The Fight for Service Dogs for Veterans With PTSD

By Rebecca Ruiz

Veterans with post-traumatic stress disorder swear that service dogs lead to remarkable improvements, but research has yet to support their widespread use. Meanwhile a Tampa VA hospital just suspended the major study on the question, over concerns for the health of the dogs

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LucasJackson/Reuters

When it comes to treating veterans with post-traumatic stress disorder, no intervention regularly receives as glowing reviews as service dogs. The use of service dogs to treat PTSD is new, though, and many of the findings at this point are anecdotal. Many veterans had eagerly hoped a pioneering study conducted by the Department of Veterans Affairs would buttress their personal experiences with science that could support implementing widespread therapeutic use.

By pairing veterans with a service dog and tracking their condition over three years, the study could demonstrate to service dog providers around the country how to effectively train for PTSD patients, and might provide convincing evidence for the VA system to create a benefit for the treatment.

Last week, however, the agency confirmed that it had suspended the study at the James A. Haley Veterans' Hospital in Tampa, FL, for the second time this year after alleging that a vendor violated its contract and endangered the health of its dogs. The latest setback left about 100 veterans on the study's waiting list without any hope that they'd receive a dog in the near future. It also raised the thorny question of how to conduct research in a field that is new, but where the need is urgent.

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Traditionally used for blind, deaf, or physically disabled patients, service dogs have only recently been trained to perform tasks that can improve PTSD symptoms, like wake a veteran from a nightmare or create a buffer in large crowds or public places.

Patients often experience dramatic improvement, say service dog experts. They feel renewed confidence in social situations, decrease medication use, and are less likely to startle. Some veterans say it's the only treatment that ever worked so well.

Congress, which required the study in 2009, permitted the VA to match as many as 200 veterans with service dogs. Mark Ballesteros, a spokesperson for the VA, said in a statement to The Atlantic that the study had so far paired 17 dogs with veterans and that the agency is "developing a new plan to carry out this important research." It also notified the Office of Inspector General about the contract violations for further investigation.

Carol Borden, executive director of the vendor under investigation -- Guardian Angels Medical Service Dogs, Inc., in Williston, FL, -- vehemently denied the VA's allegations.

"We were doing this work before and we will continue to do this work because we love our veterans and are passionate about our success and what we are able to give people through our dogs," Borden told me. "We will continue to carry on with anyone who qualifies that wishes to continue with our program."

In a document related to the investigation, officials said they expected the study to resume in 10 months after changes have been made to its design.

In particular, the VA plans to conduct a nationwide search for the best dogs, expanding the number of providers and contracting instead with trainers to pair veterans with an animal. Doing so, the agency hopes, will eliminate a problematic conflict of interest wherein the service dog provider may perceive a financial incentive to pair dogs regardless of whether or not they have received necessary training or would perform well.

Such are the hard lessons of designing a study that is the first of its kind for the VA. But the research has been troubled from the start. It began with three service dog providers, two of which stopped participating earlier this year; it was initially suspended from January to June after a dog bit a young girl. Guardian Angels had no reported incidents when the study resumed.

Brian Jones, a former sergeant major who performed special operations as an Army Ranger and Delta Force soldier, was on the waiting list and said both suspensions were disappointing. He was notified last week by email that VA had canceled its contract with Guardian Angels, advising him to seek the assistance of a mental health provider if the news was upsetting. The email recommended that he not use Guardian Angels, and said that if he received a service dog during the study's suspension, he would be withdrawn from the research.

Jones, who has visited the Guardian Angels facility and said the conditions were pristine, plans to proceed with getting a service dog from Borden. He is scheduled to receive Sarge, a one-year-old German Shepherd, in December, and that thought gives him comfort.

Jones, 56, served for two decades before retiring in 2006. He says he's struggled with PTSD symptoms for about 10 years and works hard to manage them. Jones hopes that Sarge will help alleviate his unease in crowds and difficulty sleeping.

Jones is deeply worried about fellow veterans who have been counting on the VA study to pair them with a dog, fearful that some might feel hopeless.

"I will move forward," Jones says. "I have a life to live. If I wait on the VA, I will be waiting forever."

The fact that research in this area is limited primarily to the VA is troubling to both veterans and experts who feel that one government agency cannot be expected to provide all of the answers. The need, however, is seen as pressing: As many as 520,000 service members who were deployed to Iraq or Afghanistan since 2001 have or may develop PTSD.

Dr. Elspeth Cameron Ritchie, a psychiatrist and former colonel in the Office of the U.S. Army Surgeon General, told me that more money, research and academic/non-profit partnerships are needed to provide scientific evidence for the anecdotes, and a framework for training and pairing.

As an example, Ritchie points to National Education for Assistance Dog Services (NEADS), a Massachusetts-based provider that has quietly researched treating post-traumatic stress. (Ritchie serves on NEADS' advisory council.)

The organization spent two years -- and more than $500,000 -- on a pilot program that matched 16 veterans with trained dogs. Dr. Cynthia Crosson, a psychiatric consultant who led the effort, said the study was designed as exploratory and qualitative instead of quantitative. She looked at measures of improving wellness, but said those were initially difficult to identify in the context of receiving a service dog as treatment.

Crosson, who has specialized in studying child abuse, said she confronted a similar challenge in studying post-traumatic stress recovery: "Initially, it was how do you quantify people's healing?"

Through the pilot, NEADS has developed techniques for training and measuring improvement that Crosson was hesitant to describe before publishing the results in a journal. NEADS has since made the pilot a part of its regular programs.

That's one more provider that has done thorough research on PTSD service dogs, but it will take several similar efforts and millions in funding over the next few years before evidence-based best practices can be handed down to every service dog organization that wants to train for PTSD treatment.

In the meantime, the VA study remains stalled, and the agency recently ruled that it would not provide service dog benefits to treat mental health issues.

For Brian Jones, what matters is getting a highly-trained dog that will likely give him relief after years of searching. Though that day is still a few months away, the idea brightens his outlook: "Tomorrow is going to be better because I'm going to have this dog."

This article available online at:

http://www.theatlantic.com/health/archive/2012/09/the-fight-for-service-dogs-for-veterans-with-ptsd/262863/