GAO Report On Medical Improvement

The Government Accountability Office (GAO) has issued a report entitled "Clearer Guidance Could Help SSA Apply The Medical Improvement Standard More Consistently." This is a summary from the report:

Several factors associated with the medical improvement standard (the standard) pose challenges for SSA when assessing whether beneficiaries continue to be eligible for benefits. First, limitations in SSA guidance may result in inconsistent application of the standard. For example, SSA does not clearly define the degree of improvement needed to meet the standard, and the DDS directors GAO surveyed reported that they use different thresholds to assess if medical improvement has occurred. Second, contrary to existing policy, disability examiners in a majority of the DDSs are incorrectly conducting CDRs with the presumption that a beneficiary has a disability rather than with a “neutral” perspective. Other challenges associated with the standard include inadequate documentation of evidence as well as the judgmental nature of medical improvement determinations. All these factors have implications for the consistency of CDR decisions. However, due to data limitations, GAO was unable to determine the extent to which these problems affect decisions to continue or discontinue benefits.

GAO's belief that a medical improvement standard somehow means that there is no presumption that a claimant who has been awarded disability benefits remains disabled is ridiculous on its face and suggests a basic misunderstanding. One can read the Social Security Act and regulations to mean this, but it is a logical absurdity. We definitely have a medical improvement standard and that means there must be specific evidence of medical improvement to justify terminating benefits. This means, in fact, that there is a presumption of continued disability regardless of what the statutes and regulations say, because otherwise there is no medical improvement standard. This is the only way a medical improvement standard could be applied.

Like almost all GAO reports, this one suggests that Social Security give clearer guidance to decision makers and that decisions should be more consistent, but fails to suggest any specific ways in which Social Security could achieve these goals.

Interesting, the report shows that Social Security is performing fewer continuing disability reviews in recent years, but cutting the same or more claimants off benefits for medical improvement.