Social Security Disability Insurance Research Articles

Veteran Affairs disability compensation: Likely the U.S.’s largest disability program, but what do we know about its impacts on service‐disabled veterans?

AbstractThe last few decades have seen rapid growth in the size of the Veterans Affairs Disability Compensation (VADC) program, which provides tax‐free cash benefits to veterans with disabilities connected to military service. Given this recent growth, VADC is on pace to eclipse Social Security Disability Insurance (SSDI) to become the largest U.S. disability program by expenditures. Although there are decades of causal research on the design and impacts of SSDI, there is no comparable body of evidence for VADC. In this Policy Insight, we discuss how causal evidence was produced for Social Security‐administered disability programs and why there is a lack of this evidence for VADC. Chief among the explanations is a lack of VADC data access available to the broader researcher community, access that Social Security facilitates for the programs it administers. However, even with this access, the proliferation of benefits and services targeted to service‐disabled veterans implies that existing earnings loss studies and causal estimates of the impact of VADC benefit receipt on any given outcome of interest likely are mismeasurements of true effects. We conclude with recommendations for restructuring approaches to research design to accurately estimate impacts of VADC benefits as well as the wide array of other programs supporting service‐disabled veterans.

Medical Malpractice in Otolaryngology within the United States: A LexisNexis-Based Demographic Analysis.

Otolaryngologists are at a significantly greater risk of being sued than most other physicians. To date, there is a lack of studies characterizing trends in otolaryngology malpractice claims. To assess these trends and risk variables, this study examined malpractice claims against otolaryngologists. Retrospective database review. LexisNexis Jury Verdicts and Settlements. The LexisNexis legal database was used to locate jury verdicts and settlements related to medical malpractice in otolaryngology, from 2018 to 2024. The study did not include any claims covered by the Social Security Disability Insurance, Workers' Compensation, Healthcare Law, or Criminal Law and Procedure categories. Temporal trends were evaluated, and logistic regression was used to identify independent risk factors. Out of 903 items, 79 reported malpractice cases were included (mean age 44.5; 60.3% female). The most sued subspecialty was head and neck oncology (32.5%). Negligence (93.7%) was the primary cause of action. Of cases sent to the jury, 87.7% of them resulted in a verdict in favor of the defendant. The mean plaintiff verdict payout was $7,432,508.06 and the mean identified settlement amount was $1,562,500.00. Physical injury (62.0%) was the highest type of harm. Regional analysis indicated a higher percentage of cases from New York favored the defendant (21.1% vs 13.6%; P = .034). This study highlights key trends in otolaryngology malpractice claims, emphasizing the prevalence in cases of head and neck surgery, primarily attributed to negligence. By identifying trends and risk factors, otolaryngologists can get a better understanding of the dynamics surrounding malpractice.

Understanding disability benefits decision-making among adults with self-reported work disabilities: A qualitative study

BackgroundTake-up gaps in safety net programs, long documented in the US, are an important policy problem as non-take up compromises the equity objectives and efficacy of programs. The Social Security Disability program is an example of this: more than 20 million adults report a work disability, but only around 11 million currently receive disability benefits through the Social Security Disability Insurance or Supplemental Security Income programs. ObjectivesWe examine decision-making around benefits application among adults with self-reported work disability who have never applied for disability benefits. MethodsWe conducted 39 interviews with work-disabled adults who have never applied for disability benefits. Thematic analysis identified key barriers and inhibitors to disability application. ResultsHigh transaction costs involved in disability applications coupled with the widespread perception of low approval rates was mentioned as a critical deterrent. Uncertain and lengthy medical processes after disability onset were also frequently reported as a key deterrent. Stigma about receiving disability benefits did not emerge as a factor in application behavior, although a change in self-concept involving an adjustment to benefit-receiving, work-disabled status was cited as a barrier to claiming. ConclusionOur results broadly align with those of other research that examined the information, transaction, and social costs of applying for benefits. Nevertheless, the qualitative data afford a more in-depth, grounded understanding of the primary factors affecting application decisions, and how those interact. These insights are important to inform targets for interventions to reduce barriers to take-up of benefits among potentially eligible adults with disabilities.

SPOUSAL LABOR SUPPLY, CAREGIVING, AND THE VALUE OF DISABILITY INSURANCE

AbstractThis article evaluates the insurance value of the Social Security Disability Insurance (SSDI) program among married households when wives face a trade‐off between market hours and spousal care following their husbands' disability. Event study analyses show that wives' labor supply responses to their husbands' disability are small, and instead, a considerable amount of time is spent in spousal care. Using a dynamic structural model, I find that incorporating time loss due to spousal care increases the insurance value of SSDI relative to its costs. Finally, budget‐neutral policy reforms that subsidize the cost of care can improve social welfare.

"Diagnosed with New Health": Social Security Policy Recommendations for People with Cycstic Fibrosis in Ohio Transitioning to a Longer Lifespan

Cystic fibrosis (CF) is a chronic, progressive, genetic, and life-limiting lung disease that impacts approximately 105,000 individuals globally, including 40,000 individuals in the United States. In 2019, a revolutionary new drug, elexacaftor/ivacaftor/tezacaftor (ETI), was approved to manage some of the major symptoms of CF and dramatically increase the lifespan of people with cystic fibrosis (pwCF). Many individuals with CF cannot work full time and require Medicaid, Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), and other financial assistance programs to pay for treatments and medical expenses. Yet in recent years, pwCF who are on ETI have been increasingly losing benefits. A possible explanation for this is the effectiveness of ETI in improving lung function, creating the perception that pwCF are no longer disabled by their condition. Even with this “miracle" drug, pwCF continue to experience significant complications and vulnerabilities to their physical and mental health as well as limitations on daily living and employment. The compounded vulnerabilities these individuals experience leave them without a safety net. Social Security policies for pwCF require revisions to prevent further biopsychosocial damage to this population. Two policies will be recommended: leniency in redetermination, and CF education for those who make determination decisions.

Forensic assessment of somatoform and functional neurological disorders.

Functional neurological disorders (FND) and somatization are common in clinical practice and medicolegal settings. These conditions are frequently disabling and, if arising following an accident, may lead to claims for legal compensation or occupational disability (such as social security disability insurance). However, distinguishing FND and somatization from symptoms that are intentionally produced (i.e., malingered or factitious) may pose a major forensic psychiatric challenge. In this article, we describe how somatoform disorders and FND lie along a spectrum of abnormal illness-related behaviors, including factitious disorder, compensation neurosis, and malingering. We provide a systematic approach to the forensic assessment of FND and conclude by describing common litigation scenarios in which FND may be at issue. Forensic testimony may play an important role in the resolution of such cases.

Endometriosis and Disability: Analysis of Federal Court Appeals of Social Security Disability Insurance and Supplemental Security Income Claims by Individuals Suffering From Endometriosis

BackgroundEndometriosis, a chronic noncancerous gynecologic condition commonly characterized by disruptive physical and psychosocial symptoms, can be disabling. Individuals in the United States with endometriosis who are unable to work before retirement age can apply for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI). Given the multi-step process of disability review, it is important to better understand how disability decisions are made. This study aimed to examine approaches and rationales of U.S. federal appeals courts reviewing SSDI and/or SSI claims involving endometriosis-related issues of appeal. MethodsWe searched Westlaw and Nexis Uni records, available as of January 2021, for federal appeals of SSDI and SSI claims including endometriosis as an impairment. Two independent reviewers screened full-text cases and extracted data. Framework Analysis was applied to courts’ rationales regarding endometriosis-related issues of appeal. ResultsEighty-seven appeals addressed an endometriosis-related issue. Three themes—evidence, treatment, and time—were identified across the decisions. The courts' discussions across themes exposed rationales and evidentiary requirements that posed challenges for claimants with endometriosis. The courts found subjective reports of symptoms insufficient evidence of impairment and positive responses to treatments to indicate cures or prevent claimants from demonstrating the necessary continuous 12 months of impairment. Some courts expected claimants to use treatments such as contraception or hysterectomy without addressing the risks of such treatments or the fact that they might have been counter to claimants’ needs and preferences. ConclusionsIndividuals with endometriosis face evidentiary obstacles and common misconceptions about disease, diagnosis, and treatment in disability claims. SSDI and SSI endometriosis claims are systematically disadvantaged, particularly among those without access to care. The health care, policy, and legal systems can leverage the findings in this study to create a more equitable disability application and review system for those with chronic pain conditions such as endometriosis.

Opioid Use Among Social Security Disability Insurance Applicants

Our study is the first to provide statistics on opioid use among Social Security Disability Insurance (SSDI) applicants. We use an innovative machine-learning method to identify opioids in open-ended text fields in SSDI administrative data. We find that more than 30% of applicants between 2007 and 2017 reported using one or more opioids, a rate that is about 50% higher than in the general population. Rates of reported opioid use varied over time, peaking at 32% in 2012. Reported opioid use also varied by age, gender, education, receipt of SSI, and across states. There was a positive and statistically significant association between (a) reported opioid use and SSDI awards and (b) reported opioid use SSDI award and death; these are associations and do not demonstrate a causal relationship.

Contraceptive Use Among Traditional Medicare And Medicare Advantage Enrollees.

Medicare is the primary source of health insurance coverage for reproductive-age people with Social Security Disability Insurance. However, Medicare does not require contraceptive coverage for pregnancy prevention, and little is known about contraceptive use in traditional Medicare and Medicare Advantage. We analyzed Medicare and Optum data to assess variations in contraceptive use and methods used by traditional Medicare and Medicare Advantage enrollees, as well as among enrollees with and without noncontraceptive clinical indications. Clinically indicated contraceptives are used for reasons other than pregnancy prevention, including menstrual regulation or to treat acne, menorrhagia, and endometriosis. Contraceptive use was higher among Medicare Advantage enrollees than traditional Medicare enrollees, but use in both populations was low compared with contraceptive use among Medicaid enrollees. We found significant variation by Medicare type with respect to contraceptive methods used. Relative to traditional Medicare, the probability of long-acting reversible contraception was more than three times higher in Medicare Advantage, and the probability of tubal sterilization was more than ten times higher. Overall, Medicare enrollees with noncontraceptive clinical indications had twice the probability of contraceptive use as those without them. Medicare coverage of all contraceptive methods without cost sharing would help address financial barriers to contraceptives and support the reproductive autonomy of disabled enrollees.

The effect of Medicaid expansion on the take-up of disability benefits by race and ethnicity.

Public disability programs provide financial support to 12 million working-age individuals per year, though not all eligible individuals take up these programs. Mixed evidence exists regarding the impact of Medicaid eligibility expansion on program take-up, and even less is known about the relationship between Medicaid expansion and racial and ethnic disparities in take-up. Using 2009-2020 Current Population Survey data, we compare changes in Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) take-up among respondents with disabilities living in Medicaid expansion states to respondents with disabilities living in non-expansion states, before and after Medicaid expansion. We further explore heterogeneity by race/ethnicity. We find that Medicaid expansion reduced SSI take-up by 10% overall, particularly among White and Hispanic respondents (10% and 21%, respectively). Medicaid expansion increased SSDI take-up by 8% overall, particularly among White and Black respondents (9% and 11%, respectively). Moreover, we find that Medicaid expansion reduced the probability that respondents with disabilities had employer-sponsored health insurance by approximately 8%, suggesting that expansion may have reduced job-lock among the SSDI-eligible, contributing to the observed increase in SSDI take-up.

The Impacts of the COVID-19 Pandemic on Receipt of Needed Medical Care and At-Home Support among U.S. Households Receiving Supplemental Security Income and Social Security Disability Insurance on the Basis of Disability.

More than 8.1 million Americans with disabilities qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Individuals with disabilities were particularly vulnerable to COVID-19, which may have altered individual and household behavior. Research on the impact of COVID-19 on individuals with disabilities and their families remains limited. Authors analyzed 2020 National Health Interview Survey data. Logistic regression models were applied, controlling for the effects of age, race, sex, income, education, employment, and health status. Households with SSI/SSDI beneficiaries with disabilities were associated with significantly greater odds of delaying or forgoing medical care and receiving needed personal and household care at home due to COVID-19 compared with households without beneficiaries. The health and well-being of households with individuals with disabilities may require more robust and inclusive social work initiatives that aim to reduce adverse pandemic impacts.

Course and predictors of social security disability insurance in patients with borderline personality disorder over 24 years of prospective follow-up

BackgroundThe utilization of Social Security Disability Insurance (SSDI) is frequent in patients with borderline personality disorder (BPD) and may represent a meaningful marker of a patient’s symptom severity, poor psychosocial functioning, and/or inner suffering. Over 24 years of prospective follow-up, the present study aims to describe the course of SSDI and assess the role of clinically relevant predictors.MethodsA total of 290 inpatients with BPD were interviewed at baseline and 12 consecutive follow-up waves, each separated by two years, after index hospitalization. Included were also 72 inpatients with other personality disorders. Surviving patients were reinterviewed. A series of interviews and self-report measures were used to assess psychosocial functioning and treatment history, axis I and II disorders, and childhood/adult adversity.ResultsResults show that rates of SSDI utilization were relatively stable over 24 years of follow-up (on average, 47.2% of the patients with BPD were on SSDI). Patients with BPD were three times more likely to be on SSDI than patients with other PDs. Patients with BPD displayed flexibility in their usage of SSDI. By 24 years, 46% of patients remitted, out of which 85% experienced recurrence and 50% of the patients had a new onset over time. In multivariate analyses, four variables were found to predict SSDI status in patients with BPD over time. These variables were: age 26 or older, lower IQ, severity of non-sexual childhood abuse, and presence of PTSD.ConclusionsThe results of this study suggest that a combination of a demographic factors, childhood adversity, natural endowment, and comorbidity are significant predictors of receiving SSDI over time. On a group level, there is a relative stability of SSDI usage over time, but on the individual level, the present study found a high fluctuation in receiving SSDI over 24 months of prospective follow-up.

Occupations, retirement, and the value of disability insurance

Occupations vary greatly in physical intensity, and there are, correspondingly, many differences in later-life work disability risk, retirement patterns, and applications for Social Security Disability Insurance (SSDI)—a national program that insures shocks to work productivity due to disability, with about nine million current beneficiaries in the U.S. In light of its widespread coverage and large differences in utilization across occupations, this paper aims to measure the value of the SSDI program across a broad population and the extent to which it influences the major choice of occupation. Using data from the Health and Retirement Study and O*NET, I estimate a life-cycle equilibrium model of occupational choice, work, savings, and disability at older ages, and find that incorporating occupations and preference heterogeneity is an integral part of understanding work and SSDI application behavior. While SSDI coverage is nearly universal and the premiums from workers are uniform, estimates suggest that the value of the program varies greatly, from being worth 2.1 to 14.5 percent of earned income—depending on preferences and choice of occupation—though for all groups it is welfare improving. I also find that SSDI plays an important role in the choice of occupation for older workers, providing an insurance value that results in over ten percent more people choosing physically intense, blue-collar occupations at older ages. This overall effect, however, masks the underlying selection of less risk-averse individuals into blue-collar jobs, which, if not accounted for, would lead to overstating the effects of the SSDI program on behavior. A counterfactual experiment aimed at eliminating the distortion created by uniform SSDI tax rates shows that—even without any additional employer accommodation of disabled workers—occupation-specific tax rates lead to fewer aggregate work-disabled years.

Association of Intensive Lifestyle Intervention for Type 2 Diabetes With Labor Market Outcomes

An intensive lifestyle intervention (ILI) has been shown to improve diabetes management and physical function. These benefits could lead to better labor market outcomes, but this has not been previously studied. To estimate the association of an ILI for weight loss in type 2 diabetes with employment, earnings, and disability benefit receipt during and after the intervention. This cohort study included participants with type 2 diabetes and overweight or obesity and compared an ILI with a control condition of diabetes support and education. Data for the original trial were accrued from August 22, 2001, to September 14, 2012. Trial data were linked with Social Security Administration records to investigate whether, relative to the control group, the ILI was associated with improvements in labor market outcomes during and after the intervention period. Difference-in-differences models estimating relative changes in employment, earnings, and disability benefit receipt between the ILI and control groups were used, accounting for prerandomization differences in outcomes for linked participants. Outcome data were analyzed from July 13, 2020, to May 17, 2023. The ILI consisted of sessions with lifestyle counselors, dieticians, exercise specialists, and behavioral therapists on a weekly basis in the first 6 months, decreasing to a monthly basis by the fourth year, designed to achieve and maintain at least 7% weight loss. The control group received group-based diabetes education sessions 3 times annually during the first 4 years, with 1 annual session thereafter. Employment and receipt of federal disability benefits (Supplemental Security Income and Social Security Disability Insurance), earnings, and disability benefit payments from 1994 through 2018. A total of 3091 trial participants were linked with Social Security Administration data (60.1% of 5145 participants initially randomized and 97.0% of 3188 of participants consenting to linkage). Among the 3091 with fully linked data, 1836 (59.4%) were women, and mean (SD) age was 58.4 (6.5) years. Baseline clinical and demographic characteristics were similar between linked participants in the ILI and control groups. Employment increased by 2.9 (95% CI, 0.3-5.5) percentage points for the ILI group relative to controls (P = .03) with no significant relative change in disability benefit receipt (-0.9 [95% CI, -2.1 to 0.3] percentage points; P = .13). The findings of this cohort study suggest that an ILI to prevent the progression and complications of type 2 diabetes was associated with higher levels of employment. Labor market productivity should be considered when evaluating interventions to manage chronic diseases.

Social Security Disability Insurance and intergenerational economic mobility

AbstractEconomic opportunity in the United States is shaped by parental health and disability. We hypothesize that Disability Insurance (DI) may mitigate the observed pattern. Using linked survey and administrative data, we find children of work‐limited parents have 4.1 percentiles less upward economic mobility and 4.3 percentiles more downward mobility relative to children of non‐limited parents. Despite poorer health, children of parents initially awarded DI experience a negligible mobility gap relative to peers whose parents never apply to DI and 3.6 percentiles more upward mobility than peers of parents who are initially denied benefits—suggesting DI may moderate economic mobility.

A behavioral economics assessment of social security disability insurance earnings reporting documents

BackgroundSocial Security Disability Insurance (SSDI) beneficiaries who work are often overpaid, with a median overpayment amount of over $9000. These overpayments occur when the Social Security Administration (SSA) pays benefits to beneficiaries not entitled to them because of work; beneficiaries are required to repay the debt to SSA. Work-related overpayments most often occur because beneficiaries work but do not follow SSDI program rules to report earnings and evidence suggests that SSDI beneficiaries are often unaware of reporting requirements. ObjectiveTo assess written earnings reporting reminders that SSA makes available to SSDI beneficiaries as a way of diagnosing a potential barrier to earnings reporting that contributes to overpayments. MethodsUsing insights from the behavioral economics literature, this article provides a comprehensive diagnosis of SSA's written communications that include earnings reporting reminders. ResultsBeneficiaries are infrequently notified or reminded of requirements, especially at points in time when that information is actionable; the content is not always clear, salient, and urgent; relevant text can be hard to find; and communications rarely emphasize how easy it is to report, what needs to be reported, deadlines for reporting, and the consequences of failing to report. ConclusionsPotential shortcomings in written communications may contribute to limited awareness about earning reporting. Policymakers should consider the benefits of improving communications about earnings reporting.

The effects of expanding access to mental health services on SS(D)I applications and awards

The growing number of individuals suffering from a serious mental illness underscores the important role of interventions such as treatment, policies, and programs to support those in need. Such support efforts often interact in unanticipated ways. This paper considers the degree to which access to mental health treatment services affects participation in federal disability programs including the Supplemental Security Income and the Social Security Disability Insurance (SS(D)I) programs. Our main approach uses an identification strategy that leverages county-level variation in the number of mental health treatment establishments to estimate changes in access to mental health treatment on SS(D)I program participation—measured by applications and awards. We also explore a series of event studies and heterogeneity analyses. Our results show that an increase in mental health facilities increases participation in SS(D)I programs. A 10 percent increase in a county’s number of office-based mental health establishments increases the SSI application rate by 1.2 percent and the SSDI application rate by 0.7 percent. While the overall sample suggests that this does not translate to an increase in SS(D)I awards, we do find increases in awards in counties that have a higher proportion of residents below the poverty line. This suggests that increasing access to mental health resources can be a pathway through which people suffering from severe mental illness can be diagnosed and access social safety nets.

Making Social Welfare Policy in America: Three Case Studies since 1950

Making Social Welfare Policy in America: Three Case Studies since 1950

Opioid Use Among Social Security Disability Insurance Applicants, 2013–2018

Opioid use is common among Social Security Disability Insurance (SSDI) beneficiaries who account for a disproportionate share of opioid-related hospitalizations and mortality. However, little is known about the prevalence of opioid use prior to SSDI enrollment. Understanding when opioid use is established and how it correlates with individual characteristics and community prescribing practices would inform policy approaches to reducing opioid-related harms among SSDI beneficiaries. We estimated the prevalence of opioid use among SSDI applicants by applying a natural language processing algorithm to SSDI application data. We find the prevalence of opioid use among SSDI applicants declined from 33% in 2013 to 24% in 2018. In contrast, the share of applicants with musculoskeletal impairments, which are commonly associated with pain, was unchanged. The share of applications reporting opioid use declined across both sexes, all age groups and education levels, and all regions. There was substantial variation, however, in the magnitude of decline by geography, with the smallest declines in parts of the Midwest and Southeastern United States. SSDI application rates and applications reporting opioid use were more likely to come from communities with higher opioid prescribing rates. Our estimates suggest most SSDI beneficiaries began opioid use prior to entering the SSDI program.

Examining Differences in Self-Reported Health and Access to Health Care Among People With Early- and Late-Onset Disability

The purpose of the study is to compare self-reported health and access to health care among people with early- and late-onset disability. Adults with disabilities 18 to 62 years of age participated in the 2018 U.S. National Survey on Health and Disability (NSHD), which is a nationally representative, internet-based survey that provides data related to health insurance and access to health care. A subsample of participants who reported age at disability onset ( n = 1,188) completed measures related to demographics, health status, health insurance, and access to health care services. Results show that people with early-onset disability were significantly more likely to receive Supplemental Security Income (SSI; p < .001), less likely to receive Social Security Disability Insurance (SSDI; p < .001), more likely to have Medicaid ( p < .001), and less likely to have Medicare ( p < .01). People with late-onset disability were more likely to report service limitations and were more likely to report fair/poor health ( p < .001). Overall, study findings suggest that people with late-onset disability report higher out-of-pocket health care expenditures, greater access limitations, and poorer health. Medical professionals and disability service providers should be mindful about assisting this population in locating appropriate health insurance coverage, health services, and financial assistance.