[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.
* * * * * * *