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78–671 2013

THIRD IN A HEARING SERIES ON SECURING THE 

FUTURE OF THE SOCIAL SECURITY DISABILITY 

INSURANCE PROGRAM 

HEARING 

BEFORE THE

SUBCOMMITTEE ON SOCIAL SECURITY 

OF THE

COMMITTEE ON WAYS AND MEANS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED TWELFTH CONGRESS 

SECOND SESSION 

MARCH 20, 2012

Serial No. 112–SS14 

Printed for the use of the Committee on Ways and Means 

( 


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COMMITTEE ON WAYS AND MEANS 

DAVE CAMP, Michigan, Chairman 

WALLY HERGER, California 

SAM JOHNSON, Texas 

KEVIN BRADY, Texas 

PAUL RYAN, Wisconsin 

DEVIN NUNES, California 

PATRICK J. TIBERI, Ohio 

GEOFF DAVIS, Kentucky 

DAVID G. REICHERT, Washington 

CHARLES W. BOUSTANY, JR., Louisiana 

PETER J. ROSKAM, Illinois 

JIM GERLACH, Pennsylvania 

TOM PRICE, Georgia 

VERN BUCHANAN, Florida 

ADRIAN SMITH, Nebraska 

AARON SCHOCK, Illinois 

LYNN JENKINS, Kansas 

ERIK PAULSEN, Minnesota 

KENNY MARCHANT, Texas 

RICK BERG, North Dakota 

DIANE BLACK, Tennessee 

TOM REED, New York 

SANDER M. LEVIN, Michigan 

CHARLES B. RANGEL, New York 

FORTNEY PETE STARK, California 

JIM MCDERMOTT, Washington 

JOHN LEWIS, Georgia 

RICHARD E. NEAL, Massachusetts 

XAVIER BECERRA, California 

LLOYD DOGGETT, Texas 

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 

Jennifer Safavian, Staff Director 

Janice Mays, Minority Chief Counsel 

SUBCOMMITTEE ON SOCIAL SECURITY 

SAM JOHNSON, Texas, Chairman 

KEVIN BRADY, Texas 

PATRICK J. TIBERI, Ohio 

AARON SCHOCK, Illinois 

RICK BERG, North Dakota 

ADRIAN SMITH, Nebraska 

KENNY MARCHANT, Texas 

XAVIER BECERRA, California 

LLOYD DOGGETT, Texas 

SHELLEY BERKLEY, Nevada 

FORTNEY PETE STARK, California 


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C O N T E N T S 

Page 

Advisory of March 20, 2012 announcing the hearing ........................................... 2 

WITNESSES 

PANEL 1: 

The Honorable Michael J. Astrue Commissioner, Social Security Administration ................................................................................................................ 6 

PANEL 2: 

Trudy Lyon-Hart Director, Office of Disability Determination Services, 

Vermont Agency of Human Services, on behalf of the National Council 

of Disability Determination Directors ............................................................. 41 

Lisa D. Ekman Senior Policy Advisor, Health & Disability Advocates on 

behalf of the Consortium for Citizens with Disabilities Social Security 

Task Force ......................................................................................................... 53 

Dan Bertoni Director, Education, Workforce, and Income Security Issues, 

U.S. Government Accountability Office .......................................................... 67 

Leighton Chan, M.D. Chief, Rehabilitation Medicine Department, National 

Institutes of Health .......................................................................................... 87 

Nicole Maestas, Ph.D. Senior Economist, RAND Corporation ......................... 100 

SUBMISSIONS FOR THE RECORD 

AFGE, Statement .................................................................................................... 134 

University at Buffalo Law School, Statement ....................................................... 143 

NHCHC, Statement ................................................................................................. 151 

Ruth Kolb, Statement .............................................................................................. 157 

QUESTIONS FOR THE RECORD 

The Honorable Michael J. Astrue ........................................................................... 118 

Trudy Lyon-Hart ...................................................................................................... 122 

Dan Bertoni .............................................................................................................. 125 

Leighton Chan, M.D. ............................................................................................... 129 

Nicole Maestas, Ph.D. ............................................................................................. 131 


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THIRD IN A HEARING SERIES ON SECURING 

THE FUTURE OF THE SOCIAL SECURITY 

DISABILITY INSURANCE PROGRAM 

TUESDAY, MARCH 20, 2012 

U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON WAYS AND MEANS, SUBCOMMITTEE ON SOCIAL SECURITY, Washington, DC. 

The subcommittee met, pursuant to notice, at 10:31 a.m. in Room 

B–318 Longworth House Office Building, the Honorable Sam Johnson [Chairman of the Subcommittee] presiding. 

[The advisory announcing the hearing follows:] 


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HEARING ADVISORY 

FROM THE COMMITTEE ON WAYS AND MEANS 

Chairman Johnson Announces the Third in a 

Hearing Series on Securing the Future of the 

Social Security Disability Insurance Program 

Tuesday, March 20, 2012 

U.S. Congressman Sam Johnson (R–TX), Chairman of the House Committee on Ways and Means Subcommittee on Social Security, today announced a hearing on 

how disability is decided. The hearing will take place on Tuesday, March 20, 2012, in B–318 Rayburn House Office Building, beginning at 10:30 a.m. 

In view of the limited time available to hear witnesses, oral testimony at this hearing will be from invited witnesses only. However, any individual or organization 

not scheduled for an oral appearance may submit a written statement for consideration by the Subcommittee and for inclusion in the printed record of the hearing. 

BACKGROUND: 

The disability insurance program pays benefits to those who have worked in the past but are determined unable to work because of a disability that is expected to 

last more than a year or result in death. The responsibility to make the initial finding on disability was assigned to the State Vocational Rehabilitation Agencies or 

other appropriate State agencies in the Social Security Act Amendments of 1954. 

All 50 states, plus the District of Columbia and Puerto Rico, maintain fully federally-funded agencies, collectively referred to as Disability Determination Services 

(DDSs), which decide initial and continuing eligibility of disability claims. The DDS 

examiner does not see claimants face-to-face and must rely on relevant medical evidence that is provided by the claimant and/or medical sources in deciding whether 

the individual is disabled, as defined by Federal regulation and Social Security Administration (SSA) policies. 

In FY 2011, the DDSs received over 3.3 million initial disability claims, the high- est in the SSA’s history. Examiners completed nearly 3.4 million initial claims, reducing the backlog of pending applications to 759,000, nearly 300,000 fewer claims 

than were pending at the end of FY 2010. The average processing time for initial 

disability claims was 109 days in FY 2011 and is projected to rise slightly in FY 

2012. Over the most recent five-year period for which data is available, the percentage of all applications for disability benefits that were allowed ranged from 36–38 

percent. 

The Social Security Act considers people eligible for benefits when they are unable ‘‘to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment which can be expected to result in death 

or which has lasted or can be expected to last for a continuous period of not less 

than twelve months.’’ The disability has to be so severe as to prevent them from 

doing any ‘‘substantial gainful work which exists in the national economy,’’ whether 

a specific job is available or not. The disability must result from a physical or psychological condition that is ‘‘demonstrable by medically acceptable clinical and laboratory diagnostic techniques.’’ In 2012, the level of earnings that constitutes performing SGA is $1,010 per month for non-blind individuals and $1,690 for blind individuals. 

Most claims are evaluated under a five-step sequential evaluation process. The 

first two steps screen out individuals who are currently working above the SGA 

threshold and applicants whose impairments are not severe. The third step compares the individual’s condition to the ‘‘medical listings’’—a regulatory list of conditions that are considered severe enough to prevent a person from doing any gainful 

activity. If the individual’s condition does not meet or equal the severity of a condition in the medical listings, the examiner proceeds to step four, which is assessing 

the individual’s residual functional capacity (what an individual can do despite his 

or her impairment—including past relevant work). If the individual is found able 

to perform past relevant work, the claim is denied. If not, the examiner must deterVerDate Mar 15 2010 12:59 Mar 19, 2013 Jkt 078671 PO 00000 Frm 00006 Fmt 6633 Sfmt 6621 I:\WAYS\OUT\78671.XXX 78671

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mine at step five whether the individual can undertake other work. State examiners 

rely on medical evidence obtained from the claimant’s health care providers, and can 

also consult with medical experts and may purchase one or more consultative examinations. 

The SSA also has several fast-track procedures for evaluating claims from individuals with a terminal illness, or who have certain especially severe conditions that 

are highly likely to be allowed (called Compassionate Allowances and Quick Disability Determinations). 

In announcing the hearing, Social Security Subcommittee Chairman Sam Johnson 

(R–TX) said, ‘‘Americans with disabilities deserve to get the right decision 

as early as possible, but that’s just not how it currently works. States struggle on the front lines to make sense of the program’s complex rules to decide who gets benefits. At the same time advances in treatment, rehabilitation, and the workplace have created new opportunities for those with disabilities to return to work. Securing the future of the disability insurance 

program should address these challenges and opportunities while keeping 

the process fair for both claimants and taxpayers.’’ 

FOCUS OF THE HEARING: 

The hearing will focus on how disability insurance eligibility decisions are made, 

including the definition of disability and the Federal-State relationship. 

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://waysandmeans.house.gov, select 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, submit all requested information. ATTACH your submission as a Word or WordPerfect document, in compliance with the formatting requirements listed below, by the close 

of business on Tuesday, April 3, 2012. 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 or (202) 225–3625. 

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. 

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 availVerDate Mar 15 2010 12:59 Mar 19, 2013 Jkt 078671 PO 00000 Frm 00007 Fmt 6633 Sfmt 6621 I:\WAYS\OUT\78671.XXX 78671

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ability 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://www.waysandmeans.house.gov

f 

/. 

Chairman JOHNSON. Good morning. 

The hearing will come to order. Good morning and welcome to 

the third hearing in our series on ‘‘Securing the Future of Social 

Security Disability Insurance.’’ 

Today, we will focus on how disability is decided. For more than 

50 years, the Social Security Disability Insurance Program has provided a vital safety net for workers who have worked long and recently enough and who meet the definition of ‘‘disability.’’ 

When Congress created the Disability Insurance Program in 

1956, it defined ‘‘disability’’ as the ‘‘inability of an individual to 

work due to a physical or mental impairment.’’ 

‘‘Qualified impairments’’ are those that are expected to last for 

no less than one year or those expected to result in death. 

Over the years, the Social Security Administration has created 

complex criteria, emphasizing ‘‘complex,’’ and a time consuming 

process that is frustrating to claimants, costly to the taxpayer, and 

frequently raises questions about the consistency, accuracy and 

fairness of this program. 

Our witnesses today will tell us how claimants apply for disability, how the state disability determination agencies, which are 

fully funded by Social Security, decide eligibility. 

As we will hear today, deciding whether someone is eligible for 

benefits is far from easy. 

The examiners supported by medical consultants must analyze 

medical and other evidence and take a series of complicated steps 

to make their decisions. 

In the 1980s, Congress also created requirements relating to the 

opinion of treating doctors, and how pain and other symptoms affect the ability of an individual to work. 

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

It is no surprise then that there are wide variations in outcomes, 

raising questions about whether this program is being administered consistently across the country, and whether claimants are 

being treated fairly. 

Further, Social Security has had an up hill climb for years to 

provide the kind of policy oversight, quality review, and ongoing 

training that massive disability workloads require. 

It has also struggled to stay current with needed updates to the 

list of medical conditions considered severe enough to qualify for 

benefits. 

While this program has served as a vital safety net to millions 

of Americans, the reality is much has changed since 1956. 

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

more productive lives. 


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Legal and social changes have promoted participation by people 

with disabilities into mainstream society, and the nature of work 

has changed significantly, as we have moved from an economy 

largely defined by manual labor to a service and knowledge based 

economy. 

Yet, the ‘‘all or nothing’’ standard of half a century ago is often 

criticized as ‘‘work disincentive,’’ furthering dependence by those 

who might otherwise be able to achieve varying levels of self support. 

As we consider securing the future of this program, we owe it to 

the American public to ensure that the program effectively serves 

the interests of applicants, beneficiaries, and taxpayers. 

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

Mr. BECERRA. Mr. Chairman, thank you very much for calling 

this, the third hearing in our series examining the Social Security 

Disability Insurance System. 

I want to just begin by mentioning that Social Security disability 

is an earned benefit. It is not something that you just get. You 

have to have paid into the system, which means you have to have 

worked and paid into the system, and you must have suffered a 

work ending disability to be able to qualify. 

Even so, the requirements for receiving benefits are very tough. 

You mentioned that. Only the very sickest and most disabled 

Americans qualify. 

The majority of Americans with disabilities do not meet Social 

Security’s strict eligibility standard. To qualify, applicants must 

submit detailed medical and other evidence demonstrating that 

they are either dying or too sick or disabled to work at all, and that 

their condition will last more than a year. 

Moreover, in deciding whether someone cannot work, SSA considers not just an individuals’ previous job or occupation, but 

whether he or she can assume any job in the nation’s economy that 

that individual could do despite the person’s medical condition. 

Individuals who do not meet these criteria are not eligible for 

disability assistance from Social Security. 

Evaluating whether an individual is so sick or disabled that he 

or she cannot work is a difficult task, involving complex evaluations of medical evidence and other factors. 

DI benefits are not generous. A typical worker receives about 

$13,000 a year. Because they are either too sick or too disabled to 

work at all, those benefits translate into a life line for many of 

those Americans and their families. 

We owe it to these Americans to pay their benefits when they 

need them. Let’s remember one in seven beneficiaries of these disability benefits dies within a year of being awarded benefits. 

We owe it to all Americans and workers who pay into the Social 

Security system to safeguard their contributions and pay only benefits to those who meet the strict standard. 

Social Security’s operating budget is lower today than it was in 

2010, because of decisions made in this Congress in what to appropriate and how much to appropriate to the different agencies. 

That, to me, is alarming, at a time when Social Security is increasing its workload because of the economy, because of the numVerDate Mar 15 2010 12:59 Mar 19, 2013 Jkt 078671 PO 00000 Frm 00009 Fmt 6633 Sfmt 6602 I:\WAYS\OUT\78671.XXX 78671

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ber of individuals aging into the system. We are finding that the 

Department’s budget or the Administration’s budget is actually 

shrinking in its ability to meet the needs. 

That, I believe, is distressing. 

As I have said before, I think we owe it to the hundreds of millions of Americans who pay into the system or who receive benefits 

to hold hearings specifically on these critical decisions on budgets 

for the Social Security Administration. 

Americans’ contributions into the Trust Fund are what pay for 

Social Security’s operating expenses. Budget cuts have real consequences now and in the future for Social Security and its recipients. 

Initial disability claims, the topic of this hearing, are a good example. With an aging population and the worst recession since the 

Great Depression, the Social Security Administration receives over 

three million applications for disability benefits a year, an average 

of nearly 13,000 claims a day. 

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

Due to budget cuts, SSA has been operating under a hiring 

freeze, which means there are fewer workers to process claims, assist the public, and safeguard the Trust Fund than there were in 

2011. 

The state DDS offices which evaluate applications have lost more 

than ten percent of their staff compared to last year. This is the 

equivalent of about 2,000 skilled workers, many of whom had years 

of experience. 

As a result, the amount of time it takes to make the decision on 

an application is rising, as is the backlog of people waiting for a 

decision, which is currently about 750,000 disabled individuals. 

Mr. Chairman, this is an important hearing. I believe that we 

must continue to take a close look at how the system operates. We 

have to make sure the benefits are there for those who need them, 

and I am glad that we are holding this in a series of hearings on 

the Social Security Administration, and in this case, on the disability program. 

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

Chairman JOHNSON. Thank you, Mr. Becerra. 

As is customary, any member is welcome to submit a statement 

for the hearing record. 

Chairman JOHNSON. Before we move onto our testimony today, 

I want to remind our witnesses, all of them, to please limit your 

oral statements to five minutes. 

However, without objection, all the written testimony will be 

made part of the hearing record. 

We have two panels today. Seated at the table is our first panel 

witness, the Commissioner of Social Security, Michael Astrue. 

Welcome, Commissioner. You may proceed. 

STATEMENT OF MICHAEL J. ASTRUE, COMMISSIONER, SOCIAL 

SECURITY ADMINISTRATION 

Mr. ASTRUE. Thank you, Mr. Chairman. 


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Chairman Johnson, Ranking Member Becerra, and Members of 

the Subcommittee, thank you for this opportunity to talk about our 

disability programs. 

These programs have become more complex and more people depend on them. Over the past five years, we have improved service 

despite limited resources and the huge influx of new disability 

claims. 

In addition to our core work, we have seen a drastic rise in our 

non-program work. Increasingly, our waiting rooms are filled not 

with people looking for help with retirement or disability, but with 

people needing verifications so they can qualify for Federal, state 

or local programs, or for employment. 

Together, we need to figure out how to keep improving services 

as the population expands and baby boomers age. 

To succeed, we need experienced employees, up to date technology, and streamlined policies. We must make more and smarter 

investments in technology in order to best use our declining resources. 

Toward this goal, we are providing people with convenient online 

options. We are close to testing an uniform case processing system 

for DDSs. 

We are using electronic tools to help us better decide and document cases to improve quality. We are using technology to identify 

more and more cases for fast tracking, and we are moving from pilots to permanent process with health IT, which has the potential 

to make dramatic improvements, both in quality and efficiency. 

These IT investments demonstrate that we understand that we 

can no longer do business as usual. 

Nevertheless, technology alone cannot make disability determinations. The complexity of the disability programs requires 

skilled employees to make those decisions. 

Unfortunately, after two straight years of less funding than we 

had in Fiscal Year 2010, we will have lost 7,000 experienced employees who we cannot afford to replace. 

Rather than spend time on initiatives we cannot fund, we have 

focused on program simplifications. Some of these ideas we have 

implemented on our own. On others, we need your help. With your 

support, we can make other smart changes. 

The President’s Fiscal Year 2013 budget includes a legislative 

proposal, the Work Incentives Simplification Pilot, or WISP, which 

has great potential to encourage persons with disabilities to return 

to work. 

For several years prior to 2009, we received about 2.6 million initial disability claims each year. Since 2009, that level has increased 

dramatically to last year’s nearly 3.3 million disability claims. 

To deal with this sharp increase, we added capacity to our DDSs 

and flexible national resources to help us quickly reallocate additional support to the most stressed states. 

The dedication of our DDS staff and support from our Federal resources has helped us keep pending disability claims considerably 

lower than our original projected levels. 

Furthermore, our average processing time of 104 days, and that 

includes both the field office and the state DDS time, is near a 

record low since we began using that combined measure. 


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Social Security remains a sound investment. We have drastically 

reduced the time claimants wait for a hearing decision. 

In Fiscal Year 2011, we cut the average wait for a hearing below 

one year for the first time since 2003. Wait times are also down 

in field offices and our 800-number. 

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

Moreover, we have increased employee productivity by about four 

percent in each of the last five years. Few if any organizations, 

public or private, have similar accomplishments. 

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

The scope, sensitivity, and complexity of our programs requires 

well-trained people on the front lines and in key support roles. We 

simply cannot continue to lose so many employees and keep up. 

That challenge requires a complicated and ongoing conversation 

with Congress, which is why we are so pleased to participate in today’s hearing. 

Before I conclude, I want to give you also an update on the Social 

Security Death Master File, which I testified about last month. 

After working closely with OMB and interested Federal agencies, 

I am pleased to announce that we have provided the Subcommittee 

with our proposed legislative specifications designed to limit access 

to the Death Master File in order to reduce identity theft. 

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

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

have. 

[The prepared statement of The Honorable Michael J. Astrue follows:] 


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wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.001

HEARING BEFORE 

TIlE COMMITTEE ON WA YS AND MEANS 

SUBCOMMITTEE ON SOCIAL SECURITY 

UNITED STATES HOUSE OF REPRESENTATIVES 

MARCH 20, 2012 

STATEMENT 

OF 

MICHAEL J. ASTRUE 

COMM ISSIONER 

SOCIAL SECURITY ADi\1JNISTRA nON 
10 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.002

ChuimJarl JohnSOn ilrld Me!1lbtrs oflhe Subeommi((.,~; 

Thank you lor Ihis opportunily 10 disc\,ss our disability progral11.~ . Th"Y (Ire a CrllCi(11 pan 

of America's Sllti:ly nel. Through these programs, we provkk vitul support 10 SOll1e of 

lhe mo, t vulnernblc members of our socicl)'. roda)'. 1 will di~u,;s hOI\" lhe ddinilion of 

disabilily 113s ~hallgl'd over lillIe. how I\e cvaluule disability claims. lhe rule State 

:Igcncies play in the disabilil)' claims process, and a IcgislatJ"e proposol in the I'rC$idCIlI'S 

current budgel request Ihm would l\.'Store SOclul Security Disahility Insurance lSSDI) 

dcmonstrnlion authorily lUld ioitiate a pilot project 10 simplify relullllo work rules. 

(nlrncillel;nn 

Under ti}e Social Security Act (Act). I\'e administ~r two major rrograms thai provide cash 

bclleiits to ~r!\Ons with disahl ing phys ic~1 :md l11enl~1 di>orders: the SSDI prog.r.lm and 

the Supplemeol3l Security Income (SSI) proytull. The SSDI program provides benefits 

to disabled workers and 10 lheir (kpcndcnts and survi\'ors. Worke rs become insured 

under Ihe SSDI progJ~111 basc() 011 contribu!ions to Ih.: Social Security InlSI fUI1()s through 

la:l:es on lhe ir wages and self·employment inoome. Umkr the Acl, mOSI SSDI 

bencfieiarie5 rc.::eive Mcdicare after beillg entitled to cash ben.:fits for 14 months. SSI is 

a !'edewl mcanHestcd program funded by .:nl'f"~1 w:< rc~cnUl'S ()~' igncd to prollitle eush 

:Issistance to ag,ed. blin(). and disabled persons lI'ilh !ittle or no income or resources to 

meet their basic needs for food. clothin)!., llnd shelter. Lust fiscal y.:ar. our progrnms 

provided an average of (loout IS million Il<.,.ncfkiark~ wilh a total ofappro)o:immciy S 175 

billion in bcni:lit paym(>nt!;. 

These programs have grown in both comple ~ity and Ihe number ofpe-opll' I\ho ()qlCnd on 

them. Q,'er the last fil'c years, we have improved the disabil ily process despite the hugc 

innux of new ()isability cluims th,'l husstmined OUf limited resources. We have met new 

progmm 3n() adOlinislrntivc rl'quin:mcnts at minimal ('05110 the llL":payC~. Our owrhload 

is approximUlely 1,5 pereent of all the benefit payment!; tbat \I'C make. During my lime 

~s Commissioner, we have facl-d ,;ellerJI extraordinary service deiive!)' challenges. The 

~ging of the !laby Boomer populatioo alTecll'd us in twO ways: we saw an incn:ase() 

,\orkl03d, and we 10S1 our more expcnene"d cmpjoyL~s to retirement. We have seen an 

incr"'Jsc ill inilial disability el;lims or about :!5 percent during the ecunomic ()owntun1. ' 

f (lr PY 20 13. \IC arc requesting 5 11 .760 billion for our administrutivc c~pcoses, 3 modeSl 

increase rrom rv 2012. I urgc Cungress hl pass this k-vel o f funding bet~~use we have 

pro\'cn Ihat we dcliVl·r. We have dr.u;til'3I1y reduced Ihe time cbimunl~ wait for a hcaring 

de.:i.ion. In FY 2011, wecul tbc 3\·eruge wail bc o\\'on~ y~ar fOrlhe firstlime since 
11 


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Z003. Wait times ""r~ also down in lield offices an() Oil our 800·numbcr. Busy signals on 

our 800-llumber wen: the lowest ever. 'n1«lU£h the hard II orl.- of our l.'"Tllployees :Ind 

Ie>:hnological 3()vaneements, wc hJVC increased employe;.' productivily by an avcrnge of 

about four pereent in each ofthc lasl tiv~ years. Few. if any. orgnni}.alion~ hal'~ 

llcl.Xlmplishcd sim ilar improvcm • .'nls. 

We uchieved these improvcments ~I'l:n as we hDI'e slClldily increased our pmgrom 

inll:gr;lY work as well. Sincc 2007, we haH' doublC"d our Supplcrn~l1lal Security Income 

(SSI) non-dis..'\bilily rCdelCm1in~lions and increased our medical Continuing DiSllbitily 

Reviews (CDRs) by ov\.'( SO [X.'f~ent. nnd we wilt c(lnduct l."\'1.1t more rt:views this fist" .. J 

year. Thc bcnelit5 \Ie SOlV~ through these efforts far out\lcigh th~ir costs. amI IIC h:hc 

sccn II significant increase in SSI payment aecumcy. Thc Adminislrntion strongl)-

supp<)MS the progl1nn intq;rily cap 3djustllll'l1ts antht)ri..:C"d by the Budgct Control Act. 

II hich would pul Social Sceurity on a len-re"r p~lh to eliminatc the b~cklog in program 

intcgrit), rel'icws. The I'n:sident's Budget requests 51 billion for SSA progl1llll integrity ill 

2013 and calls 011 Congress to appropriatc the rell13ining SI40 million in program 

inlegrity funding 3uthoriz.:d undcr the BCA for 20 12_ 

DcSpitc these rcmarkable Outcomes, in FY 201 I and FY 20 I 2, we r('Ccil'cd 

IIppropriatinns thut were niT below whatthc President requ ... stC"d. Although our annual 

appropriation incrcas,'d hctw<,,'n FY 2011 and FY 2011. duc 10 rescissions to our 

infoml31iOll t ... chnology nccount in I'Y 20ll \\c nrc opemtillg with 5400 million Ic;;s than 

we had in rv 2010. Thc In\\"e,.,h~n-f\.--qucsled appropriation. couplC"d Wilh thc IT acct)unl 

rescissions, forc<,s,,~ to nl~ke harJ choice~,;o that we call di.-e.:t our limitCd resoured 10 

our most vitnl sen·ic<,s. 

Our FY 1013 hudg.:t requcst is I~-an. Wc have already curbed lower priority activities so 

that W~ ean COl1tinuc to aclliel'C IWU of our n1l>5t important goals - eliminating the 

hearings b~ckJog anJ focuSing on progmll1 integrity wort.. Whil" we will ~cbie\"e goals 

~s>ociated wilh these priorities. II"C simply t"llnnot do all of the other work we ~re requin:d 

to do. We exp<'\:t to lose over 3,000 employe,",; in FY 20 12 and Ol'er 1.000 morc in FY 

2013, on top o(the more than 4.000 cmployees \\"t 31~ady lost in FY 201 I - a lota\ 105s 

of IIIl1fC th:m 9.000 Social Securit)" ~nd SlUlC Dis:\bilit)" Dctcnninatioll S,'r\"kl"'; 

clllploy<'cs injust three year.!. Whcn I leave of1icc in 2013, the ag~tl~y will ha~e about th~ 

!omnc number of employees thaI we had when I orrivC"d in 2007 even tholl~ our wort. has 

inere3SC"d dramJlically. j{ctir':Ill~!Il and Survivor claims will have incrc3s;;:d Ily over 30 

per.:cnt aud dis:abitity claims" jll h~l'c iner ... ased by ncarl)' 25 percent since thm timc. 

III addition to incn:3scs in our core prugrnm workloads. wc QITcr Ics!iCr-kno\l n but 

imponant scrvico:.s that lead 10 millions (If Americans visiting our field of1iees or calling 

us cach year. For c.'l:mnplc, in I'Y 2011. ,,'c issutd about I million rcpla(><'tHcnt Mcdic;lrc 

cards, and handled nearly I million transactions in aJlllini,lcring: Ihc M~d care low. 

inwme subsidy pT\~J.Il":lOl. Oth~r responsibi litil.'"S ill~lude support ing the Department of 
12 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.004

IlonWland Sccurlly'S pro{;ram 10 ' crily new employee hird, lor which wt handle e~rl y 

I 25,{)()O inquiries each year. In 1bel, if you look al our woiling rooms lod~y. you see very 

fCII' o lder Americans. You do sec younger Americans. often with ehildn:n. waiting for a 

do.::um~nt somc othcr Federal. Slate. or local agency is requiring for nUlhenikaiion 

purposcs. It could be a replacemenl Social SecurilY card or a tx."f1dll vcrifie;!liun: we 

handle about 25 million rt:que ~ts lor these ..tocumcut~ each year. Together. we n~ed to 

figure OUI how to build UfXJll our SUCCL'SseS in lighl ofthcse ehallcl1g~s. 

I>dinilion of Diullilil)' 

For bolh Ihe ssm :m..t 5S1 disability progrdms, Ih~ ACI gen~"f3lly dcJincs disability as h~ 

inability to gag~ in any subSlantial gainful Delivily (SGA) ~ to a phy~ ieal or mental 

impairment Ihat has lasled or is c.xpt'Cled til la$t at l~ast one year or W rI.'suit ill dcath.~ 

Under th is vcry Slriet staudaroJ, a person is disabled only ifhe or she eanno\ \lark due to ~ 

medically dcltTIuinuble irnpaimlem. As the Cornminee 011 ~ys and Me311s lIoled in its 

fl'pon that accomp!lllied the Social St:t"lIri l)' Am(!/1(//IICIIIS of 1956, even 911cr.;on with a 

cvcrc impaimlem cnnnOt receive disability benefits if he or she eRIl cngage in :my SOA. 

Moreover, the A~t docs Ilot pm id ~ shon-Ienn IIr p:U1ial disability benelits. 

Lei rn~ etnphusize that the AeluSl:S 3 specialized definition of disability developed over 

Ihe ycar.s hy Conb'Tess 10 :lddress the staled ml tory purposes of the ssm and .sS) 

progl ams. The Act's definili!)n of disabilily llould nQl ~ $Uilahle ror olhN Fe.kral 

programs with diO"crelll purposc~. Under ssm. insured workers I~ho beeulllc disabled 

rI.-ceil e monthly benefits b.ls<.-d un their p<lst camin!;::!. In contrast. lhe ikl1artment or 

Vetcrons AI13irs ovide~ disability compensation \0 I'elerons bascd on Ihe scI'crity of 

disabilities l\.'Sulting rrom injuries 01" discasl'S incum.-d While (Ill 3l·tivc military scl""icc. or 

were mud~ II'n ~ by active mllitul)' scrvic~: lurthermoTt'. I"ctcrJns may receive b~nellts 

li)r pilttial di511bility. This specialized st;tndard fot Anlt'fieans who have 5llcri ficcd their 

health ror the good of the entire COllntry is appropri~lc for Ihe specific clrcumslmKcs they 

nrc imcndcd 10 Dddress. 

To provitle a more complete undcrst:md.ing of our dctlnilion. I will sketch the hislol') ,)f 

its dcveloplncm. 

! '111. s".·1i!J '''''=''';f)' A",,,"/m<wl .• "1I9'1 <=<,«1 !Iw SSI dls.1bill'j I""wnn' for child .. "" "ndb".[It I 8. ".In ~" 

d.I'o'I;" "M Ji;abilltl """ ,,'M oa...-.l 001 "<"np4nI~l" ",,(:Ii,y"lo on impaimJ • .". ~ "ool,J b< ~i>atoli". r ... "" 

IWI" I, . Tho "",:tMaI ~Jpwujbilil\ "'''' /1'"..* OtIP""l._II\· R""' ."'I"~II"" ,kl of I~ "",.r.d.d In. A<t to."""" " .'<1>"",o4<:fin;'i;m ...... tll<at>iHIy for <~~4n:n ~in.t S~L 19 qUlll lf)' fi .. SSI di»bmly t:>:<><11~ ~ 'hil~ mil" ,,"I· •• 

l·'i....,;,t , .. me",.,1 "",wiH"" ,'''' """,," in ",,,,,,<J ond """'" fW><1~1 IImi""~"". lhi:< _dll;'" ","" h;n .. 

,,,,,,N. "'" ,.,. .'1"'<,."<1 '0 '''''L ... I""" ~"" ) ..... or rnok in <katII. ,\1)' t<:<I''''''''y will r"""" l1li1)' on tht deli.i,ion or d;",biJi'~ for ~DI "on.., .. an.l $SI aolul'" 
13 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.005

Congress first dciined disability in the Social S1,,'wit)' A('/ Am<.'II{/i'W/IIS ()/1951. This 

la\\ applied 10 ..... orkers \\'ho \\'er.:: eilher blind or unable 10 cngt\g~ in SGA beea~ of any 

medically determin:lbl<.l imp:limlenL. \Ihieh could he e:,:~'cLcd to be pcnnanel1!. The lUI\" 

did not pro id<.l cash benefitS to disabled "orkers but inskad prole.;ted tlieir ability to 

f«eivc retirement bcnciits. Retiremcnt bcndits art t.XlmputL'<l bosetl on earnings: 

therefore, a disabled \Iorker with a "period of disability" could hal'e cxpcriencl-d reduccd 

or no relirement IlcncfilS duc to his or her lost earnings. The 1952 amendments 

<.--sLahlishL-d the concept of~ "disability freeze," under which we could exclude a dis;,bled 

"orhr's periods of disability wll'::n calculating his or hcr relir.:men\ hl:nelits. Ilow<.l~.:r. 

as cnacIL-d, the lall' Co..:pired on July I, 1953, and did nOi allow II person to file a claim 

unlil aller June 30, 1953. It was essentially nnn-o perative. 

T\\'o years later, the Sodal Si.'r'lril), Amelldlllem,,· oJ 1954 en:;lli:d the first openuiolln) 

Social Security <lisability progr.un: it instilUl.:d the <lisabiJity freele for workers who met 

the law's d ... tinitioo of disability. fhe 1954 Inw defined disability as blindmss or th ... 

"ilmbility to eaga!; ... in any l.lbJ;t nti31 gainful activity by ri.':lsun of any nll-dicully 

dctemlil1~bli: phys;\;al ur mental impainnen\ "I"ch c~n be e.xpected 10 rcsult in death or 

to be of long-colllinued and indefinite dunltion." Oih.:r than a slight change in the 

dUf'Jlional n'tjuiremcllI, this definition did not diner from Ihe 1952 definition. 

Congn:s.~ established the paym ... nt of cash b<.:ncfits in the Sm:illl Security Ame"dmcl1l" 0/ 

1956. To hi: .:Iigible for cash benefits. the legislntion defin ... d di sa bilit~ to also require 

Ih31 the dnimant hnd 10 hi: between Ihe lll:!es of 50 and 65, complet.:: 0 ('i-month wtliting 

period, and l'ould nO\ qualify on the basis ofblinrlness. Thl' Commine.: on Wlly~ and 

Means rcpont'tl: 

lit jctir.:melll protection for th.: 70 milliOll workers under old-age and 

SU"';l'ors insumnee is incomplete beCIlUse it does nOi now ro~ ide tllo\\cr 

retirement 3gC lor those who aredemonsu'3bly retired by reasons of 3 

pennancnt Dnd IOtal di.;ability:' 

It is impon3JH 10 fl'member that dUling the debale on the 1956 3Jm'ndmcnts, rome 

opponents of this Icgislmion argued thai Cony.:s. had 110 \ properly w;sesscd the futun: 

cost uf pruviding disability bcll ... fits, In fl"Sponse, the legislmion's Uprll n~rs argued thai 

tht very ri C( definition (If dis.lbility and ulher f.::atures o f the n'::w p f'()gF.Im would eltSore 

that it wo uld n:main financiall y sound. 

' 11.11. R.,.. So, tl 8~ O~ ~S .. , .. 'lIl. 
14 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.006

1960qntJ 1970s 

The Soc';,,1 S(','urity Am('mlll/em.,' of 1Y6() removed Ih~ minimum ~ge requirement (SO) for 

reeei"ing disability bt::netilS. Congress then changed the dumlional rC"quirclllent from 

"long-<,:ol1tinucd and inddinitl' duration" 10 "exll1:ct~d to 1;\~1 for ~ continuous period of 

1101 less than 12 ,"ollths" in Ihe S"cia/ Se<'lIri~I ' ht/<'IIc1mr!nI~' uj'196J. 

In the Soda! SecurilY Am,'lIIlm,,"',\' of 1967, COllyCSi adjusted the definition of disability 

10 c larif)' "hcn a person is eon~ider"d unable 1(1 work due!CI impnlmH."nl.' Spcdficall)'. 

Congress supplemcllk'd the definilion of disability to clarify that: 

fA In individuol . , . 5h"11 be dCtemlined 10 be under n di~abilit y only if his 

physical or mental imp;!imlen! ur imp(,irrnl'nlS an: of~uch S~"~rity Ihal he 

is nol only ullable 10 do his pri'~ious work but cannOI. considering his age, 

tducatioll ulld work cxperience, enguge in nny othe r kind ofsubstomial 

W1inful work "hich cJ(ists illlhc nmionall'Conomy, regordless ofwhcther 

sHch W,lrk exists in Ihe imm~'1liatc area ill which he lives, or whelher a 

sp~d ic job I'ueancy exiSIS for hinl, ur whl'\hcr he w{luld he hired ifhe 

applk'1ltor work.J 

III paosing this law, the Icgisl atil'l.' history iudi.'atcs Ih~1 Congn:ss imend~"tllo o~er1um 

j udicial int1.'rprcla(;ons Ihat efT1.'Clivety nmd!' ileaskr for persons to be I' ligi~1c for 

disnbilily bcncJiLs, 

Hounding. Ollllhc legislalive activity oflh1s period. CongreSs rcdllcl"tilhc.wailing period 

from six mOllths \0 fiw months illihe SO<."iul S"';J'fi(I' Amelldmellls of 1971. These 

amcndml'f\lS also cn:atcd Ihe S51 progr~m, IIhiclt us.ed tlte SSDI dl'finili<)n or disabilily. 

Cougr"s~ wC)lIld not again rel'isc Ihe definition ot'db;.abilhy umil 19<)6, 

Between 1989 and 1994, tlw Jlumwr Qr pC{)plc un disability and program ~OSIS increased 

signilic~lfltly. In facl. in 1992 the HOMd ofTmm"e$ prcd ic I~'1l Lhallhe DI Trust fUlld 

would roll out in 1997, and urged prompt legislmive action. 

COlIgTCSS subseql,enlly held a number of hearings from 1993 10 1995 on the disabilityprogrum's risiug costs. Onl' issue diSC\l~scd in thl'SC hearings was the inne(lsing nUlllbcr 

of disability aliowallccS based 00 drug addictiOn or alcoholism (DA&A I. Congfl.'Ss 

initially passed legislation in 1994 to limit benetits 10 bcneficiaries wilh DA&A. 

Howcver, in Ihe Con/mel wilit Am('r;L'O Ad"IJII<"l!rllen/ A"I of 1996, Congress nalTOllcd 

"Ilk: t%1 """","",,,,, .. . 1«, tlIar,g«.1 tho d..-f,n;,"'" ~fbt"'''''''"' If<Jro tn,tr.1 I"; ... al Ituj'l" ui 5'100 '" Ins 10 th<' 

t"",.,,1 ~JMJ i){ ~{II2ilO '" Its> . 

• r~~ . :-t". iH).~ 4~ . ~ tSI(. *t SIa' !1. iltJ8. 

, 
15 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.007

Ihe dctin;liun 6fdisabit;ly I() cl'clude DA&A; a claimanl is nOI considcr\.'d 10 be di~b!ed 

if DA&A is:I contribuling faclor m~tcrialto tile detenninlltion of disability. 

Tilt:" Role of Work Incenti,'cs 

Since cr~ating Ille disability rreeze in 1954, Congress h3S consiS":ntly elopha5iz~d the 

importance ofvocmional rchabili13tion (VR) fur disabled persons. CongrL'"S~ 113S 

established various work illl·cmj\'e .~ III Ilelp disability Iwndiciarie.~ r.?tllm to work. Tlu:se 

\\ork incentivcs allow SSDI and SS I bcndiciarics to e,'nlinlll to recei"e benefits while 

pcrfomling some level of work. HOll evcr. ovcr the yeurs. theS!: work incenlives hal'l' 

been diHicuh 10 admini$ler and dimeo!! for m:nelieiari eS 10 understand. Tney h3ve also 

compliemcd the dcfinili,~n of disability. 

The Suci,,1 Se(:"rily AUU:fld"uml.\· of 1956 ~llowed S51)1 bcndiciarics who lI· ... re 

participating.in a stnk VR progr'JnllO work al SGA for lip 10 one ye3r. This pro,<isioll 

was the forerunner to the tnal \\ork period (TWP), which Cungress uriginally el13eteJ in 

1960 in ord ... r to bro'lden the work inecmil'cs oflcred to disnblcd beneficiaries. The. TWP 

now allows SSDI Illmdiciaries Wtest their nbilil), 10 work tor 9 mOl\ttL~ OVl'r a mtling 6()· 

month period; during Ihe TWP. dis.abilil~ bel1diei~r c.> recc;"c Full SSDI benefils 

regardless of how high thcir cumings migln be. 

In thc SOda! $s!r:llril)' Dis,,!)ilil), Amend",enl.,· a/I<)SIJ, CQI1 ~SS crcHIL-d a 15-month reen1itlement p ... riud. kl1!!wn as thl,' C:l:lended P<'riod uf ctigihitily (Er E), for dis.ubilhy 

bencnciaries who have completed a TWP. Under the EPE, II bcnclkiary may recci,'c 

benefits 3t any lime during Ihe rc-e.ntitlemcnt period when work aClivit)' fnlts beluw the 

SGA level. In 19tH, Congl"CSS sub~ue!!lly c;o;:pandl,-d the EI'E 10 36 months.~ 

For the SSI program, Congress look a di/Terent approach 10 rell1o~ins work disincentivcs, 

It cremcd rule ~ for coumillg income fmm earnings thm were mure Iwnelicial 10 SSt 

disabilily bencficiaries. For cnmple. Ihe Sue/al St'CW-ily Am..,rclmclIIs ofIY?] erc:l1cd 

the Plan 10 A ... hic \·c Selt~Support . This provision allows benelidarics to set aside otlt ... r 

ll1come Or resource~ for a specitieil ¢riod to pursue work gOllls Ihal wilt reduce Iheir 

reliance on beneflls. The Sacinl &.'ll1"il), Disobillty Am<.''lIlm<.'lIIs fli 1980 eliminated SGA 

35 II rcaronlO lenuinme 311 SSt disability beneficiary's benefits. COllgn'55 added !;«liQn 

1619 10 the Act. which provides spt.'<:ialbcnelits 10 SS I di5nbility bellcficiari ... s \\"ho 

pcrfonn SGA.7 

t winnow di5Cuss the ,,·lIy \I t apply Ihe definition of di53bility in order to I!v3h.!ole 

disnbitily daim5. 

· ·110;, ."«o.~.,i<ln """ in lh.: o,.",jb". R<ro>odluNH! ~ k1 "'19$7 (OIlR,j I~ ';I. 

Inj!",II . ",npcr.ll)·p""io"." C'",grn. m"",,;, """',.,,"'" i. ORJM /911 ' , 

• 
16 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.008

Enillsting Oi .. hilil)' Claim. - T hf s.,.'I"cnliBI E .. " lua lion l'rofl"S" 

For oolh disabilily programs, I,e e":lIual':: adull claimanlS und~r a slamJardi~-C<I til,e-Slep 

evaluation PNCCSS (SCqUl'11li31 ~valu:Llion). whiell Wll rOnll3lly iLl\;orporaK .... into our 

ri:i,;ulotions in 1978. AI slep O<le. we dClemline .... hC1her Ihe claimant is ~'I1gaging in SCA. 

SGA is .s i~lificanl work nomlaUy dnnc for pa} or profit. 111c Act c,lablishcs Ihe SGA 

earnings k\'~1 for blind pcl'Slms and requires us w t'St~blish Ihe SGA level rur other 

disabled pcrsons.~ If the claimnnt is engaging in SGA. lie deny Ih" daim wilh"ul 

COltsidcring IIIl'dical fuclOrs. 

If a elJinUlIll is nOI cng:lging in SGA. m step IWO we JS5CSS thecxi sl ~ncc. $everity, und 

dural ion oflhc claim;ulI's impllirmcnl lor cOlnbinalioll of il11painnCnlS). The SlJcil1l 

&cllrif)' DlWlhflj~y B,,";;p/$ Refi"'" Ael of 1984 revised Ihe Ael I" rl-quirv us 10 cC/Ilsidcr 

Ih" ~'ombin"d ciTeel ofull o ra IX'fson'S il11painn<'nls. regardle ss o1"lIhelher any on<' 

impaimli:n1 is sc\'ere ~ Throughout the scquc'11linl e'lulu3lion. wc. consider nil o(thc 

clnimam's physicJI Jnd mental imp'"l.innenlS singly 3nd in combinution.'o 

I r IIC I.klcnnin.: thaI Ihe e laimnnt dots nOI hale a mcdk-Jlly dClcnninabl c impainnent. or 

lhe impaimlclll or combined impainll~IHs nre "nol SCVl'll.'·· (i.e" till,)' d<l nol signilicunlly 

limit Ihe ctaimant's ability 10 p.::rfoml basic worl.: 3etll ilk..,;). II'" deny th" claim al the 

second step. Iflhc imp;linlll111 is u sc l·en• ... we proceed 10 the lhird Slep. 

Lisl;n!! of Impairments 

Al Ihe third ~p, wc JClcnl1inc whether lhe impainl1cnt "mectS·· or "~qu DI "lhc crileria 

of on(' <lf lhc m .. dkaJ LiSling of ImPllinnenlS (LiSlings) ;11 otlr rq:ulalions. 

111c Listin!;.'l describe lur each major bod) system the imp;l;nncnts considl'n:d so 

d<,bililOting Ihat lhey ,,'nold rC"Jsonably pre\'cnl an ndult fNm working. Tht' Act dO<.'s '101 

require the Lislio~~. but \Ie hnl'e been u5in};.them in one fonll or anolher since 1955. 

'nle listed impainncnts arc pcrm;lIlcnt. cXjX'l.itcd IU l"I.--suh in d<,alh, or lasl ror a .~ pccific 

period grc31N Ihan 12 months. 

'", .. Mitld """""' .. ~'" .'If;" """'fI&> Ii,"~ i. "u,,,,,,,ly \ I ,b90 • ,"",,1/1. L'I1"""'I~ . ,.bot di>.abkd P< ........ "'" 

"~;n~ in S(j,\ ,f""'~' urn """" ""'" SI.IIIII . "",.til U, ... h SG,\ ""''''UIIS...., i ...... 'td """ .... 11) '0 ""mIg< "'4" 

81\'''111. II",,", ,"f. "'" Atl ,p«ir.., I~ .......... n''''''''''''''b' ","nl _litho ]IOf'>(oII'~ ntrnill£>. For ."'.",rlo. "" <l«h><' 'mpoi ...... llI.n.·I,o(,-,j "'n .".,.,.><> "bon ... """'i<l<r " .... t..T M r"""'" i. ""RinK ,n Sl.iA 

• 11>,. I. " .... , ("",.td "" \lI~ "'1'«'" "r'he""~I"a1,,," ""'"'"" for t' '''''pl<. " ICOftIl' ..... ilY "~roroN ,1<11 ""i"illl!. 

r.'1~ for, ... oI""""t p:<ln :..d /Ill",," "Y'"ro ....... • Priof 10 1111> I ..... 00< ~" oW<l' f'tQU1n'<J • clllinl211' ,,, ,,",'. III I"",! "'" ,""'"",, imp,11nno. ..... 1'IIus. .. ~ """W 1\0,. dmioJ da'",",,1> ",",!>ad "''' ,,,, fD/jf< """ ...... ,,""' im[lOli,,""""', t.,11 "",...,= .", ... 
17 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.009

Using II1\.' rul~making proc~ss, we rcvisc tile LiSlings' crherio un an ongoing basis. I I 

When up<.l~ in!l a lisling, 1'1: iXmsidcrcum:nlllll-uicalliter:ltur." inlbmlation frwll 

Illedical exp.::rts, disability ~djudiC'J!ot r~edb;«;k, ~nd rescnrch by orguni7.ations sueh as 

the Institute orMcdieine. As we updol£ entire budy syslelllS, II·C al$O make targclCd 

changes to spccinc rules as nec~"SsaJ")'. 

Iflhc clai[l13nl has an '1I1paimltnilhat mcelS or cqllals the criteria in Ille Listings, w':: 

~lIow tile disability cla,m wilhout considering the el:.imant"s uge, ~ducmiun , or pastll'or\; 

c.\pcricnce. 

A, part orour process at 5tCP three, we hal'e del clop~d an im[>Onal11 initiative - our 

Compa~sion~te /l.IIO\I'30ce (CAL) inilimivc - Ihal allows us 10 idenlity chlimants who art' 

clearly disablcd bcc~usc Ibc nalllCC oClhei' disc~sc or condition Clearly mcelS the 

,talUlO')' st:lndard for disability. \Vilh the help ofsophisticmed new infonn:nilm 

technology. wc can quickly id~mify pol,'mial Compassionate AllowuncC5 and Ih,'n 

swillly nmke dccisions. We currently rt:eo ni~e I I ] CAL <:ondilions. ~nd we e.XPCCIIO 

e.xpand the !isl IUlcr this year. We 'Ol1linu(: to review nur CAL ptllky til cn~lIrc il is 

based on th~ mOSI up-llHlat(: medicnl science. 

Residll~1 rUllclioolll c:moc;w 

II Claimant II ho docs nOl meel or equal" liSling may still be di!<abled. The Act rcquin:s 

us to consider hmv it daililanl'S ,'ondition alT~ls his IIr h<:r abilily 10 perronn pri.'vimls 

"ork or, considering his or her age., cducation. and work ~xp.:ricncc, other won that 

1:.,(;,ts in the naliooal cconomy, Conse<luelltly. "e us>ess whal thc claimant eM still 1.10 

despite physi<·lll and mental impainncnts - i.c .• lIe asscss his or hcr residual funetioml 

capacity (RFC). We ust that RFC asseSS1ll<'1lI in the last 1110 steps of the sequential 

evalualion. 

We have d~vcloflCd n rcgulMOf)' frMle\\"ork 10 assess RFC. An RFe osse~Stncnt InUSI 

relkcl a claimant '5 abilily 10 pcrfonn work 3Clil'ily on a regular and continuing basis 

,I.e., cighl hours H day for thc days a week. nr an equivalent won schcdule). We assess 

the claimant·s RFC bast-d on .,l1 orthe evidence in the record. snch a5lrcatm~m history. 

objective medical el·idcncc.. 3nd 3ct;I"lie5 of daily li ving. 

We must also consider th,· credibility of a ci3imanl's subjective complaints, such as pain. 

Such deci lon~ arc inherently cxtremel)" d iOiclIlL Undcr our r~gulation . disability 

adjudic;!tor5 IISC a Iwo-st,'p pnx:css 10 c\"aluntc creiJibility. Firsl. thc adjui.licalor must 

dclemlinc wbether medical signs and labordtory findings show Ihal the claimam h~s a 

medically delerminnble impaimlcntlhm cunld rC3sonnbly be ~xpceted to pnxillec.thc. 

" W. ho ~ at&i.> ",.i>cd "...,. ti>linv to mot1Il101U1~ ""'lui""~mI> . ,·Iot $ocoi,,/ S«:<rhy o",,iJ,/iry &·""pI. R,jW", 

AN", /9!iJ "~II;ml "" Ii> ",,·i .. llw mlma....t..-. Il>c M."",IIJI.",wn <"'<11''1} • 

• 
18 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.010

pain Or ;:)tller symptoms ~ll.:gM. If tile cl;limMt has such an impairmcnt. tile adjudiCatOr 

mustthcn consider:1l1 o f the medical nd non-medical evidence 10 dctemline the 

credibility of the claimant's statemenlS about the intl"1lSity, persistence. and limiting 

effects of symptoms. 111C adjudicator cannot di ~gard the claimant's statements abQut 

his or 11<.1" symptoms simply bcc~use the ubjt'Cti"''' m~-diC"JI"'I idcnce alone docs nllt fully 

5Up[lOI1 theJll. 

The COlll1S have influencl-d our rule s about 3ssessinl:' a claimant's Rl'C. For example. 

"hen we assess the scveri!y o fa claimant's medical condition. \\c historically havc given 

greater weigllt!" the opinion nfthc physician or psycltulogist who tn::l1s th~t claimant 

We fo llowed Ihis [IOticy b~'Cali se a I~ating SOUI"\:~ usually is the moSt knowledgeable 

aOOm his or her patient's medkal condition and is in the beSt position to 3!iSCSS its 

Sl.""verity. While thl' COIll15 generally agre~d tltat adjudicators should gil'C special weight 

to treating souree opi.nions. the COIIl1S filmlulall-d dillerenl rules abQut how djudicators 

sholiid cvalua!e H'Caling source opinion5. In 1991. '1'<.' ss l1~d regulmions Ih~! ill1iculmc 

how wc cv~luatc Ircatil1l! >ourre opinions.l~ II0llcI'cr, the eoul1s hal'c cominul-u 10 

interpret this rule in connictins " ·ays. 

Once we 3Sl;CSS Ihe cl~il1lan t' 5 RFC. lIe move to lh~ fourth step oflhe sc<juential 

evalu3tion. 

Medical· Vocationnll)ccisions ISt~ps 4 and 5) 

Al step four, we considcr" hether th~ d~imanl 's RI'C prevents the clainmnl from 

perfonning any pllSt relel'Ant work. Iftlte claimant can perfonn his or her past re!cvant 

work:, wc dcny the disability claim. 

If the claimant canl1fl1 perform P:1St rcll'v:Ult wort (or if the claimanl did not have any 

past re!cvanl work.,. we movc to the fifth step ofthc sequential ~lualioll. As I will 

discllss bt;:r. we have proposed slightmooifications to this rule to streamlinc the 

adjudication pr()(!css. At stl'p five, we dl,tcnnine WhClhl't" lhe.claimalll. given his or her 

RJT, age, education, nd wOrk cxper t,,~e. cao do ()\her "OTk thai "'<iSIS in Ih~ nalional 

eC''ll{)lllY. [fa claimllnt cannol perroml olher work:. we will find thatlhe cll,inlal1t is 

disabkd. 

We use detailed \,III:3ti011:11 TUIl'S to minimi:te subjcetivity and promote n:ui(lllal 

consistenCy in do:to:nnining "hel~er a c laimanl can p<-'"ftorrn other work that t~isls in Iho: 

l1atiOIUI! CCOlllllll)'. When we ~su~d these rules i111978. we noted thaI the COl1llTliltee on 

" Under ,rw.., "·,,,I.tk>r1 •. ,,,. "ill ;, •• ""I",!ling ".igh, 1<>" .r"" n~ ph"k,,,,,', '""ni"" 1(;1 .. ".II..,uf1l'<"1..,j ") 

",«1 .. ,,11 1>' _l"!"'ib'" 01;0"'31 lind L1boflllDr)· di:lgno<lk 1"'hl\I~"":WId;, "'" """"","""' "iih tll.<lIIl< .... ubi!~1 

.. Ok", ... ill Ill< ",,~d, hi (1101 «1><. a diut>i l;,y adjuoJioalOr "'~,. nduflh 'r •• I"", ,.~",,~'> n><dkal orinio1l ... -pnll .... "r."y ro""ng ho , ... "". " ·,,,,111 1<.0"0 ",ado ;" iIl<'. ___ 'Or ~'" 010<110.1 ",,10"" . 

• 
19 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.011

Way$ lUIII ~kans. in its rcpon ae,·omp.lnyin~ the Stxifl/ .';<'(,·lIril), Alllcndmc/ll.'· of 1967, 

said Ihal: 

II is. and has been, Ihe inlenl oflht Slalule 10 provide a dtlinilion o f 

diSllbility which cun be- applied wilh unifnmliry Qnd consistency IhrougllOUI 

lhe Nalion, without regard to "hen.·:1 panicular individual may n.·side. lo 

local hiring pracliees or employer prefcreneo!$, or 10 the state o fthc local or 

n~linnal ccunomy.1l 

The mcdic:lI'\'QC;)lional rules. set OUI in a series of"pids.." rdate :lse. cducution. and past 

work experience to In,' c1ainmnt's RFC to p"rfOITll work·related physical and mcmal 

aCli viti cs_ D~rcndin g on th ~~ factors, the grid may direcl " S 10 a llow or dcoy a llisa1;lllil)' 

claim. For cases thll1 do not fall squ~rl'ly within a vQCo\ional rule. we uS<' the rules as a 

lr.m1(.·work for decision·making. In Add ition. an adjudicalor may rdy on a voca lion31 

c."I;pcn 10 idenlif), olhcr work thaI a claimam cou ld pcrfoml. 

t nol\' will e.xplaln Iht role Ihal Slale agencicsplay in administering bolh o f (lur disabilily 

progr~ms. 

tli ~9 hilitr Determination Sen'ins 

Our disability process consists o f scveral le\'i'ls ofrcvic" _ Our partners in Ihc Slaic 

~!!~'"flcies playa crucial role in our disability claims process, When we recei"e a disubilily 

ebim. we genernlly )!Cnd the claim to 3 Slmt disability oClcmlinmion !iCrvice (DDS).' I 

We rely u[)On the 54 Stmc DOSs (() develop medical evidcnce and ddermine whcth,'r 

claimams arc disabled or whelher beneficiaries cominue 10 be disabled. We r11l1 y fund 

",hal il costs Ih~: DDSs to make th~ e detenninoti"ns, including lhe salary and bt:nefils of 

DDS personnel. DDS employees are Slate cmployec ~. blll Slates are required 10 follow 

our program rules in II conSiSlenl and uniform manna.'! 111en: is only one nmional 

delinition Ilf disability in th~ SSDI and SSI progmms. DOSs gellcrtdly \l~ e 1\ team 

consisting ofa dis,1bility exaJl\in~'f and 1\ !1K-dical or psycholo!!ic~1 consullam to 

adjudicate claims. 

" ILR. Rop, to-o. S«. 90"'("",1>'1'-'>'" I' s.c.. .. oJ 30. 

" ,\ <I .. ", ... , """ "PIlI) flI<~;"'blli'J """'Ii .. """"", b) ,dopt.._ <1rin~ lidd "lfT<<.- A d.;", • ..."..,.... ,..:;" 

Ontm·;c...O\II o~imanl> tlli11l1',""i, tl~im' b:! l<1cphi.., "'in ~ ~dd "niNo (luri"" th" iIllOn~", th(,~l4im' 

"'Pf<S<n"';I" <xp1Ji ... ,n. <lcll"""", "rdi .. bili" , .. >II "'" diiabilily <M,n, 1""'< ...... .u ,,,",,;' •• , It "'l"ir«( 

"I'~ I .. :.,i9n:; and fi"", •. When d.lnl"m< file ""Ii .... our -')" """ r""r ..... tI • .- d<tinl11'>11 Qf d4o/:li1it' .. \01 on 

'-,cp""", I~ 1 ,.r,1Ie d .in", pr""""" ond • licld Om,," ""'Il~ "" "" ""'" the inl<"" .. ,I"" 'Il< d.im.1Il 1'I""i,,",-

"'! 0 .dp ... <Un: J~;h') odj,ldic .. _ 'f'Ply"", polky ... 'f"""l) .. " II Ic",", ~ W~ """ tho .... ,t I""£u:ogo ;~ all of 

"'" pal;'")' ,.."'ru.;li ..... ,,t. ... ,""',"'"ni<a1;~ ""'pJli,"),lv Ow udj"d~. Wt hoi •• 1011,,,,«1 lhi; rrau;.",.in, ... 

'''' 
20 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.012

Irthe cjaim.)nt i$ dissatisfied "ith tht initial <1i ability ,jeterminatiOn, our regulations 

provide for Ihe fo llowing three levels of ;ldminislr3live review: n reconsi<1':r3tioll by the 

DDS: '~ ;I h~aring before an a<1ministmt;ve law judge: and a ITI/ucstlo r rcvicw by our 

Appeals Coulldl. I rlhe Appeals COUlleil denies the l"t.'qu':51 for revie" (or ifthc Appeals 

Cnuncil gr.lnlS the re411e51 aoJ i;sues a dccisioo).the ch,imanl may ~ppc;lllo Fl'(kral 

Jislril1. court. Allhough il i~ nullh~ focus Qrlhis hearing, Ih,:: appeals pru.:(-ss ii an 

impon3lu pan of the disabilily dClenninmion process and ~n area Ihat we have de"ot.:d n 

great deal ofcnergy and rL"SOUI"CC5 to ol"cr thc paSI f,ve ycal1\. 

History " f thl' Fedcral-St;l!C Rl'I~tilln hi!l 

Our relmi"mship with the I)DSs dn! 1::\' back to 1<)54. At the lime, the m~ s already hnd 

I"l'Spoosibility lo r administering ,", 1I.·a ion~1 rehabilitation pmgr s under the V{H."oliO/wl 

RdmbililUlioll ACI. Congress taskcd Ihe StatC$ \I ilh de!emlining whelher k~rs 

qualified for the disabil ity freeze: il reasoflcd Ihat Ihe t~te s routinely undenouk medica l 

and vocational case devciopmcnt und had well-e t3bli hed relationships "illl medical 

professiona ls through the existing vocational rchnbililmiqll progrmos. We entered into 

lIegotiated agreements wilh Ih~ Stales w administer thc di bi il y freo.c under niteria 

and procedUre!> Ihal we e~tab hcd , When Congress crcnlcd the ssm progl":lm in 1956 

und Ihe SSI disability progmm in 1972. we e.xtcnded IhoSI:" ncgOlin!cd agreements to the 

ncw pmgmms. 

Fllilowing public criti cism of the lack of un;funnity ~nd qllal;ty in State disability 

decisions. Con!;n:ss cnJed our negotiated agreements with Ihe Slates in the Sodol 

Secllrily Di.mbilily AIII!!mllll!!/II.< 1)/ 1980. Under Ih3113\1. C 0I1!,!rt:SS inSleud n:quin:J ihe 

Stal~ to ma);:c Jisability dctcmlinatiOIlS in ac .. ·ordanee w;lh the standards anJ erilena 

conralned in the Act and our rcgulmions. Th~ 19RO Amendments also auth ri cd us to 

issue regul:!liolls c,)I1taining (X'rformance siandards and other "dministrn!ivc 

I"\:quircment~. COl)gress gave each Stall' the option o fluming over the disability 

delenninOlioll funclion 10 us. and Ilulhorized us 10 assume the diAAbility dClenninalion 

runclion of any Stme Ihal Ill' fou nd. aller nOliee and opponunily for a h~uring, w be 

substantially faili.ng to make disabil ity rmi~ati s consistent with our regllliHions and 

other written guidelines. To Ju!e, we hal'e nOI assUilled Ihe disability detemliMtion 

function o f any St3le . 

.. A d;tT"""" >O<IjuJ;" .. .", ,.,.., ,~ .. ".'" "'. ow ... I,·«I ;n Iho in;,iol d .. "' •• ..,., "' .. "" ",i. """""ldc"";",,. II . "'" 

<~"..". t) «)O(\",,\io~ a pru!LO'T'" p<l~«I io , ... .-.to. ih ..... ,!>.".;:.:. "'" d"ai>il~) '·,"miner t(> m""" Ill<- inilj.t 

dii;obi litj <I<,,,,,,,ill>l'o" -Uonc (iJl"e:I<\ nrWQr1<i ~ ",til. medic>! '" 1")·CMk1gi<"t C<>rU<II ,.."j in fOnIO ...". """ 

dimi"""", It.c o\.'Wt1liJcl111 000,,,",," 

" 
21 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.013

Performaoce Stalldard~ and Quality Revicw Initiati"es 

We take our rc;;PQnsibility to be good stcwards oflhe trust fUIlds and taxpaycn;' money 

ICry seriously 3I1d strive to provide the higJ1est quality service possible. We hal'e 

pcrlormaocc standards and l11Uhiplc Ja)ers of quality review IU <:nsure that the DDSs 

uniformly and com:ctly apply our progrJro fUlts. 

Our rules /"\.'quire the DOSs to havc an i11lem~1 quali!y assurance (QA) function. In 

:tddition, our Officc ofQualhy Pcrfomlallce (OQI') conduc1S QA reviews of samples of 

the init;:!I. l"e(ConsidcrJtion. and continuing. disability rel';ew (CDR) determinations or Ihe 

DOSs. Between FY 2007 ~nd FY 2011, OQI' revkwsshowcd thatthc ODSs improvl"ti 

their accuracy across th~ board. The I)I)Ss increa5Cd their initial claims decisional 

accuracy from 93.8 percent to 95.5 percent. They increased their l"l'Considcmlion 

dc6sion~ 1 :tCClJ!1lcy from 91.9 per"cnt 10 95.3 per"cnt. Moreovcr. Ihey increased their 

CDR dl-eisional accuracy from 95.6 percent to 97.7 pertem.!l 

As ~qu ired by the Ael, we periQrm a pre·efl~etuation review ofm 1~3sl 50 pcrCl.'IlI of all 

DDS initial and reconsideration alluwances f(lf SSI)I and SSt disabilhy lor adults, We 

also revie", a sufficient number of DDS CDR detennimuiolls thm eonlinue benefits. 

These pre .. dTcctuDlioll reviews. which arc si:par.l1e from Ihe OQP revie\\s mcmioncd 

ab<wc, alluw us to l·OTTC<:t ClTOn; IW tind before we issllc a final dl'Cisiun. Th~-sc reviews 

result in an L'Slimated $558 million in lifetime progml11 suvings, including SlII'ings 

accn,iug \0 MediC:lre and ~(]icai , BaS«(] (10 our mllst rec<mt data. thl' return un 

investment has been roughJy SII for CICry S I of the total cost ofth.., reviews. II 

To improvc theeonsistcl\l··Y and qualit), of DOS decisions. we cstahlishcd the RC{jucst for 

Progrom CooslIilaliQu (Rl'C) process. The RJ'C process allows DDSs and our'llla1ity 

reviewers to resolve difTerem.'l'S of ('pinion tht'Y have on cnscs thaI 001' has cilt'd us 

deficicm. III gClIcrJI. OOSs usc the process 10 resoll'c Ihe most cOl11plc ~ eascs. Our 

rotiey expens in heodqunncrs thoroughly review thcse eases. We post all RPC 

resolutions and relutl'd duta on our ;nlmnet. Th~ process SI.'1"I't'S severnl ke)' lunclions. It 

pro"ides n:allitC eX~l\Jplcs of proper polic)' appliCation, identifies issues and areas for 

improl'cd dis.1hility policy, and pru\'idcs our regional ofliet'"S Dnd DDSs illformatiollto 

assess loc~1 quality iS$lIes. Sinec 2007. wc have reviewed almost 5.000 cases and PQ5h:d 

their resolulions online. Further. lite RI'C team has worked <Iinx:lly with policy 

cll1npl.lllcnts to develop p!:)lic.y darilicatiulls, tmining, and Qther re.'i()UrCCS thai can rurther 

improve thi: OOnsisti:nc), and quality of disability dcti:m,in3tiulls at all adjudicativc Ic"els. 

17 The P<"'''"' j. ~ upon . SI:II"'i<cJII), "lid "" mple~f o .... ()(.W re\ . It ... n"'''' ''''' l'''fCell' o( "" ... ,,,,j,.,,.-.I "h<NOQ~ "l""-~ "j!h ,1>o.·<I<d, ,,,,, malo b; "'" DDS. 

" ""lail< con to< (OOtid in MOUAt 1I;<p).t<. t Pr«:!Y,"'tu..oo., 1;1.< .-1<"., 01 

h .. n.·/www ...... !!< .. n..; .. lalj .... rl II;.~ ;oU ) O\I.f'lf 
22 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.014

The Act and our regulmions se1 OUt a pro<.;(:s;; l() help a DDS lhal docs nut meCI our 

cxpct'tations. Currently. our threshold level for pttfomlMce 1ICcurncy inlhe DOSs is 

QO.6 percent. When 3 DDS falls below thal lhreshold during a quanef. w~ notify the 

DDS in writing and provide pt.'rfonnanw $uppon. Bnse<i ollal'ailable resourccs. we may 

work with the DDS h) identify the rooll~~use fOf the dmp in quality and 10 prewnt 

another quarter below Ihe threshold. Correcti'e 3ctjOn~ may inelude DDS in·line Md 

cnd-of-linc quoli,y revie'lS and additional tmining. We thcn provide the DDS a thr~ ..... -

momh adjustmcnt pcriQd. We hJve provided optional support to Stmes Ih31lml'c fallcn 

below the accuracy threshold fnr tIl 0 consecutil'e quaners. With our help, those Slales 

improred their accurJt')' rates tl> flIt."..t our threshold level. All DOSs ure cUITClltly 

meeting p.:rfomlancc accurn~ c~pCttations. 

Budget PnK:css 

When \\'e devclop the DDS budget. I'C initially estimate how much funding DDSs 

n:quirc h) do their thr~'C workloads: initial disability claims. n.'Considcrntions, :Uld CDRs. 

We eonsidcr actuarial fix\."Ca$t5 ror inilial disability applicati!,)ns. Adlllinistrnlion and 

eungn:s~ional priorities su~h as plllgrnm integrity). staffing levels, allril;oll rmcs, and 

produClivity. We dClemlil1~ ou~c.~pcclcd case production l,"d desired wOrklo.1d t~rgcts. 

und Ill' decide the nllloum ofre,ources that DDSs need to meet those targets. We 

rQ1mulatc an Allllual Plan in advancc of a li,;cal ycar; "e ask our regional otlic~"S alld 

DDSs to submit their cstimmed runding and cap.1city needs based on :I n~tional estimate 

tilT wot1;I(l3d pro;:c~sing. 

As the appropriations process unfolds, we consmntlycomnlilnicalc with our regionul 

otliel"S and DOSs and adjust the Allllual Plan as IlceeSS:lfy. B:'Sl'<l <m th~ resources that 

Congress appropriatcs, we-adjust our cas<: producll!,)n and workload targcts as nt'CcsSllry. 

Once we dl'lt'Tlllinc the pool of moncy ~\'3iI3blc fi,r DDS w~, we JIlOC'Jtc funding to 

individual DDSs 3ceording to our largcts in the Annual Plan. During the second and 

third quaners ofa iisClLI ycar. we alr.o conduct 3 quancrly spending plan pn.'>Ccss to allow 

the regiOllal L)ffi,'cs and DDSs to update their plans based 011 WL)rkload targets, an}' 

chi\nges in the bLidj:;ct, aod actual DDS spcndi.ng and stalling changes. 

Currcm Challenges and our Rcsponse 

PriOf 10 F'Y 1009. we n:cei\'cd about 2.6 million initial tUsability claims ca~h yeur. Sincc 

2()()9, thnt )c,·cI hOlS incri:ascd drumaticalJy: in FY 20) I. '1C rccCil'td Dearly J.J mililon 

disability claims. We moved nimbly to shift resources into initial clDims in order to help 

the StatcS avert a potential n~w backlug. We hired appro.~;m31cly 2.600 DDS cmployecs 

,n FY 2Q09 and FY :<010; those hires OCC:lmc rully producl;,·C in FY 201 1 

H 
23 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.015

DDS St.ff on Duty (Historical) 

- "".,,--- FYTD WOItIJ "...,....,.1'012. 

' ... '~ C .... ~.~ 1" ----

,- n_ n _ "- n_ n_ n_ n_ n_ N~' n~' 

[n addithm. we dcvc[oped Ilexible n3liorml rc,,;ources to hc!p us quickly direct addilion~1 

suppoon IOlhc mO;;1 ~tro:sSctl DOSs. We created Extended Scrvic~ 1C;1II15 (E.ST~) in four 

DOSs with a hi,lOry "fhigh quality and productil'ity (Ark~nsas. Mississippi. Oklahom~ 

lind Viryinta). lind IYC increased thc cap.leit)' of our Fedeml di,;.ahility units across the 

country. As 1\ n:'Suh. wccomplcwd a rccQrd number orinitia[ claims in FY 1011 and 

rciJllc~'d !lur pcniJing clnims from our historic high in [:y 20 10. The. dl'dicmion of our 

D[)S smITand suppon from he~ nIltiona l reSQUTCes have hc!IJoCd us keep initial disability 

claims si!Y1ifieanll)" below projected spending lel'I.""I •. FllnhemlOfe. as Ihl."" chan belo,,' 

ShQIIS. OIJr 3\'cm!w pl\X"e~sing lime of I 04 days!O dme Ih is yt"ar is ncar a ret"ord low 

sinec wc bcg3n tracking the CUTTent mCIISUn!. Our success duringa time ot'nhruptly 

iocreasing applic31ions is a trihule 10 th~ skill and dtdication oflhe State empillyecs II 110 

handle thc$C eluims. 

Our FY 20[2 fimdin.!! is about $[ billion kss than Ihc Presidcnt's requesl. lloS\!d IIn this 

funding k\"cI, we ~I)l~ 1 u nel loss ofJ.OOO State and Fedct'JI employces Ihis fiscal ycar. 

which is nn tOp of the 4.000 Stale ImiJ F~er:tl e",pl()yce~ \,-.. [OSt !~S( fiscal year. With 

th .. • hiring fn."<:I. .. • in FY 2011 afld only limitcd critie~1 hiriflg in FY 2012. this Icvel of 

pcrform~ncc ",lIl be shon-lil·cd. We projl~( the mnUUIlI or lime it Ulke~ to decidc ~ 

iJi.'il!bility claim will 'ncrc3sc to III days by the end of this fiscal ye~r. Similur to our 

" 
24 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.016

sut~essful str;ltegy for c)imlllatil\J!, the hcarillgs t>ackJog, rcdllcln~ the pr(w.;csslllg time lor 

initial disability claims will r~quire a multi-year appro.1ch. 

'" 

InHlal Disability Claims Average Processing llme 

(FO+OOS+OQB+Transil Time)- Excluding Technical 

Denials (Historical) 

115 - / -----'\ 

'" 

The Blldg/!I C"fllml ACI ,if lll! I (ACA) oUllio.:d a lewl ofprogrnm int.:yity funding that 

11"0uld h,I\"I:' required DOSs. with the help of mlr nllliollal disability resources. to ~olllplete 

569,000 ("DRs in I'Y 1012-- a 65 ~~Cllt increasc m 'cr the I'Y 2011 CDR level in 

addition to a continucd hiJ!,h Ic\'el of initial disability claims. lJnfonunately, Qur FY :W 12 

appropriations did not provide the BCA le\"el offunding ior program inl~'g.ri y work: 

thtreforc. we cao ollly complete 435.000 medical CDRs this year. 

In additi on,,,~ have cl"ulu:lted our cJo;trcmcly limited rl.""SQUrccs, our SllCCL""SS in holding 

down the inilial disabilitY claims P<'oding l(""Vel and 31'erage proce:jsiog lime, and a lunher 

spik.: in hearings reqll~'Sts. As a result, we decid~-d 10 tempor-~rily redircct nur Fcderol 

tlisability urUts. which Il ouJd have helped h~ndlc the [KA level ofCDRs. to help screen 

hettring requests for cases I\here Ih.:y etlll make fully fovoroble decisions without the 

need for a Ill':lring bclb~ an AU. 

funher ~accrbatins the our challenges in handling initial disability claims is the 

decision ofmaoy govcrnors to respond to fiscal crisis by furloughing DDS el1lployc<:s 

whose salaries and beoefits \Ie fully fund. Sine.: O~e~'1nbcr of2008 through February 

2011, DOS furlnughs hal'c resulted in in million io tlelaYl-d bi.'nclits and aoout S l08 
25 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.017

milJion in lost adminislr:lI;"C funding lU Ihe Slates. More iofomlulion on DOS fudoug.l1s 

is o\'oilnble 111 WW\I .sSIl.coI"/fi,rI Qughs. \\Ie cncour.lge you ~nd your constiwtnts 10 visit 

the sile, and we arc happy 10 work wilh you on Ihis issue. 

Despile the many challellges we fatt in IhcODSs. we arc doing ,'oal \II! eanlO makl!ollr 

diS3bilily processes more ellicienl. We have developed fllsh:r and easier CH]line s.:rvices 

10 meCl Ihe Bnhy Boomers' ~pec 3lions ond Keep Po,ce" ilh Ihe high nllmlx.'r ofdisuhilil), 

claims. 

Our e;.sy-to-usc online applk':llion, iClaim, h~s Iwen a huge success. [)is:lbility 

applicants can noll' file for benefits onlille allheir own pace and on Ihcirown schcdllle. 

Meanwhile. Ihe increase in online claims has helpt..-d us 10 dml lI'ilh Ihe additional 

cC'olU)llly-drivcn claims and 10 reduce our fidd office wailin ~ limes. In FY 20Qll. we 

lulled oullhe tirst ph~ ofiClaim. and we immediately saw a si~nilieanl incrcase ,n 

imenlcl ciuinlS as 0 n!sull. Our numbers continue 10 increa;;c. In FY 20 1 I. [11ore Ihan one 

milJion SSOI cl3im~IlIS (33 pc:rcCTlt of the 101al) filed unline, ~Imost qu~drup1ing the 

volume from Ihe year l>eforc iCI~im. For the flrsr 5 months ofFY 2012, 37 percenl of 

SSDI cla;mnnts 1iI<'d online, 

We are conlinuully identifying woys 10 slreamline the disability ctnims·proccss. Over Ihe 

nCA1 scverJI yea~ we will be making signit1eant impron'mcms. We nrc modemizing 

our internet disability QptxalS by streamlining dma coll~"1 on and improving 

lill1ctiunality, Tu make uur ci<"Ctrol1ic rolder complelely ciectronic, we will be!:.;n 

e3p(IIring electronic signatuTCS for medical 3UlhuriJ:ation and allow'"g uscrs tu uploud 

suppor1ing lites dir~ctly into our di .... 'bility S) stems. 

AS we expand and improve Ollr online services, we mUSt provide Ihc DO$s wilh the 1001$ 

they need In quic~ly and ;1C~'uratcly dwide disability ~'3SCS. In addition In Ihe CAL 

inilialive I discussed eaflier. our Quick DiS3bi!ity Oelemlinalion (QDD) USCS;\ complllcrb~scd predictive model in the curlicsi stages oflhe diSllbility process to identify and fastIm"'k claims where a favorab le disability deICnninJlion;$ highly likcty and medic'al 

evidence is rcJdily available. such as low bittJH"cighl oobies, certain canc;,;rs, and endsinge renal disease. We expect Ihat our <'nhunccm~'TI s 10 QDD and CAL will allow us 10 

tasl-lrac~ about 165,000 claims for Ihc' most ob"iollsly diS3bled Americans white 

maintaining dCl.'isionnlllCl:umcy. IdentifYing and paying clearly eligible claimnnts early 

in thc disability process benefits iWrsons wilh sevc're disabilities, 'Illd at thc ame time, il 

helps Ollr bac~log reduction erf<lrts. 

The Elcclronic Claims Ansly.sis Tool (cCATJ is II web-based application dl.' igned 10 

a;>sist the exnminer throughout the sequential evaluation proc.:ss. LoCAT helps examiners 

document, :llIaly:«, and udjudic(l[1.' critical asp.:l.'ls or disability claims C<)llsiSlcnl with \Hlr 

policy. ~oCA T uses ~imelljgcl1t"" palhiQg wh~n:by u:;cr·sdt'Cled oplions dNcrmmc Ihe 

subscqul.'nl queslions and guidance preSi:nted. eCA T"s fe.tlures. such as quality checks 
26 


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ami qujck lillks to rclcv~fll referenc,:,., ,lid cxQmincrs ill producin!; ""til-reasoned 

dctcnnin~lions. This doculllclllalioll is pnrticulnrly USl:lul (Of future case review because 

ill'nHbl<:s an ind~Pl"nd~nt fCvicwl."r 1:0 understand the Cx~minl'r'S act;on ~ and cOl1elusioos 

throughoulthe de'clopment and adjudication orthe claim. 

In addilion tv enhancing the docum.:nt&lion. '1u~lily. and consistency of our disability 

decisions, cCA T hilS I,1ccn un extremely uso:fllitraining tool for new cxalninc~ in thc 

DOSs. Training through l<'AT is hdping new c~aminers InOri.' quickly gain prlllici,'nc), 

in handling complicated eHS(:S. We arc currently plUrining for c"cT}' State to 11IIly 

implclllcntloCAT by Scptcmber 30.2012. which is a t!!Smmenlto our partnership witl1the 

DOSs. 

We continur 10 make signifkant pr\lgn:5S in dcvdoping the Disability Case I'ml:cssing 

System (OCI'S). DCPS will ~pl~c,: th~ 54 ditYerent COBOL·based S~ Stems thaI support 

the DDSs with stme-of·thc-art web-based l.:ehnol,)g)'. This systenl will integr'dle case 

analysis tools and he3lth intomlalion technolog:y (health rn. It will allO'" us to 

disscminate policy changes f;lsler, and il will improve eQllsiSlency among the DO$s. II 

\\'ill S:l\'e monty !x:eaus.: e~ch time w~ w~nt or need to modify our system, it will bl:one 

set ofcl1allgcs inStead of 54 very dilTerenl sets or changes. We c.\pcctlhe changes 10 

improve processing timt:S and decisiona l accuracy. We plan 10 bl:gin testing lhe initial 

ven:ion of OCI'S Imer this ycar. W,: beliel'e full OCPS impll'llH:ntutiun wi!! muke it 

easier to implement other important teehnolo~v ehanges to impn:,)\'e Ihi! disability 

pmcl'SS. 

1·le3ith IT Is olle o(lhos,," importanl tcehllology changes because it has the polentialto 

re\"olutionil.c our disability dell"f"ll1intuion process. We rely upon doc IOn:. Itospituls, and 

olhcn: in the heuhhcare field to limdy proyide Ihe medical records thm "'e need; we send 

more than 15 million reqnesls for medical fC(;ords annuslly. This largely paper·bound 

Ilori.:ll)[ld is a ,"ery timc-conS"lllilig PlIrt of the disability d~cision process. As the 

m~dical community moves toward ,:ll"Ctronic health I'\:cord~ we arc mOI'ing to\lards an 

cleclrmtic system o1"ri.-quesling 3nd' tel"<:iving nlt:dical records. With the conSl'01 of Qur 

cI~imant~, we will havc ncar instanlanl"Ous access 10 (heir m~-dica! fCeurds. I (eulth !T 

II ill dramatically improve the speed, ac;:umcy, and efficiency of this process, thll$ 

reducing the COSI of making a "'.<.Ubility decision ((lr the both ml·dica! "ommunity and the 

ta~p:l~er. Once heatth IT becomes mandan:!. our 3ccuraq should improve significantly 

~nd we, nlong with Congress, will W31l! 10 stud), changes 10 Ihe disability process iha! 

build on lhi~ 5ueCl'"SS. 

In utldition 10 parutligm-sl1ifting Ic"ltlnology, streamlining und updatillg our husiness 

processcs will also help us 10 decide: claim~ more quickly "ilhout disadl'3nlaging.thc 

claimant. For example. we allow IIdjudicators 10 proceed to slep li.-" OflhL" sequentinl 

cvaluutinn procL"SS when we have in.SLltliciclIl infonnutiun aoout a claimmu's past 

retel'ant wo-rk history 10 make Ihe iindings n..-quired at Step (Qur. !n certain ~aSl"S, if\le 

" 
27 


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find tllat a ciaima'it is 3blc t6 do other work baSed w lely On his or her age. c\lucation, and 

RrC, we could d~ny thc d~im withollt detem,ining "hether the claimant is able to 

pcrfom, past relcv:lnI work. This changc would promote adlninisu,lliw eflidency and 

help lL~ makc more timdy d;,abilil)' dctcnninntions. 

To make consistent. bc.1ter-inf(>nl'~xI decisions on whether disability claimants 'neel our 

disability criteria, we nre developing a n,-II Oc..:upationnl [nfommtion System to replace 

the Dictionary ofQccupmiQnal Tilles, In FY 2009, we convcned a panel of expens to 

guide us in thc dCI'cloplncnt of the OccupationallnfomlUlion System. In FY 2011. \Ie 

tlel'eloped a rCSI.":lrch and development plan that we will update unnually. and IIC 

completed critical baseline activities 10 ulform the design of the ()(;eupatiun31 

Infommtion System. In FY 2012 through PY 2013, we wi ll design and dell!lop prototype 

ct)mpollents of the Oceup3Iional 111lonnmion Systcm, which II ill lay Ihe groundwork for 

pilotl<:Slingschcdlllcd 10 begin in FY 2014. 

Retllldng the Ilcaring.1 Backlog 

Congress has madl' il eknr thai addressing our h~arings backlog is slil! (lllf 101' priority, 

We have made great sirides in culling Ihe a"cnlge wait for a hearing decisioll from a high 

of ncarly 18 momhs 10 b.::low one year for the first tilH~ since 1003, We haw dr.lsti~-ull y 

n.xlu<'ed the wait lor justice despite receiving a 45 percent incrcaS(: in hel1ring reqLII!$IS 

since FY 2008. In fact. weestimate Ihal \I'C reeehed over onc million more hcarings 

rcqul'SIS than we l'sjl<'ctcd when we itllp!cmC1l1ctl our 2007 hearings hacklog rct!uctiun 

plan, We arc so close to achieving OUf commitmeol to reduce the 1I"eragc \\'3il lor II 

hearing decision to 270 da>s by Ihe ent! ofPY 2013. bUI severe budget CUIS for the last 

two yl':lrs and assudate<J Ihe inability IU hire a ,,'1iei~nt number o f AUs are clmllengio,g 

our pro!;rcS.~. NC\'crthcicss, we 9Te doin!; e\'crything we can to aehievc this commitment 

We are wori;il1g \\ilh Ihe e);pel1S and the Office of I"crsonnel Mam,gcmcnt to address our 

needs 10 identify and hire qualified AUs in Ihe near-Ienn as well as me long-term to help 

meet our cOlllmitment. 

ssm Df monslralion AUlhorilV. \\!nrk Inccn1iws Simp.mfalion rilOl 

Our authority 10 inilia!e demonstration projects 10 tl.'Sl chan~!es to the disability program 

rulc.s expired in Deccmber 2005, The I'residcm'S FY 2013 budget includes II legislative 

proposallhat wuuld gil'c li S the (lutl'lority to initi~le new projects ror livc years. which is 

unponanl for generaling aod teSling ncw ideas tur bow to improve the SSDI progr~If1, 

Ooe of the ways IIC would usc Ihis demonstmtioll nUlhority would be to initiate the Work 

tn(,'cnti\'cs Simplificmioo l'ilol (WISP). 

Thc current !let ofwor\( incenlive policics ;I!ld post~ntitlemcl1l proc~'(lurl':S haw bt'Come 

"cry di11icult for the public to under.;taod and for us to ~dmil1ist..:r em.'tti\'ely. The goal 

of WISI' is 10 cont!ul1 u tl'St of simplified SSDI work rules, subject 10 rigorous evolumion 

" 
28 

f 

Chairman JOHNSON. Thank you. I appreciate your testimony. 

As is customary for each round of questions, I will limit my time 

to five minutes and ask my colleagues to also limit their questioning time to five minutes. 

Commissioner, determining whether someone meets or equals 

the medical listings is a critical step in deciding disability. Advances in medical science and treatment are constant. 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.020
29 

I was disappointed to learn from GAO’s testimony that some of 

the listings have been extended repeatedly for the last 19 to 33 

years, without updates. 

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

How in the world could updating these listings take that long? 

Nineteen to 33 years? 

Mr. ASTRUE. Well, it should not, Mr. Chairman. Very early in 

my tenure, I made it a priority to change that long-standing practice in the Agency. 

On my management initiative, not because Congress said so, not 

because OMB said so, not because GAO said so, I set the standard 

for the Agency of trying to be on a five-year cycle going forward, 

in terms of updating our medical regulations. 

I worked in biotech for almost 15 years. I know how important 

it is to have updated medical information. 

I think quite frankly GAO’s comments were a bit unfair. We did 

this on our own initiative. We have updated, if I remember correctly, eight of the 14. We are making very good progress on the 

others. 

We will not in all likelihood quite hit five years, depending on 

when you decide those five years start. It might be five and a half 

years. 

Considering there was catch up, as you yourself pointed out, the 

regulations had not been updated in 33 years, it will be easier and 

faster in the future when you only have to update for three to five 

years of medical advancement, instead of going over 33 years, 

which is what we have been doing. 

We have been trying to do this the right way. We have been trying to do this with a high degree of consensus, with participation 

from NIH, with patient advocacy groups. We have had relatively 

little complaints about this process. 

I think we have done this extremely well from a quality point of 

view. We are doing it extraordinarily quickly by historical standards. I do not really think GAO has anything to complain about at 

all. 

Chairman JOHNSON. Do you have one or two people that look 

at that all the time? 

Mr. ASTRUE. We have a person who does nothing but manage 

the regulatory process, named Paul Kryglik. He is overseen by our 

Deputy for Retirement and Disability Policy, David Rust. We have 

a lot of people working on this. 

Could I do it faster if I had more people? Yes. We are doing the 

best we can with what we have. 

Chairman JOHNSON. In their testimony, GAO says ‘‘Social Security has made several changes that hold promise for needed updates.’’ 

Yet, GAO also raises questions about whether the new process 

will work. What changes are you making and are you sure they 

will work? 

Mr. ASTRUE. Well, if I understand, they have embraced the five 

year goal. That came from me. That comes from my management 

oversight of my people. 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
30 

I think in general they are doing a terrific job. I am not quite 

sure. There was a certain vagueness to the GAO criticism there, so 

I do not really quite frankly understand what it is they are complaining about. 

Chairman JOHNSON. Well, they have to complain. 

[Laughter.] 

Mr. ASTRUE. It is Washington. Silly me. I forgot. 

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

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

According to GAO’s testimony, Social Security decided O*NET 

was not detailed enough and would not be able to withstand legal 

challenges. As a result, Social Security, according to what we know, 

is now developing its own informational system for a cost of $108 

million by 2016. 

Worse, the estimate does not include the cost of implementing or 

maintaining a system, which according to Mr. Bertoni’s testimony, 

could be significant, based on other agencies’ experiences. 

Tell me why Social Security cannot use Labor’s system instead 

of asking taxpayers to pay again to develop a separate system? 

Mr. ASTRUE. Well, quite frankly, the statute does not allow us 

to do it. O*NET does not have the specificity that the statute requires in order to make the individualized determinations that we 

need. 

The Dictionary of Occupational Titles, which was developed in 

1938, was always at best an imperfect fit. It was not designed for 

us. It just happened to be convenient and there was some overlap. 

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

We have brought in outside experts to advise us on this. Except 

for a few consultants who thought they could make money off this, 

no one has looked me in the eye and said Commissioner, you can 

just substitute O*NET for DOT. 

That is simplistic and a simply wrong approach to something 

that is very complicated and important. 

I think this Agency and a lot of Washington has had their heads 

in the sand about our vocational guidelines for a long time. 

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

was doing it. 

I am not going to benefit from this. We have diverted a lot of resources into this, despite all the pressures to deliver in other areas, 

because it is critically important for the long term future of the disability program, just as important as it is to be up to date on medical, it is important to be up to date for vocational, and there is no 

other way to do it than grind it out and do the hard work to do 

it right. 

Chairman JOHNSON. Well, ask Labor to give you some money 

for it then. 

Mr. ASTRUE. Mr. Chairman, I have had this conversation with 

some committee staff, not on this committee. There is a perception 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
31 

that is wrong, that there is this huge pool of untapped resources 

over at Labor. 

Labor decided basically to get out of this business a long time 

ago, even O*NET is done largely by contractors. 

We have tried to work with Labor as best we can. We have invited them into the process. There is this misconception that there 

is this huge untapped pool of expertise at Labor that we are not 

trying to take advantage of. That is simply not true. 

Chairman JOHNSON. I am just worried about the cost. Mr. 

Becerra, would you care to question? 

Mr. BECERRA. Thank you, Mr. Chairman. 

Commissioner, thank you for being here. Thank you, by the way, 

for the work on the DMF, on that file. All those records of deceased 

individuals that have been used by people to invade people’s privacy and steal their identity, the work you are doing, I think, will 

benefit many, many people, and we thank you for that. 

The faster we can get to that, the better. If we can help you as 

you go around to the other departments and agencies to try to 

make sure everyone works under the same standards, so we do not 

have people’s death records being revealed and used by others for 

the wrong reasons, the better off, I think, all of us will be. 

Mr. ASTRUE. It took a little while, but I think the agencies are 

aligned now. We support this proposal. What we need now is the 

Congress to move. 

I would turn it around on you a little bit. We want to help you. 

I think there is bipartisan support, which is a little rare in this city 

right now, for doing something in this area. 

I think it would be a great thing if we could find a way to all 

work together to try to make sure this bill still passes this year. 

Mr. BECERRA. It may surprise you, Commissioner, but I think 

the Chairman would agree with that statement and I would, too, 

that there can be bipartisan support on that particular issue. I 

hope we are able to work with you to make something happen soon 

to protect people’s identity. 

You mentioned earlier that your caseload has increased on the 

disability side. What were the numbers? 

Mr. ASTRUE. It is up to about 3.3 million. 

Mr. BECERRA. As opposed to what? 

Mr. ASTRUE. To 2.6, 2.65 before the recession hit. 

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

Mr. ASTRUE. We are taking in roughly 600,000 to 650,000 more 

cases than what the actuaries were projecting we would have in 

this time period before the recession hit. 

Mr. BECERRA. You were already going to increase because of 

the size of the baby boom population that was going to start working its way into the Social Security system, whether through disability or retirement, but on top of that, with the recession, double 

whammy. 

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

Mr. ASTRUE. Triple whammy. We have a lot more retirement 

applications because desperate older Americans are applying for retirement in higher numbers than we projected. 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
32 

Because we are doing so much verification for other Federal, 

state and local programs, which people are using more because of 

the recession, those workloads have gone up as well. 

Mr. BECERRA. I am looking at your written statement on page 

two where you talked about the budget. You said toward the bottom there of page two, ‘‘Our Fiscal Year 2013 budget request is 

lean.’’ 

You go on to say ‘‘While we will achieve goals associated with 

these priorities, we simply cannot do all of the work we are required to do. We expect to lose over 3,000 employees in Fiscal Year 

2012, the current year, and over 2,000 more in Fiscal Year 2013, 

on top of more than 4,000 employees we already lost in Fiscal Year 

2011, a total loss of more than 9,000 Social Security and state disability determination services employees in just three years.’’ 

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

Your current budget from Congress is about $1 billion lower than 

what you requested, and it is lower than what it was in 2010. 

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

If Congress is short changing your budget, are you able to keep 

up with these caseloads? 

Mr. ASTRUE. The answer is we have done a remarkable job up 

to this point in keeping up, and it is because of simplification, great 

work by the employees, a lot of things. 

We cannot keep this up indefinitely. I want to make sure that 

all of you understand that we are probably four to six months away 

from moving significantly backwards in most of our major service 

metrics. 

Even if we keep up the four percent increase in productivity, 

which is an extraordinary achievement, and I am not sure we can 

do that, but even if we do, it is not going to be enough to compensate for all the people that we are losing so quickly. 

Mr. BECERRA. Longer waits to get your determination on your 

disability, longer waits to be able to apply for retirement benefits, 

longer waits to receive your surviving spouse benefits. 

Probably more mistakes, because we know the longer a case sits, 

the more likely errors will be made in the determinations, so it 

seems like some folks in D.C. are being penny wise but very pound 

foolish when it comes to services that most Americans have paid 

for. 

I hope you will continue to sound the alarm and get us the information that will help us make the right decisions so that we do not 

short change our seniors and all those Americans who paid into the 

system for Social Security, whether disability, retirement, or surviving benefits. 

I thank you, Commissioner, for being here. 

Mr. ASTRUE. Thank you, Mr. Becerra. 

Chairman JOHNSON. Commissioner, I want to just set the 

record straight. This year, Social Security received an increase in 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
33 

its budget despite a 1.5 percent decrease in an overall discretionary 

cap. 

In fact, while Social Security is subject to the same long term domestic spending caps enacted in the Budget Control Act, that same 

bill gave Social Security an additional $11 billion, from 2012 to 

2021, over the budget caps, to increase continuing eligibility reviews in its DI and SSI programs. 

This year’s appropriation bills were supported equally by both 

parties, including the President, the Democrat led Senate, Ranking 

Member Levin and Ranking Member Becerra. 

Even the President’s Fiscal Year 2013 budget requested $753 

million below your request of $12.5 billion. 

The fact is our nation faces a sea of red ink that will break the 

back of our great nation unless we act now to get our fiscal house 

in order. 

The Federal Government has to live within its means, just like 

families do. That means doing more with less. 

Mr. ASTRUE. Mr. Chairman, I understand the fiscal needs, and 

certainly we live with whatever judgments Congress makes. 

Let me be clear, because I am not sure it was clear from your 

statement, our appropriation is smaller two years in a row. We had 

less in 2011 than we did in 2010 and we have less in 2012 than 

we did in 2011. 

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

Mr. ASTRUE. Substantially. 

Mr. BECERRA. Mr. Chairman, since we are out of order, if I 

could just comment as well. 

Chairman JOHNSON. Go ahead. 

Mr. BECERRA. Thank you. I think we also have to remember 

that Congress forced the Social Security Administration to use its 

reserves to try to continue to perform at a higher level. 

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

Mr. ASTRUE. Most of those were rescinded. We used some, but 

the majority of them were rescinded. 

Mr. BECERRA. Congress stripped them away from you. Not only 

are you receiving less money in your budget, but money was taken 

away from you that you would have otherwise have used for good 

purposes. 

Mr. Chairman, let’s be clear. We can try to paint this however 

we wish, and we should do hearings on this particular issue on the 

budget, because Americans have paid for the administration of the 

Social Security programs. 

This is not one of those areas where because we are in fiscal red 

ink that the Social Security Administration should suffer the consequences, because to this point today, Americans through their 

taxes have contributed more to Social Security than they have 

spent. 

Therefore, we should not find that this agency, which does tremendous work for tens of millions of people, should all of a sudden 

have to make cuts to its services because it is getting short 

changed by a Congress for deficit spending unrelated to Social Security. 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
34 

I think it is important, Mr. Chairman, that we continue to do 

these hearings, but as the Commissioner just said, there are consequences. 

Chairman JOHNSON. I believe it is your Administration that 

cut back two percent. 

Mr. BECERRA. We can have those conversations later. Let’s just 

agree on a bipartisan basis that we will not make cuts to Social Security that have no place when Americans have contributed to the 

system to pay for the services and the administration. 

Chairman JOHNSON. Thank you, Mr. Becerra. Mr. Berg, you 

are recognized. 

Mr. BERG. Thank you, Mr. Chairman. 

Moving on to a different area, Commissioner Astrue, I understand the statutory definition of ‘‘disability,’’ Social Security has a 

regulatory framework and listing of impairments considered severe 

enough to prevent an individual from working. 

I have a few questions relating to the medical listings of impairments. First, would you say that these listings rely on objective 

medical findings and are less subjective to the judgment of the 

DDS examiner? 

Mr. ASTRUE. Yes. I think that is generally the notion. If we 

think something is clear enough we can do a listing for it, in other 

words, create a presumption. Invariably, there are at least substantially objective criteria that go into that. I would not want to say 

there is no subjective element, but it is substantially objective. 

Mr. BERG. A higher standard from your point? 

Mr. ASTRUE. Yes, I think that is generally right. 

Mr. BERG. I know you have invested personally a lot of time and 

effort into the development of compassionate allowances. 

Mr. ASTRUE. Yes. 

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

Mr. ASTRUE. It is basically an expansion of the concept. What 

we do is we have gone—the listings historically would only apply 

to fairly common diseases and conditions, and what we found is we 

were making a lot of mistakes in the aggregate, in sort of rare diseases and conditions. 

The notion was on a one time effort, we went through to try to 

identify those diseases and conditions that pretty much by definition make you disabled. 

Now because we are electronic, we have the ability to pull those 

out at the front end and just allow them, which is what we do. I 

think it is about ten days now. 

They are basically an extension of the philosophy of the listings. 

I think the differences are we have moved to much smaller diseases and conditions than what we would historically recognize. 

We have pulled them out electronically in the system, and we 

have set up procedures in the DDS so they are triaged at the front 

end, so it is a very short amount of time for a decision. 

Mr. BERG. You have a more streamlined processing procedure? 

Mr. ASTRUE. Right. 

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

Disease. 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
35 

How do you decide to add a new listing? 

Mr. ASTRUE. Well, what we try to do is we look not only at the 

medical literature in detail, but we try to speak to the patient 

groups. Increasingly, we have a very broad and very productive 

partnership with NIH. 

With Huntington’s, I guess I will jump on one of our announcements, so on April 11, we are going to be announcing that we are 

adding juvenile Huntington’s to the compassionate allowance list. 

That is a first step. 

I have met with a Huntington’s group. I think the dilemma there 

is trying to figure out where to draw the lines. I think we think 

we can do it, but actually, it is one of those rare cases where it is 

harder because of technology. 

Now with genetic tests, where a lot of people are getting diagnosed at a very young age, you cannot give benefits consistent with 

the statute, just with the genetic test that says you have Huntington’s. 

Historically, it took so long to diagnose Woody Guthrie. By the 

time they knew Woody Guthrie had Huntington’s, he was long 

gone, and obviously disabled. 

Now with the new technology, we have to figure out exactly what 

symptoms of people with Huntington’s make them unable to work. 

We have not finished that process, but we are fairly optimistic that 

we are going to be able to do that. 

We have been in contact with both NIH and with the patient 

groups. That is in the neurological listings. My guess is we will 

have an NPRM out on that probably early next year, would be the 

likely schedule. 

Mr. BERG. Thank you, Mr. Chairman. I yield back. 

Chairman JOHNSON. Mr. Marchant, you are recognized. 

Mr. MARCHANT. Thank you, Mr. Chairman. 

Commissioner, last week in our district work period, I spent most 

of my time visiting with senior groups. In the conversation, usually 

in the question and answer section afterwards, in every instance, 

I had a senior that raised their hand that said they knew someone 

or some family that they were confident was receiving disability 

benefits that they felt like that person was defrauding the Social 

Security System. 

In response to that question, I would use your statistic, that 

there are 600,000 to 700,000 new claimants more than, was it ten 

years ago? 

Mr. ASTRUE. Three years ago. 

Mr. MARCHANT. Three years ago. That response brought on the 

question is the Social Security Trust Fund solvency threatened by 

the 600,000 to 700,000 more claimants. 

The general attitude is there is a fear among people who have 

worked their entire life and that this program, the disability program itself is threatening the entire integrity of the Trust Funds. 

Can you address that for me? 

Mr. ASTRUE. Sure. There is a mythology in a lot of quarters, 

and the media feeds this from time to time, that the system is ripe 

with fraud. That is simply not true. 

Is there fraud? Well, sure. With a system this big and with 

standards this complicated, is there some small level of fraud? Yes. 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
36 

I think the level of fraud is much smaller than in most government 

programs. I think it is some fraction of one percent. 

We do everything that we can to try to root those out, but I think 

what you have to be aware of is that increasingly, particularly as 

our society’s and Congress’ definition of ‘‘disability’’ has expanded, 

there are people who are legitimately disabled who do not look that 

way to their neighbors, and their neighbors make unfair conclusions. You see this with people with a variety of mental conditions. 

You see this fairly typically, for instance, with people with early 

Alzheimer’s. 

We even had a case with one of our own medical examiners who 

saw someone with early Alzheimer’s and just ridiculed the person. 

I apologized in a public hearing for the way one of our own people 

reacted. 

I think people are sometimes very quick to assume fraud when 

in fact what they are seeing is a non-apparent disability. 

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

Mr. ASTRUE. My view is the level of fraud is so low that it is 

a rounding error in terms of the solvency of the system. 

Mr. MARCHANT. Setting fraud aside, what about the increased 

number of cases, with the 1.8% total payroll deduction. Are there 

statistics out there that say the 1.8% raises this much money, and 

this much money is coming out of the system? 

Mr. ASTRUE. That is a good question. Something that should 

give you confidence in the integrity of the system, with the recession related claims, which economists and others would say typically would not meet our standards, if the system has integrity, 

then the allowance rates should drop. 

Our allowance rates have dropped during the recession, both at 

the DDSs and even more dramatically at the hearings and appeals 

level, because we are seeing more claims that are not meritorious. 

The increase in claims is not a result of any significant change 

that we have made or that you have made. 

Eighty to 90 percent of the change probably, and we will supply 

more information to you about the record, is entirely predictable, 

has been predictable for decades. 

It is what the Office of the Actuary has been telling the Congress 

would happen because people basically, with my profile, aging baby 

boomers, are in their disability prone years. 

The amount of disability allowances we are seeing are relatively 

close to what the Agency, CBO and other experts have been predicting for a long time. 

[The insert follows,The Honorable Michael J. Astrue follows:] 

f 

Mr. MARCHANT. Thank you, Mr. Chairman. 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.020a
37 

Chairman JOHNSON. Thank you, Mr. Marchant. Mr. Smith. 

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

Mr. ASTRUE. Thank you. 

Mr. SMITH. I appreciate the Social Security Administration’s efforts obviously to expedite cases through the quick disability determination process. Obviously, I believe it is important we find ways 

to move the easily decided cases through the system more quickly. 

Can you speak to the safeguards that you might have in place 

to ensure that the system still cannot be gamed perhaps amidst the 

fast track that we know probably needs to exist? 

Mr. ASTRUE. That is a very fine question. None of this happens 

on automatic pilot. As fast as this is, there is still a full medical 

review. Not necessarily a full vocational review, if it is not necessary, for instance, for a compassionate allowance. 

For QDD cases, there is still a medical/vocational analysis. It is 

just put up at the top of the queue. 

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

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

The other aspect to integrity that I think is important, it is not 

statutory, not regulatory, but something that I think you should 

know about and be concerned about for the future, is again, at a 

management level, we have set the threshold for the QDT cases, 

95 percent probability or more of allowance. 

There has been occasional internal and external pressure to 

lower that. What I would tell you is if you lower that, you start 

damaging the integrity of the system. 

It might look good in the short run, but I think you start damaging something that works really well, and I think the discipline 

of making sure that only the most likely cases are compassionate 

allowances or QDTs is an important one, but by doing it the right 

way, we are up to almost six percent, I think, of the cases decided 

in that way. I think by the end of next year, we will probably be 

at seven percent. 

It will start flattening. There is a natural end to it. I think if you 

water down the system, you start damaging something that is really important for disabled people. 

I hope in the future you will protect the integrity of the system 

and ask the Agency in the future to maintain that 95 percent 

threshold. 

Mr. SMITH. Thank you. Shifting gears a little bit, in terms of 

the hearings’ backlog, you committed to eliminate the backlog and 

reduce the average time it takes, and there has been some progress 

made obviously. 

The productivity by ALJs has increased, the backlogs have been 

reduced, and waiting times for the hearing decision are down from 

over 500 days in 2008 to 345 days in 2011. Some progress. 

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

pending and wait times will increase. 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
38 

Social Security has always worked to make the right decisions as 

soon in the process as possible. Can you speak to that and how the 

budget request reflects the numbers? 

Mr. ASTRUE. Sure. You know, at some point as much as we 

have tried to lay out a plan for what we can do, it is contingent 

on a couple of things. 

It is contingent on adequate funding from the Congress. It is contingent on an adequate supply of judges supplied by the Office of 

Personnel Management. Those are the two key variables. 

At some point, as the budget gets tighter, we are going to have 

to make hard choices about whether we back off from the goal that 

we set for ourselves, and I think that is on the table for next year. 

I hope not. 

My view is we have done, I think, a much better job than I think 

most Members of Congress expected five years ago when we started 

this process. 

If you had said to me at the time, Commissioner, can you do this, 

oh, and by the way, you are going to have the worst recession since 

the Great Depression, and you are going to have budget cuts for 

two straight years, are you still going to be able to do this, my answer would have been no, Congressman, I cannot do it. 

We are here. We have made great progress. 

The question of whether we can get from approximately 345 days 

to 270 days in the next year and a half will turn a lot on the funding situation. 

When I was General Counsel of HHS, I had in my closet a cartoon wall. My favorite was a lawyer looking at a client. He looked 

at the client and said, ‘‘Well, how much justice can you afford?’’ 

That is basically where you are. If you want justice, if you want 

270 days, then you can get that, but you have to support the budget to get there. 

Mr. SMITH. Okay. Thank you, Mr. Chairman. 

Chairman JOHNSON. The time of the gentleman has expired. 

Mr. Tiberi is recognized. 

Mr. TIBERI. Thank you, Chairman. Thank you, Commissioner, 

for your service. Thank you for being here. 

I want to make just a couple of points and then ask a question. 

One of the best things that Social Security has ever done is provide 

those of us who pay into Social Security, and yes, congressmen pay 

into Social Security, even though there is a long-standing myth 

that we do not, when I get my statement, and I got my statement 

last summer, the notice that says I am going to get this much 

money based upon quarters that I have put in, and what I have 

paid in, but then a little asterisk that says ‘‘If nothing is done by 

the time you are scheduled to turn 67,’’ it does not say 67, but by 

the time you are ready to retire at full retirement age, ‘‘you will 

only get 77 percent of your benefit.’’ 

I think that is great. I think that illustrates that there is a problem with the future of funding Social Security, not just for me, but 

for my four daughters, if we do nothing. 

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

in worse shape than the retirement fund. 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
39 

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

my predecessor. 

He says anecdotally that he can count on three out of every four 

constituents who come in to our office to seek help will ultimately 

get denied initially, and then will go to an appeal. A majority of 

those anecdotally in our office who go through the appeal process 

will ultimately get awarded. 

In relation to that context that I just gave you, when you have 

numbers that have been provided to us that it takes about $1,050 

to process a DDS claim on average initially up front, so it is a little 

over $1,000, that claim is processed in a little over 100 days, 

through our office at least, most of those are denied initially. 

Then they go to an appeal. That appeal through a judge costs 

about three times as much, three times as long. 

In view of those numbers, and those are national numbers, in addition to what we see in our office in terms of the time frame, is 

there an inconsistency in this process? 

Do we need to look at what the DDSs are doing versus the appellate process to make that system maybe more efficient? Are they 

not trained the same? 

Is there some sort of breakdown between the initial process and 

the appeal process? Can we streamline this process to make it 

more cost effective, more timely? 

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

Different iterations of that question we have been dealing with 

for a long time. I do think we have made some significant progress. 

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

The most important one is that we are moving from a fragmented, antiquated 54 siloed IT system to a state-of-the-art unified 

system that builds in the best practices that we know work. 

The most important one is something called eCAT, which uses 

basic artificial intelligence techniques to prompt examiners with 

everything they need to know when something comes up relevant, 

if multiple sclerosis comes up or rheumatoid arthritis comes up, 

whatever, it tells them everything they need to know. 

In fact, it requires for quality reasons documentation of certain 

things if our rules require it, in essence, to prevent examiners from 

taking shortcuts. 

The quality is getting better in the DDSs, and I think they have 

done a great job. 

It is also helping the fast track that Mr. Berg and others have 

mentioned, it has been a big help in terms of quality. 

When I came in and there was some resistance to doing the compassionate allowances, we did a retrospective study, and we found 

that on the things that were on my list, our error rate, which at 

that point was about six percent in the DDSs, it is probably about 

20 to 40 percent, and most of them were closer to 40 percent. 

Picking out those rare things and giving precise guidance, those 

things help. 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
40 

By definition, you are going to see the close cases. Ohio may be 

a little worse than some other states. Ohio is one of the states that 

did a lot of furloughs. That damaged morale, increased turnover, 

aggravated backlogs, meant more acrobatics in terms of staffing 

and higher costs to get things done. 

It may be a little worse in Ohio at the DDS because of that. I 

think it is moving in the right direction now. 

One of the things you should be real happy about, one of the real 

success stories, is five years ago, Columbus was probably one of the 

sixth worse hearing offices in terms of backlog in the country, made 

enormous progress, about 500 days off the wait time. 

You should particularly go and thank the new Chief Judge over 

there, Judge Allen. This is one of those cases where one person 

with backbone and management talent has made an enormous difference. 

Mr. TIBERI. Great point. I appreciate that. You are right about 

that. 

The only thing that is depressing for me is when my case worker 

has to tell people up front that you know what, you are probably 

going to get denied when you initially apply because that is what 

usually happens. That is kind of unfortunate. 

Mr. ASTRUE. Statistically, it is about one in three. I know it 

feels differently, I think because you do not get a representative 

sample—— 

Mr. TIBERI. That is probably true. 

Mr. ASTRUE. In hearing offices. It is about one in three at the 

DDSs, and right now, the allowance rate is about 50/50, it is about 

51 percent are allowed on appeal. 

Again, some of that is rational. People who are severely ill, that 

is not a static situation, particularly if the time lines stretch out, 

their situation changes. 

The obligation of our people on the way is not to decide whether 

the previous decision was right, but to look at it fresh and new. 

It is not necessarily inconsistent. Sometimes it is. 

Mr. TIBERI. Thank you. 

Mr. ASTRUE. It is not necessarily inconsistent when an ALJ 

comes to a different decision from an examiner. 

Chairman JOHNSON. The gentleman’s time has expired. Mr. 

Becerra, you are recognized for 30 seconds. 

Mr. BECERRA. Thank you, Mr. Chairman. By the way, Commissioner, thank you very much for your visit to Los Angeles and the 

offices that we have there in Los Angeles, and the work you are 

doing with them. 

Just a quick point, maybe we can follow up because we need to 

move on. I know you have instituted a new policy that will withhold the names of the administrative law judge to Americans who 

are filing their claims or to their representatives, as they try to 

move through the appeal process. I know there is some concern as 

to whether or not some folks are trying to judge shop who will conduct the hearing for that appeal. 

I think it may have been overly broad in its approach in targeting both in-person and video hearings. It sounds to me like the 

concern with judge shopping may be more related to video hearings 

than the in-person hearings. 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
41 

I am hoping that maybe we can talk further. I do not think that 

what we want to do is end up with more errors in the decision 

making, and a more arduous process for folks who do not have a 

lot of money. 

I know what we want to do is make sure the appeals process 

works in the most efficient and adequate way forward, and perhaps 

we can talk about that. 

Mr. ASTRUE. Always happy. You have my number, call any 

time. 

Mr. BECERRA. Thank you so much. Thank you, Mr. Chairman. 

Chairman JOHNSON. Commissioner, thank you for being here. 

You are doing a great job. 

Mr. ASTRUE. Thank you. I appreciate all the support from members of this committee. It does make a huge difference for us in a 

lot of big and small ways. Thank you for what you do as well. 

Chairman JOHNSON. Thank you. We will now proceed to our 

second panel. You will be excused. Thank you, sir. 

Our witnesses that are taking their seats at the table are Trudy 

Lyon-Hart, Director, Office of Disability Determination Services, 

Vermont Agency of Human Services, on behalf of the National 

Council of Disability Determination Directors. 

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

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

Dr. Leighton Chan, Chief, Rehabilitation Medicine Department 

at the National Institutes of Health. 

Dr. Nicole Maestas, Senior Economist, RAND Corporation, all 

the way from Santa Monica, California. 

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

STATEMENT OF TRUDY LYON-HART, DIRECTOR, OFFICE OF 

DISABILITY DETERMINATION SERVICES, VERMONT AGENCY 

OF HUMAN SERVICES, ON BEHALF OF THE NATIONAL COUNCIL OF DISABILITY DETERMINATION DIRECTORS 

Ms. LYON-HART. Chairman Johnson, Ranking Member Becerra, 

and Members of the Subcommittee, I am Trudy Lyon-Hart, President-Elect of the National Council of Disability Determination Directors, NCDDD, and Director of the Vermont Disability Determination Services. 

Thank you for this opportunity to testify on behalf of the administrators of the Disability Determination Services, the DDSs, of the 

states and the District of Columbia. 

Collectively, we direct the work of over 14,000 employees, processing nearly 4.8 million disability cases a year, including initial 

claims, reconsiderations, and continuing disability reviews, CDRs. 

DDSs make determinations with high accuracy, ensuring that 

over a million deserving disability applicants get benefits quickly 

each year. 

In any given year, over 70 percent of the allowance determinations in the disability program are made at the DDS level, with no 

need for an administrative law judge hearing. 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
42 

DDS accuracy, speed and volume are notable considering the program’s complexity. Adjudicators must obtain health care records 

and detailed descriptions of daily activities and work history, arrange for consultative exams if needed, analyze reams of electronic 

evidence, in the process evaluating symptoms, weighing different 

medical opinions, assessing medical severity, and determining individuals’ remaining work capacity. 

Social Security and the DDSs have historically worked together 

to provide the American public with prompt, accurate and cost effective service. 

However, our ability to continue to do so is now increasingly 

threatened. Funding in the Fiscal Year 2012 budget will not cover 

all the cases the DDSs will receive. 

The deeper cuts scheduled to occur in 2013, as part of the Budget 

Control Act, will dramatically worsen the situation. 

In early Fiscal Year 2011, SSA imposed a hiring freeze extending 

even to replacement hiring. Since then, the DDSs have lost over 

2,000 employees. Three-quarters were examiner losses, a lost capacity of over 900,000 case determinations a year. 

Already many thousands of cases are delayed in growing DDS 

backlogs. 

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

are a drop in the bucket. 

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

funding and advance hiring. 

Our pipeline of disability examiner trainees has been empty for 

a year and a half, and examiners are not quickly replaceable. It 

takes a minimum of several years of training and mentoring before 

they have the knowledge and skills to handle all cases, especially 

CDRs. 

For as long as they can, the DDSs will continue to keep cases 

moving and meet workload targets. DDS staff are highly skilled 

and extremely elastic. 

In the short term, we have shifted some support resources to 

case processing, but this is not sustainable. 

With insufficient funding for the incoming cases, continued attrition, and only minimal replacement hiring, the DDSs will reach a 

tipping point with backlogs and case delays. 

Policy changes would make the process more efficient. NCDDD 

continues to recommend consistent application of policy across the 

nation and across all appeal levels. 

Our written testimony includes recommendations in such areas 

as policy simplification, enhancement of technology tools, expansion 

of the medical listings, expansion of single decision maker authority, and reinstatement of the reconsideration in the ten prototype 

states. 

Last year alone, the DDSs allowed over 92,000 claimants at the 

reconsideration step, an invaluable service. 

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

stewardship. 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
43 

This relationship has never been more important. Collaborative 

strategy is crucial if we are to find ways to continue the service on 

which the American public relies. 

Policy changes and technology tools can further improve program 

efficiency and consistency, but the foundation must be adequate in 

funding and highly trained staff. 

On behalf of NCDDD, thank you again for the opportunity to 

provide this testimony, and I would be happy to answer any questions you have. 

[The prepared statement of Ms. Lyon-Hart follows:] 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
44 


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I h"c " .~ ~ ",,"11 sun • ., ("\>ow ~_ , ... "fth" u"um "'o~I""") 01 Vu",~ I hU h' hI) llcle",,, •• """" an.J 

·'t.:~Mp.:wivn~lc AII;'""'''~" (QllO;CALI ~ fo)!" wh,ch DDS pnl«SSing I'm< Is 9.7 d~)$ ,u,",ntl~', Th<$< 

cali.", "'" idi.-mifiL'(] h)' S<l<i31 St,,"rit} '" p",di""'" ",,>dd",~ ",ilw"", I"",lw.t<: tIIlIt ""Oh$ ~~<h inili.1 c"'" U" 

1''''1''''' ",I",cd 10 prob.bk allow .. ""," "'lh ~"ic~ C"'" fIIllC<'S,ing anilll.1'-' til,,.. wilh 111< ~igh""' ... "",,,,, lOr 

e,poJiteoJ 1'" "."dI;'ng\, 

liDS C8><: proc~.;ng lime O. ,,,,11 is qul« fIL<1 c<>n!iJerin~ 1Il0l1 pn><,,-,s n~ c~ in, 01, os OOlIIinlng bo."aldlCoII't 

,,;o;>nl<l. ..:nJio!> ciaim""" ... ",,,'<1 ... 1 to cOIbUholi, ~ '~minalioo, .• ".i) ~inB a lars" ,ol"lnc a l medical, 

JiJn<'-'on;lJ. and \",,,,,,'''"31 e'·'dene". ~""IU.lins indi"iduals' \) <lIr""""- "~i);h\.g difl""", ",,'<Ii",,1 "fIi"ion,,-

,."d dcte""inins indi.iJu.l, '<f".ininlll funclion :tnd abilhJ' 10 pc1"foml wurl: in Iho ".""",1 cconOfnr. 

fklenn'''''';''''< • .'<lui", "ppl)'ing c<1nIpk. I.\\,. "'&,,101'00' ond p<ll~l' in each c.", anil makfng e"",,,,1 d",ial, IS 

"".~"I~,,,.=. OuI ... ""emClll.llrCS slww rh.uhd)1)S~ ha,·e hi>Wri<.II) lIi","n !h. An,criCJn public 
46 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.023

prmnpl. "",,"ral~. W1~ c"" tlT,,,-1;"e ,.,,' ic<:. rn" iJi,,! I},er "II<: ,n;III,., d; .... bllil} aprl"'''n!>"'' ith "",'Uralo 

all""l1""" d"h!rminel~orn; '1I<h y ..... 

The [>OSs . 1"1 r" .. hk ,",'ward""i" "", .... i!;h' ~y do'<!Il1ining"o",inuing medical cligibil" ) onJ b) ""Iding 

di""biliiy htarillj!;S (or Ih. appc3b "r,""-'< """",, ",~",r,1>""" """,,,oJ. As illi,i.l d.im, i"",,· ..... "<1 su~"iall) 

lium rY !OO~ Ihnlu!;h F\' .!OIl (duo 10 d<''fI1ngruph;c .nd =,II1ti<: I..,h .... ~ b.l~n<inG bo,h ",>rkI,lIi<h" ilh 

limi(CJ "',"'un"" h", bc<l)mc mud, m,"" <l\Illkn~injl. 

'f"ht D()S. h .. " hi",""';",11y p",,,idoJ the Amc~k.n 1"'~li" with ,imd)'. hi~ ~U3li,) ,"-""H:", .'en d ... ,illg hord 

,.."" .... ,,i. ,i",,", whoo " .. """"" or" r.'H'f . ,ld puhlic nccod 1""'''"1". I I"" "Wf. "Uf abilil) III ,'olllioue u< d" '" 

righ, nil .. is i""", ~ingll lhn1l1, ..... 'J f'und;<\!! in 'Il< FY ~012 buJ,,", "iii n(~ "'", .. ~lItlw <II><", Ih., II,," ODSs 

,,'ill ",oc;"c. and cu" <II)" ",I>eJukd h} 1,,,,' t.),~ur in I·Y 101.! \lill Jr.Inlll1itilll) "ur;.,.'n tlt..· . i' .... rioo, 

In earl)' FY 2011 . SSA impOS«!. hirinl' r,,-.:ore 0".11 DDS d ... 'Q fundi"4\limilO'WFlS_ lllis rn."'·~c ""lend, 

.""~n 10 .."1",""",,, hiring. NlIIion"lly, t~ [)I)&I IO;!I 219~ ""'~IQ')'= rrQllt 0.:10I:>I.'f 21l1 l through Fot<""'~ 

21!11, h'Cn 11:<,,", critica"" ,1'1< . hili,) ~'pm,"'''' = "91 "f ~ I",,"-os 1I 'r~ ,""<;uni,,<$. lIoion ,'tJ""t,"S '" 

a h ... c~pac;I)""r",ef'IOO.lK)U , .. "" ,1;.~c1·."inmions~ )''''. Wi,h "'. ","'fI1 "'I'·..., "rlh. n ' 2tl[~ budl""I. SS,\ 

lI,we ,hi: [lllSs ou,l\o" 1)' r", 200 hires. bUI "i,h"u' ",pl"",-,",." hi.illl! r. .. Jl<'aril u )"ar ."'[ a h.lr. Ih"'" hi"", . 

"hile "Pp.-..",ialod - ..-~ bul 3 lI",p in 'hi: bu"h1t" prel"'''' tt.< [l1)Si lunn_ fulu",_ 

1'", M '''"8 a.l/lcy C"Jn. ODS. "ill COOt)""" U> "" "";<\C".r i, ,~~c, 10 ~,..,p the cases '~O' i"i I1IXI mCCl 

"wl:\v<td '~. !l[)S_<l~Il !; one highly '~I Il,d and QlTt'm<b da<,,,,_ ' " ,he sMn. "''''''.'1\'''':- o-nS<:>rC 

hanJlin~ ,Itt clI.ll""ic by .nifling """",ftc .. ("""h "" ,raining. ononloring. '1""li,) ,""sura""", pmf,"S'i<~'al 

",,,,,ic,1 '-''''io",. cO"""I""i,e ".,"mi".,,,,,, ""~"iglll. supt.""'i.;",,, and '"~,,a!<''''"'''! 10 """" pm"'''';''lI. 

11''''~\Cr. lit..· I)DS~ c.n"'~ ,v,",in Ih~",-' "-"''''",c "hil1o ror Ill<' I''''~ I~m' "ill""" ""ri"u. d,inmcn! hI ihlp",'I,.o' 

Sl.1T JC'IIcl"!'O'<'n' and rroi!=' ,nlegrity ,)lj(C ... no>. WI,h ;o~"fIi<il"l11 ILnding liIr <ho '"Ct""jog 0"-",-,,. ...... ~ 
47 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.024

"'Ih c'\l<1linU<J attrilion and onl)' ",inim,' "'rl"'~m''''1 hiring. Ih~ IlI)S' "III ""...,h . liprin~ pOiO' "ilil 

I>Iorgoon;"3 bac~~)lP and casc ,>ro<;"",inS tlcl.) •. 

On lOp ur .... lTdlS I"""",," SSA r • .",.".,n~)'!ihilkJ mQ;l f<:<lo,,11 rCSl)''''."c~ from IJIJS "",is"""", to OllAR. No" 

,Il.,.. "'-""""'"""'" no ioOllcr .. ,,·.ilolll,·,o B<.lp som" DDS.. OI)S; " " ,,"'111., ""'" ".'I1Jio~" 'Il. fedi."tlIIB;'''' 

lI<:Ie rtlUIlW<l '0 III< DDS. "illt m;nim.' nllli"" or rIM"in!\. ..uJiog w Ihe mony Ih<>us>"J, or "'""'" .""ail) in 

grll"in~ DIlS hackl~"" w..J 1'111""" 1"J1Slhc"f1in~ 'h< .",illin'. "flhrn>c d.imMI •. 

Wi'"'~ I)J)S si' ''''limI :I(I1"'1'ik. the r""l>«' "ffu""""'""n: __ on lhe CDR w()ri;.io<IJ '" 01 ",'n'''""' ''OJ 

inc ........, n'lISIl""'" IIi,,, :odditiuMI funcliT\l\.. hu, fu"du.,.al""" I\ill "'" I>< umci~" , '0 "o"~ " tho I)I)S. to 

procCSii lit" :uldi,ion.l ",>rtJ<>ad w,kli, it ;ndud<:< a<I'·.n .... hint't ""'ltoril) . Th. f." III:. In... OilS. h.,·. not. 

I>.."\'n .blo 10 hi", rot lhe r'ot ~.~,...oo ~ h"'f is ~ orilk,l f:lClor in OOU" aDil il) I" p"',""c", COR.. uns .~om r.crs 

a", 0.11 quidl) ",?'..".,.blc OQ!!> in. "h"d. II ,.k.,.lim•• .n~ ,,:,i(lU,"'""" lu hi", 1/1<: ,i hl ""'"'0) .....,. I« t!n:joo 

and ,00, a minim~m "f>t\ ..... l)·CON ond Mn~id, .... hlc tr3ining m~nlorin, hofo", tIt_ omplO)rt' ha,e Ihe 

~"" ... Ic-dl:~ and .~f" .. rti$<' to handl,,".11 ca!c I)·j>t$ in<k""",.k",l.\· 01 1\011 p",,",""If<J!, 1ev<1s. CDII.~ in pa"k,,1; .. 

r.:qul", e:.:po.Ti~-.J ""ami"" ...... ~h tho capo>e;l) Illr "'p.Tljudsmcnl in .0ml""'nK modi .... 1 lind'n"' .. '" 

funCl ..... ~r dim''''''1 p. ... ,.>d!=uf 'imc ond detom.in'ng ",cd!.:", i"'r"' .... men' r.'"o ... ing~\""r x kg'l 

guidel""",. API""d",,,rCIJIl. """""io"" ow,! "" ",,"dl<:<l ~ ,",,-,e m ..... l»lily !1 ..... inS ()ffi~. lite " ,gllc>ll ..... 1 

or OI )S ""judie.", .. , "ilto ,n,") ) c,,.,, ".\I"',ie, .. c ond "1""';.1"00 '".ining in ",,'din~ ad,nini>lM" ·. ilcari,'8' "'Ill 

J,."iJing kg,1 f""'in!!,.'· "f fOCI ~nd CWlCI",~," , "rI.". A. \"CIC",""" 5larr .""1;" .... .,. '" k~'·c. 'he Ol)S~ n<".:d h) 

~1X1' 0 .<It"4d) !'ip<jiO(" "flnlin""" dOld" <lrol1~ ""rN" Inf ... ,I"",11In."" 10 h'Olpih,: "",~1oaJ "dl mon.god "hil. 

Imini", ""'S"~. n(I[ "",) fur 'he <Mm;, .. ", anoJ h~rin, Bilkers Ih .. 1I.'~alrenJ) letl. bUI so f .... 'hooe 

,h~' "ill Ie",·c in !he ",,~I '''"'' )"N"'. 

8um';"'l "''''''''~~ aliocoli"" !!. 1lK" In"" om.!. R.<.............., mu,1 , uri>M Ihc 'fun, enJ M(hc disahilil} d.im, 

pro<:~"" Ihal "'''' .. oJl appli ... n" and i. for man) .lIth. ",,,·icc Ih,") ,"qui",. While. ,moll 1"'"""lagc 

, 
48 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.025

<'(lI1linuc> '" b<: "'.II ....... 'N ll1ro.,!',Il Ihe Qui.'k Il i",hilil) 1:t..1.-nninalion (QDIl!..,~ l'omp .... 'i <lruil" 

AlIow.nc~(CAI ) pnlCi:50. mI»l ofl/l< ail,,"',"ccsnN liS> \>In';"u, ~nd ~lke IOIl~ It> d.'ennin<, DOS • 

....... "\1 .<LI nie;"n, n.",,,,,,,,,.,; '0 pn'.,,",,~ ~"".,,, t;"'d~ : ,>\lI<"'i~, Ihe cla;m ~ "r ",an~ di<3hl...,j urrlionnll' "ill 

".i, in baoklOj;.< It,., hil; to, ",an"!!", "hile DUS< m.y be un.w"", "flheir dire ""'"\I, ",,,,,,,ni"8 impai".. ... ts.. 

ond cwn de.lh. I\pph,n"" "h,,<k, '~>l mwl (h" <'rilc,i~ ~I",' d .. "",w ((\ n,(:ci,,,",,,,,,,, ... ~tc d.o~,1 

tkl.,""i~ioo~ .. ithoul , ~mg ".il. "" lhat ' .... 1· ~;ao IiIl.t :rpprDpriol< "~" ;I'll" in m~n.);i"~ tho;" m • ..ri<~1 

and f,n.""ial .i,,,,,' ion. T .... ' 1""1\« ~ 0_ ils in a t,.~klo!. lho: ","'" ,"'pc"""" II 1k....,m .. 1U ~~»-..., 

m<dical n:C~N,;\g~ ""J uf'JOl.d ,""cord, "lUch I:<: rurrl""N. III ... lJill,," . tho I)[)SS n.:cd s uflk1-", 

T\.'S<~lri'esl" h.ndlc IIIr~;<" 1 CDRs.'" Ihnt ll1'1' .M k.." .11 wori;k.,1l-; in h.lanct. 

2. IIICI'Ca.",d ~S,v DS <"lIat''''''.li"" . We '"""!;flile ,!tal in W· cUm."'" .,..,m,""ic . il".ni"n. l'CSl,un:<~.n: 

"':\I ~~ w,d can"", .1" .~~ "" er ~II Ihe """ ic~ ~ .... \l. "r ~111>ur uppl .... nl., We 01"" '"·".II"i," Ih<." <h.llcog,· 

"fbalantio~ ;>.~ r"""'r<:"" ~lhccol"" ~~."' li"m I~ Fidd Off",,,,,~) the IlDS ",OIlI\R. SSI\ 

... d In ~ UUS. "," • .., n IOhi 101>1"')' or""""n~ "'i!,0lhi:r to .. on. Iho t.m .. 'rican I""'pl,' 10 'he Ik.-sl ~f our 

lIbilil) . Thi~ "o\l~l>onlion I~ I'CI)' i~,ponan( W>d "ould to< limher hnpnl\'N in lIle cur""n ~i lilalion "illl 

joiot or<"'lio""151,,"~gilin~. DDSs"an l'f'O"iok 1l1~ b.:>l .. "k. whon Ihe "' ~ll<>w "Ilii hirina n"wlII\! 

,wad)' ..,d MJ",,<,d. ",Ill SSt. ..,d th< IlI)Ss in pnnn<~ip pro:IC(iwl~' ... d $1r:t(cgj<olI) planoin! f<1!'" 

wQrl;lood .11d .... ""r<:" chM~=. Thi. pm,,,, • .; !<ht!uld incl""" dc li bc":!li,.., ri..,k """"""me11t ,, i~1 mi';g,nitm 

priorili",. lhem.d" 1 tOR """'I,,.d. ond tcdm!l ..,isl'n«· ",,">tJrC\.~ to, Ihc DDS. ","!."" bull!,~ in 11K: 

w"n.fl(J\l 110.,., ""'iP "ill in",ilabl) "u~ Ih .. " W"} Ih"",);" 1lI<" S}'$1ctn causio!'.ba<~I(\~ and ~t "yinJl. 

cluim. ~I ".d , rUIVN S(I:p. h .110 C8u=crlliCllI PI>' in lhe eXI"'ni",,,flllc OI)SSI.fl "hleh .vmp"'mi ..... 

d.ln,.n" .. ilh CSI""".!)' ~\<f< Imjl<linncn!s roro'f"dilru c.,., [lI'VC~ing. ·t'hMc<)ring lh,,~ld r",QI)[) 

, 
49 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.026

f1"!'.11lo~ ,ni~' be oxponJN 'U i"cluJ< mCtk ~l"im.nl •. 'rllis'muj! be oon~ o.",full) wunlJl '" dilulc Ihe 

",b:;ol ,,1111 """"" Ih>l can' ..... he 4Ih",c,J ~"lc~I)'. The "","n~ of claim, ,h.1 do IlOl mell ,he Ihre5ll<Jld r ..... 

(.Ion fl.gging .:oouW I"'"idt ..;o:'fol ,n{""""ti,,,, ' 01 liS$iS! ,II<: DDS.; in funlJn "';agin! ''''''r (""",.«IIl 

"""~I"!I' for "Ii"". ""'m"lhm "'" lil:cI)' 'n m<"<"1lho disabilil) ,·, ilm". 

\\'e ,t1\Jcn;l;Ind 1M' SSA i, al"" 1k,,,lop'ng "imililfpmli('li,e m<!lldinll ",,{,w.re hI help i""mify WlIIR 

<0lSl""S IhOi ""uld mO>ll ikci) "" ~lIn,,<"" 11""Ullh "'" inforno.1 ""n."d pru<<z<"j, 1't"r',a".-pn>Ji<1iw mudding 

soli",.", ol""S the .. <e lin"'! n,i!till t... .J.pl,"<I or Ikvck>lcl I",. "'" wi,h """",,,id.r.lt~~, '0 I>clp DDS! 

txt,eciJ<'O"I) ~ f«<)<t,;,k""ion.Iha, m'gh, be ")ro,,'N. ""d ,11""""",. al't"d. knlllh:-' ol'l"'.I'~ QnAR. 

r"" exumpk .. "",co."" lho, wm: ",ig,,,,,lIy .k ... i<'<I t>c.. .. """ ,/'" "op.inne", w .. ' nOJ' •. 'I"-",c"<l III I""," rull 

) ...... and "" ....... ,,1M..,.. 1I ... <I.i,"""t·, age Ii; .rpn!ll<hing 'he hordctll,.., rot a m"lieall""""i"".' .11,,,, "n"", 

4, Sj"'pIT .... 'ioo, or 4is;1biJ"I' rc"I;lJI!I' p<"llj"., " An(~hrr ,,"'Comm<nJoli,., i. ,,1 ma~~ Ji!l8llili" l'f\ll1"m pilli<) 

.Impl"r. CIlsior and q".:h.,. tu 81'f'1) in m.1 " ......... SSA is In "" rummoncIN fOf re<""lly ~t""dinJ!: I,. all 

[JI)S~. , '(>Coli"",,1 ""al~~is '~rcJ;(.'" US<."<Iin Proh.llY!'<" DOSS fur man) )"<""1"5. Tl<is <;,,~. greal "'-'!II Qr 

limo Ih.1 "01 Jlf<l ,,,,,sly II""" ob\~jn;ng and ~nll"'lj"s 1"''4 \\\>1"1.; info""'li"" Ih., \\oulJ nol mole a 

Jil"fe,c""" IV \lie fin"1 <k1,<rn,jn~''''". 

fOO DIJS. hO\~ p""'id<d SSt. \I';,h idc';l< r,,,. O!h~r ""'''' .... '0''''' nnd W~ rerom",enJ thaI ,I",) 1><.' 1.'Hnw:ked 

W i"'plcm<,,"lioo. Onccx.n'pk i, ~",cllding ::St.·s "'SUi""", delini,.", "ron -"""cpl.h nlcJi<~1 

So,m . .,," ,0 induJ~ mon' ufll", Jl<'.fcss;,"'.I$ rn!c« c'l'n'nlooly ... "<"1' 1:0)' do;ma""", ~<h "" nuf"!;< pno<tilion<n, 

phy4:ian aSSiM'"\>. li • .,,, ... "<1 ,,,,d,1 "o",c!"S. liC<1\... "<I m.'I1lall!cahh dIn"".",. nnd pi') .k~ 1 Ih.r~pN.. W~ 

bclir\'l: ,h.1 Illis c,.u ld ~"~ CQ,\Sid\'",ble 'ime.nd n.""o::- ,h., is turttntl~ $I"n' (Ifl S<"nding clainull1l< H. 

I:Il"'ul,",;''' c:<.,nm .. i • ..,. with ac"'1"ablc m<:<lie.1 ""'''''~ ", .... 1)· 'n "'f'I'""Io. 'he rmdin~ "r,h";, "'gular 

"":lIiIt!,~oo. n,~ SSA-Mc''f'llIbl.) .. 'u(l.""'. 

S, CII:Ir\UC'< 10 thl; cri .... io (tv n;1c""""y <>.I' ~ ,",!!;, (."ulfl'ml) •• ulJSllnliol woO: \Jt.o, r!a""JnIS h", ~ 

p<rr""n<d up to !lIkI ... ,} """ ago is Ct\MKI<n:.i n:1~' .. m ,,~ odjll<licuIOf> "'" .kIt",,;n;n!, "h.,Iu..,. 

• 
50 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.027

daimanl, .an do on), .. flhcir f'II'l jOO$. We """ ,."m."d ;.IHlrtrnmg ,hil p<ri;><lIO ~~NB. (Jh~n tho f1Lnid 

cb.ngos in 1e<lIllOlnlP', In.: .dC\":«I£C nf wort.; laSI P<Tfwrnod more 111M len ) COTS .go QI" 'hc C<)ntinll<d 

e,i,,<.n<c ~r"", \\,rl "in the tI'/,iIln.l ","<>nQfll) ""'1")' qo~i''''''ble . Obtain'ng and ~,. umini ."",oh Old 

in[<>n"Ol,"" ;, pn>ble,nalk. a<; dllim .. " . and "' "" empH»)'n>; 10'\0 dillicul,) ",on"",bt-ring <..u<.'tly h,'" Ih~ 

,,.,orl; """ dolle ,hal long ""n. Oiflc",,,, ,,"y. or o"'a ;ning .00 .'·oluOl'n .. Ihil; 1"'" ""."1; i"r""')3I;'''' m~)' ",. 

,,,,,·,,fllw din~n.""""'" in <Io...,i,,,,,, m.~;ng .. 'loe ons i>r<I OOAR al'!'<'al "'l". ,i..::.· om., do 001 ha'""nc 

... "'" """<>, as OOAR '0 ,·"".tiUl)a1 ~~pa1Jl "ilh ~""" Ic.lg.l Mtlli: ~urn."'L Ioonl """ naliooal ''''''''''''') . 

1>. !;()nIinuN ,""""""em.,,, <.>f'1Ii: EI\.":lronj!: c ...... Anah <i< -r ",~. ~SA h~ /k,·tk'f1<'d an d .... 'n'~iC o;a.., 

""al)".i< «",I (ct'A 1"1 ror OilS 0,,""'''"<"1"'>- "hi"h ~ ..... ",."tl) IlL ... ." ",aM ",.OO:'Wfj' b) SSA.. 11\,,;,;<,fl\\'''''' 

,,")1 a,si<!s nomi","", in wriling an ,""plan"lio" of Ilo<ir dclen"i".lio". P"'onpli,,>, the'n 1<1 oddn..,... each ;1,1' 

or ' ,.","u"nlial an.I),'" anrl ail","1 ""u,":< ,,,,,10 ;o,r 'T • ."di~'!il.,. ;mJ m<-.lic~1 ""in;"",. II jlf~vklc, ~"i~' lin~. 1<> 

n.>I.'~d pili;",. II !>Iill .... "<I~in::. II><' "".mi ...... It) u,"" ttilit;1l lh iolinj; onJ ju.!!!JlICtlI. In ,.,h", "nrJ,. Ih,' 101,1 

.Jocs "01 ·lIl.h tn.: <lo;:i,',.,,··. Many lJDS. have 10und il 10 "". "scrull",ini.>,I",,1. tsl""'i.lly .0' '''''''''' 

c.wlliner,;. iIIId ~Sl\ "'PO/l! 1 ..... resulling .:xplanation oflhl.-Ikl("mIin."lLion i, bt:lpfull<l qu.lil) n"\'C\\<rS 

. M adn'ini51mlhe law jvJ~;!S . C<"",~ms ....",uin ~111~.ignlfic.1l1 k:~mi"s c",,'c lhal ma)" .f1~<I'lan 

rrodae,ivil)' lind mQr .. lc. The 1",,1 ;Muld conlinue I~ "" funn.."r rnh;inced 10 he ,n"re ,nluil;' C. (n .tmlmlio>c 

Ihe tonnul .. ;"" or the """"' ..... "'. '''''I) sis.. 10010 provide K heller """",nUl""" "fthe "".I)·.is in the wrino" 

~,pl. n"'i"" doculncnl. 

1. :ii!!8!c lliqbi ill.£..~",,"ng 5)" lem (OC~, Wertrommond (\><Ilio",," flllldinSand d,·'olop"""1 of 

lit< rx;ps II, rqllatc tile inoli.iduall)rJS,· ,'an",," e __ p«",,~n~ ""'''1'"10' ~) "'<!O ~. rX;I'S is " • ..:<1,'<1", 

"'p""n nOli""JII~ ","",iSl"n', cflk"'n~ e,,,,,·cIT,"di.c d;s.,bili<:> case pn",,,,,,,ing. ,;ncc mul,ipl. diff,"",,' 

.,·,1,1>15 d .. "'" lOLl; I() ",'" "",~h" .. , ,..,. well. 'llLe 'inglc .)·.,1"", ","""Id include i01p"" ... '<Ilool. 10 ""I'flI'" 

, 
51 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.028

,"","ra,~ c.se "".1) ,1" SSA .rn!,h~ OtJS ""mmuni,y .r.: wor\.:'ne. "'1I. .. 1f>tt \l<1 'he m"""g=~nl Mlhi$ 

proj""" 

, h "'hc .. £.'i!W\,<i<>rI o( d .... bil"\ ~'ami!1C( a,nhori!I , Curt<:u,l) ~"""''''''''' "al'C !he .u,I\,,";,), '0 <kciok fasl· 

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• 
52 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.029

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53 

f 

Chairman JOHNSON. Thank you, ma’am. 

Ms. Ekman, welcome. Please proceed. 

STATEMENT OF LISA D. EKMAN, SENIOR POLICY ADVISOR, 

HEALTH & DISABILITY ADVOCATES, CHICAGO, ILLINOIS, ON 

BEHALF OF THE CONSORTIUM FOR CITIZENS WITH DISABILITIES SOCIAL SECURITY TASK FORCE 

Ms. EKMAN. Thank you. Chairman Johnson, Ranking Member 

Becerra, and Members of the Subcommittee, thank you for this opportunity to testify at this very important hearing. 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.030
54 

My name is Lisa Ekman. I am a Senior Policy Advisor for Health 

& Disability Advocates. I testify today on behalf of the Consortium 

for Citizens With Disabilities Social Security Task Force. 

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

The importance of SSDI to people with disabilities cannot be 

overstated. I would like to begin by sharing the stories of two SSDI 

beneficiaries with you, and tell you a little about the difference of 

SSDI being in their lives. 

First, there is the story of Angelice P. Angelice was diagnosed 

with Type I Diabetes as a teenager. She went to college and she 

worked for many years. 

Two years ago, when she was 36, she had to be hospitalized for 

diabetes related complications. Angelice spent a long time in the 

hospital, due in part to the fact that she continued to work when 

she should have stopped because it was aggravating her diabetes. 

As a last resort, Angelice applied for benefits while she was in 

the hospital. Due to the severity of Angelice’s diabetes, she was approved for SSDI benefits. 

Angelice came very close to becoming homeless when she could 

not work due to her diabetes. Fortunately, she was able to keep her 

apartment but only because a charity helped support her and pay 

her rent. 

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

Angelice receives just around the average SSDI benefit of just 

over $1,000 per month. Her rent is $550. Her SSDI allows her to 

live in her home, but she squeaks by. Without SSDI, she would be 

homeless. 

It is with sadness that I tell you that last night, Angelice passed 

away due to diabetes complications, but in the two years that she 

received SSDI, it made a tremendous difference in her life. 

There is also the story of Henry H. Henry is in his 60s and has 

severe cardiac problems. He was working in the insurance industry 

for a long time, but was not able to keep his job due to his heart 

condition. 

Henry spent all of his savings and cashed out his 401(k) before 

he applied for SSDI benefits. 

When he filed his application as a last resort, he was homeless 

and living in his car. He lived there for about a year. 

Once his SSDI benefits were approved, Henry was able to secure 

housing again and has not been homeless since. 

Given the importance of SSDI to people with disabilities, like 

Angelice and Henry, I want to highlight three key points. 

First, providing the Social Security Administration or SSA with 

an adequate administrative budget is essential to accurate and 

timely initial processing of SSDI claims. 

Second, the current definition of ‘‘disability’’ and structure of the 

SSDI program are appropriate and should not be changed. 

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

First, as has been discussed quite a bit during the Commissioner’s testimony, SSA requires an adequate administrative budgVerDate Mar 15 2010 12:59 Mar 19, 2013 Jkt 078671 PO 00000 Frm 00058 Fmt 6633 Sfmt 6602 I:\WAYS\OUT\78671.XXX 78671

wwoods2 on DSK499XVN1PROD with WAYS & MEANS
55 

et to effectively administer the SSDI program and complete initial 

disability determinations in an accurate and timely manner. 

We were pleased to see the progress SSA was able to make during Fiscal Years 2008 and 2010 in reducing the time for people 

with disabilities to receive their disability determinations. 

Unfortunately, as discussed, SSA has received no increase, although debate whether there was a decrease, no increase in their 

funding since 2010, and we are likely to see an increase in the 

processing time for initial disability applications because the funding, as discussed, is completely inadequate to keep up with SSA’s 

workload. 

Second, because the intent of the SSDI program is wage replacement and to provide income support for individuals who do not 

have the capacity to engage in substantial gainful work, the current definition of ‘‘disability’’ is appropriate. 

The definition is strict, providing benefits only to individuals 

with the most significant impairments. 

However, keep in mind that just because an individual has an 

impairment, it does not mean they will be eligible for benefits. Neither Angelice nor Henry would have been eligible for benefits if 

their impairments were less severe and did not prevent them from 

working. 

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

However, we encourage SSA to make some modest changes to ensure that medical evidence is fully developed early in the process 

so that unnecessary delay and unnecessary and costly appeals can 

be avoided. 

Such modest changes include providing more assistance to claimants earlier in the process, providing better guidance to doctors and 

other professionals regarding what evidence SSA is looking for, and 

by providing additional and improved training to disability evaluators. 

Our written testimony contains additional recommendations. 

Thank you for the opportunity to testify, and I look forward to 

answering any questions you might have. 

[The prepared statement of Ms. Ekman follows:] 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
56 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.031

CONSORTIUM FOR C ITIZ ENS 

WITH D ISABILITIES 

Hearing before the 

Rouse Ways and Means Committee 

Subcommittee on Social Securil)' 

How Disability Insurance Eligibility 

Decisions Are Made 

March 20, 2012 

Testimony or 

Lisa D. Ekman. JO, MSW 

On Behalf or Ihe Social Security Task Force 

Consortium for Citizens with Disabilities 

ON BEHALF OF: 

ASSQCimion of Unillcrsity CC1\Iers on Disability 

l3azelon Center for Menl:'ll Hl.'u hh Lalv 

Community -ga l Scrvicc~ 

Corporation for Supportive H(,using 

Easter Seals 

I-I ealth & Dis<lbility Adl'OClHcS 

Nntional Alliance on Mcntlll illness 

National Association of Councils on DCl'elopmental Disabilities 

NatiOllal Association ofD s.abil it~· RcprcseOlatilles 

Nntiollal Disnbility Rights Network 

National Organiwtion of Social Securit)' Claimants' Rcpresentatives 

National Multiple Sclerosis Society 

I'aralyzed Vctcr:ms of Amcrica 

The Arc oft ~ Unitcd Stilles 

United Spinal Association 
57 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.032

n :STlMO .... " or U SA I) . • IVoI M~ •. 11). MSW. 0 1'1 HElIAU ' OF TII E SOCIAL SECUMIT\' 

TASh: . COi"'SOlnIUM OM CITIZ"i"'S WITII DlSAHIUTn:s 

Chail1n.11n Johnson. RMkin8, MMlbo.'r ~el'ra. and M~mbo.'rsaflhe Sub\:al1llJ\j(lcc. (h~nk}()\I fi)f til<' 

()jIl"'nunily 1\1 pl"II,icle te>limon} for this hc:tring On how Social Sl'l:urit)· DisabiHI) l"s"rJn~'C (SS!)I) 

digibilil}' de<:i.i()lls lire made. 

I am" 5Clliur pull')' :wv'SQr r(ll' Ilcalth &. Di$llbiJ\ly AdvllC~ll'S (HDA1.IIDA is a nalional policy ""d 

:w\'oc~c}' gmup hcad<lnancred in CbkallO. Ulinols. [alro am a mcmllcr Mtlle C",,:;onium f~r 

Citizcns Wilh DiS3bilit;e ~ {ceo) Social Seemil}' Task Force. CCD is a working cl);llition ofnalion31 

consumer, ad\'O<a~y. provider. and pmfc"sirnlal <><&>ni,.aliOCl' l'Ion.ing logeth .. l'Iilh and on hchalf of 

tht 54 mililen child",n and ndults with di~bilitie~ and lheir families li"inl,\ illlh~ United St"I,·S. Th~ 

CCD SQci~1 Security 'fask Furcc focuseo: on dis.;lbilil)' pul;,·}, i.su<:s in lh ~ Ti l~ II disabilily progr."ns 

ond the Title XVI Supplemenl~1 Sl'Cunly Income ISSI) pmjl,f1lm. I pre""nl this (es\irTk'lny!lll bch~lr "r 

lhe unden;igne<J m~mbrns ()flhe Ceo Social S<'I:urity Ta~k Fo~e. 

The SS[JI pmgr;lm .,r't",id,·" v ital ~OO much'l1~dcd ccon\lrni,' ~eurilY and ac~<'SS III hc'a lth tuo: fur 

indi~idu.l,; IIhose impainncnl. arc SO ..,,'ere Iha( (he), preclude substantial. gainful \l0f1i.. 'I'hi. 

in"om~ ,;uppo<t prouom is an integral eompll"""t of our nation's salety 11<'\. ~fle<:l;n~ lhe core 

American value or"-'s;sli(l~ th""" in """d. We npl'r""ial" y,,,,r ;nlen"St in and anemio" 10 Ih; •• rilleal 

program. 

The Social S~curily Acimini""'I;"" ISSA I ""lU;"'''S adc'luale adminislrnl;,'e ,,:soun:es to effectively 

administer the ssm prO&'1lm and camph:l. in ilial disability d.tenninalion~ in an .ecurotc ami (imdy 

manner. S5A's adminislrotiq," budg~l (Limitation on AdministMj"c rlXp<:nst:S or LA!:) has been 

inadequale in recent y~an;. W. Il'l>c CUl1 gn"" III providr 5SA \lilh ad""lualC ",sources 10 ""11)' "UI all 

nl":c"",,,!)' pro(lrnm funclions. c.I[>«'i~lIy II) process initial claims. indudin)! hiring sumdrm SI_lhl 

lhe ~(alC Disability Del,·nnin.lion Scr.,.i~es ([J!)S) omees and in SSA'5 fi~ld offic."S. 

We bclic,~ ~)u th~ baSic .<If\lOIU", ()r(h~SS!)l prOJ,\I'"m is elr«1i>~ nnd ,h()llid be prc,;ef'l'NI. 

Bc",aus<: th~ ;nle l oflhe ssm program is \(} rcpla~~ "'a~l'S ~T\d provide incl)lne suppon fvr 

;ndi"jdu~ls " hll do not huw Ihe capacity to engage in su !;'l~ l(;a l galnrul wuri<. the cuffi:nt dclinilioo 

of disabililY is "ppropri~le . The d~finilioo is .tricl, providinl,\ bencrl\) only 10 indiv;dual~ wilh lhe 

n)o" sig/,;!ie"nl impairmonts. And nllhQugll more noo .. t. II> be done to suppon SSDI bcneficiari",; 10 

,etum 10 wat\.; 1<1 lhe. eXlent \hatthc) are ul'olo. tit<: ,'aSI m:lj\lr;ty orSSPI bcndkiarios art not ~hlc to 

w~ bo:yvI,d the substantial gainfu\ac(i'ity IeI'd g;"cn th,' ~"eri y of their imp.lirmcnts and the 

lihly cOur,;., oft!wi, di""bili\;\::S, Yet. the current dofinitirnl pro~ide" ."n;c;cn\ ne~ibilily 10 allvw. 

one,lUrage. and cspand pal'oio. that can pmnh)\C CmpIQ)'lUenl wilhin Ihc exiSling structure. While We 

sup(lUn a nU"lbcr"fSoci~J Secnrily and SSI prtIgl'lll1l ilUprQ"<:lncl)!s, lhe)' do no! dL"",~,d \Ill ",vising 

(he dclini!lQl1 I)f di~bili\ )' or chanllinjl. Ihe buk Mructu~ of tile SS!)I pr<>gram. 

!n gt'ncraL SSA d",,'S a good job I)fmnkinl; di",bilitl dctem,inalions, giwn the compl",~ily inhe "'nt 

in e"alunling .... helher 1111 indlvidual will, disabilitic, i~ enlilkd 10 ssm ben~n , ThelT are areas. 

howcl'~r. in .... hich SSA ca n ;"'p(oI·(. We "ill omlinc SOlllC l't'(:()lllnlendation~ for impro ~",cnl I~ler 

in "u, le.timony. 
58 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.033

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""1M !;SJJS"[):) I'Jlv-!Jd[)Jdd" S l 8t [JO!II!'" J'hO .l"~P!S."d~!/l ,,,lpn"l )s,nh:u · J'U A.:l 600t 

800~ pue OIOi' ;U'''' ·ilu!ill).m()lu, UI Ad 'SOOt "P!l31j1 "UBU!J p,:pilllt'lj, JOJ JIll ""!IISJ!J II! t ·~pn:>;lp 

ICUO!Ss;).{ilooJ S1J<lll-' "I 'p!~nJd VSS 'II!" Jl1lnl).,1'V ''.! i!"lP" J\!.I 'I! I!ICJIS!U!Ulp" .J ~,ilpn'l "l;J<j · U""

,,,!c(J S P"Il!J,'!"J"li"0IV"'I 'II!"" ~!41 JlO!J.ld JO S ,UII:l!JIU'iI! "punJ-JJPun ·~

lIu!pu,'.! IIcJ)lI>lj' S".., uC4';u;}'" rs ""!II!'I · l . "'l '!'C'UIUP ! """':U"" U! U!-'~"4"'1l ii 13."'1 !!£!p l!q A!!

~ ,(:t~ UO<I1'"u JOJ '41 silu!J\"1j ilOI~:n:.:t "l'll . u;>;! A:I 000;: pun A.,i ·tOO;; 1 'ij"!lln=,"II( I>!U!IU~ IlJ :t'!I

v i, , M ·MOU~ J(\J u' ,un J "'SJ", VSS PIP lUll 3·\1'."-' ",unb,)pB ~pUl!l (II ~p!hOJd SI! P~l~pUBU' ·s"!"'-''''' 

IUIl!'~l!ldd" II! g "PIU!I ':)IIU"'" ·

SB4 III" ldJ~ dn 41!M "I! ilu!se:>J'u! PlIOllI-'[)" · "!4.l ""I' )" S"' V5S s, AI!!!'I" 01 S9:>oJd "'!I!'III<!P 

'.! ' "II ,~p dop ~41 ~~u)P!~~ p;>J!nbJJ I [) "~~U, "",,",,OJ.'II I CU!UiJJ'Jp I O! U· ,(I.I"",IUOJlln ' VSS . sr · :lv

\!W~l\J! . • S~!I\~II:l"Ii OU '(I JJ!nbJJ e IUU~lJ!u"8!S lunulUU Q .W!I.ilu 01 '''''1I0~ I"UI~IJJ UO!MUJOjll! puu 

1/"!'"SJ:>OJd IG!l!U! P ! "'!I!q"' s"o!le~!1dd" puc [), "!lJldw \1 !"! r.!I 1 ,(I!I!q~"S!P S"O~I"U!"UJ\JP =nDS.1J;UU 

1 · \ISS b.>ll ~! 1V ~1~nb.> ''''"ll n OI""J ~ '!I».il ,i" !U!UlI'V " J.'I ~I tn!."S UlIU3w,1 
59 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.034

The fnil"", 10 pmviJe SS" with ad~'q"ale "'SOu",~s has had an imptlcl ()Jl1h~ ability " f SS" In 

process disability appliCJtiom and compll:1e Ikmminations in a limely mMncr. in b:uh SSt. fitld 

"nice. and SlOle DDS offices, AteonJingto the SSA 's Fisc.1 Year 1013 Budget Request. SSA had 

funding fl>l' 16,739 DDS cmplo)~~ in FY1()II, ' TiuJl "omllcr ~111" 14.825 ill FY 2012 ~"J.~, e" 

onder Ih~ I'rc~id"m's FY 2013 budlll't ~oesl. il iH Xp<'<:i.Cd 10 f.11 fanh~" 10 14,3"11 in FY 2013, That 

~1)['1'..,n15 8 14% n:dLlCi ion inlhc ""mDer ofbDS 5mrr.,aiI3blc 10 process disability BpplicaliOfls in 

j"'ttnc lasllwo )'~ar:'i. 

Al Ihe sam.' lime. Ihere has been a3igJ1irlCant inm,'a.<e in Ihe nllmDc. of in ilia I app ic~lion~ toolh for 

rcli",me/ll and disabililY b<."'CfiIS, According!U Slc"cn G .... , $ucial SccurilY', Chief ACIUlIry, in his 

Ikcctnb<r teSlimony b<fore Ihis Subcomtnil\e~, this inc",a~ is driven by boby boomers enlering 

Iheir high dis;lbility ycars and Ihe firsl "'"VC bcc'01t\ing digibk 10 ret.ir!!. 'hf ~iSt",ic Ctury of'Hlmel' 

imo lhe "1Jrlcf<'Jn'" in Ih~ 1'I60~ ond 1970!. enablinl' Ihem 1<1 qllali!)' fllr SOcial Security disability 

ben~rt!; in larg~r mnll~rs. 3nd Ihe ",n"S>i~n. In I'Y 20\ I, SSA n.o<:ei,·ed 4.8 million relirement, 

""""'i\"or, and Medica", applicatiort!;. and approsimalely J.2 million initial disabilil)' claim..-the 

highc~l nUIl1b<or ;,1 SSA hisl()f)', Thb lnm" ofin,·rtas..'d rCIi",m(nl applications i~ nol likel)' 10 '''VCrsi' 

itsclfanYliJ/l0 soon ba~d on dcmogrttphics und Ih~ ~I!ing oflhe baby OOomc'rS. AllhouJ!,h Ih,' ",Ctnl 

!!1,,,,1h in ini!i,1 disabililj .pplic,11;nn. is "'p"clro 10 Icvd orr, Ih~ n"mDerorinili.1 dis."bili,) cbims 

is eXl'e<:ted 10 "'main hi)!h. 

AssIIlllinlllhatlhe nnmlx:r ofi"ili"1 disa~nitl' cli,illl. lc,ds ufT!>,,1 rt!mnins high. SSA pn:dict~ Ihnl 

toolh Ih~ IIl"nb.:r or~!Klin!l.di,;abilily claims and ,h~ pro.:tsoiinJ:! lime 10 complC1o Ihem "ill 

inc",as".' "r!", P",sident r~qu~Slc-d an increas" in rundins lor SSA's LA!'. to 511.76 billion for FY 

2013. a "ery slight inc",ai<' ofll~ FY 2QI2 LAE. E~en ir:>SA t"'''fi,'o; th" Ine,,",u,><, it Ilas r"'lUCSleli. 

SSA predicts Ih"l J"'ndinll dis:>bilily claims "ill increao;t lu 861,000 in FV 2012 and 10 o,'cr I.! 

minion in FY 10 13.ln addil;"n. SSA rreJicl< Ihat tke uver"J;c number of d")" il "ill take lu l'1"<)<;ess 

initial disabilily c!aims will im,rc~,;c FrI')m 111 in FY 2012 10 137 in FY l013. mor,' lhan a 23% 

incrrllSC.' in One lear. IfSSA r«eil'.s kss Ihan ilS FY 201 3 butJt!et re~uesl fur LAr" il is li~tly Ih~t 

Ihe I"'ndinsclaims and Ihe di .. ~bilily proc~ssing lime·"ill "nly increase ""yond Ihe prediclion, 

Making dij.;fbililY d~'cnninaliolls is a complex prOl:CSS and req"i""s linle 10 pl'llperly ob,~it, and 

~"ahl~le lhe ,'I idcnce In m.~~e Ih. Cdm:..ct dc.:isioo "'gardinll an ~I'pli~ant'.\ claim, SSA tie ld om~c 

~nd ODS personnel, who fa,." itlerea~inll worl.load. du~ 10 tooth imernal and eXlernal t1Clors, migtn 

be "nabte lu devote the n:soun:es and lime nl..,ded IU adequately p1"<)<;es., "nd ~v3Iu"le disabilil), 

applkatinns. The. i"ailure 10 nd~qualcly develop Ihcc~idcncl' c.n rel'ull in an bICOrrcel inilinl ded~ion. 

denying the claim for an etlgible indi\'idL>ltl. Illus incrc;,sing Ih.'li~etihUQd uran pt"~1. For es~mp"'. 

il mij,'hl be dCI"moincd thai 'he "pplicanl "clu.lly mec"!S a medical listing wh~'Il all ofthc evilkncc has 

been coll«t<'<l ;Jurin!;"n "pp"al. Iflhe DOS I"'n;,mnd had bo;cn oble to complele Ihe dc~clopmcnt of 

Ihe C~ rceord duri,,&thc iniliallklcnllinalion, Ihe indil idu~1 ,,",,)Illd hav~ rtCdwd bo:"cfilS WOIlcr 

nnd the clh! and delay of an ~ppcal might h",'e betll avoid ...:!. 

Addilional funding is "'<fuin...:! fnr SSA's t.AE in ord~rtn red"c~ and eliminatc thc bad.l", allhe 

DOS nnd he"rin&l.v~l~and 10 prOI'!deejsential ~rvi= 10 th~ public. Wllile Ihe ~U",,1ll sllU~tion i~ 

dire, w'ilhout adequa,,,, o1\goinll ~rpropri'llions 10 fund SSA. ,h. fIJrwaru progress t"l:comly made by 

Ihe .genc) will d<!lcriornlc, l~a'ing pc.."p1" "ilh sc,'cre dis"bililies lil "ail yean; Ib n,eei,'c the 

ben"rt1~ 10 which Ihey 3re emi,led. 
60 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.035

We Won~) >lrg,' Con~ss 10 pro~ide 55A ",lIh ~utlicicn1 admifli;;Ir.lli\ ~ runding S<) Ihallhc", ore 

tnough pel'SOllnel in both the SSA ficld offi ..... '5 and the DOSs to adequ31~1y ptCK'CSS. ~vclt>p, and 

detennine disability claims in a limely manner. Additionallundinll i. aim needed 10 ensure that S5A 

is able \(J pm"i(\"- otloer crilical $trvi<e~ \U Ihe [>Cuple. "Ith diJ;.1bi!lli~. ~nd \U <O,WII"I (mIgnm 

imcgrity <l<1ivilies. 

II. Th~ Curr .. "t lu li n,t;,," or Ilismhility Is proprl~ ~ and Should N." He Ch ngw 

The cum:nl definition ofdlsahllily is approprime and enSl'r~s liull only lho!oe individ"als wilh the 

mQSl scven' dis:lbi litics an: eligible 10 ,,""Cd,'c I><'neftl,. Til.- cum:nt deftnition is sirict. ,,"'<juiring an 

individual to prove Ihal he orshe cannot mai""in sUMI3Jttial gainful c"'ploymct11 in Ihe nalional 

""onoon)'. The end I"cwit is Ih~l 1110' SSDI program prIlvidn bondil~ only to Ind i"iduals "ilh lit. In<lSI 

significant i,"paimlc"". Mally indi,"idu~ls n."t:civilll!- SSPI have made ~pt!" .. ,cd arr","pl~ 10 won.. 

uften cs~cerbalin g lheir impaill11enls. bHo", linally luming 10 In .. ' pmgr.m ~s a last "'SO" for crilical 

incom~ supporl for Ihem;;<:lve~ and Ihcir r~",ilies. 

The ;nl~"l orl!\e SSP! prvgntm is 1<) p'"(wid~. w~ge rcpl~ccmclI! ror work(~ woo call tIQ long,or W\lrk 

al a sub~lanlial WOinf"llcI'eI duc 10 a physical,,, menial imp3irrrr~nL "l"lIe stalulO<)' der,nili<m 

tonLain..d in ~2 U.s.C. § 423 is: 

iA) innb;lil}, 10 ~nl"'gc in an) subslamialpinrul aclivity by reasoll orany medically 

dClcll11inahlc physical or ",enlnl ''''painnenl which Can be ~lcd III ""mit in deJlh <lr which 

ha, a~t .. "tI orca ll be C~pe~led 1<) lasl f<lr a c()IltinlJ()u$ pcrlod of lI()1lcss Ih~n 12 mOl1lh,; 

In 201!. SSA dcfi~L"$ sU\)slJlmial gainful a<:til';ly (SOA) as earning llIore IMan S IOIO per "I<>IIII! roo 

indi~;dua(s "ilh di~,hillti~s (lther thnn blindnes! "lid SI.690 for indil'id"oil; wh<l arc blind. 

Individuals "h<l Urn mllre lluln SGA (after Ihe applicalilln of the ssm w""' inccmil'cs) or "ltu h" e 

disabilities likdy 10 lasl less lh,," 12 "'<lIIln. ar~ "m enlil1cd 10 n:<.:civ~ ssm t..IICr.lS. ~tofo<,,"ero in 

e\'nluallng whClher an applieMlis able 10 txrform SGA. S5A considers nol IN\I)' Ihe individulIl"s 

Cumllljoo or occupation. il ml\~t by Iuw cXDmi~e all jobs in th~ " otion.1 ~cooomy which lhut 

;ndi,·idual might be capable or perrnnning. r~pnlles. or "hclher the indi~id"al ",,,,,Id t.. hired ." 

whclher lh~re i~ an aClualjoh Opening. 111i$ ~,"dard is Vel}" Sirict and ml)$1 pe01lJ~ wlto apply ror 

b<'nefilS are d<:!';cd l>e\:auso: die)' canl101 C"Slllblish ,hal thel' ,nc"tthc statu,,")' "'lIuirem"!llS. In 2010. 

for example, onl) 56% ofl!1Ol.C "III' appli<...t ,,'cr.' ~w~rd~d b..llci<ls dm!n!; Ihl' inilinl appliculiort 

process.l 

r,1(;jminitlg Ih~ ch~"'clcri!-lic~ <If the pe<lpic wh<l receive bene fils tall assi~1 in illuSlrating the 

appropriaIC!'t'SII Orlhe cum.1I1 delinilion Ordi:l'lbilily and ~I\CSI 10,) SSA '5 dR-;:lil"c llpplicalion r\h~l 

dcfiniti<ll1. 

B.n.lirj~ri." A", l)i"N'a<- nd nir"'~n t1 }' In'p,,; .... d 

The people who ""' appro,'rd r()r bo:'leiils nJl"r dil'erse diS3bilili,os. Llcneliciarics indude people 

with: IJle "'"Be cancer .• dvanced heart di",a"". endostay renal rail",e, intelt...,lual di",bilities, 

pllysi<""~ ! djSllbilil;~S. ~ndocrinediMlrders. "ulmUIll")' Jj>nrdrrs. mel\l~1 ill~~~~. Indivj JlJ') ~ "lIh visual 

impainl\cms. "lid indi"id'1.1~ who a'" dcaf.ju.l \0 !olive" few exampl~. HUlwl'er.jUSI bcC~ ISC ~n 

• 
61 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.036

indiv;~ J.31 is di3~n()Scd "ilh ~ oflhcsc ,mp;oirmcnls docs Ml mc~n Ihnl I,,; Of sin' ... 'ill hcceli~ibk 

for bendils. The on~ Ihin!? all SSOI ~nefici r;cs h.v. in eOnlmon;~ Ihallheir ilnp;lim,enlS arc 

"""ere enoulP> 10 I,re"elllllle", from perfon,,;,,& SUbsla,!\;~1 &a'ntill .cli,·ily. 

M:IOY bmdici~oWs ~r( Icnl\in~ ll ~ ill when thl.')' apply. In facl. abc.>ul one in five male SSI)I 

ben.ficiariell "nd OI1c in seVcn f~malc 5S!)1 beneficiaries di~ "ilhin the firsl fi ,e lears of "",.i>"illl! 

b;:""fils.' Ne"I~ 70% ofSSOI N.'1ICliciarilS in 2()lU .... ereap,e 50 or old.r and n ... I)' I in 3 ,,;osagc 

60 fir older,' F,,"y_Fi,·c oul ofone_hundn:d disabkd workc", re<:dvit,~ be" dits qualiFied (or Ixnelil ~ 

b.1s00 00 an a!;e_n: ~I~-d Imr~imlcnl . Imp;lirmenl~ "hkh orc likely 10 "o~n mlher Ihan Improv. m'er li,ne. 

It is also impolrt"nl 10 oole Ihul SSDI bencf,!> ,,"Iy replace ~ pcn;cnI3I;cofthi: ... <lrkcrs· p,cvin", 

~3min!;S and, ~pcC;8Ily for 10"" and mQdC131c um~rs. are quil~ modc>l. Th •• v ... ge monlhly benefil 

in January 2012 for 3 $SDI prngrom ben<;licial)' ..... s only S I ,110 p'" m"nlh. an ,mnual inco",~ "f 

jllsl 513.320.· 11 ~ i"'r<"> U~lln h'Cp in l11i~d, f;}r ~~lmpllriSl)n pIIrpol"'s. Ih;\1 3 persoo wnrkinll JUII· 

lime, 40 hours p.:r 'Hek, and l.'lrmi"!;~1 the r~d~rnl minimum " 'age of57.25i1\1)ur, ~ams 515.0~() 

nnnually.' 

SSI)IIl<' cfilS arc $0 ~,ode511h3Itht)' tw:loa lly do nOl pro"ide cllQIOGh in~omc 10 lin ~II bencfi~iari« 

0111 ofpo,trty. In lilcl, ncarly OM-third oflhc pcoplt rec~i, lnll SSDI liw in hnn5cholds wilh IOlul 

hou* holJ incom~ ~I"w 100% o(lhc fclkral p<lv~n~' level.' 1'.1lJ!1~ with wOrk-limiling disabililic-s, 

d.spilc the a\"~i bilit r nfSSDl. are 4.5 ti", ... n"'r~ li~dy to he in chronic I""wty Ihan peoplc 

w;lhm,1 di.-abililk-".· F<lI1Y-,l.Cven perec"l oflh05e living In po'eny nv~rall atc pcoplt with 

di".bilitic~ and 65% nf I"--opl~ Ii,·jng ,n l"ng_lcnn poWrty are pc<Ipl. with disabililies. '" 

~ubllsl, ng eligibility 10.- disabi lilY benefIts is nm 8 rubbcNlnmp rn"'~s. Appticams mLJ.<t haw a 

pJlysi<'a1 Il. nwnl~1 impninl1~11! .$Inbli~hed by mooiC1lI ni;Jen~ pl"O\";ru,d by a phy.idnn." 

Statements "f$ympl0n15 ah)l\~ are not sufficient," Thus. !he kcj' to appropri. ,. disabililY 

dClcnnin"ions is full and ade'luaw duvc\<>pmc,,' oflhe ,~ e"",l1 uvidc'1I:e. 

ndividWlI ~ canlile SSOI applicalirllls in person al 3 Social Sl'Cu.i!y office. by Iclepho"~, or"nlinc. 

SSA IlblalnS inf<lrlllalioll ~boullhc indlv'duRn hnpllirmcnt(SI IhTll"~ the "Di~~ilil~ Rep.)n:' Fonn 

SSA-J36g. On the fon n, h~ individuallislS irnpainn~ I5, !JeIIling sources ~nd I>1ho;'T !IOurc.-s "f 

lI1I.'<1i'31 eYid~nc • . SSA also obl.ins ~ig:r~d <nnsem (onlls, which inch d~ penni",ion 10 con1 cl .,,~. 

treating sourc~ to oblaln m"dical oVidence. and an)' medical evidence Ihallh" indlviduul has 

(lb\llined. "IC p;,ck~ge is then ~nl I(liJlC DDS tU devc lf))llhc disabililY claim. Al l rc'lll<'SIS fur 

mcdi"al evidence n~'Ccs.sal) 10 "ulu~le the impainncnl arc $enl 0111 by lhe DDS. 

C('O jl))Of"ls inilialive< It> (",prove lhe pruc~ss '1 lhe ini!ia l dC!errninaliOfl Icvel 50 thaI tho correC! 

d«is100 can I>c: made allhe e~rli~sl poinl pos>;ible and unn«essal)' appeals can be a,oided. 

Inadequale cas.. dev. lupmc'nt allho DDS Ic\cl me~n~ thaI AUs will need 10 jpend more lime 

reviewing case. prior 10 the c~rinll' T his leads 10 I""gcr proc",,;ng limes,' d,e heari ng ~, cl. 

hnpmvcnlcn\l; Qllh. fronl end nrlhe proccss can have" significant bendici~1 imp;lct on prcwnling 

Ih~ b."klo!; and ddayslalcr in Ihe app':al, pf"\)Ce~. 

, 
62 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.037

A. N~,, ' Streenipg Inil aI c~, We support SS,\ '5 cIY<1"S (0 :lI:ccicr.ltc dl.'Cis;on;' ~<l<l de"clop 

nc\\ m~'thani'lms fQr ~p<'di(.d digibility (hroUl!hQUl Ih~ application .nd ",vi~\\ proc.:ss for f"'Oplo 

,,"hose coodilio"s 3'" Ihe n,OSI ..,,'ere and/or IL'rmin31. We encourage Ih. ~ pf<mgpi"s ""reenin!> a" 

cl3ltnants phial" mOl\: de>i:Untt'llIlliOll tP support tbeir oPfilionllolls, Ho\\cver. SSA ".USI "'~ 10 

tnsur~ (hu( (hen: is no neg'li"c infen.nee drll\\n when a cla im ;$ '1QI5<l rrl~d b) the screenins tool or 

nll[)wed at that inilia l c\"alll~(ion , 1"cn: are twO inili.li v •• thai appcBrlO be working wdl. with 5SA 

'"creas'n!'. II,.. numt,." of t lainu c01l.iderc.l in Ihese ""tegori.s each 1;""31 Y<'lI'; 

• Qllid! Oi,1I bilily Ut lcrmin. I'ons, We h,,'e ~"pjlOned IIw Qllid: Disabilily Dcwmlina,ion 

(ODD) P""'''SIi ,;;nee il forsl Ues"n in SS',\ Rcgipn I "L.lcs in August ~006 and '''IS expanded 

nation\\ide by Commis~ioncr A5t1\le in Septcmbl'r 2007. " TheQI)D proces~ ".s tlw polemi.1 of 

PfQvidinsa rlVltIp1 disabili,y decision to IhpS<' claimants whu haw utrcn.dy severe imp"if\n~n\.S 

~nJ readily ",'.iinble m .. -die,,1 e"idence, Since its in""Cption. (he.v~SI m~j()ril) ' pfQDI) C;ti,'" ~3"e 

bc:1'11 decided favorably in less Ihan 20 days, and somcli""",, injust a fcw days . 

• C"n1p~~ n"tt A lltI .. '~ n<.,. . Th;~ initiatiH all,,\\ ~ SSA tuc!'t'au' >lll "~telllii"e lisl..,f iml)(linM'I1 ~ 

thaI Wc ISSAI Un ~lInwquickl)" "ith minimal objc<:li,'c medic.1 ~'Vidcnre Ihal i. based on dinie.1 

sip,ru; <)I" labQrotory fioJillgs Qr a c~lIIbin.iltion "fbod" .... 1"~", nrc "'I'" 113 c<l<Idil;onsoo Ihi~ list. 

publi<h .. -d nn SSA's websilc . " 11.~~ ar. cUlldil;"',. Ihat dcarl)' q ualify WKk. Ihc d~",hility SllIlIoord 

I>a~d "II ubjrcti"" mffikal infilnnallPn that en" he ph(ained <I"kk ly.lJnlikc Ill<- QDD screenin.". 

"hid, OCCIlr5 only when Kit "wli("Jlion is filed , sc rtcnin~ forcornpassi""ale aliowanttS Can O,;cUr 31 

any bel ofO,e ooministmti", 31'fl"a1S pt """:<S. 

O. In", et>l'. d . .... lopmcn. of iII.o n ""~rli .r in .h~ ., ...... f$.<. We have. IIwnbt,..,. of 

n'.'C\1",nlcndalioos 10 enso,'" Ihal di;ability c l.ims all! prop...rly dc,·el(,p • ."d ~I Ihe i>e!):innillil pf Ihe proc~'5S. 

Why an: we:<Q eOlICN"c<l .I>oU( d~n'~ ~ M Ihe iniliall<-,·d~ b~$Cd on IncQlllpll1c r.:~ord~ ? Fora 

vaOcty of eaSUll~. m~ny dainwnls d~1,il-d at Ihe i"il>allel'd do 001 appeal 10 Ihe ll.'Considi:nuion 

level. ,'ven Ihpugh they ilia)' b • ." as likdy I" hccnlilled 1<1 benefil . .. lho"" \\Im do app • ."al. We ha,'c 

long ttc~n con~~m"'" al>out d~lma u; Ixi"" di"'Qllraged frum ppe~ li dcni31 s and drupping out of 

th~ pl"Ol."tU, 

Vhil~ ~n iml"'rf<'tl me:tsuI"C oflhe .f'pt."al rale bI. ... .;usc the <kIt3 IS nOilongit udinal. an SSA cha" for 

n .. eal year' lOll, "Fiscal Year 2011 Workload 0"3: Disability ()ccisions:' does I'"",;dc" ,"cl)' 

&rnernl jdN ~bo\lllhc diff"cIToc<, In appeal ntles afkr initial ~Iaim dcnial~ and Mlcr rceo,'~idNlIliOlI 

denials. Far 1Cl< ~ lh,,,! half Of ~I ima"'s whOS(' ini(ial cla ims ~rc denied go on to ""'10<:>01 

"",o""iderdtion (aI>oIl139%). In contmSl . far more lh.n 50% of d.imams \\ho n'COi,'c 

l"Ceonsid~rutiQn dellla!s. ifth",)' proc=lIO lhal slep, appeal 10 the AU I"'arin~ l<'ld, 

Onr . pecific ec"mm mbli s fo r M tterde,'elol'ment of e,idenec u rlier in th o p....,.",s illelmlc 

Ihe fOllowing, 

At the be~inning oflhe proCI.'SS. SSA shpuld uplain 10 Ihe claimant "hal ~vid"lIc~ is impon3nt "nd 

""«''''"1)'. SSA should also pnwidc appliea"'. \\ilh mOre he lp comple,ing Ih~ application, 

pankol.rl}' in lighl pf~lfetmnic f1Ijn~,,;Q Ihat all impainnent.> and >CI\'n:e~ prinfpmltltiPO ar~ 

;d(~(ificcl , incl udi~g J\()I1·physiciM and "th~r professional S<)lIn.'Cs. 

, 
63 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.038

SSA sh .... ld ensun Ih~1 1>1>s. obl.in nN1'SSlI1')' Rnd relt" . ol t" idr nct. 

Ropre><,nLal ives on~n are able LO ob\;Jl" llener medirnl infnrnl31ion boCBllse Ihey llie ICHef!; and fonn. 

Lhal ask 4ue<liOtl~ rcl~,'anl 10 Lh~ diSllbilily dtlcnnin",iQ(1 proces~. H<J"~"""'. DDS r(lfln ~ usually ask 

fur gcner~1 m~diCllI in(,)m,al;"" /dlallnOSCs. findings. (.1e.) wilholll I.il ori l\~ quc~lirm$ In Ihc Social 

Seturil}' disabiliL), slandard. One way La addn,ss Ihis would N: for SSA 10 eocour:lllc DOSs to send 

Medical Source Slnlemem ron". In IreaLing and eun'ining .locI""', 'fhc"""simplc 10m .. II1IHsl.,C 

complex. delailed medical sourtt opinions inLO Pl"clic~llionclio""1 Lcnns u$CrullO ODS 

oojudicatOl'S. SSA luis cl"I.'.,.d somc n.'innal foml< to collecl ~vid~"ct. bt'llhe'Y "al)' in qualily. Til;: 

,11"."ion is furthcrcomplie"",d bo.",3USI: some DDSs 1= Iheir own fonn" "hich ~Is" ""I)' in quality. 

SSA should ",·vjew ils oWn national forms!lIld DDS forms ~'.I n", use{! 10 toile"" ~"idence, and,.,1 

"",dards for !il.l lc- ~pecifie fomrs 10 e'lSure higher qualil)'. 

SSA sbould i" c ...... u ...,in.bu,"""",enl nll"l Fur pro\"'de rs. 

'To ;Iupn",e provide, rt.'l'p<)n.<4' 10 ~""'15 furn",,)I'IIs, ~prrupri"'~ rei",huI"SClOc'" MCS for medical 

re<:ords and rtpons nc'<.~ltn be e~~lb!ish~d. ppmpri~le rnl~S 500uld also be JJ.lid for c;m "llallve 

ex~minalj()ll~ and For ",,'di''al expert6. Incrca.ing the reimbursemenl rate will ~ndollbl,-dly improve 

provider resp""'c "'e., It 81.., will help 10 improve the lIIedical eXl"'niso: available 10 adjudicalors 

f(lf consul1a,i,'e ~arninalioll' and for me<!ical rxpcm. 

SSA "ld pn)\'ide beliH c~planalil)n. 10 medical pro.'idel"$. 

SSA and DOSs Sh'lllid provide beller ~xplllllalioM to all proVidcrs, in panicul~r Ii .. pILY~ki~n ~nd 

noo·physkillJ1 treating S<>I.In:es. ~l;>out thc di!k1bilil~' ~IMd3.,d ~nd they slwII]d as~ prol'idel'$ flit 

c'\'itl~lw:e ,elevam til 11110 standaru. 

SSA 5hould pro,'ide nlOff Inli"in ~ ~ nd uid~n,.., II> djlldic ft lol'!l . 

Many reH~ls al Ihe appeals k"e1s"'" d"", 10 earlierCm,)IleOllS ~ppljcation oFcxiS!;ngSS!\ policy. 

Addilionnltrnining..5honld be. providc~1 on imp(H'~nl nalualiun rules such a.'I: weighi,,!!. medital 

~vid:ncc. induding trmtin!! 50urce opinion~: Ihc role ()rnon·pilysician ~vid~nce: the ~Val'llliioll of 

me" .. 1 i"'p'linnen! .... pai", and otl,e •• ubje":li,'c sympwms; Ih. cvahmlior, ot'childhnod disabilil),; and 

Ih~ Ilk Mill. Sodal S'lCurity Rulin~. In 2006, SSA pillMtl using r~dialric Me{!i~al UnilS IPM U~l 10 

prlwide sp<:cialiud e~~r1i5c for ~djudic~tuN who del~rminf (·]igibility for di",bililY benefits. 

Te~ms ofinlcrdlseiplinary clinicians Wilh 'fl'I...:ialize-d dc,clop"w:nml and assessmenl cxpcnise 

I,,'\wide<! imporuOi ~upPQn fe>r Iale di",bili,y adjudicnlOf!;, We suppon the,,", I}PCS of ellans to ~elp 

make dis.:lbilily dc~i~ioni a. dTicichtly "nd as early a~ possible in lhe l'f'OC'"ss. 

SSA Should impron the qu~lily or <<In.,u ll~ti n U~ ",io~lion . 

Sleps should be laken '0 improw Ihe 'Iualily ofthecMsull"ive c~a",iu~lion teE) pn)Cess. The 

tum "Ill low ",imb"r;cnl cn\ mle i~ nor sIIn;cicnl 10 ensure Ihe qlmlily of ccmslIhali, c cxamin"lions 

(("lis) and undoubledl~ is a foclor regarding ,'hieh doclol"i and p'I}'cholo!im an. wiJlill~w conducl 

CEo f.".SSA , nU'lh;s docs nor e-xplain "hy claimanL' an: rd"""d 10 d,e wnm!! physician. gi,'.n Ihe 

di.:abling imrainncnl •. We hear far 100 mnn)' lorie~ aboul I~~ppmprinlc rcr~rr~ls. short po;:rfUIIWlfY 

(xa.ninal;ons. and examin.lions wllducl."ti in Ianl'ua1!-es olhl'r than lil~ aprl i~~I\I· s. 'rhis is ",.sltd 

ml'lnc~ lor SSA ami "nhdpf,,11o individ"al~. I'sl"-<:ially Ihose wilh low income. ,,·ho <kL not haw 

, 
64 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.039

<(\!upIClc medi.-ul IYCords doc;umc~II~" Ihcir (....,ndiIiM~ and ,,-110 ,,~d ~ high 'IlIali!y CF. re(lOft 10 

help ~tabli,;h their eligibililY. 

II is il\lpomam II) nOl~ Ih~lth~ I"C"ljlllalio<)saliow SSA II) p~y Il"C"lOting ph}s;ciall~lo pml id~ ells, b"l 

Ih")' ~rc !':Il"C"ly used in Illllt capac i)),. II is lihl)' lhol thc IlIw reimbur>l'mcnl rm~ ctlOlribuleS \0 n<'l1-

lise oft",aling pn)sicians IOreE .. SSA .11"" ld ~~pIOl''' way. 10 cxpRJ)d use oftrealing physici~I1' to 

f'l'!vidr Illi. in[OI'mOli\l<l. 

Also. t.} cns"n.' Ihal il5 flmd. a", he,ng u~ a, efTctli~dy and approprialely as pus.;ibJe, SSA ilhl>uld 

provide mOle 1I\'crsight orthc CE process. which ;s conducteJ by th~ Slaw a;:.crn:ies. 

It appears Ihal 5<lmc DDSs ",[creases fllr CEs !':Ither th~n wail for medical dll(uOIwnlmion frum Ih~ 

claimant's !real;n& !;OUI"t'(S. boIh ph)si6:ms ~nd ~on·ph}sici~n (ifrcqul"SICd). 1\ Sil!J'ilicMI fl\<;'OI' ~ 

likdy the fact tlml DnS~ np"rlIlc uJlder proccssing.!ime s~~ndards ~gainst "hich SSA mca",re.,heir 

perfomlan<"e. Cl:!iman!S' repreSenlatives f"'<Iu~nll) r~" on th~ probl~ms " 'i!h nbt3ining medical 

~I id~"c~ -reques's are "fIcII gi~ell 10'" pr;nrily ~i\"en die bus~ na!u", orm."y med;cal nfj",es: 

reimbursement rales UJ'C ;nad~iJlome: and mnny (lfr~5Iac~ m, .. dit~1 n.,(:Ofd~ slI1!f. The DDSi raft 

these same chaliengC$ Bnd "ll<'n coupled with !he regulatory time constraints. We bcli(\'c !h3t !he 

ODS. are u"d.,.,. pre"""rc III cIlt5hon eITon.!o nill.in medical infonnation from treatins 50urc<;s. 

The proce$5of e,.,.iuatin)!. "' ~ther ft per"'m ~3S a dilability Ih.t is severe~nlKJgh 10 quali!) for DI is 

"ompln. l'Jo two people with ~ di",bility are truly alike, no tn'l1er IlolV $imil .. Ik)' miglttlnok on 

I"lpcr haSi.'<l on simple r~ctOl"li such ~s ~!!e. prioreflrllil1gs le"d. prinlal")' di.~O!'is ewe. nr 

g<'Ography, That i. "~r di,...bility el'ulllBlors usc in-<1eplh revicw~ ofevidcnce fNOl profe\'l'iOIlBI, 

who h"\"~ actu"lIy io'''"ICd and inlcra<!ed. i" I"'rs"", lI"ilh !he apl,lic"nt in nrdcr 1<0 m,,1c" d;.<ahility 

dctennin~tion . rhey mllSI c, ~lu.,c IIw K,"eril), of!he diS;lbling conditiOn '" c<}ndili{ms 1111;' uni<lHl' 

indil,(dual and ,'ompare this '\eVcril)' to !he sLlndard in the law, rtgulatioM. and 5S,\ JIIllicy. 

St:ltlslkal analy~ls Ih.t e.<a,nincs cltomcteri~tlc~ li~e Ihe ones m~nlio"eJ ii, the previo~' paragnoph 

('a'i be ""I)' usclul ill C\'~luating aspects oflhe o\ ~noll S501 prOI'fllIll. like lrend~ i~ II,,' impainncnls 

fOr "hicn p • .'opie ","eile dis.,bility he"cru ... geographic disparities in disobilily pre, Jlcl\<:e. or the OjW 

Of comings prol1lc~ ofnclV !><neficiaries, forc,xample. We do not beli~l'c. hO'l'cvcr, Ihnt eVen th" 

1It()~1 _wphlsticated stal;s! ical arutly ~is can p",dic! with a'l)' del>R-'" ',f acrumey whC1hcr." indi~idu..1 

~is:.hilil y dct~m,irullion"M tOrretl or inCiJrrC<:1 or ",hether ~ p;1l1icnlar indi vi du~r~ iOlpaim'cnt 

pre,'cnts the indi"idu.11 from working. Kl'Y faclor.;;n making tht diSlt!>ilil), detcnnin~tion. ~uth ~'Ihc 

medical evi~ellce pn:sente{l. ~i "'ply canno! be caplured i" ."3IiSlics. 

A "'''''nt worlling paper by Ihe RAND Corponllion enli!t<d "00c~ Disability Insurance R<'Ceipt 

Dis<,;ou",~ Work?"' '' ;lIusl!':lle ~ the (langer in anctnptingto apply tali ical."a\ysi s III cI'alllatc the 

<ICCll,~CY Oflhc disabili!) dctennination process. ']'hc ~tatiS!ical obsc,,'alioll> made by Ihi, ""rking 

papcr. "hich did nOt indude a r."iew of~ singk illdil'idual disability cast orlhc ml'dical tvid~nee in 

"ny ease. halC bttn repeatcdly ,"i:;n:p~n"d in ,".I;;II~ ullr""nd<'<i claims .oout S5DI adjudk3tion 

an~ l:>.:ncfici~ri<'S - slleh as Ihe. not;o<) Ihal !lne.qu.all~r of current I>cnc1idllries had their ca.es wrunl!.\)" decided ~nd ~r~ not eligiblc 1m hI.~,dll.S. ~t14 "'Quid be working irtlwy did ~1It fI.'<:c;I'C SSDJ. 

Such infcrencC"S arc false and mi.intcrpret "hat Car! bc cO<lCjud~d from the workin>; pal"'r findings." 

The mo;;tth~ RAND au!hors' 51atisti~aJ anal)' ~is ~C111 ~ to be able 10 ~holV is th.1 13 percell! of 

• 
65 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.040

w~ (notlhosc "hose applicalion" ~ allo .. cd bencfil , or ~II ,lirn.e ~cci\ ing ssm bcnelils) 

h3,'1\ .1 leasl I chance. hO\\ ~"~r small. Qf lIa"ing a dill'erent QIIICUme if IMlhcr 'tImi,,~, hild 

"\'"lu310011,,, claim, 'rI,e RA NO ~uthor.; dn 001 appear IQ csl in'al~ Ihe "Clual "",1mbilil),!)I' likelihood 

(It'h:''';ng a ff~renl "UIC(lmc. W~ bclif\ ~ i\ ~ quile 1,,\\ tOr" numb.'r of rt'JSUlIS. prim~rily brtaus. 

Ihe l~l'I!l\ m:Uor1ly oftxmnincrs h~"( fairl), simil:lT ~lIowance and deni'll n1les and il is li~cly a 

different .\.,.lu.IO, WQuid come 10 lbe sam. deci,ion as the first. 

Thai ~me RJ\NO Slud)' find< "cl)' I,,,,, levels or.arnin~ ( .... en atl){Jng Ihusc denkd lK:)\cfil.Sl. w)'iell 

"ould SUjWcsllhat mnny rroplc ""Ih vcI)' scr;ClI'j balTicl'li h) "lilt ~r.: dcnietll>cn~r l" tx:.:uu ~ IMy 

do nOi m .. '1 Ihe snkl legal standard. Th. wQrking paper d~s nOi documenl poor dcdsiM making by 

DOS ua",illClS, nord"", it ,how Ilml disabled individual, who dn ",cci,~ ben~fit. c"uld work 

,nll"3d I\I1d do !l01 """,d Ihtm, inall~, Ihe "ilrkin~ p;tl"'rcOIIld nOl allcmlltlo detcnnil1~ "holhcr 

,")' aclual disability d .... crmi":"io)\~ "'~rc tOlTt'<'tl)f nOl, bc,'~uSt' Iht" ~arr;;hcrs did,,' 1 h''''t access In 

Ihe kindS of d~lailcd ,nfi'mnalion uS<!d by an adjud icator 10 determine "helher an ;ndi, id,,~1 

"rlllicam'~ condilion m,,1 Ih. ""verity mml:lrd in Ih" I."" In~ead, il ()¢ k~d for ~la1i!,i <:allrends 

based on gcncntl ind;camrs_ 

We cautiOn ag.ainSi dmw,n\!, a~~ toncl"slon~ regarding Iht ~ccnll1ey of the di!'dbilil)' lklcnninul,on 

pro,:ess or on Ih~ .fTccl ofS$DI benefit receipt on II>c wor\( behavior ofappliCllnts Nls.::d ()rl U 

""'liMIcal analysis of.d",i"i.t"'li,'" dala . Allh"uj!,h !l,~ cum:nl sptem «",Id be impro, ~d in Ihe ways 

we haw pre,iou,ly onlli,wd, il i, flindaillemally SQUltd and Ihe Slalt OOSs Pf"I' 10 becomll1<.'l1detl for 

'he carer"I, Ih(lugltlJi,1 .,',h",,;on of cvidc....:e and applicali01' oflhe law "hi~h Iltey u"" 10 ~\\'ard 

benefits, 

Condusio n 

The rf>'si dcnr~ Budget Propr;>:;al for FY 1013 is Ihe minimum need..J 10 cQotllinuc dri"ing down 

di5.1bi1ity b;u,klogs, impmv" $crvic,-s 10 pe1:Iplc lI'ill' diS3biliri('$, i....:",:iSC' clTic;"ncy, and ~«p p.c~ 

wilh Ihe rising d~m~nd~ /)fll", Am~rica" public. The "J'Cc<l and qualll)' "fSSA' ~ Ji>ability pruC~ss 

muSI c" ntinuc to improve and should nOI be allQ",ed to regress imo Ihe longer wailing jlCl'iods oflhc 

reeem past, Th~ challc"l'c< eftn only be addn..",.,d i(Conjtr<'SS :u,d th" Ad,"i" i'I<"3I;on wQrl:: 

10~C1hcr 11'1 CIl.,IlTC thai Sr>Ci~ 1 S«urity cooljOIK'S 10 be !ltt safety nel I~ "OS designed tn pmvid< ror 

ptork wIlh di~"bili j" ~"d !ltcir fi'milies, as well as retirees ,md sut"\ i"Q~ Ilf,,,,,rk(1'!1 "lid ",li='5. 

Thank you again for Ihe oppOrtunilY I() teslify, CCD looks fOlward 10 conlinuing 10 "OTk ";Ih Ih e 

Subeom,nillCc 10 prole<:llhi, vilal program fllr pc()plc "ilh di".llbilili",,_ 

SubmiUod On hc hRltot, 

Associati"" of Univ • .,.il)' Lcnters <It, Disabilily 

LllI7.don Cenler f<)("Mcn lallleahh Law 

Communily Lc!!~1 SC1'\' ic~ s 

COlp(>r3li"" for SUJlPOf1ivc Ho"sing 

Ea"c' S~~ s 

Health & Disabilily Ad,ocales 

Nal;>l>tal Allia nce on Mental Illness 

1'.';01101 Association Coul\Cil~ un [);:veIOJlmcm~1 Di,;abililk." 

N"iMal Associali"n ofDi""bilil), RCl""seillali,',," 

Nali"nal DiSlibilit)' Right> NC1\\Oo.: 

, 
66 

f 

Chairman JOHNSON. Thank you, ma’am. 

Dan Bertoni, welcome back. 

Mr. BERTONI. Thank you. 

Chairman JOHNSON. You are recognized. 


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67 

STATEMENT OF DAN BERTONI, DIRECTOR, EDUCATION, 

WORKFORCE AND INCOME SECURITY ISSUES, U.S. GOVERNMENT ACCOUNTABILITY OFFICE 

Mr. BERTONI. Mr. Chairman, Ranking Member Becerra, Mem- bers of the Subcommittee, good morning. I am pleased to discuss our preliminary findings on the Social Security Administration’s efforts to modernize its disability criteria. Last year, SSA paid nearly $170 billion to about 12 million bene- ficiaries and independents, and given the size and cost of its programs, the Agency needs current criteria to assess whether an applicant’s medical condition affects his or her ability to work. In 2003, we designated SSA’s disability programs high risk, in part, because its criteria for determining medical eligibility did not 

reflect advances in medicine and technology, and its occupational 

information did not reflect changes in the labor market. My statement today addresses SSA’s most recent efforts to up- date its medical listings and develop its own occupational information system, to better reflect the existence of jobs in the national 

economy. In summary, the Agency has made several changes to improve the timeliness and effectiveness of its medical listings updates, 

such as adopting a two tier system that first includes a comprehensive review of all disorders in a body system and making appropriate revisions; then, on an ongoing basis, conducting subsequent 

targeted reviews of that body system, focusing only on a limited 

number of conditions. 

To date, the Agency has completed comprehensive reviews for eight of 14 body systems, and has moved to the targeted phase. In 2010, they also established a five year cycle time for updating 

its listings to ensure more systematic consideration of advances in 

the treatment and evaluation of conditions. 

The Agency also contracted with the Institute of Medicine, and 

has acted on several of their recommendations, such as creating a 

standing committee to review and provide advice on the listings. 

However, SSA still faces challenges keeping its listings up to 

date, and has yet to complete comprehensive revisions for six body 

systems, which in many cases, have been ongoing for decades. 

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

The Agency has also experienced delays with its targeted reviews, and slippage in its plans to conduct post-implementation 

evaluations of previously revised listings. 

SSA has noted that challenges in this area are mainly due to 

limitations in the number and expertise of staff needed to update 

the listings, and complexity of the regulatory process. 

As you know, the Agency has begun an ambitious project to develop its own occupational inventory database by 2016, which will 

replace an outdated system it currently uses. 

In 2008, SSA took steps to guide the development of this occupational information system or OIS, to capture both the physical and 

mental demands of work to better support its disability decisions. 

Accordingly, SSA established an advisory panel of external experts tasked with making recommendations on developing a sysVerDate Mar 15 2010 12:59 Mar 19, 2013 Jkt 078671 PO 00000 Frm 00071 Fmt 6633 Sfmt 6602 I:\WAYS\OUT\78671.XXX 78671

wwoods2 on DSK499XVN1PROD with WAYS & MEANS
68 

tem, and held initial meetings with outside experts and other agencies that collect occupational information to gain insight into sampling methods and other challenges. 

Last year, the Agency issued a research and development plan 

detailing activities necessary to complete this phase by 2016, at a 

cost of $108 million. 

To date, they have made progress on several fronts, including 

using its own administrative data to identify the most frequently 

cited occupations and functional and vocational characteristics of 

its applicants. 

However, due to staffing constraints, several planned initiatives 

have slipped, and officials know that further time line adjustments 

are likely. 

To offset this challenge, SSA has used consultants with specialized expertise and is working with OPM to obtain additional staff 

skilled in industrial organizational psychology on a part time basis. 

Finally, in the course of our work, we have identified some gaps 

in SSA’s approach, such as insufficient documentation supporting 

SSA’s research and development cost estimate, and the absence of 

any information on total cost of the project over time. 

We will continue to pursue these and other issues as our work 

progresses, including how SSA is managing the OIS against best 

practices, and ensuring that the project schedule reliably estimates 

key activities and length of time they will take. 

Finally, we plan to review any risk analyses conducted by the 

Agency, as well as mitigation plans to address identified risks, including how this complex project will proceed should funding be reduced. 

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

may have. Thank you. 

[The prepared statement of Mr. Bertoni follows:] 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
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wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.042

GAO Testimony 

Before t~ e SubcommiUC(' on Soci31 

Security, CommiU,cc 011 Ways :u\d jl,IC;UlS , 

House or Represent.atives 

MODERNIZING SSA 

DISABILITY PROGRAMS 

Preliminary Observations 

on Updates of Me(tical and 

Occupational Criteria 

!I,.'e.n.Il' of 1'10,,),·1 liN''''';, ;r~~'( ... Edu<'I<Uull, II' Of ~f6 ,, . "M lou)."",' S""urll~ 
70 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.043

• G~O_ IU: 

_____ 5'~ 

... J.H 

_____ 151'~ 

....... ____ ~ _ 

-.. -~ .... - .... :'':'''':...--- - ... --- ""'1 UI\O 1·l'f!p • ...,d TI,L~ 

To:otlmnny 

SSII __ 01 .... ,"-' ...-cy---- _"~"'_iII'I'o'o 

__ ... t.oI20 __ 

Ui5_1n 1."_J l!W -..,:zo_ .... _ 

--~-~ ~GN:)_"",,­

-~ __ .,hogn- --"'--oIigItOiifi - _NIl _"-"",,II> 

~ ......... -~ -----""-

~"' __ """'iII ...-,. .... _5SII_ 

=-or: :..z:.t."::"-. 

_c.oc ."."" __ 

---.-".Q~", ......... 

" a ••• 

MODEHNIZING SSA D1SABIlJTY j' ROOIW IS 

Preliminary Obsen .. lions 011 Updat/!!j 1II Medkal and 

O CC:U,INltlo" • • Crlte rill 

Wh.t (lAO t·O",," 

Tho __ i~_($s.o.l"" __ 04"""'I.~. "'_f ............... .,.;r,g ... ~_bUl~lO_ 

~-.'""""Y<JIICIOoIn.$!;A .• _..-.u. .... _ ........ Ionnol"-d ____ ..,..........._, .. ...." 

._ _SSA~_ To __ ......,. _ -.._0_ __"""""" .~.~ss.o. ..... _ . .. ..--.g ..... _,~ __ ............. ......, ss.o. _"" ___ ..... _ .. _ .. -. '0_ .,- ss.r._ __ 

............. ........ __ _01 .. w_"'_"".", __ .. __ ... ,,_ _ 

_1arV01OOCI ___ IIt20'O . .,.ss.o.c-r ... 

_. 

~.,.,...- __ .... .-...g-.",,--~-.. ... "'~. __ blool;rvo""""'_l 

IO. ____ ~.-.....v_ To"""," ........ "'_ 

_~"'_SSA_-..gIrIF_"'. _ .. """'"._ ... ____ "" .... 01 ...... OUC/I"~'~ 

_ .. __ ... --.; ... ~ _SSA_IO 

... 

1aOIcII~"- ~ ___ .. -."""'_ oIl1o""llOb F ........... ... bodySSA .yI_""'_ .... ~ 

lIMn ~ b I~ 1O:I3)'Ht1 $SA, ... ~!OId ........ 1OdI d _ ..... 

P'O<nO

·_,... I'Io Hna"""',....~_~,"' 

.. ,.,_~.-- ................ _01..-_ ... ~ 

~.-

SSA ..... _ .... ..-..JJIotI .. ...-IIj':/O .... ___ .. _ .. 

__ . ,.. •• IOO_11t 

_'SSA",_,,"_t_ ~ ___"' sS.O......-._ ... ~01~ ..... __ 

_ ...... IMI_ ........... _"'-.,._ "':lOOt. SSA_·jIO'OfO<l"_IIa_~_.,..,. _SSA 

__ __ ... _~_ ..... ,.,.,..... _ (016f 01-._ .. ..-._ .. _ • .......,. _ _ 

_ 1"o_ ... _oIIIt01S.SSA_ ............ _ ..... .._ ..... ____ .. JJ<t1O"_. -...-_JJIotI~"_"" __ VOSOII_ 

<o,g _20'1 . .... oIf~:/O'l.SSA""'oompIMocI __ _ _ iII<luOtIg ~ __ 0I~ """""'-._ 

..... ~,.,.......,. __ O' ... ..-..,_ .•• IOO~ 

.. _WS&O. ........ b .. ~~d ... 66.0. __ ... 

__ ... \af!ir>g""""_~dId""'_ .. _ goa/Oon ...... _"'""I _10""""' .. _._ .... ,...." .......... _1lAO ............ """G sS'O' .. __ ~ ____ ..-. ... r-._-.tr 

... ___ r.lg_ .. SS'O'._."""'n ..... -...a ... '"'""'10_ ...... __ • .-015 

----------------------------
71 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.044

CM"m8n.l<>llMon, RankIng M_ B"".",a, and Membe", 01..,., 

SuI>c:orNni!lee. 

I all' ~ ••• ed to be I1ere tod/O)l k> d_ 0<fI prelinJln.'Y ClbseM1PO!'S on 

elfo<ts bV!t>oo Soco8I Secun!y AdmUl .. ~allon (SSA) Ie mode, ...... lis 

OIS>It>iIIly aile'OlI In the laS! 20 I"''''S, SSA dls~biI~~ t>l!nefiI pa\'f'l*ll5 to IIO<IGIiclare. and !heir d@pen<!enlSnne ",creased lliYek>kl . from 

$3~billlon !t11l:19O to ""'" $160' bilion In ~IO. TN!...."ber oI_:;ng.. 

"9" beneli<:iaries-also gr&W f,om at>oul 9 m,IIion " 2000 to _I 12 

million On 2010, and . ... more baby b<I<lme,. anI"" Iheof dosabjlily-Jl'OOII 

years, ,SSA "_peel" IIIe 1\lJIIIM' 01 clalm$ 10 gmw ' G ........ IN .. "<lenS .... 

~ Ind OOISI 01 iIs d~lit)o prog ....... SSA """I naooe CUl'r$1\aNl 

apprOPllate cri1ena bI' ~ 10 __ ~lhef an appJ<ar>1'a me<ioc.el 

cond,Iir:on1 alfaa n .. or M< aIIi. ly to perform _ !t111w1 1\11lIonal 

1ICIDfIOM)'. GAO na. design31!!d SSA's federal djSllbil/ly program as ... 

hig,,"",,>I; IIAI", In 2009, we ,,,,,,,n!!d Ih.al u... agency'. medocal cri1er ... d ol 

no! / ,efIect medlc8' and technological actva.-.. and \he 0CCUpII\i0n31 

cnle<ie ~ us!!d f,om "'" Oeoaru-.l 011.1100. (l.IIborJ load flOl 1>0&<1 

uP<Iat~d ~""" 1991. desprte lhe tr~ .-way I,om """'U81 talx>r jobs arod 

towa,d:1 tef'Vlce- and ~OOW1f:dg.I),ued)Ollt , 

My 1al emenllod~v focuses on irWal oIKefva!icns from "'" ""!IWog 

feview 'or tIlis Illt>commfltt!e and ".amlnes the .IaW. and ,nanagement 

01 SSA'I ei1"," to <') Update its medlC8ll1obrQ8 to reIIec! current medical 

k"""""'. and (2) dowelOQ I own ooc""""""'al OlIormahOO 11'*" (OIS) 

to .e/I&ct lilbor malICe! enange&. To ... "",o-.e '","" 1>1oo& .... ~ 

pr1o< GAO and SSA Offioe o11~01 General 'eportl. !1!ie.anl1ede<e1 

law. and regulations; prog'am documI!nl1l\lOn Including po_ 

proor!d"""" IU .... goa'-, 8fId s "I'PO""Ii"" pmjec1 plaos and coot 

esiimal .... and po&Hion papen and 1eOJlmOlIIM!rom "''''''OIily 'Or"",," arod 

"""""'"""'os We ;nleNleWe:I SSA oIfiQals, key project conIraclors and 

llakltoo>lOell, d ... blIrt1 eXlllrlS, ... "" fVQf ...... m.!MIIl 01 o\h", "9""<-

_ ""''''_!(If dl~I"Y proQfarn& Ir! OUI" ongoirQ work, we .... ~ ~ 

ev. lu,l .. SSA', plan IQ ~ ~ own OIS iO!'Iairolll bnl ~!or 

COOI ... IIma~<III ~"" $CI\II<Iul~ We wli also lev ..... mor" 1If<>a<l~ otM< 

IlIllHl SSA is 19k1l'l\l to inco<~le modern ~f of d .... bilily into 1\$ 

pragm'"" We pia" 10 15_ <Ill, f,naI repon late ," 2012 In accord.""" 

_ 

'1n _ _ 20' O. SSA _ '.l __ _ _ _ , ... _ 

.. "' .... _, ... _31_ .. 20:10 

.• ' 
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wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.045

Bac.kground 

w'1\t'I geM(-"y IccePted goyemmenIlUCli!ing slanCl.r~., ~ '''''''''rcIt ~ 

~ 

.... tI\e1 .... e !Un and lie"""'" !tie audrl to ~'" .uITICIWlI. ,~ 

10 provide .. reMONlble bal •• lor our finding. _ oon<:lllJlon1 

base<! M our .,.eM obtK1ivfl W. peJieve t .... tlM e";<>O".,. <>I>I .. nlKl 

P'''''''' • reu" ..... bIo bal.1 lor our find'"ll' and c:ondusIoN baoed on 

"'" "ur:i~ obJOCll\Iel, 

S$A ~ IWD of 1111 I~t diubIIiIY P<O!iI'Iml; tile Oowrbltqy 

I~ (01) l"'CQI'am, InACted .. 1956, end h Su:lpletnenlai Socurt!)l 

II'oCOmI (SSt) ~ . .-;led In 1872 '", orlMlIO \II -"Sible lor 01 or 

SSI beneli!l based on • dlNIlIIiIy . .." ~ _ "'"I tile def;1'Irtian 

deteminablto 

"'doaal>lllly 10< 

pI)ysicII 

IhIIMINDQ'_ 

III --.tII1nlpeorTnen! 

II, they 

1haI 

"",11_. 

") ~IIIIW 

~ 

lOOIWIuaI lfom M1II-st"'ll" anV oubsllMlal ~ ICIM!y _12),," 

IIlIe<! or II ."l)lClfIG 10 1111 I,lelll -)'N' III '""" in dU\n ' 

TDoe-..~ SSAu""~~"'_IIIaI" "'1efI(IeG, 

__ 

... pert. 10 .'I*'!II "'UboIiIJ IIKiUonI ____ end IirN .... 11 OJ' conduI:Iingr Ielllll'Ol",-_;oj __ 

'1I9S(181C! ),·AI~\"'2"'1M~ $AdII .. _ 

...nett>er 111 ~ Ie working and _I _1h'flhoIdt oK wei IS 

!he __ ~ '" -"'" 1110, IIw ~ _10 lie!> 3 

of IhII PltlCftI AI l1'li5 -. SSA ')I.IIr'IMI'I _. 1M '$ 

meaOC8ll ~1IlMfII\')."'1I11M Laotingsol~ 1110""""'" IS !Ill !IIeCIoc.I1iallng1, _ ... ~ If\IO 14 m.,orbady 1)'tIIInt lot 

edub end ..n.cc mecIIcII CIInrIrIKInIIhIII _ -. <>OUOtrnIIIIKI ~ !hi 

-"l"""'l 10 bot ....... enough 10 QUlIiIy an eppIic8n1 lor boIn!IIIIs • If 1M 

IImQaorn>e1'II_ or II IquaIIn MWIrlty 10"'" or """. 01 

'ThoDl_",_-,. __ lOt&giIIIo ___ • ..-..... __ BSl ___ ~_IO ....... _ 

-. _____ "_ -. ... 115 .. _ 

"'lu se H'~J,..~I~"'I_ \_.not"'l_~-.0!1.-"", _OdMtr~"'-CIf\'rOCIO" __ Nl ... ","",,,,,,,,,,, 

_~ 

omIt_"' ..... _ . _ ;XIC:' R HOOO '~12 ...... n., Io101l "" ......... _.I'm""'_ ... _ ....... _,',O'O _ ........... _--- 'SM20CFR BolO< 1520_ .. S.WC 

--...rIu~_, ____ JOO_"'--..,..... .... " 1 """'v<_ .... ,._1IOd\'._ ... _ 

•• > GIOC)." ..... 
73 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.046

.-io the ,"Iingf, 1M- if'JdioO!I>&! ;. detenlline<! !o h"".U djil8b<1~V . II 

not. SS ... ~ an a'!Ie$SIYIO!nI 1lI!hf! ""'Md~'1 pt>yo~ aod ITIfInla1 

teIIl<!u.! Iu_al C8j)8CIt>I,. e.m on thII ~Me""""", 5SA de\erlnlnes _tile, I!Ie in<IM<Iua1 '- able to pet10tm Pl''' ,,,levant WOI1< (""'" ") (l( 

af'Y wort; !tIlI! it perl."..,."..; '" the nallonal ecot'iOITI)I (step 5). To inrOl'm 

<Ie1e<m.,31"",. 31 II""" 4 and 5, SSA uoes a Departmen! III Latxl/ 

dalabaoe-known ",t/>II ~ ofOccupalion81 TIIIK {OOTI-Ior-'1 

in...,loo:y of lICOJP!t!ions pe<farn1ed "' !J>e nallonal 0IC()n0rrry 

Fig .... ! : SU'. Fr-5o.p -... _1 ... Il0<l P<o<ou lot Detennlnl"" OINOiIiIy 

- ~""-'- ------~ • 

! .... '-!_-, ----·"1~--- ----- ........ ___ _10.., .... .... _ ___ .. ____ ".. ... _ 7 

s..J,_......,._ ... -_ ~ .... ---.• ---....... .. _ .. _-"' ... -....... • e... ..... 4. .... __ , .. , . __ 

_ ... _____ _ ........... _ ....... - • ... • .... &:/Onr__ .. ----.,...."'-_ ......... _- -- --- 'SSA.CJI>7SO<OI ___ """"""'"'_~ __ .... _ "'-""--._--_.),IIIdwdIng...,.,-

""""' _ ... "'_c.1I>I<iI>1000 ................ -. __ __ pI>YOi<:aI .. _-"'--..,.,. ........... KIMIIeo 
74 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.047

51""" 2003, SSA's and olh<!r Ieder ... d .... bj~l y ~"'m" ~a"" rema;n!Id 

"" our hig~k ""I, in pan, because lIIoOr programs emphasize medal 

""""<fions in as&eSOi"ll worl\-capadty Wllhool adequale coMiclaral.", of 

WO<\( opporWn jes alforded by adv"",,,," in medicine. technology, and JOb 

demand" . Sinoo II><! 1990s, WiI, along w,th 5SA's OIl'" 0/ Inspeclor 

General and tIKI Social Sewrity Adoiso<y Bo.rord , Mve e.pressed 

co" ""m" thai 100 mod<:aliisti"lls Iluing ..sea 00 longer provde SUJfOClOni 

critaria ~, evaluate d .... bllity applicants' inability to worI< and that 5S ... was 

. imply e .l"""klg I"" IISI,"II' ms!eBd 01 p!!rlOdbilly "P'dau"IIitIem, in 

2008, WI' ~rtBd thai SM had establIShed a !leW prooiI'5S It:o" revising 

lI>e IIst;"9s-relerred 10 by SSA as lhe 'OOsI"""" process"-Io beller 

"leo_por:;" .. feedback irlt<l its con!inoous upOal6l\.' Hlfs- prooess, wt\ic!> 

has beet1'" efled Ii""" 2003, irIcI>KIe. ;"corpono.ling I~ from 

lIN ple _s. ifl<::Iudi"ll moId"'l experts and clB'm~ • .ami"", •. t<l 

upllat<! U""" medical cril&tla. 5S/\, lfloUld alSO gau>e, e>rtemelleedt>ad<; 

1!1'''''gh <:Ommenls !tSSOCI81OO with fligulaJory adIoos, ouch as Itle 

~oca loo of 3<Nanced noI>oes of proposod l\II&ma~ "11 (ado.'ancec:r 

net"",.) and oofices 01 prooosed ru ..... aklog (notK:ea) In Itle Fecl8nr1 

Reg1sllIt.· In !I<kI.lloo, """ )"NI' afle< a ,evrslol! ill rrra<le, SSA, S/IOUId 

Dt<lCI..a a .1..:Iy I1Iviewing iI1e c/1a"9"s. Accofdlng t<l 5SA 

""""""",talloo, th'" fnlemal """" siudy, now ,el""11<1 to;os Ih!! 

pooo;~mp ementa\lon 51..:1y, -5I\olIId inVOlve SIIrvey1ng tI>e fiIIld reg8,dlng 

the res<tts 01 the mglJl;olion and a,eas tolmprova, as .... 1 ~s ,e_"""'ng 

the dala 10 deiermi"" whelher "l<ped;Il!~ from lila ,evl""" haW! been 

~" 

With ..... poct to I/If<ltlll3bOn on jo!>s In II><! n .. 1IoM1 lICOtlOmy Ih.at. suppo!1S 

SM', .. :cup.;olioruol "';Ieria, "'" ~nd 0Il1"'$ h"""" reJlO(ted that the DOT, 

whim SSA .lill relieB on 10 II ...... " ligibtIdy al slIIpS 4 and 5 0I 11Ie 

JII'CQlSlI, ;. O\JI<lated. The DOT has- flO! been ~Ied since 1991 , and 

latlOt hilS ,,,,ce I"tl'PI>taI<II/Ie DOT Willi a new "",,"base calle<lthe 

'- GAO fe< _~~, __ ~~COuII>Hoop~ 

~.fI>_" .. """"", ,,,,,,,G~ fW~ C May l1l, 1!J(I4) 

''''''t''''IlI\;tO. "' ..... _ _ ......... .. ......,.... """"'*'Il ..... __ p_ 

"'"'" '" .......... o/ p _"""_ _ '" -. "'G """"....~ 

... .-. ... __-.... "...".".. ... or" ~_Rog;su,._ '-"',,",,-" •. " . ..-«>rr..-_""""-, .. _ ...... _ ~U C-t ~ 

'.' 
75 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.048

SSA Has Improved Its 

Process for Updating 

Medical Listings, but 

Fa(:($ ChallclIgcs 

Compl{'ting U,Klales 

SSA lln.« h1l])I'O\'ed II" 

Slr.'Il{·gy to U(IIlal(} M c<;llcru 

Lil;ling5 

Or.o.Ip;IlIoMIlnklmlaUon NeIw<lI~ (O'NET)' _ . SSA h"" 

<IeIerrnin<Id ll1al O'NET os "", .... trJclm\Iy deIde<I b .... ~ 01 _ 

SSI d .. 1IO<Wy -.. ."" I""rdole hal t>egUrI """eloping "" ""'" 015 ... or"'" I<> l><luer rell!lcl U,., pIlyoicai .I'd "",",iii oemanos oI_~ in "'" ""_.cOllOm, 

5...,. "'" "'1 _ ..... Tn 200II. SSA "" ~ _ tral <:l>of'lll8ltlat hoIcI 

promo ... I<If lmIx"'I"II """,.,.1 ""~ 1IIld_ Fnl, Itl<I .~ Is """II 

• Iw0411,,0<1 "I"itm lor ""IlOIO\I re ......... 10 m. hlirlgJ, U_ Ih<s 

"1"IOm, SSA a~1 """"' ....... ~"'" ~ update lot a Dad)' ~,.".m Mal 'e ........ all llIe d"""'M ar<l diAordfort. ~.1e<I within IMI 

_)'Stem al'l(l """'''' ,""_ ~ <IeIertn!/'Iet .,. _ FlY 1UbSo!!Q"'II1I 

upr., ... of IiIlir'IQII fo< • body 'y5\1!m 1h~1 ~ • ~tNe 

revlSOOl\. SSA .... PI"SU<I ~ more IlWgele<l "IIP'OIIth-IhIIl _ , SSA will 

cotI(iuct onvo'rr!I reviews w'~ the ,""pecta\Io!> '" ""'~irQ Ia<gMed 

re' ........ lot ........ 1 n.urlbe< of me<!le.I <Me_ IY ~ Ihool need 1<1 

De 1IPCI0t;,d ~ otricI.IlllOkI ... \11M 1iI~ updill"" 0/JtIUI<I De 

CClm!'IeIl!d """" q'"'*l\t III6n """"""_ lIpdaU, • • aIIowlng II>efI'I to 

rucu. "" tho ""'"'_ 0fI80ges """""". H_. <rII\Col4. ar.c> no"'" 

\11M !lIeN DflVOing " .. ......, c;oW(I ~ III mIIjor Of e_ no ~ ... """,0QI\8l9. AI 01 a.,ry Ma"'" 2012, SSA IIII<J bt!yun II>e 0flV0I<l9 rll\'leW 

p'oceu"'''''''" __ ........ ''''I'''~' ......... IIY8''''''''I. aaull b<lay .yslemS mat we,.,~ ~""'eIy __ . AI5<I .. 

'" ear\)' M.,cI>2012, 1I'It! agency hod rIOIyeI complola<!~_ 

""".Ion!IIOf 1h8 ... rema.nIf1!lIYs-, _ "'" ~ "!>eCb 10 <lei bel",. mey CM<IlICI """""'I.-I ...- uMI!, _t.wg_ "PfIIMC/I 

~_O'NE"T,. _________ ""'''' 

-------.---, - ,,",,,,,,, 

_. "'"",,. .. ," 
76 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.049

Aoottle< change , aoccrdiog to aQ>ef'lCy offICials, is that itJ 2010 theSSA Cornm __ seta 5-yea, cycle time for updaMg tlStings for net> body 

$~$tem, " P~oousty, SSA set .xp<(8~on dales for periodically u!>dal'll\I 

tis~ngs accord'ng to each body syslMl, ,-ang'llg flam 3 to 8 yea ... , bul 

1reQu&ntly e>Clended them SSA (llficlais believe that conduCling Ia.rgellKl 

III~1ewa wie generally atloY; It1e ~ency to CO<leIUde any peceosary 

'II"'S""", pria< Ie 11M! S-yeHr e.pl,atloo pen"" Adcfrt""' .... ,-, lIM!y .. peel 

that ""in9 the "bu"n ..... II/OCMS: whOch r!'qU~"" Bally pubOc noIifiC8.tion 

01 o:Ilar"Q"" 8M Dt>Ia,n'ng """"'SIIry data aM!ee<lbltCk \rOm in""nal aM 

e.<tem .. "allies, should help keep 00II1 ..... 00$ re~iaws on track, See ligure 

2101 !!'Ie sUIU$-an<le>piration <!ates 01 ~slirlgs for 11M! 14 <tdu~ body 

avslemll, unde<yoooy review for eim .. , oooopo .. i>enslve Or possible 

\iI~teO re'<lliOM, .... 01 eally Maret> 2{l12 

••• 
77 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.050

--

" ....... ' ... 

1 --, ........ '" 

O::.. .. ~ -

I 1._ .. ....... ...... , ..... ""'11 '

-=,..- f ...... ,. ~ , 

-----_ .. --

0nv<>'nII"'_~_' .' ,,,."'V ...... p_.,, 

-.... -_ --.. 

.. 

-

,.,,~ 

1 

--

-.~ I 

'

---- .-,-.... ,~ 

__ L p"',., ...... 1 

---'-- --

_ .. 10m 

r _ .. _r-.. ..,,, 

___ 1-.. JoI'. 

I 

---". .... ,~ 

'F ..... ___ .. .. ,._ .. _ ... _'" 

--.ss;., __ "' ___ ... --. ..... __ ..... __ _ ___ ... ~ ________ ss.._"", ... 

",,...,ro_, 

... 

______ __ .. ,<'1- ... _'""""' 

... _---""'---- _______ .... ,,:II»I"" ... ___ .. IIl' O"" ... _... _ 

__ ..... ...-............ _ ... ZI .. 

'S&A ____ "' ... .......,....._Iiooiogo.,U1l8 . ... ___ _ "xw._ ... ___ .. ~ 

5SA has made a_ ma""" by mofe eXlMsl<mIy engag'ng tile 

"I':dICIII cornmuoily 10 Iden~ry WII)'IIIO Imp'O'<e!'" medio::aIIlsIOg" For 

e.~mple. SSP. CQnlrllCled witn 1M In.Iit .... ~ of Mad"""" 10 otl.l<ly its 

'.' 
78 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.051

SSA IIru;f;''1)ericllc{.'(\ 

Delays wilh Its RcvisilJn 

ess 

medical aneOa fGr d9IPormoning di5abllity arid Ie make rt(;()mr'l'lO!fl(alioos 

for;mprOYing 1M timeliness ~I>d a<:curtlcy of I dilabiloty~, 

I'1!!Wftlng ~ a 2OO7'~ witt> m<.OII'III'I<!Itions" a"'; a '\"I'IpoAillffl 01 

e.peM In 1010, SSA lias addressed sc<TlII ollhe In,~UI~" 

reoommena~tioflS, such .. ma)flllO 1N!"<>t U'" of its a:!mon,"l/aiMI dala 10 

uPdale CI.~ atld Cr'llaring " 'landing commi!lea 1/'I,augh !he lnsl.Me 10 

pmvode """"""",nds!!"", lor II~Urgs """"""", 

SSA con\in!le$ 10 face deillYS In CI>I'fII\Ieling bo1h "",""fDhenl"e I>!Id 

_,ongoing UIlQ!I1M_ Flit en"",le, 8S of e8rty March 1012, SSA 

o!Iicia~ !old US lhey sliU needecllO COfTI!)lele C<lmj)fatrens< ... ,eYilion. foI 

Hstlngs 01""" DcId)' ,)'S,ems IMI tIa.e bIMIn ongoing [(If the laS! 19 10 33 

ye;>J'C, alief nUmefOljI e.o1ension, be\"OOd tha Driginal exp~lIlion period, 

(see table 1)_ Two 0I1/Ie "mainong lix l>rXIy .y~m lisUng5-me'''~1 and 

neurological d;,orders, wlldl "fe IItnOflSIthose SSA ~ mosl reql.MPfl~~ 

In fie 8liGrt>iIiIy m~lermirlaflM pror.&Sll--l1a .... no! been compIellen' .... ety 

rev~ lor 27 ~rs " FO\If oflhe remaining bCId~ 8yllem lisungs are oeI 

10 e.poire in 2012. 0I1he5e Iouf, SSA IS "" .... Ioping a fKII~ 01 p!'C)IICI8ed 

Nlem<tkrng for [hrM of \f>eIt\ erld M$ M,*, II tlOlk:e on tM 1000rtl'l_ 

Howe.er, ~ It urICIear whelher SSA will comple!1.' me ....rrs ...... bI!Ioreo 

tile)' erg t.e\ to el<pi"r9_ 

_oI_ ~I/rCr_~_IDoOsooo"'<>cou 

~oc 2OIN) 

" __ IOSSA_ ... __ _.a.,ollOl_ .. _IO .... _--. ... _ .. 2000 

••• ".0-".,," 
79 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.052

---........ '-

,- , ... .- ..... _.-"..... ...... c_ - ... , ......... IU' •• pI<oUc><I .-- -- .... 

~--=~===.~--... -.. - 'MO ___ ... __ ..... _ 

:=.:r:...:::-....:-....... - ... - .... ----- ~ 0tl!I0fllI ,_ """""""l $SA'. ~ ~ -., 1(1 till 

moving at ,!;oster PKCI "*' lie ~ __ ........ _ . SSA 11M 

aItHdy ._IN e_ollDndMIlot .. , .. _ oIlhe~_ 

S\'SIem SSA moV ..... need 1O.>rterdew.pir0ll0n dMft for ........ ..,...... _ 0Ih8t I>Odr ~_ ... to _ ... 2012, KCXIfdIrlIIIO ogency 

oIIOaIt. ~ may IN _ ~ $SA 11M notYat~_ 

1he _ oI~'~"" _1...:0 bOdV1Yl1em iii. and 

may Mlha ... ,_\opubb/l_noI~ ,..powMI \O~, 

_ oompIe1e !toe liM! upcM'" oI1he 1i11Ingt oy ~ """'eI\I • __ 

.... 

AllI\e...-no 

~ ,_

tme , ~ ~ SSA 

ofIicioII 

11M -. 

~8CI 

e~ 

CI"IIoIleflgft 

doNyI 

~ 

~ 

_.~ WI 

,.., ___ pn>ceU. ""*-IMv ...... ~;"tended to ...... _IY~ill 

"'" "'"'" reo' .".rI< 10 de~ .,""'her .~o!iona from 0 ............ 

we'e mat. SSA officio). tokI u. \hey only bIIII,n c:oncIuctlo:1g "'_ _ 

,n 21)11) 6Qoci1icll1~,!hey ~ OM po-l"""lIn"Mm1.Uon lludylfl 

201 1 IhBIIM'- B "'rveled umpllJoi 115 e.HoIII. 8nc11hey "'ft 

conducting oncl p1ann1r>g 10 ccndlld 1WO more llUOon ., ".. _ yea, 

,.,.,,_. 'M,II. aUD<ioty e. perts Wi! ;,,1e!\'IeWOId lIPOke hOghly 01 SSA'. ~,1Ond ,.,get8CI .... _ ~ to ~ IHd,*=k ~rtyOll_ 

updalt!he ",lIngS mor .. pr<;mpl/y I8Cenl /lela.,.. ,_ quellkln1 

_. 
80 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.053

~ 

regarding I!Ie agency I ab,i!y 10 IoIk>w its CY"enllIuSlOe$I ~roxess whole 

conIil"'JO\l!l and IJmeI)o revialcm foralll( tIOdy ays_ 

SSA Clfficl31S CIIkI red two key reasons for I .... aot:o~ '" upo:Jallrlgllllt 

~I ng. lim>lalm.., It\iI numbM arod expen. ... oIalall' and iii" <:OIllJ)lexfly 

;ancI ....,p1<!dic\a.l)lIiIy 01 me 'lIgul./Jtory ~tOO!t,, _ AcoorON'!\! to SSA ~ •• 

, . ..... ng tile med"",1 "s~ rllq""" research, deltbenoboo IeSIIIl!I 

regul./Jtory _. _ conserlSln ,.,In many sta.ehoidet5. and 

CDI1!""U8!lil'( i. a.tlleun and lifne.<:onsL""tng Ie .cnlll,. In acid""'" 

_OI>1Q !<l .n SSA. oIIieiaIln tile 0trIe& of MeGal U$lings 

1mp,-II'Iemenl. lilt! ofl'K;e .. shcr1·.latred ;mel some . tall ~ lhoo ">(perh"" 

__ ary to perform tho/I WOrk To lIda'Kl IIl_ eonItf;)"'t!I. SSA 11M 

COIltracl"" wilh Ihe IMlitute of Med",,,,,, Ie re~Oew and d~veIop 

,~s kI' ........ "'" two of tile body ayslem boling ... f{owftv .... 

SSA oIIier,,1$ loki III tfIlIt troe agency __ roo1 WfTtI"uy have " ~Ia/lle 

renew Ihis CO!\Ir~ after II .~piln in 2012. !>Of use any otiletconlrecior to _'8'16 staffirlg alIOtIIaRs oue to DUdJlet oonstr3mt. Also COO1In!:lubrog 10 

llel8ys !t; the time (eq~ lor .... terna! r-ev>ew and Pl/IlI>e ct>ImII!nl under 

tile 'eoulalo;.ry p'ocess lIlal de\)ef>d' Ia~ O!I tt>e !\Umber and tne 

autlSia.- 01 cornmerrtJ 'eeerved, accoIding \O.n SSA offK:utl For 

. _a"",*,. SSA officials told '" mat I .... advarocer:J notice of proposeO 

,ulemal(,ng 10 1 .... l<5l1'111s of menlat d'lo(I,derl in 2003 rvsulted In 500 

COIlIme"I' , ~Ith took SSA 5 vwrs \0 incorporate "110 a cIrafI notlc6 01 

~0I)CSe(l cI'ornges for reguflllO<)' rlv_. 
81 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.054

SSA Hus Begull ,UI 

Ambitious Projccr to 

Dcvc.lop ILS Own 

Sl)urce of 

Occupatiorml 

Inrol1nalio n 

SSA IS ill the Prelil11inary 

St~\' Qr iA:velvllilig a New lJp-lo.l)aU' Source or 

(')ccupatiQllllJ lnronnmion 

In 2008, SSA began " ~, II"OjeCIIO tlelielOP " __ SOUfOII of 

<ICO.lP'I_ inlorma!oon !!WI .... repIK!e 1M 0UId;ried rIiotmIloon 

euM!1tIY tIeir\IIused 10 -...,. ~ ~ ... .tile 10 IkIItteot jlMl wOfIC Ol ..,.,. ___ In .". ...- . Sinoa IhII laells. $$A 

tIM MJen u""", II-.. DOT. _ con_ • iii' 01 ~ __ Iour>cI ., tile 

nall(1na1econon'1\' __ lin! upcIfWd ill tIKI' • Tha DOT ~ 

~ 

SSA _de~ 01_ ~ .........,."'_-""' .. bNn<ing, _..,...onmenIaI NoC!W~ __ "'ilia 

........ 1han12 000~1iI/aocI ~toSSA _ 

~tIa ... _~to.~oIhofw........:h" ~ewo 110-. MOl t.- ............ __ 1h>I1aveI0i 

~~tIIe~to~""Ol""'_I_"'''ny _ __ NU!Jt" ~I ~ updMt. UbOf 0tatIed 10 repIIoca II"Ie DOT_ erNET, __ !at _ JOb .... -.-8<1 MIl tile DOl IIIA_ 

HMOl~' ~ """"eIIic:triIIv _~ 10 ... SSA ~ 

~ ilwMtig,a1lng ~ _,..._. SSAdedcted 1hat00NET"'" _ uisbng ~ _ CICClJI>IIIioo" ~_e"" 

MlIIIcienOy _ ..... _IO~ IiIgaI ~ ,,,,_111 110 

oecoooon-malung I>fOC8II SSA Iumw __ III deYeIop a _ 

~~.yaIem _wouIa_clellIoie<I 

onl<l!mri>n as IIII/Ie OOf. 1)Ut"""'" _1ndude I<Iditio!wIlnlcmliorlDn, 

suc:n as ilia ......w ...... ....,. 01_ '" IO(jOtIJOrI "'" 015 __ It) tMeI 

SM'" o.gM, Pl"ogram. "rod da\Io __ ; (2) be llalCible ~ to 

IJICOtpOnIIe thangu In SSA'I!IIIIIc-....., pn>e:eo_, _13) btl ~Ie 10 

lie up<I_ .., refI!ld \/"Ie ~ worI<p1aca ..,.",."....,nl. 

'T ... OO._._,_ ................. _ ..... _ ......... j/ID 

....",..,... - -,--,--gofIIor!oo -~ ... ~ ----....-
82 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.055

In 2008, SSA Degan \3k1og _alsteps 10 lIuille ItIII <IeYeIopmen1 '" its 

015. SSA ClUle<1 l1n "'lemal ~ arid worI<lng II"'IIIP. n well lIS an 

O<:cup3~onaI Info/mation De-.eIopmI!n! Ao:IVlSOty PItrIIII, oompMfld d 

.~tern.1 eXPllrts In alUii ''''aleC! 10 \he d.,...I!!opmer1I 01 OCI:\J!>3tional 

WOImal.on 5)'5l8ms •• TM arIVI&<Ky panel hold. quanllfly public me.!!",!,.. 

and II3s sevtlfal sUl>COlTlmi_ !/lal rev.ew matenal and make 

re<lOITVllendations to SSA on develoPing ~arioo. COIl"II)OnIInlS cf 1he OIS, 

Fet .amp1e "" 2009 ,epoR, the a<I\It""Y ","<leO ~pj>OIU!<ll/>e """" fet 

$SA 10 <Ie_eIcp I '- 1OUl'c:tO of ~ion" irlfe<malion, rather til .... 

aDapt O'NET, aM re<:emmende<l Ul81Yl"1 of dala SSA 61lCUO:1 r;:cjleet as 

well as $~es;ted way. 10 cJi>ssify ~atlCnS. 

TO fllrtlles inform rt • • ffortll. SSA 11M soughllnllUl lrcm eglllCifl' 01 

orgamzallon. Ifla1 l lItle, collect occI>Pa!1OI'I81 inf<lfmation et eIIC use tile 

DOT, Fet example •. SSA ofliciilll held in,tial ~ngs .... 1n labor and U S. 

Cer>oUI Bureau ofkl8~ to gain frlJorma\iOr1 on Uompt;ng meII\cdI USO!<Ifu< 

the O·NET, lilt! Occupalionsl Ef'IIpk>y.-.1 Statislics progf8ITI, and 

C*"sus Bureau', housencl(l.uMlys," A<ldJllet\ally, SSA and lat>ol are 

IrI tilt! proten cf complel'ng • Memo"rnh.om cf Undef$tar\d1l1ll tIlat will 

formafile Il>e ~ coIIal>orallon ellorU on lI1e new OIS. AccordIng 10 an SSA 

crr~.l ps\he ors !),cjeocllml9,nSl'l$. SSA pia,.,. 10 COOWIlne ad I'I<IC 

/OIlndlables with ~p<>ru; and 0I/III, agency cllicial, 10 e~pIom !<ptI()I/k 

s ubject fleal, such lIS Nmt)liog '"""', Besldn wotIIiog \M ~ \.abo( and 

c..n_ BUfMU Dfficials. SSA otJid.allr an<! panel "",1'I1I>eB ha ..... sougnl 

!rip", ~cm ot!'rer experts aod current US(ff$ of the DOT. sl/dl al SSA 

dls3b~ity adjU(lblet' ar'!CI8lllerntl) ~"atiort profeWor1i1ls. by 

conducting. USIlf.-lS Mnal)'lloll if> 2009 and p'etentil1g the OIS P'0I8C1 

8' e\'eMIS .nd coofe,et1OK 

In JulV 2()11 , SSA pub*shed ill detailed ,_,m and development ptan 

"'~Iining aJ ac:lrvrtin ",laIed to researching, developing, and !esliog the 

"''''~_~~''''''''''''Y ___ ''O--

lOlOII_"..F_oI .........".,_~ 

.on.~~ __ , .... pr_..",..,.",.,. __ 

_ 1or_-.rI\'IICIO~ TJooCen....a..r .... ·._""""Yl _(11"'_~~ _ doio ... _JllllaOU<lO .. ____ *_ ... --.._""'1 .... (! I _ .... c..r,.... 

~s.....,. -' Io ~. Loborrorw""'-._'""'"'l' """"" II> Joe c.......e"'_Ior ... IIur_oIl __ .... __ ..... """ ...... _ 

.. 6,..." • • _ 
83 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.056

S&\ Has Malle Progt"t!ss 011 

(1 $ O(S, bul 11 J~ TOil Soou 

tn Know if Prqjcci. 

'nnw(IIlCS Will be Mt:t. 

I\8y eo,npe,_111 c! !/'Ie 015",010.. 10 ....,_~llt1e OIS by 20'6., an 

eslima1.!Id C061 of 5 108 m~,;o" FOI elloimple, troe pl8!l ir\cIoOes se;e ..... 

t>aHI~, _die, 10 io:Je<"Iliiy al'll1 lud~ 0I1le< oceupalional1nformalion 

1)I6temll al'lO ~.rio\.os aw'OitClleS tor IrIIIlyZlng OCCUP'I~ II\iIII "'Wi 

Inrorm,~ coold be leveraged 10 SSA's OISa. 1a colledion. The pum.1so 

!nclude!1 eciMlies 10 klentify troe P'1IMfY QCWI>.lIlIonal. I\>riCIiOr'oa!, _ 

.oc.tIlIoc"l&l chaoltcleri&lica or currenl benefk:i8rie!1 OIher _ev oomponen~ 

of ,he p~~ II1CIudeoevelo!:>ng ~ of WOfk ~U"_l'. sud> n 

Ihe p/\'(Iocal BI'lI1 menial derJlilods lor jcbI. and d&la wllection .nd 

e~al)I6~, slfalegie5. SSf\ ~o pia,.,. 10 doevejop ~ ""'iegV tor pijlobtlg d3la 

COIiectic ... i\81ionw1de wimin 111$ bmt ftame. 

As 01 F,)l)Mlry 20 12. SSA I\IOd nlIt(Ie P<OO'KS on many of \tie baselll"le 

IIC\Mtie.I 0U11ined '" its , ..... rct> and de';elop/nenl plan tor the OIS " For 

e , ...,pIIl. a<X:O/diflg lC an SSA offdsl. its lrwesUgal10n of e""'ling 

OCClIpalioMllnIO/matlon "1"'1""",, now compil!l8, hal , .. ,,11M '" "oelUl 

Informalion abo'll c1Mign "' ..... OIlIer OIgan<n1lons h8-..e COfIlrorned aflll m~ogllltld_ CffI<I1inglhe<. """" ,yolem. Ad<I~lonafty , SSA's """minifY 

a""i~~; of its """" Itdm;";str.JliYe data iclentiflo.cl tt>e mo!llreq.......uv citoBd 

occ.upaOOns ;mel fullCl;o"BI al'lO ~ocaIion31 C/18,acIerioUcs of disabil!t)o 

applicants. SSA off"",,~ loki us Ihl "!J'!"C~ will ta'Qsllhe occupaboni 

identified ;" 11115 all'f/YSil tor itS ~Iot l>Iudiel of the OIS, AlI.o In 2011, SSA 

compil!led 8 """""ooheM, .. Ir~ fo, Rssesoing Rn it,dMd..a!·s 

..."aciIy fo _--key 10 inlorm"'9 the OIS content. acconIlng to SSA 

otficIaIt.-.dlwa. baHd COl '''''''''mendaioonl of DUlSode e,J>S1\5 as 

wella. SSA·. policy a nd program reqlllfem.&ntl 

'MII\e SSA hlll mOllIe p'og,enon _~ Rey Klj~jtiM, agency oItlciBii 

d .... yed 201 I <:OI'rIPiI!lio<1 dateolor CIIt1sln actiYibe. and amlC<pale ma~ing 

add'bOIl-al ~ 10 '" tlrroerll"le n 8 resu~ 01 "'" meelirIg tt& Maffing 

goals",< f""", 1 rear 2011 . For e"""'Pltl. lhe lidJ"'I .... I~a' _e delayt!"d 

by HIOe .. l months irIcIuded /inaUing ,epon. lor IIle ba"';W>e .'ud .. s a'ld 

cood""'"WllI s 1It"",!",e ,eview lfIat WOUld "'form how oc<:uP.''''''s ftUght 

be .n.~{Z8<I lot !tie OIS 5S,A offdIIlI told >IB 1IIat ttlOl~ WIIU!a Moe 

naeded 10 ~""" II>e f"d comp4amenl 01 projeded 2012 ol8N bySeptembe, 

2011 to complete aM of \Ioe 2012 p~nlled aClMtlH WiI/I", trle estma!ed 

_

_.,.I"' _"'_~dlN~"" ___ • :1 ............. 10 1100 ...... ·_ 

CAo-"·,,,' 
84 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.057

Conta.cl and 

AcknowledgmenlS 

."".., 

scl>edlll!l_ H"""""",. SSA Ol'fIC*al!l53ol me1 dol flDI ...... e me budget to 

hire new staff in September 20 1t . To add,"" th15 cllal"~ SSA 

oftk ... l. ~lred COOSU~01," IC ......,1 """'" of the" needs. SSA ol'foci;ols aIsc 

me! wI1h the 01r>C6 01 P~"," M~ 10 ""pio<e tM poss;b~iIy ot 

an lnIe.1I9f!"\CY "O",.,menl that wool<! allow SSA to """ 000 or IWC cI me 

orr.,., cI P,,"""' ..... Man"'1""l""!'~ incI ... uiaI organizational ps)'Chologisl5 

10 ""Ip on a pan.1Ime ba.'" 

A. part 01 our ongoing _. WII a", !l$SHS;ng SSA'~ cu,,,,nt 015 P«lj'ed 

-.chedull!- and COlli estimal8!l agaln$l ~l PfiOCl.:es-. and have 

pre~mlll8ri1y idenlofied some g~p$ rn SSA'. aP!)fOIOCII for I!tl<ample, beSt 

pra<:1icft f«jl.>i'e cost "'Imate. 10 be ccrnp<ehen,"", .00 irK:juoe 

In/ormallon DI>OUI ~le cycle CQl;llS'-tl1a! 1$, rIOW much me ptCje<;t 1$ 

.. peeled 10 COllI ove, lime . Howe..-er. wrute SSA hits Htimated!l'll' CO!II to 

,eseart:l'1 aOd df!.eIop It'Ieo 015, me I'SIi~dOe' no! prOied me lute>re 

CCSl$ to implement or maintain !he -Iy!lam. The COllI cf Il./Slalnir,g a01 015 

coul<! til' &rgnificanl, b8sed 0fI 01"", 1geJ'>des' e~pe,.,enc:e& 'IIII'ntlIMtng 

1IIeO' sy.'..."s lor ccIIec!;"g ""nDOIl occypa~""81 infcrmallOl'l We 

preliminarl!)' ide'Uffied olflllr gaps. wen as lac:It or dOC<lrnentiIIicM 

desaibing . tep by 'teJl r.cw !hi! <:01<1 estimate WM dfrvlOOped so lhal 

~ ~amlia' w<lh the prog,am cotJl<! <.iIId",stand r.cw ~ WOI$ Cleaoled. 

f or "'" flM\ fe!IOII due later In 2012. WI! plan 10 <Ie~WIr more 

com lIehe"'rv . ilndiogs 00 hoo. well SSA is ...... nOllging th' d!Welopmenl 

01 its. 0 15 ~81nsl tle$1 pO'&C\lCel, 'uc:I\" "lmating CQl;l$ cfl/le 015 afl(l 

e"'lI~ng lhal t!>e I)(Cjeet ,cl>edule ,elOabIy es~maleS retille<l a<:IiIr~18 . the 

ter.g1f1 of t,me lI'\ey w~1 I"~e. 8nd rIOW tMey 'I'" in\errel-ate<l w., ~ .1&0 

~nltfy ~nV milogalicn slraleg~ IhII agency may h •• e to add,ess p'oiect 

I.sh. S4J(:h i>S tile n&I< oHI>e IiI!I8f'C)' 'lOt '_""fig /ullluno l!lQ. 

Ch.irman Joh""cn, RBn~JOg Membe!- Secerr •• ami Mem~ allha 

Subr::or'm\lttee, tro. cC!1Ck.des m1 p,&!>arl!(l~, I WI~ I)e. h'pp~ 10 

'epond Ie ""y q"""llons. 

Fa ful'ther infonnaticn ~rdlllSlll1'" tesli!T1cny. P"lea-oe CCI1tac:t me 3. 

202~ 12·1215 or l>erlonol@gao.g"" In atld~icn . coolact poin .. "" CUI' 

otro:es c1 Cor>g ess~1 Relation.-.Od Pubjje Aflairs m,w be ""'no on 

lI1e 1 ... 1 P"9" cfll1,. statement. IndMduals who maae ~ey ComribY"",," 10 

!/'tis te.ti!ncnyare M"""'IeGtgIch, Assistant Di_. James 8enneH. 

Kalil Blun1enreicl1. Julie o..Vault. Ale, Gal""'" . S""~a McCoy. P3lticla M. 

Owens: AnjaliTeII~andarn , Kmhleen Van Galde<, and Waite< Van<;e 
85 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.058

Tf ........... ·"'hUS._ .. omo<I'_,.""'_"'CCI'I'f'l/l'lP''"_ .. 1m iJoIIo<I &olH. r...~ptOdu<:I""Y" __ .... dtI_in ... _..., """""""""",,"_"""'GAO. __ .. """_"..,._..., """"~""_ "' __ ioI _,,,,",_COI>I"~t'II_,~ .... -..y~ _'""" 10 __ ... _~~ 
86 

f 

Chairman JOHNSON. Thank you, sir. 

Dr. Chan, you are recognized, sir. 

STATEMENT OF LEIGHTON CHAN, CHIEF, REHABILITATION 

MEDICINE DEPARTMENT, NATIONAL INSTITUTES OF HEALTH 

Dr. CHAN. Chairman Johnson, Ranking Member Becerra, and 

Members of the Subcommittee, I am honored to have the opportunity to appear before you today to testify about NIH’s collaboration with the SSA. 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.059
87 

The SSA approached NIH in late 2007 for advice on new assessment methods that might inform their disability evaluation process. The NIH Clinical Center’s Rehab Medicine Department agreed 

to help, and based our work on widely adopted contemporary disability concepts. 

Our collaboration has been facilitated by an interagency agreement that was initiated in February 2008. I want to note this area 

we are talking about today is just one of many factors that SSA 

takes into account in their statutory role to ensure that the Agency’s disability evaluation standards reflect appropriate medical and 

vocational information. 

Currently, the SSA disability determination process is linked to 

a claimant’s diagnosis or their impairment. However, a diagnosis 

or impairment may no longer be so closely connected to an individual’s ability to work, as it has been in past years. 

The concept of disability has evolved over the last few decades, 

and this evolution has now culminated in an international agreement. 

In 2001, the World Health Organization adopted a landmark 

standard called the ‘‘International Classification of Functioning 

Disability and Health,’’ or the ICF. 

The ICF has been endorsed by all 191 WHO members, including 

the United States. 

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

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

Our work with the SSA has several components. One of the most 

important projects is the direct attempt to create a rapid, reliable, 

and objective functional assessment tool that SSA could use one 

day in real time. 

To do this, we have engaged colleagues at Boston University to 

help us develop a series of computerized functional assessments 

that utilize something called ‘‘Item Response Theory and Computer 

Adaptive Testing’’ or IRT/CAT. 

The scientific evidence validating IRT/CAT instruments has been 

available for decades. If you have recently taken the SAT or GRE 

or LSAT, you have taken an IRT/CAT test. 

The theory is really quite simple. If you want to assess an individual’s capabilities regarding a single characteristic, let’s say their 

ability to lift 300 pounds, and you need to know that in one pound 

increments, well, you could ask 300 separate questions. That would 

give you a very precise estimate, but it would take some time. 

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

For instance, you might ask that same individual can you lift 50 

pounds. If the answer to that question is yes, the next question 

might be can you lift 100 pounds. If the answer to that is no, the 

next question might be can you lift 75 pounds, and so on. 

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


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
88 

IRT/CAT tests have a significant advantage to the SSA, in addition to administering them to claimants, the SSA might also apply 

these same tests to clinicians to obtain their functional assessment 

of the claimant. This information could add an important perspective to a person’s disability claim. 

Our team is currently in the process of creating two initial IRT/ 

CAT instruments. They will assess a claimant’s interpersonal interaction skills and their mobility. 

These two topics were selected because of the high relevance they 

have to SSA’s current applicant pool. 

For these topics, assessment questions have been developed and 

the calibration tests are being completed. We will calibrate the 

tests not only to SSA claimants but also to the population as a 

whole, after which we will put together the IRT/CAT instruments 

themselves. 

An RFP or Request for Proposal is currently posted for the development of four additional IRT/CAT instruments that will cover all 

the remaining topics in the ICF related to work disability. These 

topics will likely include self care, communication, learning and applying knowledge, and general tasks and demands. 

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

Mr. Chairman, this completes my prepared remarks. Once again, 

thank you for the opportunity to testify today and provide an overview of our work with the SSA. I will be happy to answer any questions. 

[The prepared statement of Dr. Chan follows:] 


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89 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.060

TESTIMONY OF DR. LEIGHTON CHAN 

CHIEF, REHABILITATION MEDiCiNE DEPARTMENT 

NA TlONAL INSTITUTES OF HEAL H I, 

CLINICA L CENTER 

BEFORE TI-IE 

UNITED STATES HOUSE OF REPRESENTATIVES 

WAYS AND MEANS COMMITTEE 

SOCIAL SECURITY SUBCOMMITTEE 

MARCI-I 20TII , 20 12 

1 
90 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.061

Cllairman John~on. Ranking M<1'mlx:r Ul-..:erm. and "kmlx:r.l of the Subcommiul'C. I am hom>n:d 

to h~\'t thenllJ'Ol1unil), 10 n~r before ynu t<Xby IOI~slif)' nlxlul the NstionpllnJ;litul6 of 

11<'3I1h', collaOOr.uion w;lh the SoI:ial Seeurity AdministrJlion in ~Iudying ~ppr\XI"h~ for 

analy"jng funcli()n \IS;\ relal~S \0 disability ~:;*s~m""l. 

My name is Leighion Chan, I am the "hi,'f of the Rehabilit,Uiorl Medici",.' [)('p;.tnmcnl al th~ 

NI II Clinical Cl'l1ter. I am a physician "ho ~jlI.'Cia li zes in th~ dia~l1osi5 mid (reatment of 

individual. wilh di!illbilitio:s. I am also a .... "SCardirr in Ill(' 1'11 1'1 inlrnmur:1I rese<lrch prugMITTl and 

have Spell! my cureer lJ')'inS to idcuiify and remove b;.ITj"11j 10 care for this \'uhlCl';Jblc 

population. 

Ua ckgnlUnd nn "'(lIoSSA ,·oll aho .... tinn 

Th" SSA approached the NIH in AuglL~t of2()07 for 3d\ i~con ne,,· t~dlflolo gics. Jiagnosl;c 

tool~. and nu,·..! 3ssd>fncnt m~lhuds th~1 might inf,'nn th~;r disability c\'alu;ltiu" proCess. The 

NUl Clinical Center's Rchabillimion Mcdidnc Ikpal1mcnl3llrecd to help theSSA e:<a llline the 

di~bi!ity dctcmlina1i<ln PlUCC'Ss. Our oollabnr~lil'11 O:lS been rocilil:HCd by un initial hllcrAgcncy Agreement (fAA) lhal was executed in ~ImLllI)" 2008. We anticipate th~1 our "W~ 

1(>l>~thcr will /,stcn<! at kast through 1016. 

f W3nt 10 rlOtC thai OUr re><'arch at NII I in this o",a;s Oil<.' "rma"y fac\OJS th3t the SSA takl"!1 in!() 

account;n their $t:\lUlory role 10 ensure the agcncy'5 diSability tll'alu3lion ~!.1nd~ lrd s ",nC,'l 

lIppropriato:: medic~1 Rnd nx:mioll3l infonnmion. 
91 


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ShiOing (I a ... dignl< nf di<lIh lement 

The "'3)' in "'hich dis..,bility is CUlwcllIualized Rod measured ~ changed drnmalically fn the paSI 

.50 years. starting with th~ "'ork <,I f a dislinguished mwit"~1 sociologist. SruJd Nagi in 1965. Owr 

lime. mMy uthers hal'c bl,illUn Nal!,i's tlriginal frnmcwllrk . Promiocnt tun~epluallnodels <,If 

disability (Allm80 2(01) iochK!C Ihose propo~d by Nngi \ 1965. 1(91). Vcrtlrugg,,~od J~lle 

(199-1). the l~tilllle of Medicine (Bl1Indl Jr. and Pope 1997; Pope and Tarlo.' 1991: ['ope 1992). 

Abb<:rlcy (1987). Oliver i 19%. 1990. 1993) and Ihe World Iknlth Organization (1980.2001), 

Although aspects oflhesc models dilThr. they 8U 3gn:e Ihat diS:lbilily CMnot be vicwe-d as M 

individual attribute' (Zola 1993). Dis.abilil~ mHy b.: thoughl of as the dincrence l>etwc~n 

indiVidual cnpabllilies nnd Ihe;rcnvironmcnlal d(mands (Vcrbrugg~ nnd Jellc 1994). nle 

In.lilute of I> lcdicinc (10M) (199 1) nOlc-d Ihal dis~bmty is not a slablc- anribllic across silu~tion~. 

since physical and mel1l:1lli.mclionin& is innuenccd by environments. Disability is a complcK 

process. which is multidimcl1$iOrutl. dynamic. and intcrneli"e in nalun:. 

Thr Worhillcahh nrg~niLation {WHO) Inlemalinna l Clao..<iliraliol1 or .' u11 clitlning. 

Dj'a llm,,' I lld Il u lt h £1CF) 

Deb-lie ~bout Ihe coJlKepts ofdisabil;ty culmina ted ;,,2001 "hen IOC WHO adoptw a landmark 

slandard called !he ImenmiOllal Classification orFul1c!ion;n~ DisabililY and I !cahh (leF) 

(World I-It'lIlth Organizalion 2(01). The leI'" hM been ollidally endorsed b~ nil 19 1 WHO 

members. including Ihe United Stult'S. The ICF is a fi-~m~\I Ot\.: Ih:tl pruvid..s a COmmOn language 

, 
92 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.063

to Ikwrit,(, functioning as wd! ns a cOIni!f~hcnsin" ocC<)umi".s\lfsub-d{)mains ()ffunciioninl1. u 

I 

t 

Iio.~~""","_ 

t ..... _ .. <Ii><. 1 

I 

B 

1 

I 

t 

I 

t "F=I I 

Figure I; World Hcallh Orpnization", Intcmalional ClassiticutiUllofFuol\:tionln!!-

The ICF is bein!/. integr1llcd into important institutional r",meworks in thisrountry and abrood. 

In 2007. the In~ iuuc of I-kdicine (IO.\I) .... tonlmended that gQwmrnent agencit:S UdOflt IeI' 8.\ U 

l'{)occplllal fr: .. "ework "ud lan~ua!!l' (Field ~l1d kue 20(7). Thi. approach ""'a~ through 

institutional "lid di!;.Ciplinnry romlllori('!; lhnt ha"t longplaglled dili:tbility rescareh and inhibitcd 

l"tlhc.ivc cObrts ()n behalf ofpclYms "i(h di~bili(y. The ICP 110'" scn',>s as the conceptual 

frnmewor\.: nnil (cmlin.,logy for t~ nmH ""cent edition ofthc AmcrieM Medicol Association 

(AI-II\) Glliil<!s /0 tiM:. emb",lion ()fl'~rI"IIII<!IIII"'/1 lir"'cm (AMA Guides) (Koooincili 201.»). 

The ICf i~ t,(,ing k1Ugtn in lIcrulcmic institutions to future BC""'-dtions ofh~al!h \W(' pmf<'S'lionals 

aud intcgl""dl<Xi illto professional Sland:lId~ ()rp .. "ctic~ by 'mm~rous professi(lfl"II)'l:"niVl(i(),,~ 

• 
93 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.064

including the American Psycholo\:ical Association. (he AmCfican Occupational Thcrupy 

Association. Ill>: American Specch·lanlluag.;:-!Iearing A~sociRtion. the American I'h~sicaJ 

ThcrJpy Associalitm. the American Th"rapeutic R~'Cn'mion Associalion and the National 

Associalion or Social Wolters. II is (he le f tlll.'Ore(ical construct (ilal inlomls the NIH 

collaoorJlion with the SSA. 

This collaoornl;on has severnl ~'Omponc l~. One ofthc '1l<lSt impofUlnt projecL~ is to cn:'llle II real 

time funclion~1 ~ssc5smcn lhal is rapid. rcliab ~ and objective. nti~ proj~'Ct assesses the 

f~'asibil ty or " ... velopin~ Computer Adap i"~ Tl"'l (CAT) inslromelils thm could be ~'Onsjuen: d 

ror ntegr~lion inlo the SSA's disability evaluation procl'5!>es, CAT mctilodoloJ!,)', eoupk'tl with 

hem Rcspon,;e Theory (IRT). is used 10 m"",ure outcomes pm:i!idy across the full cominuum of 

human functioning, IRTfCAT repmieills 11 simple fonn ofanificiul intcHigcrx:e >Ilfiwa", 

r~uiringll computer for aUministrJtion, We are working wilh 1'l'$e3n;l!e", from UOSlon 

Universily (BUI on IRT{CA T dc,-dopment, 

To L!luSIr.I1C: I{you w~ntto 1lS.~ an individu.1l's capabi ilic~ rt:g:lrding a single cha=teri~tic. 

their ability 10 lift up 300 pounds in I pound inc~m<'nts. you CQuid ad: 1I1t:1ll up l(l 300 scparute 

qUe'\lions. This would provide a very pn'<'ise ass=mCn1 ofh(lw lIluch lhat individual C()uld 

3CIIIJIJy lift but would take quile 14l1le tim~ 10 fill-ure_oUl, Item nospo"se Ihcory'UlilillOS 

information galhel't'd in prior questions to d .. tcllllioc ",hat question should come 0<'1<1, lhereby 

eliminllling mnoy queslions and saving lill1~ ,..,<'tIed 10 Il.~ess an individual disability elaim, For 

, 
94 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.065

instance, YQU mighl ask thaI s;JnlC indiv,UIIIII, can you lijl 50 p<J\JtKl;;~ tflh" answer 10 lhat 

qUl'5lion is yes, tIle (l~"1 qvt"Sli'lll may 1:>0:, C<ln yov lift 1(10 rovn\4? Irlhe ausw"r 10 this queSlioli 

i, no. your IIC;>;I queslion IlI,ghl be ean yn" lift 75 pounds? Wilhin a $lIon po:riod oftiOle you <:1'" 

determine hnw slnJllS Ihat person is _ 

An IR1'lCAT i$ rrogrnmm~d linn In pre:;c111 a questinn from Ihe mid·mnge ofa deli'lCd list nf 

hicrun;h,cally ordered qll<'slions. The I'rol:nun then sek'Cl.$ sub"'qucnl questi"ns ~t un 

appropriate level based on the reSp()IIdcnl" prev'nll.'l :m~"e",. CQmprchcnsivc calibr:llcd 

que",ion banks rencc! a brood r:lllgc Qfability aero;;. eaeh functional <.lQmain ofinten.'S1. 

IRTIC,\T adminislnI!'On pCnnits the uSC Qft:IJ fe"~r 1<'51 quCSlinn~ (in lolal) beeau~ Ihe 

qu~slions are selecled b.1S<...J nnlhe individual's Ic~,, 1 off"nel;"". In the future, the ulil;zHtinn nf 

IRT·IIfl"ICAT le<:hnQI01!i cuuld polenlially allow the SSA In colk'Cl mo", ",b'anl. 

comprehensive. DIIlI pl\.ocisc <.lata aboul human f"!lclinninl> in a faster. mo"" emeienl fashion. 

The de velopment oflRTIC AT tools is a s.:qlK'nlially depcndcI11 process IMI la~~s about 1,,"0 

years. Each SICp ofrl(TICAT 1001 dc\'dopmenl pru.::l.'I::d~ in ao ordered fashion: one. l~p mllst be 

complele<i before advallClng to Ihe ne.~1 step. The tirst slep of the process is Ihe dc,elopmcl'u of 

assessment qucsllon~. This Sl~p encompasses "'orieing ,,"illl contenl ~JX:ns, e.~am'!llni! lit~rnture 

and ",vie"lng OIher modcl.<;/laxonnmlcs to develop question conlem and Slru.:lure. -rrn: ' .... Xl slep 

is 10 cnlibmtc the que~llonS; order them lrom c:lSICSI IO har!le,t and remove redulldom or nnn· 

informali,'c quC"StifOns. SlOlislkal ~1\'1Iy!>l"S are conducted on dma collccted from samples or 

pcrsollS similar 10 Ihe int<'l1ded audiellc~ for Ihe inslrument. The objective i~ to ~ssess the 

p:lychornetric proJX'rties nf lrn:.qucslion'. nw lil\.11 slep ofdevc!npilli! IRTICAT 1001 .. is In 

, 
95 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.066

\'alidalC tile inslrument In ou, collaboration we plM II) devdop multiple IRTfeAT UII)) 

inslnlln.:nls. 111e con lent of C"Jch instrument is unique and development ofeDell instrument must 

follow the sequential process. Examples of qllC~tions from th .. physica l mobility lRT/CAT 

iMlrument "' .. are developing indude: 

Ar .. YOll able 10 lifl a fun small (carry-on si,.e) suilca"" Imm Ih~ floor to table height'l 

• Are you able 10 sland up from a low, soil clmch? 

• Are you able to gu up one flighl of'lairs with a haltdrail? 

IRT/CA T inslru'nenl' may be quite ~dulto the SSi\. In addition to administering Ihe,.., tests to 

claimants, the SSA could al:;o apply them 1() a dinkiM about a pnt;ent to oblnin his or her 

rUllI:ti,)nal assesgnlent Mlhe claimant. This could add an impon3nl p(:rspecliv~ to;1 f!Crs.lll'S 

disabili ~ claim. 

The SSA/N11 1I8U collaboratiun is W:I'eloping IRT/CATs tailored specifi cally for 55A·s 

pUrpJ5CS -the as.se>~ment ofllor\( diSltbilily. This tirO" li~cly wi ll yield a series orsi~ IRT/CA r 

iMln,ments to assess function. These :lSS<:ssment instruments will COVer all th,· major ICF oreas 

Ihat 3'" highl~' related to work. such 3i basic mobility, cognition. interperson~1 interaction. 

commllnicatiOll,.self care. and gcnerJI tasks and dcnl"nds. 

Th~ SSNN1Hfl3U IC(lm is cum'ntly in ~'C pl\'1l:CSIl of~~Jling th~ iirst tWO IRT/CA't' 

instruments. They wil! assess: elailll31l1·S physii."'al mobility and inlcrpersoMI intemc lioll5 skills. 

' ·hesc two "'~re ""lect~..J ho.'CallSl." nftheir high relevance 1'1 SSA·s current aflPli~8'" pool. Fllr 

tht:;c do,uain.s. qUC\ltion5 1mvc bo,...,n dcvclop.:d "nd preliminary tl'!'ting is ~"Qlnpletc . Nonnat!'·c 

dam an: currently bcingClllIl'l:tcd using IIIe~c question Ixmh, arler which. final lRT/CATs will 

, 
96 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.067

be dcvcl~d. Data were collecwd rrom claimants as wcll as their health CJre providers. A 

~UCSt ror ptop!!sal is currently J1Qstl'd rorcoll1pl~ ion of the ",maining IRT/Ci\T dnelopment 

acti\'ities. We hope to have muth urour initiMI won.: ror all 5i.\ IRTICA T irtStrumcnll> completed 

b),201&. 

Mr. Ch:linnan. this compklc5 my pr~p.'n:d rcmorlls. Once ~gain. thank YOII fot the opJ1Qnunity 

to ti.'Stify today and provide an olw\'ic" ofNllrs coll~bor.:Hil c .... ork wi th Ihe Soci~1 Securit), 

Administralion on Ihe IItTfCA'T progmm. I .... ould bo:: happy 10 artS"er any questiol15lhat you 

misht have ",Ialed 10 my wort. 

, 
97 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.068

Rerere!lCe~ 

Abberky. P. 1987. The concept of Oppression aod lh~ Development ora Sociul Theory Qr 

Disability. Disul;ility, f/tmdi""l'u"d SQl.'iuO' 2 (lJ;5-19, 

Altn!al" B,M. 2001. DiSllbility Deliniti'm', "'odcis, Cla. ... ,ilicalion Schemo:s, arw:l Applications. In 

Hum/book "jDislIbiIiO' $ lIllliex, ~ditc d by G. L. Albn,<:in, K. Seelman and M. Bury. 

Thousand Oaks, C A: Sage I'ubl icolions. 

Field. M~ril yn J., alld Abn M. leuc. cds. 2007. Til" p"/",.,, "fVi,."bilil), i" ""'''rim. 

Washington. D.C., The National Ac.Jcmi cs 1'"", •. 

Inslit"l"ufM~-dici!lC. 1<)91 . ,\ Modd for Dis-1bHit}' and DiS:lbility Prevenlion. In Di,mbilily in 

"m~r;c,,: TennlN/ a "'"lim,,,/ "1J<''''/''jOr Pre,·""li"", l'<iitcd by A. M, " up.: mal 1\. R. 

Tarloy. Washington, D.C.: National Academy Press. 

NRgi. S.Z. 1%5. Some COI1CCplllllll ~SI!C5 in Dis:lhility and Rchnbilitlllion. In S,/Ciulogl' und 

Re/wbNilulifJII, ~-diled by M. B. Sussmall. Washington. D.C.: Amcrica n Sociological 

~"""i.tiun. 

Disability Con~<,pls Reyisil~d : Implications for Prevention. In Disohilil)' ;"..ll1lerim, cditc"<l by 

A. M. l'0p" and A. R. Tarlo,'. 1991. W~shinSlon, D.C.: National Academy p",s,;. 

Oliver, M. 1990. TIN: Palilit: ... ofDis,,"'em~"I. A Soda/ogie'lli ApprtJ<lc! •. New York, New Yort.: 

SI. Martin's I'rl'SS. 

()Isahilil), and Depende,ICY; A Creation ofln.Juslrial Sodet,es? In Disub/in8 /J(Jrriers-·/'.,."b/irrg 

En1"in)""'CnIS, ediled by I. SI"sitl, V. Finkelstein. S. French nnd M. Oliver. 1993. 

London: Sage l' ublicaHon~. 

~1ining hn painn~nt and Disability; l.%u~s a! SlUkc. In £.rpforing III<! DMIk. /IIi/eM <lmJ 

Di .• "bilily. ediled by C. i3aOles ~nd O. Mereer. 199b. !.ceds. UK: -rm· Disability Press. 

, 
98 

f 

Chairman JOHNSON. Thank you, sir. 

Dr. Maestas, welcome. Please go ahead. 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.069
99 

STATEMENT OF NICOLE MAESTAS, SENIOR ECONOMIST, RAND 

CORPORATION 

Dr. MAESTAS. Thank you, Chairman Johnson and Ranking 

Member Becerra, for this opportunity to testify. 

I will address my comments to the question of consistency in the 

initial disability determination process drawing on recent RAND 

research. 

DDS case examiners are called on to evaluate and weigh many 

aspects of complex cases against extensive medical and vocational 

criteria in a dynamic medical environment. 

They have heavy caseloads, and although they may consult with 

physicians, they are not themselves trained physicians. Moreover, 

as the SSDI caseload has grown, the composition of applications 

has shifted toward impairments with greater diagnostic uncertainty. 

Chief among these are musculoskeletal and mental impairments, 

which now comprise 59 percent of all applications. 

Given these factors, some variation in decision outcomes across 

DDS examiners is expected. Nonetheless, it is worth trying to minimize the extent of variation as much as possible. 

In our analysis of initial disability determinations recorded in 

SSA’s disability operational data store in 2005 and 2006, we find 

a notable degree of variation in initial outcomes across DDS examiners within the same office. 

This variation cannot be explained by differences in the mix of 

cases they evaluate. We find that after adjustments for case mix, 

one-third of examiners have allowance rates more than six percentage points above or below the average allowance rate in their DDS, 

and as many as five percent of examiners have allowance rates 

more than 12 percentage points above or below the average. 

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

While most examiners have initial allowance rates near the average for their DDS office, some do not. This means that most applicants would receive the same initial determination if their application had been assigned to a different examiner in the DDS office, 

but even so, due to the examiners who are not near the average, 

we estimate that as many as 60 percent of applicants could have 

received a different initial determination from at least one other 

examiner in the DDS office, had they been assigned to that examiner instead. 

The magnitude of this measure is driven by the examiners who 

have the lowest and highest allowance rates in a DDS office. 

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

half, from 60 percent to 28 percent. 

As you would expect, the appeals process significantly dampens 

the effect of examiner variation. In our administrative data, nearly 

two-thirds of all initial denials are appealed and 75 percent of 

these are eventually overturned. 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
100 

Once we account for appeals, we estimate that only 23 percent 

of applications could have received a different ultimate outcome, 

that is accounting for appeals, had they been assigned to a different examiner, and if we again remove the highest and lowest examiners in an office, this number falls to 11 percent. 

These figures illustrate two points. First, although most examiners have allowance rates that are near the average for their DDS 

office, many have allowance rates that are notably below or above 

their office average even after adjusting for differences in case mix. 

Because an applicant could potentially be assigned to one of 

these examiners, applicants face significant uncertainty as to 

whether their application will be initially allowed or denied. 

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

Second, it bears emphasizing that these statistics are not estimates of the fraction of applicants who should have been denied. 

Rather, they identify the size and characteristics of the group that 

would be most affected by changes in the policies and procedures 

used in initial disability determinations. 

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

impairments. 

At present, the variation in examiner allowance rates and the 

high probability of having an initial denial overturned on appeal 

means it is usually worthwhile for denied applicants and their attorneys to pursue appeals. 

The appeals process, as you know, is costly. From the time the 

initial DDS application is filed to the time a final determination is 

made, an applicant may not earn more than $1,000 a month in 

paid employment since this would exceed the SGA threshold and 

result in denial of benefits. 

In our administrative sample of SSDI applicants who received 

decisions, initial decisions, in 2005, the average time from SSDI application to final determination exceeded one year. 

While those who did not appeal waited an average of only four 

months, those who did appeal waited an average of two years before receiving a final determination. That is after exhausting all 

appeals. 

Time spent out of the labor force while seeking benefits may 

have detrimental effects on employability. Indeed, we find that 

longer application processing times reduce the employment of SSDI 

applicants in the years after their initial decision. 

Our calculations suggest that the SSDI determination process 

itself reduces the post-application employment of denied applicants 

by an average of 3.6 percentage points in years two and three after 

the initial determination, and similarly, reduces the average employment of allowed applicants by five percentage points. 

In sum, by reducing the variation in initial determinations, we 

would improve the targeting of the SSDI program. That is we 

would increase the chances that people who truly qualify receive 

benefits and reduce the chances that those who do not truly qualify 

receive benefits. 

To the extent the decision thresholds could be better aligned between the initial and appellate phases, the share of those initially 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
101 

denied applicants who decide to appeal would likely decline, and 

the detrimental effects on future employment potential would be 

reduced. 

Thank you. 

[The prepared statement of Dr. Maestas follows:] 


wwoods2 on DSK499XVN1PROD with WAYS & MEANS
102 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.070

""' c.. ____ ........ ,,_.,I ... lANe , 

"'''''---... _t,.to.NO..--.. r.o.. ... _ ... _ .. ....... 

_Fo ..... .... _ ............. ood _ _ ..... ~ __ l ... 

~.<ND C-... ~._ ..... 

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...... "",poOr.: .... .,.-- --.1 ... _ w.IO'.~ 

...... --.....,.-. ........... "' 

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_.- ~ .... __ ...... _. 

TESTIMONY 

Securing the Future of the 

Social Security Disability 

Insurance Program 

NICOLE MAESTAS 

-._Nl\2 

,_, __ ........... c-""Woy . ..... _. 

~""!'O'; .. s......,. .. _lO.2012 
103 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.071

Published 2012 by the RAND Corporation 

1776 Ma'n Street. P.D , Box 2138, Santa Monil;;a , CA 90407-2138 

1200 South Hayes Street. Arlington. VA 22202-5050 

4570 Fiftt1 Avenlle, Stiite 600. Pittsburgh . PA 15213-2665 

RAND URL: http://www.rand,orgl 

To order RAND documents or to obtain additional Information . contact 

Distribution Services: Telephone: (310) 451-7002: 

Email: order@rand.org 
104 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.072

Nicole Maestas' 

The RAND Corporation 

Securing the Future of ~ SO<;/II/ SK'urity Disability /n5Ur/l~" Prvg,.. ~ 

Before Ihe Committee on Ways and Means 

Subcommittee on So<;lal Security 

United StJles House of Representatives 

March 20. 2012 

A1\!)oll:gfl conSlslent treatment 0I8 mi ~~y silllated individuals is an frrJl1Of1anl f?I'1llC1ple ,n ,;my 

eva ua~ve system e ttle Social SectJrity Disability l"suTlInce (SSDI) program. some dl!'iir6e 01 

variation 1" decision outcomes .. crQS.5 evaluators IS mevitable. In ottler settings. y .. rlation 1!1 

decision outcomes has been aSSOCIated with case complewity, dynamism ol lhe iSlIbjed mailer; 

sizeol caseload, the resources available to assisl decision-ma~ing, attributes of the e~alua on; 

sl.dl as their prior experIences, a!XI the training and guidance proviOed 10 evalualor$. (RamjiNogales. Sc;lIoenlloltz and Schrag. 2007: Legomsky, 2007) 

Indeed, Disability Determination ServIce (DOS) case examiners are called on to e~ luale and 

Wlrigh many aspects 01 complex caRS againsl extensive medal and vocational criteria in a 

dynamic medical environment. They have heavy caseloads a!XI although they may consult with 

phy~",'an . th .. y are 1'0\ th .. "I_lves t",in<td pilyokla !>s, Ttl"" .. act<"~ poI!>\ to 111 .. importanc .. of 

e.aminer j\.Idgmenl In inllial di!Sablrl!'; dete<minations. Tile Social Secunty AdminlstriI\ion (SSA) 

has undertaken stUdies enminlng variation in allowance rates acron DDS examiners. states and 

adjlKlicalive levels_ In a seminal study. Nag; (1 969). SSA commissioned an e.pen panel to 

perform e~\ema 3udi\s on a sample of SSDI applications and fou!XI \!lal !hl! p3nel agreed Wlth 

the anginal _ard d&CI&ion in Just u!XIef 70 percem 01 cases. In a sim~ar study. GalllcdHo and 

Bye (198 1) repliei'lted a sample of claims decisions ootI'I within and betwl!e11 states. arid found 

that withirN;late disagreements were ill m;,"y cases as large or larger than disagreemenlsacross 

stales. Il ls unlj~ell' ttla! matlers have Improved since the bme 01 these early stlKlies. As the SSDI 

caselood has gfQ'Wfl, !he COlflpoSition of applications has shilled toward impairments wilh !,I'ealer 

diBgnoslic uncertainty. chief among these Bfe musculoskeletal and mental imp3irments, whICh 

now comprise 59 percent 01 .. 11 applications. These points suggest that!!\le11 though conslst~ncy 

In applying the di!Sabllity assessment criteriB is intended, it may nol be easily IIchleved in pra ctice. 

, Tile Q!Iinions and cordu.Joos e~ in Ihs testImOny iI'" the ilulllO 5 alone ilrn:t ~ root tie 

lnIMpreled as ~~"9 !hose of RAND <If any of lila oponsors of ils feSeilfGh, n •• product II pan 01 the 

RAND COf1)Oratioo e~mony series, RAND tes~monies recorll te!!Lmony PI'&Sen!ed by RAND Iss,OOltellO 

fedeml. 5"'1ft, Of IccallegislsbVe oommi_; gcwrnrTlllnr.aWOinle<loomm0ssi0n5 8nd pa",,''': aM p<lvate 

rev.ew and O"I1!rSlgfll bodies The RAND Corpor8tior1 ts a nonprofit res&irGh orgarn3Uon proVod~ ObjedMo 

analysis a!XI effective solutIOnS llIat addle» !he GhallefI9M t.OfIg till! public a!XI PIi~aU! lectors around IIlI! 

world RAND's pub"calion. do not .-urlly rel'>ed the ~s of its ....... arm cllenl5 and oporIs.0t5 

• Tl'Iil leSbmony 's av~l4able- lor free dOWntoad at ~ttp ~.r31\G org/pubslte&~mon es/CT37l rrut>1 
105 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.073

'MIile we can be certain that variation In !tKamlner tiecisiofls IS eKpected, it i$ mveh more diffteuU 

to determine how much variation 15 e~pected and how much variation is too much WMe we may 

not be ab~ to say tIow much Is too much, we should nooetheless try to minim;u tile exteot of 

~ar1atiOfl as ml.lCh as possible. 

In our analysis of initial disability determinations recorded 1n SSA's Dir.abiflty Operational Data 

Store If! 2005 and 2006 we find a notable degree of variation in In~lal outcomes across DDS 

enmlnerll with .... the same DDS office that cannot be e~pla ned by lectors such as differences In 

Ihe mill: of case.s they evaluate (Maestas, Mullen and Strand 2010). Figure 1 presents a histOgram 

01 ~efl)lners ' deviatioo Irom the overatl allowance rate within their DDS office, both unadjusted 

and adjusted for dHfefellCeS In case ml~ . Case mi~ controls include the ItaClIOll of cases In a 

gWen age group, body -syMem code category, terminal illness calegory, the fraction deckled in a 

particular month, as welt n Ihe average plioi' earnings of applicants asslgned 10 e given 

examiner. and indicators lor DDS office and 3--dig~ zip code_ 

-

-

• I. 

• 

" 

0 

_A 

Figure I 

DeViations from Mean InitIal Allowance Rate 

---; ~ 

-, 

by Disabif~y Examiner 

I 

/ 

, 

, 

, 

[, 

, , , , rl :-==__=.-:0:=;=,-.-,-"'- ,-_--_-.'1 , , ' , I \ , , 

, , ' , 

, 

, 

, 

\, 

'-

, -, ResidUals -, 

As expected, adjuslillQ IOf case mi. radl.lceS the standard devl(lUOn of exsminer lnitial allowance 

rates 110m to percellt 10 6 percent This meal'S that after adjustment for case mix, one-third of 

exatMlers have attowance rates more than 6 percentage ~nlS above or below- the avelage 

allowance rate in theil DDS, and 5 percent of examiners ha~e alklWance rates more than 12 

percentage points above or below the average. 

, 
106 


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A CO\'lseQuence 01 the vanatlon in decision outcomes ilcroSS e~amlnerlt---Varjation thai cannot be 

readi ly e~pla ned by differences in !he chara.cteristic!. of their caseloads-i5 that for many 

~pplicants, whether they are allowed ordenoed benefits depends upon the e~~miner to which 

Inerr apptk:ation"is ass'll ned. Sil1'C8. as FIgure t shows, most exam,nert; have initial aliowal1'C8 

rates near the average tor !heir DOS office, most apphcants would have reeeilled the same i"~lal 

delermination if their application had been assigned to a dfffi!rent eXBmlnef, But even!oO. due to 

the examiners who are not near !he average, we estimate Ihat as many as 60 percent 01 

~pplicanlS could have received a different initial tletennin~tion from at tees! one other IIXeminef in 

the DDS offiee, hil!! tMy been as!l!gned to lIlat examIner Instead, The magmtVde 01 th1$ measure 

Is drive" by The examine~ who heve Itle lowest end highest ellowance rates In a given ODS 

office For example. if we remove Irom our calculations Ihe top and bollom one percentol ODS 

examiners 'n an offIce (\t1ose with the highest and >owest allowance rates), then the percenT of 

applk:ants whose lMial deeision oepends on tna examiner they are assigned to WOuld lall by 

ha~-from 60 percent to 26 percent. 

The ppe~ls process signlfic~nUy d~mpens the effed 01 IIXeminer v~rl<ltio n In our administrative 

dala, nearty hall 01 all Initial denials are appealed, and 75 percent of theSe are overtumed. Once 

we i'IOCOunt lor appeals, we estimate that 23 percent of applications could have received a 

different ,,/timete outcome had mey been assigned to e different examiner, If we again remove 

from ourcak:ulations lhe top and bot1om one pefcent of e~~m'ners In a DOS office (agai", those 

with Ine higl\e$t and lowest altowance reles) this numDar would fatl lo I t percent 

These numbers illtlstl'8te two points. First, etthough mosl eX1lminers have alloweOCO! rales thet 

are near the average lor their DDS offICe, many have allowance rates that are notably belOw or 

above their office aVllrage even after adjusting lor differences i(1 case·mill. Because a~!cants 

could poten6atly be assigned to any of these examiners, appHeants face a significant degree 01 

uncertelnly es 10 whether their application witl be Ini!ietly allowed or denied, ImprO'ling 

consistency across e)aminers would significantly reduce this uncertainty aboul initial OUlcomeS. 

Seconcl. These statistics ere nol estimates of the fraction 01 ap~!cants who shOUld have been 

denied. Rather, they ldentily the lize and crharactem.1ics of the group that would be most affectecl 

by changes in the poticies end procedures used In disability c!etermlnations. This group 

disproporttonatty ,ndiKIes younger c\almams, daimants with low earnings histories and clamants 

wi\t1 ment~1 impairments (Maes\es, Mullen and Strand 2010). 

At present. the venation I" examiner allowence rates and the high probebilily of haVing an Inj~sl 

denial overturned on appeal means that k is usually worthwhile fordenied appticants end their 

allomeys 10 pursue appeals. BUI the appeals process is costly-nOIJust for the fedelal 

3 
107 


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government but also for the Indi\lldual OiIpplicanls themselves. From the time thilt an SSDI 

application Is filed to the time a final determination Is made, an applicant lNIy not earn more than 

$' ,000 per month In paid employment, since thiS would e~ceed Ihe Substantial Gainful Activity 

(SGA) threshold and result ,n a denial of benef,ts, In our admin,slrative sample o. SSDI applicants 

who received initial decisions In 2005, ttle average time trom SSOI application to fina l 

determination exceeded one year. But this average masks iI dramiltlcdilterence in averilge 

wailing lime between those who did not appeallhelr in~11J1 decision and those who did. Those 

who dOd not appeal waited an averilge of 4 months while those who did appeal wailed an average 

of 2 yea~ befofe rereivrng a final detefTl1/nalion. 

This substantiiJItime spent Olll oflhe labor lorce wMe seeking benefits may potential ly hllo'e 

detrimental eltects on skWs. jail readlroess. and employability. !!"ldeed. we find that longer 

apptfcation processing limes significantly reduce the employment and earnings of SSDI 

appik:anlS in the vea~ after their initial decision. A one standard deviation (2.4 months) inClllase 

In initial processing flme reduces annual employment rilles by about 1 percentage point (3,2%) in 

years two and three following the in~ l delermlnalion, and pe~15ts into /tie fourth post_ 

delE!fmination year (Aulor, Maestas, Mullen and Strand 2011), 

To con\eKluallze lhese numbers, we use them to estimate the impact of average applicant 

proeeS$lng Umes on labor force participation C>1 SSDI applicants, This calculation sl.Iggests IMt 

Ihe SSDI determination proc;ess reduces the post-application employment 01 denied applicants by 

an aWrBge of approx,nlille(y 3,6 percentage points (6,8%) in years two and three follow'ng the 

n~ ( determination and, similarly, reduces the average employment 01 allowed app!icanlS by 5.2 

percentage points (33%). 

Our 'esuits supgest that the posHleterrninatlon employment polentlal of applk:ants could be 

Imoroved if the systelll could achieve grea(er consistency not Ollly within the n~iaJ detefmillalion 

process itself, bUI also greater consistency between Inillal determinations and outcomes on 

appeal. Improvement along these dimensions would atso help reduce the notable disparities 

between the system's treatment 01 different impairment types, some of which exhibit a much 

greater likelihood that benefits would be awarded OIl appeal versus In the inil'al delermiJ'lation . 

For example, among fleW SSDI beneficiaries, we filld ttlal 63 percent of those with 

musculoskeletal impairments Wf!I'e awaraed bene~ts at the appellate levels, compared to 39 

percent of new beneficiaries with mental impairments-oon~uenlly , benefociiuies W~h 

musculoskeletal impairments spend significantly more time pl/lSulog bene~ts ttlan those with 

mental Impairments, 

, 
108 


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By reducing tM variation in Initial determinaiions. we would improve the targeting (lf the SSDI 

program-that is, we would increase Ihe chances that people who truly qualify recal~e benefits 

and reduce the chan<:es tllat people wilo do not qualify receive benef~s. To the extent thai 

cteci5,on thresholds could be better aligned berween the Initial and appellate pnases. trleshare of 

those initially denied appticants who decide to appeal would likely decline, and trle cSelrimenlat 

efleets on turure employment poten~al would be reduced 

, 
109 

f 

Chairman JOHNSON. Thank you, ma’am. Did you listen to Dr. 

Chan? Did you agree? 

Dr. MAESTAS. I did. I was actually quite excited by what I was 

hearing. 


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Chairman JOHNSON. Dr. Chan, you testified about the collaboration between Social Security and the National Institute of Health 

and Boston University to develop your computer tests. 

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

Dr. CHAN. I think the techniques and the procedures behind 

IRT/CAT instruments are well validated. They have been utilized 

in educational arenas for quite some time. We have been using 

them in health care for quite some time. 

They are remarkably powerful and insightful tools that can be 

done very, very quickly, particularly in the area of functional assessment. 

Chairman JOHNSON. Can people fake them? 

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

completely immune to gaming. 

On the other hand, there are, I think, several aspects to IRT/CAT 

that are really beneficial in this area. 

The first would be that the IRT/CAT instruments themselves are 

comprised of dozens if not hundreds of questions that would be 

very difficult to memorize, and indeed, very difficult to figure out 

the order those questions might come in. 

Second, we could also give the same assessment tools to the 

claimant’s clinicians, and that would provide very interesting information, and I think useful for SSA in validating certain things. 

In addition, we would be applying these tests to millions of individuals, so we would probably have some really wonderful baseline 

data looking at what a normal response pattern would be, so individuals who have aberrant response patterns potentially could be 

identified. 

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

Dr. CHAN. Yes. Mostly, it would be claimants who would be 

doing the tests, but for those individuals—— 

Chairman JOHNSON. I understand that. The person administering the test. 

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

Chairman JOHNSON. One person can do them? 

Dr. CHAN. Yes, a person could do it by himself, if that is what 

you are asking. 

Chairman JOHNSON. Do they have to be trained? 

Dr. CHAN. We sort of tailor these tests so they are at a relatively low and easy level. Obviously, we need to do that so that 

a broad range of individuals—— 

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

[Laughter.] 

Chairman JOHNSON. Do you agree with that, Doctor? 

Dr. MAESTAS. I think this sounds quite promising. 

Chairman JOHNSON. Thank you. Mr. Becerra, you are recognized. 

Mr. BECERRA. Thank you, Mr. Chairman. I cannot get quite as 

excited on the numbers, but it sounds like the two of you put a 


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111 

great deal of numbers in, and I am glad it raises your blood pressure a bit to see we might have some opportunities. 

I do think as you say, quite promising, Dr. Maestas, that we 

might have other ways to try to validate the process. 

What I take from what every one of you have said is this ain’t 

easy to do. In many cases, you are making judgments because you 

are looking at folks who are maybe right on the edge, could they 

work, and not just in their current occupation, but in some capacity 

whatsoever, and it is sometimes not an easy call to make. 

What we are trying to do is make the system as efficient and 

standardized as possible, so that way when folks have to make the 

decision, they are not guessing. They should be collecting the information as early as possible to try to help these determiners, those 

who make the determinations, to have all the information and evidence they need. 

Certainly, we have to make sure that we continue to push the 

SSA to have the tools in place that let them effectively make those 

judgments. We are talking life and death, as I think Ms. Ekman 

made clear, in most cases. 

I am troubled that what we are hearing is SSA is having to try 

to do all of this with less and less money. 

Ms. Lyon-Hart, you mentioned SSA is already struggling. You 

have already seen a number of these folks who make determinations gone. 

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

Ms. LYON-HART. It is a mix. Just as the baby boomers are getting more disabled, they are also leaving our offices. I would say 

it is probably heavy on the—I do not know the exact numbers, I 

can get them for you probably with some polling of my members, 

but what I hear is they are losing experienced examiners. 

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

Ms. LYON-HART. Correct. 

Mr. BECERRA. This worries me because we were making 

progress. We were getting the wait time down, the backlog down. 

I believe, Ms. Lyon-Hart, you also mentioned that the longer a 

case sits, the greater the chance we are going to make some mistakes with it, or it is going to become more difficult to adjudicate. 

Ms. LYON-HART. It was not me that testified we would make 

more mistakes, but it definitely takes longer. You end up refreshing the medical evidence and getting more information. It becomes 

more complicated the longer it sits. 

Mr. BECERRA. What I take from everything you are saying is 

that we have to continue to find the tools to let us make these assessments, to try to avoid the outlier decisions, whether in denial 

or granting the benefits, so that we have more consistency, but at 

the same time, do not tie the Social Security Administration’s 

hands behind its back as it is trying to move forward with an increasing caseload of individuals who are filing for claims. 

We want to make sure that those who deserve it get it, and at 

the same time, we want to make sure that those who do not deserve it do not clog the system for those who are waiting to get the 

benefits they have earned. 


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

benefits that they worked to have. 

What is your sense out there in the community of folks who are 

on the verge of securing these disability benefits or believing they 

may be on the verge of having to apply for these disability benefits? 

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

Ms. EKMAN. Thank you for the question, Congressman Becerra. 

I am not sure for the people who are going to be applying for benefits, that is a concern. They are concerned about how do I pay my 

rent, how do I get my medication. 

Mr. BECERRA. Good point. 

Ms. EKMAN. I think for advocates, there is a huge concern that 

the longer the Social Security Administration and the state DDSs 

remain under funded, the worse the conditions will get. The longer 

people will have to wait. 

It is not an overstatement to say that people die while they are 

waiting for a disability determination. 

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

benefits can get them. 

Mr. BECERRA. One final question. I know the Social Security 

Administration in an effort to try to concentrate the resources it 

has on those services that are most important had to make other 

decisions which are tough. 

They are closing offices at earlier hours. They are less able to respond to people who are applying for retirement benefits so they 

can deal with those seeking disability benefits. 

Ms. Lyon-Hart, do you think at some point it is going to become 

very obvious to the average American who is getting ready to apply 

for his or her Social Security benefits that there is a problem with 

Social Security because its budget is being so short changed? 

Ms. LYON-HART. I do think it will be obvious if it is not already. 

Mr. BECERRA. Thank you. I thank you all for your testimony. 

I hope that research can produce some real results sooner than 

later so we can apply those. 

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

Chairman JOHNSON. Thank you. Mr. Berg, you are recognized. 

Mr. BERG. Thank you, Mr. Chairman. 

I just have one question. Dr. Maestas, when someone is seeking 

disability insurance, it takes a long period of time. There is a detrimental effect on their skills during this period, and their ability to 

be employed. 

My question is if you could tell us a little bit more about these 

findings in your research that looks at that, and also what is it we 

can do about that. 

Dr. MAESTAS. It has been known for some time that many 

SSDI recipients have some employment potential. We are not talking about full time employment potential at the level of their predisability earnings necessarily, but those effects are rather large. 


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113 

For example, we estimate that had many beneficiaries, and these 

are the relatively healthy of the disabled beneficiaries, had they 

not received benefits, their employment rate could increase by as 

much as 28 percentage points. 

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

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

What this new research is saying is in addition to these effects 

of benefit receipt on employment potential and employment capacity, there are additional effects coming from the process itself that 

keeps people waiting. 

We have been able to disentangle these two components to get 

an estimate of the decay in employability that arises with every 

month that somebody waits for a final decision. 

The problem is not the initial decisions, per se. Those occur relatively quickly. The problem is when someone gets a denial, and 

of course, most people do get a denial from the initial determination process, they go on to appeal. 

The appeals process takes them into this waiting game that goes 

on a very long time. If they are denied at the ALJ level, many of 

them go on to pursue appeals at higher levels. 

It is well known in economics that as people stay out of the labor 

force, and of course, these people have to stay out of the labor force 

while they are pursuing an appeal because otherwise, they would 

be denied, employability declines. Skills depreciate. Employment 

networks erode. Investments in the latest information and technologies are not made. 

Mr. BERG. What do we do about it? What is the solution? 

Dr. MAESTAS. It is a hard problem, admittedly. We have to 

shorten processing times. We have to shorten waiting times. 

It is not only about—the Administration has made good attempts 

in this area to actually shorten times by reducing backlogs and the 

like. 

Part of the problem, what I would like to draw attention to here, 

is that too many people perceive that an appeal is worthwhile. 

If we could better align the decision thresholds that are used in 

the initial phase and the appellate phase, then we would not have 

a system where everybody believes they need to appeal to get the 

right decision outcome. 

Mr. BERG. We tend to have an automatic appeal when there is 

a denial. 

Dr. MAESTAS. Exactly. 

Mr. BERG. Which extends that period, extends that cost. Obviously, when someone is out of the workforce, it is hard for them 

to get back in, regardless of what the outcome is at the end of the 

appeal process. 

Dr. MAESTAS. The rules, of course, do require a five month 

waiting period. 

Mr. BERG. Thank you. Thank you, Mr. Chairman. I will yield 

back. 

Chairman JOHNSON. Thank you. Mr. Marchant? 

Mr. MARCHANT. Thank you, Mr. Chairman. 


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114 

I have a couple of process questions. We talked a lot today about 

baby boomers and they are entering the system as disabled beneficiaries. 

Once a person reaches the threshold of age 62 and they have the 

ability to go on early retirement, what is the process a person 

would go through once they have reached that threshold but they 

do not want to take early retirement, but then they apply for Social 

Security disability? 

Then they are denied initially, and then they are given a waiting 

period that might take them past the time whereby they would 

enter the system at age 65 in full retirement. 

How are you handling people that are entering with those kinds 

of problems? I am not sure who to direct that question to, but perhaps somebody that has some every day experience. 

Ms. LYON-HART. Actually, I am just going to speak up to say 

that I am probably not the person. We really need to know from 

Social Security, because that kind of decision happens in the field 

office. 

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

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

question. 

Mr. MARCHANT. If the person was 62 years old and they applied for total disability and the total disability benefit was $1,100 

a month, and they were able to receive early Social Security benefits, they cannot receive Social Security retirement benefits and receive Social Security disability benefits as well. 

This whole perception of the system being weighted down and 

broken because of all the baby boomers that are entering the system because they are retiring and more and more of them are becoming disabled, there seems to be a point at which that would 

flatten out because they would either go into early retirement or 

into permanent retirement. You would not be receiving both at the 

same time, would you? 

Ms. LYON-HART. No, you would not receive both at the same 

time. I misspoke. 

Mr. MARCHANT. Dr. Maestas. 

Dr. MAESTAS. I can speak to that a little bit. They would not 

receive both at the same time, but of course, the early retirement 

benefit is an actuarially reduced benefit, and the disability benefit 

is not. 

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

higher benefit level. 

Mr. MARCHANT. Are any of these things taken into consideration when the initial claim is made? It would be a very small cost 

for a person to have a combination of partial disability benefit and 

an early retirement benefit, and why would someone wait one, two 

or three years and appeal their claim if they are going to reach the 

threshold of retirement anyway? 

Yes, ma’am? 


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Ms. EKMAN. Thank you, Congressman. A person—as Dr. 

Maestas said, if I am 62 and I go and apply for retirement benefits, 

I am going to receive a reduced benefit. That will happen for as 

long as I receive benefits. 

As an individual, I am entitled to get disability benefits until I 

reach my full retirement age, which I would point out is now 66 

for people who are retiring now, and will go up to 67. 

It is a big disadvantage to me in terms of my income if I applied 

for retirement at that point. 

In the SSA evaluation for disability, there is a piece that takes 

age into account, in the vocational guidelines. 

That is considered from that perspective when someone comes in 

and applies, but it is up to the individual to decide whether they 

want to apply for early retirement or disability, and if it is an individual who has a disability, it is in their best interest to apply for 

disability because their benefit will be at the higher level, as opposed to reduced for the remainder of their life. 

Mr. MARCHANT. Okay. Thank you. Thank you, Mr. Chairman. 

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

Mr. BECERRA. Yes. I just wanted to be sure. Dr. Maestas, I 

think during some questioning by Mr. Berg, when you were talking 

about the appeals process, I think you may have mentioned there 

is an automatic appeal. 

There are not any automatic appeals, although a lot of claimants 

ultimately do file for appeal, but there is no automatic right to appeal a case to a higher level. 

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

Dr. MAESTAS. The appeals channel is open to everybody, but 

there is no automatic appeal. They decide themselves whether or 

not to pursue an appeal. 

Mr. BECERRA. Right. In other words, it does not go to appeal 

immediately if the decision is against you. You have to actually—— 

Dr. MAESTAS. You have to initiate the appeal. 

Mr. BECERRA. Correct. 

Chairman JOHNSON. Their lawyer decides. 

Mr. BECERRA. Ms. Ekman. 

Ms. EKMAN. If I could also just clarify, I do not have the exact 

number in front of me, but will be happy to get that to you, but 

a significant portion of people who are denied at the initial level 

choose not to continue on appeal. 

I think that is an important point, that we are not getting 100 

percent appeals of denials. 

Mr. BECERRA. That is my understanding as well. If you could 

provide those numbers to the Committee, I think that would be 

helpful. 

Dr. MAESTAS. I have those numbers from our data. It is twothirds, almost two-thirds, 65 percent that do pursue an appeal of 

the initial denial, as of 2005/2006. 

Chairman JOHNSON. They do appeal? 

Dr. MAESTAS. One-third do not. 

Mr. BECERRA. If you could provide those numbers, that would 

be great. 


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116 

Dr. MAESTAS. Those are in my testimony, in the written remarks. 

Mr. BECERRA. Thank you. Thank you, Mr. Chairman. 

Chairman JOHNSON. Thank you. Again, I want to thank you all 

for being here and your testimony. 

I look forward to continuing this discussion on ways to secure the 

future of this vital program at our next hearing, which will focus 

on what happens when someone appeals a denied claim. 

I want to thank you all again for being here. We appreciate it. 

Great time to see the trees outside. You have perfect timing. 

With that, the Subcommittee stands adjourned. 

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

[Questions for the Record follow:] 


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wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.078

QUI' jon~ for Ihl' Retortl 

For Ihr "brch 20. 201211~~rlng 

011 ni~abilily Otci~jnn s 

I. Tilt Sl~ l~ l'spo ~; hilit,· for inili~1 dis~hilil y d~tj ,ill ll ~ wu ~~I~h li h«l by thl' Sc>d~ 1 

Sel'urit)' Ad '\"'l'lIdmI'1II5 of 1~ 4. Ginn thl' ch~lIcn ing fiscal tinl l~ at Iht ~11' "~1 

110 Oll ... orr,. Ih ~1 ltS hnl' n in(l'.uin III ... ~rrl fellenl t,...nl'lilS III protcd lheir 

0 .. '" benefit prog .... ~·! Ifnol. h,»>· c.n YIIIIIJt ' u'"" Ihat Iht~t inilia illtdsinn) are .... ing 

~dl' objecli.-ely anll atcu .... lely? 

Th~ SIB!e- di",bilil)' detemlination !;eNias (DOS) muS! evalu~te- di$a.bility claim> bMed on 

our disability program Il"' licic ~ and regulations. We ru.ve no e" id~nt~ 11131 SLlie Ii_I iS$ue~ 

alYcet these detcm,inations. In fatt. during thto reeell! economic downturn. (Jur allowance 

r~tc'S for initial claim$ and ,""co.uide!"Jtion, have. d~rc>3S<"". 

\Ve use thc statutorily ""Illirro pn'"-<'/lj,ctuation rovi~w pro,:e~~ to condUCt a Statc·!evel 

qu~li y !"eview of 50 perccnl of DDS allowanc es. Moreowr. we. routinely conduct 

p"rfonn~OCt: occu=y "'views on 8 5:lmple Qft"d!\eS adjudicutc .... l>y the Stat<"l to enSu", h~t 

DDS de~;sions are bj t'l:liv~ and accurat~. 

2. I unll c..,lunllthrrt are ODS ~rfQrn"'net ~Dl ard~ in rt ul ntio . The unly I~ trd 

performa net mrd n~<"l t aetunlcy ~nd pro<:<"lsing limr. The u~rtnl minimal 

acceplBble I.,·r! fllr prneu~ing IIf disability insurante eldin,s is 4~.S day,;. Gi>·tn Ihl' 

.' crllg ~ DOS pNlt~ssi ng lime is o,'n 100 days. art yutll'll nning On upd,Uing Ibe.jc 

regulalion~ and will YO tl indtldt IIlhcr stllndards to tnsun II unifllrm nalionBI 

pr .n'? 

We arecu1Tt'mly revie\\in!,; these r;,gul~lions IU delenninc whelhc'r there arc cl!;:lnl!es Ib,,, 

wuuld help u. ensu~ (, uniform natiomll program. 

J. Dr. Mat.!las diJeu!lIed ' ·Hri.lions mon g DOS u~m intrs Ihal ~ad to inconsistent 

uul.om..,; for m,ndki.ries. She linds Ihnt S ptrc.nt of uamintrs ha" r uII'ard .... t..,; of 

mill"<! Ih." 12 pertenl his:.h •• or lowor Ihun lho ~"ttBg •. An"f >"o u rr"itwtd unlli •. 1 

u amintrs acrllSS Ihe Slale DDSs? Ifnot, 110 )'uu h.,'. pbns 10 do so? 

We du not review Qullicr ~amincrs across Stale DOSs. and we do 1101 have plan~ to du so. 

While we do nut focus Oil d("<:isions from sp::cil; c c.xamitl("rs. we do conduct rcgular ~ccurdey 

rJ:v;ews on a sample u!" easo:s from each St.:llc (0 mUnilor (md en,u/(' Ihe accuracy of DDS 

disabililY dCWnn;nat;ons. 

E,'cry lis.:al year \1''') we 5ct a goal for the accur. ... y rate of inilial disab;li\} dClcnninalions. 

track (hat aceurJcy !llle, and publish \I\lr p.:r!i.nntan<;C in our '1TlI1u,) Pcrfonnanc,· a,!d 

A~,,,otll1 tabilit )' Report, Each }ear since FY 2007. thc DOSs ha,'C ntel oor annual aecurdcy 

g~>a!s. 
118 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.079

Endl),ure - E'ag~ 2 - The Ilon{)rnbk Sam John )<) n - Que-sLions for Lhe Re~ord 

4. If ~ l3inl~nL' . condiLion """snut med ur~qu.ILhe li Linl:"- Lh~ "",I slep is ~n 

a~scss ~nl uflhe d~imBnl'~ nll.inin j: lIhilil)· 1(1 r"nclion. 11 0 "" d,,~ . a n e~a miner nr 

medical tunSuh.nl USC" ~(l melloc s runclion? II,," subjccli,·c is Ihal ss~", .nr? 

If a el~il11Ml's Cj>lldiTion dj)C"S I"KlI meCT or equa l Ihe Ii sL ing. . we assess ilis or hc. re~idl~'1 

fUnCliona) cap.'II:it)' (RFC). An RFC assessment is II r"netion-by-f""clioll a.<sessmenl b;!~ 

upon alii"'" .dcvant evidence nfpn individllal"s ability to il l' " ,,",-related aeti vitie,. We 

arri,'c At on RFC by cvi~ "ing the c1~imanrs m~dical =ord, his or her allel!,!llil'lls o f 

sympl()l11'. opinio n ~videl',c fmm medical and 1>Ol1111edkal ,,)U~CS, alld rcl'C)ns ofth~ 

day-to-dol)' fillle!ion oblnilled from tIT<- cI~il11ant orolh.r individuals who are familiar with th~ 

clpiI113n1. 

In as~ss in & RfC, We consider limitalion~ i!.nd ~lriction > tbaL result from m~ical y 

Mt~mlinable impoimlents (MOl), We al ~o con~jder any m'ailable infonnatio l1 pr.o,n 

mpL m~ b«tiusc s ubjectil'e descriptions may l1di(:"J t~ l1>ore ~VC r~ limit3ti on.> Or 

restrictio ns thun Can iJ<, ~hown by objecti,." m,'<.li~-al .videlle~ 11I"" . I!owewr, wedo nUl 

",msidcr limitations or ""sJriction~ ""ulting from );~, gender. body h3bitll ~ (e.!!., bod)' t) pi.> 

and ~l 'ture), coodilioning;. or inherent trengths or pr",lispositions IIlIt attribul ab le to lhe 

clainmnt's MOL Whik th ~ RFC a~SSm1.'111 is '·s"bj~cti\'e·· in the sense that ,,~base it 0 11 

the indi vidual facts of eaeh daimal11's ,'3500, V'-l.' minimize Ihis illl"'tent subjel1ivi t)' by 

applying cunsiSlent polic>' s!ancl;trds, Our eketronic case aMlysis tool (c-CA T) hdps ensure 

pOlicy CQn,isieney. We cu""mly usc e-CA"r in 12 p<>reem of our initiul claims. We recently 

mal1dal~d 111.1t al l DDS~ uSC e·CA T by CXtober 20 12. 

5. At Ihe h earin!;, nr. C han di'l(" uso;ed th e .,·o rk you are doing ,,·ith the National lnstilut "" 

IIr Iltlllh 10 huild I comlluter t'lti' ~ te.sl Ihat u n he lll assess fUllctilln. Wha t tII n "ou 

lell 11 ~ uboullhi~ I"t'Snn:h, il ~ impacl "" deciding disu bilit), in Iht fuillre, a nd th e limi,,~ 

or ., hen such an ussfssnlcnllool might he rcad)' ro r impl ementa tion '.' 

lol00g, we il1lplc,"~ntcd an imera;,;cncy agn:~~nenl wilh the Reh<1bili"u;u" I'o1cdiciI1:C 

]) ~panl11ent allh~ Naliona llnSlilUtcs of IIcalth·s Clinical Rcscan.:h Cellier 10 mlaly7,cexisling 

agency (.\;Ita and 1lSS"s.' the feasibility \If devdOI,in8 CQ''' puter Adapli\'e Tc ting (eA 1") 

inSln,mcn Lt;, 

CAT i. 3 fonn of computer. based testing that tailors qllesti un "" Ie<:tion b"" .. ..:1 upon lh<' 

daiman!'. ability I~>'CL It is similolr in approoc\1 to st""dar&l~d t~"Is .s uch "" th~ (jrnd1l3t~ 

Record Examination and Graduate t.,·lan:lgcme nl Admission T">I. Unli ke a fjxed for111Ie~t 

that asks Ihe S3me q"esl;o ~ uf c\"~ryonc. CAT instmmenLS ""k cI~i n131't s 8nd lheir plO"ldcrs 

o nl y Ih~ most \nfummliw q"cslion~ based on a I"'rSo,,·s re~pon!;i!" 10 prel'iDUS 'luestion~. 

Using Ihi" nWmllch lI s Ihe inslmmcnl til k fc"w qUL'1tions (in 101al) beca use Ihe 

sclC'Ctcd q,,~stioos are based on the individu.11's level offl1l1etlon. Usin); rcsclll\:h nd 

tcchoolo,gy thai is ffil:thoooloj:;ically rig'lroU~ und defensible, we a rc <Jc"ciopinll ihe CAT 

inwul11cJ1110 oblain infi")mmtion Oil da,mun'" fUllet,oonl abiliTies jn a manner that is 

>y$t"m31ie, compNhenslw, and effici~n\. 
119 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.080

Endosure - I'age 3 - The Honorable S80l John>Oll - Qu~lion~ for ,'''' R~or;J 

To dale. llnslon Uoi\ersily. which is!l sulx:onlfflClor. has de,'cloped qu<:~lions for 'wo ufsix 

~3tel!0ries offimelio"in!; 10 be induJ.:d in \h(> CAT instrumenl; 11k."SII cHlcgories an:: mobilily 

a"d inl"'P"rsorul inlcJ:lclionS. Addilional dom3in~ include Icamin~ arid applying 

knowblg<'. e(")mmunicalion. If-cllre. and general IMks and demnnds. Thi, scientific 

pAA~SS Wilililkc Four OIO,e )·curs iI.'i each dl)main m"~t be developed. calib,med. and 

validated 10 he sc;emilically defensible be lorc we are ablc to intcgrme the CATs hnn OU, 

cu,rent dis.1bilily pmc..'ss. Therefore. we ~J"II.'<.:1 to oompletc this instrument in 20 16 ~nd 

sub~q llentl y test 1\ ,,·j,h claimants ar.J providers. 

6. Ol" , istr nt lrainin!: can g" a long way 10 cna ting .~ nI IlU CO l.'S. In an Inspecl6r 

Gc', 1 repurt Oil Inlnlu!: in Ihc I)I)S rtleu ed nn ~b~11 I~ , 20 12, Ihe IG ro und 11\111 

~ nmCf~ Wt rf Uppl ," nllng Ihf SotI,,1 !!fcurlt)' AdltllnWntlon·., {SSA) lralnlng 

ou~es, aod in slime ns erea ling Ill eir own Ir ining mal eriu ls for Ihe ~~ nl~ topi~' . 

Th lln J Soc ial Suuril y i, p~)" i"g "' ~~ rllr slime trllining. 11 0'" docs So 1 StCnrlly 

ItI n 10 dd ll"~ Ih " r; " din gs d cnsur<' a ,in!:le IlTr$e nllllio" pdin t for Ih. SSA polic)" 

""d nelic ~ in "' kin g di s~ blill y dcei, io ns? 

We a...: laking ~ver:ll tcps 10 improve DOS IItCl<~~ to IIp-to-d3tt and accurate tmining 

m3leri~ls on disability PQlic~ Hnd pru,: ..... u~. For ~xmnp ..... ,,"e are enh~ncing{)u, ()n-lin~ 

lool~ to pruvidt n~iiQn311K:,·ess 101111 tmining malerinls. cllp'lndinS-lhe usc ofpOdtastl! and 

idro-Qn-dem~l1d 10 ~nsur~ acc~$sibjlity 10 lrainin~ using trtnd an3l}sis \0 identily spe;:ifIC 

training nceds. nnd sharing !.>cSI praetites with disability·training offic<'''' at Ihe rel'ion~1 and 

State I,,'cl •. 

We believe tl\t..'SeS«·PS will help us l1lSUrc consistency in IIU' IT"Jining and eliminatc any 

redundancy. 

7. It 5f ehlS like your dforts implemenling hn llfllT will signifi cantl)' reduce ,,"ail times ror 

inili 1 tc ion .... lIow mnc h ha'·" il lim~s b~ " reduced in Ibe pilol sil es'? WhMI 

ll tngn a re you .c in g~ 

l leahh IT ha~ the polclIlial to tra'lllfo"n our disability dCI~rminat;on process. lkvdoping the 

m~dical record,;a ou, cu",",m procc~~ is COSIly aud tirnc"""",lSuming. Il cald, IT al)tom311.'" 

thi, process 311d polcmi311y provides a morc complcte medical rewlt!. lhu~ improving I"" 

'I"'~"', IICcu'"""y. and efficicrn:y of our dc'Cision_lIlaking. 

While the actual vo!mt'" orca!;cS involving heahh IT dala i< still 'Iremely small, we have 

si.'<.:n a decrease ill th~ time needed to 3djuc.licBle those cascs. For the approximately 

I O,SOO cD.>l!S containill£ electronic dala that ,,·c revje"t<I from Octo),.,r 20 I I Ihrough April 

2012, wc.c.xp"ricnced an approximately 20 p"r<:~nl It,<.luclion in 101<11 ease p~s.ln¥- time, 

which is tIw lime from when a DDS reec;'·es an inIti al di.llbilil)' Claim II) "hen it dc.:ideSlhut 

cloim. The eompontnttime required to golher medi~~1 e~idcnce dropped dramatically for 

th~ sc cl~illl'; a mnlte, ofM'COnd~ for clcctT(>nic 1ll!."tlieAI e, idcncc corn""red 10 wecho, 

",muhs ror n typical paper-basN medica) evidence "-'queR We look f",ward to the l\Cxt 

stages oflmplCmcll1mlon "fhealth IT ~la ndMd51lm will advance Ollr ability 10 have a 

"nifoml p~ss and syslem to 1nlernet wil h the mcd1cal commlloily. 
120 

f 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.081

8, Huw many continui ng <lis~bi lil y r~"it ... s hH" e m'en pcrfurmw su far Ihi ~ fjiul lur ? 

li o ... many Df IhDS~ re"irll'S a rt f,,11 mttliu l re"irll's? 

Through April 2012. ".., h~,'c ~omplel~d 865,187 conlinuing di:>abilily n'vi~w$. Oflht"Se 

l"Cviews. 338.655 nr .... full mc\lic~1 reviews. We pl~n 10 complele -'J5.()(){\ lidlmc<lit::ll CDRs 

"ilh Our fiscal )'car(FY) 2(112 appropriale<l prog:r.lm il'lleSrily fumlinf;. 

While we will c"mplel"signilic~nlly rno .... tull m~..Jical COlts Ihan ",;: did lasl year, w" will 

be UMble 10 complele 3:< many as ,'" would have wilh Ihe Ic,'ei of funding a"lhori~cd in ~'" 

Blldge/ C,>nlrQl Act vllllil (neA). If ... ~ had lI:ccived lull BCA [unding __ $1\'J6 mi)liv" f.;w 

lOY 2012--wc wvuld h3V~ ll'l."ell able to cvmpicle a projecl<.""<l56~.OOO full '''cdreal C DRs. 
121 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.082

ncddd 

May 1~21112 

R"rn.""ol:~i.c Soon J"I1"",,.,, Ch;oim"" 

"110; Kim lIilll" .. <I. SIIIITOi"''l:11>< 

Su""ummil''''' "" So<:ial S«uril} 

C"nllniuct: /xl Wll} ~ and M ...... 

U. S, Uoo". ofR."...,scnlali>'C; 

(1·317 RiI,oom IlQUSol Office Bulldln~ 

Wa;hiIl$IOO. DC 2ijSI~ 

---. '---

--

___ '\1>00. __ 

_ G<l ... " -".,......., 

,--

--

----

Thonk yoo 3gain forpnl,idit1J! the IJ1'I"'fIlltIit)' ror NellDD til PfCSC"llc<lirnony", tho CooUni1!L'C "" Way ... ,d 

Me,,,., S"booomnjll<'" on Soci.l SC<U,;ly hc"Jti,,1' ",111;"0 1" securinllll,e f"IUre of tl'" disabilily prog""", Tne 

1;, ~1\\ ;" !, .'" our rC>poI\S<." 10 your 4"""';"" " 

/. DDS lund;,,!: 15 ""s.,/ Illt «mlin p'9'/nc/ivi'J' "",/ pr<NV,si,,~ Ii"", "",u/uN/s. W" ,,/d J'fIU '.'<p/ain /to.' 

Ilti. ",(Jrb~ AI,~. uff,,'r i"'.1i> /" p"r ltu ,~ "tNJIICrI{ n U,,,,,,, und "<IN, II/"";'''' t.,'alNii"";"'" f:Qp~d~ 

/low J" 11t ~ .. r.'P"'"/atIQlu ~lrd rt:~lrlN "M off,..., /)f)Ss ahilil)' '" Ih",jJHJlItI" ,1~,-el1!P " lid ... ·IIIrIUI' ..18;'''' 

n" d«" ..... ", dHIJ IOlfJ! 

!'""h 1}IJii .... r.mil5 ..,"",,1 budgetl'C<j ....... and '1"",,",1) '!l'-",ding 11 ..... 1" SSA based (I" r"~ ... ~<d 

wo"dO/lds. SI.lli"S. pc"..".".,1 '''lS .... ",cdi~~1 c"'" dtl'<lopln,,,1 C'><lS, and Ofl'l""'ling <'\!l'-...... "L W.,rking 

wilhin 0)1.11.1 .ilou",,1Il ,""sJr.oinL'. SSA """"i&", lh. nos. Mldgel "''10'''''' .,od I"''''ide> s!l'-lldilll', 

3"thl>rily bo.!;,,<! '''' .' "ilabilil) or rundi~. SSA 31so "".bli.h .... la'l"''' rOf m>dllClivil) 1"" ""rI, ) ".r .nd 

pn .. ," .... inlllimc, 

Indil'iduol $laIC> dc'tnniJIC-Ihti, <lite> nrflO~m"OI ror I"'rth';':(j(l'I><>diCilI ""vrds o<lll <M>l,llal;H 

t.\'a,oinOliil!>S. l'hc;e r1OU.')"~ not <Si.'t<'<l'h" hi.';llcsl r10k pIIid by oJ<tal ,Yl)lhcrll/lCfJ(;I • ., in lhe Sioto fQf 

lhe "'01" or simibr I) fPC of ~,, io,," ICIl<l~ <if f ... k ... ,,1 R~K"liJll<JJ.,-, Till. 20. 1' ... 4().1. tl().l.16241, 

Wile" fi,ll funding is not ft\'aiI3b l~ . ::iSh mol' .... lriC. DDS n.:plot<nlttll ~irin, ~o'hori') ' _ OIlSs i!<I,,, h~d " 

hard hiring I""'·~. ;i"". Ih. f311 "nllIO lIi.h . o./r1I'TJ>.lic implltt 00 ~n".gjc infJllSlrtJClU~_ Wi,h littl. nr no 

hiring oull<()I1ly. 1)1)5, MI. n.,>.IlIITin th~ ,,,,in;n ~ -pipl!lin<:,- <evertly )imi" nl\.our .t:"I',ym .d<lN:g 

,ncr~",in~ w"rldoods. 

WilI:n ,I", n"mb<-t"r~. c .. ",i,,!, in Ihe DDS 00.". .xc< .... l> ,1\0 ru'"!in~ orod .'>laffprOO\ICI'on ""pacily. II> il 

does ClIITtnUy. Ihe ,,,,,,11 i, " ha<klos or <lJ<l.liluenls· CIl>C. in lhe DDS. 211"0,'i"11 as..ignmcn< 10 .n <.,",ni"", 
122 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.083

r.". proc<.,"ij!" Of ~">l'1i" " \lIb ... '"'" ""k>1. _II a:, m«!'calll<Ses",non1. ("11"",,11), IksPII< ",cord hi!!,h 

I) DS p<tJdLlC1IVII: 1"" "'<>rk year. frollHnd sllIgi"i "finil'al and I\:coo •• denui.,. ca. ....... a"a'iins ~1"'m .. m 

to WI .~~m'nn I. at 119.352 cases nalion. II}· (~SA SllIgcd C ..... Ropon. r<IT ,,,, .. k c:no.Jin8 j 1111121. TlIc ..... 

dtla) ~ will "'~ bc.c""p'urOO in ",meiol S~A () OS p, .. t",<il"lij tim ..... (a II1Itil the ~;<~ .... r,ll>lI ~("oI)1pl<~<·(L 

I l~"w.".. ; .. ~iIU<"'IS "''' 4".-00)" """"",""Clog ~~ deJa} ... 1.n~'~\lnl!\ of (»·,"T1II1 I""\ICC1ISitLg 'imo:: and 

d .. e,i""";",, "r """,ke. 

If,,,,, ..,'·erel> .. d!<~ 0"" «sull;ng r""n tho IIlIdgel COllirul A<I ",k.err",,1 i" F'Y !OI l. il i,likely th., Ih..., 

ba<klvp "ill ill'"'''''''' exponcllli. IIl·. both in (h. nutn""" of 0",.",. .n.olOd "",I ill ,he kng:Jl, or " dela,.>. 

MOllY (lflhe ODS "1'<"OIling .. ",I. "'" f,,,-d •• ""h .... .... "fII. ",ilillea. ,,"Ie 1'<>31",,,,,1 ""d ""mini,lmli.·. «"'". Any ",<I<lel;"" in fnn;c "r,,"ined DDS 51olr"",-.k<.i I" [lI'\><C>" 0 •• ' .. " ,,,,,,Id "bvi, ... ly he •. \1",mol) 

c<I\lnl<ljlf\olutti," and IIumIJi.cII" p~bl", !o<rIi<'e. Ked",,!iO<1 in pcnd,"~ Rlf m,.,jit.ll ", i""MC nnd 

<n",ulloli, < .,"",,> " '''\lIJ funl"" oklay ca;.: <ktl\mlirt4li,)fI, ",,,,,, we PI"<: n"'tllirod Ii) .... \ju,.,.1 .... ,iJc .... '" f,UIn 

<'Vet) ""le""\1 mMical ","rr~ ~nd (0 plitohosc '"'!ul .... ""<l eXlIIn'M\ions/l"'I$ llIIIln th~ ",,~Wl<~rr .....,on!, 

r a)"in! less f..,.,. mc'dleal =<lfm "'()lIld re,ult ,n fe"'c, I,mel) repnn. and ffi(/f"C n~ fOl" consult:nh. 

"".n,inalions "'SUIII>\!! in longn pr"O<"CS.ii".8 limcs nnd hlglce, 00';1 f""I" c-. Marcy soulCS re~d)' h .... 

tliflk\lll)-' flndin8 ~"t"Ii~i,"" ~nn"" I"I, e "'(,,,ni""I;(>I"I fI!"I" id\.-.s d"" 10 I",,' ""01: (lr .... ." oool1":rnOn' unlb Iho 

~kdlcatc "elling_ 

]. Wit", ,,""III)· ~"mroJ, dl! m ,,,I>IIiO' Iklc,,,,;,,ul,,,,, S."'h.·",, (Dro'l It""" I .. p/nu /0 ",onllo, DOS 

'~·~"""n'i · and n""II ,,1 "" "II~n · N"II"""J" "wI '/"IIr.: ,·o lsl. ~ 

1)1)5. "'" "''lui",d til lea.'. '" int<n",1 ·-q""lity """'WI"" funetiltn ,ullk;"", '" .n,I,. .. ' thOI di ... bili() 

""Ic"nlnat;",,! ..,.., made a«""nl(<ir 0Ild pl"<llnp'ly- IC <Xi<' <if f"ffl;t",1 N. !:"!",io,,,. Tille 2n, 1'1111 4(.1;1. 

~~M I6201 . Ill. "'lIO/Iizat!1>I1Ii1 SIru<:t"'" nliI)' 1<>OI;·diITCMll in d'tT.""" OS . but 011 !lOSs han,. 

fuMlion t1t~1 in''''''·'' 1<11 .... '· ofe_-s f(Jr OCC\lrocy . nd p<)ij,)' compli3Me al "orio\,,' d«i" QI' "","IS during 

lho Ijlb orlhe ca:/!:. 

Anot/Ie, ospc<' of 4ual'Iy "-"",urunec i< uaininJc\. ODS, P'I""dc: I/" .. i~ing fqr n", c."",i"'f$Md "'\gning 

memorin!> and updaledl",in''', lIS ncctletl. SSi\ Ilnw,<l<s <l" i"~ l"';ni'Il! ",anuok, h .. cdho"k<. ban'" "fellS< 

.">;ampl .... Hlld \llbot tn" .. .,;~I ....... h "' inle""'live ,'id<"<I IJ"in;"J:. h"tll Ii", an~ r« .-'nle,d'., o,t,hle un 

,k.,,,.nd, OOS ,,,,i •• , ..• 11<1 n'.n"~CI"CllI mo"ilOt <I".lil} f,,, ie,.. d:ct. r", \1·e",'" ."d req' ...... 1"''1'1'''' 

00""01(31;'0) wilh SSi\ .... policy que,uorn; i" lite im"""",, or ensuring <nrcsislene)' {If policy "PI'licalioo. 

DOS! gc",",,,,II} h .. 'e rig<>r,,,,,,iniemall"',(nnnllll<. "..,daM. which ,,,,,hide ""OUT""T'" wcll .. , ti",eli"",,". 

N~I dr.::cli •• nt>s ;>ccd rn:><t"'·livil) , 1' ..... ""1 "'t"lali",, ~ h.)ld l.Jl.JS~ to ~ hi!!l' ... ...,~,...t<") SI'\nJarJ. T ... n_ 

th< .<4.ntbrJ. <Ill: DOS$ must ('Ow'" lhal Ih~ir 1aITi~ produdn& "","IIrate. woJl.docUm<f1(N ""lerm'nati""., 

J. SI>("WI Su .. ,il)" u u "'l)" mtllldQlw I~ e "'. 0/ a .. ri«lron{"·/ui,,,,· ,,"IJ· .• i,·,!1OI CA T) fi" all DOS 

~.~"",, ~"'. Wo"ld J"''' pFlI>'idr ""'" d"alh-... ". bUK· .... Col T K.." .b "d ;", be"~fil~1 

T"" oI,i,,,, o""lys; • • 001 (e-Ci\ n le.d. me .~al"'".'" l~roLItclt 1M " '11" of SCl1u,,";al "\":IIU01;O/I of 

di""bility .... king lhe e.,,"n;ne, HI ,."we, I'" p.:ninc'" q'I<.'lioo. a( "ach ",cp, It ine"'T"'fll"" ""'''" N!.ic 

<1lSt. inr,,,,,,,,«OO fn>m Ill<: d.imanlR· ;"",Iio;l(;"". ,uch '" alltg;ll;O". .• !1~. w~e.li"". and allcg<<l """"I 

d:clC •. I( pro"ide'S lin" ~ In ""IiI\<." ""lie")" bul I'" DDS t>;PIllin<:nc m.,.1 deci"" Iu,,,' Illc p<Jli~ IIf'rli ... in Iho 

indi,·iJ UlOI ~...,. afll)l'l>rri1l1c!y "cii;h("~ .ll t"" ~ idenc/:. 1,-CA'r jlI\l,.;""S a ~njR>nn pia",· for ••• ",inors 

!l<td ItK-Jic,,1 c·iln,~It~" tu " ... ·orJ Iht r,,,di,,t'S. Ihdr ""al).i, of du: ""i<knc<: . .,,<1 Ih.i, d«,.i<ln. 111 ~""h 

,Ii.-p of ""quem,.1 <,'alll.tiO<1. When <'OO1plrto .• -CA'r ICIlCf3\,-S • do<~,"<nl Wr the tl .. uwl< <3Se folder 

<kt.m'1j! th< ""all !-is ""',.."" Ih .. ""-"' •• " thol other «rnlfl\I"""" " ,,'I ..... In& <he 0"'" c"" see 110 ... lhe [)[)S 

"lll"rivc-d ~I i ... <k1="n./lljOl1. 
123 

f 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.084

4. /I"", do 'h " .. ~IJI; s Mild ,,'''It1imo< lJjJ..:' nns. ubllll)" 10 Ihom Mgkl)" dl!l"l4,,1' ulld ,,'llIuuu dul"" 

nnlf d,,," um n',k"I.'''''' '~ 

OI)S orin;"", Of ,h. ~.cIlT ''' l~...: onl~~~ . 1\ m'lf""') ... f .... '<"$ h.'o imr,."",,,,;;-d" .1I<l1~ ,he II ..... " rort.. 

I\;l"< 10000d i, 10 II< u«ful in Ininin" 1\<."\\ "'"',a.lli...".. an.J "'rr>''''in~ ",m""'""<Y in II", IIocum<lUlll;on of 

cas< de..,.,;",... W. """e lM:.f<I Ih~1 ;ubscq"em ca", ".,""" ..... fond " hclplul. S.onc "I:ll<.~ h~,.. c,',"c"",,, 

~00t" ,I", <KIr. I,me ,I ma) """. h' o","pl ... lit< <k>cum<nLaI"", of Illc Cl.'" ..,01)'", in c-CI\·r. .nd II ... · dr.", "" ",om,""," produ<,j.II). T1o.", .r~ .I>",wme I ...... ' .. j(), Ihe ''OJ ~C:IITjnlCrlh<<s ""ll the diifmnl 

1)llS ""n".", ")._,orn;. Il>c H)'" i, ,,,ill in 'lie 1"""'<';'; "r funllo.T "".,.n,,,-,ncn, ", '1I<'C1 ,h. , ... -cill. of 

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f", di<abili')"aod eoo<:""""II.""" ~I"'I..g.k "irinJl<1~ ng. ,he f"'u..,.~fthedi,q,bHi') ~,,, I'" r'WI 

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~lIed SIoI ... a" .... m m. n' Acc" unloJ,bUlty O"ic. Wu hinot<>n, DC 20648 

May 17, 2012 

The Hooorable Sam JOI1nson 

Chairman 

Subcomminee 00 Social Secu~lt 

ComminlN' on Ways a n(1 Means 

Hoose 01 Repres ..... tawes 

Thank you lor the opportunity 10 tes~fy before Ihe CommiUee on Ways ~nd Means. 

Subcommittee "n Soc;ial Security On rdl 20, 2012 during the hearing on Securing trte 

Future of1he Social Security Di5ablllty InSUfance Program, The a"ached e nclosure Is 

GAO·s,rf!spon .... to th ~ Subcommittee's quesl/on5 for the ~lXI rd If you h8.e any Ques~Qn 5. 

otease CO!1tact Oan1e1 Bertoni at (202.) 512·7215, 

Sll>e;<lrety YQlInI. 

Canlel Be<tonl, Cirector 

Ea" cafKln, WOO/orce, 

and Income Security Issues 

EnclOsure 
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wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.086

Enclosure 

1. In Mr. Bertoni's testimony , he said that Social SecLlrlty's disability program has 

mmalned o n the Government ACCOLintability Offic e's high-risk list uln part, becaLise 

their programs emphas;'ts medical co nditions In assessiflfj wo rk capac ity withoLit 

adequate consideration 01 work oppo rtLln!tles affo rded by advances In medicine, 

technology, and job demands." 

WOLild YOLi explain what thl, means? 

Modern COflcepts of disability focLis on an ifldividLlal's functional abilities in the wo~place 

environment, Induding consideration 01 the presence or lack 01 assistance. In oor 2011 high 

rfsk update . we noted !/"lat efforts to update and revise eligibility eriter1a ard not incorporate e 

modem understanding of how lechnology and labor marllet changes could affeet eligibility 

for disability benefits. I These modem views are refiected in the IntemallOnal ClassIfication 

of Functioning, Disability, and Health (len, which is t~ World Health Organization's 

framewo~ for assessing heal1h and disabil~y . This framewOO<. lakes into account the 

Interaclion 01 heal!/"l conditions and contextual faclors , such as products, technology, 

a!lliudes, and services, on an individual's fUnctioning, ralher than viewing disability solely as 

a medical or bioK>gicallssue. In other words, under this concept, two people willl the same 

impeinnent might have different degrees of wOlk disability for a variety of reasons. 

SSA's disability programs have fallen short of modern concepts, in part, by relying primarily 

on medical cond~ions 10 detelmine disability. At slep 3 01 SSA's disability determination 

plocess, SSA e~amlnel'$ assess the applicanfs medical impairment(s) against the l/sllf1gs 

ol lmpairmenls, also known as the medical listings. If \he individual'slrnpairment meels or is 

equal In severity 10 one or more 0/ those In the IiSlings, the II'IdMdual is determined to ha~e 

a disability al siep 3. At this step, SSA geflerally relies on Informallon on Ihe appllcafll's 

dlagnoS8s, lflCIuding laboratory findings, diagnostic tesls, and symptoms, as well as some 

IImiled consideration 0/ Ihe applicant's functionallimltatloflS 10 delermine Ihe severity 01 an 

impainnefl i. SSA created the listings to have a clear set of medical condil lons that, if 

presenl, preclLlde the indivfdual from working, and to limit the number of cases requiring a 

more n~ol ed and individuatired assessment of indi~idual function and capacity for wOlk. At 

the same time. thIs step 3 approach tends to equate medical severity of a medical condition 

WIth an inability 10 won.;, which IS not consistent With modem conc:epls, Rather than 

etimlflate this expedient step, experts have re<:ommended that SSA incorporate more 

consideration of Individual functioning in its medical listings where appropriate, 

SSA's disability pl"ograms also fall short of modem concepts al other sleps of its disability 

determination process, by relying on ouldated occupational informaUon to determine 

capacity to perform pasl relevant wmk (slep 4 ) or any wOO<. that Is performed in the national 

economy (step 5). To inform determinations al sleps " and 5, SSA uses a Department 01 

labor database-known as the Dictionary of OccupaliQf1al Titles {DOH-Which is an 

inventory of OGcupaliDns performed in!l1e national economy. GAO and otheN! have 

reported thaI the DOT-which has not been updated since 199\-15 outdated. In our 

testimony. we reporied on SSA's progress In creating a new occupational ,nformatlon 

system (OIS) to replace the outdated DOT. 

Ploe 2 
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wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.087

Finally, researchers and disability eKperts have commented on the limitations of SSA's 

current disability program eligibility criteria to fully consider whether an individual can 

fUnction in the workplace due to limited consideration of asslstive de'lices. inclUding those in 

the workplace--limllations that GAO has aoo noted? Several groups. such as the Social 

Securily Advisory Board and the Urboln Instilute-f1ave reported that SSA's disability 

programs shoUld focus more on whether an Individual can work gfven appropriate 

environmental or other supports, alld that SSA-through its demonstration authority or other 

means--has played or could playa role in lesting options. 

O"r forthcoming repo(l will describe how well SSA is managing the development of its 015 

against best practices and wHildentily mitigation strategies to address project risks. Our 

report w~1 also describe SSA's progress and challenges relaled to incorporating modern 

concepts into its disability criteria, s"ch as additional consideration of ,ndivid"al function, 

assislive devices, andlor workplace accommodations in SSA's disability determinatioo 

process 

2. What sho"ld Social Sec"rity be doing differently 10 get off the high·risk list? 

GAO removes a high-risk designation when leglslal~e , admlnlS1lation. and agency 

aCllons--rncludiflQ IljOsa In response 10 00' recommendatior>s-<eSlJllin signif~r>t progress 

toward resolving a high·risk problem. Specifically, ttle five criteria for determining lIttle high· 

risk desigr>aUon can be removed are (1) a demonstrated strong commitment 10, and lOp 

leadership support 101, addressing problems; (2) Ihe capacity 10 address problems; (,3) a 

corrective action plan; (4) a program to monitor cOIle<:tive meas"res; and (5) demonstraled 

progress ifl implementiflg corrective measures. 

SSA's nigh,nsk deslgnatiOll is !lased, In part. on not fully Incorporatong a modem 

understanding of how technology and labor mar10cet changes could alle<:I eligibility for 

disability benefits, but atso lor con!inulng struggles wittl growing workloadS and long walls 

for decisions. In our lasl high risk update, we found that SSA has taken steps in both areas, 

b", further action Is needed. With respect 10 incorporating a modem understanding of 

disability, our forthcoming report will detail progress SSA ha5 made and lecommend aleas 

for further action. In tum, GAO will assess SSA's lesponSB 10 thase recommendatiDfis 

against our Cliteria 10f remOVing SSA's hIgh risk designation. 

3, The Dictionary of Occupational Titles, w hich WIS the 90-10 resOurce lor jobs In the 

national economy, Is no longer being kept up 10 date by Ihe Departmenl 01 Labor. As 

a rn ull, Social Security hn decided to develop its own resource, called the 

Occup.ll!lonallnlormatlon System (OIS), Is this decision In the bast lnteresl of 

t81payers? How much is Ihe stal"lory definition of disability driwlng such a costly 

and time-consumlnig effort? 

While GAO and olhers have reported thaI SSA needs to boise its disability decisions 011 

more "pdated OCCIJpatlonallnforma~on , whether SSA's deCision to develop II new 

occupational information system (01S) Is on the best interest of taxpayers will depend on the 

ro"al shape, scope and cost, which have not yet been determined. In our testimony. we 

1 GAO, ss,.\ o-, ~ f"" VQcIoiror(j ,,-,C{H"" /M~"" ~"'~ QAO.Ol·1I1VT 

I ....... ~OC Jofj' ''. 1002) 

Page 3 
127 

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wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.088

reported that SSA has already determined that the Department 01 Labor's own replacement 

lor the ~OT he Occupatlonallnformatloo Networl<. (O·NET)-i s not sufficiently detailed for 

evatuating disability oaims, so the agel'lcy began developlllg its OWn occupational 

Information syslem to bener reflect the physical and mental demands 01 work in Ihe nal'onal 

economy. We also lepofled that SSA has made' progress on baseline activities and 

experienced delays in completing others_ Our lorthcomlng report wi ll assess SSA's 

management 01 tile OIS project against sound practices for estimating costs, scheduling, 

and assessing risk In particular, Olll report wi ll discuss challenges associated with 

deveklping iI new OIS, Including the cosl 01 maintaining a new OIS, that cook! aflect 1M 

overall suC(;ess ollhe project, 

Secausa SSA has nol yet determined lhe scope olille OIS, it i5 Slill undear the extenl to 

which the statua\ory delil1ilion of disability is dming Of witl drive the cost of Ihe 015. SSA 

has delermlned lt1al the new 015 musl enable the agern:y 10 adjudicate oaims based on the 

requirements of the Soc'al Security Act. m~uding the statuloty deflnitiOIl for dlsabihtynotably, thai the severity of the impairmellt prevents the individual from doing not Oilly his Of 

her prior wOrk. bul any work which ex.sts in Ihe national ecollomy. This in turn means Ihat 

the 015 must reflect lt1e natiollal existence alld jllcidellce 01 work, must reflect work 

requirements, and must be legally delellsib!e_ Our lorthcomlng report wi ll lake Ilole of 

SSA's progress jll determillillg the numbe! of OCClJpalions afld other types of loformaUOfl 

needed to meet these requiremenlS, It will also nOle SSA e/forts to determine the number 

and type otjobs that ale applicable to SSA ctalms. 

4, In Mr. Bertoni's testimony, he noted thai Soclat Security has.developed cosl 

estimates for the research and developmenl of OIS but not lor the Implemell18tlon or 

maintenance of the new system, Why Is It important for Social Security to have life 

cycle costs for Ihe entire 015 project althls poinlln lime, considering they are stUl in 

Ihe resean;h and design phase? Is this feasible at this juncture? 

According to illdustty lIest practices, COSt estimales should be comprehensive alld Illctude 

all costs necessary to achieve agency objectives and tllese costs sholiid be updated as the 

agency proceeds with the project and gains more information. In our testimony, we noted 

that the cost of sustaining an 015 could be sigllificani. based 011 other agencies' 

experiences mainlaining their systems 10f collecting national occupational Informatlon_ Our 

forthcoming report will d.scuss the importance of estimating PlodUctlon and maintenance 

costs 10 ensure the system being designed is viable alld atrofda~e to both produce alld 

milinlilin. It will also discuss how otl1er lederal lnlormatioll system5--such as O·NET--can 

provide some basis for eSllmating the cost of producing or maintaining an 015. 

5, Is the cost and structure oflhe current disability process suSUlinable? 

We have not conducted tile work necessary to answer this quesUon. The 5uslalnabitily 01 

me current disabmty process both in relatlonship 10 oo5t5 and structure is dependent on 

many variables and would require complex analysis 01 alternatives. 

Paye " 
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Questions for the Retard for Or. leighton Chan 

March 20" HearlnB on Disability Determinations 

Social Security Subcommittee oflhe House Ways and Means Committee 

I. In your wolimony. he sInled <'Ihe way in "hich di$;lbilily is conceptual ized and mcasur~'lI 

h3s changed dmmalica!ly in Ihe paSI SO years.'" ('icase upl~in "ilIII this menns and ho" 

il impacts II he should and should"'1 rew;,'c ix:l1c fi ts. 

As I mc!\Iioned io my teslimony. the " 'ay in "hich di!<lbilily is c,)tlCeplualilcd and mcosurcd Ims 

dlllngcd dmmalically in the pltSt 50 years. stnning "ith the wor\: ,)fn distinguisMd medical 

,;ociologist. S:md Nogi in 1%5. Owr time. mnny others have buill on Nagi's originnl fmmeln,01i; 

including Verbrugge and Jettc (1994). Ihc InstilUtc nf Medicine (Anmdt Jr. Rf\l.t P ... pe 1997; Pope 

and Tarl ... v 1991; I'ope 19921.Abb.-rlcy (1987). Oli"cr (19%. 1990. 1993)and lh~ World (I ealth 

Organization (Wi lD) (1980, 1001). Altlmugh ru;peCtS of these mod~ls dill"r. dwy all ngrec lhul 

di»bilily cannot I:oc view~ as an irnlil"idunl3tlributc. lmitc~d. disability should ~ thought of as 

the difference bet\\~cn lndl\"idu~1 Cilflllbilitics and tMir ellvironmcntal demnnd~. rhe InstitulC or 

Medidn.c (10M) has- nDteU thn! disability is rm! a ~tabk attribute a,ro~~ situ~ tion :'i . ~in~ physieal 

;lIld m~m~1 rWk:tioning i, innu.:IINd by ~nvifQnm~nLs. Di"bilitj is u co",ple~ proces~. v.hkh is 

Illuitidilllensiollal, dynamic. nnd imeraCliw in nMUIT. 

The question Ilr"hQ should and sh(}tJld nm =eil'e di:<ahility benefits fall~ outsid~ of my ar~~ of 

c~pet1ise. The N"Ulional In ~tilUtcs nr Ill.";Ilth (Nil I) ,,"as u,ked tn wnrk nn this project. in pan. 

because ofollr e:><penise in meaSllrinl!fimctio". The SoI:ial Securily Administration (SSA) is 

charg~d with <kt~nn;ninll. h",v Ihose functional as"""\01Clll~ .... ,at~ to the d~finiLiou of di:lability 

in the Social S~eurity Aet and Ihe paymen! ofbenefolS. Thus. Ibe SSA wou"l be in tilt beSt 

po!ii'ion 10 pro~ide a ~~P >11se to Ihis question. 

2. Bused on y(mresperienN. how would you defi~ di:labilily loday'! 

We have chosen 10 use Ih~ WI IO's taxonomy C"Jlled the Inlern~!ioL1'lI Classification Ilf 

Functioning. Oi>llbilily "ud ll e~lLh lief) 3$ I/)" conceptual fr:lmework for nUl coi!3bol"Jtion with 

the SSA. The ICF is OJle oftllc must ",idely u~ modc1s of disability. II has been endnr,;ctl by 

311 191 WIIO Mcmb..-r State'S and is th..' inlenl3tion31 standard used tQ dI.-,;cribe and nlea~ure 

health and diS<lbililY. In the United Stale'S. li'l~ lCF ~ being intcgruted into impOnmll institutional 

frameworks. In 2007. tilt Inslitute IlfMe-ditine recommended that gllwnlment ag<:l1cil'S noopl 

ICF a~ a con~e'plu31 fr:lm~w!lfk and I~nguag~. 

ICF Us.-s a bin·psychosocial modc1 ofdi$;lbility. in whi~h disabilitY ;5 3 mulLi-dimcnJional 

phcnumcn~ e)(peril'nc~d at tlw le"el of tlte body. the person. and socil'ty. The le F describes 

djsabilit~ using i,np.,innem infoml3tion to captll~ changes in an indil'idual's body Strllctll .... and 

body function "h ll' a~kl1o,,"lcdgjnl! thc innucnce uf ~nvironml'ntalthctors. ~och a~ " 'Ilrkplacc 

dCILlHmis atl<! 'lCcolllllluda(iu"l!. 
129 

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wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.090

Question5 for the Record for Dr, Leighton Chan 

March 20'" Hearing on Di5abllity Determinations 

SodalSecurltv Subcommittee of the House Way5 and Means Committee 

3, If. claimanl'S conditi"" does riot med or ~""Illk listing$, lh~ "eXI Sl~p is 3n 

a.~:;essm~nl ofLheciaimanl's remaining ability h) r"netilln, HOI" does an ~x,lmincr or 

mcdiCllI co",;"llanl assess so,"eone'~ r""clion? How subjccliw is l/mt llSS<.'Ssmcnt? 

Our undel'Slanding is thallhc .... sidual fUr>Clional capacil) (RFC) fonns are ill ,~1 oul by 

~djlld ical ol'5 in 111<" l)is.~biliIY Del~nninalion Servi~ (DDS) oflicC'S. Ilnwncr. in our current 

.... search, W~ hal'c nOl ~Mmin,'d SSA '5 O~ml;OnS relmcd to Iht rtsidual fUnClionAl car-'lCily 

~s.<.Cssnlelll . The SSA may be in n bl:ner po;;ilil)n to =fxmd 10 Ihis queslion, 

4. Should Ih~ d,'<:lronic claims annl)'sis 1001 ultimatel), be implcmcnl~'lI by the Soc ial 

Securily Adminimalion'! Will these tools alvnc bi.' suflicicnllo ,i.!lcmlin\' the abilU) III 

"'nrk? W!II m<'dicalliSlings 51ill be n~cd to dClcnninc eligibilllY? 

lbc Eleclronic Claims Annlysis Tool (eeAT) is G "tt>-h.1.~cd appliCUlin" dc-s;glwd 10 Rssisllhc 

adjudicalor Ihrougholll h~ cq!ICmlal evaluQtion process, cCATGidS in lIocumcmins. annlylinl!,. 

and RIIjudicatinJ;: lhe disabilily claim in accord.~ILCe wllh SSA .... gulUliQlI$, This S) ~lem i~ nOI p!lr1 

of our work "ilh SSA, pnd ~ a", nm in n po!<ilion 10 judge "'helher il should bo: impicmenlCd. 

Ni l ['s collabol':uion "';'h 'h~ SSA is ba5cd on ilem re5pon~ 111<.'(11)' snd cO"'l'ul~r IISsiSIed 

1~'Chnolog,v (IRT -CA'r). UnfortUMldy, lho> nnmc~ ar<' similar bUllhe ,ySlclIlS are disliru:1. llLe 

!,loal "flhe Nl il pro~,;~ 10 C!"<'aI~ a I"al I;lIIe fUllclional as>e"nll,m prQCt's.' lhal ~ rIIpid, 

rdiable.. obj'-.;Iil'e und c<)uld be CQnsidcl'w for inlcSI"Jlion inlO lhe gSA '. disability cvaluUI;Qn 

pro<:esses. We ure~-oupling ('Qmputel' Ad:lpti\ .... Tesl;ns «('ATl melbodolo(ry wilh Item Rl'SJlOmie 

Tb~ (IRT) 10 measure QIIlCOml"l p,..,cisdy :!Cross rhe full continuum Qfbuman funclil'lliug, 

IRT -CA T n:pres.;:nls a simple form ufar1ilici31 ;nlclli!;cncc soft,,:!re I"t'quiring a computer (or 

adminislr:lli<'t1, 

Whil ... lie are Vtry happy willi Ihe progress Wt an: making 10 creal(' new lRT·C,\ T lools. lhi! 

ultimale decisioll <.111 how Ihey mighl be impiclllCl\tcd or whelher Ihcse 101,lls c<)uld \lC used 

instead ofthc /l lcdieal l, isting pr{lC~'$S will Ix up 10 thc SSA. 

, 
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LABOR ANO POPULATION 

~Iay n.2011 

lX.,.r Chairman J"h1!wn, 

,mI ...... s_ PO 8o.2'3.! 

Tl.'c3.0

li(i0i07·2':18 --~ 3030411 

fA)!, J'O m'!I! 

AL1a~h~d pl~,,~ lind my wrin.n I"SpUnliCS to In." quesli"n~ posed I!y Committ"" 

Mcm~r.; for the nx:ord, I'I .... .I.;C 10.'1 m,' kno" ifyoll have fun her 4uesli(}n~. 

Sint~rd)'. 

Nicole MtlC'SIas 

Senior Ecunomisl 

Di .... ..:hX. RAND C.nl~'f irn-Uisabilil)' l(~sc~rCh 
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LABOR liND POf'ULATlO"l 

United Sta tes lI onse of Reflre~e ntati, es Committee un Ways and !\leans 

Snbconlluittl.'e on Sodal Scl.'lIrity 

lI ellring on Securing the future of the ssm Progru m 

March 10,1012 

Questions Submitted for the Rl.'cord 

Qu,sliu"s fru"' nl rm~n .tuhus!!" Full ll..-~ d b)' l'j;jMlns~ rrom 

[J •• Niro ~ Mu"sla~, Srnlu. F. ~'JO"mjst. KA,'\ij) Co'r •• muiOh 

If In ~m~n s le.1im"n),. sh~ p'Il,'ide-s ~ crili41>C of your rno:'Jrch_ Would y<>u 

lik~ \() ,c ~pI",d'! II ~w c,'" S,,'islical rc.cAreh be u;;.:d 10 iofunn diSOlbilily [IOli"),? 

Sialislieal ",,","reh i. {me of our mo>! I"IWI!I'I"IIOOlo r.". inlomlinll disRbilily pulie} . 

Slali~li ... 1 ~<'IIre h ha. Ihe l'I"31 ad\'imag~ ofen"bling u. 10 dr3w1lbjecliv~. ~vid~n""

b3>cd condu.iu". aboul [IOlie)' malic .... Peri,aps mo..., ill1l""1." ul), •• "Ili.,ieal research 

cmOOdie> rilli)(()l)~ proH"'uls for delormTnTng whClher a IX1l1icular conc lU:<llln ,"'" be 

l!""e'l'3li(c..J 10 Ihe larger N Pulaliun. Slali"ical "'';0.'=11 hdp;: awid 1m' rilf:'l~ o(llI~ 

anCl."\!U1lII apprua,:h. whtre tile eSll"riellce Ma ,i""le ca>c (lr S"laIiIl"'UP I'lf ~~ ,;c~ is IISC"\! 

10 dt:1w (onen iocom.oc\) inference'/; aboul~" enli ", Prolll1l111 t>r roru1at;on. au, appro;'fh 

i. mole..! in U,e long·establishcd !~ isl",~1 principlcofrdndom assignJll<!nl. .. hi eh 

provide~ I ~imple mclh!>d fordnl"inllSOUnd infcn:nccs aboollhe pro~m. ",ilhuul \~ 

need to ,e\ iow individual di""bilil)' oases. Thi. Samc .latistieal principle underlic.,; 

rnndo",i~ed cl>n roll.~d IriDls, "hieh JOrm Ih.· gold Siandani for !iCienti i~ inferenc .. in 

m.,.j ~al !iCio:11Cc. Ms. Edman (~P""''''''< "net.'fI3'nty . ,,"ullk pro""r imerprelmion ,,(our 

lindlnlli', M), w,illen ICSlII1)()11), provides 1hl"_PIllP<Cr IlIlerp ..... 1JliOllln ca",r,,1 dct~lJ. 

~) In his testimony. Dr. ehall spoI;e nhOullhe shlninll parad,gn15 nfdisullllit)', 

sayinll"\lIe way di$llbiljl)' i~ cO'ICep1uali~cd ~lId mcas~d has cb~nlled 

dr3",a!ic311)' in Ihe p.,t 50 )cars." Do )'011 ha,,,, an}lhing 10 add 10 Dr. Cban', 

assessment? Whal ideas do )'00 !tD"C for 11m, to improw h~ prog.nI ~ 

I WQuid onl)' highlighl)r. Chan 's cilalion oflhe 10M Sla ~l lIcm thai "tIi".bilily is nOI ~ 

"ablc 'lIr'bule aems~ Sililllliuns. sillcc physic.1 and mc",.1 rlinClioni'lg is ;nnue'ICed b)' 

en' irnnmenrs:' En\ ironlllOl1tnl f"c lol'S 'n"11Ide l\IJvancc> in medical ~nd >lIrgk~1 

lrealmcnlS I~~' inc",asc the likdillO<ld OfSl,,,,,,dL'g,",, u(recuvery. Ourcurrc~'1 di$l1l>ilil)' 

e\ ~lu~tion sy~!cm. h,)w .. '~r. is based Plllhc m,li<111 nfQ diS'lbllity bei,,!\ "pcnnuMnl" ifit 

is expecled to lasl longer tlla" 12 months. ~;s i~ ~T> an.'lI wh<:rc milch more rese~rcll is 

Jl<.ot:ded 10 ,md' .... !and Ihe d)'namics or and illtCrao..1ioo bc1"cen plJrticulm health 

impainncm. and diffe""lll work en~iromncn~. 
132 

f 

[Submissions for the Record follows:] 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.093
133 

AFGE, Statement 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.094

STATEMENT BY 

Wllold Skwierct:ynski 

Presidenl 

Americall Federation orGoverlllllenl Employees 

Nalional Coundl ofSSA Field Oper"Uons Locals, AFL-CIO 

BEFORE TilE 

nousli WAYS AND MEANS 

SUBCOMM ITIEE ON SOCIAL SECURITY 

ON 

SECURING THE fUTURE Of 

T HE SOCIAL SECURITY DISABILITY INSURANCE PROGRAM 

Hearing 011 March 20, 20 12 

TESTIMONY 
134 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.095

Stateme nt 01 Wltold Skwie n::zyns kl, P,eaident 

AfGE N~lIonal CouncU 0 1 SSA field Qpe'~tlon o<: ~I ., AFl..cIQ 

Baltimore, MO 

C~airma" Jo/ultorl, R8"~Ifl9 Membe, 8e<:efl1o, aoG ~ of the Social S«Wliy S~e, I 

,.,..pectfully aU ....... m;. Slaleln8n! Oil 5""''''>9 'he Fur"", 01 me Soc<sl S«urrty DIsIl/rility In~ Pwgr_, 

As Pl"...tdent of 11>11 N"''''''RI Coord of SSl\ F",kI Ope<~IIOOS Localo, !slInk <In beha~of Dpp!"O ...... lely 

31,000 Social Secooiy AtI"""",1/lIIIOrl (S5I\) l!IT>P1Oyees ., 1M!< t300 la<:llj(jo.s_ 1"_ e> ploy<!M WO/~ In field 

0!I\l:eA, Te_tV"'" Ce n!l!1S, a"" Soclal 5eQJ,iIy Ca,a Cen!",. W~lIOOt 1M ooonll)<_ mil_MI, 

SUNIVOt JrI(t oiulli1ily be~ 3J)pOca!lO!1$, S"P¢e'rTIe<It.>1 SeaMPIy Ino:ome (551) Itflplcation' a oO ~al 

~"""~, a!ld Social S8eu<tty coord applb1iorls.", ,eceived, p,-oceo.aed . ...,a rmewed 

Ss,o, employees .'" oedicateo:l to PfQ'Mr"li Itle h'llheSl ,,""lily 01 ser';"", to Ille public: In a compawonate 

ma""'" I\FGE "'P"' .. nla- emplo)'ees who are DtJJT>miIted Ie KMng _ities In the face 01 a oignifieanl 

Klema"" 01_ and .... uffico!n! foe4d staff 10 process such WOJI<, 

The primary message AFOE ",~nIs 10 ~ to you today ir; t~ at..mt.out sullicienl futldng to cany out SoCIal 

Se<:ur"Pty fM'Qg' , ba<><Io9' wdI 9'<>W, public ~ will detenorllie and rrismanag_1 0/ 1M prQg,arn, will 

/nevllllbly oce\Ir. a:l tralor' kloIt lor W8yS to SIIi"ly Co"!l(_lonal aJJ<l1l\lfl1ic . 

I~ Ii\O' FY13 budgel.ll'Ie Com<o<UIO<ler empha.W~ 1M ,~<;Ot.W-cesmfll "" ha$ sllilted to ..... ""a'~ 

fM'cceu, ""'ich Ile belie,,,,, wdt (eOIl<."e IlIe be~. ~nd pr~ I""" lOO- It>tr t>tr_i01v c;o!IH. __ • 

" you lOok dole,' you ~ "" tn.ot reduc60ns .. proc:es!ing lomo 'pr """rings <ll!cioion ... at tt, ..... pense 

'" t!le nlial daims aM ,_abOi1 fM''''''''''S, '''''''lIing .. an """"a ... ~ IIIe 'M!ul llrne to pJt>Ce5S 

<lis3nllGy claim< from 1M fnt applicatioll .o 1M ~n3' """"ng __ Cm,MI/y. I>Mrtllgs I!ad<lojjs 

,:otUin"" III !Jl'OI" and """'" eKee<l 620.000 • .mitll DI ..... ~ ..... "'I"Y _lOads. sucll as .. doa' d!!<3b!1oIy ""'1m •. rewn~ermJom; nd CDRs,._ 1 ""Ilion ao_ 

In \!Ie Budget Cotltrol A;:.I 0120", COf1!1'_ n!allo'oSiIe<t bud~f!'1ary tMn<Ja18ll lor 5SA ,eg'fIlo"oQ'" 

InIegnly "",""loads {I.e SUpplemem.1 Sewrify Income (SSt) ,ede1erminstio<1. and Cotl,inuing OiHbllity 

Re~ (COR~). 1ioWevef. an .... :I< .... attenlion and onte""~I"," of !he Ieg"""lion, tt was detennl>ed 

SSA wlR not (eceHe adc!ilion.al ' unding tD ad<Imss theu workloads. but is ~klo"ed 10 ~ lhe amount 

$IIeClfoe<llor . """ tear pertorming Ihese ""'''''loaclS. This will "''''~ on gr~1 allMlion g.ven to SSI 

R_termlnal"",. a'l<l CROS. bY, al tile ~ 01 aft a! ...... ""IJ"!oatls 01 tlw 5ocoMJ Security 

Adm.,islJJllion Th'" v.OIl be _ manlll!in!I ~mm ,. kif a01111!enc)' "",",oistrator' 

At """'" "",rot In ........ Congr ..... k>Iil i", _1 wit~ r"llarus 10 the "'roding oI lhot Social Securil)' PfOIIr""", The 

SOCIal SotC .. ,PIy I\ct of 1935 aotnorize<l. lor eOoCll '" lis pmg"'ITIIt. '" .urn 5III!ioteMt to c;otry 00. tile PIl'PII""S 0/ tit .. 

1iUe ' Tn .. Ia,'!I""9" in5ut'B<I thllltroere would ~,,)'5 "" ",lfldenl "''''''''51 to ope'''''' tIttt Soco3I Secunty programs 

8nd mala' rnone)'5 ..... n' to acrm.,is\er ' l'Ie program. WOUld be from , .... Social Sow'oIy Trust FUnd. ~r, 

ow.- 'hflyuro. II>e fun<:I;"g to ""mi<tister Soeist S8cufPty'. prog,ams became 11"11110<1 in tile aPPfoprialion prooesoo 

and fon::ed SDc:ia1 Securoly 10 compete w<tIt II\e ..... ny importat1l and valu.ble progr;oms under the ~nation 

SUborlmminee of Labof, HHS. Ed •• e,,,,,," and ,ooIated Agencle&-. 

, _ 5o<wH, _" .. ro.., .... ~Ilonof lI,,,,,,,,,.,Ot -">I"'" """""" •• ~ rf«>' "" Zf)U, , ... 10 II·X«<'''' 

"~M'''''ru. 

- , 
135 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.096

SSA liJefl ~"'ed """'* ~maO(lS baSe<! on toe 8glllg of 1M ""0"0;10<011 and I!le ~ 01 the ,ecenlon. 

T"" ""'"1I.P!l1K:ants k>H !heir Ide HVIr1!J5, ttle<, hul!n ;"tiu,allOl!. their """"'~. alld ... .." I!le~ lam',es and IIIetr 

I ...... , ""Me U>ey ...,.~ ,....'" lor II finol adminlr.mrl"" ""asion. 0isabIec1 ind'vlduals who $>lid lor dlsabihl» inSl<rl""'" 

P/ot"<:hon th100ghout IIII!ir """rICin; !rYes _rve mucn ben ... """""" lnan U>ey a,e now '1!ClI!Mrlg. Too k>ss of 

more "'." 1000 ,UII r."., Eq ...... a .... t (nE) po!IHIOIIS '" fV 11 ~ FV \2, "n<! ItIr!II~ 'e. ' ~I SIlqll6lt>1l"'" '" FV13, 

~ pt;Ice many faml/iK ill g,e"lell~3r<IY 

55A. mU51 be allltlOri!e<l eroougn "'tiding 10 "","e d~~lity <II!CiIIlMs in & timel't m3n .... , en<! !<l """1 <>ut otl>er 

crlll:aI_S ... FGE SIIOTlgIy Ufge$ lI\e Le_I"II~1p 01 1M 5ubc<>mmi\teoi! to .Wo.:IlJO!ll"Ie ~ry 

1eg51a1'" lO~H c/ eongreu. lO_rale SSI\'s LAE Dudgel aUlh<>!ily " am I"" Section :102(a) and (b) 

aIIocallolls for d,..,,-etioMry spenrklg . ... M .. m.",ta"'"'g necessary Congrenicnal ""eBig~t The!l/l8 01 the 

SSA's LAE Is dfMln by I!Ie .-.umbef '" dminlstraWe lunaioM 11 COIId'-"'l' 10 ... /Wr benef""""""" and 

applicanlS Cong ~' 'ho .... d ~ SS,,', ~'eliv6 lul"lClions fram Ille disctelionary Il<>dgel. ~ 

""1>I>OIl8 ott .... impOOaol and .ilsi P'DQ"'''''. 

Disability 

AFGE Continues 10 SU pportlh. Fede,alizallon of Ihe Disability Oelarmlnlltlon Sel\licu (ODS). 

DDSo! are (n e_ of 1M 50 StaleS ~. !he o;.trict of Coiumb", and Puerto Rico. 

SSA ,eiIN>J.--tne DOS lor 100 pe,cenl '" ._ble I"nd~u""",, 10 appr""M fIln<!Ong auU>oril'ltlMo. In 

FY 2012, SSA wI~ 'P!lnd aboul 52.216 blIllon 10 IlI<1(j I!Ie Slate DOS "P'fI"'liom · 51 49,417 potr 005 e<nJ>IoYee . 

AI>oul1.,800 DOS 'e e'I>«Ir>d!O P'~S 3.1 miilioo c",,~"'ty rnedir:al decisions nalioowlde . 

However . ., 2011 . a m8jOfrty 01 SlateS ",SI~uled rutlr:nIQI>s f<lr Sl3le emtlI<>)'eEs due !O SIa,," bWgel <I&Ik:.IS. 

an~ 01 the State lurlol.<g~s O!lcluded DOS .Iall. l\<lcI~ion.lJy , some Sillies ~a"" kmI>Ismentr>d ~ '" 

turing practcn""""'" may also a~1!Cl t~ . alSllbolity cliwno proaI ..... ng in ~ OOSs . ... FGE: svongly b8_~ 

1""1 IIII!5e to.otlougl>s a,e a ,;gn ollhe "'Iu,e of tile 0"""'" bl/urOllled I_·slate Oyol"'" 10 PI_ • quaM)' 

d,sability de",,'" ~,,,,,..a 

The SOCJal Seo..l1ty Act afld f-.al '''9u~'"",~ gMl SSA limite<! """trot ()\Ief I"" SIIIIr! DOSs, allnoo..og~ U .. 

AQ9ney Mly fur.dt. them. IiOWo/Jvet, '_'at laW .IIOW$ o,e Soc<ol Se<:o..o1ty Allmir"l'stt.lJOrI IO fe<lerali><! OOS 

emplOyees il a ,late ' sub$l8nlial/y I,.,,· !O t!W up to lIS re-sponoibililies 10 PfOC8$' clanl$ 

For mo'e 1"-"" 10 yeaf1;. AFGE "" """~mJl!d to raise r:oncem. Mooul t!leinconSililaney'" mMlc.at_1OIlS 

by II>e SllIle 00Sa-. ar>d ~as also ca lled for ttoe fe<lenltlarion 01 ttoe .ystem. SSA's approach to d~1rty lalio to 

addres.s IIIe probleml and inadequaciaa of !he Siale Dis3bi11ty Determinll"'" Servlceo- (DOS). /\FGE: Ilrongly 

believes lI1at if problems with inc:cnslstent rIecisIons al the in~"1 ctaims 1e",,1 are ~ed. appeals wiR 

d"""in~, Disability Claimanl'l ~ cooslslo!'" initial clio;'" ,nd to:eoo$lcle<.bOo1 ~. and PIOy"""n" .. 

soon as ~Ie" Ifle """'" PI"""". 

Unfortu .... l.ty. ~ chancn IPI a r:leKnanIIO be tpprOft<l at the inilialle .... h."" • 10110 00 -..\Ih ....., .. e ttoey t;ye 

an<! !heir lrlc:ctroe, faille' II1II" the nalUf. '" !heir dosab.ioty . Thar. inIlere nt in ItIr!I syslem. Each ..tale "". 

djff~fIl <>"iIeril lor hn>g Disabi' ty En ........ l"II. Eacto staU! pmYides them wiIn di/f",enl I>"Y and l>en!!f~ 

paclcages_ Somr! ~fe unionozeG. Wllole <>!/Ie'" a ... unorganlzer:l Each ~Ia! . 1"0_' aill""fIll/ll"'ing 10 Il>!!o 

emp4l)yeM E"'ployM _'1M 13te1 ""'Y mamatlcally ,,,'''' stale 10 slate In ellK!. It>eI .. at • .'>0 dlll .. ,eni dl$,)~"ij[y P«'!l13rr1$ _ I'*e shOul<t t;oe one 

For ~""mple. Stlrl .. ~ Oi>e'31J011'$ fe<:otmlndle!rte tNol tr.ose who can obi",,,, me4w:.o l ~e_1 early an<! 

often haoe ~ better ctoallOl! o! belflll ~PI"oYed for benelill fllan thr;>Se who Moe ""1Ied ",com. or reso\IICU6 
136 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.097

.00 poor accen to 1fe~1mel1! Nsbo"WIdtI. UlO6I! Bpp/yI"II lor Social Se<:uroty dISBtjllty Nove a m...:h g, .... t,,' 

""ance of l>e"19 aPllfoved !han !/lose ,""C only aPP'll "" the SUppiI!mer>! Seculily Inc:t>me (SSI) !,,<>g ram !hat 

serves tII6 low ir\cor'rIe populatIOn 

Current "'ports ,ailed !hat 60 percent 0( S«:IaI Secu'ity d~bi'l\I clam. Ie, bene/ilo were beiog 8PIlftI'o'ed in 

!he Wa<;/longlOn DOSs. while )vst 32.8 perce<>! of!hoM.,mo fMed 10( benllf~' wen! belll9 approved in tile 

Tenness!!e DDS Ne-w fiamp""ire ""!,,ow, I~.....m 0r!ltiaI SSt only disabilr/y casl!1 - 51.7 pe,cent _ . 

,..,sl<lf!1'to ot M .... ,.""'" are 8P1lfO\11!<1 JU$I n .• perce'll ot 1/1" Ii"", by !he DDS [II IMif state. TM """"""er>! 

(&lci;tl ~/SSII c/a,m d~~ HIV p<oceu alsoo s.howa Ine plitable ... ""ble BIloW.""" rales depe'1d'O\I on 

t~ $late 0( .... iMnoe. Allowance 0'81es .,a low in eve<)' stat~ . In tM .tateo of V"""""t WaslunglM, and 

~om;"g , the a1low1once O'8tea __ 4t percent. Drtly 17 perC1><11 of thole f, "!1 CO<ICIJfT8fII dJSllbiily claim. 

we,.., appfOlllld in tII6 S!<Ile ot r e~ 1100 Nonh Camlin. r llMe 1. 1\0 e"""""," to .... ow that ,,,,,";dents ot 

.some stalfl$ are I\Oice as susce ptillte 10 b8COmirrg d.sat>led n resio::ents in ott>ef .tates ObIrtously. d;flfle J'l1 

slate initial daims 8PPf"111'ai mUll haw m.,..., 10 do wim lho! bifurcated ~)'Stem Ih ..... lhe he.ollh 0' residents 01 

!hew stale$. Claimant. lire enlitle<l lo COO$iltent decitOOOt reg3J<l1et$ of their $lale of retideIIoit 0( ~ 

they afO! filing for Soaal Security or SSI alsabrlrty ben"'~. in ou. federal """",ams 

DDS - State o;ubitity 

De"'tmtn.~on SeNtell AUow 'ilr Deny'ilr Allow 'ilr Allow 'ilr Deny % 
137 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.098

~ I If ~ i ~. '-

-

'-r- r-- :i-

.. : - :-

-= 

• • 

• 

• 

• 

~ ~ .. : :- -'.:" 

• ,; • 

.. Iii 

" ;i .. • . . 

•• 

~ . .. 

• '-

Accord~ 10 the Govemmenl Aocoon\llbil~ Off.ce (GAO). a rnllJOOt\' 01 DDS', do OO! coodutllcng-lerm. 

comprel,,"'.i .... WO<l!force plan",,"'\!. whK:h would .nctlfpco'" ~ey slnueq'" Tor IKfUiIIng. Jetatn!<1g , lra,ning 

all(! otIWW'" develc>plrQ. wl)l\<lOIce capable 01 m_ng 1Ong.IMm goals. TM Stale DOS lac~ ""II""" 

mirOmum qualificatio...- for Disablliry E"""""ft" (DE'.), ~ .... " ~igh tumo..er rales- 101 employees, and do not 

IlO"IWlde ongoiflll tr:oiniog '0.- DE's. 

; 
138 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.099

AFGE is con.inc:ed that SSA 'S hOI """Ing Of ahl! to COHed Jhese prable"", AFGE ""s elCprHoed tr.eae a>na!1'ns la !/It! Sut>comm;n ... lor _ at ye~l'$, and h ... seen lillie Of no imp.royemert! w<th \lie State ODS 

$lluation Tile S~te ~OSs ",e dlffere<1t disabOtily c\ecOsiOII-maklng procedures II\an ~~·makers .t tile 

hear ..... _s-o This 1"llI. not been _e...eel by th ... Administration. It is • I<e~ p<et> .... t~at mu.t be 

r~ On order I<> rer""" 111. d...at>ilily.ySlem. AFGE S1l"Orl!liy belieYes thai I'" ontvw~ 10 ~I<)lye the 

prDDle"", that plague \lie State DOS' is to r- a~ZII! It\em This wm "'1"9 conslsrency /0 In. ;"ltIal claims 

decl~!oM I" IIHtsam. way rlMt III. Supp'-mMlAl SKurirylncom. program lllal w.as ... tablislla<1l" 

1'74 CrNtfKi .. u"lfotm system of benefi/& lor lIIe low I"come bJind. disabled and ~ed population. 

As AFGt. 1"llI ... mphas.>:IId ... p<ellioo$ testitnonV be!ore \IIrIl--k>.>sa W'Y' 10nd Meahl; SodIII S"""~ 

Subcommitleto, the tMa~ CIa'ms Manage, (OCM) poIol (anDlr.er SSA iMialive) proved 10 be hlghly 

SUCCMSfut In add_ng many pr_. In the disat>/rty prng,am DC~ _e fMPOI'sibIe 'Of ".,.k'ng 

oecisions atlOlll t!le 1>Oh-me(!;c,1 faCIO'" 01 en'~Ie ... nt."' weq 8$1".. I deCilioos lor ",ltial ,,;s a~;r y 

bene/il claims Tr.e Lewin and PEM Auodates performed an evaluation of the DCM, which w .... P"Iformed 

between November 1999 and NO"I<ember 2000. lewin ,"!.led its findings in ~ 2001 . Aceording to Lewin. 

proc:P.I~irQ time wos signrr"",nII)' beIler than the bifurcated prDOl!S5. In fact, the OCM P""""SIng M", of 62 

day. was 1»$1 0"" !laW of SSA·. inobal (liQbilily clem prooenlng u'!'" 11081 01120 deY" L_n allO found that 

cullome< seMCII impr........:l draman:: .. IIy. Clalmllnts elCprused record h"\gh ""Ilsfaclion ,ata witt> the. OCM 

PrQCeSS, eomn when clal.,... """,.., d",,1lawed The public prele~ • ~ .......,.. al_ them to m!.",cI 

w"h tho! deosoon maka,. CU!re<lIl\", tIM! ""I\" inle-ra<:l"", w~h lhe doaability!lo!clsion ~e! OCWf. al the heanng 

_t. wilen !he Admrnos!t1tIjye l8w J udge (AU) conduru. the """Mg. 0D5efV8!1on at !he im!>3Ct of !he B~ege<l 

dosablmg conrirtKln Ind evalrJaljan of the credibO(iIy of !he claimant Is • priu>e teflOn lor !he. 'IIh pert:ef)tlge '" 

""",,,,,,Is al lhe hearing Ie..el. II !he ~em was reformed "" that claNYfants could rnteract wilh decision 

fTh'II(ers !II • • Mrwll, ~ would resull "' ImPfovemems ... Ille ,rulill duos PI'OO!In. and reduce lI1e numbe< 01 

hear"'95 l11al a ... filed 

TIIfI OCM wn • pos_ !~ III etl$urirl!l \lie public II1.&t ~'5te nt and eqUUt>18 d!sab>Hty demic>ns """til made by the Agenc,r. UnlortrJnaleiy, despite lI1e pos!live OCM perience . SSA terminated ttle pi~ . AIthCIugh 

SSA conLended Ihat lhe OCM wcr.rld ODSI more lhan !he Cl.menl Pro<:e'>S. tile pilot .... , lennina.\ed belate ",. Iid 

slatrslrcal d81a could be """""led regarUing fuR prog,am costs. Cost no long., _arl to be • barne' to 

lmpt<>\llng IhfI di ... bililV ~DOI!n as .Y1<Ienc8d Dy tIM! '''''IOf,$;Mry ~orpend it ufII of admln .. ~ .... pem.es 10 

reduce the procnsinll ilme 01 dihbjrrty hearings 

It appe1O!"I" that the primary ... ason SSA ~lIIaled lI1e DCM ",lot was- d .... to ....... tance h"om the Stales. Such 

rfi<Stance ,,"lftainJy waS not based on a POO' pilot res!.ltt. 1 ... 1ead. Illfl decision a ppears 10 ha..e been based "" 

potibCal COf\5\<Jeration5 and !he les, of mOng WOhL The COhOefh5 of the stat"" a ... undetstandable in """"" '" 

lheir unat:eeptAbIy poor perf(Y1"f"lOhOe rega,alng <IeCI$oon co""ostency from ,tate to Italrt. AM their poor 

ptocesslng tOne in COff1p;I'i!ion to the OCM. Howe ..... lhe only ",al cnteria sl!ould be tl>e Ieve( 01 service lI1at is 

p"""-:led to !he clalmanl. Using clJOtomtlrsefVlOll n. ,"""su ... , tha DeM el!Q!lflded S\8t. DDS perlormance 

In IIInuall\" every category 

AFGE ... """""ende<lloCornmis~t AlII"" !NIt he """"""'" the AQe""Y.' <IeCdIOn to 1"""","11' the OCM 

pl'ol. and Irnplamenl ll1 ~ poSiI\ot1 01 tit_ OCM ;M SSA " soon "po$SObIe 1M ~ !>as rlO! .cled on 

AFGE·. reoom"l'etlllaticn. The Un"", is willing to ~ wilh !he Commrssio""r in .n lh(;ft'Il"Iert\8i &pptoach 10 

;"'!>ftMng 1!1~ d,ub~ Ofl><HS W. undtofSland h~,e wJl t\eed \0 be challll"" in policy, !>facedu,,". and i .... litllliooal aml~ntl;, as _ " funding ta Imple""'nt \IIrI DCM However. we ""'I thal ledeflllil ing the 

tntlra d ... b;Mty process tI "flY \0 impfO'oing dtS;l!)i!i~ claims ptl)C:MSr"'!l ahll Ct>rTeCIir(J 11>6 curren! appelele 

nlgmm. ... . 

ltg'&I.b .... . mendm,nl' 10 tha Social ~ Atl woold be _sal"'/ 10 al40w SSA ",.>rb~ 10 malo .. diubll~y """""""s. __ . IIII! c, .... in thedi!labilrty program requ~"" ....med<ale a nd lorQ-term changes. WIlen 

trD'ned to "",~e OMdrcal <Ie6sion!I. 5SA emp\oyee$ can prO\ll<le Jr,,,,,,,,,,.!. " •• 81 to lla(;l!icgged !<late O .... b"ry o.wm!natton agenaes. and prO\ll<le (:mer and be\tet --..ce 10 IIII! public by wrvIng • • _ MlIIie pornt or 

con!aCO The Pilot d~mQ(lS!, led lhat tl>r'l public likes tlNo DeM, empk>yf!e. ~nth""'!<I"a[i'; support I .. , 

.. 
139 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.100

~ml>lol'ft! . re eapable 0/ maileono .... ~ 0/ 1Ile CII"""" ",OC1lSS. aJ>C:Ilh/l1 11 ",01t~ t.IIbs1anlially beUt< 

IIO!rvoce than 'IM! 1:II,,,,nl biNfcaled d ..... DIIity ",0C1l' 5. 

Tlc~.t 1<1 ~ 

AFGE !'as been a nd con~nue~ to be "II ",oponent o/!/Ie "TotI\e\ to W"'" afll1 WD<II. Incer>Ii .... Imporcvemenl Act 

01 IS'99,· AFGE h9' IM)rked with dedicated SSA ""'Ploy""' •. who ~I" charged with Im!>le'mHIting thfoiegislltioo , ~ became »IlP"rt!nlf,om 11M! wry baglonitlg thai the A!le0C'/ was "'" prepared Ie la ~e ()fI this 

""' ......... ~rog'am. Oecisloos were .... de 10 conN"'" <>UI,"" mosl...,,,,1 e_nI of 1M ~'ogfam 1/I8 Program 

MalHiJ)9' Some ... '" we deci""" was linaf\dlli. $OM!! uld Inil w" an tnlarpretation of Itle tnlant of the ia .. Nonetheless, ~ appeared to be ttre beginning 01 a ".,.,.. bureaucnocy. Rather Ihan have en ag .. ncy <IGCOIInlab .. 

lor h I.ilu,e$. .... flOW have II "program" "OIl"'fo; ad .......... I .. 'ed by unaocouotable 3" party COrAAK:lors, 

\III! fadu, .. aI SSA to ItC;CUfalely eM t"",Uy ... plaln """" 1nCI!"""'" to \III! di$a1ll1Kl <lOf!'IJIIUnlty: 

\III! fa ~u", 0/ S_ Rehabilitation ~",ms; an(! 

lhe resista.-.:. 0/ d"~b'" re<:oJ)lef1 ~ to atIempI rehabililation I rdiOI "'t~m 10 work. 

llna. ""'" been ITlOI1! lhan 10 yea .. and ~ e Pll",,,,,lnatwtl are no _, 10 , ... ol"mll th ...... un tnat plaguea 

1M agency ,,"" now plague 1/18 Tidcet 10 Wo<1< pmgfllm TlIe flfld'fIJlJO of I"" GAO' repon IfUI;cale IHalIIIe 

IMIaI COf'ICerrlS"~ r..." .... bUllfIere '*"''' aceoumabMy "'an ever 

There appe.aralo be an " ability to p,ovide oonsistel\1 and !XImICI informallon about work ioceI1l""'S .."etlle, you WOI1< fcor SSA 01 ~5 Pr<I\Iram Mar\age' Tnlll is mo. ttb"" ca<JSe<lby ttle com~xily o/!he work in(;e n~.es , 

tU'S diflicu~ 10 .. "" .. ;,., if. """ .. dill"",_ fortne d .... bled '...:,poem 10 unde<5tar>rl. If In",eq,ie~1 t>ecome. 

oonfuwd anet car .. baclc and ~1Vfl diffe<ent informatIOn, IN f1"Iistarroe to a~ work Mould '* 

ur!domllnd_. 

Thioogt. '''!Iulno,,",. SSA h •• g'OWf1tn.. bu,eaU<nCY by un""ce .... nty bifu,cat'ngl'" ,npcm.ibil:itJes 0/ tI\<! 

Pr<I\I,am Manag'" .In &pilot "'''''' lad< of acrounlabilil~ and """"''9n1 ",0_ 10 tha Employmem -...., 

lIl6ong lllOOl OOnlr.ctOl, M.""" .... Wa. lIfl1nte<l . _ ~ eontracI" one olll1e Program Man,gers. T~a 

A5I"ncy 11 rewardmg Maxim .... for failure to ac:I'oie-.. tt>eir goal, 

A<Id~OO/\<IIIy , SSA', 0IIice al lhe IMJHIdOrGeneral (O/G) ~ed ~ coro<:efI'I$ HI AI.IgIal201" mIl SSA 

.... arded s~Pft»<'mal"fo; S93 milloon., gfsnt lund. to 103 wOO IfIC8ni .... and s .... lance (WtPA) g,an_s. vel 

me Agency ""'. """l>III to -.nihil how an~ bl!nefoc:",,,,,~ actualfo; ,,,,,,,,....:1 ';VtP ... SI!!Vice. duo\ng 1M 

pe,1Od of review. 

AfGE sU'Ongfy recommends Ihat thot SubCDmmittea ho4d hearings"" the challenges 0/ ouccessfu~ 

f.hab~ita~flII ,nd encouraging the d"osabIe<:J IQ Bnempl work. AFGE would I>opo! !hat:wc:h he'ring$ willallow 

I", d;scUSllOoo 01 ,",,~liIy<ng me work ;""""""". and relUm'ng m..;o. aSIIKIS of tho -rocket to Worlc "'ogram 

bact< \0 SSA. 

IClalms 

AFGE MS <:OMuCled ;ts thin! AI1nWlI I U,.."Y 01 SSA ~ ard;r.g ,Mit eo,oerieflCfi Wllh tile iCta",.. 

5i'S1ent, Tile .urvey res u~s reveal conilrMf'Cj l\aws II> I/)e pr<>gram Conoi._ with previoLts.u~ • 

.. mpIoyeM eMIl ...... Ihlll ",.."speCllng appIieanls .... II llreal risk of dfo.acMomag;ng lhemseh'es. Applicafl11 

can usifo; lose thou ... nds 01 d<>ll ... In bl,"4!r~.! TOOse S(Jrve1ed we, .. SSA erTlplO'f'!'" who ...... 1 peoole wI10 

• G,A()'1I.a.!11 _I s."Of1W _It\'. P"' ip>'i<>to Ir! ",. r .. O<\ w w .... .,.., ... "".""' •• , ... WI 10'1 .... ~U._. I OIG/MA, __ ""_ .... ~ ..... .w;., __ I'rqIfif. ~ ... "" u.nll 

, 
140 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.101

are elderly, d .... bIed, Ynl!<lycaled. POD< and 00me0tsli. SSA hasln ...... led mil""". 01 dollars 10 tJll'" eacl1 

employee ID obIa'n Inlormation thalwi~ meet all requi"""""'" "'!he law. __ .!IIe agency """,,,,Yes to 

gM! CorIg,"S \he Irllpres.On thai ~ 1o<IiIr>ov1 "' "!l (;lin lie eq~1!y effective. In ~elerm1ning ~~t 

benefil. 10 ~pPy for, and When to file for I~, wilh<>ul lhe ~tarlCe oIlrained SSA empjcyees. 

Til .... limply not the case 

M"", Ihan haH 01 "'" eIf1lIcvees S<JJV'e1ed repom.<j badllogs 01 K;1. im. 

71 % reported thal 1hey .re no! giVen adequale time to f'tKont.K:I iClaim appllca"" -.. ne<;eSSal)' 

Regarding 'ellremem claifl'ls. 

0..'1< .'.j, reported ",lire,""", iCl;oims do 001 requ~ .. '''"''''''tocto to CO!H'C! pJ'Oblems ..... 11> the appftcaooo 

al)<llor lnoomplele or Incarred wage irlformll\io!l, 

0..1y 6% reponea rebremert1 iC".m. do not requ" e r.....:ontac!S dUl! to. Month of EIi!c!.., "'sponst! 

Ihal would De disadW",ageous, Of beause 01 Incomplete mBm..~ 1n1""""lion 

On:,. 8% reported re!ir1!meflt iCla,ms do nOl ""l""e J&.CQOliICIS due Ie irlccmplele Wcrmauon "'9;ord'''II 

cI1,ldren or mili!3ry &erW:e 

89% reponed IMIII1e ~Iocdoeo "'" h ...... 1M ~ to aslo 311OU! b!.ak~n ca lWlaIlOM 10 

clete"",ne the besl Monlh 01 EIedicn without JI'CfTIPIing from a treOMd CR 

Regarding dJ..ability da' ...... 

Onl\< 1% reported disability oCblim 8ppli<:anll do net f'eQUKe "'·COf\~d. Ie correcI alleged rUles 01 

dl$.obiJit1 OM~ 

On'l< 5% repOOed d' .... b<lrty oCI8"" applicanll do flO! J1!QUKe ",-comacts dOli! Ie ,ncomplete "",dlcal 

irI ""m~fIoI1 

82'''' reported thai • min'mum of 2 foWow-IJI>S ar .. requ",,,,, 10 'e-<lOO!acl \he allPllC3nl bo!<;aUSOi of 

ir>c:o<wlele Of Incc<rect In . 

71'% repoJ1ed!hlt ~1tCIS req o"". m ... mum of 30 fTII/lllles 

Other Is.ues. 

88% "'poJ1ed ongoing protI4ems wilh 3" Party .pplicalocns 

Only J % reponed IMI 3'" Pa~y cI8,ms ,,"subm,n"" b<Mly 

Sol' .. reponed" <>S. of bener~. caused b-j 3'" Party appjlcauons. 

64"10 reported po,,,..,..,,,, conlacts ,,'" requored reg-ardng Medicare Pa n B ~tiIIemem. ~M~' applicant. 

.rf'tlflf!OUSly refuse to a",,1)< 'or ~ on "'" ",~i3I applicalion 

Since 111& Impleme!1lat1cn '" iCia ... s, lCla,ml appiJcatloos have bl!en ,e....wed and COfI'1!deIl b1 tnI,ned SSA 

employees be!<>re Pl'1'f"e"iS were 811t1!oriud. Unfortur>/JlII!y, SSA ccrninues 10 make cI>'J15I~ i1 1)"1o!1C pcIicy 

r"llatding crilical factor, 'iUdI 8$ Monlh '" ElectlOn.,1d O'-'ll"'tlonable R~""mftn , whir. .""","'9 ernpI<>yees 

to ignore Il<oblem. WIth theoe lssUO!5 Many employees 'eel ot>ilgBled 10 full)< 3S""'t applican~ in spoIe of 

CMnged poIi(:iM, " ordetlo prOieCI appllC8lltUlroc en ~r e Ihil IMy receiYe 1Iie """","015 they . ... (lye. 

SSA re/lAes to pen",", a ullils en Ihe ;"lerne! d80ms allhe ~ the appMcanl aubmits Ihem, prior to any 

arnployee "'.01",,,,,,nl, AFGE is c.on-..incl!<llhal .""" at'> Ud"~ is nece ..... ry la~ ~31, SSA 10$1 more \han 

. 000 em~ d"" Ie D<Id~1 cui • . The .ast IfIII)CfIIy of "afI'r.g losses ..... '" .",kI Office employees This 

1""r. SSA ~ "" lacr.g .""In ... h'Mg '~m. which IIIl<I<lkI JeSY~1n another .tOOjoMloM. W<II'I I ...... ' aM 

"""'" employees Ie meet 1I1e public'. a.rnands-. "FGE ,. ccncemed lllat Ccrnmissio!! ... As"' ... wll """leme'lt 
141 

f 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.102

t1iI ronal phase of !he ;Claim. process, wNet) lOCuid .... ,arna,e adjlidlcal"", "" appfOcalions, .00 eliminale all 

SSA "",pIo~"" invol"""",nt 

AFGE strongly Ilrge.t C .. ng ...... to ""Iuir8 SSA to COM"'" a n"''''''9h aU<l~ an a staIJ$tk:a'~ ""lid """'pi/! GI 

s"bmOted ;Cla;ms, prior fa any ~arodol'f 10 • I.ained SSA employee lor ~ and adjudicalion , 

AFGE strongly Ilrges Ccngreu 10 d"ea SSA 10 cease """ieme!1la1ion of a ny and all policy cha'9'" !Y 

appl;coo1ian ' simpJificllbOO' In., will ,eSYtt in. CII\ISe. !Y ~ "'COrrect ber.eM payrnenlS. 

AFGE """,gly "'~ Cangreu 10 re<l1.lBS1 ,,,~am.ng CIlmmtttee. 10 hold tteafll1gS on Ille elfe<ls af ~ 

In"'",!! CIa,m$ ptOC:\'IS$ an SSA w ... I!loads ar<ll>t!MjiClllIIH. ana",,,,,,, tne emplOyees' "fGE reprll$MtalNe$ 

tawlit)' 

In Conctuslon 

The 111"'.1 of seq....sb.h"" WCIIId be "" ~allo tI1I! Agency. lis empkIyeet; andlne p!Jllh< In", "' ... " on ,Is 

... "'..... SSA offlclal$ 1_ "",ormed Af GE tllallMy hallB "'" .... I>m ~ a ~~"'" bU<lgeI '" OMII .. tile event sequestration Is nece .... ry. HoWeve<, SSA ol'llaals explained Ihalfundlng below lhe current yeao's 

tundlog CIC<Ild 1'Il$u1/ in one (1) Iuo1cIJglI d8~ fel BII'IIY $25 million cui The resu~ CQuId be as "''''''B a$ 41 

furlough dar- pe' "",pla1H. 

UnfonUMIBIy. them wi~ a~.ys be confIO:r;og t>udgoet pnc:wibeS w;tIIir! SSA ana Ihrou;lhoulllle Fe<Ie<al 

Qovemment HoWeve" bOth lOIC!1<a<s 1»<1 ""'~ conlrlbute to Uje Sotilll Sea.Irtty 51'S""" and are er)lilled 

10 "'''''' ..... tl9h quality t.ervice. " 'Is enIlrely IJIPI'OIIrioUI! that spe»<llng I ... the adnMlstralion of SSA p<Ogram. 

be sel al 8 IevellNl fItS the neeOs of .scc..1 Securify's <X>r>lfibutol'l arod bClner.coarie., 'sitle' Ihan In aobilnlry _, thai flts within !he current poI~cal proct!ss. 

I~ 2000. If1I!!\ Cna""",n SMw 8"" Rep_ BAn)8lllon Cattlin llI"'ttO<l.LJCB<I the $odel SecumyP~IlI"""n Acl 01 

2000 (formerly 1"I,R,5447). a ~p rtisan td IQ JI(eI>IIIlI Sodlll Securlty lor II.- lelinng DaDy boomers "fGE 

strooglV e<1C01JI'898S I" s..bCCmm/tlee 10 (ea>Mider iI'Il'oducitIg legis/al"'" IhoIl .. oil ptC'o'idA $SA woth IIIe 

appropri,,1<1 luoo"'ll _110 prO<:e'Sl .i!.darms a"".II! OOS"',ntflleml!m WOI'kicacls """'''' 

TakulG SSA's adm,n,s"ative eo<pl!ll!lM "oII.iItJdI1eI' has ""01 suwon, not an", Imm AFGE and SSA WOI~I!I5 , 

blll!rom w nicr a'1d do,;8I>ilily adllOCal<Y otIIanlnlllO<ll . T~ l would [ndude AARP, 1M NalicMl CammillH to 

Preserve Sociol 5ecun!y and Medicare. lhe Alliance lor RI!lired Ameri<:a!1s, the Can......wm for i ... "" with 

Dis&l)iiitft, Ind the Sod .. Security O,wbiloly Coal~"", . 

AFGE I>I!IieYe!l Ihat bV laking the oo.";,, .. trali\le cosls OFF·eUOOET with the ",II of IIIe Soci., Sewn!)' 

ptog .. m. COI1II,"s wi! ~h! be able to ptOYl(!e strICt over$lght 10 el\$UllI \lie ad...-n,SI,8INt IlISOOICBII a'e being 

spenl efl\Cienlty 

As WI! . lwa'fA have ifllhe put, AFGE I. eommln&ci to •• lIve .. nOI onl~ "'e amploy ... ' 'dvocaitl,1xI1 

. Iso .. II wal<:hdog 'orell.nls, taxpaye .. , ~nd lot IMlr ell1:lad •• p, ..... tativ ••. 

" 
142 

University at Buffalo Law School, Statement 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.103

Arri13.2012 

~"_"'''-k_ TIt< Slid~ u." ..... ilyufNrw J.;),k 

Tt>c !1ol>(lrdble Sum Joh"""". Cha;nnln 

1I()IJ.St Conlmill<cc on \\'a~, and M~ans 

Subrommine.. on Social Sc<urily 

U"i!~d Sta!.,,; IIOOll'<'ofl<'prr_",:nlO!i\'t'S 

I<~, I-!caring. ~St<uringllw FOlllln' oflht>. $o<:ial ~uri!y Pi$llblilly uran"e Pml;l'mn_" 

Marc:h1U,201,! 

o"ar Mr. JOO"",,,: 

Varia lions in disability d~lermin~(io'lS (or l'itle 11 or T,(ic XVI bc"d;1S at both !hc stale and 

fcx!crni level are vcI)' problc!11~lic bcc~use Ihe slalUlOI)' and Tej!ulmory fn"ncwon; fur dccisio" 

making i~ hased on a slab'" ddj"i1ion of disabilily Ihal is in1endc'!! 10 openlll: unifomlly. ' Th,'".: 

vMialions raise ~veral imp ... nanl ques110n~ aboul Ih" f~irrn.'Ss oflhe Sociul S<'Curity 

Administra1ion', r'i\gcncy") administl':l1ivc dccision-ma~ing process. Onc question rais~d is 

wh~lhcr varialion, in allowan~c rdlcS bclwc",n d<'Cision ,"ak~n; al Ihe Slale Incl and wi thin lhe 

AU ("'rp> illdiC3l~ Ihat different decisi on maken; opply Ihe unifom, delinition of diSllbilil~ 

difTcl"t'Iltiy, One pilSsiblc explanation. ofcoul"$('. is tlmllbere arell ~onsid~ruble n~lnber of 

deci,ion maker.; al oolh lhe SWIC level and within Ihe AI.J corp, lhut mu~e Ikcision~ based on 

l!liosync1'll1ie pref~,Ttme.:s. mIller thnn Ihc underl}ing merits of the claim. 

C(>nsiS1cnl e,alWilion ofdisabilll)' applica(iOl'5 fllet! by similarly Silu~l~d claimants assumes 

Iha( tl,,' pnl1<><:ols uwd 10 evallllltc.diAAhilily provide ~u nicienl guiJan(;': 10 dc-.:i'ion ma~ers 10 

en.ure lhe,., ;no.li,·idn"ls 3", t,-.,alcd u,,;fomlly.l Thus. Ihi. commcntnry will c(:msider wh.1her 

U,., Agt'1l~y'" n1"'31 ofMc-dical Lisl;n¥ 9.O<i for U5C i.n ils ~, aluatiun uf "b<.-siIY I!)" 3 ,.,VCft: 

impairment has led \0 ,'ariations;" dec ~ion.s ""ncerning similarly siluated obese indi\'iduals_ 

AfkrTevicwil1g lh~ releva!" case !p,,' funo" '!)g Ihe repeal Medic~1 Lislilij1, 9.()9, my anick 

concluded Ihlll Ihe rt:[>Cal ,,(tile LL<linll'and (he i!Hld.-qu'l1c onclhodolo!\)' uljlil~-d in SSR 02-1 P 

("Rul;n!!") has h~d 3 ncg;t1;v( jonp.'lC1 on lhe Agency's ability 10 providecon;;istcnt and fair 

adjudklllion o f daims in~o!ving ob;.-sity. 

~I~ C<)mmo""",,, ~ <)n 'n) f",,"'---om;n~ ... ;d~. ~S:-"m~lIS. w"",'$ '", NM'[{)fm'SGA"'1\OP()O'I " 1!<,," 

~'lij 11(lMr~ ANI) "" lkIclM, SI,CI,RIJV A""'I~ISI~" lION'S SvllJtml\'F. ~h! ,y " llOS Of r A f"N],j'." ~ {IA. ~" L II.FV. __ (~Ol n .. ~il.blc , h\'p!I'r.)'t.-,:.,.w;tlW",I<o)1l raP<"l.'fn").~ 1"KI... ><lOCO 16l!16., 

1 I ,."."", I~ I,,,,~ .. ,,"""i!) lOt !I", '"""""" .. ~", •. ,,,,",,i~ ,..,,, in"'""e ."""~ ""8.,i'·' """";""'.'l'IOn& ",,,,,,,,",,10 

indi,id""ls; ,1<lIMol"'-'>,. &.Iuuon~. 0U>d pi!irul..-.:~I! iOJj"""i,b_i.,td "ilh hig!, bo'<d) ,, bl . In'l'I"'M,"" 

>1;JlJ"o ... "",i.,ctJ ",d, ob • .-.i,y. ,00,e, ,,,,,,,,,,,,ble ioo" ';d,,", mil'f\' oo.:'Y 1h< ,n" ... 1 "an,e ... "",i.,N "ioh """"")'. 

Th", ""ini= make ,'" 00..">< !'Olenti.lly , ·ulnrnobl< ~ i""",,,i;\<.'1l' dc,<:i,ioo moliog. ~. I ~1 

idctl,,(,·i,\!\.lmilarl) .1, ... ,,-.1 dolman" "ould II< """,lbk~.) I"""il\ll'" ,""<18,""""',, flo,..) ~I,,-~ tnd<:, I-nMI~) 

W;lb ""' .... "'Q "''''''''''' ;n mind. I ""l"" '0 '''' ky.- oil d"-t,,<l .nJ <ift"UI, <"uti ""d,I",,,, rollu ... in~ ~'" "'1',,,1 "f 

Modical Lk.in.£ 911\'- Oul Mth.s< "",",.1",'01,·,,,* ___ ""manlS. (unly ""'ow,-.I U<t'i whrn< th(-d,;/llMII'4 8M! 

'oold "" """".,00<1. rkco< < • ..,. ,,"'." 'e>'iow«l r", • "u",bo" pf r"",O<1: "It<. ~."do,.IlMr. 'YP<' "f d.;", . ."cl 

","",",,,,,,,,.;.roddi,i,,,,,,1 in,,,.im,,,nls. UjIOI\ "","pIOliM uftJl< fi",' ,"",1,"".;1 t><oon ... ~pj)a,....n ,1", "'~ ~h had 01$0 

i",,',Kl.d """<' "II ..... : I"" <I,',n,n, did .. ~ iok.'ify "",,"il), ., • :lC\C',"" i,,,poin,,,,,". -' " ... 'WiI«! ....... I!I>o)' ,,' 

,.:m";da- ~h .. h .. '10< clai"",", .lIcgcd """'i'y .... ",,'= in'l"'i"""o1. oj( ~"'~IJ,.~ !hcAlJ <i-.1mnin"d liI3! 11k: 

.:1.1""",!'sotodil) " ......... ,cn: im!""n",,",. 
143 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.104

, 

s~\'~".] key ll,..m~ s emergro lrom my ~v;e,, _ First, 1m, lack uf ron$islenl ",sull. fo'-

O\Ccmingl)' similarly situated indi,·iduais. particularly lor indi\'id""l. Wilh a hit>hcr lIMI bi.>eame 

apparenl. This finding "'a~ surpri~ing !Jt,cau"" ,)rthe as.wmplion th'llhc daim;II11's siu would 

be s" fficient III p"llhe AU On ootite thaI obcsilycoul<.l be a pul~'11lially limiling rac'nr.

l Second. 

~ sNmingJ), low 8'-'11 mi!!.hl plac<.' a elaimanl al risk for ~n ad \ler,;edeci~iM when in facl lhc 1o,. 

ElMI mflSks sig.nificanl (und dis,1bling) !leahh problems,' This is problematic gkcn the debate 

conc.:I'l1ing thc acc-ume) wilh "hkh AMI C,ln Dc ur...'<J 10 evaluate the epidcmiologicullink 

betweell (Jlness and h(allh. I'or example. for women Ih( ,,'aisHo-11;p circumference provides a 

11"'1"<' C~\lrnlc way 10 con.~idcr h<lw a palienf.~ 0""'5;1)' impa(:1S olher bodily sJ~tcIM. A third. 

~nd potcntially ,"orc significant pmhlc,", i~ that the Agency's e"aloat;on of obc~;ty might b<.-

ullder.indusi"e. Again, II ... Ruling pn)\'id.-, I;ul~ goi'bnce. Tenn> in Ihe daimon6 medical 

=ords (e.g. "sc"ere," "c1(t",me." or "nwrbid") camJQt be 0,..'<110 establisn EMI as a $eve", 

inlpairn\ent. Accordingl y. c~labli!ihing obolity a, u ...,,'ere illlp.1imlcnt thrtlugh Ihe use of 

objective medical =urds and spec ific cvid<'I"'~ of fUlIciioll31 imp.1irn\~l1t ~ should be an area of 

significant concern in a prnclilionc'1" s tase P"'P1II<ltloo,' 

P,'R I' I: T ilt. (j~N 'Y ~ CURRENT RULI1'>G fORt 11 6 EVALUA I'I(>N OF OSESIH' 

Afkr the Agency repealed ML'<Iical Lisling H19, th~ Ag,'nc), cllllCuxl SSR Ruling 02..(1 1p 10 

pn.wide guidance as to Ihe l)Valualion of obesity. A bockgrQu,i'd on tnc Ruling is ncCl'!i>'ary 

boca""", Ihc Roling itsdf mRy be a 'iou'cc ofpotcIl'ial poinl ~ of\'ulncrnbili\)' 10' obese clailnalllS_ 

Al least 0"" districi cQllM has comrlained aOOU11he Ruling's lack IIf guidal",e.~ Th" Ruling 

eorreelly acknowlcdgl:s llmt obesity is a "~'Ol1Iplex. chronic disease "haracI~ri~~d by cscl!.<siw 

HCCllnllll~li"n oftx-.dy fal.·' and e,,"dud~s thaI obesil~ ' i. gen~r~lI y lhe ",sull of~ combinalion of 

lactors (c.g .• l:\~n~l c, nI ironm~nlal , and behavio,al). Lih olher A,!:'CIlcy plOlOeol~. the lI.ulin~ 

:;('t:mingly puIs yeal emphasis nn bjective~, idcnc~ ofdis.,hi liIY. lien:. In.., Kuling Uliliz.:s BMI 

as 3 means for th~ AU to detcnnine Ihe p,~ ",,·n.:e ofob..'Sily. Ho,w\,c,. Ih~ ulilil)' ofu~ in s BMI 

as all :'\CCII""le predictc>, o flhe impaci of'_eighl ,)n heollh is s.ome,,·hal qllo:: 110n3bl~ fo, cCl1ain 

1 r ... in.l4n<·c. in R<K'k><,OQ</ ,', A",It<' •• r"",.I" <I.im.,,, haoI. HMI ~f l3,8. 9,1 tho AU did w\ mo",i .... t~ 

d.im:,onl·.' obL.,it) ..,y"h<re in hit dt>:l .. i<",. Qn "I'f""'1. ,"'" A.l:oncr, d"",i ~!he Dct lbo <I.im,"'" ''''.'l''$, 

pb),kiat1 h:.J diagt ..... .t .......... b";"~ <>I><>c •• 'll. ... -.A IhII d.im .. ~·. "-';Mh' "". ·in th< r'"Kc ,~'110. ... 0".,,-..1 "~i!ll".­

(/Qrr" A" .... , "",,-ides an,""'" "'''''''r1eof"'b)' I'fIll1ili_,, ", ... -.1 ~,~i,cly be I"'par<tt kl ti<<'dOf1"" =<>«1 

«>II<=ti", the claimont', Qbc>ity. In 1klrT, "hilolhe claim""' ~id 1>0« a 1l.\ll Q( oI(I,~ ,it< At) ""I)' monlioood in 

P""';n&Ih>, thecl.im .... •• """'il) ,..,*",bly""atm.ol!edr ,he daim""" H I",p "1"""- bock ""In. In """ ..... In~ 

'ho ta>t: 1m: ""lei., ..,.,... I><"":H' . .,..rr.:.." rr<n-.l " .Iiglll critic",m " f ,he <Ioi,,"'nt's r<pr<><'rIla!i, e. S",<tilioQJly. 

II>< <01", ,~".,.. !he: <ia,,,,,,,,, ~ <NIl) ~ubrn i"cd "'<t0f1b 10 l!II: A""" .. , ('""",,;1 """"'rtlin~ III< d.o;",,"r, <>I><:!~y 

(rom" nw,,' ~lit .,...'T und rlo~>i<,'IIt-.;,-"I'i;1. "hieh "'i ... .,J ,,",,"""" ~r"bl111a lhoc. ="'<Inl ru.o 1« .. ~m<:i'''''I~ 

"""01''fI''! " lh"Jl U ..... • ... "'M 1"'01, ~""I""H.-f ... 1 Ill'" ill",,,,,,.l"" "«J ,II< ' ..... 1 rnt. ~im"" .. s~., vo 

~ [In.'''''''' w ~ the i_, oflb< <lairlWll', ,,';i/lt 00 1\0. ~!.1i",. c~~n "bo,,· S,",'. in>I*1 m.) "' ... m 01>-';011> 

1>« .. "" cr,..., <10''''''''''' ,w •. , ~.\IU"> "''''1l''Icd I~>I (11'1 AU .<br>uld 10\1... ~"" "h .... " oi.1inlooP. B~B tl ... " (It1Ic1 rl",* ""'"' 01111« 1."'01 

II ",1.«'.1111 "1,, .. iIY. 0"",,,,, • • '>J.,,,,bd~. /l<vtlh"""lo)u I'. lJ ,00 (7i11 Cif . .!liO-IJ\<I.im.,,(, H~ll ,,~, l1,)1 ""lh 

,\;x,i," --11'_. 776 1'_Sul'f'. ~d 616 !/<I.n. III !(II I)(d.lma"" . 11.\11 ",,-,~~.I and II>< """" "",.J ~,i.o dirr.,..,.. .. 

," d;;rillllui,k Sk<Ir/,(!h 

, !;,.'" <,g., R"" ... ·"",( 6 14 F. SurP. '" ~7g I""~no", l..Jgins All""") " «>n\<:1>V"" """ lTlL'<i i<.t '" id.,." . ~f do)","""~ 

,..,..,il)' ...... . ><~ .. -) . 

• ,Vor."", .. A,,,,ri<'. b'14 p, SOW. 2d '1 l B. '1~8 iN.D. Ohio 201l >~ · !1I" C,"'" """",'<k; thai SSR ~2 ~11 P dod not 

itknliti a .\jX"if,. 1<",1 ~r .""ly.i). '1. 

,I, "'" II. • I I" 

,',,' "" ", ", 
144 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.105

3 

gr<J"VS (e.g.., women and i\r,ic~n-Americans)_ (;v"nllle Age",,), 3ckllOwledgo:s IhaIUS;"!: BM I 

to tlck.mine wh~lher an jrtdividu:.1 is obo-"St' c"n r~iill l! in 00110 false posiliv"ll and fals<· ncg3tiv"".' 

o..'Spit<.'lhis roncessioillhal ml>asuretnl.'nls oro~ily other than BML (xist, such u hip-Io.-waisl 

ratio, \h~ Rulin!! states (he ,\geney will not purdlllSC Ihese addiliuna\ ICSIS on bchalfuflh.: 

claimant because Ihe Agency believllS the medical or oth<:r evidence." in the C~ lile will be 

sumck~n III cs[ublish whelk. Ih'" ciaimant is obesc. I [owe"<",. my n;:,-!cw orc~ law suggesu:d 

(hal the Agency (and reviewing) counutru;:.gIL'<I "ilh 1I1l' qucslioll of how much evidence would 

be s((flicienl \0 cs\al>lish Ihe prt.'*I1CC of obesity (md WllClhc. obesity was in fJet a seven: 

impainnclli. 

'I'll<- guidelines for Step J are troublesome. bccau'>C- lh~ RulinsdOl!S Il<)t make it re'ddilyappan.'Ilt 

how th,' ruljudi.';)tor should oon;ider th" a.'cumulatiun of ,,-,bted impainn~ms. While tho.· Rulin!> 

does ackll<)wledge thBt obesity elIn imp.xt both physical and 11I~It1al health. the Il.ulillg·s inabilit)' 

tt) 3nicul~t~ how obesity impacts relatl'<! imp;linll~nts reflects the Agellc-y's difliculty in 

evaluating Imw till' combination of imJXIinnellts associated with obesity impart different bodily 

systcms. When the A"ency rescinded Ml'<lical Listing 9.09, the Ag~rn;)' notl'<! it would ~k~ 

steps to provide adequate l!;uidance as to the imp.1cl ofob<'sity on IWollth. To this end. the Ruling 

added prefaces to three Listings - muscuIOlikele\3J, respiratory, und <:ardio'l1O$ltlar • to provide 

guidance about the pO ~nti31 "'Te~ts oFobcsit)'. For el<alnpie, Medical tin .l! 1.00 Q 

(mu:<culoskeletnl) provide , 

Eff~cts of oi><.-sily. ON.."ity is a mL"tiically d~tcnninuble impainm."llt thaI is often 

as,",J<:iated with di~turb:mc" oflhe mus.culoskdctal S)'Slem. und di urbanc~ 

oFthis system can be a major causc of disabilit)' in individuals with obesilY. 

Th~ c(lmhinoXi clT.xts ofolxsilY wilh musc ulo kcletal inlpainnel1lS eM ~ ~ater 

thnl1 tht dTects of each oflhe IIllp;linnertts «lrtS'dc .... -d ~p~r:lld . ~rct r.: , 

when d~lCml n,l1g whelher all il1di~idll~1 "';th oh.:~ ity has J Ij ting·I~~d 

impilinn"nt rc mlJin~tj ll of impainnems. and when ~~~>$ing a cluim at 

OIh"r StCp~ nftn~ se.:juential evaluatinn !!I"tlCu .. <. indudinll wh~1I a~~ss;n an 

individuQl's .... -sidual fUI1<tiolial Cllpacity, adjudic~tnl"ll mUSt cOMid~r any additiooal and 

umillati ~e elTec\s (If <It:..-sity. 

owe"~r. Ihe MeJical Listing docs I\()t provide Further guid~nce ~s III how <l ~i ycan imp;l~1 

musculoskelelal impninncn\i. Addit'(lnaUy. Ihe prefaces 10 MeJiCl1i Listings 3.(lOl and 4.001' are 

almost identic-al und al>o do nOI provide any in;;tn..:I'nn to evuluate th¢ imp."l(:tOfobc:o;ity (In ench 

resp«li.-e bodily s)'ilem. 

In my review oFthe cue law nnly a Smalll1uml>er or ~a."<CS "ere d,:ddcd at Slep 3. In part, 

<'''quiVIIlel1"e is a ditTlCuh concc[l{ because the..., arc a Ilumber nfp\;!usiIJIe cNplanatioliS J.~ 10 wkat 

c'Iuil'ulence means.' 

Li"" Ihe crileriu oUllined For th~ cv~l"alion of obesily at Step J. Ih .. crit"rin ulilizcd For 

• " lrue r><><ilil~ " ·001.1 ",rer 10 "" lo\d iliJ\III1 ".I\<).:k>d rote! t..~I:11"""" doli"Woo of dl,;OOlI;'y, "ti!I~ "'PIW. 

",,,,I~ rer", ~> "" ,nd;,i<l ... 1 "h~ """" m«"I '"" ="'01)' derooi ,,,,,, prd;oabllill' b., " ·h"",, cl.:m "IS<"troI""""ly 

d.'>\Jod 'p.,,;'U . • ~ ... ~ .. Dltc _. n>",~, ~f."« ... ~' .. Sl F. ).d soo. 50-< OJ Ci,. 2009~"tJ.=I in rai li n~ I<> d ......... lho 

;.'<'111<1;'''' ","" .. " Ihe ,\.;".a",., ol>e:!hy """ o>11'i<t •• :Ie .... ;"'p>int>,"JIbt .. 1o",,, ,10 III , ', " 

"" , . '"'' " 
145 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.106

delen",,,,,,!; lhe functional ''''paCl of olx:sily al latcr SlCps ;n lite evah'alioll pnx:es~ is surficienlly 

vague enou!;h 10 P<JSI: a co,,~idel1lbk chalienlO~ fo( clai",~nlli_ Th~ Ruling noles Ihal obesily can 

cau~" li""talion or runction and limil;llions in cxtnional abilil~ . poslu",1 r"<Jui,,"n~n\:j, gross and 

lin~ 1I1010r ~kill" and the ability 10 !x e~p<->$<'d to c~naitl c!c .. llenlli, sw:h as heal ~'r humidity, 

Addilionally, the kuling ""II'S lhe combined etYeets of obesit~ wilh Olher impainncnts may he 

s""ater lhan miglll bc expected withoU! obesily_ 

The challenge for claimant.., ho"ewr, is how much evidence is needed 10 pmve that th~ 

claimant's ~silyhas impacl~d the daimam's ability 10 perloml the runctional "'qui",menlS of 

work Two cases illu.strnte Ihis poim.o H.wm:rford I', JJomlwr'l and S~(1rl:>ek .9 The claimanl in 

H.lllherford indicated her otlc.ity made it hlo", difficull to manipulate object' with her ling"rs, in 

addilinn tn her ability 10 walk and stand, In Sktlrbek, the "l3imant alleged his obesity limited hi. 

ability 10 walk and stand. !lolh courts. hnwewr. rej...,ted thest allegalions as being tOO 

eo~",li'-LoJ. 

Another pmhlem with the Ruling'. " uidanee is ilS lack of rredictive powc ... For csampie, Ihe. 

Rulin" suggesled lhat someone with obesity and artltrili ~ atT""li s~ wCithl·b<:arin" joinl migJn 

ha~e mOte pain and limilalion Ih3n might re exp.,ctcd f",m Ihe arthritis ~Ione. Despite Ihe 

kulin~' s attempl to poinl oul Itow obe~II}'can impocI olher imp"irmenlS such as arthritis. there 

~re numerous ""amples "fwhe", kcminsly simliarly siluHlcd cI~iman1S dp"ricncc different 

r<..,. ullS .'~ For example. in Barrol/. Ihe claimanl was 5'1" tall, ]01 JIOuoos. and lhe alle~cd 

di .... ' b;lity"as a re"dt "fllC' arthritis and oMity. In /leino, Ihe claimanl w"" S· r' tall. with a 

"ei!;ht range of230 10 32S pounds, and alleged disability as a ""ultofltcr osteoarthritis and 

obesity. In Baru/i. the co .. n rejected Ilk: AU 's conclusion Ihal the claimanl co uld stand for 1 .. 0 

hours- ada)" be.:ause.;n Ihe opinion orthe re,·iewing. court. Ihe AU did nol ade'i '~1tely consider 

the in'paci Of11\c claim:ut1 'sobesi1)" on I",. arthriti . hI c0111ra_l, the cQurt in }(-:'II() accepted the 

AW'5 conc1~ion thaI de&pilC lloe elaimant 's ohc$ily and arthriti., shc retained Ihe runctional 

ability II) stand for i~ hours (with breaks) in an eighl_hour worl.day. 

The "-'l'ullS in /Jarrell and fI~;,,,, providt a L~lulionary lak fllT ciaimBnlli bccau."" il may tic 

impossible \0 pn:dict how decision make1';' will applySSR-02-lp. '!1,t resuh in 81!rrl!ll seems 10 

logkally follow SSR-02-1 p', guidance on the funclional limital;nfl, of obesilv." "h""'35 Ihe 

AU in IId uo did nOl addTl'S' how 1he "laimant', obesity impactcd her anhr;tis." The:;<: cases 

sUl>S"~t claimanlli Il .. ..,d to specifIcally .ddreu how"'" clainlam's o\)e. ;ty uae~.batcs exi,tin.: 

impainnen~. 

PAU II : THCLtMITsor TII(; C(J\I\lON Sr".-St; AJ't'ROM:1I 

It is ~ mailer of cOmmOn Si."flSC Ihal obesi1)' Can exacerbal~ olh"r impaimlcnls. righl'! Consider 

Oile, wh~rc Ihe Third (ireuit 0""""' .. -.1 the claihlsnl's morbid obesity would .......,m 10 ha\'" 

• R","'rfonj ,. lJ",,,Jo;trl. 399 F'. Jd;ll 5SJ. 

" Sn .. 8 • 11,1"" Y. '!,,,"r. 51 ~ '. 3d UJ (8th Or 200'1) and /Jurrrlt " lJa"'/wr1. 355 r . J~ IG6S (7th C;r. llJO.'l. 

" /Jat"re". J5~ F. 3d~, 1(168 (-A 1V"'" many 1"",,1< ,,1>0 ..... 110' gn»Sly.,.,..",.lIrkI Jo "'" 110 , < .nIu-i,;< In<<. nDd il 

dl;O;O<1ly u"""",fMabI. t<>.,..-.J R .. ",,' "'~g"". timo. r .. ""ppo;c ""', Ibm" "ool~ do so 1l.I)' .It«dal un. 

rac,,,,y 1I_1»nl<" '"' ,hoc r_iC.N ,n "" ~ " '<n1 \)a:; no <"lI<oIi." I=IHhlII". """ Jjnd:~ "II,;"". 57~ 1'. 3d", II t in hi, h}potIIeIic. 1 '" ,/1< """>Ii"" Elcpen.. th. AU rdc""-""""<l ,/1< cl.,"' ..... hiol"') "r 

ubt>ily). 

I' "', ., , " 

" I, " ,'I, '" 
146 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.107

5 

eJ<ac~rbated he, jllim d)'sfuI1Clion "5 a mauer o f ··C0l1""011 sellse, .fllOl m(-.:Iieal diaJ>llOsi~.Hll 

'n,., prvbl~f11 wilh Ihis conu"Qn sense Dpprooch, h"",ewe, is th.at lllj~ Sllind.ro is sumci~l\ll)' 

,"JgUl' thaI opPQ$il~ cunclusicms could be dra"n by decis;tm makl'!'l; ,,110 may btl disinclined 10 

gr,lIl( benefits. For ;"SIUlltC. in Sami,,; v. CQmmis$l(ll1cr v/SiJ.:/o/ &""fIO', IhccQUrt noted Ih~re 

was 00 "common St'nse cxpc;:lS!ion (Mtlhe obesity would exacerbal~ Ihe impairing dfects of 

cilh~'I' the seizure diwrdcror diabetes:'!' TII;s conclusion i~. in fact, cUl1trJry \0 medical 

liternlure ulltllc S"bjl..:t. 

My 1"I:\'icw of the caw law highlights Ih ... dcgn'" of rJndomnes5 that c~is\s j" the disability 

c~J1ifil':J.tiol1 prucc,s. An understanding of ,":ut\ law in"ol~ing obesity is imrort~nt ror claimants 

because d~pilC the clear articulation by the Seventh ~nd Third Circuits in Sil.llrbd and 

RullwrjQrdufhow ubesity is tu be addre:ssed by the AU, there "pcar~ to be S<)me vari atiun at 

the district coun 1<"I'c l in II hat "ill be cxpected from th .. AU.II Yet. d~"il'" the uncertaintiu 

abuut posilive u"t~omes. there are lessoru from f>ast ~ that e:m help prJctitiun~11I pr('pare to 

repl"t'$ent obese claim:mts and avoid points of vu n~mbility. 

A. DO NOT AS$ll'-ll: AUNOIIMJ\L a CIDY Ml\SS Wt~~ " RO\ltDt: SUfFIClliNl NOllC[ ~"II 'fllI: 

DI.C"tSION MJlKt:R roCUNSIIJ~1l QmSITY 

The )'I.'inth Ci~uil'$ d£'Cision in CI'/lI)w ,'. limIter ilhISl""dl~ how un AI.J may chQQSe I() ignore a 

claimant's obvious high UMI. ~pecially when thc claimant does nOI allege obesity 8S ~ ""vere 

impaimlenL I. Thl- record did c(mtain 1IQm .. ir\Consi~tcncic~ as 10 Celaya'S height. ranging from 

·f9'· \() 5"7'.11 Additionally, durin\!. lhi: period Celaya assert.::d h~ WDo> digibl(' for benetits. 

Cel"ya's wcig.hi /1uttn"l~d betWi.",n 2QS and lJ) pounds. II Dto''''lwingon Ihe ""I;male ofhcig.hl 

~IW weight used, Ccluya's I1MI would hlt,·e. mn~cd from .. ilher Ihe lowesl classification of 11M I. 

Level 1,10 Ihe highesl da.<.>ifiClllion, l,el·cIIJJ. ' ! o"e\"~r, d~spite this obvioU5 !~, 'el of 

di",~bilit)', lhe dissent expressed 'Qn~Cm tIIatthe AU, despite \'islI;IUy ohli~rving an obe"" 

claimant, did nOI hav~ 10 explore lh~ dailOanl's obesity in a muhipl~ impairmenl anJl)"si~; 

This approllth would Iran,fom. Soeial Seeuril> ad",inistr~I;I e hearings inl0 ",ante-like 

"1li ... Slr. Jd",sOol. 

I< $.wlnl" c~"'''' , !JjSoe. $«, ~009 \\'1. JJ'IOJ 19 No. OI·S3~~ II '5 to.."1 , t~. :10091 .!lTd ~ II r.'<!. AJ'!'>-. :§ 11 (Jd 

('Ir. ~Ot It· 

" a""h'<HI/l bH r, SUl'!' ~J a\ 278 t",v;'.,int. .. ri, .... dbtrk. court ded,',"" Ihal follow."" <1«1 ..... '" wll,,.. lhe ._h "'iIt,~ ... in Sl",b...t);....., .. /><>. $(>(,),-"* Y, .• S' ...... , /ofg. \l7-CV-GJI2, 20(1'1 WL.l7J.~8(,\l1 ~O' . 4. 

20091\'~"" dl",,;.:, <QUt!. "or) In lho" Ime'I'II'IlIlioo or ,t-.< ""tm1 ..w ""plldl","'" <>fIb< AU', upl"",nl"" "r 1\0" .... AU «lftIIld<'ml "'" <Ia[man.'~ ol><oil) At SI<I'I~ andjl ,j. ("IC". fli,n!I!a<,. No. 0·1 CV.'IOII, 200b WI 

t1,8581 (S.I),N.Y 2II06 ~d"'m .. ' did "'~ <I"m """"'Iy",,~ ..... " ... 1m"""",""" bul ... m .. ...t w.,"", Il<'<~ OS 

AU '~ ..-k""" «l~1J""'1 oflhr <I.;m'''(5 ,*,,-";11) 10 ,1>< ''''1m .... ' of 61<11 w.,; ,"Ilkl"'" 00'*111<.."",.,., ofll1< 

im""jm><n.). 

'· C~la", ~ lI~nl.r. JH F. J<l 1117 (9th Cit, ::OOl). C.I"y"~ :tppli.'<! r", bo..".."" "h<n ~k"\li"all.istin~ IJ'I " ,II .. ill 

In~tT""" woil. It..: ,as< " \1:1 .... 1)"100 "",let" Itli , U"Ing. Ihisd<",i';,," a~"od ....... pl. "f,h"ditr .. ·"I' .... 

".Im.nts .. 1111'1:1,·. In O$lot>r.>hina lhe Impo<t of obts~y hI1 )\Jnc1;»>tol III.il,lI;';'". " 1d ... 117'J.Il~)".J. 

"1<1 . 

.. BMI !Ios<,il>a Ihe "'I."".,.~ip bel,.".., h<1J;m and .... igh' .. 1(\ I. ';&ni"" .. ",), ,..",..10"'\/ ""h "".1 bi>Jr rll 

cou"OI. Oto;....,.iooividu.I."'uplo...... d l!Ho ..... or\lwctl ...... wjI<'IldingOll IlI<lr BMI. Cl_" J i"''' ...... indi.k\ .. l.o 

with. U~I h<1"~n ;O,O·H,9: Cl""" 1\ i.<:Ill<k!<i,Nli.;duol, ""I"'~""" 35.0-]9,9: lind Cta. ... 111 1",100"''''''''' "boo< 

IlMl ;, p".,<r lh"" 40. 

,,, ,I" 

"" '" 

" 

" ," 
147 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.108

p"""e<:dings where tile AU must d ivin" impli.it impairments. diagnose dj s.~bil lit"S lying 

c10$t' 10 Ihe listing crilerion and detect any aUIlI qnnpelling lunhcrdcwlopmcm Ilrll"" 

record. Nothin~ in our p~ent condones 511Ch wholesale disrcg.1rd "fthe I.J ~ 

;ldjudica1ory mle.~ 

6 

The majority disa!;",ed and ar! lK-d the AU had an obligation WhL~ viewing It.. ciaimalll in_ 

pc~n should have "Icned 1m, AU Iha11..., "e"ded 10 r"cilila ~ a mul1i.iml"'innCnl analysis. even 

though Ihe IlQIl_as""rtet/ "o ndilion (obt:sit)') was nol noled in the record." 

Two prublelllS cmcrgc from Cel"yo. Fi n t. m)' review or ca",s indk3\Q lha1 en," in ;nsJam:.", 

of claims file<! by illdividU.Jls wilh" B~ llP"a"'r (han ~O, lh"'" arc mulliplc decisions where lhe 

AU did not lis\ obesit)' as a .'ICV"'" intpainn"nl !~ Th .. -secllScs iliwmmc thalprn<:lilioncrs need to 

be ~\1'3'" \h31 funher d~vel pmellt of the record concerning the ,mpaci of weisht on hcahh or 

func!ional limillllion ilia), be lIe..,e"""r)', even f\lr indi vidual. wllOS<' weighl "ould c"ns!ihne 

Level Ill. Or morbid obesil)' .~ This polenlial pilfaJlI~ads!o 3 !;<:cond pl'Qbl~m Wilh Celu.lY'. 

"hich l'<)Ilcerns Ihe level of ddsilsbou! Ihe imp""l of oo""ily on he.hh and functional limilation 

the ml..:lical records will need to L~bli~h . 

Another IDea of concern rcg,arding the Agency's use or UMJ 10 evaluale obesilY COncernS 

claimant,; with IO"'er 11M Is. 11,e", .eiali""ly lo" 'er ie.d s of "be ... i!y ~ mas~ Ih" foct lhal lhe 

claimant's o besity hall in f:l<:l grcally c,'toc<,.b;Ili.x1 olhe. health concerns.'" As pn:viousl)' 

diSc .. ",s..-d. Ihe AQcnc{s cum::nt pNI""'ols for III<: ",·slnalion of obo::sil)' plae ... hea.,)' emphasis On 

'" (<i. 1M 11$6 II. R.o", lin"m. di~_lin&). 

" /d .• 1111 81 fl, 1. 

" Seo •. lo. I" ",. •• " •• ..I"" ••. , Il l I \ilL 113581(1 No, jol)';-cv 01 112 (M ... , 25. ,01 ljoIcI.i,,,,,,,r . II.\U ""'Il"'.lO' 

th:In ~O . 1>\11 ~ AU ""<lio«l ~ Ii"" <>b<i l~ "~ a ""v"'" "" ""irm'n' I>«:aw>: mcdbJ ~nU did"'" 1o"lcolC d oi",OflC·' obc>il)· ""11.«1 rUll<,,,,,,.1 )imiuui"""I' N~rI(J<' v. A>lrff •• !O 10 WI, !n 108 :-. ... , 4:I)9(V) 1(10 10<: •. 21. 

201 O~lksp '" 1I.'lt of ]j, rh< <1 lm ·~ """'11)' ,,'2< .. ~ d,-"",",I",-<0.1 ' 0 bt:. ""w,.., impoi""<I)II; f)wvu" ~,tnH!. 

W08 WI. 61 98 1J N". 7:07-CV_ISR {Ocl. 20. ,(\lt g~ J did"", liod u..t ,>bc$I'r "OJ, .. "'~ im""i"" ,,, okopilO 

",uhirl ... tilr<nc.,,; In 1M ",«llcnl re«)n,\, \0 u,. <l:Ii"""," . """"i ~ 1Ibr;it} ..... bo1' IIMI Of SI ~I : AdJ./ .. , ". Jil""', 

2011i \\'1. 5825428 No. HOCV60 (Sq.,. 28. ;oO lO)(,!eJpil< do;""".·, IlMI of 50, oOfl<iiliOll lI0II·,.,= ... \wI< lho 

<10.1",,,,,, did "'" o.I l0ll"_il) ... ""' .", in>palml.nl, _did b< l";lify", "'''''Y rh}''i<:al li",I",,,,,,,, caOl$t>lh)' 

""," .. ily), 11<"..,,, v. A,,,,". 20 10 \\'1. 2891149Nu. ,QIl.cV·1 42 ·A (lu .. H. 2010X"1J did "", m, ... 'i,,,,<loi,,,,, ~· . 

obully ikspi'" IIMI of .6 ): k1J4ft..-J ,. ""r . 201 0 11'1, 9114~ No. S:IO.("V-OOI/22·J ~Io ' ]~. 

2OIO){cl.i", .. "t"S 1l.\11 " .. ~O bUl ... IJ did n.ol dct<,-mifto tho, oo..i<) " .. . .,,"" .. imp. i"",," b<cou>< tho doif\UUl1 

did "'" '~'lJitY OS Ul h<-l m, i!\i! I'f<''''"f'''''' <)b<>ily II! t ..... lI<orinllJ; !los"'" I' . ..I <1 rw.10I 0 WL 29274,110 N". 

:09-CV.{jfj 2_T_~7 IJ oo .. 22. 010)l<loi i,n..,t" IJ~1J "., "" (" ... "" n "1><,, ~ kll <"' plu)mem but had bol.,..",.j 

10401' ("/II""",, , .. 4.<" .... ~ r,,!!. ApJ>X.. 7OO(,10l11 Ci,.l00.!l(h ..... l ... om-.. wll<t-t. ... U did not <<lU$iilr, 

clai",.nr ~l) (D~tI 40. 711; cj. F.tJr1)' ,. Aw...-. 1 F. Supp. 2" 1233 (N.D .... ta. 2007~t n"'" ha.l a UMI $-;'''''''' than 4U """ AIJ CIT<d "hen Ilc di<l "'" C<lfl<ider d ohnanl·' nbo:,il)" It! I>< I """= 'm!,,''''''-'''') . • , Sn 0/'" -zo,.,t •. C"",,,, "S<~. 5«" 290 h .... API'>" 493 (Jnl Cir. lOOh" "'I!.I!'-.lifl$ clai""",l c"uld "'( "-"I)" 1m 

ltif)! UMI "" oM ic>U$" ,ndies!OI" <If Iimit",j,>lUi. 

,. See •. &.. /l~f/itoi: . , ..I "'~., 2(\(l'1 WL ~ 17'1\3 No. Q8.(" -!I% (~ta)' 10.. !OOQ ';"'''''''~ fI~ 1I .... , 001)"-31 .5 bul 

AU r.til<'il,o <o",(dco. "l>cI.hI:r tI\o. "I" iln .. ·~ IIh<>ky, In ."",h;"",i,,,, "im "," ......, l'fOb!enl. limit«l Ocr oI>ili.) '" 

","alkI;P,,,A;s .. ..1,/"",. l W3 WL ~7559 Nu. CIV-07·1219.(} (Sept , 2. 2008}1 AU ~"«I hy r. il n~ l<>t"",ld..T ""'" 

,",inl''''·3 <>Ini1)' \8 MI Hj alT"",«l hi. rhrtlni< m"tnltlh. pulnu"""Y ~i' ... nk"): &!T~I/{' .. ,1.<"."". ~ 

r.s""".!d 414 {I}.lkl, 200S)( 1l.\t! 3j,'i and ,I>< AIJ r.iled 1<> idrnlify lobcslly ., ...... <fC iOI Pairm",,,,, 700_. /Jo"dwtt. 3014 '. S""" I 326 IN.D. Ala. 0l).1 ~AU id "'" <"""idn- the: <1>1",.",·, .>b.. .. i'y (IlMI JJ.7) in odd;.j"" '0 

lilT 0(110...- inlp4iml<o,", i""luoJill!lanhri'i,); $eg" I., &".,,/'..,1. ) 42 1', SUW.!d Jl8 (!J. D. PCM, 0l).1~cl.i"""'I· ' 

IIMI " lIS 121111l 1bt: AIJ <kIermi"«I Ocr~ cn: ;It!p.o'rm."", inc ll>lk<l ,·""",ie "1«""i\,.",,I),1 ... ,p"",k «I"'" or.d 

m;l!f>Iin ... boll kJ w c'-HI>""" "h< ho.. ~i ) inlll"" lc.i <ct1i,,""I.rwll'!\ln~ 'n1iQn.1 fun.:1iQn;t,.;'. 

I I "I ' >"I h ,to It, ! , " 

., III I • . I.... I 

,,, 'I' I., ,,, 
148 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.109

7 

usc of an applicanl'S 8i\,tI. While Ihe A};cncy d"". acO:fl{}wledgc in the Ruling thSI there arc 

allemalive mcans of e5lablishin~ lhat a claimant i~ 01><"<,,, till' Rul;ng'~ SU!!l>~.ljon thai IIMI can 

be an approprialc toolll. .... ..J 10 establish thai Ihe clainmnl is ubese CBIl5LOS two problems during the 

disability c"Mifica!;on pro<:css. I'i""t. "hile BMI ",~as<=s II", pre~~nce offal, it might nol be Ihe 

be'l hleasuremellllO idemil)' tn", po,iliw •. To this end. some ",,,,,archers haw slliled m\'11 is 3 

"nOisy" mcaSllrcmcfll of obesity b.:(;3""" il docs 001 dislinj;uish fal from ml=I~, bone, <'Ir olh~or 

lean boc.ly mass. RicharJ Burkhauscr of Cornell Un;""",;I)' compa",d IWO dclinitiollS of obesity. 

BMI and ""tWnl "fhody tal Ilis n:kan:h suggcslSll>al BMI mighL be 3 more u.cfulll"'dicior 

oflhe impact Molle'il)' On hea lth and funclioll3llimitBI;on for m~n bul not womCn. l'r<>f~'SSOr 

f)"rkhuuscr cOrli:lud .. -d thaI nm"n~ mcn, IlMI prod"c~d 14.2tW. f.~lse posilhes and 33.541% false 

nClYllivcs. Among "<lm~n.. Professor Ilurkh~uscr concluded lhal IlMJ did lJ()l produce any false 

polliti"es. bUI61 .25% d3ssi li ~1 as non-obese y,ere fa ~ ne~lhcs. Second, Ihc high nllmber of 

"'omco crrooeou51y classified 35 l1Of1-obcsc is p;lnic"larl" dislurbing beC"llUSC oflfo.! f."lellhal of 

the dislrict3nd oppc!llalc co"n decisi,)ns surveyed. over 70 per.::~nI oflfo.! ciaimanlS ,,"cn.' y,'omcn, 

nnd 1l1\·11 is nollhc besl mea.>uremel11 oflhe impilCI offMncss on hcallh for """men. 

The d<"<:isions in Rllllli.'rjorJ ", flu,,,/ulrJ and Di<r. illu:IlTllte tile inlponPI"K:( of llle claimam·s 

allegBlion Ihal o/x>sil" i5 a severe imp.1inncllt "" lite initial application lor bencfils (lr allhe 

hearing?' !Jolh R,,'hl'ljortiand 0/(/: invol\"ed two morbidly obese claimants: the claimanl ill 

Rutherford IIad a 13MI Qf 44.8 whereas Ihe daimant in Oia~ had a aMI 01"50.9. In RUlherforJ, 

lhe clainlnlll did 001 a llege Illal he,flbe!;;IY Will; a scvefl: impairment: bUI "'Iher; argw-d Ihal 

re ren'nce~ 10 hl'r obesit)' in the medical retord w~re ,ufficienlln pUllll~ AU On notice t1utthe 

dain18nL's weight CQuld bea f~clor in tile d""i.ion. Despite these ob"iou, ,i",llals orth~ 

claimnnt" s obesity. the R",iler[ord ~u n reason.,J the AU did nol specilically haVI' to nddn.'Ss 

the cl3imaru's obesity in his d".,isi,," bc<:auw Ihee daim3nl'S <k><:101"1 we", likdy aW3'" orh~ 

"obviou," dis.:tbility. w il was app~rrintl' for thl! AU to consider Bud adopt their opinions 

~"Qnccming her functioullllimi aliol1~ and inlp:1irmeuls. 

In Dia:, which followed Rutllcrford, the roun re:lChed a different re~"h. While Diu.did n\>1 

:lllc~ obesilY as a severe impaiml~nl. the diffcn'nc~ is 3uributable 10 llw AU's ncJmowledgment 

31 Slep 2 that lhe daimant"s ob..'Sity was a severe imp.1irment. Thi~ delC11J1 ;nation tri~~ Ihe 

AU's oblig;L1ion 10 consider htr obesity al Ihe otlwr Siers as require<! by SSR 02·01 p. 

Th~ ca~s ilJustmle poin ts ofvulne",biiily ill IIII.' procc-ss for a claion~nl. l:or e:<:ample. Diu: 

:lIl<l Rwlwr[arJshuw Ihm il is impl'flanl for ci:.;mHnts tu l"SlUblish utx:·sily:u a sev ... re 

imp..1'nncnt. Iflhe claimant alleges obesity as a d,sabli,,!: coml'I;"" ur Lh.,. AU dCle"nilles .hm 

obesily is a so:ycn: impainl1ent. revic"iol: cuu~ polell1iall" ~pl"(."1 Ihe AU 10 pru"id ... a mOf'<." 

sub!;la,ui\"c dis~ussjol\ oflJ()w a d"illmnT'S obesity rnay impact other impainnCIILS ur timetioll31 

" .';..v ul$<), /lawll •.• 1,..", •• )S7 Fod. App.' . 717, n J (7111 Ci •. 2009"11 «>10\ ";,,,,<"\1 <Iii"",o'., ~II""''"'" Ito .. AU 

,...mI by foil,ng "' roM,,,,,, II« t>b<o$''Y ba«J on i"~ r""" Ik ~ of 1M .... y pII,<i<ian "h<I-e 

cuiman! did "'" , II'g' ob<>ily ........ ,..", 'ml"'im'"n' k.B"w v. A."" ... l11 !'oSt API»' 767.771 , 10th Cn. 

2 001I1AIJ <orm:lly <I<.~<'lIIlin«l <>ild;,ty """" "'" ... , ...... ""1"'1mIc", w~ <1>0: <10'''""' Jid ""' &II,,&"< "!' /riMY. 

&"'/""', IJJ r",J. API'" !>$~ , ~90 1 IIh Ci,. 1~ "n'''''' diJ IOO! II I!" IY'" "" .. ro impoi",,""'- '" 

AU did not ~.v ) Ii" """",tl' ... ..,' .... ,ml'"inntnl " I>o.-fc IlI<rr- " '" "', mod;o 1 .... '<i<noc IN: ci."m" .. •• i'~ 

i~l<"<I n..,. ot>i lil~ '0 p<'f lOrrn m<"<li"", 1.,.1 "Ml, 

I""" ,I!' '''I 

-, 

, 

, )1,1, I " 

."" 
149 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.110

8 

limitations. 

F()J' exampk in Ems ", ,IJlm". the claimant applied for 551 allcgingdis.abililY on I~ oosis of 

anl1r;\;5 inlhe knees. h.,nds. and wriStS, diabe\c~. and high cholesterol; ot:flity was nol 

idenlifiL-d." At the ht'aring. the claimant h.'stilled thaI her cum'Il1 weight "3S 268 pOllnds bUI 

nuclUatcd \0 as hij!h as 298 PQunds." AI Slcp 2 ufd(c dl°cisioll. the AU fuund Ihat the 

claimant"~ obesity was 3 severe impainnent.'" Tile only olher rcrcn:nc~ \0 the claill1ant's obesity 

came !lloril1!; the discussion urSieI' J. where the AU acimow1cdgc>d his legal oblig;llion \0 

discuss Ihl' i"'pact of the cbimm'\"s obesity on other jmpainl1cnlS:" The court. ho"cvcr. fou"d 

Ihis di~lIssion in:ldcquatc and ""m31lded Ih., c,~ fQl" funller dcvclopmcl11 of how the.c!3imanl· ~ 

otx-sil1 impacted her bjlalcrull.:r~c disorder and her ability l<) walk and/or stand:'· Where 

ubcsilY hus b,,~n delellnirK'<llo be a sewre impainnenl. Ihe AU will hav~ 10 cxplnin in her 

decision how obc:silY jij,;ured inlo h~r d~tellnina.tiol1 al any point in the liw $Iep 'i<quential 

evalua1ion PRlCt''''''' or adapt lhe recommendatiol\$ ofd()C or~ "hD " 'en: RWnre orpl~intiffs 

obesity." 

A ",~iew of'lIse law suggo:sts revi(wing C\!UI'IS vary wilkly inlheir (xpettulions of how "'Us 

evalu3tC obesity during the fove-slcp ,;cqu~lIlial evalu31ion proccs~. In part. Ih .. differing rcsUlt5 

a,... 0 produci oftcn~ion betw""nthe ACI, regulation" ond SSR 02-1 p:- Il0wl'v"" the id~a Ih31 

3.11 AU ha, virtually no obli.,ation to furthe, d~\'elop genemli1:M points of evid~I\C~ ur testimony 

is somcwhm at Qild, with other regulaliolL'i and SSR 02-1 p. Sp<.'1:ilically, 20 C.F.R. ~ 

404.1545(3 ~3) pl'I)I'itics that before Ulaking a d~'1 .. nnination tm, claimant i~ not di:labled, Ihe AU 

has an obligation U) assiSllhe dnimam in developing Ihe record. Addilionally. SSft 02-lp al,. 5 

SU£g<'S1S Ihe AU lias Ihe J1I)we, 10 """k additional Suid3n~c fr'l)m a nH,dit'31 source 10 cI:lrify 

whelher tn.: individual hru; olxsity in situation, where the clinical recurds on y~orll.1in references 

to th~ dail\l~nfs high body weight,JI 

t'JOIw;lhstanding the AU 's Obligations, Ih ~ ",vkw of ease law indit'3le5 claimants should take 

~1~P'l to develop th~ ",rord " it h r<'Spect to I"" limilations ca u,;ed by oM.~iIY on lite claimant's 

funclional cBpiteity and the elTeet "fthe c'laimant's obf'sity in combinalion "itlt Olher medical 

impaillnenls, jI T his e:m M a dimtull hurdle for two re:tSOIJli. First. it is I>\)I neressurily cI~3J' 10 

/0 ,<;Ue" .• [lli. ,. Mil"", ~OW II'L 1817~~~· I 11:.U. 1'","" 20llil. 

'" !.I. .' "2-

" /d. "' /J. 

.. hi. ", 'j, 

" f:"h'iJ¥t o. ,'&lnf<'. S6~ 1'. SUM'. 2d 42~, ~j~ ftl. IkL 100~)_ 

., See C,l' ,It ~ ~O·1.l S21fhl. I~ic '"'" ""1"·'li •• ;I\<I\OIJo pIoy.;';;'1 rlm<I;"" •• ll<h ... al~;"", .""1<Ii",, "n;ng, 

IIntog. pushlnt- polling. """,hin;;, <lIT) ing. '" ~ling: """",'I"", Ii>< ,,-... ing. II<ar,n& ""<I ~l:1g: ur>doB\.:lndlng, 

UII'f)'I"i ,,' .... )Old "'''''''''""''''1\. "mplc ;"''''IIC';'''''' _r,rjlldgn"",~ ~ldini awrurn.tdy «, ""P<"";'~"" .". 

~un""' .... """,I ,,'un ",1 ... 1,,,,,,, """ ""aliI1\!. "ilh <~, in 3 l'I>UIi"" ""'~ "'lti"i. 

" Tho Rul;1I$- ~\ ... "", """.""...,.,tli<lilOjj . ui.J.r.ce.....,.., .. I .. nal ... n\.O"". in r~ ~ JI., ... ihju\\'",''', 

in n~'~ 'll<h <oso, w<:- ,,;11_ \>Ill' jlld);f>le.H I" <S1.blilh 1110 ~ Qr' <>tocs-ill' ~~ on II>< mod",al findin!!) ~rld 

UIIIOt' .... ;~""". ;n the..".. ,""un!.. ... n ir I 'reali". , .. "".mini"1I. .... "". b;. ,"" irldi""",d I ~;;qp><""," Tit" is ~""" lin O)IQ,nrIC of a com.,uniNlions prool<'lll I.,,, catllmptJr 1111> fun",-'I'IIIlC~ of A&-,,) jOOI •. 

s,.~~ J!. Cu.",1 ", ,W""",)55 1'<'<1, AW". ~OO, ~l01lll1hdr, ~lliI'lXtt!COfd di~ IlOI ""ohl;"h ,I""""n',,,,,,,"'!} ""'"I"'IlI~ on~ f"","Ii","1 lin'liIOli<>r\$). My 1'<' i<w d,d fin.J ... '"",1 in>llrlC<S Qf """" do".-\or,"o"1 ~f!he """'1"1 

=~.-d, rOt "'".'rl., in RuU"'rf.....t.I'" IIIJ h<ld 11><,...,'<lf\I "I'-.. r",lIIi<tyIill)J 011",11", iI<-..n"ll k' "-,,oil,. 

:OikllliCHlOl n'<,;N> r"Prdi"~ • ""1,,,orDrjo r""'I"'" t<;;L but th< clai",,,,,, "' .... ~ Jl"l' j,j,.,.. r.rth< ... lkot"""'lIIO.ti"'lI/lln 

I, .' H 11-."," , ,,,I,, \ .,t 

" • , .. , I ~, 
150 

f 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.110-1

9 

whal extentlhe medical rcrords have 10 discuss tile claimant"s obesity. For instance. single 

refcrcnces in the claimant's file \0 his or her obesity may be insufficicnllo establish obesity as a 

severe impainnenl.J

! Additionally. in Guadalrq>e v, Barnhart. the AU did not have to consider 

Ihe claimant's obesity where Ihe claimant's medical records described her as obese. but she was 

not diagnosed as obese nor did the claimant's doctors suggest hcrobcsily «mtributcd 10 her ocher 

impainncnts.}$ The SI'Wfld probl\:m is that Ihe AU may alSQ CX~ the medical records to 1>01 

only di agnose the claimant wilh obesity, but also 10 discuss the impact ofth" claimant's obesity 

on hcallh Or functionallimitation.J1 More specifically, the claimant may have 10 pmduce 

medical records that explicitly discuss how Ihe claimant's obesity afTe<:ls her ability 10 work.ll 

CONCLUSION 

Two refonns are necessary. First. the Agency should revise its protocols for the evaluation of 

obesity so that greatcr accuracy and consistency in decision making can be achieved. My second 

conclusion is that the Agency should develop other criteria in addition to BMI that can be used to 

evaluate the epidemiological link between fatness and health. 

Please let me know if I may provide you with any further information regarding my researeh. 

Regards. 

Chris Pashler 

oou1d ha,' •• stablished lhe """"",,lion betw •• n her <>besily atId her ",,,,,,·,,,1.10<1 limilalioo •. R",i>eif<»'<l. 399 F. 3d 

at 554. See ol ... RkhJbat.gh v. AsrlW. 20tO Wll t421).11 (2010)(physid.n <"",,1000<1 .. '= rodOXlioo in maxi .... 1 

'~Iilolory ''''I ...... 00 pulmonary fUlKlion leSl but lhe <I.im.,,1 dialed «> ""bmil oddilional .. 'ideno:e ~ 

" S«e,g. fk»,'W' v. C"",,,,, .. lonerofSo<t/«1 Sec"';f)·. 121 Fed. App:<. 231. 236 (9tlI Ci •. 2(05)(medkal reoo«I 

"""l>.inod """ ",r ... """ from the .... !ing phys;';ian that lh<d.irrwn ",.. ... ); PrrxltashJ v. /J(Jmh,:,rI. 454 F. 3d 

731. 737(7th Ci,. 2006Xonc ~tingphy,ic"n di~ cI.imant ...... atId.,...." med;';al tq>QfI> «Iiro"pon 

~ AU noted claimant', h<ight and "eight). 

Guodalup< v. Bam""rI. 2005 WL 203380 No. 0-I-CV·7644 (S.D.N,Y. A"II.24. 2005). 

" Sa WieJe v. A"",.,. sn .', 3d 728. 732·33 (8th Ci,.lOO9)(clairrwn·, med;';a l rcc<>rd< ind;.;.tro .... had bocn 

di~ "ith <>besity. but ~di<l "'" ~ ...-hal the impact " ... 00 "' .... impoinn."" ",...-hat th<limilina 

.rr..,1 ofher <>besily " ... ~ 

.. C,.,</f .. /J ... c""'''', ofS«. S<\-.. 57 F. 3d 500. S04(3d Ci •. 2(09). 

II'I \Y 14: 

" 

I 16 ... 1·\10 , , 
151 

NHCHC, Statement 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.111

WRIITEN HSnMONV 

Of SARAH ANDERSON, ),D .. CHAIR. SSIIASK FORCE, NATIONAL HEALTH CARE fOR THE HOMHESSCOUNOl 

10 the 

AprH 1, 2012 

SUSCOMMITIEEON melAL ~ECURIrI or THE COMMmEE ON WAYS AND MEANS 

UNITED STATES HOUSE Of REPRESENTATIVES 

Chairman fohnson.. R~nk'ni! Member8t!cerra .• ~d Membel1 of the Subcon.mlnee: 

Than~ VCU lor the opportunltv to .ubml! "'rinen tenlmonv for tile "",ilrina before the H""le WaYland Means 

Commlnee SUbcommitt ... on Sot,al Secu,'ty on How Di'lolbJiity In,,,rance [llgibility Decloion. Are Made, n .. 

Nation~1 Iiea lth cale lor 'he Homeless Counc~ i. iI mtmbe"hip organization comprised 01 o~, 100 

0'llani.atlon31 membefs ilnd O\lO!r 1.000 Indi\'ldval m_ben who work ' 0 improvelhe r.ealth of people 

e.periendng P\Omele .. ness. NHCHC organizational membe<s Itldude IIrilnlees I<\d ,u!xoniraClors of . he 

fe<!e",1 Heakh Care for tn.. Home"' .. fundin,'trum. other health care pro"~" and advuCKV o"an],aIloM. 

In 2010, ou, member, se~ "U,ly ooe million horne len Pillenll, ma,...,. of w,"",m 11;1"" dl$ill>l~ie •• The SS4 

Ta,k fDfce oltht Nation.ll Health c.~ lor the Homeless CouncIIINHCHC) ilnemplS to eliminilte """emit 

barrie" 10 acce,<!", !lo,m"lit. lor po!OpJe who have a disability nd are cOlIC'Urrently e'fI"riendnl 

lIomele<s~s. 

DI$ilboI~y <~.e. and p"""",, oomele .. ne ... AbOut 15" olthe "",,·Institlltlonali,ed U.~. _~I.tlon is 

di$ilbled. ~et people ,..\til dilibilitle~constiW!e lnti of peoQ\e wr.o .re ~e"'ss In Ame,k •. u 0lminbh1na 

affordable 110".1l1li, dep' ..... d wages. hl&t!<!r un"",l>4ovrnenl. and de<1Used aue .. to hea lth I",,,rance 

"!\Ie""e over the pa" lwo d"""doe< has III..,ed an Inc~.slnl n~mbe, of Ind ividual, .M lamilles "'~h 

di •• l>litie. at o.~ of homeleuness, and m.~e$leavifli homeiessne .. mO,e dilllcult ... well. 

Oisability .,.;'Ulnce un m,Ugate ,he he.Tth .4k, .ssodated with homeless"~ .. SuwlernentaJ 5e("ri\y 

Income (5!o1) and SoLlal 5e<:urllY DI",bllIlY In,uro,." ", (5SDI) constitute. ",lelV fll't lor pe1SOns wllh di",bllllle,. 

p,,,,,,din, <;;I.h u-u,ance "n<I, u""lly, eli,ibility for pul>idy .uppor1e<! hulth in.u ... nce MP<lI<lIid/Medlc "~I . 

Those who r«eive SSt/SSOI .,ealoomore likely to beeliglble lor low...:o.t l\ou1ing. Itldudin8 IU~POr1ive 

hous!r1li. Hou.lng alleviates the ext,aordinary heallh 0."" nsociitO'd with ~omele"""", I!l(pedlte. ,«overy. 

improves qu.l~v 01 life. and helps beneflclilrleS .chle"'! Mabllity and ,ewme productivity. 
152 


wwoods2 on DSK499XVN1PROD with WAYS & MEANSInsert here 78671a.112

~o", ",'i"I diwbilily i> mo,~ d;ffi<u~ IOf ind"Id ... i> ~."",......a", """"'lei",.,,,. MrdaJ ,«<><11> ~nd 

<It;"1 lUI_ ital Ootume<l" " .. ded ." ,;,omonuno .. luort""",iily .rod m. du, •• 1oro of 1Iiw~ <ond~"'", .'" 

often dis".' ..... .,..",. manv eme'i"ocY ,oem, .nd "',pi'." "~e'e .hose. W".tl>oullnsu,aoco: 1\.0 •• SCUI"' 

.. ,e ln ,n. p.m . n.n. '<'<0'''' ... o lt ... i1Komp\ele """ ncI '_Jh enouJh In ,t>t ..... 1\oe> '0 OI$'~""'h 

dorumen .. tIc>n ,,',," 'lme. Ii_ ,1\.0, 1II<IU .end ,0 t.. epl«H:lO<. In _16<>n. IndMdw t, WIt/1 ",'Iou> .... n\.ill 

U"-'. d"".l<>prnen,"1 del ...... 0' 0.1Ie. </liI"I"'eIlTlP. I,menu ~ NIl two Oblo .0 ' ..... "" .. , w""'. mo,e 

lIO,ml .. O' ,eco,d. "ov be Ioco.ed (, •.•• ,lie "I.,e Ind 10<1"0" of .1Ie1 •• ",.,.n ...... _, 1Ie~ Ptim . ........ p,_' ... n .<IoI ... e"" fl~.' . LioIl1l In ........ ceocY lnell .... nd or> It>t W.fl .100 mo'e. ft'Iolnlllt 

docu .......... U,,,, .nd ill,,,,\Woution m< ... ;!fl<u~ _""po" " e olten ""Md by _.'!>e<. >!olen D.Io>t, Of 

dC>Ct,_ by to"""''''''' off",,,,, Ui>C"'!iO"UI. A" of ,_ fKl. ... ",o~e doru",""llrl, d ... bmto; "'''''h "'OM 

dilfl<"~ . 

Ha~ .. ~fUOI ,"lmo,u.oIten a.-. eSe,"ed be .. li .. '0' I.i ..... . 0 mHt .t>t ,....,Iro/Mn" 010" ",''''''', 

.pllllC.tkm ~ .. , .. lie, ,~." 10' I,d of "'''0''' ,,"'dleal ""PI'tl'l1If>i' , ............ SSA diw..-ito; crit'~I . 

5VoI..",l< Dime .. inl:kldellOl>f .,ce.,,!O lleo l! ~ 0;0'0. ""ufflo:i<n, 110<""",,,, .. ,,,,, of dfl,_ Ind fUncI",,,"1 

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