Monday, November 24, 2014

VA to Allow More Service Dogs in Facilities; Therapy Dog Access Rules Also Proposed

In the Federal Register for November 21, the Department of Veterans Affairs proposed regulations on animal access to VA facilities.  The proposal is a considerable expansion of the current access rule, which has remained unchanged for 29 years:

“Dogs and other animals, except seeing-eye dogs, shall not be brought upon property except as authorized by the head of the facility or designee.”

This one-sentence rule had become so inadequate, in only referring to "seeing-eye dogs," that most facilities were using a rule regarding what service dogs the VA would provide reimbursement for as an access rule. This funding rule, 38 CFR 17.148, states that the VA will generally pay benefits only if the dog and the veteran "have successfully completed a training program offered by an organization accredited by Assistance Dogs International or the International Guide Dog Federation...."  Benefits, according to the preamble to the final rules, are not provided "for a dog to mitigate the effects of  a mental illness that are not relate to visual, hearing or mobility impairments," which excludes most service dogs for PTSD. Applying this rule as an access rule meant that many veterans could not bring legitimate service dogs into VA facilities, and could not keep them in VA residential and inpatient facilities.  This was causing a great deal of pain. 

When it finalized the funding rule in 2012, the VA had stated that it was in the process of revising the service dog access rules to make them “fully compliant with 40 U.S.C. 3103(a).”  That section provides that guide dogs "or other service animals accompanying individuals with disabilities and especially trained and educated for that purpose shall be admitted to any building or other property owned or controlled by the Federal Government on the same terms and conditions, and subject to the same regulations, as generally govern the admission of the public to the property."  In addition, legislation enacted in 2012, the Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012, P.L. 112-154, section 109, which is titled Use of Service Dogs on Property of the Department of Veterans Affairs, amended 38 U.S.C. 901 to include a subsection reading:

“(f)(1) The Secretary may not prohibit the use of a covered service dog in any facility or on any property of the Department or in any facility or on any property that receives funding from the Secretary.
(2) For purposes of this subsection, a covered service dog is a service dog that has been trained by an entity that is accredited by an appropriate accrediting body that evaluates and accredits organizations which train guide or service dogs.”

It was conceivable, particularly under 38 U.S.C. 901(f)(2), that the VA would use its accredited-organizations only funding rule as the basis for an access rule, and many VA facilities and even the U.S. Army assumed that this would be the case

The proposal released on November 21 actually goes much further than these statutes might together require and in fact would make the VA's rules on service dog access largely if not entirely consistent with rules issued by the Department of Justice in 2010.  Even more surprising, the VA is now the first federal agency to consider carefully what sort of access rules should apply to therapy dogs coming into VA facilities, either for specifically designed therapy programs or as visitors to cheer up patient and resident populations.

Written comments are being sought and can be submitted until January 20, 2015. The easiest place to submit comments is upload them on the regulations.gov website.

Defining “Service Animal”

The proposed rules largely replicate the definition of “service animal” adopted by the Department of Justice in September 2010 (amended in 2011 to change the phrase “handler’s disability” to “individual’s disability,” presumably in recognition that some service dogs, such as autism service dogs, may not be handled by the person with the disability).  The Department of Justice made clear in 2010 that a service dog could be trained for a range of mental disabilities, which the VA now accepts for purposes of access, explaining:

“We explained in the proposed rulemaking associated with 38 CFR 17.148 that VA does not yet have sufficient evidence to prescribe mental health service dogs as part of a veteran’s treatment plan, and therefore cannot at this time offer benefits to support the use of such dogs. 76 FR 35163, June 16, 2011. However, the issue of whether the prescription of mental health service dogs is clinically appropriate to necessitate the provision of benefits under § 17.148 is much narrower than the issue of whether we should allow mental health service dogs to access VA facilities while accompanying individuals with disabilities. Therefore, we believe it is consistent to permit the presence of mental health service dogs on VA property for purposes of ensuring access for individuals with disabilities, while still (at this time) restricting the provision of benefits to support mental health service dogs in § 17.148.”

The VA also states that the DOJ definition is “the most relevant source for consideration of the issue of service animal presence on VA property….” The following table places the definition now proposed beside the DOJ’s definition and the prior definition used for the funding regulation.  Language not found in more than one definition is in italics. Key words are in bold. Notice the considerable overlap between the newly proposed VA access language and the 2010 DOJ language for ADA purposes. 

Comparison of Definitions of “Service Animal” under VA Rules (Access and Funding), and Department of Justice Rules under the ADA
Proposed 38 CFR 1.218(a)(11)(viii) (VA access)
28 CFR 36.104 (ADA per DOJ)
38 CFR 17.148 (VA funding for service dogs)
A service animal means any dog that is individually trained to do work and perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability. Other species of animals, whether wild or domestic, trained or untrained, are not service animals for the purposes of this definition. The work or tasks performed by a service animal must be directly related to the individual’s disability. The crime deterrent effects of an animal’s presence and the provision of emotional support, well-being, comfort, or companionship do not constitute work or tasks for the purposes of this definition. Service dogs in training are not considered service animals. This definition applies regardless of whether VA is providing benefits to support a service dog under § 17.148 of this chapter.
Service animal means any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability. Other species of animals, whether wild or domestic, trained or untrained, are not service animals for the purposes of this definition. The work or tasks performed by a service animal must be directly related to the individual's disability. Examples of work or tasks include, but are not limited to, assisting individuals who are blind or have low vision with navigation and other tasks, alerting individuals who are deaf or hard of hearing to the presence of people or sounds, providing non-violent protection or rescue work, pulling a wheelchair, assisting an individual during a seizure, alerting individuals to the presence of allergens, retrieving items such as medicine or the telephone, providing physical support and assistance with balance and stability to individuals with mobility disabilities, and helping persons with psychiatric and neurological disabilities by preventing or interrupting impulsive or destructive behaviors. The crime deterrent effects of an animal's presence and the provision of emotional support, well-being, comfort, or companionship do not constitute work or tasks for the purposes of this definition.
(a)(1) Service dogs are guide or service dogs prescribed for a disabled veteran under this section.
* * *
(c) Recognized service dogs. VA will recognize, for the purpose of paying benefits under this section, the following service dogs:
(1) The dog and veteran must have successfully completed a training program offered by an organization accredited by Assistance Dogs International or the International Guide Dog Federation, or both (for dogs that perform both service- and guide-dog assistance). The veteran must provide to VA a certificate showing successful completion issued by the accredited organization that provided such program.
(2) Dogs obtained before September 5, 2012 will be recognized if a guide or service dog training organization in existence before September 5, 2012 certifies that the veteran and dog, as a team, successfully completed, no later than September 5, 2013, a training program offered by that training organization. The veteran must provide to VA a certificate showing successful completion issued by the organization that provided such program. Alternatively, the veteran and dog will be recognized if they comply with paragraph (c)(1) of this section.

As does the DOJ, the VA definition excludes an animal whose only function is providing crime deterrent effects, emotional support, well-being, comfort, or companionship, as these do not constitute work or tasks.  This would not, however, exclude psychiatric service dogs that perform tasks specific to a mental condition since "disability" is defined to include a “physical or mental impairment.” 

Inquiries and Documentation

Following the DOJ rules, “an individual with a disability must not be required to provide documentation, such as proof that an animal has been certified, trained, or licensed as a service animal, to gain access to VA property accompanied by their service animal.” The individual may be asked if the animal is required because of a disability, and what work or task the animal has been trained to perform.  The preamble acknowledges that “in most instances, it is apparent that an animal is trained to do work or perform tasks for an individual with a disability.”  Emphasis is added to the “or” between “work” and “task” in this passage from the preamble because the proposed regulatory definition of service dog itself uses “do work and perform tasks,” as noted above.  The significance of the conjunction will be discussed further below. 

Proof of vaccinations and veterinary examinations must, however, be available “if such individual will be accompanied by the service animal while receiving treatment in a VHA residential program.”  This is to include proof of a current rabies vaccination, as required by local law, and proof of “a comprehensive physical examination by a licensed veterinarian within the last 12 months that confirms immunizations with core canine vaccines (in addition to the required rabies vaccine) distemper, parvovirus, and adenovirus-2, and screening for and treatment of internal and external parasite[s] as well as control of such parasites.”

“Additionally, the individual with a disability would be asked to confirm in writing that at least seven days have elapsed since the dog recovered from (as applicable), any of the following: vomiting, diarrhea, urinary or fecal incontinence, sneezing or coughing, open wounds, skin infections or mucus membrane infections, orthopedic or other conditions that may interfere with ambulation within the VA facility, and estrus in intact female dogs.”

Any documentation that could be requested “would only be related to the health and wellness of the animal, and would not be related to an animal’s level of training or other certification that the animal was a service animal.”

No Specific Training Organization Designated

The preamble states that its new definition of service animal is consistent with the definition in the funding rule: 

“We reiterate that we do not interpret section 109 to require that a service dog must be trained by any specific entity, and that section 109 does not prohibit VA from granting access to a broader group of service animals than those trained by accredited entities generally. We would not impose an accreditation requirement to verify that a service dog has been trained appropriately to gain access to VA property.”

The only way that section 109 can be interpreted as not requiring training by “any specific entity” involves some casuistry, and many VA facilities have been limiting access to dogs trained by member organizations of ADI or IGDF, but let us accept that access and funding can certainly be distinguished. 

Service Dogs in Training Excluded

While the DOJ definition’s use of “trained” might be assumed to mean that a dog “in training” is not a service dog, the VA has chosen to emphasize this by adding a sentence to this effect in the definition.  This is probably an effort to give VA facilities an argument for excluding poorly trained, as yet untrained, or just bogus service dogs.  (The Department of Transportation, in service animal regulations, allows airlines to choose their own policy on whether to admit service animals in training. See discussion at 73 Fed. Reg. 27659, May 13, 2008; discussed in Service and Therapy Dogs in American Society at pages 129 to 131.)

Miniature Horses

The VA does not follow the DOJ in granting a sort of provisional status to miniature horses, which can be trained to perform guide and mobility functions:

“After some consideration, we would exclude the access of miniature horses in this proposed rule because we find their larger size would make them more difficult to control within a facility or remove from a facility as needed. Horses are prey animals and thus have a heightened flee response when they perceive things in their environment as a threat. Coupled with this heightened response, VA healthcare facilities typically have smooth flooring that is able to withstand industrial cleaning and polishing (e.g. vinyl composite tile, polished concrete, etc.), which is difficult for hooved animals to walk on and may contribute to horses having difficulty ambulating or even falling. The presence of a miniature horse in VA facilities is also more likely to be disruptive and may result in egress issues because large numbers of people would likely congregate to see the miniature horse. Additionally, we are not aware that miniature horses generally can be reliably trained to be housebroken in the same manner as service dogs trained to hold their waste until it could be eliminated in outdoor areas. For instance, it would not be appropriate, especially in VA health care facility settings, to permit a miniature horse to eliminate its waste in a specialized waste bag the horse might wear while indoors. All of these factors present too high of a risk to legitimate safety concerns, both to persons and the animal, especially in VA health care facilities, to permit the presence of a miniature horse as a service animal.”

The miniature horse lobby, such as it is, should consider commenting on these observations in the preamble. 

Access Requirements for Qualifying Service Animals

Merely because a dog fits within the definition provided in the rules does not guarantee access.  The proposed rules require that it “must be in a guiding harness or on a leash, and under control of the individual with the disability at all times while on VA property.”  The VA is not responsible for the care of the animal, so if the handler is present for a procedure that will require separation from the dog for a time, the animal should not be brought in the first place as it will not be “under the control of the individual with the disability at all times.”  This point is emphasized:

“Another impossible or impractical requirement to impose upon service animals would be the requirement to remain continuously indoors in intensively monitored settings, such as acute inpatient hospital settings. In such settings, veterans would typically be recovering from an acute medical episode, and would not likely be able to effectively attend to the needs of a service animal (e.g. taking the service animal outside, or feeding or watering the service animal). Staff in these inpatient hospital settings must not be expected to set aside their patient monitoring and care duties to instead attend to the needs of a service animal. Additionally, the immediate needs of veterans in these settings would be most appropriately fulfilled by medical staff and not a service animal (for instance, getting in and out of a hospital bed).”

The preamble provides a list of hospital and facility locations from which service animals should be excluded:
  • Operating rooms and surgical suites
  • Areas where invasive procedures are being performed
  • Acute inpatient hospital settings (e.g. intensive care units, stabilization units, locked mental health units)
  • Decontamination, sterile processing, and sterile storage areas
  • Patient rooms or patient treatment areas where it is indicated that a patient has animal allergies, or has fear or phobia(s) of animals
  • Food preparation areas
  • Any area where personal protective equipment must be worn.
Restricting dogs from these areas makes sense, of course, and the VA notes that such restrictions are consistent with CDC guidance that it is generally appropriate to exclude a service animal from areas that employ general infection control measures and that require persons to undertake added precautions. Service animals can also be excluded from cemeteries, construction and maintenance sites, and grounds keeping and storage facilities, though as to cemeteries permission may be granted to service animals and even pets under certain circumstances that will be discussed below. 

A service dog can be denied access or removed “to maintain the general health and safety of veterans, VA employees, other VA stakeholders, and other service dogs.”  The preamble indicates that the VA is not restricting service dog access to those trained “by accredited entities,” but that it will “only guarantee access to VA property for those service dogs that can dependably behave in accordance with typical public access standards for public settings.”  Thus, “a service animal will be removed from VA property if the animal is not housebroken.” Other reasons for removal include acts of aggression, including “growling; biting or snapping; baring its teeth; and lunging.” Also, “disease or bad health … would warrant a service animal being removed from VA property, such as external signs of parasites on a service animal (e.g. fleas or ticks), or other external signs of disease or bad health (e.g. diarrhea or vomiting).” 

If a service animal is excluded or removed, the VA emphasizes that the handler can still obtain medical treatment and other services, just without the animal. 

Police Dogs, Research Animals, Animals at Funerals and Parades

The VA’s regulation which covers service dog access is technically included in a section entitled “Security and Law Enforcement at VA Facilities” and the proposed regulations specify that animals with law enforcement functions may be admitted to VA facilities with the approval of the facility head or a designee.  The preamble uses the example of an explosives detection dog.  The regulation also permits “[a]nimals under the control of the VA Office of Research and Development may be permitted to be present on VA property,” which would apply to certain research hospitals and other research environments. 

Pets and other animals can come onto VA property or on property under control of the National Cemetery Administration “for ceremonial purposes during committal services, interments, and other memorials, if the presence of such animals would not compromise public safety, facilities and grounds care, and maintenance control standards.”  The preamble notes that this is in line with the longstanding military tradition of having horse-drawn caissons at funerals. 

Therapy Animals

Perhaps the most surprising aspect of the proposed regulations is the reference to “nonservice animals” involved in therapy, i.e., therapy dogs, which are specified as appropriate for both structured therapeutic interventions (animal-assisted therapy, or AAT), as well as for visiting patients (animal-assisted activities, or AAA).  The proposed rule does not specifically state that such animals must be dogs, though that may be generally assumed.  AAT is

“a goal-directed intervention that incorporates the use of an animal into the treatment regimen of a patient, as provided or facilitated by a qualified VA therapist or VA clinician. AAT is designed to improve human physical, social, emotional, and cognitive function, and is provided in a variety of settings and may be group or individual in nature. Clinical disciplines such as physical, occupational, recreational, and speech therapies use AAT animals to perform tasks that facilitate achievement of patient-specific treatment goals and objectives.”

Paperwork is necessary for such an animal to be used in that “an AAT animal may be present on VHA property if the animal is used to facilitate achievement of patient-specific treatment goals, as documented in the patient’s treatment plan.”  Such documents would have to “be kept in the areas where patients receive AAT, as it is [in] these areas that an AAT animal would be exposed to patients as well as others.” 

Therapy dogs not involved in goal-directed interventions can also be admitted if they “provide opportunities for patients to experience benefits.”  Required vaccination records and other health documents on AAA dogs would also have to be kept in the wards and areas where patients encounter them.The requirement that documents be kept where dogs visit makes sense, though in my experience the documentation is often kept in a central volunteer office and not on wards.  I always carry such documents with me during visitations in any case. 

Residential Animals in Nursing Homes and Mental Health Facilities

The proposed rules allow VA Community Living Centers (CLCs) or Mental Health Residential Rehabilitation Treatment Programs (MHRRTPs), on approval of the head of a facility or designee, for “nonservice animals to be present on VHA property if those animals were present for purposes of a residential animal program….”  Here, it appears that animals other than dogs would be acceptable since there is no specified restriction and cats and birds might, if properly cared for, also be a good fit in residential animal environments. 

CLCs are long-term care settings that provide nursing home care services to veterans.  MHRRTPs are mental health care treatment facilities.  Both, according to the preamble, “have experienced a significant change in philosophy of care, which has resulted in an initiative to transform the culture of care in VA from a medical model where the care is driven by the medical diagnosis, to a person-centered model where the care is driven by the needs of the individual as impacted by medical conditions.”  This includes making these environments more homelike.  As with therapy dogs, documentation would be required:

“We would state that any VA CLC or MHRRTP residential animal present on VHA property must facilitate achievement of therapeutic outcomes (such as described above), which would be documented in patient treatment plans. We believe this requirement ensures that animals would not be merely residing on a VA CLC or MHRRTP, but rather would be permitted extended access to VHA property only for the therapeutic benefit of veterans.”

The animal would also have to pass all health requirements specified for other animals in VA facilities. 

VA’s Proposed Rule Is Broad, but Is It as Broad as DOJ’s?

The statutory requirements for access regulations would have only required that the VA broaden its access rules to include service dogs beyond guide dogs.  Service dogs would have to be trained, but the VA could have easily imposed a requirement regarding an “appropriate accrediting body,” as specified in 38 U.S.C. 901.  Instead, the VA determined that the section “does not prohibit VA from granting access to a broader group of service animals than those trained by accredited entities generally.  We would not impose an accreditation requirement to verify that a service dog has been trained appropriately to gain access to VA property.” No cognate of “accredit” appears in the proposed regulation. 

Indeed, the VA has largely adopted the position of the Department of Justice in its service animal access rules for public accommodations and for state and local governments.  There are two exceptions. As already noted, DOJ allows that a service animal must be “individually trained to do work or perform tasks for the benefit of an individual with a disability,” whereas the VA’s proposal requires that the animal be “trained to do work and perform tasks….”  This is not likely an oversight as DOJ included an extensive discussion of why it did not require that service dogs always be able to perform tasks, stating that doing work is a somewhat broader aspect of the definition “encompassing activities that do not appear to involve physical action.”  An example would be a psychiatric service dog that “can help some individuals with dissociative identity disorder to remain grounded in time or place.”  DOJ stated:

“It is the Department’s [DOJ’s] view that an animal that is trained to ‘ground’ a person with a psychiatric disorder does work or performs a task that would qualify it as a service animal as compared to an untrained emotional support animal whose presence affects a person’s disability. It is the fact that the animal is trained to respond to the individual’s needs that distinguishes an animal as a service animal. The process must have two steps: Recognition and response. For example, if a service animal senses that a person is about to have a psychiatric episode and it is trained to respond, for example, by nudging, barking, or removing the individual to a safe location until the episode subsides, then the animal has indeed performed a task or done work on behalf of the individual with the disability, as opposed to merely sensing an event.” (75 Fed. Reg. 56267, September 15, 2010)

At the very least, the VA should explain why it chose “and” where DOJ used “or” in defining what a service animal is.  The other distinction between the two definitions was that the VA did not include the examples inserted in the DOJ definition section:

“Examples of work or tasks include, but are not limited to, assisting individuals who are blind or have low vision with navigation and other tasks, alerting individuals who are deaf or hard of hearing to the presence of people or sounds, providing non-violent protection or rescue work, pulling a wheelchair, assisting an individual during a seizure, alerting individuals to the presence of allergens, retrieving items such as medicine or the telephone, providing physical support and assistance with balance and stability to individuals with mobility disabilities, and helping persons with psychiatric and neurological disabilities by preventing or interrupting impulsive or destructive behaviors.”

It may be that the VA regarded these as examples, not necessary for the definition, but it also may be that the VA is not certain it wants to sign onto “doing work” as sufficient in itself to label a dog a service animal.  Thus, the italicized language about helping persons with psychiatric and neurological disabilities by preventing…” might include non-task work under “preventing,” thus opening the door for service dog functions that the VA ultimately disagrees with DOJ as appropriate.  There is no indication that the VA is attempting to exclude psychiatric service dogs as long as they “do work and perform tasks” with regard to a mental disability.  The definition of disability specifically states that for purposes of the rules, “a disability means a physical or mental impairment that substantially limits one or more major life activities of the individual; a record of such an impairment, or being regarded as having such an impairment.” 

Will U.S. Army Change Its Access Policies?

First Page of Army Directive 2013-01, signed by Secretary of the Army John M. McHugh
In a letter sent to a service dog trainer in 2012, the subject of a prior blog,  and in Army Directive 2013-01, also the subject of a prior blog, Army Secretary John McHugh stated that the Army’s access policy was following the lead of the VA in terms of only acknowledging dogs accepted as service dogs by the VA, i.e., dogs trained by organizations belonging to Assistance Dogs International or the International Guide Dog Federation.  In the Directive, McHugh states that if the VA policy changes, the “Surgeon General will review and propose amendments to this directive for my approval.”  Since the Army’s policy related to access, not funding, the VA’s policy has indeed changed and it must be presumed that the Surgeon General is reviewing possible changes to make recommendations to the Secretary of the Army. 

Conclusion

The VA is to be commended for going much further than the mandate of the statutes that directly apply to its service dog policies, and for following the sophisticated lead of the Department of Justice, at least in most regards.  The agency is to be particularly praised for providing a regulatory framework for the admission of therapy dogs, both for AAT and AAA, to VA facilities, as well as for allowing for residential pets in certain VA facilities. 

The regulations on their face only limit service animals to dogs, following the Department of Justice.  It appears that therapy animals and residential animals could be of other species, but it might be best to clarify this.  Service miniature horses are not accepted, but horses are specifically mentioned as having been used at funerals in military tradition.  (When I was a child, my father took me to a funeral of a friend of his and I still remember the old soldier’s horse with the saddle on backwards following the hearse.)  In any case, the final rules should specify what breadth the VA is allowing here, unless the VA wants to leave this issue open for further experience and reflection. 

Veterans with service dogs who have been having access problems with non-ADI trained dogs should consider commenting to support the VA’s broad access concept.  Veterans with service dogs that are trained to “do work” but do not “perform tasks” should consider asking for clarification on the status of their dogs under the proposal.  Therapy dog handlers should consider commenting to support the regulatory access that is being proposed.  Veterans in residential facilities should consider commenting to reinforce the acceptance of the concept of “residential animals.” 

This is a major and welcome development for veterans, as well as for service dog users generally, for therapy dog handlers and their organizations, and for all Americans concerned with the abuses that the VA has been known for in its treatment of veterans.  The VA has done something right for a change. 

I want to particularly thank Bart Sherwood of Train a Dog, Save a Warrior (TADSAW) for carefully reading a draft of this blog and making many important observations.  Also thanks to Leigh Anne Novak and Dennis Civiello for comments.  

Appendix
§ 1.218. Security and law enforcement at VA facilities.
(a) * * *
(11) Animals. (i) Service animals, as defined in paragraph (a)(11)(viii) of this section, are permitted on VA property when those animals accompany individuals with disabilities and are trained for that purpose. A service animal must be in a guiding harness or on a leash, and under control of the individual with the disability at all times while on VA property. VA is not responsible for the care or supervision of a service animal. Service animal presence on VA property is subject to the same terms, conditions, and regulations as generally govern admission of the public to the property.
(ii) A service animal will be denied access to VA property or removed from VA property if:
(A) The animal is not under the control of the individual with a disability;
(B) The animal is not housebroken. The animal must be trained to eliminate its waste in an outdoor area; or
(C) The animal otherwise poses a risk to the health or safety of people or other service animals. In determining whether an animal poses a risk to the health or safety of people or other service animals, VA will make an individualized assessment based on objective indications to ascertain the severity of the risk. Such indications include but are not limited to:
(1) External signs of aggression from the service animal, such as growling, biting or snapping, baring its teeth, lunging; or
(2) External signs of parasites on the service animal (e.g. fleas, ticks), or other external signs of disease or bad health (e.g. diarrhea or vomiting).
(iii) Service animals will be restricted from accessing certain areas of VA property under the control of the Veterans Health Administration (VHA property) to ensure patient care, patient safety, or infection control standards are not compromised. Such areas include but are not limited to:
(A) Operating rooms and surgical suites;
(B) Areas where invasive procedures are being performed;
(C) Acute inpatient hospital settings (e.g. intensive care units, stabilization units, locked mental health units);
(D) Decontamination, sterile processing, and sterile storage areas;
(E) Patient rooms or patient treatment areas where it is indicated that a patient has animal allergies, or has fear or phobia(s) of animals;
(F) Food preparation areas; and
(G) Any areas where personal protective equipment must be worn.
(iv) Service animals will be restricted from accessing certain areas of VA property under the control of the National Cemetery Administration (NCA property) to ensure that public safety, facilities and grounds care, and maintenance control are not compromised. Such areas include but are not limited to:
(A) Open interment areas including columbaria;
(B) Construction or maintenance sites; and
(C) Grounds keeping and storage facilities.
(v) If a service animal is denied access to VA property or removed from VA property in accordance with (a)(11)(ii) of this section, or restricted from accessing certain VA property in accordance with paragraphs (a)(11)(iii) and (iv) of this section, then VA will give the individual with a disability the opportunity to obtain services without having the service animal on VA property.
(vi) Unless paragraph (a)(11)(vii) of this section applies, an individual with a disability must not be required to provide documentation, such as proof that an animal has been certified, trained, or licensed as a service animal, to gain access to VA property accompanied by their service animal. An individual may be asked if the animal is required because of a disability, and what work or task the animal has been trained to perform.
(vii) An individual with a disability will be required to comply with the following requirements, if such individual will be accompanied by the service animal while receiving treatment in a VHA residential program:
(A) The individual with a disability must provide VA with documentation that confirms the service animal has had a current rabies vaccine (one year or three year interval, depending on local requirements);
(B) The individual with a disability must provide VA with documentation that verifies the service animal has had a comprehensive physical exam performed by a licensed veterinarian within the last 12 months that confirms immunizations with the core canine vaccines distemper, parvovirus, and adenovirus-2, and that confirms screening for and treatment of internal and external parasites as well as control of such parasites; and
(C) The individual with a disability must confirm in writing that at least seven days have elapsed since the dog recovered from any instances of vomiting, diarrhea, urinary or fecal incontinence, sneezing or coughing, open wounds, skin infections or mucous membrane infections, orthopedic or other conditions that may interfere with ambulation within the VA facility, and estrus in intact female service dogs.
(viii) A service animal means any dog that is individually trained to do work and perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability. Other species of animals, whether wild or domestic, trained or untrained, are not service animals for the purposes of this definition. The work or tasks performed by a service animal must be directly related to the individual’s disability. The crime deterrent effects of an animal’s presence and the provision of emotional support, well-being, comfort, or companionship do not constitute work or tasks for the purposes of this definition. Service dogs in training are not considered service animals. This definition applies regardless of whether VA is providing benefits to support a service dog under § 17.148 of this chapter.
(ix) Generally, animals other than service animals (“nonservice animals”) are not permitted to be present on VA property, and any individual with a nonservice animal must remove it. However, a VA facility head or designee may permit certain nonservice animals to be present on VA property for the following reasons:
(A) Animals may be permitted to be present on VA property for law enforcement purposes;
(B) Animals under the control of the VA Office of Research and Development may be permitted to be present on VA property;
(C) Animal-assisted therapy (AAT) animals may be permitted to be present on VHA property, when the presence of such animals would not compromise patient care, patient safety, or infection control standards. AAT is a goal-directed clinical intervention, as provided or facilitated by a VA therapist or VA clinician, that incorporates the use of an animal into the treatment regimen of a patient. Any AAT animal present on VHA property must facilitate achievement of patient-specific treatment goals, as documented in the patient’s treatment plan. AAT animals must be up to date with all core vaccinations or immunizations, prophylactic medications, and regular health screenings as determined necessary by a licensed veterinarian, and proof of compliance with these requirements must be documented and accessible in the area(s) where patients receive AAT.
(D) Animal-assisted activity (AAA) animals may be permitted to be present on VHA property, when the presence of such animals would not compromise patient care, patient safety, or infection control standards. AAA involves animals in activities to provide patients with casual opportunities for motivational, educational, recreational, and/or therapeutic benefits. AAA is not a goal-directed clinical intervention that must be provided or facilitated by a VA therapist or clinician, and therefore is not necessarily incorporated into the treatment regimen of a patient or documented in the patient’s medical record as treatment. AAA animals must be up to date with all core vaccinations or immunizations, prophylactic medications, and regular health screenings as determined necessary by a licensed veterinarian, and proof of compliance with these requirements must be documented and accessible in the area(s) where patients may participate in AAA.
(E) Animals participating in a VA Community Living Center (CLC) residential animal program or a Mental Health Residential Rehabilitation Treatment Program (MHRRTP) may be permitted to be present on VHA property, when the presence of such animals would not compromise patient care, patient safety, or infection control standards. A residential animal program on a VA CLC or a MHRRTP is a program that uses the presence of animals to create a more homelike environment to foster comfort for veterans, while also stimulating a sense of purpose, familiarity, and belonging. Any VA CLC or MHRRTP residential animal present on VHA property must facilitate achievement of therapeutic outcomes (such as described above), as documented in patient treatment plans. Residential animals on a VA CLC or MHRRTP must be up to date with all core vaccinations and immunizations, prophylactic medications, and regular health screenings as determined necessary by a licensed veterinarian, and proof of compliance with these requirements must be documented and accessible on the VA CLC or MHRRTP.
(F) Animals may be present on NCA property for ceremonial purposes during committal services, interments, and other memorials, if the presence of such animals would not compromise public safety, facilities and grounds care, and maintenance control standards.
(x) For purposes of this section, a disability means a physical or mental impairment that substantially limits one or more major life activities of the individual; a record of such an impairment; or being regarded as having such an impairment.
* * * * *

Tuesday, November 11, 2014

Landlord Okays Service Dog, but Balks at Fenced-In Area for Dog’s Exercise

The federal district court for Oregon has determined that a case involving a tenant’s need for accommodations in order for her to care for a service dog must go to trial, that it cannot be resolved on cross motions for summary judgment.  Although there was some question as to the adequacy of the dog's training, the major issue concerned the tenant’s desire to put a fence around her patio and part of the common lawn of Rosewood Homes, arguing that this is the best way for her to let the dog out to relieve herself and get some exercise. 

The court analyzed the law of reasonable accommodation as it applies to the service dog user’s ability to care for a dog.  Since most court decisions in this area have concerned whether a tenant can obtain or keep a dog at all, the focus on this tenant’s request for a fence makes the case important for anyone seeking structural modifications or other accommodations to better care for a service animal in a housing context.  There will be a full trial on the unresolved issues in 2015. Oregon Bureau of Labor and Industries ex rel. Mayorga v. Housing Authority, 2014 US Dist. LEXIS 146671 (DC Or. 2014)

Tenant Seeks Service Dog

In 2005, Joy Mayorga, who suffers from degeneration of the lumbar disk, facet osteoarthritis, and fibromyalgia, asked permission from Housing Authority of Douglas County, which owns Rosewood Homes, where she lives, to obtain a service dog that would exceed the Authority’s weight and size restrictions for pets.  Mayorga’s request stated that she would “try and get a dog that meets the physical, mental, and also the temperament and attitude requirements necessary for the dog to be trained as a service dog.”  She included a letter from her doctor, Fred Black, MD, stating that “living and caring for a dog would be beneficial for Ms. Mayorga’s health.  It is my recommendation that she have a large, very sturdy dog that is at least eight months old.”  The Authority authorized Mayorga to have a dog for medical reasons. 

Mayorga’s condition confines her to bed five to seven days a month, sometimes consecutively.  Rosewood Homes consists of single-story duplex residences separated by common grassy areas shared by all residents of the complex.  Behind each unit is a concrete patio, approximately 9 x 20 feet, which is accessed by a sliding glass door.  Several months after making her initial request, Mayorga put up a fence around her patio, which the Authority directed her to remove.  Mayorga had advised the Authority that she was going to place some lattice on the corner of her patio to support flowers but, according to the Authority, had specifically stated that she was not fencing in her patio.  She more specifically requested a fence after that, but the request was denied. 

In 2008, Mayorga requested permission to bring a dog that might be trained to be a service dog into her home.  The dog, an American Staffordshire Terrier, one of two breeds called a pit bull, was five years old and weighed about 60 pounds, but had not yet been trained.  Mayorga had been a dog trainer, but not a service dog trainer.  A representative of the Authority, Janeal Kohler, asked for verification of vaccination and licensing, and then approved Mayorga’s request to bring the dog into her home. 

Mayorga then asked to fence off a kennel area behind her unit where Asia could exercise and relieve herself.  In one document, Mayorga said the fenced area would be 9 feet by 35 feet, but in another an area of 20 feet by 36 feet.  Most of the fenced area would be the patio but there would be “a bit of grass area” for the dog.  The Authority said that Mayorga could use a portable dog kennel, 3 feet by 16 feet in length, to be taken down when not in use and not attached to the building or concrete.  Mayorga responded that this would not provide sufficient exercise space for the dog and would be prohibitively expensive.  She also said that the dog, when tethered outside, another possible way of giving the dog exercise suggested by the Authority, was teased and approached by other people.  Mayorga asked that her initial request be reconsidered.  Kohler said that Mayorga’s proposed kennel would infringe on common space and suggested instead that she consider a dog walker, a more suitable assistance animal, or a temporary tether. 

Medical Release Request and Doctor’s Letter

At this point, Kohler requested that Mayorga sign a medical release so that the Authority could contact Dr. Black, but Mayorga declined to sign it, saying it was unlawful.  She also got a letter from a veterinarian and a manager of a training group stating that Asia needed an exercise area where she could be off leash.  Kohler agreed to provide Mayorga with a more carefully restricted medical release form.   Meanwhile, Dr. Black provided the following letter in support of Mayorga’s fencing request:

My patient Joy Mayorga, has given me permission to share the following information with you. Ms. Mayorga explained to me that she needs this letter from me because she has requested to be allowed to fence off an area for her service dog (which I had previously prescribed for her) thus allowing the dog to go outside on its own.

Because of her disability she has days when she can barely walk. Days when she even has to spend most of her day in bed. There is no way to determine when she will have such days nor how long they will last. At times this situation will interfere with her ability to take the dog out on a leash, even just long enough for the dog to relieve itself. She also has other health conditions that would be negatively affected by not allowing the accommodation she is requesting. All in all, I feel the best solution for Ms. Mayorga to keep and maintain her dog, is to allow her to be able to just open the door and let the dog out.

With regard to the dog's health, I can only say that because of the slow rate of Ms. Mayorga's walking, the dog will receive very little exercise. Other th[a]n that I am not in a position to speak to the dog's well being -- only Ms. Mayorga's. For her sake, I hope something can be worked out that will allow Ms. Mayorga to keep her service dog.

This time the request was denied because of (1) Mayorga’s refusal to provide written permission for physician verification, (2) a temporary tether was all she needed, (3) she could get an animal walker, and (4) there was risk in the proposed enclosure to third parties.  Kohler also said that two employees of the Authority had complained that Asia had behaved aggressively towards them.   A more senior official at the Authority indicated that Dr. Black’s letter obviated the need for the release form. 

As a side note, Dr. Black’s correspondence fits within the recommendations Dr. Thomas and I made in our article in the Journal of Forensic Psychology Practice concerning how medical professionals should write letters for patients with service and support animals.  The letters were specific to the patient, not canned documents obtained from a website, and considered how the issues presented relate to the patient’s condition. 

Mayorga and Oregon Bureau File Complaints

In 2010, Mayorga filed an administrative complaint against the Authority with the HUD and the Oregon Bureau of Labor and Industries.  The latter agency investigated the complaint and filed formal charges against the Authority and three individuals under Oregon Revised Statutes 659A.145 (Discrimination Against Individual with Disability in Real Property Transactions Prohibited) and 42 U.S.C. 3604 (Discrimination in the Sale or Rental of Housing and Other Prohibited Practices).  The Authority exercised its right to have the case heard in a state circuit court. 

In 2011, the Authority’s Board of Commissioners approved the Authority’s director obtaining bids for a possible vinyl fence and some discussions were held with a contractor.  No fence was put up, however, and in 2013 the Oregon Bureau filed a complaint against the Authority in state circuit court, which the Authority removed to federal district court.  Mayorga intervened as a plaintiff.

Federal Court’s Analysis

Judge Michael J. McShane, U.S. District Judge, observed that a “service animal, like any other assistance device, may require an additional accommodation to enable its effective use.”  Thus, an employer may be required to provide a ramp or widen a door for wheelchair travel.  The request to fence off a kennel area was such a request for an accommodation, which is to be granted if necessary to afford Mayorga the equal opportunity to use and enjoy her dwelling and if it is reasonable under the Fair Housing Act.  To prove necessity, Mayorga had to show that but for the accommodation, she would likely be denied an equal opportunity to enjoy the housing of her choice.  Giebeler v. M&B Assocs., 343 F.3d 1143 (9th Cir. 2003).

The facts indicated that Mayorga was sometimes bedridden for days and could not use the tether, presumably a long leash or a rope, as a substitute for a kennel, and in any case putting the tether on caused her pain.  There were some inconsistencies in the timing of events, however, in that Mayorga appeared to have attempted to erect a fence in the same general location even before the need to have it for the dog arose and she had provided the Authority “with an evolving explanation of her need for the accommodation.”  The judge also found some haziness in the record that made it impossible to determine whether the Authority had made improper medical inquiries regarding Mayorga, given that the Authority had the right to request information necessary to evaluate Mayorga’s disability-related need for accommodations, particularly when Mayorga’s condition was not necessarily readily apparent or already known to the Authority. 

Is Asia a Fully Trained Service Animal?

Judge McShane described Mayorga’s use of the dog as by 2014 involving the following:

“Mayorga's main physical impairment is pain caused by her lumbar disk degeneration and facet osteoarthritis…. Mayorga's pain is aggravated by bending, stooping, and walking…. Asia, Mayorga's service animal, is primarily used for stability support within her home. For example, Asia assists Mayorga in traveling up and down stairs, and walks alongside her in case Mayorga loses her balance…. If Mayorga falls, she is able to push off and/or be pulled by Asia to get off the floor…. Asia generally does not accompany Mayorga to the grocery store, doctor's office, church, or her great grandchild's school…. Mayorga does, however, infrequently walk Asia on a leash around the block, to the mail box, and to the office.”

Supporting and helping someone with mobility impairments stand after a fall fit within the functions of a mobility-impairment service animal, but it is not clear why Mayorga did not need the dog’s assistance in performing many errands.  Also, the judge found himself “unable to make any type of credible finding as to the adequacy of Asia’s training.”  It is not clear if Asia’s functions specific to Mayorga’s condition were not fully established, or if the judge is referring to Asia’s training with regard to being in public.  Mayorga initially described Asia as a “possible service animal,” and in 2008 the Authority had apparently received complaints of aggressive behavior from the dog, possibly indicating that some level of obedience training was still needed.  Is Asia’s potential aggressiveness still a problem?  The difficulties described in using a tether might suggest that Asia’s training in recall was not complete. 

The judge may have been concerned that it would be inequitable to order accommodations needed in part because the dog was not a fully trained service dog.  This issue usually arises with emotional support dogs that provide comfort but are not trained to do work or perform tasks specific to a disability.  That does not appear to be the case here.  Rather, the court may be considering what limits might be appropriate in an order covering a dog trained to perform tasks or do work related to a disability but not trained on some basic obedience commands.  The use of a dog walker for giving the dog exercise might be appropriately considered in such a situation.  

Conclusion

Judge McShane determined that a trial was needed “because a fuller record will afford a more substantial basis for decision.”  It will be important to tailor injunctive relief to the conditions obtaining at the time of the trial.    

This is not a case where a landlord adamantly refused to consider a valid request for a service animal and declined to even discuss the matter with the tenant.  The Housing Authority seems to have rethought some of its positions on its own, acknowledging for instance that its first request for a medical release was too broad.  The Authority seriously looked at the possible fencing of part of the area behind Mayorga’s unit. The court correctly saw the record so far developed as inadequate to assure a fair ruling. 

As of this writing, a jury trial on the matter is scheduled before Judge McShane on January 27, 2015. It is to be hoped that the judge will write an opinion on whatever final resolution is reached at trial.  

Thanks to Leigh Anne Novak for valuable comments. 

Monday, November 3, 2014

CDC Seeks Data on How Vets with PTSD Are Helped by Dogs; Therapy Dog Organizations Could Provide Valuable Input but May Not Be Participating

The Centers for Disease Control has begun distributing two surveys, one to veterans and one to “assistance dog providers,” in an attempt to gather data on how dogs may be helping veterans find jobs and reintegrate into society.  The survey for veterans to complete is getting a negligible response rate, so the CDC is now asking the Office of Management and Budget to approve an incentive for veterans who at least attempt to complete the form.  The incentive would be a $50 prepaid VISA card. 

An Assistance Dog Providers Survey is getting a sufficient response in the CDC’s opinion, but it must be questioned whether all the organizations that could provide valuable input are aware of this survey’s existence.  “Assistance dog,” as defined by the CDC, includes therapy dogs, yet at least one of the largest national therapy dog organizations I contacted (not the one to which I belong) was unaware the survey was being conducted.  Neither the current release in the Federal Register, nor a preliminary release on September 9, discussed in a prior blog, defined assistance dog and the definition would only become apparent to organizations from project documents that have to be requested from the CDC.  Although the response rate from service dog training organizations might be adequate, the use of service dogs by veterans is only part of spectrum of canine relationships that the CDC is attempting to gather data about. 

The issues with the two surveys are most easily discussed separately.  

Veterans Survey

The survey for veterans asks about their experience with pet ownership and how various experiences with animals have helped them physically and emotionally, and whether such experiences have been helpful in getting them reintegrated into society.  To date, only 66 veterans have completed the survey, barely 1% of the 6,000 responses the CDC has been hoping to get. 

One reason for the poor response rate is indicated in the request sent to the Office of Management and Budget.  In describing changes that are being made to a flyer that will be distributed through various veterans’ and other organizations, the CDC says that it has added a statement to the flyer “indicating that the survey is not affiliated with the Veterans Administration (VA), as some veterans may have negative feelings about the VA that would discourage their participation in the survey.” The CDC is certainly correct in this supposition as the VA has actively inhibited many veterans from obtaining and using service animals, as discussed here before. 

Another issue for some veterans may be the nature of the questions asked.  The CDC states:

“This survey will ask potentially sensitive questions, such as the race/ethnicity of the respondent and the respondent’s diagnosis. This demographic information is necessary to analyze any consistent patterns among veterans’ race/ethnicity and psychological diagnosis, as well as with level of attachment to pets and the need for assistance animals for specific populations of veterans. This information will be used to inform assistance dog training organizations of the needs of veterans obtaining assistance dogs. It will also be a step toward understanding the idiosyncratic needs of veterans based on various psychological diagn[oses].”

The time to complete the survey is estimated by the CDC to be up to an hour, which may also discourage some. 

In order to overcome these and perhaps other unknown reasons for the poor response rate to date, the CDC is now seeking approval from the Office of Management and Budget to offer a $50 VISA gift card for veterans “completing all or portions of the survey.” 

Assistance Dog Providers Survey

The second survey the CDC is distributing is for assistance dog providers, about which the CDC appears confident it will get enough responses.  This survey “will be sent by email to approximately 1,000 service dog providers,” from which the CDC hopes to get 300 responses.  As of October 17, the CDC reports that 91 organizations had completed this survey.  Three hundred might seem like an optimistic number if one thinks only of organizations that train service dogs for veterans, but the agency defines assistance dogs rather broadly as a term including—

“service dogs, service animals, therapy dogs, visitation dogs, recreation support dogs, social therapy dogs, guide dogs, hearing dogs, seeing eye dogs, eye dogs, sight dogs, mobility dogs, mobility assistance dogs, balance dogs, disability dogs, hearing dogs, hearing ear dogs, signal dogs, psychiatric service dogs, PTSD dogs, anxiety dogs, emotional support dogs, skilled companion dogs, home help-mate dogs, companion dogs, court dogs, medic alert dogs, seizure alert dogs, seizure response dogs, diabetic alert dogs, autism dogs, detection dogs, facility dogs, facilitated service dogs, 3rd party dogs, READ dogs, high schooled assistance dogs, emergency response dogs, search & rescue dogs, career dogs, and police dogs.” 

This includes a great many types of trained and professional dogs.  Despite this all-encompassing approach, the current version of the survey instrument being sent to assistance dog organizations defines only four types of assistance dogs, as follows (in the wording and emphasis of the survey itself):
  • A service dog performs specialized skills directly related to the handler's disability. Service dogs meet the standards for public access as protected by the Americans with Disabilities Act (ADA).
  • A professional therapy dog is handled, utilized, or supervised by a health or human services professional in a therapeutic setting. Although they may have specialized skills, they are not service dogs or visitation dogs.
  • A visitation therapy dog provides support, comfort, and companionship to individuals in settings such as hospitals and nursing homes. They are not service dogs nor professional therapy dogs, and do not have public access rights.
  • A support dog provides emotional or physical support or assistance related to the handler's disability, usually only in the handler's home (they may have very limited public access rights). They are not service dogs, professional therapy dogs, or visitation therapy dogs.
For each of these four categories, organizations are asked how many and what percentage of dogs that enter the program end up performing the desired function and how many dogs are put in service annually.  For professional therapy dogs, the questionnaire asks “with which health and human services professionals have your professional therapy dogs been placed?” Respondents may choose from occupational therapists, physical therapists, psychologists, physicians or psychiatrists, counselors, nurses, social works, and other (please specify). 

The survey questionnaire seems to be based on a model that is most appropriate for a service dog training program, not for a certifying organization where dogs are trained by other individuals or groups and pass a qualifying test administered by the organization.  Visitation therapy dog respondents are not asked about what sorts of facilities the therapy dog teams are working in.  Since such information is gathered to varying degrees by the certifying organizations, the CDC may be missing an opportunity to learn more about where veterans are being offered animal-assisted activities and therapies. 

Value of Survey Information

The CDC’s primary aim in conducting the surveys is to gather information about how bringing dogs into the therapies and lives of veterans may help them find jobs and happiness.  It is apparently not the only reason, however, as the October 23 release states that it is “part of a larger project that will identify priorities and new opportunities for research, as well as address policy implications associated with public access rights afforded to service dogs by the Americans with Disabilities Act.”  Whether the CDC has an understanding with the Department of Justice to share results, or whether the DOJ has asked the CDC for input regarding possible changes to its access rules, is not clear.  The reference may not be specific to service dog access issues in any case.  It is curious that in defining a support dog, the CDC says that “they may have very limited public access rights.”  This could refer to travel and housing contexts, but the CDC could also be thinking that changes might be made to rules regarding transportation modes under control of the Department of Justice, e.g., taxis.   

Another possible area of change with regard to animal access might be hinted at in another type of function specifically defined by the CDC, the professional therapy dog.  The CDC says these dogs are neither service dogs nor visitation dogs, but does not mention whether they have access beyond that of pets.  This is the only specifically defined assistance dog type where access is not referred to in the CDC’s definition.  In Service and Therapy Dogs in American Society (p. 110), I mention one instance where a dog that might belong in this category had limited access under a state statute, but I know from personal communication with one researcher that there are those in those working in treatment facilities who believe that dogs involved in animal-assisted therapies should have access rights similar to service dogs.  For instance, in New York City, handlers of therapy dogs are often limited in the facilities they can visit by the lack of access to subways and buses.

The CDC expects the results of the Assistance Dog Providers Survey to help with research projects being conducted at West Virginia University and has asked that Dr. Joseph Scotti of the WVU Psychology Department to be named a collaborating investigator.  The submission to OMB also refers to Lindsay Parenti, of the same department, one of whose papers on the categorization of assistance animals I cited in a prior blog.

Conclusion

The CDC appears to be distancing itself from the VA’s policy of granting a single service dog umbrella organization a monopoly on who can provide service dogs for veterans.  The agency also recognizes that a comprehensive study of the benefits of dogs for veterans involves looking across a number of types of interactions veterans are having with dogs, from service dog pairings to companion animals to occasional interactions with therapy dogs. 

As I have noted previously, gradients of interaction and qualification must be taken into account before a determination can be made as to where public resources are best placed and before legal restrictions can be designed equitably.  Transferring authority to a private organization without understanding the complexities of how veterans can be given the best opportunities to be aided in what they face is irresponsible, yet amazingly enough the Army has followed the blind lead of the VA in this regard, and has kept a ban on dogs for PTSD.

Scientific results cannot be handicapped by expectations and still be scientific, but research on the benefits of dogs is generally tending towards a positive assessment of their ability to make many people with both physical and psychological disabilities more comfortable, and ultimately more successful.  Cures from animal interactions are rare and should not be a sole criterion for success.  The CDC is to be commended for looking at the complexities of the issue and trying to obtain input by those most in need of the psychological and physical benefits of human-animal interactions. The agency has also taken steps to get in contact with, and obtain information from, a broad range of stakeholders working with dogs and veterans.  By making some changes to the Assistance Dog Providers Survey, even more useful data could be obtained. 

West Virginia University has a website with both surveys posted. WVU specifically notes that providers and trainers of therapy dogs are being sought to complete the assistance dog survey.  Copies of documents may also be obtained from Leroy A. Richardson of the CDC, 1600 Clifton Road, MS–D74, Atlanta, GA 30333 or send an email to omb@cdc.gov.  Mr. Richardson can be reached directly at 404-639-7570.

Appendix: Email I sent to officials of the CDC and NIOSH:

Dear ....
I believe the Assistance Dog Providers Survey will provide important information to the Centers for Disease Control and Prevention regarding the effects that various types of interactions with animals, particularly dogs, are having on veterans and their ability to return to productive positions in society. I have not had the opportunity to review the Survey of Veterans and will not comment here on that other than to say that I believe the decision to add language to the flyer emphasizing that the survey was not created by the Department of Veterans Affairs is appropriate. 

As to the survey of Assistance Dog Providers, I will make several observations. First, in the interest of full disclosure, I am a member of a national therapy dog organization and have been visiting various facilities for six years with my therapy dog, which under your survey would be defined as a visitation therapy dog. Other than in my capacity as a member of a therapy dog organization, I do not represent that organization or any other organization, business, or individual involved in therapy dog work. Further, because I have written a book and maintain a blog on various professional dog issues, any direct representation of any of the organizations involved in service or therapy dog work could conflict with the objectivity of my reporting and I do not anticipate that I would have any such organizations as clients. 

I believe that obtaining information from training organizations will be helpful in assisting the CDC and other federal agencies to develop appropriate policies and in allocating resources for research projects and government-funded programs that will help veterans return to work.  I would argue, however, that there are organizations that could provide important information that may be overlooked or which may decline to participate because of the title of the survey and because of the focus of its questions.

As to the title of the survey, many people associated with the training  and certification of skilled dogs will assume that an “assistance dog” is either (1) a service dog, (2) a category of trained dogs that includes both service and emotional support dogs, (3) a dog that qualifies for living with an individual who has disabilities in a building, condominium, or community with a no-pets policy, or (4) a dog trained by a member of Assistance Dogs International, a national organization.  There are undoubtedly other meanings that could be found for “assistance dog” than these.  Anyone assuming that your use of the term fits in such a category will likely not be aware of your broad definition (0920-0985 REV Section A) which defines assistance dogs as including “service dogs, service animals, therapy dogs, visitation dogs, recreation support dogs, social therapy dogs, guide dogs, hearing dogs, seeing eye dogs, eye dogs, sight dogs, mobility dogs, mobility assistance dogs, balance dogs, disability dogs, hearing dogs, hearing ear dogs, signal dogs, psychiatric service dogs, PTSD dogs, anxiety dogs, emotional support dogs, skilled companion dogs, home help-mate dogs, companion dogs, court dogs, medic alert dogs, seizure alert dogs, seizure response dogs, diabetic alert dogs, autism dogs, detection dogs, facility dogs, facilitated service dogs, 3rd party dogs, READ dogs, high schooled assistance dogs, emergency response dogs, search & rescue dogs, career dogs, and police dogs.”  It is to be noted that this definition appears in a document that I obtained only by direct contact with the CDC and is not contained in either of the recent releases published in the Federal Register (September 9 and October 23).  Even if many of the types of specialized dogs listed in this definition will not be particularly relevant to veterans in their efforts to return to work, some types of dogs (e.g., therapy dogs) are regularly encountered by many veterans in residence, medical, and rehabilitation settings and organizations with information on those dogs may be helpful in providing the CDC with data and contacts.

The Assistance Dog Providers Survey as presently drafted defines four specific types of assistance dogs: service dogs, professional therapy dogs, visitation therapy dogs, and support dogs, and asks specific questions for providers of each of these types of dogs.  The questions seem to me to assume a model whereby an organization completing the form would be involved in the training of the dogs that may in time be deemed qualified to engage in a specific function.  While this may be true in many instances, there are also therapy dog certifying or registration organizations that qualify dogs trained by individuals and other training organizations by administering a test or tests the passing of which result in a handler and his or her dog receiving a certificate or registration document.  To my knowledge this is the primary method of operation of the major national therapy dog organizations. A question such as the following does not fit well within this model:  “Approximately what percentage of your dogs eventually become visitation therapy dogs?”  The dogs do not in any sense belong to the certifying organization or to the administrators of the tests.  Thus, they are not “your dogs.”  Nevertheless, if a dog passes the test or tests, the organization will keep records concerning the handler and the dog and will provide insurance for a handler operating within the organization’s guidelines.  The organization is also likely to know where the dog is making visitations as handlers are generally asked to submit reports on a regular basis or may receive referrals from the organization’s administrators. Such organizations are increasingly automated in their data collection and can likely provide information that could be useful to the CDC.  Thus, even if the organization finds out that its members are involved in work covered by the survey’s areas of inquiry, officials of the organization may not feel that the survey instrument can be appropriately filled out in its current form or may be deterred by the number of qualifications that would have to be inserted before many of the questions could be answered at all.  I would suggest that a relatively few changes could make the instrument more accessible in this regard.

Since you indicate that survey results “will lead to recommendations and guidance … pertaining to animal-assisted interventions …” (79 Fed. Reg. 63403), the inclusion of information from therapy dog organizations will be important in gathering data on animal-assisted activities and animal-assisted therapies involving veterans.  Since the database may well provide information that can be useful in further research efforts, therapy dog organizations could be useful in gathering data by answering questions such as the following:

  1. What percentage of your members visit facilities, such as hospitals, residence facilities, outpatient facilities, etc. where the word “Veteran” appears in the name of the facility?
  2. In the last year, how many of your members reported visiting facilities with “Veteran” in the name of the facility?
  3. What is the number of separate facilities with the word “Veteran” that were visited?
  4. What was the total time of your members’ visits to such facilities in the last year?  
  5. Are members of your organization required to take additional training in order to participate in animal-assisted therapies or other therapeutic interventions under the control of a medical or psychology professional?  

In addition to providing information from their own databases, therapy dog organizations might be willing to survey their members with additional questions that could either be collated by the organization or provided in some form that the CDC could itself work with.  Thus, members of the organization could be asked such questions as:

  1. How many facilities do you visit where U.S. veterans are in residence or regularly receive treatment?
  2. What types of facilities do you visit where you and your dog visit veterans: Hospitals? Nursing homes? Outpatient treatment centers? Etc. Etc.
  3. How long on average do you and your dog stay with a veteran during a visit to a facility?
  4. Do you and your dog participate in any structured therapeutic activities involving treatment of veterans?
  5. If you participate in any structured therapeutic activities involving veterans, is the activity under the direction of a psychiatrist or psychologist? A physical therapist?  An occupational therapist? Etc.

The granularity of the inquiries could provide a great deal of information nationally on the animal-assisted therapies and activities that might involve therapy dogs. Obviously, privacy issues would come into play here that will have to be considered in designing questions or providing cautions to participating members. 

It is also to be noted that many therapy dog handlers are in contact with veterans who do not have pets but have a history of pet ownership and could be an ideal source for disseminating information about the Veterans Survey. In visiting the hospital which is currently the primary focus of my therapy dog visitations, I meet veterans who wish to tell me about dogs they have owned when they lived independently. Finally, many therapy dog organizations and therapy dog handlers are regular users of various social media and could help spread the word to veterans about the importance of the survey you are distributing for them.    

I have been in contact with one national therapy dog organization (not, incidentally, the one to which I belong) and found that the head of the organization was unaware of your survey despite having many thousands of members, many of whom visit facilities where veterans can be found.  Such visitations may, to use your terminology, involve either professional therapy dogs or visitation therapy dogs. I believe that not designing the survey to assure the participation of such organizations amounts to a missed opportunity for the CDC.  Also, it means that a significant part of the spectrum of potential interactions between veterans and animals is likely to be missed and not adequately described from the current survey you are using to gather data on assistance dog providers.  

John Ensminger, Esq.