Intellectual Disability Diagnosis Standards Much Tougher In U.S. Than In Canada

     From The Star Phoenix of Saskatoon, Saskatchewan:

If you lived in Niagara Falls, Ont., and got benefits for an intellectual disability, then moved across the Canada-U.S. border to Niagara Falls, N.Y., you wouldn't get them.

Psychologists can use two different yardsticks to determine your IQ, which, in turn, determines whether you are considered to have a disability, which, in turn, determines whether you get a disability cheque in the mail every month.

One yardstick is Canadian, the other American. And research by Dr. Allyson Harrison, who heads the Regional Assessment and Resource Centre at Queen's University in Kingston, Ont., finds that five times more people are diagnosed with a disability when the Canadian yardstick, or standard, is used in tests than when the U.S. standard is used. ...

In a research study, Harrison administered the Wechsler Adult Intelligence Scale, Fourth Edition, (WAIS-IV) test to Ontario university students who had been referred to her by a doctor.

But because of how the test works - it's standardized, like SATs - their answers don't mean anything unless they are measured against a standard derived from test results of people in their own demographic as determined by gender, age and educational level. ...

Of Harrison's sample, 21.2 per cent qualify for disability cheques when they're scored using Canadian standards. Only 4.2 per cent qualify using the American standards. That number - 4.2 per cent - is what you'd expect in the population of college and university students she studied.

Every Candidate Needs To Take A Stand On Social Security

     You may not have noticed or cared but Chris Christie is running for President. As a lower tier candidate, Christie feels a need to be bold. He's decided to demonstrate his boldness by campaigning on cutting Social Security by means testing benefits, cutting the cost of living adjustment and raising the retirement age. Michael Hiltzik, at the LA Times finds Christie's plan offensive. So do I, but I'm also delighted that Christie is raising these issues. It will be good to see other candidates reacting to Christie's ideas. The Republican debates in Iowa and New Hampshire should be interesting. Any plan to cut Social Security turns off about 75% of voters. The 25% who favor Social Security cuts are pretty much the Republican base.

SRRT Jobs Disappearing

     From the Wall Street Journal:

The American labor market and middle class was once built on the routine job–workers showed up at factories and offices, took their places on the assembly line or the paper-pushing chain, did the same task over and over, and then went home.

New research from Henry Siu at the University of British Columbia and Nir Jaimovich from Duke University shows just how much the world of routine work has collapsed. The economists released a paper today, published by the centrist Democratic think tank Third Way, showing that over the course of the last two recessions and recoveries, a period beginning in 2001, the economy’s job growth has come entirely from nonroutine work. ... 

In the late 1980s, routine cognitive jobs were held by about 17% of the population and routine manual jobs by about 16%. Today, that’s declined to about 13.5% and 12%.

     What does this have to do with Social Security? A high percentage of people applying for Social Security disability benefits have low cognitive abilities as well as other physical or mental impairments. Often, these people are denied Social Security disability benefits based up a finding that work involving only "simple, routine, repetitive tasks" or SRRT is available that they can do. The SRRT category is also often used to deny people who have normal cognitive abilities but who have psychiatric problems. I've always thought that questionable since psychiatric problems mostly affect the ability to show up for work, get along with other people and concentrate upon the job at hand, all of which have little to do with the complexity of the work being performed but, rightly or wrongly, SRRT is used as a catchall category for many people with psychiatric problems. However, as this study shows, the SRRT jobs are disappearing. You can't "cure" low cognitive abilities in adults with education or training. It's a fixed limitation. If SRRT jobs are disappearing, Social Security ought to be approving more people limited to SRRT.

Validity Testing Recommended

     From Science Daily:

Broader use of standardized psychological testing for applicants submitting disability claims to the U.S. Social Security Administration (SSA) should improve the accuracy and consistency of disability determinations, says a new report from the Institute of Medicine. Some proponents of mandatory psychological testing, in particular validity testing, for SSA disability applicants argue that it would result in a significant reduction of individuals allowed onto the benefits rolls and a substantial cost savings. The committee that conducted the study and wrote the report said the data necessary to accurately assess the effects on the rolls or calculate financial costs and benefits are limited, and estimates based on available data are subject to considerable error.  ...

Cognitive psychological tests are performance-based and have people answer questions and solve problems as well as they possibly can. Non-cognitive psychological tests are measures of typical behavior -- such as personality, interests, values, and attitudes. Validity tests can be used in conjunction with these standardized psychological tests to assess whether a test-taker is exerting sufficient effort to perform well, responding to the best of his or her capability, or providing an accurate report of his or her symptoms. ...

The committee recommended that under specified conditions, SSA should require standardized, non-cognitive psychological testing for all applicants whose allegation of non-cognitive functional impairment relates to a mental disorder unaccompanied by cognitive complaints or to a disorder with physical symptoms that are disproportionate to the medical findings. Testing should be required when the allegation is based primarily on the applicant's self-reporting of symptoms and is not accompanied by objective medical evidence or longitudinal medical records sufficient to make a disability determination. In addition, the SSA should require standardized cognitive testing be included in the case record for all applicants whose allegation of cognitive impairment is not accompanied by objective medical evidence. ...

Good Planning, GOP

     I think I was the first one to write publicly about this. Here's Mother Jones sounding the same theme:

With Hillary Clinton now officially running for president, progressives are upping the pressure on her to embrace their policy agenda, including the Holy Grail of expanding Social Security benefits. ...

But it's actually Republicans, not progressives, who have essentially guaranteed that Social Security will be a major issue in 2016, setting up a battle that will provide stark contrast between the two parties on the issue ...

Dylan Scott wrote last week, House Republicans passed a little-noticed procedural rule back in January that will ensure a heated debate on the Social Security at the height of the presidential campaign.

As things stand now, in the final three months of 2016, the Social Security Disability Insurance trust fund will run out of money and beneficiaries will see an immediate 20 percent cut in benefits. Luckily, there's an easy fix: Congress can simply reallocate a small amount of payroll tax income from the larger Social Security retirement fund to the disability fund. ...

But just as Republicans in recent years have turned once routine debt-ceiling votes into near-catastrophic showdowns, the Republicans' new procedural rule blocks the House from voting on this simple fix unless they also address the long-term solvency of the program by cutting benefits or raising taxes. Progressives expect House GOPers to use the rule to force through benefits cuts in late 2016.

Or at least that seems to be their plan. But what House Republicans have actually done is set up a battle that will force the two parties and their respective candidates to take a position on whether to expand or cut Social Security benefits in late 2016—just as Americans are picking their next president.

     And, please, if you're a GOP leader, just dismiss this out of hand because it's coming from Mother Jones and because you're sure the public will support your Social Security cuts once you explain that that you're only trying to save Social Security. Everyone knows it's really the Democrats who are recklessly endangering Social Security. Fox News reports this all the time.

I Keep Coming Back To This

     I keep coming back to this since it's such an interesting example of what's been happening at Social Security for the last few years as the agency, seems obsessed with making it harder to get disability benefits. Somebody made a mistake and wrote something sensible in Social Security's policy manual but it could be interpreted as helping claimants in some minor way so it had to be quickly excised but the change couldn't be announced or explained. Here's what I've posted before:

Not too long ago someone told me that this example had been added to Social Security's Program Operations Manual Series (POMS):

A 50-year-old claimant with a high school education and unskilled past relevant work has an RFC [Residual Functional Capacity] for standing/walking 2 hours of an 8-hour day and sitting approximately 6 hours of an 8-hour day. He is able to lift/carry/push/pull 20 pounds occasionally and 10 pounds frequently. This RFC falls between rule 201.12, which has a decision of disabled, and 202.13, which has a decision of not disabled. In this case, use rule 201.12 as a framework for a decision of disabled because the definitions in DI 25001.001 (Medical-Vocational Quick Reference Guide) indicate light work usually requires walking or standing for approximately 6 hours of an 8-hour day. Since the claimant can only walk or stand for 2 hours, he has a significantly reduced capacity to perform light work and a sedentary medical-vocational rule applies as a framework for a determination.

I posted about this. Not long after I posted about it, without any announcement of a change, the example disappeared from the POMS section to which I cited. However, you can still see the example on the transmittal sheet, which is available online, which notified the various components of the agency about this and other changes. As long as it's there, it's going to be cited to courts and Administrative Law Judges. So, now, the question is whether the example will disappear from the transmittal sheet? Will the agency pretend that none of this ever happened? I've heard of the concept of a non-person. Can there be a non-thing? Can Social Security permanently erase this from the memory bank?

    And here's an e-mail I received from a reader:

Regarding POMS section DI 25025.015, transmittal sheets disappear from the public site after 60 days, so you might want to save a copy. 

Transmittal sheets and archived POMS sections are maintained on SSA's internal web site indefinitely.

I don't know enough about the disability program to understand why the example was problematical, but the people who maintain the POMS web site were asked to remove the example (and did so) on March 27.  You can see at the bottom of the section, in small type, "Batch Run" and "Rev" dates indicating when it was changed.

I'd prefer you didn't mention my name if you use this information.

New Listings For Children

     Social Security is adopting revised Listings used in determining disability in children for growth disorders and weight loss. This includes one of the more interesting names for a medical condition, "failure to thrive." Children are expected to thrive, that is to rapidly gain weight and height. "Failure to thrive" is an ominous condition and a challenge for a pediatrician's diagnostic skills. When they can't figure out what the specific problem is or how to cure it, disability can result.

Isn't It Nice That They're Checking On Me!

     An elderly relative of mine recently passed away after a brief illness. A few months before he died he was surprised to receive a call from a nurse who had been hired by his last employer's retirement plan. The nurse wanted to come out and check his blood pressure. He thought that it was great that they wanted to check on him. I knew the real reason this was happening. They weren't doing this just to be nice. My elderly relative really hated to go to the doctor and hadn't been to one in several years. Since he had supplemental health insurance benefits through his former employer they knew he hadn't been to a doctor recently. They were checking to make sure he was still alive. I expect that Social Security would have been checked on him eventually for the same reason but he got sick and started using his Medicare and then he died. Social Security checks on people drawing retirement benefits who aren't using Medicare. Social Security's Office of Inspector General (OIG) has issued a report recommending that the agency extend this program to those drawing disability benefits. That makes good sense. However, as always, the agency's ability to undertake such efforts is limited by inadequate staffing caused by an inadequate administrative budget. The inadequate staffing is probably why my elderly relative's employee retirement plan checked to make sure he was alive before Social Security did.