Statement of Bruce Growick, Ph.D., Associate Professor of Rehabilitation Services, Ohio State University, Columbus Ohio; Chairman, Legislative Committee, and Past President, International Association of Rehabilitation Professionals

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

Hearing on Social Security Disability Programs' Challenges and Opportunities

July 11, 2002

To the Honorable Chairman Shaw, Ranking Member Representative Matsui, and Members of the Subcommittee, thank you for this opportunity to testify regarding the present definition of disability and its impact on Social Security Disability programs. I am very pleased to be able to speak to this distinguished committee on this matter, which is both timely and crucial to the future success and existence of the Social Security Disability Trust Fund.

I am Dr. Bruce Growick, an Associate Professor of Rehabilitation Services at The Ohio State University, where I teach courses, advice students, and conduct research in the area of rehabilitation. Rehabilitation as a disciple deals with the overall adjustment, including employment, of individuals with disabilities. I am also the former Director of Rehabilitation for the Ohio Bureau of Workers’ Compensation where I ran a state-agency helping injured workers return to employment. Presently I serve as the Chairman of the Legislative Committee of the International Association of Rehabilitation Professionals (IARP) after having been their President in 1995. IARP is an international organization of 3,400 members who work in the field of rehabilitation, providing services to people with disabilities in business and industry, for insurance companies, and at home. 

Finally, and of particular interest as part of the foundation of my testimony today is my personal experience as a vocational expert for the Office of Hearings and Appeals of the SSA for the past thirteen years. As a vocational expert in the disability determination process, I am asked by the ALJs to classify the applicant’s work experience, and to provide an opinion on their employability. As such, I have participated in thousands of Social Security hearings, and have been continually dismayed by the large percentage of individuals who apply for disability without receiving vocational rehabilitation. Therefore, in my testimony, I will address the issue of the definition of disability as it relates to incorporating vocational rehabilitation into the disability determination process, and the subsequent implications for the success of the Ticket to Work program. 

The Definition of Disability: The Dilemma of Eligibility for Benefits vs. Feasibility for Services

The definition of disability as presently defined by the Social Security Administration creates an “all or nothing” climate.  In order to be eligible for SSA, an individual must prove their inability to engage in any substantial gainful activity, i.e., work.  This definition forces individuals to focus on their inabilities.  For those individuals who have fought so hard for their eligibility, the likelihood of returning to work is unfortunately very small.  There is no room in the present definition of disability to recognize the possibility of improvement through rehabilitation. 

Acknowledging the potential benefit of rehabilitation services, time-limited eligibility is an option to consider.  This definition of disability would be appropriate for individuals who cannot perform their past work, but might be capable of performing other work in the economy.  This definition would then allow for the early identification of individuals with rehabilitation potential and increase the number of returns to work.  This trend is seen in the private disability insurance system, such as workers’ compensation, and long term disability policies.

If the medical condition deteriorates, then the inability to perform any work would result in the determination of permanent and total disability, and eligible for benefits.  With this definition, rehabilitation intervention and return to work assistance can take place before the individual has been classified as permanently and totally disabled.  Transforming the definition of disability in this way would require incorporating the assessment of rehabilitation potential into the disability determination system (DDS).  We know from the statistics related to Workers’ Compensation and Long Term disability case management that the earlier the return to work services are provided, the greatly the likelihood that the individual will return to work, if at all possible. 

Since the DDS process can take up to eighteen months to be completed, many individuals with disabilities have become unemployed and have remained unemployed in order to not jeopardize the process.  As a result, their skills, motivation to work, and work habits begin to deteriorate.  They begin to lose their identity as a worker and to adopt the identity of an individual with a disability.  With a graduated definition of disability, early intervention through vocational rehabilitation can prevent this deterioration.

You have heard from others that the concept of disability in the Social Security programs is out-of-step with current thinking, and I concur. The work and experiences of practitioners, researchers and disability advocates have resulted in increased knowledge about the barriers to employment that confront people with disabilities.  From these experiences we have begun to recognize that the inability to work results from the interaction of the individual’s functional limitations and work skills with the work environment.  However, DDS continues to make determinations of eligibility for benefits on the basis of the idea that disability is “medically determinable.” This concept of “medically determinable” disability focuses on diagnosis and not on the functional ability and rehabilitation potential of the individual.

Reports by the GAO have consistently shown that return to work is not occurring in the Social Security system, even with the advent of numerous incentives and the Ticket to Work program.  Rehabilitation is coming too late in the process, after the individual has already been declared disabled.

The Need for Rehabilitation Evaluation and Services

As stated by others, SSA still needs to incorporate into its eligibility assessment process an evaluation of what is needed for an individual to return to work. The GAO has recommended developing a comprehensive return-to-work strategy that focuses on identifying and enhancing the work capacities of applicants and beneficiaries, and I strongly concur.  May I respectfully recommend that the SSA consider using its staff to develop guidelines that will connect the application for disability with the automatic referral for rehabilitation services?  In this way, the SSA applicant will be appropriately evaluated for return-to-work services, in addition to disability determination.  There is currently a total disconnect between the disability determination process and RTW, unlike the private insurance industry where rehabilitation professionals are used on a routine basis to evaluate disability applicants for RTW potential.  This process saves money for the insurance companies, as well individuals from disability status.

Unfortunately, the recently passed ‘ticket-to-work’ law addresses this disconnect, after the fact. Even though the law’s intentions are laudable, the personal affects of declaring someone disabled dooms the process to failure.  It is good that the ‘private-sector’ is being asked to assist in the delivery of rehabilitation services, but this intervention needs to occur earlier in the process of disability adjudication.

My overall recommendation to this subcommittee is to look at ways in which the definition of disability in SSA can be changed to include rehabilitation as early as possible.  This disconnect between the SSA disability application process and rehabilitation needs to be changed so that the best efforts of the rehabilitation field can be incorporated into the disability determination process.  Thank You.