1. VHA Service Dog Benefits Everything you need to know
Joyce Edmondson, Guide and Service Dog Program
August 2018

2. Background and legal references
1961 Guide dogs for blind veterans
2001 Service Dogs for veterans hearing and mobility impaired veterans via public law
2009 VA may provide service dogs trained to aid veterans with mental illness to include PTSD via public law
An OIG report dated July 2010 performed at the request of congress shows deficiencies of the program and mandated some changes.
We have since “rolled them all together” into 38 CFR Service Dogs. This rule was effective October 5, 2012 and established a single authority relating to guide and service dog benefits by VA.

3. Benefits regulation-38 CFR 17.148
Pet insurance to ease the burden at medical centers of determining what is medically necessary for a dog.
Ease veterinarian payment concerns and the issues of becoming a accepted vendor to the government.
Travel for obtaining a dog. This was identified as a barrier for some who wanted service dogs and so the beneficiary travels regs were altered to allow any Veteran who is medically approved is eligible for travel benefit.

4. What does VHA provide ?
Under the regulations, (38CFR17.148) we will provide pet health insurance and travel to obtain and train with the new dog.
Prosthetic service provides the veterinary care via a contracted pet insurance policy. This is paid and managed centrally out of VACO. We also provide special leashes, harnesses and harness repairs as needed. PSAS pays for this locally at the station. The veteran must be eligible for service dog benefits in order to have harnesses.
Beneficiary travel pays for the travel to and from the dog organization and provides a perdiem.
Veterinary care is annual visits, immunizations, treatment of illness or injury as occurs. No grooming, kenneling or food unless RX food.

5. Insurance
Awarded to Trupanion, based out of Seattle. Start date was March 10, 2014 and we are now in our second contract. We and the Veterans have been very happy overall with the service received from Trupanion.
Once a 2641 is approved, we share the information with Trupanion on a twice monthly basis, the 10th and the 25th of the month. They provide the PSAS program office with a policy number and that is how the veteran can identify themselves.
Veterinarians who do not want to do third party billing are able to call a number from the back of the card and be paid over the telephone with a credit card from Trupanion
Veterinarians who expect the treatment to be several thousand dollars might want a certain percent down payment, Trupanion will accommodate them as well with the credit card.

6. Travel benefits
Veteran travel comes from the Beneficiary Travel Office (BTO), not PSAS.
BTO will purchase tickets for commercial travel but if Veteran is using a personal vehicle then the Veteran must submit mileage for reimbursement.
Per diem is provided at 50% of the government travel rate for the location traveling to and is REIMBURSED.
Medical center staff need to ensure that communication is given to BTO as they usually only know of travel based on a medical appointment.
MUST be pre- approved, so Veteran and provider should be discussing this prior to Veteran obtaining dog from you.

7. THIS IS AN INTERNAL VA REQUEST AND PROCESS
What is the process?
THIS IS AN INTERNAL VA REQUEST AND PROCESS
A VA provider must be involved and support the use of the dog as part of the Veterans treatment plan or rehab plan as it is sometimes called.
A VA provider MUST:
Complete the 2641 and provide information from medical record
Submit a consult to prosthetics in our electronic medical record
The documents gets scanned into the system and sent to VISN and then central office for review. Responses go back the same way.
Never too early to get approval – I can indicate that Veteran meets medical eligibility and will be eligible for travel and insurance once organization accepts- as long as ADI/IGDF accredited organization.

8. Why the 2641 process for guide dogs?
The need is two fold:
Agreed with OIG that we would treat all requests the same so that we would know volume of dog veteran teams.
Additionally, this is a method to track the volume, breed, location of the dog, etc for the pet insurance benefit.
We have found some cases of fraud and use the dog name, breed and date of birth as a way to verify/identify the dog.
Do hope to get an easier form approved.

9. How do help my Veteran make a request for veterinary benefits?
Provide your Veteran with clear documentation of the dog that can be shared by Veteran with prosthetics/medical center.
Dog name, breed and date of birth ( at least year)
If you are newly accredited and I didn’t approve your dog, I can once you are accredited if you verify that the dog was trained in accordance with the standards that you followed to get accredited.
**if this is a replacement dog, I only need the form with veterans demographic info and then the dog organization certificates or letters verifying the dog/veteran team.
You are welcome to share this information with Veterans.

10. Specific things to consider when providing a dog to a Veteran.
Consider the Veteran’s finances and travel distance to your organization.
While we have generous benefits we do not cover everything and the Veteran may not be financially stable enough to afford the travel to return for check ups. Remember the perdiem is reimbursed. It can be a burden for some Veterans.
Consider verification of finances and of medical issues claimed.

11. Mental Health Mobility Dogs
May 2016 – USH Shulkin expressed his interest in service dogs for Veterans with mental health diagnosis.
August 2016 – he sent a memo to VISN directors saying that we were going to allow Veterans with service dogs for mental health issues to receive service dog benefits as long as there is a connection to mobility. Either the Veteran has a mobility limiting diagnosis or the mental health issue impacts his/her mobility.
This impairment must be so severe and unremitting as to:
Significantly compromise the Veteran’s ability to conduct meaningful daily activities (such as employment, volunteerism, family caretaking, or creative endeavors), or
Maintain the autonomy, independence, and resources needed to participate in society, form and/or sustain meaningful relationships and supportive social networks.

12. MHMD as we call them
Yes even though Dr. Shulkin has left VA we are still working this process.
Heather Luper is collecting data and will continue to the total of 100 dogs that he called the “pilot”.
The PTSD service dog study is wrapping up and is expected to complete in roughly April Some time later that year the results will be released after provided as requested to the Institute of Medicine by the NDAA- National Defense Authorization Act of 2010.
VA will publicly publish after that point as soon as possible.

13. Questions