Sunday, September 23, 2012

Boots And Barkley American Beef Bully Sticks Recall



Kasel Associated Industries Recalls Boots & Barkley American Beef
Bully sticks Because of Possible Salmonella Health Risk



 
 Kasel Associated Industries of Denver, CO is voluntarily recalling its BOOTS & BARKLEY 6 COUNT 5 INCH AMERICAN BEEF BULLY STICKS product because it may be contaminated with SalmonellaSalmonella can sicken animals that eat these products and humans are at risk for salmonella poisoning from handling contaminated pet products, especially if they have not thoroughly washed their hands after having contact with the pet products or any surfaces exposed to these products.

Healthy people infected with Salmonella should monitor themselves for some or all of the following symptoms: nausea, vomiting, diarrhea or bloody diarrhea, abdominal cramping and fever. Rarely, Salmonella can result in more serious ailments, including arterial infections, endocarditis, arthritis, muscle pain, eye irritation, and urinary tract symptoms. Consumers exhibiting these symptoms after having contact with this product should contact their healthcare providers.

Pets with Salmonella infections may be lethargic and have diarrhea or bloody diarrhea, fever, and vomiting. Some pets will have only decreased appetite, fever and abdominal pain. Infected but otherwise healthy pets can be carriers and infect other animals or humans. If your pet has consumed the recalled product and has any of these signs, please contact your veterinarian.

The recalled American Beef Bully Sticks were distributed nationwide through Target retail stores from April through September 2012.

The product comes in a clear plastic bag containing 6 bully sticks marked with bar code number 647263899189. Kasel Industries is recalling all lot numbers because the following lot codes tested positive through analysis by the State of Colorado Department of Agriculture: BESTBY20APR2014DEN, BESTBY01JUN2014DEN, BESTBY23JUN2014DEN, and BESTBY23SEP2014DEN.

No illnesses have been reported to date in animals or humans in connection with this problem.

The recall was the result of a routine sampling by the State of Colorado Department of Agriculture which revealed that the finished products contained the Salmonella bacteria. The company has ceased the production and distribution of the product while FDA and the company continue investigating as to the source of the contamination. No other products made by Kasel Associated Industries are included in the recall.

Consumers who have purchased the 6 count 5 inch packages of Boots & Barkley American Beef Bully Sticks are urged to return it to the place of purchase for a full refund. Consumers with questions may contact Kasel Associated Industries at 1-800-218-4417 Monday thru Friday from 7am to 5pm MDT.    

Wednesday, September 19, 2012

So Which Dog Are You Going To Vote For In The 2012 Hero Dog Awards


Kristin Chenoweth To Host 2012 Hero Dog Awards Airing On Hallmark Channel November 8, 2012    
 

 
Emmy and Tony Award Winner to Lead Star-Studded Evening Honoring Courageous Canines


Hallmark Channel and American Humane Association announced today that popular television, film and Broadway star Kristin Chenoweth will host the 2012 American Humane Association Hero Dog Awards™, a star-studded evening honoring America's most courageous canines. The Hero Dog Awards, which are presented by the Lois Pope LIFE Foundation and produced by Emmy® award-winning MRB Productions, will air as a 90-minute special on Hallmark Channel November 8, 2012 at 8:00 pm ET/PT. The program will air as part of Hallmark Channel's Pet Project, the network's cross-platform campaign designed to celebrate the joy and enrichment animals bring to our lives.

"I am thrilled and honored to be a part of this unique program with American Humane Association," says Chenoweth, a passionate advocate for animals who founded her own charity, Maddie's Corner, to benefit shelter pets. "I was a judge at last year's Hero Dog Awards and am delighted to host the best and most heartwarming animal show on television."
"Kristin Chenoweth is one of my personal heroes," says American Humane Association President and CEO Dr. Robin Ganzert. "Not only is she a tremendous talent, beloved by millions of her stage, screen, and television fans, but she has a heart of gold when it comes to animal advocacy. As host for the top animal awards show in the country, she will help us capture the hearts of the nation and bring major support to the lifesaving programs that make a difference for millions of children and animals each year. She is a true heroine to them and America's noble hero dogs!"
"Kristin Chenoweth is an extremely talented and beloved stage and television personality, as well as a passionate advocate for the welfare of animals — making her the perfect choice for host of the 2012 'Hero Dog Awards,'" says Bill Abbott, President & CEO, Crown Media Family Networks. "Kristin will bring her signature warmth, compassion, and off-beat comedy to this year's show and I am positively delighted to welcome her to Hallmark Channel where she is sure to be a huge hit with our audience." 
Chenoweth joins a roster of celebrity supporters of the Hero Dog Awards, including special honoree Betty White, red carpet host Joey Lawrence and celebrity judges Whoopi Goldberg, Victoria Stilwell, Candy Spelling, Miranda LambertKristin Bauer Van StratenMichelle ForbesJ.R. MartinezTinsley Mortimer, and Megyn Price, among many others.
Two Million Ballots Cast for Nominees
Following nationwide voting in which more than two million ballots were cast by the American public, eight remarkable finalists were chosen, one winner in each of the following categories:  "Jynx" for Law Enforcement/Arson Dogs; "Holly" for Service Dogs; "Stella" for Therapy Dogs; "Gabe" for Military Dogs; "Tabitha" for Guide Dogs; "Soot" for Search and Rescue Dogs; "Tatiana II" for Hearing Dogs, and "Daniel" for Emerging Hero Dogs (ordinary dogs who do extraordinary things). These eight finalists will be flown to Beverly Hills with their human handlers, where they will walk the red carpet and be presented with a special Hero Dog award, following moving video tributes that bring their stories to life.  The evening will be capped off when one of the eight finalists will be announced as the winning American Hero Dog of the year.
Voting is currently underway at www.herodogawards.org, where a full list of the eight category winners, along with a summary of each dog's poignant story, can be found. 
Special thanks to MRB Productions for sponsoring the Hearing Dog category, Pfizer Animal Health for the Therapy Dog category, State Farm for the Law Enforcement/Arson Dog category and Trupanion for the Service Dog category.  Flying the heroes and their human handlers is JetBlue, and the airline's JetPaws program, the official airline of the American Humane Association Hero Dog Awards.
Emmy and Tony Award winner Kristin Chenoweth is an accomplished singer and actress of stage, television and film. She recently completed a North American concert tour featuring music from her latest album, "Some Lessons Learned," as well as an array of her most memorable songs and Broadway show tunes. She is known for her Tony Award-nominated turn as the original "Glinda," the good witch, in Broadway's "Wicked" and her show-stealing, Tony-winning performance in "You're a Good Man, Charlie Brown." She has received two Emmy Award nominations for her role as "April Rhodes" on the hit series GLEE. She won an Emmy for her role as "Olive Snook" on "Pushing Daisies." She also starred in "GCB" and will next be seen on "The Good Wife."

Saturday, September 15, 2012

Read The FDA Report On Jerky Pet Treats Made In China

FDA Investigates Animal Illnesses Linked to Jerky Pet Treats


September 13, 2012

What is the issue?Since 2007, the FDA has become aware of increasing numbers of illnesses in pets associated with the consumption of jerky pet treats. The majority of complaints involve chicken jerky (treats, tenders, and strips), but others include duck, sweet potato, and treats where chicken or duck jerky is wrapped around dried fruits, sweet potatoes, or yams.

The FDA has received approximately 2,200 reports of pet illnesses which may be related to consumption of the jerky treats. The majority of the complaints involve dogs, but cats also have been affected. Over the past 18 months the reports have contained information on 360 canine deaths and one feline death. There does not appear to be a geographic pattern to the case reports. Cases have been reported from all 50 states and 6 Canadian provinces in the past 18 months.

Although the FDA has been actively investigating the reports of illnesses, no definitive cause has been determined. The ongoing global investigation is complex, multifaceted and includes a wide variety of experts at the FDA including toxicologists, epidemiologists, veterinary researchers, forensic chemists, microbiologists, field investigators and senior agency officials.

In the past 10 years, there has been a dramatic increase in importation of pet food from China. Human consumption of poultry in China largely consists of dark meat, leaving a large amount of light meat poultry products available for export. From 2003, when China first approached the USDA about poultry exports, to 2011, the volume of pet food exports (regulated by the FDA) to the United States from

China has grown 85-fold (see table). It is estimated that nearly 86 million pounds of pet food came from China in 2011. Pet treats, including jerky pet treats are currently considered the fastest growing segment in the pet food market.

Dog and Cat Food Imports From China

What are the signs of the illnesses?The majority of the cases in dogs report primarily gastrointestinal signs, including vomiting and diarrhea, sometimes with blood and/or mucus, and can involve severe signs such as pancreatitis or gastrointestinal bleeding. The next most common signs relate to kidney function, including frequent urination, increased urine, severe thirst, kidney failure and some cases resemble a rare kidney related illness called Fanconi’s syndrome. Typically Fanconi syndrome is found in certain breeds of dogs that are pre-disposed to hereditary Fanconi syndrome (e.g. Basenji).

Progression of the investigation: What is being done about the problem? Since 2007, the FDA has been actively investigating the cause of illnesses reported in pets which may be associated with the consumption of jerky pet treat products. Beginning in 2007, samples of products – collected at import, at retail stores, and submitted by consumers and veterinarians -- have been tested by FDA laboratories, by the Veterinary Laboratory Response Network (Vet-LRN), and by other animal health diagnostic laboratories in the United States for multiple chemical and microbiological contaminants. The Vet-LRN program is currently focused on testing products that have been submitted by pet owners whose pets have experienced adverse effects following ingestion of the treats. In addition, starting in 2007, the FDA reached out through the veterinary community to solicit tissue samples (blood, urine, feces, necropsy, etc.) that have been associated with active jerky pet treat cases, but to date; none of the testing results have revealed the cause of the illnesses.

To date, product samples have been tested for contaminants known to cause the symptoms and illnesses reported in pets including, Salmonella, metals, furans, pesticides, antibiotics, mycotoxins, rodenticides, nephrotoxins (such as aristolochic acid, maleic acid, paraquat, ethylene glycol, diethylene glycol, toxic hydrocarbons, melamine, and related triazines) and were screened for other chemicals and poisonous compounds. DNA verification was conducted on these samples to confirm the presence of poultry in the treats. The FDA’s testing of jerky treat product samples for toxic metals including tests for heavy metals have been negative.

In 2011, samples were also submitted for nutritional composition, including fatty acids, crude fiber, glycerol, protein, ash and moisture and other excess nutrients. The purpose of nutritional composition testing is to verify the presence of ingredients listed on the label. To date, none of the testing results have revealed an association between a causative agent and the reported illnesses.

The FDA is now expanding its testing to include irradiation byproducts and is consulting with the National Aeronautics and Space Administration (NASA) experts to discuss this possibility further.

After increased complaints began in 2011, the FDA conducted five plant inspections in China during March and April 2012. These firms were selected for inspection because the jerky products they manufacture were identified with some of the highest numbers of pet illness reports. The FDA conducted the inspections to get a greater understanding of the manufacturing processes used to make the jerky pet treats and to see if this would help further the public health investigation. The FDA did identify that one firm falsified receiving documents for glycerin, which is an ingredient in most jerky pet treats. As a result of the inspection, the Chinese authority, the Administration of Quality Supervision, Inspection and Quarantine (AQSIQ), informed the FDA that it seized products at that firm and suspended exports of its products until corrective actions were taken by the firm.

The FDA has also reached out to U.S. pet food firms to enlist their help in this public health investigation and is seeking further collaboration on scientific issues and data sharing. No specific products have been recalled. However, if the FDA identifies the cause, or a recall is initiated, the Agency will notify the public.

What can pet owners do?The FDA is reminding pet owners that jerky pet treats are not necessary for pets to have a fully balanced diet, so eliminating them will not harm pets. Commercially produced pet food, which is very safe, contains all of the nutrients that pets need.

The FDA is advising pet owners who choose to feed their pets jerky pet treat products to watch their pets closely for any or all of the following signs that may occur within hours to days of feeding the products: decreased appetite; decreased activity; vomiting; diarrhea, sometimes with blood; increased water consumption and/or increased urination. If your pet shows any of these signs, stop feeding the jerky pet treat product. Owners should consult their veterinarian if signs are severe or persist for more than 24 hours, as it is important that your pet receive prompt medical attention. Blood tests may indicate kidney failure (increased urea nitrogen and creatinine). Urine tests may indicate Fanconi syndrome (increased glucose). Although most pets appear to recover, some reports to the FDA have involved pets that have died.

In addition, pet owners may want to continue to monitor information as it is posted by the FDA. The agency has continually updated the Questions & Answers document1 on its web site and will add information as it becomes available.

How can you help our investigation?
While your veterinarian will tend to your pet’s condition, you or your veterinarian can learn how to help the FDA’s Center for Veterinary Medicine (CVM) investigate your pet’s illness. Dr. Bernadette Dunham, director of CVM, shares how you can report a pet food illness on her blog2 from August 21, 2012. Cases of animal illness associated with pet foods can be reported electronically through the Safety Reporting Portal3, or by calling the FDA Consumer Complaint Coordinators in your state.

The information in this update reflects the FDA’s best efforts to communicate what it has learned from the manufacturer and the state and local public health agencies involved in the investigation. The agency will update the public as more information becomes available.

I don't know abouut you, but I wouldn't by any type of pet food from China for any of my pets.

Tuesday, September 11, 2012

Breeder's Choice Pet Food Recall


Breeder's Choice Pet Food Recalls AvoDerm Natural Lamb Meal & Brown Rice Adult Dog Formula Because of Possible Salmonella Health Risk



Breeder’s Choice Pet Food is recalling a single manufacturing batch of Breeder's Choice AvoDerm Natural Lamb Meal & Brown Rice Adult Dog Formula due to possible contamination with Salmonella. The product affected by this recall is identified below and has the following "Best Before" dates:

Product Code/SKU/ Material #UPC CodeSizeProduct Name/DescriptionBest Before Code (day/month/yr)
10000650740 5290702043 826 lb.AvoDerm Natural Lamb Meal & Brown Rice Adult Dog Formula28 Aug 2013
29 Aug 2013
30 Aug 2013

Product and product lots that do not appear on the list above are not subject to this recall.
Salmonella can affect animals eating the products and there is a risk to humans from handling contaminated pet products, especially if they have not thoroughly washed their hands after having contact with the products or any surfaces exposed to these products.
Healthy people exposed to Salmonella should monitor themselves for some or all of the following symptoms: nausea, vomiting, diarrhea or bloody diarrhea, abdominal cramping and fever. Rarely, Salmonella can result in more serious ailments, including arterial infections, endocarditis, arthritis, muscle pain, eye irritation, and urinary tract symptoms. Consumers exhibiting these signs after having contact with this product should contact their healthcare providers.
Pets with Salmonella infections may be lethargic and have diarrhea or bloody diarrhea, fever, and vomiting. Some pets will have only decreased appetite, fever and abdominal pain. Infected but otherwise healthy pets can be carriers and infect other animals or humans. If your pet has consumed the recalled product and has these symptoms, please contact your veterinarian.
No human or pet illnesses have been reported to-date. The recall notification is being issued based on a single manufacturing batch wherein a sample with the "Best Before" dates of August 28, 29 and 30, 2012 had a positive result for salmonella. The AvoDerm Natural Lamb Meal & Brown Rice Adult Dog Formula product was originally manufactured on August 29, 2012 and distributed on August 30 and 31, 2012. Salmonella testing was conducted by Silliker, Inc. (Southern California Laboratory). Breeder's Choice Pet Foods has taken immediate action to remove the product from all applicable distribution centers and retail customers, and is fully investigating the cause.
Recalled products were distributed to retailers and distributors in the states of California, Georgia, Illinois, Nevada, Virginia, and Washington.
Consumers who have purchased the AvoDerm Natural Lamb Meal & Brown Rice Adult Dog Formula product with the above-referenced "Best Before" dates are urged to contact Breeder's Choice Customer Service representatives.
A letter and instructions have been forwarded to all Breeder’s Choice Pet Food customers. Breeder’s Choice Customer Service representatives and company veterinarians are responding to inquires through the 1-866-500-6286 phone number and will answer any questions regarding pets that have been fed the product. Pet owners can also visit the Breeder’s Choice Pet Food website for more information http://www.avoderm.com/.

 Contact:
Consumer:
1-866-500-6286

Monday, September 10, 2012

So How Are The Special K-9 Elite Force Dogs Trained

Nat Geo WILD Greenlights 16-part Series "Alpha Dogs" From Executive Producers Jack Osbourne and Rob Worsoff  

 
Series Will Go Inside the Training of a Special K-9 Elite Force Dedicated to Serving Our Country

Nat Geo WILD Executive Vice President and General ManagerGeoff Daniels announced today that the network has greenlit the 16-part series Alpha Dogs, which follows the training behind a special elite force of K-9s dedicated to serving our country. Executive produced by Jack Osbourne and Rob Worsoff of Schweet Entertainment, LLC, each 30-minute episode gains exclusive access to the kennels and trainers at Indiana's Vohne Liche Kennels, one of the largest police-dog training facilities in the country.
The Alpha Dogs have jumped out of helicopters to capture Osama Bin Laden and have tracked Saddam Hussein. They're in police departments, the Secret Service and every branch of the military. Now Nat Geo WILD follows their stories — from first bite to finding the bomb.
"Alpha Dogs will focus on these highly trained dog heroes that have muscle and smarts," says Daniels. "Our viewers will love to see the incredible drills and exercises the dogs undergo, follow the instruction process with their dedicated trainers who carry top security clearances, see the application in the field for military and police units, and even watch the fun they have playing fetch on their days off."
Osbourne added, "We are excited to partner with Nat Geo WILD on this project and show everything from examining how the dogs are trained to detect drugs, weapons and improvised explosive devices to finding a hidden cell phone in a prison cell, to focusing on other real-world situations in everyday communities."
Alpha Dogs is produced for Nat Geo WILD by Schweet Entertainment, LLC. For Schweet Entertainment, LLC, executive producers are Jack Osbourne and Rob Worsoff. For Nat Geo WILD, executive producers are J-T Ladt and Ashley Hoppin, senior vice president of development and production is Janet Han Vissering, and executive vice president and general manager is Geoff Daniels.
About Nat Geo WILDFor more than 30 years, National Geographic has been the leader in wildlife programming.  The networks Nat Geo WILD andNat Geo WILD HD, launched in 2010, offer intimate encounters with nature's ferocious fighters and gentle creatures of land, sea and air that draw upon the cutting-edge work of the many explorers, filmmakers and scientists of the National Geographic Society.  Part of the National Geographic Channels US, based in Washington, D.C., the networks are a joint venture between National Geographic and Fox Cable Networks.  In 2001, National Geographic Channel (NGC) debuted, and 10 years later, Spanish-language network Nat Geo Mundo was unveiled.  The Channels have carriage with all of the nation's major cable, telco and satellite television providers, with Nat Geo WILD currently available in 56 million U.S. homes.  Globally, Nat Geo WILD is available in more than 100 million homes in 90 countries and 28 languages.  For more information, visit  www.natgeowild.com.

Wednesday, September 5, 2012

Department of Veterans Affairs Final Rule On Service Dogs for Veterans


Service Dogs for Veterans
[Federal Register Volume 77, Number 172 (Wednesday, September 5, 2012)]
[Rules and Regulations]
[Pages 54368-54382]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-21784

DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AN51

Service Dogs
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.

SUMMARY: The Department of Veterans Affairs (VA) amends its regulations
concerning veterans in need of service dogs. Under this final rule, VA
will provide to veterans with visual, hearing, or mobility impairments
benefits to support the use of a service dog as part of the management
of such impairments. The benefits include assistance with veterinary
care, travel benefits associated with obtaining and training a dog, and
the provision, maintenance, and replacement of hardware required for
the dog to perform the tasks necessary to assist such veterans.

DATES: Effective Date: This rule is effective October 5, 2012.

FOR FURTHER INFORMATION CONTACT: Lynnette Nilan, RN, MN, Patient Care
Services, (10P4), Veterans Health Administration, Department of
Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420, (406)
422-4476. (This is not a toll free number.)

SUPPLEMENTARY INFORMATION: On June 16, 2011, VA published in the
Federal Register (76 FR 35162) a proposed rule to amend VA regulations
to broaden and clarify current benefits to veterans with guide dogs,
and to establish new benefits related to service dogs. Pursuant to 38
U.S.C. 1714(b) and (c), VA may provide to veterans enrolled under 38
U.S.C. 1705 guide dogs trained for the aid of people who are blind and
service dogs trained for the aid of the hearing impaired or persons
with a spinal cord injury or dysfunction or other chronic impairment
that substantially limits mobility. Under section 1714(d), VA is also
authorized to provide certain travel expenses related to the provision
of such dogs.
    In 1961, VA promulgated 38 CFR 17.118(a) (recodified as current 38
CFR 17.154(a) in 1996) restating the statutory language, which at that
time limited VA's authority to the provision of guide dogs for blind
veterans. In 2001, Congress amended section 1714 to authorize VA to
provide service dogs for veterans with other disabilities. See
Department of Veterans Affairs Health Care Programs Enhancement Act of
2001, Public Law 107-135, title II, Sec.  201. This rule implements
that authority and establishes a single regulation relating to the
provision of guide and service dog benefits by VA.
    Interested persons were invited to submit comments to the proposed
rule on or before August 15, 2011, and we received 98 comments. All of
the issues raised by the commenters that concerned at least one portion
of the

[[Page 54369]]

rule can be grouped together by similar topic, and we have organized
our discussion of the comments accordingly. For the reasons set forth
in the proposed rule and below, we are adopting the proposed rule as
final, with changes, explained below, to proposed Sec.  17.148(b)(2),
(d), (d)(1)(ii), and (d)(3) and Sec.  17.154.

Definition of ``Service Dogs''

    Section 17.148(a) defines ``service dogs'' as ``guide or service
dogs prescribed for a disabled veteran under [Sec.  17.148].'' Multiple
commenters argued that this definition is circular, and further
contended that the omission of mental health impairments in Sec. 
17.148(b)(1) violates basic protections set forth in regulations
implementing the Americans with Disabilities Act of 1990 (ADA). See 28
CFR 36.104 (specifically recognizing service dogs trained to assist
individuals with mental impairments and defining ``service animal'' to
mean ``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''). These commenters advocated that VA should use the
definition of ``service animal'' set forth in the regulations
implementing the ADA. We make no changes based on these comments.
    The requirements in the ADA and regulations implementing the ADA
are applicable only to ``public entities,'' and Federal Government
agencies such as VA are not included in the ADA definition of a public
entity. See 42 U.S.C. 12131(1). Thus, the specific requirements set
forth in the ADA are not applicable to VA. Although this does not
prevent VA from adopting, through regulation, a definition of ``service
animal'' consistent with 28 CFR 36.104, it would be inappropriate to do
so for the purposes of the programs regulated by this rule. The ADA and
its implementing regulations exclusively address the issue of access to
public facilities by individuals with disabilities, whereas the purpose
of this rule is to authorize benefits to a veteran with a service dog.
Access is not discussed in Sec.  17.148 or Sec.  17.154. Conversely,
the ADA and its implementing regulations are neither controlling nor
informative with regard to the administration of benefits to veterans
with service dogs. The definition of ``service dogs'' in Sec. 
17.148(a) is reasonable because it is not overly broad for the purpose
of the rule, and is appropriate to effectuate Congressional intent. Cf.
38 U.S.C. 1714(c) (providing authority for 38 CFR 17.148 and
authorizing VA to ``provide service dogs trained for the aid of'' those
veterans with hearing impairments, mobility impairments, etc., but not
addressing access to VA facilities by persons accompanied by service
dogs). The concerns from commenters were that Sec.  17.148 ``reinvents
the wheel'' by establishing a new definition for a term that is already
defined in Federal regulation, and further that Sec.  17.148 was
unlawful under such regulation. However, as discussed above, the ADA
definition of ``service animal'' is not applicable, and also is not
helpful in determining the circumstances under which VA will provide
the benefits described in Sec.  17.148.
    Commenters asserted that VA should use the term ``assistance
animal'' instead of ``service dog'' because, they assert, the term
``service dog'' is understood more narrowly in the service dog industry
to refer only to those dogs that assist with mobility impairments,
whereas Sec.  17.148(a) defines ``service dogs'' to mean dogs that aid
with mobility impairments, visual impairments, and hearing impairments.
By contrast, commenters stated that ``assistance animal'' is an
industry term that encompasses dogs that assist with mobility, visual,
and hearing impairments, and in turn should be used by VA in Sec. 
17.148(a). We make no changes based on these comments.
    We disagree that every person in the service dog industry would
understand what an ``assistance animal'' is in the way described by the
commenter. Moreover, our regulations are written for a broader audience
than those who may own or train service dogs, to include VA employees
who administer benefits in accordance with our regulations. We believe
that ``assistance animal'' in fact could be interpreted to have
multiple colloquial meanings, and specifically may be likely to suggest
that VA will provide benefits for animals other than dogs. We do not
believe, as suggested by commenters, that our use of the term ``service
dogs'' to encompass guide dogs for visual impairments and service dogs
for hearing and mobility impairments would confuse veterans seeking
benefits under the rule. Most importantly, Sec.  17.148(a) clearly
defines the term and states that the definition therein applies ``[f]or
the purposes of'' Sec.  17.148. In applying for this benefit, veterans
would be expected to understand that the regulatory definition applies,
and not any other definition that may be set forth elsewhere or
understood in common parlance.

The Rule Does Not Deny Access of Any Service Dog to VA Health Care
Facilities

    Multiple commenters contended that the certificate requirement in
Sec.  17.148(c)(1) as proposed would violate their access rights under
the regulations implementing the ADA. See 28 CFR 36.302 (stating that
``[a] public accommodation shall not require documentation, such as
proof that the animal has been certified, trained, or licensed as a
service animal''). We reiterate that this rulemaking does not address
the issue of access to VA health care facilities by individuals
accompanied by service dogs, and will not be used to determine whether
a particular service dog will be allowed to enter a VA facility.
Comments that allege unlawful violations of access rights or raise
other issues relating to access to VA facilities, therefore, are beyond
the scope of this rule. Therefore, we make no changes based on these
comments. A certificate is required under Sec.  17.148(c)(1) only to
enable the veteran to receive service dog benefits, but is not required
to gain entry to VA facilities. This rulemaking does not permit or
prohibit the access of service dogs to VA health care facilities.
    Access to VA facilities by service dogs accompanying individuals
with disabilities is controlled by 40 U.S.C. 3103, which states:
``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.'' 40 U.S.C. 3103(a). The VA regulation that currently
controls the access of animals to VA facilities is found at 38 CFR
1.218(a)(11), and we are in the process of amending Sec.  1.218(a)(11)
to be fully compliant with 40 U.S.C. 3103(a).

The Exclusion of Benefits for Mental Health Service Dogs Is Not
Unlawful

    Multiple commenters asserted that the exclusion of benefits to
mental health service dogs is unlawfully discriminatory because it
creates a different standard for treatment options between those
veterans with mental health impairments and those veterans without
mental health impairments. One commenter specifically alleged that not
providing benefits for service dogs that mitigate the effects of mental
health illnesses, while providing benefits for service dogs that
mitigate the effects of

[[Page 54370]]

other impairments, may be a violation of Section 504 of the
Rehabilitation Act (Section 504). Section 504 provides:

    No otherwise qualified individual with a disability in the
United States, as defined in section 705(20) of this title, shall,
solely by reason of her or his disability, be excluded from the
participation in, be denied the benefits of, or be subjected to
discrimination under any program or activity receiving Federal
financial assistance or under any program or activity conducted by
any Executive agency or by the United States Postal Service.

29 U.S.C. 794(a).

    We agree that the benefits administered under this rule are subject
to Section 504, but disagree that not providing benefits for mental
health service dogs violates Section 504. VA is not restricting service
dog benefits based on disability. VA is providing benefits to both
physically and mentally disabled veterans for the same purpose, which
is to provide assistance for the use of a particular device (a service
dog) when a service dog is clinically determined to be the optimal
device to help a veteran manage a visual impairment, a hearing
impairment, or a chronic impairment that substantially limits mobility.
All veterans will receive equal consideration for benefits administered
for these service dogs, provided all other criteria in Sec.  17.148 are
met, regardless of accompanying mental health diagnosis. Veterans
diagnosed with a hearing or visual impairment will certainly not be
deemed ineligible for service dog benefits because they also have a
mental health impairment. We also note that mobility impairments under
Sec.  17.148 are not specifically limited to traumatic brain injuries
or seizure disorders in Sec.  17.148(b)(3). Some commenters
misinterpreted the rule to contain such a limitation and argued that
other mental impairment may produce mobility impairment. To clarify, if
a veteran's mental impairment manifests in symptoms that meet the
definition of ``chronic impairment that substantially limits mobility''
in Sec.  17.148(b)(3) and a service dog is clinically determined to be
the optimal device to manage that mobility impairment, then such a
veteran will be awarded service dog benefits. The rule does not prevent
such individualized assessments of veterans with mental health
impairments, as long as the service dog would be evaluated as a device
to mitigate the effects of a visual, hearing, or mobility impairment.
If this requirement is met, VA would not deny service dog benefits
simply because the service dog may also assist with mental impairment
that does not cause a limitation identified in Sec.  17.148(b).
    The rule prevents the administration of benefits for a dog to
mitigate the effects of a mental illness that are not related to
visual, hearing, or mobility impairments, but this restriction is not
discriminating based on the fact that a veteran has a mental
disability. This restriction is based on a lack of evidence to support
a finding of mental health service dog efficacy. In contrast, VA's
shared national experience has been to directly observe positive
clinical outcomes related to the use of service dogs and increased
mobility and independent completion of activities for veterans with
visual, hearing, and mobility impairments. Our observations are
bolstered by the existence of nationally established, widely accepted
training protocols for such dogs that enable the dogs to perform a
variety of tasks directly related to mitigating sensory and mobility
impairments (such as alerting to noise, opening doors, turning on light
switches, retrieving the telephone, picking up objects, etc.). We are
unaware of similarly vetted and accepted training protocols for mental
health service dogs, or how assistance from such dogs could be
consistently helpful for veterans to mitigate mental health
impairments.
    Although we do not disagree with some commenters' subjective
accounts that mental health service dogs have improved the quality of
their lives, VA has not yet been able to determine that these dogs
provide a medical benefit to veterans with mental illness. Until such a
determination can be made, VA cannot justify providing benefits for
mental health service dogs.
    Several commenters asserted that limiting Sec.  17.148 to veterans
diagnosed as having visual, hearing, or substantial mobility
impairments violates 38 U.S.C. 1714, which was amended in 2009 to
authorize VA to provide ``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.'' 38 U.S.C. 1714(c)(3). Though multiple commenters stressed
that this rule's exclusion of mental health service dogs violates 38
U.S.C. 1714(c)(3), we reiterate as stated in the proposed rule that
under the statutory language VA may provide or furnish a guide dog to a
veteran but we are not required to do so. See 38 U.S.C. 1714 (c)(1)-(3)
(noting that ``[t]he Secretary may, in accordance with the priority
specified in section 1705 of this title, provide'' [service dogs]). As
we explained in the proposed rule, this rulemaking expands part 17 of
38 CFR, which already addressed guide dogs for the blind, to now
authorize benefits for hearing disabled and substantially mobility
impaired veterans, because we have an adequate basis of clinical
experience and evidence to suggest service dog efficacy for veterans
with these impairments. Therefore, we make no changes based on the
above comments.

The Exclusion of Benefits for Mental Health Service Dogs Is Not
Unreasonable

    Commenters contended that VA is acting against its own practices in
administering benefits by requiring completion of a congressionally
mandated service dog study prior to determining whether to administer
mental health service dog benefits. Commenters asserted that while most
VA regulations only rely on medical judgment or medical need to justify
the provision of medical benefits, in this instance VA is without
reason requiring a higher standard of clinical evidence. As stated by
one commenter:

    VA's position that it can only act here in accord with a solid
scientific evidence base is not in accord with its own practice. In
most instances involving medical benefits, VA regulations rely
simply on medical judgment, ``medical need,'' or a determination
that providing the service is ``necessary.''

    This is not an accurate statement. Current VA regulations do not
discuss whether there is evidence to support the provision of a
particular therapy or treatment method, but this does not support the
inference that our regulations discount the need for evidence to
support the provision of such therapy or treatment. Indeed, if we
ultimately determine that mental health dogs are appropriate treatment
tools for mental health impairments, we will amend our regulations to
authorize benefits for such dogs. VA is currently evaluating the
efficacy of mental health service dogs, pursuant to the National
Defense Authorization Act for Fiscal Year 2010, Public Law 111-84,
Sec.  1077(a) (2009) (the NDAA), which states that ``the Secretary of
Veterans Affairs shall commence a three-year study to assess the
benefits, feasibility, and advisability of using service dogs for the
treatment or rehabilitation of veterans with physical or mental
injuries or disabilities, including post-traumatic stress disorder.''
All participants in this study are veterans with mental health
disabilities who are receiving service dog benefits similar to those
described in this rulemaking, but the service dogs for these veterans
assist specifically with the effects of mental illness.

[[Page 54371]]

Although the NDAA provided that effectiveness of dogs for physical
disabilities could additionally be evaluated in the study, we have
chosen to limit this study's focus to mental health disabilities.
However, we do not believe this limitation supports commenters'
assertions that VA is creating an unreasonable double standard with
regard to the need for clinical evidence, prior to administering
benefits for mental health service dogs. The NDAA study is limited to
veterans with mental health illness because VA has already determined
from a clinical standpoint that service dogs are effective for
assisting veterans with physical disabilities and mobility impairments.
Moreover, we believe that the use of the word ``or'' in the NDAA makes
the focus of the service dog study discretionary, and further that
Congress clearly intended that VA must specifically evaluate the
efficacy of mental health service dogs: ``The Secretary shall ensure
that at least half of the participants in the study are veterans who
suffer primarily from a mental health injury or disability.'' Public
Law 111-84, Sec.  1077(c)(4). There is no similar criterion in the law
to compel that any portion of the participants must be veterans who
suffer primarily from a physical injury or disability.
    Though many commenters asserted that there is sufficient clinical
evidence that VA could presently use to support administering mental
health service dog benefits, the only evidence submitted in support of
this assertion were anecdotal accounts of subjective benefits,
including: Decreased dependence on medications; increased sense of
safety or decreased sense of hyper-vigilance; increased sense of calm;
and the use of the dog as a physical buffer to keep others at a
comfortable distance. Again, we do not discount commenters' personal
experiences, but we cannot reasonably use these subjective accounts as
a basis for the administration of VA benefits. This is the precise
reason VA is currently gathering evidence in the NDAA study--to
determine how, exactly, service dogs may perform specific tasks or work
that mitigates the effects of mental health disabilities.
    Finally, we respond to multiple commenters' concerns with the
manner in which VA is currently conducting the mandatory NDAA study.
Essentially, these commenters stated that VA's conducting of the study
is unreasonable because either the methodology is flawed, or VA's
service dog organization partners in the study are inappropriate.
Particularly, commenters alleged that VA has partnered exclusively with
Assistance Dogs International (ADI) and ADI-accredited organizations in
conducting the study, and further that ADI is not a proponent of
psychiatric service dogs; such commenters accused VA of making adverse
determinations regarding the efficacy of mental health service dogs
before the study is complete. Generally, we find these comments to be
beyond the scope of this rule, because VA is not basing any decisions
in this rulemaking on any outcomes of the mandatory study, as the study
has not yet been completed. However, we will note that VA has not
partnered exclusively with ADI or ADI-accredited organizations to
conduct the mandatory study. All relevant Federal requirements
concerning research studies were followed by VA as relates to this
study; an abstract of the study to include listed eligibility and
exclusion parameters is available for public viewing at
http://clinicaltrials.gov/ct2/show/study/NCT01329341. Therefore, we make no
changes based on the above comments.

Service Dogs Must Be Certified by ADI or International Guide Dog
Federation (IGDF) for Veterans With Visual, Hearing, or Substantial
Mobility Impairments To Receive Benefits

    Multiple commenters argued that VA should remove the requirement in
Sec.  17.148(c) as proposed that a service dog complete ADI training
and be ADI certified before a veteran with a substantial mobility
impairment can begin receiving benefits under Sec.  17.148(d). These
commenters put forth many reasons in support of removing this
requirement, which we will specifically address in the following
discussion. We make no changes to the rule based on these comments. In
administering service dog benefits, VA must ensure that tested and
proven criteria regarding service dog training and behavior are in
place to ensure the integrity of the service dog benefits administered,
and the safety of veterans and others who might come in contact with
the veteran or the dog. There are no Federal standards for service dog
training that we can apply, and VA does not have the expertise to
design its own accreditation program or standards. ADI and IGDF are
national, industry-recognized organizations with established and proven
training criteria. Commenters offered many anecdotal observations
concerning the quality and reliability of non-ADI organizations to
train service dogs, but no commenters offered concrete, supportive
evidence to persuade us that there are any organizations other than ADI
or IGDF that have an established history and national credibility such
that they should be recognized in Sec.  17.148(c).
    The reliance on ADI and IGDF accreditation is no different than our
reliance on other nationally standardized criteria to ensure safe, high
quality health care across all settings. For instance, VA relies on the
Centers for Medicare and Medicaid Services (CMS) Resident Assessment
Instrument/Minimum Data Set as the comprehensive assessment for all
veterans in VA Community Living Centers (long term care facilities).
See Veterans Health Administration (VHA) Directive 2008-007. In
addition, VA requires States to rely on this tool for veterans in State
homes receiving per diem payments from VA for the provision of nursing
home care. See 38 CFR 51.110(b)(1)(i). Similarly, VA relies on and
enforces by regulation National Fire Protection Association (NFPA)
safety standards in all VA community residential care facilities,
contract facilities for outpatient and residential treatment services
for veterans with alcohol or drug dependence or abuse disabilities, and
State homes. See 38 CFR 17.63, 17.81(a)(1), 17.82(a)(1), and
59.130(d)(1). We rely on various private, State, and local
certifications concerning professional expertise. See, e.g., 38 CFR
3.352(b) (predicating aid and attendance allowance on need for care
from health-care professional licensed to practice by a State or
political subdivision thereof), Sec.  17.81(a)(3) (conditioning VA
authority to contract with residential treatment facilities that are
``licensed under State or local authority''), Sec.  17.900 (recognizing
certification of health care providers issued by, inter alia, The Joint
Commission as well as specified government organizations including
CMS). Thus, VA reliance on the recognized expertise of a public or
private organization is not uncommon, nor is it illegal or
questionable, so long as the basis for the reliance is well-reasoned
and articulated.
    Despite the negative comments that asserted that ADI is an
inefficient organization or is inadequate in some respects, other
commenters recognized that there are no other national organizations
that perform a similar function, and that there are very few
individuals who can accurately assess the quality of a service dog's
training. Some commenters praised ADI, stating that ADI certification
is ``the best route to go'' and that the requirement will ensure that
VA is not paying for dogs of ``questionable value to our vet[eran]s.''
If at some point in the future we discover an efficient way to assess
the quality of training provided by non-ADI

[[Page 54372]]

and non-IGDF dog providers, we will of course amend the rule; however,
at this time, ADI and IGDF accreditation is the best guarantee we have
that our veterans will be provided with safe, high quality service
dogs.
    We now specifically address comments that requiring certification
from an ADI-accredited organization effectively creates a sole source
contract, in violation of the general requirement for open and fair
competition in Federal Acquisition Regulations. See 48 CFR 6.101.
Multiple commenters further alleged that Sec.  17.148(c) as proposed
would violate a ``performance-based'' assessment requirement under
Federal Acquisition Regulations for service contracts, because it
emphasizes the source of service dog training rather than the result of
that training. See 48 CFR 37.600 et seq. Without discussing under what
circumstances VA may be permitted to enter into sole source contracts,
we clarify for commenters that VA is not contracting with ADI or IGDF
generally or with any ADI-accredited or IGDF-accredited organization to
purchase service dogs for veterans under this rule. There is no fiscal
conflict of interest or violation of Federal Acquisition Regulations
because the rule does not authorize any financial arrangement
whatsoever with ADI or IGDF.
    Multiple commenters stated that the ADI limitation in Sec. 
17.148(c) is inefficient and ineffective for veterans by asserting
that, compared to non-ADI organizations: There are not enough ADI-
accredited organizations around the United States to meet veteran
demand for service dogs; the cost to purchase ADI-certified service
dogs is prohibitive; and the wait to receive a service dog from an ADI-
accredited organization is too long. We make no changes based on these
comments.
    We acknowledge that not all States have registered ADI-accredited
or IGDF-accredited organizations; however, Sec.  17.148(d)(3) does
provide for the reimbursement of travel expenses associated with the
training a veteran must complete as offered by an ADI-accredited or
IGDF-accredited organization. Therefore, there will be no out of pocket
travel costs for veterans who must travel out of state to obtain a dog
after a service dog is prescribed. Thus, we do not believe the absence
of ADI-accredited or IGDF-accredited organizations in a particular
State will serve as a barrier to obtaining a service dog.
    Regarding the cost to obtain a service dog, we did not receive any
concrete evidence from commenters that non-ADI accredited or non-IGDF
accredited organizations are on average less expensive. Rather,
commenters offered anecdotal claims that non accredited organizations
are less expensive in some cases. A few commenters asserted that non-
ADI accredited and non-IGDF accredited providers have less overhead
costs because those organizations do not have to spend money to acquire
or maintain accreditation. The ADI accreditation fee is $1000.00 paid
every 5 years, with annual fees of approximately $50.00. The cost of
IGDF accreditation is a one-time fee of $795, with an annual fee of
$318 and a per unit fee of $39.45. We do not believe that these costs
would necessitate an increased cost being passed to veterans
specifically. ADI accreditation and IGDF accreditation are the only
reasonable means we have of ensuring that an organization is using
tested, standardized training and behavior criteria prior to a service
dog being placed with a veteran. We view the cost of ADI and IGDF
accreditation, therefore, as necessary and reasonable in order to
ensure that we administer benefits in a safe and consistent manner. We
clarify for one commenter that VA only intends to recognize those
service dog organizations that have full membership in ADI or IGDF, or
that are fully ADI or IGDF accredited, versus those organizations in
the process of becoming ADI or IGDF accredited. This is consistent with
our goal of ensuring VA only administers benefits for use of high
quality service dogs that were subject to standardized training
protocols.
    Regarding the wait time to obtain a dog, commenters did not provide
evidence to support that on average ADI-accredited organizations take
longer than non-ADI accredited organizations to place service dogs with
veterans. Many commenters instead provided anecdotal accounts of non-
ADI organizations not utilizing ADI-specific training, and in turn
training dogs faster than ADI organizations. Non-ADI organizations that
facilitate ``owner training'' were especially noted by commenters as
being faster and more effective for veterans, whereby the veteran would
directly train the service dog. Again, we do not believe that we should
administer benefits under the rule unless we can ensure that the
service dogs for which we pay benefits are all subject to the same set
of tested standards, to ensure safety and consistent quality. We do not
believe this level of safety and quality can be met without
accreditation based on nationally applicable criteria. This practice
follows the same process VA uses with every other product, device, or
treatment modality provided to our veterans.
    Some commenters argued that VA could use other nationally
recognized, performance based tests instead of requiring ADI
certification to demonstrate that service dogs are safe and
appropriately trained to mitigate effects of substantial mobility
impairments. These commenters stated that submission to VA of a service
dog's performance on a Public Access Test (PAT) or the American Kennel
Club's Canine Good Citizen (CGC) test, in combination with statements
indicating the level of the service dog's training and confirming the
dog's good health, would provide sufficient objective evidence that
service dogs are suitable for provision of benefits under the rule.
Nationally recognized temperament tests such as a PAT or the CGC may
indicate whether a service dog is stable and unobtrusive to the public
to justify access (and, again, Sec.  17.148 does not concern access),
but these tests do not communicate the level of a service dog's
specific training, or whether the service dog should be prescribed for
a veteran as an assistive device. An accompanying statement submitted
to VA that subjectively attests to a service dog's training is
similarly inadequate, as VA seeks to administer benefits uniformly
under the rule and therefore must ensure that all service dogs are
subject to the same performance based standards. We make no changes
based on these comments.
    One commenter expressed support of VA's decision to specifically
include seizure disorder as a covered impairment, and requested that VA
more clearly indicate in the final rule which tasks a service dog may
complete for such an eligible veteran. We reiterate that we require ADI
and IGDF certification specifically because VA does not have the
expertise, experience, or resources to develop independent criteria.
For this reason, we make no changes to the rule to provide specific
examples of tasks which any service dog may perform for a veteran. ADI
has developed training protocols for service dogs to complete work and
tasks for impairments as described in the rule, to include seizure
disorders.
    Finally, multiple commenters contended that VA could adopt
independent training programs to internally produce service dogs for
veterans, versus relying on certificates from external ADI-accredited
service dog organizations. One commenter stated that VA should initiate
an independent training program whereby veterans with post traumatic
stress

[[Page 54373]]

disorder (PTSD) participate in training service dogs for the intended
beneficiaries of this rule, i.e., veterans with visual, hearing, or
substantial mobility impairments. This commenter compared such an
internal training program to a program developed by the Denver VA
Medical Center and Denver VA Regional Office in 2009, called
``Operation Freedom,'' in which veterans assisted in advancing dogs
through CGC test training for 6 weeks as a component of the veterans'
mental health treatment plans. After completion of this 6 week basic
obedience training program, the dogs were trained by an external ADI-
accredited organization in a rigorous 7 month regimen to become service
dogs, and were placed with other veterans with disabilities. The
initial pairing of the dogs with veterans during basic obedience
training, as a treatment modality for mental health illnesses, provided
those veterans with opportunities in skills development and community
reintegration. Particularly, the program provided a bridge to community
involvement through a meaningful volunteer opportunity that served
other disabled veterans.
    Though VA is not opposed to such training opportunities as a
component of a treatment plan for a particular veteran, Operation
Freedom is not an example of an independent and internal training
program to train or produce service dogs for veterans. As the commenter
correctly stated, the dogs involved in Operation Freedom were actually
trained to become service dogs by an external ADI-accredited
organization, over an extended period of time and subject to ADI
standards as adopted and applied by that organization. We additionally
clarify that even the initial basic obedience training that veterans
assisted in providing to dogs was not provided on VA property, but
rather on the property of the ADI-accredited organization, because the
goal of Operation Freedom was to provide community reintegration
opportunities for participating veterans as part of those veterans'
treatment plans. The goal of Operation Freedom was ultimately not to
produce service dogs for veterans, and we therefore do not find this
example as provided by the commenter to be illustrative as to what VA
should enact with regards to independent and internal service dog
training programs. As stated previously, because VA does not have the
expertise, experience, or resources to develop independent training
criteria or otherwise train or produce service dogs for veterans, we
require that service dogs be trained and placed with veterans by ADI-
accredited and IGDF-accredited organizations. However, this in no way
limits any veteran's personal choice to undertake any training
experiences with any service dog organization, nor does it prevent VA
from conducting programs similar to Operation Freedom. The commenter
also noted potential cost savings for VA to conduct internal service
dog training programs that employ PTSD veterans, but as explained
earlier VA is not purchasing service dogs from ADI-accredited or IGDF-
accredited organizations, and such cost comparisons are therefore not
relevant. We make no changes based on the above comments.
    One additional commenter suggested that instead of requiring ADI
certification, that VA should hire professional service dog trainers to
join rehabilitation therapy departments (e.g., to join Occupational and
Physical Therapy departments) as VA staff, and that this would enable
VA to professionally train service dogs at a higher output and with
less cost than paying for ADI-certified service dogs. We make no
changes based on this comment, as such cost considerations are not
relevant because VA is not purchasing service dogs. VA does not have
the expertise, experience, or resources to develop independent training
criteria, and VA will not adopt or initiate internal training programs,
as this would effectively make VA act as a professional service dog
certifying body. VA's lack of expertise in this area is exactly why we
have mandated ADI or IGDF certification.

To Qualify for Benefits, a Service Dog Must Be ``Optimal'' for the
Veteran

    Under Sec.  17.148(b)(2), we require that the service dog must be
the ``optimal'' device for the veteran to manage his or her impairment
and live independently, and service dog benefits will not be provided
if other assistive means or devices would provide the same level of
independence as a service dog. Several commenters asserted that the use
of one assistive device does not necessarily obviate the need for other
assistive devices, and therefore that Sec.  17.148(c) as proposed
should not be used to exclude the prescription of a service dog if
other devices may assist the veteran. We agree in part with the
comments, but make no change to the regulation because the regulation
does not prevent veterans from using multiple assistive devices.
    For purposes of Sec.  17.148(b)(2), an eligible veteran may be
prescribed both a service dog and another assistive device, as long as
each provides a distinct type of assistance, or if, without each of the
devices, the veteran would be unable to complete tasks independently.
For instance, for a veteran with a mobility impairment that is
characterized by loss of balance and subsequent falls, both a balance
cane and a service dog might assist a veteran with balance and walking;
the cane might be optimal for assistance with walking, but the service
dog may be the optimal means for that veteran to regain a standing
position and stabilize after a fall. In such a case, the service dog
may be prescribed to the veteran, as well as the balance cane.
Similarly, a veteran with multiple impairments may be prescribed
assistive devices to assist with one impairment and a service dog to
assist with another. The ``optimal'' limitation in Sec.  17.148(b)(2)
will not limit the prescription of a service dog when necessary for the
veteran to manage the impairment and live independently, but it will
prevent the provision by VA of multiple assistive devices that serve
the same purpose. By avoiding duplication of benefits in this manner,
we maximize the amount of resources available to veterans and ensure
that benefits are provided in a responsible manner.
    Commenters stated that the ``optimal'' criterion in Sec. 
17.148(b)(2) as proposed would be used to ensure that service dogs are
prescribed as assistive devices only as a ``last resort.'' A service
dog is not a ``last resort'' in the sense inferred by the commenters.
VA will not use the ``optimal'' requirement in such a way as to deprive
any veteran of an assistive device that would best mitigate the effects
of a veteran's impairment and provide the veteran the highest level of
independence. The rule is designed, however, to promote the use of
service dogs only when it is clinically determined that other devices
will not adequately enable the veteran to live independently. This
rationale of promoting service dogs secondary to other assistive
devices is not without reason. A service dog is a long term commitment
that requires tremendous dedication and effort on the part of the
veteran, as well as significant costs--only part of which would be paid
for by VA under Sec.  17.148. A service dog must be fed, exercised,
groomed, nursed when ill, and integrated into the veteran's family as a
necessary partner in the veteran's daily life. If the extent of the
veteran's mobility impairment is such that the only tasks requiring
assistance are picking up or reaching items, then a device that is not
a service dog that fully accomplishes these tasks is not only
sufficient, but also is not unduly burdensome for the veteran. We

[[Page 54374]]

make no changes based on these comments.
    Commenters argued that the rule should contain additional criteria
that would objectively measure a veteran's level of independence
between different devices, instead of the single ``optimal'' criterion.
We believe, however, that because these are clinical determinations
based on ``medical judgment'' under Sec.  17.148(b)(2), additional
criteria are unnecessary and unhelpful. Therefore, we make no changes
based on these comments. It is clear in Sec.  17.148(b)(2) that
devices, including a service dog, will be clinically evaluated to
determine which are necessary and most beneficial for the veteran to
manage an impairment and live independently. We stressed the importance
of this clinical determination in the proposed rule:

    VA does not intend to allow cost or any other factors to
discourage the use of new technologies and equipment to maximize the
independence of veterans. We believe that providing VA with
discretion to choose between a service dog or assistive technology
based on medical judgment rather than cost-effectiveness would
ensure that VA's patients receive the highest quality of care that
the VA-system can provide.

76 FR 35163.

    One commenter additionally noted that the above rationale from the
proposed rule presumed that higher cost technologies offer a higher
standard of care. We clarify that the intent of this rationale was to
support VA's use of clinical judgment to determine what device allows
the veteran to function most independently, and not have such a
determination influenced by factors such as cost.
    Some commenters asserted that while another device may provide the
exact same functions in mitigating the effects of mobility impairments
as a service dog, service dogs nonetheless should be considered optimal
and be prescribed because they uniquely provide certain ancillary
benefits, including: Subjective feelings of increased personal comfort
and understanding; an increased sense of purpose for the veteran in
having to care for a living thing; an increased sense of self-esteem
and overall psychological well-being; and improved social and community
reintegration skills. We do not dispute these subjective accounts from
commenters; however, we believe Congress authorized VA to provide
service dogs to veterans with disabilities as a means of mitigating the
effects of a disability--and not for the purpose of companionship or
emotional support. Therefore, we make no changes based on these
comments. The authorizing statute links the provision of service dogs
to their having been trained ``for the aid of'' veterans with hearing
impairments, mobility impairments, etc.; the statute does not suggest
that ancillary benefits are to be considered. 38 U.S.C. 1714(c).
Therefore, Sec.  17.148 does not authorize benefits based on ancillary
benefits that service dogs may provide but that are not specific to
mitigating the effects of a veteran's disability, and which are not the
product of specific training. Though dogs may generally tend to
engender in their owners subjective feelings of improved well being,
this is not the intended effect of service dog assistance under 38
U.S.C. 1714(c) or Sec.  17.148.
    As proposed, the determination that the service dog is ``optimal''
for the veteran under Sec.  17.148(b)(2) was to be made by a VA
clinician using medical judgment. Multiple commenters objected to this
standard, for various reasons. Chiefly, commenters claimed that a VA
clinician would not have the requisite expertise related to service
dogs to properly compare their unique characteristics and benefits to
other assistive devices. Instead, these commenters asserted that the
decision-making process should involve either a local evaluation board
or interdisciplinary team, in which prosthetic staff and other
rehabilitative therapy staff is represented. We agree, and have amended
the first sentence of Sec.  17.148(b)(2) from the proposed rule to
require ``[t]he VA clinical team that is treating the veteran for such
impairment'' to assess whether it is appropriate to prescribe a service
dog for that veteran. The ``VA clinical team'' will include, by virtue
of being the clinical staff that is treating the veteran for the
qualifying visual, hearing, or mobility impairment, the veteran's
primary healthcare provider, and any other relevant specialty care
providers and professional staff, to include prosthetic and
rehabilitative therapy staff. Thus, the first sentence of Sec. 
17.148(b)(2) now reads: ``The VA clinical team that is treating the
veteran for such impairment determines based upon medical judgment that
it is optimal for the veteran to manage the impairment and live
independently through the assistance of a trained service dog.''
    We also recognize that ensuring that VA clinical staff is
knowledgeable regarding service dog utilization is critical to the
successful partnering of veterans with service dogs. VA is developing
and will disseminate educational tools and training opportunities that
will assist VA clinical staff to obtain this knowledge. In preparation
for the effective date of this rulemaking, we have drafted clinical
practice recommendations and have produced a video presentation for
dissemination to every VA health facility in the country. Both the
clinical recommendations and the video communicate to clinical staff
the traits, capabilities, tasks, and utility of service dogs for
mobility, hearing, and vision impairments. These and other training
materials will include professional education credits, so clinical
staff will have incentive to participate, and some training
opportunities will be required training for a veteran's clinical team
when it is necessary to determine if an assistive device is needed. The
training provided at local facilities will ensure the veteran's
treatment team will be qualified to evaluate between various assistive
means, to include understanding the abilities of service dogs, and then
be able to prescribe the most appropriate assistive device.
    Multiple commenters criticized the rule for disregarding the
expertise of service dog organizations. It is true that for a veteran
to receive benefits under the rule, a service dog must be prescribed by
the veteran's clinical team, and that decision is made without
consulting the service dog organization from which a veteran ultimately
obtains a service dog. However, the prescription of a service dog is a
treatment decision made by the VA clinical team that is treating the
veteran for the qualifying impairment, and we believe that consultation
with a private organization that has no clinical expertise as to the
medical treatment for a specific veteran is inappropriate. Therefore,
we make no changes based on these comments. At the same time, service
dog organizational expertise and experience are essential to the
process whereby a service dog is placed with a veteran. After a
clinical decision is made to prescribe a service dog, a service dog
organization will use its professional judgment to make independent
decisions concerning whether a service dog will actually be placed with
the veteran. The ADI-accredited or IGDF-accredited organization
conducts its own assessments based on national criteria and its
specialized experience in the field, and the veteran must complete the
service dog organization's evaluation and training before that
organization will match the veteran with a service dog and place that
dog in the veteran's home.
    VA's role in the service dog organization's assessment and
evaluation is purely supportive. For instance, VA will assist the
veteran with obtaining medical and psychological

[[Page 54375]]

reports and other documentation that the service dog organization may
request from VA (if approved for release by the veteran). VA will
additionally provide assistance to veterans in locating a service dog
organization, if requested. In response to one commenter, however, VA
will not formally refer veterans to specific ADI-accredited or IGDF-
accredited organizations, or initiate a process whereby a veteran may
consent to have VA act as an intermediary between the veteran and the
service dog organization. We believe such a referral system would blur
the distinct line that should exist between VA's responsibility to
determine whether a service dog may be clinically necessary for a
veteran, and the service dog actually being placed with the veteran.
The clinical practice recommendations and other guidance VA has
developed will alert VA staff to commonly available resources that
would aid the veteran in locating service dog organizations, and this
information could be provided to the veteran (e.g., the Web site to
find the nearest ADI-accredited or IGDF-accredited organization). VA
will additionally assist the veteran in obtaining medical information
the service dog organization may require.
    In response to the same commenter, VA will not develop a standard
form to be certified or otherwise completed by the service dog
organization, for the veteran to submit to VA under Sec.  17.148(c)(1)-
(2) to receive benefits. Instead, VA will accept a certificate as
required under Sec.  17.148(c)(1)-(2) in all forms as issued to the
veteran from the individual service dog organizations. Such
certificates must indicate that an adequate training program has been
completed to warrant receipt of benefits under the rule. VA's lack of
expertise in certifying whether appropriate training has been completed
is the precise reason VA has required ADI or IGDF certification for all
service dogs acquired on or after the effective date of the final rule.
    Some commenters stated that only the service dog organizations
themselves should be the designated decision makers under Sec.  17.148,
arguing that only these organizations could properly compare service
dogs to other assistive devices and determine what is the most
``optimal'' means to assist a veteran. We do not believe a service dog
organization would be so qualified, as they do not have the expertise
of licensed VA clinicians to clinically assess or treat a specific
veteran, nor do they have the clinical responsibility of VA clinicians
to evaluate assistive device options other than service dogs.
Additionally, as the benefits under the rule are to be administered
incident to a veteran's medical treatment, only the veteran's clinical
team may be designated decision makers regarding the initial clinical
assessment. Therefore, we make no changes based on these comments.
    Commenters asserted that having VA clinicians make the
determination whether a service dog is optimal discounts the veteran's
input into their own treatment options, and instead advocated that the
decision should be solely between the veteran and the service dog
organization. In keeping with VA's policy of providing patient centered
care, VA clinicians do not discount the input of veterans regarding
treatment options. As with any other medical care VA provides, the
prescription of a service dog for a veteran would be the recommended
course of treatment only after the veteran's clinical team considers
all relevant factors, to include veteran preference in treatment
options. A veteran's preference for a service dog, therefore, would
certainly be a factor in a determination to prescribe a service dog. We
make no changes based on these comments.

VA Is Not Purchasing or Otherwise Obtaining Service Dogs for Veterans
Under the Rule

    Several commenters objected to a basic premise in this rule, which
is that VA will assist veterans in determining whether a service dog is
an appropriate treatment option and will maintain service dogs through
the provision of veterinary and other benefits, but VA will not
actually purchase or obtain service dogs for veterans. We make no
changes based on these comments. As explained in the proposed
rulemaking, we reiterate that we interpret the ``may * * * provide''
language in 38 U.S.C. 1714(c) to mean that VA need not actually
purchase or acquire dogs for eligible veterans. 76 FR 35162. This is
consistent with VA policy, extant prior to the promulgation of this
rule, concerning guide dogs for the visually impaired; VA does not
purchase or obtain such dogs on behalf of veterans under the similar
authority (``may provide'') in 38 U.S.C. 1714(b). As stated previously,
we simply lack the facilities and expertise to purchase or obtain, or
to train service dogs for placement with veterans, and we will continue
to rely on independent organizations that have been recognized as
having such expertise. VA has opted instead to offer other benefits to
facilitate the provision of service dogs to veterans.
    One commenter asserted that VA purchases other ``devices'' for
veterans, and further that VA categorizes service dogs as ``devices,''
and therefore that this rulemaking must address how VA plans to
purchase service dogs for veterans from service dog organizations. We
make no changes based on this comment. The commenter did not specify
what type of ``devices'' VA purchases for veterans as a comparison to
service dogs, but we assume the intended reference was to prosthetic
devices or appliances that may be provided to certain veterans under 38
CFR 17.38 and 17.150. Although we have stated in this rulemaking that
we view a service dog as a surrogate for another assistive device, we
clarify that with regards to VA procurement policy, we do not treat
service dogs in the same manner as prosthetic devices that are
purchased for veterans. Unlike prosthetic devices that are provided by
VA to veterans at VA expense, the actual placement of a service dog
with a veteran is not VA's decision, and ultimately is not a clinical
decision--the actual placement is the decision of a service dog
organization, subject to that organization's own non-clinical
assessment and training standards. VA is unable to provide training and
fitting of a service dog for a veteran, as we provide for prosthetic
devices that are purchased for veterans, again because VA at this time
lacks this expertise.
    Notwithstanding VA's lack of expertise in purchasing or obtaining
service dogs to provide directly to veterans, several commenters
asserted that VA should cover a veteran's out of pocket costs to
independently purchase a service dog. We reiterate that the rule is
designed to support service dogs only when it is clinically determined
that other assistive devices will not adequately enable the veteran to
live independently, because a service dog is a long term commitment
that requires tremendous dedication and effort on the part of the
veteran, as well as potentially significant continuing costs for
veterans that will not be paid by VA (e.g., non-prescription food,
over-the-counter medications). VA will therefore not directly purchase
service dogs for veterans. VA will not potentially incentivize the
independent purchase of service dogs by veterans by creating an
expectation that the purchase costs will be covered.
    Another commenter asserted that VA should establish a ``fee for
service'' program to purchase service dogs for veterans, because such
remuneration would increase availability of service

[[Page 54376]]

dogs as well as decrease potential wait times for veterans to obtain
service dogs. We do not agree that the availability of service dogs
specifically for veterans is impeded by veterans' inability to cover
purchasing costs, because we understand that a majority of service dogs
are acquired by veterans with little or no out of pocket cost.
Therefore, we make no changes based on this comment. Additionally, we
do not believe that a veteran's inability to purchase a service dog
would contribute to any potential wait time for that veteran to obtain
a service dog. Rather, we believe that the only factors that would
contribute to potential wait times for veterans to obtain service dogs
would be the supply of trained and available service dogs, which is
unaffected by whether such dogs can be purchased or by whom.

VA Will Not Pay for Certain Expenses Under Sec.  17.148(d)(4)

    Commenters asserted that VA should pay for certain expenses
associated with a service dog that would be excluded under Sec. 
17.148(d)(4) as proposed. Specifically, commenters argued that VA
should pay for grooming, nail trimming, non-sedated teeth cleaning,
nonprescription medications, and nonprescription food and dietary
supplements, because commenters asserted that these services are
directly related to the dog's ability to provide assistive services,
and therefore should be considered covered by VA. See 76 FR 35164
(explaining that the restrictions expressed in Sec.  17.148(d)(4) are
present to ``ensure that the financial assistance provided by VA would
not be used to provide services that are not directly related to the
dogs' ability to provide assistive service.''). Commenters stated that
these excluded services are directly related to the dog's ability to
provide assistive services because they are either necessary to ensure
a service dog's longevity and reliable working service to the veteran,
or are necessary to maintain the higher standards of cleanliness
service dogs must maintain. We make no changes to the rule based on
these comments, but reiterate our general policy as stated in the
proposed rule that we regard the service dog as a surrogate for another
assistive device, and require that the veteran therefore utilize the
service dog responsibly and provide general care and maintenance. As
with prosthetic devices prescribed by VA, the veteran is expected to
maintain equipment by ensuring it is cared for, cleaned, serviced, and
protected from damage. In the case of prosthetic devices, VA repairs
broken equipment, and provides annual servicing and replacement parts
such as hearing aid batteries or oxygen tank refills, when needed. In
the case of a service dog, VA believes this equates to repairing and or
replacing harnesses or other hardware, providing annual and emergent
veterinary care, providing prescription medications, or paying for
other services when prescribed by a veterinarian. In the same way VA
would expect a veteran to protect and utilize his or her wheelchair in
order to keep it in good working condition, or keep his or her
prosthetic limb clean and functioning, VA expects that a veteran will
generally maintain the service dog with daily feeding, regular
grooming, and by covering any other expenses which are not clinically
prescribed by a veterinarian.
    Grooming and other excluded services in Sec.  17.148(d)(4) are
important for the general health of a service dog as an animal, and may
affect a service dog's ability to provide services. However, services
excluded in Sec.  17.148(d)(4) are not uniquely required by a service
dog to perform the work and specific tasks for which they were trained.
Services excluded in Sec.  17.148(d)(4) are general care and
maintenance services that all dogs require for general good health and
well being, and we therefore do not believe they are directly related
to the specific assistance provided by a service dog. For instance,
service dogs surely must have their nails maintained at an appropriate
length to prevent certain maladies and discomfort associated with
overgrowth or damage. However, the exact same need exists for
nonservice dogs as well, such that all dogs' general ability to walk
and maneuver is affected by maintenance of their nails. Unlike a
specialized harness provided by VA, nail grooming is not uniquely
required by a service dog to perform the work and specific tasks for
which they were trained, and hence is not covered under the rule. We
apply this same rationale for other items, such that VA will not pay
for standard, nonspecialized leashes and collars, or nonprescription
food or medications, or any other basic requirements mandated by State
governments for dog ownership generally, such as dog licenses. Again,
such standard needs are not unique to service dogs--it is for the
overall health and well being of all dogs as domestic animals that they
be adequately controlled by their owners, are routinely fed and kept
free of pests such as fleas and ticks, etc.
    Commenters stated that service dogs are subject to heightened
standards of cleanliness by virtue of being permitted access to public
areas, which in turn creates a greater need for grooming services.
Commenters asserted further that individuals with substantial mobility
impairments may not be able to complete necessary grooming to ensure
service dogs may gain access to public areas, and specifically stated
the inability of these individuals to complete grooming tasks would be
exacerbated by the fact that most ADI-certified dogs are large dog
breeds with long hair. However, we are not aware of any rules regarding
service dog access to public places that hold service dogs to
heightened standards of cleanliness that would not otherwise be
appropriate for a dog living in a home and assisting a disabled
veteran, nor did the commenters offer any specific examples of such
heightened standards. Nonetheless, we do not believe that an ADI-
accredited or IGDF-accredited service dog organization would place a
service dog with an individual who could not demonstrate an ability to
provide for the basic maintenance and care of the service dog, to
include required grooming sufficient to allow the dog access to a
public area. We make no changes based on these comments.
    A few commenters noted specifically that many of the services
excluded in Sec.  17.148(d)(4) as proposed are discounted for members
of the International Association of Assistance Dog Partners (IAADP),
and that VA should in turn pay for IAADP memberships for veterans with
approved service dogs. We make no changes to the rule based on these
comments. The sole cost savings associated with IAADP membership as
described by commenters was related to prescription medications, which
are covered under Sec.  17.148(d)(1)(ii). Additionally, because the
veteran must be generally responsible for expenses related to the
nonmedical daily care and maintenance of a service dog, the veteran
would also be responsible for membership in any organization that may
assist in covering such expenses. One commenter additionally advocated
for VA to initiate a service dog support group, and likened the
benefits of such a support group to the benefits individuals may
receive as IAADP members. For instance, the commenter suggested that
such a VA support group should have a membership requirement, and would
be a more cost effective way to use VA funds for service dogs as well
as promoting socialization and education. Although we do not disagree
with the commenter on the potential value of such a support group, we
make no changes to this rule based on the same rationale related to
IAADP membership as expressed above.

[[Page 54377]]

Benefits Will Not Be Provided for More Than One Service Dog at a Time

    Commenters asserted that a requirement in Sec.  17.148(d) as
proposed, that benefits would only be provided for ``one service dog at
any given time'' is too restrictive. Commenters stated that many
service dogs continue to live with veteran owners after being replaced
by a new service dog, and opined that the veteran should continue to
receive benefits to relieve the financial burden of continuing to care
for the retired service animal. We make no changes based on these
comments. A retired service dog would no longer be providing specific
assistance to the veteran to mitigate the effects of a disability, and
VA would therefore lack authority to continue to provide benefits to
the veteran based on his or her medical need for the service dog. To
the extent that keeping a retired service dog could be a financial
strain on a veteran, all ADI-accredited and IGDF-accredited
organizations offer the option for owners to place retired service dogs
in the homes of volunteers.
    Commenters also stated that the restriction of benefits to only one
service dog at a time does not properly consider the extended training
periods often required to obtain replacement service dogs, and will
create an undue lapse in service dog benefits for those veterans whose
current service dogs will soon be retired. Essentially, commenters
asserted that the restriction creates a costly choice for a veteran to
either apply benefits under the rule towards obtaining a replacement
service dog, or continue to have benefits apply to a current service
dog until it is officially retired. We agree that it is important that
veterans do not experience a lapse in service dog benefits when
obtaining a replacement service dog, and did not intend for the
limitation in paragraph (d) to cause such a lapse. Therefore, we have
added to paragraph (d)(3) the following note: ``VA will provide payment
for travel expenses related to obtaining a replacement service dog,
even if the veteran is receiving other benefits under this section for
the service dog that the veteran needs to replace.'' To emphasize this
clarification, we have added to the introductory text of paragraph (d)
a sentence to explain that there is an exception in paragraph (d)(3) to
the ``one service dog at any given time'' provision in the rule. This
exception will only apply to travel benefits under paragraph (d)(3),
because the organization that is training the replacement service dog
would be responsible for other benefits under Sec.  17.148(d) as needed
by the replacement dog, until the veteran actually acquires the
replacement dog from the organization. At the time the veteran acquires
the replacement service dog, the veteran would in effect be retiring
the former service dog, and would apply all service dog benefits under
this section to the replacement dog.

Service Dogs Obtained Before the Effective Date of the Final Rule

    Multiple commenters interpreted Sec.  17.148(c)(2) as proposed to
compel veterans who obtained non-ADI or non-IGDF certified service dogs
before the effective date of the final rule to undergo the
certification process with an ADI-accredited or IGDF-accredited
organization prior to being eligible for benefits. This is not the
intent or function of Sec.  17.148(c)(2), in all cases. The rule
clearly states that for veterans to receive benefits for service dogs
obtained before the effective date of the rule, veterans may submit
proof from a non-ADI or non-IGDF organization that the service dog
completed a training program offered by that organization. See Sec. 
17.148(c)(2) (explaining that it is only when a veteran may not be able
to attain such proof from a non-ADI or non-IGDF organization that
``[a]lternatively, the veteran and dog [could obtain the certification
from ADI or IGDF]''). We make no changes based on these comments.
    Commenters asserted that for previously obtained dogs, the final
rule must establish criteria in Sec.  17.148(c)(2) to allow VA to
determine whether the training courses certified by non-ADI or non-IGDF
organizations were adequate to produce a well trained dog capable of
assisting the veteran. We make no changes based on these comments. As
stated in the proposed rule, we do not have the expertise, experience,
or resources to develop independent criteria to assess the efficacy of
service dog training programs. Additionally, we do not want those
veterans with existing service dogs to be subjected to new requirements
which could prevent their receipt of benefits. Therefore, we accept a
certificate from a non-ADI or non-IGDF organization that existed before
the effective date of the final rule as proof that the veteran's
service dog has successfully completed an adequate training program,
and that a veteran who otherwise meets the criteria in the rule may
receive applicable benefits. Essentially, we are ``grandfathering in''
service dogs acquired before the effective date of the final rule by
not requiring such dogs to have ADI or IGDF certification.
    We further clarify for one commenter that the 1 year limitation in
Sec.  17.148(c)(2) to obtain a certificate that the veteran's service
dog has successfully completed an adequate training program only
applies if the certificate comes from the original non-ADI or non-IGDF
organization. The 1 year limitation is not applicable for a veteran who
must, because they cannot obtain a certificate from the original non-
ADI or non-IGDF organization, undergo new training with an ADI-
accredited or IGDF-accredited organization. See Sec.  17.148(c)(2)
(explaining that the 1 year limitation applies when a certificate is
obtained from a non-ADI organization, or ``[a]lternatively, the veteran
and dog [could obtain the certification from ADI or IGDF]''). We make
no changes to the rule text based on this comment because the language
is clear. In response to commenters' concerns that ADI-accredited
organizations will not certify service dogs that were not also
initially trained there, VA will ensure through continued workings with
ADI-accredited and IGDF-accredited organizations that there exists a
mechanism to provide for such certification.
    Lastly, one commenter advocated specifically that veterans who
currently receive VA benefits for guide dogs should not be required to
undergo the clinical determination process in Sec.  17.148(b)(2) to now
receive benefits under Sec.  17.148(d). We make no changes based on
this comment, as all veterans who would seek to receive benefits under
Sec.  17.148(d) must be subject to the same requirements, to ensure
equitable administration of benefits. However, we note that for any
veteran who is currently receiving guide dog benefits from VA, that
veteran has already undergone the same type of clinical evaluation to
determine efficacy of the dog, and would have a history of medical
documentation supporting the use of the dog as indeed the most optimal
device to manage the veteran's impairment. Effectively then, the
veterans already receiving guide dog benefits from VA would not be
subject to a new clinical evaluation process under Sec.  17.148(b)(2),
as this would be duplicative and unnecessary.

Procedures Related to Insurance Coverage and Payments

    Section 17.148(d)(1) as proposed would provide an insurance policy
to veterans with prescribed service dogs that guarantees coverage of
all veterinary treatment considered medically necessary. Commenters
urged that Sec.  17.148(d)(1) as proposed should

[[Page 54378]]

be revised for multiple reasons, with a majority of commenters stating
that certain processes involved in payment for veterinary care should
be clarified. Under Sec.  17.148(d)(1)(i), VA ``will be billed for any
premiums, copayments, or deductibles associated with the policy''
negotiated and offered by VA to veterans with prescribed service dogs.
VA will only pay premiums and other costs as specified in Sec. 
17.148(d)(1)(i) for the commercially available policy that VA provides
to the veteran, and not for any other policy that a veteran may obtain
independently. The insurance company that holds the VA-provided policy
will attain appropriate contractor status under Federal acquisition
standards by registering with the Central Contractor Registration (CCR)
to bill VA for costs specified in Sec.  17.148(d)(1)(i), and will be
subject to the same quality standards as other VA contractors.
    Multiple commenters stated that the type of insurance coverage that
VA would provide in Sec.  17.148(d)(1) as proposed was inadequate, as
all commercially available insurance policies for service dogs rely on
a reimbursement model whereby veterans would pay the out of pocket cost
for veterinary treatment, prior to filing a claim with and being
reimbursed by the insurance company. Commenters stated that VA should,
instead, establish a system where VA pays for treatment costs, such as
providing veterans with prescribed service dogs some type of debit card
to be used for veterinary care. The rule clearly states that VA, ``and
not the veteran,'' will be billed directly for all costs for which VA
is responsible under Sec.  17.148(d)(1)(i). The rule also states that
the policy will guarantee coverage for the types of treatment
determined by a veterinarian to be medically necessary in Sec. 
17.148(d)(1)(ii), but, as proposed, paragraph (d)(1)(ii) did not bar
billing a veteran for treatment costs. Our intent has always been to
negotiate and procure a contract, to the extent that is commercially
feasible, for an insurance policy that will not require the veteran to
pay any out of pocket costs for covered veterinary care and treatment
costs. VA has researched the commercial market and anticipates that VA
will be able to contract for this requirement on VA's terms. In
response to these comments and to further ensure that the regulation
effectuates our intent, we have revised the language of Sec. 
17.148(d)(1)(ii) from the proposed rule so that it bars the billing of
veterans for covered costs.
    Based on the foregoing, we do not believe that there is a need to
clarify any of the payment processes that are authorized by the
regulation or to provide in regulation any specific procedures that
will be established in accordance with the insurance policy for service
dogs, so long as the basic requirements in Sec.  17.148(d)(1) are met
concerning not billing veterans. For instance, this rule will not
specify that the insurance provider must be registered in the CCR,
because it is a requirement under separate Federal Acquisition
Regulations that all Federal contractors must be registered in CCR. See
48 CFR 4.1102.
    Commenters also criticized that typical insurance policies that
would be commercially available would not provide the scope of coverage
required to adequately care for a service dog, as the medical needs of
a service dog are higher due to the level of physical work a service
dog completes on a regular basis. We clarify that the rule intends that
VA will select a policy with broad coverage, to ensure that all
services which are likely to be considered medically necessary by a
veterinarian who meets the requirements of the insurer are in fact
covered. VA will consult with ADI, IGDF, and the American Veterinary
Medical Association to ensure that the most comprehensive policy,
specific to the needs of service dogs, is chosen. Additionally, in
response to commenter concerns that such a policy is not likely to be
accepted widely across the nation, VA will consider geographic
availability when choosing the policy.

Procedures Related to the Reimbursement of Veteran Travel Expenses

    Commenters argued that Sec.  17.148(d)(3) as proposed was vague
regarding reimbursement and eligibility for travel expenses, and should
more specifically indicate the type of travel expenses covered, to
include lodging and expenses related to training and retraining/
recertification of service dogs. We make no changes to the rule based
on these comments. The rule is clear in Sec.  17.148(d)(3) that any
veteran who is prescribed a service dog under Sec.  17.148(b) will be
eligible to receive payments for travel expenses. We reiterate from the
proposed rule that Sec.  17.148(d)(3) is intended to implement 38
U.S.C. 1714(d), ``which allows VA to pay travel expenses `under the
terms and conditions set forth in [38 U.S.C. 111]' for a veteran who is
provided a service dog.'' See 76 FR 35164. We believe that the language
of section 1714(d) can be read to interpret obtaining a dog as
``examination, treatment, or care'' under section 111, but we would not
make payment of section 1714(d) benefits contingent upon the separate
eligibility criteria in section 111. This interpretation facilitates
administration of section 1714(d) benefits by allowing VA to avoid
additional expenses associated with establishing a new means of
administering travel benefits outside of section 111 mechanisms.
    We clarify that all travel costs associated with obtaining the
service dog, to include all necessary initial and follow up training,
are covered. Additionally, all types of travel costs which are
considered reimbursable in 38 U.S.C. 111 and 38 CFR part 70 are
considered reimbursable in this rule, to include approved lodging.
    Commenters also indicated that VA should not require a prescription
for a service dog before authorizing travel reimbursement related to
procurement. We disagree and make no changes based on these comments.
We will pay travel benefits only if it is determined by the veteran's
clinical team that a service dog is appropriate under Sec.  17.148;
otherwise, we would be paying costs related to procuring an assistive
device that may not ultimately be approved for the veteran.

Only VA Staff May Provide, Repair, or Replace Hardware Under Sec. 
17.148(d)(2)

    Commenters asserted that the benefit to provide service dog
hardware under Sec.  17.148(d)(2) as proposed would be too restrictive.
Commenters stated that veterans should be reimbursed for payments made
to non-VA third party vendors to provide, repair, and replace such
hardware, instead of the current requirement that the hardware be
obtained from a Prosthetic and Sensory Aids Service at the veteran's
local VA medical facility. We make no changes to the rule based on
these comments. We believe that hardware should only be provided,
repaired, and replaced through VA, to ensure that our clinical and
safety standards are met. Merely reimbursing third-party providers does
not permit VA to oversee hardware provision to ensure that it is
``clinically determined to be required by the dog to perform the tasks
necessary to assist the veteran with his or her impairment,'' as
required in Sec.  17.148(d)(2). A clinical determination that covered
hardware must be task-specific for the type of assistance a service dog
provides is essential, or VA would be employing its professional
clinical staff to provide and repair common items related to dog
ownership generally, such as collars or leashes. The purpose of Sec. 
17.148(d)(2) is not to cover all equipment that a dog generally may
require, but rather to ensure that the veteran is not burdened in
finding, obtaining, or having to repair

[[Page 54379]]

or replace certain special hardware that a trained service dog requires
to provide specific assistance. We believe that allowing third party
vendors would also increase administrative burden for veterans, as this
would require the vendor to undergo a separate, extensive, and highly
regulated Federal process to identify, select, and utilize third party
vendors, which would cause an undue delay for veterans in obtaining
necessary hardware.

A Dog Must Maintain Its Ability To Function as a Service Dog

    Section 17.148(e) provides that for veterans to continue to receive
benefits under the rule, the service dog must continue to function as a
service dog, and that VA may terminate benefits if it learns from any
source that the dog is medically unable to maintain that role, or a
clinical determination is made that the veteran no longer requires the
service dog. A few commenters objected to the ``any source'' criterion
in Sec.  17.148(e), stating that VA should restrict sources of
information to a veteran's medical provider with regards to a veteran's
continued clinical need for the service dog, and to the service dog's
veterinarian with regards to the service dog's fitness to continue
providing assistance. We make no changes to the rule based on these
comments. We first clarify that VA will only consider the veteran's
clinical team as a source of information to determine whether the
veteran continues to require the service dog; this is contemplated in
paragraph (e), which states that ``VA makes a clinical determination
that the veteran no longer requires the dog.'' With regards to the
medical fitness of a service dog, VA must be permitted to receive
information from a broad number of sources in a continuous manner while
benefits are administered, for the safety of veterans and to ensure
that benefits are administered equitably. The ``any source'' criterion
as well reduces administrative burden for veterans, in that VA would
otherwise need to prescribe a specific and regular means of evaluating
whether a service dog has maintained its ability to function as a
service dog.
    The broad ``any source'' criterion in paragraph (e) does not mean
that VA will rely upon information from any source to terminate service
dog benefits without considering the source of the information, and
first allowing veterans to submit contrary information. The 30 days
notice prior to termination of benefits provided for in paragraph (e)
allows the veteran ample time to present contrary information, if VA
should receive information that a service dog is not able to maintain
its function as a service dog.
    Commenters additionally stated that VA should exclude any insurance
company with which VA contracts to cover veterinary care costs as a
source of information concerning the medical fitness of a service dog.
The commenters, however, did not provide a rationale for such an
exclusion. To the extent that the commenters may be concerned that an
insurance company would seek to have service dogs deemed medically
unfit to avoid excess expenditures, we do not believe any incentive
exists to do so. As we stated in the proposed rule, our understanding
is that annual caps on expenditures are a common limitation in
insurance policies that cover service dog care, and Sec. 
17.148(d)(1)(ii) specifically provides for such caps to be considered
in the administration of veterinary care benefits. We reiterate that VA
must be permitted to consider information from a broad number of
sources, and do not see any inherent reasons that this specific
limitation should be implemented. Therefore, we make no changes based
on these comments.

Appeals Procedures

    In response to commenter concerns that the rule does not detail an
appeals process for a veteran whose service dog benefits are to be
terminated, or for a veteran who is not prescribed a service dog and
cannot obtain service dog benefits, we do not believe VA must prescribe
a new appellate mechanism in this rulemaking. All decisions under this
rule, whether decisions to prescribe a service dog and initiate service
dog benefits, or decisions to terminate such benefits, are clinical
determinations and therefore subject to the clinical appeals procedures
in VHA Directive 2006-057. It is VHA policy under this appeals process
that patients and their representatives have access to a fair and
impartial review of disputes regarding clinical determinations or the
provision of clinical services that are not resolved at a VHA facility
level. This clinical appeals process will be sufficient to resolve
conflicts related to the provision or termination of service dog
benefits, without prescribing a new appellate mechanism in this
rulemaking.

Amendment of Proposed Sec.  17.154 To Include Term ``Veterans''

    One commenter requested that we further revise Sec.  17.154 as
proposed to delete the reference to ``ex-members of the Armed
Services'' and replace it with a reference to ``veterans.'' We agree
and have revised the language of Sec.  17.154 from the proposed rule to
read: ``VA may furnish mechanical and/or electronic equipment
considered necessary as aids to overcoming the handicap of blindness to
blind veterans entitled to disability compensation for a service-
connected disability.'' The term ``veteran'' has always been used in 38
U.S.C. 1714, and the regulatory term should follow the statute. In
other contexts, there may be a difference between an ``ex-member of the
Armed Forces'' and a ``veteran'' because the definition of ``veteran''
in title 38 of the United States Code requires discharge or release
from service ``under conditions other than dishonorable,'' 38 U.S.C.
101, whereas no such limitation would appear to apply to an ``ex-member
of the Armed Forces.'' In the context of 38 CFR 17.154, however, the
change does not alter the meaning of the regulation because Sec. 
17.154 refers to an ``ex-member'' who is entitled to service-connected
disability compensation and who, therefore, must be a veteran (because
such compensation is offered only to veterans discharged or released
under conditions other than dishonorable).

The Estimated Number of Respondents per Year

    The proposed rule estimated that 100 new service dogs would be
provided to veterans each year. Multiple commenters objected to this
statement, asserting that this number was far too low of an estimate,
and further was not a reflection of veteran need for service dogs but
rather a reporting of the number of service dogs that ADI could
feasibly provide to veterans each year. The estimated burden of 100 is
not an estimate of the number of veterans who may need a service dog.
Rather, this number is an estimate of the number of new veterans each
year that VA expects to present a certificate showing successful
completion of training in order to establish a right to obtain benefits
under Sec.  17.148(d). This number was based on the number of veterans
who sought to receive new guide dog benefits in fiscal year 2010 under
Sec.  17.154 (2010), which was 66, plus an additional number of
veterans we estimated who would seek to receive new Sec.  17.148
service dog benefits for hearing and mobility impairments. We estimated
the number of veterans who would seek new Sec.  17.148 benefits as a
one third increase over confirmed guide dogs for which VA provided
benefits the previous fiscal year, and based upon a projection for
multiple fiscal years, we arrived at 100 new veterans each year seeking
benefits under Sec.  17.148. The estimated number of respondents is
not, as theorized by commenters, based on

[[Page 54380]]

the anticipated supply of service dogs that could be provided annually
by ADI-accredited organizations.
    Other commenters asserted that the number of estimated respondents
at 100 was underreported in the proposed rule for financial reasons, or
that VA could only afford to purchase 100 dogs per year for veterans.
We reiterate that under the rule, VA is not actually purchasing the
service dogs from any ADI-accredited or IGDF-accredited service dog
organization, and we have no financial motive to underreport the
estimated number of respondents.

The Estimated Total Annual Reporting and Recordkeeping Burden

    Multiple commenters asserted that the proposed rule underreported
the expected burden time on veterans to complete necessary
administrative requirements to receive benefits under the rule. We
clarify that the burden time of less than 5 minutes as stated in the
proposed rule only contemplates the submission by the veteran of the
certification from the service dog organization that indicates certain
training requirements have been met, as required by Sec.  17.148(c).
The burden time does not reflect any of the time required for VA to
conduct its clinical evaluation to determine whether a service dog
would optimally benefit a veteran, nor the independent assessments that
a service dog organization conducts thereafter to place a service dog
with a veteran. Such time is not part of the veteran's burden to
respond to our collection by submitting a certificate. We have
intentionally kept paperwork to a minimum in obtaining this benefit
because veterans in need of service dogs are generally seriously
disabled and because veterans applying for these benefits will already
be enrolled in the VA health care system.

This Regulatory Action Is Not Significant Under Executive Order 12866,
and Would Not Have a Significant Economic Impact on a Substantial
Number of Small Entities

    One commenter alleged that the rule should be considered
significant under Executive Order 12866, because by limiting the source
of service animals to ADI-accredited or IGDF-accredited organizations,
VA effectively creates a sole-source contract with those agencies that
will have a major impact on the service animal industry. We interpret
this commenter's statement to mean that because they believe VA will be
purchasing guide and service dogs, that such purchasing will adversely
affect in a material way the nature of competition with non-ADI and
non-IGDF organizations. We reiterate that VA will not be contracting
with any ADI or IGDF organization to actually purchase guide or service
dogs, and make no changes to the rule based on this comment.
    Multiple commenters argued that the rule would have a significant
economic impact on a substantial number of small service dog
organizations that are either ineligible for membership in the
identified accreditation groups because they do not qualify for tax-
exempt status (in the case of ADI accreditation), or because they
cannot afford the costs and effort that accreditation entails. We
assume that commenters believe that VA will be purchasing the service
dogs, and therefore that these nonaccredited organizations would be
economically disadvantaged unless they comply with the rule's
accreditation requirements. As VA will not be actually purchasing
service dogs, we do not believe any non-ADI or non-IGDF organization,
as small entities, would experience a significant economic impact. This
rule does not prevent individuals from acquiring service dogs from any
organization, but only establishes criteria that must be met if VA is
then going to provide certain benefits related to those service dogs.
    We acknowledge that we require all service dogs obtained after the
effective date of the rule to be ADI or IGDF certified, and as such
veterans may opt to seek the assistance of ADI or IGDF organizations
over other nonaccredited organizations in obtaining such dogs. However,
there is no indication that nonaccredited organizations rely on
veterans as an essential part of their business. In fact, multiple
commenters who themselves were nonaccredited organizations, and who
objected to the ADI accreditation standard in the rule, reported
providing service dogs to veterans free of charge. There is no evidence
to suggest that a substantial number of nonaccredited service dog
organizations will be detrimentally affected by a financial incentive
for veterans to seek to obtain service dogs from accredited service dog
organizations. Even if a substantial number of nonaccredited service
dog organizations significantly rely on veterans to buy their service
dogs, there is also no evidence to suggest that the cost of obtaining
ADI or IGDF certification is beyond the reach of a substantial number
of non-accredited organizations.
    Commenters questioned the reasoning in the proposed rule for our
belief that most service dog providers that provide dogs to veterans
are already accredited by ADI or IGDF. See 76 FR 35166. Based on
multiple commenters who themselves were non-ADI service dog
organizations and who did provide service dogs to veterans, we retract
the rationale that ``[w]e believe that most service-dog providers that
provide dogs to veterans are already accredited in accordance with the
final rule'' and also retract the accompanying statement that ``[t]he
vast majority of accredited programs do not provide dogs to veterans.''
However, in view of our conclusion that gaining accreditation should
not result in a significant financial burden as explained in the
proposed rule notice, 76 FR 35166, this does not change our analysis
that the rule does not have a significant economic impact on a
substantial number of small entities.

VA Will Not Newly Initiate Proposed or Formal Rulemaking Procedures

    Multiple commenters stated that VA should abandon this rulemaking,
and that it should begin again with a new proposed rule. One commenter
further stated that VA should initiate a public hearing, or should
initiate formal rulemaking procedures related to the administration of
service dog benefits. We decline to pursue either of these actions, as
all affected parties were put on proper notice of the intended
provisions in the proposed rule, and there were no significant reasons
that commenters put forward to require a new regulatory action that
were not addressed in this final rule. We believe we have addressed all
significant comments and made changes where appropriate, or have
reasonably supported why changes were not made.
    For all the reasons noted above, VA is adopting the proposed rule
as final with changes as noted to Sec.  17.148(b)(2), (d), (d)(1)(ii),
and (d)(3) and Sec.  17.154.

Effect of Rulemaking

    Title 38 of the Code of Federal Regulations, as revised by this
rulemaking, represents VA's implementation of its legal authority on
this subject. Other than future amendments to this regulation or
governing statutes, no contrary guidance or procedures are authorized.
All existing or subsequent VA guidance must be read to conform with
this rulemaking if possible or, if not possible, such guidance is
superseded by this rulemaking.

Paperwork Reduction Act

    This final rule at Sec.  17.148 contains new collections of
information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-
3521). On June 16, 2011, in a proposed rule published in

[[Page 54381]]

the Federal Register, we requested public comments on the new
collections of information. We received multiple comments in response
to this notice. A majority of the commenters alleged the collection was
an illegal restriction of the access rights of individuals with
disabilities. The response, as also stated in the preamble to this
final rule, is that a certificate showing adequate service dog training
is not necessary to gain access to VA facilities, but rather is only
necessary to receive benefits under this rule. Some commenters stated
that the number of respondents for this collection was underreported,
because more than 100 veterans need service dogs each year. The
response, as also stated in the preamble to this final rule, is that
the estimated burden of 100 is not an estimate of the number of
veterans who may need a service dog, but rather is an estimate of the
number of new veterans each year that VA expects to present a
certificate showing successful completion of training to obtain
benefits. Finally, some commenters asserted that the expected burden
time for this collection was underreported. The response, as also
stated in the preamble to this final rule, is that the burden time of
less than 5 minutes only contemplates the submission of the required
certificate, and does not reflect any of the time required for VA to
conduct its clinical evaluation to determine if a service dog would
optimally benefit a veteran, nor the independent assessments that a
service dog organization conducts thereafter to place the service dog
with the veteran. Therefore, we make no changes to this collection.
    The Office of Management and Budget (OMB) has approved the
additional collections in part 17 under OMB Control Number 2900-0785.
We are adding a parenthetical statement after the authority citations
to the section in part 17 for which new collections have been approved
so that the control number is displayed for each new collection.

Regulatory Flexibility Act

    The Secretary hereby certifies that this final rule will not have a
significant economic impact on a substantial number of small entities
as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601-
612. We do not believe that gaining accreditation should result in a
significant financial burden, as the standards for approval by ADI and
IGDF are reasonable thresholds that are generally expected and accepted
within the industry. The approximate cost to be an accredited
organization by IGDF is a one-time fee of $795, with an annual fee of
$318 and a per unit fee of $39.45. The approximate cost to be an
accredited organization by ADI is $1000 every 5 years with annual fees
of approximately $50. Therefore, pursuant to 5 U.S.C. 605(b), this
final rule is exempt from the initial and final regulatory flexibility
analysis requirements of sections 603 and 604.

Executive Orders 12866 and 13563

    Executive Orders 12866 and 13563 direct agencies to assess the
costs and benefits of available regulatory alternatives and, when
regulation is necessary, to select regulatory approaches that maximize
net benefits (including potential economic, environmental, public
health and safety effects, and other advantages; distributive impacts;
and equity). Executive Order 13563 (Improving Regulation and Regulatory
Review) emphasizes the importance of quantifying both costs and
benefits, reducing costs, harmonizing rules, and promoting flexibility.
Executive Order 12866 (Regulatory Planning and Review) defines a
``significant regulatory action,'' which requires review by the OMB, as
``any regulatory action that is likely to result in a rule that may:
(1) Have an annual effect on the economy of $100 million or more or
adversely affect in a material way the economy, a sector of the
economy, productivity, competition, jobs, the environment, public
health or safety, or State, local, or tribal governments or
communities; (2) Create a serious inconsistency or otherwise interfere
with an action taken or planned by another agency; (3) Materially alter
the budgetary impact of entitlements, grants, user fees, or loan
programs or the rights and obligations of recipients thereof; or (4)
Raise novel legal or policy issues arising out of legal mandates, the
President's priorities, or the principles set forth in this Executive
Order.''
    The economic, interagency, budgetary, legal, and policy
implications of this final rule have been examined and it has been
determined to not be a significant regulatory action under Executive
Order 12866.

Unfunded Mandates

    The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C.
1532, that agencies prepare an assessment of anticipated costs and
benefits before issuing any rule that may result in an expenditure by
state, local, and tribal governments, in the aggregate, or by the
private sector, of $100 million or more (adjusted annually for
inflation) in any given year. This final rule will have no such effect
on state, local, and tribal governments, or on the private sector.

Catalog of Federal Domestic Assistance Numbers

    The Catalog of Federal Domestic Assistance numbers and titles are
64.009 Veterans Medical Care Benefits, 64.010 Veterans Nursing Home
Care, and 64.011 Veterans Dental Care.

Signing Authority

    The Secretary of Veterans Affairs, or designee, approved this
document and authorized the undersigned to sign and submit the document
to the Office of the Federal Register for publication electronically as
an official document of the Department of Veterans Affairs. John R.
Gingrich, Chief of Staff, Department of Veterans Affairs, approved this
document on July 30, 2012, for publication.

List of Subjects in 38 CFR Part 17

    Administrative practice and procedure, Alcohol abuse, Alcoholism,
Claims, Day care, Dental health, Drug abuse, Foreign relations,
Government contracts, Grant programs--health, Government programs--
veterans, Health care, Health facilities, Health professions, Health
records, Homeless, Medical and dental schools, Medical devices, Medical
research, Mental health programs, Nursing homes, Philippines, Reporting
and recordkeeping requirements, Scholarships and fellowships, Travel
and transportation expenses, Veterans.

    Dated: August 30, 2012.
Robert C. McFetridge,
Director of Regulation Policy and Management, Office of the General
Counsel, Department of Veterans Affairs.
    For the reasons stated in the preamble, VA amends 38 CFR part 17 as
follows:

PART 17--MEDICAL

0
1. The authority citation for part 17 continues to read as follows:

    Authority: 38 U.S.C. 501, and as noted in specific sections.


0
2. Add Sec.  17.148 after the undesignated center heading ``PROSTHETIC,
SENSORY, AND REHABILITATIVE AIDS'', to read as follows:


Sec.  17.148  Service dogs.

    (a) Definitions. For the purposes of this section:
    Service dogs are guide or service dogs prescribed for a disabled
veteran under this section.
    (b) Clinical requirements. VA will provide benefits under this
section to a veteran with a service dog only if:

[[Page 54382]]

    (1) The veteran is diagnosed as having a visual, hearing, or
substantial mobility impairment; and
    (2) The VA clinical team that is treating the veteran for such
impairment determines based upon medical judgment that it is optimal
for the veteran to manage the impairment and live independently through
the assistance of a trained service dog. Note: If other means (such as
technological devices or rehabilitative therapy) will provide the same
level of independence, then VA will not authorize benefits under this
section.
    (3) For the purposes of this section, substantial mobility
impairment means a spinal cord injury or dysfunction or other chronic
impairment that substantially limits mobility. A chronic impairment
that substantially limits mobility includes but is not limited to a
traumatic brain injury that compromises a veteran's ability to make
appropriate decisions based on environmental cues (i.e., traffic lights
or dangerous obstacles) or a seizure disorder that causes a veteran to
become immobile during and after a seizure event.
    (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.
    (d) Authorized benefits. Except as noted in paragraph (d)(3) of
this section, VA will provide to a veteran enrolled under 38 U.S.C.
1705 only the following benefits for one service dog at any given time
in accordance with this section:
    (1) A commercially available insurance policy, to the extent
commercially practicable, that meets the following minimum
requirements:
    (i) VA, and not the veteran, will be billed for any premiums,
copayments, or deductibles associated with the policy; however, the
veteran will be responsible for any cost of care that exceeds the
maximum amount authorized by the policy for a particular procedure,
course of treatment, or policy year. If a dog requires care that may
exceed the policy's limit, the insurer will, whenever reasonably
possible under the circumstances, provide advance notice to the
veteran.
    (ii) The policy will guarantee coverage for all treatment (and
associated prescription medications), subject to premiums, copayments,
deductibles or annual caps, determined to be medically necessary,
including euthanasia, by any veterinarian who meets the requirements of
the insurer. The veteran will not be billed for these covered costs,
and the insurer will directly reimburse the provider.
    (iii) The policy will not exclude dogs with preexisting conditions
that do not prevent the dog from being a service dog.
    (2) Hardware, or repairs or replacements for hardware, that are
clinically determined to be required by the dog to perform the tasks
necessary to assist the veteran with his or her impairment. To obtain
such devices, the veteran must contact the Prosthetic and Sensory Aids
Service at his or her local VA medical facility and request the items
needed.
    (3) Payments for travel expenses associated with obtaining a dog
under paragraph (c)(1) of this section. Travel costs will be provided
only to a veteran who has been prescribed a service dog by a VA
clinical team under paragraph (b) of this section. Payments will be
made as if the veteran is an eligible beneficiary under 38 U.S.C. 111
and 38 CFR part 70, without regard to whether the veteran meets the
eligibility criteria as set forth in 38 CFR part 70. Note: VA will
provide payment for travel expenses related to obtaining a replacement
service dog, even if the veteran is receiving other benefits under this
section for the service dog that the veteran needs to replace.
    (4) The veteran is responsible for procuring and paying for any
items or expenses not authorized by this section. This means that VA
will not pay for items such as license tags, nonprescription food,
grooming, insurance for personal injury, non-sedated dental cleanings,
nail trimming, boarding, pet-sitting or dog-walking services, over-the-
counter medications, or other goods and services not covered by the
policy. The dog is not the property of VA; VA will never assume
responsibility for, or take possession of, any service dog.
    (e) Dog must maintain ability to function as a service dog. To
continue to receive benefits under this section, the service dog must
maintain its ability to function as a service dog. If at any time VA
learns from any source that the dog is medically unable to maintain
that role, or VA makes a clinical determination that the veteran no
longer requires the dog, VA will provide at least 30 days notice to the
veteran before benefits will no longer be authorized.

(Authority: 38 U.S.C. 501, 1714)

(The Office of Management and Budget has approved the information
collection requirements in this section under control number 2900-
0785.)

0
3. Revise Sec.  17.154 to read as follows:

Sec.  17.154  Equipment for blind veterans.

    VA may furnish mechanical and/or electronic equipment considered
necessary as aids to overcoming the handicap of blindness to blind
veterans entitled to disability compensation for a service-connected
disability.

(Authority: 38 U.S.C. 1714)


[FR Doc. 2012-21784 Filed 9-4-12; 8:45 am]
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