106 Iowa L. Rev. 1555 (2021)

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Abstract

Social Security programs provide a vital safety net for Americans with physical or mental disabilities. Like all social programs, its policies and procedures should ideally be thoughtful and well-balanced, meaning that qualified individuals receive their benefits without undue hardship or delay, with minimal fraud and administrative waste. Applying for Social Security disability is often a years-long process, during which every facet of a claim is subjected to rigorous scrutiny, and after which only about a third of all disability claimants are approved for benefits. This leads one to wonder: were only a third of claimants truly deserving of benefits? Or are there administrative hurdles that keep deserving claimants from the benefits they need? Social Security disability is a nationwide program. While one set of rules apply regardless of where the claimant lives, the claimant’s home state plays a strong role in the adjudication process on both a procedural and substantive level. Procedurally, it is state agencies, not federal, that perform the actual claim adjudication process. Substantively, a claimant’s medical evidence comes from his or her local treatment providers, meaning that the number of approved providers located near the claimant will often determine the strength of his or her claim. On top of this, there are only a handful of rules that are tailored to the unique aspects of a claim for mental disability; the bulk of the rules are written primarily from the standpoint of physical disabilities. But how similar is a back injury to clinical depression? From what kinds of providers would claimants with these two disorders seek treatment, and what would that treatment entail? What medical evidence would those courses of treatment create? The fundamental questions here are: Can one set of rules properly—and fairly—account for these differences? And what are the consequences if they do not? These are difficult questions, and they strike and the heart of the program itself.

This Note addresses those fundamental questions, with a focus on the problems Iowans with mental impairments face in proving their Social Security claims. Following an introduction, Part II lays out the application process for Social Security disability benefits, which acts both as a necessary foundation for the discussion that follows and as a general primer for anyone unfamiliar with Social Security disability programs. Part II also introduces some common mental health issues and their treatments, and gives a broad overview of the current state of mental healthcare in Iowa. Part III discusses problems Iowans with mental illness have in proving a claim for disability, and how these inherent problems were exacerbated by recent rule changes that expanded the Social Security Administration’s discretion in weighing medical evidence. Next, Part IV offers solutions to correct—or at the very least mitigate—these hardships, and includes both solutions that work within the current systems, as well as some that propose more sweeping rule changes. This Note ends by concluding that without changes, many Iowans—and many other similarly-situated Americans—will continue to be denied the benefits they need.