VA Won’t Pay for PTSD Service Dogs. Should They?
The battle’s been brewing for years. Veterans coming back from wars with symptoms of post-traumatic stress disorder, as well as other psychological ailments such as depression and anxiety disorders that may or may not be directly related to trauma, are fighting to claim a benefit: A trained service dog – at government expense.
The problem: The expense is significant. It can cost anywhere from $10,000 to $30,000 to breed and fully train a service dog. And the Veterans Administration says it has more productive uses for the money.
Veterans groups and a loose association of dog breeders and trainers that have formed a small cottage industry providing service dogs to veterans, of course. And the veterans who have them love their service dogs and are grateful for the benefit. But after reviewing the issue, and after a period of public comment, the Veterans Administration has elected not to cover service dogs for PTSD and other psychiatric conditions.
Service dogs have long been used to help vision-impaired and hearing-impaired people and people with mobility issues. And the benefits and cost-effectiveness of seeing-eye dogs for the blind has been accepted for years.
Originally, the VA could only provide seeing-eye dogs to blind veterans. However, President George W. Bush expanded that authorization when he signed the Department of Veterans Affairs Health Care Programs Enhancement Act, which authorized the Veterans Administration to provide service dogs as a benefit for other conditions as well. However, in a 2007 memorandum, the VA concluded that there was not sufficient evidence that service dogs were a cost-effective remedy for vision and mobility-impaired veterans. However, the VA left the door open to providing a service dog on a case-by-case basis to individuals who could show that the therapeutic value of a dog and the potential cost savings over other forms of therapy justified the use.
In 2009, Congress voted to expand authorization of a service dog benefit to veterans with mental illnesses. And in 2010, Congress passed the Franken Amendment, which directed the executive branch to launch a three-year pilot program to study the therapeutic effects of service dogs for PTSD.
So What Can a Dog Do?
According to the Psychiatric Service Dog Society, a trained service dog can help an individual with PTSD or other depressive or anxiety disorders in the following ways:
- Help overcome reclusiveness by accompanying the individual on trips outside the home
- Awaken an individual suffering from night terrors
- Turn on a light to alleviate night terrors
- Help with hypervigilance by searching a room for intruders
- Interruption of dissociative spell
- Alert and intervene or distract in moments of emotional escalation
Benefits of Pet Ownership
There is little doubt that pet ownership correlates strongly with improved mental and physical health outcomes. Studies indicate that pet owners are less likely to commit suicide, get more exercise, are less likely to have heart attacks, and less likely to suffer from severe depression than those with no pets. It is not clear to what extent that relationship between pet ownership and improved health outcomes is causative versus correlative. For example, people who are more active may be more likely to go out and adopt a pet in the first place.
In any event, though, it is not necessary to have a highly-trained service animal with a five-figure price tag to realize these benefits. Most of the beneficial effects can be had with any reasonably well-behaved and affectionate dog, without any specialized training whatsoever.
So the argument for highly trained service animals for PTSD patients at government expense must go beyond the basic therapeutic effects that you can get with any good pet, and address the possible law of diminishing returns. It is possible that the government could spend larger and larger sums for trained service animals for smaller and smaller benefits.
Testing the Theory
It occurred to us that if there is any validity to the use of service dogs to treat PTSD, they would already be in common use among psychiatric patients in other contexts – possibly for rape survivors. Are dogs effective in helping rape survivors recover and function? Do they help with agoraphobia symptoms, and hypervigilance? And if they do, are they typically professionally trained and certified service dogs? What do women do who are survivors themselves but who don’t qualify for VA services? Do they seek out trained dogs? Is the benefit powerful enough that those who can afford it choose to pay for the costs associated with a trained dog with their own money?
It turns out that there is, indeed, a precedent for the use of dogs to help survivors of rape and other violent crimes overcome anxiety and other PTSD symptoms. Service Dogs for Victims of Assault, which is now defunct, was formed in 1999 to help provide dogs to survivors and raise awareness of their value in helping survivors. We spoke to their chief clinical practitioner, Carmen Davis, Ph.D., via telephone.
Dr. Davis’s Portland, Oregon practice centers largely on patients who are struggling with PTSD, often through severe child abuse. Symptoms include dissociative disorders – a psychological phenomenon in which the patient re-experiences the trauma. Other therapists sometimes refer patients to him if there is a potential need or desire for a service dog.
Davis was not familiar with any clinical studies demonstrating the effectiveness of service dogs for the PTSD population, though he did report positive results on an anecdotal basis. However, none of his patients required dogs that needed extremely high-end, specialized training that would result in a five-figure price tag. None of Davis’s clients could afford that, anyway.
“You really just need a dog with good basic obedience training, and public access training.”
However, Davis did point out there were instances where a dog could sense when an owner was going through a dissociative episode and could bring them out of it. In Carmen’s experience, though, the owners would obtain dogs with good temperaments and obedience training, and continue training the dogs themselves. Expense to the government was generally nil in these cases, but these patients did, by and large, believe that the dogs were helpful enough to justify spending their own money.
From the VA’s point of view, absent a solid clinical study demonstrating effectiveness, it would be extremely difficult to justify awarding service dogs as a benefit to treat PTSD – especially when the assumption is that a fully-trained service dog would cost tens of thousands of dollars.
However, there is a whole continuum of needs within the PTSD community. Only a very few veterans will require a high-end service dog for PTSD symptoms. It may make sense to recalibrate our thinking, and scale down the cost assumptions to reflect it.
For example, of the population of veterans collecting 50 percent or greater disability compensation because of PTSD, how many of them would trade 20 percentage points of disability for a service dog? After all, if the dog doesn’t make them less disabled, then you cannot justify the expenditure. But if the dog does result in a significant reduction of disability, then the cost of the dog could be offset by a reduction in VA benefits – perhaps on a sliding scale, reflecting the training cost of the dog. The veteran could select the desired training level himself, though it would affect VA disability compensation benefits.
If enough veterans jump at the chance, even where it costs them money, then we probably have a worthwhile benefit. If nobody takes the dog over the cash, then the whole push to cover service dogs for PTSD appears to be an attempt to latch on to the VA benefit gravy train.
Photo credit: Ed Andrieski/AP