Social Security Disability

About 2.5 million people apply to the Social Security Administration (SSA) each year for disability benefits. Disability determination services (DDS)--state agencies that make disability determinations on behalf of SSA--deny benefits to 65 out of every 100 applicants. Two-thirds of denied applications that are appealed are ultimately reversed because administrative law judges assess applicants' functional abilities using standards and procedures that differ from those used in initial disability determinations, raising questions about the fairness, integrity, and cost of the disability programs. This report discusses (1) factors that contribute to the differences between DDS' and administrative law judge's decisions and (2) SSA's efforts to make decisions in initial and appealed cases more consistent.

GAO noted that: (1) ALJs made nearly 30 percent of all awards in 1996; (2) because two-thirds of all cases appealed to ALJs have resulted in awards, questions have arisen about the fairness, integrity, and cost of SSA disability programs; (3) differences in assessing applicants' functional capacity and procedural factors, as well as weaknesses in quality assurance, contribute to inconsistent decisions; (4) ALJs are far more likely than DDSs to find claimants unable to work on the basis of their functional capacity; (5) this outcome has occurred even when ALJ and DDS adjudicators review the same evidence for the same case; (6) most notably, DDS adjudicators tend to rely on medical evidence such as the results of laboratory test; ALJs tend to rely more on symptoms such as pain and fatigue; (7) DDS and ALJ decisionmaking practices and procedures also contribute to inconsistent results because they limit the usefulness of DDS evaluations as bases for ALJ decisions; (8) in addition, SSA procedures often lead to substantial differences between the evidentiary records examined by DDS and ALJs; (9) specifically, ALJs may examine new evidence submitted by a claimant and hear a claimant testify; (10) as a result, even with a well-explained DDS decision, ALJs could reach a different decision because the evidence in the case differs from that reviewed by the DDS; (11) SSA has not used its quality review systems to identify and reconcile differences in approach and procedures used by DDSs and ALJs; (12) the quality review systems for the initial level and appeals levels of the decisionmaking process merely reflect the differences between the levels; they do not help produce more consistent decisions; (13) although SSA has not managed the decisionmaking process well in the past, its current process unification initiatives, when fully implemented, could significantly help to produce more consistent decisions; (14) competing workload pressures at all adjudication levels could, however, jeopardize SSA's efforts; (15) as a result, SSA, in consultation with the Congress, will need to sort through its many priorities and be more accountable for meeting its deadlines and establishing explicit measures to assess its progress in reducing inconsistency; and (16) this may include, for example, setting a goal, under the Government Performance and Results Act, to foster consistency in results, set quantitative measures, and report on its progress in shifting the proportion of cases awarded from the ALJ to the DDS level.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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