Commentary
Prior to the widespread implementation of VHA Directive 1188, some VA medical centers had, pardon the pun, “gone to the dogs,” in the sense that depending on the facility, emotional support companions were found in almost every area of hospitals and clinics. Their presence enabled many patients to feel comfortable enough to seek medical and mental health care, as the canine companion gave them a sense of security and calm. But some dogs had not received the extensive training that enables a service dog to follow commands and handle the stimulation of a large, busy hospital with all its sights, sounds, and smells. Infectious disease, police, and public health authorities raised legitimate public health and safety risks about the increasing number of dogs on VA grounds who were not formally certified as service dogs. In response to those concerns, in August 2015, VHA declared a uniform policy that restricted service dogs access to VA property.7 This was, as with most health policy, a necessary, albeit utilitarian decision, that the common good outweighed that of individual veterans. Unfortunately, some veterans experienced the decision as a form of psychological rejection, and others no longer felt able mentally or physically to master the stresses of seeking health care without a canine companion.
A valid question to ask is why couldn’t the most vulnerable of these veterans, for instance those with severe mental health conditions, have service dogs that could accompany them into at least most areas of the medical center? Part of the reason is cost: Some training organizations estimate it may cost as much as $27,000 to train service dogs.8 Though there are many wonderful volunteer and not-for-profit organizations that train mostly shelter dogs and their veteran handlers—a double rescue—the lengthy process and expense means that many veterans wait years for a companion.
Congressional representatives, ethicists, veterans advocates, and canine therapy groups claim that this was unjust discrimination against those suffering with the equally, if not more disabling, mental health conditions.9 For many years, the VA has done a very good deed: For those who qualify for a service dog, VA pays for veterinary care and the equipment to handle the dog, but not boarding, grooming, food, and other miscellaneous expenses.10 But until 2016, those veterans approved for service dogs in the main had sensory or physical disabilities.
A partial breakthrough emerged when the Center for Compassionate Care Innovation launched the Mental Health Mobility Service Dogs Program that expanded veterinary health benefits to veterans with a “substantial mobility limitation.” For example, veterans whose hypervigilance and hyperarousal are so severe that they cannot attend medical appointments.11
VA experts argue that at this time there is insufficient evidence to fund service dogs as even adjunctive PTSD therapy for the hundreds of veterans who might potentially qualify. It becomes an ethical question of prudent stewardship of public funds and trust. There is certainly plenty of compelling anecdotal testimony that companion canines are a high-benefit, relatively low-risk form of complementary and integrated therapy for the spectrum of trauma disorders that afflict many of the men and women who served in our conflicts. Demonstrating those positive effects scientifically may be more difficult than it seems, although early evidence is promising, and the VA is intensively researching the question.12 For some veterans and their legislators, the VA has not gone far enough, fast enough in mainstreaming therapy dogs, they are calling for VA to expand veterans’ benefits to include mental health service dogs and to define what benefits would be covered.
National K9 Veterans Day is an important step toward giving dogs of war the homage they have earned, as are increasing efforts to ensure care for military canines throughout their life cycle. But as the seventeenth century poet John Milton wrote when he reflected on his own worth despite his blindness, “Those also serve who only stand and wait.”13 The institutions charged to care for those the battle has most burdened are still trying to discover how to properly and proportionately revere that kind of furry valor.
