Disability Benefits Under Threat

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High-Priority Action Alert on Disability Benefits

November 1, 2010

In this Action Alert

What's bad about the proposed rule?

What's good in the proposed rule?

What you can do!

Social Security Disability Rules to Change - for Better and Worse

SSA Needs to Hear from You

The Social Security Administration (SSA) has proposed changes to the way

decisions are made for awarding disability benefits based on a mental

impairment. These changes will threaten the ability of people with

serious mental illnesses to obtain benefits.

SSA will not revise these proposed changes unless it hears a large

outcry from consumers, providers and experts on mental health and

disability.

The changes appear in a regulation that would amend the " Medical

Listings " -the standards that SSA uses to determine eligibility for

Supplemental Security Income (SSI) and Social Security Disability

Insurance (SSDI) benefits. While the proposed new Listings include some

very good features, these are undermined by a provision that could limit

the number of people with mental illnesses who can qualify to only one

or two percent of the nation's population. This is far below even the

most conservative estimate of the number whose mental health disability

makes them unable to work (the criterion for eligibility for federal

disability benefits) and who therefore need this monthly income.

To qualify under the proposed Listings, individuals must have more than

one " marked " impairment in functioning or one " extreme " functional

limitation. (A list of functions is provided in the Listings. It

includes such things as the ability to get along with co-workers and

others, the ability to maintain concentration, persistence and pace, and

the ability to understand, remember and apply information). These

standards are similar to current rules and pose no problem. The trouble

lies in the process disability examiners would use in deciding how an

individual meets them.

What's Bad About the Proposed Rule?

The specific problem with the proposed Listings, for both children and

adults, is a reference to standardized test results and the scores a

person must have on those tests in order to meet the new standard. The

definitions of the minimum scores are arbitrary and exclusionary.

First, there are no suitable tests that validly measure ability to work,

nor is there any research showing a link between the tests of mental

functioning that do exist and the ability to work that needs to be

measured for the SSA process. Nonetheless, SSA would encourage its

disability examiners to use " standardized tests. "

If a test is used, under the proposed rule an individual's score must be

two standard deviations below the mean for the level of functioning to

be considered " marked, " and it must be three standard deviations below

the mean for the level of functioning to be considered " extreme. " So in

addition to encouraging the use of tests that cannot measure what needs

to be measured, SSA has created a stringent- and flawed- standard in

terms of the score required to qualify. This change would drastically

reduce the number of children and adults with serious mental disorders

who qualify for disability benefits.

What's Good in the Proposed Rule?

Aspects of the new rule that are positive include the following:

A shift away from reliance on a specific diagnosis, creating instead a

functional focus. This would bring the Listings in line with scientific

thinking that diagnosis is less a determining factor in a person's

ability to work than level of functioning.

The proposed Listings still include a description of the signs and

symptoms of the various categories of mental illness, as guidance to

disability examiners. These descriptions are appropriate and helpful.

There are some modifications to the functioning that is measured and

these would align well with a later step in the disability determination

process, which measures " Residential Functional Capacity " (RFC).

The proposed Listings suggest (while not requiring) that disability

examiners use a five-point scale in assessing whether someone's

impairment results in a " marked " or " extreme " limitation in function.

Until now, examiners have had no way to anchor this. The change would be

helpful in making assessments more uniform.

The proposed Listings recognize that reaction to the stress of work is

relevant and that this may differ from one person to another. They also

include a focus on how someone's functioning varies over time, a

longitudinal approach that is helpful.

However, these positive aspects are outweighed by the detrimental impact of the

proposed testing.

SSA needs to hear about the problem from advocates, consumers and experts.

What You Can Do

Please ask SSA to revise its proposed mental impairment Listings -and

please circulate this alert widely. The deadline for comments is

November 17.

The message to SSA should be as follows:

The proposed use of standardized tests to measure the functioning of

people with serious mental illnesses is a flawed approach, with no

scientific basis.

SSA should drop all reference to standardized tests in the mental

illness sections of the proposed mental impairment Listings, especially

the requirements for people to score so low on such tests in order to

qualify for benefits.

Under the proposed rule, every year thousands of people who cannot work

would be unable to qualify for federal disability benefits.

When you submit your comments, refer to Docket No. SSA-2007-0101 so your

comments are connected to this particular regulation.

To send your message, use one of these methods:

Internet-go to http://www.regulations.gov and search for docket number

SSA-2007-0101 and follow directions.

Fax to 410/966-2830

Mail to Office of Regulations, Social Security Administration, 137

Altmeyer Bldg., 6401 Security Boulevard, Baltimore, MD 21235-6401.

To read SSA's proposed changes, download

http://edocket.access.gpo.gov/2010/pdf/2010-20247.pdf.

The Bazelon Center's Mental Health Policy Reporter is available

exclusively online and to our email subscribers. The Reporter

supplements the Bazelon Center's Action Alerts by providing a periodic

bulletin on significant policy developments that affect people with

mental illnesses.         

" Horses are God's Apology for Men "

Let us awaken then, and envince a different spirit,---a spirit that shall

inspire the people with confidence in themselves, and in us -- a spirit that

will encourage them them to persevere in this glorious struggle, until their

rights and liberties shall be established on a ROCK. " ---- ,

1777 http://percheronridersdressagejourney.blogspot.com/