STATEMENTS OF WILLIAM WINKENWERDER, JR., M.D., ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS, DEPARTMENT OF DEFENSE, ACCOMPANIED BY LIEUTENANT GENERAL GEORGE P. TAYLOR, JR., THE SURGEON GENERAL, U.S. AIR FORCE; REAR ADMIRAL BRIAN C. BRANNMAN, DEPUTY CHIEF, FLEET OPERATIONS SUPPORT, BUREAU OF MEDICINE AND SURGERY, U.S. NAVY, AND WAYNE SPRUELL, PRINCIPAL DEPUTY ASSISTANT SECRETARY OF DEFENSE, RESERVE AFFAIRS, MANPOWER AND PERSONNEL; AND LIEUTENANT GENERAL JAMES B. PEAKE, SURGEON GENERAL, U.S. ARMY

Dr. WINKENWERDER. Thank you, Mr. Chairman. Mr. Chairman and members of this distinguished committee, thank you for the opportunity to be here today to discuss the Department of Defense's Force Health Protection programs and how they impact our Reserve component service members and their families.

Today we have nearly 190,000 activated National Guard and Reserve service men and women, including those serving in Afghanistan and Iraq. We are firmly committed to protecting their health. Despite serving in some of the most austere and tough environments imaginable, today our disease and non-battle injury rates among deployed personnel are the lowest ever. The Services have improved medical screening to ensure forces are healthy, and they have enhanced theater surveillance, allowing commanders and medics to identify health hazards.

I would just state flatly and emphatically that the lessons from the Gulf war have been learned and those lessons are being put into place today. The Services evaluate all members, pre- and postdeployment and permanent health records are maintained. There is some good news that we've learned as we've looked over all those records of post-deployment health assessments of Reservists returning, and that is that they themselves have reported to us that over 92 percent indicate that their health status upon return from deployment is either good, very good or excellent.

Pre-deployment health assessments ensure that Guards and Reserve members are fit and healthy to carry out their duties. Improved pre-deployment screening in fact contributed to the backlog of activated Reservists who were waiting clearance to deploy who we heard from just earlier. The Army has worked to alleviate this backlog, and the number of troops in this status is steadily declining.

I would note to you that of the roughly 4,000 plus service members that were in that status, Reservists in the November time period, roughly 3,000, actually a bit more than that, about 75 percent have been processed through. There still are some. We heard from one or two of them today. But considerable progress has been made.

I'm also pleased with the good news that 97 percent of Reservists and Guardsmen who are reporting to mobilize are fit to deploy. In general, the Guardsmen and Reservists are fit and healthy.

Post-deployment health assessments gather information to evaluate concerns that may be related to deployment. About 127,000 Guardsmen and Reservists have had post-deployment health assessments done. Licensed medical providers determine the need for

referrals for appropriate medical followup. I noted in the comments from the panel who just spoke about the importance of engagement with that licensed provider, and I would very much agree with that. This is not nor should it be a process for just moving people through. People need to be carefully examined and asked the appropriate questions.

About 20 percent of Reservists, according to our data, require referrals. And this is a rate that's comparable to that for active duty. In January, the Department began a quality assurance program to monitor the Services' pre- and post-health assessment programs. This QA program monitors compliance with regard to completion of work and includes periodic visits to military bases to assess compliance with all the protocols.

The Services continue to immunize troops from disease and agents that can be used as biological weapons, including anthrax to smallpox. To date we have vaccinated over 1 million Service members against anthrax, and more than 580,000 against smallpox. Both programs are built on safety and effectiveness and they are validated by outside experts.

To support combat operations in Afghanistan and Iraq, medical care was provided far forward, available in most cases within minutes of injury. Over 98 percent of casualties who arrived at medical care survived their injuries. Over one-third were returned to duty within 72 hours. It's clear that far forward medical care, improved personal protection and solid procedures are saving lives, they're saving many lives, and that's good news.

For those who are seriously ill or injured, we rapidly evacuate to definitive care, using intensive care teams to treat patients during transit. Specialized programs available at our larger medical centers, particularly Walter Reed and Bethesda Naval are in place, and Walter Reed has a world class amputee management program. I'm sure General Peake would be glad to talk more about that.

Mental health is integral to overall health. And the Services have full mental health service programs for personnel at home and for deployed. Suicide prevention and stress management programs are supported by the leadership and tailored to the operation. In 2003, 24 soldiers deployed to Iraq and Kuwait committed suicide. That's a rate of about 17 per 100,000, compared with an overall Army suicide rate of about 12.8 per 100,000. This rate is higher than normal, but it is, I should note, and it's very important to understand, it's actually below the age and gender adjusted rate for the civilian population. Above the normal Army average, that age and gender adjusted rate in the civilian population is about 21 per 100,000.

Of course, every suicide is a tragic loss, and the Army is significantly beefing up its effort and requiring suicide prevention training for all personnel in units now deploying. General Peake I'm sure will be glad to talk in more detail about this important mat

ter.

I want to commend the Army for its actions in performing a study that's never been performed before that I'm aware of in the history of warfare, looking at the mental health status of service members during conflict.

Malaria remains a threat overseas. Along with other preventive measures, the Department uses chloroquine, doxycycline, pri

maquine and mefloquine for malaria prevention. While all are FDA approved, precautions for these medications must be followed. Investigations to date have not identified mefloquine, or Larium, as a cause in military suicides. The FDA last year cautioned that mefloquine should not be prescribed for persons with a history of depression. DOD follows FDA guidelines on the use of mefloquine. Our policy is that every service member who receives this medication also should receive information about possible adverse effects. I've also directed a study to assess the rate of adverse events associated with mefloquine as prescribed to the deployed service members.

The Department has improved the transition of care for service members to the Veterans Administration. VA counselors today advise our seriously injured on benefits, disability ratings and how to file claims before the member is actually discharged from the hospital. We have implemented the first stage of the computerized medical record and we are pursuing full sharing of health information with the VA.

While we are able to monitor the health status of active duty troops after deployment, we need to improve the visibility of health care obtained by deactivated Reserve component members. I recently assembled a task force to determine ways for us to better monitor the health status of Guardsmen and Reservists after their return to civilian life.

TRICARE eligibility for up to 6 months; that Congress recently passed last year, following deactivation, and eligibility for service through the VA for up to 2 years provides an excellent way to capture information and followup medical concerns. Let me be clear. We aim to ensure that all returning Guardsmen and Reservists get the care that they need.

Ensuring medical readiness of activated Reservists and providing health coverage for their families is one of our highest priorities. As we proceed, we must carefully review the need for permanent entitlements and benefits to Reservists who have not been activated. That's a topic that's been under discussion. And perhaps we believe the best way to do that is to look at the issue carefully through a demonstration program to test program feasibility and effectiveness.

Let me just close by saying that I've been on the job now for 22 years and I've had the opportunity to visit military medical units worldwide. I'm extremely proud of the men and women who serve in the military health system. They are courageous, dedicated, caring professionals. They are America's best and I'm proud to serve with them. Our Reservists and Guardsmen are doing a superb job. With your support, we will continue to offer world class health care to the men and women serving in our military.

With that, I'd be glad to answer any questions.

[The prepared statement of Dr. Winkenwerder follows:]

Prepared Statement

of

The Honorable William Winkenwerder, Jr., M.D., M.B.A.

Assistant Secretary of Defense for Health Affairs

on

Health Protection Programs for Guard and Reserve

Before the

House of Representatives Committee on Government Reform

Subcommittee on National Security, Emerging

Threats and International Relations

March 30, 2004

Mr. Chairman and members of this distinguished committee, thank you for the

opportunity to be here today to discuss the Department of Defense's Force Health Protection programs and how they impact our reserve component service members. Today, we have nearly 190,000 National Guard and Reserve service men and women activated for federal service, including those serving in Afghanistan and Iraq. DoD is firmly committed to protecting the health of our Reserve component members.

Protecting our forces is a primary mission of the Military Health System. Our Force Health Protection program is designed to ensure that all members of the total force – active, Guard and Reserve - receive the same world class of health care. The objectives of the Force Health Protection program are to recruit and maintain a healthy and fit force, to prevent disease and injury, and to provide medical and rehabilitative care to those who become ill or injured.

The rigorous medical requirements of the armed forces entrance physical examination and our periodic physical examinations, HIV screenings, annual dental examinations, physical fitness training and testing, immunizations and regular medical record reviews contribute to maintaining a healthy force. One of our most recently developed DoD policies requires all deployable forces to achieve a new Individual Medical Readiness (IMR) standard. The IMR is now used as the measure for the services' preparation of service members to deploy and execute the mission. The services are now using a common set of individual medical readiness standards to monitor the collective readiness of the force. For service members to be fully medically ready, all immunizations must be current and they must not need any dental work done. They must have all medical readiness lab tests done, including HIV tests, have no deployment-limiting medical conditions, have completed a current health assessment, and have all the medical equipment they need, including ear plugs, eyeglasses and mask inserts. By tracking the