Pages

Jan 21, 2020

GAO Report Critical Of Social Security's Treatment Of Disability Claims Complicated By Substance Abuse

     From a recent report by the Government Accountability Office (GAO):
... This report examines (1) what is known about the relationship between trends in prescription opioids and DI claims, and (2) how SSA [Social Security Administratino] considers potential prescription opioid misuse in its DI [Disability Insurance] eligibility decisions. GAO analyzed county-level data on opioid prescriptions and DI claims from 2006 through 2017; interviewed program staff involved in DI eligibility decisions in Alabama, Kentucky, and West Virginia, selected because of their high rates of opioid prescriptions and percentage of the adult population on DI; and reviewed case files for DI beneficiaries identified by the Centers for Medicare & Medicaid Services as being at risk for prescription opioid misuse or abuse. ... 
The numbers of opioid prescriptions and claims for the Social Security Administration’s (SSA) Disability Insurance (DI) program have each declined nationally in recent years, but rates vary widely across the country. National trends show both peaking between 2010 and 2014 and then declining. GAO’s analysis shows counties with the highest rates of both were concentrated in the Southeast (see figure). After accounting for economic, demographic, and other factors, GAO found that counties with higher rates of opioid prescriptions tended to have higher rates of DI claims from 2010 through 2017. These rates were also correlated with other factors. For example, counties with higher rates of each tended to have higher poverty rates. However, GAO was unable to determine whether there is a causal relationship between rates of opioid prescriptions and DI claims or other factors, given readily available data.
Program staff are required to evaluate and document substance use disorders (including opioids not taken as prescribed) when making certain DI eligibility decisions. Specifically, staff are required to evaluate potential substance use disorders for certain DI claims and deny benefits, for example, if the claimant would not be considered disabled if they stopped using drugs or alcohol. In addition, staff are generally required to document the rationale for their decision so that another reviewer can understand how they made the decision. However,staff in five of the six offices GAO visited in three states were confused about when to evaluate substance use disorders, and nine of 15 case files that GAO reviewed in which an evaluation was conducted did not have a documented rationale. SSA officials acknowledged the need to clarify policies on when to evaluate substance use disorders, and that a poorly documented rationale could lead to reversals or remands of decisions. Without ensuring that SSA’s policies are understood and that staff document their rationale, the agency may expend resources re-working cases and, in turn, delay benefits to individuals eligible for assistance.  ...
     I imagine that Social Security will find a simple way of responding to GAO's findings. They'll just make the current rule -- when in doubt, deny -- even more explicit. They certainly won't do anything to help people with dual diagnoses -- substance abuse plus another physical or mental impairment. If anything, the GAO report seems only to be telling Social Security to find a better way of checking off boxes rather than encouraging them to take a serious look at the problem.
     The GAO itself could have taken a more in-depth look at the problem. They fail to mention that the dual diagnosis issue primary concerns one psychiatric illness -- bipolar disorder -- which has a dramatic overlap with substance abuse strongly suggesting a genetic link. It's literally impossible to tease out what's caused by bipolar disorder from what's caused by substance abuse because it's all one disease entity. The GAO investigators also failed to understand that the Social Security Administration itself changed its policies in 2013 to put the burden on the claimant to prove a negative -- that their substance abuse isn't material to the determination of disability. If you're not a lawyer, let me clue you in on something well understood by lawyers. It's impossible to prove a negative. For instance, I can tell you that I've never used crack cocaine -- I haven't -- but how can I prove it? That's the whole point of Social Security's current policies. Put an impossible burden on the claimants and then deny them. The GAO report says in a footnote that Social Security told them that Social Security Ruling 13-2p, the policy change I mentioned earlier, really didn't change anything. That's seriously revisionist history. The policy in effect before the ruling was 180 degrees different. It's like this every time Social Security changes its policies. The agency insists that it hasn't changed its policies when it's obvious that it has.

5 comments:

  1. Of all the useless reports from GAO, this has to be one of the most useless. People with severe musculoskeletal conditions are more likely to use medications to control symptoms. wow.

    ReplyDelete
  2. I have seen a slight increase in the addiction to some drugs. Seems like alcohol abuse has been making a comeback. I have always said no other drug in the history of this country (maybe the world) has caused more problems than alcohol.

    I also have seen an increase in meth. Ironically, I have seen less addiction to marijuana even though out here in Cali it is pretty much legal. I have also seen a drop in opioid abuse. Feel like doctors are starting to realize how harmful these can be.

    ReplyDelete
  3. If you are so broke you are filing for DIB where is the money coming from to support drug and alcohol addiction?

    ReplyDelete
  4. The unaddressed issue is SSA's tolerance of ALJ decisions that the client can't be in pain or otherwise disabled because they have only had "conservative treatment" like not taking opioids. I see these rationales all the time and it is maddening. Moreover at least 2 Listings - for Sickle cell and digestive disorders require narcotics to justify meeting a Listing. Especially given the public and medical professions reluctance to use/prescribe such medications you'd think that SSA would ditch these bogus rules.

    ReplyDelete
  5. With all due respect to the author, most cases of DAA are not treated as one of "when in doubt deny". Quite the contrary. Perhaps the writer's perception is colored by only seeing the cases that have NOT already been approved, at either the initial or recon level.
    Many cases are painted with a knee-jerk "DAA is not material" to 1) avoid the additional documentation required (at least double the assessment), 2) satisfy many psych MC's beliefs that any drug use is caused by an underlying psychological disorder, and 3) pander to the actual requirement that DDS/SSA must prove that DAA is material in cases where mental allegations are involved (the burden of proof is in practice reversed in these mental-involved cases). Please re-read SSR 13-2p, item 7 carefully.

    ReplyDelete