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Madyson Hutchinson

James Carafano

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Next Steps in Federal Support for Veterans with PTSD

SUMMARY

Congress and the Administration both have roles to play in expanding veterans’ access to services that help heal the wounds of war, both physical and psychological. In 2015, a congressional report on military casualties estimated that approximately 140,000 of America’s veterans deployed post-9/11 suffer from post-traumatic stress disorder (PTSD). Standard treatments include cognitive behavioral therapies and psychiatric medications that often produce negative side effects and have even been linked to an increased number of suicides among veterans. Service dogs offer an alternative to traditional treatments by acting as highly trained companions that provide both practical and emotional support to veterans suffering from PTSD. The proposed PAWS Act sets up guidelines to make service dogs an official treatment option for American veterans—an alternative that Congress should support.

KEY TAKEAWAYS

About 140,000 of America’s veterans deployed since 9/11 suffer from PTSD. Standard VA treatments have been ineffective, or even made things worse.
Service dogs offer an alternative to traditional treatments as highly trained companions that provide emotional support to veterans suffering from PTSD.
The proposed PAWS Act sets up guidelines to make service dogs an official treatment option for American veterans—an alternative that Congress should support.

ongress and the Administration both have roles to play in expanding veterans’ access to services that help heal the wounds of war, both physical and psychological.

In 2015, a congressional report on military casualties estimated that approximately 140,000 of America’s veterans deployed since 9/11 suffer from post-traumatic stress disorder (PTSD).^{Hannah Fischer, “A Guide to U.S. Military Casualty Statistics: Operation Freedom’s Sentinel, Operation Inherent Resolve, Operation New Dawn, Operation Iraqi Freedom, and Operation Enduring Freedom,” Congressional Research Service, August 7, 2015,}^{https://fas.org/sgp/crs/natsec/RS22452.pdf}^{(accessed March 15, 2017).}

">1 This number does not take into account the hundreds of thousands of veterans affected by PTSD from wars prior to 9/11. PTSD lowers quality of life and puts those affected at a greater risk of self-harm and suicide.

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Standard treatments include cognitive behavioral therapies and psychiatric medications that often produce negative side effects and have even been linked to an increased number of suicides among veterans.^{Citizens Commission on Human Rights International, “A Review of How Prescribed Psychiatric Medications Could Be Driving Members of the Armed Forces and Vets to Acts of Violence & Suicide,” April 2014,}^{https://www.veterans.senate.gov/imo/media/doc/For%20the%20Record%20-%20CCHR%204.30.14.pdf}^{(accessed March 15, 2017).}

">2 An alternative? Dogs. Service dogs offer an alternative to traditional treatments by acting as highly trained companions that provide both practical and emotional support to veterans suffering from PTSD. Service dogs are trained to perform practical tasks like “searching” rooms for perceived dangers, sleeping on top of their handlers to prevent sleepwalking, and calmly standing between their handlers and approaching strangers. They also provide emotional comfort, stable companionship, and ultimately enable PTSD-affected veterans to lead a higher quality of life.

In March 2016, Representative Ron DeSantis (R–FL) first introduced a bipartisan bill called the Puppies Assisting Wounded Service Members (PAWS) Act. On July 6, 2016, Senator Deb Fischer (R–NE) introduced a similar bill that was later referred to the Committee on Veterans’ Affairs.

On May 3, 2017, Representatives DeSantis and Stephen Lynch (D–MA) reintroduced the bipartisan PAWS Act in the House. Senators Fischer and Cory Booker (D–NJ) did the same in the Senate.^{Josh Billinson, “Congress Reintroduces Bill to Give Veterans Battling PTSD Another Option,”}^{Independent Journal Review}^{, May 4, 2017,}^{http://ijr.com/2017/05/863935-congress-reintroduces-bill-to-give-veterans-battling-ptsd-another-option/}^{(accessed May 11, 2017).}

">3

The introduction of this legislation highlights an important issue: Congress, the Department of Veterans Affairs (VA), and the Department of Transportation should be more proactive in combatting the effects of PTSD on veterans by making service dogs more accessible to them.

The VA’s Failed Leadership in Research

The VA currently does not provide service dogs for physical or mental health issues related to PSTD.^{U.S. Department of Veterans Affairs, “PTSD: National Center for PTSD–Dogs and PTSD,” August 14, 2015,}^{http://www.ptsd.va.gov/public/treatment/cope/dogs_and_ptsd.asp}^{(accessed March 15, 2017).}

">4 Furthermore, the VA has delayed multiple research studies and complicated efforts to implement service-dog pilot programs to cover mental health issues.

In 2010, Congress mandated a study on the benefits of service dogs for veterans suffering from PTSD, and the VA halted that study when two service dogs bit children of veterans in their homes.^{U.S. Department of Veterans Affairs Office of Research & Development, “VA Restarting Study on Service Dogs and PTSD,” March 24, 2015,}^{http://www.research.va.gov/currents/spring2015/spring2015-2.cfm}^{(accessed March 15, 2017).}

">5 In 2012, the VA suspended further research due to concerns over the care of the dogs involved in the study.^{Patricia Kime, “New Studies Focus on Service Dogs and PTSD,”}^{Military Times}^{, May 10, 2015,}^{http://www.militarytimes.com/story/military/benefits/health-care/2015/05/10/ptsd-service-dogs-va-perdue/70944650/}^{(accessed March 15, 2017). ">}6

The VA is now in its third year of a costly and ineffective $12 million pilot study on the benefits of “emotional support” dogs. However, this study has proven to be fundamentally flawed from the beginning.

The VA is attempting to substitute “emotional support” dogs for “service” dogs. The Americans with Disabilities Act (ADA) ensures public access specifically for service dogs, not emotional support dogs. This means that veterans would be provided with an “emotional support” animal that would then not be allowed in public spaces, defeating the fundamental purpose of the program.

Furthermore, the VA procured the dogs used in the study from non-reputable breeders. Reputable breeders test their animals for poor character traits, such as aggression, and ensure that their puppies are well socialized at a young age. Using reputable breeders helps to prevent situations like a service dog biting a member of its handler’s family. In addition to using non-reputable breeders, the VA used vendors who did not have any prior experience training animals for veterans with PTSD.^{“VA Study of Service Dogs for Vets with PTSD Faces Questions,” Fox News, April 21, 2016,}^{http://www.foxnews.com/health/2016/04/21/va-study-service-dogs-for-vets-with-ptsd-faces-questions.html}^{(accessed March 15, 2017).}

">7

Currently, of the 220 veterans in the study, fewer than 100 have been matched with a dog.

Results of Independent Studies

Four major private-sector studies highlight the benefits of service dogs for PTSD-affected veterans. The Purdue University College of Veterinary Medicine, in partnership with K9s for Warriors, has launched a research study on this subject. Relying on interviews with veterans who already have service dogs, the Purdue study found that service dogs helped participants cope with daily anxiety, hypervigilance, nightmares, flashbacks, and other symptoms of PTSD.^{Purdue University College of Veterinary Medicine, “Service Dogs and PTSD,”}^{https://vet.purdue.edu/chab/ohaire/PTSD.php}^{(accessed March 15, 2017).}

">8

Tina Jaeckle, PhD, and Angi Semegon, PhD, of Flagler College in Florida conducted a similar study that relied on self-reporting measures by participants. They created a questionnaire to assess participants’ overall health. The full results have yet to be published, but Semegon and Jaeckle reported that approximately 100 respondents showed fewer health issues and overall positive outcomes.^{Flagler College, “Flagler College Receives Grant to Research K9s for Warriors Program,” March 1, 2017,}^{http://www.flagler.edu/news-events/news/2017/03/01/flagler-college-receives-grant-to-research-k9s-for-warriors-program}^{(accessed May 11, 2017).}

">9 Furthermore, their study found that 93 percent of the participants benefited from the companionship their service dog provided, and had fewer overall PTSD symptoms. This study also noted a significant decrease in participants’ use of prescription drugs. The Human Animal Bond Research Institute (HABRI) is currently funding a pilot study on the correlation between mental health of veterans suffering from PTSD and owning a service dog.

The Human Animal Bond Research Institute (HABRI) is currently funding a pilot study on the correlation between mental health of veterans suffering from PTSD and owning a service dog.^{Steven Feldman, HABRI, testimony before the Subcommittee on National Security, Committee on Oversight and Government Reform, U.S. House of Representatives, April 14, 2016,}^{https://oversight.house.gov/wp-content/uploads/2016/04/2016-04-14-Steven-Feldman-HABRI-Testimony.pdf}^{(accessed May 11, 2017).}

">10 HABRI is working with K9s for Warriors to analyze 137 military veterans diagnosed with PTSD. The study includes veterans who currently have a service dog as well as those who are on a waiting list to receive one.11 Preliminary findings note that veterans paired with a service dog exhibit significantly lower PTSD symptoms than those who do not currently have a service dog.

Finally, in October 2013, Cheryl Krause-Parello, PhD, of the University of Colorado, Denver, founded Canines Providing Assistance to Wounded Warriors (C-P.A.W.W.) to “advance disciplinary research, education and practice protocols for wounded warriors and veterans through the development of evidence based interventions.”^{Vicki Hildner, “A Veteran’s Best Friend: Therapy and Research with Dogs Help Returning Service Members,” University of Colorado, February 3, 2014,}^{http://www.ucdenver.edu/about/newsroom/spotlight/students/Pages/Service-dog-therapist-and-researcher-help-veterans.aspx?source=today}^{(accessed May 11, 2017).}

">12 She and her colleague Dr. Cari Levy plan to measure stress responses like blood pressure and heart rate in two separate groups of patients: those who receive visits from a psychologist accompanied by a service dog, and those who only receive visits from their psychologist. They plan to compare how the interaction with service dogs affects those veterans specifically diagnosed with PTSD.13

Not one of these studies reported any negative side effects.

Current Complications Facing Service Dog Programs

At this time, no national standards for the procurement and training of service dogs for veterans exist. The Association of Service Dog Providers for Military Veterans (ASPMV)—a coalition of nonprofit service dog providers—is working to create such standards. The ASPMV wants to ensure that organizations pair veterans with the highest-quality service dogs.^{Association of Service Dog Providers for Military Veterans,}^{http://servicedogs4vets.org/}^{(accessed May 11, 2017).}

">14 These “Service Dog Agency Standards” provide guidelines for accredited agencies that ensure veterans receive quality dogs, training, and assistance.^{Association of Service Dog Providers for Military Veterans, “Service Dog Agency National Model,”}^{http://servicedogs4vets.org/service-dogs-national-standards-model/}^{(accessed May 11, 2017). ">}15

Recently, a 12-year Navy veteran and student at the University of North Texas was told to remove his service dog from the campus after the dog became “uncontrollable.”^{Claire Z. Cardona, “Veteran’s Service Dog Kicked Off UNT Campus Because It Was “Direct Threat,”}^{Dallas News}^{, November 15, 2016,}^{https://www.dallasnews.com/news/higher-education/2016/11/15/veterans-service-dog-kicked-unt-campus-direct-threat}^{(accessed May 11, 2017).}

">16 The university cited multiple instances of the dog’s poor behavior including being aggressive toward other students and faculty. This instance points out another complication for service dogs in public spaces—lack of quality training.

The ADA currently does not require service animals to be professionally trained.^{U.S. Department of Justice, “Americans with Disabilities Act: Frequently Asked Questions About Service Animals and the ADA,” last updated July 20, 2015,}^{https://www.ada.gov/regs2010/service_animal_qa.html}^{(accessed May 11, 2017).}

">17 In fact, the act was written to allow handlers to train service dogs themselves rather than go through a professional trainer. However, the increasing number of cases in which poorly trained service dogs act out in public spaces shows the need for standards for the training of service animals.

Service dog fraud is also a noteworthy issue—specifically concerning airline travel. The Department of Transportation requires that airlines allow service animals to accompany passengers on flights. The problem arises when pet owners falsely claim that their household pet is a service animal to avoid pet fees imposed by airlines. This situation inadvertently affects veterans trying to travel with service animals. Seating for individuals accompanied by service animals is limited on flights, especially, if the animal is larger. If passengers are falsely disguising their personal pets as service animals, veterans are further limited in their ability to travel with their actual service animals.

Enter PAWS

The PAWS Act attempts to break the cycle of failed leadership from the VA, leveraging the accomplishments of the private sector and pressing for more relevant, research-based policies sooner rather than later.

The PAWS Act:

Establishes a pilot program where the VA provides grants to eligible organizations for each veteran referred to that organization for a service dog. To be considered eligible, organizations must be nonprofits that provide trained service dogs that are certified by Assistance Dogs International (ADI).^{Assistance Dogs International,}^{http://www.assistancedogsinternational.org/}^{(accessed March 15, 2017). ">Assistance Dogs International,}^{http://www.assistancedogsinternational.org/}^{(accessed March 15, 2017). ">}18These organizations must meet the ASPMV standards for service dog programs and agree to cover all expenses in excess of the VA grant.
Sets eligibility standards for the veterans entering the pilot program. Veterans must have been diagnosed with PTSD, been previously treated for it, and remain symptomatic. The newest version of the act includes all veterans—pre- and post-9/11.
Outlines parameters for procurement and training of service dogs. The partner organizations must provide canines with one-on-one training for a minimum of 30 hours over at least 90 days. The act also outlines plans for an in-house residential facility where veterans who receive service dogs must stay for at least 30 hours of additional training with their new service canine. The act also requires that the dogs pass the American Kennel Club Community Canine test and the ADI Public Access Test before being placed with a veteran.
Requires that service dogs be acquired from a provider that is accredited by a member organization of the ASPMV or ADI. The PAWS Act would require service dogs to be trained by accredited organizations to ensure that veterans are matched with a dog appropriate for their lifestyle and personality.
Requires that the VA establish metrics for measuring the effectiveness of the pilot program. “Effectiveness” would be determined with respect to the degree that the service dogs help participants live normally, lessen their symptoms, reduce their dependence on psychiatric medications, and improve their overall social functioning.
Requires that, at the end of the program, the Comptroller General of the U.S. submit a report to Congress on the program’s effectiveness. The Government Accountability Office is required to audit the VA’s metrics and report on the effectiveness of the program to Congress.

Next Steps

The Paws Act brings attention to an important issue. In addition to jump-starting the VA research-based policy process, there are steps that Congress can take now to improve veteran access to service animals. Congress should:

Press the VA to update its service dog policy quickly. The VA’s delayed and inconclusive research studies have cost millions of taxpayer dollars with nothing to show for it. Meanwhile, veterans continue to suffer from PTSD and commit suicide. The PAWS Act outlines measures that the VA could implement to improve its policies and ensure a better quality of life for veterans suffering from PTSD.
Insist that the VA clearly define “emotional support” dogs as “service animals” in its pilot programs. Current ADA regulations define a service canine as “any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability.” By that definition, dogs assisting veterans suffering from post-traumatic stress in VA pilot programs are “service” animals.
Encourage the VA to institute nationally recognized standards for the procurement and training of service dogs used in the VA program. Private organizations like the ASPMV have already begun to produce national standards for the procurement and training of dogs. The VA should adopt similar standards that ensure the quality of dog training for veterans.
Take action to help prevent service dog fraud in public settings. This problem routinely presents itself in airplane travel. The Department of Transportation requires that airlines allow service animals on flights without charge to the owner.^{Federal Transit Administration, “Frequently Asked Questions,” March 16, 2016,}^{https://www.transit.dot.gov/regulations-and-guidance/civil-rights-ada/frequently-asked-questions}^{(accessed March 15, 2017). ">Federal Transit Administration, “Frequently Asked Questions,” March 16, 2016,}^{https://www.transit.dot.gov/regulations-and-guidance/civil-rights-ada/frequently-asked-questions}^{(accessed March 15, 2017). ">}19 Pet owners have begun taking advantage of that regulation by passing their family pet off as a service animal.^{Gary Stoller, “Crossing the Line from Pet to Service Animal,”}^{USA Today}^{, August 3, 2014,}^{http://www.usatoday.com/story/travel/flights/2014/08/03/fliers-scam-airlines-pets-service-dogs/13325733/}^{(accessed March 15, 2017). ">Gary Stoller, “Crossing the Line from Pet to Service Animal,”}^{USA Today}^{, August 3, 2014,}^{http://www.usatoday.com/story/travel/flights/2014/08/03/fliers-scam-airlines-pets-service-dogs/13325733/}^{(accessed March 15, 2017). ">}20
Insist that the Department of Transportation reevaluate regulations that prevent airlines from discerning between pets and legally defined service animals. Current regulations prevent airlines from requiring ID cards for service animals or asking passengers specific questions about their disability in relation to their service animal.21

Conclusion

There is no “one size fits all” solution for veterans combatting post-traumatic stress. However, with more than 140,000 veterans suffering from PTSD just since 9/11, it is clear that current treatment methods are limited and new avenues must be explored. The PAWS Act highlights another treatment option and outlines a program that would establish empirical research on the effectiveness of service dogs for veterans suffering from PTSD. America’s veterans deserve no less.

James Jay Carafano, PhD, is the E. W. Richardson Fellow and Vice President of, and Madyson Hutchinson is Administrative Assistant in, the Kathryn and Shelby Cullom Davis Institute for National Security and Foreign Policy at The Heritage Foundation.

References:

[1] Hannah Fischer, “A Guide to U.S. Military Casualty Statistics: Operation Freedom’s Sentinel, Operation Inherent Resolve, Operation New Dawn, Operation Iraqi Freedom, and Operation Enduring Freedom,” Congressional Research Service, August 7, 2015, https://fas.org/sgp/crs/natsec/RS22452.pdf (accessed March 15, 2017).

[2] Citizens Commission on Human Rights International, “A Review of How Prescribed Psychiatric Medications Could Be Driving Members of the Armed Forces and Vets to Acts of Violence & Suicide,” April 2014, https://www.veterans.senate.gov/imo/media/doc/For%20the%20Record%20-%20CCHR%204.30.14.pdf (accessed March 15, 2017).

[3] Josh Billinson, “Congress Reintroduces Bill to Give Veterans Battling PTSD Another Option,” Independent Journal Review, May 4, 2017, http://ijr.com/2017/05/863935-congress-reintroduces-bill-to-give-veterans-battling-ptsd-another-option/ (accessed May 11, 2017).

[4] U.S. Department of Veterans Affairs, “PTSD: National Center for PTSD–Dogs and PTSD,” August 14, 2015, http://www.ptsd.va.gov/public/treatment/cope/dogs_and_ptsd.asp (accessed March 15, 2017).

[5] U.S. Department of Veterans Affairs Office of Research & Development, “VA Restarting Study on Service Dogs and PTSD,” March 24, 2015, http://www.research.va.gov/currents/spring2015/spring2015-2.cfm (accessed March 15, 2017).

[6] Patricia Kime, “New Studies Focus on Service Dogs and PTSD,” Military Times, May 10, 2015, http://www.militarytimes.com/story/military/benefits/health-care/2015/05/10/ptsd-service-dogs-va-perdue/70944650/ (accessed March 15, 2017).

[7] “VA Study of Service Dogs for Vets with PTSD Faces Questions,” Fox News, April 21, 2016, http://www.foxnews.com/health/2016/04/21/va-study-service-dogs-for-vets-with-ptsd-faces-questions.html (accessed March 15, 2017).

[8] Purdue University College of Veterinary Medicine, “Service Dogs and PTSD,” https://vet.purdue.edu/chab/ohaire/PTSD.php (accessed March 15, 2017).

[9] Flagler College, “Flagler College Receives Grant to Research K9s for Warriors Program,” March 1, 2017, http://www.flagler.edu/news-events/news/2017/03/01/flagler-college-receives-grant-to-research-k9s-for-warriors-program (accessed May 11, 2017).

[10] Steven Feldman, HABRI, testimony before the Subcommittee on National Security, Committee on Oversight and Government Reform, U.S. House of Representatives, April 14, 2016, https://oversight.house.gov/wp-content/uploads/2016/04/2016-04-14-Steven-Feldman-HABRI-Testimony.pdf (accessed May 11, 2017).

[11] Ibid.

[12] Vicki Hildner, “A Veteran’s Best Friend: Therapy and Research with Dogs Help Returning Service Members,” University of Colorado, February 3, 2014, http://www.ucdenver.edu/about/newsroom/spotlight/students/Pages/Service-dog-therapist-and-researcher-help-veterans.aspx?source=today (accessed May 11, 2017).

[13] Ibid.

[14] Association of Service Dog Providers for Military Veterans, http://servicedogs4vets.org/ (accessed May 11, 2017).

[15] Association of Service Dog Providers for Military Veterans, “Service Dog Agency National Model,” http://servicedogs4vets.org/service-dogs-national-standards-model/ (accessed May 11, 2017).

[16] Claire Z. Cardona, “Veteran’s Service Dog Kicked Off UNT Campus Because It Was “Direct Threat,” Dallas News, November 15, 2016, https://www.dallasnews.com/news/higher-education/2016/11/15/veterans-service-dog-kicked-unt-campus-direct-threat (accessed May 11, 2017).

[17] U.S. Department of Justice, “Americans with Disabilities Act: Frequently Asked Questions About Service Animals and the ADA,” last updated July 20, 2015, https://www.ada.gov/regs2010/service_animal_qa.html (accessed May 11, 2017).

[18] Assistance Dogs International, http://www.assistancedogsinternational.org/ (accessed March 15, 2017).

[19] Federal Transit Administration, “Frequently Asked Questions,” March 16, 2016, https://www.transit.dot.gov/regulations-and-guidance/civil-rights-ada/frequently-asked-questions (accessed March 15, 2017).

[20] Gary Stoller, “Crossing the Line from Pet to Service Animal,” USA Today, August 3, 2014, http://www.usatoday.com/story/travel/flights/2014/08/03/fliers-scam-airlines-pets-service-dogs/13325733/ (accessed March 15, 2017).

[21] Federal Transit Administration, “Frequently Asked Questions.”

This article appeared originally at The Heritage Foundation.

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