[House Report 117-31]
[From the U.S. Government Publishing Office]


117th Congress   }                                             {   Report
                         HOUSE OF REPRESENTATIVES
 1st Session     }                                             {   117-31

======================================================================



 
   PUPPIES ASSISTING WOUNDED SERVICEMEMBERS FOR VETERANS THERAPY ACT

                                _______
                                

  May 12, 2021.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

  Mr. Takano, from the Committee on Veterans' Affairs, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 1448]

    The Committee on Veterans' Affairs, to which was referred 
the bill (H.R. 1448) to direct the Secretary of Veterans 
Affairs to carry out a pilot program on dog training therapy, 
and to amend title 38, United States Code, to authorize the 
Secretary of Veterans Affairs to provide service dogs to 
veterans with mental illnesses who do not have mobility 
impairments.

                                CONTENTS

                                                                   Page
Amendment........................................................     1
Purpose and Summary..............................................     3
Background and Need for Legislation..............................     4
Hearings.........................................................     5
Committee Consideration..........................................     5
Committee Votes..................................................     5
Section-by-Section Description...................................     5
Congressional Budget Office Cost Estimate........................     6
Committee Oversight Findings.....................................     6
Constitutional Authority Statement...............................     6
Earmark Statement................................................     6
Federal Mandates Statement.......................................     6
Advisory Committee Statement.....................................     6
Performance Goals................................................     6
Applicability to Legislative Branch..............................     7
Statement on Duplication of Federal Programs.....................     7
Changes in Existing Law Made by the Bill as Reported.............     7

                               Amendment

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Puppies Assisting Wounded 
Servicemembers for Veterans Therapy Act'' or the ``PAWS for Veterans 
Therapy Act''.

SEC. 2. DEPARTMENT OF VETERANS AFFAIRS PILOT PROGRAM ON DOG TRAINING 
                    THERAPY.

  (a) In General.--Not later than 180 days after the date of the 
enactment of the Act, the Secretary of Veterans Affairs shall commence 
the conduct of a pilot program to provide canine training to eligible 
veterans diagnosed with post-traumatic stress disorder (in this section 
referred to as ``PTSD'') as an element of a complementary and 
integrative health program for such veterans.
  (b) Duration; Medical Centers.--
          (1) Duration.--The Secretary shall carry out the pilot 
        program under subsection (a) for a five-year period beginning 
        on the date of the commencement of the pilot program.
          (2) Medical centers.--The Secretary shall ensure that such 
        pilot program is carried out by not fewer than five medical 
        centers of the Department of Veterans Affairs located in 
        geographically diverse areas.
  (c) Agreements With Entities.--In carrying out the pilot program 
under subsection (a), the Secretary shall seek to enter into agreements 
with nongovernmental entities that the Secretary determines have the 
demonstrated ability to provide the canine training specified in 
subsection (a).
  (d) Required Conditions.--The Secretary shall include in any 
agreement under subsection (c) conditions requiring that the 
nongovernmental entity seeking to enter into the agreement--
          (1) submits to the Secretary certification that the entity is 
        an accredited service dog training organization;
          (2) agrees to ensure that veterans participating in the pilot 
        program under subsection (a) receive training from certified 
        service dog training instructors for a period of time 
        determined appropriate by the entity;
          (3) agrees to ensure that veterans participating in such 
        pilot program are prohibited from having access to a dog under 
        such pilot program at any time during such participation 
        without the supervision of a certified service dog training 
        instructor;
          (4) agrees to ensure that veterans participating in such 
        pilot program receive training in skills unique to the needs of 
        the veteran to address or alleviate PTSD symptoms of the 
        veteran;
          (5) agrees not to use shock collars or prong collars as 
        training tools and to use positive reinforcement training; and
          (6) agrees to provide any follow-up training support 
        specified in subsection (e)(2), as applicable.
  (e) Adoption of Dog.--
          (1) In general.--A veteran who has participated in the pilot 
        program under subsection (a) may adopt a dog that the veteran 
        assisted in training during such pilot program if the veteran 
        and the veteran's health provider (in consultation with the 
        entity that provided the canine training with respect to the 
        dog under such pilot program) determine that it is in the best 
        interest of the veteran.
          (2) Follow-up training support.--If a veteran adopts a dog 
        under paragraph (1), the entity that provided the canine 
        training with respect to the dog under the pilot program shall 
        provide follow-up training support for the life of the dog. 
        Such support shall include the provision of a contact plan 
        between the veteran and the entity that enables the veteran to 
        seek and receive assistance from the entity to ensure the dog 
        is being properly cared for.
  (f) Eligibility for Other Care and Treatment.--Participation in the 
pilot program under subsection (a) may not preclude a veteran from 
receiving any other medical care or treatment for PTSD furnished by the 
Department, including therapy, for which the veteran is otherwise 
eligible.
  (g) Collection of Data.--In carrying out this section, the Secretary 
shall--
          (1) develop metrics and other appropriate means to measure, 
        with respect to veterans participating in the pilot program 
        under subsection (a)--
                  (A) the number of such veterans participating;
                  (B) the satisfaction of such veterans with the pilot 
                program;
                  (C) whether participation in the pilot program 
                resulted in any clinically relevant improvements for 
                such veterans, as determined by the health care 
                provider or clinical team that referred the veteran to 
                participate in the pilot program; and
                  (D) such other factors as the Secretary may determine 
                appropriate; and
          (2) establish processes to document and track the progress of 
        such veterans under the pilot program with respect to health 
        benefits and improvements.
  (h) Report by Secretary.--Not later than one year before the date on 
which the pilot program under subsection (a) terminates, the Secretary 
shall submit to the Committees on Veterans' Affairs of the House of 
Representatives and the Senate a report containing the recommendations 
of the Secretary regarding--
          (1) whether to extend or make permanent the pilot program; 
        and
          (2) the feasibility and advisability of expanding the pilot 
        program to address mental health conditions other than PTSD.
  (i) GAO Briefing and Study.--
          (1) Briefing.--Not later than one year after the date of the 
        commencement of the pilot program under subsection (a), the 
        Comptroller General of the United States shall provide to the 
        Committees on Veterans' Affairs of the House of Representatives 
        and the Senate a briefing on the methodology established for 
        the pilot program.
          (2) Report.--Not later than 270 days after the date on which 
        the pilot program terminates, the Comptroller General shall 
        submit to the committees specified in paragraph (1) a report on 
        the pilot program. Such report shall include an evaluation of 
        the approach and methodology used for the pilot program with 
        respect to--
                  (A) assisting veterans with PTSD; and
                  (B) measuring relevant metrics, such as reduction in 
                scores under the Clinician Administered PTSD Scale 
                (CAPS), improvement in psychosocial function, and 
                therapeutic compliance.
  (j) Definitions.--In this section:
          (1) The term ``accredited service dog training organization'' 
        means an organization described in section 501(c)(3) of the 
        Internal Revenue Code of 1986 that--
                  (A) provides service dogs to veterans with PTSD; and
                  (B) is accredited by an accrediting organization with 
                demonstrated experience, national scope, and recognized 
                leadership and expertise in the training of service 
                dogs and education in the use of service dogs (as 
                determined by the Secretary).
          (2) The term ``eligible veteran'' means a veteran who--
                  (A) is enrolled in the patient enrollment system in 
                the Department of Veterans Affairs under section 1705 
                of title 38, United States Code; and
                  (B) has been recommended for participation in the 
                pilot program under subsection (a) by a qualified 
                mental health care provider or clinical team based on 
                medical judgment that the veteran may benefit from such 
                participation with respect to the diagnosed PTSD of the 
                veteran.
          (3) The term ``service dog training instructor'' means an 
        instructor who provides the direct training of veterans with 
        PTSD in the art and science of service dog training and 
        handling.

SEC. 3. PROVISION OF SERVICE DOGS AND VETERINARY INSURANCE BENEFITS TO 
                    VETERANS WITH POST-TRAUMATIC STRESS DISORDER WHO DO 
                    NOT HAVE CERTAIN IMPAIRMENTS.

  (a) In General.--Section 1714 of title 38, United States Code, is 
amended by adding at the end the following new subsections:
  ``(e) The Secretary may provide a service dog to a veteran under 
subsection (c)(3) regardless of whether the veteran has a mobility 
impairment.
  ``(f)(1) The Secretary shall provide to any veteran described in 
paragraph (2) a commercially available veterinary insurance policy for 
each dog provided to such veteran under subsection (b) or (c).
  ``(2) A veteran described in this paragraph is a veteran who--
          ``(A) is diagnosed with post-traumatic stress disorder or a 
        visual, hearing, or substantial mobility impairment;
          ``(B) has received a dog under subsection (b) or (c) in 
        connection with such disorder or impairment; and
          ``(C) meets such other requirements as the Secretary may 
        prescribe.''.
  (b) Applicability.--Section 1714(f) of title 38, United States Code, 
as added by subsection (a), shall apply with respect to a veteran 
provided a dog by the Secretary of Veterans Affairs regardless of 
whether the provision occurs before, on, or after the date of the 
enactment of this Act.

                          Purpose and Summary

    H.R. 1448, as amended, would require the Secretary of the 
Department of Veterans Affairs (VA) to conduct a pilot program 
at five VA medical centers, in partnership with accredited 
service dog training organizations, through which veterans 
diagnosed with post-traumatic stress disorder (PTSD) may 
participate in training mental health service dogs for 
therapeutic benefit. In addition, it removes VA's requirement 
that veterans with PTSD also have mobility impairment before 
being referred for a mental health service dog. It also extends 
VA's veterinary insurance benefit, currently available only to 
veterans who have received service dogs through VA for vision, 
hearing, and/or mobility impairments, to veterans who are 
prescribed mental health service dogs. Representative Steve 
Stivers of Ohio introduced H.R. 1448 on March 1, 2021.

                  Background and Need for Legislation

    VA continues to be innovative and responsive to veterans' 
interest in adjunctive treatment approaches to promote their 
mental health and wellbeing, through expansion of Whole Health 
offerings at every VA medical center across the country and 
through implementation of prior Congressionally-mandated pilot 
programs to partner with non-VA entities in offering veterans 
opportunities to participate in animal-assisted therapies, 
sports and recreation programs, agricultural programs, and art 
therapy. VA also has an existing pilot program in the Palo Alto 
VA Medical Center polytrauma unit to offer veterans 
opportunities to help train service dogs for fellow veterans. 
Anecdotally, veterans involved in the Palo Alto pilot program 
have noted their satisfaction with and benefits from 
participation in the canine training, which is a training-as-
therapeutic model. The intent of the Committee with the current 
legislation is to expand the number of veterans who may access 
this form of adjunctive treatment for PTSD and to make it more 
geographically accessible. The non-governmental entities with 
which VA enters into agreements to conduct the pilot program 
must submit to VA certification that they: (1) are 
organizations described in section 501(c)(3) of the Internal 
Revenue Code of 1986; (2) are accredited by an accrediting 
organization with demonstrated experience, national scope, and 
recognized leadership and expertise in the training and use of 
service dogs; and (3) have recognized expertise and staff 
experienced in training mental health service dogs 
specifically.
    VA has an existing process by which it assesses, 
prescribes, and refers veterans for service dogs, and maintains 
contracts with accredited service dog organizations for pairing 
and provision of service dogs. VA does not purchase service 
dogs for veterans as part of this process, and veterans who are 
provided with a service dog are not charged for the service 
dog. Veterans with a diagnosis of PTSD are eligible for that 
process, but only if they have mobility impairment in addition 
to PTSD. The intent of this legislation is to remove the 
additional mobility impairment requirement and allow veterans 
to participate in the VA service dog assessment, prescription, 
and referral process solely on the basis of their PTSD 
diagnosis.
    Currently, VA offers a veterinary insurance benefit to 
veterans who are prescribed and receive service dogs through 
VA. That benefit is only offered to veterans who receive 
service dogs on the basis of visual, hearing, and/or mobility 
impairment. This legislation expands the category of veterans 
who are offered the veterinary insurance benefit to include 
veterans with PTSD who receive service dogs through VA.

                                Hearings

    H.R. 1448, as introduced, was examined at a legislative 
hearing by the Subcommittee on Health on April 15, 2021. The 
following witnesses testified at the hearing: The Honorable 
Mark Takano, U.S. House of Representatives, 41st Congressional 
District of California; The Honorable Lauren Underwood, U.S. 
House of Representatives, 14th Congressional District of 
Illinois; The Honorable Steve Stivers, U.S. House of 
Representatives, 15th Congressional District of Ohio; The 
Honorable Cynthia Axne, U.S. House of Representatives, 3rd 
Congressional District of Iowa; The Honorable Brenda L. 
Lawrence, U.S. House of Representatives, 14th Congressional 
District of Michigan; The Honorable Hakeem S. Jeffries, U.S. 
House of Representatives, 8th Congressional District of New 
York; Mr. Marquis Barefield, Assistant National Legislative 
Director, Disabled American Veterans; Mr. Brian Dempsey, 
Government Affairs Director, Wounded Warrior Project; Ms. 
Lindsay Church, Executive Director/Co-Founder, Minority 
Veterans of America; Dr. Clifford A. Smith, Director, 
Analytics, Innovations and Collaborations Veterans Health 
Administration, U.S. Department of Veterans Affairs; Dr. Amanda 
Johnson, Director, Women's Reproductive Health Veterans Health 
Administration, U.S. Department of Veterans Affairs.

                        Committee Consideration

    On May 5, 2021, the full Committee met in an open session, 
a quorum being present, to consider H.R. 1448. An amendment in 
the nature of a substitute was offered by Representative Mike 
Bost of Illinois. The amendment was agreed to by voice vote. 
The Committee ordered that H.R. 1448, as amended, be ordered 
favorably reported to the House of Representatives.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the recorded 
votes on the motion to report the legislation and amendments 
thereto. A motion to favorably report H.R. 1448, as amended, to 
the House of Representatives was offered by Ranking Member Mike 
Bost of Illinois and agreed to by voice vote.

                     Section-by-Section Description


Section 1. Short title

    Section 1 establishes the title of the bill as Puppies 
Assisting Wounded Servicemembers for Veterans Therapy Act or 
the PAWS for Veterans Therapy Act.

Section 2. Department of Veterans Affairs pilot program on dog training 
        therapy

    Section 2 requires VA to establish five pilot sites at VA 
medical centers for veterans with PTSD to participate in 
service dog training for therapeutic benefit. VA must enter 
into agreements with accredited, non-governmental service dog 
training organizations to establish and conduct the pilot 
programs for five years.

Section 3. Provision of service dogs and veterinary insurance benefits 
        to veterans with post-traumatic stress disorder who do not have 
        certain impairments

    Section 3 would amend section 1714 of title 38, United 
States Code, to clarify that VA may provide a service dog to a 
veteran under subsection (c)(3) regardless of whether the 
veteran has a mobility impairment. It also requires VA to 
provide to any veteran described in paragraph (2) a 
commercially available veterinary insurance policy for each dog 
provided to such veteran under subsection (b) or (c).

               Congressional Budget Office Cost Estimate

    The Committee did not receive a formal score on the amended 
bill in time for filing.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

                   Constitutional Authority Statement

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 2942, as amended is authorized by Congress' 
power to ``provide for the common Defense and general Welfare 
of the United States.''

                           Earmark Statement

    H.R. 1448, as amended does not contain any Congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI of the Rules of the House of 
Representatives.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 1448, as amended, prepared by the 
Director of the Congressional Budget Office pursuant to section 
423 of the Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
1448, as amended.

                           Performance Goals

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are to continue to encourage the design, 
evaluation, implementation, and dissemination of VA's 
adjunctive therapeutic opportunities for veterans with mental 
health challenges.

                  Applicability to Legislative Branch

    The Committee finds that H.R. 1448, as amended, does not 
relate to the terms and condition of employment or access to 
public services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

              Statement on Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that no provision 
of H.R. 1448, as amended establishes or reauthorizes a program 
of the Federal Government known to be duplicative of another 
Federal program, a program that was included in any report from 
the Government Accountability Office to Congress pursuant to 
section 21 of Public Law 111-139, or a program related to a 
program identified in the most recent Catalog of Federal 
Domestic Assistance.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (new matter is 
printed in italics and existing law in which no change is 
proposed is shown in roman):

                      TITLE 38, UNITED STATES CODE




           *       *       *       *       *       *       *
PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *


CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE

           *       *       *       *       *       *       *



SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL 
TREATMENT

           *       *       *       *       *       *       *



Sec. 1714. Fitting and training in use of prosthetic appliances; guide 
                    dogs; service dogs

  (a)(1) Any veteran who is entitled to a prosthetic appliance 
shall be furnished such fitting and training, including 
institutional training, in the use of such appliance as may be 
necessary, whether in a Department facility or other training 
institution, or by outpatient treatment, including such service 
under contract, and including travel and incidental expenses 
(under the terms and conditions set forth in section 111 of 
this title) to and from such veteran's home to such hospital or 
training institution.
  (2) In furnishing prosthetic appliances under paragraph (1), 
the Secretary shall ensure women veterans are able to access 
clinically appropriate prosthetic appliances through each 
medical facility of the Department.
  (b) The Secretary may provide guide dogs trained for the aid 
of the blind to veterans who are enrolled under section 1705 of 
this title. The Secretary may also provide such veterans with 
mechanical or electronic equipment for aiding them in 
overcoming the disability of blindness.
  (c) The Secretary may, in accordance with the priority 
specified in section 1705 of this title, provide--
          (1) service dogs trained for the aid of the hearing 
        impaired to veterans who are hearing impaired and are 
        enrolled under section 1705 of this title;
          (2) service dogs trained for the aid of persons with 
        spinal cord injury or dysfunction or other chronic 
        impairment that substantially limits mobility to 
        veterans with such injury, dysfunction, or impairment 
        who are enrolled under section 1705 of this title; and
          (3) service dogs trained for the aid of persons with 
        mental illnesses, including post-traumatic stress 
        disorder, to veterans with such illnesses who are 
        enrolled under section 1705 of this title.
  (d) In the case of a veteran provided a dog under subsection 
(b) or (c), the Secretary may pay travel and incidental 
expenses for that veteran under the terms and conditions set 
forth in section 111 of this title to and from the veteran's 
home for expenses incurred in becoming adjusted to the dog.
  (e) The Secretary may provide a service dog to a veteran 
under subsection (c)(3) regardless of whether the veteran has a 
mobility impairment.
  (f)(1) The Secretary shall provide to any veteran described 
in paragraph (2) a commercially available veterinary insurance 
policy for each dog provided to such veteran under subsection 
(b) or (c).
  (2) A veteran described in this paragraph is a veteran who--
          (A) is diagnosed with post-traumatic stress disorder 
        or a visual, hearing, or substantial mobility 
        impairment;
          (B) has received a dog under subsection (b) or (c) in 
        connection with such disorder or impairment; and
          (C) meets such other requirements as the Secretary 
        may prescribe.

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