DEPARTMENT OF DEFENSE APPROPRIATIONS FOR 2014 HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS HOUSE OF REPRESENTATIVES ONE HUNDRED THIRTEENTH CONGRESS FIRST SESSION SUBCOMMITTEE ON DEFENSE C. W. BILL YOUNG, Florida, Chairman RODNEY P. FRELINGHUYSEN, New Jersey PETER J. VISCLOSKY, Indiana JACK KINGSTON, Georgia JAMES P. MORAN, Virginia KAY GRANGER, Texas BETTY MCCOLLUM, Minnesota ANDER CRENSHAW, Florida TIM RYAN, Ohio KEN CALVERT, California WILLIAM L. OWENS, New York JO BONNER, Alabama MARCY KAPTUR, Ohio TOM COLE, Oklahoma STEVE WOMACK, Arkansas NOTE: Under Committee Rules, Mr. Rogers, as Chairman of the Full Committee, and Mrs. Lowey, as Ranking Minority Member of the Full Committee, are authorized to sit as Members of all Subcommittees. TOM MCLEMORE, JENNIFER MILLER, PAUL TERRY, WALTER HEARNE, MAUREEN HOLOHAN, ANN REESE, TIM PRINCE, BROOKE BOYER, BG WRIGHT, ADRIENNE RAMSAY, and MEGAN MILAM ROSENBUSCH, Staff Assistants SHERRY L. YOUNG, Administrative Aide PART 2 Page Defense Health Program ....................................................... 1 U.S. Africa Command .............................................................. 155 FY 2014 Navy and Marine Corps ......................................... 179 FY 2014 Army Budget Overview .......................................... 331 FY 2014 Air Force Budget Overview .................................. 421 Outside Witness Statements ................................................. 501 U.S. GOVERNMENT PRINTING OFFICE 86–557 WASHINGTON : 2014 COMMITTEE ON APPROPRIATIONS HAROLD ROGERS, Kentucky, Chairman C. W. BILL YOUNG, Florida 1 NITA M. LOWEY, New York FRANK R. WOLF, Virginia MARCY KAPTUR, Ohio JACK KINGSTON, Georgia PETER J. VISCLOSKY, Indiana RODNEY P. FRELINGHUYSEN, New Jersey JOSE´ E. SERRANO, New York TOM LATHAM, Iowa ROSA L. DELAURO, Connecticut ROBERT B. ADERHOLT, Alabama JAMES P. MORAN, Virginia KAY GRANGER, Texas ED PASTOR, Arizona MICHAEL K. SIMPSON, Idaho DAVID E. PRICE, North Carolina JOHN ABNEY CULBERSON, Texas LUCILLE ROYBAL-ALLARD, California ANDER CRENSHAW, Florida SAM FARR, California JOHN R. CARTER, Texas CHAKA FATTAH, Pennsylvania RODNEY ALEXANDER, Louisiana SANFORD D. BISHOP, JR., Georgia KEN CALVERT, California BARBARA LEE, California JO BONNER, Alabama ADAM B. SCHIFF, California TOM COLE, Oklahoma MICHAEL M. HONDA, California MARIO DIAZ-BALART, Florida BETTY MCCOLLUM, Minnesota CHARLES W. DENT, Pennsylvania TIM RYAN, Ohio TOM GRAVES, Georgia DEBBIE WASSERMAN SCHULTZ, Florida KEVIN YODER, Kansas HENRY CUELLAR, Texas STEVE WOMACK, Arkansas CHELLIE PINGREE, Maine ALAN NUNNELEE, Mississippi MIKE QUIGLEY, Illinois JEFF FORTENBERRY, Nebraska WILLIAM L. OWENS, New York THOMAS J. ROONEY, Florida CHARLES J. FLEISCHMANN, Tennessee JAIME HERRERA BEUTLER, Washington DAVID P. JOYCE, Ohio DAVID G. VALADAO, California ANDY HARRIS, Maryland ————— 1 Chairman Emeritus WILLIAM E. SMITH, Clerk and Staff Director (II) DEPARTMENT OF DEFENSE APPROPRIATIONS FOR 2014 WEDNESDAY, APRIL 24, 2013. DEFENSE HEALTH PROGRAM WITNESSES DR. JONATHAN WOODSON, ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS AND DIRECTOR OF TRICARE MANAGEMENT AC- TIVITY LIEUTENANT GENERAL PATRICIA D. HOROHO, SURGEON GENERAL OF THE ARMY VICE ADMIRAL MATTHEW L. NATHAN, SURGEON GENERAL OF THE NAVY LIEUTENANT GENERAL (DR.) THOMAS W. TRAVIS, SURGEON GENERAL OF THE AIR FORCE OPENING STATEMENT OF CHAIRMAN YOUNG Mr. YOUNG. The committee will come to order. As you might have noticed, the attendance is not really great right now because many of our members are chairmen of other subcommittees and there is a very busy schedule of hearings of other subcommittees as well today. So our attendance may not be as good as usual. But I think you will find it to be very interesting because every member on this subcommittee has a great interest in what it is that you all do. So this morning the committee will hold an open hearing on the fiscal year 2014 budget request for the defense health program. We would like to welcome the Assistant Secretary of Defense for Health Affairs, Dr. Jonathan Woodson; the Surgeon General of the Army, Lieutenant General Patricia Horoho; the Surgeon General of the Navy, Vice Admiral Matthew Nathan; and the Surgeon General of the Air Force, Lieutenant General Thomas Travis. I would also like to mention that while Dr. Woodson, General Horoho and Admiral Nathan are veterans at testifying before this subcommittee, General Travis is making his first appearance be- fore us. And General, I think you will find that this committee is very supportive of the mission that you have and that all of the rest of you have. So this is not an adversarial committee, while on occasion we may have some very, very interesting and penetrating questions. General TRAVIS. Thank you. Mr. YOUNG. We are very interested in what you have to tell us. So many things have been happening that affect military medicine. Over the past year we all heard talk of fiscal cliffs, challenges, se- (1) 2 questration, continuing resolutions, reductions, cuts and furloughs. It is sad that in the media these discussions have largely displaced the news of the actions of our brave servicemembers, because de- spite all of the economic turmoil we are facing our servicemen and women continue to unfailingly defend this Nation, and for that we will forever be grateful. We remain committed to providing the very best in medical care to our servicemen and women who put their lives on the line for us each and every day. However, as has been the case for the last several years the De- partment faces a tremendous challenge with the growing cost and long-term sustainability of the military health service system. Mili- tary health care costs have risen from $19 billion in the fiscal year 2001 to approximately $49 billion in the fiscal year 2014 budget re- quest. However, this budget request assumes savings associated with several controversial TRICARE benefit cost sharing proposals that must ultimately be approved by Congress. We are interested to hear more about these proposals today. Additionally, the subcommittee remains concerned about contin- ued high numbers of suicides and the ability of the Department to provide mental health counseling, and readjustment support for our servicemembers returning from deployments. It is imperative for the Department to get to the heart of the issues that servicemembers and their families face during and after deploy- ments. The committee is anxious to hear about what progress the Department has made in the past year with regard to psychological health, traumatic brain injury and suicide prevention; and what this subcommittee can do to assist in making further advances in the coming fiscal year. We are concerned about the tremendous backlog in the Veterans Administration of dealing with veterans claims. And I am won- dering if there should be some delay or some other decision before the military medicine turns loose the wounded soldiers and turns them over to the VA system that is so far behind that it is just frankly terribly, terribly embarrassing. And I know that other members have the same experiences that I have in my district of people calling saying I can’t get through to the VA, I can’t get my case considered when their case needs to be considered. And that could possibly be the reason that we are having problems like sui- cides and PTSD and other issues that could be dealt with. So if you have any thoughts on whether the military medicine should keep soldiers in some cases longer before turning them over to the VA where they basically get lost or filed in a box someplace. So anyway, welcome. We look forward to your testimony and to an informative question and answer session. Before we hear your testimony, I want to turn to my good friend and the ranking mem- ber, Mr. Pete Visclosky, for any opening comments that he would like to make. Mr. VISCLOSKY. Chairman, thank you very much. I certainly want to associate myself with your remarks. Thank you for holding this hearing and thank our witnesses. We look forward to hearing from you. Thank you very much, Mr. Chairman. Mr. YOUNG. The process, as you all know, we will hear your statements. You may consolidate those statements anyway that 3 you would like. The entire statement will be placed in the record, but in the interest of time if you wish to consolidate them that would be perfectly fine, and then we will hear from each of the four of you and then we will begin the questioning. Dr. Woodson, we will start with you. SUMMARY STATEMENT OF DR. WOODSON Dr. WOODSON. Thank you very much and good morning to every- one. Chairman Young, Ranking Member Visclosky, and members of the subcommittee, thank you for the opportunity to appear before you today. The men and women who are serving in the Military Health Sys- tem continue to perform on the battlefield and here at home with great skill and courage. The military health system’s ability to si- multaneously engage in combat and medical operations and sup- port a comprehensive peacetime health system and respond to hu- manitarian crises around the world is unique among all military forces. Mr. YOUNG. Excuse me, doctor, could you pull that microphone a little closer? Dr. WOODSON. And as we all witnessed with the horrible and tragic events in Boston last week, we have also seen how the hard earned medical lessons of Afghanistan and Iraq have transposed themselves to the civilian environment with lifesaving practices that benefit all of American society. The medical readiness of men and women in our Armed Forces remains at the center of our mission and our strategy. And that strategy is coupled with our mission of maintaining a ready med- ical force, a force of professionals that are well trained, engaged in ongoing clinical practice and supported by military hospitals and clinics that are operating at optimal capacity. As we maintain our readiness support combat operations and de- liver health care services to 9.6 million beneficiaries we must also be responsible for the budgets that we are given. In 2013, the De- partment and the Federal Government has encountered headwinds.