Howls of Protest Over No Assistance Dogs for PTSD Subhead: VA Refuses Funding

by U.S. Medicine

December 13, 2012

By Stephen Spotswood

WASHINGTON – The use of trained dogs has been accepted therapy since the 1960s for persons with visual, hearing and mobility impairments. Only recently, however, have service dogs been trained to assist men and women suffering from mental health issues, such as post-traumatic stress disorder (PTSD).

Jim Stanek of Paws and Stripes with his assistance dog, Sarge.

Despite only limited scientific research in the area, many Iraq and Afghanistan veterans have reported that being paired with one of these specially trained animals has substantially improved their quality of life. The dogs not only act as companions to veterans dealing with traumatic events, they also are trained to identify symptoms and react when their owners are exhibiting signs of stress.

That’s why VA’s decision to limit benefits to animals assisting with visual, hearing, and mobility impairments, excluding those trained to assist solely with mental health problems, created such an outcry. The new rule went into effect this fall.

“This restriction is based on a lack of evidence to support a finding of mental health service dog efficacy,” explained a VA statement published in the Federal Register this fall. “Although we do not disagree with some commenters’ subjective accounts that mental health service dogs have improved the quality of their lives, VA has not yet been able to determine that these dogs provide a medical benefit to veterans with mental illness.”

The American Humane Association called on the VA to reverse the policy ending assistance dog reimbursement for veterans suffering from PTSD.

“American Humane Association’s focus on animal-assisted therapy dates back to 1945 when we promoted therapy dogs as a means to help World War II veterans recover from the effects of war,” said American Humane Association President and CEO Robin Ganzert. “We know from years of experience that the human-animal bond is a source of powerful healing, whether they are children suffering from cancer or military men and women who have suffered the stress of battle. Service dogs, in particular, are an amazing, positive resource for assisting our nation’s best and bravest though their physical pain and mental anguish.”

Despite those objections, the VA’s statement noted that it was possible to provide benefits covering service dogs trained to assist with visual, hearing and mobility impairments because of the department’s national experience directly observing positive clinical outcomes. Those observations were bolstered by the existence of nationally established training protocols for the dogs.

“We are unaware of similarly vetted and accepted training protocols for mental health service dogs or how assistance from such dogs could be consistently helpful for veterans to mitigate mental health impairments,” VA stated.

When the new rule was proposed, opponents argued that VA’s exclusion of mental health service dogs contradicts the definition established by the Americans With Disabilities Act (ADA) to include animals trained to help people with psychiatric, intellectual or other mental disabilities. VA noted that the ADA was not applicable in this case.

The new rule was even controversial for disabled veterans eligible for the assistance animal benefit, because the VA said it will provide coverage only in the future if the service dog and veteran have successfully completed a training program accredited by Assistance Dogs International or the International Guide Dog Federation.

In written comments about the proposed rule, John Ensminger, a New York attorney and author of Service and Therapy Dogs in America, expressed his concern for the accreditation requirement and for whether there were enough ADI and IGDF accredited training programs to meet the growing demand for service dogs in the military.

“The ADI approach is destined to produce a very small number of dogs,” Ensminger said.

The benefits would cover travel expenses associated with obtaining the dog and the cost of an insurance policy for medically necessary treatment and prescription medications. The policy cannot exclude service dogs with pre-existing conditions. Expenses not covered include license tags, nonprescription food, grooming, insurance for personal injury, nonsedated dental cleanings, nail- trimming, boarding, pet-sitting or dog-walking services and over-the-counter medications.

Roadblocks in the Research

The language of the rule makes it clear that VA is willing to reconsider its regulations once research has been completed demonstrating a positive clinical outcome from use of service dogs for mental health issues. The department has been working to bolster that research base but has hit numerous roadblocks in recent months.

The one VA study examining service dogs and PTSD located at the James A. Haley Veterans Hospital in Tampa, FL, was put on hold in September following allegations of poor animal treatment by one of the companies providing dogs for the study.

Approved in 2009, the study was slated to provide as many as 200 veterans with service animals trained to assist them with symptoms of PTSD. The study had placed 17 animals prior to being suspended. The study was also temporarily suspended for several months this past spring after a young girl was bitten by one of the service dogs. The study was scheduled to end in 2014.

Sen. Charles Schumer (D- NY) was one of the most vocal advocates for VA beginning its research into PTSD and service dogs several years ago. After VA announced its new regulations in September, he and several other legislators called on VA to throw out the new policy.

If VA waits until 2014 before reconsidering, an unknown number of veterans will suffer while the science catches up to the anecdotal evidence, Schumer said, adding in a statement, “Sadly, the horrors of war mean that many veterans come home with PTSD and other mental and emotional ailments. That’s why we owe it to these vets to provide them with every recovery option possible, including service dogs, prescribed by a doctor, to help them heal. Man’s best friend can be a vet’s best friend, and that’s why, as the wars are winding down and with the ranks of those suffering mental and emotional trauma remaining skyhigh, the VA should not deny benefits to veterans that will help them to access service dogs.

“With the ranks of those suffering mental and emotional trauma remaining sky-high, the VA should not deny benefits to veterans that will help them to access service dogs.”

Avenues Outside VA

VA is not the only avenue for veterans suffering from PTSD to acquire a service dog, however. Several nonprofit agencies have formed in recent years to fund the training of animals and pairing them up with veterans.

One of these, the New Mexico-based Paws and Stripes, was founded by Lindsey Stanek and her husband Jim, who served three tours in Iraq with the 82nd Airborne before being medically retired in 2008. Suffering from injuries that included TBI and chronic PTSD, he came into contact with therapy dogs while a patient at Brooke Army Medical Center in San Antonio and said he found great comfort in their presence.

After being discharged, the couple tried to find someone to train their rescue dog, Sarge, to assist Jim Stanek with mobility issues, as well as symptoms from PTSD and TBI. When they discovered how expensive the process can be — $10,000 to $30,000 to cover the many hours of extensive animal training — they began the process of creating Paws and Stripes.

The organization does not simply provide veterans with a pretrained animal. Instead, veterans entering the program choose their own dogs — either one they already own or one obtained from a shelter — and help train the animal themselves. Over a six-month course, trainers work with the veterans on a weekly basis in a group or in private classes. The goal is not only to train the animal but also to forge a bond between animal and owner that will create a more therapeutic relationship.

Since its creation in 2010, Paws and Stripes has had no want of veterans in need. “We have never had to push any sort of advertising for veterans,” explained Lindsey. “Word of mouth and any media we received have flooded our enrollment request account.”

As of October, the program, currently located only in New Mexico, has a waiting list of 700. They only accept requests from veterans, and only those who have incurred PTSD or TBI.

While they have had VA staffers refer veterans to the program, VA as an entity has never provided Paws and Stripes any assistance.

Asked about VA’s recent decision to no longer cover costs of PTSD service dogs and whether she had any doubt about the dogs’ efficacy, Lindsey said, “Service dogs may not be the best fit for every veteran diagnosed with PTSD or TBI. But it is clear from our work so far that service dogs provide a tremendous benefit for veterans that complete our program.”

Link: https://www.federalregister.gov/articles/2012/09/05/2012-21784/service-dogs

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