Article archive / September 1, 2014
Originally published: . Volume 5, No. 13. Source pages: 1, 4.
The Institute of Medicine is reviewing testimony from a variety of sources about the value of using symptom validity tests to measure exaggeration or malingering by claimants in Social Security Administration disability evaluations. Two informational meetings have been held, one in June this year and the other on August 11.
The review followed a 2013 report by the Office of Inspector General saying that the Social Security Administration (SSA) should update its policy that disallows certain tests for malingering. The SSA disagreed and sought the help of the Institute of Medicine (IOM).
Among those presenting research or theory for the Institute’s reviewers were Louisiana neuropsychologists Dr. Michael Chafetz and Dr. Kevin Bianchini. Other presenters for the Institute’s panel included nationally recognized neuropsychologist Dr. Glenn Larrabee of Florida, Dr. Michael Kirkwood of Colorado, and Dr. Jennifer Manly of New York.
The Institute convened their “consensus study” at the Keck Center in Washington DC, titled, “Workshop on Psychological Testing, Including Symptom Validity Testing, for Social Security Administration Disability Determinations.”
According to an official at the Institute, the August meeting focused on the use of validity testing and SSA policy. He said the group also explored the application of the policy “on the ground at the state level.”
Subsequent meetings will be closed sessions reserved for deliberations, noted the official. A final report will follow those closed-door deliberations.
Last year U.S. Senator Tom Coburn, known for his critique of government waste and ineffectiveness, prompted the SSA Office of Inspector General (OIG) to study the issue after Coburn’s team uncovered problems with budget overruns and backlogs in the SSA process and their administrative law judges who make decisions about claims.
After reviewing customary practices in the insurance industry and the VA, the OIG said these agencies’ goal was to look at all relevant information in making a judgment. The OIG concluded that the SSA was the only agency that rejects the use of symptom validity tests (SVTs) as an additional source of information.
The OIG concluded that SSA stands out in its unwillingness to allow the use of these tests in appropriate situations, writing, “Medical literature indicates there is consensus in the medical community that SVTs are useful in determining the validity of disability claims …”
The SSA disagreed, saying, “Due to differing opinions on the use of SVTs, and whether they add value to our disability programs, we plan to seek impartial, external expertise to evaluate our policy on the purchase of SVTs, as resources permit.” The OIG encouraged the SSA to move forward with its plans.
An important topic in medical-legal evaluations, symptom exaggeration or malingering is shown to fall between 30 percent and 64 percent when compensation is involved. Dr. Chafetz and others have determined that malingering rates in social security examinations are likely to fall between 42 percent and 45 percent.
In one study, the rates of malingering or symptom exaggeration were found to be highest when claimants were seeking federal benefits, followed next by those seeking benefits from the state, and were lowest in private cases. Researchers have also found that the degree of malingering is “dose dependent,” where the higher the reward the higher the degree of exaggeration.
Currently about 11 million people receive Social Security Disability (SSD) and 8.2 million receive Social Security Insurance (SSI) benefits. Mental disorders make up about 33 percent of the SSD and about 60 percent of SSI.
The Institute of Medicine heard several types of testimony from neuropsychologists. In his presentation on “Performance and symptom validity,” well known researcher Dr. Glen Larrabee noted that validity tests are easy to pass in patients with bona fide problems.
Erin Bigler, PhD, from Brigham Young University, presented his view that symptom validity tests are the best method to infer valid performance, but he also said that there are still questions.
Jennifer Manly, PhD., from Columbia, spoke about using these tests with culturally diverse populations and posed questions about generalizing from one cultural group to another.
Kevin Bianchini, PhD, from New Orleans, presented methodology regarding pain- related disability, and noted that in the SSA population exaggeration of disability is the central issue, not malingering.
Michael Kirkwood, PhD, from Children’s Hospital in California, reviewed validity testing in pediatric populations and deception in youngsters.
Presenters from the VA, Robert Seegmille and Stacey Pollack, PhD, the National Director of Program Policy Implementation, Mental Health Services, VA, explained that VA policy does not require or prohibit any specific tests or categories of tests. The option to order psychological/ validity tests is left to the discretion of the examiner, they said.
The August 11 meeting included presentations by the Chief Psychologist, Office of Medical Assistance, SSA, and Robin Doyle, SSA Medical Policy Expert. An afternoon panel discussion included the President, Past President, and President Elect of the National Association of Disability Examiners.
From the public documents it is not clear if comparisons were made between the current methods for establishing validity in disability evaluations and the neuropsychological methods. Senator Coburn is set to retire at the end of the current congressional term.
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