Borderline Disorder And Social Security Disability

     From Course And Predictors Of Social Security Disability Insurance In Patients With Borderline Personality Disorder Over 24 years Of Prospective Follow-up by Kramer, U., Temes, C.M., Frankenburg, F.R. et al:

Methods:

A total of 290 inpatients with BPD [Borderline Personality Disorder] were interviewed at baseline and 12 consecutive follow-up waves, each separated by two years, after index hospitalization. Included were also 72 inpatients with other personality disorders. Surviving patients were reinterviewed. A series of interviews and self-report measures were used to assess psychosocial functioning and treatment history, axis I and II disorders, and childhood/adult adversity. 

Results:

Results show that rates of SSDI [Social Security Disability Insurance] utilization were relatively stable over 24 years of follow-up (on average, 47.2% of the patients with BPD were on SSDI). Patients with BPD were three times more likely to be on SSDI than patients with other PDs. Patients with BPD displayed flexibility in their usage of SSDI. By 24 years, 46% of patients remitted, out of which 85% experienced recurrence and 50% of the patients had a new onset over time. In multivariate analyses, four variables were found to predict SSDI status in patients with BPD over time. These variables were: age 26 or older, lower IQ, severity of non-sexual childhood abuse, and presence of PTSD. ...

    There is one thing about this study that make me wonder. Hospitalization is uncommon for Borderline Disorder itself yet this study tracked patients who had been hospitalized. That would suggest that these patients either had unusually bad cases of Borderline Disorder or had other psychiatric diagnoses in addition to Borderline Disorder. I will say that sometimes those with Borderline Disorder are hospitalized by mistake because the behaviors of the patients involved suggested some other disorder such as Bipolar Disorder. There's certainly the intensity of symptoms with Borderline Disorder, just not that much risk of suicide or homicide, which, in general, is what gets you hospitalized for a psychiatric disorder these days.

    The fact that patients with Borderline Disorder were much more likely to be on Social Security disability benefits than those with other personality disorders is not surprising. To begin with, Social Security approves almost no one based upon a personality disorder alone. However, Borderline is one of the worst personality disorders you can have. If anyone is going to be approved on a personality disorder, it's likely to be someone with Borderline Disorder. Also, those with other really severe personality, disorders such as Antisocial Personality Disorder, are likely to spend a lot of time in prison. That's not the case with Borderline Disorder.

    Clients with Borderline Disorder are difficult for me to deal with but it's not just their relationships with lawyers. People with Borderline Disorder can't maintain relationships with anyone, including employers. That's the problem. The fact that less than 50% of those with Borderline Disorder are on Social Security disability benefits is proof of how hard it is to be approved for Social Security disability benefits. Very few of those with a Borderline Disorder diagnosis work more than intermittently. That's just a fact. If you have a disorder that prevents you from working on a regular basis, shouldn't you be approved for Social Security disability benefits?

User Fee Up To $117 In 2024

     The user fee, which amounts to a tax, on attorneys who represent Social Security claimants will be $117 per case for 2024.

Social Security Subcommittee Schedules New Hearing

      The House Social Security Subcommittee has scheduled a hearing on “One Million Claims and Growing: Improving Social Security’s Disability Adjudication Process” for October 26.

Yesterday's House Social Security Subcommittee Hearing

     Here's a media account of yesterday's House Social Security Subcommittee hearing on overpayments. As I expected, GOP members beat up on the Acting Commissioner, whose name they seemed unable to pronounce, probably because they'd never seen her before. When there's a problem, it's far easier to blame someone than to examine the root causes of the problem. Democratic members, of course, defended Kijakazi and expressed outrage over the agency's funding, among other things.

Nice Idea, But ...

     From an article by Jack Smalligan and Chantel Boyens of the Urban Institute in The Hill concerning Social Security overpayments and how to reduce them:

... [W]e proposed that the Social Security Administration adopt a prospective eligibility and certification process. Under this approach, the agency would review a beneficiary’s eligibility and benefit level periodically and certify the beneficiary’s benefit level for a fixed period of time. If a beneficiary’s income changed, their benefits would be revised when they were due for recertification — but the agency would not be able to claw back past payments. ...

This is not a radical proposal: It is how other safety net programs, such as SNAP, already work. This approach also aligns with the Social Security Administration’s own practice for redetermining benefits for disability beneficiaries when they experience a medical improvement that might decrease their need for benefits. ...

    I suppose this would be nice but I don't know where the manpower for doing all those Title II redeterminations would come from. Well-meaning people such the authors of this piece cannot grasp the depth of the staffing crisis at Social Security.

House Hearing On Overpayments Today

     The Social Security Subcommittee of the House Ways and Means Committee will hold a hearing at 2:00 this afternoon on Protecting Beneficiaries from the Harm of Improper Payments. Here's the witness list:

• Dr. Kilolo Kijakazi, Ph.D.
  Acting Commissioner, Social Security Administration (SSA)
• Ms. Tonya Eickman
  Program Audit Division Director, Social Security Administration Office of the Inspector General (OIG)
• Ms. Elizabeth Curda
  Director, Education, Workforce, and Income Security, U.S. Government Accountability Office (GAO)

     If your focus is on protecting beneficiaries, wouldn't you want to hear from an affected beneficiary? Instead they're calling in witnesses from Social Security's Office of Inspector General and the Government Accountability Office, agencies which have inaccurately conflated overpayments with fraud and which have favored unremitting efforts to recover overpayments. No, it looks like the focus will be on beating up on Kijakazi. I'm not sure that in general there's that much to beat up Kijakzi on anyway but blaming her for the overpayment issues is wrong. This mess has been brewing for decades.

How Do You Provide Services In This Kind Of Environment?

     The Senate Special Committee on Aging held a hearing yesterday on Securing Social Security: Accessing Payments and Preserving the Program for Future Generations. The hearing was held in Phoenixville, PA. Here's an excerpt from the testimony of Jessica LaPointe, President of American Federation of Government Employees, AFL-CIO (AFGE) Council 220, the labor union that represents most Social Security employees. This chart shows employee attrition rates at selected Social Security field office in Pennsylvania:

     Remember, these field office positions require lots of training and experience.

OHO Operating Data

     A recently released report on operations at Social Security's Office of Hearings Operations (OHO):

Click on image to view full size

 

    Note that in Fiscal Year (FY) 2022 OHO had 283,134.40 overtime hours. In the recently concluded FY 2023 OHO had 458,437.69 overtime hours, an increase of 62%. That's extraordinary when you consider the needs of other part of the Social Security Administration. OHO is so much more visible to Congress than boring parts of Social Security such as the teleservice centers and payment centers.