There's No Mystery Why Backlogs Are Increasing

Kentucky DDS Issues Report

     From WTVQ:

A new report issued Tuesday shows an increase of staggering proportions in the number of Kentucky adults and children receiving disability benefits. The report was prepared by Kentucky’s Disability Determination Services (DDS) ...

The groundbreaking study of outcomes covers a 35-year timeframe between 1980-2015. During that time, Kentucky's population grew by 21 percent while its combined disability enrollment grew exponentially by 249 percent. Childhood enrollment growth was an astounding 449 percent.

In 2015, 11.2 percent of Kentuckians were receiving some form of disability benefit payment, which is the second highest percentage in the country. ...

As the rolls have increased, so has the rate of controlled substance prescriptions. Per capita opioid prescriptions for SSI/Medicaid adult recipients have increased from 47.58 doses in 2000 to 147.29 doses in 2015, a 210 percent increase. Per capita psychotropic prescriptions SSI/Medicaid children have increased from 272.61 doses in 2000 to 456.87 doses in 2015, an increase of 168 percent. ...

The report states Social Security disability benefit dependence should be created by genuinely disabling conditions which permanently preclude individuals from ever performing remunerative work. For people so afflicted, the integrity and solvency of the system must be preserved. Tragically, some individuals in Kentucky have never experienced life without public assistance. The culture within the Social Security Administration (SSA) is described as a bureaucratic institution, the SSA is motivated to protect and, if possible, expand the scope of its activities across the full horizon of its operational domain. For the SSA, claims and beneficiaries equal budget. This simple equation drives the SSAs internal culture thereby making it a significant obstacle to long-term change. 

An outline for SSA reforms is laid out in the report and includes a recommendation for an overhaul of the SSA Program Operations Manual System (POMS) to include:

1) Mandate the use of objective medical evidence using best practices in forensic evaluation to determine benefit eligibility. Objective evidence of injury or illness must be paired with objective functional capacity evaluations that include cross-validation and intra-test reliability protocols which measure the legitimacy of demonstrated physical effort and limitation.

2) Mandate the use of best practices in forensic psychological evaluation to include symptom and performance validity tests such as the Miller Forensic Assessment of Symptoms Test (M-FAST), the Structured Inventory of Malingered Symptomatology (SIMS), the Test of Memory and Malingering (TOMM), and the Rey 15 Item Memory Test. These tests should be accompanied with the application of clinical thresholds of benefit eligibility.

3) Remove all subjective non-severe conditions from the listing of eligible conditions and require mandatory termination reviews for all recoupable conditions based on clinically accepted recovery timelines.

4) Eliminate the SSAs Medical Improvement evidentiary standard of continuing disability review in favor of an Objective Functionality review founded upon objective forensic evaluation standards.

5) Cease payment of benefits upon CDR termination pending the outcome of an appeal to an ALJ.

6) Eliminate the SSAs Lost Folder policy which restricts the re-evaluation of a beneficiary whose file has been lost. This policy is referred to as the Golden Ticket because the individual whose file is lost will likely receive benefits for the rest of his/her life without any prospect of termination. ...

Notice Some Trends Here?

     Social Security has released its Annual Statistical Report on the Social Security Disability Insurance Program, 2016. Here are some numbers from the report to consider:

 Approval rate at the initial level on all disability claims

• 2008 -- 38.7%
• 2009 -- 38.5%
• 2010 -- 36.9%
• 2011 -- 35.7%
• 2012 -- 35.7%
• 2013 -- 35.3%
• 2014 -- 34.9%
• 2015 -- 35%

Approval rate at the reconsideration level on all disability claims

• 2008 -- 10.8%
• 2009 -- 9.9%
• 2010 -- 9.0%
• 2011 -- 9.0%
• 2012 -- 8.8%
• 2013 -- 8.6%
• 2014 -- 9.1%
• 2015 -- 9.0%

Approval rate at the hearing level or above on all disability claims

• 2008 -- 68.3%
• 2009 -- 64.5%
• 2010 -- 59.9%
• 2011 -- 55.9%
• 2012 -- 52.9%
• 2013 -- 54.2%
• 2014 -- 53.7%
• 2015 -- 48.8%

Some Tidbits From NADE

     The National Association of Disability Examiners (NADE), an organization of the personnel who make initial and reconsideration determinations on Social Security disability claims, has issued its most recent newsletter. Here's some tidbits from a summary of remarks made by Deborah Harkin, Senior Advisor in Social Security's Office of Disability Policy (ODP), at a NADE conference:

ODP explored many factors while updating the musculoskeletal listings to ensure the new listings adequately addressed the needs of the disability program and disability adjudicators. Among those factors were: Requirements for objective/diagnostic imaging criterion for a disorder of the spine resulting in nerve root compromise; How to assess adults who have had unsuccessful back surgeries; Adult and childhood listings for pathologic fractures; and New childhood listings for musculoskeletal developmental delays in infants from birth to age 3 ...

When complete, OIS [Occupational Information System, being developed by the Department of Labor for Social Security to replace the Dictionary of Occupational Titles] : 

• Will contain fewer than 1,000 occupations 
• Will utilize the O*NET - Standard Occupational Classification (SOC) 
• Will code occupations’ strength and skill requirements like the DOT but also include detailed information 
• For manipulative requirements, will specify whether one or two hands are needed; reaching will include above shoulder level vs. at or below; and will include alternating sit/stand 
• Will eventually include descriptors of the basic mental and cognitive work requirements. ...

     The problem with having fewer than 1,000 occupations in your OIS is that many, perhaps most, of the occupations described would actually be composites, covering disparate jobs performed in significantly different ways. Doing this makes makes the data presentation muddy. Many of the occupations will be done at the sedentary, light and medium exertional levels as well as at the skilled, semi-skilled and unskilled levels, depending upon how it's done at the exact employer. You can use such such muddy data to justify anything you want to justify. I fear that the ability to justify any desired result is exactly the point for Social Security. The agency can say that there are some jobs in a broad category that are performed at the sedentary level and that there are some jobs in that same broad category that are performed at the unskilled level without having to show that they are the same job. The "basic mental and cognitive work requirements" would be the least that is required by any employer rather than what is normally required by an employer. Instead of the horribly outdated DOT, we'd have a synthetic OIS that would give "answers" for which there would be no real world proof. Real people would be denied disability benefits based upon a "let them eat cake" OIS.

It Just Keeps Getting Worse

From the Center on Budget and Policy Priorities -- updated from 2010

Senate Budget Would Dramatically Cut Social Security Administrative Funding

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NOSSCR Response To SSR 17-4p

     The National Organization of Social Security Claimants Representatives (NOSSCR) has responded to Social Security Ruling 17-4p.

COBRA Only Disability Claim?

     From a recent addition to Social Security's Program Operations Manual Series (POMS):

Claimants do not have to meet the non-disability requirements for Title II (e.g., insured status or an onset date more than 5 months before full retirement age (FRA)) or Title XVI (e.g., income or resources) to qualify for the additional 11 months of health care benefits under COBRA. ...

To extend health care coverage under COBRA based on disability, the individual must:

• File for disability benefits (Title II, Title XVI, or concurrent) with COBRA extension, or

• File for COBRA extension only. ...

     I've never seen any of these claims. I can't imagine many are filed.