Statement of Anthony T. Pezza, Manager, Social Security Administration District Office, Hackensack, New Jersey,
and President, National Council of Social Security Management Associations, Inc.

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

Hearing on Social Security Disability Programs' Challenges and Opportunities

June 11, 2002

Chairman Shaw and Members of the Subcommittee, my name is Anthony Pezza, and I am here today representing the National Council of Social Security Management Associations (NCSSMA).  I am also the manager of the Social Security District Office in Hackensack, New Jersey and have worked for the Social Security Administration (SSA) for 40 years.  On behalf of our membership, I am both pleased and honored that the NCSSMA was selected to testify at this hearing on the problems and opportunities facing SSA in its administration of the disability program.

As you know, Mr. Chairman, the NCSSMA is a membership organization of more than 3000 Social Security Administration managers and supervisors who work in SSA's more than 1300 field offices and teleservice centers in local communities  throughout the nation.  It is most often our members with whom your staffs work to resolve issues for your constituents relative to Social Security retirement benefits, disability benefits, or Supplemental Security Income.  Since our organization was founded almost 34 years ago, the NCSSMA has been a strong advocate of locally delivered services nationwide to meet the variety of needs of beneficiaries, claimants, and the general public.  We represent the essence of "citizen centered" government.  We consider our top priority to be a strong and stable Social Security Administration that delivers quality service to our clients - your constituents.

It is significant to note, that the number of people receiving Social Security or Supplemental Security Income (SSI) disability benefits is less than 20% of all those receiving Social Security or SSI payments.  On the other hand, about two-thirds of SSA's administrative budget, around $5 billion this year, will be spent on the work generated by the disability program. 

SSA's field offices must expend a great deal of their efforts on the disability program.  Field offices deal directly with disability applicants and recipients.   Field offices take disability claims, provide information to claimants and their representatives, initiate continuing disability reviews, and provide the public and third parties with information about the disability program.  In dealing directly with disability claimants and recipients, we hear their stories and see firsthand the impact of their impairments and our procedures on their lives.  We are in a prime position to assess the challenges and opportunities presented by the current situation.

Challenges Facing the Disability Program:

SSA's disability programs have been under severe stress for a number of years.  As reported by the Social Security Advisory Board in its January 2001 report entitled "Charting the Future of Social Security's Disability Programs: The Need for Fundamental Change", SSA's actuaries project that between now and 2010 the number of Title II disability beneficiaries will increase by 50% and the number of SSI disability recipients by 15%.  This tremendous increase in disability claims workloads will further strain a system that is already at the breaking point.  Disability claims workloads are rising around the country.  During one recent week some 60,000 initial disability cases were waiting to be assigned to Disability Examiners in the various Disability Determination Services.  There were in all probability a like number of Continuing Disability Review cases awaiting assignment.   This is just the "tip of the iceberg". 

The most prevalent criticism field offices hear concerns the amount of time it takes to get a decision.  Applicants wait an average of almost 4 months from filing to receipt of an initial decision.  The almost half a million claimants who request a hearing before an Administrative Law Judge (ALJ) each year can expect to wait, on average, more than a year from the date of the initial filing for a decision.

Delay in the process may be the most pervasive problem, but it is by no means the only problem.  Many claimants have no idea of how the process works or how decisions are made.  They have little understanding of what is required to meet the definition of disability under the Social Security program, much less what is needed to document their claim.  Unfortunately, limited resources have forced a reliance on self-help completion of forms and on telephone interviews.  Claims Representatives rarely have the time to fully review all forms completed by applicants or to fully explain how the process works.  Additionally, failure to see a claimant face to face increases the opportunity for fraudulent activity.  It is also extremely important to note and understand that many claimants are suffering from mental impairments.  This makes self-help and electronic service delivery extremely problematic for such individuals.

Other problems facing the disability program have been abundantly documented by reports of the Social Security Advisory Board, GAO, and others.  There are, for example, wide variances in allowance rates and processing times from state to state.  Court decisions have greatly complicated the disability determinations process and have resulted in a disparity between the criteria used to make initial and reconsideration decisions and criteria used at the hearing level.   In addition, recent attempts to focus efforts on helping disability recipients return to work have not resulted in a promising response. The problem is probably rooted in the "all or nothing" statutory definition of disability and the application process that focuses on inabilities rather than abilities.  These factors tend to discourage a return to work.

One of the most significant and sad points about the disability problems faced by SSA is that we've been discussing the same problems and talking about the same potential solutions for many years now.  This is not a situation that materialized overnight.  It's been a long time coming.  But it appears that the more it gets discussed and studied, the less gets done to deal with the problem.

Unfortunately, from the claimant's perspective, after years of SSA's efforts to deal with its problems in the disability area, nothing has changed.   

• There are reasons for this, among which are:
• The structure of the disability determinations and appeals process
• The competing interests of the various "stakeholders"
• The institutional bias toward the paralysis of analysis
• The limitations on resources

It is probable that we have now reached the point where all of the dire predictions about a "melt down" in the disability process will occur if action is not taken quickly and decisively to avert it.  The final straw may be the recent emergence of an unanticipated workload in the form of literally hundreds of thousands of cases that have come to be termed Special Title II Disability cases.  These cases involve situations wherein there was a failure to identify SSI recipients who, after becoming eligible for Title XVI (SSI) payments, subsequently became insured for Title II benefits.  At that point an application for Title II benefits should have been solicited and processed.  Having identified these cases, SSA is now obligated to secure and process applications.  This will involve a very significant and unanticipated expenditure of SSA's frontline field office resources.  But additionally, with specific reference to the disability issue, it is anticipated that more than half of these cases will require medical determinations.  This will further strain the already strained Disability Determinations Services (DDSs) with what could involve hundreds of thousands of additional medical determinations.   

Potential solutions to the disability crisis can be divided into two broad categories: long-term and short-term.  The long-term solutions generally require legislation.  The short-term solutions require executive decision. 

Long-Term Solutions:

The root causes of the disability dilemma were accurately described by the Social Security Advisory Board when it reported:  "…the structural problems with the agency's disability determinations and appeals process…are at the heart of many of the agency's service delivery problems."  We believe that it is essential to reexamine the nature of the federal-state relationship in the disability process.  What we have today is a system that produces wide variances in allowance rates, staff salaries, hiring and training practices, and quality assurance practices among the 54 different agencies making medical decisions.  Because SSA's disability programs are national programs, there is an obligation to ensure that all applicants receive equal treatment.  This does not appear to be the case today.  Examination of the federal-state relationship may lead to recommended changes, which in all likelihood will require legislation. 

Another long-term solution would be to change the nature of the disability program by changing the current definition of disability and modifying the program to provide for short-term as well as long-term disability payments.

Such a modified program could provide a smoother and faster initial disability determination process.  It could also build into the provision for short-term disability the work incentive provisions currently available through "Ticket to Work".

Short-Term Solutions:

While it may be prudent and desirable to pursue the relatively long-term solutions described above, which would generally require legislation, there are actions that can be taken now to improve the current process. 

Nine years ago, SSA embarked on an ambitious effort to improve the disability process by attempting to redesign the process.  A number of pilots and other efforts were undertaken.  While we haven't found a "silver bullet" much has been learned, and NCSSMA recommends that some of the positive findings from the efforts undertaken over the past nine years can and should be put to work now to help mitigate the problems with the current process.  Our specific recommendations are as follows:

• Technical Expert for Disability: The three-year-long Disability Claims Manager (DCM) pilot undertaken by SSA was successful in proving the concept that one individual could handle both the program and disability determinations aspects of disability claims.   Under this initiative, one individual in either an SSA field office or a DDS was given the responsibility for the complete processing, from initial application and interview to a final decision of an initial claim for disability benefits.  The DCM served as the claimant's point of contact throughout the process.  This pilot demonstrated reduced processing times, greater claimant and employee satisfaction, a level of accuracy at or above that of the traditional process, and at the peak of the pilot produced more work for the total number of staff hours involved than the traditional process.  It is especially significant that claimants expressed high levels of satisfaction with the level of service provided under the pilot vis-a-vis the traditional process, especially claimants whose claims were denied.  While the nature of the federal-state relationship presented difficulties preventing a general adoption of the DCM process, there were valuable lessons learned that can be put to immediate use to improve current service.  The pilot established that, within the confines of the current federal-state relationship, the role of the field office could be strengthened and enhanced in the front-end disability process.  Specifically, the NCSSMA has recommended to SSA that a new position be created in field offices whose focus would be on the processing of disability claims.  This position, which we have termed "Technical Expert for Disability" (TED), would be fully trained in the same basic medical determination training received by new DDS Disability Examiners (DEs).  Their responsibilities would include:

• Intake of initial applications for disability benefits under both the Title II and Title XVI programs
• Developing both the medical and non-medical aspects of certain claims
• Making the non-medical and making or recommending the medical decisions in predetermined types of cases, with individual state agreement
• Reviewing and taking, where indicated, the first action on disability claims being forwarded to the DDS for development and medical decision
• Training and mentoring other field office employees in the disability process

The TED position could help resolve one of the most pervasive problems in the disability process by improving the quality of the initial medical transmittals to DEs in the DDSs.  Both the timeliness and accuracy of initial disability decisions should be improved.  The TED could become the pivotal position in the disability process, providing the claimant with a single point of contact that can only be effectively accomplished by someone knowledgeable in both the medical and non-medical aspects of the disability claims process.  Once again, we urge SSA to implement this position.

• E-DIB:  SSA has recently embarked on a project to accelerate the conversion of the disability process to an electronic environment, eliminating paper files and mailings and permitting easier review and transfer of information in the disability claims process.  We applaud the Commissioner's decision to move this project quickly.
• "Intelligent" front-end system:  Field offices need to be provided with an intelligent front-end interview system that will allow the interviewer to obtain all relevant medical information.  This would include "drop down" menus and an interview path with questions based on the specific impairment.  This will result in a better front-end product and avoid unnecessary information by making the questions impairment-specific.
• Improving the appeals process: There are a number of changes to the hearings process that would make the process more efficient and reduce the length of time it takes to get hearing and appeals council decisions.

- Close the record after the ALJ decision
- Allow Agency representation at ALJ hearings
- Combine OHA and SSA field offices  

The Need for Resources

Quality and service ultimately takes staff.  SSA continues to struggle to keep up with its burgeoning disability workload.  This situation will continue and probably worsen as the "Baby Boomers" age and file for disability in growing numbers if something is not done.  Because of the nature of the disability process and program, it is not amenable to an Internet service delivery solution.  Many people who file for disability are suffering from mental disorders.  The complexity of the process makes it unlikely that this service population will be able to apply via the Internet.  These individuals need the option of face-to-face, personalized service.  The NCSSMA, in a survey released in March 2001, documented the finding that field managers felt the need for an additional 5000 employees simply to keep up with current service demands.  The Special Title II Disability workload has added to this need.  We cannot overemphasize the point that disability claimants need face-to-face, person-to-person service.  This is the most effective way to ensure that these most vulnerable of our citizens, facing crisis situations in their lives, receive the timely and quality service they deserve.

Again, Mr. Chairman, I thank you for this opportunity to appear before this Subcommittee.  I would welcome any questions that you and your colleagues may have.