Today, at a hearing on Social Security Disability Programs, the Permanent Subcommittee on Investigations, Ranking Member U.S. Senator Tom Coburn, M.D. (R-OK) released the findings of an 18-month investigation exposing flawed methods used by the Social Security Administration to award disability benefits. The investigation found that more than a quarter of 300 randomly selected case files were awarded benefits without properly addressing insufficient, contradictory and incomplete evidence.
To read the full investigative report, "Social Security Disability Programs: Improving the Quality of Benefit Award Decisions", click here.
To read Dr. Coburn's opening statement, click here.
Key findings of the investigation
1. More than a quarter of 300 randomly selected disability case files were awarded benefits without properly addressing insufficient, contradictory and incomplete evidence. This corroborated an internal 2011 review by SSA that found that administrative law judges (ALJs) got decisions wrong or had significant errors 23-26% of the time in the areas examined by the Subcommittee.
2. Every time benefits are wrongly awarded, the cost to taxpayers is at least $300,000. The average lifetime cost of a disability award is $300,000.
3. A single judge in Oklahoma City, Howard O’Bryan, awarded more than $1.6 billion in lifetime benefits in just three years. He decided more than 5,400 cases from 2007-2009 with an approval rate over 90 percent, most of them held “on-the-record” without hearings.
4. ALJs “cut and paste” images of medical records into favorable award decisions instead of including written analysis. Judge O’Bryan had to be told numerous times to stop.
5. SSA relied on insufficient and contradictory medical evidence at every level in the application process. While the most significant problems were found at the ALJ level, problems were also found with decisions made at the state-based Disability Determination Services (DDS).
6. ALJs often gave most weight to medical records from attorneys and least weight to independent DDS doctors. Attorneys often submitted one or two page forms in which a doctor found a person totally disabled. Some ALJs called these “dead man’s reports” and “store bought opinions.”
7. ALJs failed to hold proper hearings, preventing them from collecting objective and useful information. Some hearings were less than 5 minutes long; at some hearings a claimant did not speak; and at some hearings questions were asked only by attorneys, with none from ALJs.
8. ALJs admitted late-arriving evidence to override all other medical evidence. Claimant attorneys would submit evidence days – in some cases hours – prior to an ALJ hearing. Senior SSA officials said this was strongly discouraged because it too little time was left for analysis.
9. SSA relied heavily on the vocational “grids” to find claimants disabled on their 50th or 55th birthdays. SSA finds claimants disabled using the grids four times more frequently than for meeting medical listings – a reversal of past practice.
10. SSA uses an outdated Dictionary of Occupational Titles from the 1970’s to find jobs. This relic fails, for example, to capture current labor market trends. For example, it does not contain any computer-related jobs a person could do, but includes “sorter,” “cuff folder,” and “battery stacker.”
11. “Drug and Alcohol Abuse” was deemed “not material” in 24 cases in which a claimant was awarded benefits. A 2011 SSA review, however, found that failure to explain why the significance of drug and alcohol abuse was a top reason for errors in ALJ decisions.
Examples of Flawed Disability Cases
Alabama 69. Judge Intoccia awarded disability benefits solely on a one-page document filled out the day before the hearing by the claimant's doctor at the request of the claimant's attorney.
Oklahoma Case 153. Judge Falkenstein said a woman was disabled as of April 2007 for carpal tunnel syndrome, but in July 2007 her records show her working as a bartender.
Oklahoma Case 151. Judge Keltch coached a claimant how to get higher benefits by possibly lying about a "rental agreement" with his roommate.
Virginia Case 249. A woman applied for benefits based on COPD - a breathing disorder - but was sent by her attorney to a doctor who diagnosed her with "mental retardation." Judge Erwin, testifying tomorrow, said this doctor in particular had a history doing this for attorneys.
Oklahoma Case 181. Judge Hiltbrand awarded benefits to a child based on ADHD whose teachers described him as doing well. The judge indicated at the hearing he was gonig to apply the medical standards more loosely and award benefits in part because he "didn't want to penalize a good parent."
Oklahoma Case 109. Judge Hiltbrand awarded benefits to a woman who claimed a severe arm injury that kept her from moving it. Her doctor saw her in the parking lot unlock her truck, place her bag on the passenger seat, and steer the wheel of her vehicle - all with her right arm.
Oklahoma Case 111. Judge Howard O'Bryan awarded disability benefits to a former truck driver, whose case file contained notes from several doctors stating he could return to work with "no restrictions."
Virginia Case 257. Judge Peters held a four-minute hearing and instead of asking any questions, changes the claimant's date of disability to her 50th birthday and "gridded" her.
|9/13/12||Dr. Coburn's Amendments to the Veterans Job Corps Act of 2012|