Congressionally Directed Medical Research Programs: Background and Issues for Congress

Changes from November 10, 2020 to July 13, 2022

This page shows textual changes in the document between the two versions indicated in the dates above. Textual matter removed in the later version is indicated with ~~red strikethrough~~ and textual matter added in the later version is indicated with blue.

Congressionally Directed Medical Research
~~November 10, 2020~~July 13, 2022
Programs: Background and Issues for Congress Bryce H. P. Mendez
Since fiscal year (FY) 1992, Congress has appropriated funds to the Department of Since fiscal year (FY) 1992, Congress has appropriated funds to the Department of
Analyst in Defense Health Analyst in Defense Health
Defense (DOD) explicitly for use in conducting medical research. This appropriation is Defense (DOD) explicitly for use in conducting medical research. This appropriation is
Care Policy Care Policy
also known as the Congressionally Directed Medical Research Programs (CDMRP). The also known as the Congressionally Directed Medical Research Programs (CDMRP). The

U.S. Army Medical Research and Development Command U.S. Army Medical Research and Development Command (MRDC), in coordination with the , in coordination with the
Defense Health Agency, administers the program using a competitive grant Defense Health Agency, administers the program using a competitive grant ~~process.~~

process. CDMRP funding is to be used only for medical research on congressionally identified medical research topics CDMRP funding is to be used only for medical research on congressionally identified medical research topics
(e.g., breast cancer, gulf war illness, cancer, or other medical conditions). Both intramural (DOD) and extramural (e.g., breast cancer, gulf war illness, cancer, or other medical conditions). Both intramural (DOD) and extramural
(non-DOD) researchers are eligible to apply for CDMRP funding, as long as applicants meet the requirements and (non-DOD) researchers are eligible to apply for CDMRP funding, as long as applicants meet the requirements and
criteria established by CDMRP grant administrators. criteria established by CDMRP grant administrators.
DOD does not request CDMRP funding as part of its annual DOD does not request CDMRP funding as part of its annual ~~Defense Health Program (DHP) budget~~budget request process. Instead, . Instead,
Congress inserts CDMRP funding in the annual DOD appropriations act, typically under the Research, Congress inserts CDMRP funding in the annual DOD appropriations act, typically under the Research,
Development, Test, and Evaluation (RDTE) budget activities of the Development, Test, and Evaluation (RDTE) budget activities of the ~~DHP~~Defense Health Program (DHP) and Department of the Army accounts. and Department of the Army accounts.
The explanatory statement accompanying the annual DOD appropriations act typically provides further The explanatory statement accompanying the annual DOD appropriations act typically provides further
congressional direction on how DOD is to spend CDMRP funding. Only Members of Congress may submit such congressional direction on how DOD is to spend CDMRP funding. Only Members of Congress may submit such
requests for specific medical research topics and funding amounts to be included in CDMRP appropriations. A requests for specific medical research topics and funding amounts to be included in CDMRP appropriations. A
request is typically of interest to a Member or his/her constituency; requests may also be submitted on behalf of request is typically of interest to a Member or his/her constituency; requests may also be submitted on behalf of
an advocacy organization. In general, the House and Senate use similar processes to solicit, receive, and consider an advocacy organization. In general, the House and Senate use similar processes to solicit, receive, and consider
Members’ annual funding requests for CDMRP. Members’ annual funding requests for CDMRP.
Since its inception, annual congressional appropriations for CDMRP have grown from $25 million in FY1992 to Since its inception, annual congressional appropriations for CDMRP have grown from $25 million in FY1992 to
$1.$1.455 billion in billion in ~~FY2020~~FY2022. In recent years, CDMRP funding has accounted for at least half of the DHP RDT&E . In recent years, CDMRP funding has accounted for at least half of the DHP RDT&E
account. CDMRP has supported account. CDMRP has supported ~~over~~more than 50 unique research programs or topics. Cumulatively, the largest CDMRP 50 unique research programs or topics. Cumulatively, the largest CDMRP
research topics are theresearch topics are the:
 Breast Cancer Research Program ($  Breast Cancer Research Program ($~~3.79~~4.09 billion); billion);
 Peer-Reviewed Medical Research Program (PRMRP; $ Peer-Reviewed Medical Research Program (PRMRP; $~~2.71~~3.45 billion); billion);
 Prostate Cancer Research Program ($ Prostate Cancer Research Program ($~~1.93~~2.15 billion); billion);
 Psychological Health/Traumatic Brain Injury Research Program ($1. Psychological Health/Traumatic Brain Injury Research Program ($1.2661 billion); and billion); and
 Peer-Reviewed Cancer Research Program (PRCRP; $ Peer-Reviewed Cancer Research Program (PRCRP; $~~1.93 billion~~784.80 million). ).
During the annual appropriations process, CDMRP presents certain issues that may be of interest to Congress, During the annual appropriations process, CDMRP presents certain issues that may be of interest to Congress,
such assuch as:
 historical growth in DOD medical research spending;  historical growth in DOD medical research spending;
 military relevancy of CDMRP topics;  military relevancy of CDMRP topics;
 research continuity challenges;  research continuity challenges;
 duplication and overlap with other federal research entities; and  duplication and overlap with other federal research entities; and
 military health system reform.  military health system reform.

Congressional Research Service Congressional Research Service

link to page 21 link to page 21 Congressionally Directed Medical Research Programs: Background and Issues for Congress

Introduction
The Department of Defense (DOD) receives annual appropriations explicitly for the conduct of The Department of Defense (DOD) receives annual appropriations explicitly for the conduct of
medical research on topics specifically identified by Congress; these funds are administered as medical research on topics specifically identified by Congress; these funds are administered as
the Congressionally Directed Medical Research Programs (CDMRP). Since its establishment in the Congressionally Directed Medical Research Programs (CDMRP). Since its establishment in
fiscal year (FY) 1992, Congress has continued to appropriate annual funding for CDMRP, which fiscal year (FY) 1992, Congress has continued to appropriate annual funding for CDMRP, which
has managed and funded numerous DOD medical research programs and projects. has managed and funded numerous DOD medical research programs and projects.
This report provides an overview of CDMRP and describes how Congress manages CDMRP This report provides an overview of CDMRP and describes how Congress manages CDMRP
funding requests and assigns annual appropriations. It also reviews how DOD administers funding requests and assigns annual appropriations. It also reviews how DOD administers
CDMRP funding and presents several potential issues for Congress, including medical cost CDMRP funding and presents several potential issues for Congress, including medical cost
growth, military relevancy of CDMRP topics, research continuity challenges, Military Health growth, military relevancy of CDMRP topics, research continuity challenges, Military Health
System (MHS) reform, congressional earmarks, and unauthorized appropriations. System (MHS) reform, congressional earmarks, and unauthorized appropriations.
Appendix A provides a list of acronyms used throughout this report. provides a list of acronyms used throughout this report.
Background
Under Under Title 10, Section 2358 of Section 2358 of ~~Title 10,~~ the U.S. Code (U.S.C.), DOD administers a wide-range of research U.S. Code (U.S.C.), DOD administers a wide-range of research
and development (R&D) programs. DOD receives the largest amount of federal funding for and development (R&D) programs. DOD receives the largest amount of federal funding for
R&D, which primarily focuses on “basic research, applied research, advanced research, and R&D, which primarily focuses on “basic research, applied research, advanced research, and
development projects” that aredevelopment projects” that are:
 necessary to the responsibilities of such Secretary’s department in the field of  necessary to the responsibilities of such Secretary’s department in the field of
research and development; and either research and development; and either
 relate to weapon systems and other military needs; or  relate to weapon systems and other military needs; or
 are of potential interest to the DOD.1  are of potential interest to the DOD.1
In general, DOD conducts medical research based on the “needs of the National Defense Strategy In general, DOD conducts medical research based on the “needs of the National Defense Strategy
and the Joint Capabilities Integration and Development System.”2 Numerous DOD components and the Joint Capabilities Integration and Development System.”2 Numerous DOD components
perform or sponsor medical research activities, including the Defense Health Agency (DHA), the perform or sponsor medical research activities, including the Defense Health Agency (DHA), the
military departments, Defense Advanced Research Projects Agency, and the Defense Threat military departments, Defense Advanced Research Projects Agency, and the Defense Threat
Reduction Agency. DOD organizes its medical research efforts under the following focus areas: Reduction Agency. DOD organizes its medical research efforts under the following focus areas:
 biomedical informatics and health information systems and technology;  biomedical informatics and health information systems and technology;
 clinical and rehabilitative medicine;  clinical and rehabilitative medicine;
 combat casualty care;  combat casualty care;
 medical chemical and biological defense;  medical chemical and biological defense;
 medical radiological defense;  medical radiological defense;

1 10 U.S.C. §2358. In 1 10 U.S.C. §2358. In ~~FY2020, Congress appropriated $64.5 billion to DOD for~~FY2022, DOD requested $62.8 billion total R&D. For more DOD research and R&D. For more DOD research and
development programs and historical funding amounts, see CRS Report development programs and historical funding amounts, see CRS Report ~~R46341~~R46869, , Federal Research and Development
(R&D) Funding: ~~FY2021~~FY2022, coordinated by John F. Sargent Jr.; and CRS Report R44711, , coordinated by John F. Sargent Jr.; and CRS Report R44711, Department of Defense
Research, Development, Test, and Evaluation (RDT&E): Appropriations Structure, by John F. Sargent Jr. , by John F. Sargent Jr.
2 DOD, Department of Defense Strategic Medical Research Plan, p. 6, https://health.mil/Reference- 2 DOD, Department of Defense Strategic Medical Research Plan, p. 6, https://health.mil/Reference-
Center/Congressional-Testimonies/2019/04/08/Strategic-Medical-Research-Plan. For more on the National Defense Center/Congressional-Testimonies/2019/04/08/Strategic-Medical-Research-Plan. For more on the National Defense
Strategy, see CRS Report R45349, Strategy, see CRS Report R45349, The 2018 National Defense Strategy: Fact Sheet, by Kathleen J. McInnis. For more , by Kathleen J. McInnis. For more
on the Joint Capabilities Integration and Development System, see pp. 3-4 of CRS Report RL34026, on the Joint Capabilities Integration and Development System, see pp. 3-4 of CRS Report RL34026, Defense
Acquisitions: How DOD Acquires Weapon Systems and Recent Efforts to Reform the Process, by Heidi M. Peters., by Heidi M. Peters.
Congressional Research Service Congressional Research Service
1 1

Congressionally Directed Medical Research Programs: Background and Issues for Congress

 military infectious diseases; and  military infectious diseases; and
 military operational medicine.3  military operational medicine.3
To reduce unnecessary duplication of work, DOD components participate in the Armed Services To reduce unnecessary duplication of work, DOD components participate in the Armed Services
Biomedical Research Evaluation and Management (ASBREM) community of interest.4 The Biomedical Research Evaluation and Management (ASBREM) community of interest.4 The
ASBREM serves as the primary coordination body for DOD’s medical research community, ASBREM serves as the primary coordination body for DOD’s medical research community,
while individual DOD components resource and perform (or sponsor) medical research projects. while individual DOD components resource and perform (or sponsor) medical research projects.
DOD generally has the second DOD generally has the second -largest departmental largest departmental ~~total~~ expenditures on medical research, after expenditures on medical research, after
the National Institutes of Health (NIH)the National Institutes of Health (NIH), U.S. Department of Health and Human Services.5 Each year, DOD submits its budget request for medical .5 Each year, DOD submits its budget request for medical
R&D activities and projects in accordance with its statutory mission. Congress evaluates, adjusts, R&D activities and projects in accordance with its statutory mission. Congress evaluates, adjusts,
and appropriates such funds. Congress may also include additional funding for R&D activities and appropriates such funds. Congress may also include additional funding for R&D activities
that DOD may or may not have requested. that DOD may or may not have requested.
Origin of CDMRP
In the early 1990s, women’s health issues and the inclusion of women in federal medical research In the early 1990s, women’s health issues and the inclusion of women in federal medical research
were rising topics in the United States and attracted the attention of some Members of Congress.6 were rising topics in the United States and attracted the attention of some Members of Congress.6
At the time, certain advocacy groups (e.g., National Breast Cancer Coalition, American Cancer At the time, certain advocacy groups (e.g., National Breast Cancer Coalition, American Cancer
Society, Susan G. Komen Foundation) also lobbied Congress to increase federal spending on Society, Susan G. Komen Foundation) also lobbied Congress to increase federal spending on
breast cancer research, a condition most prevalent among women.7 In FY1992, Congress breast cancer research, a condition most prevalent among women.7 In FY1992, Congress
accordingly appropriated $25 million to DOD to use specifically for breast cancer research.8 accordingly appropriated $25 million to DOD to use specifically for breast cancer research.8
In considering appropriations for FY1993, Members’ interest in increasing federal funding for In considering appropriations for FY1993, Members’ interest in increasing federal funding for
breast cancer research remained. Some Members explored redirecting “$29 billion in unobligated breast cancer research remained. Some Members explored redirecting “$29 billion in unobligated
funds from prior years for the development of weapons systems planned before the collapse of funds from prior years for the development of weapons systems planned before the collapse of
the Soviet Union in 1991” to domestic programs such as the National Cancer Institute for breast the Soviet Union in 1991” to domestic programs such as the National Cancer Institute for breast
cancer research activities.9 However, certain provisions in the Budget Enforcement Act of 1990 cancer research activities.9 However, certain provisions in the Budget Enforcement Act of 1990

3 DOD, Department of Defense Strategic Medical Research Plan, p. 6. 3 DOD, Department of Defense Strategic Medical Research Plan, p. 6.
4 The role of the Armed Services Biomedical Research Evaluation and Management (ASBREM) is to “promote the 4 The role of the Armed Services Biomedical Research Evaluation and Management (ASBREM) is to “promote the
coordination and synergy of the DoD biomedical R&D efforts to provide medical products and information” required coordination and synergy of the DoD biomedical R&D efforts to provide medical products and information” required
to protect and sustain servicemembers. For more on the ASBREM, see Department of Defense (DOD), to protect and sustain servicemembers. For more on the ASBREM, see Department of Defense (DOD), Integrated DoD
Biomedical Research and Development Strategy, Medical Innovation for the Future Force, December 2017, p. iii, , Medical Innovation for the Future Force, December 2017, p. iii,
https://defenseinnovationmarketplace.dtic.mil/wp-https://defenseinnovationmarketplace.dtic.mil/wp-
content/uploads/2018/04/ASBREM_Integrated_RD_Strategy_2017.pdf. content/uploads/2018/04/ASBREM_Integrated_RD_Strategy_2017.pdf.
5 Research America, 5 Research America, U.S. Investments in Medical and Health Research and Development, ~~2013-2018~~~~, 2019~~2016-2020, January 2022, p. , p. 8, 8,
https://www.researchamerica.org/sites/default/files/Publications/https://www.researchamerica.org/sites/default/files/Publications/~~InvestmentReport2019_Fnl.pdf.~~
Research%21America-Investment%20Report.Final.January%202022.pdf. 6 See Richard M. Steingart, Milton Packer, and Peggy Hamm, et al., 6 See Richard M. Steingart, Milton Packer, and Peggy Hamm, et al., "“Sex Differences in the Management of Coronary Sex Differences in the Management of Coronary
Artery Disease,Artery Disease,"” New England Journal of Medicine, vol. 325 (July 25, 1991), pp. 226-230; , vol. 325 (July 25, 1991), pp. 226-230; "“Effective Lobbying Effective Lobbying
Increases U.S. Funds for Breast Cancer Research,Increases U.S. Funds for Breast Cancer Research,"” New York Times, October 19, 1992, p. A15; and Institute of , October 19, 1992, p. A15; and Institute of
Medicine, Medicine, Strategies to Leverage Research Funding: Guiding DOD'’s Peer Reviewed Medical Research Programs, ,
2004, pp. 13-15, https://www.nap.edu/catalog/11089/strategies-to-leverage-research-funding-guiding-dods-peer-2004, pp. 13-15, https://www.nap.edu/catalog/11089/strategies-to-leverage-research-funding-guiding-dods-peer-
reviewed-medical. reviewed-medical.
7 See 7 See "“Effective Lobbying Increases U.S. Funds for Breast Cancer Research,Effective Lobbying Increases U.S. Funds for Breast Cancer Research,"” New York Times, October 19, 1992, p. , October 19, 1992, p.
A15; and U.S. Centers for Disease Control and Prevention, A15; and U.S. Centers for Disease Control and Prevention, "“Deaths from Breast CancerDeaths from Breast Cancer -- —United States, 1991,United States, 1991,"”
Morbidity and Mortality Weekly Report, April 22, 1994, pp. 279-281, , April 22, 1994, pp. 279-281,
https://www.cdc.gov/mmwr/preview/mmwrhtml/https://www.cdc.gov/mmwr/preview/mmwrhtml/ 00026281.htm#:~:text=In%201991%2C%2043%2C583%20women%00026281.htm#:~:text=In%201991%2C%2043%2C583%20women%
20died,for%20white%20women%20(26.8).20died,for%20white%20women%20(26.8).
8 U.S. Congress, House Committee on Appropriations, 8 U.S. Congress, House Committee on Appropriations, Department of Defense Appropriations Act, 1992, Conference , Conference
report accompanying H.R. 2521, 102nd Cong., 1st sess., November 18, 1991, H.Rept. 102-328, p. 134. report accompanying H.R. 2521, 102nd Cong., 1st sess., November 18, 1991, H.Rept. 102-328, p. 134.
9 See Institute of Medicine, 9 See Institute of Medicine, Strategies to Leverage Research Funding: Guiding DOD'’s Peer Reviewed Medical
Research Programs, 2004, p. 14; and Sen. Arlen Specter, , 2004, p. 14; and Sen. Arlen Specter, "“Departments of Labor-HHS-Education Appropriations Act, Departments of Labor-HHS-Education Appropriations Act,
Congressional Research Service Congressional Research Service
2 2

link to page 22 link to page 23 link to page 22 link to page 23 Congressionally Directed Medical Research Programs: Background and Issues for Congress

(P.L. 101-508) prohibited breaches in established discretionary spending categories and (P.L. 101-508) prohibited breaches in established discretionary spending categories and
constrained such transfers from defense to domestic accounts (or vice-versa).constrained such transfers from defense to domestic accounts (or vice-versa). 10 In FY1993, 10 In FY1993,
Congress appropriated $210 million to DOD for breast cancer research, required such research to Congress appropriated $210 million to DOD for breast cancer research, required such research to
be “peer reviewed,” and designated the Department of the Army as the executive agent of the be “peer reviewed,” and designated the Department of the Army as the executive agent of the
“breast cancer research program.”11 DOD later began the practice of referring to the unrequested “breast cancer research program.”11 DOD later began the practice of referring to the unrequested
funds for use on specified medical research topics as CDMRP. Typically, CDMRP funded-topics funds for use on specified medical research topics as CDMRP. Typically, CDMRP funded-topics
are in addition to already established DOD medical research focus areas. are in addition to already established DOD medical research focus areas.
Annual Congressional Appropriations
DOD does not request funding for CDMRP as part of the President’s annual budget submission. DOD does not request funding for CDMRP as part of the President’s annual budget submission.
Instead, Congress inserts CDMRP funding into the Defense Health Program (DHP) account of Instead, Congress inserts CDMRP funding into the Defense Health Program (DHP) account of
the annual defense appropriations bill. Typically, CDMRP funding is organized under the the annual defense appropriations bill. Typically, CDMRP funding is organized under the
Research, Development, Test, and Evaluation (RDT&E) budget activity and assigned to the Research, Development, Test, and Evaluation (RDT&E) budget activity and assigned to the
funding line for funding line for Undistributed Medical Research (see (see Appendix B). While the DHP account . While the DHP account
encompasses the bulk amount of CDMRP funding, Congress may also assign such funding to encompasses the bulk amount of CDMRP funding, Congress may also assign such funding to
other defense accounts. Historically, the Army RDT&E budget activity has included several other defense accounts. Historically, the Army RDT&E budget activity has included several
CDMRP funding lines, such as “peer-reviewed neurotoxin exposure treatment” as related to CDMRP funding lines, such as “peer-reviewed neurotoxin exposure treatment” as related to
Parkinson’s disease, “peer-reviewed neurofibromatosis research,” and “peer-reviewed military Parkinson’s disease, “peer-reviewed neurofibromatosis research,” and “peer-reviewed military
burn research” (burn research” (See Appendix C).12 .12
Specific details on the medical research topics and funding amounts appropriated for CDMRP are Specific details on the medical research topics and funding amounts appropriated for CDMRP are
not included in the text of the annual defense appropriations bill. Rather, they are incorporated in not included in the text of the annual defense appropriations bill. Rather, they are incorporated in
accompanying congressional documents (i.e., conference reports or explanatory statements). accompanying congressional documents (i.e., conference reports or explanatory statements).
Congress typically allows DOD no more than two fiscal years to obligate CDMRP funds, in Congress typically allows DOD no more than two fiscal years to obligate CDMRP funds, in
keeping with the two-year obligation period generally authorized for other DOD R&D funding.13 keeping with the two-year obligation period generally authorized for other DOD R&D funding.13
Congressional Request Processes
Each year, the House Appropriations Committee (HAC) and Senate Appropriations Committee Each year, the House Appropriations Committee (HAC) and Senate Appropriations Committee
(SAC) typically issue guidance to Members that outline the procedures for submitting requests (SAC) typically issue guidance to Members that outline the procedures for submitting requests

~~1993,"~~ 1993,” Senate debate, Senate debate, Congressional Record, vol. 138, part 17 (September 16, 1992), p. S25264. , vol. 138, part 17 (September 16, 1992), p. S25264.
10 Ibid. The Budget Enforcement Act of 1990 (P.L. 101-508) established certain caps (also referred to as “firewalls10 Ibid. The Budget Enforcement Act of 1990 (P.L. 101-508) established certain caps (also referred to as “firewalls”) )
on “defense, international, and non-defense discretionary spending.” These caps also restricted discretionary defense on “defense, international, and non-defense discretionary spending.” These caps also restricted discretionary defense
spending from being “further reduced in order to increase spending for non-defense programs if it would cause total spending from being “further reduced in order to increase spending for non-defense programs if it would cause total
non-defense spending to exceed its cap level.” For more, see U.S. Congress, Senate Committee on the Budget, non-defense spending to exceed its cap level.” For more, see U.S. Congress, Senate Committee on the Budget, The
Congressional Budget Process: An Explanation, committee print, prepared by Senate Committee on the Budget, 105th , committee print, prepared by Senate Committee on the Budget, 105th
Cong., 2nd sess., December 1998, S.Prt. 105-67 (Washington: GPO, 1998), pp. 17-18. Cong., 2nd sess., December 1998, S.Prt. 105-67 (Washington: GPO, 1998), pp. 17-18.
11 U.S. Congress, House Committee on Appropriations, 11 U.S. Congress, House Committee on Appropriations, Department of Defense Appropriations Act, 1993, Conference , Conference
report accompanying H.R. 5504, 102nd Cong., 2nd sess., October 5, 1992, H.Rept. 102-1015 (Washington: GPO, report accompanying H.R. 5504, 102nd Cong., 2nd sess., October 5, 1992, H.Rept. 102-1015 (Washington: GPO,
1992), p. 10 and p. 119. 1992), p. 10 and p. 119.
12 U.S. Congress, House Committee on Appropriations, 12 U.S. Congress, House Committee on Appropriations, Committee Print of the Committee on Appropriations, U.S.
House of Representatives on H.R. 1158/P.L. 116-93, committee print, prepared by Legislative Text and Explanatory P.L. 116-93, committee print, prepared by Legislative Text and Explanatory
Statement, 116th Cong., 1st sess., January 2020, H.Prt. 38-678 (Washington: GPO, 2020), p. 298, Statement, 116th Cong., 1st sess., January 2020, H.Prt. 38-678 (Washington: GPO, 2020), p. 298,
https://www.govinfo.gov/content/pkg/CPRT-116HPRT38678/pdf/CPRT-116HPRT38678.pdf. https://www.govinfo.gov/content/pkg/CPRT-116HPRT38678/pdf/CPRT-116HPRT38678.pdf.
13 10 U.S. 13 10 U.S.C. §3131 ~~§2351~~. DOD defines an . DOD defines an obligation as a “legally binding agreement or action that will result in outlays, as a “legally binding agreement or action that will result in outlays,
immediately or in the future.” For example, when a DOD authorized employee places an order, signs a contract, awards immediately or in the future.” For example, when a DOD authorized employee places an order, signs a contract, awards
a grant, purchases a service, or takes other “actions that require the Government to make payments to the public or a grant, purchases a service, or takes other “actions that require the Government to make payments to the public or
from one Government account to the other,” DOD incurs an obligation. For more on obligations, see DOD 7000.14-R, from one Government account to the other,” DOD incurs an obligation. For more on obligations, see DOD 7000.14-R,
Federal Management Regulation, Vol 3, Ch 8, Section 0803, February 2020, p. 8-11. Federal Management Regulation, Vol 3, Ch 8, Section 0803, February 2020, p. 8-11.
Congressional Research Service Congressional Research Service
3 3

Congressionally Directed Medical Research Programs: Background and Issues for Congress

for consideration in the appropriations process.14 Only Members of Congress may submit such for consideration in the appropriations process.14 Only Members of Congress may submit such
requests for specific medical research topics and funding amounts to be included in CDMRP requests for specific medical research topics and funding amounts to be included in CDMRP
appropriations. A request is typically of interest to a Member or his/her constituency; requests appropriations. A request is typically of interest to a Member or his/her constituency; requests
may also be submitted on behalf of an advocacy organization. In general, the House and Senate may also be submitted on behalf of an advocacy organization. In general, the House and Senate
use similar processes to solicit, receive, and consider Members’ funding requests for CDMRP. use similar processes to solicit, receive, and consider Members’ funding requests for CDMRP.
Currently, each Chamber administers an electronic submission system to collect Member requests Currently, each Chamber administers an electronic submission system to collect Member requests
and accompanying documentation (e.g., justification or support letters). Committee guidance and accompanying documentation (e.g., justification or support letters). Committee guidance
generally directs Members to rank the priority of their funding requests. Though guidance can generally directs Members to rank the priority of their funding requests. Though guidance can
periodically change, a general overview of each appropriations committee’s request process is periodically change, a general overview of each appropriations committee’s request process is
described below. described below.
House Appropriations Process for CDMRP Funding Requests
The HAC requires the submission of Member requests via an electronic submission system.15 The The HAC requires the submission of Member requests via an electronic submission system.15 The
committee requires Members to prioritize and assign rankings to funding requests, by HAC committee requires Members to prioritize and assign rankings to funding requests, by HAC
subcommittee. For example, multiple funding requests for most defense-related programs are to subcommittee. For example, multiple funding requests for most defense-related programs are to
be prioritized and ranked against each other since they would be under the jurisdiction of the be prioritized and ranked against each other since they would be under the jurisdiction of the
HAC’s Subcommittee on Defense. Additionally, Members may prioritize and assign rankings to HAC’s Subcommittee on Defense. Additionally, Members may prioritize and assign rankings to
their overall funding requests without regard to the specific appropriations bill or appropriations their overall funding requests without regard to the specific appropriations bill or appropriations
subcommittee of jurisdiction. subcommittee of jurisdiction.
When considering Member requests for CDMRP funding, professional staff members of the When considering Member requests for CDMRP funding, professional staff members of the
HAC’s Subcommittee on Defense generally use the following criteria when reviewing submitted HAC’s Subcommittee on Defense generally use the following criteria when reviewing submitted
documentation: documentation:
 military relevance;  military relevance;
 past precedent and history of CDMRP funding;  past precedent and history of CDMRP funding;
 number of Member requests for a specific medical research topic;  number of Member requests for a specific medical research topic;
 a Member’s ranking of his/her overall funding requests (including requests for  a Member’s ranking of his/her overall funding requests (including requests for
CDMRP); CDMRP);
 potential outcomes from investing in a specific medical research topic; and  potential outcomes from investing in a specific medical research topic; and
 DOD practicability to execute research funding.16  DOD practicability to execute research funding.16
Senate Appropriations Process for CDMRP Funding Requests
The SAC requires the submission of Member requests via an electronic submission system, called The SAC requires the submission of Member requests via an electronic submission system, called
Legi-Mate.17 When considering Member requests for CDMRP funding, professional staff .17 When considering Member requests for CDMRP funding, professional staff
members of the SAC’s Subcommittee on Defense generally use the following criteria when members of the SAC’s Subcommittee on Defense generally use the following criteria when
reviewing submitted documentation: reviewing submitted documentation:
 military relevance;  military relevance;
 past precedent and history of CDMRP funding;  past precedent and history of CDMRP funding;

14 For a general overview of the congressional appropriations process, see CRS Report R42388, 14 For a general overview of the congressional appropriations process, see CRS Report R42388, The Congressional
Appropriations Process: An Introduction, coordinated by James V. Saturno. , coordinated by James V. Saturno.
15 The electronic submission system is available on the House intranet at https://AppropriationsSubmissions.house.gov. 15 The electronic submission system is available on the House intranet at https://AppropriationsSubmissions.house.gov.
16 Based on CRS discussions with HAC-D professional staff members, February 7, 2020. 16 Based on CRS discussions with HAC-D professional staff members, February 7, 2020.
17 The electronic submission system is available on the Senate intranet at https://appro-requests.senate.ussenate.us. 17 The electronic submission system is available on the Senate intranet at https://appro-requests.senate.ussenate.us.
Congressional Research Service Congressional Research Service
4 4

Congressionally Directed Medical Research Programs: Background and Issues for Congress

 a Member’s ranking of his/her overall funding requests (including requests for  a Member’s ranking of his/her overall funding requests (including requests for
CDMRP); CDMRP);
 potential risks or outcomes from investing in a specific medical research topic;  potential risks or outcomes from investing in a specific medical research topic;
and and
 DOD practicability to execute research funding.18  DOD practicability to execute research funding.18
Considering Member Requests
Professional staff members of the HAC and SAC review Member requests and consider the Professional staff members of the HAC and SAC review Member requests and consider the
inclusion of funding based on each committee’s established criteria, discretionary spending inclusion of funding based on each committee’s established criteria, discretionary spending
parameters outlined in the budget resolution, and congressional prerogative.19 Though not parameters outlined in the budget resolution, and congressional prerogative.19 Though not
required, some Members opt to submit additional justification or letters of support to the required, some Members opt to submit additional justification or letters of support to the
respective appropriations committee or the conference committee for their consideration of a respective appropriations committee or the conference committee for their consideration of a
specific CDMRP funding request. When considering CDMRP funding requests, the HAC, SAC, specific CDMRP funding request. When considering CDMRP funding requests, the HAC, SAC,
or conference committee may opt to add, remove, or consolidate research topics, or adjust the or conference committee may opt to add, remove, or consolidate research topics, or adjust the
assigned funding amounts. assigned funding amounts.
Once the committee recommends and approves its version of the defense appropriations bill, Once the committee recommends and approves its version of the defense appropriations bill,
proposed CDMRP funding lines and eligible research topics are typically assigned in the DHP proposed CDMRP funding lines and eligible research topics are typically assigned in the DHP
RDT&E budget activity, with further details on eligible research topics included in the RDT&E budget activity, with further details on eligible research topics included in the
accompanying committee report. If permitted by Chamber rules, the House or Senate may amend accompanying committee report. If permitted by Chamber rules, the House or Senate may amend
the CDMRP funding amounts and eligible research topics during the floor consideration the CDMRP funding amounts and eligible research topics during the floor consideration
process.20 process.20
Congressional Ban on Earmarks
CDMRP funding is described as congressionally directed spending; however, it appears not to be CDMRP funding is described as congressionally directed spending; however, it appears not to be
currently considered an currently considered an earmark by Congress. Since the 112th Congress, the House and Senate by Congress. Since the 112th Congress, the House and Senate
began observing a so-called began observing a so-called earmark ban. The ban does not exist in House or Senate chamber . The ban does not exist in House or Senate chamber
rules, but has been established by party rules and committee protocols and is enforced by rules, but has been established by party rules and committee protocols and is enforced by
chamber and committee leadership through their agenda-setting power.21 chamber and committee leadership through their agenda-setting power.21
While the earmark ban is not in House and Senate rules, the chamber rules do include a definition While the earmark ban is not in House and Senate rules, the chamber rules do include a definition
of earmarks as congressionally directed spending, tax benefits, or tariff benefits intended for a of earmarks as congressionally directed spending, tax benefits, or tariff benefits intended for a
“specific entity or state, locality, or congressional district.”22 The definitions also suggest that “specific entity or state, locality, or congressional district.”22 The definitions also suggest that
when executed through a “statutory or administrative formula driven or competitive award when executed through a “statutory or administrative formula driven or competitive award
process,” provisions would not be considered to be earmarks.23 Presumably, since MRDC uses a process,” provisions would not be considered to be earmarks.23 Presumably, since MRDC uses a
competitive award process (i.e., grants) to execute CDMRP funds, such appropriations are not competitive award process (i.e., grants) to execute CDMRP funds, such appropriations are not
technically considered earmarks under current House and Senate practices. technically considered earmarks under current House and Senate practices.

18 Based on CRS discussions with SAC-D professional staff members, February 14, 2020. 18 Based on CRS discussions with SAC-D professional staff members, February 14, 2020.
19 Based on CRS discussions with HAC-D professional staff members on February 7, 2020; SAC-D professional staff 19 Based on CRS discussions with HAC-D professional staff members on February 7, 2020; SAC-D professional staff
members, February 14, 2020; and CRS In Focus IF10514, members, February 14, 2020; and CRS In Focus IF10514, Defense Primer: Defense Appropriations Process, by James , by James
V. Saturno and Brendan W. McGarry. V. Saturno and Brendan W. McGarry.
20 For more on the House or Senate floor consideration process, see pp. 6-7 of CRS Report R42843, 20 For more on the House or Senate floor consideration process, see pp. 6-7 of CRS Report R42843, Introduction to the
Legislative Process in the U.S. Congress, by Valerie Heitshusen. , by Valerie Heitshusen.
21 For a summary of each Chamber’s definition of 21 For a summary of each Chamber’s definition of earmark, see ibid, see ibid., p. 1., p. 1.
22 CRS Report R45429, 22 CRS Report R45429, Lifting the Earmark Moratorium: Frequently Asked Questions, by Megan S. Lynch., by Megan S. Lynch.
23 House Rules XXI, clause 9 and Senate Rules XLIV, paragraph 5. 23 House Rules XXI, clause 9 and Senate Rules XLIV, paragraph 5.
Congressional Research Service Congressional Research Service
5 5

link to page 10 link to page 10

Congressionally Directed Medical Research Programs: Background and Issues for Congress

Administration of CDMRP Funding
DOD Program Administration
Ultimately, the Secretary of Defense is accountable for executing congressional appropriations for Ultimately, the Secretary of Defense is accountable for executing congressional appropriations for
CDMRP. The U.S. Army Medical Research and Development Command (MRDC) is the DOD-CDMRP. The U.S. Army Medical Research and Development Command (MRDC) is the DOD-
designated executive agent for CDMRP and other medical research activities funded by the DHP designated executive agent for CDMRP and other medical research activities funded by the DHP
and Department of the Army RDT&E budget activities.24 MRDC and DHA exercise primary and Department of the Army RDT&E budget activities.24 MRDC and DHA exercise primary
responsibility for CDMRP oversight, program execution, grant management, follow-on research, responsibility for CDMRP oversight, program execution, grant management, follow-on research,
and implementation science activities (seand implementation science activities (see Figure 1). .
Figure 1. DOD Governance of CDMRP

Source: CRS graphic based on DOD, CRS graphic based on DOD, Department of Defense Strategic Medical Research Plan, pp. 29-30; andpp. 29-30; and
CDMRP, CDMRP, About Us, “Our Team,” accessed September 28, 2020, https://cdmrp.army.mil/about/ourteam., “Our Team,” accessed September 28, 2020, https://cdmrp.army.mil/about/ourteam.
CDMRP Grants
MRDC uses a competitive grant process to award CDMRP funds. When Congress appropriates MRDC uses a competitive grant process to award CDMRP funds. When Congress appropriates
funds for a new CDMRP research topic, MRDC convenes a meeting of stakeholders (e.g., DOD funds for a new CDMRP research topic, MRDC convenes a meeting of stakeholders (e.g., DOD
and non-DOD clinicians, scientists, consumers, industry representatives, academicians, and other
24 DOD, 24 DOD, Department of Defense Strategic Medical Research Plan, January 29, 2019, pp. 29-30. The U.S. Army , January 29, 2019, pp. 29-30. The U.S. Army
Medical Research and Development Command is formerly the U.S. Army Medical Research and Materiel Command. Medical Research and Development Command is formerly the U.S. Army Medical Research and Materiel Command.
The name change took place in 2019. For more, see C.J. Lovelace, The name change took place in 2019. For more, see C.J. Lovelace, "“Army Logistics Leaders Focus on Medical Army Logistics Leaders Focus on Medical
MaterielMateriel'’s Role in Readiness,s Role in Readiness,"” Army Medical Logistics Command, September 10, 2019, , September 10, 2019,
https://amlc.army.afpims.mil/News/Article/1956385/army-logistics-leaders-focus-on-medical-materiels-role-in-https://amlc.army.afpims.mil/News/Article/1956385/army-logistics-leaders-focus-on-medical-materiels-role-in-
readiness.readiness.
Congressional Research Service Congressional Research Service
6 6

Congressionally Directed Medical Research Programs: Background and Issues for Congress

~~and non-DOD clinicians, scientists, consumers, industry representatives, academicians, and other~~
interested parties) to discuss the current research landscape and identify certain research gaps and interested parties) to discuss the current research landscape and identify certain research gaps and
opportunities. Stakeholder-developed recommendations influence the opportunities. Stakeholder-developed recommendations influence the vision setting process, process,
which determines the program’s specific research goals, investment strategy, and award which determines the program’s specific research goals, investment strategy, and award
mechanisms and amounts. A programmatic panel of civilian and military medical and scientific mechanisms and amounts. A programmatic panel of civilian and military medical and scientific
experts, as well as consumers, conducts the vision setting process. Established CDMRP programs experts, as well as consumers, conducts the vision setting process. Established CDMRP programs
periodically repeat these processes to revise their research goals based on new or existing gaps periodically repeat these processes to revise their research goals based on new or existing gaps
and opportunities and to integrate congressional direction, if any.25 and opportunities and to integrate congressional direction, if any.25
Based on the goals and programmatic details established during the vision setting process, MRDC Based on the goals and programmatic details established during the vision setting process, MRDC
issues periodic program announcements or issues periodic program announcements or broad agency announcements to alert researchers of to alert researchers of
CDMRP grant opportunities.26 The announcements typically include detailed descriptions of CDMRP grant opportunities.26 The announcements typically include detailed descriptions of
funding mechanisms, evaluation criteria, anticipated award amounts, submission requirements, funding mechanisms, evaluation criteria, anticipated award amounts, submission requirements,
and deadlines. MRDC publishes grant announcements on the Grants.gov website or the CDMRP and deadlines. MRDC publishes grant announcements on the Grants.gov website or the CDMRP
website.27 Grants are made available to intramural (within DOD) and/or extramural (non-DOD) website.27 Grants are made available to intramural (within DOD) and/or extramural (non-DOD)
researchers. Depending on the details included in each grant announcement, the Grants.gov researchers. Depending on the details included in each grant announcement, the Grants.gov
website or the electronic biomedical research application portal (eBRAP) are the designated website or the electronic biomedical research application portal (eBRAP) are the designated
application submission portals.28 application submission portals.28
Reviewing and Selecting CDMRP Grant Applications
MRDC uses a two-tiered review process when considering CDMRP grant applications. MRDC uses a two-tiered review process when considering CDMRP grant applications.
  Peer Review. This review evaluates a proposal based on certain grant This review evaluates a proposal based on certain grant
announcement evaluation criteria and determines whether a proposal is of announcement evaluation criteria and determines whether a proposal is of
“absolute” scientific merit.29 Peer reviewers typically include at least two “absolute” scientific merit.29 Peer reviewers typically include at least two
scientific experts that focus on a specific health condition or aspect thereof, and scientific experts that focus on a specific health condition or aspect thereof, and
at least one consumer reviewer.30 at least one consumer reviewer.30
  Programmatic Review. This review evaluates a proposal based on certain grant This review evaluates a proposal based on certain grant
application evaluation criteria, relevance to the DHP and the specific research application evaluation criteria, relevance to the DHP and the specific research
program’s goals, in comparison with other proposals.31 program’s goals, in comparison with other proposals.31
At the conclusion of these two reviews, the CDMRP Director validates the eligibility and funding At the conclusion of these two reviews, the CDMRP Director validates the eligibility and funding
amounts available for each recommended application.32 Once the DHA R&D Director and the amounts available for each recommended application.32 Once the DHA R&D Director and the
MRDC Commanding General conduct a final review of the recommended applications and issue MRDC Commanding General conduct a final review of the recommended applications and issue
a concurrence, MRDC then notifies individual researchers of their selection status and publishes a list of selected applications on the CDMRP website.
25 CDMRP, “2019 Annual Report: Congressionally Directed Medical Research Programs,” September 30, 2019, p. 7, 25 CDMRP, “2019 Annual Report: Congressionally Directed Medical Research Programs,” September 30, 2019, p. 7,
https://cdmrp.army.mil/pubs/annreports/2019annrep/2019annreport.pdf. https://cdmrp.army.mil/pubs/annreports/2019annrep/2019annreport.pdf.
26 A 26 A Broad Agency Announcement (BAA) is a method that allows federal departments and agencies to solicit for the (BAA) is a method that allows federal departments and agencies to solicit for the
“acquisition of basic and applied research…not related to the development of a specific system or hardware “acquisition of basic and applied research…not related to the development of a specific system or hardware
procurement.” For more on BAAs, see Federal Acquisition Regulation (FAR) §35.016. procurement.” For more on BAAs, see Federal Acquisition Regulation (FAR) §35.016.
27 The CDMRP website is available at http://cdmrp.army.mil/. 27 The CDMRP website is available at http://cdmrp.army.mil/.
28 For more on eBRAP, see http://ebrap.org/. 28 For more on eBRAP, see http://ebrap.org/.
29 CDMRP, About Us, “CDMRP’s Two-Tiered Review Process,” accessed September 28, 2020, 29 CDMRP, About Us, “CDMRP’s Two-Tiered Review Process,” accessed September 28, 2020,
https://cdmrp.army.mil/about/2tierRevProcess. https://cdmrp.army.mil/about/2tierRevProcess.
30 Individuals affiliated with other federal departments or agencies, academia, industry, or advocacy organizations may 30 Individuals affiliated with other federal departments or agencies, academia, industry, or advocacy organizations may
participate in the peer review process. participate in the peer review process.
31 National Academies of Science, Engineering, and Medicine, 31 National Academies of Science, Engineering, and Medicine, "“Programmatic Review,Programmatic Review,"” in in Evaluation of the
Congressionally Directed Medical Research Programs, pp. 92-93, https://www.nap.edu/catalog/23652/evaluation-of-, pp. 92-93, https://www.nap.edu/catalog/23652/evaluation-of-
the-congressionally-directed-medical-research-programs-review-process. the-congressionally-directed-medical-research-programs-review-process.
32 Ibid 32 Ibid., pp. 95-96. , pp. 95-96.
Congressional Research Service Congressional Research Service
7 7

link to page 12 link to page 13 link to page 12 link to page 13 link to page 13

Congressionally Directed Medical Research Programs: Background and Issues for Congress

~~a concurrence, MRDC then notifies individual researchers of their selection status and publishes a~~
~~list of selected applications on the CDMRP website.~~
CDMRP Award Management
MRDC typically disburses CDMRP awards in increments. Awardees receive these increments MRDC typically disburses CDMRP awards in increments. Awardees receive these increments
when meeting certain programmatic or administrative milestones negotiated prior to the initial when meeting certain programmatic or administrative milestones negotiated prior to the initial
distribution of funds. Throughout the duration of the award management period, which can span distribution of funds. Throughout the duration of the award management period, which can span
several years, MRDC requires researchers to provide periodic financial statements and progress several years, MRDC requires researchers to provide periodic financial statements and progress
reports. At the conclusion of the award management period, researchers are to submit a final reports. At the conclusion of the award management period, researchers are to submit a final
report on their overall findings, financial accounting, and transition plans for follow-on research, report on their overall findings, financial accounting, and transition plans for follow-on research,
if applicable. MRDC flags additional follow-up items, such as significant discoveries, patents, if applicable. MRDC flags additional follow-up items, such as significant discoveries, patents,
invention disclosures, publications, or need for additional funding support. invention disclosures, publications, or need for additional funding support.
Figure 2 summarizes the overall CDMRP grant process, from when Congress appropriates funds summarizes the overall CDMRP grant process, from when Congress appropriates funds
to grant closeout and research publication. to grant closeout and research publication.
Figure 2. CDMRP Grant Process

Source: CDMRP, CDMRP, About Us, “Funding Process,” accessed September 28, 2020, , “Funding Process,” accessed September 28, 2020,
https://cdmrp.army.mil/about/https://cdmrp.army.mil/about/~~fundingprocess~~funding process. .
Historical Funding Trends
Congress’s initial appropriation for CDMRP was $25 million in FY1992. With the addition of Congress’s initial appropriation for CDMRP was $25 million in FY1992. With the addition of
other medical research topics and funding amounts over time, annual appropriations have grown other medical research topics and funding amounts over time, annual appropriations have grown
drastically. In drastically. In ~~FY2020~~FY2022, CDMRP received $1., CDMRP received $1.4655 billion in congressional appropriations billion in congressional appropriations~~, having~~
~~grown up to 18 times its initial appropriation in 1992~~.33.33 Figure 3 shows historical CDMRP shows historical CDMRP
appropriation amounts. appropriation amounts.

33 DOD, “About Us,” 33 DOD, “About Us,” Funding History, accessed , accessed ~~September 21, 2020~~June 15, 2022, https://cdmrp.army.mil/about/fundinghistory; and DHP and Department of the Army RDT&E accounts included in the explanatory statement accompanying the Department of Defense Appropriations Act, FY2022. Between FY1992 and FY2022, congressional appropriations for CDMRP grew 18.5 times its initial appropriation amount (adjusted for inflation to FY2022 dollars using DOD’s deflators for the Defense Health Program and excluding pay and fuel). ~~, https://cdmrp.army.mil/about/fundinghistory;~~
Congressional Research Service Congressional Research Service
8 8

link to page 25 link to page 25 link to page 25

Congressionally Directed Medical Research Programs: Background and Issues for Congress

Figure 3. Congressional Appropriations for CDMRP
~~FY1992-FY2020~~, FY1992-FY2022 (in nominal dollars)

Source: CRS analysis of DOD, “About Us,” CRS analysis of DOD, “About Us,” Funding History, accessed , accessed ~~September 21, 2020,~~
June 15, 2022, https://cdmrp.army.mil/about/fundinghistory; and explanatory statements accompanying the Department of https://cdmrp.army.mil/about/fundinghistory; and explanatory statements accompanying the Department of
Defense Appropriations Act, FY1992-Defense Appropriations Act, FY1992-~~FY2020.~~
~~Notes:~~ ~~Actual~~FY2022. Note: Nominal dol ars, not adjusted for inflation. dol ars, not adjusted for inflation.
CDMRP Research Programs
CDMRP funding has supported CDMRP funding has supported ~~over~~more than 50 unique research programs or topics (se 50 unique research programs or topics (see Appendix E). .
The largest programs (by cumulative funding amounts between FY1992 and The largest programs (by cumulative funding amounts between FY1992 and ~~FY2020~~FY2022) are the: ) are the:
 Breast Cancer Research Program ($  Breast Cancer Research Program ($~~3.79~~4.09 billion); billion);
 Peer-Reviewed Medical Research Program ( Peer-Reviewed Medical Research Program (~~$2.71~~PRMRP; $3.45 billion); billion);
 Prostate Cancer Research Program ($ Prostate Cancer Research Program ($~~1.93~~2.15 billion); billion);
 Psychological Health/Traumatic Brain Injury Research Program ($1. Psychological Health/Traumatic Brain Injury Research Program ($1.2661 billion); billion);
and and
 Peer-Reviewed Cancer Research Program (  Peer-Reviewed Cancer Research Program (~~$1.93 billion~~PRCRP; $784.80 million).34 ).34
Peer-Reviewed Medical Research Program (PRMRP)
Since FY1999, Congress has included a funding line for PRMRP, which appropriates funds for Since FY1999, Congress has included a funding line for PRMRP, which appropriates funds for
medical research activities on any of the eligible topics identified by Congress. MRDC may medical research activities on any of the eligible topics identified by Congress. MRDC may

~~and DHP and Department of the Army RDT&E accounts included in the explanatory statement accompanying the~~
~~Department of Defense Appropriations Act, FY2020. Between FY1992 and FY2020, congressional appropriations for~~
~~CDMRP grew by 1,752% (adjusted for inflation to FY2020 dollars using DOD’s deflators for the Defense Health~~
~~Program and excluding pay and fuel).~~
34competitively award grants for any of the eligible topics designated for a fiscal year. Between FY1999 and FY2018, the PRMRP has awarded 1,385 grants, resulting in 2,700 peer-reviewed 34 CRS analysis of DOD, “About Us,” DOD, “About Us,” Funding History, accessed , accessed ~~September 21, 2020~~June 15, 2022, https://cdmrp.army.mil/about/, https://cdmrp.army.mil/about/~~fundinghistory~~fundinghistory; and explanatory statements accompanying the Department of Defense Appropriations Act, FY1992-FY2022. .
Congressional Research Service Congressional Research Service
9 9

link to page 26 link to page 28 link to page 15 link to page 26 link to page 28 link to page 15 Congressionally Directed Medical Research Programs: Background and Issues for Congress

~~competitively award grants for any of the eligible topics designated for a fiscal year. Between~~
~~FY1999 and FY2018, the PRMRP has awarded 1,385 grants, resulting in 2,700 peer-reviewed~~
publications and 243 patent applications or issuances.35publications and 243 patent applications or issuances.35 Appendix F lists the historical PRMRP lists the historical PRMRP
eligible research topics. eligible research topics.
Peer-Reviewed Cancer Research Program (PRCRP)
Since FY2009, Congress has included a funding line for PRCRP, which appropriates funds for Since FY2009, Congress has included a funding line for PRCRP, which appropriates funds for
medical research activities on any of the eligible cancer-related topics identified by Congress. medical research activities on any of the eligible cancer-related topics identified by Congress.
MRDC may competitively award grants for any of the eligible topics designated for a fiscal year. MRDC may competitively award grants for any of the eligible topics designated for a fiscal year.
Between FY2009 and FY2017, the PRCRP has awarded approximately 502 grants resulting in at Between FY2009 and FY2017, the PRCRP has awarded approximately 502 grants resulting in at
least 143 peer-reviewed publications.36least 143 peer-reviewed publications.36 Appendix G lists the historical PRCRP eligible cancer-lists the historical PRCRP eligible cancer-
related research topics. related research topics.
Issues for Congress
DHP RDT&E Cost Growth
In recent years, CDMRP funding has accounted for at least half of the DHP RDT&E budget In recent years, CDMRP funding has accounted for at least half of the DHP RDT&E budget
activity (seeactivity (see Figure 4). . ~~Between~~On average, between FY2003 and FY2003 and ~~FY2020~~FY2022, the base budget (non-CDMRP) for DHP , the base budget (non-CDMRP) for DHP
RDT&E increased by RDT&E increased by 6%7% per year. Concurrently, CDMRP funding also increased by . Concurrently, CDMRP funding also increased by 6%an average of 6% per year. Since FY2015, . Since FY2015,
annual congressional appropriations for CDMRP have exceeded annual congressional appropriations for CDMRP have exceeded ~~one billion dollars~~$1 billion. .

35 CDMRP, “Peer Reviewed Medical Research Program Strategic Plan,” 2019, p. 2, 35 CDMRP, “Peer Reviewed Medical Research Program Strategic Plan,” 2019, p. 2,
https://cdmrp.army.mil/prmrp/pbks/PRMRP%20Strategic%20Plan.pdf.https://cdmrp.army.mil/prmrp/pbks/PRMRP%20Strategic%20Plan.pdf.
36 CDMRP, “Peer Reviewed Cancer Research Program Strategic Plan,” 2018, p. 2 and p. 8, 36 CDMRP, “Peer Reviewed Cancer Research Program Strategic Plan,” 2018, p. 2 and p. 8,
https://cdmrp.army.mil/prcrp/pdf/PRCRP%20Strategic%20Plan.pdf. https://cdmrp.army.mil/prcrp/pdf/PRCRP%20Strategic%20Plan.pdf.
Congressional Research Service Congressional Research Service
10 10

Congressionally Directed Medical Research Programs: Background and Issues for Congress

Figure 4. DHP RDT&E and CDMRP Funding Proportions and Amounts
FY2003- FY2003-~~FY2020~~FY2022

Source: CRS analysis of DOD, Defense Health Program Fiscal Year Budget Estimates, Volume 1, Section 2, CRS analysis of DOD, Defense Health Program Fiscal Year Budget Estimates, Volume 1, Section 2,
FY2004-FY2004-~~FY2021~~FY2023, https://comptrol er.defense.gov/Budget-Materials/, https://comptrol er.defense.gov/Budget-Materials/~~FY2021BudgetJustification~~FY2023BudgetJustification/#defhealthprog; and /#defhealthprog; and
DOD, “About Us,” DOD, “About Us,” Funding History, accessed , accessed ~~September 21, 2020~~June 15, 2022, https://cdmrp.army.mil/about/fundinghistory. , https://cdmrp.army.mil/about/fundinghistory.
In most years since FY2003, CDMRP funding exceeded DOD’s actual request for medical In most years since FY2003, CDMRP funding exceeded DOD’s actual request for medical
research funding.37 Some Members of Congress have noted that this trend with CDMRP funding research funding.37 Some Members of Congress have noted that this trend with CDMRP funding
may be potentially unnecessary growth in the DHP RDT&E budget activity and poses certain may be potentially unnecessary growth in the DHP RDT&E budget activity and poses certain
risks to other defense programs subject to certain statutory budget caps on discretionary risks to other defense programs subject to certain statutory budget caps on discretionary
spending.38 For example, the conference report accompanying the FY2018 NDAA (P.L. 115-91) spending.38 For example, the conference report accompanying the FY2018 NDAA (P.L. 115-91)
references these concerns and suggests that DOD medical research focus only on military-references these concerns and suggests that DOD medical research focus only on military-
relevant topics: relevant topics:
Annual funding for CDMRP has more than doubled since 2013, when budget caps Annual funding for CDMRP has more than doubled since 2013, when budget caps
mandated by the Budget Control Act of 2011 (P.L. 112-25) took effect. This funding, mandated by the Budget Control Act of 2011 (P.L. 112-25) took effect. This funding,
neither authorized by Congress nor requested by DOD, is increasing at a time when other neither authorized by Congress nor requested by DOD, is increasing at a time when other
vital programs critical to the nation’s defense are dangerously underfunded. As long as the vital programs critical to the nation’s defense are dangerously underfunded. As long as the
budget caps remain in place under the Budget Control Act, additional funds placed in the budget caps remain in place under the Budget Control Act, additional funds placed in the
CDRMP will directly compete with other budget priorities in the Department. While the CDRMP will directly compete with other budget priorities in the Department. While the
conferees agree that DOD has a proper and vital role to play in medical research related to conferees agree that DOD has a proper and vital role to play in medical research related to
combat readiness, especially in areas like prosthetics, traumatic brain injury, and spinal combat readiness, especially in areas like prosthetics, traumatic brain injury, and spinal
cord injury, additional funding for medical research unrelated to unique military needs cord injury, additional funding for medical research unrelated to unique military needs
should be allocated elsewhere in the federal government. Therefore, the conferees should be allocated elsewhere in the federal government. Therefore, the conferees
encourage funding only those medical research and development projects that protect and encourage funding only those medical research and development projects that protect and

37 CRS analysis of DOD, Defense Health Program Fiscal Year Budget Estimates, Volume 1, Section 2, FY2004-37 CRS analysis of DOD, Defense Health Program Fiscal Year Budget Estimates, Volume 1, Section 2, FY2004-
~~FY2021~~FY2023, https://comptroller.defense.gov/Budget-Materials/FY2021BudgetJustification/#defhealthprog; and DOD, , https://comptroller.defense.gov/Budget-Materials/FY2021BudgetJustification/#defhealthprog; and DOD,
“About Us,” “About Us,” Funding History, accessed , accessed ~~September 21, 2020~~June 15, 2022, https://cdmrp.army.mil/about/fundinghistory. , https://cdmrp.army.mil/about/fundinghistory.
38 For more on the defense-related discretionary spending caps, see CRS Report R44039, 38 For more on the defense-related discretionary spending caps, see CRS Report R44039, The Defense Budget and the
Budget Control Act: Frequently Asked Questions, by Brendan W. McGarry. , by Brendan W. McGarry.
Congressional Research Service Congressional Research Service
11 11

Congressionally Directed Medical Research Programs: Background and Issues for Congress

enhance military readiness or restore the health and safety of members of the Armed enhance military readiness or restore the health and safety of members of the Armed
Forces.39 Forces.39
Observers also note that some CDMRP funds, particularly topics with limited or Observers also note that some CDMRP funds, particularly topics with limited or seemingly no no military military
relevance, should be excluded from the DOD budget or reinvested toward a research area more relevance, should be excluded from the DOD budget or reinvested toward a research area more
applicable to military needs.40 In doing so, DOD could curb its growing medical costs and applicable to military needs.40 In doing so, DOD could curb its growing medical costs and
eliminate nonmilitary-related activities from the defense budget. Alternatively, increases to the eliminate nonmilitary-related activities from the defense budget. Alternatively, increases to the
DHP RDT&E budget activity (including CDMRP) could serve as an option to continue medical DHP RDT&E budget activity (including CDMRP) could serve as an option to continue medical
research activities in lieu of potentially declining or fluctuating funding at other federal research activities in lieu of potentially declining or fluctuating funding at other federal
agencies.41 Congress could consider potential options to constrain or further optimize funding and agencies.41 Congress could consider potential options to constrain or further optimize funding and
outcomes of DOD’s medical research programs. outcomes of DOD’s medical research programs.
Military Relevance
While funding for CDMRP has generally increased each year since the program’s inception, While funding for CDMRP has generally increased each year since the program’s inception,
numerous stakeholders and observers have noted that certain CDMRP research topics do not numerous stakeholders and observers have noted that certain CDMRP research topics do not
directly relate to DOD’s statutory mission, military operations, or national security. In 2016, directly relate to DOD’s statutory mission, military operations, or national security. In 2016,
Congress considered a restriction on DOD’s use of CDMRP funds unless the Secretary of Congress considered a restriction on DOD’s use of CDMRP funds unless the Secretary of
Defense determined that such research project would “enhance, or restore the health and safety of Defense determined that such research project would “enhance, or restore the health and safety of
members of the Armed Forces.”42 The proposed restriction was included as Section 756 of the members of the Armed Forces.”42 The proposed restriction was included as Section 756 of the
Senate-passed version of the NDAA for Fiscal Year 2017. While the provision was not included Senate-passed version of the NDAA for Fiscal Year 2017. While the provision was not included
in the enacted NDAA (P.L. 114-328), the conferees noted their concern on: in the enacted NDAA (P.L. 114-328), the conferees noted their concern on:
… the amount of congressional funding for medical research in the Department of … the amount of congressional funding for medical research in the Department of
Defense’s (DOD) Congressionally Directed Medical Research Program. Since 1992, Defense’s (DOD) Congressionally Directed Medical Research Program. Since 1992,
Congress has appropriated almost $10 billion for medical research—most of it outside of Congress has appropriated almost $10 billion for medical research—most of it outside of
the DOD’s core medical research mission and not requested in the Department’s annual the DOD’s core medical research mission and not requested in the Department’s annual
budget requests.43 budget requests.43
In contrast, other observers have welcomed the use of CDMRP funds for a broad range of In contrast, other observers have welcomed the use of CDMRP funds for a broad range of
research topics that support both DOD’s mission and the general medical community. During a research topics that support both DOD’s mission and the general medical community. During a
2013 congressional hearing on the Defense Health Program budget, then-Assistant Secretary of 2013 congressional hearing on the Defense Health Program budget, then-Assistant Secretary of
Defense for Health Affairs (ASD[HA]) Jonathan Woodson thanked Congress for “supporting Defense for Health Affairs (ASD[HA]) Jonathan Woodson thanked Congress for “supporting
Congressionally-directed research programs” and also noted that such funds added “value to Congressionally-directed research programs” and also noted that such funds added “value to
military medicine but obviously American medicine by the advances that are made.”44 Certain military medicine but obviously American medicine by the advances that are made.”44 Certain
advocacy organizations (e.g., the National Breast Cancer Coalition) also note that outcomes from advocacy organizations (e.g., the National Breast Cancer Coalition) also note that outcomes from
some CDMRP research topics also affect service members, veterans, and military families, in some CDMRP research topics also affect service members, veterans, and military families, in
addition to the general public, because they are also at risk for those medical conditions.45 addition to the general public, because they are also at risk for those medical conditions.45

39 See pp. 861-862 of H.Rept. 115-404. 39 See pp. 861-862 of H.Rept. 115-404.
40 See Heritage Foundation, “The Budget Book: 106 Ways to Reduce the Size & Scope of Government,” 40 See Heritage Foundation, “The Budget Book: 106 Ways to Reduce the Size & Scope of Government,” 050 National
Defense: Cut Funding for Non-Combat Related Research,” accessed October 5, 2020, ,” accessed October 5, 2020,
https://budgetbook.heritage.org/national-defense/cut-funding-for-non-combat-related-research/. https://budgetbook.heritage.org/national-defense/cut-funding-for-non-combat-related-research/.
41 See Research America, “U.S. Investment in Medical and Health Research and Development: 2013-2018,” Fall 2019, 41 See Research America, “U.S. Investment in Medical and Health Research and Development: 2013-2018,” Fall 2019,
https://www.researchamerica.org/sites/default/files/Publications/InvestmentReport2019_Fnl.pdf. https://www.researchamerica.org/sites/default/files/Publications/InvestmentReport2019_Fnl.pdf.
42 Senate-passed National Defense Authorization Act for Fiscal Year 2017, S. 2943, 114th Congress, 2nd Session. 42 Senate-passed National Defense Authorization Act for Fiscal Year 2017, S. 2943, 114th Congress, 2nd Session.
43 H.Rept. 114-840, p. 1089. 43 H.Rept. 114-840, p. 1089.
44 U.S. Congress, House Committee on Appropriations, Subcommittee on Defense, 44 U.S. Congress, House Committee on Appropriations, Subcommittee on Defense, Department of Defense
Appropriations for 2013, 112th Cong., 2nd sess., March 8, 2012, H. Hrg. 79-874 (Washington: GPO, 2013), p. 255, , 112th Cong., 2nd sess., March 8, 2012, H. Hrg. 79-874 (Washington: GPO, 2013), p. 255,
https://www.govinfo.gov/content/pkg/CHRG-112hhrg79874/pdf/CHRG-112hhrg79874.pdf. https://www.govinfo.gov/content/pkg/CHRG-112hhrg79874/pdf/CHRG-112hhrg79874.pdf.
45 For example, see Testimony of the National Breast Cancer Coalition President Fran Visco, in U.S. Congress, House 45 For example, see Testimony of the National Breast Cancer Coalition President Fran Visco, in U.S. Congress, House
Committee on Appropriations, Subcommittee on Defense, April 8, 2020, Committee on Appropriations, Subcommittee on Defense, April 8, 2020,
https://www.stopbreastcancer.org/resources/ Congressional Research Service Congressional Research Service
12 12

Congressionally Directed Medical Research Programs: Background and Issues for Congress

The Constitution authorizes Congress to make appropriations regardless of whether those funds The Constitution authorizes Congress to make appropriations regardless of whether those funds
are relevant to a federal agency’s mission or responsibilities.46 Utilizing the constitutional “power are relevant to a federal agency’s mission or responsibilities.46 Utilizing the constitutional “power
of the purse,” Congress could continue to consider the ad-hoc or permanent practice of including of the purse,” Congress could continue to consider the ad-hoc or permanent practice of including
CDMRP funding in the annual DOD appropriations act, as well as consider restrictions on the use CDMRP funding in the annual DOD appropriations act, as well as consider restrictions on the use
of medical research funding for perceived nonmilitary related purposes. of medical research funding for perceived nonmilitary related purposes.
Research Continuity
CDMRP research areas are contingent on annual congressional appropriations and are not static. CDMRP research areas are contingent on annual congressional appropriations and are not static.
For example, Congress provided annual funding for tick-borne disease research from FY2016 to For example, Congress provided annual funding for tick-borne disease research from FY2016 to
FY2020, but provided no associated funds in FY2015. Unclear funding certainty can challenge FY2020, but provided no associated funds in FY2015. Unclear funding certainty can challenge
DOD medical research leaders during the vision-setting process. Without a clear timeline on DOD medical research leaders during the vision-setting process. Without a clear timeline on
congressional appropriations for a specific topic, it is difficult to establish an investment strategy congressional appropriations for a specific topic, it is difficult to establish an investment strategy
and to prioritize short-term and long-term research goals. Though awarded CDMRP grants help to and to prioritize short-term and long-term research goals. Though awarded CDMRP grants help to
define and contribute scientific insight on individual research questions relating to a funded topic, define and contribute scientific insight on individual research questions relating to a funded topic,
it can sometimes be unclear if the grant helped to meet DOD’s overarching goals or if any it can sometimes be unclear if the grant helped to meet DOD’s overarching goals or if any
research findings directly contributed to the development of new technology, biologics, research findings directly contributed to the development of new technology, biologics,
pharmaceuticals, therapies, or clinical treatments for the military’s needs. pharmaceuticals, therapies, or clinical treatments for the military’s needs.
For example, Congress appropriated a total of $4.4 million in FY2009 and FY2010 for a “Genetic For example, Congress appropriated a total of $4.4 million in FY2009 and FY2010 for a “Genetic
Studies of Food Allergies Research Program” (GSFARP).47 MRDC awarded nine grants to Studies of Food Allergies Research Program” (GSFARP).47 MRDC awarded nine grants to
explore a “highly innovative new concept or untested theory” and “innovative ideas and high-explore a “highly innovative new concept or untested theory” and “innovative ideas and high-
impact research approaches” using scientifically meritorious genetic research focused on food impact research approaches” using scientifically meritorious genetic research focused on food
allergies.48 At the conclusion of the grant periods, GSFARP awardees produced 17 articles in allergies.48 At the conclusion of the grant periods, GSFARP awardees produced 17 articles in
peer-reviewed medical journals discussing their findings.49 However, DOD has not clearly peer-reviewed medical journals discussing their findings.49 However, DOD has not clearly
described whether, or how, those findings contributed to military medicine, or if continued described whether, or how, those findings contributed to military medicine, or if continued
research would have likely been valuable for DOD’s purposes or the broader healthcare research would have likely been valuable for DOD’s purposes or the broader healthcare
community. community.
Since FY1992, there have been Since FY1992, there have been 2219 CDMRP research topics funded for four years or less.50 It is CDMRP research topics funded for four years or less.50 It is
possible that DOD could have found additional value from continued research if such topics were possible that DOD could have found additional value from continued research if such topics were
funded for a longer period. Congress may have stopped funding of those topics after realizing funded for a longer period. Congress may have stopped funding of those topics after realizing
other federal entities could more appropriately conduct that research. Congress could consider other federal entities could more appropriately conduct that research. Congress could consider
incorporating certain CDMRP research topics into DOD’s RDT&E base budget, exploring multi-incorporating certain CDMRP research topics into DOD’s RDT&E base budget, exploring multi-
year appropriations, or utilize congressional authorizations to establish and sustain a long-term year appropriations, or utilize congressional authorizations to establish and sustain a long-term

~~https://www.stopbreastcancer.org/resources/~~testimony-of-fran-visco-before-the-house-appropriations-subcommittee-testimony-of-fran-visco-before-the-house-appropriations-subcommittee-
on-defense-april-8-2020/; National Multiple Sclerosis Society, Congressional Talking Points, “MS Congressionally on-defense-april-8-2020/; National Multiple Sclerosis Society, Congressional Talking Points, “MS Congressionally
Directed Medical Research Program (CDMRP) Funding,” August 2016, Directed Medical Research Program (CDMRP) Funding,” August 2016,
http://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Advocacy/NEW-MS-CDMRP-Talking-http://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Advocacy/NEW-MS-CDMRP-Talking-
Points,-August-Recess-201671816_1.pdf; and Lupus Foundation of America, “Department of Defense: Lupus Points,-August-Recess-201671816_1.pdf; and Lupus Foundation of America, “Department of Defense: Lupus
Research Program,” accessed October 4, 2020, https://www.lupus.org/lupus-research-program. Research Program,” accessed October 4, 2020, https://www.lupus.org/lupus-research-program.
46 Article I, Section 9, Clause 7, U.S. Constitution. 46 Article I, Section 9, Clause 7, U.S. Constitution.
47 Explanatory statements accompanying the Department of Defense Appropriations Act, 2009 (P.L. 110-329), and 47 Explanatory statements accompanying the Department of Defense Appropriations Act, 2009 (P.L. 110-329), and
Department of Defense, 2010 (P.L. 111-118). Department of Defense, 2010 (P.L. 111-118).
48 CDMRP, “Genetic Studies of Food Allergies Research Program,” October 2010, 48 CDMRP, “Genetic Studies of Food Allergies Research Program,” October 2010,
https://cdmrp.army.mil/prevfunded/gsfarp/pbks/gsfarppbk.pdf. https://cdmrp.army.mil/prevfunded/gsfarp/pbks/gsfarppbk.pdf.
49 CRS analysis of CDMRP grant awards and publications for the GSFARP, available at 49 CRS analysis of CDMRP grant awards and publications for the GSFARP, available at
https://cdmrp.army.mil/search.aspx. https://cdmrp.army.mil/search.aspx.
50 CRS analysis of historical CDMRP funding, available at DOD, “About Us,” 50 CRS analysis of historical CDMRP funding, available at DOD, “About Us,” Funding History, accessed , accessed ~~September~~
~~21, 2020~~June 15, 2022, https://cdmrp.army.mil/about/fundinghistory. , https://cdmrp.army.mil/about/fundinghistory.
Congressional Research Service Congressional Research Service
13 13

Congressionally Directed Medical Research Programs: Background and Issues for Congress

medical research agenda across federal agencies to mitigate the funding challenges and medical research agenda across federal agencies to mitigate the funding challenges and
uncertainties affecting research continuity. uncertainties affecting research continuity.
Duplication and Overlap with other Federal Research Entities
Aside from DOD’s medical research enterprise, other federally administered and/or funded Aside from DOD’s medical research enterprise, other federally administered and/or funded
entities also conduct medical research that may overlap certain CDMRP research topics. These entities also conduct medical research that may overlap certain CDMRP research topics. These
includeinclude:
 NIH;  NIH;
 U.S. Centers for Disease Control and Prevention;  U.S. Centers for Disease Control and Prevention;
 Agency for Toxic Substances and Disease Registry;  Agency for Toxic Substances and Disease Registry;
 Biomedical Advanced Research and Development Agency;  Biomedical Advanced Research and Development Agency;
 Food and Drug Administration;  Food and Drug Administration;
 Veterans Health Administration of the Department of Veterans Affairs (VA);  Veterans Health Administration of the Department of Veterans Affairs (VA);
 National Science Foundation; and  National Science Foundation; and
 Department of Agriculture.  Department of Agriculture.
MRDC prohibits “unnecessary duplication of funding, or accepting funding from more than one MRDC prohibits “unnecessary duplication of funding, or accepting funding from more than one
source for the same research.”51 During the CDMRP application, review, and award management source for the same research.”51 During the CDMRP application, review, and award management
process, research duplication is assessed. MRDC terminates CDMRP grants identified as process, research duplication is assessed. MRDC terminates CDMRP grants identified as
unnecessarily duplicative and awardees are required to refund the government for any previously unnecessarily duplicative and awardees are required to refund the government for any previously
disbursed funds. DOD’s process to monitor and identify unnecessary duplication is the disbursed funds. DOD’s process to monitor and identify unnecessary duplication is the
responsibility of “research applicants and their institutional business officials.”52 Because the responsibility of “research applicants and their institutional business officials.”52 Because the
onus is primarily on the researcher, such overlap may go unreported or be misidentified. onus is primarily on the researcher, such overlap may go unreported or be misidentified.
Recent evaluations of CDMRP also identified opportunities to reduce the likelihood of research Recent evaluations of CDMRP also identified opportunities to reduce the likelihood of research
duplication and overlap with other federal entities. In 2012, the Government Accountability duplication and overlap with other federal entities. In 2012, the Government Accountability
Office (GAO) found that “NIH, DOD, and VA each lack comprehensive information on health Office (GAO) found that “NIH, DOD, and VA each lack comprehensive information on health
research funded by the other agencies, which limits their ability to identify potential areas of research funded by the other agencies, which limits their ability to identify potential areas of
duplication in the health research they fund.”53 GAO recommended that the three federal duplication in the health research they fund.”53 GAO recommended that the three federal
departments “determine ways to improve access to comprehensive electronic information on departments “determine ways to improve access to comprehensive electronic information on
funded health research shared among agency officials and improve the ability of agency officials funded health research shared among agency officials and improve the ability of agency officials
to identify possible duplication.”54 DOD concurred with GAO’s findings, while NIH noted they to identify possible duplication.”54 DOD concurred with GAO’s findings, while NIH noted they
do coordinate and have access to other agencies’ publicly available research databases to check do coordinate and have access to other agencies’ publicly available research databases to check
for duplicative research efforts and projects.55 Currently, CDMRP and certain other DOD medical for duplicative research efforts and projects.55 Currently, CDMRP and certain other DOD medical
research programs share its grant award data with the research programs share its grant award data with the Federal RePORTER database to promote database to promote

51 CDMRP, “Funding Opportunities,” 51 CDMRP, “Funding Opportunities,” Research Duplication, accessed October 4, 2020, , accessed October 4, 2020,
https://cdmrp.army.mil/funding/researchDup. https://cdmrp.army.mil/funding/researchDup.
52 DOD, 52 DOD, Department of Defense Strategic Medical Research Plan, January 29, 2019, p, 50. , January 29, 2019, p, 50.
53 U.S. Government Accountability Office, 53 U.S. Government Accountability Office, 2012 Annual Report: Opportunities to Reduce Duplication, Overlap and
Fragmentation, Achieve Savings, and Enhance Revenue, GAO-12-342SP, February 2012, p. 97, , GAO-12-342SP, February 2012, p. 97,
https://www.gao.gov/assets/590/588818.pdf. https://www.gao.gov/assets/590/588818.pdf.
54 Ibid. 54 Ibid., p. 100. p. 100.
55 Ibid55 Ibid., p. 100 and p. 393. , p. 100 and p. 393.
Congressional Research Service Congressional Research Service
14 14

Congressionally Directed Medical Research Programs: Background and Issues for Congress

“transparency” of “federal science research investments;” however, it is unclear how the database “transparency” of “federal science research investments;” however, it is unclear how the database
is utilized to reduce duplication or overlap among federal agencies.56 is utilized to reduce duplication or overlap among federal agencies.56
In 2016, the National Academies of Science, Engineering, and Medicine evaluated the CDMRP In 2016, the National Academies of Science, Engineering, and Medicine evaluated the CDMRP
review processes and recommended CDMRP have a “formal mechanism to coordinate with these review processes and recommended CDMRP have a “formal mechanism to coordinate with these
entities in a predictable, consistent, and standardized manner each year to learn of substantial or entities in a predictable, consistent, and standardized manner each year to learn of substantial or
new areas of research on the health condition being funded or considered for funding by those new areas of research on the health condition being funded or considered for funding by those
other organizations.”57 Though DOD invites representatives from other federal entities (e.g., VA, other organizations.”57 Though DOD invites representatives from other federal entities (e.g., VA,
NIH) to participate in certain grant development and review processes, the processes are not NIH) to participate in certain grant development and review processes, the processes are not
standardized. For example, programmatic panels for certain research topics do not include a VA standardized. For example, programmatic panels for certain research topics do not include a VA
representative, even if the topic may affect the veteran population. representative, even if the topic may affect the veteran population.
GAO reviewed CDMRP again in 2021 and found that “DOD officials coordinate with NIH and VA counterparts on CDMRP-funded research programs throughout their cyclical program and project management process.”58 The organization also found that DOD’s coordination activities, like querying an interagency database of research projects, helps CDMRP avoid and mitigate “overlap and duplication of biomedical research efforts across DOD, NIH, and VA.”59 Comprehensive interagency coordination occurs on certain topics to establish unique research Comprehensive interagency coordination occurs on certain topics to establish unique research
priorities without duplication or overlap, while other topics are coordinated on an ad hoc basis, or priorities without duplication or overlap, while other topics are coordinated on an ad hoc basis, or
not at all. Congress may consider enhancing the interagency coordination process by exploring not at all. Congress may consider enhancing the interagency coordination process by exploring
opportunities to designate a lead federal agency or further define an agency’s scope and opportunities to designate a lead federal agency or further define an agency’s scope and
responsibility for conducting research activities on certain topics. responsibility for conducting research activities on certain topics.
Military Health System Reform
The MHS is undergoing numerous congressionally directed reforms intended to reorganize the The MHS is undergoing numerous congressionally directed reforms intended to reorganize the
internal structure of the DHA and how military treatment facilities are managed and internal structure of the DHA and how military treatment facilities are managed and
administered.administered.5860 In 2019, Congress directed DOD to consolidate most of its medical research and In 2019, Congress directed DOD to consolidate most of its medical research and
public health programs under the DHA, with a deadline of September 30, 2022.public health programs under the DHA, with a deadline of September 30, 2022.5961 While the While the
military departments are to retain certain medical research and public health responsibilities, the military departments are to retain certain medical research and public health responsibilities, the
DHA is to be responsible for coordinating all DHP RDT&E and public health funds, including DHA is to be responsible for coordinating all DHP RDT&E and public health funds, including
CDMRP.CDMRP.6062
In June 2019, MRDC restructured and realigned certain responsibilities under two separate DOD In June 2019, MRDC restructured and realigned certain responsibilities under two separate DOD
entities: the DHA and Army Futures Command.entities: the DHA and Army Futures Command.6163 Depending on the research mission (DHP ~~Depending on the research mission (DHP~~
~~requirements vs. service-specific requirements), MRDC resources were also reallocated~~
~~accordingly.62 MRDC, a Department of the Army entity, executes most of the annual DHP~~
~~RDT&E funds. However, the FY2019 NDAA requires DHA’s R&D directorate to be “comprised~~
~~of the Army Medical Research Materiel Command [now known as MRDC] and such other~~
~~medical research organizations and activities of the armed forces as the Secretary considers~~

56 The 56 The Federal RePORTER database is an interagency data repository of federal research and development investments. database is an interagency data repository of federal research and development investments.
The database is administered by NIH and the National Science Foundation and includes federal partners, such as: The database is administered by NIH and the National Science Foundation and includes federal partners, such as:
DOD, Department of Agriculture, Environmental Protection Agency, VA, Department of Education, and the National DOD, Department of Agriculture, Environmental Protection Agency, VA, Department of Education, and the National
Aeronautics and Space Administration. For more, see https://federalreporter.nih.gov/. Aeronautics and Space Administration. For more, see https://federalreporter.nih.gov/.
57 National Academies of Science, Engineering, and Medicine, 57 National Academies of Science, Engineering, and Medicine, "“Programmatic Review,Programmatic Review,"” in in Evaluation of the
Congressionally Directed Medical Research Programs, p. 122. , p. 122.
58 58 U.S. Government Accountability Office, Biomedical Research: Observations on DOD’s Management of Congressionally Directed Medical Research Programs, GAO-22-105107, January 31, 2022, p. 7, https://www.gao.gov/assets/gao-22-105107.pdf. 59 Ibid. 60 For more on MHS reform, see CRS In Focus IF11273, For more on MHS reform, see CRS In Focus IF11273, Military Health System Reform, by Bryce H. P. Mendez. , by Bryce H. P. Mendez.
5961 P.L. 115-232 §711. P.L. 115-232 §711.
6062 For more on the Congressionally Directed Medical Research Programs (CDMRP), see CRS In Focus IF10349, For more on the Congressionally Directed Medical Research Programs (CDMRP), see CRS In Focus IF10349,
Congressionally Directed Medical Research Programs Funding for ~~FY2020~~FY2022, by Bryce H. P. Mendez. , by Bryce H. P. Mendez.
6163 The U.S. Army Medical Research and Development Command was previously the U.S. Army Medical Research and The U.S. Army Medical Research and Development Command was previously the U.S. Army Medical Research and
~~Materiel Command. C.J. Lovelace, "Army Logistics Leaders Focus on Medical Materiel's Role in Readiness," Army~~
~~Medical Logistics Command, September 10, 2019, https://amlc.army.afpims.mil/News/Article/1956385/army-logistics-~~
~~leaders-focus-on-medical-materiels-role-in-readiness/. For more on the Army Futures Command, see CRS Insight~~
~~IN10889, Army Futures Command (AFC), by Andrew Feickert.~~
~~62 Ibid.~~
~~Congressional Research Service~~
15

~~Congressionally Directed Medical Research Programs: Background and Issues for Congress~~

~~appropriate.”63~~ Congressional Research Service 15 Congressionally Directed Medical Research Programs: Background and Issues for Congress requirements vs. service-specific requirements), MRDC resources were also reallocated accordingly.64 MRDC, a Department of the Army entity, executes most of the annual DHP RDT&E funds. However, the FY2019 NDAA requires DHA’s R&D directorate to be “comprised of the Army Medical Research Materiel Command [now known as MRDC] and such other medical research organizations and activities of the armed forces as the Secretary considers appropriate.”65 The FY2020 NDAA (P.L. 116-92) also stipulated that MRDC is to retain certain The FY2020 NDAA (P.L. 116-92) also stipulated that MRDC is to retain certain
resources for its service-based research mission and is to transfer its DHP RDT&E accounts to the resources for its service-based research mission and is to transfer its DHP RDT&E accounts to the
DHA on October 1, 2022.DHA on October 1, 2022.6466
In December 2019, the Secretary of the Army relayed certain concerns with transferring MRDC In December 2019, the Secretary of the Army relayed certain concerns with transferring MRDC
to the DHA in a memorandum to the Deputy Secretary of Defense, noting that DHA and the to the DHA in a memorandum to the Deputy Secretary of Defense, noting that DHA and the
Office of the Assistant Secretary of Defense for Health Affairs have “failed to provide a clear path Office of the Assistant Secretary of Defense for Health Affairs have “failed to provide a clear path
forward with respect to policy and budget.”forward with respect to policy and budget.”6567 The Secretary of the Army also requested support The Secretary of the Army also requested support
for “Army’s legislative proposal to repeal the portion of the NDAA FY19 legislation, which for “Army’s legislative proposal to repeal the portion of the NDAA FY19 legislation, which
transfers Army Public Health and Medical Research and Material to DHA.”transfers Army Public Health and Medical Research and Material to DHA.”6668
Given the military services’ lingering concerns with required MHS reform efforts, Congress may Given the military services’ lingering concerns with required MHS reform efforts, Congress may
consider enacting further legislation or conduct oversight activities to clarify or emphasize its consider enacting further legislation or conduct oversight activities to clarify or emphasize its
intent regarding DHA’s and the services’ roles and responsibilities with regard to CDMRP intent regarding DHA’s and the services’ roles and responsibilities with regard to CDMRP
funding. funding.
Congressional Outlook
With With ~~over $15~~more than $18 billion in funding since FY1992, CDMRP has been a significant contributor to billion in funding since FY1992, CDMRP has been a significant contributor to
both DOD’s R&D mission, as well as the overall U.S. medical research enterprise. As future both DOD’s R&D mission, as well as the overall U.S. medical research enterprise. As future
appropriations and authorizations for DOD’s medical RDT&E programs are considered, appropriations and authorizations for DOD’s medical RDT&E programs are considered,
Congress may opt to reflect on overall federal medical research investments and the departments Congress may opt to reflect on overall federal medical research investments and the departments
and agencies administering those funds. In doing so, Congress could potentially enhance how and agencies administering those funds. In doing so, Congress could potentially enhance how
federal medical research is administered, realign medical research efforts with capable federal federal medical research is administered, realign medical research efforts with capable federal
entities, and/or maximize the benefits of federal medical research investments to taxpayers. entities, and/or maximize the benefits of federal medical research investments to taxpayers.

~~63 P.L. 115-232 §711(b).~~
~~64 P.L. 116-92 §737.~~
65Materiel Command. C.J. Lovelace, “Army Logistics Leaders Focus on Medical Materiel’s Role in Readiness,” Army Medical Logistics Command, September 10, 2019, https://amlc.army.afpims.mil/News/Article/1956385/army-logistics-leaders-focus-on-medical-materiels-role-in-readiness/. For more on the Army Futures Command, see CRS Insight IN10889, Army Futures Command (AFC), by Andrew Feickert. 64 Ibid. 65 P.L. 115-232 §711(b). 66 P.L. 116-92 §737. 67 A copy of the memorandum was obtained and published in Scott Maucione, A copy of the memorandum was obtained and published in Scott Maucione, "“Internal memo shows Army wants to Internal memo shows Army wants to
halt MTF transfers to DHA,halt MTF transfers to DHA,"” Federal News Network, January 17, 2020, , January 17, 2020,
https://federalnewsnetwork.com/army/2020/01/exclusive-internal-memo-shows-army-wants-to-halt-mtf-transfers-to-https://federalnewsnetwork.com/army/2020/01/exclusive-internal-memo-shows-army-wants-to-halt-mtf-transfers-to-
dha/. dha/.
6668 Ibid. DOD’s legislative proposals for FY2021 did not include any draft legislative text that would repeal Section 711 Ibid. DOD’s legislative proposals for FY2021 did not include any draft legislative text that would repeal Section 711
of the FY2019 NDAA. of the FY2019 NDAA.
Congressional Research Service Congressional Research Service
16 16

Congressionally Directed Medical Research Programs: Background and Issues for Congress

Appendix A. Acronyms
Glossary of Acronyms
ASD(HA)
Assistant Secretary of Defense for Health Affairs Assistant Secretary of Defense for Health Affairs
BAA
Broad Agency Agreement Broad Agency Agreement
CDMRP
Congressionally Directed Medical Research Programs Congressionally Directed Medical Research Programs
DHA
Defense Health Agency Defense Health Agency
DHP
Defense Health Program Defense Health Program
DOD
Department of Defense Department of Defense
eBRAP
Electronic Biomedical Research Application Portal Electronic Biomedical Research Application Portal
FY
Fiscal Year Fiscal Year
GAO
Government Accountability Office Government Accountability Office
GSFARP
Genetic Studies of Food Allergies Research Program Genetic Studies of Food Allergies Research Program
HAC
House Appropriations Committee House Appropriations Committee
HAC-D
House Appropriations Committee – Subcommittee on House Appropriations Committee – Subcommittee on
Defense Defense
MHS
Military Health System Military Health System
NASEM
National Academies of Science, Engineering, and National Academies of Science, Engineering, and
Medicine Medicine
NDAA
National Defense Authorization Act National Defense Authorization Act
NIH
National Institutes of Health National Institutes of Health
PRCRP
Peer-Reviewed Cancer Research Program Peer-Reviewed Cancer Research Program
PRMRP
Peer-Reviewed Medical Research Program Peer-Reviewed Medical Research Program
R&D
Research and Development Research and Development
RDT&E
Research, Development, Test, and Evaluation Research, Development, Test, and Evaluation
SAC
Senate Appropriations Committee Senate Appropriations Committee
SAC-D
Senate Appropriations Committee – Subcommittee on Senate Appropriations Committee – Subcommittee on
Defense Defense
MRDC
United States Army Medical Research and Development United States Army Medical Research and Development
Command Command
VA
Department of Veterans Affairs Department of Veterans Affairs

Congressional Research Service Congressional Research Service
17 17

Congressionally Directed Medical Research Programs: Background and Issues for Congress

Appendix B. CDMRP Funding – DHP RDT&E
Budget Activity
Figure B-1. CDMRP Funding Assigned to the DHP RDT&E Budget Activity
Department of Defense Appropriations Act, 2020 Department of Defense Appropriations Act, 2020

Source: Explanatory statement accompanying the Department of Defense Appropriations Act, 2020, as Explanatory statement accompanying the Department of Defense Appropriations Act, 2020, as
incorporated in the Consolidated Appropriations Act, 2020, H. Comm. Prt. 38-678, p. 372, incorporated in the Consolidated Appropriations Act, 2020, H. Comm. Prt. 38-678, p. 372,
https://www.govinfo.gov/content/pkg/CPRT-116HPRT38678/pdf/CPRT-116HPRT38678.pdf.https://www.govinfo.gov/content/pkg/CPRT-116HPRT38678/pdf/CPRT-116HPRT38678.pdf.
Congressional Research Service Congressional Research Service
18 18

Congressionally Directed Medical Research Programs: Background and Issues for Congress

Appendix C. CDMRP Funding – Army RDT&E
Budget Activity
Figure C-1. CDMRP Funding Assigned to the Army RDT&E Budget Activity
Department of Defense Appropriations Act, 2020 Department of Defense Appropriations Act, 2020

Source: Explanatory statement accompanying the Department of Defense Appropriations Act, 2020, as Explanatory statement accompanying the Department of Defense Appropriations Act, 2020, as
incorporated in the Consolidated Appropriations Act, 2020, H. Comm. Prt. 38-678, p. 298, incorporated in the Consolidated Appropriations Act, 2020, H. Comm. Prt. 38-678, p. 298,
https://www.govinfo.gov/content/pkg/CPRT-116HPRT38678/pdf/CPRT-116HPRT38678.pdf.https://www.govinfo.gov/content/pkg/CPRT-116HPRT38678/pdf/CPRT-116HPRT38678.pdf.
~~Notes~~ Note: RDT&E = Research, Development, Testing, and Evaluation RDT&E = Research, Development, Testing, and Evaluation.

Congressional Research Service Congressional Research Service
19 19

Congressionally Directed Medical Research Programs: Background and Issues for Congress

Appendix D. Example of a Call for Member
Funding Requests, House of Representatives
Figure D-1. Example of a Call for Member Funding Requests
House of Representatives House of Representatives

Source: e-Dear Col eague email from U.S. House of Representatives, Committee on Appropriations, e-Dear Col eague email from U.S. House of Representatives, Committee on Appropriations,
Subcommittee on Defense, “Member Submissions for FY 2021 Defense Appropriations,” sent on February 7, Subcommittee on Defense, “Member Submissions for FY 2021 Defense Appropriations,” sent on February 7,
2020. 2020.
Congressional Research Service Congressional Research Service
20 20

Appendix E. CDMRP Programs and Cumulative Funding, FY1992-~~FY2020~~FY2022
Figure E-1. CDMRP Programs and Cumulative Funding
FY1992- FY1992-~~FY2020~~FY2022
Cumulative ~~Total~~
Cumulative ~~Total~~
Research Topics
Research Topics
Total (millions)
Total (millions)
Alcohol and Substance Abuse Disorders Alcohol and Substance Abuse Disorders
$ $ 24

~~Military Burn~~
~~$ 58~~
32 Multiple Sclerosis $ 113
Amyotrophic Lateral Sclerosis Amyotrophic Lateral Sclerosis
$ $ ~~109~~

~~Multiple Sclerosis~~
~~$ 73~~
189 Myeloproliferative Disorders $ 4
Autism Autism
$ $ ~~104~~

~~Myeloproliferative Disorders~~
~~$ 4~~
134 National Prion $ 43
Bone Marrow Failure Bone Marrow Failure
$ $ 42

~~National Prion~~
~~$ 43~~
57 Neurofibromatosis*** $ 403
Breast Cancer Breast Cancer
$ $ 3
~~,791 Neurofibromatosis~~
4 ,086 Neurotoxin Exposure Treatment Parkinson's*** $ $ ~~363~~
144
Breast Cancer Research Semipostal Breast Cancer Research Semipostal
$ 27 $ 27

~~Neurotoxin Exposure Treatment Parkinson's~~
Orthotics and Prosthetics Outcomes $ $ ~~112~~
110
Chronic Myelogenous Leukemia Chronic Myelogenous Leukemia
$ 22 $ 22

~~Orthotics and Prosthetics Outcomes~~
~~$ 75~~
Osteoporosis $ 5
Chronic Pain Management Chronic Pain Management
$ 25 $ 25

~~Osteoporosis~~
~~$ 5~~
Ovarian Cancer $ 451
Combat Readiness-Medical Combat Readiness-Medical
$ 25 $ 25

~~Ovarian~~Pancreatic Cancer Cancer
~~$ 371~~
$ 6
Defense Women's Health Defense Women's Health
$ 40 $ 40

~~Pancreatic Cancer~~
~~$ 6~~
Peer Reviewed Alzheimer's $ 129
Deployment Related Medical Deployment Related Medical
$ 102 $ 102

Peer Reviewed Peer Reviewed ~~Alzheimer's~~
~~$ 99~~
Cancer $ 785
DOD/VA Medical DOD/VA Medical
$ 7 $ 7

Peer Reviewed Peer Reviewed ~~Cancer~~
~~$ 540~~

Medical $ 3 ,451 Duchenne Muscular Dystrophy Duchenne Muscular Dystrophy
$ $ 40
60
Peer Reviewed Peer Reviewed ~~Medical~~
~~$ 2~~
~~,711~~
Orthopaedic $ 489 Epilepsy Epilepsy
$ $ 50

~~Peer Reviewed Orthopaedic~~
~~$ 429~~

74 Prostate Cancer $ 2 ,150 Genetic Studies of Food Genetic Studies of Food ~~Al ergies~~
Allergies $ 4 $ 4

~~Prostate Cancer~~
~~$ 1~~
~~,930~~
~~Gulf War Il ness~~
Rare Cancers $ 8 Gulf War Illness $ $ ~~214~~

~~Rare Cancers~~
~~$ 8~~
236 Reconstructive Transplant $ 99
Hearing Restoration Hearing Restoration
$ $ 40

~~Reconstructive Transplant~~
~~$ 75~~

~~Institutional y~~60 Scleroderma $ 5 Institutionally Based Programs Based Programs
$ 486 $ 486

~~Scleroderma~~
~~$ 5~~
Spinal Cord Injury $ 398
Joint Warfighter Medical Joint Warfighter Medical
$ $ ~~394~~

~~Spinal Cord Injury~~
~~$ 318~~
474 Tick-Borne Disease $ 41
Kidney Cancer Kidney Cancer
$ $ 85

~~Tick-Borne Disease~~
185 Toxic Exposures $ $ 27
30
Lung Cancer Lung Cancer
$ $ ~~156~~
196
Trauma Clinical Research Repository Trauma Clinical Research Repository
$ 5 $ 5

Lupus Lupus
$ $ 25
45
Tuberous Sclerosis Complex Tuberous Sclerosis Complex
$ $ 89
105
Melanoma Melanoma
$ 30 $ 30

Vision Vision
$ $ ~~109~~
149 Military Burn $ 78
CDMRP-supported DOD Programs/Projects
Armed Forces Institute of Regenerative Medicine II Armed Forces Institute of Regenerative Medicine II
$ 31 $ 31

Psychological Health/Traumatic Brain Injury Psychological Health/Traumatic Brain Injury
$ 1 $ 1
, ,~~264~~
614 Armed Forces Institute of Regenerative Medicine III Armed Forces Institute of Regenerative Medicine III
$ 20 $ 20

Rapid Innovation Fund Rapid Innovation Fund
$ 36 $ 36

Centers of Centers of ~~Excel ence~~
Excellence $ 20 $ 20

~~Smal~~ Small Business Innovation Research/Business Innovation Research/~~Smal~~ Small Business Technology TransferBusiness Technology Transfer
$ 64$ 64

Defense Medical RDT&E Defense Medical RDT&E
$ 943 $ 943

Trauma Clinical Trauma Clinical
$ $ 50
70
Defense Medical RDT&E CSI Restoral Defense Medical RDT&E CSI Restoral
$ 180 $ 180

Vision Prosthesis Vision Prosthesis
$ 1 $ 1

Medical Technology Enterprise Consortium Medical Technology Enterprise Consortium
$ 26 $ 26

Source: CRS analysis of DOD, “About Us,” CRS analysis of DOD, “About Us,” Funding History, accessed , accessed ~~September 21, 2020~~June 15, 2022, https://cdmrp.army.mil/about/fundinghistory. , https://cdmrp.army.mil/about/fundinghistory.
CRS-21 CRS-21

Congressionally Directed Medical Research Programs: Background and Issues for Congress

Appendix F. PRMRP Eligible Research Topics,
FY1999-~~FY2020~~FY2022
Figure F-1. PRMRP Eligible Research Topics
FY1999- FY1999-~~FY2020~~FY2022
Acellular Human Tissue Matrix
Dystonia
Acupuncture
Early Trauma Thermal Regulation
Acute Lung Injury
Eating Disorders
Advanced Prosthetics
~~Emerging Infectious Diseases~~
Ehlers-Danlos Syndrome Advanced Proteomics
Emerging ~~Viral~~Infectious Diseases
Advanced Soft Tissue Modeling
~~Endometriosis~~
Emerging Viral Diseases Alcoholism
~~Epidermolysis Bullosa~~
Endometriosis Amyotrophic Lateral Sclerosis
~~Epilepsy~~
Epidermolysis Bullosa Anti-Diarrhea Supplement
~~Eye and Vision~~
Epilepsy Antimicrobial Resistance
~~Familial Hypercholesterolemia~~
Eye and Vision Anti-radiation Drug Development
~~Fibromyalgia~~
Familial Hypercholesterolemia Army Nutrition
~~Fibrous Dysplasia~~
Fibromyalgia Arthopod-transmitted Infectious Diseases
~~Focal Segmental Glomerulosclerosis~~
Fibrous Dysplasia Arthritis
~~Food Allergies~~
Friedreich's Ataxis Augmented Care in the Chain of Survival (ACCESS)
~~Fragile X~~
~~Autism~~
~~Freeze-Dried Platelets~~
Focal Segmental Glomerulosclerosis Autism Food Allergies Autoimmune Diseases
~~Frontotemporal Degeneration~~
Fragile X Biological Hazard Detection System/Biosensor Microchip
~~Fungal & Bacterial Infections~~
Freeze-Dried Platelets Blood Cancer
~~Fungi Free - topical agent for Onychomycosis~~
Frontotemporal Degeneration Bone-related Disease
~~Geneware Rapid Vaccines~~
Fungal & Bacterial Infections Burn Pit Exposure
~~Guillain-Barre Syndrome~~
Fungi Free - topical agent for Onychomycosis Cardiomyopathy
~~Hanta Virus~~
Geneware Rapid Vaccines Cardiovascular Health
~~Health Information Protection~~
Guillain-Barre Syndrome Casualty care
~~Health System Information Technology~~
Hanta Virus Cell Response to Anti-cancer Agents
~~Healthcare Informatics~~
Health Information Protection Cerebellar Ataxia
~~Healthcare-acquired Infection Reduction~~
Health System Information Technology Cervical Cancer - Self-Test/Screening Methods
~~Hemorrhage Control~~
Healthcare Informatics Chemical Weapons
~~Hepatitis B~~
Healthcare-acquired Infection Reduction Chemo-preventative Approaches to Smoking-related Illnesses
~~Hepatitis B and C~~
Hemorrhage Control Childhood Asthma
~~Hereditary Angioedema~~
Hepatitis B Childhood Cancer
~~High Risk Infectious Disease~~
Hepatitis B and C Chiropractic Care
~~Human Imaging Institute/Magnetoencephalography Lab~~
Hereditary Angioedema Chronic Kidney Disease
~~Hydrocephalus~~
High Risk Infectious Disease Chronic Migrane & Post-Traumatic Headache
~~Illnesses related to Radiation Exposure~~
Human Imaging Institute/Magnetoencephalography Lab Chronic Pain Management
~~Immunomonitoring of Intestinal Transplants~~
Hydrocephalus Closed Loop Frozen Blood Processing Systems
~~Infectious Disease Tracking System~~
Hypercholesterolemia Complex rAD-Vector Vaccine for MGBV
~~Infectious Disease Vaccines~~
Hypertension Composite Tissue Transplantation
~~Inflammatory Bowel Disease~~
Illnesses related to Radiation Exposure Congenital Heart Disease
~~Influenza~~
Immunomonitoring of Intestinal Transplants Conjugate Vaccines for Shigellosis
~~Integrated Tissue Hypoxia~~
Infectious Disease Tracking System Constrictive Bronchiolitis
~~Integrative Medicine~~
Infectious Disease Vaccines Counter Narcotics Tactical Operations Medical Support Program (CONTOMS)
~~Interstitial Cystitis~~
Inflammatory Bowel Disease Defense & Veterans Head Injury Program
~~Interventional Cardiovascular MRI Technologies~~
Influenza Dengue
~~Kidney Cancer~~
~~Diabetes~~
~~Laser Eye Injury/Eye Cancer~~
Integrated Tissue Hypoxia Diabetes Integrative Medicine Diarrheal Diseases
~~Leshmaniasis~~
Interstitial Cystitis Digital Mammography
~~Limb Loss and Paralysis~~
Interventional Cardiovascular MRI Technologies Disease Management
~~Listeria Vaccine for Infectious Disease &~~Kidney Cancer
DNA Vaccine Technology for Postexposure Prophylaxis
~~Low Vision~~
Laser Eye Injury/Eye Cancer Drug Abuse
~~Lung~~
Leshmaniasis Duchenne's Disease
~~Lung Cancer - CAT Scan Technology~~Limb Loss and Paralysis
Source: CRS analysis of DOD, “About Us,” CRS analysis of DOD, “About Us,” Funding History, accessed , accessed ~~September 21, 2020,~~
June 15, 2022, https://cdmrp.army.mil/https://cdmrp.army.mil/about/fundinghistory; and explanatory statements accompanying various DOD Appropriations Acts, FY1999-FY2022~~about/fundinghistory~~. .
Note: Additional PRMRP eligible research topics continued on next page. Additional PRMRP eligible research topics continued on next page.
Congressional Research Service Congressional Research Service
22 22

Congressionally Directed Medical Research Programs: Background and Issues for Congress

Figure F-12. PRMRP Eligible Research Topics (Continued)
FY1999- FY1999-~~FY2020~~
~~Lung Injury~~
~~Pre-clinical/Clinical activities of the Novonex/Ex-rad Drugs~~
~~Lupus~~
~~Pressure Ulcers~~
~~Lymphoma~~
~~Providence Cancer Research~~
~~Malaria~~
~~Prsotate Diagnostic Imaging~~
~~Medical Digital Assistance~~
~~Psychotropic Medications~~
~~Medical Records Management~~
~~Pulmonary Fibrosis~~
~~Medical Surgery Technology~~
~~Pulmonary Hypertension~~
~~Melanoma~~
~~Quantum Optics~~
~~Mesothelioma~~
~~Radiation Protection~~
~~Metabolic Disease~~
~~Real-time Heart Rate Variability~~
~~Metabolically Engineered Tissue for Trauma Care~~
~~Remote Emergency Medicine Ultrasound~~
~~Metals Toxicology~~
~~Reserve Component Medical Training~~
~~Microbiology for Cancer~~
~~Resilience Training~~
~~Microsurgery & Robotic Surgery~~
~~Respiratory Health~~
~~Military Medical Informatics~~
~~Retinal Display Technology~~
~~Miniature Renal Assist Devices~~
~~Rett Syndrome~~
~~Mitochondrial Disease~~
~~Rheumatoid Arthritis~~
~~Molecular Signatures in Tumors~~
~~Scleroderma~~
~~Mt. Sinai Cancer Research Program~~
~~Segmental Bone Defects~~
~~Multiple Myeloma~~
~~Sleep Disorders~~
~~Multiple Sclerosis~~
~~Sleep Management~~
~~Muscle Function~~
~~Smoking Cessation~~
~~Muscular Dystrophy~~
~~Social Work Research~~
~~Musculoskeletal Disorders~~
~~Spinal Muscular Atrophy~~
~~Musculoskeletal Health~~
~~Stem Cell Research~~
~~Mustard Gas Antedote~~
~~Sustained Release Drug Delivery~~
~~Myalgic Encephalomyelitis/Chronic Fatigue Syndrome~~
~~Tinnitus~~
~~Myotonic Dystrophy~~
~~Tissue Regeneration~~
~~Nanomaterials for Bone Regeneration~~
~~Traumatic Brain Injury~~
~~Nanomedicine for Drug Delivery Science~~
~~Tuberculosis~~
~~Natural Toxin Detection Technology~~
~~Vancomycin-resistant Enterococcus Infection~~
~~Neuroblastoma~~
~~Vascular Malformations~~
~~Neurological Examination Equipment~~
~~Venus 3D Technology Program~~
~~Neuroprosthetics~~
~~Vitamin D~~
~~Neuroscience~~
~~Volume Angio CAT (VAC)~~
~~Non-opioid Pain Management~~
~~Volumetrically controlled Manufacturing~~
~~Nutrition Optimization~~
~~West Nile Virus~~
~~Obesity-related Disease Prevention~~
~~Women's Heart Disease~~
~~Orthopaedic extremity Trauma~~
~~Osteoarthritis~~
~~Osteoperosis and related Bone Disease~~
~~Paget's Disease~~
~~Pancreatitis~~
~~Pathogenic-inactivated Blood Products~~
~~Pediatric Cancer~~
~~Personal Intelligent Medical Assistant~~
~~Pheochromocytoma~~
~~Plant-based Vaccines~~
~~Polycystic Kidney Disease~~
~~Post-traumatic Osteoarthritis~~
~~Post-traumatic Stress Disorder/Gulf War Illness~~

Source: CRS analysis of DOD, “About Us,” Funding History, accessed September 21, 2020,
FY2022 Listeria Vaccine for Infectious Disease & Cancer Personal Intelligent Medical Assistant Low Vision Pheochromocytoma Lung Plant-based Vaccines Lung Cancer - CAT Scan Technology Platelet-Like Cell Production Lung Injury Polycystic Kidney Disease Lupus Post-traumatic Osteoarthritis Lymphoma Post-traumatic Stress Disorder/Gulf War Illness Malaria Pre-clinical/Clinical activities of the Novonex/Ex-rad Drugs Medical Digital Assistance Pressure Ulcers Medical Records Management Providence Cancer Research Medical Surgery Technology Prsotate Diagnostic Imaging Melanoma Psychotropic Medications Mesothelioma Pulmonary Fibrosis Metabolic Disease Pulmonary Hypertension Metabolically Engineered Tissue for Trauma Care Quantum Optics Metals Toxicology Radiation Protection Microbiology for Cancer Real-time Heart Rate Variability Microsurgery & Robotic Surgery Remote Emergency Medicine Ultrasound Military Medical Informatics Reserve Component Medical Training Miniature Renal Assist Devices Resilience Training Mitochondrial Disease Respiratory Health Molecular Signatures in Tumors Retinal Display Technology Mt. Sinai Cancer Research Program Rett Syndrome Multiple Myeloma Rheumatoid Arthritis Multiple Sclerosis Scleroderma Muscle Function Segmental Bone Defects Muscular Dystrophy Sleep Disorders Musculoskeletal Disorders Sleep Management Musculoskeletal Health Smoking Cessation Mustard Gas Antedote Social Work Research Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Spinal Muscular Atrophy Myotonic Dystrophy Stem Cell Research Nanomaterials for Bone Regeneration Suicide Prevention Nanomedicine for Drug Delivery Science Sustained Release Drug Delivery Natural Toxin Detection Technology Tinnitus Nephrotic Syndrome Tissue Regeneration Neuroblastoma Trauma Neurological Examination Equipment Traumatic Brain Injury Neuroprosthetics Tuberculosis Neuroscience Vancomycin-resistant Enterococcus Infection Non-opioid Pain Management Vascular Malformations Nutrition Optimization Venus 3D Technology Program Obesity-related Disease Prevention Vitamin D Orthopaedic extremity Trauma Volume Angio CAT (VAC) Osteoarthritis Volumetrically controlled Manufacturing Osteoperosis and related Bone Disease West Nile Virus Paget's Disease Women's Heart Disease Pancreatitis Pathogenic-inactivated Blood Products Pediatric Cancer Peripheral Neuropathy Source: CRS analysis of DOD, “About Us,” Funding History, accessed June 15, 2022, https://cdmrp.army.mil/https://cdmrp.army.mil/about/fundinghistory; and explanatory statements accompanying various DOD Appropriations Acts, FY1999-FY2022~~about/fundinghistory~~. .

Congressional Research Service Congressional Research Service
23 23

Appendix G. PRCRP Eligible Research Topics, FY2009-~~FY2020~~FY2022
Figure G-1. PRCRP Eligible Research Topics
FY2009- FY2009-~~FY2020~~FY2022
FY2009 FY2010 FY2011 FY2012 FY2013 FY2014 FY2015 FY2016 FY2017 FY2018 FY2019 FY2020
FY2021 FY2022 Adrenal Cancer
 
Bladder Cancer
 
 
 
 
 
  Blood Cancers
 
 
 
 
 
 
~~Brain Cancer~~
  Brain Cancer    
 
 
 
Cancer in Children, Adolescents and Young Adults
 
 
 
 
  Cancers associated with the use of Beryllium  Cancers related to Radiation Exposure
 
Colorectal Cancer
 
 
 
 
 
 
 
 
 
  Deployment-related Skin Cancer
 
~~Esophageal Cancer~~
Endometrial Cancer   Esophageal Cancer    
Genetic Cancer Research
 
 
 
 
 
Germ Cell Cancer   Head and Neck Cancer
 
  Immunotherapy
 
 
 
 
 
Kidney Cancer
 
 
 
 
 
Listeria Vaccine for Cancer
 
 
 
 
 
 
 
 
Liver Cancer
 
 
 
 
 
 
  Lymphoma
 
 
 
 
  Melanoma and other Skin Cancers
 
 
 
 
 
 
 
Mesothelioma
 
 
 
 
 
 
 
 
 
 
  Metastatic Cancers
 
~~Myeloma~~
  Myeloma   
Myeloproliferative Disorders
 
 
Neuroblastoma
 
 
 
 
 
 
 
 
  Non-Invasive Cancer Research using Nano Particles
 
Pancreatic Cancer
 
 
 
 
 
 
 
 
Pediatric Brain Tumors
 
 
 
 
 
 
 
 
 
  Rare Cancers
 
~~Stomach Cancer~~





Sarcoma   Scleroderma and Cancer Links  Stomach Cancer         Thyroid Cancer   Von Hippel-Lindau Disease  

Source: CRS analysis of DOD, “About Us,” CRS analysis of DOD, “About Us,” Funding History, accessed , accessed ~~September 21, 2020~~April 11, 2022, https://cdmrp.army.mil/about/fundinghistory, https://cdmrp.army.mil/about/fundinghistory; and explanatory statements accompanying various DOD Appropriations Acts, FY1999-FY2022. .
Notes: For FY2010 and For FY2010 and ~~FY2010~~FY2011, Congress appropriated funds for the PRCRP, however did not identify specific research topics. , Congress appropriated funds for the PRCRP, however did not identify specific research topics.
CRS-24 CRS-24

Congressionally Directed Medical Research Programs: Background and Issues for Congress

Author Information

Bryce H. P. Mendez Bryce H. P. Mendez

Analyst in Defense Health Care Policy Analyst in Defense Health Care Policy

Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan
shared staff to congressional committees and Members of Congress. It operates solely at the behest of and shared staff to congressional committees and Members of Congress. It operates solely at the behest of and
under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other
than public understanding of information that has been provided by CRS to Members of Congress in than public understanding of information that has been provided by CRS to Members of Congress in
connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not
subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in
its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or
material from a third party, you may need to obtain the permission of the copyright holder if you wish to material from a third party, you may need to obtain the permission of the copyright holder if you wish to
copy or otherwise use copyrighted material. copy or otherwise use copyrighted material.

Congressional Research Service Congressional Research Service
R46599 R46599 · VERSION ~~1 · NEW~~3 · UPDATED
25 25