FAIR Says Disability Reporting Isn't Fair

     Fairness and Accuracy In Reporting (FAIR), a group that "has been offering well-documented criticism of media bias and censorship since 1986,"  has a report on the recent surge of media reports purporting to show problems with Social Security's disability programs. Here are a few excerpts (emphasis added):

New York Times columnist Nicholas Kristof (12/9/12) reported that poor families in Appalachian Kentucky were pulling their kids out of literacy classes. The reason: They feared that if their kids learned to read, it would disqualify them from receiving monthly $698 disability checks from the federal government’s Supplemental Security Income program. ...

According to numerous disability experts, [Kristof's column] was almost entirely wrong or unsupported ...

In a March series, NPR’s Planet Money revisited the world of SSI, this time for adults—and seemed to have learned few of the lessons of the Kristof mess. Calling the program “a hidden, increasingly expensive safety net” and “a de facto welfare program for people without a lot of education or job skills” (NPR.org, 3/13), NPR’s Chana Joffe-Walt painted a picture of soaring disability rolls and nebulous diagnoses, where a “disability industrial complex” is pushing people willy-nilly onto the dole whether they need it or not (All Things Considered, 3/25/13). ...

As with Kristof’s piece, the NPR series led to a firestorm of rebuttals, pointing out significant flaws in the reporting. Media Matters (3/22/13), calling the NPR piece “error-riddled,” cited a Government Accounting Office study (6/26/12) that found disability examiners typically relied on four to five separate medical and school records before making a determination, as well as studies by the Center for American Progress (9/10/12) and the National Bureau of Economic Research (8/05) that found receiving SSI reduced the chances of a family being below the poverty line by 11 percent ...

What has changed is that cutting SSI has become a primary policy target for political think tanks on the right and center (Investor’s Business Daily, 12/17/10; Hamilton Project, 3/29/13). In his piece, Kristof cited as a main source Richard Burkhauser, who said that as a result of SSI, “if you do better in school, you threaten the income of the parents. It’s a terrible incentive.” Kristof identified Burkhauser as a “Cornell economist who recently wrote a book on disability programs.”...

That book, The Declining Work and Welfare of People With Disabilities, was in fact published by the conservative American Enterprise Institute—home to Bell Curve author and welfare-reform godfather Charles Murray—which has fixed its sights on disability benefits for several years. Burkhauser is also a resident scholar at AEI, something Kristof never mentioned in his reporting. ...

Burkhauser’s book was also the source of Kristof’s erroneous report that 8 percent of poor children receive SSI—a number that Kristof (NYTimes.com, 1/23/13) later wrote that he factchecked by asking Burkhauser himself, who unsurprisingly confirmed it. (The actual figure, as later calculated by Fremstad—CEPR, 12/20/12—is less than 4 percent.)

NPR’s Joffe-Walt said she was alerted to the growing disability rolls—or as she put it, “14 million people hidden in plain sight”—by Wharton business economist Mark Duggan (All Things Considered, 3/22/13), who has advocated that the disabled be required to rely on private disability insurance for two years before they can switch to the government program (WSJ.com, 11/30/10). She also interviewed both Burkhauser (All Things Considered, 3/28/13) and his co-author Mary Daly (All Things Considered, 3/27/13) without noting their ties to AEI or to each other.

NPR, meanwhile, may have had its own reasons to want to seek out problems with government disability benefits: The Planet Money story was the first under a three-month underwriting deal with Lincoln Financial, a company that sells private disability insurance (to, among other clients, AEI—Daily Kos, 4/25/13)—something that NPR didn’t see fit to mention anywhere in its radio or online coverage.

Can Anyone Explain How This Happened?

     From a television station in Austin, TX:

The KVUE Defenders help a 93-year-old World War II veteran caught in government red tape. A few months ago, the Social Security Administration admitted to Charles Corvill it mistakenly changed the date of his birthday, but refused to correct it.

According to his birth certificate, his birthday is March 2. The agency incorrectly changed it to March 20. ...

Corvill says he noticed the change in his birthday while paying for his prescriptions. He says Medicare stopped making payments because his date of birth didn’t match its records.

“Well, they charged me $300 maximum when they were suppose to charge $150," Corvill said.

So, with a copy of his birth certificate in tow, he visited an Austin Social Security office to correct it.

“And [the agency representative] went around to talk to people in the office and came back and asked if I'd be willing to live with it for a while. I said, 'No way, Jose!'" said Corvill.

In April, Social Security sent him an unsigned form letter stating, “We have reviewed [your birth certificate] that indicates your date of birth is March 2, 1920. But, in the next sentence, it stated "We cannot overturn our original determination that the correct date of birth is March 20th. Please use the date of birth we have already established." ...
Social Security also claimed correcting his date of birth could reduce his monthly benefits. ...

While Corvill 's complaint went nowhere, the KVUE Defenders got results after calling Social Security and Congressman's Lloyd Doggett’s office.

Two weeks later, the agency sent him another unsigned form letter showing it corrected his birthday and wrote, "We are sorry for any inconvenience this has caused you."

Disruptive Mood Dysregulation Disorder

     The new 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the "Bible" of psychiatry, is out. One of the biggest changes in DSM-5 is the addition of the diagnostic category of Disruptive Mood Dysregulation Disorder. This diagnostic category is primarily designed for children and adolescents but I see nothing in DSM-5 that would limit this diagnosis to children and adolescents. 

     This new diagnostic category is important for Social Security since the agency is involved in determining disability in children and adolescents. Many of the children and adolescents filing disability claims will be diagnosed with this disorder.      

     This diagnosis is considered a type of depressive disorder but disruptive mood dysregulation disorder does not fit in Social Security's Listing 112.04 too well. A persistently irritable mood is mentioned in teh Listing but at least four additional criteria must be met to satisfy Part A of the Listing and those other criteria are not part of this diagnosis. My expectation is that Social Security is going to deny virtually all of these cases, at least until the agency updates the Listing.

     I fully expect that Social Security's critics will dismiss disruptive mood dysregulation disorder as merely temper tantrums. That's ridiculous but it won't stop those critics. The critics usually put the term mental illness in quotation marks to begin with since they believe that mental illness isn't, you know, like, really real. I've never quite understood the right's antipathy for psychiatry. I don't think that anyone can get through life without either experiencing mental illness or observing it up close, either in a family member or friend or someone known through work.

     Below are the DSM-5 criteria for the diagnosis of disruptive mood dysregulation disorder. Note how stringent the criteria are and think about how difficult it would be for a child or adolescent with this diagnosis to develop normally.

Disruptive Mood Dysregulation Disorder

Diagnostic Criteria 296.99 (F34.8)

A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation.

B. The temper outbursts are inconsistent with developmental level.

C. The temper outbursts occur, on average, three or more times per week.

D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers).

E. Criteria A-D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D.

F. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these.

G. The diagnosis should not be made for the first time before age 6 years or after age 18 years.

H. By history or observation, the age at onset of Criteria A-E is before 10 years.

I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.

Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.

J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]).

Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others, including major depressive disorder, attention deficit/hyperactivity disorder, conduct disorder, and substance use disorders. Individuals whose symptoms meet criteria for both disruptive mood dysregulation disorder and oppositional defiant disorder should only be given the diagnosis of disruptive mood dysregulation disorder. If an individual has ever experienced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation disorder should not be assigned.

K. The symptoms are not attributable to the physiological effects of a substance or to an other medical or neurological condition.

NADE Newsletter

     The National Association of Disability Examiners (NADE) has released its Spring 2013 newsletter. NADE is an organization of the personnel who make initial and reconsideration determinations on Social Security disability claims. Here's a quote from the NADE President's column:

One issue that seemed to come to the forefront [in meetings with Social Security officials] was the destruction of prior paper folders, especially involving claimants in pay. We discussed with SSA officials the difficulties this caused while working CDRs [Continuing Disability Reviews]. We also discussed the cost savings associated with continuing to do the CDRs. That is, for every $1 spent on a CDR there are $12 in saving realized. We discussed the different funding mechanisms associated with the CDR workload. We discussed the current evaluation standards and the probable need to revisit the Medical Improvement Review Standards (MIRS).

Doctor Sentenced For Fraud

     From the Associated Press:

A clinical psychologist in San Diego is going to federal prison for a scheme that allowed patients to falsely collect disability benefits and to avoid taking English tests for U.S. citizenship.

The U.S. attorney's office says Roberto J. Velasquez was sentenced Wednesday to 21 months in prison and ordered to repay more than $1.5 million to the Social Security Administration.

Prosecutors say Velasquez charged dozens of patients $200 each to falsely certify that they were disabled. He made up patient histories and fabricated test results.

Velasquez acknowledged falsifying two types of disability forms - one for some patients to obtain Social Security benefits and another that allowed some 50 immigrants to avoid taking the English language and civics portions of citizenship exams.

Trustees Report No Changes

     From a press release issued by the Social Security Administration:

The Social Security Board of Trustees today released its annual report on the long-term financial status of the Social Security Trust Funds.  The combined assets of the Old-Age and Survivors Insurance, and Disability Insurance (OASDI) Trust Funds are projected to become depleted in 2033, unchanged from last year, with 77 percent of benefits still payable at that time.  The DI [Disability Insurance] Trust Fund will become depleted in 2016, also unchanged from last year’s estimate, with 80 percent of benefits still payable.

Why Do People Retire Earlier Or Later Than They Planned?

From a MetLife study

Unemployment And Disability Claims

     The abstract of  Characteristics and Employment of Applicants for Social Security Disability Insurance Over the Business Cycle, a study by Stephan Lindner and Clark Burdick for the Center for Retirement Research at Boston College:

This study investigates the relationship between fluctuations in the short-term unemployment rate and characteristics of applicants for Social Security Disability Insurance. Using administrative records of the universe of applicants between 1991 and 2008, we find that almost all of the increase in applications and allowances during recession periods is due to increasing applications and allowances of people whose applications are either rejected or determined by vocational factors. People who apply during economic downturns also have lower income and assets at the time of application and lower earnings several years after application. Further decomposition results suggest that difficult macroeconomic conditions during the time of application account for the negative relationship between the unemployment rate and post-application earnings and employment.

     And in the body of the report, these statements:

The results so far suggest that more people with moderate disabilities apply when the unemployment rate is high. Therefore, one would also expect that the fraction of applicants with musculoskeletal impairments or mental disorder increases with the unemployment rate. However, we do not [fi]nd supportive evidence for such a compositional change. ...

[W]e [fi]nd no evidence that younger workers apply more frequently during recessions and that the work capacity of applications during economic downturns is higher.