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Third in a Hearing Series on Securing the Future of the Social Security Disability Insurance Program

March 20, 2012

Third in a Hearing Series on Securing the Future of the
 Social Security Disability Insurance Program  










March 20, 2012


Printed for the use of the Committee on Ways and Means


DAVE CAMP, Michigan, Chairman

WALLY HERGER, California                         
PAUL RYAN, Wisconsin
DEVIN NUNES, California
JIM GERLACH, Pennsylvania
TOM PRICE, Georgia
RICK BERG, North Dakota
DIANE BLACK, Tennessee
TOM REED, New York

RICHARD E. NEAL, Massachusetts
JOHN B. LARSON, Connecticut
RON KIND, Wisconsin

JENNIFER M. SAFAVIAN, Staff Director and General Counsel
JANICE MAYS, Minority Chief Counsel

SAM JOHNSON, Texas, Chairman

RICK BERG, North Dakota





Advisory of March 20, 2012 announcing the hearing



The Honorable Michael J. Astrue
Commissioner, Social Security Administration


Trudy Lyon-Hart
Director, Office of Disability Determination Services, Vermont Agency of Human Services, on behalf of the National Council of Disability Determination Directors

Lisa D. Ekman
Senior Policy Advisor, Health & Disability Advocates on behalf of the Consortium for Citizens with Disabilities Social Security Task Force

Dan Bertoni
Director, Education, Workforce, and Income Security Issues, U.S. Government Accountability Office

Leighton Chan, M.D.
Chief, Rehabilitation Medicine Department, National Institutes of Health

Nicole Maestas, Ph.D.
Senior Economist, RAND Corporation


Third in a Hearing Series on Securing the Future of the
Social Security Disability Insurance Program  

Tuesday, March 20, 2012
U.S. House of Representatives,
Committee on Ways and Means,
Washington, D.C.


The subcommittee met, pursuant to notice, at 10:31 a.m. in Room B‑318 Longworth House Office Building, Hon. Sam Johnson [chairman of the subcommittee] presiding.

[The  advisory of the hearing follows:]


     *Chairman Johnson.  Good morning. 

     The hearing will come to order.  Good morning and welcome to the third hearing in our series on “Securing the Future of Social Security Disability Insurance.”

     Today, we will focus on how disability is decided.  For more than 50 years, the Social Security Disability Insurance Program has provided a vital safety net for workers who have worked long and recently enough and who meet the definition of “disability.”

     When Congress created the Disability Insurance Program in 1956, it defined “disability” as the “inability of an individual to work due to a physical or mental impairment.”

     “Qualified impairments” are those that are expected to last for no less than one year or those expected to result in death.

     Over the years, the Social Security Administration has created complex criteria, emphasizing “complex,” and a time consuming process that is frustrating to claimants, costly to the taxpayer, and frequently raises questions about the consistency, accuracy and fairness of this program.

     Our witnesses today will tell us how claimants apply for disability, how the state disability determination agencies, which are fully funded by Social Security, decide eligibility.

     As we will hear today, deciding whether someone is eligible for benefits is far from easy.

     The examiners supported by medical consultants must analyze medical and other evidence and take a series of complicated steps to make their decisions.

     In the 1980s, Congress also created requirements relating to the opinion of treating doctors, and how pain and other symptoms affect the ability of an individual to work.

     A morass of policies developed to help ensure consistency and respond to the courts have also added to the complexity of the program.

     It is no surprise then that there are wide variations in outcomes, raising questions about whether this program is being administered consistently across the country, and whether claimants are being treated fairly.

     Further, Social Security has had an up hill climb for years to provide the kind of policy oversight, quality review, and ongoing training that massive disability workloads require.

     It has also struggled to stay current with needed updates to the list of medical conditions considered severe enough to qualify for benefits.

     While this program has served as a vital safety net to millions of Americans, the reality is much has changed since 1956.

     Thanks to advances in medical care, many people with disabilities experience greater independence, and as a result, can live more productive lives.

     Legal and social changes have promoted participation by people with disabilities into mainstream society, and the nature of work has changed significantly, as we have moved from an economy largely defined by manual labor to a service and knowledge based economy.

     Yet, the “all or nothing” standard of half a century ago is often criticized as “work disincentive,” furthering dependence by those who might otherwise be able to achieve varying levels of self support.

     As we consider securing the future of this program, we owe it to the American public to ensure that the program effectively serves the interests of applicants, beneficiaries, and taxpayers.

     I now recognize the Ranking Member, Mr. Becerra, for his opening statement.

     *Mr. Becerra.  Mr. Chairman, thank you very much for calling this, the third hearing in our series examining the Social Security Disability Insurance System.

     I want to just begin by mentioning that Social Security disability is an earned benefit.  It is not something that you just get.  You have to have paid into the system, which means you have to have worked and paid into the system, and you must have suffered a work ending disability to be able to qualify.

     Even so, the requirements for receiving benefits are very tough.  You mentioned that.  Only the very sickest and most disabled Americans qualify.

     The majority of Americans with disabilities do not meet Social Security’s strict eligibility standard.  To qualify, applicants must submit detailed medical and other evidence demonstrating that they are either dying or too sick or disabled to work at all, and that their condition will last more than a year.

     Moreover, in deciding whether someone cannot work, SSA considers not just an individuals’ previous job or occupation, but whether he or she can assume any job in the nation’s economy that that individual could do despite the person’s medical condition.

     Individuals who do not meet these criteria are not eligible for disability assistance from Social Security.

     Evaluating whether an individual is so sick or disabled that he or she cannot work is a difficult task, involving complex evaluations of medical evidence and other factors.

     DI benefits are not generous.  A typical worker receives about $13,000 a year.  Because they are either too sick or too disabled to work at all, those benefits translate into a life line for many of those Americans and their families.

     We owe it to these Americans to pay their benefits when they need them.  Let’s remember one in seven beneficiaries of these disability benefits dies within a year of being awarded benefits.

     We owe it to all Americans and workers who pay into the Social Security system to safeguard their contributions and pay only benefits to those who meet the strict standard.

     Social Security’s operating budget is lower today than it was in 2010, because of decisions made in this Congress in what to appropriate and how much to appropriate to the different agencies.

     That, to me, is alarming, at a time when Social Security is increasing its workload because of the economy, because of the number of individuals aging into the system.  We are finding that the Department’s budget or the Administration’s budget is actually shrinking in its ability to meet the needs.

     That, I believe, is distressing.

     As I have said before, I think we owe it to the hundreds of millions of Americans who pay into the system or who receive benefits to hold hearings specifically on these critical decisions on budgets for the Social Security Administration.

     Americans’ contributions into the Trust Fund are what pay for Social Security’s operating expenses.  Budget cuts have real consequences now and in the future for Social Security and its recipients.

     Initial disability claims, the topic of this hearing, are a good example.  With an aging population and the worst recession since the Great Depression, the Social Security Administration receives over three million applications for disability benefits a year, an average of nearly 13,000 claims a day.

     Right now, it takes SSA an average of 111 days to make a decision on a disability application.

     Due to budget cuts, SSA has been operating under a hiring freeze, which means there are fewer workers to process claims, assist the public, and safeguard the Trust Fund than there were in 2011.

     The state DDS offices which evaluate applications have lost more than ten percent of their staff compared to last year.  This is the equivalent of about 2,000 skilled workers, many of whom had  years of experience.

     As a result, the amount of time it takes to make the decision on an application is rising, as is the backlog of people waiting for a decision, which is currently about 750,000 disabled individuals.

     Mr. Chairman, this is an important hearing.  I believe that we must continue to take a close look at how the system operates.  We have to make sure the benefits are there for those who need them, and I am glad that we are holding this in a series of hearings on the Social Security Administration, and in this case, on the disability program.

     With that, I yield back the balance of my time.

     *Chairman Johnson.  Thank you, Mr. Becerra.

     As is customary, any member is welcome to submit a statement for the hearing record.

     *Chairman Johnson.  Before we move onto our testimony today, I want to remind our witnesses, all of them, to please limit your oral statements to five minutes.

     However, without objection, all the written testimony will be made part of the hearing record.

     We have two panels today.  Seated at the table is our first panel witness, the Commissioner of Social Security, Michael Astrue.

     Welcome, Commissioner.  You may proceed.


     *Mr. Astrue.  Thank you, Mr. Chairman.

     Chairman Johnson, Ranking Member Becerra, and Members of the Subcommittee, thank you for this opportunity to talk about our disability programs.

     These programs have become more complex and more people depend on them.  Over the past five years, we have improved service despite limited resources and the huge influx of new disability claims.

     In addition to our core work, we have seen a drastic rise in our non‑program work.  Increasingly, our waiting rooms are filled not with people looking for help with retirement or disability, but with people needing verifications so they can qualify for Federal, state or local programs, or for employment.

     Together, we need to figure out how to keep improving services as the population expands and baby boomers age.

     To succeed, we need experienced employees, up to date technology, and streamlined policies.  We must make more and smarter investments in technology in order to best use our declining resources.

     Toward this goal, we are providing people with convenient online options.  We are close to testing an uniform case processing system for DDSs.

     We are using electronic tools to help us better decide and document cases to improve quality.  We are using technology to identify more and more cases for fast tracking, and we are moving from pilots to permanent process with health IT, which has the potential to make dramatic improvements, both in quality and efficiency.

     These IT investments demonstrate that we understand that we can no longer do business as usual.

     Nevertheless, technology alone cannot make disability determinations.  The complexity of the disability programs requires skilled employees to make those decisions.

     Unfortunately, after two straight years of less funding than we had in Fiscal Year 2010, we will have lost 7,000 experienced employees who we cannot afford to replace.

     Rather than spend time on initiatives we cannot fund, we have focused on program simplifications.  Some of these ideas we have implemented on our own.  On others, we need your help.  With your support, we can make other smart changes.

     The President’s Fiscal Year 2013 budget includes a legislative proposal, the Work Incentives Simplification Pilot, or WISP, which has great potential to encourage persons with disabilities to return to work.

     For several years prior to 2009, we received about 2.6 million initial disability claims each year.  Since 2009, that level has increased dramatically to last year’s nearly 3.3 million disability claims.

     To deal with this sharp increase, we added capacity to our DDSs and flexible national resources to help us quickly reallocate additional support to the most stressed states.

     The dedication of our DDS staff and support from our Federal resources has helped us keep pending disability claims considerably lower than our original projected levels.

     Furthermore, our average processing time of 104 days, and that includes both the field office and the state DDS time, is near a record low since we began using that combined measure.

     Social Security remains a sound investment.  We have drastically reduced the time claimants wait for a hearing decision.

     In Fiscal Year 2011, we cut the average wait for a hearing below one year for the first time since 2003.  Wait times are also down in field offices and our 800-number.

     Through the hard work of our employees and technological advancements, we have kept our administrative costs very low.

     Moreover, we have increased employee productivity by about four percent in each of the last five years.  Few if any organizations, public or private, have similar accomplishments.

     We are proud of these accomplishments, and appreciate your confidence in us.

     The scope, sensitivity, and complexity of our programs requires well-trained people on the front lines and in key support roles.  We simply cannot continue to lose so many employees and keep up.

     That challenge requires a complicated and ongoing conversation with Congress, which is why we are so pleased to participate in today’s hearing.

     Before I conclude, I want to give you also an update on the Social Security Death Master File, which I testified about last month.

     After working closely with OMB and interested Federal agencies, I am pleased to announce that we have provided the Subcommittee with our proposed legislative specifications designed to limit access to the Death Master File in order to reduce identity theft.

     The Subcommittee’s leadership on this important issue has guided our work and we are grateful for it.

     Thank you.  I will be happy to answer any questions you may have.

     [The information follows, The Honorable Michael J. Astrue]

     *Chairman Johnson.  Thank you.  I appreciate your testimony.  As is customary for each round of questions, I will limit my time to five minutes and ask my colleagues to also limit their questioning time to five minutes.

     Commissioner, determining whether someone meets or equals the medical listings is a critical step in deciding disability.  Advances in medical science and treatment are constant.

     I was disappointed to learn from GAO’s testimony that some of the listings have been extended repeatedly for the last 19 to 33 years, without updates.

     In fact, two of the listings including those for mental impairment, which count for 21 percent of all claims, have not been comprehensively revised for more than 27 years.

     How in the world could updating these listings take that long?  Nineteen to 33 years?

     *Mr. Astrue.  Well, it should not, Mr. Chairman.  Very early in my tenure, I made it a priority to change that long‑standing practice in the Agency.

     On my management initiative, not because Congress said so, not because OMB said so, not because GAO said so, I set the standard for the Agency of trying to be on a five‑year cycle going forward, in terms of updating our medical regulations.

     I worked in biotech for almost 15 years.  I know how important it is to have updated medical information.

     I think quite frankly GAO’s comments were a bit unfair.  We did this on our own initiative.  We have updated, if I remember correctly, eight of the 14.  We are making very good progress on the others.

     We will not in all likelihood quite hit five years, depending on when you decide those five years start.  It might be five and a half years.

     Considering there was catch up, as you yourself pointed out, the regulations had not been updated in 33 years, it will be easier and faster in the future when you only have to update for three to five years of medical advancement, instead of going over 33 years, which is what we have been doing.

     We have been trying to do this the right way.  We have been trying to do this with a high degree of consensus, with participation from NIH, with patient advocacy groups.  We have had relatively little complaints about this process.

     I think we have done this extremely well from a quality point of view.  We are doing it extraordinarily quickly by historical standards.  I do not really think GAO has anything to complain about at all.

     *Chairman Johnson.  Do you have one or two people that look at that all the time?

     *Mr. Astrue.  We have a person who does nothing but manage the regulatory process, named Paul Kryglik.  He is overseen by our Deputy for Retirement and Disability Policy, David Rust.  We have a lot of people working on this.

     Could I do it faster if I had more people?  Yes.  We are doing the best we can with what we have.

     *Chairman Johnson.  In their testimony, GAO says “Social Security has made several changes that hold promise for needed updates.”

     Yet, GAO also raises questions about whether the new process will work.  What changes are you making and are you sure they will work?

     *Mr. Astrue.  Well, if I understand, they have embraced the five year goal.  That came from me.  That comes from my management oversight of my people.

     I think in general they are doing a terrific job.  I am not quite sure.  There was a certain vagueness to the GAO criticism there, so I do not really quite frankly understand what it is they are complaining about.

     *Chairman Johnson.  Well, they have to complain.


     *Mr. Astrue.  It is Washington.  Silly me.  I forgot.

     *Chairman Johnson.  To assess the functional demands of specific jobs, Social Security has long relied on the Dictionary of Occupational Titles maintained by the Department of Labor.

     Labor decided to replace this with a new system to track occupations, the Occupational Information Network, known as “O*NET.”

     According to GAO’s testimony, Social Security decided O*NET was not detailed enough and would not be able to withstand legal challenges.  As a result, Social Security, according to what we know, is now developing its own informational system for a cost of $108 million by 2016.

     Worse, the estimate does not include the cost of implementing or maintaining a system, which according to Mr. Bertoni’s testimony, could be significant, based on other agencies’ experiences.

     Tell me why Social Security cannot use Labor’s system instead of asking taxpayers to pay again to develop a separate system?

     *Mr. Astrue.  Well, quite frankly, the statute does not allow us to do it.  O*NET does not have the specificity that the statute requires in order to make the individualized determinations that we need.

     The Dictionary of Occupational Titles, which was developed in 1938, was always at best an imperfect fit.  It was not designed for us.  It just happened to be convenient and there was some overlap.

     O*NET is by comparison to the DOT very superficial and designed for ‑‑ it is further away from our purposes than the DOT is.

     We have brought in outside experts to advise us on this.  Except for a few consultants who thought they could make money off this, no one has looked me in the eye and said Commissioner, you can just substitute O*NET for DOT.

     That is simplistic and a simply wrong approach to something that is very complicated and important.

     I think this Agency and a lot of Washington has had their heads in the sand about our vocational guidelines for a long time.

     The last update on this was 1991, and that was a superficial update.  This has been a tool that needed work for a long time, no one was doing it.

     I am not going to benefit from this.  We have diverted a lot of resources into this, despite all the pressures to deliver in other areas, because it is critically important for the long term future of the disability program, just as important as it is to be up to date on medical, it is important to be up to date for vocational, and there is no other way to do it than grind it out and do the hard work to do it right.

     *Chairman Johnson.  Well, ask Labor to give you some money for it then.

     *Mr. Astrue.  Mr. Chairman, I have had this conversation with some committee staff, not on this committee.  There is a perception that is wrong, that there is this huge pool of untapped resources over at Labor.

     Labor decided basically to get out of this business a long time ago, even O*NET is done largely by contractors.

     We have tried to work with Labor as best we can.  We have invited them into the process.  There is this misconception that there is this huge untapped pool of expertise at Labor that we are not trying to take advantage of.  That is simply not true.

     *Chairman Johnson.  I am just worried about the cost.  Mr. Becerra, would you care to question?

     *Mr. Becerra.  Thank you, Mr. Chairman.

     Commissioner, thank you for being here.  Thank you, by the way, for the work on the DMF, on that file.  All those records of deceased individuals that have been used by people to invade people’s privacy and steal their identity, the work you are doing, I think, will benefit many, many people, and we thank you for that.

     The faster we can get to that, the better.  If we can help you as you go around to the other departments and agencies to try to make sure everyone works under the same standards, so we do not have people’s death records being revealed and used by others for the wrong reasons, the better off, I think, all of us will be.

     *Mr. Astrue.  It took a little while, but I think the agencies are aligned now.  We support this proposal.  What we need now is the Congress to move.

     I would turn it around on you a little bit.  We want to help you.  I think there is bipartisan support, which is a little rare in this city right now, for doing something in this area.

     I think it would be a great thing if we could find a way to all work together to try to make sure this bill still passes this year.

     *Mr. Becerra.  It may surprise you, Commissioner, but I think the Chairman would agree with that statement and I would, too, that there can be bipartisan support on that particular issue.  I hope we are able to work with you to make something happen soon to protect people’s identity.

     You mentioned earlier that your caseload has increased on the disability side.  What were the numbers?

     *Mr. Astrue.  It is up to about 3.3 million.

     *Mr. Becerra.  As opposed to what?

     *Mr. Astrue.  To 2.6, 2.65 before the recession hit.

     *Mr. Becerra.  In the last two or three years, you have increased by almost a third, 25 percent?

     *Mr. Astrue.  We are taking in roughly 600,000 to 650,000 more cases than what the actuaries were projecting we would have in this time period before the recession hit.

     *Mr. Becerra.  You were already going to increase because of the size of the baby boom population that was going to start working its way into the Social Security system, whether through disability or retirement, but on top of that, with the recession, double whammy.

     Now, more people than you expected are coming into the system.

     *Mr. Astrue.  Triple whammy.  We have a lot more retirement applications because desperate older Americans are applying for retirement in higher numbers than we projected.

     Because we are doing so much verification for other Federal, state and local programs, which people are using more because of the recession, those workloads have gone up as well.

     *Mr. Becerra.  I am looking at your written statement on page two where you talked about the budget.  You said toward the bottom there of page two, “Our Fiscal Year 2013 budget request is lean.”

     You go on to say “While we will achieve goals associated with these priorities, we simply cannot do all of the work we are required to do.  We expect to lose over 3,000 employees in Fiscal Year 2012, the current year, and over 2,000 more in Fiscal Year 2013, on top of more than 4,000 employees we already lost in Fiscal Year 2011, a total loss of more than 9,000 Social Security and state disability determination services employees in just three years.”

     While your caseload is rising, you are losing valuable and experienced personnel, and your budgets are shrinking.

     Your current budget from Congress is about $1 billion lower than what you requested, and it is lower than what it was in 2010.

     By the way, working men and women are contributing to the Social Security system every day through their paycheck contributions, so it is not that there is not the money there for Social Security to do its work because everyone who sees that paycheck deduction, that FICA tax deduction, knows they are paying for Social Security.

     If Congress is short changing your budget, are you able to keep up with these caseloads?

     *Mr. Astrue.  The answer is we have done a remarkable job up to this point in keeping up, and it is because of simplification, great work by the employees, a lot of things.

     We cannot keep this up indefinitely.  I want to make sure that all of you understand that we are probably four to six months away from moving significantly backwards in most of our major service metrics.

     Even if we keep up the four percent increase in productivity, which is an extraordinary achievement, and I am not sure we can do that, but even if we do, it is not going to be enough to compensate for all the people that we are losing so quickly.

     *Mr. Becerra.  Longer waits to get your determination on your disability, longer waits to be able to apply for retirement benefits, longer waits to receive your surviving spouse benefits.

     Probably more mistakes, because we know the longer a case sits, the more likely errors will be made in the determinations, so it seems like some folks in D.C. are being penny wise but very pound foolish when it comes to services that most Americans have paid for.

     I hope you will continue to sound the alarm and get us the information that will help us make the right decisions so that we do not short change our seniors and all those Americans who paid into the system for Social Security, whether disability, retirement, or surviving benefits.

     I thank you, Commissioner, for being here.

     *Mr. Astrue.  Thank you, Mr. Becerra.

     *Chairman Johnson.  Commissioner, I want to just set the record straight.  This year, Social Security received an increase in its budget despite a 1.5 percent decrease in an overall discretionary cap.

     In fact, while Social Security is subject to the same long term domestic spending caps enacted in the Budget Control Act, that same bill gave Social Security an additional $11 billion, from 2012 to 2021, over the budget caps, to increase continuing eligibility reviews in its DI and SSI programs.

     This year’s appropriation bills were supported equally by both parties, including the President, the Democrat led Senate, Ranking Member Levin and Ranking Member Becerra.

     Even the President’s Fiscal Year 2013 budget requested $753 million below your request of $12.5 billion.

     The fact is our nation faces a sea of red ink that will break the back of our great nation unless we act now to get our fiscal house in order.

     The Federal Government has to live within its means, just like families do.  That means doing more with less.

     *Mr. Astrue.  Mr. Chairman, I understand the fiscal needs, and certainly we live with whatever judgments Congress makes.

     Let me be clear, because I am not sure it was clear from your statement, our appropriation is smaller two years in a row.  We had less in 2011 than we did in 2010 and we have less in 2012 than we did in 2011.

     *Chairman Johnson.  You reduced your force, too, have you not?

     *Mr. Astrue.  Substantially.

     *Mr. Becerra.  Mr. Chairman, since we are out of order, if I could just comment as well.

     *Chairman Johnson.  Go ahead.

     *Mr. Becerra.  Thank you.  I think we also have to remember that Congress forced the Social Security Administration to use its reserves to try to continue to perform at a higher level.

     Those reserves were meant to help deal with any number of important activities that the Social Security Administration must perform.  Those reserves are now gone, so while ‑‑

     *Mr. Astrue.  Most of those were rescinded.  We used some, but the majority of them were rescinded.

     *Mr. Becerra.  Congress stripped them away from you.  Not only are you receiving less money in your budget, but money was taken away from you that you would have otherwise have used for good purposes.

     Mr. Chairman, let’s be clear.  We can try to paint this however we wish, and we should do hearings on this particular issue on the budget, because Americans have paid for the administration of the Social Security programs.

     This is not one of those areas where because we are in fiscal red ink that the Social Security Administration should suffer the consequences, because to this point today, Americans through their taxes have contributed more to Social Security than they have spent.

     Therefore, we should not find that this agency, which does tremendous work for tens of millions of people, should all of a sudden have to make cuts to its services because it is getting short changed by a Congress for deficit spending unrelated to Social Security.

     I think it is important, Mr. Chairman, that we continue to do these hearings, but as the Commissioner just said, there are consequences.

     *Chairman Johnson.  I believe it is your Administration that cut back two percent.

     *Mr. Becerra.  We can have those conversations later.  Let’s just agree on a bipartisan basis that we will not make cuts to Social Security that have no place when Americans have contributed to the system to pay for the services and the administration.

     *Chairman Johnson.  Thank you, Mr. Becerra.  Mr. Berg, you are recognized.

     *Mr. Berg.  Thank you, Mr. Chairman.

     Moving on to a different area, Commissioner Astrue, I understand the statutory definition of “disability,” Social Security has a regulatory framework and listing of impairments considered severe enough to prevent an individual from working.

     I have a few questions relating to the medical listings of impairments.  First, would you say that these listings rely on objective medical findings and are less subjective to the judgment of the DDS examiner?

     *Mr. Astrue.  Yes.  I think that is generally the notion.  If we think something is clear enough we can do a listing for it, in other words, create a presumption.  Invariably, there are at least substantially objective criteria that go into that.  I would not want to say there is no subjective element, but it is substantially objective.

     *Mr. Berg.  A higher standard from your point?

     *Mr. Astrue.  Yes, I think that is generally right.

     *Mr. Berg.  I know you have invested personally a lot of time and effort into the development of compassionate allowances.

     *Mr. Astrue.  Yes.

     *Mr. Berg.  How do compassionate allowances differ from conditions in listings set forth by the regulations?

     *Mr. Astrue.  It is basically an expansion of the concept.  What we do is we have gone ‑‑ the listings historically would only apply to fairly common diseases and conditions, and what we found is we were making a lot of mistakes in the aggregate, in sort of rare diseases and conditions.

     The notion was on an one time effort, we went through to try to identify those diseases and conditions that pretty much by definition make you disabled.

     Now because we are electronic, we have the ability to pull those out at the front end and just allow them, which is what we do.  I think it is about ten days now.

     They are basically an extension of the philosophy of the listings.  I think the differences are we have moved to much smaller diseases and conditions than what we would historically recognize.

     We have pulled them out electronically in the system, and we have set up procedures in the DDS so they are triaged at the front end, so it is a very short amount of time for a decision.

     *Mr. Berg.  You have a more streamlined processing procedure?

     *Mr. Astrue.  Right.

     *Mr. Berg.  Last, I have heard from constituents in North Dakota.  They are asking about the disability listing for Huntington’s Disease.

     How do you decide to add a new listing?

     *Mr. Astrue.  Well, what we try to do is we look not only at the medical literature in detail, but we try to speak to the patient groups.  Increasingly, we have a very broad and very productive partnership with NIH.

     With Huntington’s, I guess I will jump on one of our announcements, so on April 11, we are going to be announcing that we are adding juvenile Huntington’s to the compassionate allowance list.  That is a first step.

     I have met with a Huntington’s group.  I think the dilemma there is trying to figure out where to draw the lines.  I think we think we can do it, but actually, it is one of those rare cases where it is harder because of technology.

     Now with genetic tests, where a lot of people are getting diagnosed at a very young age, you cannot give benefits consistent with the statute, just with the genetic test that says you have Huntington’s.

     Historically, it took so long to diagnose Woody Guthrie.  By the time they knew Woody Guthrie had Huntington’s, he was long gone, and obviously disabled.

     Now with the new technology, we have to figure out exactly what symptoms of people with Huntington’s make them unable to work.  We have not finished that process, but we are fairly optimistic that we are going to be able to do that.

     We have been in contact with both NIH and with the patient groups.  That is in the neurological listings.  My guess is we will have an NPRM out on that probably early next year, would be the likely schedule.

     *Mr. Berg.  Thank you, Mr. Chairman.  I yield back.

     *Chairman Johnson.  Mr. Marchant, you are recognized.

     *Mr. Marchant.  Thank you, Mr. Chairman.

     Commissioner, last week in our district work period, I spent most of my time visiting with senior groups.  In the conversation, usually in the question and answer section afterwards, in every instance, I had a senior that raised their hand that said they knew someone or some family that they were confident was receiving disability benefits that they felt like that person was defrauding the Social Security System.

     In response to that question, I would use your statistic, that there are 600,000 to 700,000 new claimants, more than, was it ten years ago?

     *Mr. Astrue.  Three years ago.

     *Mr. Marchant.  Three years ago.  That response brought on the question is the Social Security Trust Fund solvency threatened by the 600,000 to 700,000 more claimants.

     The general attitude is there is a fear among people who have worked their entire life and that this program, the disability program itself is threatening the entire integrity of the Trust Funds.

     Can you address that for me?

     *Mr. Astrue.  Sure.  There is a mythology in a lot of quarters, and the media feeds this from time to time, that the system is ripe with fraud.  That is simply not true.

     Is there fraud?  Well, sure.  With a system this big and with standards this complicated, is there some small level of fraud?  Yes.  I think the level of fraud is much smaller than in most government programs.  I think it is some fraction of one percent.

     We do everything that we can to try to root those out, but I think what you have to be aware of is that increasingly, particularly as our society’s and Congress’ definition of “disability” has expanded, there are people who are legitimately disabled who do not look that way to their neighbors, and their neighbors make unfair conclusions.  You see this with people with a variety of mental conditions.  You see this fairly typically, for instance, with people with early Alzheimer’s.

     We even had a case with one of our own medical examiners who saw someone with early Alzheimer’s and just ridiculed the person.  I apologized in a public hearing for the way one of our own people reacted.

     I think people are sometimes very quick to assume fraud when in fact what they are seeing is a non‑apparent disability.

     *Mr. Marchant.  What about the issue of these claims threatening the solvency of the Trust Fund?

     *Mr. Astrue.  My view is the level of fraud is so low that it a rounding error in terms of the solvency of the system.

     *Mr. Marchant.  Setting fraud aside, what about the increased number of cases, with the 1.8% total payroll deduction.  Are there statistics out there that say the 1.8% raises this much money, and this much money is coming out of the system?

     *Mr. Astrue.  That is a good question.  Something that should give you confidence in the integrity of the system, with the recession related claims, which economists and others would say typically would not meet our standards, if the system has integrity, then the allowance rates should drop.

     Our allowance rates have dropped during the recession, both at the DDSs and even more dramatically at the hearings and appeals level, because we are seeing more claims that are not meritorious.

     The increase in claims is not a result of any significant change that we have made or that you have made.

     Eighty to 90 percent of the change probably, and we will supply more information to you about the record, is entirely predictable, has been predictable for decades.

     It is what the Office of the Actuary has been telling the Congress would happen because people basically, with my profile, aging baby boomers, are in their disability prone years.

     The amount of disability allowances we are seeing are relatively close to what the Agency, CBO and other experts have been predicting for a long time.
     [The insert follows, The Honorable Michael J. Astrue]

     *Mr. Marchant.  Thank you, Mr. Chairman.

     *Chairman Johnson.  Thank you, Mr. Marchant.  Mr. Smith?

     *Mr. Smith.  Thank you, Mr. Chairman.  Thank you, Commissioner Astrue, for coming here today and certainly for your service.

     *Mr. Astrue.  Thank you.

     *Mr. Smith.  I appreciate the Social Security Administration’s efforts obviously to expedite cases through the quick disability determination process.  Obviously, I believe it is important we find ways to move the easily decided cases through the system more quickly.

     Can you speak to the safeguards that you might have in place to ensure that the system still cannot be gamed perhaps amidst the fast track that we know probably needs to exist?

     *Mr. Astrue.  That is a very fine question.  None of this happens on automatic pilot.  As fast as this is, there is still a full medical review.  Not necessarily a full vocational review, if it is not necessary, for instance, for a compassionate allowance.

     For QDD cases, there is still a medical/vocational analysis.  It is just put up at the top of the Q.

     We confirm all these medical analyses.  We do not take the representation of the claimant as definitive.

     I think it is a system with a lot of integrity.

     The other aspect to integrity that I think is important, it is not statutory, not regulatory, but something that I think you should know about and be concerned about for the future, is again, at a management level, we have set the threshold for the QDT cases, 95 percent probability or more of allowance.

     There has been occasional internal and external pressure to lower that.  What I would tell you is if you lower that, you start damaging the integrity of the system.

     It might look good in the short run, but I think you start damaging something that works really well, and I think the discipline of making sure that only the most likely cases are compassionate allowances or QDTs is an important one, but by doing it the right way, we are up to almost six percent, I think, of the cases decided in that way.  I think by the end of next year, we will probably be at seven percent.

     It will start flattening.  There is a natural end to it.  I think if you water down the system, you start damaging something that is really important for disabled people.

     I hope in the future you will protect the integrity of the system and ask the Agency in the future to maintain that 95 percent threshold.

     *Mr. Smith.  Thank you.  Shifting gears a little bit, in terms of the hearings’ backlog, you committed to eliminate the backlog and reduce the average time it takes, and there has been some progress made obviously.

     The productivity by ALJs has increased, the backlogs have been reduced, and waiting times for the hearing decision are down from over 500 days in 2008 to 345 days in 2011.  Some progress.

     Conditions sometimes change perhaps, but in the 2013 budget request, I know hearings pending and hearing wait times will continue to decline, looking at that request, and yet the workloads pending and wait times will increase.

     Social Security has always worked to make the right decisions as soon in the process as possible.

     Can you speak to that and how the budget request reflects the numbers?

     *Mr. Astrue.  Sure.  You know, at some point as much as we have tried to lay out a plan for what we can do, it is contingent on a couple of things.

     It is contingent on adequate funding from the Congress.  It is contingent on an adequate supply of judges supplied by the Office of Personnel Management.  Those are the two key variables.

     At some point, as the budget gets tighter, we are going to have to make hard choices about whether we back off from the goal that we set for ourselves, and I think that is on the table for next year.  I hope not.

     My view is we have done, I think, a much better job than I think most Members of Congress expected five years ago when we started this process.

     If you had said to me at the time, Commissioner, can you do this, oh, and by the way, you are going to have the worst recession since the Great Depression, and you are going to have budget cuts for two straight years, are you still going to be able to do this, my answer would have been no, Congressman, I cannot do it.

     We are here.  We have made great progress.

     The question of whether we can get from approximately 345 days to 270 days in the next year and a half will turn a lot on the funding situation.

     When I was General Counsel of HHS, I had in my closet a cartoon wall.  My favorite was a lawyer looking at a client.  He looked at the client and said, “Well, how much justice can you afford?”

     That is basically where you are.  If you want justice, if you want 270 days, then you can get that, but you have to support the budget to get there.

     *Mr. Smith.  Okay.  Thank you, Mr. Chairman.

     *Chairman Johnson.  The time of the gentleman has expired. Mr. Tiberi is recognized.

     *Mr. Tiberi.  Thank you, Chairman.  Thank you, Commissioner, for your service.  Thank you for being here.

     I want to make just a couple of points and then ask a question.  One of the best things that Social Security has ever done is provide those of us who pay into Social Security, and yes, congressmen pay into Social Security, even though there is a long‑standing myth that we do not, when I get my statement, and I got my statement last summer, the notice that says I am going to get this much money based upon quarters that I have put in, and what I have paid in, but then a little asterisk that says “If nothing is done by the time you are scheduled to turn 67,” it does not say 67, but by the time you are ready to retire at full retirement age, “you will only get 77 percent of your benefit.”

     I think that is great.  I think that illustrates that there is a problem with the future of funding Social Security, not just for me, but for my four daughters, if we do nothing.

     I think that is a great service, and I would hope you would highlight that better, and obviously we are here talking about the disability fund, which according to the  Congressional Budget Office, is in worse shape than the retirement fund.

     In my office, I had a case worker who has been doing Social Security long before I got elected to Congress, who was working for my predecessor.

     He says anecdotally that he can count on three out of every four constituents who come in to our office to seek help will ultimately get denied initially, and then will go to an appeal.  A majority of those anecdotally in our office who go through the appeal process will ultimately get awarded.

     In relation to that context that I just gave you, when you have numbers that have been provided to us that it takes about $1,050 to process a DDS claim on average initially up front, so it is a little over $1,000, that claim is processed in a little over 100 days, through our office at least, most of those are denied initially.

     Then they go to an appeal.  That appeal through a judge costs about three times as much, three times as long.

     In view of those numbers, and those are national numbers, in addition to what we see in our office in terms of the time frame, is there an inconsistency in this process?

     Do we need to look at what the DDSs are doing versus the appellate process to make that system maybe more efficient?  Are they not trained the same?

     Is there some sort of breakdown between the initial process and the appeal process?  Can we streamline this process to make it more cost effective, more timely?

     *Mr. Astrue.  I am tempted to answer yes to most of those questions, but let me say this.

     Different iterations of that question we have been dealing with for a long time.  I do think we have made some significant progress.

     Compared to five years ago, quality in the DDSs is up substantially.  We have additional quality initiatives or quality related initiatives in the pipeline.

     The most important one is that we are moving from a fragmented, antiquated 54 siloed IT system to a state‑of‑the‑art unified system that builds in the best practices that we know work.

     The most important one is something called eCAT, which uses basic artificial intelligence techniques to prompt examiners with everything they need to know when something comes up relevant, if multiple sclerosis comes up or rheumatoid arthritis comes up, whatever, it tells them everything they need to know.

     In fact, it requires for quality reasons documentation of certain things if our rules require it, in essence, to prevent examiners from taking shortcuts.

     The quality is getting better in the DDSs, and I think they have gone a great job.

     It is also helping the fast track that Mr. Berg and others have mentioned, it has been a big help in terms of quality.

     When I came in and there was some resistance to doing the compassionate allowances, we did a retrospective study, and we found that on the things that were on my list, our error rate, which at that point was about six percent in the DDSs, it is probably about 20 to 40 percent, and most of them were closer to 40 percent.

     Picking out those rare things and giving precise guidance, those things help.

     By definition, you are going to see the close cases.  Ohio may be a little worse than some other states.  Ohio is one of the states that did a lot of furloughs.  That damaged morale, increased turnover, aggravated backlogs, meant more acrobatics in terms of staffing and higher costs to get things done.

     It may be a little worse in Ohio at the DDS because of that.  I think it is moving in the right direction now.

     One of the things you should be real happy about, one of the real success stories, is five years ago, Columbus was probably one of the sixth worse hearing offices in terms of backlog in the country, made enormous progress, about 500 days off the wait time.

     You should particularly go and thank the new Chief Judge over there, Judge Allen.  This is one of those cases where one person with backbone and management talent has made an enormous difference.

     *Mr. Tiberi.  Great point.  I appreciate that.  You are right about that.

     The only thing that is depressing for me is when my case worker has to tell people up front that you know what, you are probably going to get denied when you initially apply because that is what usually happens.  That is kind of unfortunate.

     *Mr. Astrue.  Statistically, it is about one in three.  I know it feels differently, I think because you do not get a representative sample ‑‑

     *Mr. Tiberi.  That is probably true.

     *Mr. Astrue.  In hearing offices.  It is about one in three at the DDSs, and right now, the allowance rate is about 50/50, it is about 51 percent are allowed on appeal.

     Again, some of that is rational.  People who are severely ill, that is not a static situation, particularly if the time lines stretch out, their situation changes.

     The obligation of our people on the way is not to decide whether the previous decision was right, but to look at it fresh and new.

     It is not necessarily inconsistent.  Sometimes it is.

     *Mr. Tiberi.  Thank you.

     *Mr. Astrue.  It is not necessarily inconsistent when an ALJ comes to a different decision from an examiner.

     *Chairman Johnson.  The gentleman’s time has expired.  Mr. Becerra, you are recognized for 30 seconds.

     *Mr. Becerra.  Thank you, Mr. Chairman.  By the way, Commissioner, thank you very much for your visit to Los Angeles and the offices that we have there in Los Angeles, and the work you are doing with them.

     Just a quick point, maybe we can follow up because we need to move on.  I know you have instituted a new policy that will withhold the names of the administrative law judge to Americans who are filing their claims or to their representatives, as they try to move through the appeal process.  I know there is some concern as to whether or not some folks are trying to judge shop who will conduct the hearing for that appeal.

     I think it may have been overly broad in its approach in targeting both in-person and video hearings.  It sounds to me like the concern with judge shopping may be more related to video hearings than the in-person hearings.

     I am hoping that maybe we can talk further.  I do not think that what we want to do is end up with more errors in the decision making, and a more arduous process for folks who do not have a lot of money.

     I know what we want to do is make sure the appeals process works in the most efficient and adequate way forward, and perhaps we can talk about that.

     *Mr. Astrue.  Always happy.  You have my number, call any time.

     *Mr. Becerra.  Thank you so much.  Thank you, Mr. Chairman.

     *Chairman Johnson.  Commissioner, thank you for being here.  You are doing a great job.

     *Mr. Astrue.  Thank you.  I appreciate all the support from members of this committee.  It does make a huge difference for us in a lot of big and small ways.  Thank you for what you do as well.

     *Chairman Johnson.  Thank you.  We will now proceed to our second panel.  You will be excused.  Thank you, sir.

     Our witnesses that are taking their seats at the table are Trudy Lyon‑Hart, Director, Office of Disability Determination Services, Vermont Agency of Human Services, on behalf of the National Council of Disability Determination Directors.

     Lisa Ekman, Senior Policy Advisor, Health & Disability Advocates, on behalf of the Consortium for Citizens with Disabilities Social Security Task Force.

     Dan Bertoni, Director, Education, Workforce and Income Security Issues, U.S. Government Accountability Office.

     Dr. Leighton Chan, Chief, Rehabilitation Medicine Department at the National Institutes of Health.

     Dr. Nicole Maestas, Senior Economist, RAND Corporation, all the way from Santa Monica, California.

     Ms. Lyon‑Hart, welcome.  Please go ahead.  You are recognized.


     *Ms. Lyon‑Hart.  Chairman Johnson, Ranking Member Becerra, and members of the Subcommittee, I am Trudy Lyon‑Hart, President‑Elect of the National Council of Disability Determination Directors, NCDDD, and Director of the Vermont Disability Determination Services.

     Thank you for this opportunity to testify on behalf of the administrators of the Disability Determination Services, the DDSs, of the states and the District of Columbia.

     Collectively, we direct the work of over 14,000 employees, processing nearly 4.8 million disability cases a year, including initial claims, reconsiderations, and continuing disability reviews, CDRs.

     DDSs make determinations with high accuracy, ensuring that over a million deserving disability applicants get benefits quickly each year.

     In any given year, over 70 percent of the allowance determinations in the disability program are made at the DDS level, with no need for an administrative law judge hearing.

     DDS accuracy, speed and volume are notable considering the program’s complexity.  Adjudicators must obtain health care records and detailed descriptions of daily activities and work history, arrange for consultative exams if needed, analyze reams of electronic evidence, in the process evaluating symptoms, weighing different medical opinions, assessing medical severity, and determining individuals’ remaining work capacity.

     Social Security and the DDSs have historically worked together to provide the American public with prompt, accurate and cost effective service.

     However, our ability to continue to do so is now increasingly threatened.  Funding in the Fiscal Year 2012 budget will not cover all the cases the DDSs will receive.

     The deeper cuts scheduled to occur in 2013, as part of the Budget Control Act, will dramatically worsen the situation.

     In early Fiscal Year 2011, SSA imposed a hiring freeze extending even to replacement hiring.  Since then, the DDSs have lost over 2,000 employees.  Three‑quarters were examiner losses, a lost capacity of over 900,000 case determinations a year.

     Already many thousands of cases are delayed in growing DDS backlogs.

     Recently, with release of the Fiscal Year 2012 budget, SSA authorized 200 DDS hire’s nationally.  These hire’s, while appreciated, are a drop in the bucket.

     With the DDS situation so fragile, further increase in our medical CDR workload is a concern.  We would need both additional funding and advance hiring.

     Our pipeline of disability examiner trainees has been empty for a year and a half, and examiners are not quickly replaceable.  It takes a minimum of several years of training and mentoring before they have the knowledge and skills to handle all cases, especially CDRs.

     For as long as they can, the DDSs will continue to keep cases moving and meet workload targets.  DDS staff are highly skilled and extremely elastic.

     In the short term, we have shifted some support resources to case processing, but this is not sustainable.

     With insufficient funding for the incoming cases, continued attrition, and only minimal replacement hiring, the DDSs will reach a tipping point with backlogs and case delays.

     Policy changes would make the process more efficient.  NCDDD continues to recommend consistent application of policy across the nation and across all appeal levels.

     Our written testimony includes recommendations in such areas as policy simplification, enhancement of technology tools, expansion of the medical listings, expansion of single decision maker authority, and reinstatement of the reconsideration in the ten prototype states.

     Last year alone, the DDSs allowed over 92,000 claimants at the reconsideration step, an invaluable service.

     SSA and the DDSs have a long history of accomplishment working together to provide high quality service and careful program stewardship.

     This relationship has never been more important.  Collaborative strategy is crucial if we are to find ways to continue the service on which the American public relies.

     Policy changes and technology tools can further improve program efficiency and consistency, but the foundation must be adequate funding and highly trained staff.

     On behalf of NCDDD, thank you again for the opportunity to provide this testimony, and I would be happy to answer any questions you have.

     [The information follows, Ms. Lyon‑Hart]

     *Chairman Johnson.  Thank you, ma’am.

     Ms. Ekman, welcome.  Please proceed.


     *Ms. Ekman.  Thank you.  Chairman Johnson, Ranking Member Becerra, and members of the Subcommittee, thank you for this opportunity to testify at this very important hearing.

     My name is Lisa Ekman.  I am a Senior Policy Advisor for Health & Disability Advocates.  I testify today on behalf of the Consortium for Citizens With Disabilities Social Security Task Force.

     The Social Security Disability Insurance or SSDI Program, provides vital economic security and access to health care for individuals whose impairments are so severe that they preclude work.

     The importance of SSDI to people with disabilities cannot be overstated.  I would like to begin by sharing the stories of two SSDI beneficiaries with you, and tell you a little about the difference of SSDI being in their lives.

     First, there is the story of Angelice P.  Angelice was diagnosed with Type I Diabetes as a teenager.  She went to college and she worked for many years.

     Two years ago, when she was 36, she had to be hospitalized for diabetes related complications.  Angelice spent a long time in the hospital, due in part to the fact that she continued to work when she should have stopped because it was aggravating her diabetes.

     As a last resort, Angelice applied for benefits while she was in the hospital.  Due to the severity of Angelice’s diabetes, she was approved for SSDI benefits.

     Angelice came very close to becoming homeless when she could not work due to her diabetes.  Fortunately, she was able to keep her apartment but only because a charity helped support her and pay her rent.

     She received a quick decision regarding her eligibility and because of SSDI, she was able to keep her home.

     Angelice receives just around the average SSDI benefit of just over $1,000 per month.  Her rent is $550.  Her SSDI allows her to live in her home, but she squeaks by.  Without SSDI, she would be homeless.

     It is with sadness that I tell you that last night, Angelice passed away due to diabetes complications, but in the two years that she received SSDI, it made a tremendous difference in her life.

     There is also the story of Henry H.  Henry is in his 60s and has severe cardiac problems.  He was working in the insurance industry for a long time, but was not able to keep his job due to his heart condition.

     Henry spent all of his savings and cashed out his 401(k) before he applied for SSDI benefits.

     When he filed his application as a last resort, he was homeless and living in his car.  He lived there for about a year.

     Once his SSDI benefits were approved, Henry was able to secure housing again and has not been homeless since.

     Given the importance of SSDI to people with disabilities, like Angelice and Henry, I want to highlight three key points.

     First, providing the Social Security Administration or SSA with an adequate administrative budget is essential to accurate and timely initial processing of SSDI claims.

     Second, the current definition of “disability” and structure of the SSDI program are appropriate and should not be changed.

     Third, SSA does a good job of administering the program, but improvements could be made.

     First, as has been discussed quite a bit during the Commissioner’s testimony, SSA requires an adequate administrative budget to effectively administer the SSDI program and complete initial disability determinations in an accurate and timely manner.

     We were pleased to see the progress SSA was able to make during Fiscal Years 2008 and 2010 in reducing the time for people with disabilities to receive their disability determinations.

     Unfortunately, as discussed, SSA has received no increase, although debate whether there was a decrease, no increase in their funding since 2010, and we are likely to see an increase in the processing time for initial disability applications because the funding, as discussed, is completely inadequate to keep up with SSA’s workload.

     Second, because the intent of the SSDI program is wage replacement and to provide income support for individuals who do not have the capacity to engage in substantial gainful work, the current definition of “disability” is appropriate.

     The definition is strict, providing benefits only to individuals with the most significant impairments.

     However, keep in mind that just because an individual has an impairment, it does not mean they will be eligible for benefits.  Neither Angelice nor Henry would have been eligible for benefits if their impairments were less severe and did not prevent them from working.

     Third and finally, both SSA and the state disability determination services do a good job of administering the SSDI program, especially given the resources they have available.

     However, we encourage SSA to make some modest changes to ensure that medical evidence is fully developed early in the process so that unnecessary delay and unnecessary and costly appeals can be avoided.

     Such modest changes include providing more assistance to claimants earlier in the process, providing better guidance to doctors and other professionals regarding what evidence SSA is looking for, and by providing additional and improved training to disability evaluators.

     Our written testimony contains additional recommendations.

     Thank you for the opportunity to testify, and I look forward to answering any questions you might have.

    [The information follows, Ms. Ekman]

     *Chairman Johnson.  Thank you, ma’am.

     Dan Bertoni, welcome back.

     *Mr. Bertoni.  Thank you.

     *Chairman Johnson.  You are recognized.


      *Mr. Bertoni.  Mr. Chairman, Ranking Member Becerra, members of the Subcommittee, good morning.

     I am pleased to discuss our preliminary findings on the Social Security Administration’s efforts to modernize its disability criteria.

     Last year, SSA paid nearly $170 billion to about 12 million beneficiaries and independents, and given the size and cost of its programs, the Agency needs current criteria to assess whether an applicant’s medical condition affects his or her ability to work.

     In 2003, we designated SSA’s disability programs high risk, in part, because its criteria for determining medical eligibility did not reflect advances in medicine and technology, and its occupational information did not reflect changes in the labor market.

     My statement today addresses SSA’s most recent efforts to update its medical listings and develop its own occupational information system, to better reflect the existence of jobs in the national economy.

     In summary, the Agency has made several changes to improve the timeliness and effectiveness of its medical listings updates, such as adopting a two tier system that first includes a comprehensive review of all disorders in a body system and making appropriate revisions; then, on an ongoing basis, conducting subsequent targeted reviews of that body system, focusing only on a limited number of conditions.

     To date, the Agency has completed comprehensive reviews for eight of 14 body systems, and has moved to the targeted phase.

     In 2010, they also established a five year cycle time for updating its listings to ensure more systematic consideration of advances in the treatment and evaluation of conditions.

     The Agency also contracted with the Institute of Medicine, and has acted on several of their recommendations, such as creating a standing committee to review and provide advice on the listings.

     However, SSA still faces challenges keeping its listings up to date, and has yet to complete comprehensive revisions for six body systems, which in many cases, have been ongoing for decades.

     Moreover, despite multiple extensions, four body systems will expire in 2012, and it is uncertain whether SSA will complete the required reviews.

     The Agency has also experienced delays with its targeted reviews, and slippage in its plans to conduct post‑implementation evaluations of previously revised listings.

     SSA has noted that challenges in this area are mainly due to limitations in the number and expertise of staff needed to update the listings, and complexity of the regulatory process.

     As you know, the Agency has begun an ambitious project to develop its own occupational inventory database by 2016, which will replace an outdated system it currently uses.

     In 2008, SSA took steps to guide the development of this occupational information system or OIS, to capture both the physical and mental demands of work to better support its disability decisions.

     Accordingly, SSA established an advisory panel of external experts tasked with making recommendations on developing a system, and held initial meetings with outside experts and other agencies that collect occupational information to gain insight into sampling methods and other challenges.

     Last year, the Agency issued a research and development plan detailing activities necessary to complete this phase by 2016, at a cost of $108 million.

     To date, they have made progress on several fronts, including using its own administrative data to identify the most frequently cited occupations and functional and vocational characteristics of its applicants.

     However, due to staffing constraints, several planned initiatives have slipped, and officials know that further time line adjustments are likely.

     To offset this challenge, SSA has used consultants with specialized expertise and is working with OPM to obtain additional staff skilled in industrial organizational psychology on a part time basis.

     Finally, in the course of our work, we have identified some gaps in SSA’s approach, such as insufficient documentation supporting SSA’s research and development cost estimate, and the absence of any information on total cost of the project over time.

     We will continue to pursue these and other issues as our work progresses, including how SSA is managing the OIS against best practices, and ensuring that the project schedule reliably estimates key activities and length of time they will take.

     Finally, we plan to review any risk analyses conducted by the Agency, as well as mitigation plans to address identified risks, including how this complex project will proceed should funding be reduced.

     Mr. Chairman, this concludes my statement.  I am happy to answer any questions you or other members of the Subcommittee may have.  Thank you.

     [The information follows, Mr. Bertoni]

     *Chairman Johnson.  Thank you, sir.

     Dr. Chan, you are recognized, sir.


     *Dr. Chan.  Chairman Johnson, Ranking Member Becerra, and members of the Subcommittee, I am honored to have the opportunity to appear before you today to testify about NIH’s collaboration with the SSA.

     The SSA approached NIH in late 2007 for advice on new assessment methods that might inform their disability evaluation process.  The NIH Clinical Center’s Rehab Medicine Department agreed to help, and based our work on widely adopted contemporary disability concepts.

     Our collaboration has been facilitated by an interagency agreement that was initiated in February 2008.  I want to note this area we are talking about today is just one of many factors that SSA takes into account in their statutory role to ensure that the Agency’s disability evaluation standards reflect appropriate medical and vocational information.

     Currently, the SSA disability determination process is linked to a claimant’s diagnosis or their impairment.  However, a diagnosis or impairment may no longer be so closely connected to an individual’s ability to work, as it has been in past years.

     The concept of disability has evolved over the last few decades, and this evolution has now culminated in an international agreement.

     In 2001, the World Health Organization adopted a landmark standard called the “International Classification of Functioning Disability and Health,” or the ICF.

     The ICF has been endorsed by all 191 WHO members, including the United States.

     The ICF considers disability to be the result of not only a person’s diagnosis but also two other very important factors, the impact that diagnosis has on their ability to function and the environmental demands placed on them in their workplace.

     It is this ICF theoretical construct that really informs our collaboration with SSA.

     Our work with the SSA has several components.  One of the most important projects is the direct attempt to create a rapid, reliable, and objective functional assessment tool that SSA could use one day in real time.

     To do this, we have engaged colleagues at Boston University to help us develop a series of computerized functional assessments that utilize something called “Item Response Theory and Computer Adaptive Testing” or IRT/CAT.

     The scientific evidence validating IRT/CAT instruments has been available for decades.  If you have recently taken the SAT or GRE or LSAT, you have taken an IRT/CAT test.

     The theory is really quite simple.  If you want to assess an individual’s capabilities regarding a single characteristic, let’s say their ability to lift 300 pounds, and you need to know that in one pound increments, well, you could ask 300 separate questions.  That would give you a very precise estimate, but it would take some time.

     Item response theory utilizes information gathered in prior questions to determine what questions should come next.

     For instance, you might ask that same individual can you lift 50 pounds.  If the answer to that question is yes, the next question might be can you lift 100 pounds.  If the answer to that is no, the next question might be can you lift 75 pounds, and so on.

     By asking five or six questions rather than 300, you can determine how much that person thinks they can lift.

     IRT/CAT tests have a significant advantage to the SSA, in addition to administering them to claimants, the SSA might also apply these same tests to clinicians to obtain their functional assessment of the claimant.  This information could add an important perspective to a person’s disability claim.

     Our team is currently in the process of creating two initial IRT/CAT instruments.  They will assess a claimant’s interpersonal interaction skills and their mobility.

     These two topics were selected because of the high relevance they have to SSA’s current applicant pool.

     For these topics, assessment questions have been developed and the calibration tests are being completed.  We will calibrate the tests not only to SSA claimants but also to the population as a whole, after which we will put together the IRT/CAT instruments themselves.

     An RFP or Request for Proposal is currently posted for the development of four additional IRT/CAT instruments that will cover all the remaining topics in the ICF related to work disability.  These topics will likely include self care, communication, learning and applying knowledge, and general tasks and demands.

     We hope to have much of the initial work for all six IRT/CAT instruments completed by 2016.

     Mr. Chairman, this completes my prepared remarks.  Once again, thank you for the opportunity to testify today and provide an overview of our work with the SSA.  I will be happy to answer any questions.

    [The information follows, Dr. Chan]

     *Chairman Johnson.  Thank you, sir.

     Dr. Maestas, welcome.  Please go ahead.


     *Dr. Maestas.  Thank you, Chairman Johnson and Ranking Member Becerra, for this opportunity to testify.

     I will address my comments to the question of consistency in the initial disability determination process drawing on recent RAND research.

     DDS case examiners are called on to evaluate and weigh many aspects of complex cases against extensive medical and vocational criteria in a dynamic medical environment.

     They have heavy caseloads, and although they may consult with physicians, they are not themselves trained physicians.  Moreover, as the SSDI caseload has grown, the composition of applications has shifted toward impairments with greater diagnostic uncertainty.

     Chief among these are musculoskeletal and mental impairments, which now comprise 59 percent of all applications.

     Given these factors, some variation in decision outcomes across DDS examiners is expected.  Nonetheless, it is worth trying to minimize the extent of variation as much as possible.

     In our analysis of initial disability determinations recorded in SSA’s disability operational data store in 2005 and 2006, we find a notable degree of variation in initial outcomes across DDS examiners within the same office.

     This variation cannot be explained by differences in the mix of cases they evaluate.  We find that after adjustments for case mix, one‑third of examiners have allowance rates more than six percentage points above or below the average allowance rate in their DDS, and as many as five percent of examiners have allowance rates more than 12 percentage points above or below the average.

     As a result, for many applicants, whether they are allowed or denied benefits depends upon the examiner to which their case is assigned.

     While most examiners have initial allowance rates near the average for their DDS office, some do not.  This means that most applicants would receive the same initial determination if their application had been assigned to a different examiner in the DDS office, but even so, due to the examiners who are not near the average, we estimate that as many as 60 percent of applicants could have received a different initial determination from at least one other examiner in the DDS office, had they been assigned to that examiner instead.

     The magnitude of this measure is driven by the examiners who have the lowest and highest allowance rates in a DDS office.

     For example, if we remove from our calculations the top and bottom one percent of DDS examiners, those with the highest and lowest allowance rates, then the percent of applicants whose initial decision depends on the examiner they are assigned to would fall by half, from 60 percent to 28 percent.

     As you would expect, the appeals process significantly dampens the effect of examiner variation.  In our administrative data, nearly two‑thirds of all initial denials are appealed and 75 percent of these are eventually overturned.

     Once we account for appeals, we estimate that only 23 percent of applications could have received a different ultimate outcome, that is accounting for appeals, had they been assigned to a different examiner, and if we again remove the highest and lowest examiners in an office, this number falls to 11 percent.

     These figures illustrate two points.  First, although most examiners have allowance rates that are near the average for their DDS office, many have allowance rates that are notably below or above their office average even after adjusting for differences in case mix.

     Because an applicant could potentially be assigned to one of these examiners, applicants face significant uncertainty as to whether their application will be initially allowed or denied.

     Improving consistency across examiners would significantly reduce this uncertainty about initial outcomes.

     Second, it bears emphasizing that these statistics are not estimates of the fraction of applicants who should have been denied.  Rather, they identify the size and characteristics of the group that would be most affected by changes in the policies and procedures used in initial disability determinations.

     This group disproportionately includes younger claimants, claimants with very low earnings histories, and claimants with mental impairments.

     At present, the variation in examiner allowance rates and the high probability of having an initial denial overturned on appeal means it is usually worthwhile for denied applicants and their attorneys to pursue appeals.

     The appeals process, as you know, is costly.  From the time the initial DDS application is filed to the time a final determination is made, an applicant may not earn more than $1,000 a month in paid employment since this would exceed the SGA threshold and result in denial of benefits.

     In our administrative sample of SSDI applicants who received decisions, initial decisions, in 2005, the average time from SSDI application to final determination exceeded one year.

     While those who did not appeal waited an average of only four months, those who did appeal waited an average of two years before receiving a final determination.  That is after exhausting all appeals.

     Time spent out of the labor force while seeking benefits may have detrimental effects on employability.  Indeed, we find that longer application processing times reduce the employment of SSDI applicants in the years after their initial decision.

     Our calculations suggest that the SSDI determination process itself reduces the post‑application employment of denied applicants by an average of 3.6 percentage points in years two and three after the initial determination, and similarly, reduces the average employment of allowed applicants by five percentage points.

     In sum, by reducing the variation in initial determinations, we would improve the targeting of the SSDI program.  That is we would increase the chances that people who truly qualify receive benefits and reduce the chances that those who do not truly qualify receive benefits.

     To the extent the decision thresholds could be better aligned between the initial and appellate phases, the share of those initially denied applicants who decide to appeal would likely decline, and the detrimental effects on future employment potential would be reduced.

     Thank you.

    [The information follows, Dr. Maestas]

     *Chairman Johnson.  Thank you, ma’am.  Did you listen to Dr. Chan?  Did you agree?

     * Dr. Maestas.  I did.  I was actually quite excited by what I was hearing.

     *Chairman Johnson.  Dr. Chan, you testified about the collaboration between Social Security and the National Institute of Health and Boston University to develop your computer tests.

     Are you saying by taking a test, Social Security can credibly assess a claimant’s ability to function in a matter of minutes?

     *Dr. Chan.  I think the techniques and the procedures behind IRT/CAT instruments are well validated.  They have been utilized in educational arenas for quite some time.  We have been using them in health care for quite some time.

     They are remarkably powerful and insightful tools that can be done very, very quickly, particularly in the area of functional assessment.

     *Chairman Johnson.  Can people fake them?

     *Dr. Chan.  Well, you know, our job really was to look at functional assessment, to determine a technique for functional assessment.  Clearly, there is no functional assessment tool that would be completely immune to gaming.

     On the other hand, there are, I think, several aspects to IRT/CAT that are really beneficial in this area.

     The first would be that the IRT/CAT instruments themselves are comprised of dozens if not hundreds of questions that would be very difficult to memorize, and indeed, very difficult to figure out the order those questions might come in.

     Second, we could also give the same assessment tools to the claimant’s clinicians, and that would provide very interesting information, and I think useful for SSA in validating certain things.

     In addition, we would be applying these tests to millions of individuals, so we would probably have some really wonderful baseline data looking at what a normal response pattern would be, so individuals who have aberrant response patterns potentially could be identified.

     *Chairman Johnson.  It just takes one person to do the test?

     *Dr. Chan.  Yes.  Mostly, it would be claimants who would be doing the tests, but for those individuals ‑‑

     *Chairman Johnson.  I understand that.  The person administering the test.

     *Dr. Chan.  Oh, on the testing side.  In general, these are computer administered tests.

     *Chairman Johnson.  One person can do them?

     *Dr. Chan.  Yes, a person could do it by himself, if that is what you are asking.

     *Chairman Johnson.  Do they have to be trained?

     *Dr. Chan.  We sort of tailor these tests so they are at a relatively low and easy level.  Obviously, we need to do that so that a broad range of individuals ‑‑

     *Chairman Johnson.  That is the kind of test we need up here.


     *Chairman Johnson.  Do you agree with that, Doctor?

     *Dr. Maestas.  I think this sounds quite promising.

     *Chairman Johnson.  Thank you.  Mr. Becerra, you are recognized.

     *Mr. Becerra.  Thank you, Mr. Chairman.  I cannot get quite as excited on the numbers, but it sounds like the two of you put a great deal of numbers in, and I am glad it raises your blood pressure a bit to see we might have some opportunities.

     I do think as you say, quite promising, Dr. Maestas, that we might have other ways to try to validate the process.

     What I take from what every one of you have said is this ain’t easy to do.  In many cases, you are making judgments because you are looking at folks who are maybe right on the edge, could they work, and not just in their current occupation, but in some capacity whatsoever, and it is sometimes not an easy call to make.

     What we are trying to do is make the system as efficient and standardized as possible, so that way when folks have to make the decision, they are not guessing.  They should be collecting the information as early as possible to try to help these determiners, those who make the determinations, to have all the information and evidence they need.

     Certainly, we have to make sure that we continue to push the SSA to have the tools in place that let them effectively make those judgments.  We are talking life and death, as I think Ms. Ekman made clear, in most cases.

     I am troubled that what we are hearing is SSA is having to try to do all of this with less and less money.

     Ms. Lyon‑Hart, you mentioned SSA is already struggling.  You have already seen a number of these folks who make determinations gone.

     Have you been losing folks with little experience or lots of experience?

     *Ms. Lyon‑Hart.  It is a mix.  Just as the baby boomers are getting more disabled, they are also leaving our offices.  I would say it is probably heavy on the ‑‑ I do not know the exact numbers, I can get them for you probably with some polling of my members, but what I hear is they are losing experienced examiners.

     *Mr. Becerra.  It is not as if when you do a hire, you automatically compensate for the loss of that seasoned examiner.

     *Ms. Lyon‑Hart.  Correct.

     *Mr. Becerra.  This worries me because we were making progress.  We were getting the wait time down, the backlog down.

     I believe, Ms. Lyon‑Hart, you also mentioned that the longer a case sits, the greater the chance we are going to make some mistakes with it, or it is going to become more difficult to adjudicate.

     *Ms. Lyon‑Hart.  It was not me that testified we would make more mistakes, but it definitely takes longer.  You end up refreshing the medical evidence and getting more information.  It becomes more complicated the longer it sits.

     *Mr. Becerra.  What I take from everything you are saying is that we have to continue to find the tools to let us make these assessments, to try to avoid the outlier decisions, whether in denial or granting the benefits, so that we have more consistency, but at the same time, do not tie the Social Security Administration’s hands behind its back as it is trying to move forward with an increasing caseload of individuals who are filing for claims.

     We want to make sure that those who deserve it get it, and at the same time, we want to make sure that those who do not deserve it do not clog the system for those who are waiting to get the benefits they have earned.

     Ms. Ekman, you brought up some real cases.  I think it is important to know that we are talking about real people who are affected, who paid into the system, who are now applying for those benefits that they worked to have.

     What is your sense out there in the community of folks who are on the verge of securing these disability benefits or believing they may be on the verge of having to apply for these disability benefits?

     Is there some concern about where we may head in the future?

     *Ms. Ekman.  Thank you for the question, Congressman Becerra.  I am not sure for the people who are going to be applying for benefits, that is a concern.  They are concerned about how do I pay my rent, how do I get my medication.

     *Mr. Becerra.  Good point.

     *Ms. Ekman.  I think for advocates, there is a huge concern that the longer the Social Security Administration and the state DDSs remain under funded, the worse the conditions will get.  The longer people will have to wait.

     It is not an overstatement to say that people die while they are waiting for a disability determination.

     There is definitely a sense that we need to provide adequate resources to SSA and the DDSs to ensure that they can make accurate and timely decisions so that people who desperately need the benefits can get them.

     *Mr. Becerra.  One final question.  I know the Social Security Administration in an effort to try to concentrate the resources it has on those services that are most important had to make other decisions which are tough.

     They are closing offices at earlier hours.  They are less able to respond to people who are applying for retirement benefits so they can deal with those seeking disability benefits.

     Ms. Lyon‑Hart, do you think at some point it is going to become very obvious to the average American who is getting ready to apply for his or her Social Security benefits that there is a problem with Social Security because its budget is being so short changed?

     *Ms. Lyon‑Hart.  I do think it will be obvious if it is not already.

     *Mr. Becerra.  Thank you.  I thank you all for your testimony.  I hope that research can produce some real results sooner than later so we can apply those.

     Mr. Chairman, I thank you for bringing these witnesses.

     *Chairman Johnson.  Thank you.  Mr. Berg, you are recognized.

     *Mr. Berg.  Thank you, Mr. Chairman.

     I just have one question.  Dr. Maestas, when someone is seeking disability insurance, it takes a long period of time.  There is a detrimental effect on their skills during this period, and their ability to be employed.

     My question is if you could tell us a little bit more about these findings in your research that looks at that, and also what is it we can do about that.

     *Dr. Maestas.  It has been known for some time that many SSDI recipients have some employment potential.  We are not talking about full time employment potential at the level of their pre‑disability earnings necessarily, but those effects are rather large.

     For example, we estimate that had many beneficiaries, and these are the relatively healthy of the disabled beneficiaries, had they not received benefits, their employment rate could increase by as much as 28 percentage points.

     Again, not the full time employment capacity.  If you look at annual earnings, it is an increase in annual earnings of about $3,700.

     For many people, this will not rise above the SGA threshold, although for many people, it would.

     What this new research is saying is in addition to these effects of benefit receipt on employment potential and employment capacity, there are additional effects coming from the process itself that keeps people waiting.

     We have been able to disentangle these two components to get an estimate of the decay in employability that arises with every month that somebody waits for a final decision.

     The problem is not the initial decisions, per se.  Those occur relatively quickly.  The problem is when someone gets a denial, and of course, most people do get a denial from the initial determination process, they go on to appeal.

     The appeals process takes them into this waiting game that goes on a very long time.  If they are denied at the ALJ level, many of them go on to pursue appeals at higher levels.

     It is well known in economics that as people stay out of the labor force, and of course, these people have to stay out of the labor force while they are pursuing an appeal because otherwise, they would be denied, employability declines.  Skills depreciate.  Employment networks erode.  Investments in the latest information and technologies are not made.

     *Mr. Berg.  What do we do about it?  What is the solution?

     *Dr. Maestas.  It is a hard problem, admittedly.  We have to shorten processing times.  We have to shorten waiting times.

     It is not only about ‑‑ the Administration has made good attempts in this area to actually shorten times by reducing backlogs and the like.

     Part of the problem, what I would like to draw attention to here, is that too many people perceive that an appeal is worthwhile.

     If we could better align the decision thresholds that are used in the initial phase and the appellate phase, then we would not have a system where everybody believes they need to appeal to get the right decision outcome.

     *Mr. Berg.  We tend to have an automatic appeal when there is a denial.

     *Dr. Maestas.  Exactly.

     *Mr. Berg.  Which extends that period, extends that cost.  Obviously, when someone is out of the workforce, it is hard for them to get back in, regardless of what the outcome is at the end of the appeal process.

     *Dr. Maestas.  The rules, of course, do require a five month waiting period.

     *Mr. Berg.  Thank you.  Thank you, Mr. Chairman.  I will yield back.

     *Chairman Johnson.  Thank you.  Mr. Marchant?

     *Mr. Marchant.  Thank you, Mr. Chairman.

     I have a couple of process questions.  We talked a lot today about baby boomers and they are entering the system as disabled beneficiaries.

     Once a person reaches the threshold of age 62 and they have the ability to go on early retirement, what is the process a person would go through once they have reached that threshold but they do not want to take early retirement, but then they apply for Social Security disability?

     Then they are denied initially, and then they are given a waiting period that might take them past the time whereby they would enter the system at age 65 in full retirement.

     How are you handling people that are entering with those kinds of problems?  I am not sure who to direct that question to, but perhaps somebody that has some every day experience.

     *Ms. Lyon‑Hart.  Actually, I am just going to speak up to say that I am probably not the person.  We really need to know from Social Security, because that kind of decision happens in the field office.

     I do know that you can have sort of a simultaneous early retirement and disability applications going at the same time, but I cannot tell you exactly how that works.

     Obviously, you would not double dip, but that kind of thing simultaneous applications does occur.  I would hesitate to answer the question.

     *Mr. Marchant.  If the person was 62 years old and they applied for total disability and the total disability benefit was $1,100 a month, and they were able to receive early Social Security benefits, they cannot receive Social Security retirement benefits and receive Social Security disability benefits as well.

     This whole perception of the system being weighted down and broken because of all the baby boomers that are entering the system because they are retiring and more and more of them are becoming disabled, there seems to be a point at which that would flatten out because they would either go into early retirement or into permanent retirement.  You would not be receiving both at the same time, would you?

     *Ms. Lyon‑Hart.  No, you would not receive both at the same time.  I misspoke.

     *Mr. Marchant.  Dr. Maestas?

     *Dr. Maestas.  I can speak to that a little bit.  They would not receive both at the same time, but of course, the early retirement benefit is an actuarially reduced benefit, and the disability benefit is not.

     They would receive a higher benefit if they are awarded disability benefits, and then at their full retirement age, they just convert into the regular retirement program, but maintaining that higher benefit level.

     *Mr. Marchant.  Are any of these things taken into consideration when the initial claim is made?  It would be a very small cost for a person to have a combination of partial disability benefit and an early retirement benefit, and why would someone wait one, two or three years and appeal their claim if they are going to reach the threshold of retirement anyway?

     Yes, ma’am?

     *Ms. Ekman.  Thank you, Congressman.  A person ‑‑ as Dr. Maestas said, if I am 62 and I go and apply for retirement benefits, I am going to receive a reduced benefit.  That will happen for as long as I receive benefits.

     As an individual, I am entitled to get disability benefits until I reach my full retirement age, which I would point out is now 66 for people who are retiring now, and will go up to 67.

     It is a big disadvantage to me in terms of my income if I applied for retirement at that point.

     In the SSA evaluation for disability, there is a piece that takes age into account, in the vocational guidelines.

     That is considered from that perspective when someone comes in and applies, but it is up to the individual to decide whether they want to apply for early retirement or disability, and if it is an individual who has a disability, it is in their best interest to apply for disability because their benefit will be at the higher level, as opposed to reduced for the remainder of their life.

     *Mr. Marchant.  Okay.  Thank you.  Thank you, Mr. Chairman.

     *Chairman Johnson.  You bet.  Mr. Becerra, do you have a clarification question?

     *Mr. Becerra.  Yes.  I just wanted to be sure.  Dr. Maestas, I think during some questioning by Mr. Berg, when you were talking about the appeals process, I think you may have mentioned there is an automatic appeal.

     There are not any automatic appeals, although a lot of claimants ultimately do file for appeal, but there is no automatic right to appeal a case to a higher level.

     I just wanted to clarify that.  That is the case; correct?

     *Dr. Maestas.  The appeals channel is open to everybody, but there is no automatic appeal.  They decide themselves whether or not to pursue an appeal.

     *Mr. Becerra.  Right.  In other words, it does not go to appeal immediately if the decision is against you.  You have to actually ‑‑

     *Dr. Maestas.  You have to initiate the appeal.

     *Mr. Becerra.  Correct.

     *Chairman Johnson.  Their lawyer decides.

     *Mr. Becerra.  Ms. Ekman?

     *Ms. Ekman.  If I could also just clarify, I do not have the exact number in front of me, but will be happy to get that to you, but a significant portion of people who are denied at the initial level choose not to continue on appeal.

     I think that is an important point, that we are not getting 100 percent appeals of denials.

     *Mr. Becerra.  That is my understanding as well.  If you could provide those numbers to the Committee, I think that would be helpful.

     *Dr. Maestas.  I have those numbers from our data.  It is two‑thirds, almost two‑thirds, 65 percent that do pursue an appeal of the initial denial, as of 2005/2006.

     *Chairman Johnson.  They do appeal?

     *Dr. Maestas.  One‑third do not.

     *Mr. Becerra.  If you could provide those numbers, that would be great.

     *Dr. Maestas.  Those are in my testimony, in the written remarks.

     *Mr. Becerra.  Thank you.  Thank you, Mr. Chairman.

     *Chairman Johnson.  Thank you.  Again, I want to thank you all for being here and your testimony.

     I look forward to continuing this discussion on ways to secure the future of this vital program at our next hearing, which will focus on what happens when someone appeals a denied claim.

     I want to thank you all again for being here.  We appreciate it.  Great time to see the trees outside.  You have perfect timing.

     With that, the Subcommittee stands adjourned.

     [Whereupon, at 12:14 p.m., the Subcommittee was adjourned.]

Member Questions For The Record

The Honorable Michael J. Astrue
Trudy Lyon-Hart
Dan Bertoni
Leighton Chan, M.D.
Nicole Maestas, Ph.D.

Public Submissions For The Record

University at Buffalo Law School
Ruth Kolb