Improving the Social Security Disability Decision Process (2007) / Chapter Skim
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4 SSA\'s Disability Programs
4 SSA\'s Disability Programs
Pages 47-65
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From page 47... ...
However, there was much debate about the potential costs of such a program and about the complexity of administering it. "There was concern about the dynamic nature of the disability program, and the administrative difficulty in making disability determinations, i.e., the subjectivity of determining whether a person was truly disabled or out of work for other reasons such as age, obsolete skills or experience, etc." (SSA, 1996:1)
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From page 48... ...
. The definition of disability eventually adopted in the Social Security Amendments of 1954 was: Inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be ex pected to result in death or to be of long-continued and indefinite duration (cited in SSA, 1996:2)
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From page 49... ...
. Initially, Social Security Disability Insurance (SSDI)
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From page 50... ...
If necessary, the DDS may also obtain additional medical evidence on a consultative basis from independent medical sources. Based on all the medical and other information, the DDS makes the initial disability decision and then returns the case to the field office.
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From page 51... ...
• Appeals Council Review -- A claimant may request review of an ALJ disability decision by SSA's Appeals Council. Administrative appeals judges (AAJs)
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From page 52... ...
SOURCE: Based on SSA data accessed April 20, 2007, at: www.ssa.gov/disability/ 4-1 disability_process_welcome_2005.htm. any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months."4 Further, "[a]
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From page 53... ...
To apply the statutory definition in a way that allows it to manage its caseload, SSA uses a five-step sequential evaluation process when deciding whether an individual is disabled. The five-step process is used by the DDS at the initial and reconsideration decision levels and in the quick disability determination process being piloted in Region 1.
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From page 54... ...
The Listings describe impairments that SSA considers severe enough to prevent an individual from doing "any gainful activity."5 The "any gainful activity" standard is a stricter standard (i.e., a higher degree of impairment severity)
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From page 55... ...
, SSA made favorable medical decisions on 37 percent of the initial claims filed under either SSDI or SSDI/SSI concurrently and on 38 percent of the SSI-only claims. After the appeals process, in which additional allowances were made, the favorable medical decision rates were 53 and 46 percent for SSDI and SSI, respectively.
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From page 56... ...
5) - 26% Equaled Able to Do 26% Listings Past Work (Step 3)
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From page 57... ...
has conducted many reviews of SSA's disability programs. Because of SSA's management difficulties -- particularly the long disability claim-processing times and inconsistencies in disability decisions across adjudication levels and locations -- as well as similar problems experienced by other disability programs, such as those of the Department of Veterans Affairs, GAO added federal disability programs to its list of high-risk government programs in 2003.
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From page 58... ...
Variability in Decision Making All DDSs throughout the country operate under the same federal procedures for making disability decisions for SSA, yet there is considerable variation among states in decision outcomes. In 2004, the percentage of initial claims allowed by individual state DDSs varied widely, from around 25 percent in low-allowance-rate states such as Tennessee and Mississippi 6 Approximately 972 days were actual processing time.
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From page 59... ...
North Carolina denied claims because the claimant had no "severe" impairment in 100% Percentage of Allowances Meeting/Equaling the Listings, 2004 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Colorado Nebraska Indiana DC Tennessee Montana South Carolina Wisconsin Utah Ohio South Dakota Georgia Florida Texas New Mexico Kansas Idaho Maryland Iowa North Dakota Kentucky Hawaii New Hampshire New Jersey Oklahoma Michigan Puerto Rico Vermont North Carolina Illinois Oregon Minnesota Louisiana Alabama Nevada Connecticut Mississippi Rhode Island Arizona Maine Other Virginia Washington Missouri Wyoming Massachusetts Pennsylvania Delaware California Alaska New York West Virginia Arkansas Median State of Disability Determination Services Agency FIGURE 4-5 Percentages of allowances for malignant neoplasms meeting or equaling the Listings, 2004. SOURCE: Data provided by SSA.
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From page 60... ...
In 2004, the Vermont DDSs obtained consultative examinations in less than 14 percent of its initial claims, but Tennessee, New York, and Indiana obtained them in more than 60 percent of their initial claims. DDSs "follow State established personnel policies with fig 4-6 respect to salaries, benefits and educational requirements; and they do their own hiring, provide most of the training for adjudicators, and establish their own internal quality assurance procedures.
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From page 61... ...
However, not all DDSs or regional appeals offices have access to a full range of medical expertise. For example, according to data supplied to the committee by SSA, in 2004, 29 of 52 DDSs had no medical consultants specializing in cardiology, 28 had no neurologists, and 25 had no orthopedic surgeons or orthopedic specialists.7 There is also variation in expertise available to provide expert testimony at ALJ hearings.
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From page 62... ...
; • differences in the training given to ALJs and State adjudicators; • differences in State agency training practices; • the fact that most claimants are never seen by an adjudicator until they have an ALJ hearing; • involvement of attorneys and other claimant representatives at the ALJ hearing; • changes in the adjudicative climate (the "message" sent by SSA, the Congress, or others to those who adjudicate claims) ; • rules that allow claimants to introduce new evidence and allegations at each stage of the appeals process; • lack of clear and unified policy guidance from SSA; • insufficient funding and staffing for the State agencies and for hearing offices; and • SSA pressures on State agencies and on ALJs to meet productivity goals.
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From page 63... ...
In addition, the plan eliminates the current appeals council review step. quick Disability Determination (qDD)
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From page 64... ...
To improve consistency in disability decision making, a copy of any DRB decision that is in disagreement with the ALJ hearing decision will be sent to the ALJ. The DRB will have 90 days from the date the claimant was notified that his or case would be reviewed by the DRB to make a decision (this compares with the average time the appeals council takes to complete a case -- 242 days in FY 2004)
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From page 65... ...
2006b. annual statistical report on the Social Security Disability Insurance Program, 200.
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