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Social Security Disability

Posted by Margaret Donohue on August 1, 2012 at 8:00 AM

I work with several companies providing social security disability assessments (SSI/SSDI).  I've done this for the past 15 years.  The system is not well understood by applicants and is extremely frustrating for those of us involved in attempting to assist applicants and the analysts and judges that send applicants to us.


My job in performing what are referred to as "Comprehensive Psychological Examinations" is to document what an applicant tells me about their condition, perform the psychological tests requested by their disability analyst, and write a report documenting "residual functional capacity" in the form of a medical source statement.  It sounds simple.  But it's very complicated and both the analysts and the applicants make it more complex than it needs to be.


So if you are going through the process let me provide some information.


First off, in this capacity I am NOT a treating doctor.  It's my job to document what an applicant tells me even if the information makes no logical sense.  So if someone wants to tell me that they used to be able to raise their arm this high (demonstrates) and now they can only rise it this high (demonstrates half as high) I will write that down and say nothing.  I do not prescribe, provide therapy, make recommendations or referrals.  I don't provide test results to applicants.


It helps if the applicant knows how they are disabled and can provide basic information about the disability.  I have very few records in most cases.  I have the name of the applicant and a list of tests the analyst has order me to perform with the applicant.  The analyst may have lots of information but that isn't always provided to me.  When an applicant just tells me that the reason they can no longer work is because they are disabled, it provides me with no information.


Disability analysts tell me what tests to perform.  In most cases they have never seen the applicant and have only a couple of sentences about the tests they are ordering.  It's often frustrating for me to attempt tests that don't seem to be related to what the applicant is reporting is wrong with them, and I'm not allowed to change tests without getting an authorization.


DO NOT TRY TO MAKE THINGS LOOK WORSE.  The vast majority of psychologists and physicians I know doing this work really want to believe you, until we can't.  Making things look worse by exaggerating, not taking presribed medication, making up new symptoms, looking up things on the internet and padding your symptom list, bringing in bags of expired medications, or bring in old devices like canes, braces, crutches, wheelchairs you used to use but no longer need, make it hard to believe you.


DO NOT BRING CHILDREN NOT BEING EVALUATED.  About 50% of our clients are recently released from jail or prison.  About 10% are registered sex offenders.  I do not want to ask a parent of a child about suicidal thoughts, or hallucinations in front of the child.  If there is no one to watch your child let your disability analyst know in advance.


DO FOLLOW YOUR USUAL ROUTINE.  Take your medications as directed.  Bring your reading glasses, hearing aids, or anything else you usually use.  Don't stay up all night the night before.  Don't radically change your diet. Don't take drugs or alcohol immediately prior to the visit unless you normally do and to suddenly stop will produce withdrawals.


DO NOT TELL YOUR CHILD BEING EVALUATED:

 

  • to act hyper, crazy or stupid
  • that they are going to see a "doctor."  The child expects shots or having blood drawn.
  • not to cooperate
  • that you will signal them to let them know if they are doing alright.  In most cases you will not be allowed in the office while your child is being evaluated.
DO TELL YOUR CHILD BEING EVALUATED:
  • just act like yourself
  • it will be like seeing a school nurse or a teacher
  • just do your best
  • answer questions they ask, if you don't know an answer say that you don't know

The cases of children being coached by parents or guardians to perform poorly has increased dramatically in the past few years.   In some cases the methods the parents use are potentially life threatening to the child--such as withholding insulin and feeding candy to a diabetic child, or withholding anti-seizure medications.  In other cases they put the child in a very difficult position of viewing an evaluator as someone mean or threatening, and the child having to choose between cooperating with what their parent or guardian has told them and what the evaluator is asking.  I have often had children with obvious learning disabilities or with other qualifying conditions performing poorly tell me their parents told them not to cooperate.  The child knows it's the same as "lying" and is often distressed in the process.  As one little boy told me--"You're nice.  I thought you'd be mean."  That just makes it hard for everybody.

Actual fraud accounts for between 2% and 12% of disability cases.  It's a small percentage that makes things difficult for everyone.  Exaggeration of legitimate complaints is far more common, but equally problematic.  

For the first few years of my practice in this area I got together with other psychologists and reviewed common test responses by this population.  I work with Pearson Assessments as a field examiner, and the responses to tests by disability applicants are not similar to other client populations.  So myself and other psychologists in this area have information on how disability applicants usually respond to standardized test questions.  We update our information every time there is a new test or a new version of a test.

I work with the same population in my private practice at times and spend the majority of my time documenting the applicant's history and treatment.  That allows a higher percentage of applicants to be approved the first time they submit their application.

PLEASE UNDERSTAND
  • Social security benefits are limited to people who are no longer able to do simple work (think WalMart greeter).  Not their usual and customary job.
  • Social Security works like insurance.  You have to have paid into the system or have been excluded from the system (disabled since birth, disabled and incarcerated, etc,).  If you want your usual and customary work insured you need a private disability policy for that.
  • I DO NOT MAKE DISABILITY DETERMINATIONS.  Your disability analyst does that.  I just document what you say and do and any test results.  I don't know if you'll be approved or not.
  • I've been doing this a long time and have seen people under the influence, off medication, fabricating symptoms, in good compliance with treatment, and with a wide variety of medical and psychological conditions.  I've probably evaluated others with your condition no matter how "rare" it is.  For example I see about 500-1000 children and adults with autistic spectrum disorder each year, about 18 children with Angelman Syndrome, and about 40 children with Prader-Willi syndrome.  Almost every day I see someone with a history of head injury, malignancy, heart disease, seizures, or neurological condition-including learning disorders and ADD/ADHD.  I've seen every type of psychological/psychiatric disorder.

The system can be quite complex and difficult for people to understand.  My mother never qualified for SSDI even when she had congestive heart failure, so she moved to China to teach English and is buried in Hunan.  My aunt qualified for SSDI after her third heart attack and second stroke were documented.  My husband didn't file for SSDI for more than 10 years after he returned as a disabled veteran from the military and was excluded from the system. Although I pay into the system I will probably never qualify for benefits.  I have a hard time thinking of conditions that might limit me from doing simple work given all the adaptive technology available.  I am disabled, but there are lots of different types of work I can do.


If you need help with being evaluated for disability, the SSDI/SSI system will arrange for you to  be seen AT NO CHARGE by me or someone like me.  If you want to see me privately to document your disability or if you've been denied and want to appeal your denial I'm happy to see you to help.

Categories: General Psychology

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