DSM Coming In May 2013 -- What About Proposed New Psychiatric Listings?

     The 5th edition of the Diagnostic and Statistical Manual (DSM-5) is due out in May 2013. Many of my readers are now going "Huh? What's that?" The DSM is the Bible of psychiatry. It is an essential tool for the diagnosis of mental illness. Indeed, psychiatry was revolutionized by the advent of the DSM. Psychiatric illness is a major basis for awarding Social Security disability benefits. The DSM has had a huge impact upon disability determination at Social Security. While it is impossible to now predict what effect it will have, the DSM-5 is almost certain to be of considerable importance to Social Security. If you have an interest in disability determination at Social Security but are not involved in it on a day to day basis, just take it from someone who is, a new edition of the DSM is a big deal for Social Security.

     Social Security has been working on new Listings of impairments, that is regulations defining which disability claims based upon psychiatric conditions require quick approval, for more than four years. Social Security got a proposal approved by the Office of Management and Budget (OMB) in the waning days of the George W. Bush administration but never published it.  (No doubt, it would have been published if McCain had won.) After Barack Obama took office, the agency went back to the drawing board and got a new proposal approved by OMB to be published for notice and comment. This proposal was highly controversial. The comments are all in. At least in theory, Social Security could send final regulations over to OMB for approval at any time. Will Michael Astrue try to finalize proposed psychiatric listings while he is still Commissioner of Social Security -- before DSM-5 comes out? Astrue's term ends in January 2013. I was surprised that OMB approved publication of the proposal. Would OMB approve final regulations that contained the controversial elements of the proposal? Would Astrue want the proposed Listings without the controversial elements? Is it already getting too close to the election for controversial regulations? Would OMB approve anything important proposed by a lame duck Republican Commissioner of Social Security?

Union Agreement Signed

     The Social Security Administration and the American Federation of Government Employees (AFGE), the union that represents most of its employees, have finally signed a new agreement. This is now subject to ratification by union members.

The Attack Pieces Continue

     Here's a Reuters piece attacking the Social Security disability programs as being in part disguised unemployment.  Here are a few excerpts, with some comments by me in brackets and bolded:

• ... Chris Low, chief economist at FTN Financial, said over time, disability will rob roughly $250 billion - or 1.6 percent - from total output each year once the economy returns to full employment, probably within the next five to seven years. This will also widen the budget deficit.
• Duggan and other economists say the major change in the growth rate stems from a series of reforms in the mid-1980s, which changed the focus of screening from medical criteria to working ability. [The golden age that Duggan longs for was actually a brief, bizarre period of extreme harshness that was extraordinarily unpopular and quickly abandoned.]
• "They are not encouraged to go back to work. [Actually, there are encouragement galore to return to work. You just don't know what you're talking about] I have gone to multiple meetings on a program called 'Ticket to Work' and there were only five people who showed up," she said. [The article is so poorly written that I cannot figure out who "she" is. The bigger problem, though, is "she" doesn't consider the possibility that the reason why so few people show up for Ticket to Work is that there are so few people drawing Social Security disability with a potential to return to work.]
• If people do return to work, they could lose benefits such as health insurance, which further discourages some from looking, said Richard Johnson, Director of the Program on Retirement Policy at The Urban Institute in Washington.[No, actually, they are allowed to continue to receive Medicare for a very long time after going back to work. Why is Johnson giving interviews about something he doesn't understand?]
• "If you provide incentives to people to go back to work, they do that," Barry Lundquist, President of The Council for Disability Awareness, a non-profit organization which advises disabled workers.[Lundquist advises disabled workers but doesn't know about the abundant work incentives that already exist? Maybe, they don't go back to work despite the incentives because the definition of disability used by Social Security assures that they're just too sick.]

     The drumbeat of articles along this long don't happen by accident. They are promoted by some entity or entities. The same ill-informed people keep getting quoted again and again. At least, they seem very concerned that work incentives be added to the Social Security disability programs. Adding another work incentive to the long list of work incentives that already exist would mostly be harmless.

Another Disability Benefits Attack Piece

     Bloomberg News is out with a piece attacking Social Security disability. It's a rehash of very argument you've ever heard that it's easy to get Social Security disability benefits, that it's a disguised unemployment program and that almost no one receiving disability benefits ever returns to work. The suggested solution is to make it more attractive for those receiving disability benefits to return to work. 

     How do you write something like this without it occurring to you that the baby boom generation might have something to do with the surge in disability claims and without finding out that there are already endless work incentives in the Social Security disability programs? Neither point is mentioned.

Disability Claim Estimated To Be Worth $260,000

     I noticed in a footnote to what was otherwise a boring report by Social Security's Office of Inspector General that Social Security's "actuary estimated the present discounted value of expected benefits for an average disabled worker award in 2011 was about $130,000 from the Disability Insurance Trust Fund and $130,000 from the Medicare Trust Fund."  In 2008, the National Academy of Social Insurance had estimated the value of an approved disability claim at $414,000 and they were only looking at the value of the cash benefits.

Social Security Bulletin

     Social Security has released the May 2012 issue of the Social Security Bulletin, the agency's scholarly publication.

ALJs Forbidden To Search Online For Info About Claimants

     From the Washington Times:

The Social Security Administration last month told its disability-claims judges they are no longer to seek out information from websites when deciding cases — taking away a tool some of those judges say would help in uncovering fraud. ...

Social Security’s ban covers all Internet sites, including social media such as Facebook.


But Sen. Tom Coburn, Oklahoma Republican and a top taxpayer watchdog, said avoiding the Internet means giving up a valuable anti-fraud weapon — one that he said even federal courts have relied upon in some disability cases.


“If an individual claims to be disabled, and then publicly posts a picture participating in a sport or physical activity on a social media website, such information should be used by [adjudicators] to determine if the claimant was truly disabled,” Mr. Coburn wrote in a letter last week to Social Security Commissioner Michael J. Astrue.

      The problem with Administrative Law Judges (ALJs) searching social media sites for information on a claimant is what lawyers call ex parte evidence, that is evidence that the ALJ receives without the claimant's knowledge. Deciding a case on ex parte evidence is a serious matter. It goes beyond simply making a mistake. It's a denial of due process. Of course, it would be possible to see something online, send the claimant and his or her attorney a copy of what you saw and allow them to respond, which makes it acceptable but it's way to easy to forget to give the claimant a chance to respond.  The problem with banning this is that it may just drive it underground.

From The NOSSCR Conference -- III

     And finally, Eric Schnaufer advises me that the National Organization of Social Security Claimants Representatives gave its Eileen P. Sweeney Distinguished Service Award to James Williams and Stella L. Smetanka. Congratulations to both.