Articles from prior issues of The Advocate

January/February, 1996

NADE Correspondence

To the Editor:

This is a partial response to Bob Kanner’s letter in the last issue of the Advocate (Nov./Dec.) based on my [unofficial] understanding of NADE’s thinking. In his letter, Bob did not have room to flesh out his objection to a Social Security Court (SSC). An SSC, using medical experts in the early 80’s, would have quickly ascertained that it was SSA’s formulae that resulted in unrealistic RFCs and put a stop to the stringency early on. An SSC would render consistent policy decisions. I think that NADE agrees that an SSC, by itself, will not solve the problem; however, it would go a long way to help the situation. The “percolation of ideas” of generalist courts have done little to restore program integrity. I agree with Bob that dropping medical improvement (MI) would not be pragmatic. DDSs are continuing 88% at the initial level and 50% at the recon level. In spite of the high percentage of DDS continuances, ALJs still reverse around 55%. This means that ALJs would simply reverse the vast majority of DDS cessations as fast as they were ceased. If all adjudicators approached decision making in the same manner, the MI standard would be just fine. The main problem remains the unresolved discrepancy between DDS and ALJ decisions.

However, Bob’s dire prediction that dropping MI would return us to the “bad old days” is not necessarily true. Though still too stringent, DDS decisions have improved sufficiently to avoid the multitude of egregious ones in the 80s. From 1965 - 1973 MI was not required, and the termination rate from medical recovery was 17.5%. When MI was required from 1974 - 1976, the medical recovery termination rate dipped to 11.7%. When MI was dropped in 1976, the medical recovery termination rate returned to 17.5% from 1977 - 1980 ---the same as 1965 - 1973. No outcry occurred because DDS decisions were still reasonable. The figures for medical recovery terminations are not available for 1981 - 1982, but the termination rate in 1983 had leaped to 27.4%, a sign of excessive stringency. MI stemmed egregious cessations but created another serious problem. The broader historical view shows that the suffering of the early 80s would not recur if we could make realistic decisions ---with or without MI.

NADE works on two fronts. First, decisional stringency. Bob observes that DDS denies claimants who meet the definition. NADE has recognized this since the 80s and has asked for more latitude to make more realistic decisions. NADE has consistently testified that the Feds’ lopsided review of allowances encourages denials. SSA claims that no evidence exists to substantiate this view, but we know better. The Advocate has published articles of NADE members that have been critical of SSA’s mis-guidance of DDS decisions. NADE has long been a vocal opponent of DDS decisional stringency.

On the second front, decisional leniency. NADE is concerned about the unrealistic leniency of so many ALJ decision. This has assumed more urgency lately because over half a million appeals a year are made to ALJs featuring a 75% reversal rate, and the Plan for a New Disability Claim Process turns ALJs into the back seat drivers of the program. Despite SSA’s assurances, ALJs-as the back-seat drivers-will explode unwarranted allowances among DCMs, making the liberal 70s look stingy by comparison. If history is a guide, Congress will react. I do not mean to make a dire prediction of my own, but remember the Reagan Administration’s proposal, viz., one must meet or equal to be allowed. If things become bad enough it is not inconceivable that a Republican Congress would revisit that idea. So, if I understand NADE, it is their desire for individually realistic, nationally consistent decisions at all levels that generates the concern about the SSC, MI, harsh DDS decisions, and soft ALJ decisions-hardly a desire to take “...out its frustrations on the claimant/recipient.”

Sincerely,

Bob Burgess