NPR’s “Planet Money” published a dramatic and concerning report titled “UNFIT FOR WORK: The startling rise of disability in America”. The article followed the stories of several social security disability applicants, focused on states such as West Virginia and Alabama with high numbers on disability, and presented a wealth of interesting and thought provoking statistics. I would like to focus on one set of statistics: the contrast of disability approvals based on diagnosis from 1961 and 2001.
The chart presenting this statistic in the NPR article is reproduced above. Its a little hard to read, I know. You have to follow the diagnosis from the left column representing 1991 disability approvals to the column corresponding to the given diagnosis in the right column for 2011. These are national statistics: there are none available for Texas. But the changes are dramatic:
- Heart Disease and Strokes used to represent the majority of disability approvals. In 2011 these maladies represented just 10.6% of new disability approvals.
- Back Pain and musculoskeletal problems once accounted for only 8.3% of disability approvals: in 2011 they were 33.8%
- Mental Illness once accounted for only 9.6% of disability in 1961 in 2011 the percent was 19.2%
So why was there a big increase in disability approvals for bad backs and mental problems? What accounts for these changes? A thresold questions has to be this: has the frequency and severity of back pain and mental illness increases in the United States over the last 50 years? Its reasonable to assume that medical treatment for all conditions -include back pain and mental problems – has progressed. The decreased percentage of disability approvals in the Heart Disease/Stroke category surely represent medical progress in those areas. So the increase in back pain and mental illness disability is puzzling. Let’s look at each diagnosis category to see if there are answers.
Back Pain/Muscolskeletal Problems
In general, our work lives as a nation have moved toward sedentary, computer-dominated settings. We should expect there are fewer Americans in jobs where severe back injuries may take place: farming, manual labor, etc. On the other hand, it is true that sedentary work and life style may not result in dramatic back injuries, but this lifestyle certainly contributes to chronic back pain issues. We all know that demographically the United States is older. Chronic back problems, of course, increase with age. So perhaps sedentary work settings and an aging population contributes, if not fully expains, the increase in disability approvals based upon back impairments.
As indicated in the above chart, disability from mental problems has gone from under 10% to nearly 20% of disabilities. Is the United States suffering a mental health epidemic? The reasonable assumption noted above that health care, in general, has progressed for all medical condition is particularly true for mental illness: the time period of 1961 to 2011 included dramatic improvements in mental health care, most prominently with the arrival of new classes of medications for depression and anxiety. Shouldn’t we as a nation be less “disabled: due to mental illness?
The Forbes/Fox News explanation
I’m going to perhaps unfairly attribute a conservative-oriented explanation to the increase in disability payments for bad backs and mental illness to Forbes and Fox, as I have never specifically read or heard opinions from these news outlets on the increase in back pain/mental illness disability approvals. However, both have consistently critiqued the rise in the number of Americans on disability as follows:
- We as a nation were simply tougher in the past.
- Americans are more “entitlement” oriented, whereas in the past Americans would not accept going on disability easily.
- The Obama administration sought to “hide” the chronically unemployed by loosening the standards for social security disability.
To be fair to Forbes and Fox News, this allegation is also made in the NPR “Unfit to Work” article, though in a less partisan manner: NPR’s article suggests unemployment has driven disability applications.
The view from the “disability-industrial complex”
I used the pejorative term used by Forbes magazine in referring to social security disability attorneys, agencies and corporate disability representation firms for dramatic effect. I do not agree with that dismissive term. After all, I guess I am a part of that complex! In an “Open Letter” to NPR in response to the “Unfit to Work” story, former commissioners of the Social Security Administration explained increases in the number of Americans on disability Increases are mostly the result of two factors: “baby boomers entering their high-disability years, and women entering the workforce in large numbers in the 1970s and 1980s so that more are now “insured” for DI based on their own prior contributions”. In a word, “demographics”.
But do demographics explain the increase in mental illness based disability claims? Are older people more susceptible to mental illness? The below chart from the National Institute of Mental Health (NIMH) would say no, in fact, mental illness is less prevalent in older Americans.
One explanation of any increase in social security disability approvals is consistently ignored in the press. Social security may, in fact, be doing a BETTER job in assessing disability. It is entirely possible that in 1961 the social security administration did a poor job in assessing mental illness disability claims, denying disability to hundreds of mentally ill persons who should have been approved under the law. Most of the discussion of this issue seems to assume that the increase in persons on social security disability is a bad thing: it may, in fact, represent progress toward a more just and compassionate society.
Of particular note is the fact that social security disability regulations were radically overhauled during the Reagan Administration via the Social Security Disability Benefits Reform Act of 1984. This law specifically directed the social security administration to do a better job in assessing mental disabilities in response to multiple federal court decisions critical of social security’s high denial rates for mental illness disability.
In sum, I think I have made a good case for the “disability-industrial complex”: demographics can explain back pain disability claim increases, and better mental health assessment by social security explains increases in mental illness claims.
I must confess, however, that most disability advocates do not fully recognize the problems in the social security disability assessment system. In my own experience as a Dallas Fort Worth social security disability attorney for 25 years, there are many Americans with marginal mental health issues that seek to parlay that problem into a regular government check (cases I do not take). There are mental health clinics that encourage and support disability applications so they can access Medicaid and Medicare benefits. There are veterans being diagnosed with PTSD based merely on the stress of being in the military rather than being in actual combat who are in fact receiving 100% VA disability and are being granted social security disability as well. I am also concerned that – unlike a degenerative physical condition – mental illness in many cases should improve with quality medical care, but many disability beneficiaries with mental illness get on disability at a young age and never leave the disability rolls.
I part company with many (maybe most) of my fellow social security disability attorneys in that I believe that failing to recognize the problems in the social security disability assessment process will in the end result in a dramatic backlash that will hurt those deserving of disability benefits. Anyone who doubts that backlash should consider the Trump Administration budget that seeks to gut the social security disability program.