[House Hearing, 114 Congress]
[From the U.S. Government Publishing Office]
CONNECTING VETERANS WITH PTSD WITH SERVICE DOGS
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON NATIONAL SECURITY
OF THE
COMMITTEE ON OVERSIGHT
AND GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED FOURTEENTH CONGRESS
SECOND SESSION
__________
APRIL 14, 2016
__________
Serial No. 114-118
__________
Printed for the use of the Committee on Oversight and Government Reform
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Available via the World Wide Web: http://www.fdsys.gov
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COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM
JASON CHAFFETZ, Utah, Chairman
JOHN L. MICA, Florida ELIJAH E. CUMMINGS, Maryland,
MICHAEL R. TURNER, Ohio Ranking Minority Member
JOHN J. DUNCAN, Jr., Tennessee CAROLYN B. MALONEY, New York
JIM JORDAN, Ohio ELEANOR HOLMES NORTON, District of
TIM WALBERG, Michigan Columbia
JUSTIN AMASH, Michigan WM. LACY CLAY, Missouri
PAUL A. GOSAR, Arizona STEPHEN F. LYNCH, Massachusetts
SCOTT DesJARLAIS, Tennessee JIM COOPER, Tennessee
TREY GOWDY, South Carolina GERALD E. CONNOLLY, Virginia
BLAKE FARENTHOLD, Texas MATT CARTWRIGHT, Pennsylvania
CYNTHIA M. LUMMIS, Wyoming TAMMY DUCKWORTH, Illinois
THOMAS MASSIE, Kentucky ROBIN L. KELLY, Illinois
MARK MEADOWS, North Carolina BRENDA L. LAWRENCE, Michigan
RON DeSANTIS, Florida TED LIEU, California
MICK MULVANEY, South Carolina BONNIE WATSON COLEMAN, New Jersey
KEN BUCK, Colorado STACEY E. PLASKETT, Virgin Islands
MARK WALKER, North Carolina MARK DeSAULNIER, California
ROD BLUM, Iowa BRENDAN F. BOYLE, Pennsylvania
JODY B. HICE, Georgia PETER WELCH, Vermont
STEVE RUSSELL, Oklahoma MICHELLE LUJAN GRISHAM, New Mexico
EARL L. ``BUDDY'' CARTER, Georgia
GLENN GROTHMAN, Wisconsin
WILL HURD, Texas
GARY J. PALMER, Alabama
Jennifer Hemingway, Staff Director
David Rapallo, Minority Staff Director
Art Arthur, Staff Director, Subcommittee on National Security
Mike Howell, Counsel
Willie Marx, Clerk
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Subcommittee on National Security
RON DeSANTIS, Florida, Chairman
JOHN L. MICA, Florida STEPHEN F. LYNCH, Massachusetts,
JOHN J. DUNCAN, JR., Tennessee Ranking Member
JODY B. HICE, Georgia ROBIN KELLY, Illinois
STEVE RUSSELL, Oklahoma, Vice Chair BRENDA L. LAWRENCE, Michigan
WILL HURD, Texas TED LIEU, California
C O N T E N T S
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Page
Hearing held on April 14, 2016................................... 1
WITNESSES
Mr. Michael Fallon, Chief Veterinary Medical Officer, Office of
Research and Development, Department of Veterans Affairs,
Accompanied by Patricia Dorn, Director, Rehabilitation Research
and Development Service, and Chris Crowe, Senior Mental Health
Consultant and Liaison, DOD Defense Centers of Excellence for
Psychological Health and TBI
Oral Statement............................................... 6
Written Statement............................................ 8
Mr. Rory Diamond, Executive Director, K9s for Warriors
Oral Statement............................................... 14
Written Statement............................................ 16
Mr. Cole Lyle, Veteran with PTSD
Oral Statement............................................... 27
Written Statement............................................ 29
Mr. Steve Feldman, Executive Director, Human-Animal Bond Research
Initiative Foundation
Oral Statement............................................... 31
Written Statement............................................ 34
APPENDIX
H.R. 4764 (114th Congress 2nd Session) Bill Text, Entered by
Representative Stephen Lynch................................... 56
H.R. 2493 (114th Congress 1st Session) Bill Text, Entered by
Representative Stephen Lynch................................... 62
Letter submitted by Paul E. Mundell, CEO, Canine Companions for
Independence, Entered by Representative Stephen Lynch.......... 67
CONNECTING VETERANS WITH PTSD WITH SERVICE DOGS
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Thursday, April 14, 2016
House of Representatives,
Subcommittee on National Security,
Committee on Oversight and Government Reform,
Washington, D.C.
The subcommittee met, pursuant to call, at 2:00 p.m., in
Room 2154, Rayburn House Office Building, Hon. Ron DeSantis
[chairman of the subcommittee] presiding.
Present: Representatives DeSantis, Mica, Hice, Russell,
Hurd, and Lynch.
Mr. DeSantis. The Subcommittee on National Security will
come to order. Without objection, the chair is authorized to
declare a recess at any time.
Veteran suicides continue to be a national epidemic.
Veterans are estimated to have a suicide rate that is 50
percent higher than those who did not serve in the military. A
major driver of suicide rates is the incident of posttraumatic
stress among our veterans. According to the Department of
Veterans Affairs, between 11 and 20 percent of those who served
in Operation Iraqi Freedom and/or Enduring Freedom suffer from
PTS. Other estimates range as high as 29 percent.
Veterans with PTS may be troubled by intrusive thoughts;
avoid people, places, and things; and experience hyperawareness
and nightmares. They may find they are no longer able to trust
and love those closest to them. Some may even feel that life is
no longer worth living.
Unfortunately, many veterans have met significant problems
in receiving the health care they deserve. The issues regarding
the inadequate treatment of veterans by the VA have been widely
reported. These include long wait times and the
overprescription of dangerous opiates. Identifying and
utilizing the full range of effective treatments for veterans
suffering from posttraumatic stress is something that the VA
must do without delay.
One treatment that complements existing therapies is the
connection of veterans with PTS with service dogs. These are
not comfort dogs or therapy dogs, as useful as those might be.
Service dogs perform valuable services for veterans, calming
them during a panic attack, turning on lights in a dark home,
waking them from nightmares.
Currently, the VA only provides service dogs to veterans
with physical impairments. However, a 2010 VA inspector general
report stated that the VA ``faces challenges implementing the
guide and service dog program. The VA only started assisting
mobility and hearing-impaired veterans with service dogs in
2008, 6 years after being authorized to do so. The VA personnel
told us the actual demand for service dogs is unknown.'' With
tens of thousands of veterans returning with mobility and
hearing impairment from wars due to the use of improvised
explosive devices and other things, this 6-year delay
represents a stunning bureaucratic failure.
The VA contends that there is insufficient evidence that
service dogs help those with PTS. However, ample scientific
findings and ongoing research suggest that the VA may very well
be wrong. Service dogs are not intended to, nor do they cure
PTS, but they provide a safe, non-addictive tool for veterans
to live normal, functioning, productive lives and they could
provide a safe complement to existing treatments for PTS. The
urgency of the veteran suicide rate demands that we explore
this option.
In the 2010 National Defense Authorization Act, Congress
authorized the VA to conduct a 3-year study on the efficacy of
pairing veterans with PTS with service dogs. Instead of being
completed in 2013, the VA study is not expected to be completed
until 2019. According to the VA, the study has undergone
``multiple significant and unexpected challenges.'' The first
phase of the study, referred to as phase 1, began in 2011 and
had to be suspended and restarted twice, once after two dogs
bit children and again after dog health issues arose.
The VA attributed these problems to issues with vendors
contracted to provide the service dogs. Many of the dogs
provided by the vendor were of substandard quality and had hip
dysplasia, a condition that could have been treated earlier if
the vendor performed standard screening procedures. Of the 26
veterans that were enrolled in phase 1, only 12 completed the
study and four more are expected to complete the study in
February of 2017.
The issues with phase 1 could have been avoided if the VA
had properly screened the vendors and had reached out to other
public and private sector organizations engaged in similar
ventures, organizations like K9s for Warriors, with is based in
the district I represent, do not experience these issues
because of their experience in sourcing and training the dogs.
Instead of conducting outreach, the VA insisted on
developing its own veterinary standards for the study, but the
Department of Defense already has its own military working dog
standards. In fact, DOD is an internationally regarded trainer
of dogs and has a team of over 55 personnel, including 14
veterinarians. Had the VA initially adopted DOD standards, the
VA could have avoided the $10-$12 million failure of phase 1.
While the VA eventually did reach out and adopt some DOD
standards, it appears that development of its own standards was
largely duplicative and wasteful. The VA began phase 2 of the
study in December of 2014 with numerous changes based on
lessons learned from phase 1. These changes included the VA
hiring its own dog trainers to provide support to veterans
throughout the study, incorporating DOD veterinary standards,
and moving the study from one site in Tampa, Florida, to three
separate sites in Atlanta, Georgia; Portland, Oregon; and Iowa
City, Iowa.
Yet the VA is only meeting half of its monthly recruiting
goal of 12 veterans for this study, similar issues echoed in
the 2010 VA IG report. This problem is not based on a shortage
of interested veterans but instead on the VA's problems filling
dog trainer positions and the alleged complexity of the study.
With the VA struggling to pair veterans with service dogs,
other organizations are attempting to fill the void. In fact,
the committee has spoken with various organizations that
cumulatively claim to have hundreds of dogs that are trained
and ready to be paired.
Contrary to the VA's assertion that ``there is not enough
research yet to know if dogs actually help treat posttraumatic
stress and its symptoms,'' there is ample anecdotal and
scientific evidence that service dogs can help veterans with
PTS.
Today, we will hear from witnesses familiar with that
evidence and from veteran Cole Lyle, who credits his service
dog with markedly reducing his PTS symptoms.
Veterans cannot wait until 2018 for the VA to introduce the
low-cost, low-risk, and high-reward treatment option. The
problem of veteran suicide is too urgent. For this reason, I
have introduced the Puppies Assisting Wounded Servicemembers
Act of 2016, cosponsored by many of my fellow committee
members, including members on both sides of the aisle.
This legislation would create a program for veterans with
the most severe levels of PTS who tried a VA-approved treatment
and remain very symptomatic to then be referred to an
accredited service dog organization. The VA would reimburse the
organization supplying those service dogs, and all funds
expended would be offset with funds from the VA Office of Human
Resources and administration expenses for administrative
offices, conference planning, historic preservation, office
artwork, and facility interior decor.
Those who risk their lives for this country deserve the
absolute best care upon their return, and time is of the
essence.
I would like to thank our witnesses for their testimony
today. We have veterans testifying and many joining us in the
audience, and I want to thank them very much for their service.
Mr. DeSantis. And with that, I will recognize the ranking
member of the Subcommittee on National Security, Mr. Lynch, for
his opening statement.
Mr. Lynch. Thank you, Mr. Chairman. I would like to thank
you for holding this hearing to examine the efforts undertaken
by the Department of Veterans Affairs to provide service dogs
to veterans of the U.S. armed forces to assist with treatment
for posttraumatic stress.
I would also like to thank today's panel of witnesses for
helping the committee with its work and again thank all our
veterans in attendance and active military.
It is the mission of the Department of the VA to serve and
honor the more than 21 million dedicated men and women who are
America's veterans in fulfillment of President Lincoln's
historic commitment to ``care for those who shall have borne
the battle and for their widows and orphans.''
With the formal end of the U.S.-led combat mission in Iraq
in 2010 and in Afghanistan in 2014, the return of over 2.7
million veterans from extended service in support of Operation
Iraqi Freedom, Operation Enduring Freedom, and other war zone
deployments, the fundamental duty of the VA to provide
dignified care to America's veterans and their families remains
as critical as ever. In turn, our continued and bipartisan
oversight of the VA is essential to ensuring that the agency is
able to carry out its important mission.
As most recently evidenced by the generation of post-9/11
veterans returning from the wars in Iraq and Afghanistan,
effective treatment for posttraumatic stress, also known as
PTSD, is one urgent area of veterans' health care that the VA
and Congress must continue to strengthen. According to the VA's
National Center for Posttraumatic Stress, 20 percent of our
veterans who served in Operation Iraqi Freedom or Operation
Enduring Freedom have PTS in a given year.
The prevalence of posttraumatic stress among our Iraqi and
Afghan veterans is primarily the result of multiple tours of
duty and repeated, severe, and constant combat exposure.
Moreover, the VA has reported that veterans with PTS are
particularly vulnerable to the risk of suicide, which continues
to affect veterans at a devastating rate. Last month, the VA
under secretary for health David Shulkin, again estimated that
every day approximately 22 veterans take their lives in this
country, and that is tragic.
Similarly, the Department of Defense reported last week
that suicide rates for active duty service members remain high
for the 7th year in a row with 265 active duty service members
lost to suicide in 2015. We are clearly failing to meet our
obligations to our returning and active service members.
The impact of posttraumatic stress in our veterans'
community is a complex and far-reaching issue that demands a
comprehensive approach to treatment and rehabilitation. This
includes robust funding for the VA to continue to expand its
mental health services. And I was proud to join the chairman to
support the bipartisan omnibus funding bill passed by Congress
and signed by President Obama at the end of last year that
would provide $50 billion for VA medical services and
specifically targets mental health care and suicide prevention.
We must also encourage the development of commonsense
alternative solutions that could further assist veterans with
PTS rehabilitation. One alternative is the topic of today's
hearing, providing service dogs to veterans with PTS to help
alleviate their related symptoms.
As noted in the American Medical Association Journal of
Ethics in June of 2015, ``Initial academic studies have
revealed that veterans paired with service dogs report less
severe PTS symptoms, stronger social relationships, decreased
substance abuse, and other increased health benefits.''
Pursuant to the Defense Authorization Act for fiscal year
2010, Congress itself mandated the VA to conduct a 3-year
study, as noted by the chairman in his remarks. That study was
to examine the benefits of using service dogs for the treatment
of rehabilitation of veterans with physical or mental injuries,
including PTS.
Regrettably, as the chairman has noted, the VA encountered
numerous challenges in getting this study off the ground,
including inadequate oversight over its service dog vendors and
inconsistent service dog training standards. As a result,
again, as the chairman has noted, the agency now expects to
complete the study in November of 2018 or into 2019.
I understand the VA is taking steps to address these
problems. However, a delay for a study of this importance for
this amount of time is simply unacceptable. And I look forward
to examining the progress of this further study with our
witnesses.
And I also think that the chairman's idea of going forward
with a pilot program, which can be based on the evidence in
hand today, is a great way to go at this problem.
So I am proud to cosponsor two pieces of bipartisan
legislation that have been introduced in Congress to facilitate
the use of service dogs to assist our veterans.
Chairman DeSantis, my colleague on this committee, has
introduced H.R. 4764, a bill to require the VA to commence the
service dog pilot program right away that is specific to post-
9/11 veterans with severe PTS. And I am proud to join him on
that.
Also, Representative Jim McGovern of Massachusetts has also
reintroduced legislation to establish a grant program to assist
nonprofit organizations in developing and establishing service
dog programs for veterans. And, Mr. Chairman, I would ask
unanimous consent if I could please submit Mr. McGovern's
legislation for the record.
Mr. DeSantis. Without objection.
Mr. Lynch. And there is a supporting statement into the
record as well.
Mr. DeSantis. Without objection.
Mr. Lynch. Thank you, sir.
As evidence continues to show that service dogs are one way
of helping veterans with PTS, I certainly support the expansion
of these efforts.
Mr. Chairman, thank you again for holding this important
hearing, and I yield back the balance of my time.
Mr. DeSantis. I thank the gentleman. And thank you for the
support for the efforts.
I will hold the record open for 5 legislative days for any
members who would like to submit a written statement.
We will now recognize our panel of witnesses. I am pleased
to welcome Dr. Michael Fallon, chief veterinary medical officer
at the Office of Research and Development at the U.S.
Department of Veterans Affairs; Mr. Rory Diamond, executive
director of K9s for Warriors; Mr. Cole Lyle, a U.S. Marine
veteran who has posttraumatic stress; and Mr. Steve Feldman,
executive director of the Human-Animal Bond Research Initiative
Foundation. Welcome to you all.
Pursuant to committee rules, all witnesses will be sworn in
before they testify. If you please rise and raise your right
hands.
[Witnesses sworn.]
Mr. DeSantis. Thank you. Please be seated.
All witnesses answered in the affirmative.
In order to allow time for discussion, please limit your
testimony to 5 minutes. Your entire written statement will be
made part of the record.
Dr. Fallon, you are recognized for 5 minutes.
WITNESS STATEMENTS
STATEMENT OF MICHAEL FALLON
Mr. Fallon. Thank you. Good afternoon, Chairman DeSantis,
Ranking Member Lynch, and members of the subcommittee. Thank
you for the opportunity to update the committee on progress in
the VA PTSD service dog study, which pairs veterans with PTS
with service dogs. I am accompanied today to my right by Dr.
Patricia Dorn, director of the Rehabilitation Research and
Development Service; and Dr. Chris Crowe, senior mental health
consultant and liaison to the DOD Defense Centers of Excellence
for Psychological Health and TBI.
The 2010 National Defense Authorization Act directed VA to
undertake a study to assess the benefits, feasibility, and
advisability of using service dogs for the treatment or
rehabilitation of veterans with physical or mental injuries or
disabilities, including PTSD. The benefits of utilizing service
dogs and guide dogs for physical disabilities are well
established. Therefore, VA designed the study to focus on
veterans with PTSD because PTSD is a high-priority health issue
in veterans, and the benefits of service dogs in assisting
people with PTSD are not established in the scientific
literature.
This is a groundbreaking study that aims to determine if
veterans with PTSD would benefit from a service dog. For the
study, VA hired its own dog trainers to provide obedience and
handling support to veterans after they receive a dog, thus
reducing experimental bias in the study.
VA also developed its own contract health, behavior, and
training standards for dogs. Three studies cites--Atlanta, Iowa
City, and Portland, Oregon--are operating and enrolling
veterans from different parts of the country. Approximately
once a quarter for 21 months, measures are taken of self-care,
interpersonal interactions, and social participation, the
severity of PTSD symptoms, sleep-related problems, suicidal
ideation, the severity of mood disorders and substance abuse,
anger directed at others, inpatient and outpatient visits,
medication usage, and measures of employment and work
productivity.
Veteran enrollment in the multisite phase of this study
began in December of 2014. As of this week, 109 of 220 veterans
have been enrolled in the study, and all three study teams will
be fully staffed to achieve an enrollment rate of 12 to 15
veterans per month, which would allow all 220 veterans to be
enrolled by the end of this year or early 2017. Data collection
will end in late 2018. The data will then be analyzed, and the
results will be published in a peer-reviewed scientific
journal.
While VA does not purchase service dogs for veterans, VA
does provide veterinary care benefits to eligible veterans to
managing visual, hearing, or substantial mobility impairment to
enable the veteran to live independently. Currently, VA does
not provide veterinary care benefits for PTSD or mental health
dogs because research has not shown them to be effective in
overcoming specific functional limitations.
The carefully designed VA study is incredibly important in
addressing shortcomings in the existing research literature
that has been reported by others. The VA continues to monitor
other scientific literature for quality evidence to inform
future policies and remains strongly committed to completing
the current study at an estimated cost of at least $12 million.
VA is strongly committed to the delivery of the best care
for veterans with PTSD. Advances in research have led to a
range of effective treatments that reduce symptoms and increase
functioning and well-being. The VA/DOD evidence-based Clinical
Practice Guideline recommends the following as first-line
treatments: trauma-focused cognitive behavioral therapies such
as prolonged exposure, or PE; and cognitive processing therapy,
or CPT; eye movement desensitization and reprocessing; stress
inoculation; selective serotonin reuptake inhibitors; and
venlafaxine, a serotonin norepinephrine reuptake inhibitor.
Research demonstrating the effectiveness of PE and CPT is
particularly strong. VHA Handbook 1160.01, Uniform Mental
Health Services in VA Medical Centers and Clinics, requires
that all VA medical centers provide access to either PE or CPT.
VA has supported this requirement by training upwards of 7,000
therapists in PE and CPT as part of a broader initiative to
disseminate evidence-based psychotherapy for mental disorders.
Uptake of evidence-based therapy such as the CPT across the VA
healthcare system was rapid.
For veterans who choose other treatment approaches, the VA
offers a range of options to treat PTSD and associated
symptoms. VA is a leader in developing evidence-based therapy,
the global standard for PTSD treatment.
Mr. Chairman, as a veteran myself, firmly committed to the
successful completion of the study, I appreciate the
opportunity to appear before you today. I and my colleagues are
prepared to answer any questions the committee may have. Thank
you.
[Prepared statement of Mr. Fallon follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. DeSantis. Thank you, Dr. Fallon.
Mr. Diamond, you are now recognized for 5 minutes.
STATEMENT OF RORY DIAMOND
Mr. Diamond. Thank you, Mr. Chairman. Thank you, ranking
member, members of the committee. We are absolutely thrilled to
be here to talk about this very important matter.
My name is Rory Diamond. I'm the Executive Director of K9s
for Warriors. We are the Nation's largest provider of service
dogs for veterans with PTS, traumatic brain injuries, and/or
who have been victims of military sexual trauma.
With me today is Brett Simon, the founder of K9s for
Warriors, and the current head of our K9 division. We also have
two of our graduates. We have Joe Swoboda, an 18-year Army
veteran who did three tours in Iraq. And he's with his service
dog Lilly. I also have with me Adam LeGrand, a 10-year Air
Force veteran who helped men and women in uniform as a medic.
He's with his service dog Molly.
As has already been mentioned, statistically speaking, 22
veterans are going to commit suicide today. That's why K9s for
Warriors exists. We are founded by a mom. Her name is Shari
Duval, and she was worried about her own son's PTS.
Five years later, K9s for Warriors has grown into an
organization with a 36 dedicated staff. We have a 9-acre,
17,000 square foot state-of-the-art campus in Ponte Vedra
Beach, Florida. And most important, we have a track record of
helping hundreds of veterans overcome the symptoms associated
with PTS. Importantly, we are very successful at preventing
veteran suicide.
Every warrior that comes through our door gets the family
treatment, I would say. They get a service K9, they get
equipment, training, certification, seminars, legal
instruction, vet care, housing, home-cooked meals. We have
house moms who listen to them. We have house dads who provide
advice. And frankly, we have full wraparound services and
follow-up for the life of the dog and the life of the veteran.
At K9s for Warriors we say we always have our veterans'
backs, and we absolutely never charge our veterans. Our program
is 100 percent free.
We've had two independent sets of researchers evaluate our
program. These are Ph.D.'s who looked at the efficacy of our
program, have come back with the exact same conclusion: The
program works. The dogs are effective.
Let me just provide a flavor of this. The average K9s for
Warriors applicant is on 10 to 15 medications. Fully 92 percent
of them will reduce or eliminate those medications after
receiving their dog. Seventy-three percent of our graduates
improve their overall health. Eighty-five percent will handle
anxiety better. Eighty-two percent report having fewer suicidal
thoughts and suicidal ideation. Seventy-seven percent report a
reduction of nightmares or night terrors, finally being able to
get a full night's sleep and being able to get back on a
lifecycle.
As Adam LeGrand, who is behind me, says about his service
dog Molly, ``She gives me the ability to be a father and a
functioning member of society again.'' And Joe, who is behind
me, also says, ``I just wouldn't be here without Lilly. She is
the light in the darkness of PTSD.''
So when we hear and read on the VA's website that there is
``not enough research yet to know if the dogs actually help
treat PTS and its symptoms,'' we fundamentally disagree. There
is not a void of research in this regard that we don't know
whether or not a service dog can help mitigate the symptoms
associated with PTSD and its associated comorbidities. There is
enough research. K9s for Warriors is an example of how that can
work.
Given the current crisis of veteran suicide in America, we
think it makes sense to err on the side of providing more
options for our veterans. What is the harm here? The very worst
thing that could happen is a veteran ends up with a dog. But
the VA's response is something that we have seen over and over
and over again, that there is a reluctance to agree that this
can work.
Our warriors report to us, and they come from all over the
country, 42 States, 150 cities, and we ask them all the time,
tell us, how is the VA treating you? How is your PTS being
treated? And this is what they tell us, and it's shockingly
similar and frustrating to hear it over and over again:
They wait and they wait and they wait and they finally get
an appointment. Then they go and get their appointment at the
hospital and they wait hour after hour after hour, and finally,
they get in front of a psychologist or a psychologist or a
clinical social worker, and they have their moment.
And let's understand what this moment is. This is the one
lifeline our government is giving these veterans to recover
from PTS. This is their one chance. And do they get 45 minutes
of a discussion of the wonderful panoply of options that we
just heard Dr. Fallon talk about? No. They report to us they
get 10, 15 minutes maybe. The first question is always about
how are your meds? And then I guarantee you they walk out with
another prescription drug. The VA has three responses to the
PTS crisis in America: Drugs, drugs, and more drugs to help you
with the drugs we already gave you. That is the response, and
we find it unacceptable.
The VA in our opinion has fumbled the first round of the
pilot program. In our opinion, we have no confidence that they
will successfully pull off the second round. We see an
immediate veteran suicide crisis today. We believe the time is
now, not after the VA gets their act together, but right now,
to start saving these lives.
We appreciate the chairman's leadership on this issue and
would be happy to answer questions.
[Prepared statement of Mr. Diamond follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. DeSantis. Thank you.
Mr. Lyle, you are up for 5 minutes.
STATEMENT OF COLE LYLE
Mr. Lyle. Well, thank you, Chairman DeSantis, Ranking
Member Lynch, distinguished Representatives of the
subcommittee. I appreciate the opportunity to testify.
I'd like to begin by saying that I'm not here for myself.
I'm here strictly for my brothers and sisters still struggling
to transition to post-military life while also struggling with
posttraumatic stress and no other options besides drugs and
therapy. I'm here for those of us in the veteran communities
who have been left behind and continue to deal with the pain of
suicide, as other veterans see no way out. I'm here for the
veterans who have lost faith in the system, lost hope for
themselves, and have lost purpose in their lives. I'm here for
the men and women that, like myself, have had to go it alone
and acquire their service dogs at extraordinary financial
burden to them.
For these reasons, I've been fighting for the last year to
change the existing VA policy. I believe that allowing veterans
to fight PTS without all options available to them is
tantamount to sending our military to fight an enemy without a
secondary weapon in their arsenal.
While in Afghanistan for the majority of 2011, my unit
served in the kinetic Helmand Province. I was based out of Camp
Leatherneck but spent some time with the British and ISAF
forces near Marjah on a Royal air base in Lashkar Gah. My
physical injuries as a result of military service are
insignificant relative to my fellow veterans.
But like many veterans today who show little signs of
physical injury, there are many scars beneath the surface.
During the last few months of my deployment, as our
replacements were starting to arrive and take over the
operational capabilities of our unit, I felt I wasn't doing
enough to help the cause of our war fighters. I started
volunteering my time, largely during sleep hours, at a severely
understaffed Bastion trauma center. It was there, mentally
unprepared for the new volunteer role I assumed, that has
affected me most in my post-deployment transition.
Upon returning stateside, veterans take a post-deployment
health assessment, which indicated that I needed to seek
treatment for posttraumatic stress. I started to utilize the VA
system, and eventually, I met with a psychologist who confirmed
the preliminary results of the health assessment. I was then
prescribed sleep aids and antidepressants and told to utilize
what's called a Veterans Center in my local area for
counseling.
A little less than 2 years on this path, the symptoms
seemed to stagnate or get worse. Upon discharge from the Marine
Corps in early 2014, interpersonal relationships were harder to
maintain than necessary, along with not having the support
system of my fellow marines and the chain of command. I didn't
have a civilian job, was not in school yet, and simultaneously
was experiencing a divorce.
In the same few months, I would experience what most
veterans now are all too familiar with: the loss of military
friends to preventable suicide. Many of these veterans had
gotten addicted to the slew of pills prescribed to them and
lost even a glimmer of hope in their lives. Some of these men
and women had spouses, had children, mothers, fathers, and
friends they left behind because the status quo of treatment
for posttraumatic stress failed them.
Life as I'd known it had been ripped away, and one night
alone, I decided to end it all. It is only for the timing of a
friend, a fellow marine, arriving on my doorstep at that exact
moment that I'm here right now, semper fidelis indeed.
The next day I quit medication cold turkey, not wanting to
continue down the dark path of opiate addiction. I sought
another way and found that a trained service dog was an option,
but not one provided by the VA. Further inquiry to local
nonprofits similar to K9s for Warriors resulted in wait times
over a year, with the demand being as high and nonprofit-based
budgets what they are.
A few months after searching myself, I got Kaya, who's at
my feet today, who quite literally pounced into my life. I had
her obedience trained, then subsequently trained for
posttraumatic stress symptoms by an Assistance Dogs
International-accredited trainer. After roughly $10,000 all
told with my family's assistance, of my own money, I got the
help I needed. Yet today, many veterans still don't have those
resources.
I still have my bad days, but with Kaya at my side, I'm
largely in a different phase. I call it recovery. Retired
Marine General James Mattis calls it posttraumatic growth. The
bad days are less frequent than they've ever been, and they
mainly come when I get news of another friend who has committed
suicide.
Since starting this quest, more and more of the veteran
community have come forward to impart upon me the stories of
their brothers and sisters who have taken their lives. Just
last week, a close friend of mine in Texas lost a marine he
served with to suicide. A month ago, one of my best friends who
I deployed with, and the father of my goddaughter, admitted to
me that he had gotten close and also would have succeeded had
another marine not stepped in.
They all come to me pleading, in fact begging, to use what
voice I have in this chamber and in the halls of Congress to
give you all this message: Service dogs will save lives. And
with the current epidemic of veteran suicides, it is
unconscionable to keep the status quo and wait any longer to
institute this change we all know is a viable solution to
reduce the epidemic of veteran suicides.
Thank you very much for the opportunity to testify, and I
look forward to answering your questions.
[Prepared statement of Mr. Lyle follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. DeSantis. Thank you.
Mr. Feldman, you are up for 5 minutes.
STATEMENT OF STEVE FELDMAN
Mr. Feldman. That's a tough act to follow.
Mr. Chairman, Ranking Member Lynch, members of the
subcommittee, thank you for the opportunity to testify today.
I'm Steve Feldman. I'm the executive director of the Human-
Animal Bond Research Initiative. That's HABRI for short. We're
a nonprofit research and education foundation that funds
research on the benefits of companion animals to human health,
and specifically, we're looking at children with autism, we're
looking at victims of domestic violence, and we're looking at
how we can use these animal-assisted interventions for veterans
with posttraumatic stress.
In addition to funding this research, we also have built
and maintained the world's largest research library on human-
animal interaction, and that's free and online and available
and searchable to anyone who's doing research in this area.
And we also support commonsense public policies that should
reflect the definitive body of science that show significant
positive health impacts that companion animals have on human
health.
The VA says it doesn't have enough evidence to support
service animals for veterans with PTS. We respectfully
disagree, and that's why we support H.R. 4764. We believe there
is significant scientific evidence to support the efficacy of
service dogs for veterans with PTS.
We funded the first systematic review of research on
animal-assisted intervention for victims of trauma. That was
conducted at Purdue University, Dr. Fallon's alma mater, and it
was published less than a year ago. And what it found was
preliminary evidence that animals provide unique elements to
address PTS symptoms.
And I think it's also really important to note, because Mr.
Diamond said what's the harm, this systematic review of
published and unpublished research found no negative effects
from any of these studies. So no harm was found in any of the
research that we looked at. So we think this supports the
conclusion that service dogs for trauma survivors, including
veterans with PTS, can positively effect depression, anxiety,
social outcomes, sleep, and quality of life.
And we're currently funding a pilot study on the effect of
service dogs on mental health and wellness in military veterans
with PTS. Scientists are measuring psychological and
psychosocial functioning, including symptoms of PTSD,
depression, life and relationship satisfaction, and quality of
life in 137 military veterans diagnosed with PTSD who either
have a service dog or who are waiting to receive one. And the
ones who are waiting to receive one is our control --scientific
control group.
And so the preliminary unpublished results indicate that
military veterans with service dogs exhibit significantly lower
overall PTS symptoms severity, and that includes better ability
to cope with flashbacks and anxiety attacks; reduced frequency
of nightmares and less overall sleep disturbance; lower
anxiety, depression, and anger; higher levels of companionship
and social reintegration; increased overall psychological well-
being; and higher levels of life satisfaction and resilience.
And we have to wait for the final results of this study to be
published in a peer-reviewed scientific journal, which we
expect to happen later this year, but we wanted to bring you
these preliminary outcomes because they're so encouraging and
so important to the discussion today.
And I also urge the committee and the VA to look broadly at
research studies that really look at several key measures of
mental health and well-being like depression, anxiety, stress,
and social integration, all of which are associated with PTS.
My written testimony covers these in great detail, and you can
find even more studies in our database.
And that's why an organization like HABRI can be hopefully
really helpful because we're looking at the broad spectrum of
research, not just one little narrow slice of it. And that
broad spectrum of research is pretty definitive. You know, for
example, we're looking at what happens in a person's brain when
they interact with an animal. The level of oxytocin, which is a
good hormone, goes up. The level of cortisol, which is the
stress hormone, goes down. And so when fingers meet fur,
there's something really fantastic that's happening, and I
think we've heard about some of the specific examples today.
You know, if you combine those scientifically documented
therapeutic effects with the trained actions of a service dog,
you get a powerful combination. The Americans with Disabilities
Act recognizes service dogs for PTSD in their regulations, and
States are increasingly updating their definition of service
animals. Just last year, the State of Florida passed a law to
expand protections of service animal statutes to include
traumatic brain injury and PTSD. And the inclusion of these
protections allows veterans who have a disability that may not
be outwardly visible to have access to public accommodations
with their service dogs. Sometimes these symptoms manifest
themselves in public, so while pets and emotional support
animals can provide some of the benefits we've just been
discussing, it's only a trained service dog that has full
public access that can provide that animal-assisted
intervention wherever and whenever it's really necessary for a
veteran with PTSD.
You know, what about the doctors on all this? We did a
survey last year which showed--of 1,000 doctors which showed
that 69 percent of them have worked with animals and hospitals,
medical centers, or medical practice, and 88 percent of doctors
a saw improvement in a patient's physical condition and 97
percent saw an improvement in patients' mental health condition
as a result of animal-assisted intervention. So doctors are
likely to be really supportive if we can get this program
going, and really willing participants as we provide service
dogs to veterans with PTS.
So I just want to conclude by saying there is a growing
body of research that demonstrates widespread positive mental
health impacts from the human-animal bond, and we hope that you
and the VA will take this broad evidence into consideration
when shaping public health policy both in relation to 4764 and
beyond.
And I hope the members of the subcommittee and the VA will
rely on HABRI as a resource. That's what we're here for, to be
a scientific resource for anyone who's interested in this.
With PTS affecting so many of our veterans, we need to make
sure that everyone has access to service dogs. And H.R. 4764
really is a great step in the right direction, and that's why
we fully support the legislation.
So, Mr. Chairman, Ranking Member Lynch, members of the
committee, I really want to thank you. I want to thank your
hardworking staff, and especially, Mr. Chairman, thank you for
your leadership on this issue. And I'm happy to answer any
questions that you may have.
[Prepared statement of Mr. Feldman follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. DeSantis. Thank you. I thank the witnesses. The chair
now recognizes himself for 5 minutes.
Dr. Fallon, so why does the reject pairing veterans
suffering from PTS with service dogs?
Mr. Fallon. We don't, Mr. Chairman. VA is thrilled that
service dogs help veterans. It's just, as a large medical
organization, we have to rely on evidence-based medicine. The
veteran population is very heterogenous. What helps one veteran
is not going to help all. We have to ----
Mr. DeSantis. Have any of the preliminary results that have
been pointed to by the witnesses at Purdue or any of those, has
that changed any of the thinking within the VA?
Mr. Fallon. Well, Mr. Chairman, I would point out that in
the publication that was funded by HABRI, Dr. O'Hare published
in 2015, one of her main conclusions was that more research
needs to be done. That's right out of the paper. She also
documented a number of deficiencies in the literature. She also
was quoted in Military Times article on her work that nonbiased
research needed to be completed. This was in 2015.
Mr. DeSantis. So that said, so the VA's approach to PTS, is
it fair to say that it relies heavily on pharmaceuticals?
Mr. Fallon. I'm a veterinarian, Mr. Chairman. I couldn't --
--
Mr. DeSantis. But you are not familiar with how these
veterans--so basically, you are just here as a veterinarian.
You don't have as much knowledge on just PTS generally?
Mr. Fallon. No, Mr. Chairman. My role here is to update you
on our study. I certainly would not pretend to be an expert in
human clinical medicine.
Mr. DeSantis. Okay. Well, because I think all the
indications we have received from witnesses, from veterans are
that, you know, you get counseling, you get drugs. I mean, that
is kind of the two things. And that is effective for some
people, but there are other people, and I think Cole Lyle is
one, that will say but that is not good. So maybe you can't
answer this, but are there dangers associated with providing
veterans opioids and other pharmaceuticals to deal with PTS?
Mr. Fallon. I couldn't comment on that, Mr. Chairman.
Mr. DeSantis. Okay. Well, what would you say to that, Mr.
Diamond?
Mr. Diamond. If you look at the Wikipedia entry for some of
these opiates, they clearly set down an entire list of side
effects, including increased suicide. In our opinion, a dog is
not going to cause any harm, and yet we see every single month
our classes, the warriors are transforming. They come in and
they're a wreck. They're overmedicated, they are lost, they are
frightened just to have left their homes.
And we see them over 3 weeks working with our staff,
working with their service dog as that bond kicks in, that they
become different people. And they are able to go out the front
door again. They're able to go to a store again. They're able
to go to the beach in Florida again. And these are things that
they could not do without their service dog. It opens the door.
It lowers barriers to even getting other help. They become more
like the people they were before they went off to war.
Mr. DeSantis. Mr. Feldman, can you--the opioids, I mean, is
there a danger of side effects with that? Is that accurate to
say that that is the case?
Mr. Feldman. I think pretty much everyone knows that, but I
do want to respond to something that Dr. Fallon said.
You know, we're here in Washington and so we've--there's a
lot of people who do regulations. You're never going to meet a
regulator who says we have enough regulations. You're never
going to meet a researcher who says we have enough research. So
of course we need to continue to do more research, and that's
what we're funding right now. But when you add it all up, we
really do think there's enough research to substantiate this
program.
Mr. DeSantis. Has there been any research that
substantiates dangerous side effects with pairing a veteran
with a service dog?
Mr. Feldman. No, sir. There is in fact an absence of that
evidence.
Mr. DeSantis. Cole Lyle, have you had any negative side
effects since you have been paired with your service dog?
Mr. Lyle. That's a strong negative, Mr. Chairman.
Mr. DeSantis. So, I mean, I think we all agree that veteran
suicides are a major problem. We need to do everything we can
to prevent them. And I think it makes sense that the VA should
explore all possible ways that this can be dealt with. And I
understand that there may not--that, you know, people can say,
well, we need more literature, but, you know, we have enough
evidence there that I think it is something that is long
overdue.
Let me ask you this, Mr. Feldman. How is the VA's
opposition to providing service dogs harm veterans with PTS?
Mr. Feldman. Well, I guess I'll just speak as a citizen on
this one. I just don't think the words veteran and waiting list
sort of belong in the same sentence. And while, you know, K9s
for Warriors and other organizations like it are doing their
best to put as many paws on the ground as they possibly can,
the only way we're really going to get this done is if we have
the VA providing that kind of support.
Mr. DeSantis. What about Mr. Diamond? What is your judgment
about the VA's posture? How has that affected veterans?
Mr. Diamond. It's cost lives. There's no question that
there are thousands of veteran suicides that could have been
prevented had they had the access to a service dog.
Mr. DeSantis. And Cole Lyle, I know you have been involved
in advocacy on this issue. You have gone through the halls of
Congress and spoken with people. What has been the reception
from Members of Congress and on both sides of the aisle so far?
Mr. Lyle. Mr. Chairman, the response has been
overwhelmingly supportive. We have bipartisan support on H.R.
4764. This is not a partisan issue. Everybody knows that we
need to take care of our veterans. Of course, we have different
ideas about how to go about that, but I personally walking the
halls of Congress and speaking with Democrats, Republicans,
conservatives, liberals, everybody agrees that this is a good
idea and that we should do it.
Mr. DeSantis. Well, you have done a very good job. You
know, as this bill progresses and we have success, some of
these guys on K Street may be coming after you, like I say,
your success and work in Congress.
And, Mr. Diamond, I think K9s for Warriors has done a great
job. It is a part of the district that I am privileged to
represent. And I know you guys have expanded and you are there
to help, but, I mean, you can only do so much. I mean, I wish
you guys could just have unlimited numbers. You know, so you
guys are part of it, but I think we need to have a broader
awareness here.
But I appreciate all the witnesses for their testimony, and
I thank you guys for coming.
And I now recognize the ranking member Mr. Lynch.
Mr. Lynch. Thank you, Mr. Chairman.
Just for the record, we had some hearings over in the
Senate on veterans and opiod addiction. And this is a 2015
hearing. And in response to questions around opiod disorder by
Senator Joe Donnelly of Indiana, VA indicated that about 68,000
veterans in 2015 had opiod use disorders. I think it represents
about 13 percent of the total population of veterans currently
taking opioids according to the VA. If 68,000 have opiod use
disorders and that is 13 percent of the veterans on opioids,
that is a huge, huge problem.
A couple of the witnesses have mentioned the cost. And we
just had an opportunity to go to Iraq last week, Anbar
Province, and they had a couple of dogs they had trained, but
those are trained for bomb detection. But I asked. I asked the
DOD. I said what does it cost for us to train a dog in that
context? And they said $55,000 each. But that is DOD. You know,
I am not surprised that the private sector is doing it for a
heck of a lot less. And that is probably apples and oranges.
They get trained for something particularly different.
But, Mr. Lyle, first of all, thank you for your courageous
service to our country and you are helping veterans still. That
$10,000 that you mentioned, is that what it cost you to ----
Mr. Lyle. Yes, sir. That's what it cost me to acquire Kaya,
to pay for her training and all initial veterinary care for
her.
I would note that $10,000 ----
Mr. Lynch. Is that acquisition as well when you ----
Mr. Lyle. Yes. Yes.
Mr. Lynch. Yes? Okay.
Mr. Lyle. I would note that $10,000 is, quite frankly,
cheap ----
Mr. Lynch. Yes. Yes.
Mr. Lyle.--for ----
Mr. Lynch. Well, the life of the dog and the benefit that
it conveys, you are right, absolutely.
Mr. Lyle. Well, the $10,000, I would pay it 10 more times
if I had to do it over again.
Mr. Lynch. Don't let the DOD hear you say that.
Mr. Lyle. Yes, I mean--but it has paid dividends in how I'm
able to overcome specific symptoms associated with military
experience, and I would recommend it highly to anybody who
feels as though opiates and traditional therapies just aren't
working for them.
Mr. Lynch. Okay. Thank you.
Mr. Diamond and Mr. Feldman, Mr. Diamond first, 17,000
square feet--I am not sure--you mentioned your facility down in
Florida. And obviously, there are efficiencies of scale because
you are training so many dogs. How many dogs do you probably
train at a time?
Mr. Diamond. Right now we have at capacity for about 30
dogs on our campus.
Mr. Lynch. Wow.
Mr. Diamond. In a couple of months we'll have capacity for
about 60.
Mr. Lynch. Okay. And what do you see in terms of the costs
of you, you know, more professionally, you know, doing it 30
times at a whack? What do you see your costs on average?
Mr. Diamond. Well, we're finally seeing economies of scale.
Two years ago we were about in the 40s. This past year we were
at about $32,000; this year, $27,000; and then we expect next
year for the entire 3-week program plus all the, you know,
lifetime wraparound services to be about $22-$23,000. So we've
finally hit economies of scale.
And I would echo Mr. Lyle's comments. We think that it's a
savings to the government with the reduction in use of
prescription drugs, reduction in use of VA services generally
speaking, and just merely the higher quality of life, the
better human being you get at the end of it ----
Mr. Lynch. Yes.
Mr. Diamond.--is a huge cost-savings for the country.
Mr. Lynch. Yes. And what is the lifespan, the average
lifespan of one of the dogs?
Mr. Diamond. It's between 8 and 12 years ----
Mr. Lynch. So 10 years ----
Mr. Diamond.--so depending on ----
Mr. Lynch.--you know, yes. Mr. Lyle, you had something
else?
Mr. Lyle. Congressman Lynch, I would note that 8 to 10
years--Kaya started helping me within weeks.
Mr. Lynch. Yes.
Mr. Lyle. It does not take 8 to, you know, 12 years for
these dogs to really assist veterans.
Mr. Lynch. Oh, no, no, no, no, no. I mean, they are
training her throughout that 10 years or so, so that is the
service that is being rendered. You divide the cost of training
and acquisition over the 10 years. You amortize it, I guess.
Mr. Feldman, do you have anything else you would like to
add?
Mr. Feldman. Well, you mentioned cost. I can tell you that
the pilot study, looking at 137 veterans, which we announced
the funding for last year and which will be completed next
month and probably published later this year, that whole study
cost just upwards of $50,000, and we're getting results, you
know, within a 2-year period. And so, yes, we need to do more
research, but it doesn't have to take that long or cost that
much.
Mr. Lynch. Yes. You know, you see the number of veterans
that we are treating with opioids, and there is just no happy
ending there with the addiction rate we have, so we have got to
try something different.
My time is expired. Thank you for your indulgence, Mr.
Chairman.
Mr. DeSantis. I thank the gentleman.
And the chair now recognizes the vice chairman of the
committee, Mr. Russell, for 5 minutes.
Mr. Russell. Thank you, Mr. Chairman, and thank you each
for being here today.
Dr. Fallon, I noticed that you served in the military.
Thank you for your service.
Mr. Fallon. Sure.
Mr. Russell. When you did serve, you served in a veterinary
capacity, as I understand it, is that correct?
Mr. Fallon. Yes, sir, I was a veterinary technician.
Mr. Russell. In that time in your service did you develop a
bond with the animals under your care?
Mr. Fallon. Oh, absolutely, sir, yes.
Mr. Russell. And would you say that now as a doctor of
veterinary medicine do you develop a nurturing bond with the
animals in your care?
Mr. Fallon. Absolutely, sir.
Mr. Russell. Okay. Do you see dangers associated with
pairing service dogs with veterans?
Mr. Fallon. Well, as the chairman mentioned, I have seen
problems with dogs, particularly dogs that are not properly
trained. For instance, we had those two children that were
bitten, which was a tragedy, certainly didn't help those
veterans. Also, there are some things to take into
consideration. If a dog becomes sick, ends up with a chronic
illness, there can be huge veterinary bills associated. The
veteran can actually become quite depressed. We've seen this
anecdotally ----
Mr. Russell. And how would you compare that, say, with
veterans suffering from opiod abuse, harming their families,
their own children ----
Mr. Fallon. I ----
Mr. Russell.--maybe harming others around them and getting
in a depressed state? Which would you say is more of a danger?
Mr. Fallon. I couldn't comment on that, sir. Again, I'm a
veterinarian. I mean, clearly, all those things are terrible
things, though.
Mr. Russell. Do you personally believe veterans would be
harmed by their care and association with service dogs?
Mr. Fallon. I do not know the answer to that question. I'm
a--I'm ----
Mr. Russell. But you have a lot of experience here, Dr.
Fallon. I mean, you served in the military ----
Mr. Fallon. I do, sir ----
Mr. Russell.--dealing with animals, you are a doctor of
veterinary medicine. You have handled a lot of animals in your
life. You have done extensive research and study. I just want
to know, since you came as an expert testifying before
Congress, I am just curious of your personal opinion.
Mr. Fallon. I'm reluctant to give my ----
Mr. Russell. Do you personally believe ----
Mr. Fallon.--personal opinion.
Mr. Russell.--veterans would be harmed by their care and
association with service dogs?
Mr. Fallon. I'm reluctant to give my personal opinion, sir,
because it could affect the study, it could bias the study, so
I would prefer not to do that.
Mr. Russell. Well, I think that that is telling. And I
appreciate you for being loyal to Veterans Administration, but
I think we have a greater responsibility as a nation to be
loyal to our combat veterans and those that have suffered a
great deal. I have handled the flesh and blood of battle on
many battlefields to include Iraq and Afghanistan. As a combat
infantryman, I have dealt with a lot of the issues that we are
discussing here today.
As a veterans advocate before entering a career in
politics, I guess if you call it a career, I have even assisted
and helped place service dogs with veterans and seen dramatic
results. You know, whether that is a placebo effect or whether
it is reality, I can tell you that the results have been
remarkable.
But here is what I also know. Opiod abuse is a tragic
indictment on the Veterans Administration. I would also tell
you that many veteran suicides, I think, are misdiagnosed. It
is not unlikely for a soldier maybe to drink a beer, but now he
is prescribed on OxyContin or Percocet, he diminishes himself
to a very low state, he doesn't breathe anymore, and then the
family finds him in the morning, is like, well, gee, Russell
didn't have any indication that he had any problems. In fact,
he was talking about going fishing this weekend and now he is
dead. And they chalk him up as a suicide.
Here, we have an opportunity to go a great deal of good
with very low risk, and if the price of that is two dog bites,
I think we can do that.
And I also think that the expense of a dog is far cheaper
than years and years and years of opiod addiction. We are
legalizing heroin in this country, and we are using our
veterans as the number one scientific lab of opiod abuse. It
really angers me.
And I have been prescribed Percocet and OxyContin, floated
around for several days, and I will tell you this, I quit cold
turkey, too, on it because I would rather have a clear head and
pain than deal with a drug addiction and depression.
I think we are not being intellectually honest here today.
And whether Dr. Crowe would like to give his, you know,
professional opinion if you can't speak to the medical side, or
yourself, give me one good reason why we should not implement
this absent the already-given opinion of further study?
Mr. Fallon. Dr. Crowe, would you like to ----
Mr. Crowe. Yes, I'd be happy to.
Mr. DeSantis. If you would stand and just raise your right
hand. Can you stand?
[Witness sworn.]
Mr. DeSantis. Okay. The witness answered in the
affirmative.
Mr. Crowe. Thanks. Thank you, Mr. Chairman, the ranking
member, and the committee.
Mr. Russell. If you could use your microphone, sir, and
thank you for being here today.
Mr. Crowe. I push this? Okay.
Thank you very much for the question.
First of all, I think we are mistakenly confusing a couple
of issues. Opioids are not used to treat PTSD. A lot of folks
with PTSD also have chronic pain conditions, and they may have
started opioids to treat the pain, but opioids are not used by
VA to treat PTSD.
We also monitor prescribing practices and send in experts
to facilities where we think there's some mis-practice going on
in an attempt to correct it.
We also--as you may know, we have the opiod rescue kits
that now are being put in the hands of every veteran who's been
prescribed opioids.
This is also a very personal issue for me. My sister died
of an unintended opiod overdose, so I take this very seriously.
But it's not part of our PTSD discussion.
Mr. Russell. Well, and I appreciate that, and thank you,
sir, for your insight. With your indulgence ----
Mr. DeSantis. Before you do your next question, can you
just state your full name for the record so we have it?
Mr. Crowe. Dr. Chris Crowe.
Mr. DeSantis. Okay. Thank you. And your title?
Mr. Crowe. Senior mental health consultant and liaison to
the Defense Centers of Excellence for Psychological Health and
TBI.
Mr. Russell. And thank you. And I appreciate your patience
with being put on the spot, but I understand you did come here
as well today.
Look, this is a real issue, and I don't believe anybody
sitting out here or up here doesn't have concern and care to do
the right things. But would you also in your professional
opinion acknowledge that those that deal more than likely with
PTSD issues are also liable to be suffering from some sort of
pain due to their service? So these two are associated
together. Would you agree with that?
Mr. Crowe. Not necessarily. You know, I think they co-occur
in many people. Folks who've been deployed, you know, have many
opportunities for injury and come back with lots of
musculoskeletal pain. Those also tend to be folks who've been
exposed to trauma and may develop posttraumatic stress
disorder. But opioids are never used to treat PTSD.
Mr. Russell. Well, and I will take you at your word for
that, but I will also, you know, absolutely put it to you that
people suffering from PTSD are often drugged in a great deal of
medications, you know, with a basket-load of issues and
problems, and being good soldiers or sailors or airmen or
marines, they take their medications. They follow the doctor's
orders.
Well, Mr. Chairman, I have exceeded my time, but I would
like to say these programs, there is far more evidence that
they work than they don't, and there is an awful lot of
evidence that we are not doing a very good job with our
treatment of PTSD and that we have a lot of veteran suicides, I
believe personally, just from observation--I only come as a
combat veteran; I am not a doctor. You know, I have just fought
for a living. And so what I would tell you is we are not
meeting those types of issues, and we are trying to drug our
veterans, send them off to some clinic rather than get them
engaged in something productive.
And with your indulgence, thank you, Mr. Chairman. I yield
back my time.
Mr. DeSantis. The gentleman's time is expired.
The chair now recognizes the gentleman from Georgia, Mr.
Hice, for 5 minutes. And we are going to have Dr. Fallon come
back and resume his spot on the witness stand.
Mr. Hice. Thank you very much, Mr. Chairman.
Dr. Fallon, do you have any idea how the VA is recruiting
qualified veterans for this study?
Mr. Fallon. The veteran participants, sir, the folks that
are actually ----
Mr. Hice. Correct.
Mr. Fallon. Yes, sir. They're recruited through each of the
three medical centers through fliers and presentations to
mental health clinicians.
Mr. Hice. Okay. Is there currently a waiting list of
qualified veterans who would like to participate?
Mr. Fallon. There is a waiting list at one of our sites,
the Portland, Oregon, site, because we've had particular
problems in recruiting qualified dog trainers for that site.
However, we now have one trainer that has--that is on--is
working now.
Mr. Hice. How large is the waiting list?
Mr. Fallon. I cannot say for sure. I would say it's
probably in the range of maybe 20 people perhaps.
Mr. Hice. And this is at one facility or ----
Mr. Fallon. One facility, yes, sir.
Mr. Hice. Okay. So are you saying that the personnel at VA
medical centers are aware of this study and are actively
engaged in informing veterans of the potential of having a
service dog?
Mr. Fallon. Yes, I would definitely say that. It's a very
popular topic of interest with our veterans.
Mr. Hice. Does the VA currently have any way to gauge the
demand for the service dogs?
Mr. Fallon. We do not, sir. We do not have a method of
gauging demand for service dogs.
Mr. Hice. Is that under consideration?
Mr. Fallon. That would be outside of my purview, sir. I
couldn't say.
Mr. Hice. Mr. Diamond, let me come to you. How are
qualified veterans referred to your organization?
Mr. Diamond. We've never advertised for a veteran to come
to our organization. They find us through word-of-mouth through
the very tight veteran community. But when the veteran applies
to us, we have a 22-page application. We do interviews,
criminal background checks. We do a thorough vetting process.
So by the time the veteran comes to our campus, perhaps a year
after they applied, we know a bevy about them and are ready to
bring them into our program.
Mr. Hice. So you don't do any advertising per se. It is all
word-of-mouth?
Mr. Diamond. Absolutely. If we advertised, we would get
inundated. We are pushing a 2-year waitlist now. There's ----
Mr. Hice. All right. That is my point. That is where I was
going. So the VA doesn't seem to have a whole lot of
information here. Of course, this has not been their program.
But you are actively involved in providing service dogs to
veterans, and you have a 2-year waiting list. I mean, do you
have any way of gauging what the need is?
Mr. Diamond. I wish we had the good measure, and I--and
since I'm under oath, I'm not going to venture a guess. But I
do know this for sure, that the number of veterans that are
referred to us from the VA because a VA treating physician says
I don't have anything else that can help you is increasing
every single day.
Mr. Hice. Sure. Absolutely.
Mr. Lyle, let me ask you--and first of all, thank you for
your service and for your testimony. Both are powerful, and we
deeply and in a heartfelt way say thank you for what you have
done for our country.
How did you find out that service dogs were an option for
PTS?
Mr. Lyle. So I actually had a personal friend of mine who
had a service dog that he also had to acquire on his own and
train. I'm not quite sure which organization he received his
dog--well, where he got his dog trained. But I knew that that
was something that was an option that veterans could utilize.
And then when I went out to organizations, specifically, I went
to organizations in Texas because that's where I'm currently
living. I got pretty much the same result, that wait times were
at least a year. I didn't feel as though I had that time to
wait.
Mr. Hice. Okay. So your introduction came through a
personal friend?
Mr. Lyle. That's correct, sir.
Mr. Hice. Okay. Mr. Diamond, let me come back to you, and
my time is almost up. Twofold question, do you find that
veterans struggle with affording service dogs as a general
rule? And how does your organization enable them to pair up?
Mr. Diamond. Well, two pieces to that, the first is that
some of our veterans have reported back to us that they would
rather make personal sacrifices than to not have--to forego
having a service dog. But they do struggle. They're on fixed
incomes, and therefore, they do have difficulty paying for it.
Most of the veterans that we get could not independently pay to
get a service dog out on their own.
So we've made a lot of partnerships with our corporate
supporters. For example, Bayer Health is--put together a
network of veterinarians to give free health care for the dogs.
We're trying to work with pet stores to get free dog food for
the veterans. We do everything we can on the back end to make
it free or almost free for the veteran.
But the overwhelming message from them is they would forgo
their own personal comfort to make sure that they have a
service dog.
Mr. Hice. Very good. Thank you, Mr. Chairman.
Mr. DeSantis. I thank the gentleman.
Mr. Lyle, what was your experience with the drugs? How did
you get prescribed by the VA?
Mr. Lyle. Well, again, Mr. Chairman, when I took the post-
deployment health assessment, which was the preliminary--what
they give you--I'm not sure the timeline but there is a
timeline that they're--the VA is required to give that once you
return stateside. I then went to a VA facility in Fort Worth
and tried to use their system. I eventually met with a
psychologist at the VA hospital in Fort Worth and was
prescribed the sleep aids and the antidepressants.
Mr. DeSantis. Why did they do that? Was it because of your
symptoms?
Mr. Lyle. Correct. So I--when I returned, I was suffering
from recurring nightmares and I would have acute anxiety
attacks. I also just had difficulty with close interpersonal
relationships. As I had mentioned previously, one of the side
effects that goes largely unnoticed as a result of
posttraumatic stress, there's a high divorce rate amongst
military members, but that also had affected me. I--it wasn't
the direct cause of the divorce, but it definitely did not help
in any way, shape, or form. So it was affecting my personal
relationships.
The nightmares specifically, Kaya is trained to recognize
when I'm having a nightmare, and she will jump up in bed and
lick my face to wake me up, so that's one of the ways that she
has assisted me in my symptoms.
And I would further note that a dog can give you a sense of
purpose that a pill will just not ever do in the sense that
there were many days I didn't want to get out of bed. I didn't
have really anything to do like--as I said, I didn't have a job
at the time, wasn't currently enrolled in school, and I didn't
have any reason to. But a service dog needs to be taken
outside, they need to be fed, they give you a reason to get up
and to be productive on a day-to-day basis and give you that
small sense of purpose again that you can grow on. And again, I
reiterate that that's something that pills just did not do for
me.
Mr. DeSantis. Because we had testimony before that this is
not something the VA is doing, providing drugs, I mean, I guess
do you disagree with what was said in your case?
Mr. Lyle. Could you repeat the question, Mr. Chairman?
Mr. DeSantis. The previous witness to Mr. Fallon when we
did the musical chairs said that that is not something--drugs
for PTS are not something the VA does, but in your instance is
that what they did or ----
Mr. Lyle. Well, my issues as a result of posttraumatic
stress, as I said, we recurring nightmares, and I got a sleep
aid as a result of those nightmares so I would disagree with
that.
Mr. DeSantis. Okay. And, Mr. Diamond, what--I mean, the
bill that we have, if you are down to $22,000, that is even
more than what we are doing, so that is good. So you are
confident that you will be able to continue to reduce the costs
of each dog?
Mr. Diamond. Yes. I would hate for our donors to hear that,
but yes, we have hit economies of scale sufficiently that our
efficiencies are in the low $20s for next year.
Mr. DeSantis. Okay. Good. Mr. Feldman, I mean, I guess,
what is your recommendation for making the case--you are
familiar with the research that is going on. What more in
Congress do we need to be finding and presenting or do you
think that there is enough facts already in existence to
justify moving forward?
Mr. Feldman. Well, we're continuing to do research and
we'll come back and share the published research that we gave
you a preview of today. A pilot program, as you've written into
this bill, is a really good way to go because you've built in
some evaluation, you've built in a report on that program as
part of the legislation. So it's a chance to continue studying
but also to help a lot of folks, so that's why we support it.
Mr. DeSantis. Great. Well, look, at the end of the day
there has been a lot of anecdotal evidence. There is some
evidence coming out in some of the literature. But here is the
thing. I could understand why that would be a cautionary tale
if there was somehow a negative side effect to this, but there
is not. So the worst-case scenario that we are talking about is
we have made some veterans happy with service dogs as
companions. That is like the worst-case scenario. And
obviously, if there is a positive effect, you are actually
giving veterans a sense of purpose, and I believe saving lives.
And I will just tell you, since we have been involved in
this issue, I have had multiple veterans come up to me and tell
me that they would have probably committed suicide but for
being paired with a service dog. And so it is not often people
look you in the eye and tell you that they probably would have
done that, and so it really, really registers when you hear
that.
Mr. Lyle?
Mr. Lyle. And, Mr. Chairman, I would also note that just
being a veteran, any veteran will probably tell you that they
have--any veteran of Iraq or Afghanistan will probably tell you
that they either have a friend or a friend of a friend that has
committed suicide and has been affected by this suicide
epidemic.
This study that was done by the VA I will also note back in
2013 that indicated the 22-veteran-a-day average committing
suicide, that study was based on 21 States. So the number
tragically is higher than 22 veterans a day. That was just a
side note.
But I will also say since I've been doing this and, you
know, I have been talking to Members of Congress, friends of
mine specifically in Texas, because the cost barriers are so
high to getting your own service dog--and many veterans join
the military to get that family, that sense of community. When
they get out, they don't have it anymore. They don't have the--
you know, the family support that I had to financially support
their endeavor. And then they get told that there are wait
times over a year and they don't feel like they have that time
so they go out and they just get a dog.
And I will note, as I believe it was Mr. Russell who had--
Congressman Russell, who had said earlier that just being
around a dog--Dr. Fallon, as a veterinarian, has said that he's
made personal connections with the animals that he's been
around, I would argue that if you don't think or believe that a
dog can be therapeutic and a service dog specifically can treat
certain symptoms specific to their posttraumatic stress, then
you probably have never owned or been around a dog.
Mr. DeSantis. I appreciate that.
Did you want to go real quick?
Mr. Lynch. Sure.
Mr. DeSantis. I was going to recognize Mr. Hurd, but if you
are going to go, I will just recognize you.
Mr. Lynch. Sure.
Mr. DeSantis. All right. I am going to recognize the
gentleman from Massachusetts.
Mr. Lynch. Okay. Thank you, Mr. Chairman.
The way this is structured under the chairman's bill, the
key relationship will be the VA and the contractor, if it is
Mr. Diamond and K9s for Warriors or any other group. The 2016
VA report said that there was a problem with the VA not getting
out to the contractor location where the training was going on
or to the home of the veteran with the dog, and that broke
down. Are we able to cure that defect in further studies, in
the existing study ----
Mr. Fallon. Yes ----
Mr. Lynch.--in ----
Mr. Fallon.--Ranking Member ----
Mr. Lynch.--the pilot program?
Mr. Fallon. Yes, absolutely. The problem was that we were
relying on the service dog organization's trainers to interact
with our veterans, and that resulted in us not getting timely
information about problems that had developed with the dog
pairs, which is why we now have hired our own dog trainers.
Mr. Lynch. Okay. Thank you.
Mr. DeSantis. The chair now recognizes the gentleman from
Texas, Mr. Hurd, for 5 minutes.
And the votes have started, but we have got 13 minutes, and
so Mr. Hurd, and then if there are other questions, we may have
time for other members, too.
You are recognized.
Mr. Hurd. Thank you, Chairman.
And I would like to thank the distinguished gentleman from
Florida for having this panel, and I would like to thank Mr.
Lyle for being here. He is from my alma mater, Texas A&M
University.
Mr. Lyle. Gig 'em.
Mr. Hurd. Gig 'em Aggies--which has a long history of
working with animals to improve the lives of humans, everything
from Texas Task Force 1, which is one of the most active urban
search-and-rescue teams. You have a student organization called
Aggie Guide Dogs and Service Dogs, which promotes the use of
service dogs. And we are also part of the TexVet Network, which
includes the Operation K9.
And, Mr. Lyle, first, I want to thank you for your service
and dedication to the safety of Americans. As a former officer
in the CIA, I had the honor of serving alongside members of the
military. I am familiar with the sacrifices that you and your
family make. And I know this is a life-changing experience and
has inspired you to give back to your community, and I
appreciate you for doing this.
My first questions, though, are actually to Mr. Fallon. Has
the VA reached out to any other organizations conducting
similar studies?
Mr. Fallon. After the difficulties we had with the pilot
study, we did site visits of ----
Mr. Hurd. The pilot study from 2006?
Mr. Fallon. The pilot study you started in 2011, sir ----
Mr. Hurd. Okay.
Mr. Fallon.--and was suspended finally in 2012. We realized
we had to change our study protocol. We actually visited major
organizations like Canine Companions for Independence in
California ----
Mr. Hurd. So my question is actually--let's start before
that. Why did the VA decide to reinvent the wheel rather than
relying on some, you know, other organizations that have a
history in doing this kind of thing?
Mr. Fallon. Well, for the pilot, sir, we relied up on the
organizations themselves, all of which professed to be very
experienced and to be able to produce high-quality dogs. And
unfortunately, that did not turn out to be true.
Mr. Hurd. I don't even know where to go. There are so many
questions. Why not reach out to DOD and leverage some of the
experience that they have? They have some world-class trainers
and they have world-class activities using dogs for all kinds
of services.
Mr. Fallon. Admittedly, we were not familiar enough with
the service dog community when we embarked on the pilot study.
There's no question that we've made mistakes.
Mr. Hurd. Say that again. Say that first part.
Mr. Fallon. We were not adequately familiar with the
service dog community and the pitfalls in that community when
we embarked on our pilot study. There's no question about that.
Mr. Hurd. So how much money did the VA spend in phase 1 to
develop veterinary standards, which I have been told are not
longer in use?
Mr. Fallon. I am not sure the exact figure. It would be
somewhere above $1 million, though, in the pilot study.
Mr. Hurd. Above $1 million or above $10 million?
Mr. Fallon. No, $1 million, sir. The $12 million figure is
for the entire phase 1 and phase 2 together.
Mr. Hurd. And could that money have been saved if the VA
had initially adopted DOD's veterinary standards?
Mr. Fallon. No, sir, it wasn't just the veterinary
standards. It was--there were training standards involved and
also follow-up by the organization's dog trainers. All those
things ended up to be a major problem.
Mr. Hurd. Now, you are in the chief veterinary medical
offices, correct?
Mr. Fallon. Yes, sir.
Mr. Hurd. What proposals have you suggested up the chain on
how to make sure we incorporate this into the VA?
Mr. Fallon. Into the study, sir, or into VA in a wider ----
Mr. Hurd. Into the VA so that more veterans could get
access to this type of care?
Mr. Fallon. Well, we were directed by Congress to do this
study, sir, and that has been my focus is to do this research
study. There are other portions of the VA that have ----
Mr. Hurd. What is the best next action?
Mr. Fallon. To complete this study successfully.
Mr. Hurd. And what is the best next action there? What is
the next step that you need to take in order to make sure this
gets completed?
Mr. Fallon. Well, we are doing them now, sir. I mean, we
have retooled and learned from our mistakes ----
Mr. Hurd. When is it going to be done?
Mr. Fallon. Pardon me?
Mr. Hurd. When is it going to be done?
Mr. Fallon. We expect the data collection to be complete by
late 2018, and then the paper would be published thereafter.
Mr. Hurd. Mr. Lyle, I have a little bit less than a minute,
but you can go over a little bit if you so need. Hopefully, the
chairman indulges my prerogative, anything that has not been
discussed during this hearing today that you think is important
to get out there?
Mr. Lyle. Well, thank you, Congressman Hurd.
I think it's important to understand and to reiterate what
I said, that a service dog not only will combat specific
symptoms like Kaya does for me in waking me up from nightmares,
et cetera, et cetera, but there is an effect that they give to
you of providing a sense of purpose. And when veterans get out,
they lose their military community, they lose their chain of
command, they get their mission, their purpose ripped away from
them very, very quickly.
And there's--nonprofits have done admirable work in trying
to assist veterans transitioning, but they're still struggling.
And I think the main reason is that they lose their sense of
purpose and they lose their mission. They don't have anything
driving them anymore. And I think a service dog also provides
that.
I will just further note very quickly that I've spent the
last year doing this, trying to raise awareness about the
issue, talk to Members of Congress, have been received very
well, and it's taken me a year to do this, funding all of this
myself. We don't have until late 2018 to have this study
completed and then understand the results and then try to have
a program initiated at that point. Twenty-two veterans a day
are committing suicide.
Anybody that is okay with that number--I wouldn't say that
anybody at the VA is okay with that number, but we have
something that we know works. We have evidence that works now.
And with 22 veterans a day committing suicide, I return to what
I said in my opening statement. That is unconscionable that we
don't explore alternative methods of treatment.
Mr. Hurd. Mr. Lyle, thank you.
Mr. Damon ----
Mr. Diamond. Thank you.
Mr. Hurd. Mr. Diamond, excuse me, thank you for your
service.
Mr. Chairman, I yield back the time I do not have.
Mr. DeSantis. The gentleman's time is expired.
I would like to thank all of our witnesses for taking the
time to appear before us today.
If there is no further business, without objection, the
subcommittee stands adjourned.
[Whereupon, at 3:20 p.m., the subcommittee was adjourned.]
APPENDIX
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Material Submitted for the Hearing Record
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