People With Cystic Fibrosis Apparently Being Targeted By Social Security

     CBS reports on Social Security  cutting off disability benefits to one young woman suffering from cystic fibrosis. Note that people involved in helping those with cystic fibrosis report that this is not an isolated case, that they’ve seen many similar cases lately. 

     I’ve seen this sort of thing many times over the years. Suddenly, I start seeing a run of clients with a particular disorder. I can remember seeing cystic fibrosis cases quite a few years ago but not recently. Mostly, what I see now is multiple sclerosis cases. It’s not that there are suddenly more people with cystic fibrosis or multiple sclerosis. It’s that Social Security has suddenly started turning down or cutting off disability benefits to people suffering from these disorders. There’s been no announcement, no public discussion of the change. The decision is made in private and almost certainly doesn’t involve really high level people. Congress isn’t consulted. It’s never written down.  It’s all done through QA, Quality Assurance. Suddenly, whenever Disability Determination tries to put a claimant on benefits for a particular medical problem, the case gets sent back. Perhaps, since this case is a termination, Social Security has decided, ultra quietly, to target people with cystic fibrosis who are already on benefits for full medical reviews. Once the personnel involved in making disability determinations receive a few such cases back and notice the targeting of those already on benefits they get the picture and start denying the claims and cutting off benefits. Social Security doesn’t have to take responsibility for what it’s doing because it’s all hidden away in individual claimant files which are not available to the public.

Schizophrenia And Social Security

I have been seeing more and more people contacting me who have been denied Social Security disability benefits even though they are schizophrenic. I have talked with other attorneys in North Carolina who tell me that they have seen the same thing. I have not seen disability claims based upon schizophrenia denied in a long time, more than 25 years. Social Security for many years that schizophrenia is such a devastating illness that any virtually every schizophrenic ought to be approved.

So what has changed? It's not been a change in the treatment of schizophrenia. There's no cure. Schizophrenia cannot be managed in the way that bipolar disorder can be managed for many people. The best that can be achieved with schizophrenia is to control the positive symptoms, the hallucinations and delusions, but treatment hardly touches the negative symptoms of schizophrenia, such as "inexpressive faces, blank looks, monotone and monosyllabic speech, few gestures, seeming lack of interest in the world and other people, inability to feel pleasure or act spontaneously." That may sound a little vague but it is very real and very disabling.

If something has changed in disability claims based upon schizophrenia, it is at Social Security. Social Security never announces these things. In fact, they always deny that they have made any change. They "announce" the change secretly using their quality assurance program. Disability Determination Services (DDS) tries to approve someone at the initial or reconsideration level, the case is subjected to quality assurance review and gets sent back because the quality assurance people did not like paying that person. Once DDS gets several returns on the same issue, they gets the picture and cut back on approving people who present that particular situation without Social Security every acknowledging that anything has changed.

Take a look below at a quality assurance return that I have seen in a client's file recently. I have redacted the identifying information. Don't try to blame it on the diagnosis of "schizophreniform disorder" instead of schizophrenia? That's technical, because the young woman in question hadn't demonstrated her symptoms for six months. Since that time, predictably, her symptoms have continued unabated. DDS got the message from this return. They got updated clinic records which showed the continuation of the same problems and they turned her down. That's why her mother called me.

I find this depressing. What do you think?

Schizophrenia

NADE Newsletter: Denials Are Less Accurate Than Allowances And The Meaning Of Relevance

The National Association of Disability Examiners (NADE), an organization of the people who make initial and reconsideration determinations on Social Security disability claims, has issued its Spring 2009 Newsletter. It is not surprising that much of the newsletter is devoted to the furloughs hitting many NADE members, who are almost all state employees, but there are other interesting things discussed.

Here are a couple of excerpts from an article about a meeting between NADE officials and Social Security Commissioner Michael Astrue:

SSA is continuing to explore the possibility of expanding the Single Decision-Maker (SDM) model and expanding the list of conditions to be included in the Compassionate Allowances (CAL) initiative. However the Office of Management and Budget (OMB) is not considering any new regulations until the economic problems have been addressed ...

NADE also renewed its call for a reduction in the 15 year vocationally relevant time period to 5 years. The Commissioner reported that the Agency was seriously considering this proposal and Associate Commissioner Glenn Sklar reported he had formed a workgroup to examine this proposal and that he expected a reduction would be forthcoming. While it may not be 5 years, it would be considerably less than the current 15 years. [Apparently, they are thinking about ten years. See below.]

Here is a little nugget from an article about a meeting between the NADE Board of Directors and Kelly Croft, Social Security's Deputy Commissioner for Quality Performance:

The Office of Quality Performance has changed the pull [of disability determinations made at the initial and reconsideration levels by NADE members] for Pre-Effectuation Review (PER) cases to one that is more of an integrity review. ...

40,000 denials will be reviewed at random (with probably more reconsiderations being reviewed). Denial case accuracy runs 90-91%. Allowance accuracy rates are 97-98%.

Social Security agrees that initial and reconsideration allowances are much more accurate than denials. A lot of people who represent claimants have been saying that for years.

This article also says that "An Occupational Information Development Advisory Panel is in place and conducting a study to change the time frame for past relevant work (PRW) from 15 years to 10 years." I did not know that the definition of past relevant work was part of that group's charter. The article quoted above indicates that Glenn Sklar is forming a workgroup to study the issue. Sklar's workgroup and the Occupational Information Development Advisory Panel's study on this issue may be the same thing.

While the issue of how far back past work may be considered relevant is heating up, it has been under study for years and may remain under study for many more years. The issue needs little study. The problem is that reducing this time period to five years would cost money -- probably not much, but some. It would be fairer, but when fairness in disability determination collides with budget considerations, the budget almost always wins.

Think about it. If you last worked at a job 14 years ago, do you think you could pick back up on that job and be able to perform it again without additional training? The answer is obviously "no" and the answer would be the same even if you reduced the time period to ten years or even seven. Resuming an old job without additional training after even five years could be a stretch. This may sound boring and technical but claimants are being denied based upon a policy that, as best I can tell, no one is willing to defend.

Correction On Quality Assurance Reviews

I received a helpful, but anonymous, response to my post about the proposed quality assurance reviews of Administrative Law Judge decisions that corrects a misunderstanding I had. I imagine I am not the only one confused by this. I have no way of asking permission to post it, but I see no way it could be traced back, so here it is:

Your comments and observations were interesting and mostly on-target. However, I believe your comment number 7 is predicated on a misinterpretation of the term "Regional Attorney." You base your comment on the assumption that the references to the "Regional Attorney" are, in fact references to the "Regional Chief Counsel" in the Office of the General Counsel (OGC). I believe you are wrong in this interpretation. Regional Attorneys are located in each of the ten Offices of the Regional Chief ALJ, within ODAR, and report to the RCALJ. They may or may not have supervisory responsibilities. Regional Chief Counsels, on the other hand, are the primary OGC executives in each region, and report to the General Counsel in Baltimore. I believe that the Plan's references to Regional Attorneys are references to the ODAR attorneys, not to any attorney (or anyone else) in OGC. To my knowledge ... there have never been any serious discussions about having OGC involved in any substantive manner in the adjudication process. (The closest was the Counsel to Council short-term project several years ago. Even then, OGC had no discretionary involvement in the outcome of any individual claim).

Although your assumptions would arguably be correct if OGC became involved in the hearing process, I do not believe that is the Agency's intent.

Social Security Medical Experts

I took a look recently at the documents connected with Social Security's process for hiring physicians as Medical Experts (ME). This caught my eye:

The ME shall maintain a satisfactory quality level of performance when reviewing disability case files. The ME’s level of performance shall be identified through the Office of Medical and Vocational Expertise (OMVE) quality assurance program and its policies and procedures. OMVE will randomly sample 1 or 2 completed work products per ME per month. The work will be reviewed by OMVE full time staff for compliance with SSA policy and procedures, completeness, and accuracy of medical assessment of severity and functional ability. Feedback documentation will be provided to the ME. The ME will have the opportunity to discuss any noted deficiency with OMVE staff and will make the agreed upon corrections to the appropriate documents.

The announcement appears to cover both MEs who testify at hearings before Social Security Administrative Law Judges (ALJs) as well as those who work for Social Security's regional and central offices. I hope these quality assurance reviews do not apply now and are not intended to ever apply to MEs testifying before ALJs.