Statement of Martin Gerry, Deputy Commissioner,
Disability and Income Security Programs, Social Security Administration

Before the Subcommittee on Social Security,
 House Committee on Ways and Means

Hearing on Social Security Disability Programs' Challenges and Opportunities

June 11, 2002

Thank you for inviting me today to discuss the Social Security Administration’s (SSA) efforts to improve the Social Security and Supplemental Security Income (SSI) disability process.  As you know, the monthly disability benefits provided through these programs represent an economic safety net for situations that any of us might find ourselves in at some point during our lifetime. Few individuals have private or employer-provided long-term disability insurance.  But nearly all American workers have Social Security.

As Commissioner Barnhart testified before you last month, the length of time the disability claim process can take is unacceptable.  The numbers of claims do not simply represent case counts, they represent people who need access to that safety net and also are counting on us for help.  Today I will focus my testimony on a description of the disability determination process and our efforts to improve it.

The Disability Determination Process

Most disability claims are initially processed through a network of local Social Security field offices and State agencies (usually called disability determination services or DDSs).  Favorable determinations (allowances) in most instances lead quickly to the payment of benefits.  Appeals of unfavorable determinations may be decided in the DDSs or by administrative law judges or administrative appeals judges in SSA's Office of Hearings and Appeals.

Social Security Field Offices

SSA representatives in the field offices usually obtain applications for disability benefits, either in person, by telephone, or by mail. The application and related forms ask for a description of the claimant's impairment(s), names, addresses, and telephone numbers of treatment sources, and other information that relates to the alleged disability. (The "claimant" is the person who is requesting disability benefits.)

The field office is responsible for verifying necessary non-medical information requirements, which may include age, employment, marital status, or Social Security coverage information. The field office sends the case to a DDS for evaluation of disability.

State Disability Determination Services

The DDSs, which are fully funded by the Federal Government, are State agencies responsible for developing medical and other evidence and rendering the initial determination on whether the claimant is or is not disabled or blind under the law.

The DDSs follow SSA rules on how to develop and evaluate medical and vocational evidence.  Usually, the DDS tries to obtain evidence from the claimant's own medical sources first. If that evidence is unavailable or insufficient to make a determination, the DDS will arrange for an independent medical examination, called a consultative examination (CE), at no cost to the claimant in order to obtain the additional information needed.  The claimant's treating source is the preferred source for the CE; however, the DDS may also obtain the CE from an independent source.

After completing its case development, the DDS makes the initial disability determination.  Generally, the determination is made by a two-person adjudicative team consisting of a medical or psychological consultant (who is usually a physician or psychologist) and a disability examiner.  If the adjudicative team finds that additional evidence is still needed the consultant or examiner may recontact a medical source(s) and ask for supplemental information.

The DDS also makes a determination whether the claimant is a candidate for vocational rehabilitation (VR). If so, the DDS makes a referral to the State VR agency.

After the DDS makes the disability determination, it returns the case to the field office for appropriate action depending on whether the claim is allowed or denied. If the DDS finds the claimant disabled, SSA will complete any outstanding non-disability development, compute the benefit amount, and begin paying benefits. If the claimant is found not disabled, the file is retained in the field office in case the claimant decides to appeal the determination.

Appeals Process

A person who is dissatisfied with an initial determination may pursue an appeal through three administrative levels and the Federal courts.  The Act requires the Commissioner to provide a claimant the opportunity for a hearing, and allows for filing of a civil action in Federal court after the Commissioner's final decision.  SSA’s regulations also provide a reconsideration review by the DDS prior to the hearing before the administrative law judge (ALJ) and an opportunity for final review by SSA’s Appeals Council.

Generally, SSA’s first administrative review for claimants—the reconsideration—involves a de novo, or fresh review of the claim (including any new evidence) by individuals who did not participate in the original determination.  The reviewers consider all of the evidence and issue a reconsideration determination.  There is no reconsideration step in the 10 States in which SSA still has in place the prototype of a revised disability process.  

The second level of administrative appeal is a de novo hearing before an ALJ who can call on medical or vocational experts, if needed, to help evaluate the evidence.  Usually the claimant obtains legal representation at this point.  Frequently, new evidence is introduced by the claimant and his or her representative, often at the hearing itself.  Claimants are allowed to appear before the ALJ and to call witnesses.

The final administrative appeal level is the Appeals Council, which may grant, deny, or dismiss a request for review of the ALJ decision.  It will grant review if the ALJ decision contains an error of law, is not supported by substantial evidence, involves a broad policy issue, or if there appears to be an abuse of discretion by the ALJ.  After an Appeals Council action, if the claimant is still dissatisfied, the next step is filing a civil action in Federal court.

Uniform Application of Policy

SSA strives to maintain and apply uniform standards at all levels of administrative adjudication and review.  SSA takes every opportunity to emphasize to disability adjudicators in all locations and at all levels the importance of following SSA rules to ensure that similar cases are decided in a similar manner throughout the country.  The result of this program-wide emphasis has been, and continues to be, more consistent application of Agency policy throughout the nation.  Without reservation, SSA remains committed to providing a fair and consistent disability determination process throughout the United States.

Efforts to Improve the Process

One of the first things that Commissioner Barnhart did after assuming office was to form a group to develop a service delivery budget to match up resource needs against the level of service we would like to deliver.  The group mapped the disability determination process from the time a claimant first contacts SSA through the initial determination and all levels of appeal.

Our preliminary analysis shows us that there is no one way to make the disability determination process faster and better.  It’s going to take many improvements—some large, some small—to take us where we need to be.  As the Commissioner testified last month, we have already announced a number of steps to address the causes of delay in the disability process.

Initial Determination Initiatives

As you are all well aware, SSA has engaged in a number of efforts to redesign and improve the disability determination process by testing a number of initiatives over the past several years.  We carefully reviewed the results of these initiatives to identify the elements that show the most promise.  Based on this review, we have decided to:

• Grant greater decision making authority to DDS disability examiners by extending single decisionmaker authority nationwide to all DDSs;
• Eliminate the formal claimant conference that was tested as part of the disability Prototype;  and
• Extend elimination of the reconsideration step in the States that have been doing the Prototype, while SSA gathers additional information and considers alternative approaches to a second-level appeal step.

Appeals Initiatives

The amount of time it takes for an individual to make his or her way through SSA’s appeals process has been a perennial concern.  In an effort to address this concern, the Office of Hearings and Appeals (OHA) implemented a new workload process commonly referred to as the Hearings Process Improvement initiative or HPI about two years ago.  Implementation of this initiative involved significant changes to the way SSA processed the hearings workload, and the organizational structure of our hearing offices. The initiative was intended to reduce case processing times, improve productivity, and enhance the quality of service to claimants.

However, while well intentioned, the initiative did not work.  There have been concerns that the HPI project has created even more bottlenecks in the process that it was intended to fix.  Simultaneously, SSA's past inability to hire ALJs to make decisions at the hearing level of the disability process compounded the unintended adverse impact that HPI had on our ability to provide timely service. 

Last year, former Acting Commissioner Larry Massanari formed a group to look at the hearing process.  Thanks to this timely analysis, this spring the Commissioner announced decisions on short- and near-term changes to the hearings process.  We are required to bargain with employee unions before we can implement some of these changes.  We certainly intend to meet that obligation in good faith and are working to implement these important changes as soon as possible.

On a short-term basis, the Commissioner immediately set aside $6 million in overtime and other costs to help expedite the processing of 30,000 to 35,000 backlogged cases in OHA.  In addition to expediting the processing of these cases, this action signaled the importance the Commissioner was placing on making program improvements.

In the near term, the Commissioner announced decisions to make changes to the hearing process.  The decisions include:

• Including ALJs in early screening for on-the-record decisions;
• Developing a short form for fully favorable decisions;
• Allowing ALJs to issue fully favorable decisions from the bench immediately after a hearing;
• Creating a law clerk position; and
• Expanding the use of technology in the OHA, including the use of video teleconferencing, speech recognition and digital recording of hearings.

Be assured, these are just the first steps that SSA will take to meet the challenge of providing a timely, efficient, and high quality hearing process.

Azdell Case

In regard to the hearing process it is important to remember that since April 1999, due to litigation pending before the Merit Systems Protection Board, (MSPB) SSA, with one special exception, has been unable to hire new ALJs to replace those who have retired.

The name of the case is Azdell v. OPM.  It was brought by a class of individuals who have challenged the method that the Office of Personnel Management (OPM) used to compute the veterans’ preference in the ranking of ALJ candidates.  The MSPB has ruled in favor of the plaintiffs in the case and against OPM.  The MSPB ordered OPM to revise the rankings.

With the interest of this subcommittee, we were able to bring on board 126 new ALJs last October from a list of candidates that has been (and continues to be) the subject of litigation.  While these additional ALJs will certainly help in addressing the backlogs, the continued inability to replace ALJs who retire or leave has the potential to seriously affect our ability to decide cases in the hearing offices. 

e-DIB

Before I close, I would like to note one final initiative that will improve the efficiency of both the initial determination and subsequent appeals process.  Simply put, SSA must accelerate its transition to an electronic disability process (e-Dib), not just for the State Disability Determination Services but also for the appeals offices.  As she stated here last month, Commissioner Barnhart is committed to the creation of an electronic system to support the disability determination and appeals process.  I assure you that I share her commitment to bring the process into the 21^st Century. 

Accelerated e-Dib is a major Agency initiative that will move all components involved in disability claims adjudication/review to an electronic business process through the use of an electronic disability folder.  When the process is fully implemented, the Agency will no longer create, mail and store paper disability folders.  Through interfaces with their existing case processing systems, components will be able to work claims by electronically accessing and retrieving information that is collected, produced and stored as part of the electronic disability folder.  Accelerated e-Dib will significantly change the business process and the ways that components interact with disability claims and will ensure that SSA has a robust platform to manage and control increasing disability workloads.

Conclusion

Finally, I thank you, Mr. Chairman, Mr. Matsui, and all the members of the Subcommittee, for your interest and offers to help as we move to meet the challenges facing the Social Security Administration.  We are all aware that these go beyond our efforts to improve disability to providing the service that Americans deserve as the baby boomers age; ensuring the program’s solvency; improving program integrity; and accomplishing all these goals with the quality staff we will need.

I look forward to working with you all in the future.