NADE Newsletter

     The National Association of Disability Examiners (NADE), whose members work at state agencies making disability determinations at the initial and reconsideration levels for Social Security, has released its most current newsletter, concerning its National Training Conference in Oklahoma City in August. Presentations by John Owen, Associate Commissioner of the Office of Disability Determinations, Hope Grunberg, Associate Commissioner of the Office of Disability Policy (ODP), Ben Gurga, Deputy Associate Commissioner of ODP, Kasey Torres, Director of the Division of Disability Quality and Kevin Huse, Deputy Assistant Inspector General For Cooperative Disability Investigations are summarized.

Ways And Means Republicans Oppose Recent Decisions By Commissioner Of Social Security

     From a press release issued by the Republican majority on the House Ways and Means Committee:

Four recently finalized rules from the Social Security Administration (SSA) are the latest examples of the Biden-Harris Administration’s expansion of federal power at a substantial cost to taxpayers, write House Ways and Means Chairman Jason Smith (R-MO), Work and Welfare Subcommittee Chairman Darin LaHood (R-IL), Social Security Subcommittee Chairman Drew Ferguson (R-GA), Budget Committee Chairman Jodey Arrington (R-TX), and Budget Committee Oversight Task Force Chair Jack Bergman (R-MI) in a new letter to Social Security Commissioner Martin O’Malley.

Over the next decade, these Biden-Harris rules from the SSA, which circumvent the fiscal accountability requirements of the bipartisan Fiscal Res    ponsibility Act, will add $37 billion in new, unpaid-for spending within the Social Security Disability Insurance (DI) and Supplemental Security Insurance (SSI) programs. 

The Biden-Harris Administration’s failure to offset the costs of these rules will both run up the already unsustainable national debt and further harm the financial health of the Social Security programs. Further, these rules were finalized at a time when the combined Social Security Trust Funds are expected to go bankrupt and be unable to pay full benefits in the next decade. ...

    The rules in question are:

• Expand the Definition of Public Assistance Household: Estimated 10 Year Cost: $15 billion
• Omitting Food from In-Kind Support and Maintenance Calculations: Estimated 10 Year Cost: $1.6 billion
• Expansion of the Rental Subsidy Policy for SSI Applicants and Recipients: Estimated 10 Year Cost: $837 million
• Intermediate Improvement to the Disability Adjudication Process: Including How We Consider Past Work: Estimated 10 Year Cost: $19.7 billion

A Little Help From GSA

     From a press release issued by the General Services Administration (GSA):

The Technology Modernization Fund (TMF) announced its latest round of investments totaling $50.2 million, aimed at modernizing critical services across two federal agencies. ...

With $19.5 million in TMF support, SSA aims to transition to a more efficient, user-friendly service featuring electronic signature capabilities and a robust online document upload platform. By 2028, SSA anticipates reducing paper mail volume by roughly half and saving over 600 staff work years annually. For the public, this could potentially save customers up to 1.3 million hours in travel time. ...

SSA plans to use $9 million in TMF support to create user-centered design guidance, build new digital tools, and modernize current backend systems for an enhanced customer experience. This effort aims to simplify notice language, create more digital options for receiving notices, and transform how SSA connects with applicants and beneficiaries. ...

As medical records grow increasingly complex and staff resources remain limited, SSA faces challenges in processing disability claims efficiently. To address this, SSA intends to use $1.9 million in TMF support to enhance several key systems, including the National Case Processing System and the Intelligent Medical-Language Analysis Generation tool. ...

    I don't see an explanation for the other $10 million.

New Policy For Reopening Due To New Five Year Past Relevant Work Standard

     From Emergency Message EM-24023: 

Beginning June 22, 2024, adjudicators will reopen a prior final agency determination or decision based on the PRW CoP [Past Relevant Work Change Of Policy] if the application of the PRW rule at the time of the prior determination or decision would have resulted in a more favorable determination or decision. 

All of the following conditions must be met to reopen based on the PRW CoP: 

• The claimant or SSA/Disability Determination Services (DDS) (or both) questioned the determination or decision in writing within one year of the date of the notice of the initial level determination on the prior claim. 
• The questioning occurred after, or was pending as of, June 22, 2024. 
• The prior claim was denied at step four or five. 
• The denial depended on a finding that the person had PRW that was last done more than 5 years earlier, transferrable skills from PRW that was last done more than 5 years earlier (without continuity of skills to PRW within 5 years of the prior determination, see DI 25005.015C), or PRW that started and stopped in fewer than 30 calendar days. 
• A revised determination or decision applying the current rules (PRW rule) would be more favorable to the claimant than the prior final determination or decision that would be reopened. ... 

What do we mean by questioning the prior final agency determination or decision in writing?

We consider the claimant or SSA/DDS to have questioned the prior final determination or decision in writing if one or more of the following conditions exist: 

•  The claimant files a written request to reopen the prior final determination or decision. 
• The claimant files a new claim alleging disability began in the period adjudicated in the prior final determination or decision (implied request for reopening). 
• The claimant files a new claim and the adjudicator, on the adjudicator’s own initiative, finds the reopening conditions above are met.
• SSA or the DDS questions the prior final determination or decision meeting the reopening conditions above. ...

    I don't see anything in Social Security's statutes or regulations requiring that reopening must be requested within one year of a prior determination. The standard is four years for Title II and two years for SSI. This dramatically limits the effect.

PRW Change Delayed Two Weeks

     The definition of past relevant work for Social Security disability determination was supposed to change from 15 years to 5 years on June 8 but that’s now to come into effect two weeks later, June 22. At least that’s the word on the street. They’ll have to publish something in the Federal Register eventually.  I don’t know what the point is. This shouldn’t require much training. Did they only belatedly notice some policy issues that were quickly apparent to those of us who represent claimants?

Deep Red In More Than One Way

 

From a Social Security fact sheet

Initial Processing Backlogs

     Social Security has released numbers showing the backlogs at the initial level on disability claims. This is from more than six months ago but I don't think there's been significant improvement since. The situation may be worse. The processing time is expressed in days. You can click on the images to view them full size.

New Instructions On Transferability Of Skills

     The Social Security Administration has issued new instructions in its POMS manual on transferability of skills for purposes of determining disability. The sections affected are:

• DI 25015.015
• DI 25015.017 
• DI 25015.019

    At first glance I don't see anything that makes a difference but this is a sensitive enough subject that it bears a closer reading than I have given it to this point. 

    My longstanding opinion is that transferability of skills should only be found quite rarely. Those who really did have transferable skills almost certainly transferred them and didn't file disability claims.

Presentation On New Occupational Information System

    On March 18, 2023, Charis Clark and Karen Litschgi of the Bureau of Labor Statistics (BLS) gave a presentation to the American Board of Vocational Experts (ABVE) on the Occupational Requirements Survey: Date and Upcoming Changes. By Freedom of Information Act request I have obtained the Powerpoint slide deck they used for the presentation. (I appreciate the Department of Labor's promptness in responding to my request.) I don't see any surprises in it but if you're interested in what's going on with Social Security's effort to have BLS create a new occupational information system for use in determining disability you should take a look. As boring as this may seem, it's vitally important to the future of Social Security disability determination. The seemingly never-ending process to develop a new system deserves close scrutiny. I don't trust Social Security on this. I'm not sure that anyone who knows much about this trusts Social Security.

    Below are links to the original Powerpoint version and to a version that I printed to PDF. If you're using the PDF version, you will see links in the upper left hand corner of the screens leading to notes apparently used by the presenters. Those notes were apparently not visible to the audience. If you use the Powerpoint version, those notes are visible at the bottom of the screen.

• Powerpoint version
• PDF version
  

    Update: You will have to ask permission to receive the file. I will approve these as quickly as I can. If you know of a better way of doing this sort of thing, I'd be interested.

Kafkaesque Indeed

 

Kafka

    Mark Betancourt has written a piece for Mother Jones magazine titled Inside The Kafkaesque Process For Determining Who Gets Federal Disability Benefits.

     The use of the term “Kafkaesque” may be more apt that Mr. Betancourt realizes. Frans Kafka’s day job was in the related field of what would today be called workers compensation claims.

No Dice For Disability Determination Patent Application

     The United States Court of Appeals for the Federal Circuit has ruled against a patent application that promises to determine whether an individual is disabled for purposes of Social Security through a computer network.

What's A Social Security Disability Claim Worth?

     One question that gets asked from time to time is "How much is a Social Security disability claim worth?" If you try to figure out some average amount of total lifetime benefits that might be paid per person approved, what does it come to? You may be surprised to hear that there are no available official or even unofficial numbers on this. To the best of my knowledge Social Security's actuaries have never produced a figure. I don't recall seeing anyone outside the agency even attempt to come up with a number in many years. The very old estimates I remember were crude.

    I'll jump in with a very rough estimate, $457,000. Let me explain my methodology. The amount of benefits paid last year to all Social Security disability recipients was $145,470 million. The number of people approved for Social Security disability benefits last year was 671,952.  Divide $145,470 million by 671,952 and you get about $249,000. That's what I'm coming up with as a rough estimate of the value of the cash benefits. The amount of Medicare benefits paid for Social Security disability recipients was $139,996 million in 2021. Divide that by the 671,952 who were approved for benefits last year and you get $208,000 as an average value for the Medicare. Total that with the cash benefits and you get $457,000. 

    I don't expect you to say QED!

    Why divide the gross benefits paid in a year by the number added to benefits in that year? My reasoning is that the average length of time that a person stays on disability benefits is the total number of people drawing benefits divided by the number approved per year. The total benefits paid in a year is the summation of the amounts paid to claimants still on benefits who were approved over the years. That number is effectively the amount for one year's cohort of claimants going on benefits multiplied by the average length of time they stay on benefits. I told you that my method was crude but try coming up with a better formula yourself!

    Let me list some objections that I can think of for my methodology and my response:

• Those benefits aren't all being paid in one year. You need to reduce the amount to a current value by discounting it. That's what actuaries do based upon imputed interest rates. Right, but the problem is that reducing the value of an income stream to a current value only works if it's a steady income stream. Both the cash benefits and the Medicare benefits go up over time due to inflation in unpredictable ways. If you factor in the inflation protection, does it really matter that I'm not trying to reduce to current value?
• At best, you're only figuring the value of Disability Insurance Benefits. SSI only claims are worth a lot less. True, but many claimants receive both Disability Insurance Benefits and SSI so those cases are worth more. Don't these two factors roughly offset each other if you're trying to come up with an average? 
• You're not figuring numbers for Disabled Widows and Widowers Benefits or for Disabled Adult Child Benefits. Yes, but those are a fairly small part of the picture. The value of Disabled Widows and Widowers benefits would be lower because of the age of these claimants. On the other hand, the value of Disabled Adult Child Benefits would have to be quite high because of the youth of those claimants.
  
• The number of people approved for Social Security disability benefits in 2021 was below the number approved in prior years due to Covid and other reasons. This means that the average length of time on benefits may be lower than the number on benefits divided by the number approved in 2021. In my mind, this is the most valid of the objections but I'm just trying to come up with a ballpark number.
  
• The value of a claim approved by an ALJ is of more interest to most people reading this blog than a general number for all claims approved. The numbers would have to be significantly higher for cases approved by ALJs since those claimants are younger on average that those approved at the Initial and Reconsideration levels. They're also less likely to have illnesses that are quickly terminal.  Yes, but I have no idea how to compute a number specific to claims approved by ALJs.
• At best, you're only coming up with a dollar figure. The disability benefits approved prevent homelessness in many cases. Disability benefits recipients are able to live in greater dignity. Try living as the uninvited house guest of a relative who doesn't want you in their home but doesn't want to throw you out on the street if you think dignity doesn't matter. Maybe more importantly, approved claimants have medical treatment that allows them to live longer. All I can say to that objection is “Amen.” Social Security disability benefits have a huge value that cannot be expressed in dollars and cents.
  

    As I said above, if you don't like my methodology try coming up with something better. If you do, please share it with us.

    Also, start to think about the process used to adjudicate Social Security disability claims. Is the process commensurate with the value of what's at stake for the claimants and the taxpayers?

Why Is Your Chance Of Winning At The Initial Level On A Social Security Disability Claim 61% If You Live In Kansas But 38% If You Live In Missouri?

      From the Social Security Administration (click on each image to view full size):

Maybe It Helps Them Get Tenure

      Take a look at this academic study, Beyond Health: Non-Health Risk and the Value of Disability Insurance by Manasi Deshpande of the University of Chicago and Lee M. Lockwood of the University of Virginia, and tell us what you make of it. They are asking the question "Should people who are 'less disabled' but still drawing Social Security disability benefits really be drawing some sort of 'welfare' benefit anyway because they're facing other serious stresses in their lives even if they're not all that disabled?"

     My first question on looking at this study is "How did you determine who was less disabled but still drawing Social Security disability benefits?" As best I can tell they answered that question for their purposes with these four questions:

Severity (PSID)

 (1) Do you have any physical or nervous condition that limits the type of work or the amount of work you can do?
- Yes
- No
- Can do nothing

(2) For work you can do, how much does it limit the amount of work you can do { a lot, somewhat, or just a little?
- A lot
- Somewhat
- Just a little
- Not at all

More-severe if \Yes" in (1) and \A lot" in (2), or \Can do nothing" in (1) Less-severe otherwise

Severity (SIPP)

 
(1) Does ... have a physical, mental, or other health condition that limits the kind or amount of work ... can do at a job or business?
- Yes
- No

(2) Does ... health or condition prevent ... from working at a job or business?
- Yes
- No

More-severe if \Yes" in both (1) and (2)

     I find it amazing that two academics would premise a 101 page study on a base as inadequate as this. Disability determination is a hard, perhaps impossible, task. Determining degrees of disability based upon four question is laughable. These authors know a lot about statistics and other abstruse stuff but pretty much zip about disability determination.

     I think the basic, unstated premise of this study is the assumption that many people drawing Social Security disability benefits aren't really that disabled. Exploring whether this assumption is a myth might be a better starting point for research that these authors had.

Book Forthcoming On Labor Market And Socal Security Disability Determination

      From a notice of a book forthcoming in September:

... In Social Security Disability Law and the American Labor Market, Jon C. Dubin challenges the contemporary policies for determining disability benefits and work assessment. He posits the fundamental questions: where are the jobs for persons with significant medical and vocational challenges? And how does the administration misfire in its standards and processes for answering that question? Deploying his profound understanding of the Social Security Administration and Disability law and policy, he demystifies the system, showing us its complex inner mechanisms and flaws, its history and evolution, and how changes in the labor market have rendered some agency processes obsolete. Dubin lays out how those who advocate eviscerating program coverage and needed life support benefits in the guise of modernizing these procedures would reduce the capacity for the Social Security Administration to function properly and serve its intended beneficiaries, and argues that the disability system should instead be “mended, not ended.” 

Dubin argues that while it may seem counterintuitive, the transformation from an industrial economy to a twenty-first-century service economy in the information age, with increased automation, and resulting diminished demand for arduous physical labor, has not meaningfully reduced the relevance of, or need for, the disability benefits programs. Indeed, they have created new and different obstacles to work adjustments based on the need for other skills and capacities in the new economy—especially for the significant portion of persons with cognitive, psychiatric, neuro-psychological, or other mental impairments. Therefore, while the disability program is in dire need of empirically supported updating and measures to remedy identified deficiencies, obsolescence, inconsistencies in application, and racial, economic and other inequities, the program’s framework is sufficiently broad and enduring to remain relevant and faithful to the Act’s congressional beneficent purposes and aspirations.

NADE Newsletter

      The National Association of Disability Examiners (NADE), a voluntary organization of employees who make disability determinations for Social Security at the initial and reconsideration levels, has released its Summer 2021 newsletter.

A Surprising Blog Post From The "Vampire Squid" Guy

      Matt Taibbi, who is a contributing editor for Rolling Stone, has posted on his blog about Social Security. In the first part, he talks about Social Security's performance evaluation system of all things. By the way, my experience is that all performance evaluation systems are a mess. There's no good way of doing it. Taibbi segues into a discussion of Social Security's disability claim adjudication process. Taibbi seems to have conflated the jobs done by different categories of employees in ways which make the system seem even more odd than it actually is.

     Taibbi, by the way, famously described Goldman Sachs as a "vampire squid." Goldman Sachs will have to live with that one for a long, long time.

Hypothetical?

     Here’s a hypothetical question that really isn't so hypothetical: Patient A is immunocompromised due to a history of treatment for cancer. Patient A has been told by her doctor that she should not leave the house except to go to medical treatment until the threat of being infected with Covid-19 has completely passed. That threat will not completely pass until well over half of the population has immunity to Covid-19 either because they have had the disease or because they have been immunized for the disease. This may not happen in the next year. Patient A's old job did not allow working from home. Does patient A meet the definition of disability in the Social Security Act? In answering this question, you're not allowed to assume away the premises of the question because you think the Covid-19 threat will somehow disappear on its own or that immunocompromised people don't really need to strictly avoid risk of exposure to Covid-19.

"The Injustices ... Are Both Many And Deep"

Carl Boatner

     From the Meridian Star:

Carl Boatner suffers from chronic obstructive pulmonary disease, coronary artery disease, two liver diseases, diabetes, obesity, hypertension, major depressive disorder and anxiety disorder.

The administrative law judge handling his appeal of the denial for disability payments determined those medical conditions “could reasonably be expected to cause” disabling symptoms.

And then he denied Boatner’s appeal.

He concluded the Carthage man’s severe medical conditions failed to “meet or medically equal the criteria for any listed impairment,” despite the fact they had once landed him in hospice, a care facility designed to give supportive care to people in the final phase of a terminal illness.

Boatner didn’t die before getting his benefits, but that wasn’t the case for Phillip E. Herring of Tupelo.

Vonda Peters of Tupelo received her brother’s third denial letter in the mail the day after his funeral in July 2019. “I don’t normally cuss, but I thought, what the f---?” Peters said.

U.S. District Judge Carlton Reeves, in a ruling that eventually awarded Boatner disability benefits, pointed to a pervasive attitude among many administrative law judges to view applicants with skepticism, adding Boatner’s judge issued denials at a rate 25 percent higher than the national average.

“The injustices of the disability payment system are both many and deep,” Reeves ruled. “Research suggests the majority of denials may be incorrect, and applicants struggling to manage their disabilities say such denials can amount to a ‘death sentence.’” ...

In a May 11, 2018, ruling, Reeves posed the question: Did the administrative law judge review the evidence properly?

Reeves’ response: No.

In his blistering opinion, he detailed where each component of the disability process had failed Boatner before he then awarded the veteran truck driver his long-denied benefits.
Reeves turned his focus on the state agency acting on the Social, Security Administration’s behalf — Disability Determination Services. ...

n his ruling, Reeves described the “waiting” Boatner had to do, saying, “Boatner has spent nearly a decade seeking disability payments from the Social Security Administration, filing his last application in 2014. Despite acknowledging the severity of Boatner’s medical conditions and his trips to death’s doorstep, the Administration has denied each of his four applications. These denials have been painful. One caused Boatner to walk out of his house, put a gun to his head, and threaten to kill himself.” ...

In his ruling, Reeves took aim at the disability examiners and the administrative law judge that handled Boatner’s case, noting the ALJ had resolved more than 600 cases in 2016. Reeves also said examiners are not prepared to handle as many cases as SSA asks them to handle.

Mississippi DDS’ 111 examiners processed approximately 64,000 cases last fiscal year, according to Patti Patterson, regional communications director for the Atlanta regional office of the Social Security Administration. Caseloads per examiner range from 65-125 cases, said Chris Howard, head of the Department of Rehabilitation Services. ...

I Like The Handcolored Look Of This Waterfall Chart