Chapter VII:  From Crazy Checks to Lazy Checks

  (Healthy people flood the Social Security disability programs)

 The Supremes create Crazy Checks

Several years ago a friend of mine, a school teacher, made a startling comment about one of her students.  She said that the boy's mother was irate because she, the teacher, wouldn't say he was misbehaving.  "She's mad," my friend said, "because her kid won't qualify for benefits unless he has a behavior problem." 

I didn't know it at the time, but my friend was telling me about a phenomenon that was spreading through many parts of the country, and gaining notoriety.  After a Supreme Court decision in 1990 (Sullivan v. Zebley), the standards used by the Social Security Administration (SSA) for determining disability in children were relaxed.  If a child did not have an impairment severe enough to qualify under normal SSA standards, he could still qualify as disabled if his behavior was simply inappropriate for his age.  Word spread and soon there were reports of parents "coaching their children to put on a demeaning, degrading act:  ‘to fail simple tests, to wet their clothes, to fight, to show signs of loss of control ....'"[98] It was also alleged that poorer parents would "use the special-ed classification as a proof of their child's disability, and consequent eligibility for Supplemental Security Income - $493 a month."[99] Benefit payments for these unruly children were called, "Crazy Checks."[100]

A little background

Disability benefits are a huge and costly part of the Social Security system, and are distributed via two distinct programs.  Social Security Disability Insurance (SSDI) is the traditional worker disability program that distributes benefits from the Social Security taxes withheld from paychecks.  Benefits paid are supposed to roughly relate to a worker's earnings history.  In this book, we refer to SSDI as the "worker" disability program. 

As mentioned previously, disability benefits are provided by another program known as Supplemental Security Income (SSI).  This program, started in the early 1970s, uses general income tax revenues to pay both disability and old-age benefits to needy recipients.  It is a welfare program that exclusively targets recipients who can demonstrate financial need.  SSI benefits are not, in any way, related to a worker's earnings history.  In fact, you don't even need a work history to collect SSI.  In this book, we refer to SSI as the "SSI welfare" program. 

Both of the disability programs are administered by the SSA, and the programs have similar standards for defining disability and determining whether a worker has an impairment.  Since both programs are financed from your pocketbook, in one way or another, they are each legitimate objects of our attention, and are discussed in this book.

Now, back to Crazy Checks

The SSA reported that, "(b)etween 1990 and 1996, the number of children eligible for [SSI welfare] benefits increased from approximately 350,000 to more than 965,000,"[101] and the Crazy Checks phenomenon clearly accounted for a significant part of that increase.  The flagrant abuses in the SSI welfare program were highlighted by the disclosure of abuse in one extended family of about 300 in Georgia. 

It takes a village (to top this family)

The SSA had awarded over $1 million in SSI welfare disability benefits to 181 members of an extended Georgia family when Georgia's state disability agency contacted the SSA to express some concerns.  It appeared that some individuals were being coached to feign illness - to "malinger."  An investigation ensued, during which many of the disabled family members rapidly "recovered."  After reviewing the family case files, the SSA Inspector General issued a report.  Here are excerpts, pertaining to 2 of the cases reviewed:

• The psychologist performing the [examination] identified the claimant, an extremely uncooperative child who offered little information about himself, as malingering and capable of significantly better performance than noted in the test results. According to a teacher questionnaire, the child's parents instructed the child to do whatever was necessary to keep the checks coming.
• [T]here was no evidence of mental retardation, the original disabling condition diagnosed at age 4. [The state agency] noted that every time the claimant tried to talk, the mother would put her hand over his mouth. The teacher's report indicated the child was in regular classes, and there was no evidence of mental retardation.[102]

Publicity about cases such as these created a demand by the public for reform, and in the mid-1990s Congress responded.  The Crazy Checks phenomenon was curtailed with legislation defining a child's disability as an impairment or combination of impairments that cause "marked and severe functional limitation."[103] Behavior disorders and less severe learning disabilities no longer qualified.  In addition, Congress prudently passed legislation which denied SSI welfare disability and worker disability benefits "to people whose addictions [alcohol and/or drug] are considered to be a ‘contributing factor material to' the determination of their disability status."[104] These law changes took hundreds of thousands of people off of the disability rolls by the late 1990s, and have already saved billions of dollars.

However, despite the legislative attempts to restore sanity to the process of defining impairments, awards for questionable illnesses are again on the rise.   The SSA does not seem able or willing to use common sense in this area.  As a result, rising costs threaten the financial health of the entire Social Security system.  Worker disability benefits skyrocketed by $6 billion dollars in 2002, an increase of over 10% in just one year.[105] That brought the total of worker and SSI welfare disability benefits to $96 billion per year. 

New challenges

As we learned from the Crazy Checks episode of the 1990s, a little looseness in the regulatory definition of "disability" can lead to a flood of applications for benefits.  This is particularly true with certain subjective impairments that are hard to define and hard to diagnose. 

Mental illness is a broad category comprising several of the most subjective impairments.  Despite the reform efforts of the mid-1990s, the number of people awarded benefits for mental disorders started to climb after 1997, as can be seen in the chart, below.  Statistics show that the number of workers awarded disability benefits for mental disorders increased by more than 37% between 1997 and the year 2001 (Figure 14).[106]  Presently, one third of all workers receiving disability benefits, made their claim on the basis of mental disorders.  It is the largest single category of worker disability.[107]  

In the SSI welfare disability program trends are much worse.  In the 4 years between 1997 and 2001, adult disability awards for mental disorders increased by nearly 41%, and disability awards for children with mental disorders increased by almost 60%.  (See Figures 15 and 16.)[108]  Presently, more than 60% of SSI welfare disability recipients are eligible based on mental disorders.[109] That's 60% of a colossal $30 billion spent on SSI welfare disability beneficiaries - each year.[110]  And, that $30 billion is more that ten times the amount spent for disability benefits in the program's first full year of operations, in 1974.  "Over the next 10 years, the combined federal cost alone for SSI and related Medicaid benefits is estimated at $122,000 per recipient."[111]         (Remember, there are millions of them.)  

Why does the explosion of mental health disabilities continue, even in the post-Crazy Checks era?  Is it fluoride in the water or something contagious?  Were our medical treatments and drugs better twenty years ago than today?  And, what explains the fact that mental illness awards in the worker disability program have increased by nearly 10 fold since 1960, while the insured population increased by a factor of less than 3?[112]   

The legal standards

Part of the problem has to do with the law itself, and how it is administered.  At first glance, the legal definition of disability, and the requirements to demonstrate a disability, seem to be very clear - and tough.  The law defines a disability as

... inability to engage in any substantial gainful activity ... which exists in the national economy ... by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months ....[113] 

The law also states:

An individual shall not be considered to be under a disability unless he furnishes such medical and other evidence of the existence thereof as the Commissioner of Social Security may require.  An individual's statement as to pain or other symptoms shall not alone be conclusive evidence of disability as defined in this section; there must be medical signs and findings, established by medically acceptable clinical or laboratory diagnostic techniques, which show the existence of a medical impairment that results from anatomical, physiological, or psychological abnormalities which could reasonably be expected to produce the pain or other symptoms alleged ... (emphasis added).[114]  

In other words, there must be

• medical signs and findings of an abnormality which could produce
• alleged pain or other symptoms which are severe enough to result in
• inability to participate in any substantial work anywhere in the national economy

That is the law, and it is straightforward, right?  Unfortunately, the administering regulations related to this statute are less clear.  They state:

We must always attempt to obtain objective medical evidence and, when it is obtained, we will consider it in reaching a conclusion as to whether you are disabled.  However, we will not reject your statements ... solely because the available objective medical evidence does not substantiate your statements (emphasis added).[115]   

In other words, the SSA will try to follow the law but, if it can't - don't worry about it.[116]

You too can qualify!

Let's see how the clear standards set forth in Social Security law are actually applied by the SSA.  Within the agency's "Blue Book" manual is a "Listing of Impairments" considered "severe enough to prevent a person from doing any gainful activity."  Section 12.07 of the Listing of Impairments pertains to Somatoform Disorders, which are defined by the SSA to be "physical symptoms for which there are no demonstrable organic findings or known physiological mechanisms" (emphasis added).   The SSA states that these Somatoform disorders may qualify a claimant for benefits if there is medical documentation of any one of three stated conditions, including this one: 

... unrealistic interpretation of physical signs or sensations associated with the preoccupation or belief that one has a serious disease or injury (emphasis added)

In other words, you can qualify if the doctor documents that you are a hypochondriac!

But - not so fast.  You've got to prove that you have this make-believe illness.  The doctor must also note the presence of "at least two" of the following four conditions:

1  Marked restriction of activities of daily living; or

2  Marked difficulties in maintaining social functioning; or

3  Marked difficulties in maintaining concentration, persistence, or pace; or

4  Repeated episodes of decompensation [depression], each of extended duration.[117]  

That means you can qualify as having a severe disability, rendering you unfit for any significant work "which exists in the national economy," if you complain of pains or other physical symptoms that cannot be supported with organic findings, and cannot be explained by any demonstrable physiological mechanism, provided you are a documented hypochondriac who has trouble dating and trouble concentrating.  Gee! Maybe my teenage son can qualify for benefits.

Let's visit the doctor's office

One can imagine the charade that must take place between doctor and patient in regard to these Somatoform disorders.  The doctor can't really observe anything, except the fact that his patient keeps showing up, complaining of symptoms the doctor can't explain, or even observe.  The very fact that the patient keeps making medical appointments for no apparent cause becomes the cause itself.  You see, his hypochondriasis is the disorder.  As for the other required medical observations, concerning the patient's social life, ability to persist in activities, mental concentration, etc., the doctor can do no more than take the patient's word for it, write it down, and pretend he made direct medical observations.  No wonder disability costs are so high. 

Somatoform disorders are just one category of several that are invitations to abuse.  In a scathing report on the SSI welfare program's vulnerability to fraud, the GAO states:

SSI is inherently vulnerable to people who, with the help of others, feign their impairments to obtain benefits. ... Our analysis of a sample file of SSI beneficiaries ... shows that the majority [over 60%] of disabled recipients had the types of impairments that SSA and DDS staff considered susceptible to feigning.

The GAO also produced a listing of these easily-faked impairments.  That list includes, among others, organic mental disorders, affective disorders (e.g., panic and depression), anxiety disorders, personality disorders, mental retardation, and, yes, somatoform disorders.  But not all of the vulnerable impairments are mental in nature.  Also listed are blindness, back pains, disorders of the muscles, etc., and various sprains and strains.[118]  

Designer diseases

Private insurance companies are already looking with alarm at the rising costs associated with old stand-bys, such as back pain and some forms of carpal tunnel syndrome, as well as newer forms of disability, such as Chronic Fatigue Syndrome, fybromyalgia, and "new ‘designer' disabilities, such as mid-life crisis syndrome."[119]   (So far, I don't think that SSA has paid benefits for mid-life crisis, but when they do, I'll be ready.)  Many private insurance companies are re-writing policies in an effort to limit the payment of benefits in certain cases where objective medical evidence is lacking.  It is time for the SSA to do the same.

The perfect disability gives rise to Lazy Checks

One of the newer and more controversial impairments is Chronic Fatigue Syndrome (CFS).  Is it physical?  Is it mental?  Who knows!  Now, don't get me wrong.  I am quite sure that many people with CFS really do feel terribly tired and completely unfit for work - even if their doctors can't find a thing wrong with them.  The problem, however, is that an invisible ailment presents an irresistible temptation for some people who want to abuse the system.  And for those fakers, the benefits we pay for their Chronic Fatigue Syndrome might be called, "Lazy Checks." 

A detailed analysis of CFS teaches us about the Social Security disability programs, and how they are administered.  The Centers for Disease Control (CDC), states that CFS is indicated in a patient who has:

• Severe chronic fatigue lasting at least 6 months, with no apparent medical conditions accounting for it, and
• any four of the following symptoms: "substantial impairment in short-term memory or concentration, sore throat, tender lymph nodes, muscle pain, multi-joint pain without swelling or redness, headaches of a new type, pattern or severity, unrefreshing sleep, and post-exertional malaise lasting more than 24 hours."[120]

If you notice, it is possible to be diagnosed with CFS under the CDC standard, without verifiable symptoms or pathologies.  This is because a doctor can't see 6 months of continuous fatigue, headaches, pain "without swelling or redness," "unrefreshing sleep," or "post-exertional malaise."  Each of these symptoms has to be described to the doctor by the patient.  Even the SSA acknowledges this.  In a Policy Interpretation Ruling devoted to CFS, the SSA says:  "Under the CDC definition, the diagnosis of CFS can be made on an individual's reported symptoms alone once other possible causes for the symptoms have been ruled out."  The SSA goes on to say that this CDC standard does not, therefore, meet the legal standards for awarding disability benefits because "there must also be medical signs or laboratory findings ... . "[121]  

SSA - the tough guys?

The SSA sounds tough, right?  Wrong.  The SSA correctly requires "medical signs or laboratory findings," but then gives a definition of "signs or findings" which is so loose that the standard becomes a joke.[122]  It does this by offering the following category of loopholes that (supposedly) "establish the existence of a medically determinable impairment."

Some individuals with CFS report ongoing problems with short-term memory, information processing, visual-spatial difficulties, comprehension, concentration, speech, word-finding, calculation, and other symptoms suggesting persistent neurocognitive impairment.  When ongoing deficits in these areas have been documented by mental status examination or psychological testing, such findings constitute medical signs or (in the case of psychological testing) laboratory findings that establish the presence of a medically determinable impairment (emphasis added).[123]  

Does this mean that, if I report that I am having trouble with concentration, or report that I am having trouble with my memory, or report that I can't figure out a math problem, the doctor will write it down, give me a 15-minute "mental status examination," and, voila:  these are no longer simply my own statements; they have been transformed into "medical findings"?[124]  

If you read between the lines, it appears that the Centers for Disease Control (CDC) didn't think so either, when it reported the results of its well-known 4-city survey of the Chronic Fatigue Syndrome.  It noted:

No biological markers of CFS have been identified, and no diagnostic tests have been developed; the illness is diagnosed primarily on the basis of symptoms and signs reported by the patient and exclusion of other possible causes of prolonged, debilitating fatigue (emphasis added).[125]  

In other words, the CDC diagnosis guidelines for CFS don't involve medical signs or laboratory findings because there are none.

A few disclaimers

First, it should be stated that CFS has only recently been recognized as an impairment by the SSA, and so far, very few awards have been made for it.  Also, we need to consider that there are, no doubt, many who truly feel tremendous fatigue that makes it extremely difficult to work.  And for those people, we truly should feel sympathy.  But, I suspect that there are others who simply think they have an impairment, and still others who are outright fakers, looking for those "Lazy Checks."  No matter which category, however, there are plenty of CFS support groups to back them up (just check the Web), and plenty of attorneys ready to help them prepare their applications (for a standard percentage, of course).  In fact, one Web site even has a "sample" medical report, suggesting the "compelling points" that might be made by doctors in their own reports on CFS.[126]   (Attention Doctors!  If you use this model medical report, be sure to replace the sample patient name with that of your own patient.)  So we have here the potential for an ongoing and growing financial calamity.  If you want to scam the government, CFS just might be the "perfect disability."  It has invisible causes and invisible symptoms, for which there are "no biological markers," and "no diagnostic tests." 

To this point, we have concentrated on subjective impairments that are difficult for the SSA to deal with.  But, even with the relatively clear-cut cases, the SSA fails to prudently control claims.

Flunking Claims Management 101

Normally, SSA disability rulings are top secret, and not revealed to the public.  But, recently, a small number of these have become public indirectly, through lawsuits filed by employees under the Americans with Disabilities Act (ADA).  Filing for Social Security disability benefits while suing under ADA provisions seems contradictory because, to assert a claim under the ADA, one must be fully capable of doing the desired job, given a "reasonable accommodation."  On the other hand, to qualify under the Social Security Worker Disability program one must have a "severe disability" rendering him unable to work anywhere in the national economy.  Did these litigants want to eat their cake, and have it too?   After studying the 43 ADA cases, James M. Taylor, Managing Editor of Accommodating Disabilities Business Management Guide, reaches some startling conclusions about how the SSA administers its disability program.  In a detailed analysis of the worker disability program titled, "Facilitating Fraud:  How SSDI Gives Benefits to the Able Bodied", Mr. Taylor puts it this way:

A review of SSDI cases and a look at SSDI statistics show a clear pattern of SSA officials' turning a blind eye to all standards and common sense when passing out benefits.... Despite the clear language and the compelling purpose behind the strict SSDI eligibility standards, SSA has been allowing persons with minor or nonexistent disabilities to collect SSDI benefits (emphasis added). [127]

According to Taylor, the 43 jaw-dropping cases are just the "tip of the abuse iceberg," and are indicative of massive program waste:

The payment of billions of Social Security dollars annually to persons with only minor impairments wastes money meant for retirement and pushes the system more quickly toward bankruptcy.[128]  

Here are just a couple of excerpts from Taylor's outline.

The peeved Wendy's worker

There is the case of the Wendy's cook, with a kidney impairment, who quit his job because he was miffed that a new supervisor changed his work schedule:

When the restaurant's president of human resources learned of the misunderstanding, he contacted the cook, apologized for the misunderstanding, offered the cook his previous work schedule, and offered him back wages for the time that he had refused to report to work.  The cook refused to accept the president's apology, offer of reinstatement, and offer of back pay and instead took a job at another restaurant. ... Despite the unmistakable proof that the cook was indeed medically qualified to hold numerous restaurant jobs ... SSA continued to grant him SSDI benefits. ...[129]  

Crocodile Dundee at home - disabled at work

And, there is the case of the hunting, hiking, camping and scuba diving railroad conductor, who was too ill to work: 

A conductor for the Norfolk Southern Railroad injured his knee and back while working on the job.  After successful surgery, the conductor nevertheless applied for a leave of absence and filed for SSDI benefits. ...

After surgery, the conductor engaged in a wide spectrum of recreational activities.  He frequently hiked, fished, camped, hunted, and went scuba diving.  Nevertheless, he claimed that he had difficulty putting on his shoes and that, when bathing, he needed help washing his back.  His own physician concluded, ‘I must admit that this man seems to be physically qualified to do almost any type of work. ...'

Despite the conductor's successful participation in the above-listed rigorous sporting activities, SSA granted him full benefits....[130]  

What is most disturbing is the fact that not one of the claimants in Taylor's 43 cases seems even close to meeting the legal requirements for disability;  yet, they were awarded benefits. 

If the SSA can't handle these cases sensibly, how well will it do in administering the new "designer diseases."

Chaos within the SSA

Have I given you the impression that the SSA is one big fuzzyheaded organization, liberally and quickly awarding benefits?  I hope not, because that is not an accurate picture.  Actually, the SSA is more like a mosaic of differing philosophies and goals.  "There are wide variations in decision making between different regions of the country and different levels of adjudication, raising questions about whether claimants are being treated consistently and fairly" (the Social Security Advisory Board).[131]  

Although it is a federal program, and the Social Security program foots the bill, the initial disability decisions are made by agencies within all of the 50 states.  And, some states, like New Hampshire, award benefits at twice the rate of other states, such as Texas. 

An even greater disconnect is found between the different levels of adjudication within the SSA.  In 2000, about 62% of applications were denied at the initial level.  Of those who appealed to the second level (the "reconsideration" level), 84% were denied.  At this point, those denied were two-time losers, so you would expect that their chances were slim to none in any further appeals, right?  Wrong.  Almost 60% of those who appeal to the third level - the Administrative Law Judge (ALJ) hearing level - won![132]  

The ALJ hearing level comprises about 1000 would-be Johnny Cochrans, each with 1 or 2 weeks of medical training (far less training, by the way, than that of most state adjudicators at the initial level).  These lawyers are defiant in resisting any attempts by SSA officials to apply uniformity and rationality to decision making, or to promote ALJ productivity. 

Many ALJs have viewed SSA's efforts to exert management control over administrative matters as an infringement on their decisional independence.  The relationship has deteriorated to the point where the judges recently voted to form a union, with the view that this was necessary to have their views taken into account (the Social Security Advisory Board).[133]  

I don't know about you, but I sense a problem within the ALJ hearing room.  There, you may find an Administrative Law Judge with a hair across his butt, and a claimant represented by his own specialist attorney.  What you won't find, however, is anyone representing you and me.  This may explain why someone can be, at once, Crocodile Dundee and disabled. 

The truly disabled get lousy service

Our focus, so far, has been on the wasteful awarding of benefits to people who may not be truly disabled.  That results in cost increases that affect every worker who is in the Social Security system.  But, there is another side to this story.  The truly disabled, who need help quickly, are also ill-served by the present system.   This has been repeatedly noted by the GAO:

Our prior work has shown that SSA's disability determination process has long suffered from a set of serious problems.  The process is time-consuming, expensive, fragmented, and complex.  Ongoing weakness in making timely and accurate determinations results in beneficiaries often waiting more than 1 year for final disability decisions.  Continued inefficiency results in very few beneficiaries leaving the rolls to return to work.[134]   

In fact, the GAO has reported that it may take over three years for some disabled workers to finally get their benefits.[135] And, often, a lawyer ends up with a percentage of those benefits.   That is a very long time to wait, and a lot of money to pay, for a person who is unable to earn a living.

A fish rots from the head down

We have heaped most of the blame for questionable disability awards on the SSA, and it is well-deserved.  But the U.S. Supreme Court deserves our attention as well.  It seems that about every ten years it has to muck up the disability waters with a bone-headed ruling.  There was the Zebley case in 1990 - the one that led to the "Crazy Checks."  And, in 1999, there was the Cleveland v. Policy Management Systems Corporation case.  In that case, the Supreme Court indicated, contrariwise to the District Court and Fifth Circuit Court of Appeals, that it is possible for an individual to assert that she is "totally disabled" (to get worker disability benefits), while simultaneously asserting that she is fully capable of work, if only her employer would make a few "reasonable accommodations."  Justice Stephen G. Breyer wrote that it is possible to be disabled for worker disability purposes and not for ADA purposes because "the Social Security Administration (SSA) does not take into account the possibility of ‘reasonable accommodation' in determining SSDI eligibility," as is the case under provisions of the Americans with Disabilities Act (ADA).  That's puzzling.  "Reasonable Accommodation" is the law of the land, but the SSA needs not assume that employers are following that law.[136]  Given the Court's myopic perspective, perhaps it is time for our legislators to amend this law to mandate that the SSA make its rulings under an assumption of "reasonable accommodations."

Summing it up

The legal standards for determining disability appear to be tough and objective - at first glance.  But, apparently, the code and regulations leave far too much wiggle room for the disoriented and confused SSA, and for the technicality-minded Supreme Court.  Benefit payments for the worker disability and SSI welfare disability programs totaled about $87 billion in 2001, and they jumped to about $96 billion in 2002.  Solutions are needed.  

What we must do

• We should only pay benefits for verifiable impairments, based on medical signs or symptoms that are not exclusively derived, directly or indirectly, from the claimant's own statements.
• For workers with strong and obvious disability claims, an expedited process should be used, to give quick relief.
• Disability should be defined in the context of the aids, assistance, and other "reasonable accommodations" that employers are required to provide. The law should be amended to reflect this.
• Appeals should be submitted to independent panels comprising representatives of government, workers, employers, medical professionals, vocational experts, and insurance companies. Their decisions should be a matter of public record, provided claimant identities can be concealed. The public has a right and a need to know how disability benefits are awarded.
• If none of the above works to stop the hemorrhaging of money out of the Social Security disability programs (worker disability and SSI welfare disability), let's provide beneficiaries with a private insurance plan option. This option is explored in more detail in Chapter XIV.

[98] Editorial, "Expect the Worst, Get the Best?" The Times and Free Press, 21 June 1999.

[99] Kay S. Hymowitz, "Special Ed: Kids Go In But They Don't Come Out" [online] City Journal, vol. 6, no. 3, Summer 1966- [cited 5 November 2002]; available from http://www.city-journal.org/html/6_3_special_ed.html. 

[100] The monthly benefit is adjusted for inflation.  In 2003 the basic federal benefit is $552 per month.  Some states add additional benefits on top of this.

[101] "Welfare Reform and SSI Childhood Disability," a Social Security Factsheet [online] (Social Security Administration, February 1997- [cited 19 March 2002]), 1.

[102] Office of Inspector General, "Special Joint Vulnerability Review of the Supplemental Security Income Program," (A-04-95-06020) [online] (Social Security Administration,16 December 1997- [cited 2 May 2002]), section titled Malingering, cases 2 and 4; available from http://www.ssa.gov/oig/ADOBEPDF/audit_htms/49506020.htm.

[103] "Welfare Reform and SSI Childhood Disability," 2.

[104] Public Law 104-121, signed by President Clinton on March 29, 1996.

[105] "2003 OASDI Trustees Report" (Social Security Administration, 2003), table IV.A2.

[106] Unadjusted gross rates.

[107] "2001 Annual Statistical Report on the Social Security Disability Insurance Program" (Social Security Administration, Office of Policy, 17 September 2002), table 29.

[108] Unadjusted gross rates.

[109] "SSI Annual Statistical Report, 2001" [online] (Social Security Administration, June 2002- [cited 15 October 2002]), table 21 (total of mental retardation and mental other rows); available from http://www.ssa.gov/policy/docs/statcomps/ssi_asr/2001/. 

[110] $30 billion is the total of federally-administered payments made for blind and disabled SSI beneficiaries from April, 2002 through March, 2003.

[111] "Supplemental Security Income: Additional Actions Needed to Reduce Program Vulnerability to Fraud and Abuse," HEHS-99-151 (U.S. General Accounting Office, September 1999), 1.

[112] By analysis of Mental Disorders column in Table 29 of the "2001 Annual Statistical Report on the Social Security Disability Insurance Program" [online] (Social Security Administration, September 2002- [cited April 2003]); available from http://www.ssa.gov/policy/docs/statcomps/di_asr/2001/index.html and Workers Insured in Event of Disability column in Table 4c1 [online] (Social Security Administration, 2 February 2002- [cited 3 April 2003]); available from http://www.ssa.gov/OACT/STATS/table4c1.html. 

[113] U.S. Code Title 42, Chapter 7, Subchapter II, Section 423 (d) (1) (A) and (d) (2) (A).

[114] U.S. Code Title 42, Chapter 7, Subchapter II, Section 423 (d) (5) (A).

[115] U.S. Code of Federal Regulations, Section 404.1529 (c) (2).

[116] In minimizing the importance of objective medical evidence, the SSA is skirting the law because Code Section 423(d)(5)(A) requires the presence of medical signs, and those are defined in Regulation 404.1528 as "anatomical, physiological, or psychological abnormalities which can be observed, apart from your own statements" (emphasis added).

[117] "Disability Evaluation Under Social Security" (aka "Blue Book"), Publication no. 64-039 [online] (Social Security Administration, May, 2002- [cited 25 November 2002]), part A, section 12.07; available from http://www.ssa.gov/disability/professionals/bluebook/.

[118] "Supplemental Security Income: Additional Actions Needed to Reduce Program Vulnerability to Fraud and Abuse," 31.

[119] Bill Colopoulos, "Group Long Term Disability:  Strategic Concepts for Plan Sponsors" [online] (BenefitsLink.com, Inc., 2001- [cited 26 November 2002]); available from http://www.benefitslink.com/articles/ltd.shtml.

[120] "Chronic Fatigue Syndrome" [online] (U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 4 February 2002- [cited 26 November 2002]); available from http://www.cdc.gov/ncidod/diseases/cfs/index.htm.

[121] "Titles II and XVI:  Evaluating Cases Involving Chronic Fatigue Syndrome (CFS)," SSR 99-2p: Policy Interpretation [online] (Social Security Administration, 30 April 1999- [cited 3 March 2002]); available from http://www.ssas.com/ssr99-2.htm. 

[122] Actually, the SSA is only half right when it says "there must also be medical signs or findings."  In point of fact, the law reads that there must be medical signs and findings.  The two terms are not interchangeable.  A sign is a directly observable condition, whereas a finding could be deduced indirectly via testing. 

[123]Titles II and XVI:  Evaluating Cases Involving Chronic Fatigue Syndrome (CFS). 

[124] If a person is trying to feign problems with concentration, memory, or cognitive skills, it is very easy for him to manipulate a mental status examination so that the results reinforce the claimed impairment.  For example, he might be read the names of 3 objects and then asked to recall those 3 objects (to test his memory).  To evaluate his concentration, he might be asked to count backwards from 100 by 7.  A determined applicant who is feigning CFS symptoms will know exactly how to respond to those questions.

[125] "Surveillance for Chronic Fatigue Syndrome - Four U.S. Cities, September 1989 Through August 1993" [online] (U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 21 February 1997- [cited 3 March 2002]); available from http://www.cdc.gov/mmwr/preview/mmwrhtml/00046433.htm.

[126] "Writing a Convincing Medical Report" [online] (Charlotte, N.C.:  CFIDs Association of America, undated- [cited 4 March 2002]); available from http://www.cfids.org/archives/2000rr/2000-rr1-article04.asp.

[127] James M. Taylor, "Facilitating Fraud, How SSDI Gives Benefits to the Able Bodied," Policy Analysis no. 377 [online] (Washington, D.C.:  Cato Institute, 15 August 2000- [cited 20 July 2002]), 1,3; available from http://www.cato.org/pubs/pas/pa377.pdf.

[128] Ibid., 3.

[129] Ibid., 8-9.

[130] Ibid., 9.

[131] "Charting the Future of Social Security's Disability Programs:  The Need for Fundamental Change" [online] (Social Security Advisory Board, January 2001- [cited 25 October 2002]) Executive Summary; available from http://www.ssab.gov/disabilitywhitepap.pdf.

[132] Ibid., 8 

[133] Ibid., 18.

[134] "Status of Achieving Key Outcomes and Addressing Major Management Challenges," GAO-01-778 (U.S. General Accounting Office, 11 June 2002), 5.

[135] "Efforts to Improve Claims Process Have Fallen Short and Further Action is Needed," GAO-02-826T (U.S. General Accounting Office, June 2001), 24.

[136] The ADA rules do not apply to smaller employers; however, the SSA is not supposed to award worker disability benefits if the applicant is able to "engage in any substantial gainful activity ... which exists in the national economy."  The available employment does not have to be everywhere - just "in significant numbers" in the region where the claimant lives, or in several regions of the country (U.S. Code Title 42, Chapter 7, Subchapter II, Section (d)(1)(A) and (d)(2)(A)).