Social Security Disability
Commissioner Proposes Strategy to Improve the Claims Process, but Faces Implementation Challenges Gao ID: GAO-04-552T March 29, 2004Delivering high-quality service to the public in the form of fair, timely, and consistent eligibility decisions for disability benefits is one of SSA's most pressing challenges. This testimony discusses (1) the difficulties SSA faces managing disability claims processing; (2) the outmoded concepts of SSA's disability program; and (3) the Commissioner's strategy for improving the disability process and the challenges it faces.
SSA is at a crossroads in its efforts to improve and reorient its disability determination process. Although SSA has made some gains in the short term in improving the timeliness of its decisions, we found that SSA's disability decisions continue to take a long time to process. Despite some recent progress in improving the timeliness of disability decision-making, individuals who initially are denied disability benefits and who appeal still have to wait almost an additional year before a final hearing decision is made. In addition, evidence suggests that inconsistencies continue to exist between decisions made at the initial level and those made at the hearings level. Also, SSA's disability programs are grounded in an outdated concept of disability that has not kept up with medical advances and economic and social changes that have redefined the relationship between impairment and the ability to work. Furthermore, employment assistance that could allow claimants to stay in the workforce or return to work--and thus to potentially remain off the disability rolls--is not offered through DI or SSI until after a claimant has gone through a lengthy determination process and has proven his or her inability to work. Further, the Commissioner has developed a strategy to improve the disability determination process, including the timeliness and consistency of decisions. While this strategy appears promising, we believe that several key challenges have the potential to hinder its progress, including risks to successfully implementing a new electronic disability folder and automated case processing systems; human capital problems, such as high turnover, recruiting difficulties, and gaps in key knowledge and skills among disability examiners; and an expected dramatic growth in workload.
GAO-04-552T, Social Security Disability: Commissioner Proposes Strategy to Improve the Claims Process, but Faces Implementation Challenges
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Testimony:
Before the Subcommittee on the Oversight of Government Management, the
Federal Workforce and the District of Columbia, Committee on
Governmental Affairs, U.S. Senate:
United States General Accounting Office:
GAO:
For Release on Delivery Expected at 9:00 a.m. EST:
Monday, March 29, 2004:
SOCIAL SECURITY DISABILITY:
Commissioner Proposes Strategy to Improve the Claims Process, but Faces
Implementation Challenges:
Statement of Robert E. Robertson, Director, Education, Workforce, and
Income Security Issues:
GAO-04-552T:
GAO Highlights:
Highlights of GAO-04-552T, a testimony before the Subcommittee on the
Oversight of Government Management, the Federal Workforce and the
District of Columbia, Committee on Governmental Affairs, U.S. Senate
Why GAO Did This Study:
Delivering high-quality service to the public in the form of fair,
timely, and consistent eligibility decisions for disability benefits is
one of SSA‘s most pressing challenges. This testimony discusses (1) the
difficulties SSA faces managing disability claims processing; (2) the
outmoded concepts of SSA‘s disability program; and (3) the
Commissioner‘s strategy for improving the disability process and the
challenges it faces.
What GAO Found:
SSA is at a crossroads in its efforts to improve and reorient its
disability determination process. Although SSA has made some gains in
the short term in improving the timeliness of its decisions, we found
that:
* SSA‘s disability decisions continue to take a long time to process.
Despite some recent progress in improving the timeliness of disability
decision-making, individuals who initially are denied disability
benefits and who appeal still have to wait almost an additional year
before a final hearing decision is made. In addition, evidence suggests
that inconsistencies continue to exist between decisions made at the
initial level and those made at the hearings level.
* SSA‘s disability programs are grounded in an outdated concept of
disability that has not kept up with medical advances and economic and
social changes that have redefined the relationship between impairment
and the ability to work. Furthermore, employment assistance that could
allow claimants to stay in the workforce or return to work”and thus to
potentially remain off the disability rolls”is not offered through DI
or SSI until after a claimant has gone through a lengthy determination
process and has proven his or her inability to work.
* The Commissioner has developed a strategy to improve the disability
determination process, including the timeliness and consistency of
decisions. While this strategy appears promising, we believe that
several key challenges have the potential to hinder its progress,
including risks to successfully implementing a new electronic
disability folder and automated case processing systems; human capital
problems, such as high turnover, recruiting difficulties, and gaps in
key knowledge and skills among disability examiners; and an expected
dramatic growth in workload.
What GAO Recommends:
This testimony, which is based on prior GAO reports and testimonies,
does not contain recommend-ations. However, these previously-issued
products contained a number of recommendations to SSA aimed at
addressing concerns about (1) implementation of the electronic
disability folder and the automated case processing systems and (2)
human capital challenges such as high turnover, recruiting
difficulties, and gaps in key knowledge and skills among disability
examiners.
www.gao.gov/cgi-bin/getrpt?GAO-04-552T.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Robert E. Robertson as
(202) 512-7215 or Robertsonr@gao.gov.
[End of section]
Mr. Chairman and Members of the Subcommittee:
Thank you for inviting me here today to discuss one of the Social
Security Administration's (SSA) most pressing challenges--delivering
high-quality service to the public in the form of fair, timely, and
consistent eligibility decisions for disability benefits. SSA
administers two of the largest federal disability programs, Disability
Insurance (DI) and Supplemental Security Income (SSI). In calendar year
2003, SSA paid over $85 billion in cash benefits to about 8.6 million
beneficiaries (ages 18 to 64) with disabilities.[Footnote 1] In
addition, SSA has spent more than $100 million since the first half of
the 1990s to address long-standing challenges concerning the
timeliness, accuracy, and consistency of its disability decisions.
However, continuing difficulties with claims processing--together with
a program design that is out of synch with technological and medical
advances that have increased the potential for some people with
disabilities to work--led us in 2003 to designate modernizing federal
disability programs, including DI and SSI, as a high-risk area urgently
needing attention and transformation.[Footnote 2]
Today, I will discuss some of the difficulties SSA is experiencing in
its disability determination process and challenges the agency is
facing as it attempts to address these issues. The information I am
providing today is based primarily on work we have conducted over the
last several years.
In summary, we believe that SSA is at a crossroads in its efforts to
improve and reorient its disability determination process. SSA
continues to experience lengthy processing times for disability
decisions and inconsistencies in these decisions. In addition, SSA's
disability programs are grounded in an outdated concept of disability
that has not kept up with medical advances and economic and social
changes that have redefined the relationship between impairment and the
ability to work. To address these concerns, the Commissioner has
developed a strategy to improve the disability determination process.
While this strategy appears promising, we believe that several key
challenges have the potential to hinder its progress, including risks
to successfully implementing a new electronic disability folder and
automated case processing systems; human capital problems, such as high
turnover, recruiting difficulties, and gaps in key knowledge and skills
among disability examiners; and an expected dramatic growth in
workload.
Background:
To be considered eligible for benefits for either SSI or DI as an
adult, a person must be unable to perform any substantial gainful
activity by reason of a medically determinable physical or mental
impairment that is expected to result in death or that has lasted or
can be expected to last for a continuous period of at least 12 months.
Work activity is generally considered to be substantial and gainful if
the person's earnings exceed a particular level established by statute
and regulations.[Footnote 3]
The process of determining eligibility for SSA disability benefits is
complex, fragmented, and expensive. The current decision-making process
involves an initial decision and up to three levels of administrative
appeals if the claimant is dissatisfied with the decision. The claimant
starts the process by filing an application either online, by phone or
mail, or in person at any of SSA's 1,300 field offices.[Footnote 4] If
the claimant meets the non-medical eligibility criteria, the field
office staff forwards the claim to one of the 54 federally-funded, but
primarily state-run Disability Determination Service (DDS) offices. DDS
staff--generally a team composed of disability examiners and medical
consultants--obtains and reviews medical and other evidence as needed
to assess whether the claimant satisfies program requirements, and
makes the initial disability determination. If the claimant is not
satisfied with the decision, the claimant may ask the DDS to reconsider
its finding.[Footnote 5] If the claimant is dissatisfied with the
reconsideration, the claimant may request a hearing before one of SSA's
federal administrative law judges in an SSA hearing office. If the
claimant is still dissatisfied with the decision, the claimant may
request a review by SSA's Appeals Council.[Footnote 6] The complex and
demanding nature of this process is reflected in the relatively high
cost of administering the DI and SSI programs. Although SSI and DI
program benefits account for less than 20 percent of the total benefit
payments made by SSA, they consume nearly 55 percent of the annual
administrative resources.
SSA Faces Difficulties Managing Disability Claims Processing:
SSA has experienced difficulty managing its complex disability
determination process, and consequently faces problems in ensuring the
timeliness, accuracy, and consistency of its disability decisions.
Although SSA has made some gains in the short term in improving the
timeliness of its decisions, the Commissioner has noted that it still
has "a long way to go."[Footnote 7] Over the past 5 years, SSA has
slightly reduced the average time it takes to obtain a decision on an
initial claim from 105 days in fiscal year 1999 to 97 days in fiscal
year 2003, and significantly reduced the average time it takes the
Appeals Council to consider an appeal of a hearing decision from 458 to
294 days over the same period. However, the average time it takes to
receive a decision at the hearings level has increased by almost a
month over the same period, from 316 days to 344 days.[Footnote 8]
According to SSA's strategic plan, these delays place a significant
burden on applicants and their families and an enormous drain on agency
resources.[Footnote 9]
Lengthy processing times have contributed to a large number of pending
claims at both the initial and hearings levels. While the number of
initial disability claims pending has risen more than 25 percent over
the last 5 years, from about 458,000 in fiscal year 1999 to about
582,000 in fiscal year 2003, the number of pending hearings has
increased almost 90 percent over the same time period, from about
312,000 to over 591,000.[Footnote 10] Some cases that are in the queue
for a decision have been pending for a long time. For example, of the
499,000 cases pending in June 2002 at the hearings level, about 346,000
(69 percent) were over 120 days old, 167,000 (33 percent) were over 270
days old, and 88,500 (18 percent) were over 365 days old.
In addition to the timely processing of claims, SSA has also had
difficulty ensuring that decisions regarding a claimant's eligibility
for disability benefits are accurate and consistent across all levels
of the decision-making process. For example, the Social Security
Advisory Board has reported wide variances in rates of allowances and
denials among DDSs, which may indicate that DDSs may be applying SSA
standards and guidelines differently.[Footnote 11] In fiscal year 2000,
the percentage of DI applicants whose claims were allowed by a DDS
ranged from a high of 65 percent in New Hampshire to a low of 31
percent in Texas, with a national average of 45 percent.[Footnote 12]
In addition, the high percentage of claimants awarded benefits upon
appeal may indicate that adjudicators at the hearings level may be
arriving at different decisions on similar cases compared to the DDSs.
In fiscal year 2000, about 40 percent of the applicants whose cases
were denied at the initial level appealed, and about two-thirds of
those who appealed were awarded benefits.[Footnote 13] Awards granted
on appeal happen in part because decision-makers at the initial level
use a different approach to evaluate claims and make decisions than
those at the appellate level. In addition, the decision-makers at the
appeals level may reach a different decision because the evidence in
the case differs from that reviewed by the DDS. We are currently
reviewing SSA's efforts to assess consistency of decision-making
between the initial and the hearings levels.
Moreover, in 2003, we reported on possible racial disparities in SSA's
disability decision-making at the hearings level from 1997 to 2000
between white and African-American claimants not represented by
attorneys.[Footnote 14] Specifically, among claimants without
attorneys, African-American claimants were significantly less likely to
be awarded benefits than white claimants. We also found that other
factors--including the claimant's sex and income and the presence of a
translator at a hearing--had a statistically significant influence on
the likelihood of benefits being allowed.[Footnote 15]
SSA's Disability Programs Currently Grounded in Outmoded Concepts:
In addition to difficulties with the timeliness, accuracy, and
consistency of its decision-making process, SSA's disability programs
face the more fundamental challenge of being mired in concepts from the
past. SSA's disability programs remain grounded in an approach that
equates impairment with an inability to work despite medical advances
and economic and social changes that have redefined the relationship
between impairment and the ability to work. Unlike some private sector
disability insurers and social insurance systems in other countries,
SSA does not incorporate into its initial or continuing eligibility
assessment process an evaluation of what is needed for an individual to
return to work.[Footnote 16] In addition, employment assistance that
could allow claimants to stay in the workforce or return to work--and
thus potentially to remain off the disability rolls--is not offered
through DI or SSI until after a claimant has gone through a lengthy
determination process and has proven his or her inability to work.
Because applicants are either unemployed or only marginally connected
to the labor force when they apply for benefits, and remain so during
the eligibility determination process, their skills, work habits, and
motivation to work are likely to deteriorate during this long wait.
Commissioner's New Strategy for Improving the Disability Determination
Process Appears Promising, but Faces Several Challenges:
In SSA's most recent attempt to improve its determination process, the
Commissioner, in September 2003, set forth a strategy to improve the
timeliness and accuracy of disability decisions and foster return to
work at all stages of the decision-making process. SSA's Commissioner
has acknowledged that the time it now takes to process disability
claims is unacceptable. The Commissioner has also recognized that going
through such a lengthy process to receive benefits would discourage
individuals from attempting to work.[Footnote 17] To speed decisions
for some claimants, the Commissioner plans to initiate an expedited
decision for claimants with more easily identifiable disabilities, such
as aggressive cancers. Under this new approach, expedited claims would
be handled by special units located primarily in SSA's regional
offices. Disability examiners employed by the DDSs to help decide
eligibility for disability benefits would be responsible for evaluating
the more complex claims. To increase decisional accuracy, among other
approaches, the strategy will require DDS examiners to develop more
complete documentation of their disability determinations, including
explaining the basis for their decisions. The strategy also envisions
replacing the current SSA quality control system with a quality review
that is intended to provide greater opportunity for identifying problem
areas and implementing corrective actions and related training.
The Commissioner has predicated the success of her claims process
improvement strategy on enhanced automation. In 2000, SSA issued a plan
to develop an electronic disability folder and automated case
processing systems. According to SSA, the technological investments
will result in more complete case files and the associated reduction of
many hours in processing claims. SSA also projects that the new
electronic process will result in significantly reduced costs related
to locating, mailing, and storing paper files. SSA is accelerating the
transition to its automated claims process, known as AeDib, which will
link together the DDSs, SSA's field offices, and its Office of Hearings
and Appeals. According to the Commissioner, the successful
implementation of the automated system is essential for improving the
disability process.
Beyond steps to improve the accuracy and timeliness of disability
determinations, the Commissioner's strategy is also consistent with our
1996 recommendations to develop a comprehensive plan that fosters
return to work at all stages of the disability process and integrates
as appropriate: 1) earlier intervention in returning workers with
disabilities to the workplace, 2) identifying and providing return-to-
work services tailored to individual circumstances, and 3) structuring
cash and medical benefits to encourage return to work.[Footnote 18] The
Commissioner has proposed a series of demonstrations that would provide
assistance to applicants to enhance their productive capacities, thus
potentially reducing the need for long-term benefits for some. The
demonstrations include early interventions to provide benefits and
employment supports to some DI applicants, and temporary allowances to
provide immediate, but short-term, cash and medical benefits to
applicants who are highly likely to benefit from aggressive medical
care. In addition, demonstrations will provide health insurance
coverage to certain applicants throughout the disability determination
process.
While the Commissioner's proposed approaches for improving the
disability determination process appear promising, challenges,
including automation, human capital, and workload growth, have the
potential to hinder its success.[Footnote 19]
Automation. We have expressed concerns about AeDib, which could affect
successful implementation of the Commissioner's strategy. Our recent
work noted that SSA had begun its national rollout of this system based
on limited pilot testing and without ensuring that all critical
problems identified in its pilot testing had been resolved.[Footnote
20] Further, SSA did not plan to conduct end-to-end testing to evaluate
the performance of the system's interrelated components. SSA has
maintained that its pilot tests will be sufficient for evaluating the
system; however, without ensuring that critical problems have been
resolved and conducting end-to-end testing, SSA lacks assurance that
the interrelated electronic disability system components will work
together successfully.
Additionally, while SSA has established processes and procedures to
guide its software development, the agency could not provide evidence
that it was consistently applying these procedures to the AeDib
initiative. Further, while SSA had identified AeDib system and security
risks, it had not finalized mitigation strategies. As a result, the
agency may not be positioned to effectively prevent circumstances that
could impede AeDib's success. To help improve the potential for AeDib's
success, we have made a number of recommendations to SSA, including
that the agency resolve all critical problems identified, conduct end-
to-end testing, ensure user concurrence on software validation and
systems certifications, and finalize AeDib risk mitigation strategies.
Key human capital challenges. We have also expressed concerns about a
number of issues surrounding human capital at the DDSs that could
adversely affect the Commissioner's strategy. The more than 6,500
disability examiners in the DDSs who help make initial decisions about
eligibility for disability benefits are key to the accuracy and
timeliness of its disability determinations. The critical role played
by the DDS examiners will likely be even more challenging in the future
if the DDSs are responsible for adjudicating only the more complex
claims, as envisioned by the Commissioner. Yet, we recently found that
the DDSs face challenges in retaining examiners and enhancing their
expertise.[Footnote 21]
* High examiner turnover. According to the results of our survey of 52
DDSs, over half of all DDS directors said that examiner turnover was
too high. We also found that examiner turnover was about twice that of
federal employees performing similar work. Nearly two-thirds of all
directors reported that turnover had decreased overall staff skill
levels and increased examiner caseloads, and over one-half of all
directors said that turnover had increased DDS claims-processing times
and backlogs. Two-thirds of all DDS directors cited stressful workloads
and noncompetitive salaries as major factors that contributed to
turnover.
* Difficulties recruiting staff. More than three-quarters of all DDS
directors reported difficulties in recruiting and hiring enough people
who could become successful examiners. Of these directors, more than
three-quarters reported that such difficulties contributed to decreased
accuracy in disability decisions or to increases in job stress, claims-
processing times, examiner caseload levels, backlogs, and turnover.
More than half of all directors reported that state-imposed
compensation limits contributed to these hiring difficulties, and more
than a third of all directors attributed hiring difficulties to other
state restrictions, such as hiring freezes.
* Gaps in key knowledge and skill areas. Nearly one-half of all DDS
directors said that at least a quarter of their examiners need
additional training in areas critical to disability decision-making,
such as assessing symptoms and credibility of medical information,
weighing medical opinions, and analyzing a person's ability to
function. Over half of all directors cited factors related to high
workload levels as obstacles to examiners receiving additional
training.
* Lack of uniform staff standards. SSA has not used its authority to
establish uniform human capital standards, such as minimum
qualifications for examiners. Currently, requirements for new examiner
hires vary substantially among the states. Over one-third of all DDSs
can hire new examiners with either a high school diploma or
less.[Footnote 22]
Despite the workforce challenges facing them, a majority of DDSs do not
conduct long-term, comprehensive workforce planning. Moreover, SSA's
workforce efforts have not sufficiently addressed current and future
DDS human capital challenges. SSA does not link its strategic
objectives to a workforce plan that covers the very people who are
essential to accomplishing those objectives. While acknowledging the
difficulties SSA faces as a federal agency in addressing human capital
issues in DDSs that report to 50 state governments, we have recommended
that SSA take several steps to address DDS workforce challenges to help
ensure that SSA has the workforce with the skills necessary for the
Commissioner's strategy to be successful. These include developing a
nationwide strategic workforce plan addressing issues such as turnover
in the DDS workforce, gaps between current and required examiner
skills, and qualifications for examiners.
Future workload growth. According to SSA's strategic plan, the most
significant external factor affecting SSA's ability to improve service
to disability applicants is the expected dramatic growth in the number
of applications needing to be processed. Between 2002 and 2012, SSA
expects the DI rolls to grow by 35 percent, with applications rising as
baby boomers enter their disability-prone years.[Footnote 23] Over the
same period, more modest growth is expected in the SSI rolls. SSA
estimates that, between 2002 and 2012, the number of SSI recipients
with disabilities will rise by about 16 percent.[Footnote 24]
The challenges SSA faces in keeping up with its workload have already
forced agency officials to reduce efforts in some areas. For example,
the Commissioner explained that in order to avoid increasing the time
disability applicants have to wait for a decision, she chose to focus
on processing new claims rather than keeping current with reviewing
beneficiaries' cases to ensure they are still eligible for disability
benefits, called Continuing Disability Reviews (CDRs). In fiscal year
2003, SSA did not keep current with the projected CDR caseload. The
Commissioner says that this situation will continue in fiscal year
2004, despite the potential savings of $10 for every $1 invested in
conducting CDRs.[Footnote 25] However, in reducing the focus on CDRs,
not only is SSA forgoing cost savings, but the agency is also
compromising the integrity of its disability programs by potentially
paying benefits to disability beneficiaries who are no longer eligible
to receive them.
In closing, as stated earlier, SSA is at a crossroads and faces a
number of challenges in its efforts to improve and reorient its
disability determination process. Mr. Chairman, this concludes my
statement. I would be pleased to answer any questions that you or other
members of the subcommittee may have at this time.
Contacts and Acknowledgments:
For further information regarding this testimony, please contact Robert
E. Robertson, Director, Education, Workforce, and Income Security at
(202) 512-7215, or Shelia Drake, Assistant Director, at (202) 512-7172.
Michael Alexander, Barbara Bordelon, Kay Brown, Beverly Crawford,
Marissa Jones, Valerie Melvin, Angela Miles, and Carol Dawn Petersen
made key contributions to prior work covered by this testimony.
[End of section]
Related GAO Products:
Electronic Disability Claims Processing: SSA Needs to Address Risks
Associated With Its Accelerated Systems Development Strategy. GAO-04-
466. Washington, D.C.: March 2004.
Social Security Administration: Strategic Workforce Planning Needed to
Address Human Capital Challenges Facing the Disability Determination
Services. GAO-04-121. Washington, D.C.: January 27, 2004.
SSA Disability Decision Making: Additional Steps Needed to Ensure
Accuracy and Fairness of Decisions at the Hearings Level. GAO-04-14.
Washington, D.C.: November 12, 2003.
High-Risk Series: An Update. GAO-03-119. Washington, D.C.: January 1,
2003.
Major Management Challenges and Program Risks: Social Security
Administration. GAO-03-117. Washington, D.C.: January 2003.
Social Security Disability: Disappointing Results From SSA's Efforts to
Improve the Disability Claims Process Warrant Immediate Attention. GAO-
02-322. Washington, D.C.: February 2002.
Social Security Disability: Efforts to Improve Claims Process Have
Fallen Short and Further Action is Needed. GAO-02-826T. Washington,
D.C.: June 11, 2002.
SSA Disability: Other Programs May Provide Lessons for Improving
Return-to-Work Efforts. GAO-01-153. Washington, D.C.: January 12, 2001.
SSA Disability Redesign: Actions Needed to Enhance Future Progress.
GAO/HEHS-99-25. Washington, D.C.: March 12, 1999.
Social Security Disability: SSA Must Hold Itself Accountable for
Continued Improvement in Decision-making. GAO/HEHS-97-102, Washington,
D.C.: August 12, 1997.
SSA Disability: Return-to-Work Strategies from Other Systems May
Improve Federal Programs. GAO/HEHS-96-133. Washington, D.C.: July 11,
1996.
FOOTNOTES
[1] Excludes dependents and survivors who receive DI benefits. Also
excludes persons 65 and over and children under 18 who receive SSI
payments. SSI beneficiaries include recipients of federal SSI,
federally-administered state supplementation, or both. In calendar year
2003, 833,269 DI workers also received SSI benefits because of low
income and assets. The number of beneficiaries is based on draft SSA
data.
[2] U.S. General Accounting Office, High-Risk Series: An Update,
GAO-03-119 (Washington, D.C.: Jan. 2003).
[3] The Commissioner of Social Security has the authority to set the
substantial and gainful activities level for individuals who have
disabilities other than blindness. In December 2000, SSA finalized a
rule calling for the annual indexing of the nonblind level to the
average wage index of all employees in the United States. The 2004
nonblind level is set at $810 a month. The level for individuals who
are blind is set by statue and is also indexed to the average wage
index. In 2004, the level for blind individuals is $1,350 of countable
earnings.
[4] SSA permits DI, but not SSI, applicants to file for benefits
online.
[5] In her September 2003 testimony before the House Committee on Ways
and Means, the Commissioner said that she intended to revise the
disability determination process. For example, she proposed eliminating
the reconsideration and the Appeals Council stages of the current
process.
[6] If the claimant is not satisfied with the Appeals Council action,
the claimant may appeal to a federal district court. The claimant can
continue legal appeals to the U.S. Circuit Court of Appeals and
ultimately to the Supreme Court of the United States.
[7] Statement of the Honorable Jo Anne B. Barnhart, Commissioner,
Social Security Administration: Testimony before the Subcommittee on
Social Security of the House Committee on Ways and Means, September 25,
2003.
[8] Beginning with fiscal year 2000, the basis for calculating the
average elapsed time of hearings level cases was changed from those
cases processed only in September of the fiscal year to those processed
throughout the fiscal year.
[9] Social Security Administration, Strategic Plan 2003-2008.
[10] The number of pending hearings includes Medicare hearings.
[11] Social Security Advisory Board, Charting the Future of Social
Security's Disability Programs: The Need for Fundamental Change
(Washington, D.C.: January 2001).
[12] A 2002 study found that adjusting for economic, demographic, and
health factors cuts the variation in allowance rates among states in
half. See Strand, Alexander, "Social Security Disability Programs:
Assessing the Variation in Allowance Rates," ORES Working Paper No. 98,
Social Security Administration, Office of Policy.
[13] U.S. General Accounting Office, Social Security Disability:
Efforts to Improve Claims Process have Fallen Short and Further Action
is Needed, GAO-02-826T (Washington, D.C.: June 11, 2002).
[14] U.S. General Accounting Office, SSA Disability Decision Making:
Additional Steps Needed to Ensure Accuracy and Fairness of Decisions at
the Hearings Level, GAO-04-14 (Washington, D.C.: Nov. 12, 2003).
[15] Due to the inherent limitations of statistical analysis, one
cannot determine whether these differences by race, sex, and other
factors are a result of discrimination, other forms of bias, or
variations in currently unobservable claimant characteristics.
[16] U.S. General Accounting Office, SSA Disability: Other Programs May
Provide Lessons for Improving Return-to-Work Efforts, GAO-01-153
(Washington, D.C.: Jan. 12, 2001).
[17] Statement of the Honorable Jo Anne B. Barnhart, Commissioner,
Social Security Administration: Testimony before the Subcommittee on
Social Security of the House Committee on Ways and Means, September 25,
2003.
[18] U.S. General Accounting Office, SSA Disability: Return-to-Work
Strategies from Other Systems May Improve Federal Programs, GAO/
HEHS-96-133 (Washington, D.C.: July 11, 1996).
[19] These are problems that have been well established in our previous
reports. We currently have a study underway that, among other issues,
is reviewing challenges to implementing the new strategy.
[20] U.S. General Accounting Office, Electronic Disability Claims
Processing: SSA Needs to Address Risks Associated With Its Accelerated
Systems Development Strategy, GAO-04-466 (Washington, D.C.: Mar. 2004).
[21] U.S. General Accounting Office, Social Security Administration:
Strategic Workforce Planning Needed to Address Human Capital Challenges
Facing the Disability Determination Services, GAO-04-121 (Washington,
D.C.: Jan. 27, 2004).
[22] Some DDSs may have higher educational requirements for some
applicants or may use standards other than or in addition to education.
The minimum educational requirements described do not necessarily
reflect the actual credentials of DDS examiners hired by the DDSs.
[23] Social Security Administration, Strategic Plan 2003-2008.
[24] Social Security Administration, Annual Report of the Supplemental
Security Income Program, May 2002.
[25] Statement of the Honorable Jo Anne B. Barnhart, Commissioner,
Social Security Administration: Testimony before the Subcommittee on
Social Security of the House Committee on Ways and Means, February 26,
2004.
