NADE Releases Newsletter

The National Association of Disability Examiners (NADE), an association of disability examiners who work for state disability determination agencies, has released its Summer 2006 Newsletter. The Newsletter contains a good deal of detail about the Disability Service Improvement (DSI) experiment.

SSA Chief Actuary Opposes Accrual Accounting

USA Today reports that Social Security's Chief Actuary, Stephen Goss, has come out against accrual accounting for Social Security. Under accrual accounting Social Security's future obligations would have to be shown on government accounting reports, much as private corporations include their own future obligations to their retirees in their financial reports. Some accountants are recommending accrual accounting for Social Security. Part of this may simply a desire for higher accounting standards, but others seem to have an ulterior motive of making Social Security seem dangerously unstable. The Bush Administration opposes accrual accounting for Social Security.

NADR Newsletter

The National Association of Disability Representatives (NADR) has released its Summer 2006 Newsletter.

Proposed Changes To Immune System Listings

Social Security has issued a Notice of Proposed Rule Making (NPRM) that would amend the immune system Listings. The NPRM includes a major change that will help many who suffer from rheumatic disorders. Here is the summary of the change from the NPRM:

Each of these current listings, except current listing 14.09D [for AIDS], also requires you to have all four of the constitutional symptoms or signs: Severe fatigue, fever, malaise, and involuntary weight loss. We propose to revise this requirement to ‘‘at least two’’ of the constitutional symptoms or signs instead of all four, because we believe that the requirement in the current listing is too severe.

The proposal continues the trend of making the Listing preambles longer and longer. If current trends continue, the Listings will eventually be well over a hundred pages in length. An example of the padding of the Listing preambles occurs in the discussion of the AIDS Listing, which would be amended by the NPRM to include the following language that is already more appropriately included elsewhere in the Regulations:

Your symptoms, including pain, fatigue, and malaise, may be important factors in our determination whether your immune system disorder(s) meets or medically equals a listing or in our determination whether you are otherwise able to work. In order for us to consider your symptoms, you must have medical signs or laboratory findings showing the existence of a medically determinable impairment(s) that could reasonably be expected to produce the symptoms.

Kentucky Woman Sentenced For Social Security Fraud

A Middlesboro, KY woman has been sentenced to six months of home detention and three years of probation for SSI fraud. She had concealed the fact that her boyfriend was living with her and that they owned more than one vehicle. There must be more to the story than is revealed in the Middlesboro Daily News, since on its face, a boyfriend living in the home of an SSI recipient would not necessarily be fraud.

Newsletter Gives Important Information on DSI

The Disability Benefits Project of Massachusetts Legal Services, has published its May-June, 2006 Newsletter. Massachusetts is part of Social Security's Region I, where the Disability Service Improvement (DSI) plan has just started. The Newsletter provides important information about DSI based upon a July training session with SSA officials. Here is the expected timeline for DSI in Region I:

• August 1, 2006: DSI begins.
• Early September 2006: Initial cadre of FedROs are ready to accept cases; the Medical and Vocational Expert System (MVES) is ready to accept cases.
• Early December 2006: ODAR hearing offices and the Decision Review Board (DRB) are ready to accept cases.
• Early 2007: Cases start arriving at hearing offices and DRB in larger numbers.

The Newsletter provides the following information about staffing and training for DSI:

SSA is hiring 70 FedROs; about 15-20 support staff; and 7 supervisory ROs, who will all be located in Falls Church, VA, at ODAR headquarters to facilitate close monitoring during the initial DSI implementation. Eventually, they may be located in other areas of the country. To distinguish the FedROs from the ALJ hearing process, there is a separate ODAR Associate Commissioner for FedROs. The current Acting Associate Commissioner is Jim Winn. FedROs will receive eight weeks of training, starting in August; support staff will receive two weeks.

The Newsletter reveals that SSA plans to tell the claimant and their attorney in an acknowledgment letter the name and contact information for the Federal Reviewing Officer assigned to the case.

The Newsletter contains news about the Medical Vocational Expert System and the Nurse Case Managers it will employ:

The Medical and Vocational Expert System—MVES – will be the new way that medical and vocational expertise is sought by adjudicators. As explained by Martin Gerry, the FedRO “may” obtain a medical expert (ME) or vocational expert (VE) for a case from the MVES. The FedRO is “required” to contact the MVES if new evidence is submitted or he or she intends to change the DDS decision. He stressed that the FedRO will “consult” with the MVES and is not required to follow the MVES expert’s opinion. ALJs who want an ME or VE will be required to go through the MVES.

How will expert requests be handled? SSA provided this example. The FedRO gets case with new evidence. The FedRO contacts the MVES to “consult” and get medical advice. The case will be assigned to a nurse case manager (NCM), a new position. While most will be in units for different body systems, there will be some who can deal with multiple impairments. The NCM will identify the problem and then refer the case to an appropriate expert in the MVES. With the electronic folder, it will be easy for the expert to access the folder.

Who are the experts? Initially, doctors in the Federal DDS will form the core of the MVES. SSA is working with Johns Hopkins Hospital in Baltimore, MD, to provide the rest of the expertise. As examples of MEs who will be available nationally, Mr. Gerry mentioned specialists in autoimmune diseases, Lou Gehrig’s disease (ALS), and claimants who are chronically homeless. For VEs, current lists will be used until national qualifications are established.

Who will conduct CEs? SSA is preparing a request for proposal to medical professionals in Region I, primarily in academic medical institutions, who will be paid the “going rate” to perform CEs. SSA understands the need for local access and is looking at these major medical institutions because they generally have clinical networks in a number of locations.

Despite the description of the duties of the Nurse Case Managers, I would suggest watching this carefully. The number of Nurse Case Managers being hired just for Region I, 90, plus the job title suggests that some additional duties are being planned for the Nurse Case Managers.

The Newsletter says that "SSA headquarters will provide the Field Offices with DSI instructions on August 1st, but a public version of instructions will not be available for one to two months."

Treasury Secretary Eager For Social Security Privatization

MarketWatch reports that Henry Paulson, in his first speech as Secretary of the Treasury, spoke of his desire to make progress towards President Bush's goal of "reforming" Social Security with private accounts.

Illiteracy and Social Security Disability

Social Security regulations give some weight to a claimant's illiteracy in determining disability. It may surprise some just how common illiteracy is. A 2003 study by The National Center for Education Statistics found that 14% of adults have below basic skills in reading prose. One would expect this group to be greatly overrepresented among disability benefits applicants.