Apr 18, 2013

You Ought To Read That Radical Disability Benefits Reform Act Of 1984

     In right wing explanations for the increase in the number of people drawing Social Security disability benefits you read again and again that the Disability Benefits Reform Act (DBRA) of 1984 is the problem. Supposedly, DBRA was a dramatic loosening of standards that allowed untold numbers of healthy people to get on benefits due to alleged musculoskeletal and mental disorders.
     The problem with this theory is that it's possible to actually read what DBRA says. But first, you might want to read then President Ronald Reagan's signing statement on DBRA. You won't find a single reference to musculoskeletal disorders or mental disorders. That's because DBRA primarily concerned the establishment of a medical improvement standard for termination of disability benefits. All Reagan said about the other provisions of DBRA was that "Several other changes are written into this new law that will clarify and expedite the administration of the disability program." Those tricky Democrats put one over on the Gipper.
     Here's the actual language from DBRA that might have some applicability to musculoskeletal disorders:
An individual’s statement as to pain or other symptoms shall not alone be conclusive evidence of disability as defined in this section; there must be medical signs and findings, established by medically acceptable clinical or laboratory diagnostic techniques, which show the existence of a medical impairment that results from anatomical, physiological, or psychological abnormalities which could reasonably be expected to produce the pain or other symptoms alleged and which, when considered with all evidence required to be furnished under this paragraph (including statements of the individual or his physician as to the intensity and persistence of such pain or other symptoms which may reasonably be accepted as consistent with the medical signs and findings), would lead to a conclusion that the individual is under a disability. Objective medical evidence of pain or other symptoms established by medically acceptable clinical or laboratory techniques (for example, deteriorating nerve or muscle tissue) must be considered in reaching a conclusion as to whether the individual is under a disability.
     If you haven't already fallen asleep from reading this language, you probably noticed that, again, the term "musculoskeletal" doesn't appear anywhere. Back pain doesn't come up either. You'll also notice that the language hardly looks like it would throw open the floodgates for the approval of any disability claim. If anything it looks a bit tough. To be complete, I'll note that DBRA also created a Commission to study the evaluation of pain but I'll save you the trouble of looking that one up. At considerable expense, the Commission produced a report that almost no one read, a report that had exactly zero effect upon policy or practice at Social Security.
     Here's the language from DBRA concerning mental illness:
The Secretary of Health and Human Services ... shall revise the criteria embodied under the category "Mental Disorders" in the "Listing of Impairments" ... The revised criteria and listings, alone and in combination with assessments of the residual functional capacity of the individuals involved, shall be designed to realistically evaluate the ability of a mentally impaired individual to engage in substantial gainful activity in a competitive workplace environment.
     Why was DBRA ordering Social Security (which was then part of the Department of Health and Human Services) to write new mental impairment listings? Because of the decision in Mental Health Ass'n of Minnesota v. Schweiker, 554 F.Supp.157 (D. Minn. 1982), which was a searing indictment of Social Security's standards for assessing disability claims based upon mental illness. This lawsuit came about because of a revolt by some physicians involved in implementing those mental illness standards. I was around at that time. I can tell you that if an agency is capable of having remorse, Social Security had remorse after that lawsuit. Does ordering Social Security to rewrite its regulations so that they "realistically evaluate the ability of a mentally impaired individual to engage in substantial gainful activity in a competitive workplace environment" sound like it would inject something radical into Social Security's evaluations of disability claims based upon mental illness? Please read the decision in Mental Health Ass'n of Minnesota before you advocate going back to the standards applied by Social Security in evaluating mental illness before DBRA. If you really want to go back to those days, I can tell you that the standard actually required for approval based upon mental illness was something like "requires long-term institutionalization."
    By the way, if you read a little further in DBRA you'll notice that it included a provision to make it easier for state vocational rehabilitation agencies to get rewards for their success in putting Social Security disability recipients back to work. Even back then the idea of reducing rehabilitation to lower the costs of the Social Security disability programs was being tried but even then that was hardly new. Notice that I said that DBRA was designed to make it easier to get these rewards. The rewards had been established much earlier. Efforts to get disability benefits recipients back to work go back about as far as Social Security disability itself. Of course, DBRA's changes did not lead to an improvement in the rehabilitation rate. None of these legislative efforts have worked nor will any future efforts along this line work. But I needn't bother saying this. Congress doesn't want to hear that the vast majority of Social Security disability recipients are just too sick to be helped by rehabilitation.


Anonymous said...

Excellent and quite accurate post, Charles. I'm sure the trolls here will complain about it, but I'm also sure they won't have any substance to back those complaints. 12213

Anonymous said...

So far, so good, no trolls and that was a very good post too.

Anonymous said...

So why does SSA waste time and money on disability reviews? Since the vase majority have no intention of returning to work, why not just make all medical decisions permanent? Focus the resources on other parts if the programs.