Why Are There So Many Disabiltiy Recipients In Kentucky?

     Dustin Pugel at KY Policy Blog has responded to the recent arguments from the Kentucky Disability Determination Service director about the increase in the number of Kentuckians drawing Social Security disability benefits. Here's a long excerpt:

While some argue the considerable increase in DI beneficiaries in Kentucky is the result of a deficient culture that doesn’t value work, the data does not support this.  The rise in DI beneficiaries in Kentucky — from 148,375 in 2000 to 203,471 in 2016 — might seem alarming, but it is actually closely related to demographic factors, including the aging of the large baby boomer population and the increase in the number of women in the workforce who have the paid work history to qualify for DI.

Older workers are simply more likely to become disabled, and there has been growth in the number of older workers as the baby boomers aged. The likelihood that a worker will collect DI doubles between ages 30 and 40, 40 and 50, and ages 50 and 60. In Kentucky, 76 percent of DI beneficiaries are between 50 and 64 years old.

Kentucky, like the nation as a whole, has been undergoing a swell of population in that age group as the youngest baby boomers began to turn 50 in the late 1990s.

• As a share of the state’s population, those 50-64, has increased 49 percent, from 13.6 percent in 1990 to 20.2 percent in 2016.
• The number of 50-64 year old Kentuckians has increased 79 percent, from 501,679 in 1990 to 896,268 in 2016

This also means, however, that we should expect the number of DI beneficiaries to decline as more boomers reach full retirement age – and out of eligibility for DI. And that is exactly what has been happening.

After rising for a number of years, DI enrollment in Kentucky has dropped every year since 2013.

Women have also become a larger share of the workforce and subsequently, a larger share have been paying into Social Security and begun to qualify for DI. This is why women have accounted for much of Kentucky’s growth in DI beneficiaries. In fact the number of men receiving DI in Kentucky grew 41 percent between 2000 and 2016, but women with DI benefits nearly doubled, at 95 percent.

Some point to Kentucky’s high number of DI beneficiaries compared to other states as a reason for concern. However, most of the variation among states can be largely explained by four factors: a less educated workforce, an older workforce, fewer immigrants (as most immigrants do not qualify for DI) and an industry-based economy (including mining) that involves more physical wear and tear. Kentucky ranks high in these categories compared to other states:

• 5 percent of Kentuckians aged 25 or older completed at least a high school degree (3rd worst in the U.S.).
• The median age in Kentucky is 38.5 years old (18th oldest in the U.S.).
• Only 3.1 percent of Kentuckians are foreign-born (6th lowest in the U.S.).
• 4 percent of Kentuckians work a blue collar job (14th highest in the U.S.).

This Is What Happens When There Aren't Enough Employees To Get The Work Done

There's also the problem that by the time they finally get to talk to someone they're really exasperated and hard to deal with.

Clarification On Third Party Assistance In Filing Claim

     This is from Social Security's Emergency Message EM-17032:

... A third party can help a claimant file for disability benefits by completing an iClaim for DIB or DIB/SSI. Once the third party submits the iClaim, the claimant receives an Internet Application Summary by mail to review, sign, and return to a field office (FO) or workload support unit (WSU). ...

     I post this -- and Social Security issued it -- because at times past some agency employees have felt it was improper, even illegal, for a third party, such as an attorney, to complete an online claim form at the behest of a claimant. This always seemed ridiculous to me but it must still make some sense to Social Security since they are still insisting that if a third party completes the online form, what has been filed is only a protective filing date until the claimant puts her or her "wet signature" on a piece of paper.
     I've often wondered whether someone could make a living just charging people a fee for helping them file their Social Security claims of all sorts; not representing them just helping them file claims. Social Security would probably try to hassle anyone who did this by insisting they get any fees they charge approved case by case even though there would be no real representation but should they? People need better help than they're getting from the Social Security Administration. Their employees do their best but the agency is understaffed and unable to deliver service at the level many people need.

2% COLA

     The Cost Of Living Adjustment (COLA) for Social Security for 2017 is 2%. This applies to benefits beginning December 2017. Payments for that month will be made in January 2018. Below is the entire list of 2018 adjustments announced at this time (you can click on it to view it full size:

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.