Dec 14, 2009

I Sure Am Glad We Have Conquered Diabetes!

From a Notice of Proposed Rule-Making (NPRM) in the Federal Register today:
Because of advances in medical treatment and detection, most endocrine disorders do not reach listing-level severity because they do not become sufficiently severe or do not remain at a sufficient level of severity long enough to meet our 12-month duration requirement. This is true even for people who have recurrent episodes of hypoglycemia or of diabetic acidosis (also called diabetic ketoacidosis, or DKA), a serious outcome of uncontrolled blood glucose levels. Current listings 9.08B and 109.08A, which provide criteria for people who have recurrent episodes of DKA, and listing 109.08B, which provides a criterion for children who have recurrent episodes of hypoglycemia, reflect an earlier view that people with wide fluctuations in their blood glucose levels had uncontrollable DM. We consulted with endocrinologists, diabetologists, and other medical experts who treat DM, and they indicated that the current listings reflect only inadequate glucose regulation. The information we obtained from these experts and relevant medical references demonstrates that adequate glucose regulation is achievable with improved treatment options, such as a wider range of insulin products.

For these reasons, we believe that, with one exception, we should no longer have listings in sections 9.00 and 109.00 based on endocrine disorders alone, and we are proposing to remove all such current endocrine listings. The sole exception is for children under age 6 who have DM and require daily insulin.

McPaper Notices State Furlough Problems

From USA Today:
Millions of Americans are waiting longer for unemployment checks, disability payments and food stamps as states furlough workers who process the benefits. ...

The number of people waiting for their first disability checks increased 38% in 2009 to 768,666, according to the Social Security inspector general. Nationally, the average length of time to process a claim went from 81 days in 2008 to 83 days in 2009. ...

Furloughing workers who help the needy is "fundamentally irrational," says Social Security Commissioner Michael Astrue. Disability, unemployment and food stamps are funded by the federal government. "People should be getting their benefits."

Some News From Nancy Shor

Nancy Shor has been Executive Director of the National Organization of Social Security Claimants Representatives (NOSSCR) since 1979. Ms. Shor spoke this past Friday at a Continuing Legal Education (CLE) conference put on by the North Carolina Association for Justice (NCAJ). Below are a few items that I gleaned from her remarks, with one interjection from me in brackets. Could someone explain to me how the last item below could possibly be achieved?
  • In January 2010 Social Security will be distributing 1099s to attorneys and others who have received direct payment from Social Security in 2009 of fees for representing Social Security claimants. There will be one 1099 for each individual who received at least one fee totaling $600 or more and another 1099 for each firm for which such an individual worked. Each 1099, however, will list each individual payment of a fee.
  • Social Security has no advice for attorneys who receive 1099s containing mistakes other than to call the agency's 800 number or one of its field offices. Ms. Shor suggested that this sounded inadequate to her.
  • Ms. Shor thinks that all those who represent Social Security claimants will have full access to Social Security's computer records on their clients within something like six months, although it sounded like she would not be amazed if this date slipped a bit.
  • Ms. Shor is hopeful that withholding of fees for representing Supplemental Security Income (SSI) claimants as well as withholding of fees for certain non-attorney representatives will soon become permanent.
  • David Foster, head of Social Security's Office of Disability Adjudication and Review (ODAR), has told Ms. Shor that it has been noticed that there are an unusually high number of objections to video hearings when certain Administrative Law Judges (ALJs) are to preside. Social Security is considering withholding the name of the ALJ with which a video hearing is being scheduled in order to prevent forum shopping. [What do attorneys do as a counter-move? Does Social Security want that?]
  • The public has until February 15, 2010 to comment upon the recent report of the Occupational Information Development Advisory Panel (OIDAP) of which Ms. Shor is a member. Ms. Shor recommended that the attendees read the report and file comments upon it.
  • Ms. Shor has been told that claimants filing a request for a hearing today will receive a hearing within 275 days, but this may happen at the expense of claimants who already have pending requests for hearings.

Why Doesn't SSA Want To Work With DOL?

In making disability determinations, the Social Security Administration (SSA) relies upon the Dictionary of Occupatonal Titles (DOT), both as a means of classifying a claimant's past work and as a means of determining whether alternative jobs may exist which the claimant can perform despite his or her impairments. The data upon which DOT is based dates back more than thirty years. There is universal agreement that the DOT is unreliable, but Social Security still uses it to deny disability claims. The DOT was produced by the Department of Labor (DOL). The DOL has produced a replacement for the DOT called the O*NET. Unfortunately, the O*NET as it currently exists does not mesh with Social Security's methods for determining disability.

Social Security appointed the Occupational Information Development Advisory Panel (OIDAP) to study what to do about this situation. OIDAP has recently issued its report. There is one glaring omission in the lengthy OIDAP report -- any discussion of the possibility of SSA working with DOL to create some version of O*NET that would satisfy Social Security's needs. Instead, OIDAP recommended that Social Security create its own occupational information system, that is its own equivalent of the DOT or O*NET, from scratch.

OIDAP may not feel like working with DOL, but that feeling is not mutual. The DOL recently set up a panel to review O*NET. That panel has issued its report which is available to download for free. The report devotes an entire chapter to the question of how O*NET might be made to work for disability determination. I have reproduced that entire chapter elsewhere. Here are some excerpts from that chapter (emphasis in original):
Given that occupational information is critical for use in disability determination, our panel invited Sylvia E. Karman, a representative of SSA, to make a presentation on this issue. SSA appears to think that O*NET is not able to fulfill the needs of vocational rehabilitation experts and others involved in the process of disability determination. ...

Having ruled out the use of O*NET for disability determination purposes, SSA has begun taking steps to develop its own occupational information system. In December 2008, the commissioner of social security established the Occupational Information Development Advisory Panel. ... The panel’s report, issued in September, 2009, recommends the creation of a new “Social Security Administration Occupational Information System” for use in disability determination ...

The panel understands that, pending SSA’s response to the advisory panel recommendations, the jury is still out on the topic of whether and to what extent O*NET should be changed or expanded to meet SSA’s needs. However, given public demand for budgetary restraint and efficient government, which acquire additional importance in times of economic recession and slow economic growth, duplication in government functions should be prevented. Therefore, the development of parallel, possibly redundant, occupational information systems, one for general purposes termed O*NET and the other tailored to the needs of SSA, is of concern to taxpayers. In addition, dual data collection processes would seem unnecessarily expensive.

The panel is not advocating the adoption of O*NET by SSA or the development of a hybrid O*NET-Disability system in the disability determination process. However, we conclude that a considerably modified and expanded O*NET may be capable of informing the disability determination process. There are also some potential economies of scale to be derived from the development of a single occupational information system to be used by both agencies, which may allow cost-sharing of resources in such functions as data collection and system maintenance. ...

Not all stakeholders share the opinion that O*NET cannot be amended to meet the needs of those involved in disability determination. In fact, the Committee to Review the Social Security Administration’s Disability Decision Process called for interagency collaboration (Institute of Medicine, 1998). Its 1998 report encouraged SSA to explore some interagency agreement “to initiate a version of O*NET that would collect information on minimum as well as average job requirements to better serve SSA’s needs to assess ability to engage in substantial gainful activity” (p. 24).

We found evidence suggesting that these calls for collaboration between DOL and SSA were heeded. In 2000, vocational rehabilitation professionals initiated discussions with DOL and SSA which led to the creation of the Inter-Organizational O*NET Taskforce with representatives of 16 associations of physicians, psychologists, therapists, counselors, insurers and educators (Cannelongo, 2009). The group met for 4 years and proposed development of a modified version of O*NET called O*NET –D (for Disability) that would incorporate occupational information gathered in the field by disability professionals trained in job analysis, using standardized questionnaires. A pilot study of the approach funded by DOL yielded promising results. Although SSA staff initially agreed with the plan and submitted it to the SSA administrator, the agency later withdrew its support.

At around the same time, SSA commissioned the American Institutes for Research (AIR) to examine the suitability of O*NET for the disability determination process (Gustafson and Rose, 2003). Based on an analysis of the initial O*NET database (the “occupational analyst” database), the AIR research team found that reliability, definitional, and anchoring issues could lead to problems if O*NET data were used for disability determination. At the same time, however, the authors identified specific steps for addressing these problems. For example, they suggested that a disability decision maker could use O*NET task lists and other descriptive information to help determine the activities of claimants’ current jobs and described an approach to using selected O*NET descriptors that would adjust for the positively skewed distributions of ratings of these descriptors. Gustafson and Rose (2003, p. 15) concluded that “SSA could implement into the [disability determination process] a version of O*NET that is legally defensible and acceptable to decision-makers and claimants alike.”

Another piece of evidence, suggesting the continued possibility of collaboration between DOL and SSA, is the testimony provided by former O*NET director, James Woods, to the SSA advisory panel on January 13, 2009 (Woods, 2009). In his address, he regretted that earlier efforts to accommodate the SSA needs into O*NET did not bear fruit; however, he remained hopeful that O*NET
may provide a basis to help SSA focus on a specific set of data needs and to organize data within the O*NET framework—for SSA’s specific needs. O*NET, or at least the lessons learned in developing the O*NET system, may provide a starting point rather than SSA starting from scratch.
In spite of such past interagency efforts, communication and collaboration between DOL and SSA regarding a common occupational database now appears quite limited. An inspection of their most recent communications suggests that both agencies have reached the implicit conclusion that DOL will not modify O*NET to accommodate disability determination users, and that SSA will build an entirely different occupational information system for its purposes. The fact that SSA’s newly formed advisory panel does not include a DOL liaison suggests that the development of an SSA-sponsored system may proceed relatively independent of O*NET.

[The report goes on to examine objections raised by SSA to using the O*NET and then comes to its conclusions and recommendations]
Recommendation: SSA and DOL should create an interagency task force to study the viability of potential modifications of O*NET to accommodate the needs of SSA with regard to disability determination. Before implementing these or similar modifications, however, we recommend that the task force conduct (1) an in-depth needs analysis of the occupational information required by the current disability determination process and (2) an interagency cost-benefit and
cost-sharing analysis of the additional resources that would be needed to make O*NET suitable to the disability determination process.

Average Processing Time Report





This was published in the Social Security Forum, the newsletter of the National Organization of Social Security Claimants Representatives (NOSSCR). The newsletter itself is not available online. Click on each page to see it full size. The report concerns the processing times at Social Security's hearing offices.

Here are some numbers over time for comparison:
  • January 25, 2007 -- 508 days
  • May 25, 2007 -- 523 days
  • July 28, 2007 -- 528 days
  • August 31, 2007 -- 523 days
  • November 30, 2007 -- 500 days
  • February 29, 2008 -- 511 days
  • May 30, 2008 -- 523 days
  • June 27, 2008 -- 529 days
  • July 31, 2008 -- 530 days
  • September 3, 2008 -- 532 days
  • November 5, 2008 -- 476 days
  • December 3, 2008 -- 480 days
  • March 8, 2009 -- 499 days
  • April 24, 2009 -- 505 days
  • June 3, 2009 -- 505 days
  • September 29, 2009 -- 472 days
  • October 30, 2009 -- 446 days

Dec 13, 2009

Early Accounting Operations At Social Security

Updated Fee Payment Stats

Below are undated statistics on payments of fees to attorneys and others for representing Social Security claimants:

Fee Payments

Month/Year Volume Amount
Jan-09
28,423
$101,128,880.69
Feb-09
31,352
$112,791,207.17
Mar-09
29,199
$104,155,187.96
Apr-09
30,963
$110,133,425.19
May-09
36,603
$126,725,262.45
June-09
31,799
$113,962,564.84
July-09
34,802
$124,621,068.71
Aug-09
28,218
$100,279,282.51
Sept-09
28,455
$100,918,402.40
Oct-09
36,729
$131,011,485.43
Nov-09
29,423
$103,696,628.46

It is worth noting that representing Social Security claimants now generates more than a $1 billion a year in fees. We first passed that threshold last year.

Dec 12, 2009

More On Monday

I will have some excerpts on Monday, but if you have the slightest interest in what replaces the Dictionary of Occupational Titles (DOT) in disability determination at Social Security, you need to take a look at Chapter 8 of A Database for a Changing Economy: Review of the Occupational Information Network (O*NET) and then ask yourself why Social Security is insisting on forging ahead on its own at enormous expense on a project which is far outside its field of expertise.