Disability Determination Under Social Security: Increasing Rates of Approval.

Supplemental security income (SSI), is the lifeline for our patients living in the community. Absent disability benefits most of our patients are homeless. Many will be hungry, poorly clothed, and have only rudimentary health care. The disability determination system will approve disability for < 30% of those adults making an initial application. The rate of actual disability is much higher. A large cohort (n = 251) of likely disability applicants had comprehensive diagnostic evaluations. These evaluations revealed extensive co-occurring psychiatric symptoms and features, particularly obsessive-compulsive features. Recognition and appreciation of the burden of co-occurring conditions leads to a robust increase in approval rates. Administrative or structural features of the disability determination system also depress allowance rates.