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The categories aren't really correct. 1 and 2 don't make sense because disability is a binary, and the benefit amount is determined at the financial qualification stage. This is the preliminary stage where SSA makes sure that claimants are legally qualified and has to be completed before they'll send it to adjudication. Once we start considering medical eligibility it's a binary; you don't get more money because you're "more disabled" or whatever. The sole exception would be that there's an optimization that can be made for people who continue to work but make below the financial eligibility threshold, but that really has nothing to do with the determination office. 3 isn't really a category because I had no way of knowing whether someone was using an attorney, what kind of advice they were getting, or whether they genuinely thought they were disabled. I'd break down the claimants into the following categories:
The Classic Case: The first category consists of the typical 50+ blue-collar worker (usually) who has some kind of musculoskeletal disorder (back problems being the most common) that prevents them from doing heavy labor. When I was there, these probably constituted half of our approvals. These people were genuinely hurt, but may or may not have been disabled, depending on the severity of their condition. For example (real case, though my memory isn't precise), Larry was a 55 year old black guy who worked as a welder for most of the 20 previous years, no other employment. His back problems had been developing for some time, causing him to miss work. About a year prior he had back surgery and was off work for a while recovering, and felt good doing work around the house. He tried to go back to work once he was medically cleared, but he only lasted a few weeks. He wasn't having the constant pain he was having before, but 8 hours of bending over, kneeling, and crawling around exacerbated the pain, which went away with rest. The medical records were about what one would expect from someone experiencing the symptoms he described. Easy approval.
The Generally Unhealthy: People with myriad legitimate health problems that don't rise to the level of a disability. These people are usually over the age of 40, can be male or female, and have significant employment history, though mostly at the kind of jobs that don't pay particularly well. They have HBP. They have diabetes. They have fibromyalgia. They have back pain. They have a heart condition. They're obese (usually, though not always). These tend to be the most annoying cases to deal with because the application asks them to specify the conditions for which they're claiming disability for, but if (more like when) we find they have 500 other problems we have to ask if it affects their ability to work, and of course it does, so now we have to keep requesting records from doctors that take forever to receive and don't contain any usable information. The worst part is that they are all on antidepressants they got from a PCP and they've never seen a psychiatrist. So when they tell us their anxiety and depression affects their ability to work we have to schedule as psych workup, which takes forever to schedule because these people always live in rural areas with one guy who's willing to accept the low rates we pay for them to fill out significantly more paperwork than usual. Once they actually see somebody who confirms that they aren't so anxious they can't go to the grocery store without freaking out, they get denied.
The Complex Cases: People who obviously can't work but only due to complicated situations that are hard to qualify under the existing criteria. People with lingering stroke recovery symptoms, people with rare auto-immune disorders, rare diabetic conditions, people who are fine most of the time but have conditions that flare up every couple months and put them in the hospital for 2 weeks, during which time they lose their jobs. It's 50/50 whether these are approved or denied upon initial determination. If they get someone who looks at the big picture, they'll be approved; if they get someone who is a stickler for the rules, they'll be denied. All supervisors would tell you to deny these people. If they appeal, they'll almost certainly be approved.
The Psycho Kids: These are people under the age of 30 who have never had a job that pays above minimum wage and no education beyond high school who are claiming disability due to vague depression/anxiety. Again, they're taking medication but it's unlikely they've ever seen an actual mental health professional, and if they did it was something like they talked to a therapist once or twice. They certainly aren't receiving any regular psychiatric treatment, and no suicide attempts or hospitalizations. These are almost always rural whites. They are invariably denials.
The Accidental Cases: These are similar to the first type of case except the claimant is younger and is claiming disability not based on a degenerative condition but on the inability to due his job following a traumatic injury. they are usually misinformed about the law, however, and think that they're disabled because they can't go back to their normal job, and are usually under this impression because they worked with an older guy who got it. Unfortunately for them, as long as they're capable of doing a sedentary job, they aren't disabled. One guy, who broke his back in a motorcycle accident, told me his doctor told him he wouldn't be able to be a mechanic anymore and should do something with computers. He then jokingly told me that he didn't know anything about computers. Though he didn't realize it, this was practically an admission from his doctor that he was still able to work. These cases are almost always denials.
The True Psychos: These are the real psych cases, almost always SSI, usually involving younger or homeless claimants. Mental retardation, schizophrenia, anxiety/depression serious enough to end in multiple hospitalizations, severe bipolar disorder. Children usually also have serious behavioral problems at home or at school. Usually approvals, with a few weird denials mixed in due to the occasional odd circumstance.
The Death Bed Cases: These are people with terminal diseases who aren't going to survive for much longer. There's an entire division that deals with nothing but these to get the approvals in faster, though in some cases there's an expedited process where they can start receiving benefits before full approval. Always approved.
The One-Shot Cases: People who have one weird condition that obviously doesn't qualify them, but they apply anyway on the off chance they're approved. One woman in her early 30s applied because of heavy vaginal bleeding. This also includes people who have already retired, get some condition, and apply for SSDI to top up their pensions before they qualify for regular benefits. One guy who had a desk job with the state Auditor General's office tried applying because he started having mini-strokes after he retired, though he was hard-pressed to explain how they would have theoretically prevented him from working had he not been retired. These are denials.
I hesitate to categorize them based on genuine cases versus those that are simply trying to game the system because, with the possible exception of the psycho kids and the one-shot cases, I don't really think that anyone is consciously trying to game the system. The rest of these people are either genuinely disabled or genuinely think they're disabled. The classic cases are actually disabled but will go back to work if they can. The generally unhealthy aren't disabled but are convinced they are, the complex cases may or may not be disabled but they can be forgiven for thinking they might be, the accidental cases think they are based on a misunderstanding of the law, the true psychos are disabled but might not know it themselves, same with the death bed cases. Even the one shot cases have a lot of people think that they're disabled based on the simplistic formula of medical condition + makes my job difficult = permanent disability.
And even if some people are consciously trying to game the system, their cases are so obviously bullshit that no one trained to adjudicate them would ever consider approving them. These articles can cite various doctors and lawyers all they want, but even with coaching, nobody who is willing to "retire" because $945/month is forthcoming is intelligent enough to keep up an elaborate ruse for decades. In my career since, I've had to prepare witnesses for depositions, and while I'm not going to say that witnesses never lie in depositions, I can say that it's not because of anything theur attorneys told them to say. Properly preparing a witness for deposition takes days, unless they're a corporate representative who has testified several times before. Even for a corporate witness, it's not easy to prepare them to answer questions in a way that isn't inadvertently damaging. And these are people with college degrees and careers at the highest levels of business. Some hillbilly who barely graduated high school isn't going to be able to effectively fake disability no matter how many doctors and lawyers talk to him, because he's not going to know how to answer the questions. I'd be more worried about a legitimate claimant being denied because they gave the answers they thought the adjudicator wanted to hear than someone who gets denied because they answered honestly. Unless they have a really sophisticated understanding of how the process works, they're not going to be able to do it, and the factors are complicated enough that they're not going to get such an understanding. Even the people here, or who write psych blogs, or articles from NPR, or who are physicians treating claimants, seem to have such an understanding.
Edit - Pinging @ThomasdelVasto
Thanks! Learned a lot. Dispelled some notions. AAQC rec'd.
Unfortunately, this actually makes me more pessimistic than if you had said "50% of claims are bullshit." This is because what you're describing really does look like a political solution to medical problems. It does seem insane that certain jobs, if done repetitively over 20+ years, will, with high probability, lead the laborer to breaking their own body to the point of disability. I don't think those jobs should be "highly regulated" so that people can work them and remain healthy; I think they shouldn't exist for humans at all. I don't want more coal miners (i.e. humans who travel under a mountain) - I want coal mining robots.
Keep in mind that my analysis is based on the subset of people who applied for disability, and not the population at large. Further, blue collar workers with musculoskeletal problems accounted for 50% of approvals, not 50% of total claims. This number may actually be a bit high, since most of the death bed cases were sent to a special unit that I didn't deal with. As a proportion of total claims, I'd say they were no higher than 10%. For volume of total claims, the generally unhealthy accounted for the highest proportion, followed by psycho kids and complex cases. This is taking into account that death bed cases had enough volume to merit their own unit to expedite them, though since I didn't work there I can't comment on volume.
While I don't doubt that blue collar work is harder on the body than other work, disability isn't particularly common. In my current job, I defend industrial equipment manufacturers and contractors in products liability cases, and out of hundreds of cases I've handled, I've seen maybe three or four where the plaintiff was receiving disability, or had even made a disability claim, and this is for a subset of the population that worked industrial jobs for decades. You also need to take into consideration that while blue collar work is more likely to lead to legal disability, that likelihood is largely independent of whether it's likely to contribute to the underlying medical condition. People who work office jobs where they sit on their ass all day don't quit work and apply for disability because of bum knees, and even if they did they'd be denied. It's not that the jobs causes the disability so much as it is that the disability prevents them from doing the job.
Again, very interesting and informative.
If I'm reading you correctly, my updated hypothesis has also been more or less invalidated. We aren't in a situation in which a meaningful percentage of blue collar (or any) careers create the demise of those who work in them. And from previous comments, we can also say with decent confidence that "disability grift" isn't a multi-billion dollar scam industry. Furthermore, with the amounts involved, there aren't really "disability queens" who are collecting thousands of dollars per month. It's an unfortunate group of mostly honest people who get a few hundred extra dollars to get by. Based on your comments on the end-of-lifers, it also seems disability insurance acts as kind of publicly-funded hospice care as well. Sad, but understandable.
Given all of this, I'm actually, now, tempted to think that system works about as well as a system like this could. It's inefficient, sure, but it feels like it's mostly doing a service to those in need (perhaps to an unsatisfying emotional degree) and without a disproportionate drain on public resources.
I'll make the humble request again to get your input on that.
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As one of "The True Psychos," I'd personally like to thank you for laying this out so clearly and in such detail. AAQC'd.
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Would just like to thank you for writing all this up about a world some of us rarely see.
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