Take a look at this letter from the National Association of Disability Examiners (NADE), an organization of personnel who work at state Disability Determination Services (DDS) agencies and make initial and reconsideration determinations on disability claims. The letter was sent to Ruby Burrell at Social Security central offices. It concerns a proposal called the "Integrated Disability Process." I do not think that I have heard of this "Integrated Disability Process" previously. This may be a significant plan, but it is hard to tell exactly what is in the works, since we can only read a response to the plan, rather than the plan itself. It is also hard to tell how far along they are on this.
Here are a few excerpts to give you an idea of what may be afoot -- and note that it gets more interesting as you go along:
Here are a few excerpts to give you an idea of what may be afoot -- and note that it gets more interesting as you go along:
We advise that caution be used when placing weight on the TPs [Treating Physicians] MSS [Medical Source Statements], as these can sometimes be overly restrictive and in some instances fraudulent. Increased program costs will be the result of incorrect decisions driven by these types of MSSs. Some States have commented that, in many cases, TP MSSs appear to be exaggerated because many TPs want their claimant’s to receive benefits or they do not want their patients to believe that it was the TPs report that kept them from receiving benefits. ...
We support a standardized form for the MSS. This form should include in its format adequate space for individual comments/input as well as a statement that the source himself feels that the MSS he is providing is consistent with his medical findings. ...
The requirement of obtaining a MSS at the reconsideration level seems to be based solely on the ALJs’ ‘discomfort’ in making a decision without a MSS in file. This is based not on fact but rather a belief amongst ALJs that having an MSS makes their decision legally defensible. This change will inevitably result in an increase in processing time, as fruitless efforts to obtain an MSS from uncooperative providers are pursued. ...
Slide #25-27: there may be a benefit in rewriting SSR 96-2p and eliminating the ‘controlling weight’ provision. There is no similar concept in other governmental or private agencies. Removing the concept of a controlling opinion would allow for more equity in the consideration of other opinions. ...
There is some support for the concept of DDSs conducting selected face-to-face interviews by highly trained DDS staff before the case goes to ODAR. This could provide some cost benefit savings for many cases involved in the more costly appeals process at the ODAR level. We would welcome additional discussion on this proposal.
By the way, NADE, what a way to feed into the stereotypes that others have about DDS personnel! Really, I did not think you would be that concerned about a few more claimants being approved.
2 comments:
It is not that we ALJ's are uncomfortable about making a decision without a treating physician's MSS in the record but that it is highly likely that if we affirm a denial the case will be returned by the Appeals Council and the District Court. I personally am not comfortable with an MSS that is simply a check the box form because of the line of cases indicating that such forms (whether completed by SSA or the treating physician are not substantial evidence - see e.g. Mason v. Shalala, 994 F. 2d 1058 (3rd Cir. 1993); O’Leary v. Schweiker, 710 F.2d 1334, 1341 (8th Cir., 1983)).
I really can't believe the nerve of these people with respect to the "controlling weight" regulation. Don't they realize that it came out of years of litigation in the Second Circuit and if the Agency had not written 20 C.F.R. 404.1527 and 404.927 to conform with the multiple opinions in SCHISLER there would have been hell to pay! I had been hopeful that the Obama administration would bring a new approach to our problems but with the appointment of Dr. Susan Daniels to the transition team my hopes have been crushed. My choice to retire as of January 3, 2009 now seems even more the right choice.
I was somewhat annoyed reading that letter, as a member of this organization. There are a lot of points in it that came across as uninformed. This is a good example: "We prefer to retain the current practice that allows the DDSs to give weight to a MSS provided by a TP who also provides credible objective evidence that can support the MSS. Currently, DDSs do not have to assign weight to a MSS provided by a TP if there is a lack of credible evidence to support the MSS."
The official current practice is that these opinion statements need to be well-supported and not inconsistent with other evidence, but it does not have to be "credible objective evidence" which usually means discarding these opinions because they didn't agree with what the examiner or medical consultant wanted to do and therefore are not "objective". While I realize that there are sometimes some issues with medical source statements, there seems to be this attitude that there's some kind of plot to exaggerate claimants' problems so that they will obtain benefits.
That and Ms Huskey or whoever writes letters for NADE needs a proofreader - the misspelled words and typos do not look professional.
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