Veterans choice applies to types of treatments, not just access

In discussing veterans’ health care, one of the most commonly used words is “choice.” Most often, choice is used in the context of allowing veterans to seek care within their community, rather than at a VA facility. However, there are other important aspects of choice that are less discussed, but equally important when it comes to veterans’ health care is the choice of treatment options.

When it comes to assisting veterans diagnosed with post-traumatic stress disorder (PTSD), the VA asserts that there are two basic types of effective treatments, psychotherapy (talk therapy), or medication.

{mosads}Given the VA’s history of overprescribing  prescription medications, and often prescribing ineffective medications such as Prazosin, which recently failed to show it could reduce nightmares or improve sleep quality in a trial of 304 military veterans, veterans should also have a choice of access to alternative treatment methods, particularly when it comes to complicated psychiatric disorders like PTSD.

One such alternative treatment method that VA has been slow to embrace is the use of psychiatric service dogs. In the same way that veterans advocates use the word choice, VA uses the phrase “evidence-based therapies” to describe its justification for use of mediation and psychotherapy, and its antipathy toward less-traditional treatment methods, such as psychiatric service dogs.

However, as I have argued previously, VA has a tendency to manipulate science for its own benefit, not that of veterans.

The use of psychiatric service dogs at the VA is no exception.  When Congress mandated the VA conduct a pilot program studying the effectiveness of psychiatric service dogs in 2010, VA had to twice suspend the program, once when two dogs bit the children of veterans, and again, when the health of some dogs in the study were compromised. VA also asserted that there was a lack of availability of trained dogs.  

The disastrous results of VA’s initial study have caused some in the nonprofit community to question whether VA purposely set up the study to fail, so that VA would not have to pick up the tab for training psychiatric service dogs, which can often cost nearly $30,000.

But, according to Rory Diamond, CEO of K9s For Warriors, “By their own admission, the VA’s suspension of their program had nothing to do with the effectiveness of psychiatric service dogs, it had to do with shortcomings in their training protocols. Independent studies have already proven dogs to be a highly effective form of treatment for PTSD, so it’s time to stop debating this and time to start funding it.

“And no one expects the VA to go into the service dog training business. There are already groups out here that do that, and that do it very well. K9s for Warriors alone has already paired over 400 veterans with service dogs. We could help a lot more with a little more help from the VA.”

In Congressional testimony, VA’s position has been presented several times by Dr. Michael Fallon, VA’s Chief Veterinary Medical Officer, who stated most recently that “VA does not provide benefits for PTSD or mental health dogs because they are not known to be effective in overcoming specific functional limitations; [VA’s revamped] study is incredibly important in building the evidence base.”  

This is not the first time that the VA, and Dr. Fallon in particular, have been hostile toward man’s best friend.  Dr. Fallon also recently came under fire for staunchly defending VA’s canine research program, stating that dogs “enjoy being on the treadmill, they look forward to it” after being implanted with pacemakers without pain relief. Despite Dr. Fallon’s defenses, VA Secretary Dr. David Shulkin recently reversed course, stating that he “is not a strong believer in the need for canine research.”

Moreover, a recent non-VA study, conducted by researchers at Purdue University that involved 141 Iraq and Afghanistan war veterans diagnosed with PTSD, found that veterans with psychiatric service dogs had lower depression scores, better mental quality of life scores, greater satisfaction with life, higher levels of psychological well-being, better abilities to cope with adversity, and lower social isolation scores.

Most importantly though, VA evaluates mental health conditions, including PTSD, based on occupational and social impairment, and participants in the study exhibited a greater ability to get out and participate in social activities, missed less work, and showed fewer impairments on the job than those without a psychiatric service dog.

In addition to the Purdue University Study, in 2017, Kaiser Permanente Northwest Center for Health Research released the results of a study involving 78 veterans with PTSD, which showed that those with animals had better overall mental health, less substance abuse, and higher ratings on their interpersonal relationships.  However, the authors of both the Purdue and Kaiser Permanente studies acknowledged that more research on the subject is required.

If Congress decides to take another go at an internal VA study, it could begin by passing the Puppies Assisting Wounded Service members Act of 2017 (PAWS Act), introduced by Rep. Ron DeSantis (R-Fla.), that would direct the VA to carry out a five-year pilot program under which it provides grants to eligible nonprofit organizations to provide service dogs to veterans who suffer from PTSD after completing other evidence-based treatment.  

The bill currently has 212 cosponsors in the House, implying widespread support for the VA to do more than its current efforts on the use of psychiatric service dogs. Although VA is currently scheduled to complete its revamped study later this year, the results aren’t expected until 2019.

Given the number of veterans that not only struggle with PTSD, but with suicidal thoughts and mental health generally, the VA must act swiftly to prevent any future tragedies, and provide veterans with not only choice of treatment providers, but with a choice of scientifically-based alternative treatment methods, such as psychiatric service dogs, as well.

Rory E. Riley-Topping has dedicated her career to ensuring accountability within the Department of Veterans Affairs (VA) to care for our nation’s veterans. She is the principal at Riley-Topping Consulting and has served in a legal capacity for the U.S. House of Representatives Committee on Veterans’ Affairs, the National Veterans Legal Services Program, the U.S. Court of Appeals for Veterans Claims, and the Department of Veterans Affairs.