The Department of Veterans Affairs will pay service-dog benefits to veterans with vision, hearing or mobility-related injuries but not to veterans suffering only with post-traumatic-stress-disorder and other mental health disabilities.
A 67-page, final draft of rules concerning veterans in need of service dogs was published today in the Federal Register and will become final in 30 days. In justifying its decision, the VA cited "nationally established" and "widely accepted" training protocols for sight, hearing and mobility-assistance dogs and the lack of similar training protocols for mental health service dogs.
In addition, because there is little clinical research on mental health service dogs, the "VA has not yet been able to determine that these dogs provide medical benefit to veterans with mental illness."
"Until such determination can be made, VA cannot justify providing benefits for mental health service dogs," according to a pre-released copy of the rules obtained by The Palm Beach Post on Tuesday.
Veterans with service dogs were baffled by the rule.
"You get doctors and people telling you that you're not disabled enough," said Jim Stanek, an infantryman in the U.S. Army who served three tours of combat duty in Iraq. Stanek, who has been diagnosed with PTSD and traumatic brain injury, helped found Paws 4 Stripes, a non-profit group in Albuquerque, New Mexico, that provides service dogs and training to veterans with PTSD and mental health disabilities.
"What do I have to do? Have my leg amputated?" Stanek asked. "Is that what I need to do to get what I need to recover?"
Service dogs are individually trained to perform tasks for a specific person. Some of the tasks performed to assist veterans with PTSD include surveying darkened rooms, turning on lights, re-orienting their owner during nightmares or flashbacks, navigating through crowds, sensing anxiety, enforcing boundaries for personal space and retrieving a cellphone, said Sally Chester, secretary of Genesis Assistance Dogs Inc. of West Palm Beach.
"I know what service dogs can do," said Chester, who has lived with and involved with service dog training groups since 2005, after her husband, Don, became a quadriplegic after a car accident. "Veterans have reported to me what a support their service dogs are."
Under the new rule, the VA will only provide benefits when the veteran is diagnosed with a visual, hearing or substantial mobility impairment and the clinical team treating the veteran determines that a trained service dog is the best "device" to manage the disability.
The benefits will cover travel expenses associated with obtaining the dog and the cost of an insurance policy that covers 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, non-sedated dental cleanings, nail trimming, boarding, pet-sitting or dog-walking services and over-the-counter medications.
Among the most controversial provisions of the new rule: the VA will only provide coverage 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 sent to the VA in August 2011, John Ensminger, a New York attorney and author of Service and Therapy Dogs in America, expressed his concern for the accreditation requirement and 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 VA defended its position, saying it estimated that only 100 veterans with properly accredited training will apply for mental health service dog benefits this year. The VA also intends to train clinical staff about the skills performed by service dogs and how to determine if a service dog is "the most appropriate assistive device."
Despite the new rule Ensminger is concerned that medications will trump service dogs when it comes to treating PTSD.
"What it may mean in practice is, if we can tranquilize you to a certain level with psychotropic medications, then you don't need a dog," Ensminger said. "I think that is wrong."