Disability Programs: SSA Has Taken Steps to Address Conflicting Court Decisions, but Needs to Manage Data Better on the Increasing Number of Court Remands
Published: 2007-04-05T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: The Social Security Administration's (SSA) Disability Insurance and Supplemental Security Income programs provided around $128 billion to about 12.8 million persons with disabilities and their families in fiscal year 2005. Claimants who are denied benefits by SSA may appeal to federal courts. Through current initiatives, SSA is attempting to reduce the number of cases appealed to courts and remanded back to SSA for further review. In addition, there have been long-standing concerns about how SSA responds to court decisions that conflict with its policies. GAO was asked to examine: (1) trends over the past decade in the number of appeals reviewed by the courts and their decisions, (2) reasons for court remands and factors contributing to them, and (3) SSA's process for responding to court decisions that conflict with agency policy. GAO reviewed SSA data and documents on court decisions, remands and SSA's processes and interviewed agency officials and stakeholders on data trends, reasons for remands, and SSA processes.
section_title: What GAO Found
paragraphs: Between fiscal years 1995 and 2005, the number of disability appeals reviewed by the federal district courts increased, along with the proportion of decisions that were remanded. More disability claims were remanded than affirmed, reversed, or dismissed over the period, and the proportion of total decisions that were remands ranged from 36 percent to 62 percent, with an average of 50 percent. Remanded cases often require SSA to re-adjudicate the claim, with the result that--along with the passage of time and new medical evidence--the majority of remanded cases result in allowances. According to SSA officials and outside observers, a range of errors prompted by heavy workloads is responsible for court remands of SSA's disability determinations, but data that would confirm or clarify the issue are incomplete and not well-managed. SSA has only recently begun collecting data on remands, and we found these data to be incomplete. Additionally, this information is collected by two different offices that have created somewhat different categories for the data, making some of the information inconsistent and possibly redundant. Meanwhile, SSA has acknowledged the need to reduce remands and, in 2006 along with other initiatives, introduced new decision-writing templates to improve efficiency and reduce errors. SSA has a process in place for determining whether appellate court decisions conflict with the agency's interpretation of disability statutes or regulations and has taken steps in recent years to align its national policies with appellate court decisions. For example, officials and stakeholders attributed a downward trend in appellate court decisions that conflict with agency policy to significant policy changes instituted by SSA in the mid-1990s. In addition, for those cases where the agency acceded to conflicting appellate court decisions by issuing acquiescence rulings within the related circuits, we found that about half of the rulings issued were eventually replaced with national policy. Moreover, GAO found that the timeliness of acquiescence rulings had improved since 1998, when SSA established a timeliness goal of 120 days.

section_title: Letter
paragraphs: In fiscal year 2005, the Social Security Administration (SSA) provided  In fiscal year 2005, the Social Security Administration (SSA) provided  approximately $128 billion in cash benefits to about 12.8 million persons  approximately $128 billion in cash benefits to about 12.8 million persons  through the nation’s two largest programs for persons with disabilities and  through the nation’s two largest programs for persons with disabilities and  their families—the Disability Insurance (DI) and the Supplemental  their families—the Disability Insurance (DI) and the Supplemental  Security Income (SSI) programs. In administering these programs over the  Security Income (SSI) programs. In administering these programs over the  past decade, SSA has faced challenges associated with lengthy decision- past decade, SSA has faced challenges associated with lengthy decision- making processes and difficult disability determinations. In an effort to  making processes and difficult disability determinations. In an effort to  introduce more efficiency and fairness in its decision making, SSA has  introduce more efficiency and fairness in its decision making, SSA has  undertaken a “Disability Service Improvement Process,” about which we  undertaken a “Disability Service Improvement Process,” about which we  offered testimony in June of 2006. Among the problems this initiative is  offered testimony in June of 2006. Among the problems this initiative is  designed to address is the number of SSA disability decisions that are  designed to address is the number of SSA disability decisions that are  appealed to the federal courts and subsequently remanded or referred  appealed to the federal courts and subsequently remanded or referred  back to the agency for re-adjudication. Such appeals and remands can add  back to the agency for re-adjudication. Such appeals and remands can add  several years to the time it takes disability claimants to receive final  several years to the time it takes disability claimants to receive final  decisions on their applications. Most appealed cases are reviewed only by  decisions on their applications. Most appealed cases are reviewed only by  the district courts, the first level of court review. However, if a disability  the district courts, the first level of court review. However, if a disability  claim reaches the appellate court or Supreme Court, the decision may  claim reaches the appellate court or Supreme Court, the decision may  have implications for SSA policy. There has been a long-standing concern  have implications for SSA policy. There has been a long-standing concern  that SSA does not respond adequately to appellate court decisions that  that SSA does not respond adequately to appellate court decisions that  conflict with its own policies by taking timely and appropriate action to  conflict with its own policies by taking timely and appropriate action to  reconcile them.  reconcile them.
You asked that we examine: (1) the trends of the past decade in the  number of appeals reviewed by the district courts and their decisions; (2)  the reasons for court remands and factors that may contribute to the  incidence of those remands; and (3) SSA’s process for responding to  appellate court decisions that conflict with agency policy and the agency’s  response in recent years.
To address the first research objective, we analyzed data from SSA on the  number and types of decisions made by federal district courts for fiscal  years 1995 to 2005. We also grouped and analyzed district court decisions  by circuit for fiscal year 2005, the only year for which complete data by  circuit were available. Furthermore, we analyzed agency data on the  decisions SSA made after a case was remanded (i.e., allowances or denials  of claims) for fiscal years 1995 to 2005. We also analyzed these remand  data to identify trends over time and by circuit, a category that we created  using SSA data on claimant state of residence. SSA officials were  interviewed to gather information on potential reasons for any trends. To  address the second objective, we obtained data on cited reasons for  remands from two SSA databases that are maintained by two separate  offices in SSA responsible for litigating claims in court and re-adjudicating  remanded cases. We compared the data to determine how effectively SSA  was capturing information on reasons for remands within the agency. In  addition, we interviewed SSA officials and other stakeholder groups,  including federal court judges and claimant representatives, on reasons for  remands and factors that influenced them. For the third objective, we  interviewed SSA officials and obtained available documents on how SSA  determines whether a court of appeals decision conflicts with its policies  and what option to pursue to address conflicting decisions, e.g., appeal or  issue an acquiescence ruling whereby the agency agrees to abide by the  court judgment in future cases, albeit only in that jurisdiction. We also  obtained data on the number of acquiescence and other rulings that SSA  issued since establishing its regulations on acquiescence in 1990. For  acquiescence rulings, we further reviewed SSA’s timeliness in issuing  acquiescence rulings, as well as the number issued by circuit and how SSA  replaced acquiescence rulings with nationwide policies. We were unable  to independently determine how significantly any given court decision  conflicted with SSA policy or whether SSA should have pursued one  option over another. We also interviewed SSA officials and relevant  stakeholders—including selected federal court judges and claimant  representatives from the Seventh and Ninth circuits, which represent  those with the lowest and highest numbers of SSA policy changes  associated with acquiescence rulings—to obtain information on how court  decisions and their related agency rulings have affected SSA’s disability  adjudication policy in recent years. After interviewing officials and  reviewing related data reports and manuals, all quantitative data used in  this report were assessed and, with the exception of the reason for remand  data, were determined to be sufficiently reliable for the purposes of this  report. Issues related to the reason for remand data are discussed further  on pages 20 to 21. All work was conducted between February 2006 and  January 2007 according to generally accepted government auditing  standards. See appendix I for more information on our methods.
subsections: section_title: Background
subsections: section_title: Disability Determination and Administrative Appeals
paragraphs: In fiscal year 2005, the Social Security Administration (SSA) paid  approximately $128 billion in cash benefits to about 12.8 million  beneficiaries through the two largest federal programs available to  persons with disabilities and their families: the Disability Insurance (DI)  program and the Supplemental Security Income (SSI) program. Both  programs serve those who are medically determined to be unable to  engage in any substantial gainful activity due to a severe physical or  mental impairment that is expected to last at least 12 months or result in  death.
Claimants must apply to SSA to receive disability benefits from these  programs and if awarded benefits, claimants may also have to requalify for  support through what are known as continuing disability reviews. In most  of the country currently, claimants who are denied initial or continuing  benefits by SSA may appeal their denials administratively up to three  times, each time for review by a different adjudicatory entity. These  entities are 1) the state disability determination service that performs the  initial review of disability claims and, in most states, a reconsideration  determination, 2) an administrative law judge (ALJ) in SSA’s Office of  Disability Adjudication and Review, and 3) a group of appellate reviewing  officials within SSA known as the Appeals Council. The number of claims  or appeals reviewed at each level in 2005 were: over 2.6 million by state  agencies, almost 520,000 by ALJs, and over 94,000 by the Appeals Council.
Disability determinations at all of these levels are often complex and  necessarily involve some degree of subjectivity by adjudicators, and the  nature of these decisions have contributed to long-standing concerns  about the extent to which adjudicators across the agency consistently  interpret and implement SSA’s national disability policy. To help achieve  more consistent application of policy between the state disability  determination service level and the ALJ level, in 1996, SSA established the  process unification rulings, a set of nine Social Security rulings for all SSA  disability adjudicators to follow in matters involving difficult judgments,  such as the weight to be given to opinions of claimants’ treating physicians  versus medical opinions from other sources, and the evaluation of pain  and other subjective symptoms. See appendix II for more details on  process unification rulings.
section_title: Cases in Federal Court
paragraphs: After claimants exhaust all administrative review options within SSA, they  may then appeal their claims outside the agency to federal court. A  claimant must first file an appeal with a federal district court within one of  12 federal judicial regions, known as judicial circuits. Figure 1 provides  information on which states and territories are included in these circuits.
In deciding the case, a district court judge or magistrate usually either  affirms an agency decision, reverses the decision (essentially affirming the  claimant’s case), or remands it back to SSA for further review. According  to SSA officials, remanded cases are generally reviewed by the ALJ who  made the original decision. Judges can also dismiss a case if its scope is  outside the court’s legal jurisdiction.  Furthermore, if SSA prefers not to  defend a case that has been filed, usually because of an error it has  identified, the agency may request that the judge remand the case back for  the agency’s review.
Court remands have implications for SSA’s workload, the types of  decisions SSA adjudicators make on remanded cases, and the time  claimants must wait for decisions on their cases. Generally, when cases  are remanded, ALJs must perform new hearings, which could involve new  evidence presented at the time of court reviews. These remanded cases  add to the already high workloads that ALJs have in reviewing denials by  the agency’s disability determination service offices. The load may also  affect ALJ decisions: In its September 2006 report, the Social Security  Advisory Board found a small correlation between increased ALJ  workload and increased allowances. Furthermore, although remanded  cases are given priority in the line of cases that must be reviewed by ALJs,  a substantial amount of time may pass before new decisions can be made  at this administrative level, and the ALJ’s decision may undergo another  review by the Appeals Council. In fiscal year 2006, it took SSA nearly a  year on average to process court remanded cases from the district courts.
After a district court decision, both the claimant and SSA may appeal the  case to a circuit court of appeals (also called an appellate court) and,  beyond this, to the Supreme Court. However, few cases reach these  appellate court levels and most disability cases are resolved in the district  courts. According to SSA, no more than 20 district court cases have been  appealed by the agency to the appellate courts each year since 2000. The  Supreme Court has only reviewed four cases involving disability claims  since 1991. See figure 2 for an overview of the disability appeals process.
section_title: How Federal Court Decisions May Affect SSA Policy
paragraphs: SSA is not obligated to follow a district court decision that conflicts with  agency policies beyond that specific case. However, the agency is  required to follow appellate court decisions for cases within that circuit,  unless the agency seeks further judicial review.  If the Supreme Court  issues a decision, SSA is bound to follow the decision nationally.  Several  district, appellate, and Supreme Court decisions have affected disability  policy in the past two decades. Appendix III outlines some cases that have  resulted in such changes.
SSA implemented its current policy of acquiescence in 1990 in response to  the concerns of external stakeholders, including claimant representatives,  that SSA had failed in the 1980s to offer timely and appropriate responses  to appellate court decisions. With the acquiescence ruling, SSA agrees to  follow the appellate court’s holding on new cases only when they fall  within the jurisdiction of that appellate court. SSA rescinds an  acquiescence ruling if one of the following occurs: 1) the Supreme Court  overrules or limits the relevant appellate court decision; (2) an appellate  court overrules or limits itself on the relevant issue; (3) Congress enacts a  law that obviates the acquiescence ruling; or (4) SSA clarifies, modifies, or  revokes the regulation or ruling that was the subject of the pertinent  appellate court decision.
section_title: Disability Service Improvement Process
paragraphs: With new regulations issued in March 2006, SSA began implementing the  Disability Service Improvement (DSI) process in August 2006 on a limited  basis—i.e., in states in the Boston Region—and plans to gradually roll out  the initiative to other regions.  The regulations include changes to the  appeals process within the agency that could potentially affect the number  and types of cases that will go to federal courts in the future. Among these  changes is the gradual replacement of the Appeals Council with a Decision  Review Board, designed to ensure the accuracy of SSA decisions and  reduce remands from federal courts. The Board would only review select  cases based on whether they are considered likely to have contained  errors or involved new policies, rules, and procedures. Under the DSI  process, claimants who are unhappy with ALJ decisions, therefore, could  no longer turn to the Appeals Council, but rather must appeal directly to  the federal courts. In our June 2006 testimony, we reported that the public  and stakeholders were concerned that replacing the Appeals Council with  a Decision Review Board may increase the number of cases appealed to,  and thus the workloads of, the federal courts. In its response to these  concerns, SSA officials maintained that DSI improvements will ultimately  reduce the need for court appeals and also reduce remands. As part of its  DSI initiative, the agency is making a systematic effort to collect and  analyze data on court decisions in the course of training staff and keeping  ALJs current. Such monitoring and data collection are consistent with the  Office of Management and Budget’s and GAO’s internal control standards  for all federal agencies.
section_title: Court Reviews and Remands Have Increased in Recent Years with Remands Often Resulting in SSA’s Subsequently Awarding Benefits
paragraphs: Between fiscal years 1995 and 2005, the number of disability appeals  reviewed by the courts and decisions to remand these cases increased, and  in the majority of remanded cases, claimants were subsequently granted  benefits by SSA. In 2005, the year for which disaggregated data were  available, GAO found the proportion of remands by district courts varied  significantly by circuit. However, GAO did not find substantial variation by  judicial circuit in SSA decisions on court remanded cases.
subsections: section_title: Cases Reviewed by District Courts Increased over the Past Decade, as Did the Proportion Remanded Back to the Agency
paragraphs: We found that federal district courts reviewed an increasing number of  disability cases over the past decade, which corresponded with the  increasing number of cases processed by SSA. Although the number of  cases reviewed by federal district courts fluctuated over time, they  generally increased by 20 percent from about 10,300 in fiscal year 1995 to  about 12,400 by fiscal year 2005. (See fig. 3.) According to SSA officials,  the increase in the number of claims reviewed by the courts may be a  result of the increase in the number of claims that passed through the  Appeals Council, SSA’s final decision-making body, over the same time  period.
Over the same period, remands were generally the most common district  court decision, and their proportion increased by 36 percent from 1995 to  2005. Of those SSA cases decided by the district courts on the merits and  not dismissed, 50 percent were remanded, 44 percent were affirmed, and 6  percent were reversed on average. (See fig. 4.) Notably, the proportion of  remands reached its peak in 2001.  Although a range of factors may affect  the extent of court remands, some SSA officials suggested that the Appeals  Council, having reviewed a record number of ALJ decisions in 2000, may  have made mistakes in a greater share of cases that were subsequently  appealed to, then remanded by, the district courts.
The proportion of remands exceeded the proportion of affirmances in  1997 and continued to increase until 2001. Specifically, in 1995 only 36  percent of SSA decisions were remanded by the courts while 57 percent  were upheld or affirmed. However, by 1998, the proportion of remands  increased to 49 percent, while the proportion of affirmances declined to 46  percent. When we showed SSA officials these trends, they generally  attributed the shift to the process unification rulings, which the agency  had established in 1996. According to SSA officials, the increased remands  reflected district court efforts to assure that SSA adjudicators were  following the agency’s new procedures.
section_title: The Proportion of Remanded Cases Varied by Circuit
paragraphs: GAO found substantial variation in the proportion of cases remanded by  judicial circuit in fiscal 2005, the only year for which data by circuit were  available. (See fig. 5.) Although remands and affirmances were the most  frequently occurring types of decision in each circuit, the proportion of  each varied considerably among the circuits. Specifically, the percent of  remands ranged from a low of 35 percent to high of 78 percent, while  affirmances ranged from 22 percent to 61 percent.
SSA officials were not in agreement about why there might be differences  in the types of decisions across judicial circuits. According to some,  differences might be due to judges in different circuits interpreting  disability laws differently. Others told us that disparities in the number of  claims appealed to district courts across circuits may contribute to these  differences. (See app. IV, fig. 14 for more information on the number of  cases reviewed by circuit for fiscal year 2005.) Currently, SSA does not  have sufficient data that would allow them to determine why these  decisions vary by circuit but plans to obtain this information as part of the  DSI process implementation.
section_title: In the Majority of Remanded Cases, Claimants Were Awarded Benefits
paragraphs: Of the 57,000 cases remanded by the district courts between 1995 and  2005, SSA awarded benefits to the majority of claimants—about 66  percent—upon re-adjudication, with the remainder being denied (about 30  percent) or dismissed (5 percent). (See fig. 6.) Agency officials said the  large percentage of awards in remanded cases were due, in part, to the  fact that the lengthy period of the appeals process increased the likelihood  that the nature or severity of claimants’ disabilities would change. The  officials also attributed the awards to information in the court’s written  judgments that made it possible for ALJs, in reviewing cases anew, to  make more accurate decisions. The proportion of allowances in court- remanded cases after re-adjudication is just below the average allowance  rate of 70 percent for all ALJ decisions.
We did not find substantial variation in SSA decisions on court-remanded  claims across judicial circuits. As shown in figure 7, the proportion of  allowances for remanded cases ranged from 62 percent to 72 percent by  circuit—relative to a national average of 66 percent.
section_title: Remands Have Been Attributed to a Range of Errors Caused by Heavy Workloads, but SSA Data That Could Shed More Light on the Problem Are Inadequate
paragraphs: According to agency officials and stakeholders, a range of errors  precipitated by heavy workloads is responsible for court remands of SSA’s  disability determinations, but SSA data that would confirm or clarify  reasons for remands are incomplete and not well managed. SSA has  acknowledged the need to reduce remands and in 2006, along with other  initiatives, introduced a new writing tool for ALJs in order to improve  efficiency and better document decisions. However, agency data that  would inform the problem and help address remands are incomplete and  not well managed.
subsections: section_title: Stakeholders Attribute Various Reasons for Remands to High SSA Workloads
paragraphs: Stakeholders commonly cited two reasons for remands: written  explanations that did not support the decisions and inadequate  documentation of consideration given to medical evidence. They  expressed the view, however, that errors made with respect to  documenting decisions were due, in large part, to heavy SSA adjudicator  workloads. Poor decision writing by ALJs and their staff was cited by all  groups of stakeholders we interviewed, including SSA officials, district  court judges, claimant representatives, and other stakeholders.  Specifically, district court judges said they did not always believe that  SSA’s decisions were wrong, but that the written explanations did not  always support those decisions. Some claimant representatives said that  poorly written decisions may be symptomatic of improper consideration  of evidence and procedures by ALJs.
With regard to the inadequate documentation of consideration given to  medical evidence as a reason for remands, district court judges and  claimant representatives we interviewed said ALJs either do not document  how they weighed treating physicians’ opinions and assessed claimant  statements about pain and other symptoms, or they do not consider them  as required by the process unification rulings. ALJs we interviewed  responded that addressing such evidence is sometimes very difficult and  cited cases in which the treating physician appeared to be simply  repeating claimants’ opinions about their inability to work, rather than  offering substantive information about the conditions that would prevent  work. Some district judges agreed that considering and incorporating  medical evidence into a decision can be difficult, but stressed the  importance of articulated and well-documented opinions in order for  district court judges to make a decision other than to remand.
Stakeholders we interviewed varied in their opinions regarding whether  requirements of the process unification rulings were overly cumbersome  and, therefore, resulted in remands. Members of the Appeals Council and  the Social Security Advisory Board staff we spoke with believe that the  process unification rulings provide important guidance, but have also  made procedures for making decisions and decision-writing more  cumbersome. On the other hand, representatives of the Association of  Administrative Law Judges told us that they have not heard such  complaints and, while acknowledging that decision-making involved more  work, believe the rules did not make decision-writing overly cumbersome.
At the same time, many of those we interviewed, including ALJs and  district court judges, said the heavy ALJ workload was behind the  apparent errors in documenting agency determinations that lead to  remands. Some ALJs asserted that the frequency of court remands has not  been unreasonable considering the number of cases that they must  review. These ALJs also said their workload expectations of 50 to 60  hearings a month affected the time and attention they could give to each  case. They asserted that they would need to write significantly fewer  decisions in a month in order to assure that the work would withstand  scrutiny by the federal courts. They noted that other ALJs who are able to  write decisions that the courts uphold produce as few as five a month.  Because the time needed to review cases and write decisions varied,  however, representatives of the Association of Administrative Law Judges  were unable to suggest an ideal number of cases that would be reasonable  for ALJs to process. Specifically, these representatives said that decisions  to deny benefits take substantially longer to document than those  involving allowances. These representatives also stated that the number  and quality of staff that ALJs have available to help process and write  decisions vary.
Finally, stakeholders also suggested that a variety of other factors  contribute to remands, such as: ALJs’ providing poor instructions to  decision writers, SSA’s not providing adequate feedback to ALJs on  reasons for remands, and federal courts’ having bias against ALJs’  decisions. Some stakeholders further stated that federal court bias may be  rooted in concerns over how well decisions are generally written,  expectations about how determinations should be made, and concerns  with the amount of time and attention given to cases under the current  workload.
Acknowledging the need to address remands from the federal court, SSA  is taking steps to mitigate common documentation errors. One step has  been to promote the use of a decision-writing tool known as the Findings  Integrated Templates (FIT). This tool contains more than 1,600 templates  for presenting analysis of evidence and ensuring that required statutes and  regulations are followed. These templates are also designed to prevent  common mistakes, such as failure to establish an appropriate date for the  onset of disability benefits. SSA officials also said this tool is intended to  help manage workloads by reducing the potential for miscommunication  between ALJs and their staff and the time spent writing decisions.  According to SSA officials, SSA plans to monitor the extent to which  decisions written with this tool are remanded from the federal courts.  Appeals Council judges we interviewed have reviewed some decisions  written with FIT and have found them to be better articulated than  decisions that did not rely on this tool. However, both Appeals Council  judges and ALJ association representatives mentioned that the tool will  not replace the need for additional, competent decision-writing staff.
Additionally, SSA is pursuing a broader set of initiatives under its  Disability Services Improvement (DSI) initiative that it hopes will result in  more accurate decisions earlier in the process and, thereby, ultimately  reduce workloads at the ALJ level. For example, as a part of DSI, SSA is  implementing an expedited determination process for clear-cut cases,  which it calls its Quick Disability Determinations. The agency also plans to  add a level of reviewing attorneys, known as federal reviewing officials,  who can affirm, reverse, or modify appealed agency decisions prior to  their reaching ALJs. However, DSI is currently underway only in the  Boston Region, and SSA has yet to evaluate the effectiveness of this  initiative.
section_title: Agency Remand Data Are Incomplete and Not Well Managed
paragraphs: While SSA collects data on reasons for remands, we found that the data  are not well managed, incomplete, and therefore not reliable. Two  separate SSA offices recently began collecting data on remanded cases to  identify and track the reasons for remands in order to help train ALJs and  their staff on how to reduce the number of remands. Nevertheless, while  the two offices were collecting and using the data for the same purpose— training—they told us that they were not collaborating. When the two  offices—the Office of Disability Adjudication and Review (ODAR) and the  OGC—developed lists of categories to group reasons for remands, the  offices did not consult with each other. As a result, the lists of categories  used by these offices are not the same, and SSA officials told us that the  offices may well classify similar remands differently. Moreover, some  remand categories in the two data systems may be duplicative, resulting in  an inefficient use of agency resources. SSA officials acknowledged that  better data reliability and collaboration between the two offices are  needed and that, while the agency plans to develop a common vocabulary  for remand reasons, it has yet to develop specific plans and timetables for  addressing these issues.
Through our conversations with SSA officials and reviews of reports, we  also found that these data were not consistently entered into the agency’s  databases. Within both systems, at least one reason should be entered per  remanded case, but this did not always occur; instead, we found the extent  to which this information was entered varied by database and SSA  regional office. For the OGC reports, we found that the number of reasons  recorded exceeded the number of cases, as would be expected; however  officials were not confident that the data on remands reasons were  accurate or complete because the officials have not been able to assess the  quality of the data. Within the ODAR reports for fiscal years 2005 and 2006,  on the other hand, there were substantially fewer reasons reported than  cases. Regional reports showed that SSA’s Seattle and New York offices  have been collecting the most information on remands. Notably, the  agency’s Boston office––which is the first to implement the structural  changes of DSI––and the Philadelphia office have collected the least  amount of information. SSA officials told us that they were aware that  remand data were not entered into ODAR’s system consistently in early  fiscal year 2005, and said they subsequently reiterated the importance of  collecting this information to staff. SSA officials also mentioned that they  are considering making remand reasons a mandatory field in the ODAR  database to improve collection.
section_title: SSA Has Taken Several Steps Since 1990 to Align Its Policies Nationally with Court Decisions
paragraphs: SSA officials have a process in place for determining whether appellate  court decisions conflict with the agency’s interpretation of disability  statutes or regulations, and the agency has taken steps in recent years to  align its policies nationally with appellate court decisions. In those cases  where the agency acceded to certain appellate court rulings by issuing  acquiescence rulings, we found that about half of the rulings were  eventually replaced with national policy. Also, we found that the number  of acquiescence rulings has declined in more recent years, a decline that  SSA officials mainly attributed to the agency’s implementation of its  process unification rulings of 1996, which officials believe created less  room for differences of opinion between the courts and the agency  regarding broader policies. Moreover, we found that the timeliness of  acquiescence rulings had improved since 1998, when SSA established a  timeliness goal of 120 days.
subsections: section_title: SSA Has a Process in Place for Reviewing and Addressing Appellate Court Decisions that Conflict with the Agency’s Interpretation of Law or Regulations
paragraphs: When an appellate court decision is rendered, SSA officials review the  decision to determine whether it conflicts with agency interpretation of  law or regulations. The primary office responsible for this evaluation is the  OGC, SSA’s office responsible for legal matters. For disability issues, OGC  works in conjunction with the Office of Disability Programs, SSA’s office  responsible for policy matters. These offices may consult with the Office  of Disability Adjudication and Review, which rendered the agency’s final  decision prior to its being appealed to federal court, as well as the  Department of Justice (DOJ), the entity generally responsible for  representing SSA in federal court.
If SSA determines that the appellate court decision conflicts with its  policy, then it decides whether to appeal the case to the Supreme Court or  to modify its policy to conform with that decision. According to officials,  SSA rarely challenges appellate court decisions, and decisions to appeal  are ultimately the prerogative of DOJ, because DOJ represents SSA in  court. Some of the situations in which SSA would consider appealing to  the Supreme Court are: a conflict between circuits; an issue of exceptional  importance involving high visibility or significant funds; a statute or  regulation held by the courts to be unconstitutional; or an important  regulation held to be invalid.
If SSA decides to follow the appellate court decision, it issues an  acquiescence ruling that applies only within that circuit. However, because  these rulings result in inconsistent policies throughout the country, the  agency has added a clarification in the preamble to its 1998 regulations  that acquiescence rulings are generally temporary policies that are not  intended to remain in effect permanently. Therefore, after issuing an  acquiescence ruling, SSA attempts to pursue a uniform national policy  through various means, such as modifying regulations or rules, issuing  new regulations or policy interpretations, seeking legislative changes, or  re-litigating the issue within the same circuit. When SSA successfully  incorporates the acquiescence ruling into national policy, it rescinds the  acquiescence ruling.
When SSA finds it necessary to issue an acquiescence ruling, it has  procedures in place for informing adjudicators of these departures from  national policy. According to officials, SSA communicates these and other  rulings to SSA officials who make claims determinations, such as ALJs,  through a variety of sources including: the Federal Register, SSA’s internal  operations manual, the agency’s Web site, and e-mails. In some instances,  officials learn about these rulings through training sessions. However,  because most acquiescence rulings since the 1990s concerned narrow  issues, SSA officials said the rulings have not warranted special training  for adjudicators.
section_title: SSA Has Taken Steps to Align Its Policies with Court Decisions by Issuing Acquiescence Rulings More Quickly and Following with Changes in National Policy
paragraphs: SSA has taken steps to align its policies with the court decisions by issuing  acquiescence rulings in a timely manner and following up with changes to  its national policies. Since the implementation of its current acquiescence  policy, SSA has issued 45 acquiescence rulings, the majority of which  relate to determining whether a claimant is eligible for disability benefits.  (Fig. 8 shows the number of rulings issued each year from 1990 to 2006,  and app. V provides synopses of court holdings concerning disability  determinations that led to acquiescence rulings.) Most of these rulings  were issued between 1990 and 2000, when SSA published an average of  four acquiescence rulings per year. In contrast, during the 6-year period  from 2001 to 2006, the agency issued only five such rulings. SSA officials  attributed the decline in acquiescence rulings to implementation of its  process unification rulings, which they believe created less room for  differences of opinion between the courts and the agency regarding  broader policies.  Specifically, officials commented that the process  unification rulings clarified SSA policy as well as filled gaps in policy that  were previously open for the courts to fill, and noted that, while the courts  are not bound by these and other Social Security Rulings, the courts have  frequently deferred to SSA’s rulings.  As a result, SSA has seen a decline  in the number of significant court cases involving disability law over time.  (See app. III for a listing of key court cases.)
We found that the number of acquiescence rulings issued by SSA varied by  circuit during our study period (1990 to 2006), ranging from one in the  First Circuit to eight in the Ninth Circuit. (See fig. 9.)  SSA officials pointed  out that the number of acquiescence rulings the agency issues in a given  circuit is a function of the number and types of decisions issued by the  appellate court within that circuit. For example, officials said that the  Ninth Circuit has the largest disability caseload, and therefore, one would  expect it to have the highest number of acquiescence rulings. Also,  because the Ninth Circuit’s decisions largely concerned technical issues,  SSA officials said they were less amenable to Supreme Court Review. This  official added that the Ninth as well as Eighth Circuits have had precedent- setting decisions.
Since SSA established a regulation in 1998 that included a timeliness goal  for issuing acquiescence rulings, the promptness of issuances has  improved. (Fig. 10 depicts the timeliness of acquiescence rulings issued  from 1990 to 2006.) Prior to establishing the regulation, SSA took more  than a year to issue over 80 percent of the rulings. Since then, 54 percent  of acquiescence rulings were issued within the guideline of 120 days (or 4  months). For those rulings that were not issued within 120 days, in most  instances the timeliness goal did not apply because SSA either sought  further judicial review or needed to coordinate with DOJ or other federal  agencies.
Once SSA has issued acquiescence rulings, the agency has frequently  succeeded in replacing them with uniform national policies. We found that  since 1990, nearly half of all acquiescence rulings (21 of 45) were  rescinded and replaced by more permanent guidance. Further, most of  these rescissions resulted from the agency’s issuing or modifying rulings  or regulations. (Fig. 11 shows how acquiescence rulings were rescinded.)  According to officials, acquiescence rulings are most commonly rescinded  when the agency revises, publishes, or revokes rules and regulations— actions that are fully within the agency’s control. Six other rescissions  occurred through other means: three from Supreme Court rulings  upholding SSA’s policies and three from changes in law made by Congress.
However, according to SSA, some issues brought about by federal court  decisions, such as those involving the Constitution or federal law, have led  to acquiescence rulings that have not been rescinded by the agency. For  example, acquiescence ruling 91-1(5), which involves a claimant’s right to  cross-examine an examining physician, remains in effect because SSA  officials believe the only option for rescinding the ruling would require re- litigating the case. However, according to SSA officials, the relevant  circuit appellate court and the Supreme Court have declined to review this  ruling. Other reasons that acquiescence rulings may remain in effect  include a lack of practical implications of the acquiescence ruling for other  circuits or the fact that an acquiescence ruling was only recently issued.  Replacing the acquiescence ruling with nationwide policy typically takes a  significant period of time—in one case, 16 years.
section_title: Conclusions
paragraphs: On the whole, SSA has taken many steps to align its policies with court  decisions and establish uniform national standards. The fact that the  agency made some substantial changes to its policies in the mid-1990’s  may account for the reduced incidence of acquiescence rulings in the past  5 years.
On the other hand, the high proportion of remanded and awarded claims  for the past decade has likely cost SSA additional time and resources to  process, and may have impeded the timely award of benefits to eligible  individuals. While the DSI improvement initiative is designed to ameliorate  this problem, the lack of reliably collected and well-managed data on court  remands is likely to inhibit that effort. Although SSA plans, through the  implementation of DSI, to gradually address the heavy workload that has  been cited by many for contributing to errors that lead to remands, the  agency cannot pinpoint specific reasons for remands and take corrective  action without more reliable data. To the degree that the agency does  collect some data, the fact that collection is carried out by two different  offices risks inconsistency and divergent interpretations. This lack of  complete and consistent information ultimately undermines the agency’s  ability to serve people with disabilities and their families.
section_title: Recommendations
paragraphs: To ensure the agency has accurate and well-managed information to use in  identifying corrective actions for reducing remands, we recommended that  the Commissioner of SSA implement the following two measures:  take steps to ensure the reliability of data on reasons for remands, and    coordinate agency data collection on remands and ascertain how best  to use this information to reduce the proportion of cases remanded by  federal courts.
section_title: Agency Comments
paragraphs: SSA provided us with comments on a draft of this report, which we have  reprinted in appendix VI. In its comments, SSA agreed with both of our  recommendations for improving data on remands and outlined actions it  plans to take to enhance data reliability and collection. Specifically, in an  upcoming update to the Case Processing Management System, SSA plans  to make the reasons for remands a mandatory data input field.  In addition,  SSA plans to establish an intercomponent work group to address issues  related to remand data, and analyze data on the use of the Findings  Integrated Templates and court decisions.
SSA also provided technical comments which generally improved the  accuracy of the report, and we have incorporated them as appropriate.
Copies of this report are being sent to the Commissioner of SSA,  appropriate congressional committees, and other interested parties. The  report is also available at no charge on GAO’s Web site at  http://www.gao.gov.
Please contact me on (202) 512-7215 if you or your staff has any questions  concerning this report.  Contact points for our Offices of Congressional  Relations and Public Affairs may be found on the last page of this report.  Other major contributors to this report are listed in appendix VII.
section_title: Appendix I: Objective, Scope, and Methodology
paragraphs: We designed our study to obtain information on (1) the trends of the past  decade in the number of appeals reviewed by the district courts and their  decisions; (2) the reasons for court remands and factors that may  contribute to the incidence of those remands; and (3) SSA’s process for  responding to appellate court decisions that conflict with agency policy  and the agency’s response in recent years. To obtain information on these  issues, we collected relevant quantitative and qualitative data from SSA;  interviewed SSA officials and stakeholders within and outside the agency,  such as district court judges, claimant representatives and experts; and  reviewed agency policies and regulations that address appellate court  rulings that conflict with SSA disability program policies. To determine the  completeness and accuracy of data we obtained, we took steps, described  below, and determined that these data, with the exception of reasons for  remand, were sufficiently reliable for use in this report. We conducted this  work between February 2006 and January 2007 according to generally  accepted government auditing standards.
To address the first research objective, we obtained national data from  SSA on the number and decisions of cases reviewed by federal district  courts—the first level of federal court review—for fiscal years 1995 to  2005 and analyzed these data for trends over time. Our analysis excluded  cases that were dismissed because dismissals are generally decided on  technical and procedural grounds rather than on the merits of the claim.  For fiscal year 2005, the only year for which complete data were available,  we obtained information from SSA on court decisions by state. We then  categorized and analyzed these data by circuit. Furthermore, we obtained  and analyzed agency data on the decisions SSA made on disability cases  after they were remanded (i.e., allowances or denials of claims) for fiscal  years 1995 to 2005. We also categorized and analyzed these data by circuit  using information on the claimant’s state of residence. SSA officials were  interviewed to gather information on potential reasons for any trends. In  addition, we interviewed SSA officials and reviewed previously issued  agency reports and data manuals to assess the reliability of these data.
To address the second objective, we also obtained data on cited reasons  for remands from two SSA databases, the Case Processing and  Management System (CPMS), and the National Docketing/Management  Information System (NDMIS), which are maintained by two separate  offices in SSA responsible for re-adjudicating remanded cases and  litigating claims in court. We compared the data to determine how and  what SSA is reporting on reasons for remands within the agency. After  interviewing agency officials and reviewing reports, we determined that  these data were not sufficiently reliable for providing detailed information  on reasons for remands, although some information was used to illustrate  what SSA currently collects. In addition, we interviewed SSA officials and  other stakeholder groups, including federal court judges and claimant  representatives from the Seventh and Ninth circuits and experts, on  reason for remands and factors that influenced them. Stakeholders from  these two circuits were selected because these jurisdictions represent  those with the lowest and highest numbers of SSA policy changes resulting  from acquiescence rulings. Information from these interviews is not  generalizable to all circuits or stakeholders.
For the third objective, we interviewed SSA officials and obtained  available documents on how SSA determines whether a court of appeals  decision conflicts with its policies and what option to pursue to address  conflicting decisions, e.g., appeal or issue an acquiescence ruling whereby  the agency agrees to abide by the court judgment in future cases, albeit  only in that jurisdiction. We also obtained data on the number of  acquiescence and other rulings that SSA issued since establishing its  policy of acquiescence in 1990. For acquiescence rulings, we further  reviewed SSA’s timeliness in issuing acquiescence rulings as well as the  number issued by circuit and how SSA replaced acquiescence rulings with  nationwide policies. We were unable to independently determine the  extent to which court decisions conflicted with SSA policy or whether SSA  should have pursued one option over another. We also interviewed SSA  officials and relevant stakeholders, including selected federal court judges  and claimant representatives, to obtain information on how court  decisions and their related agency rulings have affected SSA disability  adjudication policy in recent years.
section_title: Appendix II: Summary of Process Unification Rulings
paragraphs: SSR 96-1p: “Application by the Social Security Administration of  Federal Circuit Court and District Court Decisions.” Policy  interpretation stating that SSA decision-makers will be bound by SSA’s  nationwide policy until an acquiescence ruling is issued and that SSA  does not acquiesce to federal district courts within a circuit.
SSR 96-2p: “Giving Controlling Weight to Treating Source Medical  Opinions.” Policy guidance for applying the regulatory provision that  requires the adoption of a treating source’s medical opinion on the  nature and severity of an impairment when the opinion is not  inconsistent with other substantial evidence in the claimant’s file and  the opinion is supported by medically acceptable diagnostic  techniques.
SSR 96-3p: “Considering Allegations of Pain and Other Symptoms in  Determining Whether a Medically Determinable Impairment is Severe.”  Policy interpretation on the consideration of symptoms in determining  whether an impairment is “severe” at step 2 of the sequential evaluation  process.
SSR 96-4p: “Symptoms, Medically Determinable Physical and Mental  Impairments, and Exertional and Nonexertional Limitations.” Policy  interpretation explaining, among other things, that symptoms are not  medically determinable impairments; that limitations, not impairments,  are categorized as “exertional” or “nonexertional”; and that symptoms  may result in nonexertional or exertional limitations.
SSR 96-5p: “Medical Source Opinions on Issues Reserved to the  Commissioner.” Policy interpretation on evaluating medical source  opinions on issues such as whether an individual’s impairment(s)  meets or is equivalent in severity to the requirements of a listing in  SSA’s Listing of Impairments; what an individual’s residual functional  capacity is; whether an individual’s residual functional capacity  prevents him from doing past relevant work; and how the vocational  factors of age, education, and work experience apply.
SSR 96-6p: “Consideration of Administrative Findings of Fact by State  Agency Medical and Psychological Consultants and Other Program  Physicians and Psychologists at the ALJ and Appeals Council Levels of  Administrative Review; Medical Equivalence.” Policy interpretation  regarding weight given to Disability Determination Services level  medical and psychological consultant findings at the ALJ and Appeals  Council levels.  Explanation of requirements for ALJs and the Appeals  Council to obtain the opinion of a physician or psychologist designated  by the Commissioner in making a determination about equivalence to  the listings.
SSR 96-7p: “Evaluation of Symptoms in Disability Claims: Assessing the  Credibility of an Individual’s Statements.” Policy interpretation on  when the evaluation of symptoms, including pain, requires a finding  about the credibility of an individual’s statements about pain and  symptoms, and the factors to be considered in assessing the credibility  of such statements.
SSR 96-8p: “Assessing Residual Functional Capacity in Initial Claims.”
Policy clarification of the term residual functional capacity and  discussion of the elements considered in assessing residual functional  capacity.
SSR 96-9p: “Determining Capability to Do Other Work—Implications of  a Residual Functional Capacity for Less Than a Full Range of Sedentary  Work.” Policy interpretation on the impact of a residual functional  capacity assessment for less than a full range of sedentary work on an  individual’s ability to do other work.
section_title: Appendix III: Key Federal Court Rulings on Social Security Administration Disability Adjudication
paragraphs: Heckler v. Campbell, 461 U.S. 458 (1983)  The U.S. Supreme Court upheld SSA’s use of its vocational grid  regulations.
Hyatt v. Heckler, 579 F.Supp. 985 (W.D.N.C. 1984)  In a class action, the U.S. District Court for the Western District of North  Carolina found SSA’s policy on pain contrary to Fourth Circuit law. This  ruling enjoined SSA from refusing to follow the law of the circuit.
Lopez v. Heckler, 725 F.2d 1489 (9th Cir. 1984)  The Ninth Circuit Court of Appeals enjoined SSA to uphold prior decisions  requiring SSA to apply a medical improvement standard before  terminating benefits.
Stieberger v. Heckler, 615 F.Supp. 315 (S.D.N.Y. 1985)  In a class action, the U.S. District Court for the Southern District of New  York ruled that SSA had violated the rights of claimants by not following  circuit court law on the weight to give treating physician evidence. After  this decision SSA introduced its policy of Acquiescence Rulings when the  agency is not willing to implement an appellate decision nationwide.  Acquiescence rulings explain how SSA applies decisions of Courts of  Appeals in the circuit in which the decision was rendered.
Schisler v. Heckler, 787 F.2d 76 (2nd Cir. 1986)  The Second Circuit Court of Appeals found that a treating physician’s  opinion on the subject of medical disability is binding unless contradicted  by substantial evidence.
Hyatt v. Heckler, 711 F.Supp. 837 (W.D.N.C. 1989)  On remand, the U.S. District Court for the Western District of North  Carolina found SSA’s policies on pain did not conform to circuit law. The  court ordered these policies to be cancelled and drafted a new ruling on  pain for North Carolina adjudicators.
Sullivan v. Zebley, 493 U.S. 521 (1990)  The U.S. Supreme Court struck down SSA’s regulations for determining  whether a child is disabled because the regulations denied benefits to  children whose impairments did not meet or equal the listing of  impairments and did not allow the child to qualify for benefits based on an  individualized functional assessment.
Schisler v. Sullivan, 3 F.3d. 563 (2nd Cir. 1993)  The Second Circuit Court of Appeals upheld SSA’s 1991 regulations on the  opinions of treating physicians as a valid use of SSA’s regulatory power.
Hyatt class action settlement  SSA agreed to re-adjudicate 77,000 cases under the 1991 regulations on the  evaluation of pain and other symptoms.
Barnhart v. Walton, 535 U.S. 212 (2002)  The U.S. Supreme Court upheld SSA’s interpretation that the claimant’s  inability to work last, or be expected to last, 12 months. The court also  upheld SSA’s regulation precluding a finding of disability when the  claimant returns to work within a 12-month period.
Barnhart v. Thomas, 540 U.S. 20 (2003)  The U.S. Supreme Court upheld denial of benefits to a claimant who was  still able to do her previous work without determining whether that type  of work continued to be available in the national economy.
section_title: Appendix IV: Additional Information on Disability Appeals
paragraphs: Appeals Council denials of Social Security disability claims increased by  about 36 percent from about 48,300 in Fiscal Year 1994 to about 65,800 in  Fiscal Year 2004.
SSA decisions on disability claims following remands from federal district  courts increased from about 3,000 in Fiscal Year 1995 to almost 7,500 in  Fiscal Year 2005.
The twelve judicial circuits with district courts that review Social Security  disability claims varied in the number of claims they reviewed in Fiscal  Year 2005. For example, the District of Columbia District Court reviewed  less than 100 claims, while the district courts in the Ninth Circuit reviewed  almost 3,000.
section_title: Appendix V: Summary of Court Holdings for Acquiescence Rulings Related to Disability Determinations
subsections: section_title: Rescinded? Court holding
paragraphs: The court held that social security regulations allow the use of a vocational expert only at  step five of the sequential evaluation process; and therefore, reliance on a vocational  expert is improper in making the step four determination as to whether a claimant can  return to past relevant work.
The court held that SSA can re-open an otherwise final administrative determination at  any time when a claimant, who had no individual legally responsible for prosecuting the  claim at the time of the prior determination, established a prima facie case that mental  incompetence prevented him from understanding the procedure to request administrative  review, unless SSA holds a hearing and determines that mental incompetence did not  prevent the claimant from filing a timely appeal.
The court held that entitlement to a subpoena for cross-examination purposes of an  examining physician is automatic and must be granted.
The court held that in deciding the appeal of a determination that an individual’s disability  has medically ceased, the adjudicator must consider the issue of the individual’s disability  through the date of the Secretary of Health and Human Services’ final decision, rather  than only through the date of the initial cessation determination.
The court held that an Appeals Council dismissal of a request for review of an ALJ  decision for reasons of untimeliness is a “final decision” and subject to judicial review.
The court held that a person’s return to substantial gainful activity within 12 months of the  onset date of his or her disability, and prior to an award of benefits, does not preclude an  award of benefits and entitlement to a trial work period.
The court held that an initial determination in the Social Security or SSI programs must  be reopened when the notice of the initial determination did not explicitly state that the  failure to seek reconsideration results in a final determination, and the claimant did not  pursue a timely appeal.
The court held that a claimant for disability or SSI benefits who has an IQ score in the  range covered by listing 12.05C and who cannot perform his or her past relevant work  because of a physical or other mental impairment has per se established the additional  and significant work-related limitation of function requirement.
The court held that, in making a determination following an individual’s re-entitlement  period that an individual with a disabling impairment has engaged in substantial gainful  activity, the Secretary of Health and Human Services may not consider work and  earnings by the individual in a single month rather than an average of work and earnings  over a period of months.
The court held that, in making a disability determination on a subsequent disability claim  with respect to an un-adjudicated period, an adjudicator must adopt a finding regarding a  claimant’s residual functional capacity, made in a final decision on a prior disability claim  arising under the same title of the Social Security Act unless there is new and material  evidence.
The court held that, in order to find that the skills of a claimant who is close to retirement  age are “highly marketable” within the meaning of the Secretary of Health and Human  Services’ regulations, SSA must first establish that the claimant’s skills are sufficiently  specialized and coveted by employers as to make the claimant’s age irrelevant in the  hiring process and enable the claimant to obtain employment with little difficulty.
The court held that a claimant for Disability Insurance or SSI benefits based on disability  who has an amputation of a lower extremity and cannot afford the cost of a prosthesis  has an impairment that meets the listings.
The court held that, in making a disability determination on a subsequent disability claim  with respect to an un-adjudicated period, where the claim arises under the same title of  the Social Security Act as a prior claim on which there has been a final decision by an  ALJ or the Appeals Council that the claimant is not disabled, SSA must: (1) apply a  presumption of continuing nondisability and, if the presumption is not rebutted by the  claimant, determine that the claimant is not disabled; and (2) if the presumption is  rebutted, adopt certain findings required under the applicable sequential evaluation  process for determining disability, made in the final decision by the ALJ or the Appeals  Council on the prior disability claim.
The court held that a person’s return to substantial gainful activity within 12 months of the  onset date of his or her disability, and prior to an award of benefits, does not preclude an  award of benefits and entitlement to a trial work period.
The court held that a claimant for Disability Insurance benefits or SSI benefits based on  disability who has mental retardation or autism with a valid IQ score in the range covered  by Listing 12.05C and who cannot perform his or her past relevant work because of a  physical or other mental impairment has per se established the additional and significant  work-related limitation of function requirement of the regulations.
The court held that, in making a disability determination or decision on a subsequent  disability claim with respect to an un-adjudicated period, where the claim arises under the  same title of the Social Security Act as a prior claim on which there has been a final  decision by an ALJ or the Appeals Council, SSA must adopt the finding of the demands  of a claimant’s past relevant work made in the prior decision unless new and material  evidence or changed circumstances provide a basis for a different finding.
The court held that in making a disability determination or decision on a subsequent  disability claim with respect to an un-adjudicated period, where the claim arises under the  same title of the Social Security Act as a prior claim on which there has been a final  decision by an ALJ or the Appeals Council, SSA must adopt the finding of a claimant’s  residual functional capacity made in the final decision by the ALJ or the Appeals Council  on the prior disability claim unless new or additional evidence or changed circumstances  provide a basis for a different finding.
The court held that SSA is required to find that a claimant close to retirement age and  limited to sedentary or light work has “highly marketable” skills before determining that  the claimant has transferable skills and, therefore, is not disabled.
The court held that SSA is required to find that a claimant close to retirement age and  limited to sedentary or light work has “highly marketable” skills before determining that  the claimant has transferable skills and, therefore, is not disabled.
The court held that an Appeals Council dismissal of a request for review of an ALJ  decision for reasons of untimeliness is a “final decision” and subject to judicial review.
The court held that, in making a disability determination on a subsequent disability claim  with respect to an un-adjudicated period, SSA must consider a finding of a claimant’s  residual functional capacity made in a final decision by an ALJ or the Appeals Council on  the prior disability claim as evidence and give it appropriate weight in light of all relevant  facts and circumstances but that SSA does not have to adopt the finding.
The court held that a determination of medical equivalence under the regulations must be  based solely on evidence from medical sources.
The court held that an ALJ, when receiving evidence from a vocational expert must ask  the expert how the testimony or information corresponds to information provided in the  Dictionary of Occupational Titles and must ask the expert to explain the difference if the  testimony or evidence differs from the Dictionary.
The court held that SSA has the burden of proving at step five of the sequential  evaluation process that the claimant has the residual functional capacity to perform other  work which exists in the national economy.
The court held that a claimant’s return to substantial gainful activity within 12 months of  the alleged onset date of his or her disability, and prior to an award of benefits, does not  preclude an award of benefits and entitlement to a trial work period.
The court held that SSA may not apply the Medical-Vocational Guidelines (grid rules) as  a frame work to deny disability benefits at step 5 of the sequential evaluation process  when a claimant has a nonexertional limitation without either: (1) taking or producing  vocational evidence; or (2) providing notice of the agency’s intention to take official notice  of the fact that the particular nonexertional limitation does not significantly erode the  occupational job base.
The court held that for cases concerning Listings 12.05 or 112.05 decided by ALJs or the  Appeals Council before September 20, 2000, which have been remanded by the courts  to SSA, the ALJ should apply the pre-September 20, 2000 version of the Listing as  interpreted by the Seventh Circuit.
The court held that for certain applicants under age 18, ALJs and Administrative Appeals  Judges must make reasonable efforts to ensure that a qualified pediatrician or other  specialist evaluates the case.
section_title: Appendix VI: Comments from the Agency
section_title: Appendix VII: GAO Contact and Staff Acknowledgments
subsections: section_title: Staff Acknowledgments
paragraphs: Robert E. Robertson (Director), Michele Grgich (Assistant Director),  Danielle Giese (Analyst-in-Charge), Susan Bernstein, Candace Carpenter,  Joy Gambino, Suneeti Shah, Albert Sim, Ellen Soltow and Rick Wilson  made significant contributions to this report. Luann Moy, Vanessa Taylor,  and Walter Vance provided assistance with research methodology and  data analysis. Daniel Schwimer provided legal counsel.
section_title: Related GAO Reports
paragraphs: Social Security Administration: Agency Is Positioning Itself to  Implement Its New Disability Determination Process, but Key Facets  Are Still in Development. GAO-06-779T. Washington, D.C.: June 15, 2006.
Social Security Administration: Administrative Review Process for  Adjudicating Initial Disability Claims. GAO-06-640R. Washington, D.C.:  May 16, 2006.
High-Risk Series: An Update. GAO-05-207. Washington, D.C.: January  2005.
SSA’s Disability Programs: Improvements Could Increase the Usefulness  of Electronic Data for Program Oversight. GAO-05-100R. Washington,  D.C.: December 10, 2004.
Social Security Administration: More Effort Needed to Assess  Consistency of Disability Decisions. GAO-04-656. Washington, D.C.: July  2, 2004.
Social Security Administration: Strategic Workforce Planning Needed to  Address Human Capital Challenges Facing the Disability Determination  Services. GAO-04-121. Washington, D.C.: January 27, 2004.
Social Security Disability: Disappointing Results from SSA’s Efforts to  Improve the Disability Claims Process Warrant Immediate Attention.  GAO-02-322. Washington, D.C.: February 27, 2002.
Standards for Internal Control in the Federal Government.   GAO/AIMD-00-21.3.1 Washington, D.C.: November 1999.