Social Security and You: Disability program under constant review

I recently saw about two dozen pending proposals from legislation supposedly intended to improve the administration of the Social Security disability program. All I could say to myself was: “Here we go again.” I will explain my ho-hum attitude.

I worked for the Social Security Administration for 32 years. And in each and every one of those years, Congress passed laws designed to “fix” the disability program. In each one of those years there were also internal SSA studies, commissions and resulting proposals intended to make the disability process more fair, more streamlined, and at the same time, less prone to fraud and abuse.

So what’s going on with that? Why is the disability program seemingly always under scrutiny and constantly subject to congressional and administrative meddling? The answer to that question is what this column is all about.

Here is the bottom line: Any disability program is an absolute mess to manage. The Social Security disability system is even more prone to administrative nightmares because it is, by far, the biggest such program in the country.

Why is the disability program such a mess? Because it is so subjective. For example, compare it to the Social Security retirement program. The eligibility rules for retirement are relatively cut and dried; you walk into a Social Security office, show your birth certificate to prove you are old enough for benefits, answer a few questions and meet a few other eligibility requirements, and you qualify for benefits. No muss, no fuss.

But it’s a completely different story for the disability program. And that’s because it is hard to get people to agree on the answer to this question: How disabled is too disabled to get disability benefits? One person’s disabling condition is another person’s minor inconvenience. Think of this in practical day-to-day terms to which anyone can relate. We all know co-workers who call in sick with a case of the sniffles. On the other hand, we also know co-workers who will show up at the workplace even though they look like they are knocking on death’s door. In other words, we all have different interpretations of what keeps a person from being able to work.

Here is another example: I have a neighbor who has multiple sclerosis. He uses a wheelchair and needs other forms of help, yet he still goes to work every day. At the same time, I’ve encountered thousands of people over the years who call themselves disabled because they have a bad back or sore knees. Is my neighbor “disabled”? How about the guy with the bad back?

The government tries to make the Social Security disability program as objective as possible with a handbook full of regulations to help SSA adjudicators decide who is legally disabled and who isn’t. Teams of medical professionals are also involved in the process. Yet some government bureaucrat, after reviewing the medical evidence, consulting the professionals and following the guidelines, will have to make a subjective decision about a person’s eligibility for disability benefits.

Let’s take that guy with the bad back. I’ll call him Frank. We’ll say that Frank has some painful spinal damage. How severe should spinal damage be to qualify for disability? His job required heavy lifting; he certainly can’t do that kind of work anymore. But perhaps there are other less strenuous jobs Frank can do. Should he qualify for Social Security disability if he is capable of working those other jobs?

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Let’s assume that Frank filed for Social Security disability and was told his spinal condition was not severe enough to receive benefits. But then, let’s say, he mentions that he also has high blood pressure and hearing problems. Neither one of those conditions by itself is legally disabling. But how about all three of them together?

Following this scenario, let’s assume that the initial person adjudicating Frank’s claim decides “No,” he is not disabled enough according to law.

Frank is upset because he considers himself disabled. So he files an appeal. And after an 18-month wait (because tens of thousands of others are filing appeals), he eventually meets with a judge who interprets the rules a bit differently and approves Frank’s claim. Frank has mixed emotions. He’s happy that his claim has finally been approved; but he’s upset the process took so long. So, he writes his member of Congress demanding that something be done to improve the process. The congresswoman agrees that the program is too strict and co-sponsors a bill demanding that the SSA “fix” the disability program.

But is the process broken? Was the first adjudicator wrong? Or was the judge too lenient? Different people will have different opinions. Perhaps that’s just the nature of a subjective process.

Let’s follow Frank’s case a little further. Six months after he is enrolled for disability benefits, a neighbor sees him out on a ladder cleaning his gutters. It took a lot of effort, but Frank managed to do it. The neighbor has always been a little suspicious of Frank’s disability allegations. Seeing Frank on the ladder put his neighbor over the edge. His neighbor contacts the Social Security fraud department and alleges that Frank is cheating the system.

This call triggers a fraud investigation. SSA adjudicators re-examine Frank’s claim. After interviewing Frank and obtaining current medical records, they decide he is still legally disabled.

This upsets Frank’s neighbor even more. So he writes his congresswoman claiming that “the incompetent government is wasting taxpayer money by sending monthly checks to a guy who is clearly not disabled.” The sympathetic congresswoman agrees that the program is too lenient and sponsors a bill demanding the SSA fix the disability program. And on and on it goes!

By the way, Frank’s case is a true story (with the name changed). It’s a case I was involved in about 20 years ago while working for the SSA.