May 28, 2016

This Will Certainly Encourage Greater Use Of Social Security's Online Systems

     From a report on this week's Congressional hearing on Social Security's information systems:
... During the hearing, [Acting Social Security Commissioner] Colvin announced the agency will, starting this summer, improve security with additional personal information protection: Social Security website users will need to enter a username, password and one-time texted passcode to a Social Security-registered cellphone to access their accounts. ...

May 27, 2016

Social Security At Cannes Film Festival

     You'd think that the Cannes Film Festival is about the last thing I'd be writing about but there really is a social security connection this year, if a little obliquely. The Cannes grand prize, the Palme d'Or, was awarded to "I, Daniel Blake", a drama about a disabled man in Britain trying to cope with a social security disability process that seems stacked against him. If it were set in the United States, it would be an even more infuriating tale. On this side of the Atlantic, we don't just deny dignity to the disabled; we provide a "system" that leaves a huge proportion of the disabled to fend for themselves without government assistance.

May 26, 2016

Hearing On Social Security Information Systems

     The House Oversight and Government Reform Committee is holding a hearing today on Information Systems at Social Security. You can watch the hearing below or read the written statements of the witnesses.

May 25, 2016

Being Prepared

     Here's a short excerpt from a hospital record on one of my clients: "Pt has drill bit set beside bed. When asked why he brought it with him, pt states 'In case I need to cut off my leg.' Dr. ______ notified."

May 24, 2016

Final Mental Regs Coming

     The Social Security Administration has submitted Revised Medical Criteria for Evaluating Mental Disorders final regulations to the Office of Management and Budget (OMB). These had appeared in the Federal Register as proposed regulations on August 19, 2010.
     Below are some excerpts from the proposed regulations.  I've added comments in brackets:
  • The proposed paragraph B3 criterion is the same as the current paragraph B3 criterion, “maintaining concentration, persistence, or pace,” except that we propose to change “or” to “and.” This would not be a substantive change in the paragraph B3 criterion, but only a clarification of the overall requirement. [Going from a requirement of meeting one criteria to a requirement of meeting three criteria is not a substantive change?]
  • One of the provisions from §416.926a(e) that we are including in this definition explains that “marked” is the equivalent of functioning we would expect to find on standardized testing with scores that are at least two, but less than three, standard deviations below the mean. ... A person whose functioning is two standard deviations below the mean is in approximately the second percentile of the population; that is, about 98 percent of the population functions at a higher level. [Social Security is trying to put a 2% cap on the percentage of the population that can be found disabled by mental illness? About 1.1% of the population suffers from schizophrenia. About 1-3% of the population suffers from mental retardation. If we are limiting the listings to the bottom 2% of the population in terms of mental functioning, we are talking about a group that is either in long term care or is not far from needing it.]
  • Currently, we have an interagency agreement with the Clinical Research Center to explore the possibility of using International Classification of Functioning domains in predicting disability. [Sounds like Social Security is looking for some simple testing instrument to determine disability.]
  • ID/MR [Intellectual Disability/Mental Retardation] is often demonstrated by evidence from the period before age 22. However, when we do not have evidence from that period, we will still find that you have ID/MR if we have evidence about your current functioning and the history of your impairment that is consistent with the diagnosis, and there is no evidence to indicate an onset after age 22.
  • In 12.05C, the term “severe” has the same meaning as in §§404.1520(c) and 416.920(c). Your additional impairment(s) must cause more than a slight or minimal physical or mental functional limitation(s); it must significantly limit your physical or mental ability to do basic work activities, as we explain in those sections of our regulations and §§404.1521 and 416.921. The limitation(s) must be separate from the limitations caused by your ID/MR; for example, limitation in your ability to respond appropriately to supervision and coworkers that result from another mental disorder or in your physical ability to walk, stand, or sit. If your additional impairment(s) is not "severe" as defined in our regulations, your ID/MR will not meet 12.05C even if your additional impairment(s) prevents you from doing your past work because of the unique features of that work. [Wait a minute! Are we trying to redefine what is meant by the term "severe impairment" so that something can prevent past work but not be severe -- using the mental impairment listings to redefine an important concept that appears elsewhere in the regulations? Please tell me that Social Security does not really want to reopen the non-severe impairment can of worms.]
     There's no way of knowing what modifications Social Security has made before submitting final regulations to OMB. Normally, Social Security makes no more than minor changes in wording. It's always been my impression that absent overwhelming outside pressure Social Security only tries to please its internal audience when it writes regulations.

A Little Update On A DOT Replacement -- Don't Expect It Soon

     The National Association of Disability Examiners (NADE), an organization of the personnel who are involved in making initial and reconsideration determinations on Social Security disability claims, has issued its Spring 2016 newsletter.
     The newsletter includes a summary of a meeting that NADE officials had with Gina Clemons, Social Security's Associate Commissioner for the Office of Disability Policy. Here's an excerpt from NADE's writeup of the meeting:
The new OIS [Occupational Information System] will include many occupational descriptors similar to those adjudicators currently use in the DOT [Dictionary of Occupational Titles]. The DOT contains discrete and well-established descriptions of the physical demands of occupations, but it does not provide information on the mental and cognitive requirements of occupations. The agency hopes to include mental and cognitive data elements in the OIS. However, this would be part of a separate BLS 9Bureau of Labor Statistics] collection, so they are working hard to determine the most useful mental and cognitive elements before BLS performs further testing in this area. The agency’s goal is to have this new tool (without the mental and cognitive data elements) ready for use by 2019.