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43–248 2008

[H.A.S.C. No. 110–111]

HEARING

ON

NATIONAL DEFENSE AUTHORIZATION ACT

FOR FISCAL YEAR 2009

AND

OVERSIGHT OF PREVIOUSLY AUTHORIZED

PROGRAMS

BEFORE THE

COMMITTEE ON ARMED SERVICES

HOUSE OF REPRESENTATIVES

ONE HUNDRED TENTH CONGRESS

SECOND SESSION

MILITARY PERSONNEL SUBCOMMITTEE HEARING

ON

BUDGET REQUEST ON THE VIEWS OF

MILITARY ADVOCACY AND BENEFICIARY GROUPS

HEARING HELD

FEBRUARY 7, 2008

(II)

MILITARY PERSONNEL SUBCOMMITTEE

SUSAN A. DAVIS, California, Chairwoman

VIC SNYDER, Arkansas

LORETTA SANCHEZ, California

NANCY BOYDA, Kansas

PATRICK J. MURPHY, Pennsylvania

CAROL SHEA-PORTER, New Hampshire

NIKI TSONGAS, Massachusetts

JOHN M. MCHUGH, New York

JOHN KLINE, Minnesota

THELMA DRAKE, Virginia

WALTER B. JONES, North Carolina

JOE WILSON, South Carolina

DEBRA WADA, Professional Staff Member

JOHN CHAPLA, Professional Staff Member

ROSELLEN KIM, Staff Assistant

(III)

C O N T E N T S

CHRONOLOGICAL LIST OF HEARINGS

2008

Page

HEARING:

Thursday, February 7, 2008, Fiscal Year 2009 National Defense Authorization

Act—Budget Request on the Views of Military Advocacy and Beneficiary

Groups ................................................................................................................... 1

APPENDIX:

Thursday, February 7, 2008 ................................................................................... 39

THURSDAY, FEBRUARY 7, 2008

FISCAL YEAR 2009 NATIONAL DEFENSE AUTHORIZATION ACT—BUDGET REQUEST ON THE VIEWS OF MILITARY ADVOCACY AND BENEFICIARY GROUPS

STATEMENTS PRESENTED BY MEMBERS OF CONGRESS

Davis, Hon. Susan A., a Representative from California, Chairwoman, Military Personnel Subcommittee ............................................................................. 1

McHugh, Hon. John M., a Representative from New York, Ranking Member,

Military Personnel Subcommittee ...................................................................... 2

WITNESSES

Barnes, Joseph L., National Executive Director, Fleet Reserve Association ...... 6

Becker, F. Jed, Vice Chairman, Armed Forces Marketing Council ..................... 12

Bowers, Todd, Director of Government Affairs ..................................................... 3

Johnson, David, Chairman, American Logistics Association ............................... 10

Moakler, Kathleen B., Director, Government Relations, The National Military

Family Association ............................................................................................... 7

Strobridge, Col. Steve, (Ret.), Director, Government Relations, Military Officers Association of America, U.S. Air Force ....................................................... 9

APPENDIX

PREPARED STATEMENTS:

Becker, F. Jed ................................................................................................... 71

Bowers, Todd ..................................................................................................... 49

Davis, Hon. Susan A. ....................................................................................... 43

Johnson, David ................................................................................................. 54

McHugh, Hon. John M. .................................................................................... 47

Moakler, Kathleen B. ....................................................................................... 85

Statement of The Fleet Reserve Association by Joseph L. Barnes .............. 121

Statement of The Military Coalition presented by Col. Steven P.

Strobridge, Joseph L. Barnes, and Kathleen B. Moakler .......................... 133

DOCUMENTS SUBMITTED FOR THE RECORD:

Duffy, Peter J., Deputy Director Legislation, National Guard Association

of the United States ...................................................................................... 187

Page

IV

DOCUMENTS SUBMITTED FOR THE RECORD—CONTINUED

Iraq and Afghanistan Veterans of America Issue Report, January 2008

on Mental Health Injuries, The Invisible Wounds of War ........................ 218

Statement of The Naval Reserve Association ................................................ 205

Statement of the Reserve Officers Association of the United States ........... 195

QUESTIONS AND ANSWERS SUBMITTED FOR THE RECORD:

Mrs. Boyda ........................................................................................................ 238

Mrs. Davis ......................................................................................................... 237

Mr. McHugh ...................................................................................................... 238

(1)

FISCAL YEAR 2009 NATIONAL DEFENSE AUTHORIZATION ACT—BUDGET REQUEST ON THE VIEWS OF MILITARY ADVOCACY AND BENEFICIARY GROUPS

HOUSE OF REPRESENTATIVES, COMMITTEE ON ARMED SERVICES, MILITARY PERSONNEL SUBCOMMITTEE, Washington, DC, Thursday, February 7, 2008.

The subcommittee met, pursuant to call, at 3:04 p.m., in room

2212, Rayburn House Office Building, Hon. Susan A. Davis (chairwoman of the subcommittee) presiding.

OPENING STATEMENT OF HON. SUSAN A. DAVIS, A REPRESENTATIVE FROM CALIFORNIA, CHAIRWOMAN, MILITARY

PERSONNEL SUBCOMMITTEE

Mrs. DAVIS. Good afternoon, everybody. Thank you for being

here. I want to call this meeting to order.

I want to thank all of you for your attendance today. And we understand that it has been relatively short notice, although you

seem very well prepared. So I hope that we were able to give you

the kind of information that you need.

Our hearing today focuses on the views of military advocacy and

beneficiary groups. Similar to last year, we have invited a handful

of organizations to testify on a wide range of programs and policies

that affect our servicemembers, retirees, and their families.

Historically, as you all know, many of these organizations have

been asked to share their views at individual hearings that focused

on specific topics. And that has been very useful, of course, to the

subcommittee. But sometimes we were only able to hear from people on a specific hearing topic. And so, we haven’t been able to necessarily put that into a full context and see many of the competing

requests that you all naturally are going to be bringing and that

come from your organizations.

I know last year we were interrupted by a series of votes. But

the subcommittee did find it informative to have just a beneficiaryfocused hearing.

In anticipation of the hearings that the subcommittee will have

on a wide range of topics, we thought it would be helpful again

today to hear from the advocacy and from the beneficiary organizations as we begin our efforts to go out to members’ districts as well

and to see firsthand these issues and how that insight might help

us as we develop the Fiscal Year 2009 National Defense Authorization Act (NDAA), which is what we are going to be doing, as you

know, in the coming year.

Given that we will have limited resources—and I think that is

no surprise to anybody—and especially the difficulty in finding

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mandatory spending to address a multitude of needs, we hope that

the subcommittee will be able to hear from you about what your

key priorities are for the servicemember and for their families.

I want to welcome you all today. Mr. Todd Bowers, Government

Relations Director for Iraq and Afghanistan Veterans of America;

Mr. Joseph Barnes, National Executive Secretary for the Fleet Reserve Association; Mrs. Kathleen Moakler, Director of Government

Relations Department, National Military Family Association; Colonel Steve Strobridge, USAF, Retired, Director, Government Relations Military Officers Association of America; Mr. David Johnson,

Chairman of the Board, American Logistics Association; and Mr.

Jed Becker, Vice Chairman of the Armed Forces Marketing Council.

I wanted to mention that Mr. Barnes, Mrs. Moakler, and Colonel

Strobridge are here not just to represent their individual organization, but you are here also to represent the positions of The Military Coalition (TMC), which is comprised of over 30 uniformed

services and veterans organizations. And we know they all would

love to be at the table. So you have a special burden on you today.

Given the time limitations, of course, we cannot hear from everybody, so we have asked the coalition to represent its members

today.

I want to thank all of you, thank you for your testimony. And

we look forward to the hearing today.

And I want to turn to Mr. McHugh and see if he has any comments that he would like to make.

[The prepared statement of Mrs. Davis can be found in the Appendix on page 43.]

STATEMENT OF HON. JOHN M. MCHUGH, A REPRESENTATIVE

FROM NEW YORK, RANKING MEMBER, MILITARY PERSONNEL SUBCOMMITTEE

Mr. MCHUGH. Thank you, Madam Chairman. I will try to be very

brief. I would ask that my full statement be entered in the record

in its entirety. And let me note that I think you covered the waterfront pretty effectively, and your speech could stand in good stead

for mine, in fact. But let me add my words of welcome to all of our

panelists.

Most of them represent organizations that are certainly no

stranger to this subcommittee. And we thank them, as you noted,

Madam Chair, for their continued advocacy for the systems that

their members rely upon and for those concerns that their members bring to them.

And all of you really provide an invaluable link between folks

that we need to focus on and care a great deal about and their concerns and help us better understand what we need to do. I want

to give a particular tip of the hat to Mr. Bowers, whose first appearance here, particularly in his association with Iraq and Afghanistan Veterans of America, shows the continuing sacrifices and

service that our men and women in uniform make. And we look

forward to your comments.

As you noted, Madam Chair, all of the groups didn’t have a lot

of forewarning. As I looked at the presentation of the formal testimony for The Military Coalition, about 50 pages and 50 issues they

3

raised, we may want to compress it even more next year. But I

think what that does show, in all seriousness, is how broad the

range of challenges that we face.

And as you noted, Madam Chair, every dollar we have to spend we probably have $1,000 or more in places that we could well expend it. And again, to echo your words, Madam Chair, the fact that

we can benefit from the focus and from the prioritizations that our

presenters will provide to us here today is very, very important.

And as we go forward in the rest of the hearings, this our first,

as the chairwoman noted, in the development of the Fiscal Year

2009 NDAA, we certainly look forward to working with all of you.

And ultimately, at least I would strongly recommend, working with

Chairman Skelton and, of course, the ranking member and others

and having our imprint on the House Armed Services Committee

(HASC) view and estimates letter to go the Budget Committee. Obviously we need to make sure that we weigh in and do our best to

try to extract the resources under that process that would be necessary in this challenge.

So thank you, Madam Chair, for the leadership in bringing us together here today. And I look forward to everybody’s testimony.

[The prepared statement of Mr. McHugh can be found in the Appendix on page 47.]

Mrs. DAVIS. Thank you. Thank you, Mr. McHugh. I think we are

just going to go down the line.

Mr. Bowers, if you would like to start. And we will go ahead and

hear everyone’s testimony and then take questions. Thank you.

STATEMENT OF TODD BOWERS, DIRECTOR OF GOVERNMENT

AFFAIRS, IRAQ AND AFGHANISTAN VETERANS OF AMERICA

Mr. BOWERS. Thank you. Ms. Chairman, ranking member, and

distinguished members of the committee, on behalf of the Iraq and

Afghanistan Veterans of America (IAVA) and our thousands of

members nationwide, I thank you for the opportunity to testify

today regarding military personnel policies and programs.

As the war in Iraq continues into its fifth year, this generation

of troops faces new and unique problems. Today IAVA is releasing

our annual legislative agenda. Our legislative agenda covers the

entire warfighting cycle, before, during and after deployment, and

outlines practical solutions to the most pressing problems facing

Iraq and Afghanistan veterans today.

In my ten-year career as a Marine reservist I have had the honor

of serving in Iraq twice. During these tours it became clear to me

that taking care of the individual on your left and right is paramount to accomplish your mission. Only when I returned home did

I understand that taking care of the people you served with once

you get home is just as important.

This is not only a moral issue, but it is a national security concern. A rifle is only as strong as the mind controlling it.

Our 2008 legislative agenda is now available on our website. And

excuse the shameless plug, but if everybody goes to www.iava.org,

they can see what I have brought for the committee today.

We also have along with our legislative agenda reports on many

issues facing veterans today, things ranging from traumatic brain

injury (TBI), mental health injuries to many others.

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I have brought copies of our legislative agenda and reports with

me today for your convenience. In the interest of brevity today I

limit my testimony to our key proposals regarding mental health.

Rates of psychological injuries among new veterans are high and

rising. At least 30 to 40 percent of Iraq veterans, or about half a

million people, will face a serious psychological injury, including

depression, anxiety, or post-traumatic stress disorder (PTSD).

Multiple tours and inadequate time at home between deployments increase rates of combat stress by 50 percent. The ramifications of psychological injuries are clear. Untreated mental health

problems can and do lead to unemployment, domestic violence, substance abuse, homelessness, and in worse scenarios, suicide.

Twenty percent of married troops in Iraq say that they are planning a divorce. At least 40,000 Iraq and Afghanistan veterans have

been treated at a Veterans Administration (VA) hospital for some

form of substance abuse. The current Army suicide rate is the highest it has been in 26 years.

Reports released just last week found a 20 percent increase in

the number of suicide attempts in the Army alone. The first step

to coping effectively with the mental health crisis is addressing the

stigma attached to receiving mental health treatment.

More than half of soldiers and Marines in Iraq who test positive

for a mental health injury are concerned that they will be seen as

weak by their fellow servicemembers. One in three of these troops

worry about the effect of a mental health diagnosis on their career.

As a result, many troops who need care do not seek treatment.

IAVA supports efforts already underway to reduce mental health

stigma. The Air Force, for instance, has seen a 30 percent drop in

suicide rates since the institution of a comprehensive suicide-prevention campaign. IAVA recommends creating a Department of Defense (DOD)-wide initiative to share best practices for mental

health treatment, including outreach and education regarding mental health for both troops and most importantly, their families, and

an emphasis on education for military leaders in the service and

leadership academies.

In addition, servicemembers suffering from service-connected

mental health issues should not be improperly penalized for their

injuries. IAVA recommends imposing an immediate moratorium on

military discharges for personality disorders until an audit of past

personality discharges is completed.

Moreover, troops should be able to seek voluntary alcohol and

substance-abuse counseling and treatment without the requirement

of command notification. Such notification could be at the discretion of the treating mental health professional.

Finally, IAVA supports amending the Uniform Code of Military

Justice (UCMJ) to establish a preference for mental health treatment over criminal prosecution for military suicide attempts. I am

proud to announce that IAVA has partnered with the Advertising

Council, also known as the Ad Council, on a very important project

that will have nationwide impact on stigma that is often associated

with members of our military who seek mental health treatment.

Over the next three years, IAVA will be working with the Ad

Council on a massive media campaign aimed at informing the

American public and our Nation’s military that seeking help is a

5

sign of strength rather than weakness. We hope that the outcome

of our efforts will be an American public that is more understanding of the difficulties that veterans face when they reintegrate into

society.

But in addition to addressing stigma, the Department of Defense

must do a better job of screening troops for mental health problems. The current system of paperwork evaluations, the Post-Deployment Health Assessment (PDHA) and Post-Deployment Health

Reassessment (PDHRA), is ineffective.

A 2006 study led by Army Colonel Charles Hoge, MD, at the

Walter Reed Army Institute of Research, looked at the results of

Iraq veterans’ PDHAs. Only 19 percent of those returning from

Iraq self-reported a mental health problem. But 35 percent of those

troops actually sought mental health care in the year following

their deployment.

If the PDHA is intended to correctly identify troops who will

need mental health care, it simply does not work. A follow-up study

in 2007, also published in the Journal of the American Medical Association, concluded, ‘‘Surveys taken immediately on return from

deployment substantially underestimate the mental health burden.’’

Although the PDHRA, which troops fill out six months after deployment, is more likely to identify mental health injuries, its overall effectiveness is also dubious. Troops may not be filling out their

forms accurately. Troops needing counseling are not consistently

getting referrals. And those with referrals do not always get treatment. IAVA therefore supports mandatory and confidential mental

health and traumatic brain injury screening by a mental health

professional for all troops, both before and at least 90 days after

a combat tour.

After stigma and inadequate screening, the final barrier to mental health care is lack of access. The number of licensed psychologists in the military has dropped by more than 20 percent in recent

years. Less than 40 percent of troops with psychological wounds

are getting treated.

Funding within the Department of Defense must be focused on

current shortages of mental health professionals. IAVA recommends a study of reasons for attrition among military mental

health professionals and the creation of new recruitment and retention incentives for mental health care providers such as scholarships or college loan forgiveness.

Military families with TRICARE should have improved access to

mental health care services. And active duty families should be

given unlimited access to mental health care and family and marital counseling on military bases.

I thank you for providing me the opportunity to testify before you

this afternoon. I hope that the information I have provided will

help to lay the groundwork for the committee to eliminate the obstacles that our Nation’s newest veterans are facing. It would be

my pleasure to answer any question you may have at this time.

Thank you.

[The prepared statement of Mr. Bowers can be found in the Appendix on page 49.]

Mrs. DAVIS. Thank you. Thank you, Mr. Bowers.

6

And I let Mr. Bowers go about one and a half minutes over. And

if everybody can try and stay in the five minutes, that would greatly appreciated. I know that your time is very precious, and we

want to hear from you. So if you can do that, great. We will let you

go over just a little bit. But that doesn’t include all of us up here,

of course.

Please, Mr. Barnes.

STATEMENT OF JOSEPH L. BARNES, NATIONAL EXECUTIVE

DIRECTOR, FLEET RESERVE ASSOCIATION

Mr. BARNES. Madam Chairwoman, Mr. McHugh, and distinguished members of the subcommittee, thank you for this opportunity to present the concerns of The Military Coalition. The extensive coalition statement reflects the consensus of TMC organizations and extensive work by eight legislative committees, each comprised with representatives from the coalition’s nearly three dozen

military and veterans organizations. I will briefly address key Active Duty, Guard and Reserve, and retiree issues, and my colleagues will then address other issues.

But first, I wish to thank you and the entire subcommittee for

the steadfast and strong support of our military personnel, retirees,

veterans, their families, and survivors, and particularly for recently

enacted wounded warrior enhancements. Sustaining adequate Active, Guard and Reserve end strength to effectively prosecute the

war effort and other demanding operational commitments is vital

to our national security. And TMC urges strong support for Army

and Marine Corps end strength increases in fiscal year 2009 and

beyond.

Wearing down the force contributes to serious morale, readiness,

and retention challenges. And the coalition remains concerned

about the Air Force and Navy’s ambitious end strength reductions.

Restoring military pay comparability remains a top priority, and

TMC urges this distinguished subcommittee to authorize at least a

3.9 percent pay hike. We appreciate your leadership authorizing

past higher than employment cost index (ECI) active duty pay

hikes. And despite significant progress on compensation levels, a

3.4 percent gap continues.

Housing standards determine local housing allowance rates,

which need to be revised to more appropriately reflect where service personnel are living. For example, only E–9s, which comprise

1.25 percent of the enlisted force, are eligible for Basic Allowance

for Housing (BAH) for single-family detached homes.

The need to address permanent change of station (PCS) expense

reimbursements is detailed in our statement. These include temporary lodging expenses for Continental United States (CONUS)

moves, reimbursements for house hunting trips, car rentals when

vehicles have already been shipped, and authority to ship two privately owned vehicles overseas.

The coalition strongly supports giving credit for all active duty

service since September 11, 2001 for reserve retirement-age adjustment purposes. The coalition also supports reinforcing the employer support for the Guard and Reserve program to include tax

relief for employers of selected reserve personnel.

7

Guard and Reserve issues are extremely important, and in addition to these concerns, dozens of other issues are addressed in the

Guard and Reserve commission recommendations. And the coalition respectfully recommends that this distinguished subcommittee

schedule a separate hearing focused solely on the panel’s findings.

TMC supports integrating Guard and Reserve, Montgomery G.I.

Bill (MGIB), and active duty MGIB laws under Title 38 along with

the restoration of basic reserve MGIB rates to the intended level

of approximately 50 percent of the active duty rates.

And in considering the transfer of education benefits to spouses,

it is also important not to forget currently serving Veterans Educational Assistance Program (VEAP)-era personnel who are not authorized to enroll in the MGIB. The coalition urges this distinguished subcommittee to act on recommendations of the Veterans’

Disability Benefits Commission (VDBC) and implement a plan to

eliminate the reduction of VA disability compensation for military

retired pay for all disabled retirees.

Finally, the coalition remains committed to adequately funding

to ensure adequate access to the commissary benefit for all beneficiaries and appreciates this distinguished subcommittee’s effective

oversight of this important benefit. Providing adequate programs,

facilities, and support services for personnel impacted by Base Realignment and Closure (BRAC) actions, re-basing initiatives, and

global repositioning is very important, particularly during war

time, which alone results in significant stress on servicemembers

and their families due to demanding operations commitments, repeated deployments, and other service requirements. Morale, Welfare, and Recreation (MWR) programs must also be adequately

funded.

Thank you again for the opportunity to present our recommendations. And I stand ready to answer any questions you may have.

[The prepared statement of Mr. Barnes can be found in the Appendix on page 121.]

Mr. BARNES. Kathy Moakler will now discuss family readiness,

military spouse, and survivor issues.

STATEMENT OF KATHLEEN B. MOAKLER, DIRECTOR, GOVERNMENT RELATIONS, THE NATIONAL MILITARY FAMILY ASSOCIATION

Mrs. MOAKLER. Madam Chairwoman, Mr. McHugh, and other

members of the Personnel Subcommittee, thank you for the many

family-friendly provisions included in the Fiscal Year 2008 NDAA.

We are gratified that you have recognized the important role that

families play in supporting our servicemembers in all stages of deployment.

Excellent support programs exist. It is important to find out

which programs families are finding most effective and channel resources toward supporting those programs. The evaluation process

and report you require in the 2008 NDAA should help to accomplish that.

You also recognized the excellence of the yellow ribbon reintegration program by calling for this program to be implemented by the

National Guard in all states and territories. This strong reintegration process, taking the initiative to educate families along with the

8

returning servicemember, acknowledging the challenges of reconnecting as a family, and providing information and tools to accomplish this is too important a task to ask the National Guard to

stretch already thin financial resources. We hope that this would

be funded.

As deployments continue, military families can be stressed to the

breaking point. We endorse the IAVA’s assertion of the need for

greater access to mental health care and counseling for returning

servicemembers and families.

Military children, the treasure of many military families, have

shouldered the burden of sacrifice with great pride. We appreciate

this subcommittee’s requirement of a report from DOD on programs that touch military children and their caregivers and hope

the research can provide a basis for the most effective programs for

our children.

A fully funded, robust family readiness program is crucial to

military readiness. As deployments continue, families must know

there is a secure yet flexible set of support services across all components available to them to reinforce readiness and build resiliency.

While military child development centers have consistently been

ranked highest in national ratings, families still experience access

problems. Despite new centers and funding provided last year,

there is still a shortfall of over 30,000 spaces. Increased needs for

respite care for both the families of the deployed and families with

special needs also add new strains to the system. We ask the committee to remain committed to helping all military families access

quality childcare.

Education is important to military families. The education of

military children is a prime concern of their parents. The need for

DOD-provided supplemental funding for impact aid is increasing.

And we ask for increased supplemental funding, especially for

schools who find themselves with increased numbers of military

students.

The coalition appreciates the interest of the Administration and

Congress in expanding the eligibility of servicemembers to transfer

Montgomery G.I. bill education benefits to family members. Military spouses face unique employment challenges as they deal with

deployments and relocations. We appreciate the partnerships being

developed between DOD and the services with the Department of

Labor and employers. Extending military spouse preference to all

Federal agencies would expand employment opportunities for this

very mobile workforce.

The coalition is grateful for the implementation last fall of the

long-awaited full replacement value reimbursement.

Servicemembers still have concerns as they anticipate a move.

They can face insufficient housing capacity, both on and off the installation, over-crowded schools, and the shortage of other community support structures due to BRAC and re-basing.

We appreciate your continuing attention to the needs of the families of those who have made the greatest sacrifice, the survivors of

those who have died as a result of active duty service. The coalition

views the special survival allowance as a first step toward the repeal of the SBP/DIC offset. We would urge this subcommittee to exVerDate 22-MAR-2001 14:24 Dec 12, 2008 Jkt 043248 PO 00000 Frm 00012 Fmt 6633 Sfmt 6633 C:\DOCS\110-111\038020.000 HAS2 PsN: HAS2
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pand eligibility for this allowance to all Survivor Benefit Plan

(SBP)/Dependency and Indemnity Compensation (DIC) eligible survivors.

Family readiness is integral to servicemember readiness. The

cost of that readiness is part of the cost of war and the national

responsibility. We ask Congress to shoulder that responsibility as

servicemembers and their families shoulder theirs.

Thank you. And I look forward to your questions.

[The prepared statement of Mrs. Moakler can be found in the Appendix on page 85.]

Mrs. DAVIS. Thank you.

Colonel.

STATEMENT OF COL. STEVE STROBRIDGE (RET.), DIRECTOR,

GOVERNMENT RELATIONS, MILITARY OFFICERS ASSOCIATION OF AMERICA, U.S. AIR FORCE

Colonel STROBRIDGE. Thank you, Madam Chair, Ranking Member McHugh, and members of the subcommittee. My portion of the

coalition testimony will address healthcare.

We fully support Mr. Todd Bower’s comments on care for wounded warriors and their families. And we very much applaud the first

step actions that the subcommittee took last year. But much more

is needed.

For one, members and families who are forced from active duty

because of service-caused disabilities should retain active duty level

TRICARE coverage for three years. The new law does that only for

the servicemember, not for the family, and only when no V.A. care

is available. That is too limited and too vague for troops facing extended rehab after leaving active duty.

We allow three years active duty coverage for survivors when a

servicemember dies. We think the severely wounded and their families deserve no less.

We are also concerned that there is no central oversight to ensure that all departments and services implement best practices for

multiple ongoing TBI and PTSD projects. We urge including this

responsibility into the newly legislated DOD/VA inter-agency program office.

Finally, we support the disability retirement model in which

DOD accepts the VA assigned disability ratings. But we still need

to address inter-service differences on what conditions are unfitting

and which ones are pre-existing. But we do oppose doing away with

the DOD disability retirement system entirely, as some envision,

which we think would substantially reduce retirement benefits for

many wounded warriors.

On TRICARE fees, we don’t support the large increases, as you

know, that are proposed by DOD and the task force. And we urge

you to restore the $1.2 billion budget cut. We think it is wrong that

the task force focused only on cost to the government with barely

a sentence on what military people earn for their career of sacrifice.

In 2001 the new Administration’s officials praised TRICARE for

Life, but now act as if no one expected that providing health care

for retirees over 65 would be expensive. We can’t see what changed

10

during six years of war that makes the military community any

less deserving of that benefit.

The plan to raise drug co-pays 100 to 400 percent would put

them higher than most civilian plans. The Blue Cross Blue Shield

plan that Military Officers Association of America (MOAA), my organization, offers our civilian employees has lower co-pays for pharmacy across the board than what the task force proposes for the

military. DOD would quadruple the retail generic co-payment from $3 to $15, and that is higher than 87 percent of civilian plans charge.

Wal-Mart is offering generics to any civilian in America for $4.

There is something wrong there.

The coalition believes military benefits should be driven by

standards and principles, not by the budget. Just as we have statutory standards for most other major military compensation elements, we urge the subcommittee to put some standards in this

year’s defense bill using H.R. 579 and S. 604 as models. Fundamental among these are that military retirement and health

benefits are the primary offset for the extraordinary sacrifices inherent in a 20- to 30-year military career, that extended sacrifice

constitutes a very large in-kind prepayment of premiums far beyond what other Americans pay that dwarfs the cash payments

that we are so focused on.

Finally, that the percentage increase in military fees in any

given year shouldn’t exceed the percentage growth in military compensation. For years the coalition has offered to partner with the

Defense Department on alternative ways to reduce government

costs without hurting beneficiaries. But the department refused

that offer.

Now, thanks to Dr. Kassels and General Granger, they are looking at some of our options. And we will be willing partners, if allowed.

One final item—a recent Government Accountability Office

(GAO) report confirmed that Guard and Reserve members are overcharged for TRICARE Reserve Select (TRS) by about $50 for single

people and $175 a month for families. We urge the subcommittee

to cut those TRS fees and direct refunds to the people who have

clearly paid too much. We continue to believe—and the Commission

on the Guard and Reserve agreed—that the government will save

money and reserve families will be better served by authorizing an

optional subsidy to continue their civilian family coverage when

they are mobilized just as we already do for DOD civilians.

That concludes my statement. And we thank you for your consideration.

[The prepared statement of Colonel Strobridge can be found in

the Appendix on page 133.]

Mrs. DAVIS. Thank you.

Mr. Johnson.

STATEMENT OF DAVID JOHNSON, CHAIRMAN, AMERICAN

LOGISTICS ASSOCIATION

Mr. JOHNSON. Good afternoon, Madam Chair, and members of

the subcommittee. The American Logistics Association (ALA) is

most grateful to you for your continued strong leadership in preVerDate 22-MAR-2001 14:24 Dec 12, 2008 Jkt 043248 PO 00000 Frm 00014 Fmt 6633 Sfmt 6633 C:\DOCS\110-111\038020.000 HAS2 PsN: HAS2
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serving and improving the commissary exchange MWR benefits for

servicemembers, retirees, and their families. I ask that my written

statement be entered into the record in its entirety.

It is an honor to be here today as chairman of the American Logistics Association representing nearly 250 of America’s leading

manufacturers, nearly 60 brokers and distributors, service companies, media outlets, and more than 1,400 individual members who

are actively engaged in providing goods and services to the military

resale and MWR activities. I want to reaffirm ALA’s strong commitment to maintaining the commissary and exchange benefit as

an integral part of the total non-pay compensation package for

servicemembers and their families.

Many of the issues I will address today will be similar to issues

raised in prior years. In virtually every instance, progress has been

made, but there is more to do.

Specifically, I will address the state of commissary surcharge dollars, Guard and Reserve outreach efforts, Armed Service Exchange

Regulations (ASER), exchange joint ventures, and finally, I will

provide some comments on some pending legislation.

Madam Chair, I am pleased to convey to this subcommittee a

huge well done on the issue of finding relief for limited commissary

surcharge dollars. For the past several years, the members of this

subcommittee have voiced concern in unison about the challenges

facing Defense Commissary Agency (DeCA) with the increased burdens being placed on the surcharge account by BRAC and re-stationing construction requirements.

Your leadership and persistence, along with the determination of

this association, elevated the issue to the Secretary of Defense. And

in a recent ruling by the DOD general counsel, the determination

was made that commissary construction projects that are not necessitated by BRAC or re-stationing cannot be paid out of surcharge, but must come from BRAC or Military Construction

(MILCON) funding.

As a result of DeCA’s outstanding job managing the military

commissaries, shoppers continue to save an average of over 30 percent on groceries when compared to the retail grocery stores. Accordingly, the commissary benefit and savings have become increasingly more important to the National Guard and Reserve

members and their families.

In a recent initiative, DeCA and ALA partnered to provide close

to $100,000 in DeCA certifichecks to needy Guard and Reserve

families just prior to Christmas. In addition, DeCA has set out an

aggressive scheduled for increased outreach efforts to support the

Guard and Reserve. The longer term need to provide a more permanent solution to affording better access to the retail benefits for

the Guard and Reserve may require some out of the box thinking

and support from this subcommittee.

Our association actively supports and promotes programs that

enhance the quality of life for our military servicemembers, retirees, and their families. Exchanges are a key component of DOD’s

quality of life programs. Unfortunately, authorized patrons continue to be limited in their choice and selection of merchandise sold

in the exchanges.

12

The armed service exchange regulation, ASER, delineates what

can or cannot be sold in exchanges. Madam Chair, it is ALA’s position that shoppers should have a choice without restrictions on

merchandise sold in exchanges.

Elimination of the furniture restrictions would permit greater

availability of furniture, afford servicemembers the opportunity to

receive the best possible value, and therefore, provide a true noncompensation benefit with absolutely no burden on the taxpayers.

In addition, use of the military star card offers a lower interest rate

and payment terms, especially for deployed troops.

Finally, I would like to take a moment to address two legislative

initiatives that we are tracking. The first is H.R. 1974, the Federal

Employee Combat Zone Tax Parity Act. We support this initiative

to provide tax relief for service in a combat zone by civilian employees of the United States. As you are aware, there have been years

of tireless service by exchange associates to man field exchange operations under extremely dangerous conditions to support the quality of life of our deployed troops.

Next, we express our support for H.R. 4071, the Disabled Veterans Right to Commissaries and Space Available Travel Act. This

proposal would extend benefits to service-disabled veterans with a

rating of 30 percent or more and to their families.

The same arguments about over-crowding and cost will be raised

that were faced when full shopping privileges were being considered for the Guard and Reserve. It did not happen. The sky did not

fall.

In a recent interview with Admiral Michael Mullen, chairman of

the Joint Chiefs, he laid out one of his key initiatives for 2008,

which was to take care of servicemen and women when in uniform

and afterwards. This initiative goes in that direction.

The nature of injuries today and the technology and treatments

has changed the nature of disabilities. We support his initiative.

Thank you, Madam Chair and members of this subcommittee for

providing industry the opportunity to present its views on these

critically important topics. More importantly, thank you for your

stewardship over these important benefits that are essential to our

military families’ quality of life. I will be happy to answer any

questions.

[The prepared statement of Mr. Johnson can be found in the Appendix on page 54.]

Mrs. DAVIS. Thank you. Thank you.

Mr. Becker.

STATEMENT OF F. JED BECKER, VICE CHAIRMAN, ARMED

FORCES MARKETING COUNCIL

Mr. BECKER. Good afternoon, Madam Chairwoman and distinguished members of the subcommittee. My name is Jed Becker.

And I am a member of the Armed Forces Marketing Council

(AFMC). I am most appreciative for being given the opportunity to

be here today to offer comments concerning the military resale system and the vital role it plays in supporting our troops and their

families.

As referenced, AFMC is a non-profit business league founded in

1969. Member firms work on the behalf of the manufacturers who

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supply consumer products to military resale activities around the

world. Succinctly, the purpose of the council is to encourage the

worldwide availability of quality consumer products at the best

possible prices and value and to promote unity of effort in this endeavor through a cooperative working relationship among Congress, the military, and the supplier industry.

Member firms are small, privately-held businesses formed in response to the need for efficient, specialized services, marketing, and

merchandising. In order to limit my verbal statement, I have prepared a written statement and would ask that those comments are

entered into the record.

As backdrop, I would like to note that the military resale stands

out as a most successful system. In simple terms, it works well. It

is honest, efficient, and responsive. Taxpayers, legislators, and

leaders throughout government can share in the pride of this outstanding success story.

Madam Chairwoman, this committee brings a clear legacy of prudence in protecting the value of the resale benefit. It has protected

the system from unfounded reorganizations, while it has correctly

encouraged and supported the very competent resale operators

along their driven path in their process of continuous improvement.

In addition to the broad scope balance provided by your oversight,

this committee has been effective in recognizing and seizing those

opportunities at the margin that serve to maximize the value of the

benefit while minimizing the expense to taxpayers.

Looking forward, we would like to call your attention to a few

matters on which we seek your support. Second destination transportation funding—Congress has passed legislation that mandates

funding the cost of transporting American products to foreign-based

resale operations. Maintaining this commitment is of vital importance to the well-being of military families. Your vigilance in directing continuity in this program is requested.

Earlier in my comments I noted that this committee has effectively seized many favorable opportunities at the margin. The

AFMC requests your attention to two such opportunities that were

mentioned by my colleague here, Mr. Johnson.

First, we remind you that the antiquated ASER restrictions limit

the exchanges in terms of the merchandise they can sell. The conditions under which these restrictions were placed have changed

dramatically over time. We urge you to grant relief from these restrictions. Such relief would enhance the value of the exchange

benefit to all qualified shoppers and would do so at no expense.

Second, the AFMC believes you will find a high yield, highly

leveragable opportunity to support our disabled veterans in supporting H.R. 4071 that has been introduced by Congressman Filner. This legislation proposes to extend exchange and commissary

shopping benefits to veterans rated as 30 percent disabled or greater. We believe that affording this benefit would come at virtually

no cost to the government and would again accomplish a great deal

in taking care of those servicemembers who have made a great personal sacrifice in defense of our country.

In closing, I would like to note that the military resale industry

is fragile. Shortsighted plans disguised as innovation will continue

to threaten its comprehensive efficacy. Most easily overlooked in

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this beneficial evolution of military resale is the power of two

things: first, the intelligence and awareness of our servicemembers

and their ability to recognize a marginalized benefit; and second,

the risks we all would assume if we failed to recognize that America is deriving service from resale system employees that exceed

their costs.

With very, very few exceptions these are people of high order

serving those who defend our freedom. Measures that might break

their spirit of purpose would bring tragic loss to all of us. I welcome

your questions.

[The prepared statement of Mr. Becker can be found in the Appendix on page 71.]

Mrs. DAVIS. Thank you. I want to thank you all very much for

staying within the time and around the time. And we appreciate

that.

Let me start, I think, with one of the difficult questions to ask.

And that is—and I think you made a good attempt at trying to

prioritize. But we know that within all the initiatives that have

been brought forth and that have been brought forth for some

time—because a lot of this is clearly not new. We have been trying

to expand on the benefits for some time.

But these programs really do require mandatory offsets in order

to be included in the defense authorization bill, whether it is

MGIB, reserve retirement, SBP, DIC, or concurrent receipt. You

know, all of them would require us to do that.

So given our limited ability to address mandatory increases, do

you feel comfortable—are you in a position to say what the highest

priority would be, so that we have a better way of trying to look

at the limited funds that we are obviously going to have to work

with? And we don’t expect there to be a consensus at the table, I

can assure you.

But some of you may have played this game that, you know,

where you have a list of things up on a wall and you put the green

sticker and the red sticker for them—can you put up your green

sticker? You know, what is it that you would pick first that you

think that we absolutely need to deal with? And we can start with

anybody who feels they would like to jump in.

Colonel STROBRIDGE. Well, Madam Chairwoman, I think the

members of the subcommittee and the staff, I hope, will agree that

we do this every year. We realize that it is impossible for you to

do everything and that we do make a good faith effort to try to

prioritize and provide you and the staff some options to make

progress. It is, you are right, very difficult to pick one item and say

we want to do this at the exclusion of some other thing.

We all have associations that represent different segments of the

population. And, of course, each has their own priority. But I think

we have worked very hard to try to identify ways to make progress

on the survivor benefits issue, for example, ways to make progress

on the concurrent receipt issue. If we can’t do the whole thing,

what is the first priority? And we try to establish those.

One of the important ones, I think, that kind of cuts across most

of the areas of the population this year, unfortunately, is the

TRICARE issue. And the mandatory aspect of that, we understand,

15

is the pharmacy issue. And it is particularly bad when they propose egregious fee increases.

We realize the challenge that places on you. That affects pretty

much everybody. It affects active duty families, many of whom are

on TRICARE Standard. It affects the Guard and Reserve families,

many of whom don’t live near a military facility and have to go

down and get their medications. And when you are talking about

$15 for generic and $25 for brand name and $45 for off-brand and

you are talking about a family that may have four or five prescriptions, that adds up to a lot of money over the years.

So if I personally had to pick one item, I would say that is important. But I would stress that we really want to work very hard

with the subcommittee to find ways to identify other progress.

The omission of the active duty death survivors from the SBP/

DIC was particularly painful. I think we don’t like to see people

who are in that situation feel like they have been, you know, left—

that somebody is telling them they don’t deserve any relief, even

as small as that was.

Mrs. DAVIS. Okay. So I wanted to follow up with you because I

think that was a relatively small benefit. And some people would

say it was almost offensive actually.

Colonel STROBRIDGE. Yes.

Mrs. DAVIS. And so, but at least addressing it in a small way,

you think, is helpful.

Colonel STROBRIDGE. We understand from dealing with the subcommittee that—we do realize that that is a small step, that it is

the first step. And we believe that in good faith. We know you are

trying to do it.

Mrs. DAVIS. Okay. Thank you.

I want to let anybody else jump in. I am going to limit myself

to the five minutes, and then we are going to go to other members.

And we will come back to a number of other ones.

Yes, Mr. Barnes.

Mr. BARNES. Madam Chairwoman, I just wanted to reference

Steve’s comments here about in trying to determine the priorities.

It is very important with our association, I think as the coalition

as a whole, to consider the number of personnel affected.

And the health care funding issue, both with regard to the Department of Defense and the Department of Veterans Affairs affects everyone. It affects many of the issues that have been addressed here. And that is first and foremost on our list. And evaluating these from that perspective is very important.

Mrs. DAVIS. Anybody, real quickly? I said I was going to limit

myself to five minutes, but perhaps would you like to follow up

with that, Mr. McHugh, as part of your—can you do this in 30 seconds? Or I will come back to you.

Mrs. MOAKLER. I think an issue that is very important to active

duty and Guard and Reserve families, especially those of the deployed, is access to quality childcare.

Mrs. DAVIS. Okay.

Mrs. MOAKLER. That is extremely important.

Mrs. DAVIS. Okay, thank you.

Mr. JOHNSON. Yes, Madam Chair. The issue that I see as paramount is continued full support of the commissary funding. It is

16

the same issue that we address every year. But if you look at the

value of that benefit and the return on investment for the expenditures, it is money well-spent. And I believe that we would ask you

to consider that——

Mrs. DAVIS. Okay, great.

Mr. McHugh, pick up?

Mr. MCHUGH. Well, Jed, you don’t have any thoughts on this?

Mr. BECKER. I do, so I appreciate your carrying this out. I was

afraid you weren’t going to. Actually, relative to some of the issues

that are raised by some of the other panelists, we have the good

fortune that you have some oversight involving some assets that,

I believe, are immediately leveragable to yield meaningful benefit

to this important population.

And when I say that, I mean the existing commissary and exchange facilities that are fully capitalized. They are there. They are

accessible to many of these potential beneficiaries. And I will have

to return to the two notes that I made in my opening statements.

One is to revisit the ASER restrictions. It is simply take an asset

and use it in a sub-optimal way. Without the ASER restrictions,

the benefit would be enhanced dramatically without any cost.

The other item was the possibility of expanding these benefits to

those who are disabled when defending the country who, again, at

no incremental cost to the government or an extremely, extremely

low cost, negligible, could enjoy those benefits.

Mr. MCHUGH. Okay. Then let me follow up on your two comments, Jed. Both you and Mr. Johnson may want to address this.

ASER is something that when I had a chance to serve as chair

of this subcommittee I supported expanding or narrowing the restrictions, depending on your perspective. The subcommittee under

Dr. Snyder has done that as well. And we have had some challenges, shall we say, from, as we are told to call them, the other

body.

I am curious. Have you had any opportunity to talk to representatives of the other house and what is your perspective on them?

Because the fact of the matter is while there may not be a cost to

taxpayers, per say, as I know you are aware, there are those in the

private business communities surrounding bases that are concerned about these expansions. But through all of that—I will

speak for myself—I have certainly been supportive.

But it gets a little frustrating when we act on occasions and they

don’t. Have you had a chance to talk to them? I will rephrase the

question.

Mr. BECKER. Yes. No, we have. And, in fact, I think in some instances we had thought we had won the support we were seeking.

And I would only note that we appreciate your continuing support

and your patience while we attempt to work on the other side.

My sense is that in some instances these items have been lost

among the many items on their agendas. And I don’t really have

the sense that we have much opposition not as much as we have

a lack of follow up. But we will continue to pursue it and appreciate your support.

Mr. MCHUGH. David, I don’t know if you want to add to that or

not.

Mr. JOHNSON. No, I don’t. I concur completely.

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Mr. MCHUGH. The proposal to extend exchange and commissary

benefits to non-retirees, 30 percent disabled has been addressed in

some of the military trade publications and elsewhere, there are

those who are at least concerned that this kind of expansion would

serve to erode the benefit to those who are receiving it currently.

I am not in any way validating that argument or unvalidating it.

I am curious how you would respond to those who hold that concern. And they hold it legitimately. I don’t think there is any reason to denigrate their perspective necessarily. But what would you

tell them?

Mr. JOHNSON. What I would say, Congressman, is the same arguments came up when they argued against giving full commissary

shopping privileges to reservists several years ago. They thought

that it denigrates the benefit of the active duty. And I strongly disagree.

As a reservist myself, I know what a benefit it is for the troops

under my command that they have access to that benefit. And I

think for our veterans who are 30 percent disabled or more I think

that speaks volumes about what we are willing to do for them. And

as Mr. Becker explained, it is virtually no cost at all to the commissary system to absorb those shoppers.

Mr. MCHUGH. Just curiosity—the 30 percent figure—is that just

associated with the current disability compensation level? Is that

where the 30 percent came from? Why 30 percent? Why not 25?

Why not 40? Why not?

Mr. JOHNSON. I think we just came out in support of Congressman Filner’s bill, which was the 30 percent.

Mr. MCHUGH. Okay. All right, all right.

I don’t know if anyone on The Military Coalition side wants to

be heard on this or not.

Colonel STROBRIDGE. Yes, sir, I would. And this is one where we

do have a difference of opinion with our friends in ALA. And we

strongly supported extension of privileges to the Guard and Reserve, so that is not our concern.

Some people, I think, think of this as a wounded warrior issue.

The reality is if you are 30 percent disabled in service, you are

going to be retired. As a retiree, you will have an I.D. card. You

will be entitled to commissary and exchange privileges.

The issue that we are talking about, to me, is primarily people

who separate from the service, in many cases serve a civilian career, incur a disability later in life. Those folks, to us, fully deserve

their veterans compensation, their disability compensation, their

veterans benefits. But that is not the same as serving a career,

which is what we see the commissary as part and parcel of the

military benefit that DOD provides as an employer to its current

employees and its career employees.

And to us that is why we have DOD separate systems from VA.

It is a career compensation benefit. If you are disabled immediately, you get it. If you incur it later in life, you are a VA beneficiary, but you are not entitled to the DOD benefits. We fought the

commissary subsidy so many times and had to make that argument to justify it it is difficult, I think, to back it away when that

argument is not being made because we know it will be in the future.

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Mr. MCHUGH. I thank you.

Madam Chair, I see the red light. I appreciate your patience. If

there is another round, I would be happy to ask some more questions.

Mrs. DAVIS. Thank you. Well, I think that is an important question. And, you know, we don’t necessarily want to put people on the

spot, but we understand that there is a real difference of opinion

in that and appreciate that we might come back to that issue.

Ms. Boyda.

Mrs. BOYDA. Thank you. Thank you all for being here. This is extremely helpful. For those of us who are freshmen, it is nice to actually kind of participate in this instead of being in this fog where

we were last year. So it is wonderful.

Mr. Bowers, I would like to ask you some questions just on when

you were talking about—first of all, thank you very much for your

service and for going over and being deployed twice. I didn’t hear

an answer from you when you said—what was—did I hear an answer what your number one priority would be? I didn’t.

Mr. BOWERS. Well, overall, our number one priority, what we are

going to be working on this year—and then we understand the

funding concerns that come along with it—is a more revamped and

up to date Montgomery G.I. bill. The reason being is that—and G.I.

bill is no longer what it once was. And we see the G.I. bill as one

of the most effective reintegration tools for veterans of this generation.

Our second priority that we really are pushing on and one that

I think may be more appropriate today is the mandatory confidential counseling for veterans before and after their deployment within 90 days once they return from combat. This requires an initial

investment. But we see this in the long term essentially as a cost

savings plan.

The issues that we aren’t addressing now when veterans return

from combat are eventually going to come back and bite us in the

rear end about 20 years from now when they have some serious

difficulties reintegrating into society, which as we all have learned,

is going to come with a higher price tag. We see it as an initial investment and a way to sort of stop these things beforehand. And

to be very honest, it cuts out the element of the ten percent.

That is a big elephant in the room right now. But there is always

going to be those individuals that may or may not be taking advantage of the system. By requiring mandatory pre and post-deployment screening, you are setting a baseline and having something

to follow through with. So you know exactly how combat has affected them, both mentally and physically to some extent.

Mrs. BOYDA. Thank you very much. In your testimony you had

said that multiple tours and inadequate time at home and between

deployments increased rates of combat stress at 50 percent. Where

do you have those numbers?

Mr. BOWERS. Well, I am going to defer to one of our many reports

that we just released a few days ago. We have annotated in there

where we did get those numbers. And I know that some of the resources that we have had have the numbers come out of the Institute of Medicine and also a few numbers from the Rand Corporation that have been extremely beneficial. But I would appreciate

19

the opportunity to be able to follow up and provide those numbers

to you in-depth with one of our reports.

Mrs. BOYDA. I would appreciate that——

And out of the testimony someone was going to be working with

the Advertising Council. Who was that? That was you.

Mr. BOWERS. Yes.

Mrs. BOYDA. I represent Topeka, Kansas, which actually in the

district there is Fort Riley, Fort Leavenworth, head of the National

Guard for Kansas. But I live in Topeka. There is a VA hospital that

kind of was the Mayo Clinic of mental health back in the 1950’s.

The Menninger Clinic actually came from that.

And so, we work in issues of PTSD and traumatic brain injury,

just the whole mental health issue quite a bit. And obviously we

are seeing that it is getting very, very difficult to keep and to have

trained professionals on. Are you planning to do any kind of Ad

Council, again, of asking people to step up and serve their country

by serving our veterans?

Mr. BOWERS. Yes, we are. I think what we are doing is we are

deferring to the experts in regards to the advertising aspect. And

we have been very fortunate to have Batten, Barton, Durstine &

Osborn (BBDO) Corporation take us on pro bono to come up with

these ads and how it is going to work.

It is a three-year campaign. We begin our focus groups actually

next week. And we will be doing a tremendous amount of those

throughout the country. And I believe one of the locations include

Kansas, to know what people will be most receptive from.

During the World Series we ran two ads to see if this program

was going to be effective. And with a partnership with Major

League Baseball, ourselves, and the Ad Council we set up a website

called welcomebackveterans.org.

The advertisement was very effective with Tom Hanks doing the

voiceover saying, ‘‘If you, the general American public, even if you

have not been touched by the veterans who have served in this

war, want to help, here is where you can go to.’’ And we had a tremendous impact.

And we are hoping to be able to see that in our stigma reduction

campaigns. Even the name, post traumatic stress disorder leads

you to a disorder as a fault.

I always convey to my Marines—and I did this just last weekend—that when you come home from a combat, if you have been

impacted by something, it doesn’t make you weaker. It makes you

stronger.

You harness those things that you deal with, and it makes you

a better Marine or soldier, airman or sailor. You are able to see

what you have had and be able to build on that.

The Marine Corps always says pain is weakness leaving the

body. Well, that shouldn’t just be limited to physical aspects. It

should also be mental issues.

Mrs. BOYDA. I hope you would let us know in this committee if

there is anything that we can do to help further that cause. And

on behalf of Staff Sergeant Boyda, who is now 63 years old, Semper

Fi.

Mr. BOWERS. Thank you.

Mrs. DAVIS. Thank you.

20

Dr. Snyder.

Dr. SNYDER. Thank you, Madam Chairman.

Mrs. Moakler, was it you that mentioned the beyond the yellow

ribbon campaign? I think it was.

Mrs. MOAKLER. Yes.

Dr. SNYDER. And the funding of it. And I don’t know if you saw

yesterday when Secretary Gates testified with Admiral Mullen before the House Armed Services Committee, the full committee. I

asked him about it, and then Representative Kline brought it up

also about the funding for it. And, as you know, we authorized it

in the National Guard bill, but it hasn’t seen any money yet for it.

I am optimistic that we will see that funding come available

through the supplemental process over the next few months. But

we all need to follow that along closely. I think the Pentagon is

committed to seeing that it is funded and understands the value

of it.

And one of Secretary Gates’ staff members grabbed me during a

break in the hearing. And he had all the numbers down. He knew

what kind of money they were looking for. And it is just that we

have got to see the supplemental process flow.

So I am optimistic that will happen. But it is something that we

all together need to follow.

Mrs. MOAKLER. It is a great program. It was so successful in

Minnesota. And we certainly would like to see that enacted in all

the other states and territories to help those families.

Dr. SNYDER. Yes. Representative Kline was a strong advocate of

that and is on this subcommittee also.

I wanted to spend some further time on this G.I. bill issue. And

I just came from Secretary Peake’s, former lieutenant general, now

Secretary of Veterans Affairs—Peake—his first budget hearing before the Veterans Affairs Committee. And in his opening statement,

Chairman Filner talked about one of his goals for this session of

Congress is to see—I forget how he explains it, but a G.I. bill for,

you know, this era. He wants to really modernize the bill.

And we are seeing a lot of proposals out there. Senator Webb

probably has the most far-reaching, which I think would be great,

which goes back to the days of right after World War II. I think

Representative Bobby Scott has the mirror bill on this side.

Several of you have mentioned different ideas for the G.I. bill.

My concern I have about this is we are getting back to maybe

where we were a few years. We are all going to come up with great

ideas.

The problem we are going to have is the one that we have in the

jurisdiction reserve component, active component. One is coming

out of the Veterans Affairs Department and that committee, and

one is coming out of the Pentagon and this committee. And the two

bodies have different ideas.

The Congress is in agreement about it. But the Pentagon is very

clear. They see the reserve component G.I. bill as being a management issue. They don’t see it as being a reintegration issue.

And I think you can make a very strong argument that even for

a reserve component member who comes back and stays in the reserve, if they have been in a combat situation for 12 or 15 months,

it clearly is a reintegration issue. I also think it is an issue of inVerDate 22-MAR-2001 14:24 Dec 12, 2008 Jkt 043248 PO 00000 Frm 00024 Fmt 6633 Sfmt 6633 C:\DOCS\110-111\038020.000 HAS2 PsN: HAS2
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vestment in people. People deserve it, particularly if the active

component veterans are getting it.

And so, I have this fear that—you know, the last defense bill

that was just signed by the President a few weeks ago we made

progress on this reserve component issue, but nearly as much as

we ought to. And we haven’t dealt with the disparity in benefits,

the actual amounts. We haven’t dealt about the disparity between

what the G.I. bill pays versus what cost of a four-year education

is. We haven’t dealt with the $1,200 issue.

I mean, there are a lot of issues we haven’t dealt with. I think

we are kind of getting in a situation now where we are all coming

up with these ideas. The bottom line is, I think, that if we don’t

deal with this conflict in jurisdiction between the Pentagon and the

Department of Veterans Affairs, none of these things are going to

go very far.

And so, it comes back to this idea of the bill that the staff here

worked on a lot. And it is very complicated trying to merge these

things together. Because until it gets under one jurisdiction I think

we will continue to hear from people in the Pentagon it is a management tool, our reenlistment is good for reserve component, we

don’t need to change that benefit.

And some of you may know from the past with Secretary

Dominguez, who is a very nice guy, but, I mean, he actually—I

kind of backed him into a corner and said, if we can keep—were

you there, Colonel Strobridge, when I said, ‘‘Well, if we reduced it

by 50 percent and reenlistment rates stayed the same, you are

okay with that? If we reduced it by 80 percent?’’

I mean, he had to acknowledge yes, he was, because as a management tool, if the reenlistment rates for reserve component are

the same, it means you don’t have to change the G.I. bill. And I

think that misses the point of the G.I. bill.

So I have rambled on too much with this. But my basic question

is do you all have concerns that we now are getting a lot of ideas

about the G.I. bill but if we don’t deal with this issue of jurisdiction

that the Pentagon and the Department of Veterans Affairs being

separated we are not going to make much progress in the G.I. bill.

Again, Colonel Strobridge, if you don’t mind——

Colonel STROBRIDGE. Yes, sir. As I know you know, we strongly

supported that initiative last year.

Dr. SNYDER. Yes.

Colonel STROBRIDGE. We agree with you that is a fundamental

underpinning. Very frankly, we thought that is what we were going

to get last year rather than—we were hoping for the reserve transition, but we were kind of surprised to get the reserve transition

and not the consolidation.

We agree with you that that is a key issue. From our standpoint,

there are so many initiatives out there, we would agree with almost any of them. The issue is what can be done.

You know, we are sort of in the same boat we were when you

asked us to prioritize things. We will take just about anything that

is progress because there are so many problems.

I can’t think of too many bills out there that we wouldn’t support. And whatever works out to be the lowest common denominaVerDate 22-MAR-2001 14:24 Dec 12, 2008 Jkt 043248 PO 00000 Frm 00025 Fmt 6633 Sfmt 6633 C:\DOCS\110-111\038020.000 HAS2 PsN: HAS2
22

tor that Congress will support, you will find our enthusiastic support for.

Dr. SNYDER. My time is up, and maybe we can go back around.

I will go at this again.

But it is going to be hard for us to have a Senator Webb-type

bill or a comprehensive donor-type bill without bringing this together because we could do a Senator Webb bill, but I bet it would

not include reserve component, the way the jurisdiction currently

is.

In the next round I will pursue this further so more of you can

make comments.

Colonel STROBRIDGE. Madam Chair, would you indulge me for 15

seconds to fix a grievous omission in a previous answer?

Mrs. DAVIS. Sure.

Colonel STROBRIDGE. My conscience is really bothering me. You

talked about prioritizing. One of the really important things is the

Guard and Reserve retirement system where we did it prospectively and we didn’t give credit for those years of repeated tours in

Iraq that have already been served. That is a huge priority.

Mrs. DAVIS. Great, thank you.

Ms. Shea-Porter.

Ms. SHEA-PORTER. Thank you.

I was very interested, Mrs. Moakler, when you started naming

daycare as the top priority for you. Could you expand on that a little bit and tell us exactly why that came first with all the other

issues that we have heard about?

Mrs. MOAKLER. I think as families continue to live through deployments, the need for respite care is growing. And that is a segment that we really haven’t addressed in childcare before. Because

when you are a single parent with a deployed servicemember, you

need a break. You need a break.

And there is really not enough designated drop-in care for folks

at most military child development centers. But there is a real

need to leave the kids for a day or so and have that open. And a

lot of installations are opening up their child development centers

for respite care.

We also have the added need for the parents of children with

special needs where they need respite care as well. And what agencies are they going to look for? They are going to look for that excellent child development center on the installation to be available

to them as well as one of their benefits. So that is why we are refocusing a little bit this year on the basics, on those basic benefits

that we want for military families in peacetime and in war.

Ms. SHEA-PORTER. Okay, thank you. And could you tell us a little

bit about the children who are at the daycares right now, the

changes and what you see is necessary for the daycares to treat the

special conditions that the children are experiencing?

Mrs. MOAKLER. I think we are looking forward to some of the research that is going to be done on the affects of deployment on children. We are doing some of that within the National Military Family Association. We have our Operation Purple Camp. And we are

surveying children and parents as to how the children are dealing

with deployment and the war and how parents perceive children

dealing with deployment and the war.

23

We are also working with the folks who look at the very young

children, from zero to three, who previously people might not have

considered how they were reacting to the absence of a parent for

a great amount of time, reacting to the stress that the single parent is going through. But more and more research is being done

into that. And we are hoping that as they come out with an outcome that this will be able to be offered to the caregivers of the

young children.

Ms. SHEA-PORTER. And Congressman Jones tells the story—and

it just keeps sticking in my mind—about going to read to some children at a military facility. And one of the children saying to him

my daddy is not dead yet.

And I am wondering, you know, obviously this is having an impact on these children and if they are able to take care of them

through the daycare centers, if there is special training, if there is

money available to train the people who are working with these

children every day. And those kids have the same kind of anxiety

that Congressman Jones talked about seeing.

Mrs. MOAKLER. And we are educating these young parents, too.

I know we have new parent programs with the military. But in our

testimony we spotlighted one young man, and he happens to be the

son of one of our staff members. His dad was deployed for six

months, and they were getting ready to go to the airport to pick

him up.

And he seemed very reluctant to go with his mom to the airport.

And his mom couldn’t understand what the problem was. And part

of the problem was that he wanted to know will daddy still like me.

And, of course, his mother was just floored that she hadn’t

stopped to consider what his feelings might be, what his worries

might be with his father coming back. So just making parents

aware to ask the right questions and to kind of anticipate the reactions of their children to the deployment is very important.

Ms. SHEA-PORTER. Thank you. My time is expired.

Mrs. DAVIS. Thank you. Thank you. It is my time for questions,

so I will go ahead and do that, and we will have another round as

well.

I believe it was yesterday Admiral Mullen mentioned or said in

the middle of testimony over on the Senate side when asked about

the services—he said the services are not broken, but they are

breakable. I am wondering if you were to say to him, you know,

this is what you should look for, this is where the indications might

be, particularly as it relates to families and those coming back,

what would you tell him, what maybe in parlance metrics? What

would you want him to be looking at that you think would be an

indication of where we are?

Do you want to begin?

Mrs. MOAKLER. I think that we want to make sure that the families have the tools to deal with the deployments, that they have access to counseling when they do run up against a brick wall, when

they can’t handle the 15-month deployments any more. We also

want when the servicemembers do come back, as part of their reintegration process, that they are given time to come together

again as a family because they need that time in order to sustain

them when the deployments come again.

24

And so, giving lip service to two weeks off or a limited amount

of time when the servicemember comes back to be with their families and then it is right off again into training or, you know, don’t

take too much leave. Even though you might have that 30 days,

you know, don’t take too much leave because we need to get right

back into the saddle and get going again. Families need time to rebuild, they really do.

Mrs. DAVIS. Anybody else?

Mr. BARNES. Excuse me. Madam Chairwoman, I just want to reference the importance of adequacy of end strength. And the workload continues despite many of the draw-downs and reductions in

personnel. And I know from personal interaction and information

I have received one on one that in many cases, particularly with

regard to the Navy, due to shortages of certain job specialties and

what have you, exacerbated perhaps by ratings, consolidations, and

what have you, that senior enlisted personnel bear a growing responsibility to fulfill the jobs and the requirements of their subordinates because of vacancies in their company, their division or what

have you.

So the adequacy of end strength is very, very important. I know

with regard to the Navy that individual augmentees continue from

the—for support of the war effort. Those individual billets are

taken out of hide at the command activity level. And the work goes

on. So that, in and of itself, is an example of stress on personnel

and the importance of the adequacy of end strengths.

Just a final aspect, as you all know—growing career personnel

to serve in key positions because of their technical skills is very,

very important. And when we are downsizing and requiring those

personnel to depart from the service, that has a significant impact.

But I reiterate that the scope of work continues despite decreased

personnel.

Mr. BOWERS. If I could just draw in on sort of a personal aspect

where my unit is preparing to go on our fourth deployment, we fulfill a very important role within the Marine Corps. And that is civil

military operations. We are a civil affairs unit.

When these conflicts started, I think that there was a difficulty

in understanding the end strength of how many people we would

need to fill these civil military operation roles. So I have sort of

made up my own phrase for this. But I refer to it as interhumantation, where we are seeing other military occupational specialties fulfilling other military occupational specialties where there

may be gaps.

For my specific instance, the Marine Corps is utilizing our unit

to fill civil military operation gaps. This may be effective, but it is

a very slow process. It takes a long time to get someone who has

spent their entire career known as ‘‘Death from Above’’ to start reintegrating and working with civilians on a battlefield. It is a possibility, but it is very difficult. And that is why looking at the overall

scope of what jobs are needed for a coin or counter-insurgency operation is going to be most effective.

We discussed a lot of this, too, and I draw back to another one

of our reports appropriately titled, ‘‘A Breaking Military,’’ that I

would be happy to share with you today where we look at these

number factors. We look at where the end strengths will be and the

25

impact that lengthy deployments will have on individuals and,

again, their families.

Mrs. DAVIS. Thank you. Thank you. I appreciate that. It really

departs a little bit from some of the specifics here, but we have

such a great group of witnesses, and I wanted you to be able to

comment.

Mr. McHugh, do you want to go on, and I will come back and

do a few other questions?

Mr. MCHUGH. Mr. Becker, in your comments—I may miss a word

or two of the quote here, but I think I got it pretty quickly. You

summed up and said we should be aware of what you called shortsighted initiatives disguised by innovation. Do you recall that?

Mr. BECKER. I do.

Mr. MCHUGH. Whatever do you mean?

Mr. BECKER. In my several years in this industry, sir, I have had

the opportunity to witness what were some very creative efforts to

alter the benefit. And in some instances they have included initiatives to alter the composition of the commissary benefit by, for example, increasing the surcharge to effectively offset the costs of the

commissary to an increased extent on the backs of the patrons.

And I think I understand the ingenuity behind it. But I would

caution that the consumers at the other end of that equation would

very quickly figure out what had happened and that its creativity

would be overwhelmed by its failures.

I think likewise there have been efforts to consolidate exchanges

in a forced manner with a belief that what is bigger is better. And

I am not sure that in my commercial experience there is evidence

of that. And I know for certain it is back to the people factor that

I noted in my last comments. A lot of the folks who are working

in this channel of commerce separate from being a delivery system

are people who have an affinity for the community they are serving.

And an enterprise made up of people who are committed to the

end users can lose the spirit that they bring to work every day if

they are forced into a machine designed by someone elsewhere.

And so, in those two instances I think were raised as ideas with

all good intent, but without experience close at hand to the business itself.

Mr. MCHUGH. Thank you.

Mr. Johnson, you used the phrase out-of-the-box thinking. You

encouraged us to use that. Do you have any out-of-the-box thoughts

for us, suggestions?

Mr. JOHNSON. I do. With regards to the commissary benefit and

getting greater outreach to Guard and Reserve, greater use of the

Internet, some off-site caselot sales to Guard and Reserve units,

maybe even mobile-type stores in an armory-type unit, to reach out

to those Guard and Reserve families who are not necessarily close

to a military base.

Mr. MCHUGH. Thank you. I have got a few moments here, so I

am just trying to remember. I think it was Mr. Bowers. In your

statistics in your presentation, your written presentation, you

talked about 20 percent of the troops in Iraq identify as going to

seek a divorce. Did I hear that correctly?

Mr. BOWERS. Yes.

26

Mr. MCHUGH. And I truly don’t know, and I am just curious. Do

you know what the rate is for non-deployed troops that will seek

divorce? Or is that not the kind of thing we ask people? I don’t

know.

Mr. BOWERS. For non-deployed troops, I know that the rate is

higher than the national average. But in no way, shape or form is

it anywhere near that amount.

Mr. MCHUGH. So if you are deployed, that 20 percent figure is

higher than it would be if you were not?

Mr. BOWERS. Yes. And I have also found that with multiple deployments this is having an increasing impact whereas the percentage rate goes up per deployment.

Mr. MCHUGH. Right. But would it be possible to get some data

on that, if you have a chance?

Mr. BOWERS. I would be more than happy to.

Mr. MCHUGH. Great.

Mr. BOWERS. Again, for the third time, I am going to fall back

on one of our—little reports——

Mr. MCHUGH. That is fine. That is fine. If that is in there, that

is great.

Mr. BOWERS. Yes, sir.

Mr. MCHUGH. And let me ask the question about another reference. And you may choose to give the same answer, and that is

fine as well.

You talked about in the mental health area there are presently

19 percent of returning troops self-identify as having a mental

health problem. And yet in the study you noted—within the year

35 percent actually seek mental health care.

Did that study, do you know—and if you don’t, maybe you could

find, was 35 percent totally the result of the deployment? In other

words, it is certainly possible for someone to come back, not have

a mental health problem and a year later have a mental health

problem that had absolutely nothing to do. I mean, that happens

in the Congress all the time with going away. So is that 35 percent

deployment-related, or is it a percentage?

Mr. BOWERS. Yes, those numbers are actually derived from a

GAO study that was done on the effectiveness of the PDHA and

the PDHRA.

Mr. MCHUGH. Okay.

Mr. BOWERS. So the only individuals that were incorporated in

those numbers were individuals who actually filled out the PDHA

and the PDHRA.

Mr. MCHUGH. No, I understand that. I apologize for not making

myself clear. Within a year 35 percent then say I have a mental

health problem, I need care. I am curious are all of those 35 percent then seeking mental health care and counseling because of the

deployment? A lot of things can cause you to seek mental health

care other than rooted in the deployment.

Mr. BOWERS. Yes, and I believe I can find that out for you most

definitely.

Mr. MCHUGH. Okay, great.

Mr. BOWERS. But I would say that those numbers are increased

greatly by the sheer impact that combat deployment makes on——

Mr. MCHUGH. I have no doubt.

27

Mr. BOWERS. Yes.

Mr. MCHUGH. I am just curious. Because as we pursue this, it

is going to come up, so it would be better to have the answer before.

Mr. BOWERS. Definitely.

Mr. MCHUGH. That is all I am saying. I have no doubt about

that. I am not challenging you at all. I am just curious how the

data breaks out.

Mr. BOWERS. Yes. And I would be more than happy to—we have

been punching numbers until midnight the past few days. So——

Mr. MCHUGH. Okay? Terrific. Thank you. Believe me, I understand. Thank you very much.

And thank you all.

Thank you, Madam Chair.

Mrs. DAVIS. Thank you.

Ms. Boyda.

Mrs. BOYDA. Yes, actually I would like to just make a few comments, one I should have said earlier. But I just came off the floor,

and Representative Edwards and I had offered an amendment that,

I think, will be passed. It says in-state tuition for all of our active

duty, no matter if you get moved or whatever. Once you start, you

have got in-state tuition.

So I just thought you might want to be letting your members

know that we expect that to be passing whenever we get back here.

We will vote on that, and that should be good to go.

And then, Kathy, I would just like to congratulate you on the

Purple Camps and how it just keeps on moving up and they are

doing more and more. Some longitudinal data and really looking at,

not only what is going on with our families, but what is actually

impacting our families adversely and positively and collecting that

data in a very, you know, rigorous manner. So it is exciting.

And I hope everybody is as supportive as they can be for all the

money that goes into it. And you guys have pulled it off. So thank

you very much.

Mrs. MOAKLER. Thank you.

Mrs. BOYDA. I would like to go back just to the issue of what we

were kind of talking about a little bit earlier, too. And that is the

one to one deployments that we have been keeping on talking

about. And it sounds as if the one to one deployments everybody

says gee, that is a really good idea. I hope we can get there soon.

And there isn’t a lot of clarity yet about what soon means. But,

you know, would you all weigh in on what you would recommend

to Congress, to the DOD, to the Secretary of Defense? If we don’t

get one to one deployments any time, you know, within the next

few months, what does that mean?

Colonel STROBRIDGE. That is a hard question. Maybe I will try.

Mrs. BOYDA. Thank you.

Colonel STROBRIDGE. I think the answer is that the committee is

already trying as fast as you can. End strength increases—that is

the key thing. We realize there is limitations on the possible. We

were asking before what are the indications of problems. To me,

you know, we are becoming deaf from alarm bells and warning sirens, it seems like.

28

You know, when we have the Department of Defense saying if

you were meeting our retention and recruiting goals—I am saying,

at what cost. Look at the bonuses that we have to give to people

to get them to stay. Look at what is happening to the families that

we all know we kind of get, you know, deluded by the possible, I

guess, you know.

I don’t think anybody at this table would say one to one is what

we want for the force for the long term or even necessarily one to

three. The first time we heard the Army talk about one to three

about five or six years ago, most of us looked around the room and

said, ‘‘Good grief, that is way more than we ever had.’’ You know,

one to three would cause huge retention problems.

And I think we are amazed that even with the bonuses retention

is as good as it is today. And I think that tells you probably what

Todd will tell you, that people are going to save their buddies because they know somebody else is going to have to go if they don’t.

You know the answer. You are trying to do it as much as you

can. We all feel the same pain, I think.

Mrs. BOYDA. Are you part of that voice then again, saying this

needs to be done sooner than later?

Colonel STROBRIDGE. Absolutely. The biggest thing that we are

concerned about, very frankly, for the long run is people saying,

‘‘Gee, if we manage to draw down the forces in Iraq, maybe we

won’t have to plus up the Army.’’

But to us, we need to plus up the Army no matter what. The lesson that we learned from this one is that we didn’t have enough

troops to fight a major war. You never know when a major war is

coming. We need to be better prepared for the next one than we

were for this one.

Mrs. BOYDA. Thank you.

Todd, did you have something?

Mr. BOWERS. I would just agree with that. When I mentioned to

my mother that I might be going back for my third tour and she

was choking me, it was hard for me to convey to her that the reason being is that I am going because my Marines are going. And

that is the final issue. If they go, I go. There is no questions asked.

And it is going to be an honor to go back for a third time. But

I think that with these increased numbers that we all have sort of

been in agreement on here, you know, it is going to make a stronger fighting force and give us more time to train, re-up, and be

ready for the next fight.

Mrs. BOYDA. When I am out in my communities and questions

like this or comments like this come up, I try very much to say that

many of our families are doing just fine. You know, that no matter

how many times they have been deployed, they are going to go

back out there and do what it takes. And they are doing just fine.

And many of them aren’t. But I try to make sure that I differentiate that a lot of families out there that don’t want to be brought

into this conversation—everything is fine and they will do whatever it takes for however long it takes. And many of them aren’t.

So this is like most things. It is a mixed bag. You need to be sensitive to situations. But again, thank you for your answers.

Mrs. DAVIS. Thank you.

And, Ms. Shea-Porter.

29

I am sorry. Dr. Snyder?

Dr. SNYDER. Thank you.

Mrs. Moakler, I appreciate your attention today to children of

our military families. A couple of weeks ago a family member returned from his second tour to Iraq. His Air Force tour was a fourmonth tour. It was the second time he went. Both times he was

gone his wife has been pregnant.

So this time when he returned, we were all out at the airport

with balloons and signs. And his little toddler was out there. I

think he is four years old, although I am embarrassed I can’t remember.

But, you know, when you see people come off the plane and there

is the husband and the wife hugging and the congratulations and

all, that moment when the little boy went over to be with his

daddy, I almost felt like that was a private moment that it was so

poignant. You know, that I felt like I didn’t mind watching him

kiss his wife.

But I felt like that moment with the little boy was just so private

and so important that it really brought home to me how important

those relationships are and how important they are to families.

And anyway, I appreciate it. That is just a long way of saying I

appreciate your attention to children.

I want to go back to this issue of the G.I. bill and, Mr. Bowers,

maybe give you a chance and anyone else that wants to comment.

I have got questions I am saving for this end of the table, too. But,

Mr. Bowers, if you want to comment on the issue of the G.I. bill

and this jurisdiction or anything else that you want to talk about.

Because you mentioned that in your discussions also.

Mr. BOWERS. As I mentioned before, the G.I. bill is something

that we are going to be really focusing on this year. It is one of our

top priorities. I can tell you that probably about 80 percent of our

membership that we have been talking to has a tremendously difficult time with getting through college. I relate that to the amount

of deployments that individuals are using.

And we do stand by—we would love to see a picture perfect

Montgomery G.I. bill similar to S.22, Senator Webb’s Montgomery

G.I. bill for the 21st Century. And I attribute that to a partnership

that we had with the VFW where we took Iraq and Afghanistan

veteran members and also VFW members who had served in the

Vietnam War and met with different offices and said, I served

three tours, a cumulative of 3.5 years active duty next to the Vietnam veteran who served roughly one year.

And then we compared how much each of us pays by the numbers for college. And the varying differences were incredible. And

so, we do stand by that we would love to see it updated to at least

what it once was to be more efficient.

Dr. SNYDER. The challenge you are going to have is your membership is both active component and reserve component member.

Correct?

Mr. BOWERS. Exactly.

Dr. SNYDER. And I think the challenge that you are going to have

is what are you going to do when either on the veterans side we

are able to deal with the active component veterans and raise that

G.I. bill benefit—and if we are able to do that, I think the great

30

likelihood is it will be difficult for the reserve component benefit to

follow through this committee because we already have budget

issues with the guard to the present budget proposal and how we

fund things or to place catch-up in reserve component. Some of us

would think that ought to be the first step.

And so, it just seems like this issue of the jurisdiction is going

to—I mean, I applaud the laudatory goal you have stated. But I

think the practicality is it is going to be—we have got some difficult terrain to get through anyway. And to deal with the jurisdiction issue makes it even harder. Has your organization thought

through this issue of reserve component versus active component?

Mr. BOWERS. We have. And we have often looked at the idea of

recodification under Title 38 and seeing if that is the most effective

measure. And that is something that we are still looking at to see

is that something that would be beneficial. I know that we do say

that we don’t see the G.I. bill specifically as a retention tool because if you serve four years versus 16 years, your benefits are still

the same.

Dr. SNYDER. Right.

Mr. BOWERS. So when we hear that debate, that many times

comes up, we don’t feel that that is exactly realistic.

Dr. SNYDER. I think the only people that actually see the G.I. for

reserve component as being only a retention tool is a very small

group of high ranking civilians in the Pentagon.

Mr. BOWERS. Yes.

Dr. SNYDER. I think almost everybody else does not agree with

that.

I wanted to, before my time runs out, at this end of the table—

would somebody give me my annual update on fresh produce?

Mr. BECKER. I think your original interest in fresh produce

stemmed from a personal experience in witnessing that particular

category and how it was treated in a particular commissary.

Dr. SNYDER. Mold.

Mr. BECKER. I am of the belief that there are probably other

experts——

Dr. SNYDER. Actually, no, that is not true, if I might correct you.

It came from a hearing right here.

Mr. BECKER. Is that right?

Dr. SNYDER. I think it was a Marine gunnery sergeant who, I

think, John, had come back from overseas and somebody asked him

do you have any problem with—what have you heard from your

family. And he said my wife thinks the produce is bad.

So then a week or two later, I went out to Little Rock Air Force

Base and looked at their produce. And it was worse than what his

wife thought their produce was. But it started right there at that

table. In fact, he was sitting right where you are, I think, Mr.

Becker.

Mr. BECKER. Well, I can’t forego the opportunity to let you know

how—what an impact you have had on the commissary system in

the fact that—I think one of the greatest success stories in the last

couple of years is the tremendous progress that has been made in

the area of produce. Sales prove it. Customer satisfaction proves it.

So the long arm of Congress has touched the commissary system

once again.

31

Dr. SNYDER. Good. Thank you.

Mrs. DAVIS. Thank you.

Mr. MCHUGH. If I may, if the gentleman will yield. I would note,

however, you have not had similar success with your annual interest in tattoos.

Dr. SNYDER. No, no, not impacting the tattoo policies at all.

Mr. MCHUGH. No, 50 percent is pretty good.

Mrs. DAVIS. Ms. Shea-Porter. And then we will go to Mr. Jones.

Ms. SHEA-PORTER. Thank you. I have to laugh because I had a

relative who ran the commissaries in Europe years ago, and nothing has changed. This sounds familiar to conversations from decades ago.

Anyway, what I wanted to ask, please, Colonel Strobridge, I

wanted to talk to you a little bit about what I heard yesterday in

the HASC hearing with Secretary of Defense Gates and your reference to some of the health care issues, TRICARE specifically. I

was looking at the defense budget yesterday, and they are looking

for efficiencies and ways that they plan to save money and said

that, really, it is a monkey on their backs how much the cost of

health care is.

And then I listened to your reference about TRICARE and the

fees, the increase in fees. And I wanted to have you take the opportunity to talk about it for a moment or two and if you think any

of the fees should be raised and if not, if you have any other ideas.

Colonel STROBRIDGE. Yes, ma’am. Number one, we think DOD is

vastly overstating the concern about the cost bogey relative to the

rest of America. When health care is 15 or 16 percent of the national economy and we are worried about the defense budget going

from 8 percent to 11 percent, from our perspective, gee, that is a

lot better than the rest of the country is doing, to start with.

Number two, one of the points that we have made consistently

is that DOD seems a lot more interested in shifting costs to beneficiaries than they have been so far than getting more efficient

themselves. The example that we use is the mail-order pharmacy

system where DOD constantly talked about we need to raise copays in the retail system to shift beneficiaries to the more cost efficient mail-order system when they knew for six years exactly

which beneficiaries were using which high-cost drugs and never

once spent a then 37 cent stamp to go ask them do you realize how

much money you would save if you used this mail-order system.

And we offered to partner with them to do that. Our organization

produced a brochure trying to push people to do that. DOD never

did. And so, we have listed a bunch of different things that DOD

could, one of which the Congress did last year, requiring the Federal pricing in the retail system. We will be very interested to see

how that works on the dynamics of the pharmacy.

But our view is when we have gone to talk to the Department

of Defense whatever we proposed was that doesn’t get enough

money out of the beneficiaries, we are not interested in that. As a

matter of fact, we were told point blank we are not interested in

working with you. We are out to get X dollars out of the beneficiaries.

Now, that was some time ago. And, as I said, to Dr. Kassels credit, he has reached out to the beneficiaries more. And we are optiVerDate 22-MAR-2001 14:24 Dec 12, 2008 Jkt 043248 PO 00000 Frm 00035 Fmt 6633 Sfmt 6633 C:\DOCS\110-111\038020.000 HAS2 PsN: HAS2
32

mistic we will get some progress on those kinds of things. But to

us we certainly have a long way to go.

I think one of the things that we overlook is that the military

system is inherently inefficient. The mission of the military medical

system is war, wartime readiness. When we deploy the doctors and

then have to shift all the beneficiaries to the private sector, we

can’t complain that the beneficiaries are costing more money.

You know, when you close down access to military facilities and

push people out to the retail pharmacies or we close installations

so that people no longer live next to military pharmacies, we can’t

complain that somehow the beneficiaries are costing more money.

When Congress says that it is wrong for military retirees over 65

to be thrown out of their military health care benefit and we are

going to authorize them TRICARE For Life and TRICARE Senior

Pharmacy, which we did in 2001, it is wrong, in our view, to come

back and then use the numbers and say, ‘‘My gosh, look how much

costs have increased since 2001.’’

Congress knew that. We knew it was going to happen. We did

it intentionally. It was no surprise.

Ms. SHEA-PORTER. Before I run out of time, let me ask you a

quick question. When my husband was in the military, we had very

easy access. We didn’t have TRICARE. We just went and got what

we needed. Are there people making decisions now not to fill prescriptions because, in spite of the benefit, they still don’t have the

money to make up the gap? Do you know that people are actually

refusing or are unable to accept service or a pharmacy prescriptions that they need?

Colonel STROBRIDGE. I am sure there are some older people who

have many medications doing that.

Ms. SHEA-PORTER. Okay.

Colonel STROBRIDGE. The military co-pays for pharmacy right

now, I have to say, are pretty reasonable. When you start going

from $9 to $25 or to $45 because we are pushing more and more

medications to the non-formulary and you have older people who

take a lot of medications, that is a lot of money that we are asking

people to—and as I have said—and I have some statistics that we

went out and got from private sector surveys, if the subcommittee

is interested.

The pharmacy benefit proposals they are offering, they are recommending in the budget are worse than most civilian plans. And

to us, if one of the purposes of the health care system is to say if

you served 20 or 30 years under these adverse conditions, we will

give you one of the best deals in America, that is not it.

Ms. SHEA-PORTER. Thank you.

Mrs. DAVIS. Thank you. I might just mention it would be interesting to me and I am sure the committee if you have some suggestions that you have put forward that you feel have been ignored,

you know, dismissed, even if they have what may be seen as a

marginal impact, I think we would be interested in looking at

them.

Colonel STROBRIDGE. We will be more than happy to provide

those for the record.

Mrs. DAVIS. It is the cumulative impact. And that would be good

to see. One of the things that we are going to do is have an opporVerDate 22-MAR-2001 14:24 Dec 12, 2008 Jkt 043248 PO 00000 Frm 00036 Fmt 6633 Sfmt 6633 C:\DOCS\110-111\038020.000 HAS2 PsN: HAS2
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tunity in members’ districts to talk about health care at length.

And I would be interested in some of those suggestions.

Colonel STROBRIDGE. Yes, ma’am. You know, if I can offer just a

couple of modest examples that are just incredible to us, one of the

worst things that you can do is smoke for your future health. And

yet TRICARE doesn’t pay for smoking cessation services. You

know, what kind of no-brainer is that?

Mrs. DAVIS. Thank you.

Mr. Jones.

Mr. JONES. Madam Chairman, thank you. I wanted to be here

earlier because of this panel and many friends, and I see new faces

I didn’t know. But I listened to you. Yesterday I had the Marine

League, people from all around this country, men and women who

had served in the Marine Corps coming in talking about their

issues.

And I hope, Madam Chairman—I don’t know who the nominee

is going to be for the presidency. But when I look at the numbers—

and I am not talking about your numbers. But I look at where this

country is, where we are going, and I don’t know where the money

is going to come from.

Yesterday Mr. Gates—I am going to use it again. I like him. I

complimented him on being a man of integrity, something we didn’t

have prior to Mr. Gates, quite frankly. That is my opinion.

But we are providing the blood and the money. And I was enraged last week to read in USA Today of how those who were supposed to be our allies are not meeting their pledge. So these people

who are not sending any of their troops to fight—primarily the

Middle East, the Saudis, and others—had agreed to a pledge of

$15.8 billion to help rebuild Iraq. As of this time, they have paid

$2.5 billion.

This country, America, has already spent $46 billion to rebuild

Iraq. And, Madam Chairman, whomever this President is, he, she

or it, I don’t know who it is going to be. But there has got to come

a time that this country says to those who are getting rich and rich

because they are charging us $87 for a barrel of oil—so the American taxpayer is paying for it.

The American taxpayers’ sons and daughters are dying and losing their legs. Many are going to come back and be retired like

many of you at this table.

And when I hear what you are asking for—and you should be

able to get 95 percent of what you are asking for. But if this country doesn’t understand that borrowing money from foreign governments to pay our bills means we do less for the American people

and those who have worn the uniform. And I didn’t come down

here to be outraged. I just came down here to, quite frankly, listen

to you knowing that what you are asking for we ought to be able

to accommodate 75 to 80 percent.

But when you are trying to police the world and nobody is helping you pay the bill, it is coming out of your programs. And I hope

and pray that the next President and those of us in Congress in

both parties will come back to understand that a country that is

in financial trouble like this country better get on sound footing

and start taking care of its people first before we take care of everybody else.

34

And I don’t have a question to ask. I am familiar with some of

these issues. I just want to vent and show my frustration in your

behalf, quite frankly. Thank you.

Mrs. DAVIS. Thank you. Thank you, Mr. Jones.

I wonder if I could just turn to you for a second, Mr. Bowers, and

talk a little bit about the mental health issues.

Mr. BOWERS. Yes, ma’am.

Mrs. DAVIS. And you have mentioned how important it is to reduce the stigma for servicemembers. And, in fact, there have been

some programs, I think, that have been put in place of retained

teaching to try and help commanders as well as kind of a peer

teaching program. But I don’t know that that has really been implemented yet in a way that we would see any true results at this

point.

Could you tell us if you think—is that a proper way to go, to educate, when people come into the services early enough or before

they deploy? And when it comes to families, I was talking to some

people involved with wounded warriors one day in my office. And

we were talking a little bit about the education and training because some of the troops that I have met with at Balboa had said,

you know, we need to do this really early. We need to understand

these issues so that they see it in themselves and others.

And I was told you don’t want to, you know, deal with that too

early because families are too nervous when their loved one is deployed. So bringing up the importance of understanding these mental health issues too early could, you know, be difficult.

Mr. BOWERS. Exactly.

Mrs. DAVIS. What would you say to that? I mean, how early

should this education begin? What part of the deployment process

should it be part of? And how do we best inform families as well?

Is that earlier, or is it after the fact? You know, really early.

And let me just follow up one or two quick questions. You said

that you thought a coordinated approach to suicide prevention

would be more effective than the current programs, which really

are by individual services. And I wonder if you could comment on

that, whether we need to do that in a coordinated way or more separate.

And the other issue really is whether or not the changes that we

are talking about in having, you know, early screening and whatever—do we need time to really see if they are working? Or should

we be talking about expanding programs early or doing something

different? You know, how much time would you assess we should

wait in order to see if something has actually taken hold?

Mr. BOWERS. Well, I think I relate this to the reason we would

like to see mandatory pre- and post-deployment screening is that

because then that reduces the stigma hands down. I connect this

to in the late 1980’s when we required all members of the branches

of service to start taking mandatory drug testing. Before then, individuals were called in to take either a urine analysis or a blood

sample, and the stigma began, and people started talking and saying, hey, sergeant so and so is doing drugs because he just got

called in to do testing.

It wasn’t until we required everybody to do it that that stigma

vanished. It was no longer a thought that if you are called in to

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do drug testing that you are using drugs. That cuts that element

away right there.

I look at this, honestly, as a cost savings plan. If we can do it

before and after their deployment and know the exact impact that

is there, then we know it has happened.

Your comment about when do we start training these individuals—I would like to see—and something that we have discussed

is I would like to see more integrated programs with combat medics and corpsmen that are the individuals that are on the front

lines to be able to recognize combat stress. These are the individuals that are there on the ground. And they are the ones that can

be prepared to handle a lot of these issues.

I tell my Marines regularly that I am not a mental health expert,

by any means. But I can tell when one of my Marines is in trouble.

As things are laid out now, we are required to self-diagnose. I

don’t know when I am having a hard time. But the people that do

know once I return home are the families. They are the first line

of defense. And what better time than when an individual is deployed to begin training programs with the family to help recognize

this?

There are programs—and I am sure National Military Family

Association (NMFA) can comment on this more accurately. But

there are training programs right now for individuals. There is key

volunteer programs. There is the battle-mind training, a program

that the Army has instituted approximately 18 months ago where

they are addressing these issues. But by being able to recognize it

right when individuals need it the most is going to be the most effective way.

In regards to suicide prevention, we have been extremely pleased

to see the Department of Veterans Affairs establish a suicide prevention hotline. We have seen the branches of service do suicide

training. For National Guardsmen and Reservists, though, this is

a very difficult task.

We get the opportunity to see these individuals once every 30

days, and that is it. It is hard to assess whether someone really

needs to be reached out to to get help.

With that said, I would love to see a DOD-wide sort of survey

or program or report to find out what the most effective measures

are. Currently I really do believe the Air Force has done that.

Based on their numbers, that they have seen a 30 percent reduction in suicide with their programs.

If DOD was able to harness the successes that the Air Force has

had and spread that Marine Corps-wide—excuse me, can you tell

I am playing favoritism here? If they go DOD-wide with a lot of

these initiatives, we are going to be extremely beneficial in the long

run.

Mrs. DAVIS. Thank you.

Mrs. Moakler, did you have a quick response in terms of families? As I said, it was suggested to me that if you talk about this

too early, people are just going to be scared even more than they

are.

Mrs. MOAKLER. I think families need to be educated so that they

are enabled to take care of their own quality of life, to address

their own issues without any kind of doom and gloom, like this is

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exactly how you are going to feel. I think they need to be educated

about how these feelings are natural. You are going to encounter

a certain amount of stress.

Todd mentioned battle-mind. There is a spouse battle-mind. DOD

has come up with fact sheets on military home fronts and deployment health websites that are easy to read, that families can look

at and say, ‘‘You know, maybe I am feeling a little bit like that.

No, it is not terrible to feel that way.’’

But I can call military one source and get some counseling to

help me deal with some stresses that I might be going through

with deployment or my children might be going through with deployment. NMFA itself—we are going to be launching a military

health component of our website with a vast resource link page to

make it easier for military families to, as a matter of course, look

into these things for themselves. And military families are already

doing that because they are looking at the web for mental health

resources.

Mrs. DAVIS. Thank you. And as you can see, we are into a third

round, which is unusual. We are usually running with votes. There

we go.

But, Dr. Snyder, do you want to jump in?

I am sorry. Mr. McHugh, go ahead.

Mr. MCHUGH. Don’t be sorry. I am going to feel sorry for these

panelists and say, look, we have had two hours, round of questioning, a call for votes, extensive testimony. If I have any further

questions, I will submit it for the record. But thank you all, as I

tried to indicate in the opening statement, my opening statement,

for what you do.

And, you know, Colonel, you mentioned your efforts through your

organization to try to prioritize and work with us. And I want to

underscore that wasn’t just you talking. You live that, and all of

your organizations have been leaders and very, very helpful to me

and I think I can confidently say to everyone on this panel. So keep

up the great work. Thank you.

Mrs. DAVIS. Thank you.

And, Dr. Snyder, you said you did have a question. Please, go

ahead.

Dr. SNYDER. It is really not a question. This topic came up on

the other side, the Veterans Committee today, in that there has

been some discussion about the New York Times series on veterans

who had come back and had committed crimes. This whole issue

of how you discuss this issue, I think, has become something important. And I, in the spirit of time, think I will just say we can

talk about divorce rates and all those kind of things. The bottom

line is the great majority of people who come back do very, very

well.

The problem is that from the outside it may be appearing that

they are feeling very, very well and they may just be miserable.

But they may be performing well. They are good with their kids.

They are doing their job. But life is not the same.

And I think what we are talking about is how do you alleviate,

in the spirit of friendship, human misery of people, the great majority of whom, are functioning reasonably well. And I don’t know

how we get around this issue of being advocates for additional

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mental health services without over-dramatizing it. But that is

what we have been trying to do here for the last year or two or

three.

Mrs. DAVIS. Thank you. And I would say that I believe that we

will be having a whole panel on mental health as we follow up with

the year. So we will have more focus on that.

Ms. Shea-Porter, do you have a question or comment?

Ms. SHEA-PORTER. I just wanted to say that later today I will be

making a statement on the floor about a young man who died in

my district recently and left behind a seven-month-old and a wife

and a grieving family and community. And this is what this is really all about, that each one who serves our country takes that risk

and every member of the family takes that risk with him or with

her.

And so, it is our commitment here in a bipartisan effort to make

sure that you have what you need and that we say thank you in

the right way to all of you and to those who serve us each day. So

I just wanted to say thank you.

Mrs. DAVIS. Thank you. Without objection, I just want to read

this into the record. I ask unanimous consent to include the following written testimonies: Mr. Peter Duffy, Deputy Director, Legislation, National Guard Association of the United States; Ms. Rose

Elizabeth Lee, Chair, Government Relations Committee, Gold Star

Wives of America, Incorporated; statement from the Reserve Officers Association of the United States; and statement from the

Naval Reserve Association. All those will be part of the record.

I want to thank all of you for submitting them. I want to thank

this wonderful panel for being here today. We greatly appreciate all

of your input. And we will look forward to working with you in the

future. Thank you very much.

[The information referred to can be found in the Appendix on

pages 187, 195 and 205.]

[Whereupon, at 4:54 p.m., the subcommittee was adjourned.]

A P P E N D I X

FEBRUARY 7, 2008

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QUESTIONS AND ANSWERS SUBMITTED FOR THE

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QUESTIONS SUBMITTED BY MRS. DAVIS OF CALIFORNIA

Mrs. DAVIS. It would be interesting to me and I am sure the committee if you

have some suggestions that you have put forward that you feel have been ignored,

you know, dismissed, even if they have what may be seen as a marginal impact,

I think we would be interested in looking at them.

It is the cumulative impact. And that would be good to see. One of the things that

we are going to do is have the opportunity in members’ districts to talk about health

care at length. And I would be interested in some of those suggestions.

Colonel STROBRIDGE. I would offer the following list of initiatives that we believe

have the potential to reduce long-term defense health costs, in many cases to a significant degree, without impinging on health benefits or beneficiaries.

1. Authorize TRICARE coverage of smoking-cessation services (e.g., hypnosis,

which many smokers have found successful) and products, which multiple studies

indicate is a top-rated means of reducing long-term health costs.

2. Exempt immunizations, preventive measures (e.g. mammograms,

colonoscopies), and medications/services for chronic diseases (e.g., diabetes, asthma)

from deductibles and co-payments to reduce long-term health costs (studies show

even a modest co-pay deters some for using these services/medications, and many

private sector plans are eliminating co-pays as participation incentives).

3. Encourage retention of other health insurance by making TRICARE a true

second-payer to other insurance (TRICARE now often pays nothing; paying the

other insurance’s co-pay would be far cheaper than having the beneficiary migrate

to TRICARE).

4. Stimulate use of lower-cost mail-order pharmacy by eliminating all mailorder co-pays.

5. Change the electronic claim system to reject errors in real time to help providers submit ‘‘clean’’ claims and to reduce delays and multiple submissions.

6. Do more to educate beneficiaries and providers on advantages of mail-order

pharmacy; change the law to explicitly allow defense officials to contact beneficiaries

as needed to do so, since DoD General Counsel indicates there are statutory limits

on current authority to do that.

7. Simplify TRICARE Prime referral system to reduce contractor overhead.

8. Reduce TRICARE Reserve Select costs by allowing members the option of a

government subsidy (at cost capped below cost of providing TRICARE) for payment

of civilian employer health premiums during periods of mobilization; over the longer

term, as deployment requirements ease, this would be much less costly than funding

TRICARE coverage for members and families in non-deployed status.

9. Reduce/eliminate DoD-unique administrative requirements that compel contractors to assume more overhead costs (and charge higher fees) than entailed in

other insurance programs.

10. Offer special care management services to beneficiaries with chronic and expensive conditions.

11. Establish centralized DoD ‘‘high-cost pharmacy’’ for central ordering and filling of prescriptions for exceptionally high-cost drugs (AF model has been successful).

12. Realign military treatment facility pharmacy budget process for centralized

funding, with greater emphasis on accountability and cost-shifting/reimbursement to

reduce departmental/service/installation/facility incentives to act in ways that reduce their specific obligation but increase DoD costs (e.g., robbing local hospital

funding to meet operational needs, which forces more beneficiaries into more expensive civilian care).

13. Consider test of voluntary participation in Medicare Advantage Regional

PPO to foster chronic care improvement and disease management programs.

14. Size military facilities (least costly care option) to reduce reliance on civilian

Prime networks (most costly care option) and treat more retirees under age 65; for

example, military providers see far fewer patients per day than civilian providers,

238

in part due to reductions in staff support, so providers have to spend more time on

administrative work; restoring staffing will free providers to see more patients.

15. Increase pharmacist positions and establish satellite military pharmacies

off-base in high-retiree/Guard/Reserve-population areas to recover more prescription

business from higher-cost retail systems; reestablish prescription courier services

that were popular at many locations under which retirees could have their medications delivered from a military pharmacy at some distance from their homes; establish pharmacy counters in commissaries/exchanges to facilitate one-stop shopping to

reduce inconvenience of having to visit multiple on-base facilities and spend time

waiting in military pharmacies.

16. Examine further savings options available from consolidation of medical

services.

QUESTIONS SUBMITTED BY MR. MCHUGH

Mr. MCHUGH. Within a year 35 percent then say I have a mental health problem,

I need care. I am curious are all of those 35 percent then seeking mental health

care and counseling because of the deployment?

Mr. BOWERS. That data is currently not available. With that said, the PDHA and

PDHRA are only administered to service members who have served on active duty

for a 90-day period. Therefore, a referral is made based off of deployment-related

circumstances. I have provided a copy of the most recent PDHRA that will clarify

the wording of these questions. Please note that although this new version (January

2008) is posted on the Deployment Health Clinical Center website, the older version

(June 2005) continues to be utilized for the assessment process as of March 2, 2008.

The new form has not been fully implemented. A 2006 study led by Army Col.

Charles Hoge, MD, at the Walter Reed Army Institute of Research, looked at the

results of Iraq veterans’ PDHAs. Only 19 percent of troops returning from Iraq selfreported a mental health problem. But 35 percent of those troops actually sought

mental health care in the year following deployment. If the PDHA is intended to

correctly identify troops who will need mental health care, it simply does not work.

A follow-up study in 2007, also published in the Journal of the American Medical

Association, concluded: ‘‘Surveys taken immediately on return from deployment substantially underestimate the mental health burden.’’ Although the PDHRA, which

troops fill out six months after deployment, is more likely to identify mental health

injuries its overall effectiveness is also dubious. Troops may not be filling out their

forms accurately, troops needing counseling are not consistently getting referrals,

and those with referrals do not always get treatment.

Charles W. Hoge et al., ‘‘Mental Health Problems, Use of Mental Health Services,

and Attrition from Military Service After Returning from Deployment to Iraq or Afghanistan,’’ Journal of the American Medical Association, March 1, 2006, 295, p.

1023: http://www.iava.org/images/JAMA.pdf.

Mr. MCHUGH. So if you are deployed, that 20 percent figure is higher than it

would be if you were not?

Would it be possible to get some data on that, if you have a chance?

Mr. BOWERS. Yes. And I have also found that with multiple deployments this is

having an increasing impact whereas the percentage rate goes up per deployment.

[The information referred to can be found in the Appendix on page 218].

QUESTIONS SUBMITTED BY MRS. BOYDA

Mrs. BOYDA. In your testimony you had said that multiple tours and inadequate

time at home and between deployments increased rates of combat stress at 50 percent. Where do you have those numbers?

Mr. BOWERS. According to the military Mental Health Advisory Team (MHAT)’s

survey of soldiers and Marines in Iraq, soldiers deployed to Iraq more than once

were 50 percent more likely to be diagnosed with mental health injuries than those

on their first deployment.

‘‘Mental Health Advisory Team (MHAT) IV Brief,’’ General James T. Conway,

Commandant of the Marine Corps, April 18, 2007, p. 17: http://

www.militarytimes.com/static/projects/pages/mhativl8apr07.pdf.

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