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63–016 2011

CLEARING THE DISABILITY CLAIMS BACKLOGS: 

THE SOCIAL SECURITY ADMINISTRATION’S 

PROGRESS AND NEW CHALLENGES 

ARISING FROM THE RECESSION 

HEARING 

BEFORE THE

SUBCOMMITTEE ON SOCIAL SECURITY 

OF THE

COMMITTEE ON WAYS AND MEANS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

NOVEMBER 19, 2009

Serial No. 111–38 

Printed for the use of the Committee on Ways and Means 

( 


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COMMITTEE ON WAYS AND MEANS 

CHARLES B. RANGEL, New York, Chairman 

FORTNEY PETE STARK, California 

SANDER M. LEVIN, Michigan 

JIM MCDERMOTT, Washington 

JOHN LEWIS, Georgia 

RICHARD E. NEAL, Massachusetts 

JOHN S. TANNER, Tennessee 

XAVIER BECERRA, California 

LLOYD DOGGETT, Texas 

EARL POMEROY, North Dakota 

MIKE THOMPSON, California 

JOHN B. LARSON, Connecticut 

EARL BLUMENAUER, Oregon 

RON KIND, Wisconsin 

BILL PASCRELL, JR., New Jersey 

SHELLEY BERKLEY, Nevada 

JOSEPH CROWLEY, New York 

CHRIS VAN HOLLEN, Maryland 

KENDRICK B. MEEK, Florida 

ALLYSON Y. SCHWARTZ, Pennsylvania 

ARTUR DAVIS, Alabama 

DANNY K. DAVIS, Illinois 

BOB ETHERIDGE, NORTH Carolina 

LINDA T. SA ́ NCHEZ, California 

BRIAN HIGGINS, New York 

JOHN A. YARMUTH, Kentucky 

DAVE CAMP, Michigan 

WALLY HERGER, California 

SAM JOHNSON, Texas 

KEVIN BRADY, Texas 

PAUL RYAN, Wisconsin 

ERIC CANTOR, Virginia 

JOHN LINDER, Georgia 

DEVIN NUNES, California 

PATRICK J. TIBERI, Ohio 

GINNY BROWN–WAITE, Florida 

GEOFF DAVIS, Kentucky 

DAVID G. REICHERT, Washington 

CHARLES W. BOUSTANY, JR., Louisiana 

DEAN HELLER, Nevada 

PETER J. ROSKAM, Illinois 

JANICE MAYS, Chief Counsel and Staff Director 

JON TRAUB, Minority Staff Director 

SUBCOMMITTEE ON SOCIAL SECURITY 

JOHN S. TANNER, Tennessee, Chairman 

EARL POMEROY, North Dakota 

ALLYSON Y. SCHWARTZ, Pennsylvania 

XAVIER BECERRA, California 

LLOYD DOGGETT, Texas 

RON KIND, Wisconsin 

JOSEPH CROWLEY, New York 

LINDA T. SA ́ NCHEZ, California 

JOHN A. YARMUTH, Kentucky 

SAM JOHNSON, Texas, Ranking Member 

KEVIN BRADY, Texas 

PATRICK J. TIBERI, Ohio 

GINNY BROWN–WAITE, Florida 

DAVID G. REICHERT, Washington 

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records 

of the Committee on Ways and Means are also published in electronic form. The printed 

hearing record remains the official version. Because electronic submissions are used to 

prepare both printed and electronic versions of the hearing record, the process of converting 

between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process 

is further refined. 


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C O N T E N T S 

Page 

Advisory of November 12, 2009 announcing the hearing ..................................... 2 

WITNESSES 

The Honorable Bob Filner, a Representative in Congress from the State 

of California .......................................................................................................... 6 

The Honorable Michael J. Astrue, Commissioner, Social Security Administration ........................................................................................................................ 11

The Honorable Barbara B. Kennelly, Acting Chair, Social Security Advisory 

Board ..................................................................................................................... 86 

Beth Bates, Claimants’ Representative, on behalf of the Consortium for Citizens with Disabilities, Jackson, Tennessee ........................................................ 91 

The Honorable Patrick O’Carroll, Inspector General, Social Security Administration ................................................................................................................... 106 

Ann P. Robert, Vice President, National Council of Disability Determination 

Directors, Springfield, Illinois ............................................................................. 110 

The Honorable Larry A. Auerbach, Administrative Law Judge, on behalf 

of the Federal Bar Association, Atlanta, Georgia .............................................. 114 

SUBMISSIONS FOR THE RECORD 

Council of State Administrators of Vocational Rehabilitation ............................. 170 

Corporation for Supportive Housing Advocacy and Training Center .................. 180 

Council of State Administrators of Vocational Rehabilitation ............................. 182 

Eunmi Choi, statement ........................................................................................... 189 

Ibrahim Dere, statement ......................................................................................... 194 

James F. Allsup, statement .................................................................................... 201 

Leri Harper, statement ........................................................................................... 203 

National Council of Social Security Management Associations, Inc. .................. 205 

Social Security Disability Coalition ........................................................................ 207 

The Huntington’s Disease Society of America ....................................................... 220 


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CLEARING THE DISABILITY CLAIMS 

BACKLOGS: THE SOCIAL SECURITY 

ADMINISTRATION’S PROGRESS AND NEW 

CHALLENGES ARISING FROM THE RECESSION 

THURSDAY, NOVEMBER 19, 2009 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON WAYS AND MEANS, 

SUBCOMMITTEE ON SOCIAL SECURITY, 

Washington, DC. 

The Subcommittee met, pursuant to notice, at 1:54 p.m., in Room 

B–318, Rayburn House Office Building, the Honorable John S. 

Tanner [Chairman of the Subcommittee] presiding. 

[The advisory announcing the hearing follows:] 


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HEARING ADVISORY 

FROM THE COMMITTEE ON WAYS AND MEANS 

Subcommittee on Social Security Chairman 

Tanner Announces a Hearing on Clearing the 

Disability Claims Backlogs: The Social Security 

Administration’s Progress and New Challenges 

Arising From the Recession 

November 12, 2009 

By (202) 225–9263 

Congressman John S. Tanner (D–TN), Chairman, Subcommittee on Social Security of the Committee on Ways and Means, today announced a hearing on Clearing 

the Disability Claims Backlogs: The Social Security Administration’s Progress and 

New Challenges Arising From the Recession. The hearing will take place on 

Thursday, November 19, 2009 in Room B–318, Rayburn House Office Building, beginning at 1:30 p.m. 

BACKGROUND: 

This hearing continues the Subcommittee’s examination of the Social Security Administration’s (SSA) efforts to reduce its unprecedented backlog in disability claims. 

Due in part to prolonged underfunding, the backlog of disability appeals hearings 

grew significantly in recent years. By December 2008, more than 768,000 Americans 

were waiting for a hearing decision—a historic high. Total waiting times for a decision on a claim can extend to three or four years, and testimony before the Subcommittee has included personal stories of those who have lost their homes, depleted life savings, or even died while awaiting a decision. 

In FY 2008 and 2009, Congress provided SSA with additional administrative 

funding to begin to reduce the hearings backlog and address other service delivery 

shortfalls. This allowed SSA to hire additional Administrative Law Judges (ALJ) 

and hearing office support staff. SSA has also made eliminating the hearings backlog a top agency priority and has taken measures to increase efficiency and productivity. All of these changes have had an impact: since January 2009, the hearings 

backlog has begun to slowly decline, and dropped below 723,000 by the end of the 

fiscal year. 

SSA is facing new challenges due to the recession, however, that are threatening 

backlog reduction efforts. In FY 2009, incoming disability claims increased by nearly 

15 percent. Incoming claims are projected to increase by an additional 12 percent 

in FY 2010 and continue at elevated levels through 2013. Congress provided additional funding for FY 2009 and 2010 in the American Recovery and Reinvestment 

Act of 2009 (P.L. 111–5) to help SSA process these increased claims. 

Even with this funding, however, the capacity of the state Disability Determination Services (DDS)—which process initial disability claims—cannot be expanded 

quickly enough to keep up with such steep claims increases. This problem is made 

worse because a number of states have instituted hiring freezes or furloughs for 

state employees as a way to address state budget shortfalls, and have not exempted 

DDS employees even though the DDSs are completely federally funded. As a result, 

SSA now projects that by the end of FY 2010, more than one million Americans will 

be awaiting a decision an initial disability claim, up from about 567,000 at the end 

of FY 2008. The increase in initial claims also affects the DDSs’ capacity to process 

reconsideration appeals and conduct continuing disability reviews, which are important to program integrity. 


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The steep increase in new disability claims will also result in more appeals to the 

hearing level that will challenge the capacity of SSA’s hearing offices in the next 

several years. Without sufficient resources in FY 2011, SSA will not be able to stay 

on track to eliminate the hearings backlog by 2013 while also addressing the emerging DDS backlog and processing the large volume of claims anticipated in FY 2011. 

In announcing the hearing, Social Security Subcommittee Chairman Tanner said, 

‘‘I am very pleased to see that Congress’ commitment to reducing the Social 

Security Administration’s backlog is finally resulting in an overall decline 

in pending disability hearings. I commend SSA and its hardworking employees for the success of their efforts. However, SSA is now facing large 

increases in disability claims due to the recession, and this is threatening 

to undo the hard-won progress we have made. The rapidly growing backlog 

at the initial claims level is a particularly serious concern. I am committed 

to ensuring that SSA aggressively addresses these problems, and that the 

agency has the tools to ensure that Americans who are in dire need of disability benefits can receive prompt consideration of their claim.’’ 

FOCUS OF THE HEARING: 

This hearing will focus on the effect of SSA’s unprecedented backlog in disability 

claims on applicants with disabilities, and the agency’s efforts to address these challenges, including SSA’s recent progress in reducing its hearing backlog and its plans 

for addressing the emerging backlog at DDSs. The hearing will also examine the 

impact of the recession on disability claims processing, including projected claims 

increases, and the need for adequate resources to reduce the backlogs and adjudicate recession-driven claims. 

DETAILS FOR SUBMISSION OF WRITTEN COMMENTS: 

Please Note: Any person(s) and/or organization(s) wishing to submit for the hearing record must follow the appropriate link on the hearing page of the Committee 

website and complete the informational forms. From the Committee homepage, 

http://democrats.waysandmeans.house.gov, select ‘‘Committee Hearings’’. Select the 

hearing for which you would like to submit, and click on the link entitled, ‘‘Click 

here to provide a submission for the record.’’ Once you have followed the online instructions, complete all informational forms and click ‘‘submit’’ on the final page. 

ATTACH your submission as a Word or WordPerfect document, in compliance with 

the formatting requirements listed below, by close of business Thursday, December 3, 2009. Finally, please note that due to the change in House mail policy, the 

U.S. Capitol Police will refuse sealed-package deliveries to all House Office Buildings. For questions, or if you encounter technical problems, please call (202) 225– 

1721. 

FORMATTING REQUIREMENTS: 

The Committee relies on electronic submissions for printing the official hearing 

record. As always, submissions will be included in the record according to the discretion of the Committee. The Committee will not alter the content of your submission, 

but we reserve the right to format it according to our guidelines. Any submission 

provided to the Committee by a witness, any supplementary materials submitted for 

the printed record, and any written comments in response to a request for written 

comments must conform to the guidelines listed below. Any submission or supplementary item not in compliance with these guidelines will not be printed, but will 

be maintained in the Committee files for review and use by the Committee. 

1. All submissions and supplementary materials must be provided in Word or WordPerfect 

format and MUST NOT exceed a total of 10 pages, including attachments. Witnesses and submitters are advised that the Committee relies on electronic submissions for printing the official 

hearing record. 

2. Copies of whole documents submitted as exhibit material will not be accepted for printing. 

Instead, exhibit material should be referenced and quoted or paraphrased. All exhibit material 

not meeting these specifications will be maintained in the Committee files for review and use 

by the Committee. 


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3. All submissions must include a list of all clients, persons, and/or organizations on whose 

behalf the witness appears. A supplemental sheet must accompany each submission listing the 

name, company, address, telephone, and fax numbers of each witness. 

The Committee seeks to make its facilities accessible to persons with disabilities. 

If you are in need of special accommodations, please call 202–225–1721 or 202–226– 

3411 TTD/TTY in advance of the event (four business days notice is requested). 

Questions with regard to special accommodation needs in general (including availability of Committee materials in alternative formats) may be directed to the Committee as noted above. 

Note: All Committee advisories and news releases are available on the World 

Wide Web at http://democrats.waysandmeans.house.gov 

f 

Chairman TANNER. In the interest of time we will begin now. 

There will be another series of votes in about an hour, is that correct? So we will start. 

Thank all of you for being here. This hearing is both timely and 

important, as you know. Our hearing today focuses on the oversight of the Social Security Administration’s efforts to reduce an 

unprecedented backlog in disability claims. The backlog works a severe hardship, as many of you know, on those who are waiting. I 

know that all Members have heard from constituents about it. 

There is some good news. The hearing backlog has begun to decline from 768,000 to 718,000, partly because of our investment last 

year that could have been considered overdue. The bad news is the 

recession is threatening to overtake what gains we have been able 

to make in the backlog. 

The further complicating problem, of course as you know, is the 

state Disability Determination Services (DDS). Some are being furloughed, and some are cutting back. As far as I know, none are 

being enlarged to deal with this, and so, as it relates to the backlog 

and to the credibility of the program, the continuing disability reviews, it’s clear we have a problem. So, in this hearing we are 

going to try to highlight some things that will help. 

We are delighted that we are able to have this hearing now, because we think it’s very, very timely. 

[The prepared statement of Mr. Tanner follows:] 

Prepared Statement of Chairman Tanner 

Today’s hearing continues the Subcommittee’s ongoing oversight of the Social Security Administration’s (SSA’s) efforts to reduce its huge and unprecedented backlog 

in disability claims. In 2000, there were about 310,000 Americans awaiting a hearing on a disability claim. By December 2008, that number had more than doubled, 

reaching 768,000—a historic high. This has led to long wait times for applicants, 

sometimes as long as three or four years. 

Because applicants often have little or no income while awaiting a decision on 

benefits, the backlog has caused severe hardship to hundreds of thousands of Americans with significant disabilities. We will hear some of their stories today. We also 

hear about this issue every day from our own constituents in Tennessee who are 

often in desperate need. 

Today we have good news and bad news to report. First, the good news. After 

many years of growing backlogs in SSA’s hearing offices, we have finally turned a 

corner. Since the beginning of 2009, the hearings backlog has begun to slowly decline, and is now down to 718,000. This shows that Congress’ investment in SSA 

is starting to pay off. The Subcommittee particularly wants to commend all the dedicated SSA employees who have contributed to this success. 

The bad news, however, is that this hard-won progress is now being threatened. 

Due to the recession, new disability claims have increased significantly. From FY 


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2008 to FY 2009, these claims increased by almost 15 percent, and they are projected to increase by another 12 percent in FY 2010, and to continue at higher levels 

for several years. 

Congress recognized the need to address this problem last year when it provided 

funds in the American Recovery and Reinvestment Act to help SSA process additional recession-driven claims in FY 2009 and 2010. But even with this funding, the 

state Disability Determination Services (DDSs), which make decisions on initial disability claims, cannot expand their capacity quickly enough to handle this very 

large, unexpected workload. This problem has been made worse because a number 

of states have instituted hiring freezes or furloughs for state employees and have 

not exempted DDS employees, even though the DDSs are completely funded by SSA. 

As a result, another severe backlog is emerging, this time at the initial claims 

level. By the end of FY 2010, an astonishing 1 million Americans will be awaiting 

a decision on their initial disability claims—nearly double the number that were 

waiting just two years before. The initial claims backlog has already topped 780,000 

nationwide—a 35 percent increase from this time last year. In my own state of Tennessee, we have seen an even bigger increase, with the initial claims backlog increasing by more than 60 percent since last year. 

And because the same DDS employees who evaluate initiate claims also perform 

continuing disability reviews (CDRs) to determine if current beneficiaries remain eligible, the DDS backlog also poses serious challenges to SSA’s program integrity efforts. SSA has fallen far behind in conducting CDRs, even though these reviews 

have been demonstrated to generate considerable savings. 

This situation is clearly unacceptable. SSA has expressed its commitment to addressing the DDS backlog problem, and I understand that today the SSA Commissioner will present to us his plan for expanding the agency’s capacity to process initial claims. I look forward to hearing it. 

Just as alarming is the potential impact of these recession-driven claims on SSA’s 

hearings backlog. The claims increases the DDSs are now seeing will soon result 

in increased appeals to the hearing level. If SSA’s hearing offices do not have the 

resources to handle this added workload while still tackling the existing backlog, 

SSA will not be able to fulfill its goal of eliminating the hearings backlog by the 

end of FY 2013. In fact, the hearings backlog could begin to rise again. 

All of this adds up to very significant challenges for SSA in FY 2011. The agency 

will be faced with three difficult tasks. First, because the impact of the recession 

on claims is expected to continue, to keep up with incoming claims, SSA will need 

to process a much higher number of claims than the agency has in the past. Second, 

it is imperative that SSA begin reducing the initial claims backlog, which by FY 

2011 will have reached more than 1 million. Third, we cannot afford to let the hearings backlog reduction plan falter. We must stay on track with this plan’s targets 

even though the recession will bring increased appeals to SSA’s hearings offices. 

Today we should pause to celebrate the progress that is being made. But we also 

need to prepare to move forward with even more conviction. I look forward to hearing about SSA’s plans for meeting these challenges. And I look forward to the insights of our other witnesses about what is needed—from Congress and from the 

Administration—to ensure that we do not backslide. 

Millions of Americans pay Social Security taxes every year with the promise that 

if they become severely disabled, Social Security will be there for them. But the 

lengthy delays many face when they apply for benefits means that we now are falling short on that promise. I am committed to ensuring that these problems are addressed, so that Americans who apply for disability benefits can receive timely consideration of their cases. 

f 

Chairman TANNER. Congressman Filner, thank you for coming. 

We appreciate your interest in this subject today. I have assurance 

that Mr. Johnson is on his way, so, in the interest of time, I would 

like to go ahead and recognize you for the purpose of hearing your 

testimony. If any of our Members have an opening statement, I 

would ask unanimous consent that it be placed in the record. 

Mr. Filner, you are recognized, sir. 


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STATEMENT OF THE HONORABLE BOB FILNER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA 

Mr. FILNER. Thank you, Mr. Chairman. I appreciate the opportunity to be here, and your timeliness in holding this hearing. As 

bad as those backlog statistics that you mentioned are, I think that 

certainly in my state of California, the backlog may be understated, 

due to several policies in California that are being implemented, to 

hide that backlog. I think we need to take action on that. 

You guys have, I think, all read the Inspector General reports, 

and he is going to—he is here today. On March 24th, he testified 

before the Subcommittee that since January 1st of this year, California’s initial claims pending have increased by 9.7 percent, and 

its reconsideration claims pending by 6.1 percent, as a result of the 

increased applications and state furloughs. 

Unfortunately, since the March 24th Subcommittee hearing, the 

situation has continued to deteriorate, in California especially, now 

that the California Disability Determination Services workers are 

furloughed three days a month. 

In a report, in fact just released yesterday, a review by the inspector general shows that the rate of increased applications continued to grow through fiscal year 2009, totaling about 15 percent 

above the previous year. The growth in new claims has outpaced 

the DDSs ability to keep up with the new workload. 

By the end of fiscal 2009, the number of initial cases pending 

had grown, as you said, to almost 770,000, about 38 percent higher 

than the end of fiscal year 2008. Social Security plans to spend $2 

billion in fiscal year 2010 on DDS operations, and expects the 

DDSs to process almost 4 million claims. 

But state furloughs have had an effect on that ability to process. 

There are nine states, as I understand it, furloughing or considering furloughing the DDS employees for fiscal year 2010, which 

will result in a significant shortfall of capacity. The OIG expects 

approximately 69,000 disability cases to be delayed in processing 

over the next year. This wait will result in about $162 million in benefits that will 

not be paid to disabled beneficiaries during this period that would 

have been paid, had the furloughs not occurred, and, of course, 

these states will lose over $39 million in Administration funding 

from Social Security because the employees are furloughed. 

Now, what doesn’t show up in the statistics—in fact, I believe 

there is a deliberate attempt in California to hide the impact of the 

furloughs—for example, prior to the furloughs, DDS assigned all 

initial and reconsideration cases to line unit examiners within 24 

to 48 hours. In September 2009, California DDSs began, as they 

call, staging initial and reconsideration claims. 

What this meant was the assigning of a case to a fictional examiner. Those cases are, in essence, a backlog although I don’t think 

they’re counted in a backlog. Those cases are simply set aside with 

no development initiated, until some later point, when they can be 

assigned to a real person. 

California has, in just the last two months, has a staged case category of 15,000 cases. The increased backlog and decreasing work 

hours because of the furlough have also led to California DDS reinterpreting a Federal regulation that allows cases to be closed, and 


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denied when a claimant fails to pursue or cooperate with the processing of their claim. This is a change in the state DDS policy from 

the pre-furlough situation. 

Employees of California DDS have been instructed to close and 

deny claims for disability benefits if, within 20 days of receiving 

the case, if the claimant fails to complete and return a long, detailed form known as a function report. This form has a supplement which requires the claimant to find a third party to complete 

a portion of the form. This is a 25-page form, and if it’s not in the 

file case within 20 days, the DDS workers are pressured to close 

and deny the case without any further case development. 

So, the statistics show ‘‘case closed.’’ This is despite the fact that 

the very nature of these disabilities—they can’t complete the task 

in 20 days. These forms are sent to homeless claimants, cancer patients, illiterate claimants, even blind claimants. Their inability to 

complete these forms is resulting in denial of benefits without a 

substantive disability determination. This is criminal, in my view. 

And, under the pre-furlough days, the workers would go out and 

help the people develop their claims, help them with this 25-page 

form. One branch—and I have talked to people in branches all over 

the state, by the way, Mr. Chairman, I would be happy to provide 

documentation to your staff of the situation—one branch in Northern California reported that 30 percent of their cases had been 

closed in this manner. Another California branch, an internal quality review, showed that the quality was at 60 percent, meaning 40 

percent of the cases reviewed contained significant errors. 

A study of the last three fiscal years on quality reveals a significant decline in case accuracy. Since the inception of the furloughs, 

the quality has twice dipped below the Federal minimum threshold 

of 90 percent. 

Mr. Chairman, I think the Social Security Administration has 

some recourse in this. They have asked governors not to do the furloughs. By the way, the furloughs do not save money. Let me make 

sure everybody understands that. If you furlough a case worker, 

the Federal pay is just not made. The state doesn’t save any 

money. In fact, the state loses its administration fee for that. 

We have begged Governor Schwarzenegger to not do it, but he 

apparently wants all the workers through the state to be furloughed together, even though it doesn’t save them any money, it’s 

costing, I think, thousands of claimants to lose their beneficiary. 

I have written a bill, Mr. Chairman, which I will introduce shortly, which tries to deal with the situation. Current Federal law allows the Social Security Administrator to federalize DDS employees if a state ‘‘substantially fails’’ to live up to its responsibility to 

process claims. My bill, the Don’t Delay Services Act, is intended 

to prevent the state furloughs in this situation. My bill would deem 

furloughs of DDS employees a substantial failure, triggering the 

provision of existing Federal law that allows SSA to federalize 

DDS. 

There are some costs and other implications of that. But I think 

it ought to be studied, get the cost figures, and tell the states that 

if they don’t do this properly, they’re going to be federalized. I hope 

the committee will look at that legislation. 

I appreciate the opportunity to be here today. 


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[The prepared statement of Mr. Filner follows:] 

Prepared Statement of The Honorable Bob Filner, 

A Representative in Congress from the State of California 

Mr. Chairman, Thank you for allowing me to testify today before the House Ways 

and Means Subcommittee on Social Security. I appreciate the opportunity to tell the 

Subcommittee Members about how state furloughs are impacting my home state of 

California. I am also interested in letting you know about legislation that I will soon 

introduce to address this issue. 

I understand that the Subcommittee has held hearings on this important issue 

already. In March, you heard from many distinguished witnesses, including the Social Security Administrator, Michael Astrue, and Inspector General, Patrick 

O’Carroll. 

As you know, Mr. O’Carroll has written several reports about the impact of state 

furloughs and hiring freezes on disability claims processing. On March 24th, he testified before the Subcommittee that: ‘‘Since January 1, 2009, California’s initial 

claims pending have increased by 9.7 percent and its reconsideration claims pending 

by 16.1 percent as a result of increased applications and the State furloughs.’’ Unfortunately, since the March 24th Subcommittee hearing, the situation in California 

has only gotten worse. 

While some states have exempted Disability Determination Service (DDS) employees from the furloughs at the urging of the Social Security Administration, the State 

of California has not exempted DDS employees. This is despite the fact that DDS 

employee salaries are fully funded by the Federal Government. 

The unnecessary furloughs for California DDS employees are pushing back the decisions on individuals’ benefits by months and harming thousands of disabled residents who are needlessly waiting for their claims to be processed. A new report 

issued by the Inspector General estimates that 53,136 cases will be delayed in 2009 

as a result of the State of California’s furloughs! 

The furloughs are also impacting state DDS employees by reducing their salaries, 

making it harder for families to make ends meet. Since July 10th, State of California employees have been furloughed 3 days per month for a total of at least 36 

days in 2009. These 3 furlough days translate to an approximate 13.8% reduction 

in monthly pay. 

Finally, furloughing DDS employees is actually making the State of California’s 

budget crisis worse because the state has to pay benefits until the federal claim is 

approved and the state if forgoing income tax revenue from furloughed employees. 

Governor Schwarzenegger’s insistence on furloughing DDS employees is not helping the people of California, not helping the State of California solve its budget crisis, and is simply an indefensible and illogical policy! 

Earlier this year, the Social Security Inspector General released a report outlining 

several options for addressing the crisis, including working with States to stop DDS 

furloughs, transferring work to other disability examiners and/or hiring private contractors, and federalizing the DDS. 

To date, Vice President Biden and others have succeeded in working with many 

states to ensure that DDS employees are exempted from furloughs. Unfortunately, 

the State of California and other states have ignored the facts and continue to furlough DDS employees. 

That is why I think it is time for Congress to consider other options to stop the 

state furloughs. 

Current federal law allows the Social Security Administrator to federalize DDS 

employees if a state ‘‘substantially fails’’ to live up to its responsibilities to process 

claims. I will soon introduce The Don’t Delay Services Act, which is intended to prevent state furloughs of DDS employees. 

My bill would deem furloughs of DDS employees a ‘‘substantial failure,’’ triggering 

the provision of existing federal law that allows SSA to federalize DDS. As drafted, 

the Don’t Delay Services Act would not change any provisions of federal law concerning the rights and protections of these workers. 

I understand that federalizing DDS employees is not a perfect solution. However, 

in passing the legislation, Congress would be sending a wake-up call to Governor 

Schwarzenegger. As the Subcommittee continues to work to eliminate the disability 

claims processing backlog, I hope the Subcommittee will consider my bill. 

Thank you again for allowing me to testify before the Subcommittee. 

f 


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Chairman TANNER. Thank you, Mr. Filner. We will take your 

testimony to heart and under advisement, and we will be back with 

you. 

Mr. FILNER. I thank you. Again, I have documentation for your 

staff of this. 

Chairman TANNER. If you could give that to the Subcommittee 

staff, that would be great. Thank you very much. 

Mr. Johnson, in the interest of time we decided to hear Mr. 

Filner’s testimony. Would you like to give your opening statement 

now? 

Mr. JOHNSON. Can I? 

Chairman TANNER. Yes, sir. Absolutely, you can. 

Mr. JOHNSON. Thank you, Mr. Chairman. You know, Republicans and Democrats alike on this committee have long worked together to make sure Social Security has the resources it needs to 

effectively administer their benefit programs. During the last two 

fiscal years, Social Security received funding at levels higher than 

the President’s request, along with an additional $1 billion to build 

a new computer system center, and to process rising numbers of 

claims for disability benefits. 

Today, Social Security is going to, again, report to taxpayers 

what return they are getting on their money. Here, we will see 

some long overdue good news on the appeals front. Hearing offices 

have increased productivity, and this has resulted in lower wait 

times for those who have been waiting well over a year for a decision. 

Beyond addressing today’s service delivery challenges, lasting returns on investment depend on Social Security modernizing its 

technology, infrastructure, and consistently addressing program 

waste, fraud, and abuse, including conducting continuing disability 

reviews in order to save billions in program dollars and build taxpayer confidence. So, I will be listening for real progress in those 

areas. 

Although clearing disability backlogs is important, today marks 

the fourth hearing of this Subcommittee this Congress, and the 

third hearing on backlogs, while we continue to ignore the fiscal 

challenges that Social Security faces. In August, the Congressional 

Budget Office reported that Social Security cash surpluses will turn 

into cash deficits in the next two years, and that the disability insurance trust fund will be unable to pay full promised benefits in 

just nine years. 

President Obama expressed his commitment to advance Social 

Security reform, and we know the sooner we act, the better it is. 

Further, we have had no hearings on other key agency challenges, including the ongoing problem of identity theft and Social 

Security number misuse by those attempting to work illegally in 

this country. I hope this committee will turn to those issues, on a 

bipartisan basis, as soon as possible, and examine the options for 

change and solutions. 

I thank the witnesses for joining us today, and thank you, Mr. 

Chairman, for allowing me to make this comment. 

[The prepared statement of the Honorable Sam Johnson follows:] 


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f 

Chairman TANNER. Yes, sir. Thank you. Our second panel is 

the Commissioner, Mr. Astrue, who was sworn in on February 12, 

2007 for a 6-year term. Commissioner, you have a long biography 

here, a highly successful biotechnology lawyer, I see. I don’t know, 

maybe we could use some expertise around here, but, anyway, 

we’re delighted you’re here. Without any further ado, I will recognize you, sir, and, if I may, ask for your complete statement to be 


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11 

put in the record. If you could hold your oral comments to five minutes, we would appreciate it. 

STATEMENT OF MICHAEL J. ASTRUE, COMMISSIONER, 

SOCIAL SECURITY ADMINISTRATION 

Mr. ASTRUE. Yes, Mr. Chairman. I have a longer statement for 

the record, and I will make a brief oral statement. 

Mr. Chairman, Mr. Johnson, Members of the Subcommittee, 

thank you for this opportunity to discuss our progress in driving 

down the hearings backlog and in managing the emerging backlog 

at the DDSs. 

Overall, the news is good. For my first 22 months, we steadily 

reduced the rate of increase in pending hearing cases. We hit the 

turning point this past January. In every month since then, the 

number of pending cases has dropped. The rate of decline is accelerating in the last three months, we reduced the hearings backlog 

by a greater percentage than we did in the previous seven months. 

We have steadily reduced the number of cases that have waited 

the longest. In fiscal year 2007, we started by resolving virtually 

all 65,000 cases pending over 1,000 days. This fiscal year we are 

ahead of schedule in resolving over 135,000 cases pending 825 days 

or longer. 

Mathematically, our targeted effort with older cases meant that 

average processing time remained artificially high for a while, but 

that figure is also starting to drop now. Since June, we have kept 

it below 500 days, and last month it was 446 days. 

Moreover, the average processing time for our most backlogged 

offices is coming down faster than for other offices. In February 

2007, the average processing time for Atlanta was 852 days, and 

we had 6 offices with processing times between 650 and 820 days. 

Last month, our most backlogged office was Dayton, at 651 days. 

Let me be clear that 651 days for a hearing is not acceptable, but 

shortly, such performance will be a disturbing piece of history. By 

the middle of next year, seven new offices will open in Michigan, 

Ohio, Georgia, North Carolina, and Indiana, our five most congested states. With plans for 25 new hearing offices, 7 new satellite 

offices, and scores of office modifications and expansions, we are 

adding the capacity for the cases that continue flooding in. 

Our hearing offices should also be very proud of their three consecutive years of greatly improved productivity. Without that 

achievement, we would not have reduced the backlog this past 

year. 

We have a number of ways to track productivity, but an important bottom-line measure is the percentage of Administrative Law 

Judges who reach our expectation for a minimum annual disposition of 500 cases. That number is steadily increasing each year. In 

2007, 46 percent of our judges reached that level. In fiscal year 

2009, 71 percent reached that level. That individual success is also 

a team success. Each judge now receives support from a recent 

high average of 4.6 support staff per judge. 

Success comes from hard work, better systems, better training, 

and better business processes. We designed National Hearing Centers to quickly help the most beleaguered offices. More and more 

applicants in remote locations are asking for video hearings, which 


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are not only more efficient, but also more professional for judges 

and applicants than holding hearings in motels or other makeshift 

places. 

Improvements at the DDSs also help with backlog reduction. We 

are fast-tracking more cases for approval in a matter of days: about 

100,000 last year; and about 140,000, we project, this year. A new 

system called e-CAT improves the quality and consistency of decisions. Every state in the nation will have this upgrade before we 

move from 54 separate COBOL-based systems to begin testing a 

common state-of-the-art web-based system in April 2011. 

Unfortunately for the DDSs, not all the news is good. Case filings 

are rising faster than we can hire and train new employees, and 

the number of pending cases is increasing. State furloughs aggravate the problems created by the recession. As nonsensical as it is 

for states to respond to fiscal crisis by furloughing DDS employees, 

many of them have done so. I am grateful to Vice President Biden 

and the many members of this Subcommittee who have helped me 

persuade some governors not to take this misguided action. 

In short, we have made solid progress. We are applying the same 

thoughtful planning and best practices from our hearing plan to 

handle the additional initial disability claims. We are expanding 

our capacity at the initial level. By the end of fiscal year 2010 we 

expect to have nearly 2,800 more DDS employees than we had at 

the end of fiscal year 2008, and we are increasing the number of 

Federal workers who are reviewing these cases. With your support, 

we hope to beat our target date of 2013 for elimination of the disability backlog, despite all the new cases from this recession. 

We understand, too, that we have many other service challenges—from the work CDR issues, to reduced waiting times, clearer notices, better telephone services, and other areas. We are going 

to do our best to live up to your expectations. 

Thank you. I would be happy to answer any questions you may 

have. 

[The prepard statement of Mr. Astrue follows:] 

Prepared Statement of The Honorable Michael J. Astrue, Commissioner, 

Social Security Administration 

Chairman Tanner, Ranking Member Johnson, and Members of the Subcommittee: 

Thank you for the opportunity to discuss our progress in driving down the hearings backlog, our strategy to manage the surge of initial disability applications, and 

our ongoing efforts to improve service delivery and program integrity. 

I am proud to report to you today that last year we improved service across the 

agency, and we are currently maintaining that momentum as we begin fiscal year 

(FY) 2010. 

For nearly 75 years, our programs and responsibilities have continued to change 

and expand. Our employees worked hard to keep up by creating new systems and 

streamlining policies and processes that helped us improve productivity by an average of 3 percent each year over the last 5 years. Even though, until recently, we 

had not received sufficient funding to keep pace with our increased workloads. 

Your help in changing this pattern of chronic underfunding came at a most critical time, just as the recession and the aging Baby Boomers were exacerbating our 

already fragile situation. We greatly appreciate the funding Congress provided in 

our FY 2009 appropriation and in the American Recovery and Reinvestment Act of 

2009 (Recovery Act). Our use of these additional resources demonstrate—to you, to 

the President, and most importantly, to the American public—that we are a sound 

investment. 

In FY 2009, we processed more retirement, initial disability, and hearing applications than ever before. We increased our average agency-wide productivity by 4.49 

percent over FY 2008. 


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We made solid and sustained progress in eliminating our hearings backlog by reducing both our pending hearings for the first time in a decade and the time applicants waited for a hearing. These accomplishments are all the more impressive considering that, at the same time, we continued to focus on the oldest, most complex, 

and time-consuming cases. 

In FY 2009, we processed over 175,000 more initial disability claims than we had 

expected to process in that year. We kept the pending level below 800,000 even 

though we received nearly 400,000 more applications than we had in FY 2008. We 

also reduced the initial disability claims average processing time by 5 days. We decided the cases of about 100,000 Americans with the most severe disabilities 

through our Quick Disability Determination and Compassionate Allowance initiatives in about ten days from the date of receipt in the State Disability Determinations Services (DDS). 

We launched our new online application, iClaim, in December 2008. This quick, 

easy-to-use online service helped us deal with the increase in benefit applications. 

We decreased waiting times in our field offices and on our 800 Number. 

During this difficult economic crisis, Americans are turning to us for help more 

than ever before. In FY 2010, we expect to receive 1.2 million more claims than we 

received in FY 2008. I weighed the risks of an uncertain budget against the need 

to sustain our progress and decided to authorize our components to continue hiring 

and working maximum overtime during the continuing resolution (CR). Therefore, 

we are using the multi-year Recovery Act funding to help sustain our momentum 

this fiscal year during the CR. We, nevertheless, are counting on your support to 

pass the President’s full FY 2010 budget. This budget will help sustain the substantial progress made in the past year. 

Plan to Address Rising Workloads 

We have detailed, achievable plans in place to address our soaring workloads, and 

our employees are dedicated to eliminating the hearings backlog by 2013. They are 

also poised to keep up with the recession-driven increase in initial disability claims. 

We will not, however, be able to achieve these goals without timely, adequate, and 

sustained funding. 

In FY 2009, Congress provided us with $126.5 million above the President’s budget request and authorized $500 million of the Recovery Act funds to help us process 

our rapidly rising retirement and disability workloads and to reduce the hearings 

backlog. 

In FY 2009, we hired approximately 8,600 new employees, most of them in less 

than six months, which was our largest hiring effort since the creation of the Supplemental Security Income (SSI) program about thirty-five years ago. Management 

at every level of the agency responded to this hiring opportunity with the urgency 

that tough times require. Given all of the conditions and hurdles involved with hiring in the civil service and the obstacles created by some governors and State legislatures in staffing the DDSs, this accomplishment is a great testament to the skill 

and dedication of everyone involved. Along with that hiring, we also maximized the 

use of overtime across the agency. 

We recognize, though, that merely adding employees, while critical to our success, 

will not solve all of our problems. Expanding our use of technology is essential— 

we become more efficient as we automate additional processes. We used Recovery 

Act funds to purchase additional computers for our new employees, as well as video 

conferencing equipment for hearings and increased bandwidth to improve the availability of our systems. In January 2009, we took possession of our second data support center, and by May, began moving some of our workloads to the new center. 

These enhancements allowed us to reduce by two-thirds the time our disability systems were down. 

In August 2009, we released a request for proposals to expand our use of health 

IT to gather electronic medical records. Obtaining medical records is one of the most 

critical and time-consuming aspects of making disability decisions. Health IT holds 

the promise to drastically reduce our disability processing times. In January 2010, 

we will use Recovery Act resources to issue $24 million in contracts with additional 

medical providers and networks. 

Early in my tenure, I recognized the need for a new, state-of-the-art data center. 

It is vital that we have a stable, reliable data center to protect the sensitive data 

we maintain and to achieve our ongoing efforts to improve automation and increase 

the use of online services. In the Recovery Act, Congress gave us $500 million to 

build and partially equip a new, modern data center that will incorporate green 

building technology. It is a complicated process to plan and build a new data center, 

and it will not be completed until 2013. We have been planning for the new facility 

for some time, and in August, 2009, the General Services Administration (GSA) 


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issued a request for expressions of interest for site selection. We anticipate awarding 

the contract in early 2010. 

In addition to handling our customary work, we played a critical role in issuing $250 economic recovery payments, ahead of the statutory deadline, to over 55 million beneficiaries who received Social Security and Supplemental Security Income 

benefits. These payments injected more than $13 billion into the struggling economy. 

Maintaining Momentum to Eliminate the Hearings Backlog 

As I have said many times, eliminating the hearings backlog is a moral imperative. In FY 2009, we received over 30,000 more hearing requests than in FY 2008. 

Despite this increase in the number of requests, I am pleased to report the news 

is good. For my first 22 months, we steadily reduced the rate at which the number 

of pending cases increased. We hit the turning point this past January, and in every 

month since then, the number of pending cases dropped. The rate of decline is accelerating—in the last three months, we reduced the hearings backlog by a greater 

percentage than we did in the previous seven months. By the end of FY 2009, we 

had reduced our pending hearings by nearly 38,000 cases. 

Morally and operationally, we should focus our attention on applicants who have 

been waiting the longest for their hearings; no one should have to wait years for 

a decision on their benefit claim. We have steadily reduced the number of cases that 

have waited the longest. In FY 2007, we started by resolving virtually all 65,000 

cases pending over 1,000 days. In FY 2008, we cleared nearly all 135,000 cases 

pending over 900 days. In FY 2009, we resolved nearly all 166,000 cases pending 

over 850 days. For FY 2010, we are ahead of schedule in resolving the over 135,000 

cases pending 825 days or longer. 

Mathematically, our targeted effort with older cases meant that average processing time remained artificially high for a while, but that figure is also now starting to drop. We have kept it below 500 days since June 2009, and last month it 

was 446 days. Moreover, the average processing time for our most backlogged offices 

is coming down faster than for other offices. In February 2007, the average processing time for Atlanta was 852 days, and we had six offices with processing times 

between 650 and 852 days. Last month our most backlogged office was Dayton, Ohio 

at 651 days. 

While 651 days for a hearing is not acceptable, but shortly such performance will 

be a disturbing piece of history. By the middle of next year, seven new offices will 

open in Michigan, Ohio, Georgia, North Carolina, and Indiana, our five most congested states. With plans for 25 new hearing offices, 7 new satellite offices, and 

scores of office modifications and expansions, we are adding the space we need to 

address the cases that continue flooding in. 

The expansion of our physical infrastructure will allow us to accommodate additional ALJs and support staff. While we still have work to do to reach 

our goal of an average processing time of 270 days, we have made significant 

progress and have a clear plan in place to reach that goal. 

In FY 2009, we hired 147 ALJs and over 1,000 support staff in the Office of Disability Adjudication and Review (ODAR), which is responsible for our hearing offices. In FY 2010, we plan to hire another 226 ALJs and maintain an average support staff ratio of at least 4.5 support staff per judge. By the end of FY 2010, we 

should have about 1,450 ALJs on board. 

The Government Accountability Office recently agreed that under our hearings 

backlog reduction plan, we should be able to reduce our backlog, but noted that 

reaching our goal by 2013 is largely dependent on our ability to improve ALJ hiring, 

availability, and productivity. Sufficient resources and a strong pool of candidates 

from which to hire additional ALJs are vital elements to our success. Office of Personnel Management (OPM) Director John Berry has worked very closely with us to 

address our need to maintain a qualified pool of candidates through the ALJ examination process. I am extremely appreciative of John’s decision to open a new ALJ 

register because OPM’s continued support is critical for us to achieve our ALJ staffing needs. 

ODAR should be proud of its three consecutive years of greatly improved productivity. Without that achievement, we would not have reduced the backlog last year. 

We have a number of ways to track productivity, but an important bottom-line 

measure is the percentage of ALJs who reach our minimum annual disposition expectation of 500 cases. The number of ALJs, who reach that level, is steadily increasing. In FY 2007, 46 percent of our ALJs reached that level. In FY 2008, 56 

percent reached that level, and in FY 2009, 71 percent reached that level. In fact, 

last fiscal year 89 percent of the ALJs disposed of over 400 cases. That individual 

success is a team success because the ALJs need sufficient support staff to prepare 


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the cases for a hearing and write up the decisions after the hearing has been held. 

Last year, our ALJs received support from a recent high average of 4.6 support staff 

per ALJ. 

Success has come from hard work, better systems, better training, and better 

business processes. We designed National Hearing Centers (NHCs) to quickly help 

the most beleaguered offices. In 2009, we opened three new NHCs, in addition to 

Falls Church, Virginia: Albuquerque, New Mexico; Chicago, Illinois; and Baltimore, 

Maryland. In May 2010, we plan to open our fifth NHC in St. Louis, Missouri. 

The ALJs in the NHCs hold hearings remotely using video conferencing equipment, providing us the flexibility to better balance pending workloads across the 

country. We are seeing results in some of the most-backlogged offices that transferred cases to our first NHC in Falls Church, Virginia. Average processing times 

in Atlanta, Georgia; Cleveland, Ohio; and Flint, Michigan have dramatically improved with the assistance of the NHC. In FY 2009, the NHCs issued over 9,000 

decisions. 

We continue to expand our use of video technology. We are furnishing more hearing offices with video equipment so offices with available resources can assist offices 

with the greatest backlogs. More and more claimants in remote locations are asking 

for video hearings, which are not only more efficient, but also more professional and 

appropriate for ALJs and claimants than holding hearings in motels or other makeshift places. We are reducing the use of these temporary hearing sites, replacing 

them with video hearing rooms in field offices and other Social Security facilities. 

We implemented the Representative Video Project to allow representatives of disability claimants to use their personal equipment to participate in hearings from 

their own offices. 

In addition to processing the most aged cases, we are taking a number of steps 

to expedite fully favorable decisions. We reinstituted the Attorney Adjudicator program to allow our most experienced attorneys in appropriate cases to make on-therecord, fully favorable decisions without a hearing. In FY 2009, attorney adjudicators issued over 36,000 favorable decisions. We have also instituted special Federal 

Quality Reviewer screening units and a Medical Expert Screening process to help 

identify cases that we can allow without the need for a hearing. 

We identified cases that were likely allowances and electronically transferred 

them back to the DDSs for further review. As a result of this initiative, the DDSs 

allowed nearly 15,000 claims in FY 2009, and we were able to dismiss those requests for hearing. 

The DDSs will not be able to provide the same level of assistance this year—they 

will be handling a flood of new initial disability applications. But our backlog reduction plan is not static. We continue to look for new ways to achieve our goals. We 

are using predictive modeling to help us decide which new techniques will most effectively help eliminate our backlog and improve our business process. 

We are testing a new, more sophisticated screening tool to identify cases for senior 

attorneys to review. We used predictive modeling to help us determine the proper 

balance between the number of attorneys screening cases and the number who are 

writing decisions for ALJs. Based on our analysis, we are identifying 100 senior attorneys to work in a virtual screening cadre to review the disability hearing backlog 

for potential allowances. We believe that this innovative solution using our improved screening methodology and the electronic folder to move work to the members of the virtual unit will identify about 14,600 on-the-record, fully favorable allowances this year. These cases will not require a hearing before an ALJ. This new 

initiative will allow the DDSs to focus on processing initial disability claims without 

jeopardizing our progress in reducing the hearings backlog. In addition, we are adding centralized, regional units to pull cases and write decisions to more quickly address emerging issues. 

We are working more efficiently in our hearing offices. In FY 2009, we made significant progress to eliminate the remaining paper hearings folders and to transition 

to an all-electronic environment. In this electronic environment, we are establishing 

a standardized electronic hearings business process. This process standardizes the 

day-to-day operations and incorporates best practices for hearings offices nationwide. We began rolling out this process to 30 hearing offices in FY 2009. We will 

implement it in all hearing offices by the end of FY 2010. 

As we increase our capacity to hear and decide cases, we must consider the resulting workload for the Appeals Council (Council). The Council’s receipts are outpacing 

dispositions, with an almost 16 percent increase in receipts in FY 2009 over FY 

2008. We expect that receipts will continue to increase by another 12 percent in FY 

2010. Last fiscal year, we began preparing for the increase by hiring 16 new administrative appeals judges, 45 new appeals officers, and almost 200 new paralegals 

and attorney advisers. We revamped the new analyst training course with the goal 


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of shortening the historic learning curve. The new training curriculum has been a 

success, and productivity has exceeded expectations for the class of analysts that 

graduated in July 2009. 

In FY 2009, the Council had many successes. It processed over 89,000 requests 

for review, 7 percent more than it processed in FY 2008. Despite increasing receipts, 

it exceeded its case processing goal with an average processing time of 261 days, 

even while eliminating cases over 750 days old. 

Since I became Commissioner in 2007, I have repeatedly stated that reducing the 

hearings backlog is our number one priority, and that is still the case. We have implemented a solid plan and have demonstrated that it is working. With your continued support, I am confident that we will eliminate the hearings backlog by 2013. 

Strategy for Unprecedented Increase in Disability Claims 

However, we currently face another serious challenge—the flood of initial disability claims resulting from the economic downturn. The unemployment rate affects 

the number of disability claims we receive, and with the recent unemployment numbers at over 10 percent, the number of our disability applications will peak in 2010 

at over 3.3 million. We are using our experience and some of our strategies from 

the hearings backlog reduction plan to implement a complementary plan to process 

the additional initial disability claims resulting from the recession. 

We expect nearly 700,000 more initial disability claims in FY 2010 than we received in FY 2008. We simply do not have the capacity to process all of the incoming 

applications with the same timeliness of the past year. 

Processing disability claims is our most labor-intensive workload. We cannot address our current challenge without additional staff, particularly disability examiners and medical consultants in the State DDSs. We developed a strategy to increase our capacity and optimize our productivity to return to the pre-recession initial claims pending level by 2013. 

The increase in our FY 2009 appropriation and Recovery Act funding allowed us 

to begin implementing our strategy last fiscal year. We hired 2,600 employees in the 

DDSs, ending FY 2009 with 1,400 more employees than at the end of FY 2008. 

While these hires helped us process over 200,000 more disability claims last year 

than we did in FY 2008, they spent a lot of their time in training and were not 

fully productive. This year we expect that the additional fully-trained staff will process substantially more cases. 

Despite the nearly 17 percent increase in initial disability claims in FY 2009, the 

DDSs increased productivity by 3 percent, and so far their quality and average processing times are generally holding up well. Average initial disability processing time 

decreased 5 days to 101 days, and nationally the DDSs achieved the highest level 

performance accuracy in the past decade. 

For the DDSs, not all the news is good. Disability applications are rising faster 

than we can hire and train, and the number of pending cases is increasing—escalating the pressure on the DDSs. Despite our employees’ heroic efforts to process 

initial disability claims timely and accurately, our pending cases had grown to nearly 780,000 by the end of FY 2009—over 200,000 more cases than at the end of FY 

2008. Our pending disability claims could reach as much as 1 million this year. We 

know this pending level is unacceptable and are working diligently to minimize the 

increase. 

State furloughs aggravate the problems created by the recession. As nonsensical 

as it is for States to respond to the fiscal crisis by furloughing employees whose salaries and benefits we fully fund, many of them have done so. I have spent a lot of 

time over the last year trying to educate State officials on the unnecessary and 

harmful effects of furloughing DDS employees. I have personally spoken to many 

governors or State officials, and I wrote letters to every governor and to the National Governor’s Association. In addition, each of our ten Regional Commissioners 

has been aggressively pursuing DDS furlough exemptions at the local level. 

We have received considerable support from you and the Administration. I am 

grateful to Vice President Biden and the many Members of this Committee who 

have helped me persuade some governors not to take this misguided action. 

We were successful in gaining exemptions or partial exemptions in several States, 

like Michigan, Nevada, New York, and Colorado. Other States, such as California, 

Wisconsin, Ohio, and Hawaii, have ignored our clear logic and have imposed destructive furloughs on our DDS employees. Currently twelve States have implemented furloughs that affect our DDS employees. I know that, like me, you are frustrated by these decisions. 

While some States have argued that the furloughs are not affecting their ability 

to make disability determinations, these assertions are simply not true. For example, California is furloughing DDS employees three days each month. In FY 2010 


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this decision will delay $11 million in disability benefits to over 40,000 of California’s most vulnerable residents at a time when the State already has one of the 

highest unemployment rates in the country. There are many clear signs of the deterioration in service. In spite of the hard work of the dedicated DDS employees, the 

number of initial claims currently pending in California is 22 percent higher than 

in 2008. The percentage of California cases pending over 90 days has grown. In the 

first calendar quarter of 2009, California’s Initial Claims Performance Accuracy was 

below the Federal regulatory threshold. 

The residents of California should not be penalized for the actions of their officials. We are trying to mitigate the problems in California by deferring 9,000 continuing disability reviews so that the DDS can concentrate on initial applications, 

maximizing the use of overtime, obtaining medical consultant assistance from another State, and providing Federal assistance with State medical reviews. 

As we began developing our strategy to process the additional recession-driven 

disability claims, we knew that certain States and regions had been harder hit by 

the recession than others. Since unemployment rates correlate directly with the 

number of disability claims we receive, we began to take a closer look at the unemployment rates and forecasts of disability receipts at the State level. We are using 

this information to decide how to allocate our resources—based on not only the current situation, but also on future population and unemployment trends. 

In addition, we are analyzing a combination of DDS key indicators to determine 

a State’s ability to keep pace with its current and future receipts. We focus on the 

indicators that most directly demonstrate the State’s ability to handle additional 

claims, such as how old the cases are, how long they have been pending, the level 

of receipts, the processing time, the rate at which we are losing our employees, and 

whether the DDS is under a hiring freeze or furlough. By monitoring these indicators, we can quickly provide assistance to the most overwhelmed States. 

This year we will continue to implement our strategy to process the increased receipts. With the President’s FY 2010 budget, we plan to add 1,400 new DDS employees. By the end of FY 2010, we expect to have 2,800 more DDS employees on board 

than we did at the end of FY 2008. 

We are using our best practices from the hearings backlog reduction plan to create centralized units—similar to the National Hearing Centers—that will assist 

States across the Nation. These new units, called Extended Service Teams, will be 

placed in States that have a history of high quality and productivity and the capacity to hire and train significant numbers of additional staff. In FY 2010, we plan 

to place 280 new employees in four States (Virginia, Arkansas, Oklahoma, and Mississippi) to help staff the teams that will be able to quickly take cases from the 

hardest hit States. 

We are also expanding our Federal capacity to process cases. We currently have 

a Federal unit in each of our ten regions and two units in Baltimore that assist the 

DDSs in processing cases. In FY 2010, we plan to provide 237 additional hires in 

these units. 

In addition to hiring more disability examiners to process the claims, we also need 

to increase our medical consultant staff to support the examiners. Traditionally, the 

medical consultants work onsite in the DDSs to review the medical evidence, provide guidance to the examiners on the severity of the applicants’ conditions, and, 

in many cases, sign off on disability determinations. 

If we do not have sufficient evidence to make a disability determination, we often 

send applicants for a consultative examination with a medical professional. These 

exams can increase the cost and waiting times for a disability decision. It is sometimes challenging to find medical providers with the appropriate specialty necessary 

for the exam. For example, psychiatry is a specialty that can often be difficult to 

obtain. We plan to use our video conferencing technology to conduct psychiatric consultative exams remotely. This technology will help us save money and time by reducing the claimants’ travel to these exams. 

We will continue to enhance our Quick Disability Determination (QDD) and Compassionate Allowances (CAL) initiatives to fast-track cases that are likely allowances. QDD uses a predictive model to identify certain cases that are likely allowances, such as low birth-weight babies, cancer, and end-stage renal disease. CAL allows us to quickly identify applicants, who are clearly disabled based on the nature 

of their disease or condition. The list of CAL conditions currently contains 25 rare 

diseases and 25 cancers. We have held five public hearings to obtain critical information to develop and enhance this list of conditions. In July, we held a hearing 

on Early-Onset Alzheimer’s disease, and yesterday in San Francisco, I presided over 

our latest hearing on schizophrenia. We plan to increase the number of conditions 

on the CAL list in early calendar year 2010. In 2010, we expect that our enhancements to QDD and CAL will allow us to fast-track about 140,000 decisions for the 


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most severely disabled Americans while maintaining accuracy. These improvement 

at the DDSs also help reduce the hearings backlog. 

We are also exploring options for expansion of single decision maker (SDM) authority to cases that are identified as QDD or CAL. SDM allows a disability examiner to adjudicate a case without the approval of a medical or psychological consultant. 

Another automated tool, the Electronic Claims Analysis Tool (eCAT), is proving 

to be extremely valuable to the disability decision process. eCAT improves the quality and consistency of our decisions by aiding examiners in documenting, analyzing, 

and processing the disability claim in accordance with regulations. We expect that 

the use of eCAT will produce well-reasoned determinations with easy-to-understand 

explanations of how we reached our decision. This documentation is particularly 

useful for future case review if an appeal is filed. We are beginning to look at adapting eCAT for use at the hearing level. 

In addition to enhancing the documentation, quality, and consistency of our disability decisions, eCAT has been an extremely useful training tool for the many new 

examiners we are hiring in the DDSs. All states have the training version of eCAT. 

Training through eCAT is helping new examiners more quickly gain proficiency in 

processing complicated cases. 

We are accelerating the expansion of eCAT since we have determined that it is 

working well in the DDSs that have piloted it. We have already started rolling it 

out in eight States, and we are currently planning to roll it out to all DDSs by December 2010. 

Every state in the Nation will have this upgrade before we implement the common Disability Case Processing System (DCPS). Currently each of the DDSs has its 

own unique case processing system, many of them COBOL-based. In April 2011, we 

will begin beta testing a common, state-of-the-art web-based system that will provide additional functionality and the foundation for a seamless disability process. It 

will make it easier to implement technology changes and will position us to take 

advantage of health IT. 

For more than a year, we have been piloting the use of health IT to help speed 

decisions on disability claims. Applicants who have been treated at Beth Israel Deaconess Medical Center in Boston, Massachusetts or at MedVirginia facilities in Richmond, Virginia can authorize their medical records to be transferred electronically 

to the DDSs. Generally, we receive medical records from these facilities in less than 

a minute. 

In these two pilots, the receipt of electronic medical records has reduced the average DDS processing time to about 48 days, a nearly 50 percent decrease. In fact, 

we are making medical decisions within 48 hours of taking the claim in 11 percent 

of the pilot cases. 

Using Recovery Act funding, this fiscal year, we are expanding our use of health 

IT to more health care providers and States. In January, we will award competitive 

contracts to providers and networks that will give us standard medical data needed 

to make disability decisions. A key requirement of these contracts is that data must 

be delivered over the Nationwide Health Information Network that ensures secure 

transmission of personal health information. We are actively participating in the 

Department of Health and Human Service efforts to produce technical standards for 

widespread use, including in our health IT systems. 

Improving Service Delivery 

We understand, too, that we have many other service challenges—from the work 

CDR issue that Chairman and Mr. Johnson highlighted last Thursday to prompt 

telephone service, reduced waiting times, clearer notices, and many other services. 

We knew the aging baby-boomers would put pressure on our 800 Number and 

field offices. As this generation is becoming more comfortable conducting business 

on the Internet, we must offer more online services to meet their demands and relieve some of the strain on our field offices. In addition, Americans of all ages began 

turning to us for assistance during this economic crisis. Our online services, automated telephone services, and additional agents answering the 800 Number are providing the public with service options to conduct their business from the comfort of 

their own homes. 

The implementation of iClaim in December 2008, combined with our effective 

marketing campaign starring Patty Duke, provided an instant spike in both online 

retirement and disability applications. Online retirement applications increased 

from 26 percent to 35 percent in less than one month. Online disability applications 

also increased from 14 percent to 21 percent. We have maintained the increase in 

Internet claims with online retirement applications currently at 34 percent and disability applications at 22 percent. In FY 2009, over 400,000 more applicants filed 


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for benefits on the Internet, more than twice as many as the year before.. This increase helped us deal with the additional recession-driven claims and helped us reduce our waiting times in field offices. 

Our online applications took the top three rankings in the most recent American 

Customer Satisfaction Index (ACSI). The ACSI tracks trends in customer satisfaction and provides valuable benchmarking insights of the consumer economy for companies, industry trade associations, and government agencies. Our Retirement Estimator led all scores, iClaim followed closely, and our Medicare Subsidy application 

came in third place. 

This year we are implementing several new projects to improve our current online 

services and to provide additional online options to the public. In February 2010, 

we plan to expand the capability of iClaim to allow persons to file for Medicare-only 

benefits at age 65 if they choose to delay retirement benefits while they continue 

to work. We plan to increase the number of our online services in Spanish. We will 

start by creating a Spanish version of our retirement estimator. With enhancements 

to iClaim and new marketing strategies, we expect to increase the percentage of online retirement applications to 38 percent this year. 

Even though we did not market our online disability application when we 

launched iClaim, online applications for disability have also increased. We expect 

this positive trend to continue when we release a simplified electronic version of the 

Adult Disability Report in January 2010. We use this form to obtain basic information on the applicant’s medical condition and treating sources. This improvement 

will reduce the time needed to complete the disability application and improve the 

quality of the information we receive. We expect to increase the percentage of online 

disability applications to 25 percent this year. 

In October, we began rolling out the first phase of the Appointed Representative 

Suite of Services. This process allows appointed representatives of disability applicants to view their clients’ electronic folders through secure online access. Additional 

phases of this initiative will provide folder access to more representatives, simplify 

the process for submitting appeals, and document a representative’s appointment. 

This online service will alleviate workloads in our field offices. 

This year we will also pilot a Claims Data Web Service. Each year we receive over 

100,000 paper applications and appeals filed by third party organizations, such as 

representatives, hospitals, and social workers. Our field office employees must 

manually enter all of this information into our systems. This pilot will allow selected 

third parties to submit application information electronically to field offices, eliminating the time our employees spend manually keying this data. 

Our 800 Number is often the first point of contact the public makes with us. If 

they are greeted with a busy signal or placed on hold for an extended period of time, 

they may become frustrated and come into our field offices instead. Last year, we 

significantly reduced waiting times and busy signals on the 800 Number. 

Our 800 Number call volume has been increasing each year, exceeding 82 million 

calls in FY 2009. To handle the increasing number of calls, we hired about 260 additional telephone agents last year, and we used technology to effectively forecast call 

volumes, anticipate staffing needs, and better distribute calls across the network. 

As a result, we improved our speed of answering calls by 25 percent. We answered 

calls within an average of 245 seconds, the lowest average wait time in 6 years. We 

also reduced our average busy rate from 10 percent in FY 2008 to 8 percent last 

year. 

As we expect call volumes to increase this year, we plan to hire additional telephone agents to maintain our 800 Number services. To position ourselves for the 

future, we started exploring click-to-communicate technologies to allow telephone 

agents to assist users as they use our online services. We started the process to replace our 800 Number system with more-modern technology and began working 

with GSA to build a new teleservice center in Jackson, Tennessee. The new teleservice center, the first to be opened in more than a decade, will open in 2011. 

Even with our efforts to improve our online and telephone service, we have experienced a steady increase in the number of field office visitors. Field offices averaged 

806,000 visitors per week in FY 2006, 825,000 in FY 2007, and 854,000 in FY 2008. 

In FY 2009, we averaged over 866,000 visitors each week. 

With the additional funding we received from Congress last year, we were able 

to add about 1,400 more employees in our front-line operational components and 

made maximum use of overtime to take claims and answer our 800 Number calls. 

In addition to processing more claims than ever before, we reduced office wait times 

despite increasing field office traffic. With the President’s FY 2010 budget, we plan 

to maintain our staffing level and work maximum overtime to minimize wait times 

and provide the best possible service to the unprecedented number of Americans, 

who continue to turn to us for assistance in this difficult economic environment. 


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In addition to using video technology to reduce our hearings backlog, we are exploring ways that it can help us process our initial disability claims, and we are 

using it in our field offices to connect to persons who live in remote areas or find 

it difficult to visit a field office. We are piloting video service delivery by using available staff in a less-busy office help other offices that may be overwhelmed with visitors waiting for service. In addition, we are placing video equipment at third-party 

sites, such as hospitals, community centers, libraries, and Indian reservations to 

provide field office service. 

We continue to pilot self-help computers in our waiting rooms. These computers 

offer access to our online services. Currently, about 60 offices are testing this service. In addition, we are piloting Social Security TV in some of our field office reception areas. The televisions broadcast information about our programs and services, 

such as explaining what documents are needed when applying for benefits or a Social Security number. We can tailor the broadcasts to the local demographics, providing information in multiple languages. We currently offer this service in 18 field 

offices, but we are expanding its use to 150 more offices this year. 

Increasing Our Program Integrity Efforts 

One of our ongoing challenges is how to effectively balance our important program 

integrity work with the growing need to serve the public. Both efforts profoundly 

affect peoples’ lives as well as the economic health of the Nation. Sustained, adequate, and timely funding is vital to helping us achieve this balance. 

The primary tools we use for ensuring proper payments are continuing disability 

reviews (CDR), which are work or medical reviews to determine if disability beneficiaries are still disabled, and Supplemental Security Income (SSI) redeterminations, which are reevaluations of the non-medical factors of SSI eligibility. 

Recently, however, we have paid the price for the growth in workloads and tight 

budgets. Resource limitations have reduced the number of CDRs and SSI redeterminations we can handle. We do not want to defer this important work because 

these reviews help ensure that we pay the right beneficiary the right amount at the 

right time. 

In addition to increasing our capacity to serve the public, the President’s FY 2010 

budget makes a renewed funding commitment to our program integrity efforts as 

part of a government-wide initiative to make government more effective and efficient. Specifically, the FY 2010 budget provides $758 million for our program integrity efforts, an increase of $254 million from FY 2009. If enacted, this additional 

funding will assist us in protecting the public’s tax dollars. 

With the funding proposed in the FY 2010 budget, we can complete a total of 

794,000 CDRs, of which 329,000 will be full medical CDRs, and 2,422,000 SSI redeterminations. We estimate that every dollar spent on medical CDRs yields at least 

$10 in lifetime program savings. 

In FY 2008, our payment accuracy for OASDI was 99.7 percent with respect to 

overpayments and 99.9 percent with respect to underpayments. For SSI, the rate 

was 89.7 percent with respect to overpayments and 98.2 percent with respect to underpayments. Clearly, payment accuracy is very high in the OASDI program and 

with respect to SSI underpayments; nonetheless, we believe we can do better. SSI 

overpayments accuracy is another story. This is the lowest accuracy rate in the program since its early days. We are committed to improving our payment accuracy 

and reducing the volume and magnitude of improper payments we make in both 

programs. I recently appointed an agency executive to enhance our efforts. 

CDRs 

We initiate work CDRs based on work activity when a beneficiary voluntarily reports that he or she is working, when wages are posted to a beneficiary’s earnings 

record, or when a beneficiary has completed a trial work period. Last year, we completed more than 165,000 work CDRs in our field offices. 

Generally, the Social Security Act requires us to conduct medical CDRs on a periodic basis to ensure that only beneficiaries who continue to be disabled receive benefits. In conducting these CDRs, we use one of two methods. We send some cases to 

the DDSs for a full medical review; others may be completed using the mailer process. 

We have seen a rise in our full medical CDRs pending since FY 2002. I must caution that, even with the proposed increase in dedicated funding this year, we project 

the number of pending full medical CDRs will increase by over 100,000 cases to 

roughly 1.5 million. We know we need to do better. 

We must also ensure that we pay SSI in the correct amounts. One of the ways 

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view all the non-medical factors of SSI eligibility, such as resource and income levels 

and living arrangements. 

There are two types of SSI redeterminations: scheduled and unscheduled. 

Generally we periodically schedule all recipients for a redetermination at least 

once every six years. Moreover, we target the most error-prone cases each year 

using a statistical model. We conduct unscheduled redeterminations when recipients 

report, or we discover, certain changes in circumstances that may affect the SSI 

payment amount. 

In FY 2009, we completed over 1,730,000 SSI redeterminations. This fiscal year, 

we plan to process nearly 700,000 more redeterminations than last fiscal year. 

In addition to CDRs and SSI redeterminations, we have developed other program 

integrity initiatives that use cost-effective means to help us further manage and protect the programs we administer. Electronic data matching provides a foundation 

for our ongoing program integrity work. To identify both OASDI and SSI beneficiaries who are no longer eligible for benefits, we match data in our records with 

over 400 State and local government organizations and 65 Federal agencies. 

We are using modern technology in innovative ways to help us detect and prevent 

payment errors. To maximize our return on investment, we focus on addressing the 

leading causes of error. For SSI beneficiaries, unreported resources and changes in 

earnings from work are two significant factors that contribute to payment errors. 

We have recently expanded two projects targeted to improve our ability to identify 

bank accounts for SSI applicants and to make it easier and more convenient for 

beneficiaries to report their wages each month. 

The Access to Financial Information project automates our access to financial 

data. This process allows us to identify and verify bank accounts held by SSI applicants and recipients. We have tested the process in New York, New Jersey, and 

California. 

The President’s FY 2010 budget includes up to $34 million for us to expand this 

project. We are encouraged by these early results, but there is a lot of work ahead 

as we expand and continue to develop plans for implementing this project in additional States and accessing data from more financial institutions. 

Receipt of wages is another leading cause of SSI overpayments. To make it more 

convenient and easier for beneficiaries to report wages, we have recently implemented nationally an automated monthly telephone wage reporting process. The 

process uses both touch-tone and voice recognition telephone technology to collect 

the wage report. Our software automatically enters the wage data into the SSI system, which is much more efficient than if the beneficiary visited a field office, and 

we manually enter the report into our system. We are encouraging beneficiaries to 

use the telephone reporting system. 

At the same time, we continue working with the law enforcement community to 

pursue cases of fraud and abuse in our programs. Through our Cooperative Disability Investigations (CDI) program, a joint venture with the Office of the Inspector 

General (OIG), DDSs, and State and local law enforcement personnel, we work collaboratively to investigate allegations of fraud and abuse related to initial disability 

claims. We currently have 20 units in 18 States. We plan to open two new CDI units 

this year in South Carolina and Missouri. Last year, we estimate that the program 

yielded an additional $240 million in program savings. Our Inspector General estimates the CDI program returns $14 in program savings for every $1 invested. 

Sustaining Momentum Under the President’s FY 2010 Budget 

Prior to FY 2008, we had been under-funded for 14 straight years by a total of 

over $2 billion, and the recession continues to increase our workloads beyond what 

we projected. We now expect about 100,000 more retirement and 350,000 more disability claims this year than we projected in the FY 2010 President’s budget. 

Since I became Commissioner, even before the recession hit, I have been informing you that we were facing an avalanche of retirement and disability claims at the 

same time we were addressing a large hearings backlog. In the past two years, you 

have heard our pleas and provided additional funding. I greatly appreciate your support. 

Recent appropriations have allowed us to hire thousands of new employees and 

provide the space and equipment they need to serve the public. These new employees are helping us improve our services, but they require extensive training to handle our complex work. This training time delays the positive effect that they will 

have on our workloads. Thus, our greatest opportunity for success is directly tied 

to timely, adequate, and sustained funding. 

We are acutely aware of the Nation’s difficult economic situation, and we take our 

responsibility very seriously. We have prudently used the additional resources you 

have provided to make comprehensive improvements to our services to the American 


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public at a time when they need us most. We have demonstrated sound, yet flexible, 

planning that we can adapt to the changing economic situation. 

Even though we are currently operating under a CR, our Recovery Act funding 

is allowing us to maintain the momentum we gained in the last year. 

For FY 2010, the President proposed a significant investment in us—$11.6 billion, 

a 10 percent increase over FY 2009. This increase is essential to maintain our 

progress. Without it, the hearings backlog will worsen, and we will drown in the 

flood of additional disability claims. 

With the President’s FY 2010 budget, we plan to hire a total of about 7,500 employees, which will allow us to maintain our staffing levels in our front-line operational components and add 1,400 employees in the DDSs and 1,300 employees in 

our hearing offices. We will process nearly 270,000 more initial disability claims 

than we did in FY 2009. We will minimize the increase in pending initial disability 

claims, and maintain our course to return the pre-recession pending level by 2013. 

We will process nearly 65,000 additional hearing requests and ensure that the 

hard-earned progress we have made to reduce the backlog is not lost because of the 

economic downturn. We will remain on track to eliminate the backlog by 2013. 

We will make progress on the program integrity workloads that we have deferred 

processing. Finally, we will continue to modernize our information technology, which 

will enable us to pursue 21st-century modes of service delivery. All of these investments are critical to ensuring that we can overcome the dual challenges of accurately and efficiently processing our ever-increasing workloads and meeting the 

public’s demand for our services into the future. 

In short, we have made solid progress, and hope to beat our target date of 2013 

for the elimination of the hearings backlogs despite all of the new cases stemming 

from the recession. We are committed to working with Congress and the American 

people to achieve our goals and improve service in the years ahead. With your support, we will successfully overcome our challenges, but it will take a few years, and 

we will continue to need timely, adequate, and sustained funding. 


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f 

Chairman TANNER. Thank you, Commissioner. You mentioned 

the DDS backlog in 2013. The DDS backlog really is a rather recent phenomenon, isn’t it? 

Mr. ASTRUE. Yes. 

Chairman TANNER. Why would it take to 2013? 

Mr. ASTRUE. It’s a product of the recession, Mr. Tanner. We 

were hit last year with, I believe about 400,000 more cases than 

the actuaries originally projected. We will probably take in about 

700,000 more cases this fiscal year than were projected. We were 

just not set up to handle an extra million cases, because we were 

struggling a bit with staffing. It also takes time to hire and train 

new employees. 

So, we have moved as aggressively as we can. We have beefed 

up the DDSs as much as we can. We are moving some Federal 

workers to the processing of cases. There are some states that have 

looked at other states that are furloughing and understand that 

there is an issue. They have volunteered to set up special units to 

handle work from other states. 

We have special units called Extended Service Teams in four 

states that are going to help us pick up from some of the states 

that are going to be lagging with the furlough issue and the impact 

of the recession. 

Chairman TANNER. Do you have any comment about what Mr. 

Filner said about the situation in California? 

Mr. ASTRUE. The situation in California is a source of great 

concern. Right now, the number of pending cases is building up, 

and that’s usually what happens right before our average procVerDate Nov 24 2008 03:34 Jan 25, 2012 Jkt 063016 PO 00000 Frm 00048 Fmt 6633 Sfmt 6602 I:\WAYS\OUT\63016.XXX GPO1 PsN: 63016

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essing times start to deteriorate. The average processing times 

have not significantly deteriorated yet, but that’s likely to happen 

in the next few months. 

California is a state that has had issues in quality. They’re right 

near the bottom of the States in quality, even before what’s been 

going on lately. We have been having trouble getting clear information about some of the things happening in California. I believe 

both the director of the DDS and the number two retired recently. 

It’s a little confusing in California. We do have concerns. 

We don’t have recent, as I understand it, quality review information that would verify some of the complaints that Mr. Filner is 

making, but we are monitoring it as closely as possible. We certainly share the concern that California may be heading toward a 

very inappropriate situation. 

Chairman TANNER. Well, if the situation is as concerning as 

Mr. Filner testified, California may deserve some special sort of attention from you. If a judge is instructed to close cases for the 

wrong reasons, that is very concerning. We are really interested, 

and would appreciate you letting us know what you find out. 

Mr. ASTRUE. We are on this. We are trying to—— 

Chairman TANNER. It is sort of unusual for a Member to come 

here with those sorts of statements, so we are concerned. 

Mr. ASTRUE. Yes. 

Chairman TANNER. It is not something we take lightly. 

Mr. ASTRUE. We will report regularly to the Committee on the 

California situation. 

Chairman TANNER. Good. 

Mr. Johnson. 

Mr. JOHNSON. Thank you, Mr. Chairman. Mr. Astrue, we have 

talked before about the Agency’s outdated technology that includes 

computer programs that are still COBOL-based. 

Mr. ASTRUE. Yes. 

Mr. JOHNSON. That’s 1950s technology. 

Mr. ASTRUE. Yes, sir. 

Mr. JOHNSON. Today we have got a lot better stuff. 

Mr. ASTRUE. We do. 

Mr. JOHNSON. Can you tell me what you’re doing to modernize 

your system? 

I am told that it could take as long as seven years for you guys 

to get it updated. Can you talk about that to us? 

Mr. ASTRUE. Yes. We are trying to do as much as we can as 

fast as we can, in terms of systems modernization. It is a daunting 

task, because, first of all, we have got 38 million lines of COBOL 

code. 

We have to be very careful as we replace code, that we don’t disrupt service. A lot of the programs are tied in with each other in 

intricate ways, and sometimes it’s very difficult. When you pull out 

a piece of it, you have to be very careful that you’re not having unintended consequences. We are moving to do that as aggressively 

as we can. 

The first big step is, when we went electronic with the DDSs, we 

kept the COBOL. That will be replaced. We should have the—— 

Mr. JOHNSON. When? 


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Mr. ASTRUE. April 2011 is the target date for when the beta 

will be ready on that, and then it will probably be a roll-out over 

another 18 months. 

Mr. JOHNSON. Why is that taking so long? Goodness gracious, 

we’ve got technology out there. I mean, everybody in this audience 

can go out there and get a new computer and be upgraded today. 

Why can’t you guys do that? 

Mr. ASTRUE. Well, it’s not just a question of the hardware. The 

hardware is fairly simple to do. It’s the software that takes a long 

time to rewrite and to tie in with all of the other software. 

To give you some sense, the effort to come up with a much better 

online retirement form, if I remember correctly took some time. 

The online retirement form had to cut across 39 separate COBOLbased programs that then had to be retied together. It is a long and 

difficult task. My sense is we may, over the next three years, be 

able to replace half of it. 

However, I don’t think it’s realistic, particularly in the core of the 

program, the data on everybody. That’s a big task, and it’s going 

to take us a while to get to that. If we had more resources we could 

do it faster, but there are trade-offs. There is a lot of pressure to 

supply—— 

Mr. JOHNSON. So you’re telling me it’s true, it might take you 

seven years to get the program fixed? 

Mr. ASTRUE. Yes, sir. 

Mr. JOHNSON. That’s gross. I think you ought to get into that 

and figure out how to do it a little better. 

You know, you said by early calendar year 2010 you would have 

enough hardware and software in Durham to build up all the 

Agency claims and data processing center systems, should there be 

a catastrophic event at your center in Baltimore. Is that still true? 

And what does ‘‘early calendar year 2010’’ mean? 

Mr. ASTRUE. The situation for the back-up center now is that 

the building is completed and the equipment is in there. They are 

moving a little bit faster than, I think, originally planned on getting some of the equipment in. 

We are now—let me just double-check. We will be able to fully 

back up and recover in just a few months, Mr. Johnson. So we are 

ahead of the old schedule. 

Mr. JOHNSON. That’s new technology down there? 

Mr. ASTRUE. Yes, that is substantially new technology. We try 

to stay away from—— 

Mr. JOHNSON. That’s a back-up? 

Mr. ASTRUE. It’s a back-up. 

Mr. JOHNSON. Why can’t you use it as primary, then? 

Mr. ASTRUE. We are going to start using it as partial primary, 

probably increasingly over the next two years, because we run out 

of capacity at the National Computer Center in 2012. We won’t 

have the replacement for the National Computer Center completed 

until then, so we are gradually shifting some functions over to the 

back-up center, and will be tying together the old National Computer Center and the new back-up center until we have the new 

National Support Center up and running. That should start coming 

on probably mid-2013. 


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Mr. JOHNSON. Mr. Chairman, I think we ought to be getting 

a report about every six months on the progress of that thing, because I think it’s gross to have systems that old that don’t work 

right. My opinion. Thank you, sir. Thank you for your testimony. 

Chairman TANNER. We might do it a little more often than six 

months, if that would be all right. 

Mr. JOHNSON. Every month would be fine. 

[Laughter.] 

Chairman TANNER. That’s what I was thinking, too. 

Mr. Pomeroy. 

Mr. POMEROY. Thank you, Mr. Chairman. Mr. Astrue, it’s nice 

to see you again. I like the straightforward tone of your testimony. 

I mean, I don’t think you make any bones about it. The backlogs 

that we have are not acceptable. The Agency performance, certainly with plenty of congressional culpability because of funding, 

allowed a situation to grow to absolutely unacceptable levels of 

backlog. I appreciate the headway that you’re making. 

A couple of interesting items in your testimony. You indicated 

that in 2009 you hired 8,600 new employees, the largest hiring effort since the creation of the Social Security program. 

Mr. ASTRUE. Yes. 

Mr. POMEROY. Would you care to elaborate on that? 

Mr. ASTRUE. In fact, I think what is more remarkable, and a 

great tribute to the people in the Agency, is we hired about 8,300 

of those in 51⁄2 months. We were on a hiring freeze because of the 

continuing resolution until early March of this year, and I believe 

we hired something like 325, 350 employees for the whole agency, 

from October 1 until mid-March. 

With the combination of the funding in the Appropriations bill 

and the funding in the American Recovery and Reinvestment Act, 

we went pedal to the metal, and we hired over 10 percent of the 

agency in 51⁄2 months. 

Mr. POMEROY. Are you on track with the resources now given 

to staff up to where you need to get? 

Mr. ASTRUE. We are for now. I don’t know yet what the situation is going to be for 2011. There is sort of the good news/bad 

news with the Recovery Act. Technically that’s not part of the baseline budget for the Agency. Therefore, I think, whether you view 

my request for this year as overly aggressive or fair depends a little bit on how you look at the Recovery Act. 

Certainly the Recovery Act money for the new National Support 

Center, I think, should be conceptualized as a one-off. It would not 

be fair to view that as part of the baseline. However, I do think 

that the backlog money, in my view, really is a recognition that 

that should have been in the baseline all along, and ought to be 

viewed—— 

Mr. POMEROY. How is OMB viewing it? 

Mr. ASTRUE [continuing]. In context of this—— 

Mr. POMEROY. Is it being added to baseline? 

Mr. ASTRUE. I don’t know. We don’t have the pass-back yet, so 

I don’t know how they’re going to view it. 

Mr. POMEROY. That might be something we might want to inquire—I am sure staff is noting this. The staffing component of the 

stimulus money needs to be continued. No one viewed that that 


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staffing up was required for the duration of the stimulus bill only, 

or 2009. It is part of getting the Agency back to where it needed 

to be. 

Mr. ASTRUE. Without talking out of school, I think it’s fair to 

say that that’s one of the premises of my budget request. 

Mr. POMEROY. I would hope, Mr. Chairman, that the Subcommittee might write a letter of inquiry to OMB, exploring this 

topic, or I will personally, if the Subcommittee doesn’t care to. 

Chairman TANNER. We already have. 

Mr. POMEROY. We have already? Ah, that’s cracker jack staff. 

[Laughter.] 

Mr. POMEROY. Now, speaking of cracker jack staff, let’s move 

to ALJs. As my cracker jack staff was saying, ‘‘Ask him how they’re 

doing, relative to when you threw a fit,’’ and so, I will try and—— 

[Laughter.] 

Mr. POMEROY. I will try and rephrase that. I believe it was 

your second day in office, but I was absolutely appalled that the 

litigation at the early part of the decade, then resolved, didn’t 

break loose hiring because hiring had been frozen for some time. 

Indeed, three or four more years went on with OPM absolutely 

screwing this thing up, and the Agency not unscrewing it up. 

Actually, as a member of the Committee of oversight, I felt like 

we were led down a primrose path with representations by everybody that were completely inaccurate, relative to the staffing up of 

ALJs. How are we doing, relative to where we need to be? 

In the end, I absolutely believe this is a critical component of the 

backlog question. 

Mr. ASTRUE. Right. I certainly share your sense it was a rocky 

start, Mr. Pomeroy, and you had a lot of company in that regard. 

I do want to thank the Subcommittee as a whole, and you, in particular, as the primary point person for influencing OPM, because 

certainly it wasn’t going very well, just us trying to do it directly. 

Without your help, I don’t think it would have happened. 

We had a little bit of a replay of some of those issues recently, 

but we have an ally in John Berry, the new head of OPM, who is 

very attuned to these issues. I think he is in sympathy with where 

the Subcommittee and I are on this. It’s a shame that we have had 

to take some of these issues up to Mr. Berry to get them resolved, 

but we have had some great progress. They have opened up the 

register again. They won’t tell us how many people were on the 

register, though we have heard that there were 900 people as of 

eight o’clock the night they cut it off, and that there are probably 

1,200 to 1,400, we’re guessing, that are on the register. We don’t 

know, but that should be more than ample for our needs. 

We have hired already—well, actually, no, not yet. Tomorrow you 

will help us swear in 43 more Administrative Law Judges. We are 

scheduled to hire 226 for the year. 

Mr. POMEROY. Where will that bring the number? 

Mr. ASTRUE. That will bring the number up to about 1,450. I 

believe, that is what we’re aiming at. 

Mr. POMEROY. About 1,450? 

Mr. ASTRUE. Let me just make sure I’m getting my years right. 

Yes. We will be aiming for about 1,450, and the Fiscal Year 2011 

budget shoots for a slightly higher number than that. 


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Right now, as long as OPM does what it needs to do between 

now and roughly the end of February, it’s on the critical path, because the truth is, right now we don’t have space to put them. With 

this class that we’re swearing in tomorrow, we’re putting judges 

into pretty much every office that we have available for Administrative Law Judges. 

So, the hiring for the summer is predicated on an awful lot of office space being open. It looks like GSA is going to hit the mark 

on that. Most of it is coming—— 

Mr. POMEROY. Does this Committee—I know my time is up. Do 

we need to be corresponding with GSA, as well as OPM on making 

certain that we don’t have an office backlog? 

Mr. ASTRUE. I think you can send them a general letter congratulating them on good progress and sharing your concern. We 

have had a couple of isolated incidents a few places around the 

country, but generally, the GSA work has really been outstanding 

on this. I want to give them credit, because when we first started 

opening up offices, we were about the only game in town. But with 

the Recovery Act, they have been very busy. 

So, we actually have a list of the offices that are supposed to be 

open. I can append to my testimony. But we have one that—— 

[The information follows:] 


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Mr. POMEROY. You know, my time is so far over. Mr. Chairman, we might want to consider Subcommittee letters to OPM and 

GSA both, asking that they do everything possible to facilitate the 

work of the Agency in getting the ALJ number to where it needs 

to be. 

I thank you, and yield back. 

Mr. ASTRUE. Okay. 


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Chairman TANNER. Thank you, Earl. I agree, and maybe we 

will have a hearing sooner than later to follow up on some of these 

questions that are coming out. They are very good. 

Ms. Schwartz, please? 

Ms. SCHWARTZ. Thank you, Mr. Chairman. Thank you for this 

hearing. I do want to follow up on what both looks like good work 

and good progress. Still, the numbers seem really shocking to us. 

We get calls all the time, of course, in our offices, and I noticed in 

Pennsylvania, it’s still a year wait, basically, you know. 

So, it’s hard to tell people ‘‘If you’re lucky, it will be a year,’’ you 

know? 

Mr. ASTRUE. Yes. 

Ms. SCHWARTZ. That’s kind of where we are. I both want to 

compliment you on all the progress you’re making, and also say it’s 

just not quite enough; we want more. We want it to be better, we 

want it to be faster. 

Mr. ASTRUE. If there were a magic bullet and I could do it faster, I would. I think the problem has been that the system hasn’t 

really been managed carefully. A lot of this is just good management but it takes time. 

Then part of it is capacity. It’s a combination of the systems in 

operation not being good enough and not having enough capacity 

in the right places, which we’re also working very hard to try to 

equalize around the country. 

When this large group of new offices start coming on stream this 

summer, by the end of the year, calendar year, you should see huge 

differences in certain parts of the country. 

Ms. SCHWARTZ. I wanted to follow up on some questions I had 

at the last hearing on this subject, I guess, in April. 

Mr. ASTRUE. Yes. 

Ms. SCHWARTZ. It was particularly about the use of the medical exchange of information system. 

Mr. ASTRUE. Yes. 

Ms. SCHWARTZ. I want to follow up on the exchange of the information through technology, and understanding that you, 

through the Recovery Act, had additional dollars for the exchange 

of what is very complicated and sometimes very time consuming information to get, and that is the actual information on the medical 

condition. 

Could you update us on how much of that is information is now 

being transferred or transmitted electronically? 

Mr. ASTRUE. Sure. 

Ms. SCHWARTZ. Has that, in fact, helped to speed things up? 

Mr. ASTRUE. Sure. 

Ms. SCHWARTZ. Also, how do you see this process moving forward? To what degree is that sort of universally being applied 

across the board, and helping in reducing the number of days? 

Mr. ASTRUE. I think I and most of the senior people in the 

Agency are really excited about this development, because this is 

the one big paradigm changer in disability processing that we see 

coming forward in the next couple of years. 

We spend an enormous amount of our administrative time, 

money, and effort chasing down medical records, and if that can be 

more efficient and complete it will help tremendously. Even withVerDate Nov 24 2008 03:34 Jan 25, 2012 Jkt 063016 PO 00000 Frm 00055 Fmt 6633 Sfmt 6602 I:\WAYS\OUT\63016.XXX GPO1 PsN: 63016

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out trying very hard in the couple of pilots we have been able to 

actually see what would work, we have been able to cut our processing times roughly in half. 

It also is going to improve quality, because a major source of 

error is we often don’t realize that the medical record is incomplete. 

The claimant’s attorneys often don’t recognize that it’s incomplete; 

particularly for certain psychiatric and sexually transmitted diseases, claimants are often very reluctant to volunteer that that’s 

really a major issue for them. So, it’s huge, in terms of timeliness, 

it’s huge in terms of quality. 

What’s frustrating is that we’re not there yet. It would make my 

life so much easier, and life for the people we serve so much easier, 

if they were ready. So what we’re trying to do is make sure, with 

the money, that the systems that are being built by others are 

going to be compatible with ours. 

Ms. SCHWARTZ. Interoperability, yes. 

Mr. ASTRUE. Jim Borland has had the lead for SSA over at 

HHS, as they helped design the standard. We are spending a lot 

of time with VA and DoD, as they design their standards to try to 

make sure that it’s as seamless as possible. 

I am hoping that, at the back end of this recession, there are at 

least a few early adopters in the private sector that would make 

our life a lot easier. For instance, Kaiser Permanente seems to be 

further ahead than a number of others. If they were to have even 

a third of their members in California on this, it could make a huge 

difference in fixing the mess in California. 

Ms. SCHWARTZ. Well, they are moving ahead, and as you know, 

the Recovery Act also provided an additional $19 billion for the private sector doctors and hospitals to implement electronic medical 

records. Those standards for interoperability and those Federal 

standards, HHS is moving ahead on that, and should help. Although it’s clearly not universal yet. 

Could you give us some idea, though, about what percentage or 

number of records you are now actually being able to obtain electronically? 

Mr. ASTRUE. It’s time. I am with you on that. I would like to 

see this today. 

Ms. SCHWARTZ. Yes. 

Mr. ASTRUE. I am impatient. So we’re piloting in Massachusetts 

with Beth Israel Deaconess, and with Med Virginia, which has 

been active in building the system that I think everyone is going 

to be using for the transfer of this kind of health care information. 

We have additional pilots that we’re using. With the 24 million 

dollars under the Recovery Act, they’re allowed to expand this and 

accelerate it as quickly as possible, but it’s a little premature for 

actual results yet. 

Ms. SCHWARTZ. Because I would certainly like to see SSA, and 

I mentioned this before, use electronic records similarly to the Veteran’s Administration, which does have electronic medical records, 

and it is interoperable. 

Mr. ASTRUE. Yes. 

Ms. SCHWARTZ. Any veteran anywhere in the country can access their records, or at least their providers can, so that should 


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help reduce some of the wait. In many cases, we’re obviously trying 

to push states and networks and regional networks. 

But again, maybe not for right now, but I would be interested, 

as you are monitoring this, to see both how fast it’s going—I mean, 

you can’t do this all yourself, you have to have them electronic on 

the other end, you’re absolutely right. 

Mr. ASTRUE. Right. 

Ms. SCHWARTZ. But to the degree of how much it’s helping the 

Agency, how many days it’s saving, it’s pretty impressive to think 

it could cut time in half. That’s pretty good. 

Mr. ASTRUE. We haven’t built changes from this into any of our 

assumptions yet. I think our actuaries need to see something a little bit more concrete before they’re going to do it. 

But I think when that curve starts to accelerate, it’s going to 

move a lot of our numbers in a positive direction. It’s a very exciting prospect, and that’s why we’re spending time and money on it 

now. Because the sooner it gets here, the better it’s going to be for 

everybody. 

Ms. SCHWARTZ. I appreciate your efforts on this, and I know 

that so do so many of our constituents who rely on this information. I thank you, and we will continue to talk about it. 

Mr. ASTRUE. Thank you. 

Chairman TANNER. Thank you, Ms. Schwartz. Mr. Becerra. 

Mr. BECERRA. Thank you, Mr. Chairman. Mr. Commissioner, 

good to see you again. 

Mr. ASTRUE. Thank you. 

Mr. BECERRA. Thank you for the work that you have done. I 

appreciate that you were able to come back to us and tell us that 

you have made some progress in reducing the backlogs. We should 

heed your warnings about what could happen in the future if we 

don’t provide you with the resources that you need. 

I want to focus on California. I know you have tried to get the 

governor in our state of California to exclude the DDS workers 

from the furloughs that he has instituted for state employees. I 

know that we all know that he has not done that. 

Now, the impact of those three-day furloughs per month is that, 

essentially, 15 percent of the work is not being done on any given 

month. If you take into account the size of the backlogs that already exist throughout the country, but certainly in California as 

well, and you reduce the availability of services by 15 percent, just 

across the board, not taking into account anything else, along with 

the fact that you and others have testified and provided information about the increasing caseload that’s coming in, the claims that 

are coming in, an increase of about 15 percent in the last fiscal 

year from 2008 to 2009, and expecting another 10 to 15 percent 

over 2009 to 2010. Through probably 2013, I’m told, the estimate 

is that we will continue to see an increase in case claims coming 

in for disabilities. 

To lose 15 percent for no reason whatsoever—because we’re willing to pay the money, the Federal taxpayers are willing to pay each 

state the money to provide the services; the state of California, the 

governor is not spending one red cent to provide a salary to the 

people who would do these determinations—15 percent, more or 

less, cut right off the top, on top of the fact that you see an avaVerDate Nov 24 2008 03:34 Jan 25, 2012 Jkt 063016 PO 00000 Frm 00057 Fmt 6633 Sfmt 6602 I:\WAYS\OUT\63016.XXX GPO1 PsN: 63016

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lanche of another 15 percent of claims coming, does that, to you, 

lead you to conclude that the governor and the State of California 

are making a good faith effort to provide effective services to California’s disability applicants? 

Mr. ASTRUE. Well, I think that you can’t take an action like 

this without, at a minimum, harming timeliness, and potentially 

hurting quality, as well. 

A number of states are furloughing managers, but not staff. I do 

not know what they think that does, but that is surely going to create quality issues, too. 

Mr. BECERRA. So, is that an effective way to administer that 

program? 

Mr. ASTRUE. No. This caught me off guard. I don’t think any 

previous Commissioner has had to deal with anything like this before. The first state was California last December. It was, to me, 

so nonsensical that, I will be honest, I was caught off-guard again, 

because I thought it was a one-off. 

I said, ‘‘Well, okay. This is a strange decision. What other state 

is going to do this?’’ But then there was a steady pitter pat, and 

I have probably spent 10 percent of my time this year trying to get 

states not to do this. 

Mr. BECERRA. Your use of the word ‘‘nonsensical’’ is perhaps 

the best word I have heard so far about this process that the governor in California is implementing. 

I can’t imagine that it helps with any kind of uniform administration of those disability services when you have people who can’t 

come in to work, simply because the governor said, ‘‘You can’t come 

in, even though the Federal taxpayers are paying the salaries of 

those individuals as well.’’ 

Mr. ASTRUE. Oh, yes. It’s devastating for morale, and we have 

seen this. We have had about a dozen states where—— 

Mr. BECERRA. Right. So let me ask you this, Commissioner. 

Under the statutes, you have the ability to declare that the governor and the State of California are not fulfilling their obligations 

under our Federal laws to administer the programs that they have 

said that they would accept under the Social Security Administration’s duties, and under the Social Security Act. 

You have written a letter. The response was not positive. You tell 

me now what you, as a Commissioner of the Social Security Administration, and therefore responsible for those thousands of Californians who are trying to get their claims processed, will do. 

Mr. ASTRUE. We have some statutory authority. 

Mr. BECERRA. You have lots of statutory authority. I can cite 

you the section. I can read you the underlying portions or the yellow highlighted portions. You have lots of authority. You said it. 

The governor has been acting in a nonsensical manner when it 

comes to the ability of Californians who are disabled, or at least 

claim to be disabled, to have their claims processed. 

With backlogs that take hundreds of days to process, you have 

a governor who has said, ‘‘You’re not going to go to work and process the claims of disabled Californians, even though I, as governor, 

have nothing to do with paying you for the work that you are going 

to do on behalf of those Californians who work very hard to have 

a system in place so they could get their claims heard.’’ 


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Mr. ASTRUE. Right. Certainly there is a factual predicate, 

where we would have an obligation to step in. I am not sure I particularly want to advertise what that line is right now. I don’t 

think that does anyone any good. 

But what I would say is perhaps we should talk offline about 

what some of the considerations—— 

Mr. BECERRA. I will give you my personal phone number, if you 

like. 

Mr. ASTRUE. Okay. 

Mr. BECERRA. Mr. Chairman, you have been gracious with the 

time. But, Commissioner Astrue, I hope that you will do something 

more than just write a letter, because it is unconscionable that a 

chief of state would tell his people that they will not get services, 

even though another level of government is providing every single 

penny to provide those services. I think that is only nonsensical, as 

you said, it’s unconscionable. 

I thank you, Mr. Chairman, for the time. 

Mr. ASTRUE. If I could just note, Mr. Chairman, we have actually done a lot more than writing a letter, too. We actually have 

been working very closely with the unions and employee groups. 

We have intervened and filed, essentially, a friend-of-the-court brief 

in one of those cases in support of one of the unions. 

We have been talking to editorial boards. I was actually in touch 

with one of the major papers the day before yesterday in California, talking at some length about this issue. So we are trying 

to work this as best we can. 

Mr. BECERRA. I apologize if I made the representation that you 

were not doing more. 

Chairman TANNER. Well, yes, I know you have spoken out in 

editorial boards on the East Coast, and I would hope that you 

would do so again on the West Coast. 

Mr. ASTRUE. Yes. 

Chairman TANNER. Ms. Sa ́nchez. 

Ms. SA ́ NCHEZ. Thank you, Mr. Chairman. Commissioner 

Astrue, first I really want to applaud you for the work that SSA 

has done over the past year, you know, in the face of, obviously, 

very increased demand. SSA has managed to reduce the backlog, 

and although it’s still longer than many of us would like to see, 

progress is being made. First of all, I just want to commend you 

for that. 

I also want to commend you on your efforts to fight the furloughs 

for DDS employees. As somebody from California, obviously that is 

an issue that is of special concern to me, especially given that, as 

my colleague, Mr. Becerra, said, California is going to face an increase in the number of applications, and we are actually seeing a 

decrease in the number of those applications that are being processed. 

I, too, agree that the furloughing of employees, when it doesn’t 

cost the state any money to have them working on those days, is 

completely unconscionable. I was interested in your testimony saying that you at first thought California was kind of an anomaly, 

and then you had other states come on board. How many states, 

all together, are furloughing DDS employees? 


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Mr. ASTRUE. It fluctuates almost on a week-to-week basis. The 

current count is 9 across the board, and I think it’s been higher 

than that. One of the frustrating things is you put a lot of effort 

in and sometimes you think you’ve won the discussion. Then all of 

a sudden there is another round of fiscal crisis, and then a state 

legislative meeting and you’ve lost. 

So, we have put a lot of time and effort into it. I think at one 

point we were as high as maybe 15 states. 

Ms. SA ́ NCHEZ. So you have had a little bit of success in convincing some of the governors not to do this. 

Mr. ASTRUE. We have. Often, to give credit where credit is due, 

we have gone to the members of our committees of jurisdiction, 

both here and in the Senate, to ask for help, because often, you 

carry a lot more weight with governors. Matter of fact, you always 

carry more weight with governors than I do. 

Ms. SA ́ NCHEZ. Not to, you know, pat the California delegation 

on the back, but in February I got members of the California delegation to send a letter to the governor, specifically. 

Mr. ASTRUE. Yes, you did. 

Ms. SA ́ NCHEZ. The letter requested the Governor to not furlough these employees. We got a response back that was pretty 

much a non-response. 

Do you have a more thorough explanation? Are they giving you 

a rationale for why they want to continue to furlough these employees? 

Mr. ASTRUE. Well, the original rationale that they gave us 

turned out not to be true, which is that the unions were insisting 

on it. In some states, that turned out to be true, because I think 

the union positions around the country have been inconsistent. In 

California, it turned out that that was not, in fact, accurate. We 

ended up, as I mentioned, supporting litigation from one of the 

unions in California. 

Ms. SA ́ NCHEZ. What more can Members of Congress do to help 

you try to combat this? 

Mr. ASTRUE. I think what you can do, which is not easy, and 

maybe in some cases not even fully appropriate for me to do, is 

that you are all part of political networks in your home states. 

Your majority leaders and minority leaders in your state legislatures, they need to hear from you on these things. 

Sometimes I can’t get to the governors. They get walled off by 

staff or budget directors, or that type of thing. Usually I can get 

through, but not always. 

You need, I think, if you’re in a state that is having these issues, 

to try to educate the political establishment broadly. Because just 

getting to one person won’t necessarily solve it over the long run. 

So, anything that you can do in that regard would be enormously 

helpful to us, and we would be very grateful. 

Ms. SA ́ NCHEZ. Okay. Switching topics really briefly, last April 

I read a New York Times article, the title of which is, ‘‘Insurers 

faulted as overloading Social Security.’’ 

The story discussed these whistleblower lawsuits against insurance companies who were forcing their beneficiaries number one, 

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wise, they’re not going to pay them benefits under their policies. I 

was quite surprised and appalled by this sort of movement, and the 

impact that it has on Social Security resources to process claims. 

How much effort is the Administration putting into looking at 

the role that outside entities are having in adding to that backlog? 

Mr. ASTRUE. Sure. This issue has sort of heated up in recent 

years. We’ve got a couple of studies going. We’ve got some results 

for private insurers. We are also looking at the extent to which 

states are requiring an application to us as perhaps an inappropriate barrier to welfare benefits in their own states, as well. 

Certainly, we don’t condone either of these practices. In the qui 

tam action in Boston that I believe generated a lot of the media 

coverage, it was a split decision. The insurance companies lost a 

few of those cases, they won a few of those cases. So, clearly, there 

is abuse. We don’t condone that. 

Our take so far is that the workload burden from the private insurance companies from these abuses is relatively small. We are 

not persuaded yet that, in certain states, the comparable practice 

on the public side might not be more of a problem. But it has been 

difficult, getting the data to determine that. It is taking us longer 

to run those studies. 

So, I would say that for private insurance companies, it’s an 

issue, but a very small one. We are not sure yet, with the state 

agencies, how big a problem it is. We hope by some point next year 

to have a better answer to that question. 

Ms. SA ́ NCHEZ. Okay, thank you. Mr. Chairman, I would just 

ask unanimous consent to be able to enter that article into the 

record. I will yield back my time. 

Chairman TANNER. Without objection. 

[The information follows:] 


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Chairman TANNER. Commissioner, before we move to a nonCalifornian, may I—— 

[Laughter.] 

Chairman TANNER. May I ask you to provide us with a copy of 

the legal filing that you all made in the California case? 


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Mr. ASTRUE. I would be delighted to, thank you. 

[The information follows:] 


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Chairman TANNER. Thank you. Mr. Kind, you are recognized. 

Mr. KIND. Thank you. I may not be from California, but my answers may not be any easier. But, first of all, thank you, Mr. 

Chairman, for holding this very important hearing. Mr. Astrue, 

thank you for being here. 

While progress is being made, and I congratulate you and thank 

the Agency for the priority you have placed on the backlog issue, 

it’s clear more work needs to be done. 

Mr. ASTRUE. Absolutely. 


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Mr. KIND. I also want to thank you for the quick response that 

the Agency provided in my request to have video teleconferencing 

equipment installed in Lacrosse, Wisconsin, which had a large 

number of backlogs. 

But that was quickly responded to. The equipment is in. It’s 

going to reduce now the travel time and the expense and burden 

for applicants and their representatives, and the administrative 

judges, as far as moving around the state in order to deal with the 

huge backlog in western Wisconsin. 

Having said that, I also took a chance or a moment before coming over here to take a look at the processing time in Madison and 

Milwaukee, in particular. I know we’re facing some big issues, but 

if you look at the average processing times for the hearing offices 

around the country, I see that Madison hearing office has an average processing time of 588 days, which ranks 135 out of 143 offices, 

nationwide. Milwaukee is 552 days, which is 124 out of 143, both 

of which have more than doubled the processing time of the fastest 

office. 

And I am wondering if you have any information to share why 

this is occurring in Wisconsin, why the processing time is so slow 

there. 

Mr. ASTRUE. That’s a very fine question. One of the things that 

I figured out a few months after I became Commissioner was that 

I was walking into a situation with horrible national backlogs. But 

when I really had a chance to get deep into the numbers, it was 

clear that we had a distribution issue around the country. 

Essentially, the infrastructure of our hearings office hadn’t 

changed in 20 years. It was the same number of offices in the same 

locations with the same number of judges, and the demographics 

of the country have changed enormously in that time period. 

As bad as the backlog was in many places in the country, if I you 

actually take your fingers on a map of the United States—I used 

Madison, Wisconsin on the west, and the eastern shore of Michigan 

on the other—and slide down, then start angling to the east, and 

then end up in Florida, you see case filings per administrative law 

judge a few years ago of three or four per day. As much as we’re 

pushing for more productivity, no judge is fast enough to decide 

that many each day. 

Mr. KIND. Right. 

Mr. ASTRUE. In my lifetime, no judge is going to be deciding, 

four cases per day. We’ve got other places, like New Haven, Connecticut, where they’re only taking in half a case per judge per day. 

So, there is a misallocation around the country. 

So, we spent a lot of time with the selection of these new offices 

looking at the demographics of the country for population growth 

and also looking at filing incidence, because there are some places, 

like Michigan, that have been in chronic recession since 2001, 

where the filing rates are very high, and we’re trying to equalize 

that around the country. 

Mr. KIND. Well, I am glad to hear that you are sensitive to the 

caseloads. 

Mr. ASTRUE. For Wisconsin, the key thing is that we are upgrading the satellite office in Madison to a full hearing office. 

Mr. KIND. Yes. 


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Mr. ASTRUE. GSA is on schedule for that for June of next year. 

Mr. KIND. Well, I appreciate that. Obviously, there are some 

issues still. 

But, Mr. Chairman, I just received, on November the 6th, a letter from a friend, an attorney, who represents many Social Security 

applicants from western Wisconsin. I would like unanimous consent to have this introduced to the record at this time. 

Chairman TANNER. Without objection. 

[The information follows:] 


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Mr. KIND. But I want to also just quote from him. There are 

some examples of what he has been seeing out there, and in one 

particular example, he stated, ‘‘A middle-aged Eau Claire area 

woman became disabled when her knees deteriorated to the point 

where she needed knee replacements. Her knee conditions have led 

to back problems causing chronic pain, for which she has had to 

take highly potent narcotic drugs. After waiting nearly three years 

for a hearing, the judge finally granted her benefits within just 10 

minutes. And while waiting for her hearing, her family lost its 

home to foreclosure, and had to file for bankruptcy. And after the 

hearing, he had asked her if they would have lost their home and 

had filed for bankruptcy if she had been getting her Social Security 

check all along. And tearfully, she replied, absolutely not.’’ 

‘‘And to add insult to injury, I just received a telephone message 

from her just a few days ago, that even though this client’s fully 

favorable decision was dated August 31 of 2009, she has still not 

received her first check or her back pay. She called the Social Security district office last week, and was told it could take 90 days for 


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the payment center to get her into pay status, and to issue her payment for past due benefits.’’ 

Now, this is not all that atypical, unfortunately, and this, I 

think, is the human dimension to the backlog urgency that we’re 

facing: real people, real problems, and, typically, some of the poorest and most vulnerable members of our society. 

So, the more we can concentrate on that the better, and I know 

we have a dual role here, as far as your implementation and our 

support in Congress to getting this done. I think it is important 

that we continue to see that we do everything we can to alleviate 

this type of suffering throughout the country. 

Mr. ASTRUE. I’m in absolute agreement. I do think that when 

we get through the recession and we go to health IT, we will be 

able to cut the time at the state level by more than half. 

In the strategic plan that we have laid out, the goal is to get to 

an average processing time of 270 days. We still have a way to go, 

but that’s what we’re trying to do. 

Mr. KIND. Mr. Chairman, with your indulgence, I just received 

word that one of our outreach rural SSA offices has to be shut 

down now, because of threats that were being delivered to the staff 

there, and, therefore, protective services have been brought in. 

They’re going to investigate and make sure that those threats 

aren’t carried out, and something bad doesn’t happen, but I hope 

this isn’t a trend that you are seeing out there, as far as threats 

of violence. 

Mr. ASTRUE. Sadly, it is. We have a violence report when there 

is an actual assault or a serious threat to an employee. I insist on 

reading every single one of those. When I started, I was probably 

seeing about three of those a week. As the economy started to unravel, you could see it in these reports, and I sometimes get 10 a 

day now. So it’s been a very serious issue. 

It is remarkable to me we haven’t had any actual loss of life yet. 

We have had some very close calls, and it is a scary thing. I think 

a lot of times people don’t appreciate the courage of the people on 

the front line in our offices. They face a lot of very disturbed, angry 

people day in, day out and don’t know what people like that are 

going to do. 

Mr. KIND. I echo that. I thank you for acknowledging the fine 

work that’s being attempted out there for us, too. Thank you. 

Thank you, Mr. Chairman. 

Chairman TANNER. Thank you. I will call on Mr. Johnson, you 

are recognized for a follow-up. 

Mr. JOHNSON. Thank you, Mr. Chairman. You know, the idea 

of states preventing people from working, like in California as you 

just talked about is concerning. How many states are doing that, 

do you know? 

Mr. ASTRUE. We’re up to 10 right now. 

Mr. JOHNSON. Ten of them? 

Mr. ASTRUE. Mr. Johnson, 10, yes. 

Mr. JOHNSON. Have you talked to all of them? 

Mr. ASTRUE. I have talked to pretty much all of them, or at 

least tried to. I—— 

Mr. JOHNSON. Well, we pay their salaries, don’t we? 


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Mr. ASTRUE. Yes, and we pay their overhead. Of course, it’s also 

state taxes that are foregone, too. So they’re actually directly hitting their coffers, as well. 

On top of it—and, again, it is more important than just the fiscal—the people who don’t get cash and health benefits from us are 

often tapping their other state programs, too. So it’s just a devastatingly nonsensical thing for states to be doing, from both a 

moral and fiscal point of view. 

Mr. JOHNSON. It’s both parties, right? 

Mr. ASTRUE. Yes, it’s bipartisan. It’s split pretty evenly, Mr. 

Johnson. 

Mr. JOHNSON. Yes. 

Mr. ASTRUE. That’s right. 

Mr. JOHNSON. Thank you. Let me ask you another one. In August you responded to a letter where you confirm that 1,700 prisoners received benefits erroneously. We know that over 8,000 payments were sent in error to those who died. 

Have you recovered all that? And if Congress decides to send another $250 payment, can you assure us that those mistakes won’t 

happen again? 

Mr. ASTRUE. Not quite. We’re almost there, Mr. Johnson. So, 

first of all, one of the things it’s important, I think, to recognize is 

that not all of the prisoner payments were errors. The legislation 

was written in a manner that we were supposed to pay some prisoners. We did indicate at the time—— 

Mr. JOHNSON. I understand that. 

Mr. ASTRUE [continuing]. That we didn’t have the databases for 

that, and everyone was in a rush—— 

Mr. JOHNSON. That’s because your computer system isn’t up to 

date. 

[Laughter.] 

Mr. ASTRUE. Well—— 

Mr. JOHNSON. Come on. 

Mr. ASTRUE. Normally we’re not in the business of tracking 

prisoners. So, I would certainly encourage you, if there is a return 

to another $250 payment, which the Administration and I support, 

that Congress reconsiders the approach to prisoners. That would 

eliminate the problem, all together. 

But we are embarrassed by this. It’s not a large amount of 

money in the context of $13 billion. We have gone through several 

exercises to say, ‘‘What are the lessons learned,’’ ‘‘Are we ready if 

we’re asked to do this again?’’ 

For the widows, there is almost no lost money. That’s all pretty 

much been taken care of. They’re whittling down on the prisoners. 

It’s often difficult to get cooperation from the states. I believe—I 

will confirm this for the record—it’s fewer than 500 that we’re still 

working on at this point. It’s a work in progress. Hopefully within 

the next few months we will have done everything that we need 

to do on that. 

[The information follows:] 


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Mr. JOHNSON. Thank you, Mr. Chairman. 

Mr. ASTRUE. But we’re not quite done yet. 

Chairman TANNER. Well, in the next few months we want to 

stay updated. We may have a follow-up right after the first of next 

year, to see how we’re doing and see what we can do with this. 

Mr. ASTRUE. Okay. 


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Chairman TANNER. There are, as Mr. Kind indicated, people 

suffering. 

Commissioner, thank you very much. 

Mr. ASTRUE. Thank you, Mr. Chairman. 

Chairman TANNER. We will be back in touch with you quite 

soon. 

Mr. ASTRUE. Okay. Thank you, Mr. Chairman. Again, thank 

you for all your support. We very much appreciate it. 

Chairman TANNER. I am going to introduce the next panel 

while they are taking their place. Ms. Barbara Kennelly, of course, 

is the President and Chief Executive Officer of the National Committee to Preserve Social Security and Medicare, and she was here 

for 23 years and survived, so, Barbara, it is always good to see you 

again. We are always glad to have you back, and we’re going to 

look forward to your testimony. 

Also on the panel is Ms. Beth Bates. She works in my district, 

in Tennessee, and she is a lawyer who is quite knowledgeable in 

these matters. Beth, we are delighted to have you here. 

We also have the Honorable Patrick O’Carroll. Mr. O’Carroll, of 

course, as you know, is the Inspector General at the Social Security 

Administration. Mr. O’Carroll, thank you for coming today. I am 

going to speed this list up. 

Ms. Robert, thank you for being here. She is from Chicago, Illinois, and has much experience in matters of this nature. 

Mr. Larry Auerbach, who is the Administrative Law Judge at the 

Social Security Administration in the Atlanta office is also here. 

We are delighted to have all of you. I apologize for the hurried introductions, but we’ve got a time problem, and it’s not our friend 

at the moment. 

Sam, do you have any comments? 

Mr. JOHNSON. No. 

Chairman TANNER. Congresswoman, you are recognized. 

Ms. KENNELLY. I was not here in Congress for 23 years. 

Chairman TANNER. You weren’t? 

Ms. KENNELLY. No. 

Mr. JOHNSON. Turn your mic on. 

Chairman TANNER. Let’s see. It says, ‘‘After a distinguished 23 

years’’ in elected public office. I get it. 

Ms. KENNELLY. Yes. 

Chairman TANNER. Okay. 

Ms. KENNELLY. I was a city councilwoman for many years. 

Chairman TANNER. Yes. 

Ms. KENNELLY. Then I was Secretary of the State of Connecticut. I was here in Congress for 17 years. 

Chairman TANNER. Okay. 

Ms. KENNELLY. I was on this Committee. 

Chairman TANNER. Well, you escaped all right. 

Ms. KENNELLY. Yes. No, no, no. I was on this Committee 16 

years. 

Chairman TANNER. I know. 

Ms. KENNELLY. I loved every single moment that I was here. 

Chairman TANNER. Well, we are glad to have you back. Thank 

you. 


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Ms. KENNELLY. I want to tell you, Congressman Johnson, I am 

the Acting Chair of the Social Security Advisory Board, and I was 

getting prepared for this hearing. I was really kind of nervous 

about testifying so I studied last night questions you asked Syl 

Scheiber. They were very good questions. Do you remember them? 

They were very complicated. I read them three, four, five times. 

Now, you’re not going to ask me those today, are you? 

[Laughter.] 

Ms. KENNELLY. They were wonderful questions. I think that’s 

what we have to remember, is how important this Committee is, 

and how important Social Security is. 

Now, I will read my testimony. 

STATEMENT OF BARBARA B. KENNELLY, ACTING CHAIR, 

SOCIAL SECURITY ADVISORY BOARD 

Ms. KENNELLY. I am pleased to appear before you today in my 

capacity as the Acting Chair of the Social Security Advisory Board 

to discuss the progress SSA has made in clearing the disability 

backlogs. 

Is the Commissioner still here? Well, he has done a very good 

job. There were some old, old, old cases, and he came in, and he 

really went at those old cases. I don’t have the figures. Kim, do you 

have them, or does somebody have them? I mean, what he did was 

exceptional, and I think he should get credit for that. 

What I really wanted to thank the Committee for is the active 

interest it has taken in reducing the disability backlogs. But you 

only could do it as a result of your work. The appropriation for SSA 

was nearly $10.5 billion, and the Recovery Act included an additional $500 million to address the increased claims due to the recession, and attack the backlog that had been choking the system, 

forcing applicants to wait for years to receive a Social Security 

check. 

As you know, SSA has long struggled with managing its disability hearings workload. The chief source of the problem has been 

years of under-funding, coupled with a growing caseload. As a result, the President requested $11.45 billion for SSA, in administrative costs. If SSA had any chance of keeping up with the influx of 

claims it will need its full appropriation. 

The fiscal year 2011 budget is now being prepared by OMB. It 

is my hope that the President and the Congress will include sufficient funds in the fiscal year 2011 appropriation to address both 

current backlog cases and new claims triggered by the recession. 

SSA will need about $950 million, just to maintain current staffing. 

In addition, they will need funds to expand capacity at the disability and the hearing offices to address backlogs and increased 

claims. 

Earlier this year, the Subcommittee sought the perspectives of 

the Advisory Board on the progress made by SSA in using Recovery 

Act resources to reduce its disability claims backlog. In the seven 

months since the hearing, we have been watching closely as the 

Agency has carried out its backlog reduction initiatives, including 

148 new Administrative Law Judges, which is wonderful. 

I mean, hiring 1,000 hearing office support staff, establishing 

three national hearing centers, and eliminating cases that were 


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over 850—and that’s what the Commissioner did—850 days old. 

That is unacceptable, absolutely unacceptable. Productivity in the 

hearings offices has been steadily increased. ALJs have improved 

their production, and nearly three quarters of the judges are clearing between 500 and 700 cases per year. 

The Board was briefed on several initiatives underway at the office of hearings and review that will emphasize data analysis and 

processes. One initiative was the development of a model that stimulates the current work process in order to identify steps in a process that creates bottlenecks. Some of these initiatives hold promise. 

However, in my view, as the Agency continues to streamline the 

hearing process, it is critical that due process for beneficiaries be 

maintained. We focused on that when I was on the Committee. The 

recent gains in reducing the hearings backlog are a significant accomplishment. We anticipate that the Agency will continue to improve its process at that level. 

However, SSA is being confronted with a tremendous growth of 

new claims. This year SSA received 3 million new disability claims, 

380,000 more than previously expected. This is already placing significant stress on the DDSs. They have now 783,000 initial claims 

pending, an 18 percent increase from April. 

The rapid increase in unemployment is a major reason for the 

unexpected increase in disability applications. Historical trends 

document that disability applications rise and fall in tandem with 

the unemployment rate. People with disabilities who previously 

worked despite their medical conditions are now unable to find 

work, and may decide to apply for disability benefits. These people, 

combined with the Baby Boomers—I hate that word ‘‘Baby 

Boomers,’’ it’s overused—who are reaching prime disability age, 

could raise DDSs claims to 2010 to 3.3 million, according to SSA 

actuaries. 

Although the number of new claims will drop as the recession 

eases, earlier cases will still be clogging the process. A rapid rise 

in the backlog claims at the initial stage will have significant consequences for applicants. These are people facing dire economic circumstances, if they do not receive a fair and timely disability decision. SSA has pledged to bring down the current number of initial 

claims from 783,000 to 525,000 by 2013. But they will need the 

comprehensive strategy in order to be successful. 

Between now and 2013, SSA may realize some gains in productivity and efficiency, as more electronic initiatives come online. But 

these do not provide relief in the near term. DDS needs to be adequately funded, and have sufficient staff to carry out their mission. 

In addition, I must remind you that the state furloughs that 

have been—you talked about those—are making this problem 

worse. 

As we look down the road, it is clear that 2010 and 2011 will 

present extraordinary workloads for the Social Security Administration. It is imperative that we have the resources and plans in 

place to meet the challenge, and to be able to continue to provide 

the high quality public service for which they are known. 

Let me tell you. One of the few regrets I have in my life is I 

didn’t work harder on Social Security when I was on this Committee. I know you do work hard, Sam. John, you’re Chairman, but 


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let me tell you, this is a huge program. For years, Social Security 

was like a nice Subcommittee. It had retirement, it had disability 

and it had spousal benefits, but you know what? It’s got much bigger than that. Social Security benefits are a huge part of our country. 

Right now, with the economic situation that we’re in, I ask the 

two of you to work really hard to make sure that the people of this 

country are taken care of, because I’ve got to tell you, Social Security is very important to this country. 

[The prepared statement of Ms. Kennelly follows:] 

Prepared Statement of The Honorable Barbara B. Kennelly, Acting Chair, 

Social Security Advisory Board 

Chairman Tanner, Mr. Johnson, Members of the Subcommittee. I am pleased to 

have this opportunity to appear on behalf of the Social Security Advisory Board to 

present the Board’s view on the progress made by the Social Security Administration (SSA) in clearing the disability backlogs. As you have noted, the agency is facing unprecedented workloads in the Disability Determination Services at the same 

time they are diligently working to bring down the backlogs in the hearings offices. 

Mr. Chairman, I want to thank the Congress and especially this Subcommittee 

for the much-needed investment that you have already made in the Social Security 

Administration. In FY 2009, Congress provided SSA with an administrative budget 

of $10.4 billion—$126.5 million above the President’s budget request. I also want 

to thank you for the enactment of the American Recovery and Reinvestment Act, which provided SSA with another $500 million to process the growing backlog of disability claims. These funds have helped ensure that the agency is able to fulfill its 

vital role in serving the American public. 

Through the services it provides, the Social Security Administration touches the 

lives of nearly 60 million beneficiaries, 145 million workers and nearly every American. One out of every six individuals receives monthly cash benefits from Social Security or Supplemental Security Income (SSI), the major programs that SSA administers. This fact alone should be an indicator of the importance of continuous, 

smooth operations of this agency. 

Social Security is an important economic lifeline for millions of America’s most 

vulnerable people, including aged individuals and persons with disabilities, as well 

as their spouses, dependents, and survivors. In fiscal year 2009, 42.6 million people 

were receiving retirement and survivor benefits and another 15.1 million were receiving disability benefits. SSA processed over 4.7 million retirement and survivor 

claims, 2.8 million initial disability claims, and 661,000 disability hearings during 

the fiscal year that has just ended. The agency provided services to the public in 

general by processing over 19 million requests for new or replacement Social Security cards, posting 273 million earnings items to individual earnings records, answering 67 million calls to its 800-number and receiving over 45 million visitors to 

the local field offices. 

Over the past 74 years, the agency has been a diligent steward of the public’s 

trust, overseeing the benefit programs upon which so many individuals and families 

depend. In recent years, however, SSA’s ability to fulfill its mission has been severely strained. Chronic underfunding despite growing workloads has been the chief 

source of the problem. In his fiscal year 2010 budget, the President has requested 

$11.45 billion for the Social Security Administration. If SSA has any chance of keeping up with its growing workload, it will need this full appropriation. The fiscal year 

2011 budget is now being prepared by the Office of Management and Budget. It is 

my hope that the President and the Congress will include sufficient funds in the 

fiscal year 2011 appropriation to address the current backlog of cases as well as the 

new recession-driven claims. 

Fiscal Year 2009 Accomplishments 

It is well known to this Subcommittee that SSA has long struggled with managing 

its disability hearings workload. This year, indeed, may well be a watershed year 

for the hearing process where new business processing and management analysis 

tools have been developed, electronic service delivery has been improved, and muchneeded staff has been added. 

The investment made in SSA has had a significant impact on the agency’s ability 

to address the disability backlog. They have been able to do unprecedented hiring— 

nearly 9,000 new employees. These new personnel have allowed them to replace reVerDate Nov 24 2008 03:34 Jan 25, 2012 Jkt 063016 PO 00000 Frm 00092 Fmt 6633 Sfmt 6621 I:\WAYS\OUT\63016.XXX GPO1 PsN: 63016

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tiring staff and expand critical front-line service in the field offices, the state disability determination services, and the hearings offices. For the hearings process, 

this additional funding gave the Office of Disability Adjudication and Review 

(ODAR) the ability to hire 148 Administrative Law Judges (ALJs), bringing the total 

ALJ corps up to 1,238 judges as well as adding 1,000 support staff. 

Earlier this year, this Subcommittee sought the perspectives of the Social Security 

Advisory Board on the progress made by SSA in using ARRA resources. When that 

hearing was held last April, the effects of the recession were not evident in the hearing appeals process. The backlogs and long waiting times for a decision were–and 

still are–a function of understaffing, lack of a standardized business process, and 

fledgling electronic tools that were still being tested. At that time over 760,000 people were waiting on average nearly 500 days for disability decisions from Administrative Law Judges. 

In the seven months since that hearing, productivity in the hearings offices has 

steadily increased; each month the number of pending claims has declined and the 

number of people now waiting for a hearing has decreased nearly five percent. Administrative Law Judges have improved their average daily production. Nearly 

three-quarters of the ALJs are clearing between 500–700 cases per year; this is a 

15 percentage point increase over fiscal year 2008. SSA exceeded its productivity 

goals by processing almost 14,000 more hearings than originally estimated and 

ended the fiscal year with an average processing time 25 days lower than anticipated in earlier FY 09 budget estimates. 

When SSA developed its hearings backlog reduction plan in 2007, they acknowledged that too many claims had been allowed to languish unadjudicated far too 

long. This year, under the most recent phase of the ‘‘aged case initiative’’ ODAR has 

cleared over 166,610 cases that were over 850 days old. At the end of FY 09, less 

than 1 percent of hearings pending was 850 days or older. The aged case backlog 

is now sufficiently stabilized that they have been able to incorporate new standard 

operating business rules that will ensure that the oldest cases are routinely adjudicated first. 

In several of the Board’s reports, and most recently in our April 2009 report on 

improving public service through technology, we stated that SSA needed to do a better job of integrating electronic service delivery options into its business process. 

Growing workloads coupled with the public’s increasing demand for alternative 

ways to do business with the agency requires that SSA explore new ways of meeting 

with claimants and their representatives and holding hearings. With the funding received from Congress, SSA has been able to meet that challenge and the agency has 

opened three new National Video Hearings Centers to help process workloads for 

hearings offices with exceptionally large backlogs. This increased capacity has resulted in over 86,000 hearings being held sooner rather than much later. 

The recent gains in productivity are a significant accomplishment, and we fully 

expect the agency to continue to improve its process. However, they are now confronted with a tremendous growth in new claims. As a result, productivity improvements alone will not be sufficient. There needs to be additional investment in staff. 

SSA projects it may lose up to 44 percent of its current employees by 2016. Within 

the ALJ corps, 59 percent are retirement-eligible and another 31 percent will become eligible to retire between FY 2010 and FY 2019. Moreover, new workload projections indicate that they will need to add approximately 400 more ALJs, bringing 

the total ALJ corps up to 1,600. 

Last April, the Board was briefed on several new initiatives underway in ODAR. 

The agency is placing a growing emphasis on data analysis and process management. They have developed an electronic business process model that simulates how 

work currently is processed, and for the first time, will be able to systematically 

identify steps in the process that create bottlenecks or do not add value to the process. While this initiative is very new, it holds promise for improving workload management throughout the hearings process. Through this modeling, ODAR will be 

able to plan proactively for changes in receipts and how to redistribute workload, 

anticipate the need for changes in staffing mix, and determine what can be mitigated by improved management practices. The current use is focused on assuring 

the success of the agency’s plan to reduce the backlog. Going forward, it will give 

ODAR the capability to manage proactively, not just reactively. It is a new direction 

for ODAR and we hope it will prove effective. 

Growth in workload 

The hearings backlogs are still of tremendous concern but become even more so 

when they are coupled with the anticipated rise in claims over the next 10 years. 

SSA’s workload will increase dramatically. Projections indicate that retirement 

claims are likely to jump by over 40 percent and disability claims could rise by nearVerDate Nov 24 2008 03:34 Jan 25, 2012 Jkt 063016 PO 00000 Frm 00093 Fmt 6633 Sfmt 6621 I:\WAYS\OUT\63016.XXX GPO1 PsN: 63016

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ly 10 percent. The 2009 OASDI Trustees Report estimated that by 2015 there will 

be 50 million retirees, widows and widowers, and dependents receiving benefits. 

Those individuals will be expecting efficient and modern service from the Social Security Administration. 

But the anticipated growth in claims does not stop there. The baby boomers are 

entering their disability prone years and the number of initial disability claims is 

projected to rise steadily over the next several years, and indeed it has. The Office 

of the Chief Actuary (OACT) has carefully tracked the anticipated growth in disability claims that will be due to the baby boom population. Projections made in 

2007–2008 for the fiscal year 2009 hovered just around the 2.6 million mark. But 

the reality has been significantly different. In 2009, SSA actually received 3 million 

new disability claims this year, about 380,000 more than originally expected. 

The most obvious factor impacting the volume of disability applications today is 

the recession with its significant increase in unemployment. Recent history demonstrates that disability applications generally rise and fall in tandem with the unemployment rate. The DI application rate per 1,000 workers among non-elderly 

adults rose 37% from 1989 to 1993 (from 8.3 per 1,000 workers to 11.5), and by 49% 

from 1999 to 2003 (from 8.8 per 1,000 workers to 13.1). One exception was seen 

from 1980 to 1984 when eligibility for disability was significantly curtailed while unemployment soared. 

The logic is straightforward. In a recession with widespread unemployment, people with disabilities who previously worked despite their condition may find themselves without a job, especially people with fewer skills or who are approaching retirement. These people may be more likely to apply for disability benefits to support 

themselves and their families. The recession may speed up an application that 

might have been made later or it may encourage more individuals who think that 

they might have a disabling condition to apply for benefits. 

What does this mean for SSA’s disability workload? The 15 percent increase in 

new initial claims experienced in fiscal year 2009 has put extraordinary stress on 

the DDS system. Backlogs are climbing and there are now 783,000 initial claims 

pending in the DDSs. This is an 18 percent increase since April. And it is anticipated that these backlogs will grow. More recent projections by SSA’s actuaries estimate that DDS claims in 2010 will peak at 3.3 million, and stay just above 3 million 

through 2012. SSA expects pending claims in the DDS to climb to 1 million by the 

end of 2010. These claims forecasts may increase or decrease as unemployment figures change. 

Tackling the Initial Claims Workload 

SSA has acknowledged that the pending level of initial claims in the DDSs is unacceptable and they have pledged to bring the pending workload down to 525,000 

by fiscal year 2013. Their strategy to reduce this backlog includes additional hiring 

and overtime in the DDSs. With the additional funding provided by Congress this 

year, the DDSs were able to hire 1,400 new disability examiners. Even though they 

were not fully engaged for the entire year, these new hires were instrumental in 

processing an additional 30,000 claims. 

SSA’s electronic folder makes it fairly easy to transfer work to other offices. An 

element of the agency’s current plan includes shifting work out of heavily-impacted 

DDSs and into offices, including the federal quality assurance units, where there is 

excess capacity. In addition, SSA is in the process of establishing four ‘‘mega-DDSs’’. 

Similar to the National Hearings Centers, these state mega-DDSs will be able to 

provide assistance to overloaded DDSs from anywhere in the country. 

The agency also continues to improve and expand their ‘‘compassionate allowance’’ 

and ‘‘quick disability decision’’ processes. These tools, combined with ongoing policy 

simplification initiatives may help to speed up decision making and free up valuable 

disability examiners for the more complex cases. 

Need for a comprehensive workload strategy 

As SSA works to reduce its disability backlog and address the influx of new 

claims, the agency should be encouraged to develop a comprehensive strategy. This 

would include establishing a plan for processing initial claims just as it has created 

a plan for processing appeals in a more timely and efficient manner. 

It strikes me that the DDSs are in a position similar to the one that the hearings 

offices were in about two years ago. They have suffered staffing losses and had some 

success with electronic adjudication tools. However, electronic tools alone are not 

enough to offset the reductions in disability examiners and medical staff and the 

increase in caseloads. SSA has relied to date on shifting workloads across offices 

and ramping up productivity, but nothing will work without funding for additional 

staff. We do not want to produce efficiency at the expense of due process. 


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SSA has a number of electronic initiatives under development including electronic 

medical evidence (EME) and health information technology (HIT) tools that may 

hold long-term promise. Recently, the Board was briefed on the scope and timeline 

for the EME and HIT initiatives. We are encouraged by these initiatives. SSA has 

a basic plan for development and implementation and is making good use of the 

ARRA funding. We appreciate the work that is going on within the organization. 

Over the next three years, SSA should have several projects underway which could 

greatly enhance the electronic exchange of medical evidence. If effectively implemented, they should improve timeliness of disability decisions and enhance public 

service. 

Similarly, work continues on the development of a single DDS case processing system which will streamline case processing, improve data sharing, and help to improve management. 

The longer-range strategies for improving the disability process are necessary, but 

they do not provide relief in the near term for the hundreds of thousands of vulnerable individuals who have turned to the Social Security Administration for assistance. We believe that a comprehensive backlog reduction plan–similar to the one developed for ODAR—should be instituted for the DDSs. Working with the DDSs, the 

agency should be able to identify and adapt the best practices from the hearings 

backlog reduction plan; in addition consideration should be given to accelerating the 

eCat disability adjudication analysis tool. SSA and its state partners must move 

swiftly to staff fully the mega-DDSs and establish the criteria that will be used for 

obtaining workload assistance from these centers. 

There is one caution I need to raise: the backlog reduction plan in the DDSs cannot come at the expense of well-reasoned and high quality decisions based on a welldeveloped evidentiary record. Rushing cases out the door to meet production goals 

does not, in the end, improve service to the American public. DDSs need to be adequately funded and have sufficient staffing to carry out the job. I do not need to 

remind this Subcommittee that the furloughs that have been imposed by States on 

nine DDSs slow the progress in reducing the backlogs and undermine the quality 

of public service. These issues need to be resolved as quickly as possible. 

Beyond 2010 

It is only a matter of time that the surge in initial claims is felt in ODAR. If the 

traditional waterfall of appeals occurs, about 45 percent of those denied at the initial level will request reconsideration, and then approximately three-quarters of the 

individuals who are denied at the reconsideration level will appeal to the ALJ. It 

takes about 250 days, on average, for an initial claim that has been appealed to 

reach ODAR and then several more months before the case is on an ALJ’s desk. 

This means that the increased caseloads in the DDSs will begin to materialize in 

ODAR in the second half of 2010 or in early 2011. Without continuing assistance 

from the Congress, these disability cases could take several years to work their way 

through the agency. 

As we look down the road, it is clear that fiscal year 2011 will present extraordinary workload levels throughout the Social Security Administration. It is imperative that the agency has the resources and tools in place to meet this challenge and 

to be able to continue to provide the high-quality public service for which it is 

known. 

Thank you for inviting me to appear before you today. I will be pleased to answer 

any questions you may have. 

f 

Chairman TANNER. Thank you. Thank you for all your service, 

and your testimony. We will ask unanimous consent that Members 

may submit written questions to you all if we run out of time here. 

Thank you. 

Ms. Bates, welcome from west Tennessee. You’re recognized for 

five minutes. 

STATEMENT OF BETH BATES, CLAIMANTS’ REPRESENTATIVE, 

ON BEHALF OF THE CONSORTIUM FOR CITIZENS WITH DISABILITIES, JACKSON, TENNESSEE 

Ms. BATES. Thank you, Mr. Chairman, Ranking Member Johnson, and Members of the Subcommittee. Thank you for inviting me 


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to testify here today on behalf of the Consortium for Citizens with 

Disabilities Social Security Task Force. 

I have represented individuals with Social Security and SSI 

claims for more than 25 years. I would like to thank the Chairman 

and his district office staff in Union City and Jackson for a great 

deal of help over the years. 

Social Security finds itself at a critical crossroads. For the first 

time in a decade in fiscal year 2009, the backlog at ODAR, the 

third level of disability adjudication, was reduced from the previous 

year. That was both in number of pending cases, the length of time 

that they pended, and in processing time. 

At the same time, we think because of the recession, there was 

a huge increase in the backlog of cases at the first two levels of adjudication, the State DDSs. About 40 percent, nationwide. I suggest 

respectfully that this increase in the backlog there, largely due to 

the numbers of new cases, threaten the goal of Social Security to 

eliminate the backlog at ODAR by the year 2013. 

I am honored to be here, but I am saddened, because I see the 

suffering caused by the backlog with my clients. My client, Mr. H, 

who lives in Huntington, Tennessee is all too typical. When I met 

him in early 2008, he and his teenage son were homeless. They 

were staying in a dangerous area, and in a motel. 

He had a—Mr. H had a history of arthritis, liver disease, coronary artery disease, depression, adult attention deficit disorder. He 

had worked as a grocery bagger and as a sawmill laborer. He had 

been out of the work force for some time, caring for his invalid 

mother, who subsequently became too ill to stay at home, and had 

to go to a nursing facility. 

Unfortunately, Mr. H was turned down twice at the Disability 

Determination Section, and requested a hearing in January of 

2009. He is still waiting. He is waiting at Nashville ODAR. The 

ODARs where I practice, Nashville and Memphis, while slightly 

better than Madison and Milwaukee, they had lost ground in the 

year 2009, and the processing time has actually increased. 

I think that Tennessee, unfortunately, is a good example of the 

problems with the backlog. In 2009, Tennessee’s backlog increased 

from—increased to 66 percent at the first 2 levels. That was in the 

top 10 in the nation. That was above the 40 percent, nationwide. 

The director of DDS has been good to work with. Other advocates, colleagues of mine, have tried to improve the process. But 

Tennessee is third from the bottom in approvals at the initial and 

reconsideration stage. I say that’s a double whammy that’s going 

to hit the five ODARs in Tennessee, and in particular, Memphis 

and Nashville, that seem to have the biggest backlog. 

I am an optimistic person. But, absent additional resources in 

2010, which I think are on target, and 2011, I can’t say but that 

it will get worse, because we have cost of living and overhead type 

issues there. 

I do appreciate what the committee has done, and the Congress 

has done in 2008 and 2009—as other witnesses have indicated— 

and have marked up for 2010, but I think we are going to need 

even more in 2011 to maintain the progress that has been made. 

We support many of the other non-dollar initiatives that the 

Commissioner has suggested, such as increased technology, the 


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senior attorney adjudicator program. We just have one word of caution, that any proposals—we don’t want our clients’ due process 

rights to be jeopardized. We want the folks who are eligible under 

the law to receive the benefits that they need for their basic necessities of life. 

Thank you. 

[The prepared statement of Ms. Bates follows:] 

Prepared Statement of Beth Bates, Claimants’ Representative, on behalf of 

the Consortium for Citizens with Disabilities, Jackson, Tennessee 

Chairman Tanner, Ranking Member Johnson, and Members of the House Ways 

and Means Social Security Subcommittee, thank you for inviting me to testify at today’s hearing on ‘‘Clearing the Disability Claims Backlogs: The Social Security Administration’s Progress and New Challenges Arising From the Recession.’’ I am honored to testify today but am saddened that the reason is because my clients have 

waited so long and endured many hardships before receiving the disability benefits 

to which they are entitled. 

I am an attorney in Jackson, TN, and a member of the National Organization of 

Social Security Claimants’ Representatives (NOSSCR). For more than 25 years, I 

have represented individuals with disabilities in their claims for Social Security and 

Supplemental Security Income (SSI) disability benefits. I am testifying today on behalf of the Consortium for Citizens with Disabilities (CCD) Social Security Task 

Force, of which NOSSCR is an active member. CCD is a working coalition of national consumer, advocacy, provider, and professional organizations working together with and on behalf of the more than 54 million children and adults with disabilities and their families living in the United States. The CCD Social Security 

Task Force (hereinafter CCD) focuses on disability policy issues in the Title II disability programs and the SSI program. 

The focus of this hearing is extremely important to people with disabilities. Title 

II and SSI cash benefits, along with the related Medicaid and Medicare benefits, are 

the means of survival for millions of individuals with severe disabilities. They rely 

on the Social Security Administration (SSA) to promptly and fairly adjudicate their 

applications for disability benefits. They also rely on the agency to handle many 

other actions critical to their well-being including: timely payment of the monthly 

Title II and SSI benefits to which they are entitled; accurate withholding of Medicare Parts B and D premiums; and timely determinations on post-entitlement issues 

that may arise (e.g., overpayments, income issues, prompt recording of earnings). 

Because the economic downturn has led to an unexpected surge of new applications, SSA finds itself at a critical crossroads. The wave of new claims is having a 

very significant impact at the state Disability Determination Services (DDSs) that 

will eventually affect the hearing level. At the DDS levels (initial and reconsideration), the number of new applications, applications waiting for a decision, and processing times are all on the rise. In fiscal year (FY) 2009, SSA received 385,000 new 

claims, an increase of nearly 15% since the end of FY 2008. Even more worrisome 

is the growing backlog of pending initial claims at the DDSs, i.e., those waiting for 

a decision, up nearly 40% since the end of FY 2008. 

In FY 2009, the news was more positive at the hearing level. For the first time 

in a decade, SSA finished FY 2009 with fewer hearing level cases waiting for a hearing and decision than at the beginning of the year. But we are deeply concerned 

that any progress in eliminating the hearing level backlog will be delayed as the 

surge of new applications are denied and then are appealed, putting SSA’s plan to 

eliminate the hearing level backlog by 2013 at risk. 

While recent appropriations have allowed SSA to hire some new staff and to reduce processing times at the hearing level, these amounts will not be adequate to 

fully restore the agency’s ability to carry out its mandated services. Given the many 

years of under-funding and the need for more than a $600 million annual increase 

just to keep up with fixed costs, additional funding is required to reduce and eliminate the backlog at the DDS and hearing levels and to provide essential services 

to the public. While the current situation is dire, without adequate, ongoing appropriations to fund SSA, the forward progress recently made by the agency will deteriorate, leaving people with severe disabilities to wait years to receive the benefits 

to which they are entitled. 

THE IMPACT ON PEOPLE WITH DISABILITIES 

As the backlog in decisions on disability claims continues to grow, people with severe disabilities have been bearing the brunt of the delays. Behind the numbers are 


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1 If a claimant dies while a claim is pending, the SSI rule for payment of past due benefits 

is very different—and far more limited—than the Title II rule. In an SSI case, the payment will 

be made in only two situations: (1) to a surviving spouse who was living with the claimant at 

the time of death or within six months of the death; or (2) to the parents of a minor child, if 

the child resided with the parents at the time of the child’s death or within six months of the 

death. 42 U.S.C. § 1383(b)(1)(A) [Section 1631(b)(1)(A) of the Act]. In Title II, the Act provides 

rules for determining who may continue the claim, which includes: a surviving spouse; parents; 

children; and the legal representative of the estate. 42 U.S.C. § 404(d) [Section 202(d) of the Act]. 

Thus, if an adult SSI claimant (age 18 or older) dies before actually receiving the past due payment and if there is no surviving spouse, the claim dies with the claimant and no one is paid. 

individuals with disabilities whose lives have unraveled while waiting for decisions—families are torn apart; homes are lost; medical conditions deteriorate; once 

stable financial security crumbles; and many individuals die.1 Numerous recent 

media reports across the country have documented the suffering experienced by 

these individuals. Your constituent services staffs are likely to be well aware of the 

situations faced by people living in your districts and they provide valuable assistance. I have had many contacts with Chairman Tanner’s district offices in Jackson 

and Union City, Tennessee. His staff has been extremely helpful, when they are 

able to assist. 

Backlog in Appeals of Disability Claims: The Human Toll 

I have represented individuals in their Social Security and SSI disability claims 

since 1984 at all administrative and judicial levels. My clients’ hearings are held 

by Administrative Law Judges (ALJs) in the Memphis and Nashville, TN, hearing 

offices of SSA’s Office of Disability Adjudication and Review (ODAR). Like the growing number of initial applications and hearing requests, my client caseload has 

grown by 40%. I have noticed that my clients are waiting longer and longer for hearings to be scheduled. The experiences of several of my clients illustrate the hardships endured by many claimants waiting for a decision on their claims and for payment of awarded benefits: 

♦ Mrs. W lives in Dyersburg, TN, with her husband and young family. She is illiterate and reclusive. She and her family receive much assistance from older 

family members. She applied for disability benefits on August 7, 2008, based 

on mental retardation. She was denied despite psychological evaluations showing IQ scores in the 60s and deficits in adaptive function. As her attorney, I 

asked for a decision on the record both at the Disability Determination Services 

(DDS) and hearing levels. Her claim was denied by the DDS and her hearing 

request was filed on February 20, 2009. She is still waiting for a hearing date. 

♦ Mr. H lives in Huntingdon, TN. When he first retained me on April 3, 2008, 

he and his teenage son were homeless. They were forced to stay in a motel in 

a dangerous area. I filed an online disability report; Mr. H completed SSI and 

Social Security disability applications. Mr. H had worked as a sawmill laborer 

and a grocery bagger. He had been out of the workforce for a time caring for 

his invalid mother until her health worsened and she had to enter a nursing 

facility. Mr. H suffers from liver disease, arthritis, coronary artery disease, depression and adult attention deficit disorder. Fortunately, he and his son were 

able to move into public housing. He was denied at the first two levels by the 

Tennessee DDS and requested a hearing on January 23, 2009. He is still waiting for a hearing date. Mr. H and his son live on state welfare benefits of approximately $185 per month plus food stamps. 

♦ Mr. M is homeless and has been diagnosed with bipolar disorder. He has recent 

suicide attempts. I began to represent him in April 2008. He had previously 

requested a hearing while living near Tampa, FL. His brother, who lives in 

rural western Tennessee, attempted to rescue Mr. M. However, Mr. M decompensated in the summer of 2008 and had to be hospitalized at Western State 

Mental Hospital in Tennessee. Upon discharge, he was released to a group 

home in Nashville, some 100 miles away from his brother. He lived for almost 

a year in the group home and now has a supportive housing apartment. He 

has no income. Mr. M’s hearing is scheduled on December 17, 2009, some 18 

months after he came to Tennessee. I have previously requested on the record 

decisions twice, but have received no response to my requests. 

Most claimants’ representatives have clients who have faced similar difficult circumstances to those endured by mine, including deteriorating health and even 

death, due to lack of health insurance and access to necessary medical treatment, 

sometimes as simple as antibiotics. Foreclosures and bankruptcies have increased, 

with claimants losing their homes and vehicles and their economic stability. I have 


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included more descriptions of other claimants and the hardships they have faced at 

the end of my statement, starting on page 12. 

SSA’S NEED FOR ADEQUATE RESOURCES TO ADDRESS GROWING 

BACKLOGS 

For many years, SSA did not receive adequate funds to provide its mandated services, a key reason for the hearings backlog. Between FY 2000 and FY 2007, the resulting administrative funding shortfall was more than $4 billion. The dramatic increase in the hearing level disability claims backlog coincided with this period of significant under-funding. 

Recent Congressional efforts to provide SSA with adequate funding for its administrative budget have been encouraging. In FY 2008, the tide finally changed for the 

first time in a decade, when Congress appropriated $148 million over the President’s 

budget. The FY 2009 SSA appropriation provided SSA with more than $700 million 

over the FY 2008 appropriation. 

We are extremely grateful to Congress for recognizing SSA’s need for adequate 

resources and including additional funds for SSA in the American Recovery and Reinvestment Act of 2009 (ARRA). ARRA provided SSA with $500 million to handle 

the unexpected surge in both retirement and disability applications due to the economic downturn. SSA also received badly needed funds to replace its aged National 

Computer Center. With the FY 2009 appropriation and the ARRA funding, SSA 

planned to hire 5,000 to 6,000 new employees, including 147 new ALJs and 850 

hearing level support staff. This additional staff undoubtedly led to SSA’s ability to 

make progress on the backlog at the hearing level. 

Congress appears to be moving towards providing SSA with an FY 2010 appro- priation approximately the same as President Obama’s request of $11.45 billion for 

SSA’s Limitation on Administrative Expenses (LAE), a 10 percent increase over the 

FY 2009 appropriation. While the agency is operating under a Continuing Resolution, we are optimistic that SSA’s final FY 2010 appropriation will be similar to the 

$11.45 billion amount, allowing SSA to hire more staff, including 226 additional 

ALJs and support staff. 

WILL THE HEARING LEVEL BACKLOG BE ELIMINATED BY 2013? 

The most significant delays in SSA’s disability determination process are at the 

hearing level. The average processing time for cases at the hearing level has increased dramatically since 2000, when the average time was 274 days. In FY 2009, 

the average processing time for disability claims at the hearing level was 491 days, 

about 16.5 months. We appreciate the effort by SSA to reduce the processing time, 

but an average of 16.5 months—close to one and a half years—is still too long for 

individuals waiting for a hearing decision. In addition, the average processing times 

at the initial and reconsideration levels are increasing. For individuals with disabilities who have no health insurance, have lost their homes, have declared bankruptcy, or who have died, that is simply too long to wait. 

The current processing times in some hearing offices are striking, and much 

longer than the 491-day average at the end of FY 2009. It is important to keep in 

mind that this is an ‘‘average’’ and that many claimants will wait longer. In September 2009, the average processing time at 48 hearing offices was above the 491 

day national average, with 20 offices over 600 days. 

Is the Hearing Backlog Improving? By the end of FY 2009, it was clear that 

ODAR was making slow but steady process in key areas to address its backlog and 

improve processing times, thanks to the hard work of ODAR ALJs and staff and 

the additional resources available due to Congressional appropriations, including 

the ARRA funding. 

• Pending cases. For the first time in a decade, ODAR finished FY 2009 with 

fewer hearings pending than in the prior year. The increased resources, including 147 new ALJs and support staff are having a positive impact at the hearing 

level. The pending number of cases dropped for nine straight months from a 

record high of 768,540 in December 2008 to 722,822 in September 2009. This 

is the lowest pending number of ODAR cases since February 2007. The pending 

number dropped by 11,377 in September 2009 alone, the biggest drop in FY 

2009. The reduction in pending cases is even more notable since the number 

of requests for hearing increased in FY 2009, up to 625,003, a 5.7% increase 

over the 591,888 received in FY 2008. 

• Processing times. The average process time in September 2009 was 472 days, 

the lowest monthly processing time since November 2005. The average processing time for all of FY 2009 was 491 days, down from 514 days in FY 2008. 

• Dispositions. The number of dispositions cleared by ALJs on a daily basis was 

2,940.47 in September. This is the highest monthly average since records have 


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2The processing times reflect the times at the end of September in the respective fiscal year. 

been kept, beginning in FY 2004. The increase is concomitant with the record 

number of ALJs now on duty. For the year, dispositions were up about 20%. • Age of pending cases. The length of time cases are pending is also improving. 

The percentage of requests for hearing pending over one year was 31% in September 2009. This is the lowest percent since October 2004. The average age 

of a pending case is 282 days. It peaked this year at 317 days in January 2009. 

Improvement Is Not Uniform. Despite the overall improvement in the hearing 

level statistics, not every hearing office has benefited and some claimants are waiting even longer than one year ago. On one hand, some offices have experienced exceptional improvement in processing times, as much as 4 to 5 months in just one 

year, for example: Madison, WI; Houston-Bissonet, TX; and Long Beach, CA. In contrast, other offices continue to experience worsening times that are several months 

longer than last year, for example: Memphis, TN; Louisville, KY; and Bronx, NY. 

A comparison of processing times at the end of FY 2009 and FY 2008 for hearing 

offices in or near the districts of Subcommittee Members reflects this disparity and 

the fact that much work lays ahead.2

California: Los Angeles Downtown: 362 days (FY09) vs. 376 days (FY08); Los 

Angeles West: 492 days (FY09) vs. 525 days (FY08); Long Beach: 351 days (FY09) 

vs. 533 days (FY08) 

Florida: Tampa: 539 days (FY09) vs. 622 days (FY08) 

Kentucky: Lexington: 452 days (FY09) vs. 448 days (FY08); Louisville: 545 days 

(FY09) vs. 465 days (FY08) 

New York: Bronx: 605 days (FY09) vs. 516 days (FY08); Manhattan: 490 days 

(FY09) vs. 420 days (FY08); Queens: 482 days (FY09) vs. 446 days (FY08) 

North Dakota: Fargo: 448 days (FY09) vs. 485 days (FY08) 

Ohio: Columbus: 630 days (FY09) vs. 771 days (FY08) 

Pennsylvania: Elkins Park: 360 days (FY09) vs. 402 days (FY08); Philadelphia: 

350 days (FY09) vs. 386 days (FY08); Philadelphia East: 377 days (FY09) vs. 422 

days (FY08) 

Tennessee: Memphis: 538 days (FY09) vs. 442 days (FY08); Nashville: 501 days 

(FY09) vs. 475 days (FY08) 

Texas: Dallas Downtown: 367 days (FY09) vs. 463 days (FY08); Dallas North: 331 

days (FY09) vs. 403 days (FY08); Fort Worth: 306 days (FY09) vs. 372 days (FY08); 

Houston-Bissonet: 328 days (FY09) vs. 471 days (FY08); Houston Downtown: 340 

days (FY09) vs. 298 days (FY08); San Antonio: 330 days (FY09) vs. 427 days (FY08) 

Washington: Seattle: 511 days (FY09) vs. 551 days (FY08) 

Wisconsin: Madison: 488 days (FY09) vs. 652 days (FY08); Milwaukee: 627 days 

(FY09) vs. 658 days (FY08) 

SIGNIFICANT INCREASE IN NEW CLAIMS FILED AND GROWING DDS 

BACKLOGS 

Since the end of FY 2008, new disability claims filed have been climbing steadily, 

up nearly 15% by the end of FY 2009. But what is more troubling is how the increase grew throughout FY 2009: December 2008 Quarter: 6.92%; March 2009 Quarter: 15.23%; June 2009 Quarter: 16.32%; September 2009 Quarter: 20.25%. 

The most alarming trend is the increase in the number of pending claims (initial 

and reconsideration levels), up 38.8% since the end of FY 2008 and climbing from 

763,183 to 1,059,241. This means that, at the end of FY 2009, more than 1 million 

disability applicants were waiting for a decision on their claims at the initial and 

reconsideration levels. When you add the 722,822 pending cases at the hearing 

level, nearly 1.75 million people with disabilities were waiting for a decision. If the 

new applications continue to increase at the higher level seen in recent months, the 

total number of pending initial applications alone in the DDSs could hit over 

1,000,000 claims by the end of FY 2010. This would be an 80% increase in pending 

initial claims in just one year. 

Claimant representatives in some states, including myself in Tennessee, have noticed the increase in processing times. This is not surprising since the percentage 

increase of pending cases in some states is much higher than the national average. 

For example, at the initial level, the number of pending claims increased nationwide 

by 38.1% at the end of FY 2009, compared to the end of FY 2008. However, in my 

state of Tennessee, the increase was 66.2%. Other states with significantly higher 

percentage increases in pending initial level claims include: North Dakota (68.5%); 

Ohio (59.3%); and Texas (55.8%). 

What does the increase in applications and pending claims at the DDSs mean for 

the hearing level? Approximately 22% of the initial claims will result in a hearing 


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request. This means there is a potential increase of 85,000 additional hearings just 

from the FY 2009 applications, a statistic that underscores the fragility of the 

ODAR progress accomplished in FY 2009. 

Looking more closely at the situation in my state of Tennessee, there is reason 

to be concerned. The increase in new claims will contribute to worsening a difficult 

situation at the hearing level. Tennessee had one of the biggest increases in pending 

claims in FY 2009 (66.2%), which was much higher than the national average. Historically, Tennessee has had one of the lowest DDS allowance rates. In FY 2008, 

the Tennessee DDS allowed only 25.1% of initial claims (vs. a 36.0% national average) and only 8.7% of requests for reconsideration (vs. a 13.8% average). Out of 52 

DDSs, Tennessee rated 50th, slightly better than only Mississippi and Georgia. As 

noted above, the processing times at both the Memphis and Nashville ODAR hearing offices did not improve in FY 2009 but rather grew worse—Memphis by nearly 

100 days or more than 3 months, and Nashville by 26 days or nearly one month. 

All of these trends—increased applications, a very low DDS allowance rate, and 

worsening hearing level processing times—do not bode well for my clients and other 

individuals in the state. As a result, I fear that things will get worse before they 

get better. 

Exacerbating the problem of a significant increase in new claims is the impact on 

DDSs of state budget crises. Even though DDS salaries, offices, and overhead are 

fully funded by SSA, some states are imposing hiring restrictions and furloughs of 

employees, including DDS workers, because of budget problems. Earlier this year, 

Commissioner Astrue wrote to Governors, asking them to exempt DDSs from hiring 

freezes and furloughs. In September 2009, Vice-President Biden sent a letter to Gov. 

Edward Rendell, the Chair of the National Governors’ Association, also urging that 

states exempt DDS employees from state furloughs. These furloughs lead to loss of 

administrative funding for the state DDSs and, more importantly, delay payment 

of benefits to disabled beneficiaries. 

SSA’s ABILITY TO PERFORM OTHER IMPORTANT WORKLOADS 

Program Integrity Workloads. The processing of continuing disability reviews 

(CDRs) and SSI redeterminations is necessary to protect program integrity and 

avert improper payments. Failure to conduct the full complement of CDRs would 

have adverse consequences for the federal budget and the deficit. According to SSA, 

CDRs result in $10 of program savings and SSI redeterminations result in $7 of program savings for each $1 spent in administrative costs for the reviews. However, 

the number of reviews actually conducted is directly related to whether SSA receives the necessary funds. In addition, it is important, when it conducts work 

CDRs, that SSA assess whether reported earnings have been properly recorded and 

ensure that it properly assesses whether work constitutes substantial gainful activity (SGA). 

Impact on Post-Entitlement Work. Staffing shortages also have led to SSA’s 

inability to fully carry out many other critical post-entitlement workloads. One area 

that has slipped, often with a very detrimental impact on people with disabilities, 

is the processing of earnings reports by beneficiaries. When beneficiaries faithfully 

notify SSA of earnings or other changes that may reduce their benefit payment 

amounts, it may be months or years before SSA sends an overpayment notice to the 

beneficiary, demanding repayment of sometimes tens of thousands of dollars of accrued overpayments. It is shocking to beneficiaries to receive these notices, when 

they reasonably assumed that SSA had processed the information they submitted, 

and it is challenging, if not impossible, for someone subsisting on benefits alone to 

repay the overpayments. Many individuals with disabilities are wary of attempting 

a return to work out of fear that this may give rise to an overpayment, resulting 

in a loss of economic stability and health care coverage upon which they rely. 

SSA needs to develop a better reporting and recording system and promptly adjust benefit payments—thus preventing these overpayments. It is important to note 

that, in and of themselves, overpayments do not indicate fraud or abuse as beneficiaries are encouraged to work if they are able. The problems arise when reported 

earnings are not properly recorded and monthly overpayments are not properly adjusted. 

CCD RECOMMENDATIONS REGARDING SSA’s ADMINISTRATIVE FUNDING 

We are optimistic that SSA will receive a final FY 2010 appropriation of $11.451 

billion for SSA’s LAE, the same amount proposed by the President. SSA will use 

this funding and about $350 million from the ARRA funding to address the growing 

workloads facing the agency. Based on these funding levels, during FY 2010, SSA 


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will be spending at least $11.8 billion to address the current staffing levels and associated costs necessary for the agency to function. In FY 2011, SSA will be faced with additional costs of nearly $620 million just 

to deal with inflationary costs associated with items such as salaries, benefits, rents, 

and facility security. The resulting funding level, $12.42 billion will not address the 

increased number of new claims, the newly created DDS backlog, and SSA’s plan 

to eliminate the hearing level backlog by 2013. To address these workloads, SSA 

will need additional resources. We estimate that an additional $780 million will be 

necessary—at least $480 million to address the increased number of disability 

claims and at least $300 million to continue making progress in reducing and eliminating the hearings backlog by 2013. 

To address the unprecedented increase in workloads and to prevent a severe dis- ruption in service delivery, we recommend that a minimum of $13.2 billion be included in the FY 2011 President’s budget request for SSA’s administrative funding. 

RECOMMENDATIONS FOR IMPROVING THE DISABILITY CLAIMS PROCESS 

Money alone will not solve SSA’s crisis in meeting its responsibilities. Commissioner Astrue is committed to finding new ways to work better and more efficiently. 

CCD has numerous suggestions for improving the disability claims process for people with disabilities. We believe that these recommendations and agency initiatives, 

which overall are not controversial and which we generally support, can go a long 

way towards reducing, and eventually eliminating, the disability claims backlog. 

Caution Regarding the Search for Efficiencies 

While we generally support the goal of achieving increased efficiency throughout 

the adjudicatory process, we caution that limits must be placed on the goal of administrative efficiency for efficiency’s sake alone. The purposes of the Social Security 

and SSI programs are to provide cash benefits to those who need them and have 

earned them and who meet the eligibility criteria. While there may be ways to improve the decision-making process from the perspective of the adjudicators, the critical measure for assessing initiatives for achieving administrative efficiencies must 

be how they affect the very claimants and beneficiaries for whom the system exists. 

People who find they cannot work at a sustained and substantial level are faced 

with a myriad of personal, family, and financial circumstances that will have an impact on how well or efficiently they can maneuver the complex system for determining eligibility. Many claimants will not be successful in addressing all of SSA’s 

requirements for proving eligibility until they reach a point where they request the 

assistance of an experienced representative. Many face educational barriers and/or 

significant barriers inherent in the disability itself that prevent them from understanding their role in the adjudicatory process and from efficiently and effectively 

assisting in gathering evidence. Still others are faced with having no ‘‘medical 

home’’ to call upon for assistance in submitting evidence, given their lack of health 

insurance over the course of many years. Many are experiencing extreme hardship 

from the loss of earned income, often living through the break-up of their family 

and/or becoming homeless, with few resources—financial, emotional, or otherwise— 

to rely upon. Still others experience all of the above limits on their abilities to participate effectively in the process. 

Proposals for increasing administrative efficiencies must bend to the realities of 

claimants’ lives and accept that people face innumerable obstacles at the time they 

apply for disability benefits and beyond. SSA must continue, and improve, its established role in ensuring that a claim is fully developed before a decision is made and 

must ensure that its rules reflect this administrative responsibility. 

Technological Improvements 

Commissioner Astrue has made a strong commitment to improve and expand the 

technology used in the disability determination process. CCD generally supports 

these efforts to improve the disability claims process, so long as they do not infringe 

on claimants’ rights. Some of the technological improvements that we believe can 

help reduce the backlog include the following: 

1. The electronic disability folder. The initiative to process disability claims 

electronically has the prospect of significantly reducing delays caused by the 

moving and handing-off of folders, allowing for immediate access by different 

components of SSA or the DDS, and preventing misfiled evidence. 

2. Expanding Internet access for representatives. Under Electronic 

Records Express (ERE), registered claimant representatives are able to submit evidence electronically through an SSA secure website or to a dedicated 

fax number, using a unique barcode assigned to the claim. This initiative 


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3 20 C.F.R. §§ 404.936 and 416.1436. 

4The program is extended through August 10, 2011. 74 Fed. Reg. 33327 (July 13, 2009). 

5 20 C.F.R. § 405.315(a). 

holds great promise, given that significant problems with the current process 

exist. 

Under the current process, representatives are to be provided with a CD 

of the exhibited or ‘‘pulled’’ file shortly before the hearing and earlier in the 

process after the appeal has been filed but before the file is exhibited. Due 

to staffing shortages in hearing offices, I have had problems obtaining the 

CDs and even obtaining barcodes, which allows me to submit evidence electronically. Receiving incomplete CDs leads to problems. I am unable to know 

what evidence is in the record so that I can determine what evidence I need 

to obtain and submit. This also can lead to submission of duplicate evidence, 

which is time-consuming for ODAR staff but is the only way that I can ensure that ODAR has received the evidence. This can cause significant delay 

both during and after the hearing. 

We are optimistic that these problems will be resolved in the near future. 

I am very much looking forward to having direct access to my clients’ electronic folders. A small group of representatives is involved in an SSA pilot 

that gives them direct access to their clients’ electronic folders, allowing them 

to download the contents through the ERE website. SSA has been working 

on security and authentication issues and has a plan to gradually rollout this 

initiative. I believe that it will make the hearing process more efficient for 

all parties involved—claimants, their representatives, and SSA. 

3. Use of video hearings. Video hearings allow ALJs to conduct hearings 

without being at the same geographical site as the claimant and representative and have the potential to reduce processing times and increase productivity. We support the use of video teleconference hearings so long as the 

right to a full and fair hearing is adequately protected; the quality of video 

teleconference hearings is assured; and the claimant retains the absolute 

right to have an in-person hearing as provided under current regulations.3

However, we have received complaints from representatives that, in some 

cases, ALJs are discouraging claimants from exercising their right to an inperson hearing. A new SSA pilot allows representatives to participate in 

video hearings from their own private offices, with their clients present in 

the representative’s office. The representative must agree to the terms established by SSA. This pilot provides claimants with another option for their 

hearings. 

Other Improvements at the Hearing Level 

1. The Senior Attorney Program. This program allows senior staff attorneys 

in hearing offices to issue fully favorable decisions in cases that can be decided without a hearing (i.e., ‘‘on the record’’). I have had clients approved for benefits by senior attorneys in both the Memphis and Nashville hearing offices. This cuts off many 

months in their wait for payment of benefits. I am pleased that Commissioner 

Astrue decided to authorize the program for at least the next two years.4 In FY 

2009, senior attorneys decided more than 36,300 cases, a 50% increase over FY 

2008. This means that more than 36,000 claimants were able to receive their disability benefits months sooner. 

2. Findings Integrated Templates (FIT). FIT is used for ALJ decisions and integrates the ALJ’s findings of fact into the body of the decision. While the FIT does 

not dictate the ultimate decision, it requires the ALJ to follow a series of templates 

to support the ultimate decision. Representatives can use the FIT template, which 

is available on the SSA website, to draft proposed favorable decisions. Many representatives are now using the template either when requested by the ALJ or on 

their own initiative. When the draft proposed decision is submitted to the ALJ, it 

can lead to a speedier decision. 

3. Increase time for hearing notice. We have previously recommended that 

the time for providing advance notice of the hearing date be increased from the current 20 days to 75 days. Based on my experience, I strongly believe that this increase will allow more time to obtain medical evidence before the hearing and 

makes it far more likely that the record will be complete when ALJ reviews the file 

before the hearing. The 75-day time period has been in effect in SSA’s Region I 

states since August 2006 5 and, based on reports from representatives, has worked 

well. 


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6 20 C.F.R. §§ 404.1619 and 416.1019. 

Improvements at the Initial Levels 

CCD supports initiatives to improve the process at the initial levels so that the 

correct decision can be made at the earliest point possible and unnecessary appeals 

can be avoided. Improvements at the front end of the process can have a significant 

beneficial impact on preventing the backlog and delays later in the appeals process. 

1. New Screening Initiatives. We support SSA’s efforts to accelerate decisions 

and develop new mechanisms for expedited eligibility throughout the application 

and review process. We encourage the use of ongoing screening as claimants obtain 

more documentation to support their applications. However, SSA must work to ensure that there is no negative inference when a claim is not selected by the screening tool or allowed at that initial evaluation. There are two initiatives that hold 

promise: 

• Quick Disability Determinations. We have supported the Quick Disability 

Determination (QDD) process since it first began in SSA Region I states in 

August 2006 and was expanded nationwide by Commissioner Astrue in September 2007.6 The QDD process has the potential of providing a prompt disability decision to those claimants who are the most severely disabled. Since 

its inception, the vast majority of QDD cases have been decided favorably in 

less than 20 days, and sometimes in just a few days. • Compassionate Allowances. This initiative allows SSA to create ‘‘an extensive list of impairments that we [SSA] can allow quickly with minimal objective medical evidence that is based on clinical signs or laboratory findings or 

a combination of both. . . .’’ SSA has published an initial list of 50 conditions 

on its website, with more to be added at a later date. Unlike the QDD screening, which occurs only when an application is filed, screening for compassionate allowances can occur at any level of the administrative appeals process. SSA has held recent Compassionate Allowance outreach hearings with 

expert panels to consider early onset Alzheimer’s disease and schizophrenia. 

2. Improve development of evidence earlier in the process. In previous testimony, CCD has made a number of recommendations to ensure that disability 

claims are properly developed at the beginning of the process. Claimants’ representatives are often able to provide evidence that we believe could have been obtained 

by the DDSs earlier in the process. Our recommendations include: 

• Provide more assistance to claimants at the application level. At the 

beginning of the process, SSA should explain to the claimant what evidence 

is important and necessary. SSA should also provide applicants with more 

help completing the application, particularly in light of electronic filings, so 

that all impairments and sources of information are identified, including nonphysician and other professional sources. • DDSs need to obtain necessary and relevant evidence. Representatives 

often are able to obtain better medical information because they use letters 

and forms that ask questions relevant to the disability determination process. 

However, DDS forms usually ask for general medical information (diagnoses, 

findings, etc.) without tailoring questions to the Social Security disability 

standard. One way to address this would be for SSA to encourage DDSs to 

send Medical Source Statement forms to treating and examining doctors. 

These simple forms translate complex, detailed medical source opinions into 

practical functional terms useful to the vocational professionals at DDSs and 

hearing offices. • Increase reimbursement rates for providers. To improve provider response to requests for records, appropriate reimbursement rates for medical 

records and reports need to be established. Appropriate rates should also be 

paid for consultative examinations and for medical experts. • Provide better explanations to medical providers. SSA and DDSs 

should provide better explanations to all providers, in particular to physician 

and non-physician treating sources, about the disability standard and ask for 

evidence relevant to the standard. 

• Provide more training and guidance to adjudicators. Many reversals at 

the appeals levels are due to earlier erroneous application of existing SSA policy. Additional training should be provided on important evaluation rules 

such as: weighing medical evidence, including treating source opinions; the 

role of non-physician evidence; the evaluation of mental impairments, pain, 

and other subjective symptoms; the evaluation of childhood disability; and the 

use of the Social Security Rulings. 


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7 74 Fed. Reg. 48797 (Sept. 24, 2009). 

• Improve the quality of consultative examinations. Steps should be 

taken to improve the quality of the consultative examination (CE) process. 

There are far too many reports of inappropriate referrals, short perfunctory 

examinations, and examinations conducted in languages other than the applicant’s. 

3. Eliminate reconsideration. To create a more streamlined process, we have 

supported elimination of the reconsideration level and adding some type of pre-decision contact with the claimant. SSA has tested the elimination of reconsideration 

in ten ‘‘prototype’’ states [AL, AK, CA—Los Angeles, CO, LA, MI, MO, NH, NY— 

Albany and New York City, PA] for nearly ten years and it was recently extended 

through September 28, 2012.7 Claimants’ representatives in those states report that 

the process works well without a review level between the initial determination and 

the ALJ level. 

ADDITIONAL RECOMMENDATIONS 

In addition to addressing the backlog and SSA’s funding issues, there are several 

other legislative proposals that the Subcommittee may be considering this year. 

• Protecting claimants’ privacy rights. We understand that it can be cumbersome for SSA to obtain medical records, as it is for claimants and their 

representatives, and that SSA is exploring more efficient ways to secure the 

necessary evidence. While we support ways to make this process more efficient, we believe that claimants’ privacy rights must be protected. We will 

work with SSA to find a way to obtain, as efficiently as possible, a claimant’s 

authorization for release of medical records to SSA, while protecting the individual’s privacy rights. 

• Extension of the fee demonstrations in the SSPA. Access to experienced 

and qualified representatives through the lengthy and complex application 

process is critically important to claimants. To this end, we support allowing 

claimants to enter into voluntary agreements with representatives for fee 

withholding and direct payment procedures whether under Title II or Title 

XVI. The Social Security Protection Act of 2004 established two demonstration projects that should be made permanent because they have proven to be 

effective in increasing claimants’ access to effective representation: (1) Extension of the Title II attorney fee withholding and direct payment procedures 

to SSI claims; and (2) Allowing nonattorney representatives to qualify for fee 

withholding and direct payment, provided they meet certain requirements. 

Unless they are extended or made permanent, the demonstrations will sunset 

March 1, 2010. 

• Increase and indexing of the fee cap. Rep. John Lewis has introduced 

H.R. 1093, which contains two provisions regarding the current $5,300 fee 

agreement fee cap: (1) Increase the current fee cap to $6,264.50 (which represents the figure if it had been adjusted for inflation since the last increase 

in 2002); and (2) Index the fee cap for future years to the annual COLA. We 

support these changes since they ensure that there will be a knowledgeable, 

experienced pool of representatives available to represent claimants. 

• Work incentives. The Ticket to Work and Work Incentives Improvement Act 

was enacted nearly ten years ago and is overdue for evaluation of its effectiveness in employment of those receiving Title II and SSI disability benefits. 

We urge renewal, strengthening, and permanent extension of expired/expiring 

provisions including (1) SSA’s Title II demonstration authority to test promising approaches for work incentives and related provisions; (2) Demonstration to Maintain Independence, set to expire this year, to provide Medicaid 

buy-in coverage to working individuals whose conditions or disabilities are not 

yet severe enough to qualify them for disability benefits; (3) Protection and 

Advocacy for Beneficiaries of Social Security to protect the rights of beneficiaries as they attempt to return to work; and (4) Work Incentives Planning 

Assistance, which provides state grants for outreach and education to individuals with disabilities about supports and services regarding employment. 


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8Some of these claimant descriptions appeared in testimony presented by Peggy Hathaway 

on behalf of the CCD Social Security Task Force at a Joint Hearing of the House Ways and 

Means Subcommittees on Social Security and Income Security and Family Support on Eliminating the Social Security Disability Backlog, March 24, 2009. The testimony is available at 

http://democrats.waysandmeans.house.gov/hearings.asp?formmode=view&id=7618. 

CLAIMANT STORIES PROVIDED BY REPRESENTATIVES IN 2009 8

CALIFORNIA 

♦ Mr. B is a 57-year-old man from Los Angeles, CA. He worked in construction 

for over 30 years before he became disabled. He has been unable to work since 2003 

and is homeless. His only income is $221 per month from General Relief. He has 

congestive heart failure, torn rotator cuffs in both shoulders, severe arthritis in his 

knees, severe depression, and possible cerebral atrophy. He applied for benefits in 

October 2007. After his claim was denied, Mr. B obtained representation and he 

filed a request for a hearing in April 2008. He has been homeless the entire time 

while he waited for a hearing. During the wait, his depression and physical health 

have worsened. Mr. B’s condition requires him to rest during the day and keep his 

feet elevated, however he was unable to comply because shelters do not allow residents to remain during the day. Not having a place to rest caused his feet and legs 

to swell, resulting in a great deal of pain and discomfort. He also was hospitalized 

after coming down with an infection in one of the shelters. 

Mr. B’s hearing finally took place in July 2009, more than 14 months after requested. The ALJ issued a favorable decision on November 2, 2009, more than two 

years after Mr. B applied for benefits. Once he begins to receive benefits, in another 

3 or 4 weeks, he will finally be able to find a permanent home and start working 

on improving his health. 

FLORIDA 

♦ Mr. M is a 57-year-old man who worked as a Vocational Rehabilitation Specialist for over 20 years in Florida. He developed severe arthritis throughout his 

body, wears bilateral hand splints, knee splints, has developed severe joint degeneration, spinal cord degeneration, is agoraphobic, depressed, and anxious. He cannot 

take care of himself and he has no family to help him. He is about to lose his home. 

Mr. M has exhausted his savings and his attorney writes monthly letters to his 

mortgage company asking for extensions on his payments while he is waiting for 

his hearing. Nevertheless, the company is about to foreclose on his home. 

NEW YORK 

♦ A 46-year-old man from Queens, NY, diagnosed with severe asthma, cardiac 

disease, and severe depression, requested a hearing in August 2008. He last worked 

as a truck driver and warehouseman. He died from cancer in September 2009. 

Based on information received by his attorney, his hearing will not be scheduled any 

time soon. 

NORTH DAKOTA 

♦ Mr. N worked as an assistant manager of an automotive/tire shop in Fargo, 

ND. He was injured while on the job in June 2006. He did not apply for Social Security disability benefits until August 2007. He has severe, chronic myofacial pain and 

dysfunction syndrome, joint dysfunction, and lumbar and thoracic musculoligamentous sprain/strain. He also has severe major depressive disorder and panic 

disorder related to his injury, which has resulted in hospitalization. Mr. N requested 

a hearing on March 21, 2008. He was finally found disabled by a decision of an ALJ 

(without a hearing) on February 19, 2009. Correct payment of his Social Security 

benefits was delayed due to an erroneous calculation of benefits based on his North 

Dakota workers compensation claim. Benefits for his wife and dependent children 

also were miscalculated. He received only a small portion of his regular monthly 

benefit (less than $100 per month) and had to wait over seven months before he 

received his past due benefits and began receiving the correct monthly benefit 

amount. He was not receiving any wage loss benefits from workers compensation 

during this timeframe. 

OHIO 

♦ Mr. N is a 55-year-old former maintenance supervisor who lives in Chillicothe, 

OH. He has small vessel ischemia, cerebrovascular disease, lumbar scoliosis, degenerative joint disease, vision loss, migraine headaches, depression, anxiety, fatigue, 

memory loss, and partial paralysis to his left side caused from two strokes. Mr. N 

filed his request for hearing in September 2007. While waiting for a hearing, he has 

had five liens put on his home, and does not have medical insurance to receive the 


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medical treatment that he needs. His primary care physician has discussed his 

treatment options and has explained that his health will continue to decline, and 

that it is crucial for him to receive treatment as soon as possible. 

♦ Mr. W, a 37-year-old fork lift driver from Columbus, OH, has a head injury and 

bipolar disorder, which prevent him from working. He filed his application for disability benefits in November 2006. While waiting for a hearing, he and his family 

were evicted from their apartment and his wife left him. He is living in a house 

with a friend and is unable to pay rent. However, when he is awarded benefits, he 

will owe back payment for the rent and continues to fall further into debt. 

♦ Mr. P, a 60-year-old data entry person who lived in Columbus, OH, had back 

and knee problems, epilepsy, and a number of infections that kept occurring 

throughout his body. He filed his application for disability benefits on April 25, 

2006. While waiting for a hearing, Mr. P became increasingly ill due to infection 

and chronic lymphedema. He died on December 11, 2007. An on-the-record favorable 

decision was made on October 9, 2008, ten months after his death. Mr. P was found 

disabled as of May 1, 2002 (four years before he applied for benefits) through the 

date of his death. 

PENNSYLVANIA 

♦ An attorney in Fort Washington, PA, reports that many clients have difficulties 

applying for Title II or SSI disability benefits because they do not have health insurance or the means to pay for medical treatment. They cannot treat their impairments, so their conditions get worse, and they cannot prove the existence of disability. If they apply and are denied, there is a two-year wait for a hearing to be 

scheduled. For SSI applicants awarded benefits, past due benefits are paid in installments, even if they are threatened with eviction or foreclosure or are unable 

to pay for their medical treatment. One client, a former fast food worker, received 

an ‘‘on the record’’ decision in November 2008, but received half of her back benefit 

despite facing a foreclosure and has not yet received the other half of her benefits. 

She cannot pay for her medication or co-pays. Her attorney suggested she go to the 

SSA field office, but she is too sick and disabled to travel there and her cognitive 

impairment prevents her from effectively communicating. 

♦ Mr. D lives in Dalmatia, PA. He is a veteran of the Vietnam War and is a victim of Agent Orange and has other war-related health and mental problems. He had 

obtained a favorable decision on his Social Security disability claim. However, because of a mix-up at SSA, it was nearly two years until his attorney was able to 

straighten out his payments. He has a son with the same name and the SSA system 

had the two individuals mixed in with each other. While waiting for his payments, 

Mr. D’s house went up for a Sheriff’s sale after foreclosure. Two days before the 

sale, he called his attorney, crying, and said that he had no more reason to live. 

Out of sheer desperation, they called Rep. John Kanjorski’s office, which was able 

to help get the Sheriff’s sale postponed. Further, within two weeks, someone at SSA 

was trying to straighten out the mix-up. Within two months, the payments started. 

Mr. D’s attorney notes that he does not believe this would have been accomplished 

if Rep. Kanjorski’s office had not intervened. 

♦ Ms. L is 50 years old and lives in Pennsylvania. She has been diagnosed with 

cirrhosis of the liver caused by Hepatitis C. Although she has finally received a 

hearing date, the wait has been a struggle for her. She has had her utilities shut 

off, her car repossessed, and her health has worsened. Ms. L’s medical care is very 

costly. She has been non-responsive to certain treatments for her cirrhosis and is 

now on the liver transplant list. 

TENNESSEE 

♦ Mrs. C, a 43-year-old radiology/CT scan tech, lives in Clarksville, TN. She is 

unable to work due to diabetes, depression, anxiety disorder, fluid and arthritis in 

her knees, spondylothesis, spinal stenosis, degenerative disc disease, broad based 

disc bulges and severe pain and weakness in both legs. She filed her application for 

disability benefits in June 2007. While waiting for her hearing, Mrs. X and her family have been evicted from their home. Both of their vehicles have been repossessed, 

and they are having extreme difficulties paying for their day to day living. Her husband is on the verge of being laid off and, if that happens, there will be no income 

at all for this family. Due to the backlog, this claimant and her family may lose everything before she is able to get a hearing date and decision. 

♦ Ms. A is 61 years old and lives in Milan, TN. She has Major Depressive Disorder, which prevents her from working. She filed her application for benefits in 

2007. Ms. A’s hearing has not yet been scheduled but her attorney has requested 

an on-the-record decision. She and her husband, who is currently employed, were 

forced to file for Chapter 7 bankruptcy in order to keep their house. The majority 


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of her husband’s check is going to the bankruptcy trustee each pay period, leaving 

them with only $4 to $27 per pay period for all of their other expenses, such as groceries and utilities 

♦ Mr. D, a 48-year-old man who lives in Gibson County, TN, has musculoskeletal 

impairments. He filed his application for disability benefits in 2007. Mr. D’s hearing 

has not yet been scheduled. He has lost his home and his wife left him. He is essentially homeless, living with various family members and friends. 

♦ Mr. W is 53 years old and currently lives in Haywood County, TN. He has been 

diagnosed with musculoskeletal impairments. He filed his application for disability 

benefits in late 2004. It was denied and he had to appeal the case to federal district 

court. The court remanded the case, but not until mid to late 2008. After a remand 

hearing in 2009, his claim was allowed. However, while waiting for the decision, he 

lost his home and has had to live with various family members. 

TEXAS 

♦ Ms. A is a resident of Austin, TX, who filed a claim for disability benefits on 

April 27, 2006, after undergoing a quadruple coronary bypass. Ms. A’s claim was 

denied initially and on reconsideration, and she requested a hearing on April 3, 

2007, which was held on February 4, 2008. While awaiting the hearing, Ms. A experienced extreme financial hardship resulting in the foreclosure of her home and increased depression and anxiety. Unfortunately, her claim was denied by the ALJ in 

a April 2, 2008, decision. She appealed to the Appeals Council, which resulted in 

a remand order, dated August 27, 2008, for another hearing. As of this date, the 

remand hearing has not been scheduled, 15 months after the Appeals Council remanded the case. While waiting for her new hearing, Ms. A has continued to experience extreme financial hardship and, on several occasions, homelessness was a very 

real possibility. 

♦ Mr. A is 45 years old and lives with his wife in Mission, TX. He has degenerative disc disease of the lumbar spine status post lumbar laminectomy, major depressive disorder, and borderline intellectual functioning, which prevent him from working. He filed his application in September 2003. The claim was denied initially in 

November 2003 and at reconsideration in February 2004 and he requested a hearing 

a few days later. While waiting for a hearing, Mr. A’s house burned down in November 2004. His hearing was finally held in June 2006, more than two years after he 

filed his appeal. The hearing was continued in order to obtain a psychological consultative examination and a supplemental hearing was held in July 2007. The ALJ 

denied the claim and on appeal, the Appeals Council remanded the case back to the 

ALJ. During this period, Mr. A was forced to file for bankruptcy. He had a remand 

hearing in February 2009 before the same ALJ who previously denied his case. At 

the remand hearing, the ALJ announced he would be awarding a fully favorable decision. 

♦ Mr. R is 48 years old and lives in San Antonio, TX. He has back pain, joint 

pain, hearing problems, Hepatitis C, and a head injury, which prevent him from 

working. He filed his application for benefits in January 2007. While waiting for a 

hearing, he became homeless and cannot receive proper medical attention. Mr. R 

has to rely on the kindness of friends for his basic necessities. 

WISCONSIN 

♦ A middle-aged Eau Claire area woman became disabled, when her knees deteriorated to the point where she needed knee replacements. Her knee conditions led 

to back problems, causing chronic pain for which she has to take highly potent narcotic drugs. After waiting nearly three years for her hearing, the ALJ allowed her 

case after ten minutes. While waiting for her hearing, her family lost their home 

to foreclosure and she had to file for bankruptcy. After the hearing, her attorney 

asked if they would have lost their home or had to file for bankruptcy if she had 

been getting her Social Security disability benefits sooner. Tearfully, she replied, absolutely not. To add insult to injury, her attorney just received a telephone message 

from her in early November 2009. Even though this client’s fully favorable decision 

was dated August 31, 2009, she has still not received either her first check or her 

past due benefits. She called the Social Security District Office and was told it could 

take 90 days for the Payment Center to get her into pay status and to issue her 

payment for past due benefits. 

♦ In early November 2009, a man from Humbird, WI, received his fully favorable 

decision, almost three years after filing his Social Security disability application. 

Unfortunately, he was served one day later with a Summons and Complaint to foreclose his home. (His monthly mortgage payment had been increased from $327 per 

month to over $900 per month, because the mortgage lender had to pay his property 

taxes last year.) He is now hoping to negotiate a redemption, but it is unclear 


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whether the mortgage holder will do so. If not, he will have to file for bankruptcy. 

His attorney is hoping that the SSA Payment Center will not delay payment of his 

case, so he will have his past due benefits to use in his attempts to work something 

out with the mortgage holder. 

♦ Also in early November 2009, the husband of a claimant from Chippewa Falls, 

WI, came to the wife’s attorney’s office to ask if there is anything the attorney could 

do to expedite payment of the wife’s benefits. His wife had filed her application in 

July 2006. Nearly three years later, she received a fully favorable hearing decision, 

dated June 19, 2009. Five months after the ALJ found her disabled, she still has 

not received either a monthly benefit payment or her past due benefits. The client 

and the attorney’s staff have placed calls to the SSA field office. They have been 

told that the delay is caused by the Payment Center and that all the field office 

can do is try to prod the payment center to pay the benefits. 

♦ While waiting for his hearing, Mr. L became homeless. He lived in the La 

Crosse, WI, area and was waiting for a traveling ALJ to schedule his hearing in 

La Crosse. Over a one and a half year wait, Mr. L’s attorney tried to expedite the 

hearing since he was homeless and winter was approaching. In January 2009, his 

attorney sent the ALJ another letter indicating that Mr. L was living in a shanty 

in the woods, hunting rabbit for food, and using a campfire to keep warm. Eventually, his hearing was scheduled for April 2009, but the ALJ approved the case without the need for a hearing. By that time, Mr. L had moved to another state to stay 

with someone. 

* * * * 

CONCLUSION 

As you can see from the circumstances of these claimants’ lives and deaths, delays 

in decision-making on eligibility for disability programs can have devastating effects 

on people already struggling with difficult situations. On behalf of people with disabilities, it is critical that SSA be given substantial and adequate funding to make 

disability decisions in a timely manner and to carry out its other mandated workloads. We appreciate your continued oversight of the administration of the Social 

Security programs and the manner in which those programs meet the needs of people with disabilities. 

Thank you for the opportunity to testify today. I would be happy to answer questions. 

ON BEHALF OF: 

American Association on Intellectual and Developmental Disabilities 

American Council of the Blind 

American Network of Community Options and Resources 

Association of University Centers on Disabilities 

Bazelon Center for Mental Health Law 

Community Access National Network (TIICANN) 

Epilepsy Foundation 

National Alliance on Mental Illness 

National Association of Disability Representatives 

National Disability Rights Network 

National Health Care for the Homeless Council 

National Organization of Social Security Claimants’ Representatives 

National Spinal Cord Injury Association 

Paralyzed Veterans of America 

Research Institute for Independent Living 

The Arc of the United States 

United Cerebral Palsy 

United Spinal Association 

World Institute on Disability 

f 

Chairman TANNER. Thank you very much, Ms. Bates. Of course 

I should mention we will accept all your statements for the record 

in their entirety. 

Mr. Inspector General, welcome. You are recognized, sir. 


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STATEMENT OF PATRICK P. O’CARROLL, JR., INSPECTOR 

GENERAL, SOCIAL SECURITY ADMINISTRATION 

Mr. O’CARROLL. Good afternoon, Mr. Chairman and Mr. Johnson. Thank you for calling this hearing, and giving me the opportunity to testify about SSA’s efforts to reduce the backlog of initial 

disability claims. This has been a challenging time for the American economy and the American people. At such times, people turn 

to the safety net of Social Security in record numbers. 

In fiscal year 2009, SSA received almost 3 million applications 

for disability benefits, which was an increase of some 15 percent 

over the previous year. The State Disability Determination Services, or DDSs, were able to process eight percent more claims than 

the year before. However, this still created a net deficit, leaving the 

backlog at its current level of three-quarters of a million claims. 

One significant threat to SSA’s efforts to decrease this backlog 

has been the furloughing of DDS employees by states struggling 

with budget issues. Federal regulations discourage, but do not prohibit, this practice. To date, nine states are furloughing all of their 

DDS employees, and three states are furloughing some of their 

DDS employees. In states furloughing all DDS employees, this has 

created a 14 percent shortfall of capacity for processing applications. 

In our report, ‘‘Impact of State Budget Issues on SSA’s Disability 

Programs,’’ issued earlier this week, we estimate that the furloughs 

will cause delays in 69,000 claims, and delays in issuance of $126 

million in benefits to those in need. 

Also troublesome from an integrity perspective is the resulting 

increase in the backlog of medical continuing disability reviews, or 

CDRs. These reviews result in program savings of $10 for every 

dollar that’s invested. Resources that could be used for CDRs are 

being reallocated to processing initial claims, and program dollars 

are lost. 

Significant efforts have been made to limit the impact of the furloughs. The Commissioner contacted all the state governors and 

many state legislators. Vice President Biden wrote to the National 

Governors’ Association. There was even litigation in California that 

sought to preclude the furloughs. 

As a result of these and other efforts, two states exempted their 

DDSs from the furloughs, and three states partially exempted their 

DDS employees, saving another 11,000 claims and $24.4 million 

from being delayed. SSA has hired 192 new staff for Federal units 

that process initial claims. The Agency transferred cases facing 

delays from states to those Federal units to ensure timelier processing. 

SSA should be commended for its efforts to minimize the impact 

of state furloughs and other hiring and staffing issues. Still, these 

state actions have clearly resulted in delays and increased the 

backlog. 

SSA staffing is another issue critical to the reduction of this 

backlog. Congress was aware of the increased workload that the 

economic downturn would engender when it passed the American 

Recovery and Reinvestment Act. The act provides $500 million to 

SSA to process retirement, disability, and survivors insurance 

workloads, and SSA has put that money to good use. 


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Of the $500 million, SSA invested $251 million in its office of operations, which has now hired 1,531 additional staff. We reviewed 

SSA’s plan for these funds, and found that the plan and the placement of the new hires was appropriate. Most of the other $249 million was invested in hiring 300 additional staff in the DDSs, and 

35 ALJs and 556 support staff in the Office of Disability Adjudication and Review. We are now conducting similar reviews of SSA’s 

use of these funds. 

Finally, I would be remiss if I didn’t use this opportunity to encourage continued vigilance, with respect to program integrity. In 

attending to the backlog of initial claims, it is critical that SSA and 

the DDSs continue to conduct CDRs and refer suspicious claims to 

the OIG’s cooperative disability investigative units and field divisions. 

The efforts that Congress, SSA, and the OIG have put forward 

are important elements in ensuring that the backlog of initial 

claims is ultimately reduced to an acceptable level. I pledge the 

OIG’s continued support in this effort, and I thank you for the invitation to be here today. I will be happy to answer any questions. 

[The prepared statement of Mr. O’Carroll follows:] 

Prepared Statement of The Honorable Patrick O’Carroll, Inspector General, 

Social Security Administration 

Good morning, Mr. Chairman, Mr. Johnson, and Members of the Subcommittee. 

As always, it’s a pleasure to appear before you, and I thank you for the invitation 

to be here today. I’ve appeared before you several times to discuss the backlog of 

disability appeals, and the Social Security Administration’s (SSA) efforts to reduce 

that backlog to ensure that appellants eligible for benefits receive them in as timely 

a fashion as possible. Today, we are looking at SSA’s backlog in initial disability 

claims, a backlog of over three-quarters of a million people currently waiting for 

sorely needed benefits. 

The past two years have been challenging ones for the American people, as the 

economy struggled. In times such as these, people turn in ever-increasing numbers 

to the world’s largest social insurance program. In Fiscal Year (FY) 2009 alone, SSA 

received almost 3 million initial disability claims, an increase of 15 percent over FY 

2008. These numbers challenge SSA’s ability to provide world-class service delivery, 

creating workloads that exceed resources and causing delays and backlogs. These 

numbers also create challenges for both SSA and the Office of the Inspector General 

(OIG) with respect to stewardship, as we strive to ensure that only those eligible 

for benefits are granted them. 

To make the challenges even more daunting, the financial strain on the states 

caused by the faltering economy have resulted in furloughs that further slow the 

application process; and the increase in applications has forced the dedication of resources to processing applications, rather than conducting medical continuing disability reviews (CDR) or work CDRs, or taking other steps to ensure integrity. 

It is critical that Congress and the American people have reason to be confident 

that Social Security benefits will be provided to those who need them, and equally 

confident that their tax dollars are being spent well and wisely. The OIG is at work 

on both sides of this equation, helping SSA to maintain its high level of service 

through timely audits and recommendations, while also acting as a watchdog, to ensure that benefits are paid properly, and that appropriated resources are used as 

intended. 

Congress was certainly well aware of the challenges SSA would face in the current economy when it provided SSA with $500 million under the American Recovery 

and Reinvestment Act (ARRA) to process disability and retirement workloads, as 

well as $500 million to replace the National Computer Center and $90 million to 

process one-time economic recovery payments of $250 to beneficiaries. The OIG received $2 million to ensure that these funds were used properly, and I’d like to 

share some of our work in that area today. 

The funds provided to SSA to process initial claims were critical. As I mentioned, 

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crease in claims filed, against only an 8 percent increase in claims actually processed by the State Disability Determination Services (DDS). These delays are 

caused not only by the increase in applications, however, but also by State furloughs, staffing problems, and other issues. 

The furloughs are particularly troublesome. Federal regulations discourage furloughs of DDS personnel, but this has not stopped furloughs from occurring. To 

date, nine states are furloughing all their DDS employees and three states are furloughing some DDS employees. 

In states that are furloughing all of their DDS employees, this has created a 14 

percent shortfall of capacity for processing claims. In our report, Impact of State 

Budget Issues on SSA’s Disability Programs, issued earlier this week, we estimate 

that the furloughs have caused delays in 69,000 claims, and delays in the issuance 

of $126 million in benefits to those in need. In addition to the furloughs themselves, 

other issues are contributing to this impact. Certain states have encountered high 

attrition rates among DDS employees, others have encountered pay freezes, and still 

others have hiring practices that are problematic. 

The Commissioner has made significant efforts to limit the impact of furloughs, 

and was able to make some progress. He contacted all of the State Governors and 

many State legislators. Vice President Biden wrote to the National Governors’ Association, and there was even litigation in California that sought to preclude furloughs. 

As a result of these and other efforts, two States exempted their DDSs from State 

employee furloughs, and three States partially exempted DDS employees, saving another 11,000 cases and $24.4 million from being delayed. Several more States fully 

or partially exempted DDSs from hiring restrictions. Additionally, SSA hired 192 

new staff for Federal units that process initial claims, and transferred cases facing 

delays from States to those Federal units to ensure timelier processing. 

While SSA should be commended for its efforts to minimize the impact of State 

furloughs and other hiring and staffing issues, it is indisputable that these State 

actions have resulted in delays and kept benefits out of the hands of those in need. 

Staffing at SSA is another critical factor in timely processing of applications, and the ARRA funds provided for that purpose have been put to use. Of the $500 million 

allocated to this purpose, SSA allocated $251 million to its Office of Operations, 

which is using the funds to process disability and retirement workloads. Operations 

hired 1,531 new employees, and authorized the use of overtime pay to keep pace 

with applications. 

The Office of Management and Budget issued guidance on spending and accounting for ARRA funds, and this guidance included the publication of detailed plans 

for use of the funds. The OIG just issued a report evaluating SSA’s plan for the 

$251 million allocated to the Office of Operations. Overall, we found that the plan 

was appropriate, and the placement of new hires was based on appropriate factors. 

The remaining $249 million was primarily directed to the DDSs, which hired 300 

additional employees, and the Office of Disability Adjudication and Review, which 

hired 591 employees, of which 35 were Administrative Law Judges and 556 were 

new support staff. The OIG is conducting audits of the plans for the DDS’ and 

ODAR’s use of ARRA funds, similar to the audit conducted of the Operations plan. 

SSA’s efforts to minimize the impact of State budget shortfalls, and its initial efforts with ARRA funds, have been important steps in ensuring that initial applications encounter as few delays as possible, but more needs to be done. While additional resources would be of significant immediate benefit, there are long-term 

issues that can be addressed to prevent future backlogs. 

For example, SSA received $500 million in ARRA funds to replace the National 

Computer Center (NCC), SSA’s aging repository for the data and electronic processes that enable SSA to pay benefits to 50 million Americans. Replacement of the 

NCC is critical to the future of the Social Security system. 

The OIG is monitoring SSA’s progress. At present, we continue to await specifications for the project, which we intend to subject to rigorous review. Our reports will 

ultimately be published on our website, as well as Recovery.gov, and we will remain 

involved in the process until a new data center is complete and operational. 

Infrastructure and hardware, however, are only part of the equation, as SSA’s primary data applications require modernization. SSA’s attempts to upgrade its software to improve service delivery and stewardship are ongoing, but need to be given 

a higher priority. It is important that SSA consider all software options carefully 

and ensure that it is taking the best approach. As we point out in our Financial 

Statement Audit, consideration must be given to the benefits gained from the administrative funds transferred to SSA’s IT budget each year. In addition, the OIG 

strongly supports giving SSA’s Chief Information Officer sufficient delegated authority and resources to fulfill required security responsibilities. 


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Since I have mentioned two of the three ARRA mandates given to SSA, let me 

briefly state that the OIG also reviewed SSA’s use of the $90 million provided to 

process one-time $250 stimulus payments. We found that SSA implemented a comprehensive process to identify and report these costs, and met OMB’s requirements 

for transparency and accountability. The process was not without its challenges, 

however, including the issuance of checks to some ineligible prisoners and deceased 

beneficiaries. While perfection is an unreasonable expectation, improvements can be 

made legislatively and procedurally to tighten the process for future stimulus payments. 

The primary focus of this hearing, however, is the disability application backlog, 

and in addition to the efforts I described earlier, SSA has made other inroads toward streamlining the initial disability determination process, reducing the backlog 

and, more importantly, getting benefits into the hands of those who qualify, and 

need them, as quickly as possible: 

• Compassionate Allowances provide expedited approval to disability applicants 

with confirmed diagnoses of certain severe impairments. These Allowances let 

SSA quickly target the most obviously disabled individuals for benefits based 

on objective medical information that SSA can obtain quickly. 

• Quick Disability Determinations (QDD) are cases that are electronically identified as having a high potential that the claimant is disabled, when evidence 

of the claimant’s allegations can be easily and quickly obtained, and when the 

case can be processed quickly in the DDS. These cases are prioritized for fast 

turnaround. We estimate that the Compassionate Allowances and QDD initiatives will account for approximately 3.7 percent of initial disability claims. 

• Additional Administrative Law Judges and hearing office support staff have 

been hired by SSA, and the recommendations from our draft report, Hearing 

Office Performance and Staffing, are being considered in ensuring that staffing ratios in SSA hearing offices are optimized to make the most of the new 

ALJ corps. 

• SSA is developing a multi-year plan to reduce the initial claim backlog. According to SSA, the key components of this plan are: 

• increased adjudicatory capacity in the DDSs and Federal processing components; 

• improved efficiency through automation; 

• expedited IT investments to optimize systems performance; 

• expanded use of screening tools to assist in identifying likely allowances; 

and 

• refined policies and business processes to expedite case processing. 

The OIG will review the Agency’s plan when it is available, and will monitor its 

progress closely. 

• SSA has instituted a Senior Attorney Adjudicator Initiative, which allows attorney adjudicators to issue fully-favorable on-the-record decisions. The goal 

is to expedite decisions while preserving ALJ resources for the more complex 

cases that require a hearing. 

• SSA has also instituted an Informal Remand Initiative, in which a hearing 

office can return a denied claim to the DDS for review of the previous determination when there is a strong likelihood that the denial will be reversed, 

again saving hearing resources for more complex cases. 

Finally, I would be remiss if I did not point out that integrity continues to be a 

primary focus of the OIG. Our continuing support for increasing the number of 

CDRs has never wavered. As important as it is to ensure that applicants are eligible 

for benefits at the time of their initial application, it is equally important to ensure 

that they remain eligible as time goes by. However, SSA is expecting to have a backlog of 1.5 million medical CDRs by the end of FY 2010. SSA had eliminated the 

CDR backlog when Congress provided the Agency dedicated funding that could only 

be used for CDRs. After that funding ran out in FY 2002, the backlog grew again. 

When SSA performs a full medical CDR, it costs about $1,000, but provides an estimated return on that investment of $10 to $1. 

Similarly, the Cooperative Disability Investigative program, or CDI, is an important ingredient in the integrity formula. The CDI Program began in Fiscal Year 

1998 as a joint effort by the SSA and the OIG, in conjunction with the DDS and 

State or local law enforcement agencies, to effectively pool resources for the purpose 

of preventing fraud in SSA’s Title II and Title XVI disability programs and related 

Federal and State programs. In 1998, the CDI Units became operational in 5 states. 

The program currently consists of 20 units located in 18 states, with 2 additional 


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units to become operational in FY 2010. Since its inception, the CDI program has 

closed 26,448 cases, and generated about $1.35 billion in SSA program savings and 

another $829 million in non-SSA savings. 

As more individuals apply for benefits, allegations to these 22 CDI units across 

the country will increase. These units play a key role in ensuring that, while reducing the backlog of disability claims, SSA and the DDSs have an avenue available 

to them to further explore claims that may be suspicious or lack sufficient information to make a determination. Thus, the CDI program helps maintain the level of 

accuracy and integrity in these programs that the American public deserves. 

In summation, the OIG is dedicated to working with Congress and SSA to reduce 

the backlog of disability claims, and to ensuring that this takes place in an environment in which efficiency, integrity, and transparency are paramount. SSA’s efforts 

to date are commendable, and we look forward to continuing to assist in this critical 

undertaking. I thank you again for the invitation to speak with you today, and I’d 

be happy to answer any questions. 

f 

Chairman TANNER. Thank you very much, Mr. Inspector General. 

Ms. Robert, we are delighted you are here, and glad to hear from 

you in your capacity on the Disability Determination Services. So, 

welcome. Thank you for being here. 

STATEMENT OF ANN P. ROBERT, VICE PRESIDENT, NATIONAL 

COUNCIL OF DISABILITY DETERMINATION DIRECTORS, 

SPRINGFIELD, ILLINOIS 

Ms. ROBERT. Thank you very much, Mr. Chairman, Mr. Johnson. My name is Ann Robert, and I am honored to be here on behalf of the National Council of Disability Determination Directors. 

The NCDDD is comprised of managers and directors of the State 

DDSs. 

As you have heard today, the state DDSs process all kinds of 

claims, including initial applications, reconsiderations, and continuing disability reviews. You have also heard today about the increases in the initial applications. While there have been increases 

in recent years in funding for SSA—and the NCDDD thanks Congress for the resources that the DDSs have received to assist in 

giving the good public service that they have—those resource needs 

are certainly going to continue, in light of the increased applications. 

What’s complicating the Disability Determination Services’ ability to handle those increasing workloads are some of the other 

things that you’ve heard about today. For example, the furloughs. 

Despite the Commissioner’s efforts to exempt all DDS employees 

from those furloughs, all of his attempts have not been successful. 

What a furlough costs is not just problems in processing time, or 

problems in working claims, but it also costs dollars from the State. 

You heard that today. For example, a one-day furlough in the State 

of Ohio costs the state $345,000 in administrative funding, 

$149,900 in delayed monthly benefits to claimants, and impacts 

731 claims. So you can see that the impact of even one day of furlough is significant. 

While SSA has authorized hiring in the DDSs, the hiring has not 

always been optimized, because some other states have freezes and 

delays in hiring. Other states have been able to hire. 

But with hiring, you don’t get immediate results for increased capacity or productivity. The Social Security disability program is 


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complex, and requires significant training to bring an examiner to 

the point where they’re independent and productive. The initial 

learning curve, coupled with the problems with attrition that the 

DDSs currently encounter are impacting the DDSs’ ability to process this workload. 

Now, it’s been interesting, as the DDSs move forward, they have 

always—even with limited resources—processed cases, stepped up 

to the plate, provided good public service. The days of increased applications currently—and as we move in the future—provide significant challenges to the DDSs, which certainly will require some 

additional funding. 

The Social Security Administration has requested, and Congress 

has provided, additional funding for technology. Technology forms 

a very important basis for improving claim processing, and it is 

critical that that funding continue to provide the capacity and the 

capability to provide good public service through an efficient and 

quality case-processing system. 

You’ve heard from the Commissioner today about a couple of the 

initiatives: the DCPS, or the common case processing system; the 

QDD and CAL initiatives, and also eCAT. Those initiatives are important. They combine both technology and policy. NCDDD supports the continuation of those initiatives, and will work with SSA 

for the further development and roll-out of all of those initiatives 

in the DDSs. 

Social Security is working right now on a—— 

Chairman TANNER. If you did all that from memory, you’re 

pretty impressive. 

[Laughter.] 

Ms. ROBERT. It’s what we lawyers do, isn’t it? 

Social Security is working right now, as you heard from the Commissioner, on workload planning issues. You have also heard from 

him how they are creating some ESTs, or extended service teams, 

which will provide national resources to some of the DDSs needing 

assistance. It’s very critical that the DDS community be involved 

in every part of this process. 

State DDSs are used to doing workload sharing, and helping out 

with additional workloads. In fact, we helped with the ODAR reduction by taking some informal remand cases. But transferring 

cases from state to state can be both politically sensitive and technologically challenging. So, this move must move forward with 

much caution and much collaboration by the DDSs. 

NCDDD will continue to work with the SSA in development of 

an operational plan that is cost efficient, that is cost effective, ensuring success to address the workload while providing good, quality service, and program stewardship. 

We want to thank Commissioner Astrue for his collaboration and 

support of the DDS community. We want to thank this committee 

for their support of the funding for the Social Security Administration that assists the DDSs, and we also look forward to enhancing 

the partnership of the Federal-State relationship. 

So, in closing, the need for additional resources comes in a variety of ways. Certainly we need funding for staffing. We also need 

additional funding to continue with the initiatives, and funding for 


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the robust infrastructure that needs to support this case processing 

system that can handle all these claims. 

So, thank you, Mr. Chairman, for inviting me to come here today, 

and for all your work in this regard. 

[The prepared statement of Ms. Robert follows:] 

Prepared Statement of Ann P. Robert, Vice President, National Council of 

Disability Determination Directors, Springfield, Illinois 

Chairman Tanner, Mr. Johnson, Members of the Subcommittee, my name is Ann 

Robert and I am honored to have this opportunity to appear on behalf of the National Council of Disability Determination Directors (NCDDD) to comment on the 

effect of SSA’s unprecedented backlog of disability claims, the agency’s efforts to address those challenges, the impact of the recession on disability claims processing, 

and the ongoing need for adequate resources to address these issues. 

The National Council of Disability Determination Directors (NCDDD) is a professional association composed of the Directors and managers of the Disability Determination Services (DDS) agencies located in each state, the District of Columbia, 

Puerto Rico, and the Virgin Islands. Collectively, members of the NCDDD are responsible for directing the activities of approximately 15,000 employees who process 

nearly 4 million claims per year for disability benefits under the Social Security Act. 

NCDDD goals focus on establishing, maintaining and improving fair, accurate, timely and cost-efficient decisions to persons applying for disability benefits. The mission 

of NCDDD is to provide the highest possible level of service to persons with disabilities, to promote the interests of the state operated DDSs and to represent DDS directors, their management teams and staff. 

The DDSs are entirely federally funded by SSA and make medical determinations 

for the Social Security disability programs. The DDSs adjudicate various claim types 

including initial applications, reconsiderations, and continuing disability reviews. 

Many SSA executives have referred to the DDSs as the ‘‘best bang for the buck’’ 

in promoting governmental efficiency and effectiveness. NCDDD believes the Federal-State relationship is an important piece of the solution to addressing the increasing backlog of disability claims. 

NCDDD appreciates the increases in SSA funding over the past few years and 

sincerely thanks Congress for the resources to assist the DDSs in providing the 

needed and necessary service to those Americans reaching out for help in desperate 

and difficult times. The recent funding increase has resulted in a decrease in the 

backlog and processing time at the hearings level. The DDSs received additional 

funding for overtime which they utilized for the Informal Remand process to assist 

ODAR with the backlog reduction. 

The DDSs have seen a significant increase in the filing of initial disability claims 

which started in early FY 2009 as Baby Boomers predictably began to leave the 

workforce in their disability prone years and the nation began to experience the consequences of the economic downturn. As workers unexpectedly lost their jobs, they 

sought any other source of income, including Social Security disability benefits. Between the end of FY 2008 and the end of FY 2009, the number of initial claims has 

increased 14.8%. The total number of initial pending claims is expected to exceed 

one million by the end of FY 2010. 

The full or partial furlough of DDS staff in several states has added additional 

hardship to processing the disability workload. These furloughs have continued despite the support of the Administration and the committed leadership and support 

of Commissioner Astrue to exempt these federally funded DDS employees from the 

furloughs. Currently there are thirteen (13) states with full or partial furloughs. 

These furloughs compromise efforts by DDS staff to allow claims, including extreme 

hardship claims, and the ability of the DDS to provide the necessary public service. 

A one (1) day furlough can cost a state like Ohio $345,000 in administrative funding 

and $149,900 in delayed monthly benefits while impacting 731 claims. In other 

cases, DDSs have not been able to optimize all the hiring authorized by SSA due 

to a state-imposed hiring freeze or state hiring delays. 

SSA has requested significant funds to process the disability workloads and Congress has generously provided these funds. While the DDSs have worked to hire to 

optimal levels, the increasing complexity of the disability program criteria requires 

approximately 12–18 months of experience in the program for a disability examiner 

to become fully independent and productive. Therefore, hiring does not immediately 

translate to increased capacity and productivity. This initial learning curve, coupled 

with the current attrition in the DDSs (12.3% annually) is a significant challenge 

for the state DDSs in maintaining a qualified and experienced workforce. HistoriVerDate Nov 24 2008 03:34 Jan 25, 2012 Jkt 063016 PO 00000 Frm 00116 Fmt 6633 Sfmt 6621 I:\WAYS\OUT\63016.XXX GPO1 PsN: 63016

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cally, despite limited resources, the DDSs have worked to provide the much needed 

public service. However, the rising number of applications and the limited ability 

to hire and retain qualified and trained staff will have significant negative impact 

for the DDSs and the public we serve. 

SSA has, for the past few years, looked for ways to utilize technology to provide 

greater capacity and more efficient claim processing. The move to electronic claim 

processing was a significant task and one that came with some difficulty but much 

benefit to the disability claimant and to those components adjudicating disability 

claims. SSA has continued to request funds for technology and those funds have 

been and continue to be critical to ensuring the necessary capacity and capability 

to provide not only efficient but also high quality service to which the American 

public is entitled. 

Currently SSA has various initiatives combining policy and technology which have 

the potential to improve claim processing on several levels. The Disability Case 

Processing System (DCPS) is a SSA initiative partnering and collaborating with the 

States to design a case processing system to be used by all Disability Determination 

components. This case processing system should, when complete, provide a comprehensive process to produce efficiencies. DCPS must have sufficient infrastructure 

to provide a robust system that is stable, available, and responsive. DCPS should 

facilitate case processing not only in an individual DDS but when the need arises 

to assist with future workload challenges between Disability Determination components. The Quick Disability Determination/Compassionate Allowance (QDD/CAL) 

initiative is a process which allows the system to prioritize cases through technology 

providing for early identification of cases with a high potential of allowance thereby 

delivering expeditious service to those in desperate need. Another important but 

separate initiative of SSA is the Electronic Case Analysis Tool (eCAT). This tool can 

assist an examiner in working through a complex claim to reach the correct decision 

at the earliest point in the process. NCDDD supports each of these initiatives and 

will continue to work with SSA to further develop, refine, and roll out these processes. 

SSA has begun planning for the potential to achieve greater capacity to address 

additional claims. The strategies are, necessarily, multifocal and involve both state 

and federal components. For example, SSA has funded four DDSs to create Expanded Service Teams (EST) to produce work as a separate entity and as a ‘‘national resource’’ with a yet to be finalized methodology as to how states will quality 

for assistance and how this process would impact productivity for any affected component. 

The DDSs have a long and successful history of working cooperatively to assist 

with other workloads on an informal basis. With this background of success, the 

DDS community should be actively involved in all discussions to determine the best 

methodologies to provide assistance to any state while keeping in mind our primary 

focus of providing the best public service possible. Transferring work from state to 

state or to other components is both politically sensitive and frequently a technologically challenging venture that needs to be considered cautiously. Any plan to address the workload should be replete with appropriate mechanisms to assure accountability and consistency in decision-making regardless of which State Agency or 

federal disability component processes the claim. NCDDD will continue to advocate 

for DDS involvement in this plan and for a process that is well researched. NCDDD 

will assist in identifying and resolving potential problems or obstacles to ensure an 

efficient and effective process for those involved in this work flow process and those 

affected by it. 

SSA is facing unprecedented increases in workload and requires an appropriate 

level of funding to continue to serve the American public with timely and accurate 

decisions, for both new applications and continuing disability reviews. SSA and the 

DDSs must receive adequate resources to provide necessary staffing, continue important initiatives, and provide a robust infrastructure that delivers the system stability and availability for claim processing. NCDDD stands ready to work cooperatively with the SSA in developing an efficient, consistent, and cost-effective operational plan that will ensure the success of addressing this unprecedented workload 

while continuing to provide quality public service and program stewardship. We 

would be remiss if we did not publicly acknowledge the outstanding and unwavering 

support that Commissioner Astrue has provided to the DDS community. His collaboration and partnership have been invaluable to the identification of solutions and 

successes in the disability process. 

Mr. Chairman. On behalf of NCDDD, thank you again for the opportunity to provide this testimony. NCDDD has a long track record of success working with SSA 

to provide the highest level of service. I hope that this information is helpful to the 


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Subcommittee. NCDDD is willing to provide any additional assistance you may need 

and I would be happy to answer any questions you may have. 

f 

Chairman TANNER. Thank you very much, Ms. Robert. We 

agree that your organization has to be a critical part of this. 

Judge Auerbach? Your Honor, you are recognized. 

STATEMENT OF LARRY A. AUERBACH, ADMINISTRATIVE LAW 

JUDGE, ON BEHALF OF THE FEDERAL BAR ASSOCIATION, 

ATLANTA, GEORGIA 

Judge AUERBACH. Thank you, Mr. Chairman. I am Larry 

Auerbach, from the Atlanta downtown hearing office of Social Security, and I believe I am required to give the disclaimer that I am 

not speaking on behalf of Social Security or the Federal Bar Association, but rather, the Social Security section of the Federal Bar 

Association. 

There has been, as there has to be, a lot of talk about statistics 

and data here. That is how we gauge what the problem is, and how 

we gauge our success in dealing with the problem. But Congressman Kind and Ms. Bates each talked about individuals who suffer 

because of the delay. 

As a judge, it is sadly common that I see individuals who are suffering those losses, individuals whose medical notes indicate that 

surgery is needed, but can’t be done until disability is approved; individuals who are not taking their diabetes medication or their hypertension medication, because of a lack of funds while they are 

waiting on the approval of their disability. 

These people don’t just suffer at that time, but their disabilities, 

which might sometimes be temporary, become permanent disabilities while they are awaiting adjudication. That’s a devastating 

blow to those individuals, and it’s also a blow to the American taxpayers, who will then be funding disability payments for these individuals and health care costs for the rest of their lives. 

I have seen individuals who have lost their homes, lost their cars 

while they are waiting on their determination. Without a car, people often don’t have access to medical care. Without homes, they 

lose safety, stability for themselves and their families. Sadly, we 

find too often that we can’t even find the individuals to notify them 

that their day in court has finally come. 

The human face of this is tragic. It has, as has been noted by 

everyone here, improved dramatically. When I started just threeand-a-half years ago as a judge with Social Security, the average 

claimant that I saw had applied for benefits about four years before 

the date of his hearing. Today, I am seeing claimants who applied 

about two years before the date of the hearing. That’s still a really 

long time, and, tragically, too long. 

Progress has been made because of support from Congress and 

support from this committee, and initiatives that Commissioner 

Astrue talked about. The Social Security section applauds those. 

The improved technology has been a great benefit. The increased 

numbers of Administrative Law Judges and, just as importantly, 

the increased number of staff, has been vital to reducing the backlog and the wait times. 


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Judge Cristaudo, who was here earlier, sitting behind the Commissioner, and his team have done a lot to implement the Commissioner’s plans, but if you look at the data, some of which are cited 

in my written testimony, there is a wave of claims being filed now 

with the state DDSs. The resources now will not accommodate that 

wave. 

What will happen is that the backlogs will increase, the wait 

times will increase, and the tragic effects on human beings will increase, unless there is decisive action. In my written testimony 

there are a number of specific recommendations. The DDSs—and 

I know they are well represented here—they have been overburdened for years. With the increased load, they will be further overburdened. 

The Social Security section would support some congressional action to prevent the furloughs at DDS—not any particular bill; I’m 

not familiar with the specific bill which has been proposed, but we 

would support some action to prevent these State employees from 

being furloughed. 

We also think there is a need for improved adjudication at DDS 

to mitigate the problems and the downstream flow that comes to 

the hearing offices. I believe it was Congressman Becerra who 

talked about consistency. There really isn’t consistency in state 

DDSs. If a claimant from your home State of Tennessee or my 

home State of Mississippi were to take the bridge right across the 

Mississippi River to Arkansas, their chance of initial approval 

would go up by 50 percent. That’s really an unacceptable result. 

Justice, simple justice, demands that there be more consistency in 

the program. 

And we would urge that Congress ensure that Social Security 

Administration has the authority and has the mandate from Congress to remedy that. That needs to be done by closer oversight, the 

resources for that oversight, and enforcement action, training, or 

whatever is necessary. 

We fully support the improved increased technology that Social 

Security has implemented. It’s been a tremendous benefit, having 

electronic files. I can conduct hearings in three states in one week 

without ever leaving Atlanta. That’s a great benefit. But we have 

to remember that every case is a human being who needs his day 

in court, who needs his due process, and who needs to be able to 

tell an impartial judge his story. 

Technology can’t do everything. Only people can do it, people who 

have the time, the ability, and the willingness to stop and listen 

and understand the details of that individual’s case and their medical history. 

I believe the inspector general covered most of what I wanted to 

say about continued disability reviews. But I would like to point 

out that, beside being a tremendous benefit to the taxpayer, saving 

$10 for every $1 spent, they are also, in a way, are a benefit to the 

claimants. Claimants who know that they will face a continuing 

disability review are provided an added incentive to take advantage of medical care, vocational services, and other services to get 

themselves back into the workforce. Sometimes they need that 

extra push. 


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*Our members include Attorney representatives of claimants, Administrative Law Judges, Administrative Appeals Judges, staff attorneys in the Office of Disability Adjudication and Review, 

attorneys in the Social Security Administration’s Office of General Counsel, U.S. Attorneys and 

Assistant U.S. Attorneys, U.S. Magistrate Judges, District Court Judges, and Circuit Court 

Judges. 

But part of that process is that claimants who disagree with the 

findings have a right to a due process hearing before an administrative law judge. So we have to understand that when we fund 

CDRs, we also have to fund the judges and the staff to hear those 

disability claims. 

Thank you, Mr. Chairman, Mr. Johnson, for your time. I would 

be happy to answer any questions. 

[The prepared statement of Judge Auerbach follows:] 

Prepared Statement of The Honorable Larry A. Auerbach, Administrative 

Law Judge, on behalf of the Federal Bar Association, Atlanta, Georgia 

I am Larry Auerbach and I am appearing here on behalf of the Social Security 

Section of the Federal Bar Association. I am an Administrative Law Judge (‘‘ALJ’’) 

in the Office of Disability Adjudication and Review of the Social Security Administration in the Atlanta, Downtown hearing office. While having only been an ALJ for 

three and one-half years, I have heard and decided approximately 1,700 appeals. 

Prior to becoming an ALJ, I was an attorney for 27 years with the Office of the Solicitor, U.S. Department of Labor; during the last 12 of those years I served in various management positions, including Deputy Regional Solicitor. 

I am pleased to be here today representing the Social Security Section of the Federal Bar Association. My remarks are exclusively those of the Social Security Section and do not necessarily represent the views of the Federal Bar Association as 

a whole. Moreover my remarks do not reflect the views of the Social Security Administration. 

Unlike other organizations associated with Social Security disability practice that 

tend to represent the interests of one specific group, the Federal Bar Association’s 

Social Security Section embraces all attorneys involved in Social Security disability 

adjudication.*

The common focus of the FBA’s Social Security Section is the effectiveness of the 

adjudicatory process at all phases including hearings in the Office of Adjudication 

and Disability Review (ODAR), the appeal process before the Appeals Council, and 

judicial review through the federal courts. Our highest priority is ensuring the integrity, fairness, independence, and effectiveness of the Social Security disability adjudication process to those it serves—both Social Security claimants themselves and 

the American taxpayers who have an interest in ensuring that only those who meet 

the criteria for eligibility receive these benefits. 

We appreciate the continuing commitment that the Social Security Subcommittee 

has shown for fair and effective adjudication of disability claims. As we will discuss 

in more detail below, your support has enabled the Social Security Administration 

to reverse the long-standing trend toward increased backlogs and longer wait times. 

Most importantly, this is being done without sacrificing due process. We strongly 

believe that the growing disability claims workload can, and indeed must, be addressed without limiting claimants’ opportunity for full due process at every stage. 

In fact, we believe that affording due process at every stage is essential to fulfilling 

the Commissioner’s objective of reaching the right decision at the earliest possible 

stage of the process. The ODAR hearing before an impartial judge is the method 

by which claimants have an opportunity to tell their story. This right must never 

be abridged. 

Increased staff and improved technology have had a dramatic and positive effect 

on the disability appeals process. By way of example, in October 2009 ODAR had 

66,200 case dispositions. This is an increase of almost 60 percent from October 2007 

when there were 41,361 dispositions. We applaud Congress for the funding which 

has made this possible. Nevertheless, delays remain at unacceptable levels. Furthermore, increases in applications will strain even the increased resources. A growing 

adjudicatory backlog is foreseeable unless significant additional resources are provided. 

When we speak of anticipated increases in case filings due to the difficult economy, it is important to note that this is not based on mere speculation. ODAR hears 

cases which have been appealed from state Disability Determinations Services and 


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in 2009 alone, there was a 38 percent increase in the number of disability claims 

received by these state agencies. As we will discuss in more detail, projections call 

for even greater increases in coming years. 

We thank the Social Security Subcommittee for holding this hearing and for keeping the attention of the American public on the problems faced by hundreds of thousands of Americans who too often wait years for a determination of their claims. 

The Social Security Administration’s Inspector General has reported that the long 

waits adversely affect as many as 80 percent of all claimants, with 30 percent saying that the long waits impacted their access to health care. 

As a judge, I see the human face of these statistics. Few days pass during which 

I do not see severely disabled individuals who have suffered serious and even irreparable physical, emotional and economic harm while awaiting a decision. It is sadly 

common to see medical treatment notes which state, for example, that: 

1. A claimant is awaiting approval of disability benefits so he can have necessary back surgery. 

2. A claimant could not afford his diabetes medication and has now developed 

irreversible neuropathy or retinopathy. 

3. A claimant’s psychiatric condition has deteriorated because of the lack of 

funds for therapy and medication. 

It is also common to see individuals who have lost homes and cars while awaiting 

a benefits determination. The losses do not just result in the loss of creature comforts for claimants. They result in the loss of safe and secure housing, the loss of 

transportation to medical care, and even the loss of a stable address where claimants can be contacted regarding their health or the status of their disability claim. 

It is important to avoid viewing that disability adjudication process as merely cold 

numbers and statistics. Each case represents a human being, and often a family, 

whose lives are on hold awaiting a decision. The time spent in each stage of the 

claims process—from initial application to final determination—is a seemingly endless wait to those in need. The maxim, ‘‘Justice delayed is justice denied,’’ is never 

more true than in the disability adjudication process. 

We commend the Commissioner on the great strides which have been made in reducing the backlog and reducing wait times. The Commissioner is in the fourth year 

of an ambitious program ensuring that those claimants who have waited the longest 

have their claims adjudicated. In the first year of this program, the Commissioner 

directed that all claimants whose hearing requests would have been pending for 

1000 or more days received ALJ decisions by the end of fiscal year 2007. Each year, 

the Commissioner has set his goal as shortening this time, and he has achieved 

each goal. 

The current goal is that by the end of fiscal year 2010, ODAR will have held hearings and issued decisions for every claimant whose request for hearing would be 800 

days old by that date. The goal is to ensure that all claimants who requested a hearing on or before July 18, 2008 receive an ALJ-issued decision by September 30, 

2010. This goal is achievable, but we must note that upon meeting this goal we will 

still have claimants who have waited for a decision well over two years since their 

request for hearing. It is also important to remember that these claimants all have 

been through the mandatory state Disability Determination Service (‘‘DDS’’) administrative process prior to requesting a hearing, a process that commonly takes six 

months to one year. 

Our testimony today advances five recommendations: 

1. State Disability Determination Services should be provided significantly enhanced resources. 

2. SSA should continue to hire Administrative Law Judges and support 

staff, and add needed hearing offices. 

3. SSA should continue to develop and implement improved technological and other initiatives. 

4. New efforts are needed to accomplish the Commissioner’s goal of making the right decision at the earliest possible stage. 

5. Continuing Disability Reviews should be fully funded at every stage of 

the process. 

Let’s examine each of these recommendations: 

1. State Disability Determination Services should be provided significantly 

enhanced resources. 

Initial disability determinations are made by state Disability Determination 

Services. These state agencies are funded by the Federal Government. Only 

claimants who are denied fully favorable decisions by these agencies may request 


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hearings before an Administrative Law Judge in ODAR. These DDS decisions 

have a major impact on the workload of ODAR and play a vital role in the disability process. In these difficult economic times, the number of disability claims 

is increasing dramatically. In fiscal year 2009 there were 385,000 more claims 

filed than in the prior fiscal year. This is a one-year increase of approximately 

15 percent. Estimates are that in 2010 there will be 733,000 more disability 

claims filed than in fiscal year 2008. Current estimates by SSA’s Office of Budget 

indicate that in fiscal years 2009 through 2012 there will be over 2.25 million 

more disability claims filed than there would have been if the 2008 rate had remained constant. This is a staggering increase in the workload of DDSs. 

Aging baby boomers, inadequate healthcare, and decreased jobs in the economy all contribute to the projected increase in the number of claims. The increased numbers of claims do not represent simply unemployed individuals who 

are capable of competitive work. Many are individuals who, due to mental or 

physical impairments, were marginally productive workers in years past. In today’s struggling economy, businesses find that they simply cannot afford to retain such workers. Of course, all claimants, whether or not they qualify for benefits, are entitled to a fair and timely adjudication of their claims. 

The DDSs are overburdened and improved efficiency cannot prevent the increased numbers of applicants from causing delayed decisions by the DDS. Further, increased pressure on state workers to decide more and more cases is likely 

to decrease the time spent on each determination and thus negatively impact the 

accuracy of the decisions made. Such a result would be detrimental to the claimants who may be wrongly denied benefits, as well as to American taxpayers who 

will bear the costs of improperly granted benefits. 

The problem is further exacerbated by the many states who, for economic reasons, have furloughed state employees, including DDS workers. Despite the fact 

that 100 percent of the salaries and overhead expenses of DDS employees is 

borne by the Federal Government, these states have decreased the number of 

DDS workdays available to process the increased number of cases. Some governors have continued their ‘‘savings’’ despite the fact that two months ago Vice 

President Biden sent a letter to Governor Edward Rendell of Pennsylvania, the 

Chair of the National Governor’s Association, urging that DDS employees be exempt from state furloughs. 

This situation requires immediate attention. We urge Congress to respond by 

not only providing adequate funding for DDS, but also requiring full work weeks 

for DDS employees. 

2. SSA should continue to hire Administrative Law Judges and support 

staff, and add needed hearing offices. 

In the last 18 months, SSA has significantly increased the number of Administrative Law Judges and support staff. These increases are ongoing and many of 

the newest staff are still working their way to full productivity. This increase 

in resources already has resulted in a dramatic increase in the number of adjudications. It is important to note that ODAR has not simply added people; it has 

added a corps of highly competent and dedicated individuals. Each decision made 

by ODAR judges is important to the taxpayers and is critical to the claimant. 

Our newest judges have shown themselves to be capable adjudicators who understand how important it is to make the right decision and how to do so with speed 

and efficiency. 

The Commissioner has wisely matched increased numbers of ALJs with significant increases in support staff. It is critical that the numbers of ALJs and 

support staff continue to increase. As I commented at a recent staff meeting, statistics may indicate that I produced a certain number of dispositions, but that 

is misleading. I do not decide cases by acting alone. There are staff members who 

organize the evidence and schedule the hearings, others who obtain missing 

medical evidence and arrange for necessary consultative examinations, and still 

others who perform a myriad of tasks essential to the adjudicatory process. In 

addition, staff attorneys and paralegals turn decisional instructions into draft decisions. Each case disposition is the product of a team of individuals. 

Commissioner Astrue has recently increased the support staff to ALJ ratio 

from just over four support staff members per ALJ to about four and one-half 

support staff members per ALJ. We believe that this increase will add efficiency 

to the adjudicatory process. We commend the Commissioner for this staffing decision. As we move to greater reliance on technology, it is hard to predict what 

the most effective and efficient ratio will be. We urge the Commissioner to continue to monitor the staffing ratios so as to maximize the ALJ’s ability to 

produce legally sound and just decisions. 


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As discussed later, electronic processes have substantially increased efficiency. 

However, there is a critical limit to this. Each decision requires a judge to analyze and fully understand the medical evidence and other documentation in a 

file. The judge must then use good judgment to apply the law to the facts he 

finds. Electronics cannot replace human judgment. No matter how efficient our 

technological processes become, critical judgments must be made thoughtfully by 

human beings. If for no other reason, this immutable fact requires that there be 

increased staffing. Otherwise, the increased number of claims will exacerbate the 

unconscionable delays which have been faced by citizens who have come to their 

government in their time of need. 

The Commissioner has opened two national hearing offices and plans to open 

two more. These offices conduct video hearings in states where they are most 

needed. This has helped reduce the backlog and improve the disposition time. 

In addition, the Commissioner plans to build 13 traditional hearing offices 

around the country. If these are properly located and staffed, they should help 

reduce the backlog of cases. 

Efficient and fair adjudication can be advanced through greater use of technology, and SSA is making that happen. But we cannot rely on technology alone. 

SSA must continue to increase its cadre of well-trained, skilled, motivated, and 

caring employees—both ALJs and support personnel. 

3. SSA should continue to develop and implement improved technological 

and other initiatives. 

SSA is rapidly moving to implement a fully electronic business process. This 

process has significantly enhanced efficiency. I fully expect that the implementation of newer technology and processes will further enhance efficiency. Electronic 

files have also helped improve the decisional process by making it easier for the 

judge to fully review the evidentiary record. 

Improved use of technology has also enhanced the efficiency and productivity 

of ODAR. Funding hardware and software for full implementation of technological advances is undoubtedly expensive. However, we believe that doing so is 

essential to reduce the hearing backlog. In the long run, technology will save 

many times its cost and it will greatly assist SSA’s ability to provide timely and 

just decisions. 

Video hearings enable judges to conduct hearings without traveling to remote 

hearing sites. Judges are able to interact with claimants by videoconferencing so 

that the claimants can be seen and heard as if they were in the hearing room 

with the judge. This has added to ODAR’s flexibility in using resources where 

they will be most effective in accomplishing our mission and reducing our backlog. As an example, in a single week I have conducted live hearings in Atlanta, 

Georgia and video hearings with claimants in Greenville, North Carolina and 

Tampa, Florida. By teleconferencing, I did this without travel expenses and with 

no work time spent traveling. 

Video hearings may not be right for every claimant. Some of the Federal Bar 

Association Social Security Section’s members have expressed concerns that 

video hearings may make it more difficult for judges to accurately decide issues 

such as pain or mental health, or may make some claimants unduly nervous or 

confused. The Commissioner’s rules permit claimants who are concerned about 

video hearings to opt out of such hearings and to have an in-person hearing 

without undue delay in their cases. This option is an important protection for 

the claimants’ right to due process. If this option were to be eliminated, the 

credibility of the hearing process would be undermined. 

ODAR is rapidly moving to the point where all evidence will be stored electronically and there will be no paper files. The advantages of this are numerous. 

When working with thousands of paper files, it was too common for staff to have 

to take valuable time to search for a file that had accidentally been misfiled, was 

being reviewed by an expert witness, or had simply been mislaid. This wasted 

time has been eliminated. 

In addition, the production of electronic copies of the record for use by claimant’s representatives, or medical or vocational experts in advance of the hearing 

is much easier and faster. In the past, the claimants’ representatives had to arrange to review voluminous files in ODAR offices or arrange for them to be copied. Now, in a fraction of the time previously required, an electronic copy can 

be created for the experts and the claimants’ representatives. 

ODAR is implementing a technology referred to as the ‘‘Representatives Suite 

of Electronic Services.’’ This will permit claimants’ representatives to view the 

complete up-to-date evidentiary file on their own computers. Security safeguards 

are being built into this system to prevent unauthorized access to the obviously 


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highly sensitive documents in claim files. When this system is fully implemented, it will save resources that are now spent providing claimant representatives computer disks with file information. Currently, this often occurs two or 

more times in a single case to ensure that the representative has current information during preparation. This technology will also reduce time spent in hearings ensuring that all evidence is in the file. 

ODAR has a number of judges and decision writers who work flexi-place on 

a regular basis. This is consistent with Government policies encouraging flexiplace and tele-work. Currently these employees must have computer disks made 

for each file. This consumes significant time and creates a huge number of disks 

that have to be destroyed. We recommend that the Commissioner explore improvements in technology to allow SSA employees to have the same secure access 

to electronic files that claimants’ representatives will have. 

There are other, as yet unexplored, technological tools that will be of great 

value. These might include the ability to search all of the medical evidence in 

a file for key words or dates so that a judge can more readily review all medical 

evidence related to a particular impairment or a particular time period. 

Increased use of senior attorneys has been another important tool in enhancing ODAR’s efficiency. We commend the Commissioner for permitting senior attorneys to review files and issue fully favorable decisions when warranted by the 

evidence. We look forward to the creation of the Virtual Screening Unit, whose 

establishment is under way. One hundred senior attorneys in this unit will review cases selected by a sophisticated computerized process as potentially appropriate for fully favorable decisions without a hearing. These initiatives involving 

senior attorneys will enable deserving claimants to get earlier decisions and free 

up ALJs to hear and decide more difficult cases. 

4. New efforts are needed to accomplish the Commissioner’s goal of making 

the right decision at the earliest possible stage. 

The DDSs make the initial determinations regarding disability claims and 

therefore have the first opportunity to make the correct decision. While these 

agencies operate with federal funds under a uniform set of federal rules and regulations, the outcomes are far from uniform. Even a cursory glance at approval 

rates by various DDSs shows that there are significant disparities among the 

states. In fiscal year 2008, Georgia and Tennessee DDSs approved benefits on 

initial determination in only 25 percent of the claims filed. In contrast, in 2008 

Virginia DDS awarded benefits to 44 percent of its claimants on initial application, while New Hampshire DDS granted benefits to 52 percent of its claimants 

at that stage. These disparities cannot reasonably be explained by state or regional population differences. In 2008, Mississippi DDS approved 24.5 percent of 

claims at the initial stage while in the neighboring state of Arkansas, the rate 

was 36 percent (almost 50 percent higher.) Similarly Connecticut DDS’s rate was 

33 percent approval compared to its neighboring states of New York (44 percent), 

Massachusetts (46 percent), and Rhode Island (38 percent). 

My own personal experience is based upon a relatively small sampling of primarily Georgia disability claims. I do not see claims in which benefits are awarded by the state DDS, but I have had the opportunity to review a large number 

of claims that have been denied by the Georgia DDS. Other members of the Federal Bar Association have shared their experiences with me as well. Based upon 

this experience, it appears that all too often, the DDS has paid scant attention 

to the effect of pain and fatigue on a claimant’s ability to work. This occurs despite Social Security Rulings that mandate consideration of these factors. 

The disparities among states should be addressed for a number of reasons. The 

first and foremost is basic justice. The outcome of a claimant’s case should not 

depend on his or her state of residence. In addition, improper early stage denials 

cause undue hardship to claimants and increase the workload, and thus the 

backlog, of hearing offices. If higher approval rates are the result of improper 

approvals, this places an unnecessary burden on American taxpayers. 

SSA has a quality review process that is designed to ensure that state DDSs 

follow federal rules. This process should be enhanced to ensure accurate and fair 

determinations. Where SSA review shows a significant error rate, the Commissioner should take, or be required to take, action. This should include the delivery of enhanced training to DDS staff and management and closer oversight of 

the state’s work until significant progress is made. For the benefit of the claimant and the taxpayer, SSA needs to receive and be a good steward of the resources and authority provided by Congress, and Congress needs to continue to 

exercise the necessary oversight. 


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5. Continuing Disability Reviews should be fully funded at every stage of 

the process. 

SSA conducts Continuing Disability Reviews (CDRs) to assure that recipients 

of disability benefits continue to satisfy eligibility requirements. CDRs serve two 

important purposes. First, they save taxpayer money. As Commissioner Astrue 

noted in his March 24, 2009 testimony before this subcommittee, every dollar 

spent on CDRs yields ten dollars in program savings. Second, CDRs provide recipients an incentive to fully utilize available medical care, vocational rehabilitation services, and job training to help them re-enter the workforce. 

Because of inadequate funding levels for over a decade, SSA has accumulated 

a significant backlog of nearly 1.6 million full medical Continuing Disability Reviews. The failure to timely conduct these reviews has significantly affected the 

federal budget and the deficit. It has been estimated that, if these CDRs had 

been conducted on a timely basis, over $20 billion in long-term Social Security 

program savings would have been achieved. Unfortunately, current estimates 

project that SSA will only be able to conduct 329,000 full CDRs in FY 2010. 

Funding of CDRs will not reduce the hearing backlog and, in fact, it may add 

to it. When benefit recipients are found to no longer be eligible for benefits, some 

will seek hearings challenging these determinations. These hearings are an important due process right that should not be abridged. Full funding for CDRs 

must include additional funding for ODAR to adjudicate CDR appeals. This will 

require funding above that needed to eliminate the backlog of initial claims. 

When considering this additional funding, it is important to keep in mind the 

savings created by CDRs. Conducting continuing disability reviews is the right 

thing to do for the taxpayers and for the recipients of benefits. 

Mr. Chairman, thank you once again for the opportunity to appear before you and 

the subcommittee today. The Social Security Section of the Federal Bar Association 

looks forward to working with you and the Social Security Administration in improving the disability adjudication process. I would be happy to answer any questions you may have. 

f 

Chairman TANNER. As I said earlier, if you all would agree, 

Members will submit questions following the hearing. Would that 

be acceptable? 

Judge AUERBACH. Absolutely. 

Chairman TANNER. We got here late because of votes, we’ve got 

to leave early because of votes. I have got to say, and I know Mr. 

Johnson agrees because we have talked about this, we take this obligation very seriously. Your testimony will be carefully and closely 

considered and utilized. We appreciate you very much being here. 

Ms. KENNELLY. Mr. Chairman. 

Chairman TANNER. Barbara, do you want to say something? 

Ms. KENNELLY. Yes, I want to say one thing, and Ranking 

Member Johnson talked about it. The technology at Social Security 

is behind the times. When you’re talking about hundreds and hundreds of thousands of cases that need to be determined, I feel we 

are not doing enough about the technology. 

You know what we’re going to do? We’re losing money, we’re losing taxpayers’ money about this. The COBOL system is terrible, 

and you two can change it. You could do it. That’s all. 

[Laughter.] 

Mr. JOHNSON. It’s going to take seven years to fix it. 

Ms. KENNELLY. No, you know Sam, you could do it. 

Chairman TANNER. We are trying, let me say that. 

I thank all of you all for being here, and we very much appreciate your efforts to alleviate what is the backbone, really, in many 

ways, of our society. Thank you a lot. We stand adjourned. 

[Whereupon, at 3:33 p.m., the Subcommittee was adjourned.] 

[Questions for the Record follow:] 


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[The questions submitted to the Honorable Michael J. Astrue 

from Chairman John Tanner for the Record follow:] 


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[The questions submitted to the Honorable Michael J. Astrue 

from the Honorable Sam Johnson for the Record follow:] 


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[The questions submitted to the Honorable Patrick P. O’Carroll 

from Chairman John Tanner for the Record follow:] 


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[The questions submitted to the Honorable Patrick P. O’Carroll 

from the Honorable Sam Johnson for the Record follow:] 


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[Submissions for the Record follow:] 


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f 

Statement of the Corporation for Supportive Housing Advocacy and 

Training Center 

Chairman Tanner, Ranking Member Johnson, and Members of the Subcommittee: 

Thank you for the opportunity to submit written testimony on the issue of the 

Social Security Administration’s disability claims backlog. 

Our organizations are committed to providing housing, services and advocacy to 

individuals who have no or limited income and who have disabilities, especially 

those involving serious mental illness and/or co-occurring disorders. As part of this 

commitment, we particularly focus on individuals who have been or are homeless, 

many of whom have experienced homelessness for years. We appreciate the recent 

efforts of the Social Security Administration (SSA) to address the disability claims 

backlog, specifically those claims awaiting hearing level decisions. The reduction in 

this backlog that has started and the ongoing efforts to reduce it are commendable. 

We believe that aspects of the disability determination that contribute to denials 

for people who are homeless and, therefore, to the need for appeals include, the following: 

• Lack of access to medical care and evaluations needed to document individuals’ physical and mental health conditions; 

• Need for case managers or other community staff to conduct outreach and to 

help homeless individuals to navigate the complex disability determination 

process; 

• Difficulties in accessing benefits for people who have co-occurring disorders 

that include substance use; 

• For people who have mental illness and/or cognitive disorders, lack of recognition of long-term homelessness as an indicator of marked functional impairment; 

• General inability of individuals with serious mental illness to access the innovative and creative strategies that SSA has implemented such as Quick Disability Determination and compassionate allowances; 


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• Need for specialized training of SSA and DDS staff in understanding homelessness and its impact on individuals’ health; and 

• Failure to identify claimants as homeless and failure to flag claims from 

homeless individuals as in need of expedited processing. 

To address some of the needs of this population, we advocate for changes that 

only Congress can enact as well as changes that are underway or could be considered at SSA. These include: 

SSA: 

• Include schizophrenia and homelessness as a compassionate allowance category, something already considered by SSA as evidenced by the recent compassionate allowance hearing on schizophrenia held in San Francisco on November 18; 

• Consider compassionate allowances for homeless individuals with other specified impairments, such as bipolar disorders and certain cognitive impairments; 

• Partner with community mental health and other health providers to assist 

people who are homeless with navigating the SSA disability application process. This would include training such providers in the completion of the SSI 

application (SSA–8000) (until the SSI application is possible to do on-line) so 

that such providers could submit such applications on behalf of individuals 

without having to have the applicant come into the SSA office; 

• Implement promising practice models such as SOAR to serve populations who 

need special assistance, adults who are homeless and who have mental illness 

and partner with other federal agencies including, SAMHSA, to coordinate 

implementation of such models 

• Conduct specialized training for SSA and DDS staff in homelessness, mental 

illness, and co-occurring disorders, and in identifying and expediting claims 

of individuals who are homeless; 

• specific staff at the SSA local offices and encourage state Disability Determination Service offices to assign DDS staff to expedite and do medical reviews of homeless claimants, so as to have staff who become specialized in 

providing services to people who are homeless and who have mental illness 

and/or co-occurring disorders; 

• Provide specific direction to the DDS regarding the interpretation of current 

requirements for the consideration of people with co-occurring disorders to improve consistency and generate greater understanding of these requirements 

across the country; 

Congress: 

• Re-visit the 1996 statutory change regarding substance use in the SSA disability determination process. Currently, if a person has substance use that 

is deemed ‘‘material’’ to one’s disability, that individual is denied. Such a consideration is often virtually clinically impossible in the face of ongoing substance use. Most treating physicians do not and cannot make this determination, let alone medical reviewers who are asked to create this distinction 

based on an individual’s paper record. In addition, many individuals who 

have these disorders use substances to address symptoms of mental illness, 

e.g., auditory hallucinations, significant depression, manic symptoms, etc. 

Much documentation proves the link between mental illness and substance 

abuse. Yet, because of the difficulty in deciding whether a person’s substance 

abuse is material to an individual’s disability, homeless people who are, in 

fact, disabled are often denied. Current statutory requirements are contrary 

to the evidence regarding assessment and treatment of people who have these 

disorders. It would be an important step for Congress to reconsider this statute and its impact after 13 years of its implementation. 

• Provide funding to SSA to partner with community providers to offer the necessary assistance to help individuals who are homeless and who have serious 

mental illness and/or co-occurring disorders with navigating the SSA disability application process. 


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• Begin to conduct a dialogue on the array of public benefits that need to be 

available to assist individuals and families to exit long-term poverty, and help 

these individuals address poverty that results from loss of jobs, poor education, health difficulties that do not rise to the level of eligibility for SSA 

benefits. 

We thank you for the consideration of our comments. 

Sincerely, 

Corporation for Supportive Housing Advocacy and Training Center 

f 

Statement of Council of State Administrators of Vocational Rehabilitation 

The Council of State Administrators of Vocational Rehabilitation is pleased to 

submit this statement for the record for the November 19, 2009, House Ways and 

Means Social Security Subcommittee’s hearing on the progress SSA has made in 

clearing the disability backlog. 

CSAVR’s members are the Administrators of 80 state agencies that provide vocational rehabilitation services to persons with disabilities. For over 80 years the 

State-Federal Vocational Rehabilitation program has been providing a wide range 

of services to people with disabilities. The program has helped million of people with 

significant disabilities return to work and live better and more productive lives. 

The VR program is a cost effective program with a proven track record. In 2007 

the Public VR program and its partners helped over 200,000 people with disabilities 

find, return to, or retain employment. VR customers earned over $3.0 billion in 

wages, paid $966 million in federal, state, & local taxes, and generated 36,000 new 

jobs. In fact, on average every person VR helps find or retain employment will ‘‘pay 

back’’ through taxes the cost of their rehabilitation services in just two to four years. 

The VR program and the Social Security Administration have a long and mutually beneficial partnership helping people with disabilities on SSDI and SSI return 

to work. SSA reimburses VR agencies for the cost of services VR provides to SSDI 

and SSI beneficiaries after a beneficiary is at work for nine months. VR agencies 

are also strong partners in SSA’s Ticket-to-Work program. The most recent data 

from the Social Security Administration reveals that for every dollar SSA reimburses VR, SSA has saved seven dollars in benefits that it would have paid out. 

This results in an annual net savings of $754 million to the Social Security (SSDI) 

and Supplemental Security Income (SSI) programs. 

CSAVR’s interest in this hearing and on the issue of the backlog stems from the 

fact that nearly 60 percent of SSA’s state Disability Determination Service (DDS) 

agencies are under the direction of state VR agencies. Our members see every day 

the growing burden caused by the lack of funding and the expanding demand for 

benefits caused by the current economic downturn. 

CSAVR has strongly supported the Subcommittee’s efforts to boost appropriations 

for clearing the disability backlog at all levels. We applaud Commissioner Astrue 

and his team for their dedication to aggressively resolving this problem. This issue 

is extremely important to people with disabilities. 

Title II and SSI cash benefits, along with the related Medicaid and Medicare benefits, are the means of survival for millions of individuals with severe disabilities. 

They rely on the Social Security Administration (SSA) to promptly and fairly adjudicate their applications for disability benefits. They also rely on the agency to handle many other actions critical to their well-being including: timely payment of the 

monthly Title II and SSI benefits to which they are entitled; accurate withholding 

of Medicare Parts B and D premiums; and timely determinations on post-entitlement issues that may arise (e.g., overpayments, income issues, prompt recording of 

earnings). 

Because the economic downtown has led to an unexpected surge of new applications, SSA finds itself at a critical crossroads. The wave of new claims is having a 

very significant impact at the state Disability Determination Services (DDSs) that 

will eventually affect the hearing level. At the DDS level (initial and reconsideration), the number of new applications, applications waiting for a decision, and processing times are all on the rise. In fiscal year (FY) 2009, SSA received 385,000 new 

claims, an increase of nearly 15% since the end of FY 2008. Even more worrisome 

is the growing backlog of pending initial claims at the DDSs, i.e., those waiting for 

a decision, up nearly 40% since the end of FY 2008. 


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1 If a claimant dies while a claim is pending, the SSI rule for payment of past due benefits 

is very different—and far more limited—than the Title II rule. In an SSI case, the payment will 

be made in only two situations: (1) to a surviving spouse who was living with the claimant at 

the time of death or within six months of the death; or (2) to the parents of a minor child, if 

the child resided with the parents at the time of the child’s death or within six months of the 

death. 42 U.S.C. § 1383(b)(1)(A) [Section 1631(b)(1)(A) of the Act]. In Title II, the Act provides 

rules for determining who may continue the claim, which includes :a surviving spouse; parents; 

children; and the legal representative of the estate. 42 U.S.C. § 404(d) [Section 202(d) of the Act]. 

Thus, if an adult SSI claimant (age 18 or older) dies before actually receiving the past due payment and if there is no surviving spouse, the claim dies with the claimant and no one is paid. 

In FY 2009, the news was more positive at the hearing level. For the first time 

in a decade, SSA finished FY 2009 with fewer hearing level cases waiting for a decision and hearing than at the beginning of the year. But we are deeply concerned 

that any progress in eliminating the hearing level backlog will be delayed as the 

surge of new applications that are denied are appealed, putting SSA’s plan to eliminate the hearing level backlog by 2013 at risk. 

While recent appropriations have allowed SSA to hire some new staff and to reduce processing times at the hearing level, these amounts will not be adequate to 

fully restore the agency’s ability to carry out its mandated services. Given the many 

years of under-funding and the need for more than a $600 million annual increase 

just to keep up with fixed costs, additional funding is required to reduce and eliminate the backlog at the DDS and hearing levels and to provide essential services 

to the public. While the current situation is dire, without adequate, ongoing appropriations to fund SSA, the forward progress recently made by the agency will deteriorate, leaving people with severe disabilities to wait years to receive the benefits 

to which they are entitled. 

THE IMPACT ON PEOPLE WITH DISABILITIES 

As the backlog in decisions on disability claims continues to grow, people with severe disabilities have been bearing the brunt of the delays. Behind the numbers are 

individuals with disabilities whose lives have unraveled while waiting for decisions—families are torn apart; homes are lost; medical conditions deteriorate; once 

stable financial security crumbles; and many individuals die.1 Numerous recent 

media reports across the country have documented the suffering experienced by 

these individuals. Your constituent services staffs are likely to be well aware of the 

situations faced by people living in your districts and provide valuable assistance 

and help, where possible. 

SSA’S NEED FOR ADEQUATE RESOURCES TO ADDRESS GROWING 

BACKLOGS 

For many years, SSA did not receive adequate funds to provide its mandated services, a key reason for the hearings backlog. Between FY 2000 and FY 2007, the resulting administrative funding shortfall was more than $4 billion. The dramatic increase in the hearing level disability claims backlog coincided with this period of significant under-funding. 

Recent Congressional efforts to provide SSA with adequate funding for its administrative budget have been encouraging. In FY 2008, the tide finally changed for the 

first time in a decade, when Congress appropriated $148 million over the President’s 

budget. The FY 2009 SSA appropriation provided SSA with more than $700 million 

over the FY 2008 appropriation. 

CSAVR is extremely grateful to Congress for recognizing SSA’s need for adequate 

resources and including additional funds for SSA in the American Recovery and Reinvestment Act of 2009 (ARRA). ARRA provided SSA with $500 million to handle 

the unexpected surge in both retirement and disability applications due to the economic downturn. SSA also received badly needed funds to replace its aged National 

Computer Center. With the FY 2009 appropriation and the ARRA funding, SSA 

planned to hire 5,000 to 6,000 new employees. This additional staff undoubtedly led 

to SSA’s ability to make progress on the backlog at the hearing level. 

Congress appears to be moving towards providing SSA with an FY 2010 appropriation approximately the same as President Obama’s request of $11.45 billion for 

SSA’s Limitation on Administrative Expenses (LAE), a 10 percent increase over the 

FY 2009 appropriation. While the agency is operating under a Continuing Resolution, we are optimistic that SSA’s final FY 2010 appropriation will be similar to the 

$11.45 billion amount, allowing SSA to hire more staff. 


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SIGNIFICANT INCREASE IN NEW CLAIMS FILED AND GROWING DDS 

BACKLOGS 

Since the end of FY 2008, new disability claims filed have been climbing steadily, 

up nearly 15% by the end of FY 2009. But what is more troubling is how the increase grew throughout FY 2009: December 2008 Quarter: 6.92%; March 2009 Quarter: 15.23%; June 2009 Quarter: 16.32%; September 2009 Quarter: 20.25%. 

The most alarming trend is the increase in the number of pending claims (initial 

and reconsideration levels), up 38.8% since the end of FY 2008 and climbing from 

763,183 to 1,059,241. This means that, at the end of FY 2009, more than 1 million 

disability applicants were waiting for a decision on their claims at the initial and 

reconsideration levels. When you add the 722,822 pending cases at the hearing 

level, nearly 1.75 million people with disabilities were waiting for a decision. If the 

receipts continue to increase at the higher level seen in recent months, the total 

number of pending initial applications in the DDSs could hit over 1,000,000 claims 

by the end of FY 2010. This would be an 80% increase in pending claims at the 

initial level in just one year. 

What does the increase in applications and pending claims at the DDSs mean for 

the hearing level? Approximately 22% of the initial claims will result in a hearing 

request. This means there is a potential increase of 85,000 additional hearings from 

the FY 2009 applications, a statistic that underscores the fragility of the ODAR 

progress accomplished in FY 2009. 

Exacerbating the problem of a significant increase in new claims is the impact on 

DDSs of state budget crises. Even though DDS salaries, offices, and overhead are 

fully funded by SSA, some states are imposing hiring restrictions and furloughs of 

DDS workers because of budget problems. Earlier this year, Commissioner Astrue 

wrote to Governors, asking them to exempt DDSs from hiring freezes and furloughs. 

In September 2009, Vice-President Biden sent a letter to Gov. Edward Rendell, the 

Chair of the National Governors’ Association, also urging that states exempt DDS 

employees from state furloughs. 

Nor are State budgets likely to see improvement in the near term. According to 

the National Governors Association/National Association of State Budget Officers 

(NGA/NASBO) Fall 2009 Report, Fiscal Survey of States-Preliminary Data, November 12, 2009, ‘‘Fiscal conditions significantly deteriorated for states during fiscal 

2009, with the trend continuing through fiscal 2010 and even into 2011 and 2012. 

The severe national recession drastically reduced tax revenues from every revenue 

source during fiscal 2009 and revenue collections are forecasted to continue their decline in fiscal 2010. As state revenue collections historically lag behind any national 

economic recovery, state revenues will remain depressed throughout fiscal 2010 and 

likely into fiscal years 2011 and 2012. The economic recession, which began in December 2007, has significantly affected state spending, as more than half the states 

decreased their General Fund expenditures in fiscal 2009, and two-thirds of states 

enacted fiscal 2010 budgets with decreased General Fund spending. 

The weakening of state fiscal conditions is also reflected in the fact that states 

will have faced $250 billion in budget gaps between fiscal year 2009 and fiscal year 

2011. Of this $250 billion, states closed $72.7 billion in budget gaps during fiscal 

2009 and $113.1 billion prior to the enactment of their fiscal 2010 budgets in order 

to bring them into balance with drastically declining revenues. However, even after 

solving these gaps, an additional $14.5 billion in budget gaps remains in fiscal 2010 

and states face at least $21.9 billion in budget gaps for fiscal 2011. In order to help 

close these gaps, 42 states cut their enacted fiscal 2009 budgets by $31.2 billion and 

33 states cut their fiscal 2010 expenditures by $53.5 billion. Additionally, states enacted tax and fee increases of $23.8 billion along with additional increases in other 

revenue measures of $7.7 billion for fiscal 2010.’’ 

Despite this bleak fiscal picture in the states and in the face of furloughs and hiring freezes, some state agencies have been successful in working around the problem of DDS furloughs by negotiating overtime and other work arrangements that 

allow DDS staff to keep their caseload as current as possible. However, even these 

stopgap measures will become more difficult to maintain as fiscal pressures continue 

to mount within state budgets and the number of new claims increase. 

WILL THE HEARING LEVEL BACKLOG BE ELIMINATED BY 2013? 

The average processing time for cases at the hearing level has increased dramatically since 2000, when the average time was 274 days. In FY 2009, the average 

processing time for disability claims at the hearing level was 491 days, about 16.5 

months. We appreciate the effort by SSA to reduce the processing time, but an average of 16.5 months—close to one and a half years—is still too long for individuals 

waiting for a hearing decision. In addition, the average processing times at the initial and reconsideration levels are increasing. For individuals with disabilities who 


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have no health insurance, have lost their homes, have declared bankruptcy, or who 

have died, that is simply too long to wait. 

The current processing times in some hearing offices are striking, and much 

longer than the 491-day average at the end of FY 2009. It is important to keep in 

mind that this is an ‘‘average’’ and that many claimants will wait longer. In September 2009, the average processing time at 48 hearing offices was above the 491 

day national average, with 20 offices over 600 days. 

Is the Hearing Backlog Improving? By the end of FY 2009, it was clear that 

ODAR was making slow but steady process in key areas to address its backlog and 

improve processing times, thanks to the hard work of ODAR ALJs and staff and 

the additional resources available due to Congressional appropriations, including 

the ARRA funding. 

• Pending cases. For the first time in a decade, ODAR finished FY 2009 with 

fewer hearings pending than in the prior year. The increased resources, including 147 new ALJs and support staff are having a positive impact at the 

hearing level. The pending number of cases dropped for nine straight months 

from a record high of 768,540 in December 2008 to 722,822 in September 

2009. This is the lowest pending number of ODAR cases since February 2007. 

The pending number dropped by 11,377 in September 2009 alone, the biggest 

drop in FY 2009. The reduction in pending cases is even more notable since 

the number of requests for hearing increased in FY 2009, up to 625,003, a 

5.7% increase over the 591,888 received in FY 2008. 

• Processing times. The average process time in September 2009 was 472 

days, the lowest monthly processing time since November 2005. The average 

processing time for all of FY 2009 was 491 days, down from 514 days in FY 

2008. 

• Dispositions. The number of dispositions cleared by ALJs on a daily basis 

was 2,940.47 in September. This is the highest monthly average since records 

have been kept, beginning in FY 2004. The increase is concomitant with the 

record number of ALJs now on duty. For the year, dispositions were up about 

20%. 

• Age of pending cases. The length of time cases are pending is also improving. The percentage of requests for hearing pending over one year was 31% 

in September 2009. This is the lowest percent since October 2004. The average age of a pending case is 282 days. It peaked this year at 317 days in January 2009. 

• Improvement Is Not Uniform. Despite the overall improvement in the 

hearing level statistics, not every hearing office has benefited and some claimants’ areas are waiting even longer than one year ago. On one hand, some 

offices have experienced exceptional improvement in processing times, as 

much as 4 to 5 months in just one year. In contrast, other offices continue 

to experience worsening times that are several months longer than last year. 

SSA’S ABILITY TO PERFORM OTHER IMPORTANT WORKLOADS 

Program Integrity Workloads. The processing of CDRs and SSI redeterminations is necessary to protect program integrity and avert improper payments. Failure to conduct the full complement of CDRs would have adverse consequences for 

the federal budget and the deficit. According to SSA, CDRs result in $10 of program 

savings and SSI redeterminations result in $7 of program savings for each $1 spent 

in administrative costs for the reviews. However, the number of reviews actually 

conducted is directly related to whether SSA receives the necessary funds. SSA’s 

Budget Justification refers specifically to CDRs based on medical factors. It is important when SSA conducts work CDRs that it assess whether reported earnings 

have been properly recorded and ensure that they properly assess whether work 

constitutes substantial gainful activity (SGA). 

Impact on Post-Entitlement Work. Staffing shortages also have led to SSA’s 

inability to fully carry out many other critical post-entitlement workloads. One area 

that has slipped, often with a very detrimental impact on people with disabilities, 

is the processing of earnings reports by beneficiaries. When beneficiaries faithfully 

notify SSA of earnings or other changes that may reduce their benefit payment 

amounts, it may be months or years before SSA sends an overpayment notice to the 

beneficiary, demanding repayment of sometimes tens of thousands of dollars of accrued overpayments. It is shocking to beneficiaries to receive these notices, when 

they reasonably assumed that SSA had processed the information they submitted, 

and it is challenging, if not impossible, for someone subsisting on benefits alone to 

repay the overpayments. Many individuals with disabilities are wary of attempting 


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a return to work out of fear that this may give rise to an overpayment, resulting 

in a loss of economic stability and health care coverage upon which they rely. 

SSA needs to develop a better reporting and recording system and promptly adjust benefit payments—thus preventing these overpayments. It is important to note 

that, in and of themselves, overpayments do not indicate fraud or abuse as beneficiaries are encouraged to work if they are able. The problems arise when reported 

earnings are not properly recorded and monthly overpayments are not properly adjusted. 

RECOMMENDATIONS REGARDING SSA’S ADMINISTRATIVE FUNDING 

CSAVR is optimistic that SSA will receive a final FY 2010 appropriation of 

$11.451 billion for SSA’s LAE, the same amount proposed by the President. SSA 

will use this funding and about $350 million from the ARRA funding to address the 

growing workloads facing the agency. Based on these funding levels, during FY 

2010, SSA will be spending at least $11.8 billion to address the current staffing levels and associated costs necessary for the agency to function. 

In FY 2011, SSA will be faced with additional costs of nearly $620 million just 

to deal with inflationary costs associated with items such as salaries, benefits, rents, 

and facility security. The resulting funding level, $12.42 billion will not address the 

increased number of new claims, the newly created DDS backlog, and SSA’s plan 

to eliminate the hearing level backlog by 2013. To address these workloads, SSA 

will need additional resources. We estimate that an additional $780 million will be 

necessary—at least $480 million to address the increased number of disability 

claims and at least $300 million to continue making progress in reducing and eliminating the hearings backlog by 2013. 

To address the unprecedented increase in workloads and to prevent a severe disruption in service delivery, we recommend that a minimum of $13.2 billion be included in the FY 2011 President’s budget request for SSA’s administrative funding. 

RECOMMENDATIONS FOR IMPROVING THE DISABILITY CLAIMS PROCESS 

Money alone will not solve SSA’s crisis in meeting its responsibilities. Commissioner Astrue is committed to finding new ways to work better and more efficiently. 

CSAVR has numerous suggestions for improving the disability claims process for 

people with disabilities. We believe that these recommendations and agency initiatives, which overall are not controversial and which we generally support, can go 

a long way towards reducing, and eventually eliminating, the disability claims backlog. 

Caution Regarding the Search for Efficiencies 

While we generally support the goal of achieving increased efficiency throughout 

the adjudicatory process, we caution that limits must be placed on the goal of administrative efficiency for efficiency’s sake alone. The purposes of the Social Security 

and SSI programs are to provide cash benefits to those who need them and have 

earned them and who meet the eligibility criteria. While there may be ways to improve the decision-making process from the perspective of the adjudicators, the critical measure for assessing initiatives for achieving administrative efficiencies must 

be how they affect the very claimants and beneficiaries for whom the system exists. 

People who find they cannot work at a sustained and substantial level are faced 

with a myriad of personal, family, and financial circumstances that will have an impact on how well or efficiently they can maneuver the complex system for determining eligibility. Many claimants will not be successful in addressing all of SSA’s 

requirements for proving eligibility until they reach a point where they request the 

assistance of an experienced representative. Many face educational barriers and/or 

significant barriers inherent in the disability itself that prevent them from understanding their role in the adjudicatory process and from efficiently and effectively 

assisting in gathering evidence. Still others are faced with having no ‘‘medical 

home’’ to call upon for assistance in submitting evidence, given their lack of health 

insurance over the course of many years. Many are experiencing extreme hardship 

from the loss of earned income, often living through the break-up of their family 

and/or becoming homeless, with few resources—financial, emotional, or otherwise— 

to rely upon. Still others experience all of the above limits on their abilities to participate effectively in the process. 

Proposals for increasing administrative efficiencies must bend to the realities of 

claimants’ lives and accept that people face innumerable obstacles at the time they 

apply for disability benefits and beyond. SSA must continue, and improve, its established role in ensuring that a claim is fully developed before a decision is made and 

must ensure that its rules reflect this administrative responsibility. 


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2 20 C.F.R. §§ 404.936 and 416.1436. 

3The program is extended through August 10, 2011. 74 Fed. Reg. 33327 (July 13, 2009). 

4 20 C.F.R. § 405.315(a). 

Technological Improvements 

Commissioner Astrue has made a strong commitment to improve and expand the 

technology used in the disability determination process. CSAVR generally supports 

these efforts to improve the disability claims process, so long as they do not infringe 

on claimants’ rights. Some of the technological improvements that we believe can 

help reduce the backlog include the following: 

1. The electronic disability folder. The initiative to process disability 

claims electronically has the prospect of significantly reducing delays caused by 

the moving and handing-off of folders, allowing for immediate access by different components of SSA or the DDS, and preventing misfiled evidence. 

2. Expanding Internet access for representatives. Under Electronic 

Records Express (ERE), registered claimant representatives are able to submit 

evidence electronically through an SSA secure website or to a dedicated fax 

number, using a unique barcode assigned to the claim. This initiative holds 

great promise, given that significant problems with the current process exist. 

Under the current process, representatives are to be provided with a CD of 

the exhibited or ‘‘pulled’’ file shortly before the hearing and earlier in the process after the appeal has been filed but before the file is exhibited. Due to staffing shortages in hearing offices, representatives have had problems obtaining 

the CDs and even obtaining barcodes, which allows me to submit evidence electronically. We are optimistic that these problems will be resolved in the near 

future. 

3. Use of video hearings. Video hearings allow ALJs to conduct hearings 

without being at the same geographical site as the claimant and representative 

and have the potential to reduce processing times and increase productivity. We 

support the use of video teleconference hearings so long as the right to a full 

and fair hearing is adequately protected; the quality of video teleconference 

hearings is assured; and the claimant retains the absolute right to have an inperson hearing as provided under current regulations.2 However, we have received complaints from representatives that, in some cases, ALJs are discouraging claimants from exercising their right to an in-person hearing. A new SSA 

pilot allows representatives to participate in video hearings from their own private offices, with their clients present in the representative’s office. The representative must agree to the terms established by SSA. This pilot provides 

claimants with another option for their hearings. 

Other Improvements at the Hearing Level 

1. The Senior Attorney Program. This program allows senior staff attorneys 

in hearing offices to issue fully favorable decisions in cases that can be decided without a hearing (i.e. ‘‘on the record’’). This eliminates many months in the wait for 

payment of benefits. We are pleased that Commissioner Astrue decided to authorize 

the program for at least the next two years.3 In FY 2009, senior attorneys decided 

more than 36,300 cases, a 50% increase over FY 2008. This means that more than 

36,000 claimants were able to receive their disability benefits months sooner. 

2. Findings Integrated Templates (FIT). FIT is used for ALJ decisions and integrates the ALJ’s findings of fact into the body of the decision. While the FIT does 

not dictate the ultimate decision, it requires the ALJ to follow a series of templates 

to support the ultimate decision. Representatives can use the FIT template, which 

is available on the SSA website, to draft proposed favorable decisions. Many representatives are now using the template either when requested by the ALJ or on 

their own initiative. When the draft proposed decision is submitted to the ALJ, it 

can lead to a speedier decision. 

3. Increase time for hearing notice. We recommend that SSA provide advance 

notice of the hearing date 75 days prior to the hearing date rather than the current 

20 days. The 75-day time period has been in effect in SSA’s Region I states since 

August 2006 4 and, based on reports from representatives, has worked well. 

Improvements at the Initial Levels 

CSAVR supports initiatives to improve the process at the initial levels so that the 

correct decision can be made at the earliest point possible and unnecessary appeals 

can be avoided. Improvements at the front end of the process can have a significant 

beneficial impact on preventing the backlog and delays later in the appeals process. 


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5 20 C.F.R. §§ 404.1619 and 416.1019. 

1. New Screening Initiatives. CSAVR supports SSA’s efforts to accelerate decisions and develop new mechanisms for expedited eligibility throughout the application and review process. We encourage the use of ongoing screening as claimants 

obtain more documentation to support their applications. However, SSA must work 

to ensure that there is no negative inference when a claim is not selected by the 

screening tool or allowed at that initial evaluation. There are two initiatives that 

hold promise: 

• Quick Disability Determinations. CSAVR supports the Quick Disability 

Determination (QDD) process, first begun in SSA Region I states in August 

2006 and expanded nationwide by Commissioner Astrue in September 2007.5

The QDD process has the potential of providing a prompt disability decision 

to those claimants who are the most severely disabled. Since its inception, the 

vast majority of QDD cases have been decided favorably in less than 20 days, 

and sometimes in just a few days. 

• Compassionate Allowances. This initiative allows SSA to create ‘‘an extensive list of impairments that we [SSA] can allow quickly with minimal objective medical evidence that is based on clinical signs or laboratory findings or 

a combination of both . . . .’’ SSA has published an initial list of 50 conditions 

on its website, with more to be added at a later date. Unlike the QDD screening, which occurs only when an application is filed, screening for compassionate allowances can occur at any level of the administrative appeals process. SSA has held recent Compassionate Allowance outreach hearings with 

expert panels to consider early onset Alzheimer’s disease and schizophrenia. 

2. Improve development of evidence earlier in the process. Claimants’ representatives are often able to provide evidence that we believe could have been obtained by the DDSs earlier in the process. Our recommendations include: 

• Provide more assistance to claimants at the application level. At the 

beginning of the process, SSA should explain to the claimant what evidence 

is important and necessary. SSA should also provide applicants with more 

help completing the application, particularly in light of electronic filings, so 

that all impairments and sources of information are identified, including nonphysician and other professional sources. 

• DDSs need to obtain necessary and relevant evidence. Representatives 

often are able to obtain better medical information because they use letters 

and forms that ask questions relevant to the disability determination process. 

However, DDS forms usually ask for general medical information (diagnoses, 

findings, etc.) without tailoring questions to the Social Security disability 

standard. One way to address this would be for SSA to encourage DDSs to 

send Medical Source Statement forms to treating and examining doctors. 

These simple forms translate complex, detailed medical source opinions into 

practical functional terms useful to the vocational professionals at DDSs and 

hearing offices. 

• Increase reimbursement rates for providers. To improve provider response to requests for records, appropriate reimbursement rates for medical 

records and reports need to be established. Appropriate rates should also be 

paid for consultative examinations and for medical experts. 

• Provide better explanations to medical providers. SSA and DDSs 

should provide better explanations to all providers, in particular to physician 

and non-physician treating sources, about the disability standard and ask for 

evidence relevant to the standard. 

• Provide more training and guidance to adjudicators. Many reversals at 

the appeals levels are due to earlier erroneous application of existing SSA policy. Additional training should be provided on important evaluation rules 

such as: weighing medical evidence, including treating source opinions; the 

role of non-physician evidence; the evaluation of mental impairments, pain, 

and other subjective symptoms; the evaluation of childhood disability; and the 

use of the Social Security Rulings. 

• Improve the quality of consultative examinations. Steps should be 

taken to improve the quality of the consultative examination (CE) process. 

There are far too many reports of inappropriate referrals, short perfunctory 

examinations, and examinations conducted in languages other than the applicant’s. 


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ADDITIONAL RECOMMENDATIONS 

In addition to addressing the backlog and SSA’s funding issues, there are several 

other legislative proposals that the Subcommittee may be considering this year. 

• Protecting claimants’ privacy rights. We understand that it can be cumbersome for SSA to obtain medical records, as it is for claimants and their 

representatives, and that SSA is exploring more efficient ways to secure the 

necessary evidence. While we support ways to make this process more efficient, we believe that claimants’ privacy rights must be protected. We will 

work with SSA to find a way to obtain, as efficiently as possible, a claimant’s 

authorization for release of medical records to SSA, while protecting the individual’s privacy rights. • Extension of the fee demonstrations in the SSPA. Access to experienced 

and qualified representatives through the lengthy and complex application 

process is critically important to claimants. To this end, we support allowing 

claimants to enter into voluntary agreements with representatives for fee 

withholding and direct payment procedures whether under Title II or Title 

XVI. The Social Security Protection Act of 2004 established two demonstration projects that should be made permanent because they have proven to be 

effective in increasing claimants’ access to effective representation: (1) Extension of the Title II attorney fee withholding and direct payment procedures 

to SSI claims; and (2) Allowing nonattorney representatives to qualify for fee 

withholding and direct payment, provided they meet certain requirements. 

Unless they are extended or made permanent, the demonstrations will sunset 

March 1, 2010. • Increase and indexing of the fee cap. Rep. John Lewis has introduced H. R. 1093, which contains two provisions regarding the current $5,300 fee 

agreement fee cap: (1) Increase the current fee cap to $6,264.50 (which represents the figure if it had been adjusted for inflation since the last increase 

in 2002); and (2) Index the fee cap for future years to the annual COLA. We 

support these changes since they ensure that there will be a knowledgeable, 

experienced pool of representatives available to represent claimants. • Work incentives. The Ticket to Work and Work Incentives Improvement Act 

was enacted nearly ten years ago and is overdue for evaluation of its effectiveness in employment of those receiving Title II and SSI disability benefits. 

We urge renewal and permanent extension of expired/expiring provisions including (1) SSA’s Title II demonstration authority to test promising approaches for work incentives and related provisions; (2) Demonstration to 

Maintain Independence, set to expire this year, to provide Medicaid buy-in 

coverage to working individuals whose conditions or disabilities are not yet 

severe enough to qualify them for disability benefits; (3) Protection and Advocacy for Beneficiaries of Social Security to protect the rights of beneficiaries 

as they attempt to return to work; and (4) Work Incentives Planning Assistance, which provides state grants for outreach and education to individuals 

with disabilities about supports and services regarding employment. However, 

it is critical that future efforts be devoted to permanently extending and 

strengthening these important return to work supports. 

f 

Statement of Eunmi Choi 

Eunmi Choi 

PAD 5106 PUBLIC ORGANIZATIONS 

Nevin Smith 

December 2, 2009 

THE REQUIREMENT TO IMPLEMENT THE PUBLIC OPTION: 

New Network and New Organization as an administrator, 

negotiator and consultant 

The introduction of the public option where public sector could compete with private sector for selling health care insurances at the same market will need the wellstructured network system as a major variable. The current situation in the United 

States is the worst health care system operated by the principle of market competition admitted as ideal type in everywhere. In other words, the optional insurance 

purchasing depending on one’s own ability eventually causes the asymmetric structures of health care system and the national problems beyond the expected efficiency of market competition. At this point, the public option could be a watershed 


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for health insurance reform, only if the health care network system execute adequately and fairly across each sector among public, private, and non-for-profit organizations. To implement the public option, there are several requirements the nation 

might need. Therefore, I am going to state about the current health care system in 

the United States and the ideal configuration of the network system with a new organization where the public option might be implemented. 

HEALTH CARE SYSTEM 

Part 1. Government 

Federal Government and state governments are involved in health care plan 

through either way, even though the government cannot cover all population in the 

United States. On the one hand, ‘‘Medicare’’ is regarded as a federal program with 

no insurance companies under Federal Government, which covers most persons aged 

65 or elder, certain people on Social Security disability, and which is composed of 

a hospital insurance plan and a supplementary medical insurance plan. However, 

it is not limited by individual demand, but a single-payer system as an entitlement 

program. Firstly, Medicare hospital insurance (called Part A) assists patients in covering cost in-hospital, post-hospital nursing home care, and home care, and it is subsidized by Social Security payroll taxes. Secondly, Medicare medical insurance 

(called Part B) supplements welfare providing diagnostic laboratory costs, physical 

therapy, and surgeon service; moreover, it is associated with the hospital insurance 

plan. Thirdly, Medicare prescription drug coverage (called Part D) supports the costs 

of prescription medications in a bit. 

On the other hand, ‘‘Medicaid’’ is also a federal program, but it is administered 

by state government with different rules, which is for low-income and vulnerable 

people with children, under age 65, as well as over who already tired out their Medicare benefits. This Medicaid program provides fundamental medical services—e.g. 

hospital, nursing facility and home health care, and physical remedy Medicare does 

not cover, as well as family planning, preventive care, outpatient prescription drug, 

and eyeglasses. For instance, each state has a protection and advocacy agency funded from the Federal Center for Mental Health Services. The agencies have to provide the protections for mental illness people and conduct the investigations in order 

to care for them. 

The Medicare and Medicaid program are supported by Federal Government and 

state governments providing premiums, deductibles and share of costs. In addition, 

their finance is appropriated by general tax structure. While Federal Government 

is responsible of the general provision of health care plans, state governments support more specific services that are not covered by Federal Government. 

Part 2. Non-for-profit 

As contracting out or privatization, the entire organization in non-for-profit sector 

is associated with linkage partners either directly or indirectly. As third-sector closely interrelated with governments or private sector, non-for-profit organizations play 

a major role to provide health care services, to allocate health plans through networks, and to provide multiple services that are fairly different among the organizations. Their funds are derived from federal, state, and county governments and they 

also reinvest their earnings in to their infrastructure. In other words, their pure 

premium is supposed to invest on actual health care services, not administrative 

costs. Through federal regulations, managerial responsibility and administration are 

transferred from the governments to non-for-profit organizations in order to improve 

health care services. For instance, the Health Care Financing Administration 

(HCFA) as the one of the state agencies in Kansas State rendered the administrative responsibility, case management, to nonprofit Area Agencies on Aging. Non-forprofit aims at reduce state payroll expenses and shrink the size of the state Medicaid bureaucracy. In addition, it is required to change clientele type, the volume 

of cases, and the urgency of care for those clients (Barbara S. Romzek and Jocelyn 

M. Johnston, 1999, p. 112) 

Non-for-profit organizations usually subcontracted with federal program under the 

governments to provide upgraded services, trustworthy services, and lower-price 

services unlike Medicaid program; on the other side, they in practice provide more 

beneficial services and build safer health care network than for-profit agencies do. 

Part 3. For-profit 

Health care in for-profit sector is usually operated by one or two monopolistic 

mechanism rather than competitive mechanism. Almost private companies such as 

insurance agencies, private hospital, medical laboratory, pharmacy and so forth intend to focus on their benefit and profit of them in that they are designed with a 

variety of ways and for distinctive purposes. However, some quality of health plans 


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by for-profit organizations tends to against high costs, which is far from ideal market in terms of laissez-faire. Moreover, their policy inclined to vary depending on 

customers (divided into age, sex, and health status). According to Organizing the 

Health Insurance Market (1992), Peter Diamond indicates common pattern of health 

insurance companies. One is a variety of insurance premiums for people in different 

categories, with a wide range of premiums. Second is the underwriting, which is the 

technical term for screening applicants in order to determine risk class and acceptability, including the possibility of refusing to sell to individuals because they are 

not viewed as profitable given the risk classification and rates used. Third, in some 

state, there is a government organized residual pool, without underwriting so that 

everyone in that state can buy some coverage. These phenomena lead uninsured 

people and unfair tradeoff. 

Health plans through for-profit sector can be selected by certain customers who 

do not choose the public sector or non-for-profit sector, and then they usually expect 

the different policy and the more qualified services compared to prices. Therefore, 

for-profit sector can be operating through premium and marginal benefit, especially 

market incentives relied on their profit. 

THE GOAL OF THE PUBLIC OPTION 

The public option mentioned below is based on President Barack Obama’s Health 

Care Speech to Congress on September 12, 2009. 

The public option as per choice and competition will provide more realistic security and stability to those who have health insurance and to those who do not have 

yet. The public option will reduce the growth of health care costs for the families, 

businesses, and governments and then it gives responsibility to the government and 

insurance companies, as well as employers and individuals, which is related to multiple-payer environment. 

First, nothing in this plan will require changing the coverage, if one already has 

health insurance through job, Medicare, Medicaid, or individual acquisition. Rather, 

this plan will make better health care condition; for example, insurance companies 

cannot drop the coverage any more whatsoever having severe illness. It means there 

will be no more arbitrary cap of coverage. Besides, insurance companies will have 

to serve preventive care and routine checkups. All in all this plan will lead saving 

money and lives in terms of more security and stability. 

Second, this plan will guarantee affordable and qualified insurance to everyone, 

if one has not health insurance, if lose one’s job or change, or if have small business. 

For this plan, a new insurance exchange will be established for individuals and 

small businesses to purchase health insurance at competitive prices. In case of disability to afford the low-priced insurance, tax credits based on one’s need will be 

provided. Therefore, insurance companies will be in the participation of the new insurance exchange having an incentive that can recruit millions of new customers. 

Based on second plan, improvement of health care system can work only if everyone 

has health insurance either way. 

In sum, three outlines are followed: (1) consumer protections with insurance, 

(2) an exchange where purchasing affordable coverage by individuals and small 

businesses, and (3) an obligation for affordable people to buy insurance. 

TODAY’S PROBLEM 

Those who live in threatened bankruptcy are extraordinary hardships to have 

health insurance. They are not welfare people, but middle-class Americans. Most of 

them cannot afford high costs that are three times if one is self-employed rather 

than employer. Or, in spite of the fact that there are persons who are able or willing 

to pay, they are often denied to purchase insurance because of high risky to cover. 

While some purchase health insurance from public or non-for-profit sector, others 

obtain from private sector. However, it leads a number of problems such as low 

quality services, insufficient services, high price insurance, and so forth. 

As a rising costs problem in the United States, insurance premium is almost three 

times than wages. The reason is that small businesses require for their employees 

to pay high premium or give up the entire coverage. Moreover, hidden tax due in 

part to uninsured people causes the rising costs in emergency room or charitable 

care. 

These health care systems of nowadays mentioned above give disabilities deprivation and taxpayers tremendous burden. These problems cause greater costs to Medicate and Medicaid programs in terms of the red operation due in part to increased 

needs. Furthermore, there exist contradictory opinions. On the left, they argue that 

a single-payer system that acutely separates the private insurance market and the 

government provision to the whole like Canada’s is the solution. On the right, they 


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insist that the employer-based system should be quit and then individuals should 

buy health insurance by themselves. 

IDEAL NETWORK AMONG PUBLIC, PRIVATE, AND NON-FOR-PROFIT 

SECTOR 

For the public option, the new network is required to combine public, private, and 

non-for-profit sector with a new organization. This is because the size of health care 

system will be enlarged more than ever. The public option will be based on customers’ choice and agencies’ competition at the market. Public sector for the whole 

customer, private sector for qualified service, and non-for-profit sector for fairer 

trade should be established under the new network. Besides, goal consensus, efficient service delivery, and professional association through the adaptable policy are 

needed to implement the public option. 

First of all, the public option is to guarantee beneficiaries to keep security and 

stability. This goal can affect all sectors and then the organizations in public, private, and non-for-profit sector have to remind of it, not focus more on their lucrative 

results or marginal costs. While the governments are to merely provide subsidies 

from general taxation into Medicare and Medicaid programs and to contract with 

non-for-profit organization, companies in private are to only seek profits regardless 

of social equity so far. The result could lead serious national problems like the gap 

between wealth and poverty. When all of the organizations reach the same consensus, the goal of the public option will be enhanced. The policy among all sectors 

needs to include the definition of the goal, even though they compete with each 

other at the same market. 

Second, the network of public, private, and non-for-profit sector is required interrelating for efficient service delivery, not merely delivery focused on health care expenditure. This is because public sector will hire partial employees from private sector in order to implement the public option. On the public side, the governments 

do not provide direct service, but support the overall programs; non-for-profit organizations contracted with the government intend to provide specific service than the 

governments. On the other side, private agencies can supply the best service to only 

limited customers who pay high costs or are healthier with no serious problems. At 

this point, incentive depending on each sector’s characteristic will be a versatile solution in the new network. As a technical assistance incentive—e.g. intensive-service 

unit, concerted programs or education and advice-monitoring, non-for-profit organizations can supply the improved service to customers who prefer the non-for-profit 

sector to others. As a participatory incentive in the new insurance exchange, private 

organizations can attract new customers in terms of their capacity, and public organizations also can be motivated in competition with private organizations. These incentives will affect to policymaker among the organizations. 

Finally, professional association related to all sectors will make the network as 

the whole. It means that through the new network, professional association can 

share the value of providers and the intention toward buyers, which will be able 

to build stronger relationship among them. It leads the similar tasks or reproductions in the new network as institutional isomorphism or internal structural similarities. Furthermore, they can negotiate to implement the public option with a kind 

of guidelines from professional association and then understand the reason of the 

implementation of the public option. As a result, professional association will be able 

to avoid disparity of the health care system 

FOR THE PUBLIC OPTION, THE NEW ORGANIZATION AS AN ADMINISTRATIOR, NEGOTIATOR, AND CONSULTANT 

The new organization will aim to cover full-scale, which limits exclusion of customers who cannot afford or already have health problems, which stimulates low 

quality services to improve and which controls exorbitant prices at health insurance, 

hospital, doctor, and etc. The new organization with new national programs is to 

execute health care reform, cover young adults, protect retiree health benefits, and 

generate a new federal grant for implementation of the public option. 

At health insurance exchange derived from health care reform, the new insurance 

market will be open to individuals and employers to purchase health insurance by 

their choice from the competition among public, private non-for-profit sector, even 

new health insurance cooperatives (co-ops). The new organization for the implementing public option will have to keep an eye on the health insurance exchange 

whether to be transparent or equitable to every participant. If necessary, the negotiation related to the prices would be required within all sectors. It does not mean 

of price-fixing or the formation of Cartel. All of agencies in public and private, even 

non-for-profit sector will appear their own policy to new customers. Moreover, these 

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iWhile opt-in system is that state governments can produce a public plan or vice-versa, optout system the state governments have to set up a public option, however, they can stop providing the public plan. 

surance agencies. In health care system, the methods of funding originate in direct 

payments, general tax payments and subsidies or donations. This is where the new 

organization will control the policy including the range of customers and the prices 

of health insurance in order to implement the public option appropriately. 

In addition, the new organization will be able to put pressure on the new network 

of public, private, and non-for-profit sector in order to make them to have their responsibility, as well as every individual and every employer having either small or 

big business. Again, public sector will have all-inclusive responsibility to implement 

the public option by encouraging high quality including the improvement of Medicare and Medicaid programs. Especially, state governments can decide on opt-in or 

opt-out system.i Either way, they cannot avoid their accountability to provide health 

services and products. Private sector will conduct more fairly under the public option. Because for-profit agencies will have to compete with public sector, their monopoly will turn into reasonable trade market. 

What is more important thing is the new organization will blur the service boundary of public, private and non-for-profit sector if various health programs are gave 

the sector, respectively. This organization will be toward better health care system. 

It means that the same direction to new health care system can bring a successful 

result of supply-driven services away from obviously separated sectors, as if the one 

organization encourages providing qualified health service and as if the clearly separated sectors are the divided divisions within the one organization. It also means 

that the new organization will not impose the same rules and ways to deliver health 

services, but induce the same enthusiasm for better health care system in terms of 

the public option. On the other side, each individual or employer will purchase the 

health insurance through the new network. They will also need some advice to figure out which will be suitable to their own conditions. This is where the new organization will be applied as a consultant, which means the new organization should 

not merely determine the certain health insurance to the certain customer, but support to decide the proper health insurance with much information. 

Finally, in the new network with the new organization, insurance purchasing will 

be operated by customized health care in that all sectors are interrelated under the 

new organization as well as every individual and employer receive the guidelines 

or suggestions from the new organization. This new network will be within the market where public, private and non-for-profit sector will compete together, which 

leads the insurance industry. 

Figure 1. The ideal network with the new organization: the new organization in 

the new network can control overall sectors to successfully implement the public option. As the provider, public, private and non-for-profit sector will serve various 

health programs and health insurance at the same market; as the buyer, each indiVerDate Nov 24 2008 03:34 Jan 25, 2012 Jkt 063016 PO 00000 Frm 00197 Fmt 6633 Sfmt 6621 I:\WAYS\OUT\63016.XXX GPO1 PsN: 63016

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vidual and self-employed will be able to purchase health insurance depending on 

their ability and give health care programs at the market. 

CONCLUSION 

To rebuild health care system, trust from customers and conscience among each 

organization as organization-to-organization perspective are important. The public 

health care option announced by the president Barack Obama would deserve everyone in the United States. All of the programs related to health care are performed 

by the Federal Government and state government, for-profit organizations, and nonfor-profit organizations respectively. As a result, it brings national problems and 

gives the realization to improve overall health care system. For successful implementation of the public option, the new organization that is not involved in public, 

private, or non-for-profit sector, but one of the administrators, negotiators and consultants could be required. If the ideal model I mentioned the new network with 

the new organization is possible, I would expect that every customer in the United 

States will have their own health insurance without any fear of contemporary 

health care system, as the nation tends to encourage the public option in spite of 

critical opposition that it is merely extended Medicare plan, and that if any policies 

implemented at national level should be accepted, it would acknowledge the big government leads the increased tax revenues and thereby it would restrict individual 

decision whether to purchase health insurance or not. 

To sum up, it is necessary to concern about the new network or the new organization to alternate the original system. The entire network system can be changed by 

the radical purpose or the social demands. Therefore, well-constructed network system can improve the overall efficiency, quality and acceptability. 

REFERENCES 

Diamond, P. (1992). Organizing the Health Insurance Market. Econometrica, 60(6), 

1233–1254. 

Lee, S. D., Alexander, J. A., & Bazzoli, G. J. (2003). Whom Do They Serve?: Community Responsiveness among Hospitals Affiliated with Health Systems and Networks. Medical Care, 41(1), 165–179. 

Provan, K. G., & Milward, B. H. (1991). Institutional-Level Norms and Organizational Involvement in a Service-Implementation. Journal of Public Administration Research and Theory, 1(4), 391–417. 

Romzek, B. S., & Johnston, J. M. (1999). Reforming Medicaid through Contracting: 

The Nexus of Implementation and Organizational Culture. Journal of Public 

Administration Research and Theory, 9(1), 107–139. 

Schneiberg, M. (2005). Combining New Institutionalisms: Explaining Institutional 

Change in American Property. Sociological Forum, 20(1), 93–137. 

Florida—State Resource Guide. (n.d.). Retrieved November 28, 2009, from http:// 

mentalhealth.about.com/cs/localandregional/a/florida.htm. 

Medicare and Medicaid: What’s the Difference? (2005). Retrieved November 28, 2009, 

from http://www.nolo.com/legal-encyclopedia/article-29615.html. 

Medicaid: A Program Overview. (2000, September). Retrieved November 28, 2009, 

from http://www.policyalmanac.org/health/archive/hhs_medicaid.shtml. 

The Value of Nonprofit Health Care. (n.d.). Retrieved November 27, 2009, from 

http://www.nonprofithealthcare.org/reports/5_value.pdf. 

White, J. (2007). Markets and Medical Care: The United States, 1993–2005. The 

Milbank Quarterly, 85(3), 395–448. 

f 

Statement of Ibrahim Dere 

A healthcare system network design proposal for the U.S.: 

‘‘No uninsured left behind’’ 

Ibrahim Dere PAD 5106—Public Organizations, Fall Semester 

Instructor Nevin Smith 

December 2, 2009 

1. INTRODUCTION 

The healthcare system reform in the U.S. has been a hot topic from beginning of 

the 2008 presidential election campaign. The president Barrack Obama has promVerDate Nov 24 2008 07:39 Jan 26, 2012 Jkt 063016 PO 00000 Frm 00198 Fmt 6633 Sfmt 6621 I:\WAYS\OUT\63016.XXX GPO1 PsN: 63016

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ised to passed comprehensive health reform in order to control rising health care 

costs, guarantee choice of doctor, and assure high-quality, affordable health care for 

all Americans (The White House, retrieved on 11/25/2009 from http:// 

www.whitehouse.gov/issues/health-care). 

In this paper, I will try to design a healthcare system network in which the public 

organizations will actively participate in both policy regulation level and provision 

level in the healthcare industry and running by a public, private, and not for profit 

organizations collaboration. 

2. THE CONCEPTUAL FRAMEWORK 

a. The necessity of public-private-NPO partnership 

They are well known facts that, about 16% of the entire population has no health 

insurance in the U.S. (retrieved on 11/25/2009 from http://www.gallup.com/ 

poll/121820/one-six-adults-without-health-insurance.aspx) and healthcare is 

more expensive than many industrialized country. The reform should also aim to 

reduce the general level of price in health industry. Unavailability of the healthcare 

or accessing to the healthcare with unreasonable prices has some disadvantages for 

not only for individuals but also for the entire society. 

Public option is a type of service provision of not only healthcare, but also other 

public services, such as education, national security, etc. Public service production 

and/or provision is generally done by a collaboration of the governmental, for profit, 

and not profit organizations. Of course, like any goods and service, in healthcare 

issue, whole service can be served or ant necessary goods, such as medicine, drug, 

prosthesis, etc. can be provided by the government by health professionals who are 

working for government in the health institutions owned by the government. In this 

kind of provision option, ‘‘public option’’ would be regarded just as an ‘‘ideal type’’ 

or a ‘‘pure type’’. Max Weber suggest ‘‘an ideal type is formed by the one sided accentuation of one or more points of view’’ according to which ‘‘concrete individual 

phenomena . . . are arranged into a unified analytical construct’’; in its purely fictional nature, it is a methodological ‘‘utopia [that] cannot be found empirically anywhere in reality.’’ (Stanford Encyclopedia of Philosophy, Aug 24, 2007, retrieved on 11/25/2009 from http://plato.stanford.edu/entries/weber/#IdeTyp). 

Even in the national security which has been regarded as the ‘‘pure public service,’’ the ideal type does not exist. More or less private or nongovernmental stakeholders involve in the service provision process. No matter what kind of system will 

be implemented after the healthcare reform bill passed, not only the uninsured who 

will utilize the projected the system, but also under the insured individuals will be 

affected the healthcare reform. Therefore, all of the stakeholders, including private 

insurance companies, private health institutions, pharmaceutical industry, and medical industry will be affected positively or negatively. It is not an unexpected that 

such interest groups will make effort to influence policy making process to maximize 

their interest. 

According to Bozeman’s dimensional model, few complex organizations are purely 

public or purely private. Instead, some mix of public and private authority influences the behavior o f most organizations. If publicness is independent o f the formal legal status o f the organization, it is convenient t o think that some government organizations are ‘‘more public’’ than others, that some business organizations 

are ‘‘more private’’ than others, and that it is possible for specific business organizations to be ‘‘more public ‘‘in some respects than specific government organization. 

Chaordic system thinking view emphasizes that systems flow or change naturally 

and perceives work organizations as complex adaptive systems. They also suggest 

that Chaordic system thinking perceives the member of an organization (a unit of 

the healthcare system) as operating in both horizontal (e.g. cross departmental) and 

vertical (e.g. cross-hierarchical) heterarchical system aggregates in which more complex structures and mental models may develop (Bozeman & Bretschneider, 

1994). 

According to William F. West, bureaucratic structures are means of political control and political actors choose administrative institutions that will perpetuate their 

interests in the future. He also quotes from Terry Moe (1989 and 1990) has described the relationship between interest groups and bureaucratic structure in a 

more systematic way than traditional pluralist theory provides. Whereas members 

of the general public (and even well-informed voters) know little about the implications of administrative procedures and organizational arrangements, groups are 

highly attentive to issues of program design: Interest groups take an active part in 

the politics of structural choice, and politicians have strong incentives to be sensitive to their interests and demands (West, 1997). 


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b. The necessity of intergovernmental labor division 

If we consider the facts that the U.S. is one of the most populous and wealthiest 

nations in the world in terms of GDP and GDP per capita, and private healthcare 

and health insurance system have been dominated by the private entities/insurers 

throughout its history, the proposed healthcare design should include the private 

(nongovernmental) parties, more or less. Besides that the United States has a Federal Governmental system and it has been strong local government tradition. 

Amendment 10of the U.S. Constitution Ratified on 12/15/1791 states that ‘‘The 

powers not delegated to the United States by the Constitution, nor prohibited by it 

to the States, are reserved to the States respectively, or to the people.’’ (Retrieved 

on 11/25/2009 from http://www.house.gov/house/Constitution/Amend.html). 

The layers of government: in the U.S. three layers of government with sovereignty 

of their own (not a single government) provide public services, levy taxes, and borrow money. Indeed, there are more than 86,000 governments in the U.S., counting 

federal, state, and local entities (Frederickson, 1997). Additionally, private and 

nonprofit stakeholders the proposed healthcare system will be a complex organizational network. The proposed healthcare systems in which the government involved 

has been illustrated as below in order to show how it will be complex by a Republican Congressman, Kevin Brady, 8th District of Texas. (Retrieved on 11/25/2009 

from http://www.house.gov/apps/list/press/tx08_brady/71509_hc_chart.html). 

Any complex organization is made up of a number of subsystems [governmental 

layers], which in turn consist of sub-subsystems [departmental sections of the governments]. The smallest system level of any organization may be defined as the role 

performed by each contributing member, with the system parts consisting of those 

aspects of his personality required for role performance. These role-based sub-systems should not be confused with organizational subdivisions, such as hospitals, insurers, physicians, or individuals (Lyden, 1975). 

c. The necessity of governance and networking 

[Public service] [p]rovision means government intervention to ensure availability 

or, generally, to finance the service; it does not require production by the government.’’ (Mikesell, 2007). Where traditional public administration emphasizes the 

internal dynamics of public agencies, the newer forms of action often involve elaborate partnership arrangements with nongovernmental actors (Salamon, 1989). 


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Frederickson defines the governance as a wide range of types of organizations and 

institutions that are linked together and engaged in public activities and the patterns of interaction of multiple-organizational systems or network (Frederickson, 

1997). Newer tools [in public administration] share a significant common feature: 

they are highly indirect they rely heavily on wide assortment ‘‘third parties’’— . . . 

private hospitals . . . , to deliver publicly financed services and pursue publicly authorized purposes. The upshot is an elaborate system of third-party government in 

which crucial elements of public authority are shared with a host of non-governmental or other governmental actors. . . . In a sense, the ‘‘public administration 

problem’’ has leaped beyond the borders of the public agency and now embraces a 

wide assortment of ‘‘third parties’’ that are intimately involved in the implementation, and often the management, of the public’s business. . . . many countries in 

western Europe have non-profit sectors quite a bit larger than that in the U.S., financed largely through grants and contracts from the state. In shifting the focus 

in public problem solving from agencies and programs to generic tools, the new governance also shifts the attention from hierarchic agencies to organizational networks. The defining characteristics of many of the most widely used, and most rapidly expanding, tools is their indirect character, their establishment of interdependencies between public agencies and a host of third-party actors. As a result, government gains important allies, but loses the ability to exert complete control over the 

operation of its own programs, instead of sharp division between the public and private spheres, [the new government tools] blend the two together (Salamon, 2002). 

In public private partnerships, contracts replace hierarchy. Instead of chain of authority from policy to product, there is a negotiated document that separates policymaker from policy output. (Donald F. Kettl, p 21). 

In most industries, routines, programs, goals, public accounts, and structures are 

subject to both competitive and institutional isomorphic pressures. Such pressures 

presumably dampen such behavioral consequences of legal form as might otherwise 

exist. Competition among for profit and nonprofit healthcare providers, for example, 

is said to make the latter more socially responsible and the former more efficient 

than they would otherwise be. Hollingsworth & Hollingsworth report declining differences on a range of structural and performance variables of nonprofit, for profit, 

and public hospitals between 1935 and 1979. Thus form-related differences might 

emerge more strongly in comparisons among industries with differing compositions 

in one society, or between the same industries in different places (DiMaggio & 

Anheiner, 1990). Kessler & McClellan suggest that areas with a presence offerprofit hospitals have approximately 2.4% lower levels of hospital expenditures, but 

virtually the same patient health outcomes. They conclude that for-profit hospitals 

have important spillover benefits for medical productivity. (Kessler & McClellan, 

2002). 

La Porte suggests that modern organizational life is characterized increasingly by 

a growing number of intra-, inter-, and trans-organizational relationships. These 

phenomena are signaled by terms for (i) structure, such as complex systems, coalitions, various forms of federalism, for example, marble cake federalism, communication nets, and allusion to the computer/electric circuitry metaphor, (i.e., as networks); (ii) characteristics of component relationships, such as inter-dependence, 

tight (or loose) coupling, multiple horizontal or vertical relationships between elements/members of a network; and (iii) dynamics or process, such as bargaining, action, or information flows, and resource exchanges between net members. He adds 

that the metaphor of networks advances the descriptive discussion at least one useful step toward more specificity in characterizing the webs, interconnected systems, 

and interdependencies of modern public organization. He continues that the network metaphor connotes relationships, between net members, that are cooperative, 

and to a significant degree self-reenforcing. The networks are likely to be large, 

spread over wide geographies. Salient descriptive characteristics would include (i) 

the scale and general structure of the net, (ii) the properties of its ties or 

connectivity, (iii) the patterns of exchanges among net members, and (iv) the problem more salient in public networks than in private, economic one (La Porte, 

1996). 

Lee, Alexander, and Bazzoli suggest that health institutions which are affiliated 

with health systems and more diversified systems or networks (legally integrated 

or connected with a loosely and voluntarily network) tended to be more responsive 

to the communal needs compared to freestanding communal hospitals (Lee, Alexander, and Bazzoli, 2003). It can be argued that scale economics and high level 

of diversity in a network enhance the skills and resource for the health institutions. 


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d. Necessity of a self adaptive system 

Kira and Eijnatten suggest that, in order to promote work-organizational sustainability, they consider organizations as chaordic open systems and propose to extend 

the foundations of socio technical system (purposefully designed and controlled to 

generate services or products) from operational ST to chaordic ST chaordic system 

thinking. At the work-organizational level, sustainability means an ability to find 

ways to deal with challenges and capability to create new opportunities for a productive existence (Kira & Eijnatten, 2008). 

3. NETWORK DESIGN PROPOSAL 

I propose a public health insurance model that both governmental, for profit and 

non for profit organizations are acting their roles within a harmony to sustain the 

healthcare system which has been one the most complex industries in the U.S. 

The health insurance system is an inseparable part of the healthcare system in 

the U.S. In my model. every citizen, including legal residents must have at least 

one full coverage health insurance policy (primary policy). In addition to the existing 

private insurance companies, the Federal Government will create a publicly-owned 

insurance company which will be the last resort for obtaining a health insurance 

and the first source for the public employees. Individuals may purchase the policy 

either from private insurers or governmental health insurance company individually. Employers must purchase health insurance policy for their employees from 

either from private insurers or governmental health insurance policy. In this case, 

the half-cost of the primary policy will be charged to the employee. Employee’s part 

will be retained/checked off from the employees’ salaries and transferred to the insurer on behalf of the employee. Primary insurance policy will cover the employee’s 

spouse—if the spouse is not working-, children under 18 years old. For each extra 

family member, the employee’s part will increase slightly. Public employers will purchase the health insurance policy from the governmental health insurance company. 

Self employers will be subject to the rules which are applied to the employees. The 

employers cannot hire a part time employee who has no health insurance. Partial 

amount of the policy will be paid to the employee. Governmental insurance will 

cover all of the medical expenses including, medicine, eye care, dental plan. Aesthetics procedures will be out the policy unless there is medical necessity and will 

be paid by the patients. Governmental insurance policy will be purchased by the 

government for unemployed people or people who has no income or fortune. Federal 

Government will create a fund in order to subsidize the governmental health insurance company. By subsidization of the governmental health insurance for destitute 

individuals, the government will apply redistributive policy by transferring fiscal resources from one class or group to another (Lowi, 1972). The governmental health insurance company will collect its premium revenues 

just like the tax revenues and nonpayment of the governmental health insurance 

premiums will be evaluated like tax offense. 

None of the medical service or treatment will be provided free or co-pay free by 

the government. If the patients has no salary to pay for the co-pay, this amounts 

will be met by the government. Even in this case, the patients will pay a ‘‘symbolic 

price, i.e. $1’’ for each service as co-pay. The government will pay the insurance expenses instead of the medical expenses to the medical institutions. 

The healthcare service will be a federal issue. But the Federal Government will 

not be the healthcare service provider. It will be responsible for supervising the governmental health insurance company, organizing and supervising the healthcare 

system. The Federal Government will set the tariffs as price cap for each medical 

examination and medical supplies which will be applied by the governmental health 

insurance company to make payment to the health institutions. While this tariff will 

not be binding for private health insurance companies, private hospitals, and drug 

companies, it will be used in order to prevent the application exorbitant price policy 

for private entities. In other words, the government will not set the price of the 

services or medical materials, but it will limit to the governmental health insurance 

company for the payment of each payment. By doing this the government will apply 

a regulative policy to set standards in terms of price (Lowi, 1972). All of the stakeholders, such as representatives of consumers’ organizations, pharmaceutical industry, private hospitals, and insurance companies, will participate in the regulatory 

process in accordance with the governance. 

The laws, rules, and regulations flexible as much as possible in order to cerate 

a well adaptive system to meet the requirement of new unpredictable circumstances. 

The public health institutions will be classified as three or four categories. ‘‘The 

first category health institutions’’ will take care of the basic health problems for instance tonsillitis etc. The second one will take care of more complex health problems 

that are not solved in the first step. Finally, at the third step, complex problems 


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that are not solved health problems will be taken care of. Except for military institutions, the first and second category public health institutions will be transferred 

to the local governments, and the third category health institutions will be under 

the responsibility of the states. These facilities will be funded by the governmental 

health insurance company. If these institutions accept patients who hold private insurance policy, the co-pay’s will be transferred by the institution and the private insurers’ part will be transferred to the governmental insurance company by the private insurers. 

Healthcare system providers will consist of governmental, private, and nonprofit 

organizations. Private health insurance holders will keep going to the private institutions. The governmental health insurance holders will have three options: 

1–They will have option to go to the public health institutions by paying reasonable co-pay. 

2–They will have option to go to the nonprofit health institutions by paying copay, if the institution applies. 

3–They will have option to go to the private health institutions by paying copay. But in this case co-pay will not be fewer than the amount that public 

institutions apply. Private health institutions will must charge and collect the 

co-pay from the patients who hold the public health insurance policy. 

The existing programs Medicare, Medicaid, the Children’s Health Insurance Program and the Veterans Health Administration will be merged in the governmental 

health insurance program. Wealthy senior citizen will have to purchase their own 

health insurance. (Richard Epstein, retrieved on 11/25/2009 from http:// 

healthaffairs.org/blog/2008/03/13/health-care-disparities-deregulation-firstredistribution-last/). 

Every individual will have a medical record which is kept in a federal institution 

and every transaction will be recorded within the account. (Medical record privacy 

misuse will be a federal offense to protect privacy.) Every insurer, including the governmental company will notify each member’s personal information, especially 

whether or not he or she has a valid policy. Frictional uninsured interims will be 

covered by the governmental health insurance company. 

The government (federal, state, and local) or governmental health insurance company will not produce or sell drugs or medical supplies. They will pay the governmental insurance policy holders medical expenses to the private providers such as 

private hospitals, pharmacies, medical supplies sellers, etc. Public health insurer, 

having a huge negotiation power, may obtain the medication form the drug companies from cheaper prices. 

In case of epidemic or pandemic, which is declared by the Federal Governmental 

nationwide or in partial in the country, urgent and/or compulsory health expenses 

for every citizen will be paid by the governmental health insurance company regardless of valid policy. 


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4. CONCLUSION 

As a conclusion, I propose a public option model which will coexist private health 

insurance companies, private health institutions, private pharmaceutical companies, 

and nonprofit health institutions together with the public entities that are functioning at regulatory and/or street level. This model will be a public umbrella that 

provides a full coverage health insurance both to uninsured individuals together 

with people who utilizing the existing public medical aid programs and suffering 

from the unaffordable health insurance policies. Due to the fact that, in the public 

option, private and not for profit organizations will keep playing their important 

roles, governance will be a key concept to cooperate all three sectors in order to sustain the healthcare system. Instead of sharp division between the domains of public, 

private, and not for profit, they will form a self evolving -as much as possible- and 

complex structure. Redistribution will be another key characteristic of the system 

due to the fact that enlarging public interference/portion in the healthcare system 

will necessitate extra fiscal resources and taxpayers will have to pay more. In order 

to built up and pursue the good governance patterns, a well defined, well functioned, comprehensive, and adaptable organizational and technological networks 

should be created by beginning from the federal level through to the bottom level 

and from the governmental domain to the private and not for profit domains. 

5. BIBLIOGRAPHY 

Amendment 10of the U.S. Constitution Ratified on 12/15/1791 states that (http:// 

www.house.gov/house/Constitution/Amend.html). 


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Kettl, Donald F., The Transformation of Governance, Public Administration for 

Twenty-First Century America, The Johns Hopkins University Press, Baltimore, 

Maryland, 2002. 

Bozeman, Barry & Bretschneider, Stuart, The ‘‘Publicness Puzzle’’ in Organization 

Theory: A Test of Alternative Explanations of Differences between Public and Private Organizations, Journal of Public Administration Research and Theory: J– 

PART, Vol. 4, No. 2 (Apr., 1994), pp. 197–223. 

DiMaggio, Paul J. & Anheier, Helmut K.,The Sociology of Nonprofit Organizations 

and Sectors, Annual Review of Sociology, Vol. 16 (1990), pp. 137–159. 

Frederickson, H. George, The Spirit of Public Administration, Jossey-Bass Publishers, San Francisco, 1997, 272 p. 

Gallup Inc. (2009). Retrieved on 11/25/2009 http://www.gallup.com/poll/121820/ 

one-six-adults-without-health-insurance.aspx. 

Kessler, Daniel P. & McClellan, Mark B., The Effects of Hospital Ownership on 

Medical Productivity, The RAND Journal of Economics, Vol. 33, No. 3 (Autumn, 

2002), pp. 488–506. 

Kira, Mari & van Eijnatten, Frans m., Socially Sustainable Work Organization: 

A Chaordic System Approach, System Research and Behavioral Science, (2008) 25, 

473–756. 

La Porte, Todd R., Shifting Vantage and Conceptual Puzzles in Understanding 

Public Organization Networks, Journal of Public Administration Research and Theory: J–PART, Vol. 6, No. 1 (Jan., 1996), pp. 49–74. 

Lee, Shoou-Yih D., Alexander, Jeffrey A., Bazzoli, Gloria J., Whom Do They 

Serve?: Community Responsiveness among Hospitals Affiliated with Health Systems 

and Networks, Medical Care, Vol. 41, No. 1 (Jan., 2003), pp. 165–179. 

Lowi, Theodore J., Four Systems of Policy, Politics, and Choice, Public Administration Review, Vol. 32, No. 4 (Jul.—Aug., 1972), pp. 298–310. 

Lyden, Fremont James Lyden, Using Parsons’ Functional Analysis in the Study 

of Public Organizations, Administrative Science Quarterly, Vol. 20, No. 1 (Mar., 

1975), pp. 59–70. 

Mikesell, John, Fiscal Administration: Analysis and Applications for the Public 

Sector, 7th Edition, by Thomson Wadsworth, 2007, 707 p. 

Salamon, Lester M., Beyond Privatization: the Tools of Government Action, Washington D.C.: Urban Institute Press, 1989. 

Salamon, Lester M., The Tools of Government A Guide to New Governance, Action, 

Governance and the Tools of Public Action, Oxford University Press, 2002. 

Stanford Encyclopedia of Philosophy, (2007), Retrieved on 11/25/2009 from http:// 

plato.stanford.edu/entries/weber/#IdeTyp. 

West, William F., Searching for a Theory of Bureaucratic Structure, Journal of 

Public Administration Research and Theory: J–PART, Vol. 7, No. 4 (Oct., 1997), pp. 

591–613. 

The White House, The, retrieved on 11/25/2009 from http://www.whitehouse.gov/ 

issues/health-care. 

f 

Statement of James F. Allsup, President, CEO and Founder of Allsup 

Chairman Tanner and Members of the Subcommittee, thank you for considering 

my written testimony today regarding the Social Security Administration’s challenges in managing the massive disability claim backlog during the current economic downturn. 

My name is James Allsup, and I am a former employee of the Social Security Administration and the founder and CEO of Allsup Inc., the largest non-attorney Social Security Disability Insurance (SSDI) representation company. Since 1984, we 

have helped more than 120,000 individuals obtain disability benefits. 

A Grave New Threat 

Earlier this year, I provided written testimony before the full Ways and Means 

Committee, commenting on an increasingly grave threat to the SSDI system, and 

most importantly, to hundreds of thousands of disabled individuals. Despite the best 

efforts of the Social Security Administration and policymakers to address an exploding backlog of claims at the hearing level, the highest unemployment levels in 25 

years were causing desperate Americans to flood the Social Security Administration 

with disability claims at an unprecedented rate. 

From 2004 through 2007, application levels were stable, with the SSA processing 

between 2.1 million and 2.2 million SSDI applications each year. Those numbers 

began increasing in 2008—when for the first time more than 2.3 million applications 


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were filed. They grew even more dramatically, to more than 2.7 million, in the recently completed FY 2009. 

It’s amazing the difference one year can make. For years, disability advocates 

have been working to raise awareness of the massive backlog of claims at the hearing level. Congress and the Administration should be commended for providing the 

resources needed by the SSA to begin addressing that challenge. The men and 

women of the SSA deserve praise for using those resources wisely to reduce the 

number disability hearings pending for the first time since 1999. 

Unfortunately, the current crush of applications will undo that progress. The SSA 

recently reported that the level of initial claims pending now exceeds 1 million people—that’s nearly a 40 percent increase over the level from FY 2008. It is quite clear 

that even as the backlog improves at the hearing level, the line for benefits continues to grow rapidly at the front end of the system. 

If They Only Knew 

The long wait for benefits imposes real costs to applicants, according to a recent 

national claimant survey conducted by Allsup. People with disabilities experience financial crises, extreme stress and declining health while stuck in the federal disability backlog. An overwhelming majority of SSDI applicants face grave setbacks 

and wish they would have known from the start that expert representation was 

available to assist them. 

Arthur Blair, of Gaithersburg, MD., was a program manager at a group home before a combination of osteoarthritis, severe back pain and depression made it impossible for him to keep working. During his two-year wait for SSDI benefits, Mr. Blair 

tapped deep into his savings and had to sell his home after he and his wife were 

unable to make their mortgage payments. His condition also worsened. 

According to Mr. Blair: ‘‘I think the process takes away our humanity. There are 

no resources to help you. You are in a financially devastating position, and by the 

time you’re approved, you have accumulated so much debt and lost everything 

you’ve worked for. It’s almost impossible to recuperate what you lost.’’ 

Mr. Blair’s experience is typical, according to Allsup’s 2009 survey of SSDI claimants. Of the nearly 300 successful SSDI claimants who came to Allsup for representation, 90 percent said they faced negative repercussions while waiting for their 

SSDI award. These included: 

• Stress on family—63 percent 

• Worsening illness—53 percent 

• Draining of retirement/savings—35 percent 

• Lost health insurance—24 percent 

• Missed mortgage payments—14 percent 

• Foreclosure—6 percent 

• Bankruptcy—5 percent 

Nearly 80 percent of respondents reported facing ‘‘barriers to handling the SSDI 

process on [their] own,’’ including problems with understanding (48 percent) and 

completing (61 percent) the necessary forms. Three-fourths (75 percent) said the 

level of stress they experienced while applying for SSDI benefits was either ‘‘extreme’’ (39 percent) or ‘‘significant’’ (36 percent). 

Only half (51 percent) of all applicants knew third-party representatives could 

help them apply for SSDI benefits. Almost nine in 10 (85 percent) survey respondents said they would have found it useful for the SSA to inform them in advance 

of their options for receiving help with their SSDI application. Another 83 percent 

would have found it helpful or valuable if the SSA had provided them with a list 

of authorized third-party representatives from which to choose. 

Unfortunately, because applicants often are unaware help is available, too many 

initial claims are denied for reasons that have nothing to do with the applicant’s 

disability status. If applicants only knew third-party assistance was available to 

professionally review their application and help properly and accurately document 

their disability, thousands of claimants could be processed faster and applicants 

could avoid the painful financial and personal repercussions of being stuck in the 

system. 

Collaboration, Not Privatization 

As always, I emphasize that increasing the assistance offered by third-party SSDI 

representatives is not, as some have charged, a step toward privatization. It is a 

way for government to leverage the existing capabilities of expert disability representatives to help address a real and growing crisis. It is very similar to the Internal Revenue Service’s acknowledgement of tax preparation professionals, who provide valuable assistance to taxpayers in navigating a complex tax system. 


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Literally hundreds of thousands of government worker-hours could be saved if 

more applications processed by the Social Security Administration were professionally documented before being submitted. This would leave these employees free 

to accomplish their primary mission—reviewing applicants, adjudicating appeals 

and administering the SSDI process. 

Chairman Tanner and Members of the Subcommittees, I commend you for holding 

this hearing to raise awareness of these issues. Thank you again for the opportunity 

to provide testimony. I look forward to working with you to address this growing 

crisis. 

f 

Statement of Leri Harper 

The Social Security Administration’s approach to disability, past and present, fails 

to address the problems and inadequacies of processing claims via the state Disability Determination Services (DDS), where there is ample evidence of regional differences in claims processing. AFGE strongly believes that if problems with inconsistent decisions at the initial claims level are addressed, appeals will diminish. Disability claimants deserve consistent initial claims decisions and payments as soon 

as possible in the claims process. 

The concurrent disability process shows inexplicable variable allowance rates depending on the state of residence. There is no evidence to show that residents of 

some states are twice as susceptible to become disabled as residents in other states. 

Obviously, different state initial claims approval rates have more to do with the bifurcated system than the health of residents of these states. Claimants are entitled 

to consistent decisions regardless of their state of residence or whether they are filing for Social Security or SSI disability benefits. The SSA Office of Quality Performance (OQP) is tasked with keeping track of nationwide consistency of disability 

claims, and their own studies reveal the disability process shows inexplicable variable allowance rates depending on the state of residence. For instance a study for 

fiscal year 2009 revealed that if a claimant applies in New Hampshire, they have 

nearly a 52% chance of being allowed at the initial level. If a claimant applies in 

Tennessee, they have a 24% chance of being allowed. These inequities have never 

been addressed, and there is an inherent inconsistency between states in what is 

supposed to be a national disability program with consistent program standards. 

http://ssahost.ba.ssa.gov/pmr/index.aspx. 

Regional differences are apparent, with many southern states at the low end of 

the spectrum for approving initial disability decisions; while many east and west 

coast states are at the high end for initial allowance determinations. 

The SSA Office of Quality Performance is the enforcer of the national disability 

claims standards, who are tasked to review initial disability claims under the same 

nationwide rules. We reviewed the most recent initial disability claim quality report 

from the Disability Quality Branch (DQB) of the Office of Quality Performance. Interestingly, no matter what state DDS is measured, the states’ quality performance 

is all rated at a quality level of 91.5% or above in accuracy levels. All state DDS 

agencies are declared by OQP/DQB to provide good quality decisions, no matter how 

divergent their allowance or denial rate of initial claims. http://quality.ba.ad.ssa.gov/ 

hq/direports/qaper/pdf/itable1.pdf. 

During the past two years, the Office of Quality Performance decided to institute 

a change in the Disability Quality Review Branch process to try and iron out differences in their own national review process. In an attempt to resolve these inconsistencies, the Disability Quality Branch of the Office of Quality Performance now 

requires their employees to review cases from any state in the Union. 

Prior to this change in policy, Disability Quality Review branch employees were 

limited to reviewing cases only from their individual regions, meaning that the same 

federal reviewing staff would consistently review the same state DDS offices for 

whom they were responsible. These regional Disability Quality Branches reinforced 

the inequitable allowance rates time and again, which they recognized as a problem 

that needed resolution. 

Despite the Office of Quality Performance attempts to create a national virtual 

national review process, where Disability Quality Branch workers are called on to 

review cases from any state, we see no significant change in the state DDS’ divergent allowance rates, meaning that the review program is ineffective. Even though 

we have a national quality review component that is well aware of the discrepancy, 

they have not been able to solve the problem, even with extensive hiring of new examiners during the past two years. 


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We believe that policing the state DDS adjudication practices is a lot like herding 

cats, with various policy inconsistencies, political influences, and regional differences that have no place in a national disability adjudication program. 

Unfortunately, the chances for a claimant to be approved at the initial level have 

a lot to do with where they live and their income rather than the nature of their 

disability. That is inherent in the system. Each state has different criteria for hiring 

Disability Examiners. Each state provides them with different pay and benefit packages. Some state DDS offices are unionized, while others are not. Each state provides different training to their DDS employees. Employee retention rates vary dramatically from state to state. In effect, there are 50 different disability programs 

when there should be one. 

There is no evidence to show that residents of some states are twice as susceptible 

to become disabled as residents in other states. Obviously, different state initial 

claims approval rates have more to do with the bifurcated system than the health 

of residents in these states. Claimants are entitled to consistent decisions regardless 

of their state of residence or whether they are filing for Social Security or SSI disability benefits. 

According to the Government Accountability Office (GAO), a majority of DDS’ do 

not conduct long-term, comprehensive workforce planning, which should include key 

strategies for recruiting, retaining, training and otherwise developing a workforce 

capable of meeting long-term goals. The State DDS agencies lack uniform minimum 

qualifications for Disability Examiners and have high turnover rates for employees 

and do not provide ongoing training for Disability Examiners. It is a key problem 

that must be reconciled in order to reform the disability system. 

Although the State DDS system is fully subsidized by SSA, state budgetary problems adversely affect the ability of SSA to provide disability services. For example, 

California State DDS workers were forced to accept weekly 8 hour furloughs due 

to the budget deficit situation in the State. Michigan DDS workers along with other 

MI State employees were furloughed due to State budget shortfalls even though 

DDS worker salaries were also fully funded by SSA. 

As many participants in the hearing testified, multiple state DDS offices followed 

suit, furloughing employees that were supposed to be earmarked for federal workloads, causing SSA to lose valuable initial case processing time, and resulting in 

worsening the disability backlog considerably. 

Social Security Commissioner Astrue recently made a decision to solve the initial 

case backlog by taking away work from states where there are average to high allowance rates, and creating mega-DDS offices in states where the allowance rates 

are lower. These states include Oklahoma, Mississippi, Arkansas, and Virginia. The 

Commissioner plans to reassign cases from states that supposedly need assistance. 

Commissioner Astrue calls these ‘‘Extended Service Teams’’ and says ‘‘. . . they will 

be placed in States that have a history of high quality and productivity and the capacity to hire and train significant numbers of additional staff.’’. However Mississippi has an initial disability allowance rate of 26.6%, Arkansas 37.1%, Virginia 

40.4%, and Oklahoma 38.6%. 

Interestingly, we noticed the Commissioner decided to locate these new centers in 

right-to-work states where union representation is absent. This will result in getting 

the work done more cheaply, but we think SSA will get a poorer quality of work 

and less well-documented claims that will ultimately end up at the hearings level. 

This will require the ODAR staff to obtain additional documentation and consultative exams that will again build more case processing delays into those claims. 

While we are concerned with the loss of union jobs nationwide, we are more concerned with consistency and fairness in the disability determination process. We 

would like to point out that Commissioner Astrue created this tier of mega-DDS offices ‘‘under the radar’’ without input from the congressional representatives whose 

states are affected, and this may be of concern to those representatives. 

AFGE predicts this backlog of disability claims will end up in multiple appeals 

that will glut the ODAR system once again, Because additional work will now be 

funneled to mega-DDS offices that have a historically low allowance rates, we predict the numbers of appeals will rise dramatically once the initial claims backlog 

is unclogged with the proposed temporary, stop-gap measures. This is not the best 

course of action for lasting change, consistency of decisions, and smooth workflow. 

We understand that everyone want to solve the problem of backlogged disability 

cases, but piecemeal solutions will not work when the underlying problem of consistency between the state DDS disability adjudication practices versus the federal adjudication rules are not addressed. The bifurcation of the disability program between Federal and State workers is an anachronism dating to 1956 when the SSA 

disability program was created by Congress. It is time to modernize and create a 

unified, comprehensive Federal disability system. AFGE recommends the federalizaVerDate Nov 24 2008 03:34 Jan 25, 2012 Jkt 063016 PO 00000 Frm 00208 Fmt 6633 Sfmt 6621 I:\WAYS\OUT\63016.XXX GPO1 PsN: 63016

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tion of the State Disability Determination Services; keeping the jobs in the states 

but supplying these skilled workers with federal jobs. At that point, national standards and training can occur where SSA actually has control of their own process. 

This will bring consistency to the initial claims decisions in the same way that the 

Supplemental Security Income program (that was federalized from the states in 

1974) created a uniform system of benefits for low income, blind, disabled and aged 

population. 

AFGE believes the time to act is now to federalize DDS workers and provide consistent oversight and training that will bring timely, consistent nationwide decisions 

for the vulnerable disabled claimants that we are committed to serve in an unbiased 

and equitable fashion. 

Submitted by, 

Leri Harper 

Disability Examiner/Social Insurance Specialist 

For AFGE Local 3937 

Seattle, WA 

f 

Statement of the National Council of Social Security 

Management Associations 

I am the President of the National Council of Social Security Management Associations (NCSSMA). I have been the District Manager of the Social Security office 

in Newburgh, New York for eight years and have worked for the Social Security Administration for 29 years. On behalf of our membership I am pleased to have the 

opportunity to submit this written statement for the record to the Committee. 

NCSSMA is a membership organization of nearly 3,500 Social Security Administration (SSA) managers and supervisors who provide leadership in 1,262 Field Offices and 35 Teleservice Centers throughout the country. We are the front-line service providers for SSA in communities all over the nation. We consider our top priority to be a strong and stable Social Security Administration, one that delivers 

quality and prompt community based service to the people we serve, your constituents. 

We are certainly concerned about the tremendous challenges facing the Social Security Administration. We wholeheartedly agree with Commissioner Astrue’s statement that it is a moral imperative that the disability backlogs be eliminated. On 

a daily basis, employees in our offices speak to thousands of individuals throughout 

the country who are desperate to receive a decision on their claims for disability 

benefits. 

We are very appreciative of the support that the House Ways and Means Social 

Security Subcommittee has provided to improve SSA’s budget situation. The additional funding SSA received in FY 2008 and FY 2009 has helped significantly to prevent workloads from spiraling out of control and assisted with improving service to 

the deserving American public. As an example, SSA has been able to provide additional resources for our Teleservice Center (TSC) operations, and recently announced the opening of a new TSC in Jackson, Tennessee, to assist in reducing our 

National 800 Number Network busy rates. We are also grateful for the Subcommittee’s support for the President’s proposed FY 2010 budget for SSA. If this budget 

is approved by Congress, it will help SSA continue to make progress on the numerous workloads we are challenged with, and maintain the momentum that was so 

difficult to achieve. 

As a result of inadequate budgets received over the past decade through FY 2007, 

the number of staff in SSA Field Offices declined significantly. In fact, SSA’s staffing levels were, until just recently, at the lowest levels since the SSI program started in 1974. Because SSA workloads were growing during this period, customer waiting times increased and call answering rates declined. With the more adequate 

funding for SSA in FY 2008 and FY 2009 there have been significant efforts to restore staffing levels to near where they were in FY 2004, but they are still lower 

than in previous years. This additional staff, along with the significant amounts of 

overtime we have been authorized to work, have assisted greatly with addressing 

our rapidly growing workloads and increased number of customers and callers. 

The following is a brief overview of the workload challenges that are confronting 

Field Offices. 

1. Additional Claims and Appeals. Field Offices are expected to receive 1.04 

million more retirement claims and 1.08 million more disability claims in FY 2009 

and FY 2010 above FY 2008 levels. In addition to the higher volume of disability 


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claims received by Field Offices, as the DDSs and the Hearing Offices reduce their 

backlogs, many more additional claims are being approved and must be adjudicated 

to pay benefits due. The Hearing Offices’ cases can require extensive development 

and are particularly time consuming for Field Offices to process. 

2. Improving SSI Quality and Additional SSI Redeterminations. According to a November 2009 OMB report, in FY 2009 SSA paid out approximately $45.0 billion to SSI recipients. However, there was an improper payment rate of $5.436 billion or nearly 12.1%, one of the largest in the Federal Government. A November 

2009 study by the SSA Office of Inspector General stated that for the 5-year period 

ending in FY 2008 SSA paid $204.5 billion to SSI recipients. Of that total, $16.6 

billion was overpaid, representing 8.1% of outlays. Underpayments during this same 

5-year period totaled $3.4 billion or 1.7% of outlays. Given the significant overall 

dollars involved in SSA’s payments, even the slightest errors in the overall process 

can result in millions of dollars in improper payments. 

The SSA Office of Inspector General stated that completing additional SSI redeterminations will help to reduce this error rate because SSA will identify these incorrectly paid dollars earlier. In FY 2010, Field Offices will work about 1.1 million 

more SSI redeterminations than FY 2008. This is nearly a 100% increase in SSI redeterminations. The staffs processing these cases are working at a very high rate 

of production. In fact, SSA productivity increased by 3.17% in FY 2009. However, 

we are concerned that despite this increased production, there is insufficient time 

to review the cases adequately for accuracy. Improving the process means not only 

doing more SSI redeterminations, but also having sufficient time to review the work 

for accuracy. 

3. Medical Continuing Disability Reviews. Field Offices are also processing 

more medical Continuing Disability Reviews (CDRs). In FY 2008 SSA processed 

235,000 medical CDR cases. In both FY 2009 and FY 2010, we are scheduled to 

process 329,000 cases. This increase in processing medical CDRs will assist significantly with addressing program integrity concerns. However, there is currently a 

backlog of 1.5 million medical CDRs pending processing. Accomplishing this medical 

CDR backlog has the potential to save the American taxpayers approximately $20 

billion. Additional resources will be needed in Field Offices and the DDSs to process 

medical CDRs and to ensure program integrity. 

4. Work Continuing Disability Reviews. Field Offices are also making a concerted effort to address the volume of work CDRs that are awaiting processing. 

Since April 2009, the number of pending work CDRs in Field Offices has been reduced from about 66,000 cases to the current 55,000 cases. During the same period, 

the number of ‘‘over one year old’’ cases has been reduced from approximately 7,650 

to under 700 cases. Reducing the number of pending work CDRs will help to minimize the large overpayments often encountered on these cases. 

5. Field Office Customers. Field Offices have worked diligently to redirect resources to reduce the amount of time a claimant waits to see an SSA interviewer. 

We are making significant progress despite our many challenges. In October 2009 

a claimant waited an average of 19 minutes, as compared to 22.8 minutes a year 

earlier. This is a significant accomplishment considering the fact that the number 

of customers visiting SSA Field Offices continues to increase. In FY 2009, there 

were over 45 million customers, an increase of 600,000 customers from FY 2008. 

6. Field Office Telephone Calls. Field Offices are struggling to answer telephones with the increased workload demands. We handled about 58 million calls in 

Fiscal Year 2009. This is an increase of 4 million calls from FY 2008. SSA studies 

by the Office of Quality Performance state Field Office telephone busy rates were 

about 58% in Fiscal 2009, which is an increase of 3% from the prior year. Many 

offices must direct staff to handle walk in traffic to reduce waiting times, and as 

a result have insufficient staff to answer telephone calls. 

7. Training. Field Office management is having difficulty with allocating sufficient time for ongoing staff training. Workload demands necessitate that direct staff 

be assigned to accomplish production work at the expense of much needed training. 

8. eServices or Internet. SSA is transitioning more work processes to electronic 

service delivery. The FY 2010 goal is to have 38% of Retirement claims and 25% 

of Title II Disability claims filed on the Internet. SSA Field Offices have had to address significant issues resulting from the increased volume of claims filed electronically. Almost all Disability Internet applicants must be recontacted to perfect the 

application. For Retirement claims, many claimants must be recontacted to address 

the error prone area of month of election. While electronic services have assisted 

Field Offices significantly with the unprecedented high number of SSA applications 

received, it is important to note that staff must still spend significant time processing many of these electronically initiated actions. Also, electronic services provide 

only minimal relief to inner city offices, offices with rural service areas, and areas 


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with a high percentage of non-English speaking applicants, because these areas 

have populations not as likely to use or have access to computers or the Internet. 

It is essential that SSA continues to receive positive budgets to ensure that Field 

Offices are able to adequately serve the American public and to process important 

workloads. As illustrated above, even with the recent more favorable SSA budgets, 

Field Offices are still struggling with tremendous workload demands. We are also 

especially concerned about the program integrity workloads and the billions of dollars that are being lost due to the backlog of medical CDRs and overpayments in 

the SSI program. 

Commissioner Astrue’s testimony indicates that Field Offices are expected to 

maintain their current staffing levels in FY 2010 and about 2,700 additional positions are scheduled to be added to the Hearing Offices and DDSs. While additional 

staff is much needed for the Hearing Offices and DDSs to address the disability 

backlogs and these positions should not be reduced, additional staff for Field Offices 

would yield significant improvement in service to the American public and assist 

with the disability backlog. Our network of 1,262 community based Field Offices is 

an integral part of SSA’s service delivery system, and the Field Office is where the 

disability process begins and ends. Increased staff for Field Offices would reduce 

workload backlogs, address program integrity concerns, improve SSI accuracy performance, and allow for the transmittal of a more accurate and complete disability 

product that would assist with expediting disability decisions. 

SSA’s flexibility to continue to provide necessary resources in FY 2010 will be determined much by the President’s proposed budget in FY 2011 and future years. If 

these budgets are not adequate to address the workload challenges, the progress 

made in the past two years will be eroded. Field Offices could redirect some of the 

overtime dollars currently expended to hire additional temporary or permanent employees if flexibility is provided due to the expectation of a favorable SSA budget 

in FY 2011. 

We believe a minimum of $13.2 billion is needed for SSA’s FY 2011 administrative 

funding. This level of funding would provide SSA with the resources necessary to 

continue the progress made, while at the same time protecting many Americans 

from severe and unnecessary economic hardship. Our community based staffs are 

very committed to serving the American public, but we must have the tools and resources to do so. We sincerely appreciate your ongoing support to provide adequate 

funding for the Social Security Administration. We remain confident that this increased investment in SSA will benefit our entire nation. 

On behalf of the members of NCSSMA I thank you for the opportunity to submit 

this written statement to the Subcommittee. NCSSMA members are not only dedicated SSA employees, but they are also personally committed to the mission of the 

agency and to providing the best service possible to the American public. 

f 

Linda Fullerton’s Letter 

Members of the Committee: 

My name is Linda Fullerton, President/Co-Founder of the Social Security Disability Coalition, and it is again with great sadness, anguish and despair that I submit this testimony to you today as I have done several times in the past. But as 

usual my testimony apparently must not ever be read by anyone there, from what 

I can tell, based on what I saw. I watched this entire hearing on the internet, and 

each hearing that I see continues to be a source of major frustration for me. It happened that this hearing took place on my 54th birthday. Most people would have 

celebrated their birthday doing joyous types of things. Unfortunately since I filed 

for my own Social Security Disability benefits on December 6th 2001, I no longer 

have reason to celebrate much of anything anymore. 

My life was permanently destroyed with the stroke of pen by a neglectful government employee, to whom I was just an SS number, and it is more than I can bear. 

So now, not only will I never recover from my illnesses, but I will never recover from 

the permanent financial and physical devastation this has had on my life. After 

fighting and waiting for 11⁄2 years, and losing all my life savings, pension money 

and any chance of ever having financial security again, my claim was finally approved. Even though a person may eventually get their benefits, the devastation 

does not miraculously disappear once the checks start coming. It often leaves a permanent scar on one’s life. The stress I endured during that time and continue to 

deal with, every day living on the edge of total ruin, on top of all my illnesses is 

unbearable beyond belief and it is killing me. My health problems have become 

worse, and new ones have arisen as a result of all this stress. Each day is worse 


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than the one before, with no hope in sight for any type of relief. I don’t know how 

I am going to survive without some miracle like winning the lottery. My ‘‘American 

Dream’’ will never be realized. I have now been forced to live the ‘‘American Nightmare’’ for the rest of my days, because I happened to get sick, and file a claim for 

Social Security Disability benefits, a Federal insurance policy that I was forced to 

pay into for over 30 years. I am now doomed to live in poverty for the rest of my 

life, in addition to all my medical concerns. I will never be able to own a home, or 

get another car. My current vehicle which is on death’s door, is the ONLY method 

of transportation I have for survival. When things break down now, I cannot fix 

them and have to do without. I struggle every day to pay for food, medicines, 

healthcare, gas etc. having to decide which things I can do without till the next 

check comes, since I live strictly on the inadequate, monthly SSDI check I receive, 

always teetering on the brink of disaster. I did not ask for this fate and would trade 

places with a healthy person in a minute. 

As a result of that horrible experience, I thought it was extremely important to 

watch the hearing that you held on this issue that affects the very lives of millions 

of this nation’s most vulnerable citizens. I would not wish this hell on anyone, and 

I did nothing wrong to deserve it, I just happened to get sick in America. I was 

forced to pay for an insurance policy out of my paycheck every week, and when I 

needed that benefit the most, the Federal Government tried to prevent me from getting it. Even more sad than my situation, are the ones who have died while waiting 

to get their benefits approved. 

During 2006 and 2007, at least 16,000 people fighting for Social Security 

Disability benefits died while awaiting a decision (CBS News Report—Disabled And Waiting—1/14/08). This is almost more than 4 times the number 

of Americans killed in the Iraq war since it began. 

During 2007, two-thirds of all applicants that were denied—nearly a million people—simply gave up after being turned down the first time (CBS News Report— 

Failing The Disabled—1/15/08). 

PLEASE NOTE—I personally was the source behind these CBS News reports and 

was featured in the broadcast of ‘‘Disabled And Waiting.’’ 

Something is seriously wrong, when even one person in this country should have 

to be put through this nightmare. You may think I am bitter but nothing could be 

further from the truth. I believe everything happens for a reason, and I learned a 

lot from this experience. I want to turn it into something positive, and use this 

knowledge I have gained to make sure that nobody else suffers again, when they 

need help from the SSA. In fact, in order to do that more effectively, I actually 

reached out to the SSA, in spite of my bad experience, and have met some wonderful people there as a result, who are in fact very dedicated and hard working individuals. I am forever grateful for their concern for our problems, but we need many 

more of them. I testify today, not to get your pity, but so you can get an accurate 

picture of what is really happening to the most vulnerable citizens of this nation. 

I want to illustrate how decades of neglect, lack of oversight, and under funding of 

the Social Security Administration’s Disability program, has a very negative impact 

on the lives of disabled Americans such as myself whom you were elected to serve 

and protect. Therefore, I must ask: When are you going to stop this abuse? 

Call For Open Congressional/SSA Disability Hearings 

I have been following these hearings, for over five years now, and I find it deeply 

disturbing, and glaringly obvious, that not one panelist/witness selected to appear, 

is an actual disabled American who has tried to get Social Security Disability benefits, and who has experienced this nightmare for themselves. Unfortunately this 

continues to be the case with this hearing as well. While the witnesses you continually rely on may be very reputable in their fields, unless you have personally tried 

to file a claim for Social Security Disability, you cannot begin to understand how 

bad this situation really is, and therefore the panelists you continue to rely on are 

not fully qualified to be the only authority on these issues. 

I was forced to watch this hearing on the internet, because my repeated requests 

over the last several years to testify in person, have been blatantly ignored. I have 

made it very clear in previous written testimony submitted for the hearing record, 

through faxes, e-mails and phone calls, to all the Congresspeople in my district, others on this Subcommittee, and many others in both the House and the Senate Committees that affect the Social Security Disability Program in any way, that I want 

to testify in person at these important hearings that directly affect me and others 

like myself. As an actual disabled American, I again make the same request today, 

as I have in the past, that in future Congressional hearings on these matters, that 

I be allowed to actively participate instead of being forced to always submit testiVerDate Nov 24 2008 03:34 Jan 25, 2012 Jkt 063016 PO 00000 Frm 00212 Fmt 6633 Sfmt 6621 I:\WAYS\OUT\63016.XXX GPO1 PsN: 63016

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mony in writing, after the main hearing takes place. For some reason beyond my 

comprehension, you still will not let me do that. 

I often question whether anybody even bothers to read the written testimony that 

is submitted when I see the continued lack of results after previous hearings. I am 

more than willing to risk my very life for the opportunity to testify, should I be permitted to do so, since I believe so strongly in the importance of this program. In 

fact, I ask that you call another hearing, and allow me to be the sole witness, since 

the eye opening information I have to share with you would fill the entire 1- 2 

hours, since this program is so badly broken, and filled with corruption at every 

level. I have also come up with solutions to all the problems as well, which I would 

also be discussing at that time. I want a major role in the Social Security Disability 

reformation process, since any changes that occur have a direct major impact on my 

own well being, and that of millions of other disabled Americans just like me. I also 

propose that Congress immediately set up a task force made up of SSDI claimants, 

such as myself, who have actually gone through the claims process, that has major 

input and influence before any final decisions/changes/laws are instituted by the 

SSA Commissioner or members of Congress. This is absolutely necessary, since nobody knows better about the flaws in the system and possible solutions to those 

problems, then those who are forced to go through it and deal with the consequences 

when it does not function properly. 

As a result of my repeatedly denied requests to testify, it is my opinion, that you 

don’t want to know what is REALLY going on. Since my last written testimony I 

have released a video on the internet called: 

American Nightmare—It Can Happen To You! 

I made it to alert the American people to the ugly realities of what it is like to 

try and get the SSDI benefits that they have been forced to pay for, and may never 

survive to actually collect. They need to know how the Federal Government continually breaks its social contract with them on a daily basis. It seems to me that if 

you do not have to face someone such as myself, that has barely lived through this 

horrible nightmare, and has had their whole life permanently devastated as a result 

of continued neglect of this program, we remain just a bunch of SS numbers whose 

lives can be destroyed without guilt. We are in fact, your mothers, fathers, sisters, 

brothers, children, grandparents, friends, neighbors, and honorable veterans who 

have served this country. Something is severely wrong with this picture! 

When you question the SSA Commissioner at these hearings, why have you not 

ordered him to provide the data on how many Americans have actually died each 

year, or have been forced to use state provided services, while waiting for their SS 

Disability claims to be processed? Since the SSA also pays out a one time death benefit to a survivor’s family, and contracts out the medical portion of disability claims 

to the states who provide the Social Service programs that disability applicants 

often need to use, this data should be readily available if you bothered to ask for 

it. These are important questions that need to be answered, but it seems to me you 

don’t care enough about the disabled to ask them. How can you get an accurate handle on this situation without all the facts and appropriate witnesses who wish to 

testify? Who better to give feedback at these hearings than those who are actually 

disabled themselves, and directly affected by the program’s inadequacies! It seems 

you have forgotten that WE are the customers, and the SSA and Congress work to 

serve us. I find it hard to believe that these hearings cannot be scheduled in such 

a way that different and more appropriate witnesses could be allowed to testify. If 

you continue to do the same thing over and over again, as you have for the past 

several years, you will continually get the same poor results, which is exactly what 

is happening. You ask the same questions, of the same people, and wonder why 

there is little to no, improvement between hearings. There is a major piece of the 

puzzle missing—the people you have been elected to serve—and until you really 

commit to getting the ALL the information needed to fix the Social Security Disability program, you are making decisions based on a lack of important information, 

which can be very detrimental, and the problems are going to continue to escalate, 

no matter how much money you put toward fixing them. 

There are five main reasons for the disability hearing backlogs: 

• Lack of communication and educating the public 

• States of denial 

• State and private disability companies forcing claimants to file disability 

claims with SSA or risk losing private coverage 

• Lack of oversight 

• Lack of funding 


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Lack Of Communication Between Claimants, Doctors And SSA, Lack Of 

Education On What Is Needed For A Claimant To Prove A Disability 

Claim 

Currently there is little to no communication between the SSDI claimant and the 

SSA caseworkers handling their claims. More communication is needed and review 

of records by the claimant should be available at any time during all stages of the 

disability determination process. Before a denial is issued at any stage, the applicant should be contacted as to ALL the sources being used to make the judgment. 

It must be accompanied by a detailed report as to why a denial might be imminent, 

who made the determination and a phone number or address where they could be 

contacted. Also many times medical records submitted are lost or totally ignored. 

In case info is missing, or the SSA was given inaccurate information, the applicant can provide the corrected or missing information, before an actual determination at any level is made. This would eliminate many cases from having to advance 

to the hearing or appeals phase. 

Also many times doctors, hospitals etc often do not respond to SSA requests for 

medical information in a timely manner, or sometimes ignore these requests entirely. ALL doctors, and medical professionals including those at the VA should be 

required by Federal or State law, to fill out any medical forms and submit documents requested by the SSA within strict timelines or they will not be allowed to 

practice medicine in this country. Also as part of their continuing education program 

in order to keep their licenses, doctors should also be required to attend seminars 

provided free of charge by the SSA, in proper procedures for writing medical reports 

and filling out forms for Social Security Disability and SSI claimants. 

The major criteria used by the SSA to decide a disability claim, is residual 

functionality and the ‘‘Blue Book Of Listings,’’ yet this is not usually information 

that the general public is privy to when filing a disability claim. In fact it is a pretty 

well kept secret unless you know enough to do some research. In other words since 

the process is so nebulous from beginning to end, the deck is purposely stacked 

against a claimant from the very start. When the average person files a claim they 

seem to think that all they have to do is mention what is wrong with them, get 

their doctors to back up their medical claims, say they are disabled and cannot 

work, fill out a few forms and the checks will start coming in the mail. While in 

a ideal world the process should be that simple, nothing could be further from the 

truth. They do not realize, and are never told, that they must not only list their 

illnesses, but more importantly describe HOW their illnesses prevent them from 

doing work and daily activities. They are not told to list EVERYTHING that is 

wrong with them, and often only file a claim for one condition, that in itself may 

not be disabling, when they have several of them, that in combination, may in fact 

render them totally disabled. Many file claims because they cannot perform the job 

they have been doing for years, or cannot work as many hours that used to before 

they get sick. They do not fully understand that they have to not be able to work 

ANY job in the national economy, and that the SSA does not pay for partial disability. The SSA needs to do a much better job of educating the public at the onset 

of filing a disability claim to avoid confusion. 

States Of Denial—The REAL Reason Behind The Social Security Disability 

Hearing Backlogs 

Since Social Security Disability is a Federal program, where you live should not 

affect your ability to obtain benefits. Sadly this is not the case. While funding is 

a major problem that SSA faces, the other primary reason for these hearing backlogs, continues to be ignored during these proceedings, and that is the initial phase 

of the disability qualification process which is handled by the individual state DDS/ 

Disability Determination Services offices. There, the most crucial part of your disability claim, the medical portion, is reviewed by a caseworker/adjudicator and medical doctor on their staff who never sees you, and in most cases never even communicates with you at all. Too much weight at the initial time of filing, is put on the 

SS caseworker’s opinion of a claim. There needs to be more oversight that disability 

decisions be based with controlling weight given to the claimant’s own treating physicians opinions and medical records in accordance with (DI 24515.004) SSR 96–2p: 

Policy Interpretation Ruling Titles II And XVI: Giving Controlling Weight To Treating Source Medical Opinions. Even though this policy ruling is in place, this is very 

often not happening. 

Excerpts from GAO–09–511T—Further Actions Needed to Address Disability Claims and Service Delivery Challenges—3/24/09: 

Although SSA is responsible for the program, the law calls for initial determinations of disability to be made by state DDS agencies. The work performed 


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at DDS offices is federally financed and carried out under SSA disability program regulations, policies, and guidelines. See 42.U.S.C. § 421(a)(1). 

From September 1998 to January 2006, over 20 percent of disability examiners hired during that period left or were terminated within their first year. 

DDS officials said the loss of experienced staff affects DDS’ ability to process 

disability claims workloads because it generally takes newly hired examiners 

about 2 years to become proficient in their role. 

For example in November 2009: 

• Mississippi had the lowest percentage of approvals at the initial level 

of 24.4% 

• Alaska and Colorado had the lowest percentage of approvals at the 

reconsideration level of 0% 

• Puerto Rico had the highest percentage of approvals at the initial 

level of 61.9% 

• Massachusetts had the highest percentage of approvals at the reconsideration level of 30.5% 

Source: Social Security Administration—November 2009. 

That is a major fluctuation depending on what state you happen to apply for benefits in. Something is extremely wrong with this picture and proves the inconsistency of decision making by the state DDS offices in handing Federal disability 

claims. 

What would be an incentive for states to deny Federal claims? Since many Social 

Security Disability claims are SSI or both SSI/SSDI combined claims and many 

states offer to supplement SSI payments at a higher benefit amount, therefore they 

want to keep as many off the rolls as possible so they do not have to pay out this 

supplement. Also since there is a different pay scale for government vs state employees who are often underpaid, lack training, are overworked, and must meet 

quotas of cases processed, the tendency is greater to rubber stamp denials to move 

claims off their desk when a case needs too much development. Thus the explanation for the fluctuation in denial/approval/backlog rates by state. Unfortunately 

there is very little if any training or oversight on the state DDS offices to make sure 

they are making the proper decisions on disability claims. This is why so many 

claimants appeal to the hearing level where a huge percentage of bad claims decisions are overturned and cases are finally approved. Anyone who doesn’t see that 

a ‘‘Culture Of Denial’’ has become a pervasive part of an SSDI claimants encounter 

with the SSA, is either totally out of touch with reality or is reacting evasively to 

the subject. 

Excerpts from GAO Report GAO–04–656—SSA Disability Decisions: More 

Effort Needed To Assess Consistency of Disability Decisions—Washington— 

July 2004: 

‘‘Each year, about 2.5 million people file claims with SSA for disability benefits . . . About one-third of disability claims denied at the state level were appealed to the hearings level; of these, SSA’s ALJ’s have allowed over one-half, 

with annual allowance rates fluctuating between 58 percent and 72 percent 

since 1985. While it is appropriate that some appealed claims, such as those in 

which a claimant’s impairment has worsened and prohibits work, be allowed 

benefits, representatives from SSA, the Congress, and interest groups have long 

been concerned that the high rate of claims allowed at the hearing level may 

indicate that the decision makers at the two levels are interpreting and applying SSA’s criteria differently. If this is the case, adjudicators at the two levels 

may be making inconsistent decisions that result in similar cases receiving dissimilar decisions.’’ 

‘‘Inconsistency in decisions may create several problems . . . If deserving 

claimants must appeal to the hearings level for benefits, this situation increases 

the burden on claimants, who must wait on average, almost a year for a hearing 

decision and frequently incur extra costs to pay for legal representation . . . 

SSA has good cause to focus on the consistency of decisions between adjudication levels. Incorrect denials at the initial level that are appealed increase both 

the time claimants must wait for decision and the cost of deciding cases. Incorrect denials that are not appealed may leave needy individuals without a financial or medical safety net . . . An appeal adds significantly to costs associated 

with making a decision. According to SSA’s Performance and Accountability Report for fiscal year 2001, the average cost per claim for an initial DDS disability 

decision was about $583, while the average cost per claim of an ALJ decision 

was estimated at $2,157 . . . An appeal also significantly increases the time reVerDate Nov 24 2008 03:34 Jan 25, 2012 Jkt 063016 PO 00000 Frm 00215 Fmt 6633 Sfmt 6621 I:\WAYS\OUT\63016.XXX GPO1 PsN: 63016

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quired to reach a decision. According to SSA’s Performance and Accountability 

Report for fiscal year 2003, the average number of days that claimants waited 

for an initial decision was 97 days, while the number of days they waited for 

an appealed decision was 344 days . . . In addition, claimant lawsuits against 

three state DDS’s have alleged that DDS adjudicators were not following SSA’s 

rulings or other decision making guidance . . . However, according to DDS 

stakeholder groups, SSA has not ensured that states have sufficient resources 

to meet ruling requirements, which they believe may lead to inconsistency in 

decisions among states. Furthermore, SSA’s quality assurance process does not 

help ensure compliance because reviewers of DDS decisions are not required to 

identify and return to the DDS’s cases that are not fully documented in accordance with the rulings. SSA procedures require only that the reviewers return 

cases that have a deficiency that could result in an incorrect decision.’’ 

Excerpts from: Statement For The Record Of The National Association Of 

Disability Examiners—Georgina Huskey, President—Prepared For Subcommittee on Social Security/Subcommittee on Income Security and Family Support Of the Committee on Ways and Means Joint Hearing on Eliminating the Social Security Disability Backlog—March 24, 2009: 

‘‘Even at the DDS level, where few backlogs are publicly reported and where 

the average processing time for an initial claim is nearly 100 days, the stark 

reality is that there are tremendous backlogs pending. Just because disability 

claims have been assigned does not mean they are being worked and disability 

examiners who carry caseloads two, three and even four times the number 

deemed reasonable are, in essence, housing a backlog of claims at their desk. 

Unfortunately, this backlog of claims can lead to mistakes in case development 

and contribute to mistakes in judgment, resulting in the potential for erroneous 

decisions.’’ 

‘‘As experienced staff walk out the door, either due to retirement or because 

of career changing decisions, SSA and the DDSs have struggled in many parts 

of the country to attract the kind of new hires that will keep the Agency at a 

level of competence required in its service delivery. Prior to the recent economic 

downturn, DDSs were reporting an annual attrition rate approaching 15% with 

more than 22% of newly hired disability examiners leaving by the end of their 

first year. The result has been an increasing lack of experienced personnel to 

process increasingly more complex disability claims and forcing the DDSs to utilize limited training funds to continually hire new staff, rather than provide ongoing training for existing staff.’’ 

Furloughs By States Of DDS Workers/Federalizing DDS Workers 

There has been a movement in many states over the past several months to furlough the DDS workers in an effort to ‘‘save money’’ for the states due to their increasing budget problems. What is not often communicated properly to the public 

is that these workers are in fact paid by the Federal Government and not the states. 

Therefore no actual money is saved by these furloughs and the public is harmed 

greatly due to their inability to be able to work. If federal disability claims take 

longer to process, then there becomes a greater need for these claimants to file for 

state services such as Medicaid, food stamps and cash assistance and in fact causes 

the more burden to the states. It amazes me that the state governments continually 

fail to see this connection. 

404.1640 Performance Standards—General 

The following sections provide the procedures and guidelines we use to determine 

whether the State agency is substantially complying with our regulations and other 

written guidelines, including meeting established national performance standards. 

We use performance standards to help assure effective and uniform administration 

of our disability programs and to measure whether the performance of the disability 

determination function by each State agency is acceptable. Also, the standards are 

designed to improve overall State agency performance in the disability determination process and to ensure that benefits are made available to all eligible persons 

in an accurate and efficient manner. We measure the performance of a State agency 

in two areas—processing time and quality of documentation and decisions on claims. 

State agency compliance is also judged by State agency adherence to other program 

requirements. [56 FR 11020, Mar. 14, 1991] 

404.1641 Standards of performance 

(a) General. The performance standards include both a target level of performance 

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resents a level of performance that we and the States will work to attain in the future. The threshold level is the minimum acceptable level of performance. Performance below the threshold level will be the basis for the Commissioner’s taking from 

the State agency partial or complete responsibility for performing the disability determination function. Intermediate State agency goals are designed to help each 

State agency move from its current performance levels to the target levels. 

(b) The target level. The target level is the optimum level of performance. There 

are three targets—one for combined Title II and Title XVI initial performance accuracy, one for Title II initial processing time, and one for Title XVI initial processing 

time. 

(c) The threshold level. The threshold level is the minimum acceptable level of 

performance. There are three thresholds—one for combined Title II and Title XVI 

initial performance accuracy, one for Title II initial processing time, and one for 

Title XVI initial processing time. 

(d) Intermediate goals. Intermediate goals are levels of performance between the 

threshold levels and the target levels established by our appropriate Regional Commissioner after negotiation with each State agency. The intermediate goals are designed to help the State agencies reach the target levels. Failure to meet these goals 

is not a cause for considering the State agency to be substantially failing to comply 

with the performance standards. However, failure to meet the intermediate goals 

may result in consultation and an offer of optional performance support depending 

on the availability of our resources. [46 FR 29204, May 29, 1981, as amended at 

56 FR 11020, Mar. 14, 1991; 62 FR 38452, July 18, 1997] 

404.1642 Processing time standards 

(a) General. Title II processing time refers to the average number of days, including Saturdays, Sundays, and holidays, it takes a State agency to process an initial 

disability claim from the day the case folder is received in the State agency until 

the day it is released to us by the State agency. Title XVI processing time refers 

to the average number of days, including Saturdays, Sundays, and holidays, from 

the day of receipt of the initial disability claim in the State agency until systems 

input of a presumptive disability decision or the day the case folder is released to 

us by the State agency, whichever is earlier. 

(b) Target levels. The processing time target levels are: 

(1) 37 days for Title II initial claims. 

(2) 43 days for Title XVI initial claims. 

(c) Threshold levels. The processing time threshold levels are: 

(1) 49.5 days for Title II initial claims. 

(2) 57.9 days for Title XVI initial claims. [46 FR 29204, May 29, 1981, as 

amended at 56 FR 11020, Mar. 14, 1991] 

404.1643 Performance accuracy standard 

(a) General. Performance accuracy refers to the percentage of cases that do not 

have to be returned to State agencies for further development or correction of decisions based on evidence in the files and as such represents the reliability of State 

agency adjudication. The definition of performance accuracy includes the measurement of factors that have a potential for affecting a decision, as well as the correctness of the decision. For example, if a particular item of medical evidence should 

have been in the file but was not included, even though its inclusion does not 

change the result in the case, that is a performance error. Performance accuracy, 

therefore, is a higher standard than decisional accuracy. As a result, the percentage 

of correct decisions is significantly higher than what is reflected in the error rate 

established by SSA’s quality assurance system. 

(b) Target level. The State agency initial performance accuracy target level for 

combined Title II and Title XVI cases is 97 percent with a corresponding decision 

accuracy rate of 99 percent. 

(c) Intermediate Goals. These goals will be established annually by SSA’s regional 

commissioner after negotiation with the State and should be used as stepping stones 

to progress towards our targeted level of performance. 

(d) Threshold levels. The State agency initial performance accuracy threshold 

level for combined Title II and Title XVI cases is 90.6 percent. 

404.1650 Action we will take if a State agency does not meet the standards 

If a State agency does not meet two of the three established threshold levels (one 

of which must be performance accuracy) for two or more consecutive calendar quarters, we will notify the State agency in writing that it is not meeting the standards. 

Following our notification, we will provide the State agency appropriate performVerDate Nov 24 2008 03:34 Jan 25, 2012 Jkt 063016 PO 00000 Frm 00217 Fmt 6633 Sfmt 6621 I:\WAYS\OUT\63016.XXX GPO1 PsN: 63016

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ance support described in 404.1660, 404.1661 and 404.1662 for a period of up to 12 

months. [56 FR 11020, Mar. 14, 1991] 

404.1670 Substantial Failure—General 

After a State agency falls below two of three established threshold levels, one 

being performance accuracy, for two consecutive quarters, and after the mandatory 

performance support period, we will give the State agency a 3-month adjustment period. During this 3-month period we will not require the State agency to meet the 

threshold levels. Following the adjustment period, if the State agency again falls 

below two of three threshold levels, one being performance accuracy, in two consecutive quarters during the next 12 months, we will notify the State that we propose 

to find that the State agency has substantially failed to comply with our standards 

and advise it that it may request a hearing on that issue. After giving the State 

notice and an opportunity for a hearing, if it is found that a State agency has substantially failed to make disability determinations consistent with the Act, our regulations or other written guidelines, we will assume partial or complete responsibility 

for performing the disability determination function after we have complied with 

404.1690 and 404.1692. [56 FR 11021, Mar. 14, 1991] 

404.1690 Assumption of Disability Determination function when we make a finding 

of substantial failure 

(a) Notice to State. When we find that substantial failure exists, we will notify 

the State in writing that we will assume responsibility for performing the disability 

determination function from the State agency, whether the assumption will be partial or complete, and the date on which the assumption will be effective. 

(b) Effective date of assumption. The date of any partial or complete assumption 

of the disability determination function from a State agency may not be earlier than 

180 days after our finding of substantial failure, and not before compliance with the 

requirements of 404.1692. 

All phases of disability claims processing should be moved to and handled out of 

the Social Security individual field offices, including the DDS phase which is the 

medical determination phase currently handled by the states, and all hearing 

phases of the disability process. All people who process Social Security disability 

claims should be employees of the Federal Government to ensure accuracy and uniform processing of disability claims under Federal regulations and Social Security 

policies which is currently not the case. If the states are to continue to handle the 

DDS phase of the disability process, then all state employees handling Social Security claims should be required to receive a minimum of 3 months standardized 

training by the Social Security Administration, in SSA policies and Federal regulations governing SSDI/SSI claims processing. If more time and effort were put forth 

to communicate with claimants, and to make the proper decision at the onset, there 

would be no need for all these cases to be appealed to the hearings level in the first 

place. That in itself would be a huge factor in reducing the hearing backlogs, but 

this fact has been greatly ignored. Until you properly devote the time and energy 

to look into and reform this crucial part of the problem, the hearing backlogs will 

continue to grow at an uncontrollable rate, no matter how much money you give 

to the SSA. 

Social Security Disability Program Problems—Contributing Burden Factor on Medicaid/Social Service Programs For States 

There seems to be a relationship, between SSDI claims processing issues/backlogs, 

and the need for claimants to also apply for state funded Medicaid/Social Service 

programs. Many are forced to file for Medicaid, food stamps and cash assistance, 

another horrendous process. For example in New York State, about half the 38,000 

people now waiting on disability appeals, for an average of 21 months, are receiving 

cash assistance from the state (New York Times 12/10/07). Those who file for these 

programs while waiting to get SSDI benefits, in many states, have to pay back the 

state out of their meager benefit checks once approved. As a result they’re often 

kept below the poverty level, almost never able to better themselves since they can’t 

work, and now are forced to rely on both state and federally funded programs instead of just one of them. This practice should be eliminated. 

Regulation Is Necessary To Avoid Improper Social Security Disability Claim Filings 

Due To State And Private Insurance Company Policies 

There is a growing number of claims being filed by people who may not actually 

qualify for disability benefits under Social Security guidelines, but who are being 

forced to file Social Security Disability/SSI claims by their private disability and 

state disability carriers or risk not being eligible for benefits under those programs. 

Recently there has been media coverage on this issue which can be found here: 


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Insurers Faulted As Overloading Social Security—NY Times—Mary 

Williams Walsh—4/1/08 

http://www.nytimes.com/2008/04/01/business/01disabled.html 

Exhibit D—Letter To Senator Charles Grassley From Disability 

Claimant Who Was Required By Private Insurer To File Claim For Social Security Disability Regardless Of Eligibility Or Risk Loss Of Private Disability Insurance Benefits—1/21/09 

http://grassley.senate.gov/private/upload/Exhibit-D.pdf 

Exhibit E—Letter From SSA Commissioner To FTC Chairman Regarding Private Disability Companies Requiring Their Claimants To 

File For Social Security Disability Benefits—11/26/08 

http://grassley.senate.gov/private/upload/Exhibit-E.pdf 

Congress and the SSA needs to look into this issue and this practice needs 

to be stopped immediately as this too greatly adds to the disability backlog 

problem. In this case the claimants should not be penalized but the insurance 

companies should be. 

Lack Of Oversight Which Is Crucial To Resolving The Hearing 

Backlogs 

It is obvious that for decades oversight of SSA practices has been greatly, 

lacking which is one of the major reasons we have the enormous hearing backlog you are dealing with today. At the hearing you asked the Commissioner why 

he was not using the Federal regulations listed above to help the states and 

claimants deal with the furlough issue and he had no good answer. The incredibly high denial rates at the initial and reconsideration levels, are highly suspect, and eventual approval of a majority of these cases at the hearing level 

proves that lack of oversight at these phases contributes to the hearing backlog 

as well. In an editorial letter from SSA Commissioner Astrue dated 8/21/08 to 

the Atlanta Journal Constitution in regards to the severe hearing backlogs it 

was stated that ‘‘We have taken a big step toward resolving that problem by 

bringing onboard 175 additional administrative law judges and additional staff 

to support them.’’ 

In reality: 

At of the end of fiscal year 2007 the amount of ALJ’s available to hear 

cases was at 1006, and at the end of fiscal year 2008 the amount of ALJ’s 

available to hear cases dropped to 960.13. In fiscal year 2009 there were 

in fact only 1056.63 ALJ’s available to hear cases. 

Source: Social Security Administration Reports 

The 175 new ALJ’s that the SSA Commissioner hired has in reality only added 

50 judges over the fiscal year 2007 level. Basically this is still inadequate amount 

of ALJ’s, since it does not account for the fact that more judges may continue to 

leave for various reasons (retirement etc), and that the level of disability claims continues to increase instead of decrease, based on past history. The Commissioner has 

failed to publicly account for this fact, so he makes it sound like there is going to 

be several additional ALJ’s above and beyond previous years, when he is in reality 

replacing judges who are leaving and not actually increasing by any substantial 

amounts, the number of the additional staff he truly needs. Also very often these 

judges have not even been allocated to the areas that have the largest hearing backlogs and there is no oversight on the SSA Commissioner to make sure they go where 

they are needed most. So the likelihood of the claims backlog being resolved with 

this so called ‘‘fix’’ is slim to none. In other words ‘‘this is like putting a band aid 

on a gushing wound.’’ More investigation of this problem by Congress, the Inspector 

General and GAO needs to happen immediately! 

Horrendous Customer Service—Where Is The Oversight? 

In a January 2007 Harris poll designed to evaluate the services provided by 13 

federal agencies, the public rated SSA at the bottom of the public acceptance list 

and it was the only agency that received an overall negative evaluation. SSA Field 

Offices have lost over 2,500 positions since September 2005 and nearly 1,400 positions since September 2006. In 2007 SSA Field Offices saw about 43 million visitors 

a week, and that number is expected to increase by over a million more in 2008. 

Constituents visiting these local Field Offices continue to experience lengthy waiting 

times and the inability to obtain assistance via the telephone. 


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Here is just a small sampling of some of the major problems with the current Social Security Disability program and State Disability (DDS) offices who process the 

initial phase/medical portion of disability claims: 

• Severe under staffing of SSA workers at all levels of the program Claimants 

waiting for weeks or months to get appointments, and hours to be seen by 

caseworkers at Social Security field offices Extraordinary wait times between 

the different phases of the disability claims process • Very little or no communication between caseworkers and claimants throughout the disability claims process before decisions are made. • Employees being rude/insensitive, not returning calls, not willing to provide 

information to claimants or not having the knowledge to do so • Complaints of lost files and in some states, case files being purposely thrown 

in the trash rather than processed properly • Security Breaches—Complaints of having other claimants information improperly filed/mixed in where it doesn’t belong and other even worse breaches • Fraud on the part of DDS/OHA offices, ALJ’s, IME’s—purposely manipulating 

or ignoring information provided to deny claims, or doctors stating that they 

gave medical exams to claimants that they never did. • Claimants being sent to doctors that are not trained properly, or have the 

proper credentials in the medical field for the illnesses which claimants are 

being sent to them for. 

• Complaints of lack of attention/ignoring—medical records provided and claimants concerns by Field Officers, IME doctors and ALJ’s. 

• Employees greatly lacking in knowledge of and in some cases purposely violating Social Security and Federal Regulations (including Freedom of Information Act and SSD Pre-Hearing review process). 

• Claimants cannot get through on the phone to the local SS office or 800 number (trying for hours even days) 

• Claimants getting conflicting/erroneous information depending on whom they 

happen to talk to at Social Security—causing confusion for claimants and in 

some cases major problems including improper payments 

• Proper weight not being given to claimants treating physicians according to 

SSA Federal Regulations when making medical disability determinations on 

claims. 

• Complaints of ALJ’s ‘‘bribing’’ claimants to give up part of their retro pay 

(agreeing to manipulation of disability eligibility dates) or they will not approve their claims 

• Poor/little coordination of information between the different departments and 

phases of the disability process 

• Complaints of backlogs at payment processing centers once claim is approved 

Federal Quality Review process adding even more wait time to claims processing, 

increasing backlogs, no ability to follow up on claim in this phase. 

NOTE: These complaints refer to all phases of the SSDI claims process including 

local field offices, state Disability Determinations offices, CE/IME physicians, Office 

of Hearings and Appeals, the Social Security main office in MD (800 number). 

Improper CE/IME Medical Exams Ordered By Social Security Result In 

Higher Rate Of Denials, Hearings And Appeals 

Too much weight at the initial time of filing, is put on the independent medical 

examiner’s opinion of a claim. CE/IME examiners are paid a fee by Social Security 

for each person they see, so the more claimants they process, the more money they 

make. Often times they are caught saying they performed exams that they in fact 

never performed, make mistakes, or make false, misleading statements about claimants. Many times the DDS offices or ALJ’s are sending claimants to doctors that 

have very limited knowledge of their specific health conditions, who are not specialists, or even the proper type of doctor, to be examining a claimant for the type of 

medical conditions that they have. These doctors have no real idea how a patient’s 

medical problems affect their lives after only a brief visit with them, and yet their 

opinion is given greater authority than a claimant’s own treating physician who sees 

them in a much greater capacity? Something is way out of line with that reasoning, 

yet it happens every day. Even though a claimant’s treating physicians are supposed 

to be given greater weight in decision making, this is often not the case. Whenever 

SSA required medical exams are necessary, they should only be performed by board 

certified independent doctors who are specialists in the disabling condition that a 

claimant has (example—Rheumatologists for autoimmune disorders, Psychologists 

and Psychiatrists for mental disorders). Common sense dictates that these poorly 

executed, and often unnecessary, medical exams result in a waste of time, money 


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and energy, for both the claimants and the SSA, especially when the claimant ends 

up appealing a denial based on these improper SSA ordered examinations. 

Utilize Hearing On The Record/Pre-Hearing Review Option To Reduce 

Backlogs 

More emphasis and support staff need to be devoted to the pre-hearing review 

process which could greatly reduce the current hearing backlog. This would obviously and should require more communication between hearing office staff and 

claimants or their representatives to update case files. Once the files have been updated, many would be able to be decided solely on the records in the file without 

having a full hearing in front of an ALJ. 

Changes/Proper Funding Necessary For SSA To Accomplish It’s Goals And 

Properly Serve Disabled Americans 

I continually hear talk at these hearings about increasing the funding for the 

SSA, and you asking witnesses for answers, on how much the SSA will need to fix 

the current problems, and prevent new ones from arising in the future. One thing 

is said at the hearings, but when push comes to shove to vote for the SSA budget 

money, other programs or projects become higher priority, even though properly 

funding the SSA is literally a matter of life and death for millions of Americans. 

Nothing is more important than the health and well being of the American people, 

and as elected officials it is crucial that you never lose sight of that priority! Still 

I see that the SSA is under funded almost every year, and there is a continued challenge to get the money that the SSA requests. SSA should not have to compete each 

year for funding with the Departments of Labor, HHS and Education which are 

highly publicized and therefore, often more popular programs. All money that is 

taken out of American’s paychecks for Social Security should not be allowed to be 

used for anything else other than to administer the program and pay out benefits 

to the American people. 

As stated in the previous testimony provided by Witlold Skierwczynski—President—National Council Of Social Security Administration Field Operation Locals to 

the House Ways And Means Committee on 4/23/08 it is recommended that: 

Congress should enact off budget legislation including SSA administrative expenses with benefits which are already off budget. Congress should retain appropriations and oversight authority albeit unencumbered by artificial budget 

caps and scoring restrictions. 

Congress should enact legislation requiring the Commissioner to submit the 

SSA appropriation request directly to Congress. 

Congress should support the House Budget Committee recommendation to in- crease the SSA administrative budget by $240 million over the President’s 

budget request. 

Social Security Disability Claimants Face Permanent Devastation And 

Death Resulting From The SSDI Claims Process 

Social Security Disability is an insurance policy which was created to be a safety 

net for millions of disabled Americans, and for many such as myself, it has become 

their only lifeline for survival. Unbearable stress, severe depression and suicidal 

thoughts are very common side effects of the disability claims process. I know this 

not only from my own personal experience, but from thousands of others that have 

contacted me to tell me their horror stories. The abuse and worry that applicants 

are forced to endure, causes even further irreparable damage to their already compromised health, and is totally unacceptable. Due to the total devastation on their 

lives and health as a result of the SSDI claims process, use of the SS Ticket to Work 

program, or any future chance of possibly getting well enough to return to the work 

force, even on a part time basis, becomes totally out of the question. Plus there is 

always the stress of having to deal with the SS Continuing Disability Review Process every few years, where the threat of having your benefits suddenly cut off constantly hangs over your head. 

I must report with great sadness and disgust, that all these hearings have not 

brought about much progress, if any at all, and things continue to worsen by the 

day. In our country you’re required to have auto insurance in order to drive a car, 

you pay for health insurance, life insurance etc. If you filed a claim against any of 

these policies, after making your payments, and the company tried to deny you coverage when you had a legitimate claim, you would be doing whatever it took, even 

suing, to make them honor your policy. Yet the government is denying Americans 

their right to legitimate SSDI benefits everyday and this is an outrage! I continually 

hear you talk about hearing waiting times 200 days vs 600 days, like it was nothing 

but a number. Everyday that a disabled American must wait for their benefits, is 


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a day that their life hangs on by a thread, or worse yet, they do not survive. The 

stress from that alone is enough to kill anyone. Since it has been proven over the 

years that the average American has about two weeks worth of savings, anything 

over a 14 day waiting period in any phase of the SSDI process is totally unacceptable. Cutting hearing wait times down to even 30 days, is nothing to tout as some 

great accomplishment on your part, as it still puts claimants lives in jeopardy. If 

any other private company/organization operated with as poor customer service, and 

processing times that the SSA currently does, subjecting people to hours, days, 

weeks, months, and worse yet years, to get their issues resolved, all employees 

would be fired, and they would be shut down within weeks. Nobody would even attempt to give them their business, yet Americans are held hostage to the SSA since 

they are required to pay for their services out of their wages, and rightfully expect 

to get what they have paid for. This is outrageous when something this serious, and 

a matter of life and death, could be handled in such a poor manner. Common sense 

would also lead you to the conclusion, that there is a strong correlation between the 

crisis that disabled Americans face while trying to get their benefits, and the housing, and economic meltdown this country is in the midst of. I challenge anyone of 

you to try and live for more than two weeks, not relying on your assets (since many 

SSDI applicants lose all their assets while waiting for a decision on their claims), 

with absolutely no income, and see how well you survive. Also keep in mind that 

you are not disabled on top of it, which adds its own challenges to the problem. 

Based on my own experience, and the experiences of thousands of others which have 

been shared with me, and current conditions, I firmly believe that the SSDI/SSI program is structured to be very complicated, confusing, and with as many obstacles 

as possible, in order to discourage and suck the life out of claimants, hoping that 

they ‘‘give up or die’’ trying to get their disability benefits! The statistics at the beginning of this testimony back up my statement: 

Disabled Americans Unite For Reform Of Social Security Disability Insurance 

Program 

The Social Security Disability Coalition, of which I am President/Co-Founder, 

is made up of Social Security Disability claimants and recipients from all over 

the nation. It was born out of the frustration of my own experience, and the 

notion that others may be dealing with that same frustration. I was proven to 

be totally correct beyond my wildest imagination. Our group is a very accurate 

reflection and microcosm of what is happening to millions of Social Security Disability applicants all over this nation. We fill a void that is greatly lacking in 

the SSDI/SSI claims process. While we never represent claimants in their individual cases, we are still able to provide them with much needed support and 

resources to guide them through the nebulous maze that is put in front of them 

when applying for SSDI/SSI benefits. In spite of the fact that the current system is not conducive to case worker, client interaction other than the initial 

claims intake, we continue to encourage claimants to communicate as much as 

possible with the SSA in order to speed up the claims process, making it easier 

on both the SSA caseworkers and the claimants themselves. As a result we are 

seeing claimants getting their cases approved on their own without the need for 

paid attorneys, and when additional assistance is needed we connect them with 

FREE resources to represent them should their cases advance to the hearing 

phase. We also provide them with information on how to access available assistance to help them cope with every aspect of their lives, that may be affected 

by the enormous wait time that it currently takes to process an SSDI/SSI claim. 

This includes how get Medicaid and other State/Federal programs, free/low cost 

healthcare, medicine, food, housing, financial assistance and too many other 

things to mention here. We educate them in the policies and regulations which 

govern the SSDI/SSI process and connects them to the answers for the many 

questions they have about how to access their disability benefits in a timely 

manner, relying heavily on the SSA website to provide this help. If we as disabled Americans, who are not able to work because we are so sick ourselves, 

can come together, using absolutely no money and with very little time or effort 

can accomplish these things, how is it that the SSA which is funded by our taxpayer dollars fails so miserably at this task? 

Social Security Disability Coalition—offering FREE information and support with a focus on SSDI reform. 

http://groups.google.com/group/socialsecuritydisabilitycoalition 

Please visit the Social Security Disability Coalition (ARCHIVE) website, or the Social Security Disability Reform petition website: 


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Archive Of Old Social Security Disability Coalition MSN Group 

Website 

http://ssdcoalitionarchive.multiply.com 

Sign the Social Security Disability Reform Petition—read the horror stories from all over the nation: 

http://www.petitiononline.com/SSDC/petition.html 

At these two sites you will see thousands of stories and over 8000 signatures and 

comments on our petition, from disabled Americans whose lives have been harmed 

by the Social Security Disability program. You cannot leave without seeing the excruciating pain and suffering that these people have been put through, just because 

they happened to become disabled, and went to their government to file a claim for 

disability insurance that they worked so very hard to pay for. 

Fraud/Program Integrity—The Stigma Encountered By Social Security Disability Claimants 

SSDI is not welfare, a hand out, reward, golden parachute or jackpot by any 

means, and most people would be hard pressed to survive on it. Yet, often claimants 

are treated like criminals—viewed as frauds trying to scam the system, and that 

the SSA must ‘‘weed out’’ them out by making it as hard as possible to get benefits. 

Yes, I’m well aware as I write this, that there’s some who’ve abused the system and 

that’s a shame, because it casts a bad light on those who really need this help. The 

percentage of claims that in fact, aren’t legitimate is very miniscule. In March 2009, 

the average monthly Social Security Disability Insurance (SSDI) benefit was only 

$1061.86. Nobody in their right mind would want to go through this process, and 

end up living in poverty on top of their illnesses, if they could in fact work. I have 

heard nothing in these hearings or this hearing today that addresses the fraud on 

the part of the Federal Government used to deny deserving claimants their benefits. 

I have heard nothing about the rubber stamping of denials, the tossing out of claimant files, the security breaches of highly sensitive data, the total disregard of overwhelming evidence by claimants treating physicians, subjecting claimants to unnecessary fraudulent CE/IME exams, and the cases of ALJ’s ‘‘bribing’’ claimants to give 

up years of back benefits or they will not approve them. All these things are criminal at best. Most Americans do not know their rights under the law, that they are 

allowed to get copies of their SSA claim files. If more people exercised this right, 

they would be horrified to know what was happening behind their backs, and the 

true perpetrators of fraud would come to light. in a major way. The SSA currently 

spends way more resources to evaluate cases (Federal Quality Review Process) that 

are approved, more than any that are denied unjustly. 

In closing, in spite of my own horrible experience, I have vowed to do everything 

humanly possible to get total reform of the Social Security Disability program so 

that nobody else will ever have to endure the hell that I have had to. I ask that 

you please: 

Introduce and pass the: Fullerton—Edwards Social Security Disability Reform Act: 

http://groups.google.com/group/socialsecuritydisabilitycoalition/ 

web/fullerton-edwards-social-security-disability-reform-act 

Since my time is quickly running out, I hope you will join me soon in my quest 

to accomplish this final lifetime goal, to make our country a better place for our 

most vulnerable citizens. Thank you for your time and consideration. 

Sincerely, 

Linda Fullerton—President/Co-Founder—Social Security Disability Coalition 

Social Security Disability Nightmare—It Could Happen To You! 

http://www.frontiernet.net/∼lindaf1/SOCIALSECURITYDISABILITYNIGHT 

MARE.html 

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220 

Statement of The Huntington Disease Society of America 

On behalf of the Huntington Disease Society of America (HDSA), thank you to 

Chairman Tanner, Ranking Member Johnson, and distinguished Members of the 

Subcommittee for holding this important hearing and for the opportunity to submit 

written testimony today. 

Filing for Social Security Disability Insurance (SSDI) is a complex, burdensome 

process, especially for those living with a rare disease such as Huntington’s Disease 

(HD). HD is a genetic neurodegenerative disease that causes total physical and 

mental deterioration over a 10 to 25 year period. The disease affects 30,000 Americans, while another 250,000 are at risk of inheriting it from an affected parent. 

Symptoms of HD can include involuntary movement, dementia, obsessive-compulsive behavior, depression, mood swings, inability to concentrate and immobility. 

There is currently no cure for HD, and while medications may temporarily reduce 

the intensity of some symptoms, none halt the progression of the disease. Eventually, every person diagnosed with HD will lose the ability to live independently as 

the disease advances and ultimately claims their life. 

Documenting a disability like HD can be difficult because of the complexity of 

problems that prevent an individual from working. Given the often subtle onset of 

symptoms, it is hard to pinpoint exactly when a person with HD first became disabled. Further, the neurological listings under the Disability Evaluation Under Social Security, (also known as the Blue Book), have not been comprehensively revised 

in more than 20 years. As a result, people with HD who apply for Social Security 

disability benefits experience numerous delays and denials due to the continued use 

of outdated and insufficient medical criteria. 

The symptoms of HD that are absent from the current listing and result in the 

highest incidence of delays and denial of benefits are behavioral and cognitive impairments. These impairments include distortions of mood, and perception. Under 

the current Blue Book listing, HD is referred to as ‘‘Huntington’s Chorea,’’ a name 

that captures the physical impairments typical of the latter stages of the disease 

but fails to recognize the triad of symptoms that include the less profound but 

equally debilitating cognitive and behavioral symptoms now widely accepted as 

characteristic of HD. Since HD affects each individual differently, these declines are 

often more debilitating than motor abnormalities. Despite this fact, the lack of visible dysfunction of motor abnormalities has caused many people affected by HD to 

remain undiagnosed and unable to receive badly needed benefits. A revised definition that captures the complex nature of the disease and its many emotional and 

cognitive manifestations beyond the ‘‘chorea’’ is needed to reduce the number of 

delays and reapplications of genuinely disabled HD individuals. 

In 2004, the SSA began a formal rule-making process to revise the medical criteria for all neurological conditions; a process that has been plagued with ongoing 

delays. According to SSA personnel the proposed final guidelines will be issued no 

sooner than December 2010 with implementation likely to occur in 2012. The primary source of the delay is SSA need to revise the criteria for all neurological conditions.We believe that in order to successfully facilitate HD applicants through the 

disability process, clear and separate guidelines for determining disability due to 

HD are needed. By separating the guidelines for HD from the general neurological 

listings, the unique symptoms of HD will be identified and addressed. The backlog 

of disability claims will be decreased by allowing HD individuals to apply one time 

for disability rather than force them to make multiple applications. 

In furtherance of this goal, Representatives Bob Filner (D) and Brian Bilbray (R) 

of California introduced H.R. 678, the Huntington’s Disease Parity Act of 2009. This 

legislation would direct the SSA to immediately revise the medical criteria for determining disability as a result of HD.It would also eliminate the two year waiting period.Currently, there are 56 Representatives who have cosponsored H.R.678. 

As Congress and SSA look for ways to reduce the growing backlog of disability 

claims, we ask that the Administrator expedite the rule-making process, and update 

the medical criteria and outdated guidelines for HD. Updating the medical criteria 

of HD will support SSA’s efforts to make timely and accurate disability determinations. Further, updating the guidelines would save time, money, resources and emotional energy on the part of the Social Security Administration and the individuals 

and families it serves who suffer the effects of this disease. Thank you again for 

holding this important hearing and for the opportunity to provide Members of the 

Subcommittee with written testimony this afternoon. 

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