The Vermont Legislative Joint Fiscal Office is asking why there is a higher percentage of Vermonters drawing Social Security disability benefits due to mental illness than the national average. I'll give them an answer they haven't considered. Vermont is in Social Security's Region I. That Region has long had higher approval rates than other Regions. Regions matter since Regional Office Quality Assurance reviews most favorable determinations (but few unfavorable determinations) made within the Region. Mental illness disability determinations are particularly sensitive to differences in adjudicative climate.
10 comments:
Perhaps it is due to the region being more liberal. I am guessing more liberal doctors are willing to actually help their patients. One of my doctors, my primary doctor for 7 years, told me, "There must be SOMETHING you can do!" after having filled out many forms for my employer stating that I couldn't work for month after month. Another doctor stated on one of these forms that "I don't think he will EVER be able to return to work." She wrote that for my employer, but wasn't willing to do it for SSA.
Rural state. Harder to access treatment. Suspect there is also a rural inclination to be less likely to seek treatment for mental health issues until symptoms are worse.
Also think of the people who want to live in Maine. I'm only being halfway facetious here.
Regional Office quality reviews are no longer limited to that region. The quality reviews have been distributed across the Regional quality branches for a number of years now.
932 exactly what I thought
"Regional Office Quality Assurance reviews most favorable determinations". Well that explains how my favorables are getting randomly selected for Appeals Council review. I didn't realize that most favorable opinions get a second round of review.
Before saying that a state is liberal or stingy in awarding benefits, you have to look at the application rate, allowance rate, and prevalence rate. For a number of reasons such as the availability of other supports in a state, individuals, whose conditions would ultimately be determined not to meet the statutory definition of disability, may be less likely to apply. Simply put, there is a greater element of self selection in these states.
If the mental health treatment system for poor people sucks in a particular area (or if access to the system is very limited), a lot of mentally disabled claimants are going to lose just due to insufficient documentation of their conditions. Liberal states typically have better access to mental health care for their poor citizens than conservative states like the ones that rejected Medicaid expansion. More available mental health care = more documentation of the mental illness, which makes legitimate claims more likely to be granted. One factor of several, but an important one.
Vermont is one of the few states in which SSA recognizes LICSW practitioners as acceptable medical sources based on state law. If you've reviewed multiple medical records, you'll likely recognize that therapists without Ph.D. or M.D. credentials fairly consistently attest to greater limitations than may be found elsewhere, and often seem to base these opinions on patient reports. Then the district court, consistent with liberal leanings of Congressional interests and with the liberal bent of the state as a whole, reinforces reliance on those LICSW opinions as treating source opinions from acceptable medical sources, and adjudicators feel pressure to decide more and more in favor of otherwise marginal cases. In short, this report comes as no surprise.
(6:39 adding to his own comment)
My earlier comment was primarily intended to provide some additional insight unique to Vermont, but after thinking about this issue a bit more, I'd also like to point out that this paints a somewhat unique picture of how local preferences (liberal leanings of a given state) can have a distinct influence on application of an otherwise level playing field of a federal program.
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