Symptom Validity Tests -- Senator Coburn And OIG Want Them

     From a recent report by Social Security's Office of Inspector General (OIG):

In a January 30, 2013, letter to the Inspector General, Senator Tom Coburn, M.D., requested we review SSA's policy that stated it would no longer allow DDSs or ALJs to purchase SVTs [Symptom Validity Tests]. SVTs are used to determine whether an individual is exhibiting signs of malingering. ... The Agency began discouraging the purchase of SVTs in the early 1990s. In January 2012, SSA issued a reminder to DDSs that it should not purchase these tests. According to SSA senior officials, the Agency disallowed the purchase of SVTs because of weaknesses in the tests' psychometric properties and their limited value in determining, with certainty, a claimant's credibility. SSA stated that these tests could not prove whether a claimant was credible or malingering because there is no test that, when passed or failed, conclusively determines the presence of inaccurate self-reporting. However, according to medical literature and national neuropsychological organizations, there is consensus in the medical community that SVTs are useful in identifying malingering in disability evaluations, when used in conjunction with other evidence in the case file. We also determined VA, RRB, and private disability insurance providers fund SVTs for use in their disability determination processes. ... 

     In its response to the OIG report, Social Security noted that the list of medical sources given by OIG as supporting SVT was incomplete since it did not include differing medical opinion. Also, Social Security noted that the professional societies cited in the OIG report are on record recommending SVT, hinting at a possible conflict of interest. The members of these organizations would benefit if Social Security were to begin ordering SVTs. Social Security told OIG that "We believe that tests cannot prove malingering, as there are no tests that conclusively determine the presence of inaccurate patient self-reporting." However, Social Security also said that "Due to differing opinions on the use of SVTs, and whether they add value to our disability programs, we plan to seek impartial, external expertise to evaluate our policy on the purchase of SVTs, as resources permit. In addition, we plan to seek external expertise on psychological tests from the Institute of Medicine to include an examination of published research and studies on SVTs ..."