Some nights, Army veteran Russel Keyser has nightmares that he said are as terrifying as horror movies -- vivid dreams that take him back to the savage violence he saw in Kosovo.
That is when he is especially glad to have Artemis nearby.
Artemis is a Belgian Malinois, a Shepherd dog that was placed with Keyser as a service animal. She monitors his moods, comforts him when he's anxious, and protects him from things that might make him uneasy.
"For the anxiety level, she starts biting my hand like a nibble," Keyser said. "And the nightmares she licks my face. And also she tells me when it's time to go when she jumps up and grabs me. That's the cue to remove myself from a place because I'm being overwhelmed."
Keyser is among hundreds of U.S. veterans who are working with service dogs to help relieve symptoms of Post Traumatic Stress Disorder. At the Ronkonkoma, N.Y. veterans home where Keyser lives, Artemis hangs close to him, watching him carefully with her amber-colored eyes.
When the pair leave home, Artemis gets behind Keyser and blocks him from people who might startle him.
"If the service dog helps me stay in public places around people, that means I can get the help I need," said Keyser, who said he was too anxious to attend treatment sessions until Artemis began going with him.
Keyser received Artemis about a year ago from a Long Island charity called Paws of War, one of several non-profit organizations around the country that rescues shelter dogs and trains them to assist people with PTSD.
"Having a service dog or emotional support dog or even a companion animal is one tool of recovery for their wounds of war, whether they're physical or hidden wounds," said Paws of War co-founder Dori Scofield.
But owning a dog can be expensive for veterans, who sometimes have little income. Paws of War helps pay for veterinary care and other expenses, but Scofield is frustrated that the Department of Veterans Affairs won't cover part of those expenses.
While the federal agency pays for service animals for veterans with visual, hearing, or mobility disorders, it will not do so for former service members whose only disability is PTSD.
"It's just as debilitating and crippling as any other physical disability," she said. "We hope that in the not too distant future, the VA will provide these services."
The VA has studied service animals' potential benefits for PTSD patients, but the agency said that research has been inconclusive.
"I would say there are a lot of heartwarming stories that service dogs help, but scientific basis for that claim is lacking," said Michael Fallon, the VA’s chief veterinary medical officer. "The VA is based on evidence based medicine. We want people to use therapy that has proven value."
Yet the VA's efforts to study the possible benefits of service animals have been plagued with problems. Congress mandated a study in 2010, but the VA suspended it just months after it began, when two of the dogs in the study bit the children of veterans. The study restarted in 2012 but was again stopped because of issues with the dogs' health and training.
A new study is underway and the VA is now recruiting veterans to participate. But it isn’t expected to be finished before 2019.
Meanwhile, the VA stresses that the agency is providing other treatments to veterans with PTSD, including cognitive behavioral therapy and medications.
Keyser, the Kosovo veteran, said he does not need to see any scientific studies to know that Artemis is helping him. He said he's no longer as apprehensive about public places, and he isn't as likely to have severe reactions if something startles him.
"How it works, I don't know. I don't care," he said. "I can live a normal life. I could not live a normal life without her."
