From the report (page 150) of the House Appropriations Committee on the Labor-HHS Appropriations bill, which covers the Social Security Administration:
The Committee can "believe" what it wants but any function assessment battery will be worthless in determining disability. You cannot test someone's work capacity over the course of a few hours and extrapolate from that to determine the person's ability to work eight hours a day, five days a week, fifty weeks a year. You cannot say that because a person has run 100 yards that they can run a marathon, much less say that the person can run a marathon at the same pace that they have run 100 yards. There's no way around this problem.
Functional assessment batteries have always been and will always be fool's gold. They appeal only to those who give little thought to the matter, especially if they have no interest in justice, and to those who stand to profit from performing the functional assessment batteries.
The United Kingdom has started using functional assessment batteries in determining disability. It's been pretty disastrous.
If you think disability determination in the United States is problematic, you'd right. Disability determination is an inherently messy, imprecise business. That doesn't mean that things can't be made worse. Things could get a lot worse with widespread use of functional assessment batteries.
The Social Security Administration (SSA) has partnered with the National Institutes of Health to create a functional assessment tool that is reliable and objective and may inform the disability determination process. One of the major projects of this partnership is the Functional Assessment Battery (FAB). The Committee believes the FAB tool could serve to provide uniform, objective evidence to the disability determination.The Committee notes its concern that SSA is currently limiting the use of this tool for only survey research. The Committee directs SSA to test the use of the FAB as part of the demonstrations undertaken within the Disability Early Intervention Initiative.The bill has now been reported out of Committee.
The Committee can "believe" what it wants but any function assessment battery will be worthless in determining disability. You cannot test someone's work capacity over the course of a few hours and extrapolate from that to determine the person's ability to work eight hours a day, five days a week, fifty weeks a year. You cannot say that because a person has run 100 yards that they can run a marathon, much less say that the person can run a marathon at the same pace that they have run 100 yards. There's no way around this problem.
Functional assessment batteries have always been and will always be fool's gold. They appeal only to those who give little thought to the matter, especially if they have no interest in justice, and to those who stand to profit from performing the functional assessment batteries.
The United Kingdom has started using functional assessment batteries in determining disability. It's been pretty disastrous.
If you think disability determination in the United States is problematic, you'd right. Disability determination is an inherently messy, imprecise business. That doesn't mean that things can't be made worse. Things could get a lot worse with widespread use of functional assessment batteries.
Wouldn't it be nice if actual tests were performed with actual objective results, rather than CEs that simply say reduced range of motion. If they will actually perform the tests, like a OT would, I think the results would be helpful. At least more helpful than a CE full of BS results for tests that were never performed.
ReplyDeleteFunctional Capacity Evaluations are no better than hocus pocus.
ReplyDeleteCharles, you mean worse than the current practice of reps submitting MSSs that have farcical responses and ask questions most TS would not actually know, such as how minutes your patient can sit, stand or walk.
ReplyDeleteIt does appear to be a bogus test that would exclude many legitimate claims. At best, such tests offer a limited snapshot in time of a person's function. Such snapshots have very limited value because:
ReplyDelete-Very few medical conditions cause the same limitations all the time. In fact, most fluctuate considerably, in both the short and long term.
-The disability standard calls for evaluation of a person's ability to sustain function over time, not how they are doing at a single point in time.
Also, to the extent any test ignores subjective evidence it is flawed. Nobody serious in this line of work contests that subjective symptoms can and do disable many people.
@Anon 42
ReplyDeleteYou raise an interesting fiction that underlies a lot of disability adjudication. If, as you say, a treating doctor could not accurately opine on how long a patient can perform exertional activities, then the argument would be even stronger that a DDS non-examining physician or CE could not do so either. They have observed the claimant less. Are you any less skeptical of their opinions?
Functional assessment batteries have always been and will always be fool's gold. They appeal only to those who give little thought to the matter, especially if they have no interest in justice, and to those who stand to profit from performing the functional assessment batteries. battery life
ReplyDelete