Department of Veterans Affairs

Jan 26, 2012

Facility Dogs – The Rodney Dangerfield Of The Canine Companions for Independence World

Al , , , Service Dogs, Video 0 Comment

I’ve said for a long time that Facility Dogs are the Rodney Dangerfield of the Canine Companions for Independence world, and, in my experience, even most associated with CCI aren’t really aware of the wide variety of things they do.

I know I sure didn’t give them the respect they deserve initially, and that was largely because every time I heard them being brought up, it was as a means to an end, specifically in military hospitals, of educating patients about applying for service dogs. Now that’s certainly a great thing and very much a part of what they do, but they have a tremendous role to play all on their own, and there aren’t nearly enough of them out there.

That’s why I was so happy to see this great recent video with CCI Facility Dog Scully and his partner Elizabeth Penny – they are perhaps the best example I’ve seen of using the full range of a Facility Dog’s capabilities in a physical rehabilitation environment. Video is only 7 1/2 minutes, but if you don’t even have that much time, fast forward to 2:25 where Elizabeth explains and demonstrates what Scully does, and give me 5 minutes.

The video speaks for itself and says more than I ever could, but note the big things Elizabeth talks about having Scully help with:

  • articulation of speech – e.g., after strokes, aphasia, or brain injuries with the associated difficulty speaking
  • physical therapy – grooming, walking, feeding, teaching commands
  • education – patients who might benefit from a service dog get hands-on training and actually work with him
  • pure motivation – especially with pediatric patients, just to get them up and outta the bed (“Sometimes patients will say ‘I’ll come down for Scully, but I’m not coming down for therapy.’”)

You can see a whole list of rehabilitation goals Scully helps with at his WakeMed page:

  • Improve memory
  • Improve word retrieval
  • Improve sequencing skills
  • Improve socialization
  • Increase auditory comprehension
  • Increase verbal spontaneous speech
  • Increase motivation for participation
  • Increase attention
  • Improve use of upper extremities
  • Improve ability to interact with dog
  • Improve use of gestures in language
  • Improve articulation
  • Improve sitting balance
  • Improve gait training
  • Decrease situational depression

(By the way, Scully, as you some of you may have wondered about, was named for Vin Scully, the legendary Dodgers broadcaster. Very cool story about how that happened – I don’t know that Vin himself even knows there is a dog named after him.)

There are several CCI Facility Dogs involved in military settings, most notably Tommy at the Naval Medical Center San Diego Comprehensive Combat Casualty Care Center (C5); and Ascot and Bhadra at the Oklahoma City VA Medical Center. Based on numerous conversations I’ve had over the years, though, I’m firmly convinced that the vast majority of occupational therapists have no idea what a Facility Dog can do, and if they did, they’d be pounding on CCI’s door to get one.

Elizabeth said it best: “I don’t know if I could go without having a dog in rehab. The impact that it has made on my patients, and my coworkers… I just don’t know that I could go without one.”

Jun 16, 2011

VA Releases Notice Of Proposed Rulemaking For Service Dogs

Al Service Dogs, Standard, Veterans

VA released its Notice of Proposed Rulemaking (NPRM) for service dogs (RIN 2900-AN51–Service Dogs) today for public comments which must be received by August 15.

What’s there is not so much anything new as it is the actual implementation of things VA has already said they would do and is in some cases already doing, so if you’re looking for any big earth-shattering changes, you’ll be disappointed. The one notable new thing is the travel payment portion, which has been discussed, but this is the first it’s been officially added.

I don’t think any of it will really surprise anyone who’s been involved with the discussions over the past few years, but I realize most haven’t. If you’re not familiar with the long history, I’ve included related links at the end of this post which may help.

The NPRM is 26 pages, and you need to read the whole thing, but lemme give you the highlights. And, to save the suspense, I’ll tell you up front that what’s not there is just as important, if not more so, than what is.

What’s there:

  • benefits authorized only if the veteran is diagnosed as having a visual, hearing, or substantial mobility impairment
  • defines substantial mobility impairment as a spinal cord injury or dysfunction or other chronic impairment that substantially limits mobility
  • interprets chronic impairment that substantially limits mobility to include, but not be limited to, disabilities such as a traumatic brain injury or a seizure disorder
  • requires clinical determination by a VA clinician that it is optimal for the veteran to manage such impairment and live independently through the assistance of a trained service dog
  • will not authorize benefits if other means (such as technological devices or rehabilitative therapy) will provide the same level of independence
  • recognizes only service dogs obtained through an Assistance Dogs International (ADI) or International Guide Dog Federation (IGDF) accredited organization, with the following exception
  • for dogs acquired before the effective date of this rule, requires the veteran to provide a certificate showing that the veteran and dog have completed a training course offered by a guide or service dog organization in existence before the effective date of the regulation; veteran has up to 1 year after the effective date of the rule to do so
  • provides an insurance policy to every eligible veteran as the mechanism for providing payment for veterinary care
  • requires that VA, and not the veteran, will be billed for any premiums, copayments, or deductibles associated with the policy
  • provides all hardware clinically determined to be needed by the dog to perform its task, including standard equipment such as harnesses
  • authorizes payment of travel expenses associated with obtaining a service dog to veterans who have been prescribed a service dog by a VA clinician
  • the service dog must maintain its ability to function as a service dog, determination to be made by either a veterinarian if the issue involves the dog’s health or by a VA clinician if the issue is whether the veteran still meets the clinical prerequisite for eligibility

What’s not there – two big funding items many are clamoring for:

  • no money to pay organizations who provide service dogs to eligible veterans; this is not mentioned in the NPRM
  • no money for dogs for mental health issues, including PTSD; this is specifically addressed in the NPRM, as follows:

“In 2009, Congress authorized VA to provide service dogs for the aid of persons with mental illnesses by amending section 1714. Although VA welcomes the possibility that trained dogs may provide valuable services to veterans diagnosed with certain mental illness, at this time we do not have any scientific data to determine, from a purely clinical standpoint, whether or when service dogs are most appropriately provided to veterans with mental illness, including post-traumatic stress disorder. In the National Defense Authorization Act for Fiscal Year 2010, Pub. L. 111-84 (2009), Congress mandated a 3-year study on the effectiveness of dogs for mental health purposes. The results of this study will help us learn more about the services that trained dogs can provide for veterans diagnosed with mental health conditions. Upon the completion of the study and analysis of its results, VA may revise its regulations in order to provide this service to our veterans.”

There are gonna be a lotta people upset about that second one, although, again – this merely restates VA’s position, and I know it’s not a surprise to many of those who support funding it because I’ve seen them complaining about it many times before. Regardless of your feelings about it, though, you still need to know what the VA position is, and that’s why I’ve pointed it out here.

The bottom line for me here is the same as always. Unlike so many, I don’t see the VA as the solution to the problem of getting more service dogs, and only the best ones, paired with more veterans. Simply put, it’s an awful lot of hassle for very little reward.

Sure, I’m happy to see VA paying anything that might make the difference between a veteran who needs a service dog applying for one and not applying because he thinks he can’t afford the associated care costs, even if the organization is providing the dog for free. I’ve always argued for that – and for that exact reason – so it was great news when last year VA finally started paying the same benefits to those with service dogs as they had with guide dogs for years, and also that they are now willing to pay travel expenses for a veteran to get a service dog as well.

But I have yet to see any organization say specifically how many more dogs they’d be able to provide veterans even if the VA approved things that have been discussed, particularly actually paying a portion of the cost of the dog directly to the organization. As always, throwing money at something isn’t just gonna make it happen. Organizations also have to weigh the amount of time and effort that’s being spent trying to get those benefits approved, as well as whatever strings are attached to them if they ever are.

Not to mention the inevitable slow reaction time when dealing with government that is built into their processes by design. It’s bad enough when they aren’t even focused on an issue to begin with, but even when you get well-meaning people with the best intentions focused on an issue it still takes forever to get something done.  Just like the issue here of paying benefits – it took 7 years to get VA’s attention, another year after that just to get them to agree to a relatively small thing, and it’s gonna take at least another year after that to get it written into their rules.

Plus VA will always be constrained here. They’re not allowed to recommend specific organizations even if they were capable of evaluating which ones are the best, which they aren’t, something those of us involved in the service dog world have known for years and VA freely admits in this NPRM. The best they can do is what they did here – defer to saying a place has to be ADI or IGDF accredited. And you can bet there will still be those who don’t even like that and will say so during the comment period.

I’m not suggesting we write it off altogether, but I just don’t see everyone putting their hopes in government as the key to making this happen, and I think that all our efforts are much better spent on things like private fundraising as well as outreach to veterans.

In any event, comments are now open and instructions on making them are at the NPRM link above if you are so inclined.

Related links:

“New VA Guide Dog And Service Dog Directive; Corresponding Bills In Congress”

“VHA’s Guide And Service Dog Program Could Not Ensure That All Qualified Veterans Received The Opportunity To Benefit From Service Dogs”

“Veterans With Service Dogs Are Now Eligible For VA Benefits, But May Need To Reapply”

“Finally, The Real Story About The VA And Service Dogs For Veterans”

“Why The VA Has Provided No Money For Service Dogs – In Their Own Words”

Jun 6, 2011

“VA Trauma Center Treats Most Grievously Wounded Troops”

Al , , , Link, Service Dogs, Veterans

Palo Alto — Marine Lance Cpl. Jorge Ortiz, 19, of Fresno, who was critically injured in an explosion in Afghanistan, rests at the Polytrauma Rehabilitation Center at the Department of Veterans Affairs hospital in Palo Alto, where physicians and therapists take a team approach to care for those who have suffered catastrophic injuries. PHOTOGRAPH BY: Mark Boster / Los Angeles Times“VA trauma center treats most grievously wounded troops”

“Despite your injuries, you’re still a Marine and the Commandant has ordered you to cooperate with the doctors and therapists and get back in the fight.”

Saw this one over the weekend, again via Soldiers Angels Germany.

There’s lots you can take from this story – that comment really got a lotta people’s attention including mine. It’s another in a series of articles by Tony Perry of the LA Times, one of which I’ve previously linked here, and as MaryAnn Phillips at SAG says, he “has done some terrific reporting about the 3/5 Marines…”.

The other thing that stuck out for me was this, something I keep bringing up because we can’t lose sight of it:

“The number of troops suffering amputations and other catastrophic injuries is increasing as the U.S. counter-insurgency strategy requires them to leave the protection of heavily armored vehicles and do more foot patrols to help win support from Afghan civilians.

Also increasing are the numbers of personnel suffering a kind of wound — traumatic brain injury — that may leave no outward marks but can inflict lasting damage.”

Apr 13, 2011

New VA Guide Dog And Service Dog Directive; Corresponding Bills In Congress

Al , Service Dogs, Veterans

It dawned on me that I haven’t mentioned the new VA directive on service dogs and guide dogs here, and since it came out last month without a lotta fanfare, I should.  And also mention the two corresponding bills in Congress designed to put the directive change into law.

The intent of the new directive is to correct a long-standing issue that I’ve written about here before (“AMVETS Addresses Two Tough Issues Concerning Service Dogs For Veterans”) where veterans with service dogs (even those approved by VA) were not allowed to take those dogs into VA medical facilities. In the past, each facility director was allowed to make their own policy, VA in DC couldn’t (or wouldn’t) step up and create a uniform policy for service dogs (as had been done long ago for guide dogs), but they have now done that.

I’ve included the entire directive in the images below, just click on them for the big versions. You can also download the PDF here:

“VHA Dir 2011-013, Guide Dogs and Service Dogs on Veterans Health Administration (VHA) Property”

VA says they have done a lot internally to educate their people about the new directive via publications, e-mail, and conference calls. I’ll be interested to hear what veterans encounter in individual facilities.

Note there are also two bills in Congress intended to codify this change, the concept being that, while directives are nice, faces change and we need to get this one into the law. If you’ve been here more than once, no secret to you that I’m not a big fan of trying to do things via the law for a number of reasons, not the least of which is you never really can count on what you’ll get. (All you need to do is look at the Stolen Valor Act – we have judges who’ve ruled that lying about your military service record is free speech protected by the First Amendment. Yeah, right.)

Nonetheless, I think this is a great idea and needs to be done. The House bill is H.R. 1154, “Veterans Equal Treatment for Service Dogs Act”; the Senate one is S. 769 – you can track those here:

http://www.govtrack.us/congress/billtext.xpd?bill=h112-1154

http://www.govtrack.us/users/events.xpd?monitors=bill%3As112-769

If you are so inclined, contact your representatives and let them know you support these two bills.

Mar 1, 2011

Canine Companions For Independence Veterans Outreach Event At Oklahoma City VA Medical Center March 19

Al , , Service Dogs, Veterans

Now that it’s March, great time for a reminder about the upcoming Canine Companions Salutes Independence military focused event on March 19th at the Oklahoma City VA Medical Center.

It’s a big deal – I’ll just insert  the flyer here and you can see for yourself. Click on the image for the even larger PDF version.

Dec 30, 2010

Must-Read Article About Service Dogs For Veterans In Military Times Today

Al , , , , , Service Dogs

Absolute must-read article in Military Times and its associated individual service newsweeklies (Air Force Times, Army Times, Navy Times, Marine Corps Times) today for anyone with an interest in service dogs for veterans, especially a veteran thinking about getting a service dog.

It’s not long – just go read the whole thing, and have anyone you can think of with a possible interest read it as well. Lotta stuff said there in a very public venue that’s needed to be said and, frankly, hasn’t been. Or at least not often enough or by those I’d expect to be saying it, anyway.

“Disabled troops, vets misled on service dogs”


Coupla small quibbles for me there, but not serious enough to be relevant or affect the overall thrust at all.

I’ve been directly involved with this specific subject daily for over four years, and service dogs in general longer than that, and I can tell you with complete certainty that most veterans, their families, and the professionals working with them still have NO IDEA what’s available, which places are good, which are not, and so on.

In fact, it’s even worse now than when I first got involved with it because of both the increased potential veteran demand for service dogs and the misleading information pumped out daily by the media, bloggers, some organizations, and even veterans with dogs themselves.

Super job by my friend Christina Roof at AMVETS once again stepping into the breach to educate everyone with the straight story.

Nov 9, 2010

Another Great Dog Option For Veterans Dealing With Post-Traumatic Stress – Paws For Purple Hearts

Al , , , , , , , Service Dogs, Veterans

Another Great Dog Option For Veterans Dealing With Post-Traumatic Stress – Paws For Purple Hearts

There’s an article today in the Washington Post about another great option for using dogs to help veterans whose only or primary issue is post-traumatic stress – Paws for Purple Hearts.  Actually, as the title of the article suggests, the dogs help those veterans as well as the veterans with serious physical injuries who ultimately receive the dogs once they’ve been trained as service dogs.

“Dual-duty dogs”

Rick Yount from Paws for Purple Hearts with his golden retriever Gabe.
Rick Yount from Paws for Purple Hearts with his golden retriever Gabe.

(There may be a few inaccuracies in the article – for example, I’m certainly familiar with the legislation, but I’m not sure exactly which bill the writer is referring to here: “Legislation that would create a $7 million, five-year pilot program at up to five Veterans Affairs facilities is currently before the Senate.” – but that doesn’t detract from the overall theme.)

I’ve known about PPH for several years, but I’m surprised to find I’ve never written about it here – just searched and didn’t see anything. The biggest thing I’ve always liked about it was the separation – these are veterans with post-traumatic stress training service dogs for OTHER veterans who have physical issues, as opposed to getting the dogs themselves. That removes much of what I’m concerned about with using service dogs where those with PTS are concerned while still offering them the benefits.

Plus, the program is run under the auspices of Bergin University of Canine Studies, which was known as the Assistance Dog Institute for many years.   Bonnie Bergin’s a little far out for me on some things, BUT she is, after all, the person credited with starting the whole assistance dog movement and who founded Canine Companions for Independence, and her organization is a long-time accredited member of Assistance Dogs International.

All of which is far better than the vast majority of what’s out there. I am increasingly concerned with some of the organizations that have popped up outta nowhere, especially those training “PTSD dogs”, one in particular that’s got my attention and I’ve been biting my tongue hard about since I first heard of it about six months ago. (I’m still being quiet for now, but maybe not much longer – that’s how much this place scares me.)

Please – if you’re gonna look for a service dog to help you or someone else deal with PTS, be smart.  Even though I’m no fan of the whole concept (at least as it’s being implemented right now), I can still aim you at a number of places who train those kinda dogs who I’d talk to LONG before some I see getting a lotta favorable press and who I’d likely not talk to at all.

In any event, might need some refinements, but I think the whole PPH concept is a good one overall and I’d like to see a lot more programs like it.  About the only “bad” thing I see is using “Paws” in the name, since there are so many places that use that and it’s confusing. There are some great ones – most notably Paws With A Cause – and some other definitely not-so-great ones.  As I always say, look closely.

Sep 29, 2010

AMVETS Addresses Two Tough Issues Concerning Service Dogs For Veterans

Al , , , , Service Dogs

Big points to Christina Roof and AMVETS for issuing this press release yesterday (“AMVETS Clarifies Stance On Veterans’ Service Dogs”) and taking on some unpopular issues nobody seems to want to deal with, particularly the second one.

Definitely worth reading the whole thing because there are a lot of good background details you want to be aware of in it (and, for the record, I had nothing to do with it at all – we just agree about a lot of  things), but here are the two main issues.  The first one everybody will get behind, the second I have no doubt AMVETS will take heat for, but that doesn’t change the fact that they’re correct and the issue needs to be addressed:

“…access for service dogs other than guide dogs to VA facilities remains at the discretion of each individual medical center director.”

I’ve discussed this before, but the ADA doesn’t cover public access for anyone at VA facilities other than employees.  The result (and there are documented cases of this happening right now) is the classic Catch-22 where a veteran has a legitimate service dog under the ADA, that dog has been approved for benefits by the VA, but the veteran can’t take the dog into VA facilities, in many cases the very ones where he’s receiving treatment for the same physical issues for which he has the dog.

“There are no current ADI standards for psychiatric service dogs and minimal scientific data to support assertions on their overall effectiveness… Given the current situation, AMVETS warns that accepting assertions about psychiatric service dogs at face value could prove to be a disservice to affected veterans, only creating more hurdles to earned care and benefits.”

If you went by the majority of what you see online, on TV, and in print, you’d never realize this was the case – you’d think this was a done deal.  Well, it’s not, and as I’ve said many times, I have big qualms about this whole area, particularly since so many have “declared victory and gone home” on this subject, as if the mere fact that a veteran suffering with post-traumatic stress is out in public with a dog proves that the dog is working and that it is an effective solution.

As I’ve said, I want to write shorter posts more often rather than longer ones, so I will continue to address why I feel that way in other posts.  There are a number of solid reasons, and I will, as always, do my best to give you the information and tools you need to make your own decisions.

Aug 19, 2010

Congressman Asks VA Secretary To Allow Service Dogs In All VA Facilities

Al , Service Dogs

The latest from my friend Christina Roof at AMVETS in the ongoing attempt to get service dogs approved in all VA facilities – a letter from Rep Ron Klein of Florida asking Secretary Shinseki to change the regulations to reflect this. (Click on the images for larger, more readable versions.)

Some of you are already aware of this, but individual VA facilities control their own access, and VA has said they cannot order them to allow service dogs because they don’t have regulatory authority to do that. This has resulted in the ultimate irony in some cases – a veteran has his service dog approved by the VA, but is then unable to take the dog into the VA medical facility where he receives care.

As I’ve said before, classic thing where your initial reaction is “This is so dumb, you must be making it up.” and then you realize “No, this is so dumb, you couldn’t make it up.”

Definitely something that is long overdue being corrected.  Stay tuned.

Jul 9, 2010

“VHA’s Guide And Service Dog Program Could Not Ensure That All Qualified Veterans Received The Opportunity To Benefit From Service Dogs”

Al , Service Dogs

That quote is from this audit report published a few days ago by the Department of Veterans Affairs Office of the Inspector General, a report that confirms what many, including me, have been saying for years.

“Audit of Guide and Service Dog Program”

If you’re not aware of the long history on this subject, see these previous posts, the first of which I wrote 15 months ago after I’d already held off writing it for over a year:

“Why The VA Has Provided No Money for Service Dogs – In Their Own Words”

“Finally, The Real Story About The VA And Service Dogs For Veterans”

You really need to read the whole short 17-page report (and closely to get the whole flavor because there are some key nuances in it), but here’s the highlights (or lowlights):

  • VA only started assisting veterans with service dogs in 2008 – 6 years after it was authorized (my jaw STILL gets tight every time I think about this)
  • Since FY 2009, VA only provided financial support for 8 – count ‘em, 8 – service dogs as opposed to 230 guide dogs during the same period
  • “…knowledge and use of service dogs at VA medical centers was incomplete and inconsistent.”
  • VA didn’t give sufficient guidance to medical center staff to ensure consistent decisions on requests for service dogs or make their staff fully aware of the benefits and the application process for them
  • “…prior to 2008, VHA’s guidance to VA medical center personnel was to deny requests for service dog benefits. Since 2008, VHA’s guidance has been to use service dogs after considering other options.”
  • VA says they haven’t seen a big demand for dogs, but the IG says “the number of veterans who obtained service dogs outside VHA demonstrates a demand exists that VHA needs to address.”

So what’s it all mean?

First, the report doesn’t come right out and say this, but it effectively confirms that there are a lotta people already in the VA system who should’ve been getting benefits paid for their routine service dog expenses and haven’t been. That’s why pretty much everybody in the VA system who has a service dog needs to reapply for that approval – I’ve already written about that here:

“Veterans With Service Dogs Are Now Eligible For VA Benefits, But May Need To Reapply”

Second, VA is on the hook to implement a new program (which includes dogs for those suffering from mental impairments) that was part of legislation passed last year and where VA will be paying for some dogs. The report said they are on track, but there are some important deadlines coming up in the next few weeks.

Third, the report mentioned the increased outreach by VA but said it hadn’t been effective. Interesting that the IG didn’t make a recommendation about increasing or improving that outreach, particularly given that the VA is currently actively working on a program to do just that, but has still not yet completed it.

Fourth, and the biggest one to watch, the draft regulation outlining VA’s service dog policy is in their “normal  2-year  review  process” and is supposed to be final in July 2011.  (2 years is “normal”?? I knew there was a review process, but I had no idea – no wonder we have problems.  That means if you start working on something right now, by default you are already automatically two years behind – unbelievable.)  In addition, and this is key:

“A directive to define policy for the issuance of service dogs to eligible veterans with mobility or hearing impairments; outline the benefits covered by VHA related to obtaining  and  funding  training,  veterinary care, and hardware; and set specific criteria to exercise this authority is also being prepared. This directive will match the regulations and will be issued immediately after the regulations are published.

In the interim, by October 2010 VHA will develop guidance on clinical criteria to determine whether a veteran will benefit from a service dog trained for the aid of the hearing impaired or trained for the aid of persons with spinal cord injury or dysfunction or other chronic impairment that substantially limits mobility to veterans with such injury, dysfunction, or impairment.”

Now, with all that said and for all my moaning about this subject, I’ll still go back to what I’ve said all along.  I don’t think the government is the solution to this problem, and this situation is the perfect example of why, for what should be very obvious reasons. It’s gonna take education (“If You Want More Service Dogs for Veterans, First You Have to Get More Veterans Who Want Service Dogs”) and private effort and money to get it done.

Even with the new legislation this will still be true.  While authorizing an additional 200 dogs and paying $10K towards the cost of each one is nice, first, properly training an additional 200 dogs is a major effort you don’t just snap your fingers and make happen and, second, $10K doesn’t come anywhere near what it costs to properly train each dog and support its placement, a lifelong commitment.

That doesn’t mean I’m not happy to see VA finally get pressed to do what they should’ve been doing all along, though – I am.  Or that the VA shouldn’t step up and fulfill its responsibilities.  But the question, as always with me, is: will this mean that more veterans get more of the best service dogs? (The key word being “best’ – we have plenty of half…”way” “service dogs” already).  The jury’s still out on that one.

Lemme also say something else I’ve said before. I know there are many people working at VA, including some that I know personally, who I have no doubt are “good guys” and are trying to help.  I know it’s gotta be tough to be working at the VA these days, and I wanna thank you for sticking it out and trying to make things better under those conditions.

Let’s hope we’re done with this kinda stuff and can move forward in a lot more positive way from now on.

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