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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H. Res. 698 Introduced in House (IH)]

111th CONGRESS
  1st Session
H. RES. 698

  Expressing the sense of the House of Representatives that the fatal 
 crash of an MV-22 aircraft on April 8, 2000, in Marana, Arizona, was 
         not a result of aircrew human factors or pilot error.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             July 30, 2009

Mr. Jones submitted the following resolution; which was referred to the 
                      Committee on Armed Services

_______________________________________________________________________

                               RESOLUTION

 
  Expressing the sense of the House of Representatives that the fatal 
 crash of an MV-22 aircraft on April 8, 2000, in Marana, Arizona, was 
         not a result of aircrew human factors or pilot error.

Whereas an MV-22 aircraft crashed on April 8, 2000, in Marana, Arizona, killing 
        the pilot, Lieutenant Colonel John A. Brow, the co-pilot, Major Brooks 
        S. Gruber, and 17 other Marines aboard the aircraft;
Whereas Lieutenant Colonel Brow and Major Gruber possessed excellent and 
        unassailable records throughout their careers in the United States 
        Marine Corps and gave their lives for the United States and the Marine 
        Corps in the crash on April 8, 2000;
Whereas after the accident Lieutenant Colonel Brow's commanding officer 
        described him as a ``highly regarded pilot, both in the C-130 and MV-22, 
        and his expertise and recommendations lent a great deal to the MV-22 
        program.'';
Whereas after the accident Major Gruber's commanding officer described him as a 
        ``very highly regarded pilot, both in the CH-53E and MV-22, whose work 
        with special operations gave unique insight to the MV-22 program.'';
Whereas numerous reviews and investigations following the accident document that 
        the pilots of the aircraft involved in the accident were not provided 
        with the necessary and critical knowledge of the potential for sudden 
        loss of controlled flight in the MV-22 following Vortex Ring State (VRS) 
        onset or the training to recognize, avoid, or recover from the extreme 
        dangers of VRS in the MV-22;
Whereas after the accident Naval Air Systems Command called for a thorough 
        investigative flight test program to find the MV-22's boundaries of VRS, 
        characterize its handling qualities, and establish the basis for a new 
        flight limitation, new pilot procedures, and a cockpit warning system, 
        if warranted;
Whereas, as a result of testing following the fatal accident, a visual and aural 
        cockpit warning system was developed to alert the aircrew when the 
        aircraft exceeded the Naval Air Training and Operating Procedures 
        Standardization (NATOPS) flight manual's rate-of-descent limit;
Whereas, on July 27, 2000, the Marine Corps announced in a press release that a 
        combination of ``human factors'' caused the April 8, 2000, crash, 
        stating that ``deviations from the scheduled flight plan, an unexpected 
        tailwind and the pilot's extremely rapid rate of descent into the 
        landing zone created conditions that led to the accident.'';
Whereas the press release also stated the ``although the report stops short of 
        specifying pilot error as a cause, it notes that the pilot of the ill-
        fated aircraft significantly exceeded the rate of descent established by 
        regulations for safe flight.'';
Whereas the press release issued by the Marine Corps also quoted Commandant 
        General James L. Jones as saying that ``the tragedy is that these were 
        all good Marines joined in a challenging mission. Unfortunately, the 
        pilots' drive to accomplish that mission appears to have been the fatal 
        factor.'';
Whereas the language of the press release is damaging and inaccurate because, at 
        the time of the crash, adequate testing of the MV-22 in the High Rate of 
        Descent (HROD) and the VRS regimes had not been conducted, the MV-22 did 
        not have a VRS warning system, and the pilots did not have adequate 
        knowledge of the potential for sudden loss of controlled flight in the 
        MV-22 following VRS onset or the training to recognize, avoid, or 
        recover from the extreme dangers of VRS in the MV-22;
Whereas according to the investigation conducted pursuant to the Judge Advocate 
        General Manual (JAGMAN investigation), on April 8, 2000, Lieutenant 
        Colonel Brow and Major Gruber were participating in an Operational 
        Evaluation (OPEVAL) to determine the operational effectiveness and 
        suitability of the MV-22 and to continue tactics development to support 
        the promulgation of an Operational Tactics Guide;
Whereas an OPEVAL is to be conducted under realistic scenarios in day, night, 
        and adverse weather;
Whereas the OPEVAL of April 8, 2000, called for a long-range night Non-combatant 
        Evacuation Operation exercise involving the insertion of a security and 
        processing unit;
Whereas, according to the Comptroller General, the Operational Test and 
        Evaluation Force's MV-22 report on the OPEVAL indicated that the MV-22 
        ``Naval Air Training and Operating Procedures Standardization (NATOPS) 
        manual lacked adequate content, accuracy, and clarity at the time of the 
        accident. Additionally, because of incomplete developmental testing in 
        the High Rate of Descent (HROD) regime, there was insufficient 
        explanatory or emphatic text to warn pilots of hazards of operating in 
        this area. The flight simulator did not replicate this loss of 
        controlled flight regime.'';
Whereas the preliminary NATOPS manual and MV-22 ground school syllabus provided 
        insufficient guidance or warning as to high rate of descent airspeed 
        conditions and the potential consequences of a rapid rate of descent;
Whereas the officer conducting the JAGMAN investigation stated that ``The fact 
        that this aircraft not only found itself in a Vortex Ring State 
        condition with no apparent warning to the aircrew, but also departed 
        controlled flight is particularly concerning.'';
Whereas, based on this evidence, it is clear that the pilots of the aircraft 
        involved in the accident on April 8, 2000, did not have the knowledge, 
        warning systems, or training needed to avoid or recover from VRS onset 
        at the time of the accident;
Whereas, on December 15, 2000, after a second crash of a MV-22 aircraft that 
        year, then-Secretary of Defense Bill Cohen determined that the accident 
        history of the MV-22 aircraft and other testing issues required an 
        independent, high-level review of the program and therefore established 
        a Blue Ribbon Panel to review the safety of the MV-22 aircraft and to 
        recommend corrective actions;
Whereas the Blue Ribbon Panel was briefed by the Comptroller General and the 
        contents of this brief were incorporated into a subsequent Comptroller 
        General report which cited concerns about the adequacy of development 
        tests conducted prior to the MV-22 aircraft entering the operational 
        test and evaluation phase, in particular that such developmental testing 
        was deleted, deferred, or simulated in order to meet cost and scheduled 
        goals;
Whereas the original plan to test the flying qualities of the flight control 
        system of the MV-22, including various rates of descent, speeds, and 
        weights, would have provided considerable knowledge of the MV-22 flight 
        qualities especially in areas related to the sudden loss of controlled 
        flight following VRS onset;
Whereas, to meet cost and schedule targets, the actual testing of the MV-22 
        conducted was less than a third of the testing originally planned;
Whereas the MV-22 pilots involved in the accident did not understand the optimum 
        use of nacelle tilt to recover from VRS onset;
Whereas additional HROD and VRS developmental testing could have prevented the 
        tragic accident on April 8, 2000, in Marana, Arizona, by providing the 
        pilots the knowledge and training to either avoid or recover from VRS;
Whereas the Comptroller General report also revealed that the Director, 
        Operational Test & Evaluation of the Department of Defense stated that 
        ``while the possible existence of VRS in the MV-22 was known when flight 
        limits for OPEVAL were established, the unusual attitude following entry 
        into VRS was not expected'' and ``thus, the first indication the pilot 
        may receive that he has encountered this difficulty is when the aircraft 
        initiated an uncommanded, uncontrollable roll.''; and
Whereas Lieutenant Colonel Brow and Major Gruber and their families are 
        dishonored by the assertion that the aircrew was in any way responsible 
        for this fatal accident: Now, therefore, be it
    Resolved, That it is the sense of the House of Representatives 
that--
            (1) the fatal crash of an MV-22 on April 8, 2000, in 
        Marana, Arizona, was not a result of aircrew human factors or 
        pilot error that can be attributed to the late Lieutenant 
        Colonel John A. Brow or the late Major Brooks S. Gruber who 
        performed their duties as United States Marine Corps aviators 
        competently and professionally;
            (2) the fatal factor in the crash of an MV-22 on April 8, 
        2000, was the aircraft's lack of a Vortex Ring State (VRS) 
        warning system and the failure to provide the pilots with the 
        necessary and critical knowledge and training regarding the 
        extreme dangers of VRS onset in the MV-22;
            (3) because of inadequate High Rate of Descent (HROD) and 
        VRS developmental testing, the pilots of the MV-22 involved in 
        the accident on April 8, 2000, were not trained or able to 
        recognize, avoid, or recover from VRS onset in the MV-22; and
            (4) had adequate HROD and VRS developmental testing been 
        conducted prior to the Operational Evaluation of April 8, 2000, 
        and had a VRS warning system been installed in the aircraft, 
        Lieutenant Colonel Brow and Major Gruber would have been better 
        able to avoid or recover from VRS.
                                 <all>
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