DEPARTMENT OF DEFENSE APPROPRIATIONS FOR 2009 HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS HOUSE OF REPRESENTATIVES ONE HUNDRED TENTH CONGRESS SECOND SESSION SUBCOMMITTEE ON DEFENSE JOHN P. MURTHA, Pennsylvania, Chairman NORMAN D. DICKS, Washington C. W. BILL YOUNG, Florida PETER J. VISCLOSKY, Indiana DAVID L. HOBSON, Ohio JAMES P. MORAN, Virginia RODNEY P. FRELINGHUYSEN, New Jersey MARCY KAPTUR, Ohio TODD TIAHRT, Kansas ROBERT E. ‘‘BUD’’ CRAMER, JR., Alabama JACK KINGSTON, Georgia ALLEN BOYD, Florida KAY GRANGER, Texas STEVEN R. ROTHMAN, New Jersey SANFORD D. BISHOP, JR., Georgia NOTE: Under Committee Rules, Mr. Obey, as Chairman of the Full Committee, and Mr. Lewis, as Ranking Minority Member of the Full Committee, are authorized to sit as Members of all Subcommittees. PAUL JUOLA, GREG LANKLER, SARAH YOUNG, PAUL TERRY, KRIS MALLARD, LINDA PAGELSEN, ADAM HARRIS, ANN REESE, TIM PRINCE, BROOKE BOYER, MATT WASHINGTON, B G WRIGHT, CHRIS WHITE, CELES HUGHES, and ADRIENNE RAMSAY, Staff Assistants SHERRY L. YOUNG, Administrative Aide PART 3 Page Defense Health Program ....................................................... 1 National Guard and Reserve Issues ................................... 83 Department of the Air Force ................................................ 197 United States Central Command ......................................... 243 Air Force Posture .................................................................... 315 Printed for the use of the Committee on Appropriations VerDate Nov 24 2008 23:43 Feb 03, 2009 Jkt 046475 PO 00000 Frm 00001 Fmt 7513 Sfmt 7513 E:\HR\OC\46475P1.XXX 46475P1 smartinez on PROD1PC64 with HEARING PART 3—DEPARTMENT OF DEFENSE APPROPRIATIONS FOR 2009 VerDate Nov 24 2008 23:43 Feb 03, 2009 Jkt 046475 PO 00000 Frm 00002 Fmt 6019 Sfmt 6019 E:\HR\OC\46475P1.XXX 46475P1 smartinez on PROD1PC64 with HEARING with PROD1PC64 on smartinez DEPARTMENT OF DEFENSE APPROPRIATIONS FOR 2009 HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS HOUSE OF REPRESENTATIVES ONE HUNDRED TENTH CONGRESS SECOND SESSION SUBCOMMITTEE ON DEFENSE JOHN P. MURTHA, Pennsylvania, Chairman NORMAN D. DICKS, Washington C. W. BILL YOUNG, Florida PETER J. VISCLOSKY, Indiana DAVID L. HOBSON, Ohio JAMES P. MORAN, Virginia RODNEY P. FRELINGHUYSEN, New Jersey MARCY KAPTUR, Ohio TODD TIAHRT, Kansas ROBERT E. ‘‘BUD’’ CRAMER, JR., Alabama JACK KINGSTON, Georgia ALLEN BOYD, Florida KAY GRANGER, Texas STEVEN R. ROTHMAN, New Jersey SANFORD D. BISHOP, JR., Georgia NOTE: Under Committee Rules, Mr. Obey, as Chairman of the Full Committee, and Mr. Lewis, as Ranking Minority Member of the Full Committee, are authorized to sit as Members of all Subcommittees. PAUL JUOLA, GREG LANKLER, SARAH YOUNG, PAUL TERRY, KRIS MALLARD, LINDA PAGELSEN, ADAM HARRIS, ANN REESE, TIM PRINCE, BROOKE BOYER, MATT WASHINGTON, B G WRIGHT, CHRIS WHITE, CELES HUGHES, and ADRIENNE RAMSAY, Staff Assistants SHERRY L. YOUNG, Administrative Aide PART 3 Page Defense Health Program ....................................................... 1 National Guard and Reserve Issues ................................... 83 Department of the Air Force ................................................ 197 United States Central Command ......................................... 243 Air Force Posture .................................................................... 315 U.S. GOVERNMENT PRINTING OFFICE 46–475 WASHINGTON : 2009 VerDate Nov 24 2008 23:43 Feb 03, 2009 Jkt 046475 PO 00000 Frm 00003 Fmt 7513 Sfmt 7513 E:\HR\OC\46475P1.XXX 46475P1 smartinez on PROD1PC64 with HEARING COMMITTEE ON APPROPRIATIONS DAVID R. OBEY, Wisconsin, Chairman JOHN P. MURTHA, Pennsylvania JERRY LEWIS, California NORMAN D. DICKS, Washington C. W. BILL YOUNG, Florida ALAN B. MOLLOHAN, West Virginia RALPH REGULA, Ohio MARCY KAPTUR, Ohio HAROLD ROGERS, Kentucky PETER J. VISCLOSKY, Indiana FRANK R. WOLF, Virginia NITA M. LOWEY, New York JAMES T. WALSH, New York JOSE´ E. SERRANO, New York DAVID L. HOBSON, Ohio ROSA L. DELAURO, Connecticut JOE KNOLLENBERG, Michigan JAMES P. MORAN, Virginia JACK KINGSTON, Georgia JOHN W. OLVER, Massachusetts RODNEY P. FRELINGHUYSEN, New Jersey ED PASTOR, Arizona TODD TIAHRT, Kansas DAVID E. PRICE, North Carolina ZACH WAMP, Tennessee CHET EDWARDS, Texas TOM LATHAM, Iowa ROBERT E. ‘‘BUD’’ CRAMER, JR., Alabama ROBERT B. ADERHOLT, Alabama PATRICK J. KENNEDY, Rhode Island JO ANN EMERSON, Missouri MAURICE D. HINCHEY, New York KAY GRANGER, Texas LUCILLE ROYBAL-ALLARD, California JOHN E. PETERSON, Pennsylvania SAM FARR, California VIRGIL H. GOODE, JR., Virginia JESSE L. JACKSON, JR., Illinois RAY LAHOOD, Illinois CAROLYN C. KILPATRICK, Michigan DAVE WELDON, Florida ALLEN BOYD, Florida MICHAEL K. SIMPSON, Idaho CHAKA FATTAH, Pennsylvania JOHN ABNEY CULBERSON, Texas STEVEN R. ROTHMAN, New Jersey MARK STEVEN KIRK, Illinois SANFORD D. BISHOP, JR., Georgia ANDER CRENSHAW, Florida MARION BERRY, Arkansas DENNIS R. REHBERG, Montana BARBARA LEE, California JOHN R. CARTER, Texas TOM UDALL, New Mexico RODNEY ALEXANDER, Louisiana ADAM SCHIFF, California KEN CALVERT, California MICHAEL HONDA, California JO BONNER, Alabama BETTY MCCOLLUM, Minnesota STEVE ISRAEL, New York TIM RYAN, Ohio C.A. ‘‘DUTCH’’ RUPPERSBERGER, Maryland BEN CHANDLER, Kentucky DEBBIE WASSERMAN SCHULTZ, Florida CIRO RODRIGUEZ, Texas ROB NABORS, Clerk and Staff Director (II) VerDate Nov 24 2008 23:43 Feb 03, 2009 Jkt 046475 PO 00000 Frm 00004 Fmt 7513 Sfmt 7513 E:\HR\OC\46475P1.XXX 46475P1 smartinez on PROD1PC64 with HEARING DEPARTMENT OF DEFENSE APPROPRIATIONS FOR 2009 THURSDAY, FEBRUARY 28, 2008. DEFENSE HEALTH PROGRAM WITNESSES HON. S. WARD ‘‘TRIP’’ CASSCELLS, M.D., ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS LIEUTENANT GENERAL ERIC B. SCHOOMAKER, M.D., PH.D., ARMY SUR- GEON GENERAL, COMMANDER, U.S. ARMY MEDICAL COMMAND VICE ADMIRAL ADAM M. ROBINSON, M.D., SURGEON GENERAL, U.S. NAVY LIEUTENANT GENERAL JAMES G. ROUDEBUSH, M.D., SURGEON GEN- ERAL, U.S. AIR FORCE INTRODUCTION Mr. MURTHA. I want to welcome this distinguished panel before the Committee. This is an open hearing. And we appreciate what you folks have done. I was just talking to some of you privately, and Mr. Young was, too. And of course, what we have been wres- tling with is trying to figure out, is there a better time to inter- vene? Can we intervene sooner? And Admiral Mullen gave me a book, ‘‘War and Redemption,’’ which talks about the difficulties and struggles people had in World War II and Iraq and so forth. And I have read three or four books. John Parrish, Dr. Parrish, wrote a book about his experience in Vietnam. And a couple other books I have read talked about the emotional and mental problems that they have had. One thing I found is when I went to Fort Hood, I found a much better clinical screening course than I saw before, a much better counseling service. And I think, as we work our way through this extra money we put in last year and we get case workers out there who can follow people through the whole system, I think we are going to be much better off. But we welcome you. And there are a lot of different hearings going on, and many of our members are both chairmen and ranking members, because they are senior be- fore they can get on this subcommittee anyway, so we will go as quickly as we can. We will take your testimony, if you will summa- rize it for us, and we will get right to the questions. Mr. Young. Mr. YOUNG. Mr. Chairman, I just want to extend my welcome also to the witnesses today. And as I have said so many times be- fore, you know, I do not have much of a medical background, but I have seen what I consider to be some real miracles in our mili- (1) VerDate Nov 24 2008 01:38 Feb 04, 2009 Jkt 046475 PO 00000 Frm 00001 Fmt 6633 Sfmt 6633 E:\HR\OC\A475P2.XXX A475P2 smartinez on PROD1PC64 with HEARING 2 tary hospitals. And we have had some problems, but we deal with the problems. We are just glad to have you here, and I look forward to hearing your testimony. Mr. MURTHA. Nobody has been in the forefront more than Mr. Young and his wife going to the hospitals, talking to people, mak- ing sure that they had—and I have done my bit, and we want to make sure medical services get their share of the budget. And some of the things we have done I think have been obviously very impor- tant to the overall ability of the medical services to respond to the needs that are out there of the troops. So, Dr. Casscells, we will start with you and go right through the surgeons general. But we want to keep your opening statements as short as you can. Dr. CASSCELLS. Thank you, Mr. Chairman, Congressman Young. I really want to say, on behalf of the Under Secretary, Dr. Chu, and Gordon England, and all the Pentagon leaders, and you will hear from the services, we appreciate this chance to visit with you. We come here, as usual, with two eyes open, two ears open, and great appreciation for what this committee has done. Mr. MURTHA. Is his microphone turned on there? SUMMARY STATEMENT OF DR. CASSCELLS Dr. CASSCELLS. Sorry, sir. Thank you, Mr. Chairman, Congress- man Young. I really want to say, on behalf of the Under Secretary, Dr. Chu, and Gordon England and all the Pentagon leaders, and you will hear from the Services, we appreciate this opportunity to get your guidance. We have gotten a lot of excellent guidance over the past year, in addition to some extraordinary support. And as I mentioned to you a minute ago, you and this Committee have been the leading advocates for the healthcare for our members. And it is deeply, deeply appreciated because it is an arm wrestle in the Pentagon. Dollars do count, as well as the other guidance. So your continued interest in this and Mr. Young’s and Mrs. Young’s is deeply, deeply appreciated, sir. So we are today, again, to get guidance and to give you a report. The simple form of the report is, we are making pretty good progress. The GAO report this morning in the Washington Post on the situation at Walter Reed, for example, is encouraging.