Broader use of psychological testing may improve process for social security disability determination

Broader use of standardized psychological testing for applicants submitting disability claims to the U.S. Social Security Administration (SSA) should improve the accuracy and consistency of disability determinations, says a new report from the Institute of Medicine. Some proponents of mandatory psychological testing, in particular validity testing, for SSA disability applicants argue that it would result in a significant reduction of individuals allowed onto the benefits rolls and a substantial cost savings. The committee that conducted the study and wrote the report said the data necessary to accurately assess the effects on the rolls or calculate financial costs and benefits are limited, and estimates based on available data are subject to considerable error. However, the report provides a framework for evaluating the financial impact of implementing the committee's recommendations.

In 2012, SSA provided benefits to nearly 15 million disabled adults and children. Under SSA, state agencies determine disability based on medical and other evidence considered relevant in an applicant's case record, which may include standardized psychological tests. Cognitive psychological tests are performance-based and have people answer questions and solve problems as well as they possibly can. Non-cognitive psychological tests are measures of typical behavior -- such as personality, interests, values, and attitudes. Validity tests can be used in conjunction with these standardized psychological tests to assess whether a test-taker is exerting sufficient effort to perform well, responding to the best of his or her capability, or providing an accurate report of his or her symptoms. SSA recognizes that some psychological tests are valid and reliable and provide useful data, but it does not require psychological testing in cases involving mental disorders other than intellectual disability. In addition, SSA policy precludes the purchase of validity tests as part of a consultative examination to supplement an applicant's case record. However, applicants and their representatives sometimes submit validity test results in support of their claims, and there are different opinions in the use and value of validity tests for work disability evaluations. In this context, the SSA asked IOM to carry out its study.

The committee recommended that under specified conditions, SSA should require standardized, non-cognitive psychological testing for all applicants whose allegation of non-cognitive functional impairment relates to a mental disorder unaccompanied by cognitive complaints or to a disorder with physical symptoms that are disproportionate to the medical findings. Testing should be required when the allegation is based primarily on the applicant's self-reporting of symptoms and is not accompanied by objective medical evidence or longitudinal medical records sufficient to make a disability determination. In addition, the SSA should require standardized cognitive testing be included in the case record for all applicants whose allegation of cognitive impairment is not accompanied by objective medical evidence. All non-cognitive and cognitive psychological testing should include a statement of evidence asserting the validity of the results. Assessment of validity, including the use of validity tests, helps the evaluator interpret the accuracy of an individual's non-cognitive and cognitive test results. Therefore it is an important addition to the case record, the committee said. However, validity tests do not provide information about whether an individual is disabled, and a determination that the validity testing alone was not proved valid is insufficient grounds for denying a disability claim. For cases in which validation is not achieved, SSA should pursue additional evidence of the applicant's allegation.

One of the main purported benefits of mandatory psychological testing, specifically validity testing, is the potential to generate substantial savings for the SSA disability programs. The committee found that potential cost savings associated with testing vary considerably based on the assumptions about the groups to whom it is applied and how many false claims it detects, and thus rejects. A full financial cost-benefit analysis of psychological testing will require SSA to collect additional data both before and after the implementation of the report's recommendations.