Service dogs trained to support veterans with post-traumatic stress disorder can decrease the severity of their symptoms better than companion dogs classified as emotional support animals, according to the results of a long-awaited study by the Department of Veterans Affairs.
Research involving 227 veterans -- 153 of whom remained with their paired dogs for the entire study -- showed that both types of animals helped decrease PTSD symptoms in their owners. But results were more significant in participants paired with a service dog.
In addition, veterans paired with service dogs had fewer suicidal behaviors and less ideation at the 18-month point, while both groups displayed a decrease in other symptoms such as anger and disrupted sleep.
However, the research found that, while both groups showed slight improvements in their mental health, there was no change in their levels of disability and no difference in physical health by the study's completion.
"While both groups appeared to have experienced some benefit, an improvement in overall disability and quality of life among veteran participants with PTSD was not observed with the provision of a service dog relative to provision of an emotional support dog," wrote the authors of the study, "A Randomized Trial of Differential Effectiveness of Service Dog Pairing Versus Emotional Support Dog Pairing to Improve Quality of Life for Veterans with PTSD."
The research, a copy of which was obtained by Military.com, was a decade in the making. In 2010, Congress ordered the VA to study the impact service dogs may have on veterans with PTSD. At the time, Iraq and Afghanistan veterans were being diagnosed with PTSD at alarming rates, and suicide among veterans was skyrocketing. So veterans advocates and members of Congress began exploring alternative and complementary therapies to treat veterans' mental health disorders.
The fiscal 2011 National Defense Authorization Act required the VA to embark on research to determine whether trained service dogs could help veterans with PTSD. The department initiated a small study in Florida, but the research had significant flaws, including an original design in which the control group was made up of veterans who weren't paired with animals -- all but one of whom dropped out when they learned they would not get a dog.
Then, two children were bitten by dogs in the study, and issues arose with the nonprofits that provided the service dogs, including one found to have unsanitary and cramped living conditions that affected the dogs' health. Other organizations provided multiple service dogs with hip dysplasia -- a genetic condition that responsible breeders screen for and try to eliminate through careful breeding techniques. Two dogs died, one from an undisclosed but known blood disorder, the other from a brain tumor.
With lessons learned, the VA restructured the research, bringing in experts on PTSD, as well as emotional support dogs to serve veterans in the control group.
Service dogs trained to assist people with PTSD learn a range of tasks, such as standing in front of or behind their handler to fend off crowds or approaching people. They also may wake a person from a nightmare, "sweep" a room before their handler enters, or turn on lights.
The emotional support dogs in the study all met a high level of obedience standards, having earned what is known as their Canine Good Citizen designations, and provide love and companionship. But unlike service dogs, they are not trained to handle tasks for a person with a disability, including PTSD.
Service dogs and emotional support animals are accommodated under federal housing guidelines under the Fair Housing Act, but only service dogs are protected at places of employment and in public spaces. Both types of dogs are allowed on airlines, but the Transportation Department moved in December to greatly restrict the presence of emotional support animals on aircraft.
For the study, the VA paired veterans with dogs including Labrador retrievers, golden retrievers, Labrador retriever-golden retriever mixes, and German shepherds. Roughly the same number of veterans were assigned a service dog, 114, or an emotional support dog, 113, but some dropped out of the study before they received an animal. In the end, 97 participants were paired with a service dog and 84 with an emotional support dog.
The participants were mostly male, 80%; white, 66.3%; and had an average age of nearly 51, with the majority being combat veterans from Vietnam, the 1990-91 Persian Gulf War and Iraq.
At the start of the study, the participants did not know the type of dog with which they would be paired. They found out at the three-month mark and then were followed over an 18-month period; they were assessed throughout the duration of the study on their physical and mental health.
According to the results, both groups "appeared to have experienced some benefit" to their mental health, although an improvement in overall disability and quality of life was not observed.
The most significant finding was a 3.7-point drop in PTSD symptom scores among those with a service dog, "along with sleep improvements in both groups and declines in suicidality and anger over the 18-month period in the group with service dogs."
PTSD and combat-related depression are thought to affect up to 20% of Iraq and Afghanistan veterans. Roughly 30% of post-9/11 veterans treated at VA medical facilities have screened positive for PTSD, according to the department.
Earlier this week, members of Congress reintroduced a bill that would require the VA to cover the cost of service dogs for mental health issues and facilitate their placement with veterans. The Puppies Assisting Wounded Servicemembers, or PAWS, Act, introduced by Rep. John Rutherford, R-Fla., would require the VA to create a grant program to pay for service dogs for veterans with PTSD.
The VA currently covers only the veterinary costs of service dogs that support veterans with physical disabilities, including blindness and mobility issues.
The PAWS Act, which would give grants of up to $25,000 to eligible organizations to provide service dogs for veterans, has been introduced in some form at least four times since 2016. It passed the House last year, but the VA has consistently opposed it, saying it would "undermine statutorily required VA functions."
Responding to questions about the study, which the VA has not yet formally released, department officials said the results show service dogs can be an "effective adjunct to usual care for veterans with PTSD."
"The study does not support the use of service dogs as an alternative to mental health treatment, and VA continues to recommend that veterans be offered evidence-based care for PTSD," a department official said.
VA doctors can designate a veteran's pet as a support animal, allowing patients to live in locations where pets are not allowed or that have breed restrictions. But VA officials say they do not "actively encourage or discourage doctors to designate veterans' pets as emotional support animals."
"There is currently a lack of evidence for the effectiveness of emotional support animals," they added.
VA officials said the service dog study had a number of limitations, including the fact that it was nearly impossible to keep veterans from knowing what type of dog -- service or emotional support -- they were paired with, since getting a service dog requires weeks of instruction, usually on site with the dog provider.
The study also lacked a true control group because all veterans were paired with dogs.
"It is important to keep in mind that a placebo-controlled design not only would have created ethical challenges but could potentially have raised problems with an appropriate analysis as it introduces other biases that cannot be readily mitigated," the authors wrote.
Results of the VA's service dog study, which were to be reviewed by the National Academies of Sciences, Engineering and Medicine before their release, may provide momentum for passage of the PAWS Act.
From 2005 to 2018, 89,160 veterans died by suicide, according to the most recent data from the VA -- more than the number of Americans killed in each major U.S. conflict except World War II and the Civil War.
"Frankly, it's comical except it's not funny that the VA has been studying this issue, thinking about it, pondering over it for a decade," said Rep. Michael Waltz, R-Fla. "Veterans should have a full menu of options and different types of therapies, whether that's service dogs, hyperbaric chambers, or other alternative therapy. We have to get out of this paradigm of just providing drugs to vets."
-- Military.com reporter Steve Beynon contributed to this report.