USA: Determining Disability: Long Covid Highlights the Shortcomings of Social Security Administration's Approach to Disability, 2023, Campbell

DETERMINING DISABILITY: LONG COVID HIGHLIGHTS THE SHORTCOMINGS OF SOCIAL SECURITY ADMINISTRATION’S APPROACH TO DISABILITY

Sierra Campbell

The Health Law & Policy Brief
VOLUME 18, ISSUE 1

Free fulltext:
https://www.healthlawpolicy.org/wp-content/uploads/2023/12/Health-Law-Policy-Brief_Volume-18.1.pdf

TABLE OF CONTENTS I. INTRODUCTION .....................................................................................................................1

II. LONG COVID ........................................................................................................................ 1 A.
Long COVID Overview ...............................................................................................2 B. Long COVID and Federal Civil Rights Law .............................................................. 4 C. Long COVID and the Social Security Administration ................................................. 5

III. SOCIAL SECURITY DISABILITY INSURANCE (SSDI) ................................................. 6 A. SSDI Overview ............................................................................................................ 6 B. SSDI Process ............................................................................................................... 6

IV. EVASIVE CONDITIONS ANALOGOUS TO LONG COVID ........................................... 9 A. Chronic Fatigue Syndrome (CFS) ............................................................................. 10 B. Fibromyalgia ............................................................................................................. 11

V. SHORTCOMINGS OF SSA'S APPROACH TO DISABILITY .......................................... 12 A. Discretion and Subjectivity in Establishing the Statutory Definition of Disability ... 12 B. Discretion and Subjectivity in Diagnoses and the Medical Causation Requirement 14 C. Discretion and Subjectivity in Commissioner's Listing of Impairments .................... 19 D. Discretion and Subjectivity in SSA Determinations .................................................. 21 1. Evaluations of Medical Opinions.................................................................... 22 2. Determinations Regarding Credibility of Claimant's Testimony ................... 24 3.
Residual Functional Capacity (RFC) Assessment and Application of Vocational Factors.............................................................................................. 27

VI. PROPOSED SOLUTIONS: MITIGATING SUBJECTIVITY, ADDRESSING INEQUITIES, AND ENSURING SUPPORTS FOR THOSE WITH DISABILITIES ............ 29 A.
Investments to Promote Health Equity....................................................................... 30 B. Research on Long COVID.......................................................................................... 30 C. Social Security Ruling or Guidance on Long COVID ............................................... 31
D. Legal and Non-Legal Representation throughout Disability Process ...................... 33 E. Procedural Reform to Disability Process .................................................................. 35 F. Creation of Article I Social Security Disability Court ............................................... 36

VII. CONCLUSION ................................................................................................................. 38

 

"I. INTRODUCTION

Long COVID impacts the health and economic security of millions. Yet, because it is a recent phenomenon and remains difficult to diagnose, people unable to work due to Long COVID are experiencing additional barriers to accessing Social Security Disability Insurance (“SSDI”). This paper explores the ways in which the Social Security Administration’s (“SSA”) approach to disability is influenced by individuals’ discretion and subjective views of disability, impairment, and employment, especially when people are unable to work due to evasive or hard to diagnose conditions like Long COVID. The paper looks to other evasive conditions in order to offer recommendations to how SSA could better support people with Long COVID and people with disabilities generally.

Part I provides a brief overview of Long COVID; its impact on the health and financial security of millions of Americans; its developing interaction with federal civil rights law; and the uncertainties regarding its interaction with programs administered by the Social Security Act, including the Social Security Disability Insurance (“SSDI”) program. Part II provides an overview of SSDI and the determination process for SSDI benefits. Part III introduces two hard-to-diagnose conditions that are analogous to Long COVID and can be used to inform the approach to SSDI benefits for Long COVID. In Part IV, this paper explores the influence of discretion and subjectivity throughout SSA’s approach to disability— from the creation of the statutory definition of disability and the medical causation requirement to the Listing of Impairments and the SSDI determination process. Part IV further looks to hard-to-diagnose conditions to highlight the ways in which this subjectivity exacerbates inconsistencies and racial and economic inequities. Finally, Part V offers recommended solutions to mitigate this subjectivity, promote equity and consistency, and better ensure support for those with disabilities."