rest of the 

world in both real terms and on a percentage basis in the granting 

of first degrees in engineering with only 4.5 percent of first university degrees being granted in engineering versus 12.6 percent for 

the European Union and over 21 percent across Asia. Combined 

with the NSF findings that the average age and retirement rate of 

the engineering workforce will continue to rise over the next several years, our task force reiterates the need for robust S&T programs at DOD as critical to our economic competitiveness and national security. Several of the proposed reductions to individual 

S&T program elements are dramatic and could have negative impacts on future military capabilities. While basic research accounts 

are properly weighted under the President’s request, applied research, the 6.2 accounts would receive an 11.2 percent reduction. 

Applied research programs may involve laboratory proof of concept 

and are generally conducted at universities, government laboratories or by small businesses. Many successful demonstrations lead 

to the creation of small companies and 6.2 applied research has 

also funded the education of many of our best defense industry engineers. Failure to properly invest in applied research would stifle 

a key source of technological and intellectual development and 

stunt the creation and growth of small entrepreneurial companies. 

Advanced technology development, 6.3, would experience a dramatic 18.3 percent decline under the President’s budget. 

These resources support programs where ready technology can be 

transitioned into weapon systems. This line item funds research in 

a range of critical material technologies, including improved body 

armor to protect troops against IEDs and in developing lightweight 

armor for vehicle protection. With the problems faced in Iraq and 

Afghanistan with IEDs and the need for improved armor systems, 

it does not seem wise to cut materials research. 

Another key program for the defense S&T community is the university research initiative which supports graduate education in 

mathematics, science and engineering. Under the proposed budget, 

this program would see a 2.1 percent decrease to 335.9 million. 

Sufficient funding for the URI is critical to educating the next generation of engineers and scientists for the defense industry. A lag 

in program funds will have a serious long-term negative consequence on our ability to develop a highly skilled scientific and engineering workforce to build weapon systems for years to come. 

Mr. DICKS. You have 1 minute. 

Ms. SHARP. Thank you. While DOD has enormous current commitments, these pressing needs should not be allowed to squeeze 

out the small but very important investments required to create 

the next generation of highly skilled technical workers for the 

American defense industry. 

In closing, I have three recommendations from our task force. 

The first is that we urge the subcommittee to support the President’s request for the 6.1 basic research accounts for S&T programs. The second is that the task force recommends the subcommittee provide an additional $563 million in support for the 6.2 

applied research account function in order to ensure workforce and 

project stability in this critical area of defense research. 


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And third, we also recommend that the committee support the 

Pentagon’s stated goal of devoting 3 percent of the department’s 

baseline budget to Defense S&T program, 6.1, 6.2 and 6.3 accounts. 

I thank the committee for its ongoing support of defense science 

and technology. Our task force appreciates the difficult choices that 

Congress must make in this tight budgetary environment. We believe, however, that there are critical shortages in the DOD S&T 

areas, particularly in those that support basic research and technical education that are critical to U.S. military in the global war 

on terrorism and defense of our homeland. Thank you. 

[The statement of Ms. Sharp follows:] 


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Mr. DICKS. Thank you very much. I appreciate your statement. 

John Boslego, M.D., director of the Vaccine Development Global 

Program, PATH. I am very glad to have you here today. 

THURSDAY, MAY 20, 2010. 

PATH 

WITNESS 

JOHN BOSLEGO, M.D., DIRECTOR, VACCINE DEVELOPMENT GLOBAL 

PROGRAM 

Dr. BOSLEGO. Good morning, sir. My name is John Boslego and 

I am the director of the Vaccine Development Global Program at 

PATH. I would like to begin by thanking Chairman Norman Dicks 

and Ranking Member Bill Young for the opportunity to testify before the subcommittee. Chairman Dicks understands the mission at 

PATH, has been a strong supporter of PATH programs. 

I speak for all of my colleagues at PATH when I thank him for 

his support and key leadership on the issues that are critical to our 

work. PATH is an international NGO and creates sustainable, culturally relevant solutions enabling communities worldwide to break 

longstanding cycles of poor health. By collaborating with diverse 

public and private sector partners, we help provide appropriate 

health technologies and vital strategies that change the way people 

think and act. We wish to take this opportunity to recognize the 

specific and unique areas of expertise that the DOD brings to bear 

in advancing innovation that ensures people in low resource settings have access to lifesaving interventions and technologies. 

Through DOD, the U.S. Government is able to apply this core capacity to improving health throughout the world. The global health 

research efforts of DOD respond to diseases many Americans never 

see up close, but which military personnel stationed in developing 

worlds experience, alongside local communities. Medicines, vaccines 

and diagnostics for health threats that disproportionately affect the 

developing world are critical for their protection. Health is also an 

important factor in global stability and security. The heavy burden 

of disease in developing world hinders economic and social development, which in turn, perpetrates conditions that breed political instability. 

DOD health research therefore benefits not only the U.S. military but also has the potential to reduce this health burden, by 

doing so reduce the likelihood of physical conflict. PATH requests 

of fiscal year 2011 that the subcommittee provide robust support 

for DOD research and development programs aimed at addressing 

health challenges, particularly for military malaria vaccine development research, as well as for research at DARPA aimed at developing protective countermeasures and developing health care to 

military personnel and civilians in remote resource poor and unstable locations. 

More than one-third of the world’s population is at risk for malaria, with approximately 250 million cases each year. The most of 

nearly 1 million annual deaths from malaria are among children in 

Africa under the age of 5. According to the 2006 Institute of Medicine report, malaria has affected almost all military deployments 


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since the American Civil War and remains a severe and ongoing 

threat. 

The same report noted that a vaccine would be the best method 

of averting the threat of malaria, given the likely increasing number of deployments to high-risk areas. Military researchers within 

the military infectious disease program are at the forefront of efforts to develop the malaria vaccine. One example of DOD’s impact 

in malaria research is the most promising vaccine candidate in existence today. It is called RTSS. Research at Walter Reed contributed to the development of the vaccine candidate in early testing 

of RTSS created by GlaxoSmithKline was done in collaboration 

with the U.S. military. 

Today thanks to innovative partnership between GSK Bio and 

PATH, the malaria vaccine initiative works to accelerate development of malaria vaccines and assure their availability and accessibility in the developing world. RTSS is now in a large-scale phase 

3 trial, typically the last stage of testing prior to licensure. The 

U.S. Army is assisting in this trial by supporting one of the field 

sites in Kenya. Although the efficacy of RTSS in its current formulation is unlikely to prove adequate for military purposes despite 

its potential benefit to young children in Africa, it has shown that 

developing a vaccine against malaria is possible and paved the way 

for other development efforts that could ultimately allow the military to vaccinate its men and women against malaria before deploying them to endemic regions. 

Unfortunately, DOD’s spending on military infectious diseases 

research in general and specifically on malaria research has been 

declining for several years from levels that were already comparatively small given the historic impact of malaria on overseas deployments. Current funding levels are nowhere near what is needed to develop urgently needed countermeasures against malaria. 

PATH requests that the subcommittee reverse this trend and provide the resources needed to develop the necessary tools, including 

vaccines to protect soldiers, sailors, airmen and Marines from this 

deadly and debilitating disease. 

Another program making great contributions to research and development is DARPA. DARPA has identified as a priority the development of technologies that can both help the U.S. military and be 

of use to DOD sponsored humanitarian relief operations. One example is the technology pioneered by DARPA that has led to electrochemical generators of chlorine that may be able to fulfill a community’s need for effective disinfectants for water or surfaces by 

using just salt water and a simple battery source. PATH has 

partnered with Cascade Designs on a new generation of smart 

electrochlorinators that has the potential to expand the project initiated by DARPA to broader community reach for both military and 

civilian benefits. 

The device effectively inactivates bacteria, viruses and some protozoa to create safe drinking water. Since the generators can be 

powered by solar-charged batteries, they are accessible to communities that do not have electricity infrastructure. The costs are significantly less than required for the current large scale community 

systems, putting this solution within reach of very poor and small 

communities. The defense threat reduction agency, DTRA, is also 


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doing groundbreaking work as it investigates innovations in vaccine and chemical reagent thermostabilization and point of care diagnostic tests for infectious diseases. 

This has positive implications for global health and U.S. military 

support in low-resource settings. Such technologies will enable 

rapid pathogen identification in field and threat zones to more rapidly enlist target interventions. 

In conclusion, in light of the critical role that DOD plays in global health research and development and the fact that the investments in this area have been falling, we respectively request that 

the subcommittee provide the resources to maintain this important 

core capacity. We thank you very much for your consideration. 

Mr. DICKS. Let me ask you, the Gates Foundation is doing some 

significant work on malaria; isn’t that correct. 

Dr. BOSLEGO. Yes, sir. 

Mr. DICKS. Are you involved with that as well? 

Dr. BOSLEGO. Yes, we are. 

Mr. DICKS. That is what I thought. And you think that DARPA’s 

role in this is constructive? 

Dr. BOSLEGO. Yes, sir, very much so. Although DARPA is not 

working on the malaria piece per se. They are working on some of 

these newer innovations that would help, in this case, the purification of water. 

Mr. DICKS. On Homeland Security, we had some problems initially with vaccines and various other treatments for various things 

that could happen in that relationship. Has that relationship between Homeland Security and HHS improved or is it still pretty 

shaky? 

Dr. BOSLEGO. I cannot comment on that, sir. I am not familiar 

with those discussions. 

Mr. DICKS. There was a significant problem there. Thank you. 

Any other questions? Okay. Thank you very much. 

[The statement of Dr. Boslego follows:] 


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Mr. DICKS. Sherry S. Galloway, registered nurse, board member 

of ZERO, the project to end prostate cancer. 

THURSDAY, MAY 20, 2010. 

ZERO 

WITNESS 

SHERRY GALLOWAY, R.N., BOARD MEMBER, ZERO, THE PROJECT TO 

END PROSTATE CANCER 

Ms. GALLOWAY. Mr. Chairman, members of the committee, thank 

you very much for the opportunity to speak to you today about the 

Prostate Cancer Research Program and the congressionally directed medical research programs at the Department of Defense. 

Many people can speak to you effectively about the research this 

program has done or is doing, about its history, funding levels and 

accomplishments. But I want to talk to you about how we can affect the future of prostate cancer research by looking at two men 

in my life who fought this deadly disease. My husband, Tom, and 

my son, Jeremy. When we leave here today, I hope you understand 

why I hold out hope for the future that research promises to give 

us and why I ask you to increase prostate cancer research funding 

so that the PCRP can lead us there. 

My name is Sherry Galloway. I am a nurse, a mother, a wife and 

a sister. I have a personal relationship with prostate cancer after 

watching its horrific impact on both my son and my husband. My 

husband’s diagnosis was made when he was 54 and that made a 

little more sense at that age to me, although that is not old. And 

we do think of this disease often as an old man’s disease. The 

treatment my husband received was not without side effects. His 

nerve-sparing prostatectomy left him impotent. While that persists 

today at 60, he is alive and cancer free. I would give anything to 

have my son alive and cancer free. Jeremy’s prostate cancer was 

diagnosed 4 years after my husband’s and he was 35 years old. 18 

months later he was dead. 

When he was 34, Jeremy complained of back pain that would not 

subside. He was fit, he was healthy and strong. He turned 35 in 

Burma where he was delivering medicine to villages there. When 

he returned home, he felt tired and he was still in unremitting 

pain. He was having night sweats. So he went to an infectious disease specialist thinking maybe he had caught something in the jungle or in the forest. They did blood tests and found that he was 

walking around with almost no platelets. They sent him to the ER. 

His own physician reviewed his MRI, saw that he had no platelets 

and they immediately thought of lymphoma, which is more typical 

in young men. They also thought about testicular cancer also in 

young men. And both are very treatable. His first bone biopsy revealed cells that were suspicious of prostate cancer, however the 

oncologist couldn’t believe that. So they continued to test him, 

transfuse him and look for everything else. And finally they called 

in a urologist. At that time, my son’s DRE was normal and 

ultrasound of his prostate was normal. His PSA was 441. When repeated, it was more like 460. At that time, he was diagnosed with 

advanced metastatic hormone refractory prostate cancer. Three 


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months later—actually the hormones after 3 months. It was hormone refractory. The hormones did not work. 

When you looked at his CAT scan, his bone scan, all you saw was 

black throughout his axial skeleton and his clavicle with little spots 

on his brain. That was all tumor. So his back pain was due to his 

metastasis, not due to the prostate cancer which was asymptomatic, completely. Jeremy was married on a Saturday in September of 2006 and 2 days after his wedding he started chemotherapy. Things began to slip for him about a year after his diagnosis. There were nights when he would sit in a hot tub with 

Epsom salts and just sob because he was in pain and he was depressed and scared. 

And I would just sit by the tub. There was nothing I could do 

but listen. On good days, he dedicated time to research. He discovered numerous prostate cancer research projects, each one of which 

became a source of hope for us. He was started in the Provenge 

trials, clinical trials. Unfortunately he was in the control group. So 

he never received the Provenge which today is an accepted treatment for advanced metastatic prostate cancer. That was a huge 

disappointment. 

Later he was accepted into an experimental treatment at the 

University of Oregon in which he would have received a mini 

allogenic total bone marrow transplant. Fortunately, the approval 

of this came about 3 days before he died. So he was unable to get 

this. Jeremy accepted being experimented on with grace, even 

when elephant doses of pain medication did not work. He was in 

excruciating bone pain 24/7. He couldn’t sit, he couldn’t stand, he 

couldn’t lay down anywhere without pain. He slept through most 

of his first wedding anniversary because he was so highly drugged 

and in so much pain. And his wife had to sit there alone and sometimes with me because Jeremy couldn’t play, although he tried to 

remain positive about his life. 

For 33 years, Jeremy was healthy and he worked tirelessly for 

human rights and environmental sustainability. Among his many 

accomplishments was a special award given to him while he was 

sick by the Rain Forest Action Network. He also brokered an agreement between several guitar companies and Greenpeace whereby 

no old growth forest trees would be used in the manufacture of guitars. Six weeks before his death, I literally had to kidnap him from 

the hospital so he could go get his award. We had to cover up our 

dress clothes with hospital gowns and sneak out of the hospital and 

go in a rickety RV to get him to these awards. I wheeled him down 

the aisle to a standing ovation of over 300 people. 

Then he stood up on the stage and spoke with such power that 

during those moments, it was hard to imagine that he was so sick. 

After receiving his award and returning to the hospital, the staff 

came in and spoke with him and his wife and then his father and 

I were asked to join them while they gave the talk about preparing 

for the end of life. It was the speech where they kindly ask you 

whether you want to just continue with treatment that isn’t going 

to work or you want to go home. Jeremy and Beth decided that Jeremy would die at home. During the final weeks of his life, Jeremy 

was in agony. There were no comfortable positions. He vomited and 

retched repeatedly and with extreme force because of all the radiVerDate Mar 15 2010 03:50 Jun 11, 2011 Jkt 066611 PO 00000 Frm 00355 Fmt 6602 Sfmt 6602 E:\HR\OC\A611P2.XXX A611P2

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ation treatments he had had that went through his abdomen to affect his spine to keep from paralyzing him. He took medication for 

pain, nausea, constipation, appetite, anxiety and sleep. He began to 

wander at night, even on medication, and maybe because of it. 

His friends organized into teams so 2 or 3 of us would be with 

Jeremy around the clock. I slept so little that Jeremy’s friends 

nicknamed me ‘‘zombie mom.’’ Jeremy’s morphine pump wasn’t 

working and he became incontinent of stool and urine. My proud, 

strong, beautiful son would stand docile at the toilet while his wife 

or I wiped a continuing stream of stool that was running down his 

legs until it stopped and we could put a diaper on him. We had diapers, we had clothing, we had water and medication with us at all 

times if we did go outside. Jeremy’s ankles became so swollen and 

painful that he could barely walk. 

In Jeremy’s final days, his diet consisted largely of mashed potatoes, which is all he wanted most of the time. He also ate his favorite cookies that I baked for him and special granola that his stepsister made for him. He slept on a hospital bed in his living room 

and at night he would pull himself up and with help shamble into 

the bedroom to kiss his wife goodnight. When he could, he would 

sit at his computer and try to do a little work. There are some pictures here of him healthy and also in these final stages that I will 

pass around for you to look at. He tried to do a little e-mail. And 

then finally he just opted to stop. He just stopped eating, stopped 

drinking and asked the hospice nurses to up his morphine so he 

could sleep his last days away. It was Thanksgiving week of 2007 

and he slept but was restless. He had fallen out of bed a week earlier when friends couldn’t stay awake and he was in constant pain 

every time he even moved in bed. He began to have that nauseatingly sweet smell of ketosis that has when your body is wasting. 

The day before Thanksgiving, he woke up in the afternoon and told 

my husband and I very clearly I am dying, but it is all right. 

And he had a smile on his face. He said some very loving things 

to us and went back to sleep. That night he actually awoke and 

sang and chanted with his friends. That was the last time he woke 

up. On Thanksgiving day, he did not wake up again, although his 

eyes were slightly open at all times and his mouth was hanging 

open. But he was not conscious. On Friday, the day after Thanksgiving, my sister’s 50th birthday, the autumn weather was gentle 

and the space was quiet, respectful. We sang and read to Jeremy. 

We wandered around. We were tired, we were exhausted and wandering and waiting. That night at about 7:00, I could tell that his 

breathing had changed and I knew the end was coming. He died 

peacefully, his wife holding his right hand and me holding his left 

as I had promised. His dad, step-dad, siblings and friends were all 

there as were my sister and best friend. 

A helium balloon that had been floating about the room for several days slipped out the window and floated skyward. Jeremy had 

a peaceful look on his face for the first time in months. We send 

our sons off to war and they may not come back or they come back 

less than whole when they left home. We send them off to college 

not knowing where they will go from there but still we have hope 

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ened, he was in jungles. He was not safe. I knew this and I feared 

for him, but at the same time I was proud. I never expected that 

prostate cancer would kill him. Prostate cancer took away my hope. 

I learned that it is an old man’s disease and I know that it is not. 

300 men die each year in the United States under the age of 40. 

If that is not enough for you to fund research, then look at the almost 30,000 men that will die this year alone in the United States 

from prostate cancer. We need to increase funding. What I have described to you today is the life of someone dying of a highly aggressive form of prostate cancer. This is not rare. His own oncologist 

is the same age and has lost 4 young men to prostate cancer and 

many more older men. Perhaps if a more accurate test for prostate 

cancer existed, my child would have known about his cancer earlier 

and he could be here talking to you himself. 

I will never know because there just aren’t enough funds to do 

all the research that needs to be done. Perhaps had the research 

been done on newer techniques, my husband would not be impotent. It is because of the research we know that it does not work. 

There is no question that the PSA is not a good enough diagnostic 

test but it is all we have. There is no question that there are aggressive cancers that we cannot watch and wait. Prostate cancer 

kills more men than any cancer except lung cancer and has a mortality rate comparable to breast cancer. Each month, I read another 

article about the inadequacy of the PSA test and each day I wait 

for a better test. And every day I question why more and more 

funding seems to go to a few types of cancer, none of which are the 

greatest killer of men in this country. It is one thing to criticize the 

test we currently have to screen men for this insidious killer and 

quite another to find a viable solution. 

Unless you increase funding for the Prostate Cancer Research 

Program, I fear good research will be left unfunded. No one is asking you to make the same sacrifice Jeremy made. No one is asking 

you to go through the pain that my son went through, the embarrassment, the deterioration and a very horrific and painful death. 

All I ask is that you consider increasing funding for prostate cancer 

research so that no more mothers, children, husbands, wives have 

to suffer the way my family has. Thank you for your time. 

[The statement of Ms. Galloway follows:] 


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Mr. DICKS. Thank you for your very compassionate statement. 

We appreciate it very much. Any questions? Thank you. Jonathan 

W. Simons, Prostate Cancer Foundation. Welcome. 

THURSDAY, MAY 20, 2010. 

PROSTATE CANCER FOUNDATION 

WITNESS 

JONATHAN SIMONS, M.D., PRESIDENT AND CHIEF EXECUTIVE OFFICER, PROSTATE CANCER FOUNDATION 

Dr. SIMONS. Thank you very much. I am Dr. Jonathan Simons. 

I am the President and chief executive officer of the Prostate Cancer Foundation. Nothing I can say can be as profound or as important as what Ms. Galloway said about her son. I am just speaking 

on behalf of the other 27,000 families that aren’t here right now 

from 2009 that could not articulate the pain and the courage of the 

experience of human prostate cancer. 

In the last 22 years, I have been involved myself as an oncologist 

and the scientist funded by the American taxpayer in the care of 

over 1,000 prostate cancer patients. Today I lead a foundation that 

in its 17-year history has raised over $400 million through the 

Prostate Cancer Foundation and actually funded 1,200 laboratories 

around the United States and America and the world in order to 

see a cure for prostate cancer and eradicate death and suffering. 

Our single and total goal is to put ourselves out of business as a 

foundation and end suffering from prostate cancer. What the committee doesn’t know is that probably in the entire history you have 

been briefed—certainly Chairman Murtha was briefed this quietly—last year we reduced deaths from prostate cancer since projected from 1993. 

In fact, a 30 percent reduction in deaths doesn’t bring back Jeremy Galloway. But actually between 1993 and 2010, 180,000 American men have not died from prostate cancer who were projected 

to through a concerted effort of earlier detection, advocacy, better 

care and biomedical research supported by the defense appropriations committee, the National Cancer Institute, the Prostate Cancer Foundation. If we did nothing more except for never except the 

unacceptable, by 2013, with that reduction in death rate, we would 

have saved more American men’s lives than have died in the history of American warfare on the battlefield from Bunker Hill to the 

Persian Gulf, which is actually a pretty remarkable statement, 

which I expect the committee has not heard either. But if you save 

the half a million American lives by 2039 with the current effort, 

you would still be losing an American man, whether young or old 

by your definition, every 19 minutes around the clock, 365 days a 

year. 

Prostate cancer is a molecular form of terrorism and one of the 

greatest threats to the lives of the citizens of the American people. 

Now, it is true that prostate cancer is complicated. The committee 

will learn in July at a press conference we will hold that out of Ann 

Arbor there are 24 kinds of prostate cancer. The American people’s 

investment in the human genome research has actually brought us 

a very interesting and complicated story. Unlike breast cancer, unVerDate Mar 15 2010 03:50 Jun 11, 2011 Jkt 066611 PO 00000 Frm 00369 Fmt 6602 Sfmt 6602 E:\HR\OC\A611P2.XXX A611P2

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like colon cancer, there are 24 kinds of prostate cancer. You can see 

it in the DNA and it is unique to prostate cancer. What would that 

mean? One, it would mean you have gotten a huge return on your 

investment out of this committee. Because after our foundation, 

which has put over $8 million into it, the second leading funder of 

this research has been the Department of Defense, a congressionally mandated research program. The understanding of these genes 

has come from the National Cancer Institute and the NIH. It is a 

concert, a symphony concert of public-private partnership and biomedical research but where American people are giving philanthropically, paying taxes and actually medical scientists and patients like the Galloways and their families have all come together. 

July of this year is one of the most important months in the history of over 50 years of concerted prostate cancer research. If there 

are 24 kinds of prostate cancer, what could that mean? Well, it 

could mean that there is a kind of prostate cancer that will never 

take your life and it will probably show up when you are 80. There 

is a kind of prostate cancer that can strike you down by 50. And 

actually there ought to be a test for everyone. When we indict the 

PSA test as being an insufficient test, which it is, we are actually 

only indicting our ignorance in our inability to sort of prosecute, so 

to speak, molecular diagnostics. 

But now we have this ability and actually the DOD has the program in place, which I will discuss in a second, to actually fast forward progress. The other thing is I have no personal relationship 

with Don Berwick and CMS. But if I were running CMS in August, 

one of the most important contributions in diagnostics for cancer 

would have actually come out of the DOD. This test of 24 clona 

types or what kind of clone it is should change forever the future 

of prostate cancer care. 

I cannot speak to the pain and suffering of Sherry Galloway, but 

I can actually make a specific set of recommendations for the committee to consider. In my testimony, I have asked the committee 

to consider $40 million over the additional 80 million to fast forward three things that would improve the lives of families like the 

Galloways in the future. One would be to simply put $10 million 

into fast forwarding this new kind of test. It is cancer specific. It 

is prostate cancer specific and the DOD already has that infrastructure. Secondly, the committee has probably not been briefed, 

but there are four drugs up for FDA approval this year, Provenge, 

the vaccine which did not work for Jeremy Galloway, which was 

just FDA approved; Abiraterone, which was just in license by Johnson & Johnson up for phase III review. 

There is also going to be Ipilimumab and there will be MDV3100. 

All four of these new medicines in phase III trials came through 

the Department of Defense prostate cancer clinical trials program 

in cities like Portland, Seattle, Baltimore, Ann Arbor. Actually 

through an early clinical trials network which is not supported by 

the National Cancer Institute but actually is funded by your appropriation, run by the doctors, the same doctors that are NCI cancer 

centers. This is widely unappreciated as well. But again, prostate 

cancer has been largely underappreciated in American life historically. All this being said, there is a lot more work to do in biomedical research. The public debate around PSA is really a debate 


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about a better test and I submitted the data to your taxpayers 

money and mine. 

We actually have real hope for patients if we can fast forward 

that kind of research. What is interesting, though, is also that the 

DOD congressionally mandated research program asks scientists 

like myself and doctors like myself to do three things that are unusual in NCI funding or NIH funding which are largely underappreciated. 

When I had the occasion to talk with Chairman Murtha last 

year, he squinted and he said why don’t we know more about this. 

What he is referring to is that when you get a grant which I have 

gotten several in my career at Emory University, and before that 

on the faculty of Johns Hopkins from the DOD from this program, 

you are expected to provide milestones and actually endpoints and 

contingencies just in the same kind of culture that logistics and 

procurement are a part of life in the military. 

And since I am the son of the greatest generation GI Bill father, 

I kind of got it although at first when I was asked to provide 

timelines for my research I said this is not your NIH as I knew 

it. If you want to put patients on clinical trials, if you want to 

study how vaccines work, if you wanted to define genes and you 

are held somewhat accountable to simply report your progress, it 

has turned out that most cancer scientists and physicians like myself enjoy it, welcome it because the program also incentivizes higher performance. 

It is the first Federal program for biomedical research where actually some of the culture of excellent tactics in the field are rewarded in cancer research. Completely unexpected as a consequence of giving Captain Kami or others actually in the Pentagon 

control the program. It is not a workaround. 

It is a new invention in cancer research. And I would recommend 

to the committee that it ought to be reviewed as it actually may 

be better practice for certain aspects of our NIH right now. Lastly, 

with the 24 kinds of prostate cancer, there are a significant number of new medicines that might be developed for a Jeremy Galloway. In fact, if you have a disease that is now 24 diseases but it 

looks like one under the microscope, it is no different than saying 

if you have 24 diseases you have 24 treatments. For our biotech 

and pharmaceutical industry there is a huge opportunity and most 

practically in terms of asking for 20 million to fast forward new 

medicines, 10 million for a new better test than the PSA, 10 million 

for additional clinical trials—yeah, go ahead. 

Mr. DICKS. You have 1 minute. 

Dr. SIMONS. I have got it. In addition to doing all these things, 

I cannot emphasize enough the courage of the patients and families 

that participate in these clinical trials, Mr. Chairman. Without 

DOD funding, the progress I reviewed for you today would not have 

happened. Thank you. 

Mr. DICKS. Thank you. Another very compelling case. 

Ms. KILPATRICK. Mr. Chairman. 

Mr. DICKS. Yes, Ms. Kilpatrick. 

Ms. KILPATRICK. Thank you, Mr. Chairman. Why would the National Cancer Institute not approve a DOD project for their doctors 


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and researchers to participate in as well? Is it competition or is it 

who is the best or—— 

Dr. SIMONS. It is just that NCI doesn’t fund it. In prostate cancer, early clinical trials, there is not a program at NCI for early—— 

Ms. KILPATRICK. So they don’t—— 

Dr. SIMONS. The DOD funds it. 

Ms. KILPATRICK. Right. So they fund it, but you ought to be partners in the illness because it is catastrophic. 

Dr. SIMONS. I agree, Ms. Kilpatrick. But the last time that prostate cancer research was reviewed, I was on the panel, was in the 

Clinton administration for coordination between the DOD. After 9/ 

11, a lot of things happened in this country. But a research strategy for American medical research did not take place in the last— 

we haven’t—our government hasn’t actually looked at our strategy 

in prostate cancer for 10 years. 

Ms. KILPATRICK. Thank you. 

[The statement of Dr. Simons follows:] 


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Mr. DICKS. The committee is adjourned until early June when 

testimony will be provided by the head of the U.S. Special Operations Command. Thank you. 

[The following organization, Aplastic Anemia & MDS International Foundation did not appear before the committee but submitted testimony for the record:] 


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