As part of developing this paper, we obtained data on the “natural history” of SSDI/SSI applicants with schizophrenia, particularly regarding how their applications have been adjudicated. The SSA provided such data from their Disability Research Files, for SSDI/SSI applicants who applied within a diagnosis category that SSA calls “Schizophrenia/Paranoid Functional Disorders”. SSA also provided parallel data for SSDI/SSI applicants overall, across all diagnoses. Data are for applicant cohorts from 1998–2007, with SSDI and SSI applicants pooled.
The total number of new applications, across all diagnosis categories, was 1,996,753 in 1998 and rose monotonically to 2,618,500 in 2007 (with the exception of 2004, which exceeded all other years with 2,681,689 applications). displays the fraction of each year’s cohort that was allowed, denied and/or dropped, or still pending at the time of the analysis. Overall, slightly more than half of applications were allowed (or pending, for the most recent years); the rate of denial ranged between 45.3% (2001) and 49.4% (2005). Most (~70%) of allowances were made at the point of initial determination; relatively few (<10%) were made at the point of first appeal; and the remainder (20–25%) were made at the point of second appeal.
Disposition of SSI/SSDI Applicants - All Diagnoses
The total number of new applications in the “Schizophrenia/Paranoid Functional Disorders” category was 45,807 in 1997, rose monotonically to 57,246 in 2004, and then declined monotonically to 50,585 in 2007. shows for each year the fraction of SSDI/SSI applications in this category that was allowed, denied/dropped, or pending at the time of analysis. In this diagnosis category, approximately 80% of applicants were awarded (or pending), and around 20% denied/dropped. Most (~80%) of determinations in favor of allowances were made at the point of initial review, with the rest roughly divided between the first and second points of appeal. Following this relatively high award rate, applications in the category “Schizophrenia/Paranoid Functional Disorders” has accounted for around two percent of all SSDI/SSI applications, but around 3.5% of SSDI/SSI awards, between 1998 and 2007.
Disposition of SSI/SSDI Applicants with Schizophrenia/Paranoid Functional Disorders (SSA Diagnosis Code 2950)
These data indicate that most SSDI/SSI applications with “Schizophrenia/Paranoid Functional Disorders” are ultimately allowed; moreover, they are allowed at a substantially higher rate, and earlier in the adjudication process, than SSDI/SSI applications overall. With regard to the 20% of applications in this category that are not allowed, the literature identifies several possible factors that we are currently unable to assess empirically. For instance, SSA’s diagnostic category includes applicants who do not claim to have schizophrenia. There is less scientific basis for a presumption of disability for other nonaffective psychotic disorders than for schizophrenia. Similarly, it seems very likely that some applicants in this category who claim to have schizophrenia would not actually meet the formal diagnostic criteria for this disorder, and thus fall outside the evidence we summarize in this paper. SSA’s electronic data systems do not currently enable analysis of the types or validity of diagnostic evidence submitted by applicants. It is quite possible, therefore, that the 80% final allowance rate for the SSDI/SSI category of “Schizophrenia/Paranoid Functional Disorders” actually underestimates the rate for applicants with valid diagnoses of schizophrenia per se.
Finally, we note that it is difficult for us to assess how frequently applicants dropped initially unsuccessful SSDI/SSI applications, rather than pursuing them through all available appeals. This seems particularly relevant for applicants with schizophrenia, given the evidence described below that schizophrenia frequently impairs persistence and imposes various cognitive limitations that may impede disability application and appeal. The data reported by SSA do provide some indication that applicants with “Schizophrenia/Paranoid Functional Disorders” may drop initially unsuccessful applications more frequently than applicants overall. Specifically, of the approximately 20% of applications in this diagnostic category that are denied or dropped, only 10% (2% of all applications in this diagnostic category) were definitively denied, i.e., through initial adjudication and two rounds of appeal. Thus, 98% of applicants who persisted through two rounds of appeal eventually were awarded, in contrast to applicants overall of which closer to 15% (so around 6.5% of all applications) were definitely denied.