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Not Many Malingerers on Social Security Roles, Commission Says

September 12, 1986

WASHINGTON (AP) _ There are not many malingerers on Social Security’s disability rolls, but people should not be permitted to win benefits solely because they claim to be in chronic pain, says the Commission on the Evaluation of Pain.

The commission recommended Thursday that Congress extend a two-year-old statute, due to expire at the end of the year, that allows disability examiners to consider pain along with other medical or mental factors.

Four of the 20 commissioners filed a sharp dissent in which they asked, ″What is it about pain alone that provokes such discrimination and the denial of a statutory entitlement?″

The majority of the commission, chaired by Dr. Kathleen M. Foley, chief of pain service and neurologist at the Memorial Sloan-Kettering Cancer Center in New York, called for further study to determine how many cases there are in which a person claims to be suffering from such chronic conditions as back pain or severe migraines and has no other medical evidence of disability.

″Some commission members believe the granting of disability benefits may have unintended consequences resulting in reinforcement of chronic illness behavior,″ said the report, which Health and Human Services Secretary Otis R. Bowen forwarded to Congress on Thursday.

The commission concluded, ″There are simply not very many malingerers in the Social Security disability applicant population,″ in part because the examiners and medical professionals are good at spotting fakers.

But the commission noted that pain remains subjective, defying objective measurement. It recommended that the government conduct rehabilitation experiments to try to get chronic pain-sufferers back into the workforce.

When the results from further studies and those experiments are in, the majority said, Congress should appoint a new pain commission to decide whether chronic pain alone should be classified a disability.

The dissenters, including three of the panel’s 11 physicians, said:

″We see no adequate reason ... why victims of disabling pain should be singled out for particularly harsh denials of the benefits that are routinely paid to victims of other disabling conditions such as heart disease, diabetes, alcoholism, obesity or paranoid schizophrenia.″

″There is no good reason to wait for another study, another three years, another pain commission, to do our work,″ said Drs. Richard Black, a professor of anesthesiology and former director of the Pain Clinic at the Johns Hopkins Medical Institutions; Harold Carron, a professor of anesthesiology at the Georgetown University School of Medicine; and Marc Hertzman, a professor of psychiatry at the George Washington University Medical Center, along with David A. Koplow, a Georgetown law professor.

The commission, which included experts in nursing, rehabilitation and insurance, said pain is an issue in as many as half of the 55,000 disability claims now pending in federal courts.

Social Security pays almost $20 billion a year in disability benefits to 2.7 million workers and 1.2 million members of their families. The average family gets $891 a month. In addition, a related welfare program, Supplemental Security Income, pays almost $8 billion a year to 2.6 million blind and disabled poor people.

The comission said the typical chronic pain sufferer might be a middle-aged manual laborer who suffers a severe back injury in a fall and is out of work for months. ″The pain persists despite apparent tissue healing,″ it said.

″The stereotypical chronic pain syndrome claimant is not a hypochondriac, a malingerer or a hysteric. He is not ‘making up’ the pain, not cynically plotting strategies for unwarranted receipt of disability benefits. Instead, his pain is real and very unpleasant, but also very complicated,″ it said.

″For some, the continuation of pain is rewarded by increased concern and solicitousness from spouse and family; for others pain provides a ‘legitimate’ rationale for quitting an unpleasant work environment; for still others, the luxury of concerted medical attention is a powerful lure,″ it said.

″Without corrective action, a chronic pain syndrome individual slips ever deeper into a rut over time. The pain never abates, and the status of ‘pain disabled’ provides a certain legitimacy and, sometimes, a steady income.″

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