Pain and Disability Clinical, Behavioral, and Public Policy Perspectives (1987) / Chapter Skim
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4. Conflicts and Contradictions in the Disability Program
4. Conflicts and Contradictions in the Disability Program
Pages 66-84
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From page 66... ...
This chapter examines the tensions and inconsistencies among the statutory, regulatory, medical, judicial, and programmatic perspectives on disability, highlighting those aspects that relate most directly to the claimant whose chronic pain is not fully substantiated by objective clinical evidence. By so doing it further elucidates the complexities of the issues and provides a more complete context for drawing conclusions about the way in which chronic pain complaints are evaluated in the program and for making recommendations for changes.
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From page 67... ...
Federal quality review of disability decisions is carried out in 10 SSA offices by more than 500 examiners and medical consultants. Finally, there are the federal district courts.
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From page 68... ...
In executing these functions, there is often room for agencies to exercise their own discretion. In the case of the authorizing statute for the disability program, Congress linked medical condition to employability but did not distinguish clearly between those who cannot perform work functions because of their conditions and those who might be able to work but are unemployable because of their conditions (Mashaw, 19831.
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From page 69... ...
. The increased reliance on discretionary criteria paralleled the growth in the disability program's expenditures during the same period, and hence became an easy target for criticism of the SSA by Congress.
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From page 70... ...
Department of Health and Human Services, 1987) notes that although "the primary mission of the disability program is to pay monthly benefits to those found to be disabled, a subsidiary objective is to help restore disabled individuals to productive activity." As an income support program, disability insurance must take care not to undermine work incentives.
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From page 71... ...
The beneficiaries themselves may have little incentive to try to be rehabilitated after being found "disabled." Not only have many of these people had to work hard to produce the necessary evidence for their cases, but they have also typically waited a long time for the process to be completed. The elapsed time between initially filing a claim and eventually being found eligible for benefits can easily exceed 2 years if there are appeals.
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From page 72... ...
Treating physicians, like claimants, have no inherent interest in the overall size or expenditures of public programs. Because theirs is an individualistic view, there is no reason to expect that treating doctors have taken broad programmatic interest into account in assessing the patient's medical condition and functional levels.
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From page 73... ...
Although intuition would suggest that personal physicians are more lenient and the SSA's consultant physicians more stringent in their judgments, there are few data to support this claim. In fact, one study found that consultative physicians thought 48 percent of a sample of disability claimants could work, whereas treating physicians thought that 55 percent of the sample could work (Carey and Handler, 1986~.
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From page 74... ...
Administrative Law Judges Versus Program Administrators A claimant who has been denied benefits at the initial acid reconsideration levels of administrative review can request a hearing before an ALE. This level of review differs in many important ways from both the lower and the higher levels of review.
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From page 75... ...
The high average rate of reversals is also of concern. In both instances, observers worry that inappropriate subjectivity enters into decisions; hence, there is an implicit questioning of the accuracy and appropriateness of the judges decisions (Mashaw et al., 19781.
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From page 76... ...
Several concerns were aired during this debate: first, some members of Congress thought the courts were exercising excessive influence in defining standards by which to assess chronic disabling pain; second, pain decisions varied widely from circuit to circuit, suggesting that the law was not being uniformly interpreted or applied; third, the courts were accused of going beyond what Congress intended by giving too much weight to claimants' allegations, thereby broadening and redefining statutory definitions; and fourth, by comparison, some members of Congress thought the SSA's rulings were too restrictive, such that some pain claimants were being improperly denied benefits (Subcommittee on Social Security of the Committee on Ways and Means, 1981; Collins and Erfle, 19851. As described in Chapter 3, in an effort to clarify its intent; and as part of the 1984 amendments, Congress legislated a statutory standard for evaluating chronic disabling pain.
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From page 77... ...
Although the court's only function is to interpret and apply existing law, not to rewrite it, continuing interpretation necessarily leads to expanded application of statutes, which may go beyond Congress' original intent. Conversely, it has been argued that the SSA has been excessively restrictive in promulgating internal rulings and agency regulations that allegedly ignore congressional intent.
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From page 78... ...
In the absence of common, consistent disability determination standards, federal circuit court judges have attempted to articulate what they consider to be workable and fair guidelines. Thus, at the federal court level, as at all the other levels of review, human judgment plays a part.
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From page 79... ...
In the second version of the theory, a worker already on the disability rolls faces a choice between keeping the level of income provided by the program or returning to the labor force. In the third version, in which the impact of disability benefits on rehabilitation is at issue, no such model of conscious choice is specified, but the underlying assumption in this version is that the financial gains from remaining disabled exert a negative influenccperhaps unconsciously~n the patient's desire to regain skills and functional abilities.
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From page 80... ...
a job provides as on the monetary rewards. Program Rules as an Explanation of Labor Supply For recipients of Social Security Disability Insurance (SSDI)
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From page 81... ...
During the period from the mid 1960s to the early 1980s, many ofthese programs began to require that applicants for general assistance and/or AFDC file an application with the Social Security disability programs; these state programs were eager to shift costs out of the state budgets and onto the federal treasury. Hence, some (perhaps large)
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From page 82... ...
In: New Approaches to Treatment of Chronic Pain: A Review of Multidisciplinary Pain Clinics and Pain Centers (Ng, L.K.Y., ed.)
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From page 83... ...
The Social Security disability program and labor force participation. Working Paper No.
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From page 84... ...
84 THE PROBLEM OF PMN FOR THE SSA United States Department of Health and Human Services. Report of the Commission on the Evaluation of Pain.
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