The American Association for Disability Policy Reform
— rehabilitation first —
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Social Security's Poor Investigation of Disability Claimants
(The Need for Community-based Investigation of Disability Applicants)
A major problem of the Social Security disability programs is the Social Security Administration's poor investigation of disability claimants prior to making decisions. It's a problem that leads to frequent errors in disability decisions and discriminates heavily against the poor (details).
Consider the following examples, keeping in mind that they are typical of the Social Security Administration's handling of about one-third of disability applicants. The problem illustrated here is a frequent and highly persistent one. The names are fictitious.
- Karen, age 42, applied for disability benefits, claiming heart, lung, back and knee problems, colitis with incontinence and mood swings. She had a history of alcohol and hard drug abuse. The Kansas Disability Determination Service denied her application for benefits, stating that if she did not abuse alcohol or drugs she would be able to work.
Karen lived in a shelter in Wichita where a shelter worker had an opportunity to observe her for several hours a day, multiple days a week, for about three months. The shelter worker revealed that Karen had been monitored for drug and alcohol abuse and had abused neither. Although she presented herself to others as a highly-functional leader and organizer, she was very different. Trivial events frequently triggered episodes of depression lasting for days and, if she tried to work, she had to lie down and rest about every 15 minutes. Lacking the correct information, the Social Security workers who "evaluated" Karen had a very different (incorrect) impression of her and came to the wrong decision.
- Fred, age 54, applied for disability benefits, claiming that difficulty standing and walking and shortness of breath kept him from working. A medical consultant at the Minnesota Disability Determination Service evaluated his medical records and determined that he was not disabled and that he could stand and walk for at least six hours a day while lifting and carrying 25 pounds frequently and up to 50 pounds occasionally. On appeal, a second medical consultant affirmed the decision. Later, careful investigation revealed that Fred was badly overweight, had severe knee and hip arthritis that almost completely prevented him from walking even with a walker, and had a severe lung problem that, alone, would have prevented him from doing significant work. The medical consults were well-trained and careful, but with poor information, they made ridiculous decisions.
- Roger, age 33, applied for disability benefits, claiming mental problems. Dr. Schlosser, a psychological consultant at the Kansas Disability Determination Service, decided that his problems would not last for one year (as required for disability benefits) and dismissed his application with two words: "duration denial." On appeal, a second medical consultant affirmed the decision. Later, careful investigation showed that Roger had severe mental problems, starting at an early age, and showing no sign of lessening. At the age of 10 he had heard voices telling him to kill animals. Since then, he continued to hear voices, was suspicious of others, was paranoid, and in frequent conflict with others. In his last job he was feared by his co-workers and was said to speak a mysterious "language" that only one other person could understand. People in uniform made him panic. The psychological consultants were well-trained, but with poor information, they made ridiculous decisions.
- Lisa, age 56, applied for disability benefits because of an uncontrollable tremor affecting both hands. The Kansas Disability Determination Service sent her to Dr. Duncan, who did a cursory examination (failing to investigate her tremor) and concluded that she had "no manipulative impairment." Based on this "information," her claim was denied. Later, careful investigation revealed that she had a severe tremor involving both hands, that the tremor ran through multiple generations of her family, that she had been forced to give up multiple activities because of it, that she could not hold a cup of liquid, and that she need help eating. The examiner who made the decision was well-trained, but with poor information, made a ridiculous decision.
- Ann, age 60, applied for disability benefits because one of her knees kept "locking up" making her unable to stand and walk reliably. The Kansas Disability Determination Service sent her to a brief examination, during which she was able to walk a few steps without difficulty. As a result, they concluded that there was nothing wrong with her knees and denied her claim. They never knew that she had been seen by an orthopedic surgeon who had obtained a magnetic resonance imaging (MRI) scan that showed that she had a serious knee problem, just as she claimed. After I "discovered" the MRI, and after a two-year wait, an administrative law judge granted disability benefits.
- A married couple both applied for and were granted disability benefits. They were eventually found to have been operating three businesses, an auto repair business, an inflatable toy and carnival company, and a household goods shipping company. They were convicted of Social Security fraud and their benefits ceased.
Ridiculous decisions are commonplace in disability evaluations, prompting applicants to ask "What planet are those people [those who evaluate disability cases] living on?" The reason for this is that Social Security decision-makers commonly are forced to make decisions on the basis of poor information. One study of 2,454 disability decisions showed an overall error rate of about 30%. Other studies have supported this conclusion. Persons with combinations of low socioeconomic status (the poor), little education, and low intelligence are particularly susceptible to these errors. For them, the error rate is probably around 50%.
Most of the Social Security Administration's decision-makers are well-trained but, lacking good information, they cannot make accurate decisions. Despite the urging of many, over many years, the Social Security Administration has refused to demand and Congress has refused to fund the careful community-based investigation of disability claimants that is necessary for accurate decisions. As a result, the errors to continue.
The Social Security Administration's poor investigation of disability applicants affects the poor and the uneducated more than others. Lacking medical care and without past medical records, their applications for benefits are turned down when they should be approved. They then loose their homes and go without medical care and basic necessities while their disability lawyers "earn" 25% of the ever-increasing back benefits. Surely reform is needed.
Last updated on 1/10/21.