Editor's Note: This story contains descriptions of alleged sexual assault.
Guiding her cart down an aisle of a Virginia grocery store, Leigh Michel attracts more attention than the average shopper.
"Do you know where the dog food is?" one man asks her. This kind of attention makes her uneasy.
"No, I don't," Michel answers. "Sorry."
The man assumes Michel would know the answer because her service dog, an English black Labrador named Lizzy, is walking at her side.
He's not the only shopper watching Michel and Lizzy. Some skirt around them in the bread aisle ("Oh, she won't bite," Michel assures one woman), and others ignore the boundaries of typical service dog decorum near the condiments.
"Is she friendly?" a man asks, reaching out to pet Lizzy and launching into a story about his mother's service chihuahua.
Michel indulges him briefly, tells him to have a good day and moves on.
"Without [Lizzy], I wouldn't even be talking to the cashier," Michel says as she approaches the checkout. "So I guess she's actually kind of my trainer, getting me to talk to people."
Michel is a retired first sergeant in the U.S. Army, where she trained as a Chinese linguist, jumped out of airplanes at Fort Bragg, N.C., and traveled the world as a chaplain assistant for 29 years.
She transitioned to civilian life earlier this year but continues to heal physical and mental wounds she has carried for decades, and her service dog Lizzy provides relief that Michel says no other therapy or medication can match.
Service dog providers are seeing an influx of applications from veterans like Michel who have experienced sexual trauma while in the military. But the U.S. Department of Veterans Affairs, which provides veterinary benefits for service dogs assigned to people with physical disabilities, does not currently recognize psychiatric service dogs as a proven therapy for mental illness.
"That part of me is gone, taken from me"
Leigh Michel entered the Army in 1989. "I figured I would be a linguist and get a good job when I get out," she recalls. "I'm not staying in the Army. I don't need that. But look at me 29 years later: They get you."
The language program didn't work out for Michel so she became a chaplain assistant instead. For most of her career, she says, she embedded with troops — in Afghanistan, in Germany, in the Demilitarized Zone between North and South Korea — where she served as a sounding board for her peers' greatest fears and dearest hopes.
While stationed at Fort Bragg, Michel received her jump wings, a military badge earned through U.S. Army airborne divisions. She rose up in the ranks, eventually earning the rank of first sergeant in Afghanistan.
But Michel was also quietly experiencing trauma from the stories entrusted to her as a chaplain assistant.
"I hear the sexual assaults, the rapes, the abuses to children," she says. "I hear that they're in a position now with their boss that they can't seem to get out of, horrible family stories, how many people they've killed."
She visited soldiers maimed or killed in combat, and those sights continue to haunt her.
But Michel says she couldn't vent to anyone.
"I'm just walking around with all this stuff in my head and compounded with my own stuff that ends up happening, it's just way too much."
Michel is referring to multiple sexual assaults she says she experienced from her time in basic training to her last years in the Army, many of which she chose not to report. Michel says sometimes she was embarrassed or her high rank intimidated her from offloading trauma onto her chaplain, who was also her commanding officer.
All that trauma has battered her memory (she forgets what she needs at the grocery store or what word to use in a sentence), but she seems to recall each of her sexual assaults in vivid detail, like benchmarks or chapters of her military career.
Michel says at least three male service members assaulted or molested her between 1990 and 2005.
But the most traumatic incidents happened while Michel was stationed at Bagram Airfield in Afghanistan in 2012.
During the first instance, Michel says she was in the bathroom, undressing to take a shower, when an Air Force officer slammed her against a wall and raped her. A noise outside startled her assailant, and Michel said he threatened to kill her if she told. She did not report the assault.
"I dealt with it [by putting] it in a box. I had a job to do. We're in Afghanistan, and I can't slow down now," she says.
Later that year, Michel says she was doing her laundry when a local civilian quickly approached her. He pulled her into a bunker, cracked her head against a concrete wall and raped her. She took a sick day from work the next day but did not report it.
"I'm the first sarge," she says of that decision. "I don't want my soldiers to know. They're going to know that part of me is gone, taken from me. So you have to stay strong like they tell us. Keep fighting."
Veterans with sexual trauma in search of comfort
Michel began to break down when she returned home after the Afghanistan assaults. Her boyfriend noticed she was jumpy and quick to anger. She says she was triggered by concrete walls. She didn't want to leave the house.
Michel began seeing a counselor in 2015. She says she has been diagnosed with severe post-traumatic stress disorder, major depressive disorder and mild traumatic brain injury.
Around the same time, Michel began seeking treatment for severe back pain, a result of performing so many jumps and carrying heavy military gear for nearly three decades.
"I'm on 15 different medications or something now. It's crazy," Michel says. "Between my physical and my behavioral health, there's just a lot of crossed wires."
In 2016, Michel applied for a service dog from the organization Semper K9 in northern Virginia, listing military sexual trauma as one of her problems. Michel instantly knew Lizzy, named after a World War II Army nurse, was the dog for her and took her home after weeks of training.
Lizzy calms Michel down like nothing else can, especially during panic attacks or nightmares.
"She'll come up right behind me and lay, but her whole body is touching mine, and it's kind of like, 'Hey I'm here, it's OK.' And there's been times that I've woken up once she's done that, and then I can go back to sleep because she's right there and she just lays with me," Michel says.
Lizzy also picks up things Michel has dropped and takes off Michel's shoes. The dog has learned the signs that Michel is distressed, like fidgeting, and works to comfort or distract her.
According to the VA, 1 in 4 female service members and 1 in 100 male service members who come through its facilities report experiencing military sexual trauma (MST), which includes sexual assault and harassment.
Psychiatry and medication are frequently prescribed therapies to help veterans combat many of military sexual trauma's lasting effects. And now, some veterans are using psychiatric service dogs as a tool to supplement traditional recovery methods.
"We have seen an influx in veteran applicants who are willing to disclose that type of trauma," says Christopher Baity, who runs Semper K9.
He says there are a lot of similarities between veterans who have experienced MST and veterans who have combat-related PTSD: agoraphobia and antisocial behavior, for instance. Baity conducts the same dog training for both.
K9s for Warriors, a large service dog provider in Florida, has also seen more demand from veterans who have experienced MST. The organization recently developed female-only classes, largely made up of women who have been sexually assaulted. Rory Diamond, CEO of K9s for Warriors, says working with them requires extra care.
"We have a very masculine, male military staff. They have to approach the warriors much differently that have MST, which is to be kinder, gentler, quieter. Don't be and don't act like the people who perpetrated this to them," he explains.
Not yet enough reliable evidence
The use of service dogs for veterans' mental health dates back at least to World War II, when a formerly-stray Yorkshire terrier named Smoky accompanied doctors and nurses as they made their rounds at a military hospital. Smoky is widely regarded as one of the first therapy dogs.
Despite this history and the growing number of veterans with PTSD who use psychiatric service dogs, the VA does not currently support them.
"There is not yet enough reliable evidence for VA to form an official stance on psychiatric service dogs related to medical benefit. However scientific advances have led to proven effective interventions for most mental health conditions," a VA spokesperson said in an email to NPR. "VA is committed to Veterans receiving safe and effective treatments that are most likely to lead to the best clinical outcomes."
A statement on a webpage for the National Center for PTSD, which is maintained on the VA website, argues that psychiatric service dogs might hamper recovery by rendering veterans unable to function without a dog at their side.
"For example, if the dog keeps strangers from coming too close, the owner will not have a chance to learn that they can handle this situation without the dog. Becoming dependent on a dog can get in the way of the recovery process for PTSD," the statement reads.
The VA offers to cover veterinary care for service dogs for veterans with physical injuries, like blindness or mobility issues, but it does not provide the same benefits for psychiatric service dogs. Still, in most cases, psychiatric service dogs are permitted to accompany veterans in VA facilities, regardless of the VA's stance on their validity.
The spokesperson said that any service dogs receiving support from the VA must be accredited with Assistance Dogs International, which on its website acknowledges the effectiveness of service dogs for psychiatric reasons.
Baity, who estimates that nearly 99 percent of service dog recommendations he receives come from VA doctors, says it is time for the VA to recognize psychiatric service dogs.
"A service dog is a service dog, no matter if the person is blind or assaulted in the military and can't perform normal life," Baity says. "A service dog is a piece of durable medical equipment that performs a specialized duty for a disabled American, like a cane, wheelchair or prosthetic."
A study from researchers at Purdue University earlier this year revealed "clinically significant reductions in PTSD symptoms" among veterans with service dogs who were also receiving regular medical care. These veterans exhibited "lower depression, higher quality of life, and higher social functioning."
The study was sponsored by the Human-Animal Bond Research Initiative Foundation and Bayer Animal Health, and partnered with K9s For Warriors.
In a response to a question about the Purdue study, the VA's spokesperson said, "More research is needed."
The VA began studying the effectiveness of psychiatric service dogs in 2011 at the behest of Congress. After years of failed attempts, the VA is sponsoring a clinical trial expected to wrap up in 2019. The spokesperson adds the department is also piloting a benefits program for veterinary insurance.
A statement on the VA's website promises that "if research supports the use of service dogs for PTSD, VA will provide veterinary care for such dogs."
Michel says whatever a study might show, there's no question Lizzy has changed her life.
"I want to get better. It's just hard. But she's the primary help that I have right now to get there, over going to a shrink and taking pills. As long as she's with me, I feel OK, which is better than usual."
Michel is setting goals for herself with Lizzy by her side. A major one? "Go to a bar with some friends, have a drink, and not be scared."
SCOTT SIMON, HOST:
Dealing with the effects of sexual assault is a lifelong process that can be filled with, like, psychiatry appointments and medication. As NPR's Adelina Lancianese reports, some veterans are turning to psychiatric service dogs as an additional way to navigate that overwhelming world, even though the Department of Veterans Affairs does not recognize them or pay for veterinary care.
ADELINA LANCIANESE, BYLINE: Retired 1st Sgt. Leigh Michel guides a metal cart down an aisle. Grocery shopping is full of anxiety for the Army veteran. Michel turns to the black Labrador named Lizzy keeping stride at her side. What do we need?
1ST SGT LEIGH MICHEL: Dog food and dishwasher would be over here.
LANCIANESE: Michel reaches for an item on a shelf. Lizzy keeps watch. Michel drops a coin, and Lizzy picks it up.
MICHEL: Yeah, good - look; she just wants a treat. Yeah. Good dog.
LANCIANESE: Lizzy is Michel's service dog, and she's helping Michel overcome mobility issues from back injuries, as well psychological pain. At her house near Quantico, Va., Lizzy pulls off Michel's flip-flops.
MICHEL: Good dog. Give it. It's not a toy.
LANCIANESE: Michel spends most of her time here alone with Lizzy.
MICHEL: And I feel safer that way. But when I have to interact with her, she's developed relationships and I see how happy she's making everybody else, I feel safe with them.
LANCIANESE: She fidgets with her jewelry as she speaks. Lizzy, sensing discomfort, nestles her head under Michel's foot. Michel has major depressive disorder and post-traumatic stress resulting from multiple unreported sexual assaults during her 29 years of service. And as an Army chaplain assistant, she was a sounding board for peers who had experienced similar trauma.
MICHEL: I hear the sexual assaults, the rapes, the abuses of children coming up. I hear that they're in a position now with their boss that they can't seem to get out of. You know, horrible family stories, how many people they've killed.
LANCIANESE: Michel reached her breaking point.
MICHEL: You know, I'm walking around with all this stuff in my head, and compounded with my own stuff that ends up happening, and it's just - it's way too much.
LANCIANESE: She says she became jumpy, quick to anger, forgetful, reclusive. Michel started seeking help through therapy and medication, but Lizzy calms Michel down like nothing else can, especially during panic attacks or nightmares.
MICHEL: She'll come up right behind me and lay, but her whole body is touching mine. And it's kind of like, hey, I'm here, it's OK. And there's been times that I've woken up once she's done that, and then, you know, I can go back to sleep because she's right there. And she just lays with me.
LANCIANESE: According to the Department of Veterans Affairs, a fourth of all female service members report experiencing military sexual trauma, or MST. That includes sexual assault and harassment. Recovery is complex, full of emotional ups and downs.
CHRISTOPHER BAITY: (Imitating crying) Oh, thank you.
LANCIANESE: This is Christopher Baity demonstrating how a service dog can comfort a crying veteran by distracting them.
BAITY: Essentially, it's a game. He thinks, hey, when I see this behavior, I'm going to get a treat. All I got to do is bug you.
LANCIANESE: Baity runs Semper K9, the organization where Michel got Lizzy.
BAITY: We have seen an influx in veteran applicants who are willing to disclose, you know, that type of trauma.
LANCIANESE: Others are as well. Rory Diamond is the CEO of K9s For Warriors, a large service dog organization in Florida.
RORY DIAMOND: We do three female classes a year. By and large, those classes are composed of women who have MST.
LANCIANESE: He says working with them requires extra care.
DIAMOND: So we have a very masculine male military staff. They have to approach the warriors much differently that have MST, which is to be kinder, gentler, quieter. Don't be, and don't act, like the people who perpetrated this to them.
LANCIANESE: But a statement on the VA's website argues that service dogs might harm recovery by rendering veterans unable to function without a dog at their side. Although the VA offers benefits to veterans who have service dogs for physical injuries, a spokesperson said in a statement that there's not enough evidence to form an official stance on the benefit of psychiatric service dogs. So Michel pays for Lizzy's veterinary care. She says it's worth it.
MICHEL: I want to get better. It's just hard. But she's the primary help that I have right now to get there, over going to a shrink and taking pills. You know, as long as she's with me, I feel OK, which is better than usual.
LANCIANESE: After years of failed attempts at studying the effectiveness of psychiatric service dogs like Lizzy, the VA says it is sponsoring a new clinical trial that's expected to wrap up next year. Adelina Lancianese, NPR News.
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