United States Government Accountability Office

GAO Report to Congressional Requesters

DISABILITY 

PROGRAMS 

SSA Has Taken Steps 

to Address Conflicting 

Court Decisions, but 

Needs to Manage Data 

Better on the 

Increasing Number of 

Court Remands 

April 2007 

 

GAO-07-331 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

April 2007

DISABILITY PROGRAMS 

SSA Has Taken Steps to Address 

Conflicting Court Decisions, but Needs to 

Manage Data Better on the Increasing 

Number of Court Remands 

Highlights of GAO-07-331, a report to 

congressional requesters 

The Social Security 

Administration’s (SSA) Disability 

Insurance and Supplemental 

Security Income programs 

provided around $128 billion to 

about 12.8 million persons with 

disabilities and their families in 

fiscal year 2005. Claimants who are 

denied benefits by SSA may appeal 

to federal courts. Through current 

initiatives, SSA is attempting to 

reduce the number of cases 

appealed to courts and remanded

back to SSA for further review. In 

addition, there have been longstanding concerns about how SSA

responds to court decisions that 

conflict with its policies. 

GAO was asked to examine: (1)

trends over the past decade in the 

number of appeals reviewed by the 

courts and their decisions, (2) 

reasons for court remands and

factors contributing to them, and

(3) SSA’s process for responding to 

court decisions that conflict with

agency policy. GAO reviewed SSA 

data and documents on court 

decisions, remands and SSA’s 

processes and interviewed agency

officials and stakeholders on data

trends, reasons for remands, and 

SSA processes. 

What GAO Recommends

GAO recommends that the

Commissioner of Social Security 

take steps to improve the reliability

and collection of data on remands. 

SSA agreed with GAO’s 

recommendations and outlined

actions it plans to take to

implement them. 

Between fiscal years 1995 and 2005, the number of disability appeals

reviewed by the federal district courts increased, along with the proportion

of decisions that were remanded. More disability claims were remanded than 

affirmed, reversed, or dismissed over the period, and the proportion of total 

decisions that were remands ranged from 36 percent to 62 percent, with an 

average of 50 percent. Remanded cases often require SSA to re-adjudicate 

the claim, with the result that—along with the passage of time and new 

medical evidence—the majority of remanded cases result in allowances.

Percent of Federal District Court Decisions by Type, Fiscal Year 1995 to Fiscal Year 2005 

According to SSA officials and outside observers, a range of errors prompted 

by heavy workloads is responsible for court remands of SSA’s disability 

determinations, but data that would confirm or clarify the issue are 

incomplete and not well-managed. SSA has only recently begun collecting 

data on remands, and we found these data to be incomplete. Additionally, 

this information is collected by two different offices that have created 

somewhat different categories for the data, making some of the information 

inconsistent and possibly redundant. Meanwhile, SSA has acknowledged the 

need to reduce remands and, in 2006 along with other initiatives, introduced 

new decision-writing templates to improve efficiency and reduce errors. 

SSA has a process in place for determining whether appellate court 

decisions conflict with the agency’s interpretation of disability statutes or 

regulations and has taken steps in recent years to align its national policies 

with appellate court decisions. For example, officials and stakeholders 

attributed a downward trend in appellate court decisions that conflict with 

agency policy to significant policy changes instituted by SSA in the mid1990s. In addition, for those cases where the agency acceded to conflicting 

appellate court decisions by issuing acquiescence rulings within the related 

circuits, we found that about half of the rulings issued were eventually 

replaced with national policy. Moreover, GAO found that the timeliness of 

acquiescence rulings had improved since 1998, when SSA established a 

timeliness goal of 120 days. 

www.gao.gov/cgi-bin/getrpt?GAO-07-331.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Daniel Bertoni 

at (202) 512-7215 or bertonid@gao.gov. 
Contents 

Letter 1

Results in Brief 3

Background 5

Court Reviews and Remands Have Increased in Recent Years with 

Remands Often Resulting in SSA’s Subsequently Awarding 

Benefits 12

Remands Have Been Attributed to a Range of Errors Caused by 

Heavy Workloads, but SSA Data That Could Shed More Light on 

the Problem Are Inadequate 17 

SSA Has Taken Several Steps Since 1990 to Align Its Policies 

Nationally with Court Decisions 21 

Conclusions 27

Recommendations 28

Agency Comments 28 

Appendix I Objective, Scope, and Methodology 30 

Appendix II Summary of Process Unification Rulings 32 

Appendix III Key Federal Court Rulings on Social Security 

Administration Disability Adjudication 34 

Appendix IV Additional Information on Disability Appeals 36 

Appendix V Summary of Court Holdings for Acquiescence Rulings

Related to Disability Determinations 39 

Appendix VI Comments from the Agency 42 

Appendix VII GAO Contact and Staff Acknowledgments 45 

Page i GAO-07-331 SSA's Disability Determination Process
Related GAO Reports 46 

Figures 

Figure 1: Map of Federal Judicial Circuits 8 

Figure 2: Disability Process after SSA Final Decision 10 

Figure 3: Federal District Court Decisions on Disability Claims, 

Fiscal Year 1995 to Fiscal Year 2005 13 

Figure 4: District Court Decisions on Disability Claims 14 

Figure 5: District Court Decisions by Circuit (Fiscal Year 2005) 15 

Figure 6: SSA Decisions on Remanded Disability Claims, Fiscal 

Year 1995 to Fiscal Year 2005 16 

Figure 7: SSA Decisions on Disability Claims Following Court 

Remands by Judicial Circuit, Fiscal Year 1995 to Fiscal 

Year 2005 17 

Figure 8: Number of Acquiescence Rulings Issued, 1990 to 2006 24 

Figure 9: Number of Acquiescence Rulings by Circuit, 1990 to 2006 25 

Figure 10: Timeliness of Acquiescence Rulings, 1990 to 2006 26 

Figure 11: How Acquiescence Rulings Were Rescinded, 1990 to

2006 27

Figure 12: Appeals Council Denials of Social Security Claims, 

Fiscal Year 1994 to Fiscal Year 2004 36 

Figure 13: SSA Decisions on Disability Claims Following Court 

Remands 37

Figure 14: Social Security Claims Reviewed in Federal District 

Courts in Fiscal Year 2005 by Judicial Circuit 38 

Page ii GAO-07-331 SSA's Disability Determination Process
Abbreviations 

ALJ administrative law judge

CPMS Case Processing and Management System 

DI Disability Insurance 

DOJ Department of Justice 

DSI Disability Service Improvement 

FIT Findings Integrated Template 

NDMIS National Docketing/Management Information System 

ODAR Office of Disability Adjudication and Review 

OGC Office of the General Counsel 

SSA Social Security Administration 

SSI Supplemental Security Income 

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Page iii GAO-07-331 SSA's Disability Determination Process
United States Government Accountability Office

Washington, DC 20548 

April 5, 2007

The Honorable Charles B. Rangel 

Chairman 

The Honorable Jim McCrery 

Ranking Minority Member 

Committee on Ways and Means 

House of Representatives 

The Honorable Charles B. Rangel 

Chairman 

The Honorable Jim McCrery 

Ranking Minority Member 

Committee on Ways and Means 

House of Representatives 

The Honorable Michael R. McNulty 

Chairman 

The Honorable Sam Johnson 

Ranking Minority Member 

Subcommittee on Social Security 

Committee on Ways and Means 

House of Representatives 

The Honorable Michael R. McNulty 

Chairman 

The Honorable Sam Johnson 

Ranking Minority Member 

Subcommittee on Social Security 

Committee on Ways and Means 

House of Representatives 

The Honorable Sander M. Levin 

House of Representatives 

In fiscal year 2005, the Social Security Administration (SSA) provided 

approximately $128 billion in cash benefits to about 12.8 million persons 

through the nation’s two largest programs for persons with disabilities and 

their families—the Disability Insurance (DI) and the Supplemental 

Security Income (SSI) programs. In administering these programs over the 

past decade, SSA has faced challenges associated with lengthy decisionmaking processes and difficult disability determinations. In an effort to 

introduce more efficiency and fairness in its decision making, SSA has 

undertaken a “Disability Service Improvement Process,” about which we 

offered testimony in June of 2006. Among the problems this initiative is 

designed to address is the number of SSA disability decisions that are 

appealed to the federal courts and subsequently remanded or referred 

back to the agency for re-adjudication. Such appeals and remands can add 

several years to the time it takes disability claimants to receive final 

decisions on their applications. Most appealed cases are reviewed only by 

the district courts, the first level of court review. However, if a disability 

claim reaches the appellate court or Supreme Court, the decision may 

have implications for SSA policy. There has been a long-standing concern 

that SSA does not respond adequately to appellate court decisions that 

conflict with its own policies by taking timely and appropriate action to 

reconcile them. 

In fiscal year 2005, the Social Security Administration (SSA) provided 

approximately $128 billion in cash benefits to about 12.8 million persons 

through the nation’s two largest programs for persons with disabilities and 

their families—the Disability Insurance (DI) and the Supplemental 

Security Income (SSI) programs. In administering these programs over the 

past decade, SSA has faced challenges associated with lengthy decisionmaking processes and difficult disability determinations. In an effort to 

introduce more efficiency and fairness in its decision making, SSA has 

undertaken a “Disability Service Improvement Process,” about which we 

offered testimony in June of 2006. Among the problems this initiative is 

designed to address is the number of SSA disability decisions that are 

appealed to the federal courts and subsequently remanded or referred 

back to the agency for re-adjudication. Such appeals and remands can add 

several years to the time it takes disability claimants to receive final 

decisions on their applications. Most appealed cases are reviewed only by 

the district courts, the first level of court review. However, if a disability 

claim reaches the appellate court or Supreme Court, the decision may 

have implications for SSA policy. There has been a long-standing concern 

that SSA does not respond adequately to appellate court decisions that 

conflict with its own policies by taking timely and appropriate action to 

reconcile them. 

Page 1 GAO-07-331 SSA's Disability D bility Determinat termination Process
You asked that we examine: (1) the trends of the past decade in the 

number of appeals reviewed by the district courts and their decisions; (2) 

the reasons for court remands and factors that may contribute to the 

incidence of those remands; and (3) SSA’s process for responding to 

appellate court decisions that conflict with agency policy and the agency’s 

response in recent years. 

To address the first research objective, we analyzed data from SSA on the 

number and types of decisions made by federal district courts for fiscal 

years 1995 to 2005. We also grouped and analyzed district court decisions 

by circuit for fiscal year 2005, the only year for which complete data by

circuit were available. Furthermore, we analyzed agency data on the 

decisions SSA made after a case was remanded (i.e., allowances or denials

of claims) for fiscal years 1995 to 2005. We also analyzed these remand 

data to identify trends over time and by circuit, a category that we created

using SSA data on claimant state of residence. SSA officials were 

interviewed to gather information on potential reasons for any trends. To 

address the second objective, we obtained data on cited reasons for 

remands from two SSA databases that are maintained by two separate 

offices in SSA responsible for litigating claims in court and re-adjudicating 

remanded cases. We compared the data to determine how effectively SSA 

was capturing information on reasons for remands within the agency. In 

addition, we interviewed SSA officials and other stakeholder groups, 

including federal court judges and claimant representatives, on reasons for 

remands and factors that influenced them. For the third objective, we 

interviewed SSA officials and obtained available documents on how SSA 

determines whether a court of appeals decision conflicts with its policies

and what option to pursue to address conflicting decisions, e.g., appeal or

issue an acquiescence ruling whereby the agency agrees to abide by the 

court judgment in future cases, albeit only in that jurisdiction. We also 

obtained data on the number of acquiescence and other rulings that SSA

issued since establishing its regulations on acquiescence in 1990. For 

acquiescence rulings, we further reviewed SSA’s timeliness in issuing 

acquiescence rulings, as well as the number issued by circuit and how SSA 

replaced acquiescence rulings with nationwide policies. We were unable 

to independently determine how significantly any given court decision 

conflicted with SSA policy or whether SSA should have pursued one 

option over another. We also interviewed SSA officials and relevant 

stakeholders—including selected federal court judges and claimant 

representatives from the Seventh and Ninth circuits, which represent 

those with the lowest and highest numbers of SSA policy changes 

associated with acquiescence rulings—to obtain information on how court 

decisions and their related agency rulings have affected SSA’s disability 

Page 2 GAO-07-331 SSA's Disability Determination Process
adjudication policy in recent years. After interviewing officials and 

reviewing related data reports and manuals, all quantitative data used in 

this report were assessed and, with the exception of the reason for remand 

data, were determined to be sufficiently reliable for the purposes of this 

report. Issues related to the reason for remand data are discussed further 

on pages 20 to 21. All work was conducted between February 2006 and 

January 2007 according to generally accepted government auditing 

standards. See appendix I for more information on our methods. 

Over the past decade, the number of disability appeals reviewed by the 

district courts and the proportion of remands increased, and SSA 

subsequently granted benefits to claimants in many of the remanded cases. 

Between 1995 and 2005, the number of cases reviewed by federal district 

courts grew by 20 percent—from about 10,300 to some 12,400—which 

roughly corresponds to workload increases at SSA during the same period. 

During this period, the courts upheld SSA’s decisions to deny benefits in 

44 percent of cases on average and reversed 6 percent. However, the most 

frequently occurring decisions were remands back to the agency for 

further review (50 percent), essentially resulting in additional work for 

SSA. The proportion of reviewed cases that were remanded increased by 

36 percent over this period, with 1998 being the pivotal year when the 

proportion of remands exceeded affirmations. According to some SSA 

officials, this notable increase may have been due to new national 

guidelines for SSA adjudicators—known as the process unification 

rulings—that may have also led to federal courts using more remands to 

ensure that the guidelines were followed. With regard to the disposition of 

cases by geographic jurisdiction or judicial circuit, there was substantial 

variation in 2005, the year for which detailed data were available. Federal 

district courts in the Second Circuit—which serves part of the Northeast—

affirmed 19 percent and remanded 74 percent of cases, while district 

courts in the Sixth Circuit—which serves Michigan, Ohio, Kentucky, and 

Tennessee—affirmed 61 percent and remanded 35 percent. According to

SSA officials, case outcomes may vary from circuit to circuit because of 

differences such as judges’ interpretations of laws and the volume of cases 

that circuits examine. We also found that once cases were remanded back 

to SSA for re-adjudication, the majority of claimants—66 percent—were 

awarded benefits. According to agency officials, the changing nature or 

severity of claimants’ disabilities over the often lengthy period of appeal 

may contribute to the extent of allowances for remanded cases. 

Results in Brief 

While stakeholders suggested that remands result from a range of errors 

caused by heavy workloads, SSA data that would confirm and perhaps 

Page 3 GAO-07-331 SSA's Disability Determination Process
elaborate on these errors are incomplete and not well managed. 

Administrative law judges (ALJ), who adjudicate cases appealed within 

SSA; claimant representatives; and others whom we interviewed said 

district courts often remand cases back to the agency for re-adjudication 

due to errors associated with poor decision writing and improper use of 

evidence. For example, many stakeholders said SSA decision makers had 

failed to properly consider the opinions of treating physicians. Many 

agency officials as well as outside stakeholders attributed the errors 

resulting in remands to a heavy workload. For example, ALJs we spoke 

with expressed the view that their caseload—around 50 to 60 cases per 

month—undermined the quality of their written decisions. SSA introduced 

new decision-writing templates for ALJs and their staff in order to ensure 

more legally sufficient documentation of decisions and improve the 

efficiency of the administrative-hearings process. However, the agency’s 

ability to identify trends in reasons for remands and take corrective 

actions to reduce remands is limited by the absence of reliable data. We 

found that SSA’s data were incomplete and that the collection of these 

data, conducted by two separate offices, was inconsistent and inefficient.

SSA officials acknowledged that improvements to these data and their 

management were needed, but currently lacks specific plans and 

timetables for addressing these problems. 

SSA has a process in place for addressing appellate court decisions that 

conflict with agency interpretation of law or regulations and has taken 

steps since 1990 to align its policies nationally with appellate court 

decisions. Specifically, SSA’s offices of General Counsel (OGC) and 

Disability Programs regularly review appeals court decisions for their 

policy implications. When SSA has determined that an adverse appellate

court decision conflicts with its own interpretation of disability statutes or 

regulations, the agency then decides either to pursue further judicial 

review of the issue or accede to the court’s decision only within the 

specific circuit. SSA accedes to appellate court rulings within the specific 

circuits by issuing acquiescence rulings, which are meant to be temporary 

guidance for program implementation until the agency can determine how 

to address court decisions in a way that minimizes regional variations. 

Since establishing regulations on acquiescence in 1990, SSA issued 45 

acquiescence rulings in response to appellate court decisions, although 

there have been fewer such rulings in recent years. SSA officials said 

fewer acquiescence rulings have been needed because new guidelines for 

adjudicators, the process unification rulings of 1996, clarified SSA policy 

and filled gaps in policy that were previously open for the courts to fill, 

leading to a closer alignment of agency policy and court interpretations of 

disability law. Also, nearly half of the acquiescence rulings issued during 

Page 4 GAO-07-331 SSA's Disability Determination Process
the period of our study have been rescinded and eventually replaced with 

new laws and regulations to ensure consistency in program 

implementation. We also found that acquiescence rulings were issued 

significantly sooner, following the agency’s establishment in 1998 of a new

120-day guideline. 

To ensure the agency has accurate and well-managed information to use in

identifying corrective actions for reducing remands, we recommended that 

the Commissioner of SSA: (1) take steps to ensure the reliability of data on 

the reasons for remands and (2) coordinate agency data collection on 

remands and ascertain how best to use this information to reduce the 

proportion of cases remanded by federal courts. 

In comments to our draft report, SSA agreed with both of our 

recommendations for improving data on remands and outlined actions it 

plans to take to improve the reliability and collection of remand data. See 

appendix VI for a copy of SSA’s comments. SSA also provided a number 

of technical comments, which we generally incorporated where 

appropriate. 

In fiscal year 2005, the Social Security Administration (SSA) paid 

approximately $128 billion in cash benefits to about 12.8 million 

beneficiaries through the two largest federal programs available to 

persons with disabilities and their families: the Disability Insurance (DI) 

program and the Supplemental Security Income (SSI) program. Both 

programs serve those who are medically determined to be unable to 

engage in any substantial gainful activity due to a severe physical or 

mental impairment that is expected to last at least 12 months or result in 

death.1

Background 

Disability Determination 

and Administrative 

Appeals 

Claimants must apply to SSA to receive disability benefits from these 

programs and if awarded benefits, claimants may also have to requalify for

support through what are known as continuing disability reviews.2

 In most 

 1

 For a child to be considered disabled and therefore eligible for SSI, the child must have a 

physical or mental condition, or a combination of conditions, that results in marked and

severe functional limitations. The child’s condition or conditions must have lasted, or be 

expected to last, at least 12 months or be expected to result in death. 

2

 Children who receive SSI are also subject to a re-determination of their eligibility at 

age 18. 

Page 5 GAO-07-331 SSA's Disability Determination Process
of the country currently, claimants who are denied initial or continuing 

benefits by SSA may appeal their denials administratively up to three 

times, each time for review by a different adjudicatory entity.3

 These 

entities are 1) the state disability determination service that performs the 

initial review of disability claims and, in most states, a reconsideration 

determination, 2) an administrative law judge (ALJ) in SSA’s Office of 

Disability Adjudication and Review, and 3) a group of appellate reviewing 

officials within SSA known as the Appeals Council. The number of claims

or appeals reviewed at each level in 2005 were: over 2.6 million by state 

agencies, almost 520,000 by ALJs, and over 94,000 by the Appeals Council. 

Disability determinations at all of these levels are often complex and 

necessarily involve some degree of subjectivity by adjudicators, and the 

nature of these decisions have contributed to long-standing concerns 

about the extent to which adjudicators across the agency consistently 

interpret and implement SSA’s national disability policy. To help achieve 

more consistent application of policy between the state disability 

determination service level and the ALJ level, in 1996, SSA established the 

process unification rulings, a set of nine Social Security rulings for all SSA 

disability adjudicators to follow in matters involving difficult judgments, 

such as the weight to be given to opinions of claimants’ treating physicians 

versus medical opinions from other sources, and the evaluation of pain 

and other subjective symptoms. See appendix II for more details on 

process unification rulings. 

 3

 As a part of the Disability Service Improvement process, SSA is gradually implementing 

changes to the appeals process, starting with the Boston regional office in August 2006. 

Page 6 GAO-07-331 SSA's Disability Determination Process
After claimants exhaust all administrative review options within SSA, they 

may then appeal their claims outside the agency to federal court. A 

claimant must first file an appeal with a federal district court within one of 

12 federal judicial regions, known as judicial circuits. Figure 1 provides 

information on which states and territories are included in these circuits.

Cases in Federal Court 

Page 7 GAO-07-331 SSA's Disability Determination Process
Figure 1: Map of Federal Judicial Circuits 

Source: Administrative Office of U.S. Courts (data), map, Map Resources (presentation).

Note: There is a thirteenth federal judicial circuit, known as the Federal Circuit, which does not hear 

SSA disability cases. 

In deciding the case, a district court judge or magistrate usually either 

affirms an agency decision, reverses the decision (essentially affirming the 

Page 8 GAO-07-331 SSA's Disability Determination Process
claimant’s case), or remands it back to SSA for further review.4

 According 

to SSA officials, remanded cases are generally reviewed by the ALJ who 

made the original decision.5

 Judges can also dismiss a case if its scope is 

outside the court’s legal jurisdiction. Furthermore, if SSA prefers not to 

defend a case that has been filed, usually because of an error it has 

identified, the agency may request that the judge remand the case back for 

the agency’s review.6

Court remands have implications for SSA’s workload, the types of 

decisions SSA adjudicators make on remanded cases, and the time 

claimants must wait for decisions on their cases. Generally, when cases 

are remanded, ALJs must perform new hearings, which could involve new 

evidence presented at the time of court reviews. These remanded cases 

add to the already high workloads that ALJs have in reviewing denials by

the agency’s disability determination service offices. The load may also 

affect ALJ decisions: In its September 2006 report, the Social Security 

Advisory Board found a small correlation between increased ALJ 

workload and increased allowances.7

 Furthermore, although remanded 

cases are given priority in the line of cases that must be reviewed by ALJs, 

a substantial amount of time may pass before new decisions can be made

at this administrative level, and the ALJ’s decision may undergo another 

review by the Appeals Council. In fiscal year 2006, it took SSA nearly a 

year on average to process court remanded cases from the district courts. 

After a district court decision, both the claimant and SSA may appeal the 

case to a circuit court of appeals (also called an appellate court) and, 

beyond this, to the Supreme Court. However, few cases reach these 

appellate court levels and most disability cases are resolved in the district 

courts. According to SSA, no more than 20 district court cases have been 

 4

 The court may also modify SSA’s decision. According to SSA officials, modified decisions

are generally remanded to the agency and are therefore classified as remands. 

5

 Court remanded cases are generally re-adjudicated by ALJs but may also be reviewed by

the Appeals Council. 

6

 When a case reaches the federal courts, SSA is generally represented by U.S. Attorneys

working for the Department of Justice (DOJ).

7

 The Social Security Advisory Board is a bipartisan board that provides advice to the

President, Congress, and the Commissioner of Social Security on matters related to Social

Security and SSI. For more information about the Board’s report, see Daub, Hal et al.,

Improving the Social Security Administration’s Hearing Process, (Washington, D.C.: 

September 2006). 

Page 9 GAO-07-331 SSA's Disability Determination Process
appealed by the agency to the appellate courts each year since 2000. The

Supreme Court has only reviewed four cases involving disability claims 

since 1991. See figure 2 for an overview of the disability appeals process. 

Figure 2: Disability Process after SSA Final Decision 

Benefits

denied

Benefits

granted

Case

dismissed

SSA final decision

Appeal to federal 

district court

Dismissed Affirmed Reversed Remanded

Claimant can appeal to 

federal circuit court of 

appeals

SSA can appeal to federal 

circuit court of appeals

Case is sent

back to SSA

Source: GAO analysis.

Note: This figure depicts the typical appeals process. Circuit court decisions can be appealed to the 

Supreme Court. SSA decisions on remanded cases can be appealed back to the federal courts. For 

court remands involving continuing disability reviews, SSA decides to cease or continue, rather than 

deny or grant benefits. 

How Federal Court 

Decisions May Affect SSA 

Policy 

SSA is not obligated to follow a district court decision that conflicts with 

agency policies beyond that specific case.8

 However, the agency is 

required to follow appellate court decisions for cases within that circuit, 

unless the agency seeks further judicial review. If the Supreme Court 

 8

 An exception is district court decisions involving class action lawsuits, since these 

decisions apply to multiple individuals that may reside in other circuits. 

Page 10 GAO-07-331 SSA's Disability Determination Process
issues a decision, SSA is bound to follow the decision nationally. Several 

district, appellate, and Supreme Court decisions have affected disability 

policy in the past two decades. Appendix III outlines some cases that have 

resulted in such changes. 

SSA implemented its current policy of acquiescence in 1990 in response to 

the concerns of external stakeholders, including claimant representatives,

that SSA had failed in the 1980s to offer timely and appropriate responses 

to appellate court decisions.9

 With the acquiescence ruling, SSA agrees to

follow the appellate court’s holding on new cases only when they fall 

within the jurisdiction of that appellate court. SSA rescinds an 

acquiescence ruling if one of the following occurs: 1) the Supreme Court 

overrules or limits the relevant appellate court decision; (2) an appellate

court overrules or limits itself on the relevant issue; (3) Congress enacts a 

law that obviates the acquiescence ruling; or (4) SSA clarifies, modifies, or 

revokes the regulation or ruling that was the subject of the pertinent 

appellate court decision.

Disability Service 

Improvement Process 

With new regulations issued in March 2006, SSA began implementing the 

Disability Service Improvement (DSI) process in August 2006 on a limited 

basis—i.e., in states in the Boston Region—and plans to gradually roll out

the initiative to other regions. The regulations include changes to the 

appeals process within the agency that could potentially affect the number 

and types of cases that will go to federal courts in the future. Among these 

changes is the gradual replacement of the Appeals Council with a Decision

Review Board, designed to ensure the accuracy of SSA decisions and 

reduce remands from federal courts. The Board would only review select

cases based on whether they are considered likely to have contained 

errors or involved new policies, rules, and procedures. Under the DSI 

process, claimants who are unhappy with ALJ decisions, therefore, could 

no longer turn to the Appeals Council, but rather must appeal directly to 

the federal courts. In our June 2006 testimony, we reported that the public

and stakeholders were concerned that replacing the Appeals Council with 

a Decision Review Board may increase the number of cases appealed to, 

and thus the workloads of, the federal courts.10 In its response to these 

 9

 The agency adopted the policy in 1985, but established regulations explaining how it 

would implement this policy in 1990. 

10 See GAO, Social Security Administration: Agency Is Positioning Itself to Implement 

Its New Disability Determination Process, but Key Facets Are Still in Development, 

GAO-06-779T (Washington, D.C.: June 15, 2006). 

Page 11 GAO-07-331 SSA's Disability Determination Process
concerns, SSA officials maintained that DSI improvements will ultimately 

reduce the need for court appeals and also reduce remands. As part of its 

DSI initiative, the agency is making a systematic effort to collect and 

analyze data on court decisions in the course of training staff and keeping 

ALJs current. Such monitoring and data collection are consistent with the 

Office of Management and Budget’s and GAO’s internal control standards 

for all federal agencies.11

Between fiscal years 1995 and 2005, the number of disability appeals 

reviewed by the courts and decisions to remand these cases increased, and 

in the majority of remanded cases, claimants were subsequently granted 

benefits by SSA. In 2005, the year for which disaggregated data were 

available, GAO found the proportion of remands by district courts varied 

significantly by circuit. However, GAO did not find substantial variation by 

judicial circuit in SSA decisions on court remanded cases. 

We found that federal district courts reviewed an increasing number of 

disability cases over the past decade, which corresponded with the 

increasing number of cases processed by SSA. Although the number of 

cases reviewed by federal district courts fluctuated over time, they 

generally increased by 20 percent from about 10,300 in fiscal year 1995 to

about 12,400 by fiscal year 2005. (See fig. 3.) According to SSA officials, 

the increase in the number of claims reviewed by the courts may be a 

result of the increase in the number of claims that passed through the 

Appeals Council, SSA’s final decision-making body, over the same time 

period.12

Court Reviews and 

Remands Have 

Increased in Recent 

Years with Remands 

Often Resulting in 

SSA’s Subsequently 

Awarding Benefits 

Cases Reviewed by District 

Courts Increased over the 

Past Decade, as Did the 

Proportion Remanded 

Back to the Agency 

 11 For more information on internal control standards, see GAO, Standards for Internal 

Control in the Federal Government, GAO/AIMD-00-21.3.1 (Washington: D.C.: November 

1999) and Office of Management and Budget, Circular No. A-123, Management’s

Responsibility for Internal Control (Washington: D.C.: Dec. 21, 2004).

12 GAO found that the number of claims that were denied by the Appeals Council and 

eligible for appeal to the courts increased from fiscal years 1994 to 2004 by about 36 

percent. (See app. IV, fig.12.) We are providing information on Appeals Council decisions

over a slightly earlier period than district court data to account for the time lag between 

Appeals Council and district court decisions.

Page 12 GAO-07-331 SSA's Disability Determination Process
Figure 3: Federal District Court Decisions on Disability Claims, Fiscal Year 1995 to Fiscal Year 2005 

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Average

Decisions

Source: GAO analysis of SSA data.

Fiscal year

10,316

9,638

8,660

11,673

13,433

12,011

11,592

13,781

13,298

15,149

12,360 11,992

Over the same period, remands were generally the most common district 

court decision, and their proportion increased by 36 percent from 1995 to 

2005. Of those SSA cases decided by the district courts on the merits and 

not dismissed, 50 percent were remanded, 44 percent were affirmed, and 6 

percent were reversed on average.13 (See fig. 4.) Notably, the proportion of 

remands reached its peak in 2001. Although a range of factors may affect 

the extent of court remands, some SSA officials suggested that the Appeals 

Council, having reviewed a record number of ALJ decisions in 2000, may 

have made mistakes in a greater share of cases that were subsequently 

appealed to, then remanded by, the district courts. 

 13 The courts reviewed approximately 132,000 claims over this period, and of these claims, 

about 7 percent were dismissed. 

Page 13 GAO-07-331 SSA's Disability Determination Process
Figure 4: District Court Decisions on Disability Claims 

0

10

20

30

40

50

60

70

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Average

Percent of claims decided by district courts

Source: GAO analysis of SSA data.

Fiscal year

Percent of SSA decisions remanded back to SSA 

Percent of SSA decisions affirmed

Percent of SSA decisions reversed

36

42

47 49 50

52

62

53 54

49 49 50

44

6

57

52

46

43

42

46

32

40 41

44 46

7 6 7 7 6 5 6 6 5 6 5

Note: This figure excludes cases that were dismissed. 

The proportion of remands exceeded the proportion of affirmances in 

1997 and continued to increase until 2001. Specifically, in 1995 only 36 

percent of SSA decisions were remanded by the courts while 57 percent 

were upheld or affirmed. However, by 1998, the proportion of remands 

increased to 49 percent, while the proportion of affirmances declined to 46 

percent. When we showed SSA officials these trends, they generally 

attributed the shift to the process unification rulings, which the agency

had established in 1996. According to SSA officials, the increased remands 

reflected district court efforts to assure that SSA adjudicators were 

following the agency’s new procedures. 

The Proportion of 

Remanded Cases Varied by 

Circuit 

GAO found substantial variation in the proportion of cases remanded by 

judicial circuit in fiscal 2005, the only year for which data by circuit were

available. (See fig. 5.) Although remands and affirmances were the most 

frequently occurring types of decision in each circuit, the proportion of 

Page 14 GAO-07-331 SSA's Disability Determination Process
each varied considerably among the circuits. Specifically, the percent of 

remands ranged from a low of 35 percent to high of 78 percent, while 

affirmances ranged from 22 percent to 61 percent.

Figure 5: District Court Decisions by Circuit (Fiscal Year 2005) 

Percent of claims decided by district courts

Judicial circuit

Percent of SSA decisions reversed

Percent of SSA decisions affirmed 

Percent of SSA decisions remanded back to SSA

Source: GAO analysis of SSA data.

0

10

20

30

40

50

60

70

80

90

100

1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th DC All

48%

74%

46% 44% 42% 35%

55% 51%

55%

68%

47% 49%

51%

78%

22%

19%

52% 51% 55%

61%

43%

42% 35%

29%

48% 45%

1% 7% 3% 5% 4% 3% 2% 7% 10% 2% 5% 5%

Note: This figure excludes cases that were dismissed. 

SSA officials were not in agreement about why there might be differences 

in the types of decisions across judicial circuits. According to some, 

differences might be due to judges in different circuits interpreting 

disability laws differently. Others told us that disparities in the number of 

claims appealed to district courts across circuits may contribute to these 

differences. (See app. IV, fig. 14 for more information on the number of 

cases reviewed by circuit for fiscal year 2005.) Currently, SSA does not 

have sufficient data that would allow them to determine why these 

decisions vary by circuit but plans to obtain this information as part of the 

DSI process implementation. 

Page 15 GAO-07-331 SSA's Disability Determination Process
Of the 57,000 cases remanded by the district courts between 1995 and 

2005, SSA awarded benefits to the majority of claimants—about 66 

percent—upon re-adjudication, with the remainder being denied (about 30 

percent) or dismissed (5 percent). (See fig. 6.) Agency officials said the 

large percentage of awards in remanded cases were due, in part, to the 

fact that the lengthy period of the appeals process increased the likelihood 

that the nature or severity of claimants’ disabilities would change. The 

officials also attributed the awards to information in the court’s written 

judgments that made it possible for ALJs, in reviewing cases anew, to 

make more accurate decisions. The proportion of allowances in courtremanded cases after re-adjudication is just below the average allowance

rate of 70 percent for all ALJ decisions. 

In the Majority of 

Remanded Cases, 

Claimants Were Awarded 

Benefits 

Figure 6: SSA Decisions on Remanded Disability Claims, Fiscal Year 1995 to Fiscal Year 2005 

0

10

20

30

40

50

60

70

80

90

100

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Average

Percent of remanded claims reviewed by SSA

Source: GAO analysis of SSA data.

Fiscal year

percent of remanded claims dismissed

percent of remanded claims denied

percent of remanded claims allowed

70

59 58 60

64 65

68 69 66 67 68 66

26

38

4 6 6 4 5 5 5 5 5 5 5 5

37 35

31 30

27 25

28 29 28 30

Note: Some percentages may exceed 100 due to rounding. Because cases can be appealed and 

remanded more than once, GAO included in its analysis only claims that SSA determined had never 

before been remanded to the agency from the courts. Such cases made up about 92 percent of the

sample of remands re-decided by SSA between 1995 and 2005. See appendix III, figure 13 for 

information on the number of cases re-decided by SSA over this period. 

We did not find substantial variation in SSA decisions on court-remanded 

claims across judicial circuits. As shown in figure 7, the proportion of 

Page 16 GAO-07-331 SSA's Disability Determination Process
allowances for remanded cases ranged from 62 percent to 72 percent by

circuit—relative to a national average of 66 percent. 

Figure 7: SSA Decisions on Disability Claims Following Court Remands by Judicial Circuit, Fiscal Year 1995 to Fiscal Year 

2005 

Percent of remanded claims reviewed by SSA

Judicial circuit

Percent of claims dismissed

Percent of claims denied

Percent of claims allowed

Source: GAO analysis of SSA data.

0

10

20

30

40

50

60

70

80

90

100

1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th DC All

72% 64%

68% 68%

64%

62% 62%

66%

62%

69% 69%

66%

24%

31%

28% 27%

30% 34% 32% 30% 31%

27% 25% 30%

4% 5% 4% 5% 5% 4% 6% 4% 7% 4% 5% 5%

59%

35%

6%

Note: GAO used the claimants’ state of residence reported by SSA to determine judicial circuit. 

According to agency officials and stakeholders, a range of errors 

precipitated by heavy workloads is responsible for court remands of SSA’s 

disability determinations, but SSA data that would confirm or clarify 

reasons for remands are incomplete and not well managed. SSA has 

acknowledged the need to reduce remands and in 2006, along with other 

initiatives, introduced a new writing tool for ALJs in order to improve 

efficiency and better document decisions. However, agency data that 

would inform the problem and help address remands are incomplete and

not well managed. 

Remands Have Been 

Attributed to a Range 

of Errors Caused by 

Heavy Workloads, but 

SSA Data That Could 

Shed More Light on 

the Problem Are 

Inadequate 

Page 17 GAO-07-331 SSA's Disability Determination Process
Stakeholders commonly cited two reasons for remands: written 

explanations that did not support the decisions and inadequate 

documentation of consideration given to medical evidence. They 

expressed the view, however, that errors made with respect to 

documenting decisions were due, in large part, to heavy SSA adjudicator 

workloads. Poor decision writing by ALJs and their staff was cited by all 

groups of stakeholders we interviewed, including SSA officials, district 

court judges, claimant representatives, and other stakeholders. 

Specifically, district court judges said they did not always believe that 

SSA’s decisions were wrong, but that the written explanations did not 

always support those decisions. Some claimant representatives said that 

poorly written decisions may be symptomatic of improper consideration 

of evidence and procedures by ALJs. 

Stakeholders Attribute 

Various Reasons for 

Remands to High SSA 

Workloads

With regard to the inadequate documentation of consideration given to 

medical evidence as a reason for remands, district court judges and 

claimant representatives we interviewed said ALJs either do not document 

how they weighed treating physicians’ opinions and assessed claimant 

statements about pain and other symptoms, or they do not consider them 

as required by the process unification rulings. ALJs we interviewed 

responded that addressing such evidence is sometimes very difficult and 

cited cases in which the treating physician appeared to be simply 

repeating claimants’ opinions about their inability to work, rather than 

offering substantive information about the conditions that would prevent 

work. Some district judges agreed that considering and incorporating 

medical evidence into a decision can be difficult, but stressed the 

importance of articulated and well-documented opinions in order for 

district court judges to make a decision other than to remand. 

Stakeholders we interviewed varied in their opinions regarding whether 

requirements of the process unification rulings were overly cumbersome 

and, therefore, resulted in remands. Members of the Appeals Council and 

the Social Security Advisory Board staff we spoke with believe that the 

process unification rulings provide important guidance, but have also 

made procedures for making decisions and decision-writing more 

cumbersome. On the other hand, representatives of the Association of 

Administrative Law Judges told us that they have not heard such 

complaints and, while acknowledging that decision-making involved more 

work, believe the rules did not make decision-writing overly cumbersome. 

At the same time, many of those we interviewed, including ALJs and 

district court judges, said the heavy ALJ workload was behind the 

apparent errors in documenting agency determinations that lead to 

Page 18 GAO-07-331 SSA's Disability Determination Process
remands. Some ALJs asserted that the frequency of court remands has not

been unreasonable considering the number of cases that they must 

review.14 These ALJs also said their workload expectations of 50 to 60

hearings a month affected the time and attention they could give to each 

case.15 They asserted that they would need to write significantly fewer 

decisions in a month in order to assure that the work would withstand 

scrutiny by the federal courts. They noted that other ALJs who are able to

write decisions that the courts uphold produce as few as five a month. 

Because the time needed to review cases and write decisions varied, 

however, representatives of the Association of Administrative Law Judges

were unable to suggest an ideal number of cases that would be reasonable

for ALJs to process. Specifically, these representatives said that decisions 

to deny benefits take substantially longer to document than those 

involving allowances. These representatives also stated that the number 

and quality of staff that ALJs have available to help process and write 

decisions vary.16

Finally, stakeholders also suggested that a variety of other factors 

contribute to remands, such as: ALJs’ providing poor instructions to 

decision writers, SSA’s not providing adequate feedback to ALJs on 

reasons for remands, and federal courts’ having bias against ALJs’ 

decisions. Some stakeholders further stated that federal court bias may be 

rooted in concerns over how well decisions are generally written, 

expectations about how determinations should be made, and concerns 

with the amount of time and attention given to cases under the current 

workload. 

Acknowledging the need to address remands from the federal court, SSA 

is taking steps to mitigate common documentation errors. One step has 

been to promote the use of a decision-writing tool known as the Findings 

Integrated Templates (FIT). This tool contains more than 1,600 templates

for presenting analysis of evidence and ensuring that required statutes and 

regulations are followed. These templates are also designed to prevent 

common mistakes, such as failure to establish an appropriate date for the 

 14 For example, in fiscal year 2005, ALJs issued 524,362 decisions. 

15 However, because claimants may not appear as scheduled at hearings and SSA officials 

may not always be able to schedule this many cases, ALJs on average reviewed about 35 

cases per month in fiscal year 2006. 

16 Disability decisions are typically written by SSA decision-writers, who follow ALJ 

instructions on supporting the conclusion and citing pertinent evidence or testimony. 

Page 19 GAO-07-331 SSA's Disability Determination Process
onset of disability benefits. SSA officials also said this tool is intended to 

help manage workloads by reducing the potential for miscommunication 

between ALJs and their staff and the time spent writing decisions. 

According to SSA officials, SSA plans to monitor the extent to which 

decisions written with this tool are remanded from the federal courts. 

Appeals Council judges we interviewed have reviewed some decisions 

written with FIT and have found them to be better articulated than 

decisions that did not rely on this tool. However, both Appeals Council 

judges and ALJ association representatives mentioned that the tool will 

not replace the need for additional, competent decision-writing staff. 

Additionally, SSA is pursuing a broader set of initiatives under its 

Disability Services Improvement (DSI) initiative that it hopes will result in 

more accurate decisions earlier in the process and, thereby, ultimately 

reduce workloads at the ALJ level. For example, as a part of DSI, SSA is 

implementing an expedited determination process for clear-cut cases, 

which it calls its Quick Disability Determinations. The agency also plans to 

add a level of reviewing attorneys, known as federal reviewing officials, 

who can affirm, reverse, or modify appealed agency decisions prior to 

their reaching ALJs. However, DSI is currently underway only in the 

Boston Region, and SSA has yet to evaluate the effectiveness of this 

initiative. 

Agency Remand Data Are 

Incomplete and Not Well 

Managed 

While SSA collects data on reasons for remands, we found that the data

are not well managed, incomplete, and therefore not reliable. Two 

separate SSA offices recently began collecting data on remanded cases to

identify and track the reasons for remands in order to help train ALJs and 

their staff on how to reduce the number of remands. Nevertheless, while 

the two offices were collecting and using the data for the same purpose—

training—they told us that they were not collaborating. When the two 

offices—the Office of Disability Adjudication and Review (ODAR) and the 

OGC—developed lists of categories to group reasons for remands, the 

offices did not consult with each other. As a result, the lists of categories 

used by these offices are not the same, and SSA officials told us that the 

offices may well classify similar remands differently. Moreover, some 

remand categories in the two data systems may be duplicative, resulting in

an inefficient use of agency resources. SSA officials acknowledged that 

better data reliability and collaboration between the two offices are 

needed and that, while the agency plans to develop a common vocabulary 

for remand reasons, it has yet to develop specific plans and timetables for 

addressing these issues. 

Page 20 GAO-07-331 SSA's Disability Determination Process
Through our conversations with SSA officials and reviews of reports, we 

also found that these data were not consistently entered into the agency’s 

databases. Within both systems, at least one reason should be entered per 

remanded case, but this did not always occur; instead, we found the extent

to which this information was entered varied by database and SSA 

regional office. For the OGC reports, we found that the number of reasons 

recorded exceeded the number of cases, as would be expected; however 

officials were not confident that the data on remands reasons were 

accurate or complete because the officials have not been able to assess the 

quality of the data. Within the ODAR reports for fiscal years 2005 and 2006,

on the other hand, there were substantially fewer reasons reported than 

cases.17 Regional reports showed that SSA’s Seattle and New York offices 

have been collecting the most information on remands. Notably, the 

agency’s Boston office––which is the first to implement the structural 

changes of DSI––and the Philadelphia office have collected the least 

amount of information. SSA officials told us that they were aware that 

remand data were not entered into ODAR’s system consistently in early 

fiscal year 2005, and said they subsequently reiterated the importance of 

collecting this information to staff. SSA officials also mentioned that they

are considering making remand reasons a mandatory field in the ODAR 

database to improve collection. 

SSA officials have a process in place for determining whether appellate

court decisions conflict with the agency’s interpretation of disability 

statutes or regulations, and the agency has taken steps in recent years to 

align its policies nationally with appellate court decisions. In those cases 

where the agency acceded to certain appellate court rulings by issuing 

acquiescence rulings, we found that about half of the rulings were 

eventually replaced with national policy. Also, we found that the number 

of acquiescence rulings has declined in more recent years, a decline that 

SSA officials mainly attributed to the agency’s implementation of its 

process unification rulings of 1996, which officials believe created less 

room for differences of opinion between the courts and the agency

regarding broader policies. Moreover, we found that the timeliness of 

acquiescence rulings had improved since 1998, when SSA established a 

timeliness goal of 120 days. 

SSA Has Taken 

Several Steps Since 

1990 to Align Its 

Policies Nationally 

with Court Decisions 

 17 Specifically in fiscal year 2005, ODAR data listed 7,244 cases as being remanded but 4,668

reasons for remands. In fiscal year 2006, the data listed 6,290 cases as being remanded and 

5,434 reasons for remands. 

Page 21 GAO-07-331 SSA's Disability Determination Process
When an appellate court decision is rendered, SSA officials review the 

decision to determine whether it conflicts with agency interpretation of 

law or regulations. The primary office responsible for this evaluation is the 

OGC, SSA’s office responsible for legal matters. For disability issues, OGC 

works in conjunction with the Office of Disability Programs, SSA’s office 

responsible for policy matters.18 These offices may consult with the Office

of Disability Adjudication and Review, which rendered the agency’s final

decision prior to its being appealed to federal court, as well as the 

Department of Justice (DOJ), the entity generally responsible for 

representing SSA in federal court. 

SSA Has a Process in Place 

for Reviewing and 

Addressing Appellate 

Court Decisions that 

Conflict with the Agency’s 

Interpretation of Law or 

Regulations 

If SSA determines that the appellate court decision conflicts with its 

policy, then it decides whether to appeal the case to the Supreme Court or 

to modify its policy to conform with that decision.19 According to officials, 

SSA rarely challenges appellate court decisions, and decisions to appeal 

are ultimately the prerogative of DOJ, because DOJ represents SSA in 

court. Some of the situations in which SSA would consider appealing to

the Supreme Court are: a conflict between circuits; an issue of exceptional 

importance involving high visibility or significant funds; a statute or 

regulation held by the courts to be unconstitutional; or an important 

regulation held to be invalid. 

If SSA decides to follow the appellate court decision, it issues an 

acquiescence ruling that applies only within that circuit. However, because

these rulings result in inconsistent policies throughout the country, the 

agency has added a clarification in the preamble to its 1998 regulations 

that acquiescence rulings are generally temporary policies that are not 

intended to remain in effect permanently. Therefore, after issuing an 

acquiescence ruling, SSA attempts to pursue a uniform national policy 

through various means, such as modifying regulations or rules, issuing 

new regulations or policy interpretations, seeking legislative changes, or 

 18 For nondisability issues, OGC works in conjunction with the appropriate component, 

such as the Office of Income Security Policy. 

19 SSA may also ask the original panel of circuit court judges to rehear an issue, or ask the

entire U.S. Court of Appeals to rehear an issue(s) en banc. 

Page 22 GAO-07-331 SSA's Disability Determination Process
re-litigating the issue within the same circuit.20 When SSA successfully 

incorporates the acquiescence ruling into national policy, it rescinds the 

acquiescence ruling.21

When SSA finds it necessary to issue an acquiescence ruling, it has 

procedures in place for informing adjudicators of these departures from 

national policy. According to officials, SSA communicates these and other

rulings to SSA officials who make claims determinations, such as ALJs, 

through a variety of sources including: the Federal Register, SSA’s internal 

operations manual, the agency’s Web site, and e-mails. In some instances, 

officials learn about these rulings through training sessions. However, 

because most acquiescence rulings since the 1990s concerned narrow 

issues, SSA officials said the rulings have not warranted special training 

for adjudicators. 

SSA Has Taken Steps to 

Align Its Policies with 

Court Decisions by Issuing 

Acquiescence Rulings 

More Quickly and 

Following with Changes in 

National Policy 

SSA has taken steps to align its policies with the court decisions by issuing 

acquiescence rulings in a timely manner and following up with changes to 

its national policies. Since the implementation of its current acquiescence

policy, SSA has issued 45 acquiescence rulings, the majority of which 

relate to determining whether a claimant is eligible for disability benefits. 

(Fig. 8 shows the number of rulings issued each year from 1990 to 2006, 

and app. V provides synopses of court holdings concerning disability 

determinations that led to acquiescence rulings.) Most of these rulings 

were issued between 1990 and 2000, when SSA published an average of 

four acquiescence rulings per year. In contrast, during the 6-year period 

from 2001 to 2006, the agency issued only five such rulings. SSA officials 

attributed the decline in acquiescence rulings to implementation of its 

process unification rulings, which they believe created less room for 

differences of opinion between the courts and the agency regarding 

 20 One way SSA interprets policies is to issue Social Security Rulings, which may be based 

on case decisions made at all administrative levels of adjudication, federal court decisions, 

Commissioner’s decisions, opinions of OGC, and other policy interpretations of the law and 

regulations. Our analysis showed that of SSA’s 68 Social Security Rulings issued since 1990, 

24 percent were based on court decisions. About half of these rulings are related to

disability issues.

21 Other circumstances leading to rescission of an acquiescence ruling include a Supreme 

Court decision overruling or limiting a circuit court holding that is the basis of an

acquiescence ruling; a circuit court overruling or limiting itself on an issue that was the 

basis of an acquiescence ruling; or enactment of a federal law that removes the basis for 

the holding in a decision of a circuit court that was the subject of an acquiescence ruling. 

See 20 CFR 404.985 (e). 

Page 23 GAO-07-331 SSA's Disability Determination Process
broader policies. Specifically, officials commented that the process 

unification rulings clarified SSA policy as well as filled gaps in policy that

were previously open for the courts to fill, and noted that, while the courts 

are not bound by these and other Social Security Rulings, the courts have 

frequently deferred to SSA’s rulings. 22 As a result, SSA has seen a decline 

in the number of significant court cases involving disability law over time. 

(See app. III for a listing of key court cases.) 

Figure 8: Number of Acquiescence Rulings Issued, 1990 to 2006 

Number of acquiescence rulings

Source: GAO analysis of SSA data.

Year

0

1

2

3

4

5

6

7

8

9

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 '

4

1

6 6

2 2

1

4

5

4

5

1

0

1 111

We found that the number of acquiescence rulings issued by SSA varied by

circuit during our study period (1990 to 2006), ranging from one in the 

First Circuit to eight in the Ninth Circuit. (See fig. 9.) SSA officials pointed 

out that the number of acquiescence rulings the agency issues in a given 

circuit is a function of the number and types of decisions issued by the 

appellate court within that circuit. For example, officials said that the 

Ninth Circuit has the largest disability caseload, and therefore, one would 

expect it to have the highest number of acquiescence rulings.23 Also, 

because the Ninth Circuit’s decisions largely concerned technical issues, 

 22 Although Social Security Rulings do not have the force and effect of law or regulations, 

they are binding on all components of SSA. 

23 See appendix IV, figure 14 for more information on caseloads by circuit.

Page 24 GAO-07-331 SSA's Disability Determination Process
SSA officials said they were less amenable to Supreme Court Review. This

official added that the Ninth as well as Eighth Circuits have had precedentsetting decisions. 

Figure 9: Number of Acquiescence Rulings by Circuit, 1990 to 2006 

Number of acquiescence rulings

0

1

2

3

4

5

6

7

8

9

10

1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th

Source: GAO analysis of SSA data.

Circuit

1

6

2

5

2

7

2

5

8

3

4

Since SSA established a regulation in 1998 that included a timeliness goal 

for issuing acquiescence rulings, the promptness of issuances has 

improved. (Fig. 10 depicts the timeliness of acquiescence rulings issued 

from 1990 to 2006.) Prior to establishing the regulation, SSA took more 

than a year to issue over 80 percent of the rulings. Since then, 54 percent 

of acquiescence rulings were issued within the guideline of 120 days (or 4 

months). For those rulings that were not issued within 120 days, in most 

instances the timeliness goal did not apply because SSA either sought 

further judicial review or needed to coordinate with DOJ or other federal 

agencies. 

Page 25 GAO-07-331 SSA's Disability Determination Process
Figure 10: Timeliness of Acquiescence Rulings, 1990 to 2006 

0

10

20

30

40

50

60

70

1-4 Mo. 4-12 Mo. 1-2 Yrs. 2-5 Yrs 5+ Yrs.

Percentage of rulings

Time taken to issue ruling

Source: GAO analysis of SSA data.

Jan. 1, 1990 to June 4, 1998

June 5, 1998 to Dec. 31, 2006

54%

0%

16%

38%

47%

8%

19%

0%

19%

0%

Court decision issued:

Note: Percentages do not add up to 100 due to rounding. 

Once SSA has issued acquiescence rulings, the agency has frequently

succeeded in replacing them with uniform national policies. We found that 

since 1990, nearly half of all acquiescence rulings (21 of 45) were 

rescinded and replaced by more permanent guidance.24 Further, most of 

these rescissions resulted from the agency’s issuing or modifying rulings 

or regulations. (Fig. 11 shows how acquiescence rulings were rescinded.) 

According to officials, acquiescence rulings are most commonly rescinded 

when the agency revises, publishes, or revokes rules and regulations—

actions that are fully within the agency’s control. Six other rescissions 

occurred through other means: three from Supreme Court rulings 

upholding SSA’s policies and three from changes in law made by Congress. 

 24 According to our analysis, 27 of the 45 rulings relate directly to determining whether a 

claimant is eligible for disability benefits. As indicated in appendix V, more than half (15 of 

27) of these acquiescence rulings were rescinded. 

Page 26 GAO-07-331 SSA's Disability Determination Process
Figure 11: How Acquiescence Rulings Were Rescinded, 1990 to 2006 

Manner of rescission

Number of rulings

Source: GAO analysis of SSA data.

012 3 4 5 6 7 8 9 10 11 12 13 14 15

Congress

amended law

Supreme Court

decision

Agency published

rules or regulations 15

3

3

However, according to SSA, some issues brought about by federal court 

decisions, such as those involving the Constitution or federal law, have led 

to acquiescence rulings that have not been rescinded by the agency. For 

example, acquiescence ruling 91-1(5), which involves a claimant’s right to

cross-examine an examining physician, remains in effect because SSA 

officials believe the only option for rescinding the ruling would require relitigating the case.25 However, according to SSA officials, the relevant

circuit appellate court and the Supreme Court have declined to review this

ruling. Other reasons that acquiescence rulings may remain in effect 

include a lack of practical implications of the acquiescence ruling for other 

circuits or the fact that an acquiescence ruling was only recently issued.

Replacing the acquiescence ruling with nationwide policy typically takes a 

significant period of time—in one case, 16 years.

On the whole, SSA has taken many steps to align its policies with court 

decisions and establish uniform national standards. The fact that the 

agency made some substantial changes to its policies in the mid-1990’s 

Conclusions 

 25 SSA may re-litigate the case within the same circuit when the General Counsel of SSA, in

consultation with DOJ, concurs that re-litigation of an issue is appropriate and SSA has 

published a notice in the Federal Register of its intent to re-litigate an acquiescence ruling

issue. In addition, SSA may re-litigate a case when one of the following events occurs: an

action by both Houses of Congress indicates that an appellate court decision was decided 

inconsistently with congressional intent, a statement in a majority opinion of the same 

circuit indicates that a court might no longer follow its previous decision, subsequent 

appellate court precedent in other circuits supports SSA’s interpretation of the Social 

Security Act or regulations, or a subsequent Supreme Court decision presents a reasonable

legal basis for questioning the appellate court decision. 

Page 27 GAO-07-331 SSA's Disability Determination Process
may account for the reduced incidence of acquiescence rulings in the past 

5 years. 

On the other hand, the high proportion of remanded and awarded claims 

for the past decade has likely cost SSA additional time and resources to 

process, and may have impeded the timely award of benefits to eligible

individuals. While the DSI improvement initiative is designed to ameliorate 

this problem, the lack of reliably collected and well-managed data on court 

remands is likely to inhibit that effort. Although SSA plans, through the 

implementation of DSI, to gradually address the heavy workload that has 

been cited by many for contributing to errors that lead to remands, the 

agency cannot pinpoint specific reasons for remands and take corrective 

action without more reliable data. To the degree that the agency does 

collect some data, the fact that collection is carried out by two different 

offices risks inconsistency and divergent interpretations. This lack of 

complete and consistent information ultimately undermines the agency’s 

ability to serve people with disabilities and their families. 

To ensure the agency has accurate and well-managed information to use in

identifying corrective actions for reducing remands, we recommended that 

the Commissioner of SSA implement the following two measures: 

• take steps to ensure the reliability of data on reasons for remands, and 

• coordinate agency data collection on remands and ascertain how best 

to use this information to reduce the proportion of cases remanded by 

federal courts. 

SSA provided us with comments on a draft of this report, which we have 

reprinted in appendix VI. In its comments, SSA agreed with both of our 

recommendations for improving data on remands and outlined actions it 

plans to take to enhance data reliability and collection. Specifically, in an 

upcoming update to the Case Processing Management System, SSA plans 

to make the reasons for remands a mandatory data input field. In addition,

SSA plans to establish an intercomponent work group to address issues 

related to remand data, and analyze data on the use of the Findings 

Integrated Templates and court decisions. 

Recommendations 

Agency Comments 

SSA also provided technical comments which generally improved the 

accuracy of the report, and we have incorporated them as appropriate. 

Page 28 GAO-07-331 SSA's Disability Determination Process
Copies of this report are being sent to the Commissioner of SSA, 

appropriate congressional committees, and other interested parties. The 

report is also available at no charge on GAO’s Web site at 

http://www.gao.gov. 

Please contact me on (202) 512-7215 if you or your staff has any questions

concerning this report. Contact points for our Offices of Congressional 

Relations and Public Affairs may be found on the last page of this report. 

Other major contributors to this report are listed in appendix VII. 

Daniel Bertoni 

Director, 

Education, Workforce, and Income Security Issues 

Page 29 GAO-07-331 SSA's Disability Determination Process
Appendix I: Objective, Scope, and Appendix I: Objective, Scope, and Methodology 

Methodology 

We designed our study to obtain information on (1) the trends of the past 

decade in the number of appeals reviewed by the district courts and their 

decisions; (2) the reasons for court remands and factors that may 

contribute to the incidence of those remands; and (3) SSA’s process for 

responding to appellate court decisions that conflict with agency policy 

and the agency’s response in recent years. To obtain information on these 

issues, we collected relevant quantitative and qualitative data from SSA; 

interviewed SSA officials and stakeholders within and outside the agency,

such as district court judges, claimant representatives and experts; and 

reviewed agency policies and regulations that address appellate court 

rulings that conflict with SSA disability program policies. To determine the 

completeness and accuracy of data we obtained, we took steps, described 

below, and determined that these data, with the exception of reasons for 

remand, were sufficiently reliable for use in this report. We conducted this

work between February 2006 and January 2007 according to generally

accepted government auditing standards. 

To address the first research objective, we obtained national data from 

SSA on the number and decisions of cases reviewed by federal district 

courts—the first level of federal court review—for fiscal years 1995 to 

2005 and analyzed these data for trends over time. Our analysis excluded

cases that were dismissed because dismissals are generally decided on 

technical and procedural grounds rather than on the merits of the claim. 

For fiscal year 2005, the only year for which complete data were available,

we obtained information from SSA on court decisions by state. We then 

categorized and analyzed these data by circuit. Furthermore, we obtained

and analyzed agency data on the decisions SSA made on disability cases 

after they were remanded (i.e., allowances or denials of claims) for fiscal 

years 1995 to 2005. We also categorized and analyzed these data by circuit 

using information on the claimant’s state of residence. SSA officials were 

interviewed to gather information on potential reasons for any trends. In 

addition, we interviewed SSA officials and reviewed previously issued 

agency reports and data manuals to assess the reliability of these data. 

To address the second objective, we also obtained data on cited reasons 

for remands from two SSA databases, the Case Processing and 

Management System (CPMS), and the National Docketing/Management 

Information System (NDMIS), which are maintained by two separate 

offices in SSA responsible for re-adjudicating remanded cases and 

litigating claims in court. We compared the data to determine how and 

what SSA is reporting on reasons for remands within the agency. After 

interviewing agency officials and reviewing reports, we determined that 

these data were not sufficiently reliable for providing detailed information 

Page 30 GAO-07-331 SSA's Disability Determination Process
Appendix I: Objective, Scope, and 

Methodology 

on reasons for remands, although some information was used to illustrate 

what SSA currently collects. In addition, we interviewed SSA officials and

other stakeholder groups, including federal court judges and claimant 

representatives from the Seventh and Ninth circuits and experts, on 

reason for remands and factors that influenced them. Stakeholders from 

these two circuits were selected because these jurisdictions represent 

those with the lowest and highest numbers of SSA policy changes resulting 

from acquiescence rulings. Information from these interviews is not 

generalizable to all circuits or stakeholders. 

For the third objective, we interviewed SSA officials and obtained 

available documents on how SSA determines whether a court of appeals 

decision conflicts with its policies and what option to pursue to address 

conflicting decisions, e.g., appeal or issue an acquiescence ruling whereby 

the agency agrees to abide by the court judgment in future cases, albeit 

only in that jurisdiction. We also obtained data on the number of 

acquiescence and other rulings that SSA issued since establishing its 

policy of acquiescence in 1990. For acquiescence rulings, we further 

reviewed SSA’s timeliness in issuing acquiescence rulings as well as the 

number issued by circuit and how SSA replaced acquiescence rulings with 

nationwide policies. We were unable to independently determine the 

extent to which court decisions conflicted with SSA policy or whether SSA 

should have pursued one option over another. We also interviewed SSA 

officials and relevant stakeholders, including selected federal court judges

and claimant representatives, to obtain information on how court 

decisions and their related agency rulings have affected SSA disability 

adjudication policy in recent years. 

Page 31 GAO-07-331 SSA's Disability Determination Process
Appendix II: Summary of Process Unification Appendix II: Summary of Process Unification Rulings 

Rulings 

• SSR 96-1p: “Application by the Social Security Administration of 

Federal Circuit Court and District Court Decisions.” Policy 

interpretation stating that SSA decision-makers will be bound by SSA’s 

nationwide policy until an acquiescence ruling is issued and that SSA 

does not acquiesce to federal district courts within a circuit. 

• SSR 96-2p: “Giving Controlling Weight to Treating Source Medical 

Opinions.” Policy guidance for applying the regulatory provision that 

requires the adoption of a treating source’s medical opinion on the 

nature and severity of an impairment when the opinion is not 

inconsistent with other substantial evidence in the claimant’s file and 

the opinion is supported by medically acceptable diagnostic 

techniques. 

• SSR 96-3p: “Considering Allegations of Pain and Other Symptoms in 

Determining Whether a Medically Determinable Impairment is Severe.” 

Policy interpretation on the consideration of symptoms in determining 

whether an impairment is “severe” at step 2 of the sequential evaluation 

process. 

• SSR 96-4p: “Symptoms, Medically Determinable Physical and Mental 

Impairments, and Exertional and Nonexertional Limitations.” Policy 

interpretation explaining, among other things, that symptoms are not 

medically determinable impairments; that limitations, not impairments, 

are categorized as “exertional” or “nonexertional”; and that symptoms 

may result in nonexertional or exertional limitations. 

• SSR 96-5p: “Medical Source Opinions on Issues Reserved to the 

Commissioner.” Policy interpretation on evaluating medical source 

opinions on issues such as whether an individual’s impairment(s) 

meets or is equivalent in severity to the requirements of a listing in 

SSA’s Listing of Impairments; what an individual’s residual functional 

capacity is; whether an individual’s residual functional capacity 

prevents him from doing past relevant work; and how the vocational 

factors of age, education, and work experience apply. 

• SSR 96-6p: “Consideration of Administrative Findings of Fact by State 

Agency Medical and Psychological Consultants and Other Program 

Physicians and Psychologists at the ALJ and Appeals Council Levels of 

Administrative Review; Medical Equivalence.” Policy interpretation 

regarding weight given to Disability Determination Services level 

medical and psychological consultant findings at the ALJ and Appeals 

Council levels. Explanation of requirements for ALJs and the Appeals 

Council to obtain the opinion of a physician or psychologist designated 

Page 32 GAO-07-331 SSA's Disability Determination Process
Appendix II: Summary of Process Unification

Rulings 

by the Commissioner in making a determination about equivalence to 

the listings. 

• SSR 96-7p: “Evaluation of Symptoms in Disability Claims: Assessing the 

Credibility of an Individual’s Statements.” Policy interpretation on 

when the evaluation of symptoms, including pain, requires a finding 

about the credibility of an individual’s statements about pain and 

symptoms, and the factors to be considered in assessing the credibility 

of such statements. 

• SSR 96-8p: “Assessing Residual Functional Capacity in Initial Claims.” 

Policy clarification of the term residual functional capacity and 

discussion of the elements considered in assessing residual functional 

capacity. 

• SSR 96-9p: “Determining Capability to Do Other Work—Implications of 

a Residual Functional Capacity for Less Than a Full Range of Sedentary 

Work.” Policy interpretation on the impact of a residual functional 

capacity assessment for less than a full range of sedentary work on an 

individual’s ability to do other work. 

Page 33 GAO-07-331 SSA's Disability Determination Process
Appendix III: K

Soc

Adjudication 

ey Federal Court Rulings on

ial Security Administration Disability 

Page 34 GAO-07-331

Appendix III: Key Federal Court Rulings on 

Social Security Administration Disability 

Adjudication 

Heckler v. Campbell, 461 U.S. 458 (1983) 

The U.S. Supreme Court upheld SSA’s use of its vocational grid 

regulations.

Hyatt v. Heckler, 579 F.Supp. 985 (W.D.N.C. 1984)

In a class action, the U.S. District Court for the Western District of North 

Carolina found SSA’s policy on pain contrary to Fourth Circuit law. This 

ruling enjoined SSA from refusing to follow the law of the circuit. 

Lopez v. Heckler, 725 F.2d 1489 (9th Cir. 1984) 

The Ninth Circuit Court of Appeals enjoined SSA to uphold prior decisions 

requiring SSA to apply a medical improvement standard before 

terminating benefits. 

Stieberger v. Heckler, 615 F.Supp. 315 (S.D.N.Y. 1985) 

In a class action, the U.S. District Court for the Southern District of New 

York ruled that SSA had violated the rights of claimants by not following 

circuit court law on the weight to give treating physician evidence. After

this decision SSA introduced its policy of Acquiescence Rulings when the 

agency is not willing to implement an appellate decision nationwide. 

Acquiescence rulings explain how SSA applies decisions of Courts of 

Appeals in the circuit in which the decision was rendered. 

Schisler v. Heckler, 787 F.2d 76 (2nd Cir. 1986) 

The Second Circuit Court of Appeals found that a treating physician’s 

opinion on the subject of medical disability is binding unless contradicted 

by substantial evidence.

Hyatt v. Heckler, 711 F.Supp. 837 (W.D.N.C. 1989)

On remand, the U.S. District Court for the Western District of North 

Carolina found SSA’s policies on pain did not conform to circuit law. The 

court ordered these policies to be cancelled and drafted a new ruling on 

pain for North Carolina adjudicators.

1983 

1984 

1985 

1986 

1989 

SSA's Disability Determination Process
Appendix III: Key Federal Court Rulings on

Social Security Administration Disability 

Adjudication 

Sullivan v. Zebley, 493 U.S. 521 (1990) 

The U.S. Supreme Court struck down SSA’s regulations for determining 

whether a child is disabled because the regulations denied benefits to 

children whose impairments did not meet or equal the listing of 

impairments and did not allow the child to qualify for benefits based on an 

individualized functional assessment. 

Schisler v. Sullivan, 3 F.3d. 563 (2nd Cir. 1993) 

The Second Circuit Court of Appeals upheld SSA’s 1991 regulations on the 

opinions of treating physicians as a valid use of SSA’s regulatory power. 

Hyatt class action settlement

SSA agreed to re-adjudicate 77,000 cases under the 1991 regulations on the 

evaluation of pain and other symptoms. 

Barnhart v. Walton, 535 U.S. 212 (2002) 

The U.S. Supreme Court upheld SSA’s interpretation that the claimant’s 

inability to work last, or be expected to last, 12 months. The court also 

upheld SSA’s regulation precluding a finding of disability when the 

claimant returns to work within a 12-month period. 

Barnhart v. Thomas, 540 U.S. 20 (2003) 

The U.S. Supreme Court upheld denial of benefits to a claimant who was 

still able to do her previous work without determining whether that type 

of work continued to be available in the national economy. 

1990 

1993 

1994 

2002 

2003 

Page 35 GAO-07-331 SSA's Disability Determination Process
Appendix IV: A

Disability Appe

dditional Information on 

als 

Page 36 GAO-07-331

Appendix IV: Additional Information on 

Disability Appeals 

Appeals Council denials of Social Security disability claims increased by 

about 36 percent from about 48,300 in Fiscal Year 1994 to about 65,800 in 

Fiscal Year 2004. 

Figure 12: Appeals Council Denials of Social Security Claims, Fiscal Year 1994 to Fiscal Year 2004 

0

10

20

30

40

50

60

70

80

90

100

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Average

Number of denials (in thousands)

Source: GAO analysis of SSA data.

Fiscal year

48

38

52

70

79

66

94

80 80

69 66 67

SSA's Disability Determination Process
Appendix IV: Additional Information on 

Disability Appeals 

SSA decisions on disability claims following remands from federal district 

courts increased from about 3,000 in Fiscal Year 1995 to almost 7,500 in

Fiscal Year 2005. 

Figure 13: SSA Decisions on Disability Claims Following Court Remands 

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Number of remanded claims reviewed by SSA

Source: GAO analysis of SSA data.

Fiscal year

2,959 3,149 2,906

3,532

4,944

5,812

5,164

6,505

7,111 7,059

7,476

Page 37 GAO-07-331 SSA's Disability Determination Process
Appendix IV: Additional Information on 

Disability Appeals 

The twelve judicial circuits with district courts that review Social Security

disability claims varied in the number of claims they reviewed in Fiscal 

Year 2005. For example, the District of Columbia District Court reviewed 

less than 100 claims, while the district courts in the Ninth Circuit reviewed

almost 3,000. 

Figure 14: Social Security Claims Reviewed in Federal District Courts in Fiscal Year 2005 by Judicial Circuit 

Number of claims reviewed by district courts

0

250

500

750

1,000

1,250

1,500

1,750

2,000

2,250

2,500

2,750

3,000

1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th DC

Source: GAO analysis of SSA data.

Judicial circuit

290

533

1,209

1,531

1,087

1,914

439

1,553

2,823

778

1,533

26

Page 38 GAO-07-331 SSA's Disability Determination Process
Appendix V: Summary of Court Holdings for 

Acquiescence Rulings Related to Disability 

Determinations

Acquiescence ruling

number and circuit Rescinded? Court holding 

AR 90-3

(4th Circuit) 

X The court held that social security regulations allow the use of a vocational expert only at 

step five of the sequential evaluation process; and therefore, reliance on a vocational 

expert is improper in making the step four determination as to whether a claimant can 

return to past relevant work. 

AR 90-4 

(4th Circuit) 

The court held that SSA can re-open an otherwise final administrative determination at 

any time when a claimant, who had no individual legally responsible for prosecuting the 

claim at the time of the prior determination, established a prima facie case that mental 

incompetence prevented him from understanding the procedure to request administrative 

review, unless SSA holds a hearing and determines that mental incompetence did not 

prevent the claimant from filing a timely appeal. 

AR 91-1 

(5th Circuit) 

The court held that entitlement to a subpoena for cross-examination purposes of an 

examining physician is automatic and must be granted. 

AR 92-2 

(6th Circuit) 

The court held that in deciding the appeal of a determination that an individual’s disability

has medically ceased, the adjudicator must consider the issue of the individual’s disability

through the date of the Secretary of Health and Human Services’ final decision, rather 

than only through the date of the initial cessation determination. 

AR 92-4 

(11th Circuit) 

X The court held that an Appeals Council dismissal of a request for review of an ALJ 

decision for reasons of untimeliness is a “final decision” and subject to judicial review. 

AR 92-6 

(10th Circuit) 

X The court held that a person’s return to substantial gainful activity within 12 months of the 

onset date of his or her disability, and prior to an award of benefits, does not preclude an 

award of benefits and entitlement to a trial work period. 

AR 92-7 

(9th Circuit) 

The court held that an initial determination in the Social Security or SSI programs must 

be reopened when the notice of the initial determination did not explicitly state that the 

failure to seek reconsideration results in a final determination, and the claimant did not 

pursue a timely appeal. 

AR 93-1 

(4th Circuit) 

X The court held that a claimant for disability or SSI benefits who has an IQ score in the 

range covered by listing 12.05C and who cannot perform his or her past relevant work 

because of a physical or other mental impairment has per se established the additional 

and significant work-related limitation of function requirement. 

AR 93-2 

(2nd Circuit) 

X The court held that, in making a determination following an individual’s re-entitlement 

period that an individual with a disabling impairment has engaged in substantial gainful 

activity, the Secretary of Health and Human Services may not consider work and 

earnings by the individual in a single month rather than an average of work and earnings

over a period of months. 

AR 94-2 

(4th Circuit) 

X The court held that, in making a disability determination on a subsequent disability claim 

with respect to an un-adjudicated period, an adjudicator must adopt a finding regarding a 

claimant’s residual functional capacity, made in a final decision on a prior disability claim 

arising under the same title of the Social Security Act unless there is new and material 

evidence. 

AR 95-1 

(6th Circuit) 

X The court held that, in order to find that the skills of a claimant who is close to retirement 

age are “highly marketable” within the meaning of the Secretary of Health and Human 

Services’ regulations, SSA must first establish that the claimant’s skills are sufficiently 

specialized and coveted by employers as to make the claimant’s age irrelevant in the 

hiring process and enable the claimant to obtain employment with little difficulty. 

Appendix V: Summary of Court Holdings for 

Acquiescence Rulings Related to Disability 

Determinations 

Page 39 GAO-07-331 SSA's Disability Determination Process
Appendix V: Summary of Court Holdings for 

Acquiescence Rulings Related to Disability 

Determinations

Acquiescence ruling

number and circuit Rescinded? Court holding 

AR 97-2 

(9th Circuit) 

X The court held that a claimant for Disability Insurance or SSI benefits based on disability 

who has an amputation of a lower extremity and cannot afford the cost of a prosthesis 

has an impairment that meets the listings. 

AR 97-4 

(9th Circuit) 

The court held that, in making a disability determination on a subsequent disability claim 

with respect to an un-adjudicated period, where the claim arises under the same title of 

the Social Security Act as a prior claim on which there has been a final decision by an 

ALJ or the Appeals Council that the claimant is not disabled, SSA must: (1) apply a 

presumption of continuing nondisability and, if the presumption is not rebutted by the 

claimant, determine that the claimant is not disabled; and (2) if the presumption is 

rebutted, adopt certain findings required under the applicable sequential evaluation 

process for determining disability, made in the final decision by the ALJ or the Appeals 

Council on the prior disability claim. 

AR 98-1 

(8th Circuit) 

X The court held that a person’s return to substantial gainful activity within 12 months of the 

onset date of his or her disability, and prior to an award of benefits, does not preclude an 

award of benefits and entitlement to a trial work period. 

AR 98-2 

(8th Circuit) 

X The court held that a claimant for Disability Insurance benefits or SSI benefits based on

disability who has mental retardation or autism with a valid IQ score in the range covered 

by Listing 12.05C and who cannot perform his or her past relevant work because of a 

physical or other mental impairment has per se established the additional and significant 

work-related limitation of function requirement of the regulations. 

AR 98-3

(6th Circuit) 

The court held that, in making a disability determination or decision on a subsequent 

disability claim with respect to an un-adjudicated period, where the claim arises under the

same title of the Social Security Act as a prior claim on which there has been a final 

decision by an ALJ or the Appeals Council, SSA must adopt the finding of the demands 

of a claimant’s past relevant work made in the prior decision unless new and material 

evidence or changed circumstances provide a basis for a different finding. 

AR 98-4 

(6th Circuit) 

The court held that in making a disability determination or decision on a subsequent 

disability claim with respect to an un-adjudicated period, where the claim arises under the

same title of the Social Security Act as a prior claim on which there has been a final 

decision by an ALJ or the Appeals Council, SSA must adopt the finding of a claimant’s 

residual functional capacity made in the final decision by the ALJ or the Appeals Council 

on the prior disability claim unless new or additional evidence or changed circumstances 

provide a basis for a different finding. 

AR 99-2 

(8th Circuit) 

X The court held that SSA is required to find that a claimant close to retirement age and 

limited to sedentary or light work has “highly marketable” skills before determining that 

the claimant has transferable skills and, therefore, is not disabled. 

AR 99-3

(5th Circuit) 

X The court held that SSA is required to find that a claimant close to retirement age and 

limited to sedentary or light work has “highly marketable” skills before determining that 

the claimant has transferable skills and, therefore, is not disabled. 

AR 99-4 

(11th Circuit) 

The court held that an Appeals Council dismissal of a request for review of an ALJ 

decision for reasons of untimeliness is a “final decision” and subject to judicial review. 

AR 00-1 

(4th Circuit) 

The court held that, in making a disability determination on a subsequent disability claim 

with respect to an un-adjudicated period, SSA must consider a finding of a claimant’s 

residual functional capacity made in a final decision by an ALJ or the Appeals Council on 

the prior disability claim as evidence and give it appropriate weight in light of all relevant 

facts and circumstances but that SSA does not have to adopt the finding. 

AR 00-2 

(7th Circuit) 

X The court held that a determination of medical equivalence under the regulations must be 

based solely on evidence from medical sources. 

Page 40 GAO-07-331 SSA's Disability Determination Process
Appendix V: Summary of Court Holdings for 

Acquiescence Rulings Related to Disability 

Determinations

Acquiescence ruling

number and circuit Rescinded? Court holding 

AR 00-3

(10th Circuit) 

X The court held that an ALJ, when receiving evidence from a vocational expert must ask 

the expert how the testimony or information corresponds to information provided in the 

Dictionary of Occupational Titles and must ask the expert to explain the difference if the 

testimony or evidence differs from the Dictionary. 

AR 00-4 

(2nd Circuit) 

X The court held that SSA has the burden of proving at step five of the sequential 

evaluation process that the claimant has the residual functional capacity to perform other 

work which exists in the national economy. 

AR 00-5 

(6th Circuit) 

The court held that a claimant’s return to substantial gainful activity within 12 months of 

the alleged onset date of his or her disability, and prior to an award of benefits, does not 

preclude an award of benefits and entitlement to a trial work period. 

AR 01-1 

(3rd Circuit) 

The court held that SSA may not apply the Medical-Vocational Guidelines (grid rules) as

a frame work to deny disability benefits at step 5 of the sequential evaluation process 

when a claimant has a nonexertional limitation without either: (1) taking or producing 

vocational evidence; or (2) providing notice of the agency’s intention to take official notice

of the fact that the particular nonexertional limitation does not significantly erode the 

occupational job base. 

AR 03-1 

(7th ) 

The court held that for cases concerning Listings 12.05 or 112.05 decided by ALJs or the 

Appeals Council before September 20, 2000, which have been remanded by the courts 

to SSA, the ALJ should apply the pre-September 20, 2000 version of the Listing as 

interpreted by the Seventh Circuit. 

AR 04-1 

(9th Circuit) 

The court held that for certain applicants under age 18, ALJs and Administrative Appeals 

Judges must make reasonable efforts to ensure that a qualified pediatrician or other 

specialist evaluates the case. 

Source: Applicable appellate court decisions and GAO analysis. 

Page 41 GAO-07-331 SSA's Disability Determination Process
Appendix VI: Comments from the Agency

Appendix VI: Comments from the Agency 

Page 42 GAO-07-331 SSA's Disability Determination Process
Appendix VI: Comments from the Agency

Page 43 GAO-07-331 SSA's Disability Determination Process
Appendix VI: Comments from the Agency

Page 44 GAO-07-331 SSA's Disability Determination Process
Appendix VII: 

A

GAO Contact and Staff 

cknowledgments 

Page 45 GAO-07-331

Appendix VII: GAO Contact and Staff 

Acknowledgments 

Daniel Bertoni, (202) 512-7215, bertonid@gao.gov

Robert E. Robertson (Director), Michele Grgich (Assistant Director), 

Danielle Giese (Analyst-in-Charge), Susan Bernstein, Candace Carpenter,

Joy Gambino, Suneeti Shah, Albert Sim, Ellen Soltow and Rick Wilson 

made significant contributions to this report. Luann Moy, Vanessa Taylor, 

and Walter Vance provided assistance with research methodology and 

data analysis. Daniel Schwimer provided legal counsel. 

GAO Contact 

Staff 

Acknowledgments 

SSA's Disability Determination Process
Related GAO Reports

Page 46 GAO-07-331

Related GAO Reports 

Social Security Administration: Agency Is Positioning Itself to 

Implement Its New Disability Determination Process, but Key Facets 

Are Still in Development. GAO-06-779T. Washington, D.C.: June 15, 2006.

Social Security Administration: Administrative Review Process for 

Adjudicating Initial Disability Claims. GAO-06-640R. Washington, D.C.: 

May 16, 2006. 

High-Risk Series: An Update. GAO-05-207. Washington, D.C.: January 

2005. 

SSA’s Disability Programs: Improvements Could Increase the Usefulness 

of Electronic Data for Program Oversight. GAO-05-100R. Washington, 

D.C.: December 10, 2004.

Social Security Administration: More Effort Needed to Assess

Consistency of Disability Decisions. GAO-04-656. Washington, D.C.: July 

2, 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. 

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 27, 2002.

Standards for Internal Control in the Federal Government. 

GAO/AIMD-00-21.3.1 Washington, D.C.: November 1999. 

(130555) SSA's Disability Determination Process
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