[House Hearing, 110 Congress]
[From the U.S. Government Publishing Office]
HEARING ON CLEARING THE DISABILITY BACKLOG:
GIVING THE SOCIAL SECURITY ADMINISTRATION
THE RESOURCES IT NEEDS TO PROVIDE
THE BENEFITS WORKERS HAVE EARNED
=======================================================================
HEARING
before the
COMMITTEE ON WAYS AND MEANS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
__________
APRIL 23, 2008
__________
Serial 110-79
__________
Printed for the use of the Committee on Ways and Means
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48-116 PDF WASHINGTON : 2009
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COMMITTEE ON WAYS AND MEANS
CHARLES B. RANGEL, New York, Chairman
FORTNEY PETE STARK, California JIM MCCRERY, Louisiana
SANDER M. LEVIN, Michigan WALLY HERGER, California
JIM MCDERMOTT, Washington DAVE CAMP, Michigan
JOHN LEWIS, Georgia JIM RAMSTAD, Minnesota
RICHARD E. NEAL, Massachusetts SAM JOHNSON, Texas
MICHAEL R. MCNULTY, New York PHIL ENGLISH, Pennsylvania
JOHN S. TANNER, Tennessee JERRY WELLER, Illinois
XAVIER BECERRA, California KENNY HULSHOF, Missouri
LLOYD DOGGETT, Texas RON LEWIS, Kentucky
EARL POMEROY, North Dakota KEVIN BRADY, Texas
STEPHANIE TUBBS JONES, Ohio THOMAS M. REYNOLDS, New York
MIKE THOMPSON, California PAUL RYAN, Wisconsin
JOHN B. LARSON, Connecticut ERIC CANTOR, Virginia
RAHM EMANUEL, Illinois JOHN LINDER, Georgia
EARL BLUMENAUER, Oregon DEVIN NUNES, California
RON KIND, Wisconsin PAT TIBERI, Ohio
BILL PASCRELL, JR., New Jersey JON PORTER, Nevada
SHELLEY BERKLEY, Nevada
JOSEPH CROWLEY, New York
CHRIS VAN HOLLEN, Maryland
KENDRICK MEEK, Florida
ALLYSON Y. SCHWARTZ, Pennsylvania
ARTUR DAVIS, Alabama
Janice Mays, Chief Counsel and Staff Director
Jon Traub, Minority Staff Director
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C O N T E N T S
__________
Page
Advisory of April 16, 2008, announcing the hearing............... 2
WITNESSES
The Honorable Michael J. Astrue, Commissioner, Social Security
Administration................................................. 9
______
Sylvester J. Schieber, Chairman, Social Security Advisory Board.. 62
Marty Ford, Co-Chair, Consortium for Citizens with Disabilities
Social Security Task Force..................................... 69
Mara Mayor, Member, AARP Board of Directors, Bethesda, Maryland.. 91
Witold Skwierczynski, President of the American Federation of
government Employees National Council of Social Security Field
Operations Locals, Baltimore, Maryland......................... 102
The Honorable Frederick Waitsman, administrative law judge,
Social Security Administration, and Vice Chair, Social Security
section of the Federal Bar Association, Atlanta, Georgia....... 119
SUBMISSIONS FOR THE RECORD
America's Health Insurance Plans, Statement...................... 189
American Bar Association, Statement.............................. 192
Association of Administrative Law Judges, Statement..............
Barbara Gay, Statement........................................... 193
Colleen M. Kelley, Statement..................................... 194
Connie Plemmons, Statement....................................... 198
David A. Hansell, Statement...................................... 198
Harry Wanous, Statement.......................................... 200
James F. Allsup, Statement....................................... 200
Linda Fullerton, Statement....................................... 202
National Association of Disability Representatives, Statement.... 214
National Law Center on Homelessness & Poverty, Statement......... 217
Service Employees International Union, Statement................. 222
The American Civil Liberties Union, Statement.................... 222
The Federal Managers Association, Statement...................... 225
HEARING ON CLEARING THE DISABILITY BACKLOG: GIVING THE SOCIAL SECURITY
ADMINISTRATION THE RESOURCES IT NEEDS TO PROVIDE THE BENEFITS WORKERS
HAVE EARNED
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WEDNESDAY, APRIL 23, 2008
U.S. House of Representatives,
Committee on Ways and Means,
Washington, DC.
The Committee met, pursuant to notice, at 10:14 a.m., in
room 1100, Longworth House Office Building, Hon. Charles B.
Rangel (Chairman of the Committee) presiding.
[The advisory announcing the hearing follows:]
ADVISORY FROM THE COMMITTEE ON WAYS AND MEANS
CONTACT: (202) 225-9263
FOR IMMEDIATE RELEASE
April 16, 2008
FC--21
Chairman Rangel Announces a Hearing on
Clearing the Disability Backlog--Giving the Social
Security Administration the Resources It Needs to
Provide the Benefits Workers Have Earned
House Ways and Means Committee Chairman Charles B. Rangel today
announced that the Committee will hold a hearing on the Social Security
Administration's (SSA's) large backlog in disability claims and other
declines in service to the public resulting from years of underfunding
of the agency's administrative expenses. The hearing will take place on
Wednesday, April 23, 2008 in the main Committee hearing room, 1100
Longworth House Office Building, beginning at 10:00 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 Committee and for
inclusion in the printed record of the hearing.
BACKGROUND:
In recent years, SSA's workload has grown significantly due to the
aging of the population and new responsibilities stemming from Medicare
and homeland security legislation. Despite a productivity increase of
more than 15 percent since 2001, the administrative funding SSA has
received has been well below the level needed to keep up with this
growing workload. From Fiscal Year (FY) 1998 through FY 2007, SSA
received a cumulative total of $1.3 billion less than was requested by
the President, and $4.6 billion less than the Commissioner's own budget
for the agency.
As a result, by the end of calendar year 2007, SSA staffing had
dropped to almost the level in 1972--before the start of the
Supplemental Security Income (SSI) program--even though SSA's
beneficiary population has nearly doubled since that time.
Due to the combination of rising claims as the baby boom generation
ages and prolonged underfunding, Social Security and SSI disability
claims backlogs have reached unprecedented levels. More than 1.3
million applicants for disability benefits are currently awaiting a
decision on their claim, and total waiting times often extend into
years. In addition, as SSA tries to address the backlog crisis, the
agency is forced to divert its limited resources away from its day-to-
day operations in field offices and payment processing centers in order
to try to manage the disability backlog. The result is an increase in
long lines, delays, busy signals, and unanswered telephones, and
growing concern about closures and consolidations of local field
offices. Resource shortages have also forced the agency to cut back on
program integrity activities, even though such activities have been
demonstrated to generate considerable savings to the Trust Fund.
Under the President's FY 2009 proposed budget, the agency would be
able to make modest progress toward addressing the disability claims
backlog, but service in the field would continue to decline. Moreover,
proposals to assign additional workloads to SSA, such as expanding
SSA's role in verifying the work-authorization status of employees,
would, if enacted and not funded in full each year, force SSA to shift
scarce resources away from its core functions to carry out these new
workloads.
In announcing the hearing, Chairman Rangel said, ``We are alarmed
by the deterioration in service to our constituents and the suffering
of those who must wait years to receive benefits they desperately need.
Despite its well-earned reputation for being a can-do agency, the
Social Security Administration simply cannot do its job without
adequate funding. We have been working on a bipartisan basis to address
this problem, and will continue to do so until the disability claims
backlog is eliminated and SSA's capacity to provide high quality
service to the public is restored.''
FOCUS OF THE HEARING:
This hearing will focus on SSA's large backlog of disability
claims, its impact on applicants with severe disabilities who are
awaiting a decision on their claim, and SSA's plan to reduce the
backlog. It will also focus on the role of SSA resource shortages in
the growth of the backlog; other effects of these shortages, including
the impact on service in local field offices, telephone service, and
SSA's ability to conduct program integrity activities; and the need for
increased administrative funding in FY 2009 to address these problems.
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Chairman RANGEL. We regret that we're starting late, but
this is a very unusual type of hearing, because most of the
work that should be done by the Congress in identifying the
problem has already been done. So, it's not a Republican or a
Democratic initiative; it's a question of how many Americans
have played by the rules, paid their dues, have become
disabled, and their Government, for whatever reason, is unable
to provide the services that belong to them.
Because there are so many people, and the resources are so
limited by the Social Security Administration, we have lawyers
now making appeal to those people that have waited 2 and 3 and
4 years, where they claim that as lawyers they can do better
than the U.S. Congress.
So people are being victimized by believing in their
government, and of course in believing that they can for
outside assisted.
In addition to that, a lot of Members for honorable reasons
believe that the Social Security system can and should be used
for other purposes because they have been so effective in
getting in the past, that is, what people deserve from the
Social Security system, survivor system, that they're going to
expand it. That can only make matters worse.
So I just want the Ranking Member to know that in meeting
with Chairman Bachus this morning we all are trying to find
creative ways to get this agricultural thing going. If we come
up with anything, then we would be able to present it to you,
because you've played such an important role, not only with
Republicans in the House, not only in the conference, but with
the President, since for some reason you have a much better
working relationship with him than I do.
But I won't have to worry about that too long.
[Laughter.]
Chairman RANGEL. Having said that, if the Committee would
permit, what I would like to do is to yield to Mr. McNulty and
then to Dr. McDermott. At some point in the hearing I would ask
for them to chair that part while I'm away, and then hope that
you might designate the Ranking Members on the Social Security,
the family income, because they have really--Mr. Johnson and
Mr. Weller have worked so hard in the national good. We don't
have to--that is, Mr. McCrery and I don't have to tell you that
where we disagree we don't think it's helpful to let the whole
Congress and country know it; but I do believe that this is one
of the subjects that we do not have any problem in recognizing
the severity of what is hitting so many Americans who deserve
better service than they're getting.
So I'd like to yield to you for whatever statement you'd
want to make.
Mr. MCNULTY. Thank you, Mr. Chairman.
For more than 70 years, Social Security has provided
essential income support for literally hundreds of millions of
workers and families. In 2007 alone nearly 613 billion was
provided to more than 53 million Americans in the form of
retirement, survivors' disability, and Supplemental Security
Income benefits.
Through a national network of Social Security field and
hearing offices and state disability determination offices,
over 74,000 staff serve the public every day through work that
includes processing claims, issuing Social Security number
cards, crediting earnings records, and educating the public. We
recognize the hard work of these dedicated professionals.
Regrettably, the Agency's service to the public has
suffered in recent years. This is due in large part to limited
funding at a time of increasing workloads, those increasing
workloads, of course, due primarily to the aging of the baby
boomers. There are longer lines at local offices, more busy
signals received by callers to Social Security's 800 number,
and a hearing backlog so deep, the average waiting time for a
decision is over 16 months.
Commissioner Astrue has said, ``It is a moral imperative to
reduce the disability backlogs.'' I couldn't agree more, and
I'm sure the Chairman also agrees.
Since his arrival, Commissioner Astrue has made addressing
disability backlogs his number one priority. As he will tell us
today, he has accelerated or implemented multiple initiatives
to decrease the backlog and improve public service.
Congress has begun stepping up to the plate as well. This
year for the first time in 15 years, Congress has appropriated
more than the President's budget request for the Social
Security Administration (SSA), exceeding that request by close
to $150 million. I understand Commissioner Astrue was able to
get into the 2009 budget request to the President a 6-percent
increase of this year's budget, so that's certainly an
encouraging development.
I think part of the credit for this increase in the budget
goes certainly to the bipartisan work of our two Subcommittee
chairmen, Mike McNulty and Sam Johnson, among others on the
Committee.
Unfortunately, though, administrative funding alone can't
solve Social Security's service delivery and fiscal challenges.
We already face what some would call a fiscal train wreck in
coming decades, when the projected costs of Medicare, Medicaid,
and Social Security impose unbearable burdens on future
generations. Those projections are reality today for the Social
Security disability program. Its cost--and remember the Social
Security disability program is funded by a specific payroll
tax--we often lump together the survivors' and the disability
program, but there is a separate trust fund for the disability
program, and for the last 3 years the outgo has been more than
the income from the payroll tax dedicated to the disability
program.
Solving all of the challenges will require Members from
both parties to come together to conduct a fundamental
examination of the challenges and opportunities facing Social
Security programs. Every day of delay means fewer choices,
greater burdens on future generations. I think we all agree
that our children and grandchildren deserve better than
continued delay.
Thank you, Mr. Chairman.
Chairman RANGEL. I'd like to yield to Mr. McDermott.
Mr. MCDERMOTT. Thank you, Mr. Chairman. There are 750,000
Americans for whom today's hearing is a matter of grave
urgency. That's how many disability claims are pending before
the Social Security Administration. The backlog is more than
double what it was in the year 2000.
While the blame rests with the administration, it's not the
Social Security Administration I'm talking about. Year in and
year out the line of disabled Americans applying for help has
grown longer, while the Social Security budget has been short-
changed. Today three-quarters of a million Americans are
waiting for Congress to do the obvious, find a solution. We're
taking steps to fix this, because these disabled Americans
deserve nothing better.
The backlog in processing disability claims is a burden and
a barrier for disabled individuals who are waiting for critical
cash assistance and healthcare coverage. Perhaps no group faces
a greater challenge as a result of these backlogs, than those
who are applying for SSI.
The SSI Program is often referred to as the ``safety net of
last resort for the disabled and the elderly.'' It provides
modest cash assistance the nearly 6 million disabled
individuals who have very modest incomes and limited or no
resources. The average monthly benefit for a disabled
individual is $471, which is used to meet basic necessities,
such as food, clothing, and shelter.
Additionally, SSI beneficiaries are generally eligible for
healthcare coverage once they get on the program through
Medicaid. SSI applicants--remember these people have been
waiting for two or 3 years with no healthcare benefits; they
have to get on the program before they're eligible for
Medicaid. They're much more vulnerable than most. They are
being forced to wait for years when many don't have sufficient
resources to buy food for the next few weeks.
Making matters worse, these people often don't have
healthcare access, as I said, to healthcare at all.
For the Social Security Administration, the backlog is
making it more difficult to adequately staff field offices with
employees who can address the other critical needs, as well as
the routine changes affecting beneficiaries, like changes in
monthly income that directly affect the monthly benefit up or
down.
In other words, the current backlog is a lose-lose for
everybody. Committing ourselves to securing full funding for
Social Security Administration administrative budget is the
right thing to do for the disabled individuals who need
critical assistance now, and it's the right thing to do for the
Social Security Administration.
We know that nearly 80 million baby boomers will come
knocking on our door in the next 20 years. As it stands now,
the answer will be ``Go to the end of the line.'' It is a long
line. That's not acceptable either to them or the 750,000
disabled Americans waiting in line today.
I think you, Mr. Chairman, for having this hearing.
Chairman RANGEL. Mr. Johnson, who has really done great
work with Mr. McNulty, I'd like to yield to you.
Mr. JOHNSON. Thank you, Mr. Chairman. I appreciate your
recognition, and thank you for holding this important hearing.
Last year, Subcommittee Chairman McNulty and I successfully
worked together to send the Social Security Administration some
additional funding. The whole Committee supported that. It
needs to better serve the American people. This funding won't
solve all of Social Security's challenges, but it's a good
first step.
Many of those trying to receive benefits are angry. They
want a process they can understand, and that's fair and that
gives them the answers in a reasonable amount of time. That
just isn't happening today. Commissioner Mike Astrue knows
that, and he and his staff have been working hard to put into
action needed changes.
As we will hear, these efforts not only include added staff
but also streamlining the application process, expanding the
use of technology and developing new decisionmaking tools to
help reduce processing time, and insure the right decision is
made as soon as possible.
Implementing needed change over the short term is
necessary; however, as Ranking Member McCrery rightly points
our or will point out, we cannot continue to ignore the greater
challenges of facing Social Security today.
As we were recently reminded by the Social Security
trustees, long-term program costs cannot be sustained without
change. Even more pressing are the immediate fiscal challenges
facing the disability program. We need to take action, and the
sooner we get to work the better. We should begin by finding
ways to make disability determinations less complex, less
costly, and easier for the public to understand.
I believe we can achieve this goal while still insuring
accuracy and fairness. It won't be easy to find the answers,
but it's got to be done. Those who are unable to work are
counting on us to secure Social Security's vital safety net.
All Americans are counting on us to insure their hard-earned
tax dollars are not wasted through fraud, abuse, or needless
red tape. To that end I look forward to working with all my
colleagues, particularly Mr. McNulty and with Commissioner
Astrue.
Thank you, Mr. Chairman. I yield back the balance.
Chairman RANGEL. Thank you.
So, Mr. McCrery, if you don't have any other opening
statements at this point, I would like to call on Chairman
McNulty, not only to take over the hearing, and at the
appropriate time to share the chair with Dr. McDermott, as I go
meet with the Senators on this important issue. Thank you.
Mr. MCNULTY [presiding]. Thank you, Mr. Chairman for
scheduling this hearing, and welcome, Commissioner Astrue.
Today we focus on one of the most critical challenges
facing the Social Security Administration, the unprecedented
backlog and applications for disability benefits.
Today more than 1.3 million Americans are waiting for a
decision on their disability claims or their appeals. Due to
this backlog, applicants who are suffering from severe
disabling conditions often must wait for years, with little or
no income and in many cases without health insurance. No one
can hear their stories without being convinced that we must fix
this problem and fix it soon.
The root of the problem is simple. For too long SSA has
been severely under-funded. From fiscal year 1998 through 2007
SSA received a cumulative total of $1.3 billion less than what
was requested by the President, and $4.6 billion less than the
Commissioner's own budget for the Agency. As a result, by the
end of 2007 Agency staffing had dropped to almost level in
1972, even though SSA's beneficiary population has nearly
doubled since that time. Other workloads have also increased as
Congress imposed new responsibilities on the agencies, such as
administering major portions of the medicare prescription drug
program.
SSA has worked hard to meet this challenge, increasing
productivity by more than 15 percent since 2001. But these
productivity increases and the hard work of SSA's dedicated
employees cannot make up for the combined effects of staffing
losses and increased workloads.
The consequences of prolonged under-funding also extend
beyond the disability backlogs. Service to the public in SSA's
local offices across the country has also declined due to
staffing shortages. Our constituents increasingly face long
lines, busy signals, and other delays, and field office
closures are a growing concern.
Last year we made a start on turning this untenable
situation around. For the first time in many years, Congress
approved more money for SSA than the President had requested.
This allowed SSA to hire additional administrative law judges
and hearing office staff to address the backlog. But SSA's
funding and staffing shortfalls are far too great to be
remedied in one year.
This year we are once again making a strong bipartisan
effort to provide SSA with adequate funding. Under the
President's budget the Agency would continue to reduce the
backlogs, but service in the field would decline even further.
SSA needs at least the additional $240 million above the
President's budget request recommended in the House-passed
budget resolution.
I strongly urge Members of the Committee to join us in our
effort to make adequate funding for SSA a priority this year,
and I thank Ranking Member Johnson for his cooperation and
dedication to this cause.
At the same time, we must do our part not to burden SSA
with new responsibilities that are not part of the Agency's
mission. The Subcommittee on Social Security will hold a
hearing in the coming weeks on the impact on SSA proposals to
expand its role in immigration enforcement.
Today we will hear from SSA Commissioner Michael Astrue. I
commend you, Commissioner, for your untiring commitment to
bring down the backlog. I'd also like to thank you for your
responsiveness to the Committee's concerns, and your
willingness to work and partnership with us as we seek ways to
improve the disability process.
I also look forward to hearing the views of other
witnesses, including representatives of both SSA's
beneficiaries and its workers on the problems the Agency faces
and the measures SSA is taking to address them.
It is important that the Committee have your perspectives
as well, as we work to insure better treatment for applicants
and beneficiaries alike.
Without objection, other Members of the Committee will be
allowed to submit opening statements for the record.
At this time I would like to recognize Commissioner Astrue.
Again, thank you for the work that you've done with us over the
past year or so, Mike. We've made some progress. We need to
make more, and we look forward to hearing your views and to
having a dialog with you.
STATEMENT OF THE HONORABLE MICHAEL J. ASTRUE, COMMISSIONER,
SOCIAL SECURITY ADMINISTRATION
Mr. ASTRUE. Thank you, Mr. Chairman.
Mr. Chairman, and Members of the Committee, since I know I
may not have another chance with the full Committee, I'd like
to begin by thanking Mr. McNulty. He's been accessible, candid,
and thoughtful, and both the Agency and I will miss him a great
deal next year.
I would also like to thank all of you for your continuing
bipartisan support of Social Security. The additional $148
million you helped obtain for 2008 has helped us significantly
with staffing issues. We will replace SSA and DDS employees who
leave this year and do a net hire of 1300 more employees for
our direct service operation. In addition, we are hiring 175
administrative law judges plus up to possibly 14 more for our
new national hearing center, and 143 additional support staff
for these ALJs across the country.
Nevertheless, as many of you have said, we won't meet our
many challenges simply by spending more money to maintain the
status quo. Already some of the nearly 80 million baby boomers
have begun filing for retirement. If we are not vigilant, this
enormous caseload will hit while we're plowing through backlogs
resulting from rising workloads and dwindling resources.
We will continue to work smarter as we seek the resources
we need to meet those challenges.
On the retirement front, our upgraded E-services will
include a greatly streamlined homepage and a more accurate
online retirement benefit estimator. In September our
simplified online retirement application will increase the
usage rate, dramatically reducing filing time for the public,
and 12-18 months later will begin to adjudicate the retirement
claims without routine time-consuming review by our field
representatives.
With respect to disability, for the first time we are
updating our medical listings on a rotating 5-year schedule and
providing detailed guidance on rare diseases that are
particularly difficult to adjudicate. Our program consultation
process now allows DDSs to electronically clarify policy
concerns that we have found in their decisions. Our responses
are quick, they provide policy guidance and data that we share
with all adjudicators, and lead to better quality decisions and
policy clarifications.
The new online appeals program will reduce errors, save
field staff from the drudgery of manual inputs, and end one
source of delay for claimants.
Next week we'll meet with the DDSs to again discuss
replacing 54 separate COBOL-based computer systems that are
increasingly difficult and expensive to maintain. If we reach
consensus, I will request support in my 2010 budget for this
significant upgrade.
We're making great progress with our two Fast-Track
disability systems. One track is quick disability
determinations, or QDD, where a computer model identifies
highly probable allowances. About 2.3 percent of all new claims
are now QDDs, with a 96 percent allowance rate and a 6-8-day
processing time.
The second program in this track, Compassionate Allowances,
which will begin around Labor Day, identifies medical
conditions that are so severe that they obviously meet our
standards. Although too early to predict, we believe that by
the end of 2009 about 4 percent of our claims will be Fast
Track, possibly increasing to 6-9 percent by 2012.
As for the hearing backlog, unfortunately there is no
silver bullet. Instead, through streamlining and better use of
existing resources, we've held down the backlogs while waiting
for the infusion of new ALJs and support staff and the end of
our inefficient paper-based systems.
We are placing ALJs in the neediest office where space
allows, while maintaining adequate support staff to ALJ ratios.
Using video technology, ALJs nationwide and in the national
hearing center can conduct hearings for offices with the worst
backlogs. A pilot this summer will allow claimants to attend
video hearings in their own lawyers' offices, an example of how
new technology and thinking can be win-win for the Agency and
the people we serve.
Last year we cleared 65,000 cases pending for 1,000 days or
more. This year we've already completed 63 percent, or about
85,000 of the 135,000 cases pending for 900 days or more. These
cases require more development and slow our backlog progress
measured by total pending, but these are the most important
cases, and we must resolve them first.
For Fiscal Year 2009 I hope to reduce the tolerance level
below 900 days but will wait until September to decide,
depending on the anticipated timing and level of our funding.
Our pilot to centralize hearing notice mailings should save
considerable staff and make notices clearer. We have a number
of other automation initiatives in progress.
In conclusion, although we've made progress and it's slow
and frustrating, we are looking forward to the convergence of
two key events later this year, the substantial elimination of
the remaining paper cases and full productivity of the new
class of hired ALJs. This gives me, and should give this
Committee, significant hope for progress next year.
In Fiscal Year 2009, we will absorb at least an additional
$400 million in built-in inflationary costs. An extended
continuing resolution combined with these costs could force
additional Agency contraction. Timely support of the
President's budget is absolutely critical to continued
improvement.
Once again, I very much appreciate the bipartisan
collaboration of this Committee and its support, and would be
pleased to answer any questions that you have.
Thank you.
[The prepared statement of Hon. Michael J. Astrue follows:]
Prepared Statement of The Honorable Michael J. Astrue,
Commissioner, Social Security Administration
Thank you for this opportunity to update you on our efforts to
improve our service to the American public.
I would like to start with Social Security's front door, the field
office. The past few years have been tough for field offices. As
overall agency employment dropped from 63,569 in 2003 to 60,206 at the
end of 2007, field offices felt the effect of staffing losses more
intensely because so many of our activities mandated by law are
performed in our field offices.
As staffing fell, workload burdens grew. The general population
continued to grow, and it got older, which meant more retirement
applications and more disability applications. New state laws aimed at
illegal immigrants increased the number of people seeking replacement
Social Security cards. New Federal statutes required claims
representatives, teleservice representatives, and other field staff to
take on complex and time-consuming new responsibilities in Medicare
Part D. This year, our field offices are processing additional requests
for 1099s to help taxpayers file for payments under the stimulus bill.
Our field offices do their best, but simply cannot provide the
level of service the public expects from the Social Security
Administration at recent levels of funding. This Committee has
recognized this problem and I would like to thank you for providing SSA
with the resources to better fulfill our responsibilities to the
American public. The 2008 appropriations was the first time that
Congress has appropriated at or above the President's Budget request
since 1993.
We are grateful to you for your support, and it is helping our
field offices and teleservice centers provide improved service. We will
use some of the extra funding to strengthen our direct service
operation with the hiring of 3,900 employees, 1,300 employees more than
the expected losses for this year. We are not going to be able to meet
our challenges by continuing to ask for more money to maintain the
status quo. Increases in personnel and infrastructure costs alone for
the fiscal year that starts this October will be at least $400 million.
To cope with rising workloads and likely fiscal constraints, we
have systematically reviewed the information that we routinely request
from or provide to the public. We believe that if we can automate,
reduce, or eliminate such information exchanges, we can improve
efficiency as well as the quality of our service and the morale of our
field employees. Our Ready Retirement Team has been leading this effort
by focusing on streamlining the retirement application process, a
logical choice because this past January the first of nearly 80 million
baby boomers filed for retirement.
This team already has driven change by determining that retirees
born in this country may not need to provide their official birth
certificate to prove their age. Instead, if a retiree alleges a date of
birth that satisfies our authentication standards, we will accept the
allegation. This simple change will allow baby boomers to file more
effortlessly over the Internet, telephone, or in our offices, employing
a more efficient process that will accelerate payment of the first
check. Furthermore, field employees will save time on a significant
number of claims each year.
The Ready Retirement Team also has greatly improved the information
available to people trying to decide the right date for their
retirement. As we will soon announce, we are planning to provide people
highly accurate on-line estimates of their monthly retirement benefits,
which we compute by using their actual earnings records. Our current
online estimators are difficult and time-consuming to use, and often
fall short on accuracy. The new version will be simple, easy-to-use,
and highly accurate. Our team worked hard with the technology and with
privacy experts to ensure that the negligible risks of inappropriate
disclosure of personal information justify the substantial benefits.
Although our electronic services are usually ranked as the best of
all Federal agencies, my judgment is they are far from good enough yet
to deal with the imminent tsunami of baby boomers' claims. After broad
consultation with experts and advocacy groups, next month we will be
unveiling our new website, which will eliminate some of the visual
clutter and be significantly easier for the public to navigate,
especially if they are reaching out to us for the first or second time.
Our improved website will introduce the public to the next critical
Ready Retirement initiative: a total overhaul of our online retirement
application. Our current online form was put up quickly about 8 years
ago. It is nowhere near best demonstrated practices, and for most of
this decade only about 10% of the public has chosen to apply for
retirement online.
In order to keep field offices from being totally overwhelmed, we
are going to need to drive that online filing figure up from about 13%
to 50% over the next 5 years. The Ready Retirement Team has a September
27, 2008 deadline for the first step of a two-step implementation, and
it has already shown a terrific prototype to advocacy groups, and the
Social Security Advisory Board. We found that we could eliminate or
simplify the vast majority of the application questions, and that we
could use cues, links, streaming video, and other techniques from the
best financial services websites to give the public a friendlier,
faster, and simpler experience. We expect the current 45 minutes for
the average online retirement filing to drop to an average of 15
minutes.
The second step of the Ready Retirement process requires
modification of 39 separate COBOL-based systems and will involve some
additional improvements to the form itself. The key improvement will be
that our computers will automatically send the claim to payment without
the involvement of a claims representative. In the coming years, this
one change could free up enormous amounts of staff time.
A similar work-saver that we recently implemented is iAppeals. As
you know, State agencies, called Disability Determination Services,
decide disability claims on our behalf at the first two levels of the
adjudication process. Currently, to appeal an adverse Disability
Determination Services decision, the claimant or the claimant's
representative fills out a paper form and sends it to a field office,
where the staff manually enters the appeal into a system.
iAppeals, which is now used on a voluntary basis in about 10-15% of
all cases, eliminates this unnecessary manual work, reduces the
likelihood of human error, and ends one source of delay that
contributes to backlogs. For these reasons, in the coming year, we will
propose a regulation that will require claimants' representatives to
use iAppeals; the status quo will be available for unrepresented
claimants.
We also are having a separate intercomponent team study the waiting
areas in our field offices to improve both the efficiency of the office
and the experience of the public. We expect to roll out many changes in
the next year that will improve seating, layout, privacy, signage, and
other small, but important, things that make visiting a field office a
better experience.
Last month, I authorized the purchase of new intake kiosks for
field offices that will provide a modern, fast, and user-friendly tool
for the public to register the reason for their visit. These kiosks
incorporate touch screen technology and are similar to those many
Americans use for airline travel. We are also piloting the use of
personal computers in the field office reception area to provide the
public with connectivity to the SSA Internet website. These personal
computers provide an option for those people who may not have access to
a personal computer, or may not have understood our e-service options,
to transact their business with us electronically.
We are looking at using an unobtrusive slideshow presentation to
remind people of the documents they need in order to file a claim or
receive a new or replacement Social Security card. Those people who do
not have the necessary documentation with them can leave to get it and
come back, or call a family member to bring it to them, so that they
will have a fully successful visit. The slides will also provide
information about our online and 800 number services so visitors know
there are alternatives to visiting a field office the next time they
need service.
Before I discuss our efforts to improve our disability process, I
want to mention that immigration initiatives and demographic shifts
have further strained some field offices with demands for new and
replacement Social Security cards. To ease this pressure, we have moved
to specialized card centers, mostly in densely populated and rapidly
growing urban areas. These centers allow us to provide faster, more
efficient, and more accurate service to the public. We are co-locating
these new centers with field offices because doing so is cost-
efficient, provides more career ladder opportunities to our employees,
and most importantly, better serves the public.
Now, I would like to turn to the disability backlogs by starting
with an update about our efforts to improve the quality and speed of
Disability Determination Services decision-making. In a time of agency
contraction, for most of this decade the Disability Determination
Services have suffered even deeper cuts than SSA. We have taken steps
to reverse this trend, and I am very pleased that the Disability
Determination Services will be able to replace all staff who have left
or will leave their agencies this year. This support is a key part of
our effort to bring the number of pending cases at the State level down
below 500,000 for the first time since 1999.
Additional resources are vital, but must be accompanied by our
commitment to work smarter. A valid longstanding Disability
Determination Services criticism of SSA is that our medical listings do
not provide enough detail and do not keep pace with medical advances.
In making disability determinations, SSA uses the Listing of
Impairments (the Listings) which describes impairments that are
considered severe enough to prevent a person from doing any substantial
gainful activity. Although the Listings are a critical factor in SSA's
disability determination and have been used in millions of cases since
their initial development in 1955, I discovered last year that some of
the important listings had not been updated for decades. Updating the
Listings on a regular basis will allow disability adjudicators to
resolve disability cases more accurately and efficiently. We have
already published several final Listing regulations, and we have
developed a schedule to ensure that we update all of our medical
listings at least every 5 years.
In addition, we have made a special effort to provide guidance to
decision-makers on the rare diseases and conditions where we are most
likely to delay decisions and make mistakes. This new emphasis on rare
diseases and conditions is an important element of our effort to use
computer technology to pull the straightforward cases out of the queue
and resolve them in an unprecedented brief period of time. Our
retrospective analyses indicate that a surprisingly high percentage of
these cases are either decided incorrectly or take an unusually long
period of time to adjudicate.
The first piece of what will be a two-track fast-track system is
now up and running across the country. It is called QDD--for Quick
Disability Determination--and right now about 2.3% of all new claims
are being identified for QDD processing, and over 96% of them are
allowances. QDD allowances are being decided in an average of 6 to 8
days. During the next several months, we expect the proportion of cases
being identified for fast tracking will increase as we continue to make
adjustments to, and test the limits of, the computer model. These
adjustments should not affect the processing time nor the allowance
rate for QDD cases.
We are also getting close to piloting the second track, which we
are calling compassionate allowances. These are cases where the disease
or condition is so consistently devastating that we can presume that
the claimant is disabled once we confirm a valid diagnosis. By deciding
more cases based on medical evidence alone, we can reduce the number of
claims that require further review.
Since this is new territory, we do not know what the eventual mix
of QDD and compassionate allowance cases will be, but a reasonable
guess is that by the end of 2009, about 4% of our claims will be fast-
tracked. By the end of 2012, that number could be 6% to 9% of our
claims. I stress, however, that right now these numbers are best
guesses and that we will not really know until we have pushed this
effort for a longer period of time.
We have also extended nationwide the Request for Program
Consultation, a Disability Determination Services quality initiative
that was incorporated into Disability Service Improvement. As we are
speeding up our processing of cases, it is essential that we maintain
our focus on accuracy. An institutionalized forum for communication
between Disability Determination Services and SSA on problematic cases
is an important part of that effort.
The Request for Program Consultation provides an electronic forum
to resolve disagreements between the Disability Determination Services
and our Office of Quality Performance. These disagreements may involve,
for instance, whether a Disability Determination Services agency
obtained appropriate documentation, applied policy correctly, or
decided the case accurately. The Request for Program Consultation is a
web-based application that is available to Disability Determination
Services nationwide. The Request for Program Consultation website
allows Disability Determination Services to submit requests
electronically and those requests appear instantaneously for review by
the Request for Program Consultation Team. The Request for Program
Consultation Team analyzes and resolves cases within seven days. Prior
to this consultation process, Disability Determination Services often
waited several months for a definitive resolution on complex cases. The
Request for Program Consultation allows us to gather data on each
request and share it with all users so that they may use that
information to write better policy and make better decisions.
As we work to improve the timeliness and quality of our disability
determinations, we are also considering longer-term systems
improvement. We will be having important discussions with State
administrators in New Orleans next week to discuss a unified
information technology system to replace the current 54 separate COBOL-
based systems that are increasingly difficult to modify and expensive
to maintain. A similar consolidation effort collapsed in early 1999,
but we have been working toward this goal for nearly a year, and I am
cautiously optimistic. If we can obtain a sufficient degree of
consensus with our partners in the States in the next few months, we
may move forward with this essential improvement provided we have
sufficient resources.
We are working on a new software tool called eCAT (Electronic Case
Analysis Tool) for use by disability examiners. eCAT will prompt
examiners about questions they should ask and documentation that they
need before making a disability determination. The initial model for
eCAT was developed by the Pennsylvania Disability Determination
Services. Unfortunately, eCAT was implemented prematurely as part of
Disability Service Improvement and failed miserably. The Virginia
Disability Determination Services is helping us refine eCAT so that we
properly implement a good concept. While eCAT will not be ready to
pilot earlier than next year, it offers the hope of using cutting-edge
technology to make faster, more accurate, and better-documented
decisions.
I would like to now turn to the hearings backlog. If you step back
and look at the system as an economist would, we have had, for many
years, issues of allocation and distribution of resources. The problem
of allocation has been painfully clear--compared to 10 years ago we
have about 176 % more disability cases. We have taken a big step toward
resolving that problem by bringing onboard the 175 additional
administrative law judges and additional staff to support them. If we
can resolve space issues, we will also bring on another 14 National
Hearing Center judges this year.
The resource distribution problem is neither obvious nor is its
cause clear to me. Nonetheless, when you look at where we were a year
ago, it is clear that there was a longstanding imbalance in Office of
Disability Adjudication and Review resources. In particular, the
Chicago and Atlanta regions were dramatically under-resourced compared
to the rest of the country. The hearing offices in many of the most
backlogged cities--such as Atlanta, Cleveland, and Detroit--were
receiving 3-4 times as many filings per administrative law judge as
offices in Southern California and New England.
We have moved swiftly to correct this problem. Where we can address
it by changing jurisdictional lines in adjacent locations, we have done
so. As an example, our suburban Pittsburgh office now serves Youngstown
and other parts of eastern Ohio to take some of the burden off
overloaded offices in Cleveland and Columbus. For the same reasons, we
have reassigned responsibility for cases scheduled for video hearings
to less busy offices. At our site in Toledo, we have video hearing
capability, so that now administrative law judges in Boston assist the
Toledo office with their video hearings.
Our new National Hearing Center (NHC), which holds video hearings
from a central location, also gives us the capability to move cases
quickly and flexibly to conduct video hearings in the cities with the
worst backlogs. Right now, our NHC administrative law judges are
focusing their efforts on the backlogs in Atlanta, Cleveland, and
Detroit. We are planning to expand this NHC initiative as soon as we
can and intend to address the backlogs in Miami, Columbus,
Indianapolis, and other cities where claimants have been waiting the
longest.
With the allocation of the 175 newly-hired administrative law
judges, we have made equalizing resources a priority even though we
have received some criticism for doing so. We are sending 10 to Ohio
and just 1 to New England. That is not a regional bias--I am from
Boston myself--but a data-driven decision that recognizes that there is
a strong correlation between filings per administrative law judge and
cases pending.
We have also received some criticism that we are not providing
adequate support staff for our administrative law judge corps. In my
opinion, that is a fiction designed to sidetrack some of our
productivity initiatives. Since I began as Commissioner, I have
increased the number of support staff per ALJ from 4.1 to 4.4. The
number of staff needed to support a disposition will change as we fully
implement the backlog plan, but at the moment that number is difficult
to project with any certainty. We know that automating many of our
clerical functions will reduce the amount of time spent by staff on
more routine tasks, and allow them to absorb additional workloads. We
are also working to standardize our business process, which should
result in additional staff efficiencies. We will continue to monitor
the appropriate staff to ALJ ratio as the new processes are
implemented.
While we will still have a handful of offices that will be under-
resourced due to various barriers, such as the cumbersome process for
adding additional space, we are just months away from no longer being
able to offer resource issues as a defense to poor productivity. It is
time for everyone from senior management to the most junior support
staff to commit themselves to finding the best ways to work together to
make sure that nobody waits an inexcusable period of time for a final
decision on an appeal. Performance varies greatly from office to
office, and we are working toward having the least productive offices
model themselves, to the extent possible, after the more productive
offices.
While waiting for the new administrative law judges and support
staff to be fully trained and productive, we have done our best to
attack the backlogs with a series of administrative and regulatory
changes that have slowed the increase in pending cases and slightly
reduced average processing times. We could have made even greater
progress, but chose instead to make the important commitment to clear
out the most aged cases where the claimant has waited 1,000 days or
more for a hearing. I would like to take a little time to explain why
that decision is so critical.
For most of this decade, SSA created rules and incentives focused
solely on the most prominent metric for measuring the backlog--total
cases pending. As logical as this decision may seem at first, if you
think about it harder you will see that it creates a perverse incentive
to focus on the easiest cases and to set aside the difficult ones. That
is what happened until the start of the 2007 fiscal year, when we had
about 65,000 cases over 1,000 days old, some of which had been pending
for as long as 1,400 days.
Even though these 1,000-day-old cases generally take 5-6 times
longer than new cases to resolve, we set the goal of clearing them out
by the end of the year. We came within 108 cases of that goal by the
end of FY 2007, and I am happy to report that all of those cases are
now gone. From a moral perspective, we had to dedicate our resources to
clear out these cases because it is just wrong to let claimants wait an
unconscionable length of time in order to meet a hearing-pending goal.
We were not satisfied with our initial success, and for FY 2008, we
redefined our goal as cases 900 or more days old. We had 135,000 of the
newly-defined aged cases at the start of FY 2008. I am pleased to
report that we are ahead of schedule for completing all 135,000 of
these cases this year; we have already completed 63% of them. Our
intention is to reduce the tolerance level again in FY 2009, but I plan
to wait until September before doing so.
I know you recognize that our ability to make continued progress
with this workload in the next fiscal year will depend greatly on our
fiscal position. If we do not receive a timely appropriation or must
deal with the uncertainties and budget reductions created by a
continuing resolution of unknown duration, our task will be much more
difficult to accomplish.
Reduction of the aged cases should also produce, later this
calendar year, a real benefit for everyone who is waiting. The aged
cases represent a large percentage of the paper cases in the system,
and it is extraordinarily inefficient to run two complex hearing office
systems instead of one. What should give everybody on this Committee
hope for next year is that the paper cases should be substantially gone
by the end of the year--around the same time that most of the new
administrative law judges are reaching full productivity. The
convergence of these two events means that we expect to hit the
``tipping point''--where both total cases pending and average
processing time are declining--sometime in January or February of next
year, with the caveat that progress may be slow if we are still under a
continuing resolution.
We have other possible improvements in the pipeline. In June, we
expect to start a 6-month pilot program with the National Organization
of Social Security Claims Representatives, an association primarily
comprised of lawyers. In this pilot, we are testing a program that will
allow representatives to conduct video hearings from their offices.
This initiative should offer convenience and comfort for many
claimants, save time for attorneys, and cut down on our investment in
bricks and mortar, a cost which increases above the rate of inflation
year after year.
We are planning on a test in Michigan which will use the same type
of case profiling mechanisms that we used in our successful attorney-
advisor and informal remand initiatives to look at cases heading from
the Disability Determination Services to Office of Disability
Adjudication and Review. Michigan is a ``prototype'' State that does
not have reconsideration, and we are looking at ways of providing a
quick screening tool to enhance the quality of the initial
determinations. What we learn from this screening activity may help us
identify cases that can be triaged at an earlier point in the appeals
process.
We have started a pilot on centralized processing of notices, which
may sound dull, but in theory should save an enormous amount of time
for hearing office support staff that then can be used for moving
cases. Regardless of the success of this pilot, at a minimum it will be
an opportunity to make Office of Disability Adjudication and Review
notices more up-to-date, clear, and user--friendly.
We will continue to improve Office of Disability Adjudication and
Review's basic electronic system. A new system to help support staff
ready files for hearing should be rolling out state-by-state by the end
of the year. We are working on systems that will improve docketing and
allow authenticated attorney representatives to access the records to
check files for such things as case status and evidentiary development.
As I have said before, there is no magic bullet answer, just a
multitude of small nitty-gritty improvements necessary to run a more
efficient and compassionate process for the American public.
Before I close, I feel obligated to bring one aspect of last
month's Trustees' Report to your attention. Although the combined OASDI
trust funds do not reach exhaustion until 2041, the disability trust
fund will be exhausted in 2025 under current assumptions. Although that
date is later than the 2019 trust fund exhaustion date for Medicare
Hospital Insurance, it is one more reason why Congress needs to work
together on a bipartisan basis with the administration to give younger
Americans reason to have confidence in the future of Social Security.
To conclude, we have made slow and frustrating progress in fixing
our service delivery problems, but we are making progress, and I am
grateful to each Member of this Committee for your support. As I have
laid out in this testimony, changes that will take place between Labor
Day and the end of the year--streamlined online filing, at least 175
new administrative law judges picking up steam, and the full shift from
paper to electronic systems in Office of Disability Adjudication and
Review--should produce considerably more improvement next year.
Operating under a continuing resolution for a prolonged period of time
would worsen a situation already made difficult by years of increasing
workloads and limited resources. It is also essential that we receive
the full President's Budget for FY 2009 in order to keep up with
increasing workloads and meet our commitment to eliminate the hearings
backlog by the end of FY 2013. So I ask for your timely support of the
President's budget.
Thank you for this opportunity to lay out in detail our plans and
progress, and I will be happy to answer any questions you have.
Mr. MCNULTY. Thank you very much, Commissioner.
Commissioner, under your hearing backlog reduction plan,
the hearing backlogs would not be eliminated until the year
2013, assuming adequate funding. Now I'm assuming that if we
kind of keep on the track that we're on now, 148 million last
year and maybe 240 this year, if we keep on that kind of a
track, how significantly could we reduce that timeframe, in
other words, get the backlog dispensed with even sooner than
that?
Mr. ASTRUE. Sure. That's a good question, Mr. McNulty. So,
the plan that we laid out last year was based on some
assumptions of what we would able to do and the funding that we
would be able to get. I want to assure you that my staff is not
comfortable, that that's the minimum level of performance. We
are trying to beat those goals, and we work very hard to try to
do that.
So, for instance, when we laid out that plan, we assumed
150 administrative law judges with the new funding. We're going
to get at least 175, and if we can resolve some space issues
related to the national hearing center, we're shooting for
another fourteen more this year.
So, we've exceeded the goal that we set for ourselves.
We're trying to do that consistently. If we can get there
faster, I want to get there faster.
Mr. MCNULTY. Thank you, Commissioner. On that office space
issue, we understand that that's an issue and in some cases a
barrier to adding these new administrative law judges (ALJs)
and some staff in the hearing offices. What could the Committee
do to help you overcome some of these barriers in order to
place the staff more quickly, where they're most urgently
needed?
Mr. ASTRUE. Thank you, Mr. Chairman. Some of this is built
into the process. We go through GSA for leasing and renovation
of space. They handle an enormous number of situations around
the country. They generally do a pretty good job. But usually
even under the absolute best scenario it takes at least a year,
and often 18-24 months to acquire new space.
Certainly expressions of support from the Committee that
something is a priority, GSA tries to be responsive to that,
and we'll try to work with the Committee to indicate if there
are particular locations where the space issues are going to be
very critical. I think it's likely--we're doing an inventory
now and probably by some time next month we can sit down with
the staff and work out where the critical places are. But
they're probably Buffalo, Chicago, Albuquerque, a few other
places around the country where the faster we can access space,
either new space or add-on space, or renovation of space, could
greatly help our efforts.
When we finish that inventory, I think sitting down and
working with the Committee staff to identify those places where
you can express your support for the priority for those new
space acquisitions would be very helpful to us.
Mr. MCNULTY. Do you think we're actually going to be able
to physically position those 175 new ALJs we're talking about
for this year?
Mr. ASTRUE. Absolutely. We have actual physical space for
all 175. As I mentioned in more detail in my written testimony,
one of the things that I think has been a problem historically
is that there has been a pattern of under-allocating to the
Chicago and Atlanta regions; so my understanding is that we
have, I believe, filled every vacant office in the Chicago
region, and just close to that in the Atlanta region.
We are doing an inventory of our own space to see whether
we can do some renovations. One of the benefits of moving away
a from paper process to an electronic one is that it should
free up some space So for instance, in Buffalo and some of the
other hearing offices where space is an issue, we may be able
to move faster with the renovation than by accessing new space
if we can, for instance, clear out the paper file room, which
is huge in a lot of these offices, and convert at least one or
two parts of that office to a new judge's office. So, we're
looking at that now, and we should be much more ready to have
that conversation now that we've decided who's going where and
what we're going to need next year, in the next 30 days or so.
Mr. MCNULTY. Commissioner, on this video conferencing
issue, it sounds like these initiatives as a substitute for in-
person hearings, will offer some relief to claimants facing
long delays. But several of our leader witnesses point in their
testimony that video conferencing is not a good option for some
claimants, or some types of cases. What is your plan to insure
that claimants maintain a meaningful right to an in-person
hearing and are not faced with an impossible choice between a
video hearing soon or an in-person hearing months or years
later?
Mr. ASTRUE. Well, certainly my view is that the quality of
this technology has improved dramatically in recent years and
it's come down in cost. I've sat through a fairly sensitive
video hearing, and really felt that very little was lost in
that conversation.
So, I think for most claimants most of the time, this is a
very real option where there's no loss in quality. On the other
hand, if a claimant feels that way, they don't have to accept
the video hearing and they can wait for an in-person hearing.
For a lot of the claimants, the video hearing can often save on
travel. If you've got a mobility impairment or some other
aspect of your impairment that makes it difficult to travel, or
you've got a psychological condition, where you're going to be
more comfortable in your lawyer's office, or that type of
thing, I think the video hearings are going to be a blessing
for that certain segment of the disability population. But any
claimant who doesn't feel comfortable with it; doesn't have to
do it. We find in practice that very few claimants actually
turn down the option of the video hearing; but some of them do,
and we're always sensitive to claimants who feel that way.
Mr. MCNULTY. Thank you, Commissioner. The Ranking Member
Mr. McCrery may inquire.
Mr. MCCRERY. Thank you, Mr. Chairman.
Commissioner Astrue, there has been a lot of talk around
Congress that we may end up with a continuing resolution to
fund government operations for fiscal year 2009. If that's the
case, what effect would that have on your operations and the
effectiveness of Social Security Administration operations and
customer service during the coming year?
Mr. ASTRUE. It would be bad. We would go back to a
situation where we would have some form of hiring freeze. We've
been looking at that recently. Probably not a full hiring
freeze in the beginning. But you would see some substantial
contraction of staff, so you'd see deterioration of service
times in the teleservice centers and the DDSs, in particular.
To the extent that we need to make some commitments on
physical space, at some point we need to show GSA that we're
actually going to need the space and we're going to be able to
fill them with bodies. So, there's a risk, as I understand it,
that if we're back in a situation where we've got a hiring
freeze and financial issues, it may also slow up the space
acquisition process.
So, it would have some immediate impacts that would be bad,
but it could also have a longer term impact, because we are
going to need some additional space in some parts of the
country in order to deliver the kind of service that I think
everybody here wants us to deliver.
Mr. MCCRERY. Again, in the budget that the President has
presented, it calls for a 6-percent increase over 2009 funding,
is that right?
Mr. ASTRUE. Yes, it does.
Mr. MCCRERY. Will that 6-percent increase solve all your
problems?
Mr. ASTRUE. I wish. One of the things that we heard loud
and clear from the Congress as I came in was that the first
priority had to be disability backlog production. We agreed
with that. In fact, we had to talk--at one point the Senate was
talking about limiting the increase in funds to only that,
which I think wisely they backed off from.
But I think one of the things that wasn't clear to the
Congress in past years that we've made a point of being
transparent on, is that in all these years of contraction,
there have been workloads that have been set aside that are
less critical to most Americans. A lot of those relate to
program integrity, so they have substantial long-term costs for
the system.
But there is work that's not getting done, and my
predecessor's last budget was predicated in part on that, but I
don't think it was laid out clearly enough to the Congress what
those were. I don't think Congress understood. Certainly when I
came here a lot of Members did not understand why that budget
request was as high as it was. So, we've been very transparent.
Nobody likes to lay out where they're failing.
But I think it's important for us to explain to everyone in
Congress what is not getting done, and why, and how who we've
done the prioritization, so that you can make the judgments on
funding as to what gets done in the coming years and what
doesn't get done.
Mr. MCCRERY. Now let's talk for just a minute about the
situation with the trust fund for disability. I mentioned in my
opening remarks that for the last 3 years outlays of the
disability program have exceeded revenue coming in, and the
trust fund is going therefore slowly be drained. In less than
two decades it's projected that promised benefits, current
benefits won't be payable.
You've been conducting some demonstration projects around
the country related to gradually offsetting benefits due to
earnings, and determining the impacts of funding treatment for
those with certain mental impairments. Do you have any
preliminary results of those? Can you tell how those and other
projects might help us to fundamentally reform the disability
program?
Mr. ASTRUE. Yes. Several good questions. I also mentioned
in my testimony the 2025 date on the disability trust fund. I
think it would almost be insulting to raise the issue of the
retirement trust fund generally. There's been so much
discussion. You all know that date. But there is a tradition
that the trustees and the actuaries tend to report the combined
retirement and disability trust funds. I do think that the
status of the disability trust fund sometimes gets overlooked
as a result of that. So, I did make a point of mentioning that
in my testimony, because I think that's important for the
Committee to consider.
We don't have any data yet on the demonstration projects
that you've mentioned. We're hopeful that they it will provide
some real benefit for claimants, and some marginal improvement
in the trust funds. We are also looking at the question of work
incentives much more broadly. I think it's fair to say that
it's my perspective that the Ticket to Work Program generally
has been disappointing in terms of its result. So we do have a
task force now within the Agency that's looking broadly at the
question of work incentives with the idea of perhaps coming up
with a package of regulatory and legislative proposals.
Probably early 2009 is our timetable now.
Mr. MCCRERY. Thank you, Mr. Chairman.
Mr. MCNULTY. Thank you. The Ranking Member, Mr. Levin, may
inquire.
Mr. LEVIN. Welcome.
Mr. ASTRUE. Thank you.
Mr. LEVIN. This is a hearing, as we know, on the disability
backlog. So, I want us to focus on that, and look at from the
perspective of the person who's waiting, and not get lost in
some of the details, the organizational details that are
important.
I think everybody here has to face up to what's been
happening this last decade, especially those who had a major
responsibility. I think we need to face the music on this. As I
understand it, I have a chart that shows--and these are the
appropriations these last 10 years--that from 1999 to 2007
Congress cut the SSA budget by 4.6 billion compared to what had
been requested by the Commissioner. Indeed, compared to what
OMB requested, which was much less than the Commissioner's
request, Congress cut SSA's budget by $1.3 billion. The result
of this, one result is that today people are waiting--what's
the average for a hearing, Mr. Commissioner?
Mr. ASTRUE. It's a moving target, but it's just over 500
days.
Mr. LEVIN. That's a year and a half.
Mr. ASTRUE. Yes.
Mr. LEVIN. You and have met to talk about this, and I just
want everybody to have a sense of responsible and I think a
sense of outrage, because that's the way our constituents who
file these claims, they have every right to feel outrage.
Now you and I have discussed this. The average is a year
and a half. In many places it's much more than that, right?
Mr. ASTRUE. Yes, it is.
Mr. LEVIN. For those who are covered by the office in Oak
Park, Michigan, the average processing time is 764 days, right?
Mr. ASTRUE. Yes. That's close to the worst in the country.
Mr. LEVIN. What do we say to somebody who's waiting--that's
over two years. Right?
Mr. ASTRUE. That's correct.
Mr. LEVIN. When Congress, the last ten years until the
recent action where we increased the budget, I don't always say
to them, ``Now you've inherited this and this new Congress has
tried to begin to rectify it.'' Let me just ask you--we've
talked measures to balance between hearing offices. You've said
it's going to take until what year before we get a total grip
on this?
Mr. ASTRUE. The plan that we laid out for Congress last
year, which was based on a number of assumptions that may
change, was 2012. We hope to do better than that, and we work
very hard to try to better than that, and I like to think that
we're ahead of schedule. But if you want to say, ``I want to
see the real progress, I want to be able to make an initial
judgment,'' you probably won't be able to tell whether we're
really hitting the target clearly until the first quarter of
next year.
We've made progress with the total pending; the increase in
the total pending is down the last two fiscal years. It would
have been down more except we made the priority of the aged
cases, which take a lot more time to remove from the system.
That was with a record low number of ALJs.
With all the improvements coming, with the infusion of new
ALJs, there should be a dramatic turn somewhere around the
beginning of next year, or maybe a little sooner.
Mr. LEVIN. When you say a dramatic turn, what does that
mean?
Mr. ASTRUE. Well, we're hoping and expecting that the
backlog will hit a tipping point when the new ALJs are fully
productive, when the paper cases are substantially gone, then
we're going to be able to start driving it down at
approximately the same rate that it went up. It was going up at
about 75,000 cases a year for most of this decade. For 2007 it
went up 32,000, if I remember correctly. Annualized for the
first half of this year, it's about 11,000. So, it's been
coming down, even with limited lower resources, on the basis, I
think, of better management and improved productivity at ODAR.
I want to give the staff at ODAR a lot of credit. The only
reason it wasn't a lot worse this year is we got about a 10
percent improvement in productivity, and that's a great credit
to a lot of the people that are working very hard to try to
solve this.
Mr. LEVIN. My time's up. I just wanted everybody to face
the facts here, and I think what has happened in this country
with disability is indefensible, and we're now taking steps
to--I mean the hole was dug so deeply. This institution helped
to dig that hole.
Mr. ASTRUE. As you know, Mr. Levin, we've talked about this
several times now. I don't disagree with your basic premise,
and for me it was a motivating factor to try to come back and
fix it. I mean that's really the big challenge in the Agency. A
lot of the other big-picture issues have been taken away from
the Agency, so when you sign up to be Commissioner these days,
you're signing up to try to fix this problem, and that's what I
signed up for. It's that frustrating government doesn't move
quickly, but I think you've got enough data now to say ``It's
starting to move in the right direction; there are some good
plans in place that have not had a chance to take effect yet.''
There is some real reason to hope it's going to be
substantially better next year.
Mr. MCNULTY. Thank you, Mr. Levin. Mr. Herger may inquire.
Mr. HERGER. Thank you, Mr. Chairman. Commissioner Astrue,
earlier this year, both the Office of Management and Budget and
the Government Accountability Office identified the
Supplemental Security Income Program as having had improper
payments of over $4 billion, and the Old-Age Survivors and
Disability Insurance Program is having had improper payments of
over $2.5 billion in fiscal year 2007. I'd like to ask you
about the Administration's effort to effectively protect
against waste, fraud, and abuse. We all want to see the
application process for disability benefits move as quickly and
as accurately as possible. But at the same time we have an
obligation to make sure that disability benefits are paid to
those who are disabled and not to those who don't satisfy
program requirements.
For example, for years incarcerated individuals were
improperly receiving Social Security and welfare checks, until
our republican-led reforms in 1996 and 1999 successfully ended
this practice, saving taxpayers billions of dollars. Additional
reforms in 2004 cracked down on fugitive felons who were
illegally receiving Social Security and SSA disability
payments.
Mr. Commissioner, what are we doing to prevent fraud and
abuse in the disability application progress? As we strive to
shorten waiting times, I certainly hope we continue to pay the
proper attention to paying the right benefits to those who
actually qualify. Would you please discuss your ability to
achieve both goals, shortening waiting times, while still
getting eligibility decisions right?
Mr. ASTRUE. It's a very good question. We've got so many
important things that we're trying to do all at once. It's
difficult, but I agree that the program integrity work is very
important, and when it's set aside, there are long-term costs
for the public that we'll never recoup.
So, I think it's important for the Congress--I know this
Committee understands--but it's important for the Congress as a
whole to understand that when the budget got squeezed over the
15-year period that Mr. McNulty laid out, one of the very
important things that stopped being done the way that it should
be done is that the number of continuing disability reviews in
Title XVI and re-determinations in Title IV dropped
dramatically. The reason for that is it was one of relatively
few discretionary workloads.
A lot of what we do is absolutely mandated by Congress. As
a result, the numbers have dropped dramatically. The accuracy
is not where we would like it to be in Title XVI. Last year's
appropriation allows us to increase that important work. That
2009 budget anticipates that we will also move in that
direction.
But when something's been allowed--as with the hearing
backlogs--when something's been allowed to degrade over a
decade, you know as much as it's important, I can't fix it in a
year. So, even though there's substantial progress, we're not
going to catch up on all the cases that should have been
reviewed. We're going to be behind almost no matter what
happens in the 2009 budget. But we're going to try to catch up
as much as possible, get our accuracy rate as high as we can
possibly get it.
I should also mention that one of the casualties has been
the Inspector General's budget, which took a real cut, for
instance, last year. They do some very important work. I know
they're independent and they make their own requests, but they
do some very important work for us, and so I would like to put
in a little bit of a plug for the Inspector General, as well,
who's critical in our efforts on waste, fraud, and abuse.
Mr. HERGER. I thank you, Mr. Commissioner.
Mr. ASTRUE. Thank you.
Mr. HERGER. I yield back.
Mr. MCNULTY. Thank you, Mr. Herger. Dr. McDermott may
inquire.
Mr. MCDERMOTT. Thank you, Mr. Chairman. When I came to
Congress I came in 1989, at a time when we had a savings and
loan crisis in this country. In my view, at least a major
reason why that was created was that the Reagan Administration
cut the number of banking examiners, so that banks never got
examined. Then we found all this mess and we spent billions of
dollars bailing them out, because we did not have the proper
administrative work done by the administration. It was
deliberate not to go in and look at what banks were doing.
Now I think it's unfair for us to accuse, or to beat you up
today, and I don't intend to. I want to say that GAO has
actually taken you off the list of places where people ought to
look for fraud, waste, and abuse. Well, my colleague brings
that issue up. It is a red herring, in my view. It is not the
place to be looking. We're talking about people who are not
even adults in many cases; they're children, and we're talking
about cases in my area you have to wait 575 days to get taken
care of; 578 days in Seattle before your appeals is brought up
for a hearing.
Now what I'd like to ask you is how many of those appeals
actually qualify for SSI benefits, when all is said and done at
the end of that appeal process?
Mr. ASTRUE. Right. The allowance figure at the hearings
level has gone up in recent years, which is predictable,
because as the delays increase, it's an open-ended process; so
if people's conditions deteriorate--they may not have been
eligible in the beginning of the process, but they get benefits
if they're eligible later in the process.
Mr. MCDERMOTT. The percent who get paid if they're
benefits----
Mr. ASTRUE. It's a little over 60 percent.
Mr. MCDERMOTT. So . . .
Mr. ASTRUE. Well, you have to realize that relatively few
of the cases appeal from the states. So, about 33-35 percent--
we'll get you the precise number for the record--are allowed at
the DDS level. Approximately a third. For all the hearings and
appeals process, add about another 5 percent to that total, so
it's about 38-40 percent who actually end up getting benefits.
[The information follows:]
[GRAPHIC] [TIFF OMITTED] T8116A.001
Mr. MCDERMOTT. If that's true and you have all the
experience you have in the SSI Program, you must have a profile
of those most likely to get approved at the end of the process
2 years from now, right?
Mr. ASTRUE. Yes. Absolutely. Again, we've embraced that in
a major league way. Not just at the back end of the process,
where our quality of people have been very helpful in building
precisely the kind of templates that you see, so we can pull
those cases out, not put them through the whole process, and
decide them quickly. That's been very helpful; we've been doing
that both in terms of the voluntary remand program and the
attorney advisor program. We'll give you information on those
templates.
[The information follows:]
[GRAPHIC] [TIFF OMITTED] T8116A.002
But I think it's important to do that on the front end, as
well. So we've put a lot of effort into this Fast-Tracking in
the front end, and I know some people think, well, you know,
the percentage isn't big enough, but if we can get that number
up to approximately 10 percent of the cases in the next few
years--you have to realize, we're looking at more than 2.5
million filings per year--if we can get up to 10 percent that
means that a quarter million Americans each year will get their
benefits within 6-8 days, which is what we're hitting now.
So, I think it's very important at every stage of the
process to try to figure out where we're going wrong, figure
out what the patterns are, and try to address that. We've tried
to that very systematically in a way that I don't think we've
done before.
Mr. MCDERMOTT. I'm aware of what you're doing, and what I'm
going to ask you is: What can we do additionally to give you
authority or flexibility to make those decisions earlier rather
than putting people through a two-year waiting period to
finally give them their benefits, by which time they are worse,
and qualify?
Now some of those things you will know up front. They're
going to get worse if we don't do anything medically for these
people. They have no healthcare benefits. You know they're
going to be worse, so you could actually save money, it seems
to me, if you dealt with it up front. I'd like to hear your
suggestions about things we could do to make this better for
the process to work for those who you know you're ultimately
give money to.
Mr. ASTRUE. Well, that's a good forward-looking question.
On one of the things, we're not quite ready yet. One of the
recurring debates over decades in the system is whether we need
the state to perform two levels of review. There are a lot of
reasons right now where it's important to claimants to have
that second level of review; although there was a Clinton
Administration initiative to eliminate that, and we still have
eight states that don't have the recon.
There are some issues on that, and I've talked to Mr. Levin
about that in some detail, because one of the reasons that the
filing rates in Michigan appear to be so high is that there are
probably a lot of cases coming out of the state that shouldn't
be there in the first place. We've got a new Federal-level
initiative to see if we can screen those out with exactly the
kind of templates that you're talking about.
But I think that it's important to try to do as much right
up front as possible. So, we have a new computer system that
was rolled out prematurely in DSI, that was a disaster, that we
pulled back. We spent a year and a half trying to do it right.
It's getting close. The modified system will do a lot more
queuing for the state employed in the beginning; it will help
them assemble the records much more easily.
If we can do that well and we can find out much better
mechanisms for getting medical records into the process early -
because one of the reasons the whole system is just so
ridiculously inefficient is that at the point where we make
decisions, we don't have the full medical records. There's
joint responsibility on that. Some of that is claimant, some of
that is their attorneys. Some of it is ours. Some of it is
hospitals. Some of it is physicians.
So we're trying to get a handle on that. Particularly in a
time when the world is moving to electronic medical records, to
try to make sure that we use our resources as efficiently and
compassionately as possible, so that we make the very best
decisions as early as possible in the process. We've got room
for improvement, but we've got to make sure that we do it
right. There's a history in this Agency because of concerns
from the public of rushing a lot of things that aren't ready
for prime time. There's been a lot of damage to the Agency from
some very well intended initiatives.
So, one of the things again--and you may get frustrated
with us about this--but if you look through the testimony of
the panelists, we've got a lot of things that are being
piloted. I think that's best-demonstrated practice.
Before we roll them out for the American public, we want to
make sure that they operate the way that they were supposed to
operate. So, the e-cat system again, which was one of those
things that was inflicted on the public too early helped create
backlogs in New England, where we'd never had them before. We
pulled that out, but now we're trying to do it right, and
before we roll that out more broadly, you can rest assured that
we'll take one state, two states, tested in a limited way,
before we bring it out more broadly.
But the general idea is if we can contract the process,
make it as good as possible as early as possible, that's the
ultimate answer to reducing some of these waiting times in the
grand scheme over a slightly longer haul. That has to go in
tandem with all these incremental things we're trying to do to
make the status quo run better in the meantime.
Mr. MCNULTY. Thank you, Dr. McDermott.
Mr. MCDERMOTT. Thank you for your indulgence, Mr. Chairman.
Mr. MCNULTY. Thank you, Dr. McDermott.
Mr. Camp may inquire.
Mr. CAMP. Well, thank you, Mr. Chairman.
Before I ask my question, I just want to go back to
something Mr. McDermott mentioned. While GAO may have taken the
Agency off the high-risk category, Office of Management and
Budget and the GAO have identified the Supplemental Security
Income Program as having had improper payments of over $4
billion, and the Old-Age Survivors and Disability Insurance
Programs as having had improper payments of over $2.5 billion.
I think we all have an interest in having program integrity and
insuring that improper payments are confronted so that those
people who are truly needy are receiving those payments.
I just want to thank your staff on the frontlines that I
know my office works with closely, and appreciate their efforts
on behalf of all of those going through the disability process.
Michigan is one of those ten prototype states you mentioned in
your testimony, and so the reconsideration process is
eliminated there. GAO in 2002 decided not to expand this
because of some problems with administrative costs, increased
appeals, and we're seeing in Michigan longer wait times.
Mr. ASTRUE. Right.
Mr. CAMP. You mentioned in your testimony that you're
looking at a screening tool.
Mr. ASTRUE. Right----
Mr. CAMP. For states like Michigan. Could you just
elaborate on this initiative and what plans it might have for
states like Michigan that have seen their wait times increases?
Mr. ASTRUE. Sure. So, 14 months ago we probably spent most
of the first four months trying to get a handle on DSI. Then
when we resolved what we needed to do on that, we focused on
the backlog nationally with as much intensity as possible. We
started a process about six months ago to try to look much more
at the local level at individualized solutions, to try to
figure out where the problems were. In most of the prototype
states, it doesn't appear that it creates an enormous problem
at the hearing level, but it does appear that there's a
potential problem in Michigan. So, you know, the automatic
response is, ``Well, we'll just make them do what everyone else
does and go to recon'', which would be expensive, time-
consuming, politically controversial, and might not help the
problem for some time.
What we've tried is to look at a faster, quicker, and
smarter model. So we're looking at precisely the kind of
templates that Congressman McDermott was referring to, to see
if we can identify the cases that are coming out of the DDS in
Michigan that probably shouldn't be there in the first place;
try to do a very quick review--and by ``quick'' I'm talking
about 7-10 days as the target, and either send them back to the
DDS with instructions as to what needs to be done, or if they
should simply be allowed, we will have a process within ODAR to
send it over with the recommendation so that there can be a
quick allowance of those cases.
If that works, it's possible that that may be a model that
we could use more broadly around the country. But again, I
don't like to over-promise. I like to know what's really going
to happen before we roll it out to the rest of the country.
But I think it could be helpful in Michigan, and we should
know, I would hope, by the end of the year.
Mr. CAMP. Well, in private disability insurance by law,
those have to receive their determinations within 45 days. Many
times they get their determinations in 30 days. Are there any
tools that the private sector is using that the SSA could learn
from?, and why are they able to make their determination so
quickly?
Mr. ASTRUE. We do look at the private insurers from time to
time. They also look at us. I think that there are some
differences and I think that we do have much more of a problem
in terms of accessing medical records.
You know, typically with private insurance, you have an
employer who is very financially motivated if an employee
deserves disability benefits to cooperate with that and help
them walk through the process. We don't have anything
comparable there. So that's one of the big differences, I
think, between the private insurance and what we do, is that
the challenge of assembling the medical records so that we can
make a fair decision in the particular case is a little bit----
Mr. CAMP. To that end I understand you're working on a
health information technology system. Clearly automating the
collection of those medical records would be helpful.
Mr. ASTRUE. Right.
Mr. CAMP. Can you just sort of tell me the status of that
initiative?
Mr. ASTRUE. Well, it's a moving target. We do have what we
call Electronic Records Express, and that's been helpful. It
will be somewhat limited until the rest of the private sector
moves to electronic records. But it is helping. I think
generally we're feeling we're getting more records earlier, but
we still--one of the root causes of inefficiency in the system
is that we just don't have the right information at the right
time. We've got a long way to go before we're really up at the
level that everybody would want. Some of that's not under our
control, but we're trying to get there as fast as we can.
Mr. CAMP. Thank you. Thank you, Mr. Chairman.
Mr. MCNULTY. Thank you, Mr. Camp.
Mr. Lewis may inquire.
*Mr. LEWIS. Thank you very much, Mr. Chairman. Thank you,
Mr. Commissioner, for your service. Thank you for being here.
Mr. Commissioner, I represent Atlanta, which has the highest
backlog for disability appeal in the country. The average
processing time in the Atlanta Northfield Office is 828 days.
That is the absolute worst, the very worst in the country.
Mr. ASTRUE. You have the second-worst in Atlanta as well.
*Mr. LEWIS. In Atlanta, it's not much better than 750 days.
I have 51 individuals in my district who have contacted me for
assistance in dealing with the office of hearing appeals. The
oldest case has been pending in my office since August 13,
2004. In fact, I just found out that this case was resolved
last week after more than 11 hundred days. That is disgraceful.
That is unacceptable.
I'd like for you to tell Members of the Committee, do you
have a plan for Atlanta?
Mr. ASTRUE. Yes, we have. Again, I share your feelings
about the situation in Atlanta. It was the second hearing
office that I went to. I went up to Boston first to get a
handle on DSI, and then I wanted to see the worst places in the
country, so I went to Atlanta second.
We've hired as many ALJs as we have offices now. We're
looking at the possibility if the funding level comes through
next year, we had plans last year for five new hearing offices
that we scrapped because of the continuing resolution. Atlanta
was on the list, and I would expect that Atlanta will be on the
list next year.
Atlanta was one of the three cities that we focused on with
the National Hearing Center, so they've been getting relief
through those video hearings. We've had our quality people
going in on a special initiative to help prepare cases in
Atlanta. Atlanta was one of the cities with the overtime at the
end of last year, where we brought in people from operations,
again to prepare the old paper cases and flush them out of the
system.
But Atlanta's inexcusable. I don't have any argument with
you. In terms of backlog, they're the worst in the country
right now. We're moving as fast we can to try to address that.
I wish I could move it faster. I think you'll see some real
progress in about 6 months.
But I think that over the long run, Atlanta's one of the
cities I think as I mentioned before that is growing extremely
rapidly. We had four cities in this country last year that
added 100,000 people or more to the population. With all the
incentives to keep the status quo in the system, it's very
difficult for us to move the resources into the places that
need it the most, and it's a struggle for us.
But I do think that we're going to need significant
additional capacity in the Atlanta area. We've got two hearing
offices downtown. I would suspect that the third would probably
be in suburban Atlanta.
*Mr. LEWIS. Mr. Commissioner, it is my understanding that
two-thirds of all appeals are ultimately decided in favor of
the applicant. So maybe the Social Security Administration is
getting it wrong so many times. Following Mr. McDermott's line
of questioning, is it a way to get it right the first time?
Mr. ASTRUE. That's a very logical conclusion that people
come to quickly, but I think it's really not fair. A relatively
small number of the claimants appeal in the first place. They
are generally by definition the close-call cases, and there are
a number of reasons why the decisions are different at the
hearings level. One is if the condition of the claimant
deteriorates, they may not have been eligible at the beginning,
but particularly with the long waits, they are then eligible.
They are often represented by attorneys at that stage, who are
often critically helpful to claimants, not only in assembling
medical records but identifying the impairment. A number of the
people that get decision letters don't even allege the
disabling impairment at the first level, because there is some
stigma or some emotional concern. I saw this in the video
hearing I attended in Dallas, where it didn't look like the
claimant was going to win the appeal. I don't know, I'm pretty
sure that the person did. But what was most significantly
disabling, she didn't want to allege. The ALJ it out of her.
So, part of it is this is our people doing their job. You
know, the ALJs don't represented just the Agency. That's a
historic and unique part of our system. They represent the
claimants as well. A lot of times they pull out of the
claimants, even when they're represented, the real basis for
the disability, or pull out the information that was not
available earlier in the record to make a decision. Because the
states don't see the claimant; they're doing a purely paper
review. So, it does change the result to have that interaction
at the later stage in a smaller number of the close-call cases.
*Mr. LEWIS. Thank you. Well, Mr. Chairman, if I just may
ask just--well, Mr. Chairman, I used my time. You've been very
liberal with me. So, I yield back. Thank you, Mr. Commissioner.
Mr. MCNULTY. Thank you, Mr. Lewis.
The next Member I want to introduce I want to thank, not
just for his service to the Committee and for his service as
Ranking Member of the Subcommittee on Social Security, but also
for his heroic service to our country, Mr. Johnson of Texas.
Mr. JOHNSON. Thank you, Mr. Chairman.
I appreciate that. Commissioner, a recent inspector general
report raised concerns about the performance of administrative
law judges finding ``that the Office of Disability Adjudication
and Review's ability to process projected hearing requests and
address the growing backlog of cases will continue to be
negatively impacted by the caseload performance of some ALJs if
their status quo performance levels continue.'' Subcommittee on
Social Security Chairman McNulty and I have asked the IG to dig
deeper into the performance issues and assess the ALJ
management tools and practices utilized by the agency. Is it
not true that some ALJs are doing nothing, zero, zip during the
work day? I would like to know what action you are taking and
what changes in the law we can make that would help that? If
you would elaborate, I would appreciate it.
Mr. ASTRUE. No, I would be delighted to. Let me first of
all preface by saying the vast majority of the ALJs are solid
professionals, behaving themselves well and trying to work
productively.
Mr. JOHNSON. What is the total number of ALJs?
Mr. ASTRUE. Right now, let's see, we were down to about--we
will correct this for the record, but we were down to about
1,025, we have 40 that came on board approximately last week.
We will have a couple more classes coming in May and June, so
we are hoping by the end of the year to be somewhere between
1,175 and 1,200.
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Mr. JOHNSON. But I did not want to interrupt you, you are
talking about a minimal problem but if it is 10 or 12 even, you
are talking about people----
Mr. ASTRUE. No, let me separate it into two categories,
although they do tend to overlap. We have had some serious
misconduct issues, and we have had some serious productivity
issues with a significant minority of the judges. Historically,
I think this is part of the fallout from the eighties where
Congress stepped in to correct certain problems in the system
and protect the independence of the administrative law judges
and generally I am supportive of that, but that has calcified
into a lack of accountability. Many Commissioners have given up
trying to discipline administrative law judges, and my feeling
is that is wrong. If you are a judge, you need to treat
claimants with respect, you need to treat the taxpayers with
respect by putting in a full day, and we do have judges who do
not do that.
I have prosecuted this ALJ to the fullest so far and I am
hoping that he will be terminated. He held two Federal jobs for
3 years and falsified military documents for the other job in
order to pull off the fraud. He has not been contributing in
Atlanta. So, a casual attitude toward misconduct has a bottom
line cost for the people that we all serve. My feeling is these
are test cases. If the Merit System Protection Board removes
the judge, as we have asked them to do, great, then we have
made progress. If they do not, I am going to come back to all
of you and scream bloody murder and say you need to do
something about it.
We have had other serious misconduct issues. One ALJ one
just pled to on a prostitution charge. We have had some assault
issues. I think that is inexcusable for a judge and a judge who
actually does that should be terminated no question, but the
Merit Systems Protection Board has been extremely lenient on
judges, which is why most Commissioners have given up. But we
are not giving up, we have about a dozen cases over there now.
We had one judge who had not done a case in seven and a half
years and would not schedule cases, and I was advised that had
to go through a redress program in order to make something
stick. So, we have done that, we have been assigning hearings.
He has been resisting. He has done a handful of cases now, I
think they are all or substantially all allowances, so I am not
sure he is doing the real work. I am going to stand up to
judges like that, and it would be helpful for this Committee to
have GAO take a look at some of these cases and look
specifically at some of the cases that have gone before the
Merit Systems Protection Board and ask the question are these
one, two and three day suspensions that tend to be the most
that the ALJs get in those cases, are they really adequate to
protect the American public?
Mr. JOHNSON. But the Congress is sitting here ready to help
you and all you have got to do is ask.
Mr. ASTRUE. Will do, and I think that we will have a lot
more information shortly as to whether the MSPB is going to
stand up in some of these atrocious cases.
Mr. JOHNSON. Thank you. Thank you, Mr. Chairman.
Mr. MCNULTY. I think the Ranking Member of the Subcommittee
on Social Security. Mr. Becerra may inquire. Excuse me, Mr.
Neal may inquire.
Mr. NEAL. Thank you very much, Mr. Chairman. Welcome,
Commissioner.
Mr. ASTRUE. Thank you.
Mr. NEAL. Last week during tax disclosure time for the
candidates for president, I must tell you I was delighted to
read and then to hear that Senator McCain is a Social Security
recipient. I offer that not as a political statement as much as
it is an indication of what a policy triumph Social Security
has been and its egalitarian nature. You know how ferociously
many of us on this Committee guard Social Security. I think if
there is one message that you would take from here, it is what
the debate last year over what Social Security accomplished and
it indicated very clearly that the American people were not
about to forfeit Social Security without knowing what was
coming next and the argument that many of us made was that we
should add on to Social Security as opposed to subtracting from
it. I think Senator McCain's announcement last week that he was
a Social Security recipient serves all of us very, very well.
Let me be specific, my Social Security office in
Springfield does a terrific job and there is great interaction.
Mr. ASTRUE. I am glad to hear that.
Mr. NEAL. Well, I have great faith in them, and I must tell
you that the role the constituent work plays in Social Security
is vital and people do not start with a call to a congressional
office, they end up calling a congressional office.
Mr. ASTRUE. Right.
Mr. NEAL. It is a very important consideration and they
have been, as I have indicated, very good to work with. Let me
see if I can cut through some of this though and maybe with a
general question, you can shed some light on the issue of
assignment as it relates to judges. Hearing offices around the
country vary considerably in the size of their backlogs and the
amount of time claimants must wait for a hearing. In some
offices, the wait is less than 300 days while in others it is
approaching 900 days. In some offices, each judge has fewer
than 300 cases pending while in other offices each judge has
1,700 cases pending. What measures do you take, and is it
similar to the criminal justice system with Federal judges in
terms of trying to seek a balanced workload that can be
measured for Members of the administrative judgeship
discipline? How did this balance happen?
Mr. ASTRUE. Right, right. So, I appreciate that question.
One of the things we laid out in the written testimony, which I
believe is the first for the agency, that what has contributed
to the very phenomenon that you are concerned about and Mr.
Lewis is concerned about in district, of the resources that we
have had, which have not been enough, we have mis-allocated
them over time so that we do not have enough capacity in the
right places and part of this is it does get politicized. When
you are shifting around resources in Social Security, wherever
you are taking them from, the Commissioner is going to get a
hard time so it is easy to let the status quo go. But what we
have been trying to do very systematically is to equalize the
resources to a large extent around the country as best we can.
So, in the allocation of the administrative law judges, I am
unapologetic about the fact that some of the Members here are
not getting much benefit, some are getting a lot. I am from New
England, but I have no New England bias New England is only
getting one. Ohio alone is getting 13. But the reason for that
is if you look at the filings per administrative law judge in
places like New England, southern California, you will see 300
to 400 per administrative law judge. If you look at Mr. Lewis'
district, it is 1,200, 1,400, same in Cleveland and places like
that, and I cannot justify that. So, in the allocation of the
administrative law judges, we have realigned a lot of the
service areas to try to help the struggling offices and also
with the National Hearing Center so that we have got a
centralized cadre of judges that can move into the worse
backlog hearing offices like that because if you go through the
traditional process, it can be two, three, even 4 years, before
you get physical space up and running and moving and that is
not fast enough. My term is over by the time that gets a
benefit. That is not fast enough.
So, we are really doing the three things, the allocation
this time, we have looked very systematically at the regional
imbalances, to the extent that we can, we have tried to fix
that with this allocation. Second, we have done realignments,
some of them are very creative, the Toledo remote site is now
part of Boston and those types of things but those work and
they are starting to help, and I think expanding the National
Hearing Center is critical to this initiative.
Mr. NEAL. What you briefly said was it is possible during
your tenure that you could be there for the groundbreaking but
not there for the ribbon cutting?
Mr. ASTRUE. That is pretty close, Mr. Neal.
Mr. NEAL. Thank you. Thank you, Mr. Chairman.
Mr. MCNULTY. Thank you, Mr. Neal. Mr. Brady may inquire.
Mr. BRADY. Thank you, Mr. Chairman. I may I suggest this is
a critical round of questioning, both Mr. Lewis and Mr. Johnson
I think ran out of time to really go deeper into their
situations, perhaps at the end of this we might consider
allowing both of them an additional round of questioning
because I think both situations are worth exploring.
Mr. MCNULTY. We will go back to allow Members to ask
additional questions.
Mr. BRADY. Thank you. Commissioner, two questions, one
local, one national. In the Houston region in 2001 and 2002, we
had serious problems in our disability offices, long backlogs,
dramatic variance in disapproval rates and real concerns about
whether there is minority bias in the decisionmaking. Since
then, in the downtown office that handles our cases, my
caseworkers tell me there has been a dramatic improvement in
response time, the quality of the decisions and clearly they
feel our people on the ground in our office----
Mr. ASTRUE. That is good to hear, I was holding my breath,
thank you.
Mr. BRADY. No, you need the experts and they are, but
looking at the numbers for this year, we have two offices in
Houston, one in downtown that goes east, one in Bissonnet that
has the western side plus the northern area. The question I
have for you, in one the downtown office processing time,
backlogs are 50 percent better than in the adjacent office,
even the judges according to the numbers you provided are more
productive. The downtown office is third in the nation in cases
pending in a good way, Bissonnet 33rd. The downtown office is
top 10 in processing time, Bissonnet is far below average. My
question is I understand the disparity nationwide, I do not
understand the disparity in the same town.
Mr. ASTRUE. Yes, that is a very fair question. A lot of
these issues you can talk about as if we were a big machine,
and that is helpful, but one of the things to realize is that
in each of these hearing offices, the key movers are the
administrative law judges. It is a relatively small number of
judges in each office. If there are human issues, performance
issues, it has a pretty big impact on the area. So, it is our
view that the issue with the Bissonnet office is a human issue.
We have got three judges there that are historically very
unproductive. We have several others being counseled by the
Hearing Office Chief to try to improve their productivity. So,
I do not believe that there is anything terribly significant in
terms of resources or the demographics of the filing profile
that account for any profound differences. Again, if I am
wrong, we will correct it for the record, but I believe you
have got three of I think it is eight, again I may have that
wrong, judges where there are some significant performance
issues and that hurts everybody.
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Mr. BRADY. Thank you. Would your office sit down with me
and just dig deeper into this.
Mr. ASTRUE. Gladly, yes.
Mr. BRADY. Obviously what we want is if someone has got a
legitimate disability claim, I do not want them going into a
line that is longer and moving slower by 50 percent than their
neighbor across the street.
Mr. ASTRUE. Yes.
Mr. BRADY. Which is sort of the case today.
Mr. ASTRUE. I do not want that either but, as I said, we
have identified that there are some issues.
Mr. BRADY. Right.
Mr. ASTRUE. We are doing our best within the considerable
constraints to try to deal with that.
Mr. BRADY. Thank you. National question, I think the
additional ALJ electronic system of clearing off the aged
cases, again a good decision, all those are helpful. Part of
the problem has been I think too many cases make the ALJ level
that should be resolved either through the quick termination or
at the state level, and there has been wide variances in
productivity and cases determined at the state before they get
to the ALJs, have you been able to measure the variance between
disapproval rates and productivity levels at the state level,
and maybe more qualitatively, have you been able to measure the
cases that should have been determined before they went to the
ALJ--before they got into the line, the very long line, that
could have been disposed of in either first two determinations,
have you been able to measure that?
Mr. ASTRUE. Yes, there are some inherent difficulties
comparing state to state performance but within those
constraints, yes, we do. We measure again not by allowances or
denials but we just look at accuracy, and we look at a sample
of 3 percent of the cases, an equal number of allowances and
denials, to try to make sure that we are maintaining acceptable
levels of accuracy. There is a threshold on accuracy, which I
think I recall but I will supply that for the record, where if
a state falls below that, then we go through a rehabilitation
process and try to do some intensive work to get them up to the
same level of accuracy. In general, the states do a pretty good
job. As a matter of fact, they do a very good job, and they do
it with less money than we do. Their state workers tend not to
be paid as well as ours, they have a lot of struggles with
turnover of staff. In general, they do a very good job, they
are not perfect. Generally, they maintain high levels of
accuracy by our standards but there is a level of accuracy that
is hard to account for because our people look at it based on
the record that they had before them. If we do not get the
right information there early, we can make a right decision
based on the information we have but it is not the ultimate
right decision so we cannot relax there, we have got to try to
push as hard as we can to try to make sure that the full
medical record is available for the claimant whenever we make a
decision and that the claimant has alleged what the claimant
should be alleging and that is a real issue in a significant
percentage of cases. Such as those involving depression,
sexually transmitted diseases. A lot of times the claimant does
not come forward with what is really disabling.
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[GRAPHIC] [TIFF OMITTED] T8116A.005
Mr. BRADY. Alright, thank you, Commissioner. Thank you, Mr.
Chairman.
Mr. MCNULTY. Thank you, Mr. Brady. Mr. Becerra may inquire.
Mr. BECERRA. Thank you, Mr. Chairman. Commissioner, thank
you for being here and to all your staff that you bring with
you as well. We appreciate the work that you have done in
trying to help us increase the resources you have to hire those
ALJs that we all agree you need and that is about as positive
as I am going to be in the 5 minutes that I have.
Mr. ASTRUE. Okay, I understand, I am braced.
Mr. BECERRA. You have I believe something in the order
1,300 local or field offices throughout the nation to service
people who come to the Social Security Administration, whether
it is for disability claims, whether it is for retirement
benefits, whether it is to get a new Social Security card, to
renew an old one, to do an employment check, whatever it is,
those 1,300 local field offices handle over 40,000,000 visits
every year and it is probably going to increase once the Baby
Boomers start to retire. My understanding is that the wait time
for most Americans going into these offices, local field
offices, is somewhere between two and 4 hours before they can
be serviced by a live body in one of your offices. You can
respond after I finish this.
My understanding as well is that on average half of those
people who make a phone call to a local office never get
through because the phone is busy. Now, I could go on and on
but what concerns me is not so much what we already know, that
you do not have enough resources and enough staff and that is
why people wait forever and that is why you have millions,
thousands of Americans waiting years to get benefits on a
disability. My concern is that your budget request for this
coming year, 2009, is actually less than your budget request
was for 2008. The President's budget, you submit a budget to
the President, the President then submits a budget to us, and
then we pass a budget. The President's budget for 2009
allocates more money to ALJs but it does it at the expense of
the field offices that are overloaded to begin with, and so you
are taking from Peter to give to Paul. So, far, you have closed
two offices, local field offices, this year. Last year, you
closed 17 field offices. You plan to hire, as you have
testified, somewhere between 175 to 189 administrative law
judges this year. That is great, but you plan to hire 143
support staff for those AL judges. By your own accounts where
you talked about having 4.4 support staff for every ALJ. If you
are going to hire 175 to 189 ALJs but you are only going to
hire 143 support staff, that includes the attorneys, the
medical evidence technicians, all those folks who have to make
the work work well for the ALJ so we do not have the abuse that
some of our colleagues have talked about and the fraud, how are
you going to do it when you have fewer support staff coming in
than you have ALJs coming in when you need four support staff
for every ALJ? Mr. Commissioner, this is not the way we should
do business, something has to change. You need to shake things
up. I am surprised at how sedate this hearing is. I cannot
believe that we are here talking to you as if we are going to
go through another day, and we can just go ahead and go along
and get along. This will not change. We are talking about
people in America who work, who worked in this country, this is
not welfare. In order to qualify for disability benefit under
the program, you have to have worked. Many of these people are
in their golden age and now facing these disabilities and first
they cannot go into an office without waiting hours before they
can get service. Second, once they submit their claim, it may
take them not just 400 some odd days that it takes in a LA
office but in Atlanta it could take up to 800 or 900 days. You
should be telling us, ``Mr. Chairman, Members of Congress, this
cannot go on. We are going to change this, we are not going to
do it with a 5-percent increase or with 175 ALJs. We have got
to shake this place up.''
You parachuted in recently into a mess, so this is not
directed at you personally as the Commissioner. This is
directed at SSA, which for years submitted budgets which were
too low, to an Administration, which for years has underfunded
you, and to a Congress, which until last year underfunded you
to the tune of billions of dollars, and so we are all
complicit. Actually, those who voted for that are complicit. I
did not support those budgets.
Mr. ASTRUE. Okay.
Mr. BECERRA. What I would say to you is this, as my time
has expired and if the Chairman is gracious enough to give you
time to respond, fine, but I do not see how we are going to get
anywhere we need to go with folks who have waited 2 hours to
get serviced in a local office or those folks who have waited
700 days to receive a benefit for which they worked and paid
into the system for unless you tell us we got to shake things
up.
Mr. ASTRUE. Okay, I think I have got about 12 questions
there, so I am not going to be able--you will have to remind me
which ones I have, I am not trying to be unresponsive. So, let
me just say as a predicate, most of your facts are right. The
waiting times in the field offices are not anywhere near that
bad. There are some really unacceptable----
Mr. BECERRA. Are you willing to come with me to one of the
local field offices?
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Mr. ASTRUE. We will supply the actual data.
Mr. BECERRA. Are you willing to come with me to a local
field office and see how long it takes?
Mr. ASTRUE. I am.
Mr. BECERRA. Okay, we will set that up.
Mr. ASTRUE. I also say that I am aware that we have maybe
100 to 150 offices where it is really out of control and they
tend to be the inner-city offices and the border offices, and
that is a direct consequence of the contraction of the funding
and being in long-term hiring freezes. Unless you close a lot
of additional offices, it is much easier when you are
contracting to take employees out of the larger offices and
that is what has happened. So one of the consequences of the
freeze has been McAllen Texas and 125th Street in New York,
those have some very unacceptable waiting times. I have been in
some of those offices, I have not been in all of them, but I
have been in some of them. So, yes, I am not denying--but it is
not quite as broad as you indicated. It is not the routine
office, it is more localized.
Mr. BECERRA. Commissioner, if you bought a car, would you
wait two years to get that car? If you bought a house, would
you wait 2 years to be able to go into that house?
Mr. ASTRUE. No. I am not justifying the status quo, we have
been trying to change it but let me say a couple of things, and
I hope as I am not taking any of this personally, you will not
take any of this personally as well.
[Gavel.]
Mr. MCNULTY. If I could just suggest to my colleague that
the time has expired, let us allow the Commissioner to make an
additional response and then we will move on to the next
questioner. As I stated previously, if there are Members who
want to have a second round, we will entertain that. So,
Commissioner, why do you not wrap up on this round?
Mr. ASTRUE. So, in terms of being an advocate for the
agency and being dedicated to get the proper level of funding,
I will be quite honest, I do not feel like I have anything to
apologize for because I walked into a situation where we were
on a continuing resolution, we were on a full hiring freeze, we
had furlough warnings, and despite the furlough warnings,
Congress did not act and give us an appropriation. So, in that
context when I made my first recommendation, which was for
Fiscal Year 2009, I looked at what had been done and there was
a very high request the year before and when I came up to talk
to the key Members of Congress about that, they gave that the
back of the hand and said, ``That is a dead on arrival budget,
we did not pay any attention to it.'' Then I also looked at the
15 years where Congress came in below the President's request
and it looked to me like there was a pattern of Congress using
that as a starting point as to how much lower they would go.
So, in terms of my decisionmaking, I said how high can I make
OMB go? I went for the number that I thought would work, it
did. At 6 percent, we are way over almost every other domestic
agency in the Federal government. We also worked with all of
you and worked with OMB so there was no veto threat on the $148
million over the President's budget and we got it. So, as far
as I am concerned, on my watch, we have done pretty well-being
an advocate for the agency and getting the adequate level of
funding.
I also think there is a changed environment. There is now
concern about the work that we are not doing, in large part
because we are telling you about it, which we were not doing
before, and that may color what we do next year. But I think
that what I did in terms of my recommendation and my advocacy
was to get the best possible funding with all the constraints
that we could, and I think we did it. So, I want to be very
clear, I do not think I have anything to apologize for in that
regard.
Mr. MCNULTY. Thank you, Commissioner. Thank you, Becerra.
Mr. Ryan may inquire.
Mr. RYAN. Thank you, Mr. Chairman. Commissioner, I guess I
will pick up where my friend from California left off, but
first let me say I appreciate your just most recent explanation
here, that was very telling, very helpful. Many of us who are
strong fiscal conservatives, if there is one area where we
think that more resources need to be deployed, it is this area,
more ALJs, all of this. So, you need to use those of us here at
this dais as advocates when it comes to this appropriations
process, and that is just something I want you to do.
Mr. ASTRUE. We have and all of you but particularly Mr.
Johnson,----
Mr. RYAN. Yes.
Mr. Astrue [continuing]. And Mr. McNulty have been just
absolutely terrific.
Mr. RYAN. Conservatives, liberals, Republicans and
Democrats, we all----
Mr. ASTRUE. Again, it is why I feel I can say I take no
offense. I do not see the problem here but I think in terms of
making the case more broadly to the Congress, we still have a
lot of work to do.
Mr. RYAN. Right, so let me get to my question.
Mr. RYAN. I just have 5 minutes.
Mr. ASTRUE. I am sorry.
Mr. RYAN. You have been parachuted in, you have put
together a plan, you have to execute it, and I have three
questions and I will ask them up front because this is
something we are all experiencing. You mentioned in your
opening statement that progress is being made in wait times for
obtaining a hearing, however in Wisconsin, my constituents are
experiencing an average wait period of 620 days, as an increase
of almost 33 percent over the 2004 levels, and it is an
increase of 3 percent over last year. So, question one, what
effect will these new initiatives, such as the Quick Disability
Determination, have on reducing this wait time and when do you
believe this effect will be seen? That is question one.
Question two, because of the 5 minutes, I want to get
through these.
Mr. ASTRUE. Yes.
Mr. RYAN. As you know, the inspector general recently
released a report on ALJ caseload performance that stated among
other things that a substantial minority, I think 30 percent of
ALJs, have not completed even 400 cases. In Wisconsin, for
example, there is currently a backlog of 998 cases per ALJ. I
understand some cases take a long time, low production numbers
can be misleading, but is the SSA planning on taking any
concrete steps within the constraints of the administrative
procedures acts to introduce reasonable production metrics and
standards? That is question two.
Question three, another concern I have is the ratio of
decisions of ODAR judges that they are issuing which appear to
reverse the state DDS' determination. Approximately one-third
to one-half of the ODAR level cases that my office assists
constituents with end up in a reversal of the state DDS
decisions. So, from an appellate level, that strikes me as a
bit high, the reversal rate is pretty darn high. Is this rate
of reversal proportional to other areas in the country? Does
the SSA see a lack of uniformity in the application of
standards by the various state DDS bureaus?
Mr. ASTRUE. Okay, a lot there.
Mr. RYAN. That is why I asked them all up front.
Mr. ASTRUE. I know and, again, I apologize if I am not
fully responsive, and I would be happy to supplement for the
record.
Mr. RYAN. I would appreciate that.
Mr. ASTRUE. For the QDD and compassionate allowance cases,
I think more than a lot of people recognize these are cases
that have to a greater extent than people believe often gone
off track in the system. When we have gone back, particularly
at the less prominent cases, we have found that 20 to 40
percent of them either resulted in inappropriate denial or just
took way too long to decide.
Mr. RYAN. Twenty to 40 percent?
Mr. ASTRUE. Yes, they should have been easy cases. So this
is why we are very systematically trying to identify these
cases and just stop them from being a problem. It will make
things a little bit more efficient at the DDS level, I think we
picked up 6 days in average processing time last year. They
were mostly other from factors. I think this will be marginally
helpful in the time but the main reason you do it is just to
make sure that these people do not get lost in the system.
In terms of Milwaukee, my understanding is we are under-
resourced there and you will be moving from eight to 12
administrative law judges----
Mr. RYAN. By when?
Mr. Astrue.--There are three classes currently being
brought on board, April, May and June, that will bring us up
to, it is a little bit of a moving target but about 135 are in
those three classes. We are trying to get to the final at
minimum 175, so an additional 40 or so we should be hiring off
the OPM roster by August. So, we should be up to a full 175 by
August.
Mr. RYAN. So, we should expect 12 in Milwaukee by August?
Mr. ASTRUE. There may be a question if there is an August
hire, it may drag because most of these judges relocate, but
more or less yes. After the hearing, we will give you an
update. I do not know the specifics of the particular slots
that we hired in Milwaukee, but we will be happy to provide
that for you.
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[GRAPHIC] [TIFF OMITTED] T8116A.007
In terms of ALJ productivity, it is a real issue in the
system. We have established for the first time productivity
standards for the administrative law judges in that we are
expecting 500 to 700 cases a year, a significant portion of
them are not meeting that.
Mr. RYAN. Thirty percent of them are under 400 right now?
Mr. ASTRUE. That is right. Right now, the challenge is to
change the culture and for the most extreme cases, make it
clear that they are at a far deviation from the standard. I
think it is a dialog we need to have with the Congress as to
whether we need to put more teeth into those standards.
Mr. RYAN. These standards are now, they are out?
Mr. ASTRUE. They are out, 500 to 700.
Mr. RYAN. They are known?
Mr. ASTRUE. Yes.
Mr. RYAN. What are the consequences and the incentive
structures? Are they guidelines or strictures or what?
Mr. ASTRUE. Well, I do not want to seem facetious, it is
more of a guideline than a rule right now and, again, we are
bumping up against a lot of the statutory requirements.
Mr. RYAN. Right, that is why I asked the question.
Mr. ASTRUE. But, yes, certainly in the extreme cases. We
have a judge who has not done a case in seven and a half years,
it should not be necessary but when you go to take disciplinary
action, having a formal policy indicating the agency's
expectations are, will be helpful in some of those extreme
cases.
Mr. RYAN. You have a judge that has not done a case in
seven and a half years?
Mr. ASTRUE. Well, he is now because I am making him do them
but he had not for seven and a half years.
Mr. RYAN. He is still working for the SSA?
Mr. ASTRUE. He had not for seven and a half years is my
understanding.
Mr. RYAN. He is still working there?
Mr. ASTRUE. In terms of the ratio of reversals, again a
relatively small percentage of the cases go up to the hearing,
about one million claimants do not appeal their cases. We are a
little bit stuck. If we had a low reversal rate, people would
say it is not a fair process, it is not truly independent, and
we would get criticism for that. In recent history, it has been
about a 50 percent reversal rate. That has drifted up pretty
much in tandem with the increase in the delays, and I think the
primary reason why the allowances are going up is because of
those delays, and they are just claimants with degenerative
diseases and conditions that did not qualify but two years
later do qualify.
Mr. RYAN. Well, with the 620 delay, I can see the----
Mr. ASTRUE. Yes, that is right. It would be logical to
assume that the reversal rate will go down when we get those
backlogs down. But I also do not want to mislead you by
suggesting that the system is perfect. I think between the
DDSs, the range on the variances when you really get deep into
the numbers is pretty small. I think they do an outstanding job
by and large.
I will be honest, at the level of appeal, we do not do as
good a job. If you look at the variations between
administrative law judges, there is no justification for some
of them. We have one that denies I think about 96 percent of
the cases. We have a handful, 10 to 15, I do not remember the
precise number, we will supply it for the record, who allow
approximately 95 percent of their cases. I do not think either
is right. We have a statute that we have to adhere to. It is a
tough standard, and there are some hard cases where as a human
being you look at it and say that is a tough result but it is a
statute, and we should be enforcing it, as you have told us to
enforce it, and that is what I tell ODAR to do.
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Mr. RYAN. Alright, thank you.
Mr. MCNULTY. Thank you, Mr. Ryan. Mr. Blumenauer may
inquire.
Mr. BLUMENAUER. Thank you, Mr. Chairman. Thank you, Mr.
Commissioner, for being here. I would like to I guess take up
where my last two colleagues, we are not the worst in the
country but we are about in the bottom 10 percent. I think we
131st was the last that I saw with over 700 days. I want to get
a sense from you in an area where we do not have some of those
dynamics that you are talking about, we are just playing sort
of white bread, small metropolitan area, not with unusual
characteristics, we are not really old, we do not have
challenging populations. I am trying to get a handle on what I
am able to tell people back home about why we are getting
whacked around and what is going to happen about it for those
of us who are not at the bottom but clearly unacceptable I am
sure to you, certainly to me, and without question to the men
and women who are trapped in this system in Portland and
surrounding environments in Oregon.
Mr. ASTRUE. Right. If you could excuse me, I have got one
thing I want to check with my staff before I respond?
Mr. BLUMENAUER. Sure, sure.
Mr. ASTRUE. I want to get the answer right, I have got some
uncertainty on a couple of things related to Portland, so if
you would indulge me, if I could answer that for the record, I
want to make sure that we get it right. It is the right
concern, and I am concerned about it too but let me make sure
we get you a fair and complete answer and if we could do that
for the record, I would appreciate it.
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[GRAPHIC] [TIFF OMITTED] T8116A.009
Mr. BLUMENAUER. I defer to that, we would rather have an
accurate answer that does not haunt you or me. I would like
some extra special attention to make sure that it is aligned
properly. As I say, ours should be a region, I do not
understand the special stresses, the lengthy time, it is
driving the people that we are working with crazy.
Mr. ASTRUE. I do know, Senator Cantwell asked a somewhat
similar question last year in a hearing before the Senate
Finance Committee and one of the things that is true for the
Seattle region is the productivity of the ALJs tends to be
lower than most of the rest of the country if I remember
correctly. It is not entirely clear why that it is true. In
Washington state, I think the rotation of judges up to Alaska
is a factor, and we are trying to get a handle on that. But I
am not sure----
Mr. BLUMENAUER. I do not want mousetrap you, I respect your
kind offer to spend a little extra time to try and get the
facts nailed down.
Mr. ASTRUE. I have also just got a note. One of the things
I was checking here that was in my chart did not look accurate,
and I am glad that I checked. So, I do have--ODAR just told me
that there are two additional judges coming in Eugene and two
coming in Portland, so there is some help coming. It may not be
adequate, but we are going to do the best we can as fast as we
can.
Mr. BLUMENAUER. Well, I appreciate to know that there is a
little help on the way, and I appreciate your kind offer to
double check to make sure that we have got the facts and the
situation in place and look forward to working with you and the
agency to make sure that these people are properly served.
Thank you.
Mr. ASTRUE. Thank you, and we are happy to do so. We have
sat down, particularly recently, with a number of the Members
of the Committee to talk about the situations in their states,
and we would be happy to do that for you as well.
Mr. BLUMENAUER. I look forward to scheduling a few minutes
to follow up to see what we can do together.
Mr. ASTRUE. Great.
Mr. BLUMENAUER. Thank you. Thank you, Mr. Chairman.
Mr. MCNULTY. Mr. Linder may inquire.
Mr. LINDER. Thank you, Mr. Chairman. Since the beginning of
this hearing was used to blame Ronald Reagan for this crisis,
let me just deduce some facts. It started in 1980 when Jimmy
Carter agreed with two chairmen to increase the FDIC insurance
from $40,000 to $100,000 and let us sleep a little less and it
will become development companies, creating a huge market and
jumbo CDs. Bill Frenzel proposed a solution to that four or
five years later, and it would have cost $8 billion, it was
turned down. That is just to put some facts on the table.
Now, on to our subject. I want to follow-up with what Mr.
Ryan first raised, between December 1 of last year and April
22nd of this year, 17 of 18 appeals that we had before ODAR
reversed, and it strikes me that somehow or another you need to
inform me of the front-end or the back-end of this process.
That is a 94 percent reversal rate.
I want to raise an issue that is going to come before us
shortly that and that is Mr. Schieber is going to report that a
national Research Council report highlighted real
vulnerabilities facing the agency if a systematic transition
has not begun more moderate infrastructure including moving
away from COBOL, a 1950s system, to a current technology. For a
five year period ending in 1998, Congress gave $900 million to
the agency and dedicated investment to information technology,
what did you do with the $900 million and are you going to be
looking for more?
Mr. ASTRUE. The agency has made some significant
investments in IT; we could not deal with hundreds of millions
of American and their records and their service needs each year
without relying on IT. I do think that some of the criticisms
of the National Academy of Science report are well-founded. I
think that the agency got comfortable with the COBOL technology
and that the funding issues made it unrealistic to find a way
out. I do think that we are to some extent painted into a box.
For a number of the peripheral systems----
Mr. LINDER. Excuse me, just a moment. If you are
comfortable with a COBOL-based system, and you may be the only
people still using it----
Mr. ASTRUE. I am not telling you--I am saying we have been,
I think my systems people will tell you I am on their case on
this. We have about 36 million lines of COBOL code, and the
question is how do we get rid of as much of it as quickly as we
can.
Mr. LINDER. The point is if you want to move this country
and you to an electronic-based medical records system, you are
not going to be able to do it with that system.
Mr. ASTRUE. Right, so we have moved increasingly to web-
based systems, we are making some progress but given the huge
amount of code that we inherited, it is going to take some
time. One of the reasons, one of the things we would hope to do
if we come to agreement with the states on the state system is
move it out of the 54 separate--every time we make a change in
state disability determination systems, Bill Gray and his
people have to do 54 separate COBOL programs amending the
status quo, and it is incredibly time consuming, expensive and
it is a real issue going forward. We have been negotiating with
the states for about 9 months to see if we can come to an
agreement on specifications to go to a web-based system or
something else that is non-COBOL-based that is unified around
the country. It would be an enormous step forward if we can do
that, and we are looking for other opportunities to do that,
and we will have to ask for special funding from the Congress
for most of the changes.
One of the most problematic aspects of the NAS report is
that the core of the system, which we call ``MADAM,'' is all
COBOL-based and the magnitude of moving that system to anything
other than what it is now. It is enormous. So I will be honest,
we have got plans for a lot of the peripheral systems to move
away from the COBOL. I think we are going to be able to do it
on my watch. Technologically and financially, I do not think
that on my watch we are going to be able to fix the issue with
the core part of the program, but we have got to start a
process toward doing that. That is probably a 10 year project
and 10 years is probably past my half life.
Mr. LINDER. Mine too, thank you.
Mr. MCNULTY. Thank you, Mr. Linder. Mr. Pascrell may
inquire.
Mr. PASCRELL. Thank you, Mr. Chairman. Commissioner Astrue,
am I pronouncing that correctly?
Mr. ASTRUE. Yes, you are.
Mr. PASCRELL. You have been very forthright today. We have
confirmed that we have a large backlog of disability claims,
and we confirm that this has a tremendous impact on applicants,
extending the time period, et cetera, et cetera. You have a
plan to reduce the backlog, you relayed it before the
Committee. What is the administration's solution to this
backlog since this has not just occurred in the last 6 months,
this occurred over several years, has it not, Commissioner?
Mr. ASTRUE. Right, it really started in 2001.
Mr. PASCRELL. 2001.
Mr. ASTRUE. Right.
Mr. PASCRELL. More people come into the system. What is the
Administration's overall plan to deal with this tremendous
backlog in your mind?
Mr. ASTRUE. Well, it divides really into two categories,
one is as I think we have said pretty forthrightly, in terms of
resources we have had what economists would call both an
allocation issue, we have not had enough, and a distribution
issue in that we have not been putting it in the right places.
So I think we have laid out a fair amount of detail in the
written testimony how we have been trying to do that.
Mr. PASCRELL. So, Commissioner, if you looked at the
demographics back in 2002 and you saw the shrinking amount of
resources, I am not talking about you personally.
Mr. ASTRUE. Thank you.
Mr. PASCRELL. You saw the shrinking amount of resources,
one could very easily conclude that we are heading for a
disaster here.
Mr. ASTRUE. Well, in fairness to people who were here, I do
not think it was clear in 2001 what would be happening in terms
of resources going forward. I am not sure that people actually
believed that we would be under-funded to the extent that we
were, so in fairness to people,----
Mr. PASCRELL. You mean you think the administration did not
know that, did not understand what the ramifications are?
Mr. ASTRUE. I think we understood, I think the people that
were within the agency understood what the ramifications would
be if Congress under-funded us to the extent that actually
happened. It did happen but in 2001, I do not think in fairness
to the people who were here, I do not think that they
anticipated that that would happen.
Mr. PASCRELL. There are quite a few Social Security
disabled in New Jersey in my district. Do you know the
situation at Newark, 509 days per applicant.
Mr. ASTRUE. Right.
Mr. PASCRELL. That is not acceptable to you?
Mr. ASTRUE. No.
Mr. PASCRELL. It is sure as heck is not acceptable to me.
The Social Security disability backlog has caused extreme
hardship. You have to talk to the caseworkers in each of our
offices. They get no accolades because we think all the action
is happening down here. All the action as far as I am concerned
that is significant is happening back in our districts. These
constituents are unable to work but still must pay for their
medications. There are other healthcare needs. They have to pay
for their housing, living expenses for themselves and their
families while they wait months or even years for SSA to hear
their case. One New Jersey resident filed for disability
benefits in 2005 due to severe coronary artery disease,
recurrent congestive heart failure, requiring a pacemaker
defibrillator, diabetes, orthopedic impairments, hypertension,
other serious ailments, his case is still pending before an
administrative judge. This is cruel and unusual punishment.
Another constituent who applied for benefits in has not yet
had a hearing and his temporary rental assistance is being cut
off this month. Without help from SSA, he is going to be
homeless. The anecdotal stories here are not anecdotal, these
are real people that have faces on them. I know you care about
that, I really do. I do not think there is a person on this
Committee who questions your loyalty to the task and your
ability to move forward, but you cannot do it without
resources.
Mr. ASTRUE. That is right.
Mr. PASCRELL. What we need is more people in your
department to speak out against what I consider to be an
atrocity, and I do not believe you closed 17 offices during
this period of time.
Mr. ASTRUE. Well, actually to go through the numbers, we
have in terms of a net, we went down I think just a couple of
offices this year. We do every year and it is the exact same
process that has been since the Carter Administration, although
under my watch, we give more notice to Members of Congress than
we have historically. Historically, we have only worked through
district offices, so we now give duplicate notice to Washington
offices as well. We typically for the last 30 years, contract
about two to three offices a year. That has been pretty much
the trend, it is the same process. The numbers you are hearing
come from people that I think are trying to mislead you because
just--they call a consolidation of two offices a closing, they
do not look at the net because we open offices too. In fact,
your colleague to your left, we had this conversation that part
of the reason why we do this is that we have got places like
Las Vegas and Atlanta that are exploding in population and if
we have contracting resources, and we cannot move any of those
resources, it means that Mr. Lewis' constituents and Ms.
Berkley's constituents get short-changed compared to others.
So, we kept it approximately level for a long, long time.
Mr. PASCRELL. Well, then how many offices have you closed
since 2001?
Mr. ASTRUE. Net--again, we will give you the precise
numbers. It is the exact same trend for 30 years. It averages
two to three per years. There has been no significant deviation
from that trend in terms of the net.
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Mr. PASCRELL. Mr. Chairman, this is the lowest amount of
employees for the problem that we have in 32 years.
Mr. ASTRUE. Yes, that is right and what that creates is----
Mr. PASCRELL. You cannot put icing on that one.
Mr. ASTRUE. For Mr. Lewis and Mr. Rangel and the Members
that have inner-city offices, I do not think that they fully
appreciated that they take a disproportionate hit. Because if
you cannot close the small, under-utilized offices, where we
have lost a lot more employees and the people that are the most
stressed now, and there are some exceptions from it, but it is
the field workers in the inner-city offices and the major
border city offices because we cannot create employees out of
nowhere. If we do not have the money to pay for them, they
disappear.
Mr. PASCRELL. I agree.
Mr. ASTRUE. So I do not think we have done anything
radical. As a matter of fact, if you look at it in the big
picture, it would not be unreasonable for Congresswoman Berkley
to say to me you should close more so that you can----
Mr. PASCRELL. Commissioner, my point is that the
administration has been, not you, your Administration has
been--the administration, the people who hired you, that is who
I am talking about.
Mr. ASTRUE. I will be honest with you, I run substantially
independently. No one has told me from OMB that I have to do
this or do that in terms of offices. I come in and in terms of
the hearing offices, the processing centers, and the regional
offices---I look at it and I try to balance it out to say, ``
How can we serve the American people best?'' One of the things
that I think is a bit different from before is that we are
trying I think a little harder to be fair regionally but that
means that resources have to be moved from one place to another
and if you are one of the locations that is losing a resource,
I understand that people are unhappy about that but at some
point, when you have a city like Las Vegas that is exploding,
it is not fair to say that an office that serves four times as
many people in Las Vegas than in some place in the East in an
area that is not growing should not get more resources. So, a
lot of the moving around has been part of an effort to balance
things out geographically and the general trend. If someone is
telling you we have closed net 17 offices last year, they are
just wrong.
[Gavel.]
Mr. ASTRUE. That might be right, it averages two to three
years and it has been about the same trend and in part it is a
reaction, as you say, to the long-term under-funding of the
agency. We have been forced to make a lot of hard choices, we
do the best we can.
Mr. MCNULTY. Thank you, Mr. Commissioner. Thank you, Mr.
Pascrell. Mr. Tiberi may inquire.
Mr. TIBERI. Thank you, Mr. Chairman. Thank you, Mr.
Commissioner, for being here today and spending time with us on
a very important issue. I represent a district in Columbus,
Ohio, central Ohio, you mention it in your testimony and know a
lot of people who work in the local office, and they are
hardworking folks, overwhelmed doing their job representing or
trying to help people throughout central Ohio. I would also
like to thank some of your employees in Springfield,
Massachusetts and Orland Park, Illinois and in Roanoke,
Virginia. I am sure Ms. Tubbs Jones will thank them as well
because Ohio in particular has been using this new technology
to allow claimants to go before a TV set and give their
testimony. But, as you know, we are being just slammed.
Mr. ASTRUE. Yes.
Mr. TIBERI. Two years in central Ohio and now claimants are
going before a TV set. I know you have addressed the situation
or begun to address the situation, particularly in Cleveland
but also a couple of judges in Columbus and a few in Cincinnati
as well. You mention in your testimony that after you deal with
Cleveland and Atlanta, you are going to deal with Columbus and
Indianapolis, so one question is how are you going to do that?
In doing that, are you also prepared to look at not just the
judge issue but also the support staff issue, the hearing room
issue and all the related issues that our constituents face
because it is obviously not just one problem that we need to
solve, it is myriad of problems throughout the entire system
that a person is backlogged for two years on.
Mr. ASTRUE. Right, so the good news from your perspective
is we did look at the regional variations, and I believe that
Ohio is the big winner in the country.
Mr. TIBERI. Because we were the big loser.
Mr. ASTRUE. You were the big loser before and that is
right, and I think you have 13 administrative law judges coming
into the state of Ohio, and so that is a first step. I think
that you put your finger on having the ability to move quickly
with the electronic hearings is critically important to
addressing these backlogs and, again, because they can spring
up very quickly. A lot of these offices are four or five or six
people. You have a judge retire, you have a couple of judges
that all of a sudden become dysfunctional, and it makes a huge
difference in that local area. So, having the capacity to have
some judges in a few central locations who can move quickly
into the areas of worst backlog and help them out as we have
been helping Cleveland out----
Mr. TIBERI. But you still need hearing rooms for the
claimant to go to.
Mr. ASTRUE. Yes, that is right. In some places in the
country, we are pretty well set for that but to make this
easier, and I went through this with Mr. Levin personally a
couple of weeks ago, Oak Park is a pretty bad situation as well
and right now they do not have the hearing rooms equipped so
that people can have electronic hearings from other locations.
That equipment is being put in now, and there will be four of
those hearing rooms in Oak Park. So, we have gone through a
fairly systematic review of facilities with the new model of
realizing that this is going to be part of what we do going
forward to make sure that the physical space in the various
hearing rooms gives us the opportunity to get help from the
outside because it is critically important for the most
backlogged offices.
Mr. TIBERI. So, what is the plan? You mention in your
testimony that Columbus, Miami, Indianapolis are next on the
docket----
Mr. ASTRUE. Right.
Mr. TIBERI [continuing]. To address this problem, how do
you----
Mr. ASTRUE. Right now, we have a pilot national hearing
center with five administrative law judges just hearing cases
from Detroit, Cleveland and Miami. We are trying to add another
14 between now and the end of the year. We are hoping that we
can move more quickly than the norm because we are not trying
to get new space, with all the contraction, we do have some
excess space in some of our facilities and generally we can
renovate space much faster than acquiring new space. So, what
we are trying to do is expand in Falls Church, which is where
ODAR is headquartered, we have been able to access some space.
We believe we are going to be able to access space in the
relatively short run in Chicago and Albuquerque, and so we
should be moving up in the range of 20 to 25 national hearing
center judges fairly soon. Whether we can get them on board by
the end of the fiscal year, we are not sure yet for all of them
but we are going to try.
Mr. TIBERI. Well, I hope you will allow me to follow up
with your staff on Columbus and central Ohio as it progresses.
Mr. ASTRUE. Right, I would be happy to do that.
Mr. TIBERI. I yield back.
Mr. MCNULTY. Thank you, Mr. Tiberi. Ms. Berkley may
inquire.
Ms. BERKLEY. Thank you very much, Mr. Chairman, and let me
personally thank you for being so helpful to me and my office
on this issue and many others. Thank you very much for being
here, I enjoyed the meeting that we had in the library a few
weeks ago, and I appreciate the forthright manner in which you
are addressing the Committee. We all seem to be on the same
page and have the interests of our senior and disabled
population in our minds when we are discussing these issues.
As you are well aware, Mr. Commissioner, my district of Las
Vegas has one of the fastest growing senior populations in the
country, therefore it is very important to me that the area
field offices and the card center have the resources and
personnel that they need to provide our seniors with the
quality of service that they deserve and have earned.
Since the Las Vegas card center opened last year, I have
worked very closely with the Social Security Administration and
our local employees in the office to address a number of the
problems. You are well aware of the problems that we started
with.
Ms. BERKLEY. They range from inadequate signs, the first
time I went to the Card Center, I thought I was going to a
dermatologist office, and I am glad that we were able to fix
that. There was insufficient seating for the elderly and
disabled, people were standing for hours. There was
insufficient staffing, long, long wait times and long lines
where many of my--the lines were so large that they were going
out the door and in 110 degree temperature having older
Americans and disabled standing out in that heat was obviously
very dangerous as well as unacceptable.
I cannot thank you enough and after listening to all of my
colleagues' problems, I am a very grateful person but you have
helped us to correct the majority of the deficiencies at the
Card Center.
Mr. ASTRUE. Right.
Ms. BERKLEY. We have added 70 seats, which makes a big
difference, seven additional employees, all 19 windows are now
open for service, wait time has dropped from well over two
hours to less than a half hour, all of that is just wonderful.
I do have still concerns that I would want to share with you.
There is some concern about the Card Centers, and you know that
even though the Card Center is centrally located in Las Vegas,
it still services many of the rural areas that surround Las
Vegas. I know that, although they are not my constituents, they
are Nevadans, that they can go to their field office, there are
hours but there only once a month. Perhaps, and listening to
other people's problems, this may not be as significant as some
of the others but if you are one of the people living in these
rural areas with no access, it becomes a problem, perhaps we
can rather than once a month going to their field offices,
perhaps we could make it a little easier by extending that to
maybe twice a month if that is possible.
Also, I received I would not say complaints but there are
some concerns that the employees had a lot of overtime between
January and tax day, maybe that is just standard operating
procedure and maybe with the additional employees that have
been assigned to Las Vegas, that problem will be eliminated,
but I think I feel the need to share that with you.
We also have one of the shorter waiting times for
disability decisions with an average of less than a year, but
having heard what some of my colleagues said, even a year in my
opinion is a shamefully long time if you are waiting for these
disability benefits.
But my question to you is this under the President's
budget, SSA would make progress in addressing the disability
backlogs but it seems that it is at the expense of other areas,
other non-disability areas. If this is the case, it seems that
the backlog in other areas would rise dramatically, and we
would lose ground in areas that we have really made some
progress. Is that the case? What do you recommend and how much
would it cost to avoid this decline in service to the public?
How much more do you need? Perhaps Congress ought to take some
responsibility for this, if you do not have the resources to do
the job we are tasking you with, what resources do you need
that we should be putting in your budget?
Mr. ASTRUE. Sure. I would like to give you a more detailed
response for the record but let me give you a short response.
This year's appropriation, for which we are grateful, and the
President's budget for next year allow us to not only improve
with the disability program but also to make some significant
investment in systems, to bolster the field offices, to bolster
the teleservice centers, so there will be continued improvement
in the front line services. We have tried to be very
transparent about what we think we are going to have difficulty
doing, and we are trying to get to as many of those as
possible. We laid those out in the President's budget. We have
actually made some progress in some of those workloads because
we have had an unexpectedly large increase in productivity so
far this year, so we actually are a little bit ahead of
schedule on some of these back-end workloads. There is some
softness in the numbers because we cannot track a lot of these
things very accurately but it is in the range of $400 million
in terms of the things that we are not doing in order to get
staff up to that level.
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[GRAPHIC] [TIFF OMITTED] T8116A.011
Ms. BERKLEY. Was it $400 million or $400 billion?
Mr. ASTRUE. $400 million.
Ms. BERKLEY. Million; ``M''.
Mr. ASTRUE. I think we deliver pretty good value for the
money. The people work very hard, the systems are getting
better and better to make them more productive, and so you get
a lot for your dollar in my opinion in Social Security.
Ms. BERKLEY. Let me ask you one other question, I just did
not understand if that is $400 million over----
Mr. ASTRUE. Yes.
Ms. BERKLEY [continuing]. The budget?
Mr. ASTRUE. Yes, we identified the workloads where we did
not ask for the money this year so that Congress would
understand what choices we were making in terms of the
prioritization. If they thought we made inappropriate
prioritizations, you have the information to choose
differently.
Ms. BERKLEY. Thank you very much.
Mr. MCNULTY. Thank you, Ms. Berkley. Ms. Tubbs Jones may
inquire.
Ms. TUBBS JONES. Good afternoon, Commissioner, how are you?
Mr. ASTRUE. I am fine, thank you. How are you?
Ms. TUBBS JONES. I am doing very well, thanks. How long
have you been in office now?
Mr. ASTRUE. About 14 months.
Ms. TUBBS JONES. About 14 months. I guess our first meeting
was not probably the most exciting of your meetings, and I
really do want to compliment you on the work that you have
done, and I could put up statistics that justify the additional
six judges in Cleveland. I want to thank you for them, and I
will not put the statistics on the record, you already know
them. I was so excited to be able to say some wonderful things
to you but do you know what?
Mr. ASTRUE. Oh, do not spoil it now.
Ms. TUBBS JONES. Enjoy that moment because I am coming
after you right now.
Mr. ASTRUE. I know, I know.
Ms. TUBBS JONES. I was a judge for 10 years, Commissioner,
and I have been working the 10 years I have been in Congress
with administrative law judges of the Social Security
Administration, and you just threw them under the bus. You just
threw those judges who do such a wonderful job under the bus by
talking about one who has not heard a case in seven and a half
years, by talking about another, I do not even remember what
the heck you said about them, but I wish--see, I have learned
that when you oversee a group of folks that not only do you
challenge or chastise those that cause problems, you spend as
much time saying great things about the people who keep the
ship up when they do not have the kind of support that they
need. I think that if you said it, I missed it, so I am going
to give you the opportunity to say it again, the great work
that the administrative law judges who are there, who are
handling the kind of caseloads that they have, do a great job.
I think you owe it to them, Commissioner.
Mr. ASTRUE. I have answered the same type of question
several times from different angles. I have said here, first of
all, the vast majority of them do great work, and I said that
here earlier.
Ms. TUBBS JONES. Say it again so all those administrative
law judges can hear you say that, the vast majority of them.
Mr. ASTRUE. The vast majority of them do great work. Then
also in particular I gave them credit. This is a year where we
have seriously had contracting resources in ODAR, and the
progress on the backlog is pretty stunning. The increase in the
pending is coming down dramatically and it is because not just
the ALJs but the attorney advisors, the support staff, the
whole team, they are working together as teams. The
productivity is up about 10 percent, at least in the measure
that I consider most important, and I know some of the staff
behind me has differences of opinion, they have different
measures. But if you look at dispositions per ALJ per day, and
again that is attributing the attorney-advisor decisions and
those things to them, they are up about 10 percent this year.
The backlog would be a lot worse without that improvement and
there have been some particular offices that have been
historically problematic that have done terrific work. But I do
feel that I have to identify that there is a minority, it is 5
to 10 percent, where there are both conduct issues and
productivity problems.
Ms. TUBBS JONES. That is what I want, that is what I want
you to make it clear for the record because there is 5 to 10
percent and that means that you have a 95 or 90 percent staff
who are doing a great job. It is important to me.
Mr. ASTRUE. Trust me, we are absolutely on the same
wavelength.
Ms. TUBBS JONES. Okay.
Mr. ASTRUE. But you are in at the point now where I believe
in Cleveland you will have 15.
Ms. TUBBS JONES. Thank you. I am going to stand up and say
thank you.
Mr. ASTRUE. If you have one who is not carrying weight, you
might not see that much of an immediate impact but for some of
the other Members here, we have offices in----
Ms. TUBBS JONES. I do not want to get lost in that, I do
not have a lot of time.
Mr. ASTRUE. Okay, right.
Ms. TUBBS JONES. I just wanted it to be clear.
Mr. ASTRUE. Alright, I think we are in agreement.
Ms. TUBBS JONES. Okay.
Mr. ASTRUE. Okay.
Ms. TUBBS JONES. Tell me, there is one other area that I
have some concern about, and I would ask you to take a look at
it, would you? Ohio is one of those states where there was a
higher than average first time approval rejection, am I saying
that correct?
Mr. ASTRUE. I understand.
Ms. TUBBS JONES. You understand what I am trying to say,
right?
Mr. ASTRUE. The denials are higher.
Ms. TUBBS JONES. I mean denials, yes. I am not asking you
necessarily to give me an answer today, but what I would like
to have happen is to have a look at not only Ohio but other
places across the country where we seem to have that, can we
figure out what that can be attributable to.
Mr. ASTRUE. Right. It is a great question, we are getting
it from a couple of other Members as well. That statistic
looked at in isolation can often be very misleading because the
composition of the filings, the demographics are very different
from state to state. Interestingly, some of the states with the
lowest allowance rates, which should give you, it is a first
level cause of concern and you are asking the right question.
But when you look deeper, they are putting a higher percentage
of people on to disability than most of the states with very
high allowance rates and part of that is--and I know there has
been some criticism of insurance companies lately on this point
but in my world, what I hear anecdotally from people on the
line is that a number of states have policies that refer people
to us and make us make a decision before they get state
benefits of one kind or another and it is a budget device. What
that means is that we get a lot of people that probably should
not be there in the first place that have to go through our
process to comply with state requirements.
Ms. TUBBS JONES. Well, then what I would ask you to do is
for someone in your shop to work with us to see if we can
address that particular issue.
Mr. ASTRUE. Okay.
Ms. TUBBS JONES. Because it then becomes your business
because it is in your shop and it may well be the business of
the particular state, and we have an obligation to sit on the
state agencies as hard as we sit on you.
Mr. ASTRUE. Right, so we will--I accept that as a charge,
so we will look at that. We will give you as much detailed
information about Ohio policies as possible so you can decide
whether----
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Ms. TUBBS JONES. Who I want to beat up in Ohio.
Mr. ASTRUE. Yes.
Ms. TUBBS JONES. Thanks, Mr. Commissioner.
Mr. ASTRUE. Thank you.
Mr. MCNULTY. Thank you, Ms. Tubbs Jones. We have now
completed the first round. I think there are just a couple of
requests for follow-up. I think Mr. Brady had a follow-up
question.
Mr. BRADY. Thank you, Mr. Chairman. I will be brief and
thank you for the courtesy by the way. Commissioner, I know
that earlier this year, you suspended a proposed rule dealing
with reforms of the inefficiencies of the appeals process, and
I know you have been having conversations with various interest
groups on those rules. I want to encourage you to do that, but
I hope you understand that a number of us want you to pursue
reforms in the appeals process. No reasonable person can
justify the system we have today. We are not seeking efficiency
for efficiency sake. We are seeking a quicker appeals process
that is fair and more accurate and hopeful that if we can do it
as efficiently as possible, other resources can be used to
quicken the process and make it more fair and accurate
throughout the whole system. So, I hope you will continue to
pursue the reforms that Congress needs to take.
Secondly, I appreciate the straight talk about our
administrative law judges or any other part of the system. We
have needed this for a long time to improve the system. It may
not be comfortable but whether it is, we have some judges or
staff or whatever who are not productive and a Congress that is
not providing you the resources you need, we need to hear that
type of straight talk, so thank you.
Final point, in the system today, just looking and
reviewing the original definition of ``disability,'' clearly
medical advances, occupational advances, the fact that a
quarter of the jobs we have today did not even exist 25 years
ago. There are now opportunities where people who would be
disabled and have no chance for a work life, today because of
advances in medicine and technology are able to do that. At the
DDS level, has there been an effort to expand beyond just the
medical diagnosis of disability to incorporate occupational
experts who can identify a potential work life that a claimant
could have so that we are looking at disability in the 21st
century, occupational disability rather than just as a medical
issue as it was originally I think probably developed?
Mr. ASTRUE. Yes, good questions. So, in terms of the
regulation question, I am proud of the fact that we have made
an enormous amount of change in the last year, 99 percent of
that has been relatively uncontroversial. We got caught off
guard on the objections to a couple of the provisions of this
regulation. I still think on the merits, we were trying to do
the right thing for the right reason but the costs of having
the argument are not worth it. We have had pretty good
discussions with the advocates, and we think actually there may
be--it may be 18 months down the road but there may be some
better ways of getting to substantially the same result once we
have better systems, and we can do queuing theory for docketing
and that type of thing. So, we are hoping, we are not giving
up, we are going to try to get to the same general result
through a different process.
In terms of medical advances, I probably should not say
things like this but actually I think one of the things you
should have been critical of the agency for many years is we
have not been good enough about keeping up. One of the reasons
why cases are decided wrongly by the DDS is we do not give them
clear enough guidance or updated enough guidance. We have had
regulations on our listings issued on my watch that had not
been updated since 1979, 1985 for the digestive listing and
that is not acceptable. Right now, we are on a five year
schedule for every regulation. If you look at the docket, you
will see we are issuing a lot more regulations in the medical
area than we have historically. We are doing every five years
now, we hope to actually do every three years, I do not know if
we are going to be able to get there. But I think that is
critically important, and we are making it harder for that
staff because we are asking them to go to a level of detail
that they have not gone down to before. We have typically
stopped at a fairly high incidence rate. If you look at the
cases that go off track, a significant percentage of them are
ones where it is not the DDS' fault, it is our fault in
Woodlawn because we have not given them sufficient guidance.
Mr. BRADY. I guess the question is more directly did DDS
examiners and ALJs have access to the occupational experts who
can help determine if there is a work life that is available to
a claimant?
Mr. ASTRUE. Right. To a large extent, yes, although there
is an issue in some places in quality and quantity because I
think we have not increased the compensation for these folks
for decades. We are hoping to do that for both the medical and
the vocational experts. We also need to do better in the
vocational area. We have relied historically on a guide
produced by the Department of Labor, which they have decided
not to produce anymore, so we are going to try to take that
over and not only update it but improve it and adapt it more
for our purposes than what the Department of Labor does. So, I
do not think it is a crisis in terms of where we are, but are
we at best demonstrated practices? No. Can we do better? Yes.
Are we trying to get there? Yes.
Mr. BRADY. Thank you, Mr. Chairman. Thank you, Mr. Brady. I
believe Mr. Becerra had a follow-up.
Mr. BECERRA. Thank you, Mr. Chairman. Commissioner, again,
thanks very much for your time and all the responses and please
continue do the work. As I said to you, I did not have a lot of
space in my 5 minutes for good news, but I think in every
respect your responses prove that you are trying to do what you
can personally, Michael Astrue is trying to do what he can as
the Commissioner to make changes, so we appreciate that. I urge
you to continue to be candid with us. As I said, I urge you to
shake things up. When you come here, shake them up not just
internally but when you come here shake them up. Recognize that
you have to obviously get your paycheck but if you do the right
thing, you will get paid more than just with a paycheck, so I
just urge you to continue what you are doing.
Mr. ASTRUE. Thank you. We have been doing a fair amount of
shaking up. We have been trying to do it as politically
sensitive away as possible. I also should say I have really
been blessed in that we have put together a fairly new team.
There has been a lot of shaking up within the agency, and they
have just really come together and done an absolutely first
class job, This agency is too big for any one person to change,
and I give a lot of credit to a lot of the people sitting
behind me and some of the people who are not here today.
Mr. BECERRA. I would love to see it register on the Richter
Scale so you keep at it.
Mr. ASTRUE. Okay.
Mr. BECERRA. Support staff?
Mr. ASTRUE. Yes?
Mr. BECERRA. You did not have a chance to get to the
question to answer because I ran out of time but I do not know
how much you can give us now but perhaps in writing give us a
more elaborate response but I am very concerned that as you
hire the ALJs that we know we need, you will not have the
support staff. You already do not have the support staff, so to
hire at less than a one to one ratio when you need a four to
one or so or five to one ratio.
Mr. ASTRUE. Yes, so let me give you the short answer. We
will give you a longer answer for the record because I do think
that some people, their heart is in the right place, have
misunderstood some of our budget numbers. So, one of the things
that we did even in a time of contracting resources, we
realized that the judges cannot do the work without the support
staff, and we knew approximately when the judges were coming
in. To make it as seamless as possible, we advance hired
support staff in anticipation of the new ALJs to some extent.
So, on my watch we started at 4.1 support staff per ALJ. Unlike
a lot of the rest of the agency, that did not go down, that
went up. So, that went up to about 4.4. When the new judges are
absorbed and with the hiring that we also are doing of support
staff, we will be back down to about 4.1.
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Now, an interesting question is that the right number or
not? For the time being, I think that will work. But one of the
things that we do not know and what we want to be a little
careful about over hiring. The profile of staffing you need is
going to change fairly dramatically when you move from an
antiquated paper system to a relatively good, admittedly
needing some improvements of the electronic system profile of
people and the number of people that the old studies from 1991
indicated really do not make any sense anymore. So, we are
looking at that.
Mr. BECERRA. Okay.
Mr. ASTRUE. But we understand how important they are.
Mr. BECERRA. Please and if you can just elaborate more in
writing, that would help us to understand how you are going to
do it.
Mr. ASTRUE. We would be happy to do that.
Mr. BECERRA. Field offices, do you have any plans to close
any field offices this year?
Mr. ASTRUE. My understanding is that we do not have any
plans pending other than we worked through local communities
and the political leaders. We do some consolidations and that
type of thing. We do relatively few over the objection of
Members of Congress and political communities. There are none
of that profile now. There are some routine consolidations
going on and, again, I do not know. I do not get terribly
involved in this process, the career people run it. Your best
guess is that the future is going to look like the past. The
net, there will be about 15 to 20 offices that are affected in
some way. Net is at the end of the year we will be one to three
fewer probably, but it might not be that many. There is no goal
or anything like that. There has been I think some very
regrettable partisan attacks saying that there are plans to do
something that is a huge break from the past, and we are going
to cut half the offices, and I just want to denounce that here.
I think it is being done for partisan purposes. It scares
employees. It scares the public. I think it is shameful. So,
again, I have been up explaining this over and over again. It
is no different from when I started. It is no different really
since the Carter Administration, it is going to be about the
same.
Mr. BECERRA. Then on that, again, if you just keep us
informed.
Mr. ASTRUE. Will do.
Mr. BECERRA. Perhaps in writing give us a more elaborate
answer to that.
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[GRAPHIC] [TIFF OMITTED] T8116A.014
Mr. ASTRUE. Would be delighted.
Mr. BECERRA. Finally just a quick comment, on the appeals
process, I want to say thank you very much for taking a breath
before you move forward in instituting some of the changes that
have been proposed to the system, which many of us believe
could have hurt the process because it would have made it more
burdensome upon the claimants, the beneficiaries, so we
appreciate that and we hope you will continue to keep us
apprized and all the stakeholders apprized and allow them to be
a part of any system that you ultimately recommend.
Mr. ASTRUE. Okay, thank you.
Mr. BECERRA. Thank you.
Mr. ASTRUE. I should also note by the way I was out in one
of the hearing offices in your district just a couple of weeks
ago, which is the historical low performer for about a decade
in the system, and we sent them a signal that things needed to
change. I have to be honest, I was dubious that would happened
but if you actually look at the statistics in your Pasadena
office, there has been a remarkable pick-up in the last six
months. The spirit there seems to be very different and so in
terms of--part of this, as you were saying, is cultural and
insisting on change. So, at least, I think you have got about
four hearing offices in the vicinity of your district, one of
them has really made a pretty substantial improvement in the
last six months, so it can happen.
Mr. BECERRA. Thank you very much. Mr. Chairman, thank you.
Mr. MCNULTY. Thank you, Mr. Becerra. Mr. Meek may inquire.
Mr. MEEK. Thank you, Mr. Chairman. I have been in a couple
of meetings in my office, but I have been listening to some of
the questions that I wanted to raise here that have already
been raised at least eight or nine times. You have been very
skillful, Mr. Administrator, of trying to give the same
response. But let me just say this very quickly, all of us are
victims of closing of offices and also backlog of hearings or
appeals, I have a two to three year backlog. As you know,
myself and Congresswoman Debbie Wasserman-Shultz and Alcee
Hastings from south Florida fought vigorously to keep the
Hollandale Beach office in my district open to provide services
for the people of south Broward County in Florida--I mean in
Hollywood, Florida. But I wanted to ask the one thing I did not
hear, and I was checking with my staff, have you all researched
in any way possible some sort of information that can be
gathered so we will not have so many of these appeals to try to
cut them in half because right now the backlog as we look two
to three a year, what kind of work has gone into trying to--I
even heard your response about a person who was a judge and has
not heard a case in seven some odd years, but is there anything
being done outside of making sure that all hands are on deck to
hear these cases to clear up the backlog or seeing if some of
these cases can be resolved prior to a full blown hearing?
Mr. ASTRUE. Sure. Again, that has been an important part of
the initiative and it gets complicated, so with your permission
I will supplement for the record but let me give you the short
answer. We have two I think successful to date initiatives at
ODAR to essentially take those cases out of the system and
decide them quickly. One is we have gone back to a Clinton era
initiative, that I am not entirely clear why they terminated,
that gave more authority to attorney advisors to get rid of
cases of certain profiles to just allow them----
Mr. MEEK. I am sorry, you said attorney advisors?
Mr. ASTRUE. Attorney advisors, we have lawyers who work
essentially like law clerks for our judges in the hearing
offices and when I came, they could not decide anything, they
only could draft for judges to decide. But a lot of the judges
are overloaded and some of evidence cases changed. Maybe a
technical issue that has changed. There are categories of cases
that we do not need to bother an administrative law judge for,
so in these cases the Attorney--advisor program has been
reasonably successful. I think that program is actually
continuing to add improvements.
Our Office of Quality Performance has been instrumental in
helping us design templates where we can now analyze the
caseload electronically and look for markers that suggest that
this might be a case that is off profile, that needs more
development or should just be allowed, and we have taken those
cases and generally sent them back to the DDSs for a decision,
a lot of those cases are allowances.
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We are also, as I mentioned to the Members of for the
Michigan delegation, in those states that do not have
reconsideration, it is probably more likely that there is a
higher percentage of cases going to ODAR that probably should
not be there in the first place. So we are looking at some new
screens and we are up and running I think in June and July in
Michigan to try to see if before those cases ever get into ODAR
at all, whether they should either be sent back to the DDS or
they should go to ODAR with the suggestion that they should
consider a prompt allowance.
Mr. MEEK. Let me ask this question because, as you know, we
are under time limits. Have those reforms as it relates to
taking down the backlog before you get to a full blown hearing,
I heard you talk about the fact that the appropriations process
has not been helpful, and I am pretty sure the Office of Budget
and Management has not been the best friend in the world of
setting the stage already.
Mr. ASTRUE. I actually do not have any complaints about the
OMB. I will be honest we did better with them than I thought we
would.
Mr. MEEK. Okay, but it is not the ideal world that we need
to get us out of the hole.
Mr. ASTRUE. Not the ideal world.
Mr. MEEK. So, I guess has this been highlighted in your
request this year of saying these--especially with the backlog
issue, are these issues Congress you can look at in helping us
deal with the backlog because if that is--if these reforms are
working, then these are the things that we need to look to in
the short term, especially under these budget restraints that
we are under now, of how we can deal with some of those cases.
My wife is an administrative law judge, and I can tell you
right now, not for you all, I just want to clarify that.
Mr. ASTRUE. My wife used to be a Democratic staffer for a
Congressman.
Mr. MEEK. I just want to clear that up, but I think it is
important that we look at these, the things that are working
maybe below the radar screen but would help break down the
backlog because I can tell you right now, I have constituents
coming into my office saying, ``I do not know why I am coming
to see you because you have not been able to do anything about
my problem.''
Mr. ASTRUE. Right.
Mr. MEEK. So I am thinking that if we can get that, if
someone from your staff, at least for me, I will be an advocate
as it relates to the appropriate appropriations Committee of
dealing with this and saying we need to pinpoint money right
here so that you have the kind of army you need to deal with
those cases and set them on priority, you may be able to clear
a lot of them.
Mr. ASTRUE. That is a great question, I would be happy to
work with you on this. One of the things that I think is
important to keep in mind is that for the first part of this
decade, the backlog was going up pretty consistently about
75,000 cases a year. In my first fiscal year, that dropped to
about 32,000. I think annualized right now, and I will correct
this for the record if I am misremember, we are at about
24,000. It is not where we want to be. We have had fewer
resources, and so there should be real progress when the
resources come. Those initiatives that we put in to try to put
our finger into the hole into the dam right from the get-go, I
think have been working pretty well. We may need your help on
some of these. So, for instance, I think the attorney--advisor
proposal initiative has been helpful, it is a factor in keeping
the backlog down. Right now, it is a sun-setted regulation so
that will come up for permanent extension with the new
Administration and, as undoubtedly you know, I am going to be
inflicted on the next Administration. I think it is highly
likely that we are going to want to work with the new
Administration to make sure that that program is extended at a
minimum and maybe we will want to expand it in certain ways. I
think it is going to be important probably for some Members of
this Committee to be fluent on what we are doing, satisfied
that we are doing the right things and help us with the new
Administration, whoever it is that is trying to figure out what
to do. We are doing the right things here on some of these and
where we are going to need help with the new OMB.
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Mr. MEEK. Well, thank you so very much for your response.
Mr. Chairman, I thank you for your work in this area. As you
know, I am the only Member from Florida on this Committee, and
with all of the folks that we have involved in Social Security,
you know this is a majority priority for us, so thank you, and
I look forward to working with your staff.
Mr. ASTRUE. Thank you.
Mr. MCNULTY. Thank you, Mr. Meek. If there are no further
questions, we will close the first panel. On behalf of Chairman
Rangel and Ranking Member McCrery, I want to thank you,
Commissioner, for being with us today for your testimony.
Mr. ASTRUE. Thank you.
Mr. MCNULTY. For your hard work on this issue and for
staying with us for about three hours to answer our questions.
Shortly, we will adjourn the first panel, and I will turn the
Chair over to Dr. McDermott, who is going to chair for the
second panel. But before I do that, Commissioner, I know that
you are very serious about tackling this backlog problem. You
have shown that, you have demonstrated that by your actions,
and we have been there to try to help you with the additional
money in last year's budget, even more in this year's budget,
and we want to keep moving in that direction. I know you have
looked at this problem from the perspective of the agency, and
I know you have traveled around the country to look at it from
the perspective of our constituents, the American citizens. I
just want to leave you with a thought about looking at it from
our perspective, the representatives of the people. One of the
things that we kind of pride ourselves on when we serve in
elective office, and I have served in elective office for 39
years, is that when a constituent comes to us and asks for
help, that we get them an answer in a timely fashion.
Mr. ASTRUE. Yes.
Mr. MCNULTY. We have all had the experience of having
constituents come to us, meet with us face to face with what
seems to us to be a very obvious case where they deserve these
benefits, which they have paid for, and we respond back to
them, ``We will get back to you with an answer in a year or two
years or more.'' This is an example of government at its worst.
It is an embarrassment to us as representatives of the people.
Many Americans are suffering because of what has gone on in the
past with regard to this backlog issue. I am one that does not
tend to look backward and try to assess blame as to how we got
into the situation that we are in, I want to look forward and
figure out how the hell we get out of this thing and get back
to a position where we are properly representing our
constituents and making sure that when they are entitled to
benefits from their government, which they have paid for, that
they get them in a timely fashion. So I exhort you today,
Commissioner, to keep doing what you are doing, let us know
when we need to do more because we want to step up to the plate
and make that happen. Also that we all be on guard to make sure
that other peripheral outside issues do not end up interfering
with this modest progress that we have made up until now and
which we hope we can accelerate in the weeks and the months and
the years ahead. Thank you, Commissioner.
Mr. ASTRUE. Thank you and I agree with you 100 percent.
Again, thank you for your support, Mr. Johnson's support, the
support if the entire Committee has been vital to help turning
around things, and we are going to count on you at least as
much going forward, so thank you.
Mr. MCNULTY. Thank you, Commissioner. We will hear from the
second panel and Dr. McDermott will assume the Chair.
Mr. MCDERMOTT [presiding]. The Committee will come to
order. Witnesses on the panel would take their seats at the
dais, we welcome you and we also are grateful that you have
stayed, waiting three hours. You have now heard from the
administrator and the Committee a variety of perspectives about
what the problem here is and what ought to be done and so
forth. You have all submitted testimony to the Committee, and
without objection, your full testimony will be put into the
record. I would hope that as you testify here, you do not
merely re-do what is in your report because it is already
there, and what we would like most from you is to respond to
what you have heard so far. I think that although there are
just a few Members here, there are plenty of staff listening
and so this is an important learning experience for us, to hear
your response to what the administrator said. I hope that with
that in mind, you will adjust your testimony. I know after you
have spent all that time belaboring over it, it is desirable to
come and read it to us but do not please. We really want to
hear what you have been thinking about for the last three hours
as you have sat and listened to this hearing.
We have today with us Mr. Schieber, who is the Chairman of
the Social Security Advisory Board, and we will start with you,
Mr. Schieber. If you will press the little green button there
in front of you, I think you can probably get on the air.
STATEMENT OF SYLVESTER J. SCHIEBER, CHAIRMAN, SOCIAL SECURITY
ADVISORY BOARD
Mr. SCHIEBER. Mr. Chairman, Mr. McCrery, I want to thank
you and all the Members of the Committee for holding this
hearing, this is extremely important. I have been on the Social
Security Advisory Board since January of 1998. The first report
we wrote when I joined the Committee, the Advisory Board, was
on disability. I think we have done some 15, 16 reports,
statements, major statements on the disability program since
then. In many regards, we have known for quite a long time
about the problems that we are talking about today. They were
on the horizon long before they got here.
I think as you think about this problem and how to address
it and some of the issues that were raised in the earlier
discussion, we need to think about this as a process from
beginning to end. Part of the problem here is that there is no
one single owner of the process throughout its various stages.
You start with your application at the DDS level but that is
really not a single process itself. There are 50 states, each
has its own independent DDS. In addition to the 50 states, we
have got four other systems, one for the District of Columbia,
one for Guam, the Virgin Islands and Puerto Rico. Just in terms
of operating systems, there are three broadly used systems but
then two of the states have their own hybrid systems that they
use. Even as they implement them on single platforms, there are
variations from one state to another.
We heard a bit this morning about the need to move away
from COBOL. The Social Security Administration, as they move
into the electronic age, has been forced to cannibalize
operating budgets to try and move out of the fifties technology
platform that they are on and that has simply not been enough.
They recently moved to the electronic disability folder and now
virtually all of their applications are taken in electronic
form. But to a considerable extent they cannibalized their
operating budgets during the period they were developing that.
A number of years ago, I was doing a presentation, I have
worked in the private sector over virtually all of my career
for a major investment organization, and the chief executive
officer was doing a presentation for all the senior Members of
their staff, and he was talking about literally spending
billions of dollars to invest in the new technology platform.
They were not cannibalizing their current operating budgets,
the people with money invested through them had to be able to
check on what was in their accounts during that period of time.
They were making a capital investment and they were going to
amortize that over a period of time.
I think if you want to address the problem we have here on
the system side, literally moving from the fifties into a more
modern era, you may need to think about moving in that
direction to deal with this problem. It does not necessarily
need to be a long-term added commitment, it needs to be a
capital investment with accountability, that they need to put
together a system that starts from the beginning and is thought
through all the way to the end of the process so there is
actually integration. When we think about the DDS system and
the 54 systems or whatever they have there, they are hooking up
to Social Security systems and those have not been integrated
in the way that they should. So, as they move into the new era,
they ought to figure out how to integrate those systems.
One of the other major issues that they face as they move
into the new era are productivity issues, and I raise that in
my testimony and it came up a number of times here today. There
was an article in the Federal Times last week about ODAR,
Office of Disability Adjudication and Review. A number of their
people have become upset as they have implemented the
electronic file that they no longer can work at home as much as
they used to. They cannot have as many days when they are not
working on site in the office. The reason for that is all of
the concern that we all know about with electronic files, and
because Social Security is determined to maintain for the
security of these files, they have to be kept secure computers.
But as they have moved to processing electronic files, that is
now required that people work in the office more than they did
in the past and there has been a complaint filed and the
mediator has found in favor of the worker. So, we are forcing
the agency to deal with again fifties processes, revolving
around paper files. In fact I am not sure paper files are any
more secure at home than computer files but that is another
story.
We heard some concerns about ALJ productivity. There are a
couple of issues on ALJ input productivity. One of them has to
do with how many cases these ALJs hear. There are quite a
substantial number of ALJs in 2006 that I know of that handled
fewer than 200 cases. The Commissioner has now said that he
would like for the ALJs to handle as many as 600 or 700 in a
year. He is going to need to be able to encourage and actually
enforce that kind of productivity if he is going to achieve
what he is trying to achieve.
But there is another issue here, there is also an output
productivity concern that we all need to have. There is a group
of ALJs on the other side of the productivity equation, a group
of ALJs that is hearing massive numbers of cases. In 2006,
there was one that disposed of 2,500 cases. Think about
handling 2,500 cases, these are complicated cases, in the
period of a year, and one of the things that I know is that as
the disposal rate goes up, the approval rate goes up and that
should be a concern to all of us.
I have looked at the corps of ALJs, the ones in the 240 to
700 case disposition a year, and I have found judges that have
an approval rate of 30 percent, I have found judges that have
an approval rate of 99 percent. Now, I think both of those
numbers are wrong. I think that if there is a judge that is not
approving cases, that probably there are people who are worthy
of getting these benefits that are being denied. But when we
approve cases on a rubberstamp basis and we are not paying
attention to the law and we are not paying attention to the
facts, we are giving away money that is very substantial that
we owe the taxpayers some concern about.
The average cost of one of these cases, lifetime cost, is
well over a quarter of $1 million dollars. We need to be wary
about the issues that we are facing and that is part of the
stewardship issue that has been raised here a couple of times
this morning. One of the issues on stewardship that you need to
focus on, I know there is a difference between operating
budgets and trust fund money, but time after time when we have
looked at the stewardship issues, the review of disability
cases does catch individuals who do not deserve to be receiving
benefits who are receiving them. The estimate by the Social
Security actuaries is that for every dollar we spend here, we
return $10 to the taxpayer. But we have canceled doing much of
this work in recent years because of the other burdens that the
system is trying to deal with. This is pound penny wise and
pound foolish. I would think that if you went home and tried to
explain this to your constituents, you would have a hard time
convincing them that this is good policy.
So, I guess my comments, and I will close here, are that we
first of all need to think about this on a holistic basis,
maybe we need to make some capital investments so we can get
out of some of the morass that we are in. We cannot cannibalize
operating budgets. The Commissioner is dealing with this
massive backlog of cases, but if we want to move into the 21st
century, we have to bring on new systems and they have to be
systems that are based in the current technology and they have
to be coordinated from beginning to end. I will close in saying
in my opening comments, I said in some regard this reminds of
the story from Greek mythology, Sisyphus. As I say, I have been
on the advisory board for 10 years now, we have been look at
this issue all of that period of time. We have pushed this rock
up the hill time after time, but it seems to keep rolling back
on top of us and it is time that we all start thinking about
this in a much more logical and smarter fashion than we have
been.
Thank you very much.
[The prepared statement of Sylvester J. Schieber follows:]
Prepared Statement of Sylvester J. Schieber, Chairman,
Social Security Advisory Board
Chairman Rangel, Mr. McCrery, Members of the Committee. I am
pleased to have this opportunity to appear on behalf of the Social
Security Advisory Board to discuss the backlogs in the Social Security
disability programs as well as the current funding situation. I would
like to give you the Board's perspectives on the continuing challenges
facing the agency and our concerns about the future.
As I reflect on the current state of affairs at the Social Security
Administration I am reminded of Sisyphus from Greek mythology. As you
will recall, the gods condemned Sisyphus to endlessly pushing a rock up
a hill only to have it roll down again and again. It strikes me that
this is exactly what is happening to the employees of the Social
Security Administration who are charged with running the disability
programs and the citizens who are touched by it. We owe them a better
future.
Is History Being Repeated?
The difficulties with the disability program are not new to the
Advisory Board. Since the Board's inception in 1995, the bulk of its
work has focused on the disability program. I personally have been on
the board for more than 10 years now and it has been our major
preoccupation over my entire tenure. Beginning with one of the Board's
earliest reports in 1998, we expressed concerns about the
sustainability of the program given the anticipated growth in the
workload, its resources, its labor intensive processes, and the
perceived lack of consistency in applying Social Security's own
policies. And that was at a time when there were only 1.2 million new
claims filed every year, and the backlog in the hearings process was
under 400,000 claims. Moreover, this was after a period when the agency
had diverted resources from other parts of the program in order to
return the appellate process to a semblance of efficiency.
But by 2001 the Advisory Board felt compelled to issue another
report citing deteriorating service in the field offices and a
disability program that was swamped with a backlog of claims. By 2001,
Social Security's capacity to serve the public was increasingly at risk
due to a long-term reduction in staff levels, increased volume of
claims, and the overwhelming burden of complex program rules. The then-
Chairman of the Advisory Board told The New York Times in February 2001
``Unless there's fundamental change, we will soon see disruptions of
service. The Social Security agency lacks the ability to handle
existing workloads, and those workloads are bound to increase in the
next decade. Everybody knows there is a long-term deficit in the
financing of Social Security. But there's also a deficit in the
agency's ability to provide good service, and that should be equally
alarming to Congress and the public.''
When I appeared before the Social Security Subcommittee in February
2007, applications for disability benefits were averaging 2.5 million
per year. The Disability Determinations Services (DDS) had a little
less than 550,000 initial claims pending. But this DDS pending backlog
was due to extraordinary pressure on the DDSs to adjudicate initial
claims as a priority workload. What gave the impression as being good
customer service at one stage actually resulted in increased workloads
and delayed processing downstream. Resources were diverted from
processing reconsideration cases in order to process the initial
claims. The backlog at the DDS's reconsideration stage grew by 30,000
and an ever-larger fraction of individuals found themselves waiting
nearly 6 months for an initial decision.
On average, about 75 percent of those denied at the reconsideration
level file for a hearing before an administrative law judge. So, it
should be no surprise then that as the DDSs cleared out their backlog
of reconsideration cases, cases flowing into the hearings level climbed
to 579,000. By the end of 2007, there were 746,000 cases in the
hearings queue waiting for an ALJ judgment.
Today, we are half way through Fiscal Year 2008, a year in which
the Congress actually increased the President's budget request by $150
million. The additional funding has provided SSA with some flexibility
this year. The SSA managers have not had to choose between hiring
administrative law judges and keeping the lights on in the field
offices. I would like to tell you that this one time injection of
additional resources has been enough to turn the tide. But it has not.
Today there are over 560,000 initial claims and 107,000 requests
for reconsideration pending in the DDS and another 756,000 claims at
the appellate level. I suppose that if there is any ``good news'' it is
that the waiting time for a hearing has held steady at 503 days in the
Office of Disability Adjudication and Review. Personally, I believe
that taking an average of 503 days to process these cases at the
hearings level should be an embarrassment to us all.
The Social Security Administration's employees have always taken
pride in their ``can do'' attitude even in the face of growing
workloads, new workloads, and insufficient resources. But the reservoir
of optimism is low.
We can talk about our commitment to public service and our
willingness to address the needs of those individuals who turn to
Social Security on a daily basis. But the reality is that thousands of
disability cases languish for years as the claims representatives, the
disability adjudicators, and the administrative law judges struggle
with crushing backlogs and steadily declining numbers of workers. If we
want to achieve the goals of this program, we have to pay for it.
Pressure on the DDS has Negative Affects on the Hearings Level
The focus of this hearing--clearing the backlogs and providing
adequate resources--needs to be about more than just the state of the
workload at the hearings level. It must take into consideration the
critical steps all along the determination process. It must recognize
the problems with the systems infrastructure that supports the work
being done by staff at all levels. It must acknowledge that the baby
boomers that will cause problems for the retirement program down the
road are now in their disability prone years resulting in increased
applications that would require higher productivity if the workforce
handling cases remained stable. But it has not remained stable; we have
seen the result of the triple jeopardy: a workforce that is being
shrunk relentlessly, steady workload increases, and a lack of
technological investments that could balance demands.
DDS claims processors operate under processing time, productivity
measures, and quality control rules that put unreasonable stress on
their process and, as a result, change behavior. Forcing managers to
choose to adjudicate one type of claim, whether it is an initial claim
or a request for reconsideration, over another sends a very strong
message about their relative importance. Moreover, a quality review
process that targets allowance decisions almost exclusively also sends
an unintended message. Only a small fraction of denied cases are
selected for quality review. The chance of an insufficiently documented
denial determination sliding through the system unchecked cannot be
discounted. There may be many reasons why there has been a steady
decline in allowance rates in the DDS, but it certainly seems likely
that inadequate investment which has led to a ``start and stop'' type
of work environment is a major factor. This is not about a culture of
denial but more about human nature. When faced with pressure to clear
cases quickly, adjudicators may take shortcuts and those shortcuts can
lead to unintended outcomes.
One of the initiatives in the Commissioner's Plan to Eliminate the
Hearings Backlog is the informal remand process. Cases that were denied
by the DDS and are waiting for a hearing at the Office of Disability
Adjudication and Review (ODAR) are being screened and where appropriate
returned to the DDS for another look. The program has been in place for
about a year now and the cases that are sent back have been purposely
selected because they are the most likely to be proper allowances.
Nonetheless, out of the 34,000 cases informally remanded so far, the
DDSs have allowed 43 percent and well over two-thirds of those were
allowed without any additional development. There are a variety of
reasons why these cases are now being approved without gathering more
evidence than was gathered months or years ago, but we cannot discount
that processing pressures in earlier stages of adjudication could have
caused inadequate review the first time around. An added sad footnote
to this story is that some of the cases now being given a favorable
disability determination after being remanded to the DDSs sat in the
hearings queue at the ODAR level for three or four years before being
returned for DDS review. Of course, this gives rise to the question: If
we had enough evidence years ago to decide that these applicants were
disabled, why didn't we reach the conclusions then?
From the Board's perspective, there must be investment in the front
end of the process. SSA and DDS management should not have to make
choices about which cases are adjudicated timely and fully developed
and which are not. But that is the situation in which the disability
system managers continue to find themselves.
SSA has made tremendous strides in the development of the
electronic folder. For all of its strengths, it has some striking
weaknesses; primarily that it is not a ``single system''. Case
production processes are not coordinated from beginning to end. First,
there are 50 state DDSs plus five other territories and offices working
with five different basic IT operating systems. Even in cases where
DDSs are on a common main platform, there have been variations in their
adaptation from one DDS to the next. While all of these operating
systems and their variants feed data to the electronic folder, the
actual development and decision analysis is captured only in each DDS's
own case processing system. And beyond that, there is virtually no end-
to-end consistency in developing and adjudicating cases.
The main goal in initiatives like the development of the electronic
applications folder may be to drain the backlog swamp, but there are so
many alligators nipping at the various components they have lost focus
on the way forward. Consider the development of an approach to support
the systematic case determination process for the DDSs. To this end, an
electronic tool, known as eCat, was created to help adjudicators
develop claims on a consistent and complete basis. The budget to
develop this system was cannibalized from the Social Security operating
systems budget resulting in a patchwork approach to development and
support. Robbing Peter to pay Paul is generally a recipe for failure,
but it is particularly unwise in systems development.
The eCat system was rushed through development, was unfinished at
roll out, did not work when it was put into production and brought the
rest of the electronic case processing system to a grinding halt. As a
result, a promising new tool was pulled from operation because of poor
execution and the rush to premature implementation. Today, there is a
new initiative underway in a lab environment that appears to hold great
promise, but it is not clear how it will be integrated into an
overarching integrated system.
While the eCat experience is disconcerting, we recently learned
that the Office of Disability Adjudication and Reviews is evolving its
own electronic adjudication tools to take advantage of the electronic
folder, including a format for decision writing that is designed to
bring greater consistency and improved productivity. It appears that
ODAR has only cursory awareness of the DDS eCat initiative and has had
no input into its development even though they are the ``recipients''
of the decisional outcomes. Furthermore, they have not been able to
explore how eCat can lead to efficiencies in the hearings development
process. There appears to be a lack of a holistic electronic systems
strategy that is linked to a well thought-out process structure, that
is properly resourced and that emphasizes the interdependence of the
operating components.
Building an Infrastructure for the 21st Century
Ten years ago the Advisory Board questioned how well the Social
Security Administration would be able to develop the technological
infrastructure that would be needed to support the growing number of
claims. We believed then as we do now that in order for the agency to
meet its workload challenges, it must have a forward--thinking service
delivery strategy that capitalizes on advances in technology. The
National Research Council issued a very compelling report last year
wherein they stated that the agency faces fundamental challenges in its
ability to deliver services and urged SSA to articulate a vision for
electronic service delivery.
Furthermore, they highlighted the very real vulnerabilities facing
SSA if they did not begin a systematic transition to a more modern
infrastructure. This is not about buying the latest fancy personal
computers. This is about moving away from COBOL-based operating
systems, a 1950's technology, to modern software languages and tools.
This is about moving away from manual work sampling to integrated data
collection that permits inline measurement and quality review systems
that can assess what works, what does not, and the difference between
the two. We are talking about the potential for redesigning work in an
organization that is stifled by institutional barriers between
components and work rules that are crippling productivity advances.
When Social Security Commissioner Michael Astrue took over his
current position, he found a backlog of disability applications that
had been in the ALJ hearings queue for more than 1,000 days. Last year
he set as a goal for the agency disposing of all of these cases. This
year, he has set as a goal eliminating the backlog of some 135,000
cases that would be 900 days old at the end of the fiscal year.
Commissioner Astrue and the people involved should be applauded for
implementing any effort to reduce hearings backlogs and waiting times
for decisions.
Yet we read in the Federal Times last week that a group of Social
Security employees has filed a complaint against the agency because the
implementation of the electronic disability application process has
reduced the number of days that case technicians in the Office of
Disability Adjudication and Review can work at home as they help
prepare cases for ALJ hearings. In this modern era, with concerns about
the security of private personal information in government files,
Social Security has determined that applicants' electronic files must
be maintained on agency computers and the implementation of the new
technology has reduced the amount of work that can be done outside of
office sites preparing cases. The mediator hearing this complaint has
ruled that Social Security must reinstate the work-at-home policies
that were workable in the old paper-file world but outmoded in the
modernized environment.
One cannot help but wonder whether the taxpaying public might find
it ironic that it is unreasonable to expect people who are being paid
to prepare disability cases for hearings to come to the office to work
during the time they are being paid but that it is reasonable to expect
disability applicants to wait up to 899 days to have their appeals for
benefits heard by an ALJ. The parsing of this story may help to explain
why all of the leading candidates for President from both political
parties have sensed the American public's desire to change the way
things are done in Washington.
We are painfully aware that future Congresses and Administrations
will be facing resource constraints that will become more austere than
anything we have seen to date. Rather than commit to long-term
increased support of what is an unsatisfactory process for the
stakeholder at all levels, maybe it is time to restore a temporary
multi-year capital fund to modernize the functions at all levels of
this operation and develop systems to implement the solutions. This
capital budget would be for limited duration and come with a
stipulation that the net results be a modern integrated system that
delivers efficiencies in the operation, increases throughput of
workloads, and shortens the processing time for applicants. If there is
need for legislative action to modernize and facilitate the
determination process as part of this modernization effort, the agency
should come forward with recommendations to achieve this.
Invisible Workloads
In the Advisory for this hearing, the Committee noted that the
agency is forced to divert resources away from routine workloads in the
processing centers in order to manage the volume of cases awaiting
decisions. This is an unfortunate trade off to be forced to make.
Without adequate funding for the post-entitlement work done in the
processing centers, the spouses and children of disabled workers may
not receive their benefits in a reasonable timeframe. Beneficiaries who
report earnings on a timely basis may be overpaid because the workers
in the processing center could not reconcile the information in time to
make the needed adjustments. SSA estimates that it will cost around
$400 million in FY 2009 just to keep on top of this backroom work,
annually, without consideration of what work is already unresolved.
Unless there is sufficient investment in this workload, the post-
entitlement backlogs will be the next headline.
As the agency that touches virtually every individual in the
country through its benefit programs or through its repository of
records, SSA is the agency that Congress turns to when it needs
assistance with carrying out broad national initiatives. The welfare
reform legislation in the mid-1990's meant that the field staff had to
become experts in immigration and naturalization records; Medicare
Modernization rules mean that they now have to make more complicated
Medicare premium calculations based on complex tax rules, and they have
acquired an ongoing workload comprised of determining the
qualifications for Medicare Part D low income subsidy redeterminations.
And now there is discussion about adding additional non-mission
workloads revolving around immigration and Medicare.
Historically, Congress funds the start-up costs for these programs
but does not make provisions for the ongoing costs of doing the work.
The agency is expected to absorb the cost in the out years in its
``base'' budget. However, because fixed costs such as rent, guards, and
salaries exceed the average growth in the administrative budget, there
is no cushion to absorb additional work without additional resources.
These workloads must be funded appropriately and that includes for the
long term.
I would like to add a word of caution, however, that this is about
more than just money. I know that one of the reasons that Social
Security is assigned these tasks is because they have the critical
national mass that does not exist elsewhere. And, they have an
outstanding workforce. But the accumulation of these added mandates is
reaching the point of critical stress for this agency--we are
perilously close to adding the proverbial straw that breaks the spine
here.
In my testimony before the Social Security Subcommittee last year,
I pointed out that SSA has been forced into curtailing its stewardship
responsibilities even though that workload returns benefit savings that
are many times its administrative costs, $10 in savings for every $1
spent. By the end of this fiscal year, it is estimated that there will
be just around 1.3 million claims sitting in a backlog that should have
these reviews performed. I realize that there is a budgetary
distinction between administrative and benefit spending, but that is an
artificial distinction that most taxpayers supporting Social Security
would consider ludicrous. You might want to support an incentive-based
stewardship approach whereby the Agency can retain a percentage of such
stewardship savings. Abandoning the ability to minimize improper
payments is not only wasteful, but will worsen the future year total
deficits that will constrain future discretionary spending.
Maintaining Public Service in an Era of Growing Workloads
Over the next 10 years, SSA's workload will increase dramatically.
Retirement claims will jump by over 40 percent and disability claims
will rise by nearly 10 percent. Last December there was much fanfare as
the first of the 80 million baby boomers applied for retirement
benefits. The agency expects to process 4.3 million claims in 2008 and
is bracing itself for a 23 percent increase by 2013. The recently
released 2008 OASDI Trustees Report estimates that by 2015 there will
be 50 million retirees, widows and widowers, and dependents receiving
benefits and they will be expecting efficient and modern service from
the Social Security Administration.
But the anticipated growth in claims does not stop there. The baby
boomers are entering their disability prone years and the number of
initial disability claims is projected to rise steadily from 2.5
million to close to 2.7 million by 2013. Unless there is a fundamental
rethinking of the definition of disability and how this vital safety
net fits into the 21st century, the Trustees tell us that the number of
disabled workers receiving benefits is projected to grow from 7.1
million at the end of 2007, to 8.7 million in 2015. The ``silver
tsunami'' of the baby boomers will most assuredly place a tremendous
strain on SSA's resources unless the shortfall in funding and the need
for modernization are addressed.
Long-Term Solvency
I hate to remind the Committee about the grumpy uncle whom no one
wants to claim as part of the family, but I feel obligated in my
position to raise with you the issue of the long-term solvency of this
vital program.
The recent Trustees Report might seem to suggest that the outlook
for financing has improved relative to earlier measurements. The better
estimates in this year's report relate largely to changed assumptions
about immigration levels and do not change the underlying story about
the challenges that our nation's demographics pose for Social Security.
Disability is part of that demographic challenge.
An aging population brings with it greater incidence and prevalence
of disability. In this regard, the Disability Insurance (DI) Trust Fund
component of the system is underfunded and the funding of DI is a
problem that will need to be addressed by Congress. The timing of the
disability funding shortfall precedes that of the Old Age and Survivors
Insurance (OASI) Trust Fund. Thus, any surplus that might be viewed in
OASI as a buffer will be short lived. The contingencies regarding
disability and the related work limitations are substantially different
than in the case of the Old Age insurance program and they deserve
careful consideration. Resolving the disability financing situation and
any reforms that might go along with it should not be an afterthought
in the solvency discussion.
Mr. Chairman, I hope these comments are helpful to the Committee as
it examines the backlogs in the disability programs and addresses the
need for increased resources in order to support them. These critical
safety net programs have been a major concern of the Social Security
Advisory Board and we intend to keep a close watch on them. I would be
happy to provide any additional information that may be helpful to you,
and I would be happy to answer any questions you may have.
Mr. MCDERMOTT. Thank you for your testimony.
Marty Ford, who is the cochair of the Consortium for
Citizens with Disabilities Social Security Task Force.
Ms. Ford?
STATEMENT OF MARTY FORD, CO-CHAIR, CONSORTIUM OF CITIZENS WITH
DISABILITIES SOCIAL SECURITY TASK FORCE
*Ms. FORD. Thank you Mr. Chairman and Members of the
Committee. Thank you for inviting me to testify.
As you know, Social Security and SSI benefits are the means
of survival and a lifeline for millions of people with
disabilities. As you know, the delays and the backlogs are
intolerable. When a decision is appealed, people can wait years
for a hearing, but they also wait additional time for a
decision, and then again wait for the actual payment of
benefits. That needs to be kept in mind. In the meantime, their
lives are unraveling, their families are torn apart, their
homes are lost, their health deteriorates, and some people die
before a decision is made.
One of the CCD Members, the National Organization of Social
Security Claimants; Representatives conducted a quick survey of
their representatives to get an update on how the backlogs are
affecting people. My complete testimony has stories from 29
states, and I want to mention a few.
A man from Brooklyn, New York who has major depressive
disorders and other conditions requested a hearing in March of
2004. The hearing office failed to send him a notice, and the
hearing was dismissed when he did not appear. He obtained an
attorney who asked to reopen the case. Following a hearing, the
ALJ issued a favorable decision. He got his first SSI payment
four and a half years after his appeal. While waiting, he lost
access to medical coverage, his attorney helped him prevent
eviction, he went to food pantries, and he actually had to
borrow money to ride the subway to his hearing.
A Florida woman's disabilities stemmed from a shooting and
chronic obstructive pulmonary disease. After her claim was
denied, she requested her hearing in April of 2006. Nearly 2
years later, just this March, the ALJ allowed benefits.
Unfortunately, she died before receiving the written decision.
While waiting, she lived with her mother who has dementia and
chain smokes. About a week before her death, she told her
attorney that she believed she would die if she could not get
into a smoke-free living situation. Her attorney believes that
her compromised living situation due to lack of income
shortened her life.
A 61-year-old Michigan man requested a hearing in September
of 2005. His case was transferred to another hearing office
because of an overload in the Grand Rapids office, and a
hearing was held in 2007. Over two and a half years after his
request, he received a favorable decision in February, but as
yet he has received no benefits. His is dependent on his
children to pay his bills.
I could go on, and as I said, my testimony contains a
number of these examples. These are just a few of the claimants
who have faced real hardship and the time constraints here
don't allow me to fully convey the pain and anguish that they
and their families have endured.
As has been fully discussed today, the problems are due to
the lack of funding for the administrative process for SSA. We
think that the President's budget request for fiscal 2009 does
not go far enough. Even under that budget, SSA predicts a
combined shortfall of 8,100 work years, 8,100 work years short
for fiscal 2008 and 2009. At the same time, SSA must continue
to streamline and operate more efficiently. Commissioner Astrue
has indicated that the agency has begun a number of initiatives
to expand technological and other improvements.
My testimony includes additional recommendations for
improvements in developing evidence earlier in the process, and
we think that this is one of the keys to why some of these
cases go on too long. In the case examples, there are many that
are listed as having on the record decisions. While some of
that may be due to the fact that the person's condition has
worsened, advocates are reporting that in many cases, some of
this evidence should have been obtained earlier in the process
if it had been requested or if what was needed had been
explained to the providers and to the claimants.
In all the initiatives, we think care has to be taken to
determine how any process change will affect the claimants and
beneficiaries for whom the system exists. People who find they
cannot work at a sustained and substantial level due to
disability are faced with a host of personal, family, and
financial circumstances that impact how effectively they can
maneuver the system.
SSA must continue to improve its role in ensuring that an
individual's claim is fully developed before a decision is
made, and we urge Congress to provide SSA with the resources
necessary and provide over and above that which the President
has asked for, as SSA needs it.
Thank you.
[The prepared statement of Marty Ford follows:]
Prepared Statement of Marty Ford, Co-Chair, Consortium for
Citizens with Disabilities Social Security Task Force
Chairman Rangel, Ranking Member McCrery, and Members of the House
Ways and Means Committee, thank you for inviting me to testify at
today's hearing on Clearing the Disability Backlog--Giving the Social
Security Administration the Resources It Needs to Provide the Benefits
Workers Have Earned.
I am a member of the public policy team for The Arc and UCP
Disability Policy Collaboration, which is a joint effort of The Arc of
the United States and United Cerebral Palsy. I serve as Chair of the
Consortium for Citizens with Disabilities (CCD), and also serve as a
Co-Chair of the CCD Social Security Task Force. CCD is a working
coalition of national consumer, advocacy, provider, and professional
organizations working together with and on behalf of the 54 million
children and adults with disabilities and their families living in the
United States. The CCD Social Security Task Force (hereinafter CCD)
focuses on disability policy issues in the Title II disability programs
and the Title XVI Supplemental Security Income (SSI) program.
The focus of this hearing is extremely important to people with
disabilities. Title II and SSI cash benefits, along with the related
Medicaid and Medicare benefits, are the means of survival for millions
of individuals with severe disabilities. They rely on the Social
Security Administration (SSA) to promptly and fairly adjudicate their
applications for disability benefits. They also rely on the agency to
handle many other actions critical to their well-being including:
timely payment of their monthly Title II and SSI benefits to which they
are entitled; accurate withholding of Medicare Parts B and D premiums;
and timely determinations on post-entitlement issues that may arise
(e.g., overpayments, income issues, prompt recording of earnings).
I. THE IMPACT ON PEOPLE WITH DISABILITIES OF INSUFFICIENT FUNDING FOR
SSA'S ADMINISTRATIVE BUDGET
As the backlog in decisions on disability claims continues to grow,
people with severe disabilities have been bearing the brunt of
insufficient funding for SSA's administrative budget. Behind the
numbers are individuals with disabilities whose lives have unraveled
while waiting for decisions--families are torn apart; homes are lost;
medical conditions deteriorate; once stable financial security
crumbles; and many individuals die.\1\ Numerous recent media reports
across the country have documented the suffering experienced by these
individuals. Access to other key services, such as replacing a lost
check or promptly recording earnings, also has diminished. Despite
dramatically increased workloads, staffing levels throughout the agency
are at the lowest level since 1972.
Backlog in Appeals of Disability Claims: The Human Toll
The National Organization of Social Security Claimants'
Representatives (NOSSCR), a member of the CCD Social Security Task
Force, recently conducted a quick survey of their members for an update
on how the backlogs are affecting claimants. The following short
descriptions of individual's circumstances are a sampling of what is
happening across the country to claimants who are forced to wait
interminably for decisions on their appeals. Your own constituent
services staff are likely well aware of similar situations from your
Congressional district.
Mr. R is 38 years old and lives in Brooklyn, New York. He
has major depressive disorder, anorexia nervosa with severe weight
loss, somatoform disorder, and generalized fatigue. He applied for SSI
benefits in September 2003 and requested a hearing in March 2004. The
ODAR hearing office failed to send a Notice of Hearing for the hearing,
scheduled in December 2006. As a result, Mr. R did not appear and his
hearing request was dismissed. He obtained representation in June 2007
after the dismissal. His attorney immediately contacted the ALJ and
submitted all documents establishing that Mr. R was never informed of
the hearing. She also sent all medical evidence she had obtained. The
attorney asked the ALJ to reopen the case and to schedule an expedited
hearing. The hearing was finally held in November 2007 and the ALJ
issued a favorable decision in late November 2007. There still was a
delay in receipt of benefits as Mr. R did not receive his first SSI
past due installment payment until March 2008 and his first SSI monthly
payment until April 2008.
While waiting for the hearing decision and benefits payments,
Mr. R lost his welfare benefits and Medicaid, so he could not receive
treatment. His anorexia nervosa was so extreme as to cause severe tooth
decay requiring dentures. He received an eviction notice for his
apartment but his attorney worked with the landlord to stave off
eviction based on the fact that a new hearing was being scheduled.
Because his welfare case was closed, Mr. R had no money. He had to go
to food pantries for any donation and his neighbors helped him from
time to time. He even had to borrow money to ride the subway to his
hearing.
Ms. K applied for disability benefits in August 2004. She
lived in Key West, FL. Her husband shot her 5 times in the liver and
abdomen and then killed himself. Her disabilities stemmed from these
injuries and from chronic obstructive pulmonary disease (COPD). Her
claim was denied and she requested a hearing in April 2006. Nearly two
years later, her hearing was held in March 2008 and the ALJ stated that
benefits would be awarded. Unfortunately, Ms. K died in late March 2008
of long-term complications from her wounds and COPD, before the written
decision was received. Because she did not have money to live
independently, she was forced to live with her mother. The mother, who
has dementia, is a chain-smoker. During the last part of her life, Ms.
K had frequent hospitalizations. She would then return to her mother's
house and her condition would worsen. Her attorney last saw Ms. K about
a week before her death. Ms. K told her attorney that she believed she
would die if she could not get into a smoke-free living situation.
Since Ms. K died in part from COPD, her attorney believes that her
compromised living situation, due to the lack of income, shortened her
life.
Mrs. G, a 58-year-old woman from Georgia, worked her
entire life, the last 15 years at a convenience store. Over time, she
developed degenerative joint disease and cardiovascular problems. In
2004, she deteriorated to the point that she stopped working. She had a
house where she had lived for many years but fell behind on the
payments. Her attorney had to intercede on her behalf several times to
stop foreclosure. Her car, which she fully owned, sat idle because she
could not pay the tag fees and could not afford gas. Three years after
she applied, she had a hearing. While the ALJ stated at the hearing
that a favorable ruling would be forthcoming, it still took more than
six months after the hearing before she received her favorable
decision. Even then she had trouble getting her monthly benefits
started. Several months passed and still she did not receive past due
benefits. As she still owed back mortgage payments, the mortgage
company started foreclosure proceedings again. She reported to her
attorney that the anxiety over her claim was making her cardiovascular
problems worsen. She never received her past due benefits. She died
still waiting. Her attorney notes that Mrs. G is his fourth client who
has died in the last three years while waiting for a favorable decision
and payment of benefits.
Mr. M lived in the Chicago, IL, area. He had various
medical problems, but the most significant one was the need for kidney
dialysis, which became apparent after the application was filed. The
need for dialysis meant that his impairment met one of the listings of
impairments, at least as of the date that the dialysis began. His
request for hearing was filed in January 2007. Mr. M's medical
condition worsened. In addition, he did not have a permanent residence
and stayed with his sister for part of the time that his claim was
pending. However, he informed his attorney that his sister was moving,
that he could no longer stay with her, and that he had no alternative
place to live.
In July 2007, his attorney began a series of contacts with the
ODAR hearing office in an effort to have the case considered for an
``on the record'' decision or to schedule a hearing on an expedited
basis given Mr. M's medical condition and lack of a permanent
residence. Between July 2007 and February 2008, his attorney sent five
letters, left multiple voice mail messages, and spoke with the hearing
office director about Mr. M's case. Finally, in February 2008, the
hearing office called to schedule the case in April 2008, sixteen
months after the appeal was filed. Unfortunately, Mr. M died in March
2008. As a result, he never received the benefits to which he was
entitled. He died destitute. And because this was an SSI claim, no one,
including his sister who helped him, will be eligible to receive the
retroactive benefits.
Mr. O, from Richmond, Missouri, died in the lobby of the
ODAR hearing office while waiting to be called for his hearing on April
2, 2008. He was 49 years old and is survived by his wife and 4
children. He filed his SSI application for disability in November 2005,
alleging inability to work due to uncontrolled diabetes with
neuropathy, and shoulder and arm pain. He had worked for 14 years as a
truck driver. His claim was denied in March 2006 and he promptly filed
a request for hearing in April 2006. While waiting for hearing, he had
numerous problems with child support authorities and his home was
foreclosed upon. His representative filed a dire need request in July
2007 to expedite the hearing, but he did not receive a hearing date
until February 2008, when the hearing was scheduled for April 2, 2008,
the day he died.
Mr. N lived in the Charlotte, North Carolina area. He was
57 years old and died in August 2007. As an adult, he obtained a degree
in theology. From 1986 to 1997, he worked doing maintenance on power
generating stations. He developed heart disease and emphysema and, from
1998 to 2004, he did less strenuous work. In June 2005, he filed a
claim for Title II disability benefits. His claim was denied and he
requested a hearing in April 2006. During the wait, he developed a spot
on his lung, but could not afford a CT scan for an accurate diagnosis.
In May 2007, he received a foreclosure notice, lost his house, and had
to move in with his daughter. He died in August 2007 of ischemic heart
disease. In February 2008, months after his death, his claim was
approved on informal remand to the DDS.
Mrs. M, a 33 year old former waitress and substitute
school teacher, lives in Muskogee, Oklahoma. She has degenerative joint
disease of the lumbar spine, neck and hands; hearing loss; left wrist
injury; migraines; tingling/numbness in the left knee and left foot;
right hip problems; dizziness and nausea. She filed her application for
benefits in August 2005 and a request for hearing in May 2006. Mrs. M
is married with three children, including one son who is disabled.
After a nearby plant explosion damaged their home in 2004, the family
was forced to move into an apartment. Evicted in 2007, they have had no
permanent residence since then and have been forced to live in a
variety of temporary settings, including a shelter for women and
children (Mrs. M's husband slept in the car). After the 2007 eviction,
Mrs. M's attorney sent letters to the ODAR hearing office requesting an
expedited hearing because of the family's homelessness. Mrs. M received
a fully favorable decision on March 26, 2008, nearly two years after
she filed her request for a hearing. Her disabled child also received a
favorable decision on March 25, 2008. On April 7, 2008, an SSA district
office worker informed the attorney that both Mrs. M and her disabled
child were in pay status.
A full set of these stories, submitted from 29 states, is located
at the end of this testimony. Without a doubt, people with severe
disabilities are bearing extraordinary and unnecessary hardship as a
result of the persistent under-funding of SSA's administrative
expenses.
Inadequate Funding of SSA's Limitation on Administrative Expenses
The primary reason for the continued and growing disability claims
backlogs is that SSA has not received adequate funds for its management
costs. Although Commissioner Astrue has made reduction and elimination
of the disability claims backlog one of his top priorities, without
adequate appropriations, the situation will deteriorate even more.
Recent Congressional efforts to provide SSA with adequate funding
for its administrative budget are encouraging. The Fiscal Year 2008
appropriation for SSA's Limitation on Administrative Expenses (LAE) was
$9,746,953,000. This amount was $148 million above the President's
request and was the first time in years that the agency has received at
least the President's request.
While the FY 2008 appropriation allows the agency to hire some new
staff and to reduce processing times, it will not be adequate to fully
restore the agency's ability to carry out its mandated services.
Between FY 2000 and 2007, Congress appropriated less than both the
Commissioner of Social Security and the President requested, resulting
in a total administrative budget shortfall of more than $4 billion. The
dramatic increase in the disability claims backlog coincides with this
period of under-funding the agency, leaving people with severe
disabilities to wait years to receive the benefits to which they are
entitled.
Processing Times Have Reached Intolerable Levels
The average processing time for cases at the hearing level has
increased dramatically since 2000, when the average time was 274
days.\2\ In the current fiscal year, SSA estimates that the average
processing time for disability claims at the hearing level will be 535
days,\3\ nearly twice as long as in 2000. It is important to keep in
mind that this is an ``average'' and that many claimants will wait
longer. In addition, the average processing times at the initial and
reconsideration levels have grown over the last ten years by about 20
days at each level, with some cases taking much longer.\4\
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\1\ If a claimant dies while a claim is pending, the SSI rule for
payment of past due benefits is very different--and far more limited--
than the Title II rule. In an SSI case, the payment will be made in
only two situations: (1) to a surviving spouse who was living with the
claimant at the time of death or within six months of the death; or (2)
to the parents of a minor child, if the child resided with the parents
at the time of the child's death or within six months of the death. 42
U.S.C. Sec. 1383(b)(1)(A) [Section 1631(b)(1)(A) of the Act]. In Title
II, the Act provides rules for determining who may continue the claim,
which includes: a surviving spouse; parents; children; and the legal
representative of the estate. 42 U.S.C. Sec. 404(d) [Section 202(d) of
the Act]. Thus, if an adult SSI claimant (age 18 or older) dies before
actually receiving the past due payment and if there is no surviving
spouse, the claim dies with the claimant and no one is paid.
\2\ Social Security Disability: Better Planning, Management, and
Evaluation Could Help Address Backlogs, GAO-08-40 (Dec. 2007) (``GAO
Report''), p. 22.
\3\ Social Security Administration: Fiscal Year 2009 Justification
of Estimates for Appropriations Committees (``SSA FY 09 Budget
Justification''), p. 6.
\4\ GAO Report, p. 20.
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The current processing times in some hearing offices are striking,
and much longer than the 535 days targeted by SSA in FY 2008. SSA
statistics from March 2008 for its 144 hearing offices\5\ indicate that
the average processing time at 47 hearing offices is above the
projected average processing time. There is wide fluctuation, with some
offices over 700 days and even over 800 days.
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\5\ ``National Ranking Report by Average Processing Time'' for the
month ending March 28, 2008.
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Impact on Post-Entitlement Work
While the impact of inadequate funding on the backlog in disability
decisions is unacceptable, there are also other important functions
which SSA cannot perform in a timely manner. SSA has many mandated
responsibilities, which include: paying benefits; issuing Social
Security cards; processing earnings for credits to worker's records;
responding to questions from the public on the 800-number and in the
field offices; issuing Social Security statements; processing
continuing disability reviews (CDRs) and SSI eligibility
redeterminations; and administering components of the Medicare program,
including subsidy applications, calculating and withholding premiums,
making eligibility determinations, and taking applications for
replacement Medicare cards.
One aspect of post-entitlement work that has slipped in the past is
the processing of earnings reports filed by people with disabilities.
Typically, the individual calls SSA and reports work and earnings or
brings the information into an SSA field office. However, due to budget
constraints, SSA often fails to input the information into its computer
system and does not make the needed adjustments in benefits. Months or
years later--after a computer match with earnings records--SSA sends an
overpayment notice to the beneficiary, demanding re-payment of
sometimes tens of thousands of dollars. All too often, however, SSA
will indicate that it has no record of the beneficiary's earnings
reports. Many individuals with disabilities are wary of attempting to
return to work out of fear that this may give rise to the overpayment
scenario and result in a loss of economic stability and healthcare
coverage upon which they rely.
Advocates report seeing problems of overpayments and underpayments
generated by the inability of SSA to open its mail. Clients describe
sending in pay-stubs and not seeing any change in benefits for 6
months. One advocate indicated that his client protested and requested
waiver of an overpayment, insisting that she had reported and sent in
pay stubs as required. She requested that a Claims Representative
search the mail room and reported that a year's worth of specially
colored envelopes from her were found lying unopened in the district
office mail room.
Impact on Performing Continuing Disability Reviews (CDRs) and SSI
Redeterminations
The processing of CDRs and SSI redeterminations is necessary to
protect program integrity and avert improper payments. Failure to
conduct the full complement of CDRs would have adverse consequences for
the Federal budget and the deficit. According to SSA, CDRs result in
$10 of program savings and SSI redeterminations result in $7 of program
savings for each $1 spent in administrative costs for the reviews.\6\
However, the number of reviews actually conducted is directly related
to whether SSA receives the necessary funds. SSA's Budget Justification
refers specifically to CDRs based on medical factors.\7\ It is
important when SSA conducts work CDRs that it assess whether reported
earnings have been properly recorded and ensure that they properly
assess whether work constitutes substantial gainful activity (SGA).
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\6\ SSA FY 09 Budget Justification, p. 18.
\7\ SSA FY 09 Budget Justification, p. 92.
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The Number of Pending Cases Continues to Increase
In its recent report, the Government Accountability Office (GAO)
noted that the hearing level backlog was ``almost eliminated'' from FY
1997 to FY 1999, but then grew ``unabated'' by FY 2006.\8\ The number
of pending cases at the hearing level reached a low in FY 1999 at
311,958 cases. The numbers have increased dramatically since 1999,
reaching 752,000 in FY 2008.\9\
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\8\ GAO Report, p. 20.
\9\ SSA FY 09 Budget Justification, p. 6.
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SSA received funding in FY 2008 to hire approximately 150 new
Administrative Law Judges to conduct hearings and some additional
support staff. We understand that SSA has already hired 135 ALJs. It
will take some time for the judges to be trained and to get up to speed
in hearing and deciding disability cases. However, productivity is not
related solely to the number of ALJs, but also to the number of support
staff. While SSA senior managers and ALJs recommend a staffing ratio of
5.25,\10\ in 2006, the ratio of support staff to ALJs was 4.12. The
actual ratio represented nearly a 25 percent decrease from the
recommended level, at a time when the number of pending cases had
increased dramatically. When the support staff to ALJ ratio was higher
(FY 1999 to FY 2001) \11\, the number of pending cases older than 270
days was much lower.
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\10\ GAO Report, p. 32.
\11\ Id.
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Decreases in Staffing Result in Decreases in Services
Beyond the crisis in cases pending for hearings, SSA estimates that
in FY 2009 it will have a staffing deficit of essentially 8,100 full-
time staff.\12\ The FY 2008 shortfall is 3,300 workyears, and the FY
2009 shortfall is projected to be 4,800 workyears. We understand from
Social Security officials that these figures must be added together to
see the cumulative shortfall of 8,100 staff. This shortfall explains
the concerns mentioned above regarding the agency's ability to carry
out its mandated services.
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\12\ SSA FY 09 Budget Justification, page 92, Table 3.2--Key
Performance Targets, under Selected Outcome Measures.
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Impact of New Workloads
We were pleased that in the recent Economic Stimulus Act of
2008,\13\ Congress recognized the added work that SSA will incur as a
result of the legislation and appropriated an additional $31 million to
the agency for FY 2008. However, over the past decade, Congress has
passed legislation that added to SSA's workload, but did not
necessarily provide additional funds to implement these provisions.
Recent examples include:
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\13\ Pub. L. No. 110-185.
Conducting pre-effectuation reviews on increasing numbers
of initial SSI disability allowances. SSA must review these cases for
accuracy prior to issuing the decision.
Changing how SSI retroactive benefits are to be paid. SSA
must issue these benefits in installments if the amount is equal to or
more than three months of benefits. The first two installments can be
no more than three months of benefits each, unless the beneficiary
shows a hardship due to certain debts. Under prior law, the provision
was triggered only if the past due benefits equaled 12 months or more.
SSA must address these hardship requests and handle the increased
number of installment payments.
SSA's Medicare workloads. SSA has workloads related to
the Medicare Part D prescription drug program, including determining
eligibility for low-income subsidies; processing subsidy changing
events for current beneficiaries; conducting eligibility
redeterminations; performing premium withholding; and making annual
income-related premium adjustment determinations for the Medicare Part
B program.
Mandatory Employment Verification Would Overwhelm SSA
We are very concerned about the potential impact of legislation
under consideration to mandate the use of the electronic employment
eligibility verification system (EEVS) to all employers. Since 1996,
employers have had the option of verifying names and Social Security
Numbers of new hires against SSA's database through EEVS, an e-
verification pilot program operated jointly by SSA and the Department
of Homeland Security (DHS). Currently 53,000 employers use it to verify
the legal status of job applicants. Most are participating voluntarily,
but some are required to use the EEVS by law or due to prior
immigration violations. Studies have found that the current system,
used by less than 1% of all employers, is hampered by inaccuracies in
the DHS and SSA records. If made mandatory, the errors in EEVS would
require millions of U.S. citizens and legal immigrants to interact with
SSA to prove that they are eligible to work. At a hearing of the Social
Security Subcommittee on June 7, 2007, the SSA witness indicated that
SSA would need at least 2,000 to 3,000 additional staff to handle the
new workload.
Given the current shortage in administrative resources for SSA
discussed above (8,100 workyears short in FY 2009), we cannot support
increased mandatory responsibilities of this magnitude. Past experience
with new workloads for SSA make us wary of the capacity to fully fund
the administrative responsibilities on a sustained basis. Such a
mandate could have further devastating effects on the disability
determination system which is already so overwhelmed.
CCD Recommendations Regarding SSA Limitation on Administrative Expenses
Funding
The President's request for the SSA FY 2009 LAE does not go far
enough to put the agency on a clear path to provide its mandated
services at a level expected by the American public. SSA must be given
enough funding to make disability decisions in a timely manner and to
carry out other critical workloads. Due to the serious consequences of
persistent and cumulative under-funding of SSA's administrative
expenses, we strongly recommend that SSA receive $11 billion for its FY
2009 LAE. This amount will allow the agency to make significant strides
in reducing the disability claims backlog, improving other services to
the public, and conducting adequate numbers of CDRs and SSI
redeterminations. At a minimum, SSA should receive the President's
request of $10.327 billion plus $240 million for integrity work.
In addition, CCD also urges Congress to separate SSA's LAE budget
authority from the Section 302(a) and (b) allocations for discretionary
spending. The size of SSA's LAE is driven by the number of
administrative functions it conducts to serve beneficiaries and
applicants. Congress should remove SSA's administrative functions from
the discretionary budget that supports other important programs. The
LAE would still be subject to the annual appropriations process and
Congressional oversight.
II. RECOMMENDATIONS FOR IMPROVING THE DISABILITY CLAIMS PROCESS
Money alone will not solve SSA's crisis in meeting its
responsibilities. Commissioner Astrue has committed to finding new ways
to work better and more efficiently. CCD has numerous suggestions for
improving the disability claims process for people with disabilities.
Many of these recommendations have already been initiated by SSA.\14\
We believe that these recommendations and agency initiatives, which
overall are not controversial and which we support, can go a long way
towards reducing and eventually eliminating the disability claims
backlog. Finally, we have raised concerns about SSA proposals to revise
the appeals process for claimants who have received initial denials of
their disability claims.
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\14\ Commissioner Astrue announced a number of initiatives to
eliminate the SSA hearings backlog at a Senate Finance Committee
hearing on May 23, 2007. The 18-page summary of his recommendations is
available at www.senate.gov/finance/sitepages/hearing052307.htm. An
update on the status of the recommendations/initiatives is the subject
of the Plan to Eliminate the Hearing Backlog and Prevent Its
Recurrence: End of Year Report, Fiscal Year 2007, SSA Office of
Disability Adjudication and Review (``ODAR Report'').
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Caution Regarding the Search for Efficiencies
While we generally support the goal of achieving increased
efficiency throughout the adjudicatory process, we caution that limits
must be placed on the goal of administrative efficiency for
efficiency's sake alone. The purposes of the Social Security and SSI
programs are to provide cash benefits to those who need them and have
earned them and who meet the eligibility criteria. While there may be
ways to improve the decision-making process from the perspective of the
adjudicators, the bottom line evaluation must be how the process
affects the very claimants and beneficiaries for whom the system
exists.
People who find they cannot work at a sustained and substantial
level are faced with a myriad of personal, family, and financial
circumstances that will have an impact on how well or efficiently they
can maneuver the complex system for determining eligibility. Many will
not be successful in addressing all of SSA's requirements for proving
eligibility until they reach a point where they request the assistance
of an experienced representative. Many face educational barriers and/or
significant barriers inherent in the disability itself that prevent
them from understanding their role in the adjudicatory process and from
efficiently and effectively assisting in gathering evidence. Still
others are faced with having no ``medical home'' to call upon for
assistance in submitting evidence, given their lack of health insurance
over the course of many years. As seen earlier in this testimony, many
are experiencing extreme hardship from the loss of earned income, often
living through the break-up of their family and/or becoming homeless,
with few resources--financial, emotional, or otherwise--to rely upon.
Still others experience all of the above limits on their abilities to
participate effectively in the process.
We believe that the critical measure for assessing initiatives for
achieving administrative efficiencies must be the potential impact on
claimants and beneficiaries. Proposals for increasing administrative
efficiencies must bend to the realities of claimants' lives and accept
that people face innumerable obstacles at the time they apply for
disability benefits and beyond. SSA must continue, and improve, its
established role in ensuring that a claim is fully developed before a
decision is made and must ensure that its rules reflect this
administrative responsibility.
1. Improve Development of Evidence Earlier in the Process
CCD supports full development of the record at the beginning of the
claim so that the correct decision can be made at the earliest point
possible and unnecessary appeals can be avoided. Improvements at the
front end of the process can have a significant beneficial impact on
preventing the backlog and delays later in the appeals process.
Developing the record so that relevant evidence from all sources
can be considered is fundamental to full and fair adjudication of
claims. The adjudicator needs to review a wide variety of evidence in a
typical case, including: medical records of treatment; opinions from
medical sources and other treating sources, such as social workers and
therapists; records of prescribed medications; statements from former
employers; and vocational assessments. The adjudicator needs these
types of information to make the necessary findings and determinations
under the SSA disability criteria.
Claimants should be encouraged to submit evidence as early as
possible. However, the fact that early submission of evidence does not
occur more frequently is usually due to many reasons beyond the
claimant's control, including:
State agency disability examiners who fail to request and
obtain necessary and relevant evidence, including the failure to
request specific information tailored to the SSA disability criteria;
The failure of SSA and state agency disability examiners
to explain to claimants or providers what evidence is important,
necessary, and relevant for adjudication of the claim;
Cost or access restrictions, including confusion over
Health Insurance Portability and Accountability Act (HIPAA)
requirements, which prevent claimants from obtaining records;
Medical providers who delay or refuse to submit evidence;
Inadequate reimbursement rates for providers; and
Evidence which is submitted but then misplaced.
Claimants' representatives are often able to ensure that the claim
is properly developed. Based on the experiences and practical
techniques of representatives, we have a number of recommendations\15\
that we believe will improve the development process:
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\15\ Our recommendations include those made by Linda Landry,
Disability Law Center, Boston, MA, at the SSA ``Compassionate Allowance
Outreach Hearing for Rare Diseases'' held in Washington, DC, on
December 4, 2007. Her testimony is available online at: http://
www.ssa.gov/compassionateallowances/
LandryFinalCompassionateAllowances2.pdf.
Provide more assistance to claimants at the application
level. At the beginning of the process, SSA should explain to the
claimant what evidence is important and necessary. SSA should also
provide applicants with more help completing application paperwork so
that all impairments and sources of information are identified,
including non-physician and other professional sources.
DDs need to obtain necessary and relevant evidence.
Representatives often are able to obtain better medical information
because they use letters and forms that ask questions relevant to the
disability determination process. However, state disability
determination service (DDS) forms usually ask for general medical
information (diagnoses, findings, etc.) without tailoring questions to
the Social Security disability standard. SSA should review its own
forms and set standards for state-specific forms to ensure higher
quality.
Increase reimbursement rates for providers. To improve
provider response to requests for records, appropriate reimbursement
rates for medical records and reports need to be established.
Appropriate rates should also be paid for consultative examinations and
for medical experts.
Provide better explanations to medical providers. SSA and
DDSs should provide better explanations to all providers, in particular
to physician and non-physician treating sources, about the disability
standard and ask for evidence relevant to the standard.
Provide more training and guidance to adjudicators. Many
reversals at the appeals levels are due to earlier erroneous
application of existing SSA policy. Additional training should be
provided on important evaluation rules such as: weighing medical
evidence, including treating source opinions; the role of non-physician
evidence; \16\ the evaluation of mental impairments, pain, and other
subjective symptoms; the evaluation of childhood disability; and the
use of the Social Security Rulings.
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\16\ This evidence is often given little or no weight even though
SSA's regulations provide that once an impairment is medically
established, all types of probative evidence, e.g., medical, non-
physician medical, or lay evidence, will be considered to determine the
severity of the limitations imposed by the impairment(s).
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Improve use of the existing methods of expediting
disability determinations. SSA already has in place a number of methods
which can expedite a favorable disability decision if the appropriate
criteria are met, including Quick Disability Determinations,
Presumptive Disability in SSI cases, and terminal illness (``TERI'')
cases.
Improve the quality of consultative examinations. Steps
should be taken to improve the quality of the consultative examination
(CE) process. There are far too many reports of inappropriate
referrals, short perfunctory examinations, and examinations conducted
in languages other than the applicant's.
2. Expand Technological Improvements
Commissioner Astrue has made a strong commitment to improve and
expand the technology used in the disability determination process. CCD
generally supports these efforts to improve the disability claims
process, so long as they do not infringe on claimants' rights. The
initiative to process disability claims electronically has the prospect
of significantly reducing delays by eliminating lost files, reducing
the time that files spend in transit, and preventing misfiled evidence.
Some of the technological improvements that we believe can help reduce
the backlog include the following:
The electronic disability folder: ``eDIB.'' The
electronic folder should reduce delays caused by the moving and
handing-off of folders, allowing for immediate access by different
components of SSA or the DDS.
Electronic Records Express (ERE). ERE is an initiative to
increase the use of electronic options for submitting records related
to disability claims that have electronic folders. Registered claimant
representatives are able to submit evidence electronically through the
SSA secure website or to a dedicated fax number using a unique barcode
assigned to the claim.
Findings Integrated Templates (FIT). FIT is used for ALJ
decisions and integrates the ALJ's findings of fact into the body of
the decision. While the FIT does not dictate the ultimate decision, it
requires the ALJ to follow a series of templates to support the
ultimate decision.
Use of video hearings. Video hearings allow ALJs to
conduct hearings without being at the same geographical site as the
claimant and representative and has the potential to reduce processing
times and increase productivity. We support the use of video
teleconference hearings so long as the right to a full and fair hearing
is adequately protected; the quality of video teleconference hearings
is assured; and the claimant retains the absolute right to have an in-
person hearing as provided under current regulations.\17\
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\17\ 20 C.F.R. Sec. Sec. 404.936 and 416.1436.
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3. New Screening Initiatives
We support SSA's efforts to accelerate decisions and develop new
mechanisms for expedited eligibility throughout the application and
review process. Ideally, adjudicators should use SSA screening criteria
as early as possible in the process and we encourage the use of ongoing
screening as claimants obtain more documentation to support their
applications. However, SSA must work to ensure that there is no
negative inference when a claim is not selected by the screening tool
or allowed at that initial evaluation. There are two initiatives that
hold promise:
Quick Disability Determinations. We have supported the
Quick Disability Determination (QDD) process since it first began in
SSA Region I states in August 2006 and was expanded nationwide by
Commissioner Astrue in September 2007.\18\ The QDD process has the
potential of providing a prompt disability decision to those claimants
who are the most severely disabled. Since the QDD process's August 2006
implementation in Region I states, the vast majority of QDD cases have
been decided favorably in less than 20 days.
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\18\ 20 C.F.R. Sec. Sec. 404.1619 and 416.1019.
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Compassionate Allowances. In July 2007, SSA published an
Advance Notice of Proposed Rulemaking (ANPRM) on a proposed new
screening mechanism to be known as Compassionate Allowances.\19\ SSA is
``investigating methods of making `compassionate allowances' by quickly
identifying individuals with obvious disabilities.'' While there is no
definition of disabilities that are considered ``obvious,'' there is
emphasis on creating ``an extensive list of impairments that we [SSA]
can allow quickly with minimal objective medical evidence that is based
on clinical signs or laboratory findings or a combination of both. . .
.'' Like the QDD process, SSA is looking at the use of computer
software to screen cases by searching claims for key words in the
electronic folder.
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\19\ 72 Fed. Reg. 41649 (July 31, 2007).
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4. Other Hearing Level Improvements
The Senior Attorney Program. In the 1990s, senior staff
attorneys were given the authority to issue fully favorable decisions
in cases that could be decided without a hearing (i.e. ``on the
record''). While the Senior Attorney Program existed, it helped to
reduce the backlog by issuing approximately 200,000 decisions. We are
pleased that Commissioner Astrue has decided to reinstate the program
for at least the next two years\20\ and has proceeded with
implementation.\21\ We believe that this initiative will help to reduce
the backlog of cases at the hearing level.
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\20\ The interim final rule reinstating the program was published
in August 2007 and became effective on October 9, 2007. 72 Fed. Reg.
44763 (Aug. 9, 2007).
\21\ ODAR Report, p. 3.
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Increasing the time for providing notice of hearings.
Current regulations in most of the country provide only a 20-day
advance notice for ALJ hearings. This time period is not adequate for
requesting, receiving, and submitting the most recent and up-to-date
medical evidence prior to the hearing. SSA has proposed to expand the
75-day hearing notice requirement nationwide.\22\ We strongly support
this proposed change. This increased time period will mean that many
more cases would be fully developed prior to the hearing and lead to
more on-the-record decisions, avoiding the need for a hearing.
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\22\ 72 Fed. Reg. 61218 (Oct. 29, 2007).
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CCD Response to the NPRM: Amendments to the Administrative Law Judge,
Appeals Council, and Decision Review Board Appeals Levels
On October 29, 2007, SSA published a Notice of Proposed Rulemaking
(NPRM), which would make major changes to the appeals process.\23\ We
had very serious concerns about the proposed rule's impact on claimants
and beneficiaries and submitted extensive comments on behalf of over 30
national organizations.\24\ Our overarching concern was that many
aspects of the proposed process would elevate speed of adjudication
above accuracy of decision-making. This is problematic and not
appropriate for a non-adversarial process.
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\23\ Id.
\24\ See: http://www.c-c-d.org/task_forces/social_sec/
CCD_NPRM_comments_FINAL_12-27-07.pdf.
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On balance, we urged the Commissioner not to implement this NPRM
unless significant changes were made to protect the rights and
interests of people with disabilities. Our measure is whether the
process will be fair. While there are some positive proposed changes,
e.g., a 75-day hearing notice (the current rule provides only a 20-day
notice); de novo review by the ALJ; and retaining a claimant's right to
administrative review of an unfavorable ALJ decision, we noted that the
package of proposals, as a whole, would result in more decisions that
are not based on full and complete records. Claimants would be denied
not because they are not disabled, but because they would not have had
an opportunity to present their case. It is appropriate to deny
benefits to an individual who is found not eligible, if that individual
has received full and fair due process. It is not appropriate to deny
benefits to an eligible individual simply because he or she has been
caught in procedural tangles and barriers. We believe that the flexible
nature of the current non-adversarial, truth-seeking process must be
preserved.
As you know, on January 29, 2008, after the close of the public
comment period, Commissioner Astrue informed Representative McNulty,
Chairman of the Social Security Subcommittee, that in light of the
concerns expressed by the public and Members of Congress, he was
suspending the rulemaking process for the provisions that were
controversial.
Following that announcement, Commissioner Astrue met with members
of NOSSCR and CCD to discuss those areas of the proposed rule
considered controversial. We felt the meeting was productive and
believe that Commissioner Astrue and his staff are working in good
faith to address the serious concerns raised by advocates. We look
forward to another meeting or follow-up on those issues which SSA
officials agreed to reconsider.
Claimant Stories Provided by Representatives in April 2008
ALABAMA
Ms. S was a court reporter for 26 years in Mobile,
Alabama. She stopped working in March 2002 due to severe carpal tunnel
syndrome, chronic obstructive pulmonary disease (COPD), and psychiatric
impairments. The claimant filed a claim on her own in 2002 and lost at
the ALJ level a few years later and never appealed. She then sought
representation and her attorney helped her file a new claim. Two
hearings were held and there were two Appeals Council remands. By this
time, Ms. S had undergone several carpal tunnel release surgeries
without any real relief, became dependent on a continuous positive
airway pressure (CPAP) machine to facilitate her breathing, and her
dementia became increasingly progressive to the point that she was
completely dependent on her adult son and her sister. Following a
request to the ALJ for an ``on the record'' decision, after the second
Appeals Council remand, the ALJ issued a favorable decision on March
28, 2008.
ALASKA
Ms. B of Sitka, Alaska, applied for Title II and SSI
benefits in March 1998. After initial denial of both claims, she had a
hearing in March 2000. The unfavorable ALJ decision was issued more
than one year later in April 2001. She filed a hand-written appeal to
the Appeals Council in May 2001. In her appeal, she wrote that her
condition was grave because she had severe headaches, dizziness, lost
balance, had blurry vision, and severe head pain and fatigue. Five and
one-half years later, the Appeals Council denied review in December
2006. Ms. B was unrepresented through that point. She obtained counsel
to file an appeal to Federal court. Upon reviewing the administrative
record, her attorney immediately noticed that the record contained
substantial records from another person, including the other person's
name. These are the same medical records upon which the ALJ denied her
claim in 2001, including the finding that Ms. B was not credible. The
fact that these records belonged to another individual was obvious.
In Federal court, the incorrect records were brought to the
attention of the SSA Office of General Counsel (OGC) and the court. In
May 2007, Ms. B's attorney and the SSA attorney agreed to a remand,
which the court approved. Since May 2007, there has been no action by
SSA to move this claim toward disposition. Ms. B's attorney has filed a
request for an ``on the record'' decision but has received no response.
Ms. B is now receiving benefits but only since 2007 when she received a
favorable ALJ decision on a subsequent application. However, that
decision only paid benefits starting in September 2003.
ARKANSAS
Ms. R lives in Fayetteville, Arkansas, and filed for
Title II and SSI benefits in April 2001. Her claim was denied and a
hearing was held in December 2002. Her SSI claim was allowed but the
Title II claim was denied based on lack of insured status. On appeal to
the Appeals Council, proof was submitted that she had worked and was
insured, but the claim was denied again. Ms. R filed an appeal in
Federal court, which was remanded in April 2004 because the
administrative record was lost. Nearly two years later, in January
2006, the Appeals Council finally remanded the case to an ALJ,
certifying that all efforts to locate the file had been exhausted, to
have an immediate hearing to reconstruct the file. Ms. R's attorney has
continually contacted the hearing office regarding the remand hearing
based on the court's order four years ago. There has still been no
hearing set on this matter. Being restricted to SSI has seriously
affected her financial situation and she is being denied the Title II
disability payments, for which she has worked.
Mr. M filed a claim for benefits some time in late 2005,
which was denied. He lives in Pettigrew, Arkansas. A hearing was
requested in October 2006 and held in January 2008. A decision has not
yet been received. Mr. M has had a series of strokes, which affect his
ability to comprehend and his condition continues to worsen. He also
has been forced to move from place to place, because his family cannot
afford to pay for his living expenses and they lost their home.
Ms. C from Farmington, Arkansas, filed a claim for
benefits in early 2006. After being denied, she requested a hearing in
August 2006. A hearing was held in September 2007, but it was another
six months before she received a favorable decision, which was more
than two years after she filed her claim. During this time, Ms. C. lost
her home, which she shared with an abusive and alcoholic man because
she had no money and no other place to live. She now moves around,
including staying with her parents.
Ms. M filed a claim for benefits in August 2005 while
living in Florida. The claim was denied and she requested a hearing in
April 2006. Following that hearing request, Ms. M moved to
Fayetteville, Arkansas, and obtained representation. Beginning in
November 2006, her attorney requested that her file be transferred from
Florida to Arkansas. The transfer finally occurred ten months later in
September 2007. A hearing was held in March 2008. Ms. M continues to
decline in physical, emotional, and mental health. She had been living
with a sister, but was asked to leave. She moves from family member to
family member, and has no money for medical treatment or even basic
necessities.
CONNECTICUT
Mr. C, who worked as a landscaper, has liver failure.
While waiting two years for a hearing, he became homeless. By the time
his hearing was held, he was living in his car in the middle of winter.
He was hospitalized right after the hearing and the hospital had no
place where he could be discharged. He waited for two months after the
hearing for a favorable ALJ decision and another month after that to
start receiving benefits.
FLORIDA
Ms. K applied for disability benefits in August 2004. She
lived in Key West, FL. Her husband shot her 5 times in the liver and
abdomen and then killed himself. Her disabilities stemmed from these
injuries and from chronic obstructive pulmonary disease (COPD). Her
claim was denied and she requested a hearing in April 2006. Nearly two
years later, her hearing was held in March 2008 and the ALJ stated that
benefits would be awarded. Unfortunately, Ms. K died in late March 2008
of long-term complications from her wounds and COPD, before the written
decision was received. Because she did not have money to live
independently, she was forced to live with her mother. The mother, who
has dementia, is a chain-smoker. During the last part of her life, Ms.
K had frequent hospitalizations. She would then return to her mother's
house and her condition would worsen. Her attorney last saw Ms. K about
a week before her death. Ms. K told her attorney that she believed she
would die if she could not get into a smoke-free living situation.
Since Ms. K died in part from COPD, her attorney believes that her
compromised living situation, due to the lack of income, shortened her
life.
Mr. F filed a claim for disability benefits in September
2004 and was denied twice before his hearing in July 2006. He has well-
documented uncontrolled seizure disorder and used a wheelchair for the
first six months of his disability. He is 56 years old. While waiting
for his hearing, he could not pay his utility bills and his electricity
and water were turned off. He lived without any utilities for over six
months. He and his wife lived in a trailer. For water, they would carry
empty milk containers to a communal water faucet in the trailer park to
fill them. They used this water to wash dishes, bathe and flush toilets
for over six months. At the hearing, the ALJ approved the claim but
with an onset date of only two months prior to the hearing, and Mr. F
has appealed the onset date.
Mr. B is a 48 year old former mechanic who lives in
Bradenton, Florida. He has diabetes mellitus, failed back surgery
syndrome, three disc herniations in his lower back and two in his
cervical spine, ambulates with a cane, and has developed depression and
anxiety. His application was filed in September 2004. He has not yet
had a hearing, which is scheduled for June 18, 2008. He is a workers'
compensation recipient. However, in the interim, his benefits were
significantly reduced. He had to move in with eight other family
members and depends on them for financial support. The workers'
compensation carrier has denied several of his medical bills on grounds
that his conditions were pre-existing, so he has had no medical care
for some time.
Ms. L was a 44 year old female with advanced, end-stage
breast cancer. She lived in Bradenton, Florida. She filed an
application for benefits in 2002, her request for a hearing was filed
in August 2005, but she died from her condition in April 2006. She was
living with her mother at the time.
Mr. M is a 57 year old former businessman. He has end-
stage kidney failure, uncontrolled hypertension, and anemia. He had
numerous reports stating his condition was terminal. He filed an
application in 2004 and a request for a hearing in August 2005. He was
awarded benefits without a hearing in April 2006 by the ALJ, after his
attorney sent two letters requesting an ``on the record'' decision.
Until the ALJ decision, his phone, electricity, and other utilities
were cut off. His house went into foreclosure. He had no medical
insurance and his wife could not afford to support him.
Mr. D was a 56 year old laborer with a 6th grade
education. He had end-stage lung cancer. In 2007, he filed an
application in West Virginia, then moved to Florida. He died in
February 2008. While waiting for a determination, he lost his home,
car, wife, and all sources of income. He died in a hospice with no
family knowledgeable about his whereabouts.
GEORGIA
Mr. A is 23 years old. He previously received SSI
benefits due to a heart transplant. His benefits were terminated. Now,
Medicaid will no longer pay for his anti-rejection medication. If he
does not get this medication, he will die. His hearing request was
filed in February 2007 but no hearing has been scheduled.
Mrs. G, a 58 year old woman, worked her entire life, the
last 15 years at a convenience store. Over time, she developed
degenerative joint disease and cardiovascular problems. In 2004, she
deteriorated to the point that she stopped working. She had a house
where she had lived for many years but fell behind on the payments. Her
attorney had to intercede on her behalf several times to stop
foreclosure. Her car, which she fully owned, sat idle because she could
not pay the tag fees and could not afford gas. Three years after she
applied, she had a hearing. While the ALJ stated at the hearing that a
favorable ruling would be forthcoming, it still took more than six
months after the hearing before she received her favorable decision.
Even then she had trouble getting her monthly benefits started. Several
months passed and still she did not receive past due benefits. As she
still owed back mortgage payments, the mortgage company started
foreclosure proceedings again. She reported to her attorney that the
anxiety over her claim was making her cardiovascular problems worsen.
She never received her past due benefits. She died still waiting. Her
attorney notes that Mrs. G is his fourth client who has died in the
last three years while waiting for a favorable decision and payment of
benefits.
HAWAII
An attorney in Honolulu reports that the ALJ who hears
claims in the Honolulu ODAR hearing office has been out on sick leave
since November 2007. Since then, no hearings have been held in the
State of Hawaii. For reasons he does not know, the SSA Regional Office
in San Francisco, CA, did not make arrangements to have the hearing
docket handled by a visiting ALJ. He personally has about 50 clients
waiting for their cases to be scheduled. Like other claimants, these
are individuals with severe illnesses that prevent them from working
and they have no income. After the attorney and his clients wrote to
one of their Senators, SSA began to schedule video hearings for the end
of April 2008 in Honolulu, which the attorney reports is the first
action since the end of November 2007. However, the other islands in
Hawaii are not set up for video hearings.
ILLINOIS
Mr. M lived in the Chicago, IL, area. He had various
medical problems, but the most significant one was the need for kidney
dialysis, which became apparent after the application was filed. The
need for dialysis meant that his impairment met one of the listings of
impairments, at least as of the date that the dialysis began. His
request for hearing was filed in January 2007. Mr. M's medical
condition worsened. In addition, he did not have a permanent residence
and stayed with his sister for part of the time that his claim was
pending. However, he informed his attorney that his sister was moving,
that he could no longer stay with her, and that he had no alternative
place to live.
In July 2007, his attorney began a series of contacts with the
ODAR hearing office in an effort to have the case considered for an
``on the record'' decision or to schedule a hearing on an expedited
basis given Mr. M's medical condition and lack of a permanent
residence. Between July 2007 and February 2008, his attorney sent five
letters, left multiple voice mail messages, and spoke with the hearing
office director about Mr. M's case. Finally, in February 2008, the
hearing office called to schedule the case in April 2008, sixteen
months after the appeal was filed. Unfortunately, Mr. M died in March
2008. As a result, he never received the benefits to which he was
entitled. He died destitute. And because this was an SSI claim, no one,
including his sister who helped him, will be eligible to receive the
retroactive benefits.
Mr. R, age 48, has Lou Gehrig's Disease and became
disabled in January 2006. His claim was denied and his hearing request
has been pending since October 2007. He spent five years caring for his
ailing mother prior to her death and now needs assistance with most
activities of daily living. However, his wife cannot afford to stop
working and he cannot afford to hire an assistant. He may not live long
enough to have a hearing.
Mr. J is 51 years old. He previously received disability
benefits for five years due to a back injury. He returned to work as a
truck driver but was re-injured on the job. His employer did not have
workers' compensation insurance. He has an inoperable spinal disorder.
His application was filed in October 2005 and his hearing request was
filed more than two years ago in March 2006. His attorneys' requests
for an ``on the record'' decision and for expedited reinstatement of
benefits have been denied. Mr. J's treating physician strongly supports
this disability claim. Mr. J and his wife have lost every financial
asset that they accumulated while they were working and they now live
with the wife's elderly mother who lives on a fixed income.
Exacerbating his impairment, Mr. J was in a car accident in April 2008,
which injured his neck and head and knocked him unconscious.
Ms. K is a 52 year old woman, and a resident of Joliet,
IL. She has major depression with psychosis, diabetic neuropathy, chest
pain, and arthritis. She was 48 years old when she applied for Title II
disability benefits in 2004. She requested an ALJ hearing in February
2006 and still does not have a hearing scheduled. Since she applied in
2004, she has suffered deteriorating health and severe financial
hardship, including a utility shutoff during one of the coldest winters
in recent memory. Her attorney has been told that because she has a
paper file, this has further delayed the scheduling of her hearing. Her
attorney requested an ``on the record'' decision without the need for a
hearing based on the strength of her case and her long wait, but this
request was denied.
Mr. B from Freeport, IL, requested a hearing in November
2001 and a hearing was held in May 2002. No decision was issued and the
ALJ scheduled a supplemental hearing, which was held nearly 18 months
later in October 2003. An unfavorable decision was issued, more than
two years after a hearing was requested. He appealed to the Appeals
Council but the file was misplaced. After Congressional intervention,
the file was located and a decision remanding the case to the ALJ was
issued in August 2007, more than three years after the ALJ decision. It
has been more than 6 years since he first requested a hearing. Mr. B,
who is impoverished, is still waiting for a new date for his remand
hearing.
INDIANA
Mr. I, a 46 year old resident of Indianapolis, Indiana,
was a school bus driver. He developed high blood pressure, diabetes and
lost vision in one eye. He could no longer work. He applied for
benefits in February 2004. Without income, he had to choose food over
his medication. His diseases became uncontrolled and he was found
unconscious on his apartment floor. He was hospitalized and eventually
died in February 2007. A favorable decision was issued in August 2007,
nearly six months after his death.
IOWA
Ms. H is a Henderson, IA, resident and is now 48 years
old. She filed her application in March 2005 and requested a hearing in
December 2005. Nearly two years later, the hearing was held in November
2007, but she still has not received a decision five months later. All
evidence was submitted before the hearing and there was no post-hearing
development ordered by the ALJ. Ms. H has Hepatitis B and C and has had
Interferon treatments for almost a year. She also has severe arthritis,
gastroesophageal reflux disease, and depression. Her physician has
written that she needs to rest three hours out of an eight hour work
day and that pain would interfere frequently with her attention and
concentration.
KENTUCKY
Ms. R, age 53, of Richmond, Kentucky, worked as an
inspector for a rubber operation. She had cancer and then disability
due to a mastectomy, nerve damage, emphysema, hypertension, plus other
conditions, including depression. She applied for benefits in October
2006. Her case was appealed to the ALJ level. However, before a hearing
was scheduled, Ms. R died in March 2008. Her family continues the case.
MARYLAND
Ms. W is a 30 year old former retail employee who lives
in Westminster, Maryland. As a result of an automobile accident, she
has various cervical, thoracic and lumbar spinal conditions which cause
severe instability in her legs and affect her in all activities of
daily living, including working. She has not been able to work since
the accident and will be unable to work indefinitely. She filed her
application for benefits in early 2006, which was denied. She requested
a hearing in August 2007. The hearing was held on February 13, 2008,
and a favorable decision was issued on March 27, 2008. While this story
has had a positive end result, the path to getting there was anything
but positive. By the time of her February 2008 hearing, she was
homeless and had been living out of her beat-up, old car for months.
She was unable to pay any bills, including rent, and she was evicted.
During this time, she was unable to communicate with her attorney. She
also could not obtain proper medical treatment, and her condition
continued to deteriorate. She has finally found shelter, but is still
awaiting receipt of her first benefits payment.
MASSACHUSETTS
Ms. W lived in Worcester, MA, and was 45 years old when
she died from end-stage liver disease. She died in January 2008, while
waiting for a hearing. She filed an application in 2005 but it was
lost. She filed another application in late 2006 or early 2007, which
was denied, in part, because of failure to consider that her condition
was expected to result in death. She obtained representation and
requested a hearing in July 2007, but the appeal was not processed
promptly pending receipt of the 2005 file, which had been lost. Between
September 2007 and January 2008, her attorney contacted the SSA
district office and the ODAR hearing office on eight different
occasions, requesting that the processing be expedited because Ms. W
was in desperate need of funds and was feeling quite ill. In December
2007, the district office said the file had been sent to the hearing
office, but the hearing office denied receiving the file. On January
14, 2008, the attorney finally received a letter from the hearing
office acknowledging receipt of the hearing request. Ms. W died on
January 18, 2008.
Mr. F is a 45 year old sheet metal mechanic from
Fitchburg, MA, who worked for the same company for 25 years. He filed
his application in May 2006 at the urging of his doctor. Following
surgery for a cervical fusion, he has had complications, including
decreased range of motion, severe and constant headaches, severe
chronic pain, arm and hand numbness, and hip and back pain. His hearing
request was filed in December 2006. While waiting more than two years
for a hearing, he also developed severe anxiety and chest pain. By the
time of his hearing in October 2007, he had lost his beloved home to
foreclosure, lost both his wife's and his cars to repossession, lost
his boat, lost his 401(k) account, and nearly lost his 16 year old
daughter to severe depression after they lost their home and were
forced to move into the unfinished basement of a relative. Mr. F
received a favorable ALJ decision in December 2007 after his attorney
requested an expedited hearing.
MICHIGAN
An attorney in Saginaw, Michigan, reports that the
current delay between filing a request for hearing and the date of the
hearing in his area ranges from 24 to 28 months. This delay is on top
of waiting anywhere from two months to four months to hear whether the
initial application has been approved. While some ALJs will issue a
decision on the record, it often takes one to two months to get the
written decision and another one to four months for the individual to
actually get paid. Many clients are experiencing a delay of three years
or more between the time of initial application and the time they
finally get their benefits. He has had numerous clients who have lost
their homes, cars, and other property while waiting. Many of his
clients have had to go through bankruptcy because of the delay. These
financial stresses also contribute to family stresses and several of
his clients have gotten divorced and attribute the divorce directly to
financial stresses.
Mr. H is 61 years old and lives in Holland, Michigan. He
was unable to work and applied for disability benefits in March 2005.
He requested a hearing in September, 2005, more than 30 months ago. His
attorney requested an ``on the record'' decision in the fall of 2007,
after his case was transferred to another ODAR hearing office because
of overload in the Grand Rapids, Michigan ODAR office. The ALJ denied
the request and a hearing was held in November 2007. Two years and 8
months after requesting the hearing and 3 months after the hearing, he
received a favorable decision from the ALJ in February 2008. As of
April 10, 2008, he has received no benefits. Mr. H needs his disability
benefits so his children do not need to continue to pay his bills.
Ms. M, a 46 year old woman living in Muskegon, Michigan,
applied for disability benefits in March 2004 because she could no
longer work due to degenerative osteoarthritis of the hips and spine,
obesity, and psychological impairments. While waiting for her hearing,
she received a foreclosure notice on her house and was behind on her
utility bills. Her impairments worsened due to stress and uncertainty
about where she would live. Her representative filed a request for an
expedited hearing based on ``dire need'' in May 2006. After the
hearing, the ALJ issued a favorable decision in September 2006 but she
never received any of her benefits until December, 2006--far too late
to save her house.
MISSISSIPPI
Mr. C, a 58 year old former machinist who lives in Como,
Mississippi, has severe neck, right shoulder and arm pain after . . .
ound tumor was removed from his neck, and he is illiterate. These
conditions prevent him from working. He filed his application for
benefits in November 2004. He had a hearing January 9, 2008. During his
wait for a hearing, he lost his home to foreclosure and was unable to
afford required tests for his impairments.
Ms. D, a 47 year old former data entry clerk who lives in
Doddsville, Mississippi, has fibromyalgia, chronic obstructive
pulmonary disease, and severe anxiety, which prevents her from
performing even simple work tasks. She filed her application for
benefits in March 2005. While waiting for a hearing, she has become
homeless and unable to stay in a shelter, due to having to work for
board, which she is unable to do. Because she has nowhere to cook, she
only is able to eat food that does not require cooking.
Mr. L, a 45 year old former equipment operator who lives
in Louisville, Mississippi, lost 20% to 30% of his lung capacity in a
workplace accident. He also has severe migraine headaches, daily
blackout spells, and severe post-traumatic stress disorder (PTSD), all
of which prevent him from working. He filed an application for benefits
in February 2006. While waiting for a hearing, he is 3 payments behind
on his home and risking foreclosure, has lost all of his vehicles, and
all utility bills are about 3 months behind.
Mr. J is a 50 year old former truck driver who lives in
Leland, Mississippi. He has Type I diabetes, a pinched nerve, and back
problems. He applied for benefits in March 2006. While waiting for a
hearing, he has been forced to live in his truck for four months.
Mrs. G is a 53 year old former machine operator who lives
in Greenwood, Mississippi. She has Type II diabetes, moderate
degenerative disc disease, a herniated disc, and an esophageal
restriction. She applied for benefits in October 2006. She is currently
waiting for a hearing date. Her home is in the final stages of
foreclosure.
Mrs. K is a 53 year old former secretary who lives in
Kosciusko, Mississippi. She has diabetes, protruding discs, spinal
stenosis, arthritis, carpal tunnel syndrome, and depression. She
applied for benefits in March 2006, and is waiting for a hearing date.
She has just become homeless.
MISSOURI
Mr. O, from Richmond, Missouri, died in the lobby of the
ODAR hearing office while waiting to be called for his hearing on April
2, 2008. He was 49 years old and is survived by his wife and 4
children. He filed his SSI application for disability in November 2005,
alleging inability to work due to uncontrolled diabetes with
neuropathy, and shoulder and arm pain. He had worked for 14 years as a
truck driver. His claim was denied in March 2006 and he promptly filed
a request for hearing in April 2006. While waiting for hearing, he had
numerous problems with child support authorities and his home was
foreclosed upon. His representative filed a dire need request in July
2007 to expedite the hearing, but he did not receive a hearing date
until February 2008, when the hearing was scheduled for April 2, 2008,
the day he died.
Mrs. C is a 40 year old Marine Corps veteran who lives in
Columbia, MO. She has been unable to work as an over-the-road trucker
since December 2004 because of migraines, degenerative disc disease of
the neck and lower back, and depression. Her husband, a truck mechanic,
supports the family of four, including a daughter in college, on $1,900
monthly take-home pay. Mrs. C filed for benefits in April 2005 and
requested a hearing, which took place in March 2007. Her claim was
denied in December 2007 and she appealed to the Appeals Council in
February 2008. In March 2008, Mrs. C traveled from Missouri to Colorado
and had neurosurgery, following a diagnosis of Chiari Malformation. Her
recovery is uncertain.
Mrs. Y is a 37 year old registered nurse, from Columbia,
Missouri, who is married with three small children. She had a very good
work record until she became incapacitated by pelvic and hip pain in
December 2004, following the worsening of an injury during delivery of
one of her children. Her claim for Title II benefits was denied in
December 2006 and she requested a hearing. The family had already filed
for bankruptcy. While waiting for a hearing, her condition worsened.
She needs a rare surgery performed by only a few surgeons in the
country and which requires a six-month recovery period in a hospital
bed and another six months using a wheel chair. The family would need a
different house that is accessible. Despite the financial and medical
information, SSA did not expedite the hearing for 13 months. She
finally received a favorable ALJ decision in February 2008.
Mr. L, a 26 year old former nurse's assistant from St.
Louis, Missouri, has grand mal seizures that have been occurring more
and more frequently, and that make it dangerous for him to work. He had
to stop working as a nurse's assistant, as he had some severe seizures
at work, which caused injury to him and the fear of injury to patients
with whom he worked. He filed his application for benefits in August
2006. Since he has been awaiting a hearing, he has become homeless. He
now lives with his girlfriend's family, which is very difficult for Mr.
L and his girlfriend's family, as they are forced to care for and
financially assist a young man who is not related to them, simply
because they do not want to see him homeless. Mr. L has no health
insurance, and he cannot afford the very expensive medications that are
needed to help keep his seizures under better control. It is a ``Catch
22'' for him since he cannot work because he has seizures that are
uncontrolled, yet he cannot control the seizures until he has the money
to pay for the medications. He has been waiting almost two years to
even be heard by an ALJ.
NEBRASKA
Ms. O is now 56 years old and lives in Omaha, Nebraska.
By late 2004, symptoms from her bipolar disorder, combined with a new
diagnosis of cerebral degeneration, worsened her coordination and
cognitive skills, and precluded all work. In January 2005, she lost her
job as a cashier at a grocery store where she had been employed for 15
years. She filed her claim in June 2005. She filed a request for
hearing January 2006. On October 26, 2006 she asked for an ``on the
record'' decision because she had been hospitalized for both her
physical and mental impairments and her treating sources found
significant limitations. The request was denied and she is still
waiting for her hearing to be scheduled, more than two years after her
appeal was filed. She has exhausted all of her savings and is dependent
on county general assistance and the county mental health clinic for
all of her treatment.
Mr. B, a 46 year old former cook who lives in Seward,
Nebraska, has Bipolar I Disorder, unspecified organic brain syndrome,
paranoid personality disorder and borderline personality disorder,
which prevent him from working. He filed his application for Title II
and SSI benefits in December, 2005. While waiting for a hearing, which
was requested in July 2006, he has lost his Medicaid benefits and has
been without medical treatment and prescriptions since July, 2007.
Ms. K, a 49 year old former dry cleaning clerk who lives
in Omaha, Nebraska, has depression, post-traumatic stress disorder,
adjustment disorder with anxiety, chronic obstructive pulmonary disease
and fibromyalgia, which prevent her from working. She filed her
application for Title II benefits in October 2005 and requested a
hearing in July 2006. Ms. K is in an abusive marital relationship, but
has been unable to move out and find an alternative residence because
she does not have the income and resources to leave her husband. Also,
she is dependent upon her husband's health insurance so that she can
receive treatment and prescription medications for her disabling
conditions.
NEVADA
Ms. L is 45 years old and lives in Las Vegas, Nevada. She
worked as a clerk for an area resort. She has back, hip, knee and
breathing problems and suffers from pain including headaches and
abdominal pain. She also has depression and has not been able to
continue working. She applied for benefits in March 2005 and was denied
in August 2005. Her case was appealed to reconsideration and she
received a decision, again denying the claim, nearly three years later
in April 2008. Her case is now pending at the ALJ hearing level. She
has received utility cut-off notices and foreclosure notices. She
recently has contacted her Congressional representative to help
expedite her case.
NEW JERSEY
Mrs. E, a 50 year old former cardiac nurse who lives in
Eastampton, New Jersey, has severe pain from impairments of her lower
back, hips and shoulders (post-surgeries bilaterally) as well as
depression and anxiety attacks. These conditions have made it
impossible for her to work since 2003. She applied for benefits in
2005. While waiting for a hearing, she has exhausted all of her
retirement savings and is now being threatened with foreclosure due to
past-due mortgage payments. Her hearing has finally been scheduled for
May 2008.
Mr. N, now 59 years old, from Northvale, New Jersey, was
originally denied by an ALJ in February 2005. After appeals through the
Federal court level, the case was remanded to the ALJ in November 2006.
In January 2008, 14 months after the court remand order and 35 months
after the first ALJ denial, the ALJ issued a fully favorable ``on the
record'' decision. Mr. N has a severe mental impairment and has
expressed suicidal ideation throughout the process. At the time the
claim was approved in January 2008, foreclosure proceedings were
started by his mortgage company. Mr. N is married with 2 teenage sons.
Mr. H was living in a homeless shelter in Hackensack, New
Jersey, at the time of his February 2006 hearing. The ALJ, despite
knowing of the client's homeless situation and receiving a letter from
the client threatening suicide, did not issue a decision until October
2006, more than 7 months after the hearing date.
Mr. F is a resident of Florence, New Jersey. He
originally filed his claim for Title II and SSI benefits on December 1,
1997. He has mental retardation, a separate learning disability, and a
herniated lumbar disc. His claim has been heard by an ALJ three
separate times so far. After his last hearing, he was found to be
disabled at a date after his Title II insured status expired. He has
been eligible for SSI benefits of less than $600.00 per month and not
the Social Security benefits of at least $1,000.00 per month he had
worked to earn. The last ALJ decision was appealed to the Federal
district court, which remanded the case on June 1, 2007. A fourth
hearing is now scheduled for May 1, 2008.
NEW MEXICO
Mr. R lives in Rio Rancho, New Mexico, and applied for
benefits in November 2005. His hearing was held in August 2007. Eight
months later, he is still waiting for a decision from the ALJ. In the
meantime, he tried to return to work in order to have money for living
expenses. An acquaintance gave him a job with accommodations for his
disability. Even with the accommodations, he was unable to complete
even two months on the job, which SSA considers to be an unsuccessful
work attempt. Now Mr. R is certain that he cannot work at any job.
Ms. A lives in Albuquerque, New Mexico, and applied for
benefits in October 2005. Her hearing was held in November 2007, more
than two years later. She has had to give up her own home and move in
with her adult children. She calls her attorney every month, and the
attorney calls the hearing office to check on the status of the case.
Her case is still in post-hearing review with the ALJ, even though
there is no further development that needs to be completed.
NEW YORK
Mr. R is 38 years old and lives in Brooklyn, New York. He
has major depressive disorder, anorexia nervosa with severe weight
loss, somatoform disorder, and generalized fatigue. He applied for SSI
benefits in September 2003 and requested a hearing in March 2004. The
ODAR hearing office failed to send a Notice of Hearing for the hearing,
scheduled in December 2006. As a result, Mr. R did not appear and his
hearing request was dismissed. He obtained representation in June 2007
after the dismissal. His attorney immediately contacted the ALJ and
submitted all documents establishing that Mr. R was never informed of
the hearing. She also sent all medical evidence she had obtained. The
attorney asked the ALJ to reopen the case and to schedule an expedited
hearing. The hearing was finally held in November 2007 and the ALJ
issued a favorable decision in late November 2007. There still was a
delay in receipt of benefits as Mr. R did not receive his first SSI
past due installment payment until March 2008 and his first SSI monthly
payment until April 2008.
While waiting for the hearing decision and benefits payments,
Mr. R lost his welfare benefits and Medicaid, so he could not receive
treatment. His anorexia nervosa was so extreme as to cause severe tooth
decay requiring dentures. He received an eviction notice for his
apartment but his attorney worked with the landlord to stave off
eviction based on the fact that a new hearing was being scheduled.
Because his welfare case was closed, Mr. R had no money. He had to go
to food pantries for any donation and his neighbors helped him from
time to time. He even had to borrow money to ride the subway to his
hearing.
Ms. T lives in Ronkonkoma, New York. She is 55 years old.
She was a pharmacy technician for over thirty years. She has been
hospitalized three times in the past year for chronic obstructive
pulmonary disease (COPD). She has been unable to work since December
2005. She filed for benefits in January 2007 and requested a hearing in
May 2007. Her husband's income is not enough to meet their needs and
they have had to borrow money from family in order to meet living
expenses. This winter, they had no choice but to reduce their
expenditure on oil for the household. They tried to reduce the
household temperature, but this causes worsening of her lung symptoms.
In addition, Ms. T is depressed and constantly worries about what will
happen when the next month's bills become due.
NORTH CAROLINA
Mr. N lived in the Charlotte, North Carolina area. He was
57 years old and died in August 2007. As an adult, he obtained a degree
in theology. From 1986 to 1997, he worked doing maintenance on power
generating stations. He developed heart disease and emphysema and, from
1998 to 2004, he did less strenuous work. In June 2005, he filed a
claim for Title II disability benefits. His claim was denied and he
requested a hearing in April 2006. During the wait, he developed a spot
on his lung, but could not afford a CT scan for an accurate diagnosis.
In May 2007, he received a foreclosure notice, lost his house, and had
to move in with his daughter. He died in August 2007 of ischemic heart
disease. In February 2008, months after his death, his claim was
approved on informal remand to the DDS.
Ms. G, from the Charlotte, North Carolina area, was 50
years old when she died. She had worked in the garment trade, in
management, and retail. She applied for Title II benefits about January
2007 and requested a hearing in June 2007. She died April 4, 2008,
probably from heart disease with complications of chronic pancreatitis
and hyperparathyroidism. Her attorney notes that the facts leave out
that Ms. G was a funny, vital woman, with two children age 18 and 21.
She had left an abusive and controlling husband, and was trying to make
it on her own, with absolutely no income.
Mr. E died on August 21, 2007, at age 52 from congestive
heart failure, chronic atrial fibrillation, pneumonia, obesity and
peripheral artery disease. He lived in the Charlotte, North Carolina
area and worked for 15 years as a pipe insulator, and usually held a
second job. He applied for Title II benefits in March 2006, which was
denied, and requested a hearing in November 2006. Four months after his
death, on December 27, 2007, a favorable decision was issued without
hearing.
Ms. R, a 52 year old former cook and waitress who lives
in Rocky Mount, North Carolina, has Major Depressive Disorder, post-
traumatic stress disorder, panic attacks, carpal tunnel nerve damage in
both hands, chronic obstructive pulmonary disease, and migraine
headaches. These conditions prevent her from working. She filed her
application for benefits in November 2006. While waiting for a hearing
she encountered numerous hardships, including: being on the verge of
committing suicide; having extreme debilitating joint pain and disk
pain; becoming homeless; and having frequent nausea due to migraine
headaches. Her claim was approved in March 2008 by the ALJ after her
attorney submitted a ``dire need'' request.
OKLAHOMA
Mr. H, from Tulsa, Oklahoma, filed an application for
disability benefits in March 2006, due to Hepatitis B and liver and
renal failure. Unfortunately, he died on September 13, 2007, without
having been able to attend a hearing.
Ms. B, from Tulsa, Oklahoma, filed an application in
April 2006 and has not yet been scheduled for a hearing. She has
Multiple Sclerosis and a mental impairment. In July 2007, her attorney
wrote the hearing office requesting an ``on the record'' decision. She
is so desperate that she is willing to change her date of disability
onset to a later date. As of April 2008, no action has been taken on
the request. Since the request was made, Ms. B has been hospitalized on
at least two occasions for her psychiatric condition.
Ms. K, from the Tulsa, Oklahoma area, has a rare kidney
disease and is passing a kidney stone almost once a week, which causes
severe pain. She is diagnosed with Major Depressive Disorder, Graves
Disease, recurrent and severe pain disorder, and recurrent kidney
stones. Her treating physician has stated that she could not return to
work. After her application was denied in 2006, she requested a
hearing. In the summer of 2007, her attorney submitted additional
evidence from her treating doctor. No action has been taken. She is in
dire financial straits.
Mrs. M, a 33 year old former waitress and substitute
school teacher, lives in Muskogee, Oklahoma. She has degenerative joint
disease of the lumbar spine, neck and hands; hearing loss; left wrist
injury; migraines; tingling/numbness in the left knee and left foot;
right hip problems; dizziness and nausea. She filed her application for
benefits in August 2005 and a request for hearing in May 2006. Mrs. M
is married with three children, including one son who is disabled.
After a nearby plant explosion damaged their home in 2004, the family
was forced to move into an apartment. Evicted in 2007, they have had no
permanent residence since then and have been forced to live in a
variety of temporary settings, including a shelter for women and
children (Mrs. M's husband slept in the car). After the 2007 eviction,
Mrs. M's attorney sent letters to the ODAR hearing office requesting an
expedited hearing because of the family's homelessness. Mrs. M received
a fully favorable decision on March 26, 2008, nearly two years after
she filed her request for a hearing. Her disabled child also received a
favorable decision on March 25, 2008. On April 7, 2008, an SSA district
office worker informed the attorney that both Mrs. M and her disabled
child were in pay status.
SOUTH CAROLINA
Mr. A was living in Augusta, South Carolina, when he was
in a car accident. In his 30s, he had been working as a computer
professional, but the accident resulted in a severe and chronic pain
condition. He could not sit down, stand up or lay down for more than 15
minutes at a time. He applied for SSDI benefits in January 2003. His
case was denied in September 2003. At reconsideration, his case was
denied again in August 2004. His mother was required to return to work
from her retirement to help him with medical costs. Mr. A died five
months before his December 2006 hearing from an accidental overdose of
pain medication. He would have been 41 years old this year. The ALJ
denied the claim and his mother has continued the case by filing an
appeal to the Appeals Council. No decision on the appeal has been
received.
TENNESSEE
Ms. B from Tiptinville, Tennessee, died in July 2006 just
shy of her 52nd birthday due to chronic obstructive pulmonary disease
(COPD). Ms. B was a school cafeteria cook her entire life and stopped
working in September 2002 due to back and lung impairments. She was on
an oxygen machine, as well as a continuous positive airway pressure
(CPAP) machine. She filed her claim for benefits in 2002 and was denied
for the first time by an ALJ in February 2005 after waiting 5 months
for a decision from her first hearing in September 2004. The claim was
appealed to the Appeals Council and two years later was remanded back
to the ALJ to reconsider the treating doctor's opinion. An ALJ allowed
the claim with an ``on the record'' decision in April 2008.
TEXAS
Ms. T is 34 years old and had a good work history. Four
years ago, she developed gastrointestinal problems and lupus. She has
no health insurance or other income to use for medical treatment, even
though recent tests indicate she has had heart damage. She is 5 feet, 6
inches tall, but over the last four years her weight has been as low as
77 pounds, which should meet a listing of impairments. She has been
waiting for a hearing over 1000 days even though her attorney has sent
``dire need'' letters and requested an ``on the record'' decision. The
ALJ has denied the requests. A hearing has finally been set for later
in April 2008.
Mr. D is a veteran and living in domiciliary care at an
area VA Hospital. He was homeless and had cancer three times in a
period of just over two years. During the second episode of cancer, he
had a pulmonary embolism and was put on life support. The VA could not
find his family to see about ceasing the life support and the veteran
was in the nursing home for a period of time. Miraculously, Mr. D
survived and then had to have surgery for a brain tumor. He had to wait
over one year for his hearing. There were thousands of pages of medical
records in his file. At the hearing, he and his attorney learned that
the hearing office had not sent the medical records to the medical
expert witness for pre-hearing review. This delayed the decision. Mr. D
eventually received a favorable decision and his benefits.
A woman in the Paris, Texas area had heart and kidney
problems. She had a stent inserted so she could have dialysis. She was
waiting to start dialysis when her condition deteriorated and she died.
Three weeks later, she received a favorable ALJ decision. Her attorney
had requested an ``on the record'' decision before the claimant died,
but to no avail.
VIRGINIA
Ms. H was a 47-year-old receptionist living in a nursing
home in Fairfax, Virginia, after having been homeless on and off since
2003. She had an extensive medical history which included cervical,
dorsal and lumbar spinal strains, pinched nerve, shoulder pain,
uncontrolled diabetes mellitus, diabetic neuropathy, nephritic
proteinuria, hypertension, obesity and dyslipidemia. She also had
severe kidney disease including an acute episode of renal failure. In
June 2007, she was hospitalized with a myocardial infarction after
which she had two strokes. One in the cerebellum was complicated by
hydrocephalus requiring neurosurgical relief.
Ms. H first applied for SSI and Title II benefits in January
2004, having last worked in October 2003. She had an ALJ hearing in
August 2005 and was denied again in October 2005. She was not
represented at that hearing. She reapplied on her own sometime in 2006
and obtained legal assistance in July 2006. Another request for hearing
was filed in March 2007. Ms. H had a heart attack in June 2007 but her
legal representative was not informed until August 2007. The
representative immediately requested a favorable ``on the record''
decision. The ODAR hearing office did not respond until January 2008.
Ms. H received her Notice of Award on February 4, 2008. She received
her retroactive benefits on March 28, 2008. She died on April 3, 2008.
WASHINGTON
Ms. S is a 38 year old resident of Seattle, Washington,
who is dealing with a combination of autoimmune diseases, which have
progressively worsened. She had to drop out of medical school because
of her medical condition. She cannot work and her chronic disease
continues to worsen. She applied for benefits in May 2003. Her
representative sent briefs to the ODAR hearing office in February 2004
and July 2005. Her case was denied by the ALJ, remanded by the Appeals
Council, denied by the ALJ again, and eventually appealed to Federal
district court. The court remanded the case for a new ALJ hearing. As
of April 2008, her case is still pending for a third ALJ hearing, yet
unscheduled.
Mr. W is 48 years old and was a manager at a social
services organization in the area of Oshkosh, Wisconsin. He experienced
a worsening of mental illness (neurotic depression) and stabbed
himself. He survived but endured homelessness. He lived in a boarding
house for a time. He was getting food from shelters and the Red Cross.
He filed for benefits in March 2006 and was finally approved for
benefits in February 2008.
CONCLUSION
As you can see from the circumstances of these claimants' lives and
deaths, delays in decision-making on eligibility for disability
programs can have devastating effects on people already struggling with
difficult situations. On behalf of people with disabilities, it is
critical that SSA be given substantial and adequate funding to make
disability decisions in a timely manner and to carry out its other
mandated workloads. We appreciate your continued oversight of the
administration of the Social Security programs and the manner in which
those programs meet the needs of people with disabilities.
Thank you for the opportunity to testify today. I would be happy to
answer questions.
ON BEHALF OF:
American Council of the Blind
American Foundation for the Blind
American Network of Community Options and Resources
Council of State Administrators of Vocational Rehabilitation
Easter Seals, Inc.
Epilepsy Foundation
Goodwill Industries International, Inc.
Inter-National Association of Business, Industry and Rehabilitation
National Alliance on Mental Illness
National Association of Disability Representatives
National Disability Rights Network
National Multiple Sclerosis Society
National Organization of Social Security Claimants' Representatives
NISH
Paralyzed Veterans of America
Research Institute for Independent Living
The Arc of the United States
Title II Community AIDS National Network
Tourette Syndrome Association
United Cerebral Palsy
United Spinal Association
Mr. MCDERMOTT. Thank you very much for your testimony.
Ms. Mara Mayor is on the AARP Board of Directors in
Bethesda.
Ms. Mayor.
STATEMENT OF MARA MAYOR, MEMBER, AARP BOARD OF DIRECTORS,
BETHESDA, MARYLAND
*Ms. MAYOR. Good afternoon. Thank you very much Chairman
McDermott, Ranking Member McCrery, Members of the Committee.
AARP appreciates this opportunity to give our perspective
on what underfunding the Social Security Administration means
for Americans, especially those who are 50 and over. I would
just add as a parenthesis, my husband is a retired attorney who
volunteers at a local social services agency where one of the
things he does is he works with people on disability appeals on
a regular basis, so I have sort of an extra view from the
trenches on this one.
The programs under the jurisdiction of the Social Security
Administration are for not only the promise of earned and
deserved benefits, but also the promise that they will be
reasonably, in fact compassionately, administered.
Unfortunately, as we are hearing, today SSA is no longer the
gold standard of service it once was. The deterioration in
service reflects an increased workload and a pernicious pattern
of underfunding. SSA's core responsibility is managing the Old
Age and Survivor's Insurance Program, the Disability Insurance
Program, and the Supplemental Security Income Program.
These tasks will be even more challenging as the boomers
apply for Social Security benefits. You have heard numbers.
Just one interesting statistic, in the next 10 years alone,
nearly 13 million new beneficiaries will be added to the roles,
which translates to 16,000 per working day. That is a lot of
people. The boomer retirement comes at a time when the SSA
field offices are, as you know, strained. Despite the hard work
of thousands of dedicated Social Security employees and
managers, SSA is dealing with service issues that would make
even the strongest of organizations blanch.
To complicated the problem, SSA now plays a key role in
assessing the correct premium for Medicare Parts B and D, and
processes applications for the low-income subsidy of Medicare
Part D. That is not all. In recent years, the agency has become
an important element in the nation's homeland security efforts.
By conducting millions of Social Security number employment
verifications and other immigration related activities. Given
the enormous strain the Agency already faces in meeting its
obligations, AARP has grave concerns about proposals to expand
these types of activities.
To make matters worse, as you know, resources have only
been shrinking. SSA is at its lowest staffing level in 35 years
despite having about twice the number of beneficiaries it had
35 years ago. In addition, we know that some field offices have
been closed or consolidated. The numbers may be modest, as the
Commissioner indicated, but AARP is very concerned about the
trend. If the trend continues in this direction, essential
services will slip even further.
AARP Members and the general public are counting on the
fact that Social Security will be there financially when they
retire or become disabled, and need to be able to count on the
fact that the Social Security office will be there. You have
heard about the infrastructure, I won't go into that, it is
clearly a big issue. Clearly important resources are needed to
ensure the Agency can meet its workload, and it is not
happening and so the question is why. Although SSA's
administrative expenses are paid from the trust funds, these
expenses are subject to non-Social Security spending caps and
across the board cuts. This means funding has been artificially
low in order to comply with spending targets unrelated to
Social Security. As a result, over time there has been a
steadily increasing gap between SSA's needs and the final
appropriation. Reducing funding as though SSA actually competed
for discretionary dollars has ill-served the Agency and the
millions who rely on it.
We want to stress the impact on the American people, and
particularly those who are 50 and over, of these expanding
responsibilities coupled with less adequate resources. Clearly,
inefficient funding will hamper the Agency's ability to serve
the wave of boomers as they retire, and it will make it
impossible to make significant headway in reducing the
horrendous backlog of services in its disability program. While
the disability programs are potentially available to anyone
regardless of age, it is those over 50 who make up a major
percent of their recipients.
AARP believes Congress must respond to this funding crisis
in several ways. Provide the Agency with the resources it needs
to address the disability backlog, reject any further expansion
of administrative activities not directly related to the
Agency's core mission, and exclude SSA funding from any
domestic spending cap. We need to keep the promise of
reasonable administration of programs overseen by the Social
Security Administration, programs on which the American people,
and particularly those 50 plus rely.
On behalf of the more than 39 million Americans who are
Members of AARP, I thank you for this opportunity and would be
happy to answer questions.
[The prepared statement of Mara Mayor follows:]
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Mr. MCDERMOTT. Thank you for your testimony.
Mr. Skwierczynski, who is the president of the American
Federation of Government Employees National Council of Social
Security Field Operations Locals, your testimony please.
STATEMENT OF WITOLD SKWIERCZYNSKI, PRESIDENT, AMERICAN
FEDERATION OF GOVERNMENT EMPLOYEES, NATIONAL COUNCIL OF SOCIAL
SECURITY FIELD OPERATIONS LOCALS, BALTIMORE, MARYLAND
*Mr. SKWIERCZYNSKI. Thank you, Congressman McDermott,
Congressman McCrery, and the rest of the Committee, thanks for
inviting me.
I am with the union, I represent 50,000 bargaining
employees who work for Social Security, and we certainly have a
crisis due to the failure of the Administration and Congress to
properly fund the Agency. The witnesses here and the
Commissioner have already talked about some of the disconnects
that have occurred with regards to the disability process.
Part of the problem is that not only have we been forced to
deal with an incredibly increasing workload in the disability
process, but Congress has asked us to do other work, such as
the Medicare D subsidy, Medicare B appeals, and more stringent
evidentiary standards for Social Security number work. If in
fact there is some effort to expand our work with no match in
e-verify workloads in the immigration area, it will require an
incredible infusion of resources not only for staff but also to
upgrade our computers.
Applicants who file for disability hearings, from the time
they file the initial claim, takes about two years to get a
decision. That is outrageous. Right now, in this fiscal year
the Agency is only going to do 33 percent of its continuing
disability reviews and 60 percent of its SSI reconsiderations,
ensuring that many un-reviewed beneficiaries will incur
unnecessary overpayments. Fifty-one percent of the people who
tried to call a field office last year got no answer, and 25
percent who called the 800 number couldn't get through. Right
now, with the baby boomers filing initial claims, retirement
claims this year, we have about 16-percent increase in traffic
into our offices. Efforts by the public to try to communicate
with SSA employees have become a frustrating experience
characterized by delays, busy signals and unanswered calls.
Clearly we need more resources. We would suggest that an
$11 billion administrative budget in fiscal year 2009 would be
a start, and also an increase of 5,000 FTE over current numbers
would be a start. Enacting off budget legislation for the SSA
administrative budget is the only conceivable solution to the
yearly struggle against budget caps and Congressional scoring
requirements that results in inadequate SSA budgets year after
year, staffing cuts, and the consequent poor service. Off
budget could solve the absurdity of a system where the trust
fund is making huge surpluses, but it is used for everything
but SSA's resource requirements.
We also would recommend federalizing the disability program
and eliminating the current Federal/state bifurcation in
deciding disability claims. What we have now is we have 54
different disability systems out there with different qualities
of workers, different rules, and different training systems.
There is no consistency. In some states the approval rates are
55 percent on initial claims, others are 25 percent with no
evidence that, in those states with higher approval rates, the
people are more sick than in other states. The current system
no longer makes sense, it needs to be federalized. It would
provide consistency not only to the staff, but to the
decisionmaking process and to the training.
The most disturbing impact of the budget shortage is that
the Administration is using the lack of resources as an excuse
to initiate fundamental changes in SSA's evidentiary standards
and the way the Agency operates that will permanently damage
Social Security as a responsible social program and harm the
American public who rely on Social Security as their primary
source for retirement, survivor, and disability security. The
major transformation supported by the administration is to
diminish the historical personal service role of SSA employees
in the claims process. If claims can be filed by the public
without employee review and assistance, the savings to
administrative expenses certainly could be substantial.
But what would be the impact of that change? Already this
year, SSA has made some major changes in evidentiary
requirements. No longer do we ask for proof of age from
applicants for retirement benefits if their allegation upon
retirement matches their allegation when they got their Social
Security card. No longer to we check on somebody's citizenship,
again if their allegation matches when they first got a card to
when they filed for a claim. No longer do we seek wag earnings
information, that is earnings not posted on their earnings
record of individuals who file for retirement even though that
information would tend to increase their benefits.
All three evidentiary requirements I just mentioned hinge
on an SSA employee to review the evidence and certify its
accuracy. Eliminating such evidence enhances the opportunity
for fraud and incorrect payments.
SSA intends to introduce a new Internet Social Security
benefit application in September. The goal is to allow
claimants to file applications on the Internet without
intervention or review by a Social Security employee.
Currently, all Internet claims are reviewed by a Social
Security employee.
We have done surveys with the people who do review those
claims. 61 percent of our claims reps who review these claims
have informed us that over 50 of the claims they review, the
individuals have chosen months of election to start their
retirement benefits that are to their disadvantage. If you have
no reviews, you will have millions of people who will be filing
claims that will be choosing a pathway to retirement which are
not in their best interests.
Mandatory reviews and contacts ensure advice and assistance
on advantageous month of election, pursuit of benefits for
other eligible family members that ensure that the claimants
understand the impact of their benefit choices whether they
file for widow's benefits or retirement benefits or spouse's
benefits, and also that they get an explanation of their
reporting responsibilities.
The Internet application also eliminates a number of
questions which are designed to ferret our fraudulent people
who are retiring that aren't really retiring and also to elicit
earnings from the military or the railroad which would tend to
increase their benefits.
The stated Administration goal is to eliminate the claims
review so that it will be the applicant's responsibility to
make the right choices without help. As a substitute to
employee assistance, the administration plans to provide pop-up
screens and expanded access to third parties. Rather than have
trained government employees with a public service motivation
assisting claimants, SSA plans to shift that role to third
parties who will charge fees for their services and will have
minimal training and knowledge of the program. The
Administration has shifted its entire public relations program
to a push for SSA claimants to file Internet claims. Some
communications offer the public no other option.
Concurrent with its emphasis on Internet claims, SSA has
accelerated its office closing program with totally removes the
option of face to face service to many SSA customers. Last
year, the Commission closed 17 offices, which was the highest
number of offices closed in the history of this Agency. Despite
what the Commissioner said, you ought to review his numbers,
the only offices that were open last year were enumeration
centers which are not full workload offices, they just do
Social Security number work.
SSA's evidentiary changes and Internet claims without
employee review will undoubtedly lead to an increase in fraud
and incorrect payments. It will also lead to the transformation
of a respected social agency from one where employees were
trained to personally assist the applicants to benefits to
navigate a complex system at a time of personal crisis when
people are filing for retirement or disability or survivors
benefits, perhaps because of the death of their husband or
their wife or their mother or their father, to an agency that
expects claimants to fend for themselves. If such claimants
make unwise choices, it is their problem.
Is this the Social Security Administration that Congress
wants? If not, I would strongly urge that you ask some hard
questions of the people who run Social Security and engage in
some serious oversight and enact legislation preventing this
tragic transformation of Social Security from occurring.
I also ask that you please support Congressman Higgins'
bill, H.R. 5110, which will require SSA to provide notice and
rationale to Congress of any office closing, and also require
the SSA Commissioner to submit the Agency budget directly to
Congress, which is optional under the independent Agency system
we have, rather than to OMB.
Thank you.
[The prepared statement of Witold Skwierczynski follows:]
Prepared Statement of Witold Skwierczynski, President of the American
Federation of Government Employees National Council of Social Security
Field Operations Locals, Baltimore, Maryland
I thank Chairman Rangel, Ranking Member McCrery and Members of the
Committee, for the opportunity to present this statement regarding the
Social Security Administration's (SSA's) large backlog in disability
claims and other deterioration in public service due to years of
inadequate funding of the Agency's administrative expenses.
As President of the American Federation of Government Employee's
(AFGE) National Council of Social Security Administration Field
Operations Locals and Spokesperson for the AFGE SSA General Committee,
I present this statement on behalf of approximately 50,000
bargaining unit Social Security employees who work in over 1500
facilities nationwide. The employees represented by the Union work in
Field Offices, Program Service Centers, Teleservice (800 Number)
Centers, Regional Offices of Quality Assurance, Offices of Disability
Adjudication and Review, Regional Offices, Headquarters Offices, the
Wilkes-Barre Data Operations Center, and other sites throughout the
country where SSA employees take, process and review claims for
retirement, survivor, disability benefits and appeal requests for SSA
and SSI benefits.
The primary message the Union wants to convey to this Committee is
that Social Security is in dire need of both additional administrative
funding and Congressional oversight of its service delivery practices.
The crisis in the disability program as manifested in the obscene
delays in processing disability hearings appeals is primarily due to
the failure of the President and Congress to adequately fund
administrative expenses. Staffing levels have become much too low in
SSA. This has affected not only the disability workloads but also all
work that the Agency is required to accomplish.
Unacceptable backlogs have escalated and critical integrity
workloads are not done. The employees who work in the SSA front lines
and interact with the public are assigned impossible workloads. They
are expected to increase their productivity, interview more and more
claimants, maintain a high level of accuracy, provide friendly and
compassionate service while interacting with the public while Congress
and the President not only assign more programs and workloads to the
Agency but do so while reducing staff. Dedicated veteran employees are
fed up with the deteriorating stressful work environment and count the
days till they can retire. SSA changes priorities and engages in crisis
management efforts to plug the rapidly multiplying holes in the dam.
Employees are not asked or encouraged to provide input regarding what
should be done to solve the Agency's problems. Instead they are just
told what to do. The unfortunate victims of the decisions that have
been made to starve the Agency are the American public who rely on SSA
to provide them and their families with retirement, disability and
survivor's benefit security. Also affected are the poor aged, blind and
disabled who rely an SSA to provide subsistence SSI benefits so that
they can survive. These victims are frequently faced with delays of
over 2 years when they file for either SSA or SSI disability benefits.
Only 30 % of initial claims for disability are allowed due to an
archaic system in which state employees make decisions on whether
claimants are eligible for a Federal disability program. If their
initial claim is denied, the applicant is faced with a nightmare
scenario of delays of one to three years before their appeal is decided
by the Agency. Claimants find it difficult to interact with a Social
Security employee when they need assistance. 25 % of the calls to the
800 number are unanswered. If a claimant calls their local office they
can't get through 51% of the time. Due to the decision to save money by
closing offices, many claimants face lengthy commutes to find an SSA
office. When they arrive they face lengthy waits. If they try to file
their application through the internet, they must confront a complex
set of questions and choices with little assistance. Consequently, re-
contacts by SSA employees are virtually universal and can cause lengthy
delays in the claims process. In order to stretch resources, SSA has
loosened evidentiary standards. Standard evidence such as proof of age,
citizenship and development of recent wages not posted on a wage
earner's earnings record is no longer requested in most cases. Thus,
more ineligible claimants are approved for erroneous payments and more
claimants are paid incorrectly. Once applicants begin receiving
benefits, SSA can no longer review the accuracy of disability and SSI
benefits by conducting Continuing Disability Reviews (CDRs) at the
required levels due to staff shortages. In FY 08 the Agency will only
conduct 33% of scheduled CDRs. Consequently, thousands of individuals
who have recovered from their disabilities simply continue to collect
benefits. Thousands of SSI recipients who have not reported changes in
their income, resources or living arrangements continue to be paid
incorrectly since the Agency doesn't have enough staff to review their
cases and conduct redeterminations. In FY 08, SSA will only process 60%
of scheduled SSI redeterminations. When their cases are reviewed, SSA
assesses these SSI recipients with overpayments which are difficult or
impossible to collect from a marginal population.
Budget cuts and a shortage of personnel have been an issue at
Social Security for over 20 years, but this Agency is now using both of
them as an excuse to make a number of ``backdoor'' changes that AFGE
feels will disadvantage the millions of Americans who are part of the
``Baby Boom Generation.'' These changes include loosening evidentiary
requirements that will enhance the possibility of fraud. In addition,
SSA is planning to reduce the assistance provided to claimants when
making their choices of when to effectuate retirement benefits. Such
changes will increase the likelihood that claimants will make choices
against their interests. This is all part of a plan to save money by
shifting service to internet claims without employee review.
Offices around the United States are being closed at an alarming
rate. In 2007 SSA closed 17 offices--the highest number in SSA history.
These offices are closed without examination of the adverse impact that
such closures have on the affected community.
SSA staffing shortages have encouraged 3rd party businesses to fill
the void and offer to assist claimants in their interactions with SSA.
Such assistance, of course, is for a price. Few claimants attempt to
navigate the SSA hearings appeal system without representation.
However, SSA has plans to encourage and assist 3rd parties in expanding
the menu of services that they offer claimants for a fee. SSA
traditionally has provided assistance to claimants as part of the FICA
taxes that wage earners have paid during their working lives. Now SSA
has plans to encourage claimants to fend for themselves and use 3rd
parties who charge a fee instead of SSA employees. Expanding 3rd party
involvement in the claims process due to budgetary constraints can only
lead to pressure for future contracting out of core SSA services.
Disability
Since Commissioner Astrue's arrival at SSA, he has made a few
positive changes to address the short term problems regarding
disability hearing backlogs, such as targeting cases older than 1000
days and accelerating the rollout of the quick decision determination
process throughout the agency. He has worked with OPM and Congress to
hire 175 additional Administrative Law Judges (ALJs). He terminated
most aspects of the ill conceived Disability Service Improvement plan
initiated by his predecessor Jo Anne Barnhart. However, Commissioner
Astrue has decided to hire and train insufficient support staff that
each new ALJ relies upon to prepare cases for hearing and write and
process post-hearing decisions. The Agency intends to hire only 143
support staff for the new judges. SSA budgets 4.3 support staff for
every ALJ. 0.8 support staff per the new ALJs falls extremely short of
what is necessary to properly assist the ALJs. Failure to provide
adequate support staff is a recipe for future disaster and will
probably lead to continuing backlogs. The support staff is needed to
schedule hearings, assemble case files and evidence, work with
attorneys to insure smooth hearings, order and schedule consultative
examinations and to write and process the eventual decisions. Absent
such support, the system breaks down. Thus, we urge Congress to insist
that SSA provide each ALJ with the staff necessary for them to do their
job.
Commissioner Astrue has reassigned Agency attorneys to review cases
awaiting hearing. These attorneys are empowered to reverse denied
reconsideration cases if the evidence indicates a disability. This has
been done in an effort to reduce the 752,000 case backlog that existed
at the beginning of FY 08. AFGE feels that SSA should expand this
effort by utilizing non-attorneys within the Agency that have displayed
the ability to make appellate decisions. SSA has previously used non-
attorneys in this roll with no evidence of adverse effect in the
decision making process (e.g., Adjudicative Officers). The requirement
of a law degree for this task limits the Agency's ability to expand the
effort to concentrate energies to reduce the disability hearings case
backlog and the lengthy processing times.
SSA's approach to disability, past and present, fails to address
the problems and inadequacies of the State Disability Determination
Services (DDS). AFGE strongly believes that if problems with
inconsistent decisions at the initial claims level are addressed,
appeals will diminish. Disability claimants deserve consistent initial
claims decisions and payments as soon as possible in the claims
process.
Unfortunately, the chances for a claimant to be approved at the
initial level have a lot to do with where they live and their income
rather than the nature of their disability. That's inherent in the
system. Each state has different criteria for hiring Disability
Examiners. Each state provides them with different pay and benefit
packages. Some are unionized--others are unorganized. Each state
provides somewhat different training to their employees. Employee
retention rates vary dramatically from state to state. In effect, there
are 50 different disability programs when there should be one.
For example, State Agency Operations records indicate that those
who can obtain medical attention early and often have a better chance
of being approved for benefits than those who have limited income or
resources. (See Attachment A) Nationwide, those applying for Social
Security disability have a much greater chance of being approved than
those who only apply for the Supplement Security Income (SSI) program.
So far in FY 08 more than 61 percent of Social Security disability
claims for benefits are approved in the Washington DC DDS, while just
30 percent of those who file for benefits are approved in the South
Carolina DDS. New Hampshire approves the most initial SSI only
disability cases with more than a 55 percent allowance rate. However,
residents of Michigan, Ohio, Alabama, South Carolina and Georgia are
approved less than 30 % of the time by their respective DDS. The
concurrent disability process shows inexplicable variable allowance
rates depending on the state of residence. Allowance rates are low in
every state. In New Hampshire and Washington the allowance rate is
slightly more than 40 percent of the concurrent SSI/SSA initial
disability claims. Less than 18 percent of those filing concurrent
disability claims are approved in Georgia and Ohio. There is no
evidence to show that residents of some states are twice as susceptible
to become disabled as residents in other states. Obviously, different
state initial claims approval rates have more to do with the bifurcated
system than the health of residents of these states. Claimants are
entitled to consistent decisions regardless of their state of residence
or whether they are filing for Social Security or SSI disability
benefits.
According to the Government Accountability Office (GAO \1\), a
majority of DDS's do not conduct long-term, comprehensive workforce
planning, which should include key strategies for recruiting,
retaining, training and otherwise developing a workforce capable of
meeting long-term goals. The State DDS' lack uniform minimum
qualifications for Disability Examiners (DE's) and have high turnover
rates for employees and do not provide ongoing training for DE's.
---------------------------------------------------------------------------
\1\ GAO Report 04-121, ``Strategic Workforce Planning Needed to
Address Human Capital Challenges Facing the Disability Determination
Services''
---------------------------------------------------------------------------
AFGE is convinced that SSA is not able or willing to correct these
problems. AFGE has expressed these concerns to the Subcommittee for
several years and has seen little improvement with the State DDS
situation. The State DDSs are required to use different disability
criteria than those at the hearing levels. This has not been addressed
by this Administration. It is a key problem that must be reconciled in
order to reform the disability system. AFGE strongly believes that the
only way to resolve the problems that plague the State DDS' is to
federalize them. This will bring consistency to the initial claims
decisions in the same way that the Supplemental Security Income program
that was established in 1974 created a uniform system of benefits for
low income blind, disabled and aged population.
As AFGE has emphasized in previous testimony before the House Ways
and Means Social Security Subcommittee, the Disability Claims Manager
(DCM) pilot (another SSA initiative) proved to be highly successful in
addressing many problems in the disability program. DCMs were
responsible for making both the entitlement and disability decisions
for initial disability claims. Processing time was significantly better
than the bifurcated process. In fact, the DCM processing time of 62
days was just over half of SSA's initial disability claim processing
time goal of 120 days. Customer service improved dramatically and
claimants expressed record high satisfaction rates with the DCM. The
public preferred a process which allowed them to interact with the
decision maker. Currently, the only interaction with the disability
decision maker occurs at the hearing level when the ALJ conducts the
hearing. Observation of the impact of the alleged disabling condition
and evaluation of the credibility of the claimant is a prime reason for
the high percentage of reversals at the hearing level. If the system
was reformed so that claimants could interact with decision makers at
all levels, it could result in improvements in the initial claims
process.
SSA surveys indicated that the public preferred the DCM caseworker
approach to the current process. The DCM was a positive step in
ensuring the public that consistent and equitable disability decisions
were made by the Agency. Unfortunately, despite the positive DCM
experience, SSA terminated the pilot. Although SSA contended that the
DCM would cost more than the current process, the pilot was terminated
before valid statistical data could be compiled regarding full program
costs.
It appears that the primary reason SSA terminated the DCM pilot was
due to State resistance. Such resistance certainly was not based on a
poor pilot result. Instead the decision appears to have been based on
political considerations and the fear of losing work. Although the DDS
system is completely funded by SSA, DDS employees are State workers
enmeshed in their respective state bureaucracies. Unfortunately this
split system is a major reason that so many disability cases are
appealed and that the system is broken. Under the DCM pilot, even
claimants who were denied expressed satisfaction with the process since
they had the opportunity to have the decision explained to them by the
DCM. Congress should be very concerned when SSA spends millions of
dollars for a process that demonstrably improves the disability
processing time and results in high claimant satisfaction but is
rejected for political reasons. The concerns of the states are
understandable in view of their unacceptably poor performance regarding
decision consistency from state to state and their poor processing time
in comparison to the DCM. However, the only real criteria should be the
level of service that is provided to the claimant. Using customer
service as a measure, the DCM exceeds State DDS performance in
virtually every category.
AFGE recommended to Commissioner Astrue that he reconsider the
Agency decision to terminate the DCM pilot and implement the position
of the DCM at SSA as soon as possible. The Commissioner has not acted
on AFGE's recommendation. The Union is willing to work with the
Commissioner in an incremental approach to improving the disability
process. We understand there will need to be changes in policy,
processes and institutional arrangements, as well as funding to
implement the DCM. However, we feel that federalizing the entire
disability process is a key to improving disability claims processing
and correcting the current appellate nightmare.
Legislative amendments to the Social Security Act would be
necessary to allow SSA workers to make disability decisions; however,
the crisis in disability processing requires immediate and long-term
changes. When trained to make medical decisions, SSA employees can
provide immediate relief to backlogged Disability Determination
Agencies and provide faster and better service to the public by serving
as a single point of contact. The pilot demonstrates that the public
likes the DCM, employees enthusiastically support it, employees are
capable of mastering all aspects of the claims process and that it
provides substantially better service than the current disability
product. As a short-term approach not requiring legislative change,
AFGE is supportive of the ``Technical Expert for Disability'' position.
It would provide high quality, trained field office employees the tools
to assist disability claimants in both programmatic and medical issues,
provide professional, personalized, service to applicants, focus the
disability interview, make or recommend disability decisions, and
assist the DDS's in their development and backlogs. This position could
be utilized in the Commissioner's efforts to create a quick decision
process for those claimants who are obviously disabled. In fact,
training and enabling Technical Experts for Disability at the SSA field
office will eliminate the current hand off to the DDS of such claims.
This should further streamline the process and result in even faster
decisions.
AFGE Recommendations_
AFGE strongly urges Congress to enact legislation which
permits Federal employees to make disability decisions without
requiring the approval of States and take the necessary action to
ensure the DCM is part of the solution to the disability problem.
AFGE requests that Congress examine the current combined
Federal and state role in the disability claims system and enact
legislation to federalize the disability claims process.
AFGE recommends that Congress urge the Commissioner to
eliminate the requirement that post reconsideration disability
adjudicators require a law degree.
SSA Budget and Staffing Cuts
Based on the President's proposed budget for the next fiscal year,
SSA will have lost more than 9% of its staff in just four years. SSA
has experienced a dramatic increase in workloads as members of the Baby
Boom Generation reach their peak years for becoming disabled and start
filing for retirement benefits in 2008. From 2001 to 2007, productivity
climbed an average of 2.5% per year, for a total gain of 13.1% since
2001. SSA expects the increase in productivity for FY 2008 to be 2%
\2\.
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\2\ SSA Budget FY 09
------------------------------------------------------------------------
FY FY FY FY
FY 2005 2006 2007 2008 2009
------------------------------------------------------------------------
Budget Proposed 9,379,3 9,403, 9,496, 9,677, 10,327
24 000 000 000 ,000
------------------------------------------------------------------------
Budget Enacted 9,178,5 9,286, 9,294, 9,745, ......
56 000 000 000
------------------------------------------------------------------------
SSA Full-Time Equivalents 62,937 63,131 58,985 60,064 60,293
(FTEs)
SSA Medicare Modernization 1,268 0 0 0 0
(FTEs)
Subtotal SSA FTEs (including 64,205 63,131 58,985 60,064 60,293
OIG)
------------------------------------------------------------------------
Overtime/Lump Sum Leave 2,992 2,389 1,307 2,231 2,245
Overtime (associated w/Medicare 1,567 0 0 0 0
Modernization)
Subtotal Overtime Lump Sum 4,559 2,398 1,307 2,231 2,245
Leave
------------------------------------------------------------------------
68,764\ 65,529 61,292 62,295 62,538
3\ \4\
Total SSA Work years (including ....... (-3,23 (-4,23 (+1003 (+243)
OIG) 5) 7) )
------------------------------------------------------------------------
Unless there is a turnaround in Social Security's operating budget,
SSA's ability to get its work done will completely break down within
the next five to ten years. According to SSA's own records, 1 out of 4
callers failed to get through on Social Security's 800-number on any
given day. Those who called any of the 1260 field offices for service
in FY 07 did not have their calls answered 51% of the time. People line
up before dawn outside many offices. The time it takes to pay
disability claims to the most vulnerable people we serve can be
measured in years instead of days or months.
---------------------------------------------------------------------------
\3\ SSA, FY 06 Justification of Estimates for Appropriation
Committees
\4\ President Bush Budget for FY 08 for SSA, pg 1030
---------------------------------------------------------------------------
The President's budget request for SSA in FY 09 is $10.327 billion.
This budget would result in an increase in staff of only 229 FTE. After
years of cuts, a modest increase is better than nothing but hardly
enough to allow the Agency to reduce its backlogs while continuing to
process its day to day work. Both the House and the Senate Budget
Committees have recommended that the President's budget be increased by
$240 million. AFGE and other groups interested in the SSA
administrative cost crisis recommended that SSA be allocated $11
billion in administrative cost or $673 million over the President's
budget. This amount would restore some lost staff and allow the Agency
the opportunity to significantly reduce backlogs.
Currently, Congress borrows from the Social Security Trust Fund to
offset deficit spending and finance the war in Iraq and other budget
priorities. Meanwhile, Social Security is given barely enough funding
to accomplish its basic service demands, resulting in poor public
service, excessive delays and billions of dollars of improper payments.
This is then case even though the trust fund collects $ billions more
that is spent every year.
The Omnibus Reconciliation Act of 1990 provided that SSA FICA taxes
and benefits payments were ``off budget.'' Congress later interpreted
that SSA's Limitation on Administrative Expenses (LAE) was not covered
by the Omnibus Reconciliation Act of 1990, although the Social Security
Act stipulates that administrative costs for the Social Security
program must be financed by Social Security Trust Funds.
Since the SSA LAE (e.g., staffing, office space, supplies,
technology, etc.) is ``on budget,'' Congress decides on a yearly basis
the amount that will be authorized and appropriated to administer SSA
programs. Such appropriations are often insufficient to provide
adequate staffing since funds for SSA's LAE are a part of the overall
Labor, HHS, and Education appropriations. Programs such as medical
research, healthcare and ``No Child Left Behind'' state grants are
often viewed as more politically popular than SSA's LAE. Often SSA is
left with insufficient staff and limited overtime making it next to
impossible to adequately service the public. Such shortages adversely
affect disability processing time and cause severe integrity problems.
AFGE does not believe the American public deserves poor service
from SSA. Some claimants waiting for a disability hearings decision
lose their homes, declare bankruptcy, and some die before a decision is
made on their disability claims appeal. Their families suffer
tremendous financial hardships; some lose everything during the
prolonged wait for a decision. The public deserves efficient,
expeditious service. Currently, SSA's LAE is less than 2% of total
estimated outlays. Historically, SSA's LAE has never exceeded 2% of
expenditures.
Removing SSA's LAE from discretionary spending caps will allow
Congress to assess SSA's administrative requirements without regard to
the competing budgetary demands of the Departments of Labor, HHS and
Education agencies.
In an ``off budget'' environment Congress would continue to
maintain spending authority but would be unencumbered by artificial
caps and budgetary scoring rules. However, AFGE strongly recommends
continued Congressional authorization, appropriations and oversight of
SSA's LAE.
Congress should continue to appropriate SSA administrative expenses
to ensure integrity and efficiency. Legislation should require SSA's
Commissioner to document (in performance reports mandated under the
Government Performance and Results Act) how funds have been and will be
used to effectively carry out the mission of the agency, to meet
expected levels of performance, to achieve modern customer-responsive
service, and to protect program integrity. Most importantly, GAO must
annually inform Congress regarding SSA's progress in achieving stated
goals. Congress should also mandate that SSA's Commissioner submit the
proposed budget directly to Congress as is now only optional in the
independent agency legislation (P.L. 103-296, Sec. 101.) This
requirement to submit the SSA budget directly to Congress is also
contain in H.R. 5110 sponsored by Congressman Higgins of New York and
endorsed by AFGE.
AFGE Recommendations_
Congress should enact off budget legislation including
SSA administrative expenses with benefits which are already off budget.
Congress should retain appropriations and oversight authority albeit
unencumbered by artificial budget caps and scoring restrictions.
Congress should enact legislation requiring the
Commissioner to submit the SSA appropriation request directly to
Congress.
Congress should support the House Budget Committee
recommendation to increase the SSA administrative budget by $240
million over the President's budget request.
Integrity Workloads
SSA integrity work (i.e., continuous disability reviews (CDRs) and
SSI redeterminations) has been significantly diminished due to budget
cuts. Former Commissioner Barnhart suspended all SSI Redeterminations
and Medical Continuing Disability Reviews (CDRs) during particularly
tight budget periods. In FY 2008, SSA Commissioner Michael Astrue has
significantly reduced these workloads. SSA projects completing 235,000
medical CDRs in FY 08 instead of the scheduled 700,000. Instead of
processing 2 million SSI redeterminations scheduled in FY 08, the
Agency will only complete 1.2 million. These reviews return $10 for
every dollar invested in CDRs and $7 for every dollar invested in
Redeterminations. Without these reviews, billions of dollars of
incorrect payments result. SSA will never collect some of the
overpayments caused by insufficient integrity reviews.
Furthermore, the collapse of integrity oversight of SSA's programs
compromises the solvency of the Social Security Trust Fund. According
to GAO's 2004 report on overpayments related to SSA programs,
overpayment detections increased from about $1.9 billion to nearly $3
billion between fiscal years 1999 and 2003 \5\ In 2005, SSA improperly
paid $6.3 billion. OPM now reports that of eight Federal programs,
including SSA's Old Age, Survivors and Disability Insurance and SSI
programs, SSA accounted for more than 89 percent of the government's
improper payments in FY 2006.
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\5\ GAO Report 04-924,''SSA Should Strengthen Its Efforts To Detect
and Prevent Overpayments''
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AFGE supports fully funding Continuing Disability Review and SSI
Redetermination workloads. AFGE does not support artificial spending
limits for such workloads. Congress should authorize the resources
necessary so that SSA can produce CDR and Redeterminations levels as
envisioned in the Social Security Administration's strategic plan.
AFGE Recommendations_
Congress should authorize the resources necessary so that
SSA can produce CDR and Redetermination results as envisioned in the
SSA strategic plan.
Internet Claims, Internet Social Security Benefits Application and
Ready Retirement
The Social Security Administration has offered the public access to
Internet services for almost a decade but with mixed results. On the
positive side, ``service'' can be provided without contacting an SSA
facility. The negative affects are not so obvious or made public by the
Agency. Unfortunately, little has been done to correct these problems.
They include:
Programming flaws that do not correctly identify the
``protected filing date.''
Identity and privacy concerns
Incorrect payments
High volume of errors, resulting in re-contacts.
Creation of a new backlog at Social Security
No review process of the public's accuracy in completing
applications.
Additionally, SSA has implemented new policy changes in an effort
to eliminate employee review of claims filed through the Internet
altogether. These changes include:
Lag earnings will no longer be routinely developed.
No longer requiring proof of citizenship for age 60 or
over
No longer requiring proof of age for age 60 or over
No longer assisting the claimant in determining the most
advantageous month of entitlement.
SSA argues that savings in work years that they project will be
achieved through the relaxation of evidentiary standards and the
elimination of advice and assistance to claimants will allow the Agency
to concentrate on elimination of backlogs and improve Agency service.
Unfortunately, AFGE asserts that such changes are dangerous and will
result in enabling fraud, causing incorrect payments, and result in
claimants making decisions that are not in their best interests.
Therefore, the Union and the employees of SSA strongly disagree with
the Agency's recent policy decisions.
No Development of Lag Earnings--Effective 1/23/2008
Lag earnings are wages earned but not yet posted to the earnings
record. In the past, the claims representative determines if the prior
year's earnings have been posted to the applicant's earnings record. If
not, they are manually added to determine an accurate and full benefit
estimate. If the applicant has his/her W-2 form available, the wages
can be easily added to the benefit computation at the initial
interview. Lag wages tend to increase the benefit amount for most wage
earners. Eventually SSA conducts a re-computation of the benefits when
the IRS verifies the earnings and pays the beneficiary(s) accordingly
if lag wages are not developed for the initial claim. Unfortunately,
this process could take several months. The process sometimes takes
years if particular conversion problems occur. Eliminating lag wage
development insures that most claimants will be paid incorrectly until
the benefit amount is recomputed after receiving IRS data.
No Development of Proof of Age and Citizenship--Effective 2/11/2008
Historically, SSA requires claimants to submit evidence to
establish their rights to benefits. One of the most important parts of
the claims process is the gathering, recording and evaluation of this
evidence.
Why proof of age? To be entitled to reduced retirement benefits, a
claimant must be fully insured and have attained age 62. Thus, the
exact date of birth is critical to a claimant's eligibility for
benefits. The year of birth also affects the benefit calculation.
Retirement benefits at age 62 are reduced for every month prior to the
full retirement age. Therefore establishing a correct date of birth is
necessary to establish correct payment.
Why proof of citizenship? In 1996, the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996 (PRWORA or Public Law 104-
193) was signed into law. Section 401(a) of the Personal Responsibility
Act places restrictions on the payment of benefits to aliens in the
U.S. under Title II of the Social Security Act. An alien eligible for
benefits under Title II of the Social Security Act can be paid when he/
she is ``lawfully present in the United States as determined by the
Attorney General.'' The Attorney General defined the phrase ``lawfully
present in the United States'' for purposes of paying Title II benefits
in regulations published on September 6, 1996 by the Department of
Homeland Security (previously known as the Immigration and
Naturalization Service).
In February 2008, SSA made major policy changes that no longer
require proof of age or citizenship for those filing for benefits that
are over age 60 and make an allegation of date and place of birth that
agreed with their Social Security number record, known internally as a
``numident'' record. Thus, if an individual lied about their date and
place of birth in order to get a Social Security number for a job and
the person uses the same erroneous information at the time of benefit
application, a match will exit and neither proof of age or citizenship
will be requested by SSA. This change was instituted in February, 2008
without any regulatory notice.
AFGE strong believes this is bad policy that will lead to fraud and
incorrect payments.
Until the 1980's Social Security cards were issued without any form
of identification. Much like a library card, one simply completed a
short application, submitted the application to SSA and the Agency
issued a number and a card. Allegations of date and place of birth were
accepted on face value without evidentiary requirements. For the Baby
Boomer generation, the Social Security card was an easy record to
obtain if someone wanted to change their identity, age or even place of
birth. The Administration's reckless decision to accept a person's
allegation, as long as it agrees with the allegation on the original
application, is inconceivable and unlawful.\6\ Its purpose is not to
insure accuracy or to improve public service. The reason for these
evidentiary relaxations is to create the ability for claimants to file
Internet applications without any review or intervention of an SSA
employee.
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\6\ Soc. Sec. Act as Amended in 1996, Sec. 202(y); P.L. 104-193;
P.L. 104-208; P.L.105-33 8 CFR 103.12.
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Accept Allegation of Month of Entitlement--Effective September 2008
SSA officials have announced that in September, 2008 SSA will
introduce a new Internet Social Security Claims Benefit Application
(ISBA) which is a simpler retirement application, and which will be the
vehicle for the Agency's ultimate goal of automated adjudication
requiring no human review or intervention.
Additionally, SSA will implement a new procedure that will require
SSA claims specialists to stop providing advice and assistance to the
retirement applicant to help them decide on the effective month to
start their retirement benefits (i.e., month of election).
Determining the correct or most advantageous month of entitlement
(MOE) for an applicant is one of the most complicated and error prone
issues in processing a retirement claim. Many factors must be
considered when determining a MOE such as current work history, self
employment, Totalization rules, and past disability history.
In preparation for this hearing, AFGE has reviewed Sample RSI
Quality Feedback Reports which capture errors taken form Regional
Office of Quality Assurance reviews of retirement claims. These sample
cases clearly exhibit various actions on the part of SSA resulting in
incorrect payment amounts to the beneficiary. The following were some
of the most common errors listed in these reports----
Incorrect Date of Entitlement Causes Underpayment
Incorrect Month of Election Given Causes Underpayment and
Overpayment
Failure to Discuss Reduced Rate of Entitlement Date
Causes Underpayment
Incorrect Determination on Entitlement Date Causes
Underpayment
Failure to Determine Government Pension Offset Applies
Causes Overpayment
Failure to Include Military Service Credits Resulting in
an Underpayment
Incorrect Posting of Military Service Credits Resulting
in an Overpayment
Incorrect Processing of Military Service Credits Causes
Underpayment
Failure to Identify Military Service Issue Results in an
Underpayment
Failure to Use 2001 Lag Wages Results in an Underpayment
Failure to Take Action on Wage Gap After 1977 Causes
Underpayment
Failure to Discuss Earnings Record Thoroughly results in
Underpayment
An applicant's allegations will go unchecked unless all Internet
claims are required to be reviewed by a trained SSA Claims
Representative. SSA employees and AFGE are shocked and appalled that
such changes will go forward despite the vast number of claims that
currently require correction.
Internet Proficiency
SSA employees assist people who are elderly, disabled, uneducated,
poor and homeless. Many applicants struggle just to complete simple
forms. SSA's applications were created to obtain information which will
meet all requirements of the law including identifying potential
individuals who may be eligible for benefits on a wage earner's record.
As a result, SSA has invested millions of dollars to train its Claims
Representatives (CR). However, the Agency now intends to create an
Internet application which will not be reviewed by an SSA employee.
This is prescription for disaster.
SSA asserts that 2.5 million electronic transactions were completed
by the public in FY 07. However, a substantial number of these
electronic transactions were problematic to the degree that SSA
employees were required to recontact the transactor. SSA employees are
very concerned about the direction of the Agency strategy toward
unreviewed Internet transactions because few Internet applications are
completed accurately and, consequently, require recontact by SSA
employees. A Claims Representative from the Seattle region who has
processed Internet claims for more than a year recently told AFGE: ``I
can only think of 2 [disability claims] which were done right. One was
completed by a disabled registered nurse, and the other was completed
by a physician who had cancer.'' AFGE recently surveyed SSA employees
who process Internet claims. Seventy percent of the employees who
responded stated that 90-100% of the claims they reviewed required some
kind of re-contact. Such re-contacts included the need to develop new
applications for spouses and children, obtaining correct dates of onset
of disabilities, development of the correct month of entitlements for
retirement claims, obtaining medical information, development of
incorrect wage information, obtaining complete and accurate work
histories, identifying government pensions and correct military service
information. Employees reported that Internet claims take an average of
2 re-contacts to secure the necessary information to complete the
claim. Employees also report that each re-contact takes an average of
30 minutes, which they feel is not reflected in Agency statistics. In
many cases, it takes weeks and even months to get in touch with the
applicant, who thought the claim was completed and, therefore, had no
reason to communicate with SSA. Employees strongly believe that if they
had assisted the claimants either face to face in the office or by
telephone that the claims would have been done correctly--without the
need for any re-contacts.
Unfortunately, this cannot be verified by Agency statistics. SSA
does not and will not perform audits on the Internet claims prior to
employee review and correction. Instead, the claim is reviewed after an
SSA employee makes the necessary corrections. This creates the illusion
that the claims were completed correctly by the public. Thus, SSA has
no data to indicate that a decision to remove Internet claims review
will be beneficial to the public.
Loss of Protected Filing
An application filing date protects a person's claim for benefits.
This date is often used to establish eligibility and to determine when
benefits can begin. In accordance with 20 CFR.630, 408.330 and 416.330,
SSA must use a written statement (such as a letter) indicating the
applicant's intent to file for benefits for themselves or another
person. This is referred to as a protective filing, which can also
serve as an application date. The law is clear that an expression of
intent to file for benefits need not be on a specific form or any
particular format. Therefore, the same rules apply to oral requests.
Because potential payments are involved, SSA is required to send
letters to people who fail to keep appointments and notify them that
their benefits will be protected for up to six (6) months. If SSA does
not send this letter, the protective filing date is left open and a
person could be paid years of retroactive benefits if the matter is not
dealt with promptly.
However, SSA has decided NOT to apply this law to Internet claims.
Under the current system, when someone initiates an application on
SSA's Internet site but cannot complete it, SSA issues a confirmation
number to the individual to re-access the application but the Agency
does not consider the unsuccessful attempt to file evidence of a desire
to file which would protect the date of filing. When, and if, a person
completes the application and ``submits'' it to SSA, that is considered
the date of filing. If a month or more pass, the claimant could have
lost benefits. Listings and/or access to partially completed internet
claims are not available to field office employees for follow-up
purposes. AFGE believes this failure to protect the applicant's intent
to file a claim is a violation of law. SSA has stated the new Internet
application due to be released in September 2008 should establish a
protective filing. However, there has been no effort to correct the
current situation which due to the complexity of the Internet claims
process is common and results in loss of benefits for some applicants.
Identity and Privacy Concerns
SSA employees are unable to identify and verify the person who
filed the application for benefits on-line. Employees have become aware
of spouses, children, grandchildren, and unauthorized third parties
(such as employees of the applicant) filing Internet claims. This
leaves the system vulnerable to fraud, as claims could be easily filed
with stolen identities. Recent SSA internal reports indicate that
applicants continue to struggle to provide accurate, basic information,
such as ``name'' information. In SSA's April 11, 2008 client vs.
internet discrepancy report, more than 83% of the applications received
had discrepancies in this area. To a trained Claims Specialist, this
would be a red flag and suggest that the applicant may not be the
number holder, but rather someone else filing on his/her behalf.
Without verifying that the number holder actually filed or authorized
the claim, the SSN holder's privacy could be compromised if claims are
allowed to be processed through the Internet without employee review.
Internet Claims Processing and Backlog Potential
Every office handles these cases differently. In some places, the
Claims Representative can schedule an appointment to thoroughly review
the application, remind the applicant of the documents that are needed,
and check for any possible claims leads. Most offices force their
employees to fit these claims into hours when the office is closed to
the public or during overtime. Employees have not noticed any changes
in the volume of teleclaims and in office claims due to the accelerated
utilization of Internet claims by the public. Claims workload in
general has increased as a result of the 1946 initial baby boom
generation reaching retirement age in 2008. Thus, Internet claims
review and recontact workload is an add on that requires finding time
to process.
Payment errors will increase if claimants are allowed to file
Internet claims without review. Claimants are not familiar with the
Windfall Elimination Provision (WEP) and the Government Pension Offset
(GPO) provisions of the Social Security Act and the impact of these
laws on their benefits.
Applicants are confused when electing their Month of Entitlement
(MOE). They generally do not understand how the annual earnings test
works. Often, they will take advice from a friend or neighbor whose
experience is very different from their own. The result: a loss in
benefits (including Medicare at age 65). SSA employees who review
Internet claims identify the choice of the month of election as the
most frequent error. Currently, if upon review a disadvantageous month
of election is found, the SSA reviewer must recontact the claimant and
explain why the choice that they made appears disadvantageous. If the
claimant insists on picking a disadvantageous month to start their
benefits, employees must document the file that an explanation was
given yet the claimant chose the disadvantageous start date anyway. The
Agency is planning to eliminate this assistance and advice step
completely concurrent with the introduction of the ISBA in September.
Other Problems with Incorrectly Completed Claims
Claims submitted by spouses, family members or other third parties
are often lacking information about prior marriages and/or children
from prior marriages and/or relationships. Many times the person
completing the forms simply does not know the relationship history of
the applicant. By law, SSA considers the names of former spouses and/or
children as leads for benefits. Without further investigation by a
trained Claims Representative, these potential leads would be missed
and family members would not be paid the benefits they are due.
When an identified third party helps an applicant file for Social
Security benefits on-line, we are required to obtain an Appointment of
Representative (SSA-1696) form, signed and submitted to SSA. We also
need Consent for Release of Information (SSA-3288) form signed and
submitted before we can release any information to someone other than
the claimant. An Internet claim does not provide this form.
In spite of the numerous problems with Internet claims raised by
the Union, Commissioner Astrue has directed all SSA employees to pass
this message along to the public: use the internet rather than call the
800-number or visit an office. In some parts of the country, field
office employees and teleservice representatives (800-number agents)
have been directed to tell each and every person contacting Social
Security: ``the next time you have a problem, use our on-line
service.'' This approach has not been well received and is perceived by
the public as rude. Many SSA employees have been documented for poor
performance for not directing the public to the Internet.
This emphasis on Internet service deviates from the pledge that SSA
has made to the American public which is reiterated every year when
they are sent their earnings statements from SSA. This pledge is that
the public determines which method they will utilize to interact with
SSA. It can be in person, by phone, by mail or through the Internet.
The Agency now is asking employees to sell the public on Internet
claims even though employees realize that phone and/or face to face
service is more likely to result in an accurate and complete
application. Some Agency letters to the public now only provide the
Internet option as the exclusive method for contacting the Agency.
AFGE Recommendations_
Require SSA Commissioner Astrue to:
Restore lag wage development in claims
Restore proof of age development using the rules in
effect before the 02/08 change
Restore proof of citizenship development using the rules
in effect before the 02/08 change
Maintain a system of employee review of all Internet
claims
Pilot the new Internet Social Security Benefit
Application before Agency wide implementation.
Provide Congress with the pilot results which will
include an evaluation of claims accuracy prior to SSA employee review
prior to implementation
Maintain employee review of all Internet applications
until it can be shown that the accuracy level of Internet claims
matches or exceeds the accuracy level of telephone and in person
claims.
Request Authorizing Committees to hold hearings on the
effects of Internet claims on SSA workloads and on claimants.
Continue to permit SSA customers to select the
methodology for interacting with SSA that they prefer.
3rd Party Claims
In another effort to determine how to do the Agency's business with
inadequate resources, the Agency has been developing increasingly
friendly relationships with 3rd parties that want to take over portions
of SSA work. The plans for the ISBA application would allow 3rd parties
to file claims and protect filing dates on behalf of the claimant.
Initially, claimants will be required to sign an authorization document
to enable 3rd parties to act on their behalf. However, SSA's goal is to
eliminate that requirement. In fact, SSA intends to solicit 3rd parties
to engage in bulk filing of electronic claims for multiple claimants.
This will enable for profit companies to offer a filing service for
claimants in return for a fee. Of course, currently filing applications
through the Agency either via the teleservice system, face to face in
an office or through he Internet is free. (The service was already paid
for through taxes.) AFGE's concern is that expanding 3rd party claims
opportunities to profit making companies is the first step to
potentially contracting out core inherently governmental Agency
functions. Allowing 3rd parties to file claims on behalf of individuals
through the Internet without SSA review would enable these 3rd parties
to actually authorize payment to their clients. This is a dangerous
step towards the privatization of the Agency.
SSA employees complain frequently about the low quality of the work
product of many current 3rd party claims organizations. Typically
states and institutions contract with 3rd parties who file disability
claims with Social Security to, hopefully, remove such individuals from
state benefit roles or to defray an institution's costs of care. The
work product is frequently poor and requires recontacts for missing
information or to correct erroneous information. Allowing an expansion
of this effort to use 3rd parties to other types of applications
without strict regulatory requirements will only result in problems.
Currently attorneys and other 3rd parties are regulated with
respect to the fees that they can charge for representation of
claimants in hearings before ALJs. No rules exist for representation
fees in initial claims. There are currently no regulatory standards
regarding competency and fees for 3rd parties at the initial claim
level.
AFGE Recommendations--
Congress should enact legislation limiting contracting
out in SSA due to the inherently governmental work of much of the
Agency's business.
Congress should pass legislation proscribing maximum fees
for 3rd parties in initial claims.
Congress should pass legislation requiring 3rd parties to
register with SSA and requiring them to maintain minimal competency
standards.
Congress should pass legislation enabling SSA to revoke
3rd parties registration privileges upon discovery of incompetence,
fraud, price gauging, etc.
SSA should be empowered to sanction 3rd parties for
inappropriate conduct.
3rd parties should not be permitted to register if they
have a conflict of interest (e.g., relationships with SSA employees).
3rd party fee structures and complaints against 3rd
parties and 3rd party registration information should be fully
disclosed to claimants.
Access to claimants information protected by the Privacy
Act should be severely limited to 3rd parties
Claimants should be required to sign authorizations prior
to SSA providing any claimant data to 3rd parties.
SSA should be required to evaluate 3rd party performance
through accuracy reviews. Such reviews should be released to the
public.
Office Closures
Face-to-face interviews in Social Security offices increased by
nearly a million visitors from 2006 to 2007. Despite that increase, the
Administration has decided to accelerate the closure Social Security
offices across the country.
SSA's criteria for office closure consideration are unknown to the
union. Last October Commissioner Michael J Astrue informed AFGE that
smaller offices in urban areas will be reviewed as office leases
approach expiration. However, other high level Agency officials have
informed their employees and union officials that SSA will look at all
offices of 15 employees or less. When I asked Linda McMahon, Deputy
Commissioner of Operations, in October 2007 about the Agency's office
closing strategy, she responded that the Agency could close between 50
and 200 offices.
However, in February 2008, Commissioner Astrue publicly denied this
after AFGE alerted Congress to the Agency office closing initiative.
Since the Commissioner's public denial of an office closing plan, AFGE
has been notified by SSA that additional offices will be closed in the
future. Additionally, AFGE records indicate that in 2007 SSA closed a
record number of offices. In 2007, the Administration closed 17 offices
including:
Burbank, CA
Industry Hills, CA
San Fransisco-Parkside, CA
SF Western Addition, CA
San Pedro, CA
Hallandale, FL
Miami-Central, FL
St Louis NW, MO
Warrensburg, MO
Auburn, NY
Bay Ridge, NY
N Charleston, WV
Nacogdoches, TX
Cheektowaga, NY
Bronx River, NY
Carbondale, PA
Brentwood, PA
In 2008 SSA closed the Oskaloosa, IA office and recently announced
its plans to close the Clinton, IA office effective June 1, 2008. SSA
has also notified affected employees of its intention to close the St.
Paul MN and the Portland OR Teleservice Centers in 2009.
In recent media publications SSA stated that they agreed to keep
the Bristol, CN office open due to an increase in the FY08 budget. This
office was scheduled to close in 2007, but will remain open on a year
to year basis, depending on budget constraints. Employees in the
Clinton, IA office were also told that the Clinton office was being
closed for budgetary reasons. The press was informed that the Agency
would save $632,000 over a 5 year period by closing the Clinton office.
No verification was provided for the $10,500/mo rent and utility costs
for the 3 person office.
AFGE is very disturbed by these statements. The Commissioner has
neither notified Congress nor the union of the level of appropriation
required to maintain the current field office structure. If these
closures are due to budgetary shortfalls, then why hasn't this been
brought to the attention of Congress? Why hasn't the Commissioner
notified the Authorizing and/or Appropriating Committee?
In Fiscal Year 2008 Social Security will be at its lowest staffing
level since 1972. SSA continues to lose personnel through retirement
and attrition and the announced FY 07 replacement ratio will result in
an additional 1012 FTE reduction. The Bush Administration and SSA
Commissioner Astrue are reluctant to ask Congress for more staff but
that is the only answer to this crisis. Yet they are willing to reduce
services to the public. AFGE strongly believes that SSA should be
providing help through community-based field offices that offer full
services. This can not be accomplished through further reductions of
service to claimants and beneficiaries.
SSA pays benefits to about 50 million people every month. Every
year, SSA employees handle more than 6 million new claims for
Retirement, Disability, and Survivors benefits. SSA also process 18
million requests for Social Security cards and posts 265 million annual
earnings items for covered workers. The Agency expects significant
increases in the Continuing Disability Review (CDR) workloads, ``no
match'' cases required by the Department of Homeland Security and the
e-verify system. Under legislation proposed by Congressman Schuler and
another bill by Congressman Sam Johnson, e-verify would be mandatory
and result in 3.6 million additional interviews in the first year after
enactment. Closing offices puts a significant burden on these 3.6
million workers to correct their SSA records so that they can work.
These workloads will further challenge employees. All this is
accomplished at less than 2% administrative costs, while private
insurance companies have administrative costs of between 12-16%. How
does closing the field office in your district improve this record of
service?
It has become very clear to the employees of SSA and AFGE that the
only effective method to prevent unnecessary office closures is to
request legislation to provide for Congressional oversight on decisions
impacting Social Security offices. On January 24, 2008, Representative
Brian Higgins (D/NY) introduced the Social Security Customer Service
Improvement Act, H.R. 5110. This legislation provides procedures that
SSA's Commissioner must follow before closing an office. Those
procedures include:
Providing a detailed report to the House Ways and Means
Subcommittee on Social Security and the Senate Finance Committee
outlining and justifying the process for selecting field offices to be
closed or otherwise have limited access. Such report shall include----
an analysis of the criteria used for selecting field
offices for closure or limited access;
the Commissioner's analysis and consideration must
include factors relating to transportation and communication
burdens faced by seniors and the disabled;
a cost-benefit analysis for each field office closure
that takes into account:
the anticipated savings as a result of the closure;
the anticipated burdens, including communication
and transportation burdens, placed on elderly and disabled
citizens; and
the anticipated costs associated with replacing the
services lost by the closure.
The Commissioner must wait 6 months after the submission
of the report to Congress to close or limit access to a Social Security
field office.
AFGE urges each Member of this Committee to support and co-sponsor
this very important legislation to ensure that customer service is at a
level that citizens deserve.
Until such legislation is passed by Congress, AFGE Recommends--
Congress passes legislation enacting a moratorium on all
office closures.
Social Security Card Centers
In the last few years, Social Security has opened 6 Card Centers in
New York City, Phoenix, Las Vegas and Orlando. The Commissioner
informed the union that he intends to open at least 20 more such card
centers. Existing personnel was used to staff these new offices. This
card center concept is a bad idea. In fact, Social Security Card
Centers are an example of how to provide really bad public service!
During Fiscal Year 2007, SSA processed 17.6 million Social Security
Number (SSN) applications for new or replacement Social Security cards.
Most of them were processed in the 1260 field offices across the
country. Virtually all of SSA's field office staff has been trained to
process SSN applications. This would include clericals, Service
Representatives, Claims Representatives, Technical Experts and
management.
Once card centers are opened, the public in a broad geographic area
is required to do all their SSA card business in the card center. Local
full service offices will not do SSN card work. This requires the
public to travel in some cases long distances to get their SSA card
business done. The Las Vegas card center services 5 county
jurisdiction. Outlying cities are 200 miles from the card center. If a
person has both SSA card business and other business with SSA, they are
forced to visit 2 offices since card centers do no other work. Thus,
the Agency has created a system insuring lengthy commutes for many
customers and two stop shopping for others.
The Las Vegas card center experienced huge workloads earlier this
year. In January customers frequently started lining up at 6 AM at the
card center door that didn't open till 9 AM. At the end of the day when
the office closed at 4 PM, the 175 capacity waiting room was full and
lines were out the door. Often the last customer was serviced after 7
PM. SSA clients are inconvenienced, forced to wait hours for service
and employees were faced with mandatory overtime to service all the
customers. Universal e-verify or a resumption of the No Match program
will only exacerbate this situation.
SSA has always required its offices to be full service facilities.
There are no offices exclusively devoted to disability or retirement
claims. All field offices process whatever business that the public has
with SSA. The card centers are the 1st deviations from this policy.
They were established for security purposes. It was thought that
employees who only did SS card work would have unique expertise.
However, every SSA office outside of the card center jurisdictions does
a high volume of SSA card work. Employees in field offices have as much
expertise as card center employees in doing this work. The amount of
inconvenience that is created with card centers is unnecessary. AFGE
recommends that SSA drop the concept of card centers.
SSA is unwilling to change this policy. Therefore, AFGE believes
Members of Congress should:
Require SSA Field offices to become full service
facilities.
Request Commissioner Astrue to reverse SSA's policy of
forcing the public to leave a field office and commute to a Social
Security Card Center when they either went to the wrong office or had
multiple business with the Agency.
Request Commissioner Astrue to suspend all plans to open
additional Social Security Card Centers until this policy is reversed.
Request the authorizing Committees to hold hearings on
policies and problems related to Social Security Card Centers.
Request Appropriation Subcommittees on Labor, HHS and
Education to include language that would prevent SSA from using
appropriated dollars to fund Social Security Card Centers.
Conclusion
The Social Security system's Disability programs are a crucial
component of the social safety net, and AFGE's Social Security
employees take great pride in providing service to disability
beneficiaries. Employees are sincerely concerned about the wellbeing of
disability beneficiaries, and consider their role as helping those who
are unfortunate enough to have experienced a disability to obtain the
Social Security benefits they have earned.
The Social Security Administration has a long and proud tradition
of working constructively with its unionized workforce to make the
Social Security system efficient, fair and ``customer-friendly.'' That
is why Social Security remains so popular and successful. It is
unfortunate; however, that I must report that the years of doing more
with less has had a severe toll on the employee morale at SSA. In a
recent AFGE survey of SSA workers, 45% reported that they are
dissatisfied or extremely dissatisfied with their work experience at
SSA. Survey responses would indicate that employee's greatest
frustrations are staff shortages and a lack of time to process pending
cases due to the pressure of constant interviewing. Overwhelmingly,
employees report that they do not have enough time to devote to a
quality work product, which includes accuracy, complete and proper
explanations of rights and responsibilities to clients, investigation
of any and all inaccuracies, etc--Backlogs are growing at tremendous
rates.
I urge the Committee to do whatever is necessary to insure that SSA
receives sufficient appropriations to do the work that Congress demands
from the Agency.
AFGE is committed to serve, as we always have, as the employees'
advocate AND a watchdog for clients, taxpayers, and their elected
representatives.
This concludes my statement. I will be happy to answer any
questions that Members of the Committee may have.
Mr. MCDERMOTT. Thank you for your testimony. We will now
hear from one of those administrative law judges we have been
hearing about.
Frederick Waitsman is an administrative law judge from
Social Security Division of the Federal Bar Association in
Atlanta, Georgia.
STATEMENT OF THE HONORABLE FREDERICK WAITSMAN, ADMINISTRATIVE
LAW JUDGE, SOCIAL SECURITY ADMINISTRATION, AND VICE CHAIR,
SOCIAL SECURITY SECTION OF THE FEDERAL BAR ASSOCIATION,
ATLANTA, GEORGIA
*Mr. WAITSMAN. Thank you Congressman McDermott and thank
you Ranking Member McCrery and Members of the Committee. Thank
you for convening this hearing on an issue of vital importance
to millions of Americans.
I am pleased to be here on behalf of the Social Security
section of the Federal Bar Association. Although I am an
administrative law judge, I am not here in that capacity and my
remarks are solely those of the Social Security Section of the
Federal Bar. You should know the Federal Bar represents a broad
array of stakeholders working at all levels of the disability
adjudication process.
The primary concern of the Federal Bar is the integrity,
independence, fairness, and effectiveness of the disability
hearing process. The Commissioner is faced with a daunting task
and limited resources. He has developed a number of initiatives
to reduce the backlog and processing times. We have seen some
of these initiatives result in progress and congratulate him on
these successes.
However, we believe even more can be accomplished with
fiscal year 2009 funding in excess of the President's request.
Therefore we have made the following six recommendations.
One, SSA should continue to hire administrative law judges
and fully staff the hearing operations. We have already talked
quite a bit today about that needed staffing ratio. It has been
said that hiring 175 judges without adequate staffing is like
buying 125 trucks with gas for only 25. I would just caution
that when we talk about these various reports that show the
staffing ratio, make sure you know exactly what goes into them.
The Atlanta area has two hearing offices, and when Medicare
Part D subsidy went into effect, 10 of the decision writers
were detailed for a year and half, physically moved, did
Medicare work, yet they were counted as part of that staffing
ratio. So, the intent of the 4.5 staffing ratio is workers
actually at the work site conducting Social Security disability
work.
Two, Social Security should continue to fully implement the
electronic disability process. SSA is strongly committed to a
paperless file called eDIB that is a work in progress and needs
to be fully funded to be successfully implemented. Improvements
can be made to ensure the system can support the growing
workload and not risk a slowdown or even a crash of the system
with hundreds of thousands of claims.
Third, SSA needs to fund capital expenditures to add new
hearing offices and permanent remote sites. Both the current
and the prior Commissioner approved several new hearing offices
based upon the needs, but then, as the Commissioner said today,
there were not enough funds available to build those
facilities. That is one area that I think we need the
Congressional help for additional appropriations so we can have
facilities where the claimants and the cases are. I think we
are truly in a crisis situation, and I would refer back to what
we did when we faced Hurricane Katrina and the damage that did.
I am more familiar of Mississippi, which was part our
responsibility when I was in the management of the Atlanta
eight state region. We lost an office to the hurricane, and so
we had judges that volunteered to come in from all over the
country and help out, and so we had, on short notice we were
able to get temporary space, have it wired for video. The whole
area didn't have hotel space, which was destroyed or occupied
by FEMA workers, contractors, and everybody else, so we
couldn't get hotels to send people, but we could do the video
hearings, and so that area of southern Mississippi was not
disadvantaged or as badly disadvantaged from lack of services.
So, while it takes a long time to maybe build a full scale
hearing office, more emergent efforts could be made.
Fourth, Social Security should test initiatives before full
implementation and not count on their success to justify
reduced staffing. The Government Accountability Office has
issued a number of reports highlighting weaknesses at Social
Security caused by implementation of newer initiatives without
sufficient preliminary testing. We believe that Social Security
should hire temporary employees if it contends that we don't
need as many employees because we are going to have some kind
of new initiative that may reduce it somewhere in the future.
There are plenty of retired employees and government programs
for bringing back fully trained employees to work on a
temporary basis.
Fifth, Social Security should realign the workforce and
staffing at the hearing level by transferring cases. We have
talked about that a lot today, but the disparity across the
country is striking.
Sixth, the correct decision should be made as early as
possible in the claim review process to reduce processing time,
expense, and hardship to the claimant.
I would point out two initiatives by the Commissioner that
really proves the point that many of these claims shouldn't
make it to the Administrative Law Judge stage, that it should
have been approved at an earlier stage. These two processes
sound the same, but actually involve totally different people.
In the Atlanta region, or Atlanta's two offices, we have
DDS, which is the state agency employees reviewing our 900 day
old cases if the judge is not going to get to those in short
order. They are reviewing the same evidence we have. They may
update the evidence, but they don't have any authority to pick
a later onset date so they are fully favorable. They are paying
a high percentage of these cases without the necessity of a
hearing, and these are the same employees or the same state
agency which had denied it previously.
Then we have DQB, the division of quality control which
monitors the state agencies for their quality, and they have an
initiative where they are coming in and also reviewing a
different set of 900 day old cases, and once again, approving a
large number of cases without any amendment to the onset date.
So, Mr. Chairman, thank you once again for the opportunity
to appear before you today. The Social Security section of the
Federal Bar looks forward to working with you and the Social
Security Administration in improving the disability process.
Thank you.
[The prepared statement of Hon. Frederick Waitsman
follows:]
Prepared Statement of The Honorable Frederick Waitsman,
Administrative Law Judge, Social Security Administration, and
Vice Chair, Social Security Section of the Federal Bar
Association, Atlanta, Georgia
Chairman Rangel, Ranking Member McCrery and Members of the
Committee:
I am Rick Waitsman, Vice Chair of the Social Security Section of
the Federal Bar Association. I am an Administrative Law Judge in the
Office of Disability Adjudication and Review of the Social Security
Administration in its Atlanta North office. As an Administrative Law
Judge at SSA for the past fourteen years, I have heard and decided well
over 8,000 appeals. I also have served in the management positions of
Assistant Regional Chief Administrative Law Judge for Region IV-Atlanta
and Administrative Law Judge in Charge of the Medicare Division. I have
served in three hearing offices.
I am very pleased to be here today representing the Social Security
Section of the Federal Bar Association (FBA). My remarks today are
exclusively those of the Social Security Section of the Federal Bar
Association, and do not necessarily represent the views of the FBA as a
whole. Moreover, my remarks are not intended to, nor do they
necessarily reflect, the views of the Social Security Administration.
Thank you for convening this hearing on a matter of critical
importance to the Federal government's delivery of effective services
to the American people. As you know, the Federal Bar Association is the
foremost professional association for attorneys engaged in the practice
of law before Federal administrative agencies and the Federal courts.
Sixteen thousand members of the legal profession belong to the Federal
Bar Association. They are affiliated with over 85 FBA chapters in many
of your districts. There are also more than a dozen sections organized
by substantive areas of practice, such as the Social Security Section.
Unlike other organizations associated with the Social Security
disability practice that tend to represent the narrow interests of one
specific group, the Federal Bar Association's Social Security Section
embraces all attorneys involved in Social Security disability
adjudication. Our members include:
Attorney Representatives of claimants
Administrative Law Judges (ALJs)
Administrative Judges at the Appeals Council
Staff Attorneys at the Office of Disability Adjudication
and Review
Attorneys at the Social Security Administration's Office
of General Counsel
U.S. Attorneys and Assistant U.S. Attorneys
U.S. Magistrate Judges, District Court Judges and Circuit
Court Judges
The common focus of the FBA's Social Security Section is the
effectiveness of the adjudicatory process primarily with hearings in
the Office of Disability Adjudication and Review (ODAR), the appeal
process at the Appeals Council, and judicial review in the Federal
courts. Our highest priority is to assure the integrity, independence,
fairness, and effectiveness of the Social Security disability hearing
process for those it serves--both Social Security claimants themselves
and all American taxpayers who have an interest in assuring that only
those who are truly disabled receive benefits.
We appreciate the concern that was expressed by this Committee and
the Social Security Subcommittee that resulted in the Commissioner's
withdrawal of proposed rules that would have reduced the due process
rights of claimants and cut disability benefits by two billion dollars.
We strongly believe that the disability appeals backlog has not grown
out of an excess of due process. While there should be a constant quest
to improve the disability program, reforms should not arise out of
procedural roadblocks that cannot be navigated by claimants.
Furthermore, it is the Section's collective view that the Social
Security disability program is under considerable strain. Current
delays in the processing of claims are unacceptable. The Federal Bar
Association previously urged Congress to increase funding for fiscal
year 2008, and we applaud the Congress for appropriating funds in
excess of the President's request.
We thank the Ways and Means Committee for holding this hearing and
for shining the spotlight on this unconscionable problem and the harm
endured by hundreds of thousands of claimants who continue to wait for
years to receive a final agency decision on their disability claim.
During the painful wait, some appellants have lost their homes, others
have been deprived of medical care and necessary medication, some have
undergone bankruptcy, while others have suffered even the loss of
custody of their children, and in perhaps the most tragic of cases,
suffered from depression so severe that it has resulted in suicide.
Sadly, it is no longer unusual to review a disability claim at the
hearing level in which the claimant has died from the disabling
impairment or taken one's life from the stress of lack of resources,
without the benefit of temporary assistance from the Social Security
Administration.
I serve in the Atlanta North hearing office that was profiled in
the February 2008 CBS Evening News Report on the hearing backlog. ALJs
and appellant representatives who are members of the FBA's Social
Security Section agree that the CBS report was an accurate depiction of
the lives of those who await final agency decisions in the Atlanta
North office, as well as other offices dealing with long waits. Some
statistics about my office and its caseload illustrate the crisis at
ODAR. The Atlanta North office started fiscal year 2003 with 3,104
pending cases and during that year disposed of 3,624 cases with an
average processing time of 302 days. In that same year, we successfully
reduced the number of cases pending. However just 4 years later, at the
start of 2007, our caseload had grown to 10,490 cases. And though we
disposed of a record number of cases, our pending caseload continued to
grow to 11,922 cases. That's why our processing time for 2007 jumped
from 302 days to 751 days, despite a record--breaking number of
decisions for the office and its ALJs. The backlog in fact would have
skyrocketed even more had the Atlanta North Office not transferred over
1,000 cases to other offices. While productivity issues can take their
toll, the influx of new cases without additional resources was the
foremost cause of waits for claimants. During this rapid growth in
cases, we were able to dispose of about 2 cases per ALJ per day, but
received about 4 cases per ALJ per day.
When fiscal year 2008 began, the Commissioner of Social Security
gave the Atlanta North office a numerical goal for the number of case
dispositions relative to the size of our ALJ and support staff. The
Commissioner's national goal was to dispose of all cases that had
remained pending at ODAR for 900 or more days. Yet if we met our
numerical goal, we still would not have disposed of enough cases to
have eliminated our 900 day-old cases because we had more 900 day-old
or older cases than our disposition goal. The goal did not even take
into account claimants entitled to expedited case handling, such as
Veterans from Iraq and Afghanistan, terminal illness cases, dire need,
on the record requests, and court and Appeals Council remands.
In the starkest and simplest of terms, we do not have the resources
locally to handle the cases we are assigned. The Commissioner is
providing help by sending in visiting ALJs, utilizing their support
staff and permanently transferring cases to other offices. But these
measures by themselves are insufficient. The bottom line is that SSA
sorely needs a substantial increase in its funding so that meaningful
justice can be promptly and fairly delivered to the hundreds of
thousands of disability claimants who await an answer to their appeals.
Social Security has an expression, ``Put a Face to the Case.'' We
are not dealing with just numbers or files, but real people and real
lives. Social Security at all levels has a dedicated workforce. It
simply doesn't have enough employees to do the job the public expects
and deserves. It should be emphasized that the issue is the length of
time claimants must wait to receive a final agency decision. While the
solution involves studying all steps of the process, we should not lose
sight of the fact that in addition to the hearing backlog, the claimant
waits approximately 103 days for an initial decision and 242 days for
the Appeals Council. Approximately, 40 states provide a reconsideration
step after an initial denial which results in additional delays. In
previous testimony, the Social Security Section of the Federal Bar
Association has urged that reconsideration be eliminated because the
few cases that are approved do not justify the delay and expense.
Notwithstanding that recommendation, additional funding is needed to
increase the speed and accuracy of all stages of the application and
appeal process.
The Commissioner is faced with a daunting task and limited
resources. He has developed a number of initiatives to reduce the
backlog in offices with longer processing times. We have seen some of
these initiatives result in progress and congratulate him on these
successes. However, we believe even more can be accomplished with
fiscal year 2009 funding in excess of the President's request.
Therefore we offer the following six recommendations:
1. SSA Should Continue to Hire Administrative Law Judges and Fully
Staff Hearing Operations
2. SSA Should Continue to Fully Implement the Electronic Disability
Process (eDIB)
3. SSA Needs to Fund Capital Expenditures to Add New Hearing
Offices and Permanent Remote Sites
4. SSA Should Test Initiatives Before Full Implemenation and Not
Count on Their Success to Justify Reduced Staffing
5. SSA Should Realign the Workforce and Staffing Components of the
Office of Disability Adjudication and Review, and
6. The Correct Decision Should Be Made as Early as Possible in the
Claim Review Process to Reduce Processing at the Hearing Level
Now let's take a look at each of these recommendations:
1. SSA Should Continue to Hire Administrative Law Judges and Fully
Staff Hearing Operations
The Commissioner has announced plans to hire 175 ALJs this fiscal
year, with offers accepted by 135. The first group will be reporting to
training soon. Studies have shown that to have an effective hearing
operation, it is necessary to have approximately 4.5 staff for each
ALJ. The new hiring plan does not apply the 4.5:1 staffing formula to
new ALJs or significantly address the continuing shortage of staff in
the offices. The current staffing is well below the target and largely
negates much of the potential productivity of the ALJs.
While hiring additional ALJs is important, it should be noted that
the hiring of approximately 135 ALJs is not an absolute increase in
ALJs from prior years. It is only a down payment on the attrition that
has taken place and does not come close to matching the phenomenal
increase in pending cases. To hire ALJs without appropriate staff,
however, is like hiring pilots to solve the problem of an airline not
flying on time. The lack of support staff for an airline will still
result in delays in boarding passengers, refueling, loading and
unloading luggage, and necessary maintenance. It is the same with
hiring ALJs without adequate staffing. Without adequate staff the cases
will not be entered in a timely fashion into the computer system, the
written evidence in cases will not be associated and placed in
evidence, hearings will not be promptly scheduled, medical and school
records to be utilized as evidence will not be ordered, inquiries from
Congress, claimants and their representatives will not receive timely
responses, consultative examinations will not be ordered, and decisions
will not be timely drafted and mailed.
Experience has shown that the loss of an ALJ in an understaffed
hearing office does not usually result in a large percentage of his or
her case production being lost. The support staff can only prepare so
many cases to be heard and can draft only so many decisions. The other
ALJs who were previously underutilized with the existing staff will
pick up most, if not all, of the cases the departing ALJ would have
produced. My office lost two ALJs to retirement during the last year,
yet disposed of more cases than ever before. It is often said that
hiring more ALJs without staff is just slicing the pie into more pieces
without increasing the size of the pie.
There is another worrisome concern, owing itself to the attrition
of valuable support staff. The Commissioner has offered early
retirements to ODAR employees and others. In addition, many of the
newly hired ALJs were formerly either Hearing Office Directors, who are
the highest non-ALJ in the office, or attorneys, who were either group
supervisors or senior attorneys. This means that ODAR will be losing
many of its best and most seasoned support staff. It is critical that
these staff positions and others be filled. If SSA only hires ALJs,
total productivity will rise only marginally, as the total number of
cases will just be split more ways. Also there will be a loss of
productivity as we use ALJs and senior staff to train the new ALJs and
staff hired or promoted to new responsibilities.
2. SSA Should Continue to Fully Implement the Electronic Disability
Process (eDIB)
SSA is strongly committed to a paperless file--called eDIB--but it
is a work in progress and needs to be fully funded to be successfully
implemented. Improvements need to be made to assure the system can
support this growing workload or we risk a slowdown or even a crash of
the system, which contains several hundred thousand electronic files.
SSA is experimenting with National Hearing Offices in Falls Church
and Albuquerque, in which ALJs will hear electronic cases from across
the country by video. Since the two National Hearing Offices will only
hear cases by video and not conduct in-person hearings, we are
concerned that claimants will not have a realistic choice regarding
their entitlement to an in-person hearing. Many of our members do not
regard video hearings to be sensitive enough to decide close disability
cases. It is often difficult to decide issues of pain, mental health,
or veracity in person. A mere video image of a claimant may not promote
the accurate resolution of such subtleties. For some claimants,
appearing before a video camera makes them nervous, confused or
otherwise unable to properly present their claims. We believe it may be
a Hobson's choice to have a video hearing now, or an in-person hearing
a year-and-a-half from now. Video hearings can help reduce the backlog
provided the claimant always retains the right to an in-person hearing
in the not distant future. We urge the Commissioner to provide real
protection for the right to opt out of a video hearing without the
punishment of additional significant delays. We caution that the amount
of resources dedicated to electronic hearings not cause the
Administration to lose sight of the claimant who has been waiting years
to be heard on his paper file.
3. SSA Needs to Fund Capital Expenditures to Add New Hearing Offices
and Permanent Remote Sites
A hearing office is an office where ALJs and staff are permanently
assigned and hear cases. A permanent remote site is a location that SSA
controls through ownership or lease where ALJs hold hearings, but no
ALJs or staff are assigned. In the absence of permanent remote space,
SSA uses temporary space, such as hotel conference rooms on an as
needed basis, to hold hearings. Both the current and the prior
Commissioner approved several new hearing offices based on the pressing
need for the facilities. However, when the budgets were awarded, it was
determined that adequate funding was not available. Two of the offices
were Tallahassee and Ft. Myers, Florida. The need for permanent sites
is even more important in an eDIB environment where computers are
needed for each of the participants. An ideal situation provides for a
permanent location so the equipment does not need to be stored,
transported and set up for each day of hearings. Tallahassee not only
does not have a hearing office, despite being approved by two
Commissioners, but does not even have a permanent remote site. The
option of video hearings does not exist in temporary remote sites
because there is no place to install video communication lines and
equipment. We believe additional funding is needed to establish
permanent hearing offices at appropriate sites. Utilizing 2006 census
data, Florida (with a population of 3.6 million people per office),
Georgia (with 2.3 million people per office) and North Carolina (with
almost 3 million people per office) have an extremely low number of
offices relative to their population. By contrast, the other Region IV
states have less than 1.5 million people per office. Undoubtedly, SSA
needs additional funding to establish hearing offices and permanent
remote sites within reach of the claimants they are mandated to serve.
4. SSA Should Test Initiatives Before Full Implementation and Not Count
on Their Success to Justify Reduced Staffing
Late last year the Government Accountability Office issued a report
that found that some of the key reasons for the backlog were the
increase in applications, losses of key personnel, and management
weaknesses. (Social Security Disability: Better Planning Management and
Evaluation Could Help Address the Backlogs, December 7, 2007, GAO-08-
40) Management weaknesses were compounded by the implementation of new
initiatives without sufficient preliminary testing. The Disability
Service Improvements initiative (in the New England region) and the
Hearing Process Improvement initiative were severely criticized by GAO
for lack of adequate testing.
We are similarly concerned that SSA's current implementation of new
initiatives--like e-scheduling and other software improvements--without
sufficient testing in pilot demonstrations will not offer promised
productivity that SSA is counting on, and even possibly contribute to a
larger backlog. For example, one new initiative--e-scheduling--is a
centralized and computerized process of scheduling hearing
participants: representatives, claimants, vocational experts, medical
experts, and contract hearing reporters. Currently, a clerk calls these
individuals to schedule and assure their availability. On the other
hand, e-scheduling is more primitive in that it does not take into
account the many variables that are involved in scheduling hearings.
For example, many attorney representatives of claimants practice in
multiple hearing offices, and the e-scheduling software does not know
their Federal or state court schedule, the amount of time it takes to
get from one hearing office to another if they are being scheduled for
two offices in a day, how close an ALJ usually is able to keep on
schedule, and other factors. While e-scheduling may work in some
locations, it should be thoroughly tested before widespread
implementation. More important, it should not be prematurely counted as
a success that justifies a staffing reduction until it has been
successfully implemented on a widespread basis. We have similar
concerns regarding plans for the development of software to select and
number medical evidence and eliminate duplicate exhibits. We believe
ODAR should hire temporary employees to reduce the backlog until these
initiatives are proven worthwhile.
5. SSA Should Realign the Workforce and Staffing Components of the
Office of Disability Adjudication and Review
ODAR's workforce is not sufficiently balanced--in terms of the
locations of ALJs and staff--to deal with the rising case backlog. For
example, four offices have less than 300 cases pending per ALJ, while
26 offices have over 1,000 cases pending per ALJ. A realignment can be
accomplished by a combination of case transfers and the realignment of
service areas. Although the Commissioner plans to actually reduce case
transfers, this approach had proven largely successful, though used
only sporadically. We urge the Commissioner to continue these transfers
until there is roughly the same processing time throughout the nation.
Variances in waiting time are due to inadequate staffing, high
growth of new cases, and the misaligned boundaries of service areas.
While lack of productivity is sometimes used to explain long waits, the
data shows that 35 offices receive less than two cases per ALJ per day,
but eight offices receive over four cases per day per ALJ. Since
average ALJ productivity is less than 2.5 cases per day, the
misalignment of ALJs and cases in those eight offices contribute to the
backlog. Until these underlying reasons are addressed and successful
action taken to correct the problems they create, an aggressive case
transfer process is needed. Historically, case transfers have been
short term efforts, but they need to be viewed as an integral part of
the business process until the inequalities in waiting times are
resolved.
6. The Correct Decision Should Be Made as Early as Possible in the
Claim Review Process to Reduce Processing at the Hearing Level
There is great disparity among the various state agencies that make
the initial and reconsidered determinations on disability claims. In
fiscal year 2006, the national average of initial claims allowed was
35%. Yet, Georgia allowed 25%, Tennessee allowed 23%, Kansas allowed
28%, Ohio allowed 27% and South Carolina allowed 23%, while New
Hampshire allowed 59%, District of Columbia allowed 54%, Hawaii allowed
53% and Virginia allowed 44%. Congress has held hearings on this issue
and there is still no compelling explanation of the disparity. One of
former Commissioner Barnhart's proposals in the Disability Service
Improvement initiative was to create a Federal quality assurance
program involving centralized review of cases from all over the country
by the same Federal office. This is currently being carried out on a
localized or regional basis when the reviewing entity and respective
review standard are known by the state. We believe there should be a
quality assurance process that applies a national and uniform policy of
review. Such a policy should address the sufficiency or completeness of
medical evidence before a decision is made. We support further inquiry
to better to determine the reasons for the wide disparity in allowance
among the states and at different levels.
If SSA continues the current process of excessively denying
eligible claimants initially, the administrative costs will naturally
escalate as more cases continue to be appealed and waiting times
increase. Obviously, wrongful initial denials cause great hardship to
citizens who have paid their Social Security taxes to obtain insured
status and do not receive the benefits to which they are entitled.
Eleven years ago, GAO testified to the House Social Security
Subcommittee that ``Despite SSA attempts to reduce the backlog through
its STDP initiatives, the agency did not reach its goal of reducing
this backlog to 375,000 by December, 1996.'' (Social Security
Administration: Actions to Reduce Backlogs and Achieve More Consistent
Decisions Deserve High Priority, April 24, 1997, GAO/T-HEHS-97-118) The
backlog at that time was defined as cases pending for more than 270
days, and the goal was to reduce pending cases to the 375,000-mark.
Today, the backlog has exploded to more than 750,000 pending cases.
Last year, SSA targeted adjudicating aged cases of 1,000 days at ODAR
and this year is targeting 900-day-old cases. GAO has issued other
reports addressing the lack of an effective quality assurance program
and the failed effort of improving consistency between the initial
decisions and hearings at the appeals level. (See, e.g., Social
Security Administration: Disappointing Results from SSA's Efforts to
Improve the Disability Process Warrant Immediate Attention, February,
27, 2002, GAO-02-322) SSA needs to be sure its national criteria are
applied as uniformly as possible at all levels and in all states.
While the experience of the members the FBA's Social Security
Section is associated more directly with ODAR and the Appeals Council,
we have noticed a significant decrease in service at the district
offices, the teleservice center (800-number), the payment center, and
the disability determination services. Essential workload such as
continuing disability reviews and age 18 redeterminations to determine
whether beneficiaries continue to qualify for benefits appear to be
receiving less attention. It has been shown that continuing disability
reviews (CDRs) save over $10 of program funds for every $1 spent in
administrative costs of conducting CDRs. We urge the Congress to
appropriate sufficient funds so that the backlog of CDRs and
redeterminations can be significantly reduced and bring about service
increases in all components.
Mr. Chairman, thank you once again for the opportunity to appear
before you today. The Social Security Section of the Federal Bar
Association looks forward to working with you and the Social Security
Administration in improving the disability process. I would be happy to
answer any questions you may have.
Mr. MCDERMOTT. Thank you very much for your testimony. I
thank all the panel. Mr. McCrery will inquire.
Mr. MCCRERY. Mr. Schieber, the focus of this hearing, of
course, is on the problems that we are having near the end of
the disability determination process and getting those appeals
processed. But if some of these issues have been handled better
early in the process, we maybe wouldn't have as big a problem
to discuss today. What in your opinion are the most important
investments and changes we can make to the beginning of the
disability determination process to improve the whole system?
Mr. SCHIEBER. Part of the challenge here is to gather
sufficient information and good information as early in the
process and on a systematic basis as you can. If you look at
the DDS application process right now, in some states there is
a relatively structured process for gathering information.
This is a complicated program, and people come in with many
disabling characteristics. Oftentimes, it really is quite
difficult to ferret out exactly what it is that is the
disabling condition. If you don't go through collecting the
information on a systematic process, then it is going to be
extremely uneven.
Now, the Commissioner talked about the development of their
eCAT system that they tried to roll out as part of DSI in the
Northeast. Conceptually, it is an extremely good idea. They had
an electronic process for leading the examiner through
collecting information to build file so a decision could be
made. But when they rolled it out, it had not been properly
developed, had not been tested, and basically tied up their
whole operating system so they had to take it back down.
SSA and the DDSS have started to redevelop. They have been
going through a process with the state of Virginia and
redeveloping this in what they call a lab environment. We
actually visited with the folks in Virginia and some of the
Social Security folks just a couple of weeks ago, and it looks
like they have something extremely promising. They are going to
come out with an updated version, in July. Connecticut is using
this system, and it looks extremely promising. I think you need
to begin to gather the data on a consistent basis across all of
these states, and it needs to be as complete as possible.
One of the things that Social Security has done, it worried
about the processing time at the front end of the application
process, and encouraged the DDS's to move the application
through in 90 days. Oftentimes that 90 day hurdle comes up and
the medical data is not in the file. So, the DDS makes a
denial, and they send it on up the line. When it gets up to
ODAR for the appeals that medical evidence to be obtained for
the file. Then as the ALJ begins to consider the case, they are
considering a very different base of information than was
considered at the front end of the process.
That is what I was talking about earlier when I said we
need to integrate this process from beginning to end. We need
to think about getting all of the information as quickly as we
can so we can make a comprehensive decision as soon as we can.
Mr. MCCRERY. What can we do in Congress, if anything, to
facilitate that?
Mr. SCHIEBER. Well I certainly think that as you think
about budgets and how money is going to be spent, you should
strongly encourage, one, that they get themselves into a
consistent DDS platform across all of the states. The Federal
government is paying for the DDS operations. They need to be on
a consistent platform. Then it needs to be totally integrated
with the subsequent steps in the process. If there is
determination that the information that has been passed on to
ODAR has been insufficiently developed, the hearing office
staff needs to be able to determine that very quickly and get
it back to the DDS to get it fully developed.
We just heard here about cases that are now being referred
back to the DDSs from ODAR that have sat there for 900 days,
and now there are decisions being made that this person is
disabled without further development. This case sat there for
900 days with the information we are using today to make a
determination this person is disabled. That is insane. I don't
have to go explain it to them, but I am sure you do
occasionally, and I would think you would want to put a stop to
that sort of activity.
Mr. MCCRERY. If I might just ask one more question about
physician's records.
Mr. MCDERMOTT. Sure.
Mr. MCCRERY. It seems that that is a recurring problem in
getting everything together. We have a problem sometimes
getting records from the physicians that have treated the
individuals. Mr. Waitsman, do you find that to be a problem
often?
*Mr. WAITSMAN. It is. In Georgia, we pay a nominal fee,
either free or $10 for the doctor to get the records or for the
hospitals to give us the records. If you keep going back to the
doctor at the initial stage, at reconsideration, the attorney
every 6 months, every year, they write for records, and I write
letters requesting records, eventually the providers just
refuse to have anything to do with the program.
Mr. MCCRERY. So, what can we do about that? Does anybody
have any suggestions as to how we can----
*Mr. WAITSMAN. What doctors and hospitals have asked for
was increased reimbursements so that they get more than $10 for
giving years worth of medical records.
Mr. MCCRERY. Ms. Ford.
*Ms. FORD. The representatives that we work with in our
coalition have indicated that, once they get involved in the
case, they do some very practical things that SSA ought to look
at doing. One of them is in fact, paying more for those
records.
Another thing is providing better explanations to the
providers, the medical providers or whomever, exactly what the
case is about and what evidence is needed. In addition, SSA
should do a bit more targeted questioning when they know what
the issues are. Further, more should to be done with the
claimants in terms of explaining to them the process and why it
is so important that they let SSA know all of the doctors and
hospitals and providers that they have seen, and let SSA know
everything that there is going on with the individual so that
those impairments that are revealed at the last minute can come
out earlier in the process.
In addition, SSA must address training of adjudicators to
ensure that they are all working from the same rules, and that
they understand properly the evaluation of childhood
disability, the use of the Social Security rulings, and the
evaluation of the mental impairments, and pain and other
subjective symptoms.
These are some very practical things that need to happen,
and there is a good bit of that in my written testimony. Thank
you.
Mr. MCCRERY. Thank you.
Mr. MCDERMOTT. Mr. Johnson will inquire. Excuse me, Mr.
Lewis will inquire.
*Mr. LEWIS. Thank you very much Mr. Chairman. Mr. Chairman,
let me thank each Member of the panel for being here today. I
would just like to take a moment to welcome Judge Waitsman for
being here. I know you are a graduate of Emory University,
located in the heart of my district, and thank you for all of
your work, and thank each of you for your good work.
Judge Waitsman, you know from firsthand experience the huge
problem we are having with Social Security disability appeals
in Atlanta. You know that people are dying, literally dying
waiting for disability benefits that they deserve.
Ms. Ford listed a dozen, unbelievable in your written
testimony, are heartbreaking stories of people losing
everything while they wait for benefits they deserve.
These people who are too sick to work, too disabled to
work, in Atlanta in my office, more than anything else, more
than any other case or problem we have, the caseworkers, is
dealing with Social Securities, Social Security disability.
They call my office asking how they will pay their rent, how
they will pay for medicine, how they are going to pay for food,
or some people losing their homes while they wait for benefits.
I don't think it is fair, I don't think it is right, I don't
think it is just in a society such as ours.
I appreciate all the work that you are doing, Judge
Waitsman in Atlanta, as an administrative law judge. I know, as
a human being, not just as a judge, you know that people
shouldn't wait any longer. You heard the Commissioner talk
about the steps they are taking in Atlanta. In your opinion,
what needs to be done in Atlanta to really reduce the backlog?
What does the Social Security Administration need from Congress
to make sure that people get the benefits they need and get it
now? I don't understand it, I really don't understand why
people have to wait 600, 700, 800, 900 days. You talked about
what happened during Katrina. If for some emergency, why can't
we make the government work in such a fashion that we can
transfer people from one part of the country to another part of
the country to intervene. Can we hire more administrative law
judges or hire more Social Security Employees to make it work?
*Mr. WAITSMAN. Congressman, thanks for the kind
introduction. We just don't have enough resources in Atlanta,
and I think when you have four cases coming in every day for
every judge and average productivity is about two to two and a
half cases, it is a resource issue above everything else. So,
we have technologies that we can transfer cases around the
country, we need more hearing space. For example, we hear cases
in Atlanta, Gainesville, Augusta, and Athens. To the extent we
get help in Augusta, we have only got one room, so we need more
help. If we had a second room--we could hear more cases.
*Mr. LEWIS. Do you travel? You travel from one--Do you
actually travel?
*Mr. WAITSMAN. Yes.
*Mr. LEWIS. From one office to another office to hear a
case?
*Mr. WAITSMAN. Yes, we call them remote sites, and so we
travel to all of those, plus we can do it by video. So, I think
some of those offices--We are doing it to some degree, I don't
think sufficient level, having judges from California and other
areas that don't have enough work load, who receive less than
two cases per day per judge, so they hear some cases. Part of
the issue is if they do it by video, it is a three hour time
change, so----
*Mr. LEWIS. How do you feel as a human being when you hear
that someone came before you, they were trying to get their
benefits, and a few weeks later, maybe a month later, a year
later, you heard that they passed and never got their benefits?
*Mr. WAITSMAN. It is extremely frustrating. It used to be
unusual that we would have a death while a claim was pending.
Now it is very common. It is not just the individual, it is a
whole family that is affected for the one that doesn't--if it
is not a death, it is a family problem and issue. People are
losing their homes. Many of the homeless shelters aren't set up
for families or couples, and so you are splitting up a family.
You will have diseases such as an uncontrolled diabetic
that maybe could be controlled if they had their insulin. If
they don't have their insulin, you see that case progress.
Eventually, it is going to be a loss of vision, kidney failure,
peripheral neuropathy. It is just a heartrending situation,
that you know that the person that is not getting their
hearing. And not getting their benefits. You are picking up
that file that has been sitting around for two to 3 years, that
it is a matter of time, before a tragedy and maybe that time
arose before you even got the file.
Mr. MCDERMOTT. I'm going ask Mr. McNulty to take the chair
again [continuing]. I have a commitment I've got to go do. But
I want to say that I think your last comments really raise the
issue of why we can't deal with poor people. We watched
Katrina. We can't seem to get that figured out. But we sure do
spend a lot of time trying to speed up the licensing over at
the FDA and a lot of other places when we can't seem to put the
resources in to deal with really what are the terrible.
When you read these cases that this floor brought before us
and you see people dying in the waiting room, you have got a
serious failure of a system which I don't think anybody--maybe
no one deliberately sets out to do, but by our actions--and I
think we can fix them--we can restore some integrity to the
system.
So, I appreciate all of you coming here and testifying
before the Committee.
Mr. McNulty?
Mr. MCNULTY [presiding]. Thank you, Dr. McDermott. Mr.
Johnson may inquire.
Mr. JOHNSON. Thank you, Mr. Chairman.
Mr. Schieber, you talked about a Federal Times article.
I've got a copy of that article. It can be distributed, and I
request it be inserted into the hearing record.
Mr. MCNULTY. Without objection.
[The information follows:]
**********COMMITTEE INSERT**********
Mr. JOHNSON. Both the government and private sector have
abysmal records on computer security breeches, along with
protecting Social Security number, and preventing ID theft.
This Committee is trying to stop that through legislation. Even
our veterans have had their information stolen.
What I'd like to know is why are we allowing employees to
work from home? Personal information must be protected and not
carried home. Can you tell us what you think about that?
Mr. SCHIEBER. Well, I think protecting personal information
should be of the highest order of concern. The reasons why
people work at home, I think partly tie to history, partly tie
to evolving social acceptance of work at home in not only
government sector but in the private sector. There is a sense
that in many regards it may be more efficient. It may be green.
We're in Earth Week, I think. That if we can allow people to do
their job without having to commute, it saves them time, it
saves resources, it doesn't spew things into the atmosphere
that would be spewed if they came to work.
But the issue, though--I managed people in the private
sector for 30 years, and we had some work at home flex
schedules that we allowed our employees. But it's always a bit
of a challenge. It seems to me the important thing is that we
should do it if people can do the work at home and can be as
efficient, and in many cases maybe even more efficient than
they are by coming to the office.
Mr. JOHNSON. Well, how do you protect the information that
way?
Mr. SCHIEBER. Well, I'm guess I'm getting to the punchline
here. If you have to come to the office to do the work, then it
seems to me that's where you do the work, and going back to the
fact that security here is of the highest order of importance,
it may require that we rethink the way we were handling these
files. Maybe that's where work has to be done. Maybe moving
into this more efficient environment is going to require some
changes to work policies. We need some flexibility to get
there, or we're not going to be able to realize the
efficiencies that Commissioner Astrue was talking about.
Mr. JOHNSON. You know, Mr. Skwierczynski--is that close?
*Mr. SKWIERCZYNSKI. Skwierczynski.
Mr. JOHNSON. Sorry.
*Mr. SKWIERCZYNSKI. Skwierczynski. Thank you. Stated that
we should not believe people about their birth dates when
they're applying for retirement benefits. It seems to me that
if a guy's been working forever and using a birth date for 50-
60 years, he shouldn't have to provide a birth certificate for
somebody to look at before he gets his retirement. What's your
opinion on that?
Mr. SCHIEBER. Well, I was just sitting here thinking about
my situation.
Mr. JOHNSON. Yeah, and do you know where your birth
certificate is?
Mr. SCHIEBER. Well, at the moment I don't.
[Laughter.]
Mr. JOHNSON. I didn't think so.
Mr. SCHIEBER. I think I applied for my Social Security card
it probably in 1960, and I have consistently told the Social
Security Administration since then that I was born on July 24,
1946. You know, if I file for Social Security benefits,
retirement benefits when I reach normal retirement age, they'll
have had that birth date on record for more than a half
century.
I think what the Commissioner is trying to do is look at
the situation that he's facing. This overwhelming burden of the
baby boomers about to descending upon them, applying for
benefits. Even if they can electrify the application process,
so I can apply for my benefits online, under the old rules I
was going to have to find my birth certificate and I was going
to have to take it to a Social Security office. Well, we've
been hearing here about how hard it is to get into the Social
Security office, how overburdened the Social Security offices
are, what the Commissioner is trying to do is find some
practical ways that to deal with these issues.
We have talked to him extensively about some of these
things, about the application process. He's taking things out
of the application process that he thinks are peripheral to
making a realistic and adequate and careful determination in
most cases. He thinks that if I have been telling him I was
born on July 24, 1946 for a half century, that, you know, if I
came in and I told him that today, so I could qualify for
benefits, then maybe they'd be suspect. But I surely wouldn't
have thought of that 50 years ago, so I could qualify for
benefits today.
Mr. JOHNSON. Well, you know, a lot of states are going
automatic on all that stuff. I mean you could even get licenses
for your car on a computer nowadays. They believe what you put
in there. I mean they don't ask you for a piece of paper. I
think that's enough said on that.
Thank you for the time, Mr. Chairman.;
Mr. MCNULTY. Thank you, Mr. Johnson.
Mr. Brady may inquire.
Mr. BRADY. Thank you, Mr. Chairman. I appreciate you all
being here today and offering your insight. Clearly, the Social
Security disability process needs dramatic improvement. We all
have different suggestions on how to do it, but your insight as
users and providers of the system is a huge help.
I will note, Sam, that I decide earlier that even if I had
a question for Mr. Skwierczynski, I wasn't going to ask it
anyway, just for fear of mangling the name.
So, I appreciate you having a----
Mr. MCNULTY. It's phonetic.
Mr. BRADY. So, thank you. Mr. McCrery asked my question. I
too think that we have a continuing problem on the accuracy,
completeness, and the timing of the medical records. I have
always assumed that because the Social Security claimant
representatives are skilled, that there would be a huge
difference between the medical records of a claimant and one of
those represented by a representative.
But my question to you--and maybe I'll ask Ms. Ford this--
to your knowledge, have we ever measured the difference between
the completeness and the timeliness of the medical records for
claimants who have representatives and those who don't? I mean
you talked about some of the areas that representatives helped
claims provided; that makes to me perfect sense. But have you
ever measured the difference? Because clearly the more complete
and more timely that medical record, my assumption is the more
accurate and hopefully the quicker the system would render an
accurate decision for that person.
*Ms. FORD. Just a couple of points in response to that. I
don't think that we have done any studies on the development of
evidence. One thing I would want to know is, of those people
who are represented, whether representation, for different
lengths of time prior to the hearing; makes a difference. And
it depends on the individual and how soon they find somebody as
to how long that representative has had to help develop the
record.
I'm being reminded by my colleague that the GAO is
currently working on a report on the development of evidence.
Hopefully there will be something helpful that comes out of
their work. But, the representatives have said for years that
there are some very practical things that can be done, that
should be done by SSA, and perhaps these cases wouldn't even
reach the appeals level if the evidence was gathered earlier in
the process.
Mr. BRADY. No, it seems to me to make sense. I was just
wondering if we need to try to find some way to measure that,
so we can find out what those best practices are. You know what
I mean? Because obviously I think that is one of the many keys
to improving the whole process.
So, Mr. Chairman, again, thank you all for being here.
Thank you, Chairman.
Mr. MCNULTY. Thank you, Mr. Brady.
If there are not further questions, I want to thank the
panel on behalf of Chairman Rangel and Ranking Member McCrery
and all the Members of the Committee.
I want to thank all of you, not just for your testimony
today, but for your advocacy on behalf of our constituents and
the American people. Sometimes we have these hearings to try to
figure out what the problem is. We know what the problem is. We
know, we are painfully aware of what the problem is. You have
given us some good ideas about solutions. The ball is now in
our court. We need to do these things in cooperation with the
Administration and the Social Security Agency.
So we have made some modest progress in the last couple of
years, and the extra $150 million last year. We've got $240
million extra in our House budget resolution this year. We're
hiring 175 new administrative law judges. We're making some
modest progress.
But I thank particularly Mr. Skwierczynski for referring to
a possible problem with continuing with the progress, and
that's some of us getting together and passing new laws,
creating new additional massive workloads for the Social
Security Administration that don't have anything directly to do
with Social Security. We need to guard against that, because I
think you will agree that if we do something like that, it
blows that progress we've made so far to smithereens.
So, we need to keep our eye on the ball. We need to
continue to make more progress beyond what we have done so far.
Thank you for steering us in the right direction, and we look
forward to working with each and every one of you to make more
and more progress on this issue in the weeks, the months, and
the years ahead.
The hearing is adjourned.
[Whereupon, at 2:09 p.m., the hearing was adjourned.]
[Questions for the Record follow:]
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[Submissions for the Record follow:]
Statement of America's Health Insurance Plans
I. Introduction
America's Health Insurance Plans (AHIP) is the national association
representing approximately 1,300 health insurance plans that provide
coverage to more than 200 million Americans. Our members offer a broad
range of products, including private disability income insurance to
help consumers replace lost income in the event that a disabling
condition forces them to leave the workforce for an extended period of
time.
We appreciate the Committee's interest in reducing the backlog of
pending claims for Social Security Disability Insurance (SSDI) benefits
and ensuring that this important Federal program is meeting the needs
of Americans with disabilities in a timely manner. As the Committee
reviews these issues, we believe it is important to keep in mind the
important role that private disability insurers play in offering
products that protect consumers against the financial risk of a
disabling illness or injury that prevents an individual from working
for an extended period of time. Our statement provides an overview of
private disability insurance, while also discussing the value this
coverage offers to policyholders and a national education campaign we
have launched to increase awareness about the importance of disability
income protection. The statement also includes a brief description of
steps that AHIP and our disability insurer members have undertaken to
help the Social Security Administration (SSA) speed and improve SSDI
claim adjudication.
II. Overview of Disability Income Insurance
Private disability income insurance provides tens of millions of
Americans with protection that complements the safety net provided by
the SSDI program. Approximately 38 percent of U.S. workers in private
industry are covered by employer-sponsored short-term disability
coverage, while 30 percent receive long-term disability insurance
through their employers\1\. In addition to extending benefits to many
persons who are not eligible for SSDI, or during the time the SSA is
adjudicating an SSDI claim, this coverage provides a level of
disability income benefits that spares many Americans from financial
hardship.
---------------------------------------------------------------------------
\1\ National Compensation Survey: Employee Benefits in Private
Industry in the United States, 2006, U.S. Department of Labor, Bureau
of Labor Statistics
---------------------------------------------------------------------------
Short-term disability coverage typically pays benefits for 13 to 26
weeks based on a specified percentage of the employee's pre-disability
income--typically 60 percent--after sick leave has been exhausted.
Circumstances that may trigger the payment of short-term disability
benefits include temporary musculoskeletal or connective tissue
conditions, pregnancies, and other illnesses or conditions that are
resolved within a relatively short timeframe, thus allowing the
employee to return to work before benefits are exhausted. The valuable
protection offered by short-term disability coverage can be purchased
at a reasonable price--an average of $174 annually, according to one
study based on 2001-2003 data, when purchased as group coverage by
employers\2\. This short-term protection can be purchased in
combination with long-term disability coverage as part of a seamless
package, with the short-term and long-term benefits coordinated to
ensure that disabled workers can meet their daily expenses and avoid
financial hardship.
---------------------------------------------------------------------------
\2\ An Employer's Guide to Disability Income Insurance, AHIP
---------------------------------------------------------------------------
Additional protection is offered by long-term disability coverage
that begins to pay benefits when an individual's sick leave and short-
term benefits are exhausted. These long-term disability benefits
continue anywhere from five years to the remainder of an individual's
life. Long-term disability insurance allows policyholders to sustain
themselves financially if a catastrophic illness, injury, or disability
takes them out of the workplace for an extended period of time.
III. Value for Consumers
In 2006, more than 500,000 individuals received long-term
disability payments from private insurers. One-third of these
individuals did not qualify for SSDI. Moreover, 95 percent of reported
disabilities were not work-related and, therefore, not eligible for
coverage under workers compensation.\3\
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\3\ 2006 Council for Disability Awareness Claims Review
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Private disability insurers resolve claims within 30 days or less
for approximately 75 to 80 percent of claimants, thus ensuring that
benefits can be paid promptly to replace an eligible claimant's lost
wages. Our members' track record exceeds the requirements set by
Federal regulations, which establish a 45-day timeframe for the initial
resolution of private disability claims and allow an extension--of up
to a total of 105 days--if, for reasons beyond the control of the
insurer, more time is required to gather information.
In addition to replacing lost income for claimants in a timely
fashion, private disability insurers play a key role in restoring
disabled workers to financial self-sufficiency and maintaining
productivity for America's businesses. By investing in rehabilitation
and return-to-work programs, private disability insurers are actively
engaged in helping workers with disabilities return to the workforce.
In fact, a survey by Milliman, Inc. found that private disability
insurers spent an average of $3,200 in 2005 on each disabled employee
receiving rehabilitation and return-to-work services.\4\
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\4\ Survey of Rehabilitation and Return-to-Work Practices Among
U.S. Disability Carriers, Milliman, Inc., May 2007
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These innovative programs include a wide range of strategies in
recognition of the fact that persons with disabilities are highly
diverse and face varying circumstances. Services offered by
rehabilitation and return-to-work programs include medical case
management, vocational and employment assessment, worksite
modification, purchase of adaptive equipment, business and financial
planning, retraining for a new occupation, and education expenses. The
Milliman survey found that annual budgets for these programs, which
vary by size of company, range from $450,000 to more than $10 million.
Additionally, private disability insurers have been very proactive
in designing policies that help claimants return to work. As a result,
persons receiving private disability payments often have access to work
incentive benefits, rehabilitation benefits, workplace accommodation
benefits, and child or dependent care benefits during rehabilitation.
These innovative benefits reflect our members' strong commitment to
promoting employment and self-sufficiency among persons with
disabilities.
Disability insurers also help consumers exercise their rights under
the Social Security program. Specifically, disability insurers provide
assistance in the application process to beneficiaries who may be
eligible to apply for SSDI benefits. Claimants with expected long-term
disabilities are encouraged to apply for SSDI benefits and, according
to one study, two-thirds of individuals receiving private long-term
disability income benefits also qualify for SSDI benefits.\5\
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\5\ Council for Disability Awareness, 2006 Long-Term Disability
Claims Review
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By encouraging and assisting claimants in pursuing SSDI benefits,
disability insurers help them gain access to benefits beyond disability
income payments. This includes additional benefits for a spouse and/or
dependents, access to vocational assistance and other support from the
SSA, and eligibility for Medicare benefits after a period of 24 months.
A similar approach is taken by the Federal Employee Retirement
System, which requires disabled beneficiaries to file for SSDI
benefits. A requirement to apply for SSDI benefits is also part of many
states' workers' compensation systems, as well as public employee
retirement systems.
IV. National Education Campaign
AHIP has launched a national education campaign to promote
awareness about the importance of disability income protection and to
highlight the value disability insurance provides for workers,
employers, and taxpayers.
Recognizing that more than 100 million Americans lack private
disability income protection, our campaign has created a Web site--
www.yourincomeatrisk.org--focused on educating consumers about a wide
range of disability-related issues. The need for such education is
highlighted by survey findings showing that many American workers have
misunderstandings about their likelihood of experiencing a disability.
AHIP released survey findings in March 2008 indicating that most
baby boomers underestimate their risk of suffering a disability that
would cause them to miss work for an extended period of time. The
survey, conducted by Harris Interactive on behalf of AHIP, found that
just over a third of baby boomers think the chances of becoming
disabled due to illness or injury is 5 percent or less, a slight
majority think the chances are 10 percent or less, and two-thirds think
the chances are 20 percent or less. In reality, a worker has a 30
percent chance of suffering a disabling injury or illness causing him
or her to miss three or more months of work before reaching retirement,
according to the SSA.
The survey also found that 47 percent of baby boomers say they are
not too concerned about their chances of suffering a disabling illness
or injury. One of the reasons baby boomers underestimate their risk is
because they are unaware of the most common causes of disability,
mistakenly believing that injuries cause more disabilities than
illnesses. According to the survey, baby boomers believe the most
common causes of disability are back, muscle, or joint problems (26%),
injuries on the job (18%), and injuries off the job (16%). In
actuality, research shows that the most common causes of disability are
illnesses such as cancer, heart disease, and diabetes.
In the coming months, AHIP will be taking additional steps to
continue our national education campaign. These steps include a
retooling of our ``Your Income At Risk'' Web site, an updated consumer
guide on disability income insurance, a new publication for
policymakers and the media, and additional research on key disability
issues.
V. Private Disability Insurers Partnering with SSA to Help Speed SSDI
Claim Adjudication
AHIP and its disability insurer members are well aware of the
challenges facing SSA and the SSDI program, and believe that the Agency
needs more resources. Applications for SSDI benefits have increased
steeply in recent years--and now arrive at the rate of more than 2.5
million each year. The increased SSDI workload also comes at a time of
very serious limits on the Agency's budget for administering its
retirement income security and disability income security programs;
attrition of the Agency workforce; and the addition of new
responsibilities supporting the Medicare program and homeland security
efforts.
Congress has recognized SSA's need for additional resources, and
took steps last year to increase the Agency's administrative funding.
The Commissioner and his staff are also moving aggressively to reduce
SSDI claim delays and backlogs through steps such as hiring additional
Administrative Law Judges.
AHIP and its private disability insurer members are also reaching
out to offer assistance to help SSA speed and improve SSDI claim
adjudication. For privately-covered workers who become short-term
disability and/or long-term disability claimants, private disability
insurers compile extensive disability claim information that is also of
significant potential relevance and value to the SSDI claim
adjudication process. SSA and a group of AHIP's private disability
insurer members are currently working to test new procedures that will
facilitate SSA access to key claim information that will help SSA speed
and improve the adjudication of private claimants who apply for SSDI.
The test is initially focused on providing the Agency with objective
medical evidence, such as attending physician statements and lab and
test results, for claims expedited based on presumptive diagnoses and/
or terminal prognosis.
By providing the SSA with quality medical evidence already resident
in private disability claim files, we can begin to demonstrate the
benefits of enhanced cooperation between private disability insurers
and the nation's primary public disability income assistance program.
These steps can lead to even more robust information sharing and other
enhanced public-private cooperation in the future.
VI. Conclusion
AHIP and our members look forward to maintaining a dialogue with
Committee Members about the challenges facing the SSDI program and the
role of private disability insurance in providing consumers with
financial protection against the high costs associated with disability.
Statement of the American Bar Association
Dear Mr. Chairman:
On behalf of the American Bar Association (``ABA'') and its more
than 400,000 members nationwide, I write to present the views of the
American Bar Association on clearing the Social Security
Administration's backlog of disability claims and providing the agency
with the resources it needs to provide the benefits earned by workers
in this country. The American Bar Association commends the House
Committee on Ways and Means for maintaining a sharp focus on working to
solve a set of agency problems that inflict a terrible human toll on
hundreds of thousands of Americans who are disabled and suffering
financially due to the loss of their income and who are unable to
obtain timely and fair determinations of their disability claims. The
unprecedented backlog of cases was created because for many years SSA
was severely under-funded.
The ABA has a long-standing interest in the Social Security
Administration's disability benefits decision-making process, and we
have worked actively for over two decades to promote increased
efficiency and fairness in this system. As a diverse organization
representing the legal profession in the United States, the ABA has
been able to draw upon the considerable expertise of our membership--
claimants' representatives, administrative law judges, academicians and
agency staff--to develop a wide-ranging body of recommendations on the
disability adjudication process. The Section of Administrative Law, the
Judicial Division and the Commission on Law and Aging have worked to
develop our ABA recommendations, the goals of which are to improve the
quality of decision-making, increase fairness and efficiency for
claimants, help alleviate the backlog, encourage clarity in
communications with claimants, promote procedural due process
protections, and seek the application of appropriate, consistent legal
standards at all stages of the adjudication process.
At its April 2008 meeting, the ABA's Board of Governors adopted
policy pertaining to the Social Security Administration's
administrative budget. The policy states:
RESOLVED, That the American Bar Association urges Congress to enact
a level of administrative funding for the Social Security
Administration that permits the Social Security Administration to
provide its mandated services in a timely manner, promptly and fairly
adjudicate applications for disability insurance and supplemental
security income benefits, overcome significant disability claims
processing times and backlogs, and build the infrastructure necessary
to manage the expanding workload challenges presented by serving the
aging baby boomers filing disability and retirement claims.
The President's FY 2009 budget proposes administrative resources of
$10.460 billion for the SSA, a six percent increase over FY 2008. While
this represents a praiseworthy step forward toward reducing the
backlogs and improving services to the public, it is inadequate to
provide mandated services in a timely manner and to promptly and fairly
adjudicate applications for disability insurance and supplemental
security income benefits. As Commissioner Astrue testified at your
April 23rd hearings, SSA requires a minimum increase of $400 million to
meet increases in personnel and infrastructure costs alone for the
fiscal year that starts in October 2008. The President's budget is
insufficient to maintain an adequate number of administrative law
judges and support staff and continue reducing the backlog, and does
not address the inadequate levels of service provided to the public in
SSA field offices and customer service centers. It is up to Congress to
determine the responsible measure of support needed above and beyond
the President's proposal. We commend this Committee for pursuing the
tough fiscal and strategic question of determining a level of funding
that will ensure that the agency does the job that the American people
and their elected representatives expect it to do.
The ABA urges Congress, now and in future years, to provide SSA
with sufficient administrative funding to continue to work to reduce
the significant backlog of initial claims and appeals of disability
cases, to reverse crippling cuts in services to the public, and to
provide a sustained level of administrative funding that permits the
agency to provide its mandated services in a timely manner, promptly
and fairly adjudicate applications for disability insurance and
supplemental security income benefits, overcome significant disability
claims processing times and backlogs, and build the infrastructure
necessary to manage the significant workload challenges presented by
serving the aging baby boomers filing disability and retirement claims.
We appreciate the opportunity to submit our comments and would be
pleased to offer our assistance to the Committee as it addresses the
backlog in disability claims
and other declines in service to the public resulting from years of
under-funding of the agency's administrative expenses.
Thank you for considering our views on this important matter.
Sincerely,
[GRAPHIC] [TIFF OMITTED] T8116A.027
Denise A. Cardman
Acting Director
cc. Members, Committee on Ways and Means
Statement of Barbara Gay
The American Association of Homes and Services for the Aging
(AAHSA) is pleased to submit this comment on the need to include long-
term care in any legislated reform of the U.S. healthcare system. AAHSA
members (www.aahsa.org) help millions of individuals and their families
every day through mission-driven, not-for-profit organizations
dedicated to providing the services that people need, when they need
them, in the place they call home. Our 5,800 member organizations, many
of which have served their communities for generations, offer the
continuum of aging services: adult day services, home health, community
services, senior housing, assisted living residences, continuing care
retirement communities and nursing homes. AAHSA's commitment is to
create the future of aging services through quality people can trust.
In his April 15 testimony, former Senator David Durenberger said
that addressing long-term care financing would be a first step toward
an income security policy for this country. We would add our voice to
his in calling on policymakers not to overlook long-term care in
developing a more rational system of healthcare coverage for Americans.
On November 2, 1993, the Ways and Means Health Subcommittee held a
hearing on healthcare reform. At that time, we testified that, ``the
demographic imperative is upon us,'' and pointed out that the lack of
coverage for long-term care can be just as catastrophic for families as
the lack of general health insurance.
Sadly, little has changed in the intervening fourteen years in the
way long-term care is financed. In 1993, private insurance covered only
three percent of long-term care costs. The annual cost of long-term
care far outstripped the ability of most individuals and families to
pay for it. The cost of long-term care for those who had spent down
their financial resources and become eligible for Medicaid was a
substantial and growing burden on Federal and state governments. Family
members often exhausted their physical and financial abilities to
provide care at home and businesses experienced growing costs of
employee sickness, absenteeism, and diminished productivity due to this
``major unfunded liability,'' as our testimony termed the lack of long-
term care coverage.
Today, Medicaid continues to be the primary governmental source of
coverage for long-term care, and the cost to states in particular
supplants spending on other important state responsibilities such as
education and transportation. Individuals and families cover 52% of
long-term care costs out of pocket. The cost of paid long-term care is
only the tip of the iceberg; approximately 75% of long-term services
and supports are provided by family members on an unpaid basis, often
at a heavy physical and financial cost, including lost opportunities
for employment, health insurance, and retirement savings. Despite
almost three decades of marketing and generous Federal tax incentives,
the ``take-up'' of private long-term care insurance has been sluggish,
and this coverage is unavailable to the thousands of Americans who have
experienced a serious illness or other ``pre-existing condition.'' As a
result, private long-term care insurance continues to cover only a
fraction of long-term care costs.
Consumers often are surprised that nursing home care and services
provided in the home and community are not covered either by private
health insurance or for the most part by Medicare. In fact, it makes no
intrinsic sense to separate coverage of long-term services and supports
from other kinds of healthcare coverage. Long-term care involves many
of the same healthcare providers--nurses, doctors, hospitals,
pharmacists--who provide other forms of healthcare. Services that in
the past were provided primarily in hospitals now often are provided in
nursing homes or in community-based settings. The line between long-
term care and the rest of healthcare was never bright and the evolution
of healthcare over the last generation has obscured it even more.
Costs do not disappear if they are not covered by government
programs or private insurance. The burden of covering them simply
shifts to different levels of government, to private businesses, and to
individuals and their families, often at a time when they are least
prepared to handle them. Including long-term care in healthcare reform
is essential to integrate services for consumers and to prevent the
inefficiencies that result from hidden cost-shifting.
Recognizing the need for a new approach to financing long-term
care, AAHSA has spent the last few years researching and developing a
proposal for an equitable and affordable system of long-term care
coverage. Our plan calls for a public insurance program, with
participation on an ``opt-out'' basis to make it as universal as
possible, financed by participants' premium payments. Benefits would be
paid on the basis of disability, assessed according to the level of
need for assistance with activities of daily living. Our Long-Term Care
Financing Cabinet issued its recommendations last year, and we have
since completed economic modeling that demonstrates the feasibility of
our financing proposal. More information on our proposal and on the
need for a better system of long-term care financing is available on
our website, at http://www.thelongtermcaresolution.org/LearnMore.aspx.
A consensus on the need for long-term care financing reform along
these lines is emerging among many organizations that represent elders
and people with disabilities. Recently, the Leadership Council of Aging
Organizations and the Coordinating Council for Disabilities jointly
endorsed the principles underlying our proposal. Together, the two
coalitions represent over 150 organizations of elders, people with
disabilities, and providers of health, housing and supportive services.
In another fourteen years, the oldest of the baby boomers will
reach age 76. We no longer have the luxury of predicting a future
train-wreck in financing long-term care; the trains are now within
sight of each other. To truly protect American families against
catastrophic healthcare expenditures, Congress must include long-term
care in whatever healthcare reform plan it considers.
Every family faces the potential costs of long-term care, and every
family needs a structure for personal planning with the protection of a
public program as well. AAHSA and our members look forward to working
with the Ways and Means Committee on a comprehensive and badly-needed
reform of our entire healthcare system that will address long-term
supports and services along with other health issues and give Americans
a healthy, ethical, and affordable system of which we can all be proud.
Statement of Colleen M. Kelley
Good morning Chairman Rangel, Ranking Member McCrery and Members of
the Committee on Ways and Means. My name is Colleen M. Kelley and I am
National President of the National Treasury Employees Union (NTEU).
NTEU represents over 150,000 Federal employees in 31 agencies. Among
them are the nine hundred Attorney-Advisers and other staff members in
approximately 110 Office of Disability Adjudication and Review (ODAR)
Hearing and Regional Offices across the United States. Our union has
long been troubled by the unacceptable backlog of cases before ODAR and
believes that prompt congressional action is needed to resolve this
crisis in service to the American public, particularly those disabled
Americans applying for earned social insurance benefits.
Disability adjudication at SSA has a long and troubled history. The
current problems with the SSA disability program began in the early
1990s when the cases pending at OHA hearing offices rose from
approximately 180,000 in 1991 to approximately 550,000 in mid-1995.
Currently over 750,000 cases are pending at ODAR hearing offices and
processing times in 85% of all hearing offices are in excess of one
year. However, a quick review of the history of the number of cases
pending at ODAR demonstrates that the backlog problem is not altogether
intractable.
[GRAPHIC] [TIFF OMITTED] T8116A.026
The number of cases pending at OHA hearing offices declined from
1995 through 1999, and in fact by the end of FY 1999 there was no
longer a backlog, since 300,000 cases was deemed to be the optimum
number of pending cases for efficient adjudication. The decline in
pending during that time period is the direct result of the over
220,000 decisions produced by initiatives included in the Short Term
Disability Program (STDP), the vast majority of which were produced by
Senior Attorneys. The Hearing Process Improvement program (HPI) ended
the Senior Attorney Program. The demise of the Senior Attorney Program
and the rise of the backlog were not coincidental and are illustrative
of the management deficiencies that have plagued the disability
program.
Over 750,000 cases are currently pending at ODAR hearing offices.
This translates into an average processing time of 510 days at ODAR.
Even this is somewhat misleading. Currently, the average processing
time for a case that proceeds through an ALJ hearing decision is 553
days. In the Chicago Region the average processing time through an ALJ
hearing decision is 727 days; 3 days short of two years. Even these
unconscionable numbers do not include the time the case was at the
State Agency for an initial and reconsideration determination. To
further darken the picture is the specter of significantly increased
receipts resulting from the aging ``baby boomers'' and the less than
robust national economy. Unless decisive action is taken now, the
dysfunction of the disability system may lead to the public's loss of
faith in Social Security.
The salient fact about the current SSA disability adjudication
process is that it is unconscionably slow causing untold harm to some
of the most vulnerable members of society. None will dispute that the
public deserves far better service than SSA is presently providing. The
current situation is both a failure of adequate funding and of proper
planning and management.
Additional resources are very much needed as well as a reform of an
inefficient adjudicatory process characterized by an insufficient
number of adjudicators and the misuse of those adjudicators. Requiring
an Administrative Law Judge (ALJ) to adjudicate each and every case at
ODAR hearing offices is grossly inefficient and extremely expensive.
Many cases (dismissals, fully favorable on-the-record cases, and
requested closed period cases) can be disposed of without ALJ
involvement.
Given the underfunding of the agency, SSA is under an absolute duty
to use what funding it has as efficiently as possible. This year
Congress has provided greater funding, and SSA has decided to use part
of that increase to hire 175 new Administrative Law Judges;
unfortunately, SSA has not seen fit to provide adequate staff to
support these new ALJs. Recently, SSA conducted the largest hiring of
ALJs (135 ALJs) in this nation's history, and intends to hire at least
40 more ALJs before the end of the fiscal year. Certainly, the hiring
of such a large number of new adjudicators will have an impact on SSA's
disability backlog. However, the number of support staff for ALJs in
ODAR was critically low before the recent hiring. While it is not
altogether clear how many additional support staff SSA intends to hire
this year, even the most optimistic projections (143) are grossly
inadequate. Hearing offices were critically understaffed before the
acquisition of as many as 135 new ALJs (and 40 more to be added this
fiscal year) and are in far worse position now.
In his recent response to questions from the House Appropriations
Committee, the Honorable Ronald G. Bernoski, President of the
Association of Administrative Law Judges, stated that a judge could not
perform his/her work in isolation and the support of sufficient
competent and trained staff is essential. He further indicated that
adequate staff included 2.5 attorneys and 2.0 clericals for each ALJ.
While hiring a large number of new ALJs ``looks good'', unless they and
the current ALJs are properly supported, a reasonable return for the
expenses incurred simply will not happen.
Without sufficient staff, SSA cannot prepare enough cases to fill
the dockets of the ALJs or timely prepare and issue the written
decisions. More ALJs without more staff will mean even more unfilled
dockets, decreased ALJ productivity and wasted SSA assets. It is
prudent, if nothing else, to use remaining funds to hire the necessary
staff to make current ALJs productive.
No doubt part of the reluctance to properly staff ODAR hearing
offices is the Administration's commitment to ``contracting out'' many
inherently governmental activities. Additionally, the Agency places a
great deal of emphasis on the benefits of automation in improving
Agency operations. The GAO Report of December 2007 reported that many
SSA senior managers and ALJs recommended a staffing ratio of 5.25
support staff to administrative law judge. It also indicated that the
recommended staffing ratio could change as SSA implemented planned
automation initiatives intended to improve the hearing process and
increase efficiency. In many instances this emphasis on automation may
well be justified, but in other areas experience has shown its relative
merits are questionable. Automation may improve the situation over
time, but the fact of the matter is that SSA automation initiatives
rarely, if ever, come in on time, and even more rarely deliver what was
promised.
SSA is also committing funds to establishing ``National Hearing
Centers''. The first is already operational in Falls Church, VA; the
Commissioner recently announced a second to be situated in Albuquerque,
NM, a city that already has a hearing office. It is not clear what
operational efficiencies are achieved through the establishment of
these adjudicating entities that are not already and better served at
hearing offices. Certainly the capacity for conducting video-conference
hearings already exists in nearly every current hearing office to
facilitate conducting remote hearings and for adjudicating temporary
excess workloads. The centralized nature of National Hearing Centers
will alienate the public and further damage the Agency's credibility.
For more than seventy years SSA has strived to maintain face-to-face
contact at the local level with the public it serves. This is one of
the factors that separate SSA from the majority of Federal agencies.
National Hearing Centers would significantly weaken the bond between
SSA and the public it serves.
The advent of the electronic hearing folders facilitates movement
of cases to other hearing offices as easily as to a National Hearing
Center. There is no operational justification for the establishment of
such centers. Moreover, their unique staffing structure emphasizes the
Agency's commitment to achieving its political goals over providing
high quality service to the public.
Interestingly enough, in addition to hiring new ALJs, SSA has
already commenced a program that if properly implemented will eliminate
the backlog. Commissioner Astrue has reinstituted a version of the old
Senior Attorney Program that was responsible for eliminating the
disability backlog in the 1990's. Not surprisingly, the current
program, the Attorney Adjudicator Program, is proving to be a success
in spite of some ill-founded limitations. However, since its
commencement, improvements have been authorized and its scope expanded.
Nonetheless, it is this program with further modifications and
additions that shows the way to an adjudicatory process at ODAR that is
both effective and fiscally responsible.
Judge Bernoski has noted on numerous occasions the necessity of
reducing the number of cases that proceed to an ALJ hearing. In his
response to questions from the Appropriation Committee he stated,
``Social Security can no longer have over 90% of its disability cases
continuing on to a full hearing before an administrative law judge.''
Judge Bernoski further stated ``nowhere in our judicial system is a
judge required to take to hearing such a high percentage of cases
compared to the total docket.'' NTEU absolutely concurs.
The simple fact of the matter is that neither a hearing nor an ALJ
is needed to dispose of every case. By relieving ALJs of the
responsibility for adjudicating cases which do not require an ALJ, the
ability of ALJs to focus on those cases requiring their expertise can
be enhanced. That is the rationale behind the Attorney Adjudicator
Program.
Attorney Adjudicators, who have limited decisional authority,
augmenting the ALJ corps constitute an effective and fiscally
responsible adjudicative process. The one area of controversy involving
the former Senior Attorney Program, decisional accuracy, is not a
problem with the current program. Initial accuracy figures for the
Attorney Adjudicator Program show an accuracy rate of 95%.
Experience has demonstrated that between 25-40% of claims appealed
to ODAR hearing offices could result in fully favorable decisions
without an ALJ hearing. Additionally, 15-17% of cases appealed to
hearing offices are dismissed, many because of abandonment by the
claimant or technical defects. Very few of these cases require ALJ
involvement. Such dismissals should be handled by Attorney Adjudicators
thereby freeing the ALJ to adjudicate cases requiring an ALJ decision.
Consequently, 40-50% of appeals to ODAR can potentially be adjudicated
without the involvement of an ALJ.
The success of the former Senior Attorney Program in eliminating
the backlog of the 1990's and the very favorable beginning of the
current Attorney Adjudicator Program render arguing the merits of the
concept of attorney adjudication unnecessary. Management has recently
announced a significant increase in the number of Senior Attorneys that
will further increase the capacity of the current Attorney Adjudicator
Program.
Nonetheless, despite the promise of the Attorney Adjudicator
Program, the current crisis is of such magnitude that additional
changes are required if SSA is to get control of the backlog problem
within an acceptable timeframe. Recently, the Agency announced an
increase in the number of Senior Attorneys to 450; a net increase of 81
positions. However, the time allocated to case adjudication is
typically 25% or less. At this rate, the Agency expects approximately
30,000 fully favorable adjudications this fiscal year. While this may
temporarily stem the increase in the pending cases, its long term
effect, even considering the augmentation of the ALJ Corps to 1,250
ALJs, will not eliminate the backlog.
By increasing the number of Senior Attorneys to 700 and permitting
them to spend 50% of their time reviewing every disability case
appealed to ODAR and adjudicating the 40-50% of cases that do not
require ALJ participation, SSA can immediately reduce its pending cases
by well over 100,000 cases a year in spite of the increased receipts
expected.
The Attorney Adjudicator Program does involve decreasing the
availability of the attorney advisers for their traditional role of
drafting ALJ decisions. However, several other efficiencies are
promoted by the Attorney Adjudicator Program. Attorney Adjudicators
work on ``unpulled'' or ``unassembled'' files. Those that result in
fully favorable decisions do not have to be ``pulled''. The benefit
from not having to ``pull'' these cases cannot be overstated. Today
there are approximately 442,000 cases pending pulling; a workload that
will require over 200 days to complete if no new cases were received by
ODAR during that 200 days. Most ALJs will not hold hearings on
``unpulled'' cases and ODAR's difficulty pulling sufficient cases to
maintain ALJ dockets is a significant factor in the creation and
maintenance of the current backlog. Each disposition by an attorney
adjudicator is one less case that must be pulled.
Attorney Adjudicators would continue to draft ALJ decisions in
addition to handling their own adjudicatory dockets. Skilled decision
drafting remains a vital component of the ALJ adjudicatory process.
Retaining ODAR's most skilled staff to perform that duty is essential
if ODAR is to continue to produce quality decisions. Assigning decision
making duties to attorneys whose primary duty now is to advise ALJs and
draft decisions is obviously going to result in a decrease in decision
drafting capacity. SSA now has the assets to hire an additional 200
attorneys to maintain sufficient decision drafting capacity and 100
additional technical staff to process the increased number of
decisions. Even considering the cost of the promotions of current
employees consistent with their new duties, the total expense is far
less than that involved with hiring the massive number of ALJs and the
staff that would otherwise be necessary to support the ALJs.
In addition to increasing the number of attorney adjudicators,
small procedural adjustments would further enhance operational
efficiency. Currently, Attorney Adjudicators may conduct pre-hearing
conferences. Currently they can issue interrogatories to secure
vocational and medical expert input. Often this is all that is required
to perfect the record and allow for a fully favorable decision. While
written interrogatories significantly expand the number of cases for
which Attorney Adjudicators can issue fully favorable decisions, they
can be cumbersome and time consuming. ODAR should authorize the
attendance of medical and vocational experts at the pre-hearing
conference thereby increasing decisional accuracy while decreasing
processing time.
If the current Attorney Adjudicator Program is expanded as detailed
above, ODAR attorneys could dispose of 100,000 fully favorable
decisions and dismissals or more each year, while still spending nearly
half their time drafting ALJ decisions and advising ALJs. These cases
would not require the expenditure of any ALJ resources and would
involve relatively little staff time. This would allow the Agency to
commit a greater amount of its resources to the cases that required ALJ
adjudication.
Let me also address the situation with OFEDRO. SSA has suspended
further expansion of the Office of Federal Reviewing Officer (OFEDRO).
OFEDRO has the potential to meaningfully help with the disability
determination backlog if properly implemented. If SSA intends to resume
hiring of new staff for FEDRO, it should give preference to the
existing, high qualified and experienced staff at ODAR. In order to
recruit the best and brightest staff for any expansion of the program,
it should provide relocation allowances for all new hires recruited
from elsewhere in the agency. This is a common recruitment tool in the
Federal sector for highly qualified professionals and has been
underused by the agency.
Mr. Chairman, I thank you for this opportunity to present NTEU's
statement on this important matter. NTEU remains ready to work with the
Ways and Means Committee to do all that we can to address the crisis in
the disability determination backlog. Thank you.
Statement of Connie Plemmons
As project manager for the Disabled Homeless Project at Catholic
Social Services of Baldwin County, I see the backlog of Social Security
Disability cases first hand. The HUD grant I administer targets those
who are backlogged in this system. These people are being told by the
local SSA office they will get a determination within 90 days. Most of
them believe they will get a check following those 90 days. They are
devastated when they learn most cases are denied within 90 days, and
then they must wait 18 months before they are scheduled for a hearing,
then another 60 to 90 days before they get a check. My question is;
what is the office of Determination doing? Why are these cases being
denied by Determination just to be approved later by the ALJ? Has
anyone looked at the cases denied at the Determination level and
compared them to the cases approved at the ALJ level? Now I am being
told that a new level of bureaucracy is being created with an
``assumptive approval'' being allowed by folks not employed by the
Office of Determination and Appeals. How can people who are not trained
to do this job do a better job than the folks at Determination? It is a
classic case of waste on the part of the United States Government! My
tax dollars must be better spent. Fix the system we have. Do not create
more levels of bureaucracy to use resources that could be helping the
folks that really need the help, the disabled folks!
Yours in service to God and our country,
Connie Plemmons
Statement of David Hansell
The New York State Office of Temporary and Disability Assistance
(OTDA) is the state agency charged with helping New York's most
vulnerable citizens achieve and maintain economic security through a
range of work supports and services. OTDA's mission is multi-faceted:
Assist those who are working but still struggling to meet basic needs;
help work-capable individuals find and maintain employment; and assist
those individuals with special needs for whom engaging in work is not a
realistic priority. In order to fulfill this complex mission, OTDA
oversees a range of programs that together weave a web of services and
benefits to help families who often face more than one barrier to
economic independence. These programs include employment and training
services, food stamps, child support, home energy assistance,
immigration services, public assistance, and SSI state supplementation.
Additionally, OTDA includes the Division of Disability Determinations
(DDD), the entity which serves as the Disability Determination Service
in New York, and as such is responsible for making Federal disability
determinations for claims filed with the Social Security Administration
(SSA).
Since OTDA's oversight includes Federal disability determinations,
the state's public assistance programs and SSI state supplementation,
our perspective encompasses both our successful relationship with the
Social Security Administration with regard to disability determinations
and the troubling impact the SSA backlog has on New Yorkers generally,
and on public assistance clients awaiting an appeal in particular.
DDD makes medical determinations on disability claims filed with
the Social Security Administration (SSA) for Supplemental Security
Income (SSI) and/or Social Security Disability Insurance (SSDI). The
office collects all relevant medical evidence, and if needed, arranges
for the claimant to have an examination to gather further information.
A decision regarding medical eligibility is then made by DDD based on
all of the evidence. These two programs represent the major economic
support systems for the disabled. Additionally, individuals receiving
Federal disability benefits also become eligible for essential health
insurance through Medicare and Medicaid.
New York's DDD has long had a strong partnership with the SSA. We
value this relationship greatly, as it is beneficial for our State, for
the Federal government, and most importantly for disability claimants.
In addition, the DDD has a solid performance record, meeting and often
exceeding performance standards. Indeed, in addition to its standard
responsibilities, DDD often takes on extra tasks such as working with
SSA on pilot projects or helping other locations with reviewing their
disability applications. For example, DDD is currently working to
assist SSA with addressing the backlog through the Informal Remand
Initiative. Under this initiative, the SSA sends certain cases to DDD
to review in an effort to reduce the workload of the hearing officers.
Despite this initiative and other efforts by the SSA, the backlog
in appeals cases persists, and the impact on New York is enormous, both
at the individual and state government levels. Nearly 38,000 New
Yorkers are waiting for an appeal. These individuals wait 21 months on
average, a delay that in many cases results in a tragic loss of
savings, home or even life for some of the chronically ill or
critically disabled individuals seeking Federal benefits. Of this
total, more than 17,000 individuals awaiting an appeal are on public
assistance. This state-funded assistance is intended to be a short-term
stopgap. However, because of the long waiting period resulting from the
backlog, the state is providing months, sometimes more than a year of
assistance for individuals who, but for the backlog, are truly the
responsibility of the Federal government. More importantly, since the
public assistance grant is typically less than the disability payment,
the long delay means that disabled individuals are not getting the
level of financial support to which they are entitled and need from the
Federal government.
Moreover, the long wait places the state in a troubling position
with regard to the Federal rules governing the Temporary Assistance for
Needy Families (TANF) program. In cases where it has been determined by
the TANF program that a public assistance client meets the Federal
requirements for a disability and the appropriate application has been
filed to receive SSI, New York exempts the individual from TANF work
requirements, and provides him or her with public assistance for the
duration of the disability determination. However, while the state
exempts these individuals from TANF work requirements, Federal TANF
rules do not. Therefore, while the state is providing income support to
these individuals who are not able to engage in full-time work due to
their disability, we are at risk of penalties for not meeting the
required TANF work participation rate. This policy is extremely
problematic for states attempting to balance the conflicting demands of
these two Federal programs, and New York has been vigorously advocating
for a common sense solution through changes in TANF regulation.
However, not only is this problem not resolved, it has been exacerbated
by the long waits for Federal assistance resulting from the enormous
backlog.
By reducing the backlog in appeals and, therefore, reducing the
waiting period, individuals whose appeals are accepted would begin
timely receipt of appropriate Federal assistance, therefore freeing up
scarce state public assistance dollars for other pressing needs. And
for all who are waiting, reducing the waiting period would minimize the
potential for loss, both financial and personal, and help these people
on a path to economic stability.
Through the strong relationship between the DDD and SSA, OTDA
recognizes that SSA is making a valiant effort to address the backlog
despite a difficult combination of circumstances: years of insufficient
funding, expansion of responsibilities, and an overstretched staff.
This problem is due in part to an inadequate number of Administrative
Law Judges (ALJ) and support staff at the SSA to conduct hearings and
make determinations. However, despite repeated requests for increased
funding to address this issue, the SSA has not received adequate
funding to address this staffing shortage. While Congress provided an
increase in the FFY 2008 omnibus appropriations with language directing
that the funds be used for this purpose, given the size of the backlog
and the extensive wait times, more funding will certainly be needed. We
urge Congress to provide the SSA with sufficient funding to address
this backlog and prevent it from happening again in the future.
Given the increase in funding for FFY 2008, OTDA commends SSA for
hiring 135 new ALJs this year. However, we join Senators Charles
Schumer (D-NY) and Hillary Clinton (D-NY) in asking that the
geographical allocation of the new ALJs be revisited. We understand
from the testimony at the House Ways and Means Committee hearing on the
disability backlog that the allocation was intended to help offices
carrying a significant backlog caseload, yet only 10 of the 135 new
ALJs were assigned in New York, and to only four of the State's nine
hearing offices. Furthermore, no new ALJs were assigned to the Buffalo
office, even though that office currently has one of the longest wait
times in the country. The explanation that the allocation was made in
this manner due to the lack of office space for additional staff is
troubling. Thousands of individuals should not be made to wait for
disability assistance to which they are entitled because SSA cannot
find office space. OTDA urges SSA to reconsider the allocation plan,
and stands ready to offer assistance in finding adequate office space
if necessary.
In addition to increased funding and a reallocation of new ALJs,
OTDA recommends that Congress consider changing the criteria currently
used to determine eligibility at the time of the initial application.
ALJs are allowed significantly more discretion in allowing cases at
appeal, and DDD can often tell when a case that is being rejected based
on the standard of evidence for the initial application will be
approved upon appeal. If the DDD were allowed similar discretion to the
ALJs, then the process would be expedited without impacting the
integrity of the decision process, thereby reducing the number of cases
going to appeal, and reducing the backlog.
For the millions of individuals dealing with disabilities, SSI and
SSDI are the lifeline that helps them maintain economic stability and
security. With sufficient funding and other changes, the SSA will be
able to eliminate the backlog and provide this critical support to many
vulnerable people eligible for and entitled to Federal disability
assistance.
We hope hearings like this one will catalyze changes for the SSA.
We thank you for the opportunity to comment on this important issue.
Statement of Harry Wanous
Committee Chairman Charles B. Rangel
Representative Rangel there is a Bill that seats in the House Ways
and Means Committee it is, H.R. 2943. The Title of the Bill is ( To
amend titles II and XVI of the Social Security Act to provide for
treatment of disability rated and certified as total by the Secretary
of Veterans Affairs as disability for purposes of such titles.)
The short Title is (This Act may be cited as the `Benefit Rating
Acceleration for Veteran Entitlements Act of 2007'.) I think this is a
very good Bill, I don't understand why we have two Government agencies
wasting tax payers dollars fighting over the disability of veterans,
even when the Secretary of Veterans Affairs has certified the veteran
as totally Disabled.
I would hope that you could get this Bill H.R. 2943 out of
Committee and back to the floor for a Vote; at last look on the
internet this Bill has about 105 Cosponsors. I'm asking you as a
veteran fighting with the Social Security system for Disability sense
2006 I had to finally hire a Lawyer to help me fight the system.
Harry Wanous
Statement of James F. Allsup
Chairman Rangel and Members of the Committee, thank you for
considering my written testimony regarding the Social Security
Administration's growing disability claim backlog.
My name is James Allsup and I am the founder, president and CEO of
Allsup Inc., a Social Security Disability Insurance representation
company that has helped more than 100,000 Americans with disabilities
obtain Social Security disability benefits. For more than 30 years, I
have experienced firsthand the challenges facing the SSDI system. I am
a former SSA claims and field representative. I left the agency and
founded Allsup 24 years ago because I wanted to help people with
disabilities collect the insurance benefits they paid for.
Our nation's disability insurance system is bursting at the seams.
As Commissioner Astrue himself has stated, people are dying while
awaiting an SSDI decision. I am not going to go into detail with the
appalling backlog numbers and SSA staffing problems because this
Committee already knows that the SSDI system is in crisis. Instead, I
want to offer solutions.
Problems and Solutions
As many have acknowledged, the core problem is that the SSA does
not have the staff or the technology to process the exploding number of
SSDI applications. Hiring additional administrative law judges is a
step in the right direction, but it is similar to using a Band-Aid to
fix a leaking dam. It is simply too little, too late. The agency and
this Committee can effectively attack this crisis on two fronts: (1)
Move more quickly to embrace modern technology to move claimants
through the process faster, and, (2) Form professional relationships
with third-party SSDI representatives.
The SSA is moving forward on improving its technology initiatives.
These include:
Appeals--This new Web-based appeals process has
supplanted the traditional paper appeals form. Allsup uses iAppeals for
all its filings and we have seen faster processing times and improved
accuracy. We strongly support the agency's proposal to require all
claimants with representation to use iAppeals.
Electronic Records Express--Secure, online submission of
health records and claims evidence. Allsup uses this system to
electronically submit evidence in support of cases pending at the
hearing level. A typical claim that reaches the hearing level consists
of 700 to 800 pages of medical evidence, Activities of Daily Living
reports, denial letters and a multitude of Social Security
Administration application documents. Everyone, especially the agency,
benefits when third-party representatives are allowed to submit
evidence electronically.
Other technological improvements would help reduce the overload of
interactions between SSA and its claimants. An example would be giving
third-party representatives access to claimant data to confirm
application status. This would include forms that have been received,
status of medical records and earnings information.
Allsup supports these and other initiatives to streamline the SSDI
process. There is, however, no substitute for the hands-on, personal
service that experienced third-party representatives offer. Even with
the aforementioned technological advances, the application process is
still unwieldy, complex and bewildering to the typical applicant. They
still need help to properly complete the forms and a professional to
guide them through the process.
I respectfully submit that the agency and this Committee should
look for ways to increase awareness that professional assistance is
available. Most SSDI applicants simply do not know help is available
when they begin the process. By the time they reach the hearing level,
about 84 percent of them have such help, but why not earlier in the
process when it is so desperately needed and can reduce the number of
people who end up in the hearing backlog? The effectiveness of third-
party representatives has been proven in recent years.
We screen potential claimants to help ensure they will meet SSDI
criteria, accumulate the necessary medical evidence, and we work
closely with applicants to ensure that all documents are properly
completed in a timely manner; furthermore, we provide our customers
valuable program education and set realistic expectations. Hundreds of
thousands of worker-hours would be saved if every application processed
by the SSA was professionally documented before it was submitted.
We primarily work with claimants on the telephone and through the
mail, so they do not have to travel to SSA field offices. We help pre-
qualify claimants, we ensure eligibility and we develop accurate,
comprehensive and factual records that save the agency many hours of
claim development.
When an on-the-record hearing decision is warranted, we prepare all
the evidence, write the legal brief and submit everything as a package
to a judge for a decision. Our process is so effective that more than
70 percent of our claims that reach the hearing level are approved on
the record, which cuts months from the waiting process for the disabled
individual. About 85 percent of our claimants are awarded benefits
without ever having to speak to an SSA employee. Furthermore, our call-
center employees respond to tens of thousands of client inquiries about
the status of their claims and the SSDI claims process each month.
These are calls that would otherwise be handled by an overworked SSA
staff.
Third-party representation would be even more effective if the SSA
could electronically exchange claimant and case status information. The
result would be faster decisions, fewer backlogged claims, and
certainly less personal and financial stress. In turn, the SSA could
focus its overstretched resources on making application decisions.
I emphasize that this proposal is not a step toward privatization.
It is simply a strategic partnership between the government and
industry to meet the demands of the people with disabilities, today and
well into the future. Allsup is on the front lines of the disability
backlog challenge. Everyday, we work with individuals and their
families who are desperate because they have fallen on hard economic
times because a serious injury or illness is preventing them or a
family member from working.
Chairman Rangel and Members of the Committee, I commend you for
holding this hearing to raise awareness of these issues. Thank you
again for the opportunity to provide testimony. I look forward to
working with you to address this growing crisis.
Statement of Linda Fullerton
Members of the Committee:
My name is Linda Fullerton, and I currently receive Social Security
Disability Insurance/SSDI and Medicare. I have an inoperable blood clot
and tumor in my brain, and several incurable autoimmune disorders,
which have caused me to become permanently disabled. Social Security
Disability is an insurance policy which was created to be a safety net
for millions of disabled Americans, and for many such as myself, it has
become their only lifeline for survival. I have personally suffered
from the affects of the severe hearing backlogs (Buffalo NY OHA), due
to the enormous waiting time I endured, and I am very discouraged to
know that conditions are continuing to decline. It is hard enough to
deal with all the illnesses that I have, but then to have my entire
life destroyed with the stroke of pen by a neglectful government
employee, to whom I was just an SS number, is more than I can bear. So
now, not only will I never recover from my illnesses, but now I also
will never recover from the permanent financial devastation this has
had on my life. I don't know how I am going to survive without some
miracle like winning the lottery. I lost all my resources, life
savings, and pension money during the 1\1/2\ year wait for my SSDI
claim to be processed. I know first hand about the pain, financial,
physical and emotional permanent devastation that the SSDI process can
cause. My ``American Dream'' will never be realized. I have now been
forced to live the ``American Nightmare'' for the rest of my days,
because I happened to get sick, and file a claim for Social Security
Disability benefits, a Federal insurance policy that I paid into for
over 30 years. As a result, I will never be able to own a home, replace
my lost financial resources, or replace my only means of
transportation--a failing 11 year old car, and several other
necessities that have now broken down. I currently live strictly on the
inadequate, monthly SSDI check I receive, teetering on the brink of
disaster. I am now doomed to spend what's left of my days here on
earth, living in poverty, in addition to all my medical concerns. When
things break down now, I cannot fix them and have to do without. I
struggle every day to pay for food, medicines, healthcare, gas etc, and
this totally unbearable, continuing source of stress and frustration,
along with my worsening health conditions, is killing me. I did not ask
for this fate and Congress and the SSA are totally responsible for it.
My personal horror stories can be found on my websites at:
A Bump on the Head
http://www.frontiernet.net/lindaf1/bump.html
Social Security Disability Nightmare--It Could Happen to You!
http://www.frontiernet.net/lindaf1/
SOCIALSECURITYDISABILITYNIGHTMARE.html
Please know that in spite of my horrible experience, I am committed
to joining forces with Congress and the SSA to fix the problems with
this disability benefits program. I am devoting whatever is left of my
life to make sure that nobody else will ever have to endure the hell
that I have been forced to live with every day, and I hope you will
join me in that quest. I also ask that you forgive the harshness in the
tone at times of the this testimony, but I feel it is the only way to
fully, and accurately describe the severity of this issue.
It is also important to note that I am also President/Co-Founder of
the Social Security Disability Coalition, which is made up of thousands
of Social Security Disability claimants and recipients from all over
the nation, and our membership increases by the day. It was born out of
my frustration with my own experience and the notion that others may be
dealing with that same frustration. Our group is a very accurate
reflection and microcosm of what is happening to millions of Social
Security Disability applicants all over this nation. If you visit the
Social Security Disability Coalition website, or the Social Security
Disability Reform petition website:
Social Security Disability Coalition--offering FREE information and
support with a focus on SSD reform:
http://groups.msn.com/SocialSecurityDisabilityCoalition
Sign the Social Security Disability Reform Petition--read the horror
stories from all over the nation:
http://www.petitiononline.com/SSDC/petition.html
You will read over five years worth of documented horror stories on
our Messageboard (over 18,000 messages), and see thousands of
signatures (over 7600) and comments on our petition, from disabled
Americans whose lives have been harmed by the Social Security
Disability program. You cannot leave without seeing the excruciating
pain and suffering that these people have been put through, just
because they happened to become disabled, and went to their government
to file a claim for disability insurance that they worked so very hard
to pay for. I must take this opportunity to tell you how very proud I
am of all our members, many like myself, whose own lives have been
devastated by a system that was set up to help them. In spite of that,
they are using what very little time and energy they can muster due to
their own disabilities, to try and help other disabled Americans
survive the nightmare of applying for Social Security Disability
benefits. There is no better example of the American spirit than these
extraordinary people!
This organization fills a void that is greatly lacking in the SSDI/
SSI claims process. While we never represent claimants in their
individual cases, we are still able to provide them with much needed
support and resources to guide them through the nebulous maze that is
put in front of them when applying for SSDI/SSI benefits. In spite of
the fact that the current system is not conducive to case worker,
client interaction other than the initial claims intake, we continue to
encourage claimants to communicate as much as possible with the SSA in
order to speed up the claims process, making it easier on both the SSA
caseworkers and the claimants themselves. As a result we are seeing
claimants getting their cases approved on their own without the need
for paid attorneys, and when additional assistance is needed we connect
them with FREE resources to represent them should their cases advance
to the hearing phase. We also provide them with information on how to
access available assistance to help them cope with every aspect of
their lives, that may be affected by the enormous wait time that it
currently takes to process an SSDI/SSI claim. This includes how get
Medicaid and other State/Federal programs, free/low cost healthcare,
medicine, food, housing, financial assistance and too many other things
to mention here. We educate them in the policies and regulations which
govern the SSDI/SSI process and connect them to the answers for the
many questions they have about how to access their disability benefits
in a timely manner, relying heavily on the SSA website to provide this
help. If we as disabled Americans, who are not able to work because we
are so sick ourselves, can come together, using absolutely no money and
with very little time or effort can accomplish these things, how is it
that the SSA which is funded by our taxpayer dollars fails so miserably
at this task?
Social Security Disability Claimants Face Death and Destruction When
Applying for Benefits
I must report with great sadness and disgust, that there is blood
and destruction on the hands of both the Social Security Administration
and Congress. Both have been systematically killing and devastating the
lives of the most vulnerable citizens of this nation for decades. I
firmly believe (while nobody from the SSA or Congress will ever admit
this), the Social Security Disability program is structured to be very
complicated, confusing, and with as many obstacles as possible, in
order to discourage and suck the life out of claimants, hoping that
they ``give up or die'' trying to get their SSDI benefits!
During 2006 and 2007, at least 16,000 people fighting for Social
Security Disability benefits died while awaiting a decision (CBS News
Report--Disabled And Waiting--1/14/08). NOTE: This is more than 4 times
the number of Americans killed in the Iraq war since it began.
During 2007, two-thirds of all applicants that were denied--nearly
a million people--simply gave up after being turned down the first time
(CBS News Report--Failing The Disabled--1/15/08)
In 2007 there were 2,190,196 new applications for SSDI benefits,
and as of March 2008 there have already been 563,769 new applications.
As of April 2008 there are about 1,327,682 total pending cases and
out of that number, 154,841 are veterans.
Nationally as of March 2008, over 64% of disability cases were
denied at the initial stage of the disability claims process and it
took from 104.5-114 days for claimants to receive the initial decision
on their claim.
If a claimant appeals the initial denial asking for
reconsideration, in all but 10 test states where the reconsideration
phase has been removed, 86.5% of cases were denied and the waiting time
for this phase was an average of 88.8 days.
As of April 2008 over 756,000 are waiting for hearings with an
average wait time of 517 days
As of April 2008 over 286,000 (38%) hearings have already been
pending over a year, and there are only 951 Administrative law judges
(ALJ's), to hear all those cases, with an average of 738.02 cases
pending per judge nationwide.
Source: Social Security Administration Reports
Two-thirds of those who appeal an initial rejection eventually win
their cases (New York Times 12/10/07)
According to Health Affairs, The Policy Journal of the Health
Sphere, 2 February 2, 2005: Disability causes nearly 50% of all
mortgage foreclosures, compared to 2% caused by death.
MarketWatch: Illness and Injury As Contributors To Bankruptcy--
February 2, 2005--found that: Over half of all personal U.S.
bankruptcies, affecting over 2 million people annually, were
attributable to illness or medical bills. Fifteen percent of all
homeowners who had taken out a second or third mortgage cited medical
expenses as a reason.
According to an insurance survey, conducted by the International
Communications Research of Media, PA from Jan 10-14th 2007, on behalf
of the National Association of Insurance Commissioners, researchers
found 56% of U.S. workers would not be able pay their bills or meet
expenses if they become disabled and unable to work. 71% of the 44% who
had insurance, stated it was employer provided, so if they lose or
change jobs they would no longer have disability coverage.
In April 2006, Parade Magazine in an article called ``Is The
American Dream Still Possible?''--published the results of their survey
of more than 2200 Americans who earned between $30,000 and $99,000 per
year, most stating that they were in reasonably good health. Sixty-six
percent say they tend to live from paycheck to paycheck and nearly 83%
say that there is not much money left to save after they have paid
their bills.
Other Important Disability Statistics:
Nearly 1 in 2 (133 million) Americans live with a chronic
condition.
20.6% of the population, about 54 million people, have some level
of disability
9.9% (26 million people) have a severe disability
Note: The sources for these statistics and even more information is
listed here:
http://www.mychronicillness.com/invisibleillness/statistics.htm
This is totally unacceptable and there is absolutely no excuse for
this!
On behalf of the Social Security Disability Coalition, our response
to Congress and the SSA for this situation is:
For everyone of us that starves, becomes homeless or loses our
healthcare during this process--we blame you!
For everyone of us who files for bankruptcy during this process--we
blame you!
For the unfathomable stress and suffering we have inflicted upon us
during this process--we blame you!
For everyone of us who becomes more ill or worse yet dies during
this process--we blame you!
Horrendous Customer Service On The Part Of SSA And Congress
A January 2007 Harris poll designed to evaluate the services
provided by 13 Federal agencies, the public rated SSA at the bottom of
the list and it was the only agency that received an overall negative
evaluation. At one time in the recent past SSA was viewed by the public
as one of the best Federal agencies in delivering service. Now after
substantial staffing cuts, SSA is at the bottom of the public
acceptance list. SSA Field Offices have lost over 2,500 positions since
September 2005 and nearly 1,400 positions since September 2006. In 2007
SSA Field Offices are averaging about 850,000 visitors a week.
Constituents visiting these local Field Offices continue to experience
lengthy waiting times and the inability to obtain assistance via the
telephone.
In our country you're required to have auto insurance in order to
drive a car, you pay for health insurance, life insurance etc. If you
filed a claim against any of these policies, after making your
payments, and the company tried to deny you coverage when you had a
legitimate claim, you would be doing whatever it took, even suing, to
make them honor your policy. Yet the government is denying Americans
their right to legitimate SSDI benefits everyday. This is outrageous
when something this serious, and a matter of life and death, could be
handled in such a poor manner. No other company or other government
organization that I know of operates with such horrible results and
turn around times. If any other corporation in this country did
business like this, the majority of employees would be fired on the
spot, and the company would be shut down within a year, yet these
problems have been growing worse for decades.
Congressional offices as part of their functions, contact Social
Security on behalf their constituents going through the SSDI process
all the time, so you must be fully aware of all the problems, and are
the ones who can help correct many of them. I find it incredulous that
almost nothing has been done to initiate reform of the system that is
wreaking havoc on the disabled citizens of this nation. While the
majority of Americans were shocked at the reaction of the Federal
government in the aftermath of hurricane Katrina, I wasn't surprised at
all to see people dying in the streets. I shudder to think of how many
more lives will be further ruined or lost, when the mentally and
physically disabled victims of Katrina, other natural disasters, 9/11
victims who survived that day, but are now disabled and facing a
similar fate, Veterans and the millions of other disabled Americans,
encounter their next experience with the Federal government as they
apply for their SSDI benefits. Little or nothing is heard about the
service men and women who are injured and have to go through this
nightmare to get their SSDI benefits, in addition to their struggles
with the VA. Horrible treatment for those who give of their lives to
protect our country. We are all being abused at the hands of our
government, and to date our cries for help have continually been
ignored. This apathetic, negligent attitude towards this crisis must be
changed immediately. I am sad to say that you have failed us miserably,
doing us a grave injustice in this area. It's time that you speak out
about the crimes being committed against your constituents, and create
the legislation needed to correct decades of abuse and corruption of
this Federal program. Keep in mind a country is only as strong as the
citizens that live there, yet the current Social Security Disability
program preys on the weak, and decimates the disabled population even
further.
Permanent Devastation Resulting From The SSDI Claims Process
Many are under the mistaken notion that once the SSDI benefit
checks come, if one is finally approved for disability benefits, that
everything will be OK. Often the devastation caused while waiting for
SSDI claims to be processed leaves, permanent scars on one's health and
financial wellbeing as it did for me. Unbearable stress, severe
depression and suicidal thoughts are very common side effects of the
disability claims process. I know this not only from my own personal
experience, but from thousands of others that have contacted me to
relate their personal experiences with the SSDI claims process. The
abuse and worry that applicants are forced to endure, causes even
further irreparable damage to their already compromised health, and is
totally unacceptable. Due to the total devastation on their lives and
health as a result of the SSDI claims process, use of the SS Ticket to
Work program, or any future chance of possibly getting well enough to
return to the workforce, even on a part time basis, becomes totally out
of the question. Plus there is always the stress of having to deal with
the SS Continuing Disability Review Process every few years, where the
threat of having your benefits suddenly cut off constantly hangs over
your head.
Call For Open Congressional/SSA Disability Hearings
I also find it deeply disturbing, and glaringly obvious, that at
this latest hearing, and at past hearings over the last several years
on this issue, that not one panelist/witness selected to appear, has
been a disabled American, and one who has actually experienced this
nightmare first hand. Something is severely wrong with that picture!
You continually choose the same panelists from the legal, disability
advocate community etc when there is any representation at all. Unless
you personally have experienced these problems yourself, you cannot
even begin to fully understand how devastating they really are, and
therefore are not fully qualified to be the only authority on these
issues. It is my understanding that there are also those within the SSA
itself, who have wanted to testify for several years, and until
recently have also been shut out of these hearings as well. In my
opinion, it seems that you don't want to know what is really going on.
If you don't actually have to face us in person, we remain a bunch of
SS numbers whose lives can be destroyed without guilt. We are in fact,
your mothers, fathers, sisters, brothers, children, grandparents,
honorable veterans who have served this country, your friends and
neighbors.
How you get an accurate handle on this situation without all the
facts and possible witnesses who wish to testify in person? I find it
hard to believe that these hearings cannot be scheduled in such a way
that more appropriate witnesses could be chosen to testify. As an
actual disabled American, I ask again as I have in the past, that in
future Congressional hearings on these matters, that I be allowed to
actively participate instead of being forced to always submit testimony
in writing, after the main hearing takes place. I often question
whether anybody even bothers to read the written testimony that is
submitted when I see the results of hearings that were held in the
past. I am more than willing to testify before Congress, to risk my
very life for the opportunity, and I should be permitted to do so. I
want a major role in the Social Security Disability reformation
process, since any changes that occur have a direct major impact on my
own wellbeing and that of our members. Who better to give feedback at
these hearings than those who are actually disabled themselves, and
directly affected by the program's inadequacies! A more concerted
effort needs to be utilized when scheduling future hearings, factoring
in enough time to allow panelists that better represent a wider cross
section of disabled Americans, to testify in person. It seems to me if
this is not done, that you are not getting a total reflection of the
population affected, and are making decisions on inaccurate
information, which can be very detrimental to those whom you have been
elected to serve. I also propose that Congress immediately set up a
task force made up of SSDI claimants, such as myself, who have actually
gone through the SSDI system, that has major input and influence on the
decision making process before any final decisions/changes/laws are
instituted by the SSA Commissioner or Members of Congress. This is
absolutely necessary, since nobody knows better about the flaws in the
system and possible solutions to those problems, then those who are
forced to go through it and deal with the consequences when it does not
function properly.
There are three key reasons why the Social Security Disability
program has been broken for decades, lack of proper funding for the
SSA, apathy on the part of Congress and the SSA to fix the problems,
and lack of oversight on all crucial parts of the program.
SSA Commissioner Improperly Allocates ALJ's For SS Disability Hearings
Recently SSA Commissioner Michael Astrue asked Congress to approve
extra funding in order to hire additional ALJ's to try and reduce the
severe SS Disability hearings backlogs across the country. While I
agree that the SSA does need more funding, in fact way more than was
actually finally given to them, there must be some major oversight by
independent entities to ensure that these funds in fact are actually
used/allocated appropriately. Here is a recent example that raises a
red flag for such oversight and an immediate investigation. At the link
below you will find a spreadsheet that shows the locations where the
newly acquired ALJ announced by the SSA Commissioner have been
allocated
As of March 2008:
It takes 669 days (nearly two years) for the average Western New
Yorker to have their SSA case heard and processed in the Buffalo
Hearing Office. This office is the worst in NY State for SS Disability
hearing backlogs and out of 145 hearing offices nationwide, Buffalo
ranks at 126, as one of the worst processing times in the country.
It ranks at 111 out of 145 hearing offices, at 47%, for the number
of SSA hearings SSA cases in the Buffalo Hearing Office have been
pending for over a year, among the highest percentages in the country.
Administrative Law Judges in Buffalo have some of the largest
caseloads in the country, with an average of 895 cases pending before
each judge.
Source: Compiled from various SSA reports March 2008
Commissioner Astrue used the Argument that there was not enough
office space in the Buffalo hearing office but that was immediately
refuted by Congressman Brian Higgins:
Congressman Higgins Says Lack of Space Is Poor Argument for
Staffing Shortfalls in Local Social Security Disability Office--4/24/08
http://higgins.house.gov/newsroom.asp?ARTICLE3116=7715
``If the problem is office space, I would be happy to find them
available space in downtown Buffalo tomorrow,'' Higgins added, pointing
out that according to a Militello Realty report on downtown Buffalo
property, as of January 779,228 square feet of Class A office space was
vacant in the immediate downtown area. Congressman Higgins noted that
staffing shortages aren't exclusive to the Administrative Law Judges.
Staffing at Western New York field offices have decreased
substantially--by approximately 170 employees--over the past 25 years,
even though the need for services has increased.''
How many other states is this happening to? Where is the much needed
oversight on this issue?
Severe under staffing of SSA workers at all levels of the program
Claimants waiting for weeks or months to get appointments, and hours to
be seen by caseworkers at Social Security field offices
Extraordinary wait times between the different phases of the disability
claims process
Very little or no communication between caseworkers and claimants
throughout the disability claims process before decisions are made.
Employees being rude/insensitive, not returning calls, not willing to
provide information to claimants or not having the knowledge to do so
Complaints of lost files and in some states, case files being purposely
thrown in the trash rather than processed properly
Security Breaches--Complaints of having other claimants information
improperly filed/mixed in where it doesn't belong and other even worse
breaches
Fraud on the part of DDS/OHA offices, ALJ's, IME's--purposely
manipulating or ignoring information provided to deny claims, or
doctors stating that they gave medical exams to claimants that they
never did.
Claimants being sent to doctors that are not trained properly, or have
the proper credentials in the medical field for the illnesses which
claimants are being sent to them for.
Complaints of lack of attention/ignoring--medical records provided and
claimants concerns by Field Officers, IME doctors and ALJ's.
Employees greatly lacking in knowledge of and in some cases purposely
violating Social Security and Federal Regulations (including Freedom of
Information Act and SSD Pre-Hearing review process).
Claimants cannot get through on the phone to the local SS office or 800
number (trying for hours even days)
Claimants getting conflicting/erroneous information depending on whom
they happen to talk to at Social Security--causing confusion for
claimants and in some cases major problems including improper payments
Proper weight not being given to claimants treating physicians
according to SSA Federal Regulations when making medical disability
determinations on claims.
Complaints of ALJ's ``bribing'' claimants to give up part of their
retro pay (agreeing to manipulation of disability eligibility dates) or
they will not approve their claims
Poor/little coordination of information between the different
departments and phases of the disability process
Complaints of backlogs at payment processing centers once claim is
approved
Federal Quality Review process adding even more wait time to claims
processing, increasing backlogs, no ability to follow up on claim in
this phase
NOTE: These complaints refer to all phases of the SSDI claims process
including local field offices, state Disability Determinations
offices, CE/IME physicians, Office of Hearings and Appeals, the
Social Security main office in MD (800 number).
States Of Denial--Federalize State DDS Offices
Since Social Security Disability is a Federal program, where you
live should not affect your ability to obtain benefits. Sadly this is
not the case. The only way to solve this inconsistency is to Federalize
the State DDS's and we are in agreement with AFGE on this. The first
problem that must be addressed, and major cause for the huge backlog of
disability hearing claims, is the overwhelming denial rate at the
initial DDS level of the claims process. If claims were processed
properly at this stage of the process there would be no need for the
claimant to appeal to the ALJ hearing phase in the first place, and
that would be a huge factor in reducing the hearing backlogs. It seems
that this fact has been greatly ignored.
The SSDI/SSI process is bogged down with tons of paperwork for both
claimants and their treating physicians, and very little information is
supplied by Social Security, as to the proper documentation needed to
process a claim properly and swiftly. When you file a claim for
benefits, you are not told that your illness must meet standards under
the Disability Evaluation Under Social Security ``Blue Book'' listing
of medical impairments, or about the Residual Functional Capacity
standards that are used to determine how your disability prevents you
from doing any sort of work in the national economy, or daily
activities, when deciding whether or not you are disabled. In other
words since the process is so nebulous from beginning to end, the deck
is purposely stacked against a claimant from the very start. Many times
when medical records are supplied by the claimant, they are lost or
ignored.
Excerpts from GAO Report GAO-04-656--SSA Disability Decisions: More
Effort Needed To Assess Consistency of Disability Decisions--
Washington--July 2004 which can found at:
http://www.gao.gov/new.items/d04656.pdf
``Each year, about 2.5 million people file claims with SSA for
disability benefits . . . About one-third of disability claims denied
at the state level were appealed to the hearings level; of these, SSA's
ALJ's have allowed over one-half, with annual allowance rates
fluctuating between 58 percent and 72 percent since 1985. While it is
appropriate that some appealed claims, such as those in which a
claimant's impairment has worsened and prohibits work, be allowed
benefits, representatives from SSA, the Congress, and interest groups
have long been concerned that the high rate of claims allowed at the
hearing level may indicate that the decision makers at the two levels
are interpreting and applying SSA's criteria differently. If this is
the case, adjudicators at the two levels may be making inconsistent
decisions that result in similar cases receiving dissimilar
decisions.''
``Inconsistency in decisions may create several problems . . . SSA
rulings are binding only on SSA adjudicators and do not have to be
followed by the courts . . . Adjudicators currently follow a detailed
set of policy and procedural guidelines, whereas ALJ's rely directly on
statutes, regulations, and rulings for guidance in making disability
decisions . . . If deserving claimants must appeal to the hearings
level for benefits, this situation increases the burden on claimants,
who must wait on average, almost a year for a hearing decision and
frequently incur extra costs to pay for legal representation. . .SSA
has good cause to focus on the consistency of decisions between
adjudication levels. Incorrect denials at the initial level that are
appealed increase both the time claimants must wait for decision and
the cost of deciding cases. Incorrect denials that are not appealed may
leave needy individuals without a financial or medical safety net. . .
What would be an incentive for states to deny Federal claims? Since
many Social Security Disability claims are SSI or both SSI/SSDI
combined claims and many states offer to supplement SSI payments at a
higher benefit amount, therefore they want to keep as many off the
rolls as possible so they do not have to pay out this supplement. Also
since there is a different pay scale for government vs state employees
who are often underpaid, lack training, are overworked, and must meet
quotas of cases processed, the tendency is greater to rubber stamp
denials to move it off their desk when a case need too much
development. Thus the explanation for the fluctuation in denial/
approval/backlog rates by state. Unfortunately there is very little if
any training or oversight on the state DDS offices to make sure they
are making the proper decisions on disability claims. This is why so
many claimants appeal to the hearing level where a huge percentage of
bad claims decisions are overturned and cases are finally approved.
Anyone who doesn't see that a ``Culture Of Denial'' has become a
pervasive part of an SSDI claimants encounter with the SSA, is either
totally out of touch with reality or is reacting evasively to the
subject.
Social Security Disability Program Problems--Contributing Burden Factor
on Medicaid/Social Service Programs For States
There seems to be a relationship, between SSDI claims processing
issues/backlogs, and the need for claimants to also apply for state
funded Medicaid/Social Service programs. Many are forced to file for
Medicaid, food stamps and cash assistance, another horrendous process.
Those who file for these programs while waiting to get SSDI benefits,
in many states, have to pay back the state out of their meager benefit
checks once approved. As a result they're often kept below the poverty
level, almost never able to better themselves since they can't work,
and now are forced to rely on both state and federally funded programs
instead of just one of them. This practice should be eliminated.
Improper CE/IME Medical Exams Ordered By Social Security Result In
Higher Rate Of Denials/Appeals
CE/IME examiners are paid a fee by Social Security for each person
they see, so the more claimants they process, the more money they make.
Often times they are caught saying they performed exams that they in
fact never performed, or make mistakes, even false statements about
claimants. Many times the DDS offices or ALJ's are sending claimants to
doctors that have very limited knowledge of their specific health
conditions, who are not specialists, or even the proper type of doctor,
to be examining a claimant for the type of medical conditions that they
have. Even though a claimant's treating physicians are supposed to be
given greater weight in decision making, this is often not the case.
These doctors see you once for a few minutes, and yet their opinion is
given greater authority than a claimant's own treating physician who
sees them in a much greater capacity? Something is way out of line with
that reasoning, yet it happens every day. It therefore results in a
waste of time, money and energy, for both the claimants and the SSA,
when the claimant ends up appealing a denial based on these improper
SSA ordered examinations.
Detrimental Regulations
There are some very detrimental, regulations that SSDI applicants
are subject to as well, and are a great shock to them. Under Federal
law, there's a five month benefit waiting period, and five months of
back money withheld, which claimants will never see again. It was
originally six months but Congress voted to reduce it to five.
Apparently it is assumed that disabled Americans do not need that
money. Studies have shown that most Americans have about two weeks of
financial resources to live on. SSDI recipients must also wait another
24 months, in addition to the 5 month waiting period from disability
date of eligibility (the date that SS determines that you were
officially disabled) in order to qualify for Medicare benefits. Keep in
mind that if you let any sort of health insurance policies lapse for
too long, and don't maintain continuous health coverage, you may have a
very difficult time getting a new insurance carrier, since they may
hold your poor health against you, and consider many things as ``pre-
existing conditions'' so you may not be covered for those illnesses.
Congress expects a population who can no longer work, to go without
five months of retro pay, have no health insurance, and wait several
months to several years to have their disability claims processed. In
my state when a healthy person loses their job, provides the necessary
documents and files for Unemployment Insurance, their payments
automatically start within a few weeks. It is blatantly obvious that
those who find this to be acceptable standards are totally out of touch
with reality and have no regard for human life.
Ticket To Work Program--Catch 22--Fear and Mistrust of the SSA
According to SSA disability guidelines: Social Security pays only
for total disability. No benefits are payable for partial disability or
for short-term disability. You have a valid claim if you have been
disabled or are expected to be disabled for 12 consecutive months, or
your condition will result in your death. Your condition must interfere
with basic work-related activities for your claim to be considered. If
your condition is severe but not at the same or equal level of severity
as a medical condition on the list, then they must determine if it
interferes with your ability to do the work you did previously. If it
does not, your claim will be denied. If you cannot do the work you did
in the past, the SSA looks to see if you are able to adjust to other
work. They consider your medical conditions and your age, education,
past work experience and any transferable skills you may have. If you
cannot adjust to other work, your claim will be approved. If you can
adjust to other work, your claim will be denied. Currently the SSA
forces the disabled to go through years of abuse trying to prove that
they can no longer work ANY job in the national economy due to the
severity of their illnesses in order to be approved for benefits. The
resulting devastation on their lives, often totally eliminates the
possibility of them ever getting well enough to ever return to the
workforce, even on a part time basis, in order to utilize the SS Ticket
to Work program. Yet ironically once they are approved they are allowed
to earn up to $900 and still receive benefits. Confusing to say the
least. Then sometimes weeks after they are finally approved for SSD/SSI
benefits, after their health and finances have been totally destroyed
beyond repair, they receive a ``Ticket To Work'' packet in the mail,
another waste of SSA funds. A cruel joke to say the least and it is no
wonder that they fear utilization of the Ticket to Work Program, and
distrust the Federal Government! The Ticket to Work Program is often
viewed as a carrot and stick it to the disabled approach. I recommend
in addition to the current Ticket to Work Program, funding for the
creation of an Interim (transitional) SSDI disability program for those
who are chronically ill, but still may be able to work a few hours a
week/month. They would apply for interim disability benefits to start
and for every month they could not work they would get a full check.
For any full month or portion of a month that they could work they
would be paid the difference or nothing based on the amount of the SSDI
benefit they would earn by not working that month. They would be
eligible for full Medicare benefits from the onset. When their
illnesses progressed to a point that working is no longer an option,
full SSDI benefits would automatically kick in. This would continue to
increase benefits for the SSA trust fund, since these part time workers
would still be contributing to the fund.
Continuing Disability Review/CDR Process Must Be Changed
Many people suffer from conditions acquired at birth or chronic
conditions that have NO cures and over time these diseases grow
progressively worse with no hope of recovery or ever returning to the
workforce. The threat of possible benefits cut off, and stress of a
review by Social Security again is very detrimental to a recipients
health. This factor needs to be taken into consideration when reforming
the CDR process. In those cases total elimination of the tedious
medical component of CDR's should be considered, only requiring
verification of contact info, or a longer period of time between
reviews such as 10-15 years rather then every 3-7 years, as is
currently the case. This would save the SSA a great deal of time, money
and paperwork which could then be used to get new claimants through the
system faster.
Eliminate Need For Proposed Third Party Claims/Paid Legal
Representation
First of all the SSDI claims process should be set up so there is
very little need for cases to advance to the hearing and appeal stage
since that is where the major backlog and wait time exists. I feel
strongly that an SSDI claimant should not have to pay for legal
representation to get benefits that they have already paid for with
their taxes. I am also highly opposed to the possibility of a claimant
having to pay a third party for assistance to file a claim at the
onset. Congress must intervene immediately to prevent this from
happening, and in fact change the law that the claimant has to pay for
legal representation at all. This adds an additional financial burden
to the claimant. The current SSDI claims process is set up to line the
pockets of the legal system, as you are encouraged from the minute you
apply for benefits to get a lawyer. The need of lawyers/reps to
navigate the system and file claims, and the SSD cap on a lawyer's
retro commission is also a disincentive to expeditious claim
processing, since purposely delaying the claims process will cause the
cap to max out--more money to the lawyer/rep for dragging their feet
adding another cost burden to claimants. In other words the system is
structured so that it is in a lawyer's best interest for your case to
drag on since they get paid 25% of a claimant's retro pay up to $5300--
the longer it takes the more they get. From the horror stories I hear
from other claimants, many attorneys are definitely taking advantage of
that situation. The SSA should instead provide claimants with access to
FREE resources that can help in the process of filing SSDI claims and
keep the legal community out of it.
Americans Most Sensitive Data in Jeopardy
The following article discusses the SSA employee work at home
situation.
Concern Over Federal Times Article: Arbitrator Tells SSA To Restore
Telework, Negotiate Changes--Federal Times--Courtney Mabeus--
4/16/08
http://www.federaltimes.com/index.php?S=3482166
I am very concerned with the increased possibility of identity
theft if SSA employees are allowed to take work home because they are
too overloaded on their jobs. Employees should never be allowed to take
this sensitive data home for any reason. Sensitive data has already
been compromised at the VA, and this should not be allowed to happen
ever again, especially jeopardizing our most vulnerable citizens to
this very real and stressful possibility. I have personally caught the
SSA in some major security breaches already, and this practice will
only make those incidents even more common. Every effort must be made
to properly secure this most sensitive information for the American
people. In order to properly protect citizen's identities ALL sensitive
data should only be able to be accessed on government secure systems at
the job site only. This is obviously going to require more manpower and
financial resources, and Congress must make sure that the SSA has every
resource it needs to protect this data, at their disposal immediately.
Influx Of Improper SS Disability Claim Filings Due To State And Private
Insurance Company Policies
There is a growing number of claims being filed by people who may
not actually qualify for disability benefits under SSDI guidelines, but
are being forced to file SSDI claims by their private disability and
state disability carriers or risk not being eligible for benefits under
those programs. Recently there was an article on this issue in the NY
Times which can be found here:
Insurers Faulted As Overloading Social Security--NY Times--Mary
Williams Walsh--4/1/08
http://www.nytimes.com/2008/04/01/business/01disabled.html
Congress and the SSA needs to immediately look into this issue and
this practice needs to be stopped immediately as this greatly adds to
the disability backlog problem.
Reinstate DCM
Currently, the most crucial part of a disability claim, the medical
portion, is reviewed by a state DDS caseworker/adjudicator and medical
doctor on their staff who never sees you, and in most cases never even
communicates with you at all. Then they make a critical life changing
decision as to whether or not they feel you are disabled based on the
information that you and your doctors have provided. It is absolutely
necessary for a claimant to be able to communicate with the decision
maker and to be able to provide updated information on their medical
conditions, especially before a decision is made on a claim. It is
common sense, that proper communication at the initial level, would
definitely result in a reduction of appeals at all further levels of a
disability claim. The high decision reversal rate at the hearing (ALJ)
level is concrete proof of that. It is recommended that the Disability
Claims Manager (DCM) pilot, where DCMs were responsible for making both
the entitlement and disability decisions for initial disability claims,
be reinstated, and eventually extended to the entire country. With
proper staffing to allow for communication between decision maker and
claimant, this would definitely result in time and cost savings, for
both the SSA and the claimants if this were reinstated.
Excerpts from GAO Report GAO-04-656--SSA Disability Decisions: More
Effort Needed To Assess Consistency of Disability Decisions--
Washington--July 2004 which can found at:
http://www.gao.gov/new.items/d04656.pdf
An appeal adds significantly to costs associated with making a
decision. According to SSA's Performance and Accountability Report for
fiscal year 2001, the average cost per claim for an initial DDS
disability decision was about $583, while the average cost per claim of
an ALJ decision was estimated at $2,157. . .An appeal also
significantly increases the time required to reach a decision.
According to SSA's Performance and Accountability Report for fiscal
year 2003, the average number of days that claimants waited for an
initial decision was 97 days, while the number of days they waited for
an appealed decision was 344 days.
Changes/Proper Funding Necessary For SSA
SSA should not have to compete each year for funding with the
Departments of Labor, HHS and Education which are more publicized and
often popular programs. As stated in the previous testimony provided by
Witlold Skierwczynski--President--National Council Of Social Security
Administration Field Operation Locals to this Committee on 4/23/08 it
is recommended that:
Congress should enact off budget legislation including SSA
administrative expenses with benefits which are already off budget.
Congress should retain appropriations and oversight authority albeit
unencumbered by artificial budget caps and scoring restrictions.
Congress should enact legislation requiring the Commissioner to
submit the SSA appropriation request directly to Congress.
Congress should support the House Budget Committee recommendation
to increase the SSA administrative budget by $240 million over the
President's budget request.
Concern Regarding SSA's Future Movement Away From Personalized Customer
Service
I totally disagree with the agency's goal of eliminating an SSA
employee to assist with the filing of a claim. I am very concerned
about recent changes that emphasize the use of the internet for filing
Social Security Disability claims. In fact I always urge our members to
file in person rather than use the internet to file their disability
claims. Many disabled Americans do not have access to the internet or
their disabilities prevent them from using it properly. This can result
in improper filing of a claim and delay or result in a denial of
benefits. Since we encourage our members to provide as much medical
information as possible to the SSA at the initial filing of their claim
in order to speed up the process, it is impossible to provide this
information if a claimant chooses to use the internet instead. I agree
with previous testimony provided by Witlold Skierwczynski--President--
National Council Of Social Security Administration Field Operation
Locals to this Committee on 4/23/08, that here are several flaws with
this proposed movement as follows:
Programming flaws that do not correctly identify the ``protected
filing date/disability date of eligibility.''
Identity and privacy concerns
Incorrect payments
High volume of errors, resulting in re-contacts.
Creation of a new backlog at Social Security
No review process of the public's accuracy in completing
applications
I am very concerned about the loss of protected filing for internet
claims and this should never be allowed. This could result in a major
loss of much needed benefits which is not acceptable. Immediate efforts
must be made to look into and correct this situation.
Lag earnings must also continue to be properly developed so that a
claimant's wages can be easily added to the benefit computation at the
initial interview and to make sure that proper payments are made to
claimants right from the start. The encouragement of internet claims
filing will make this almost impossible. This will cause a dramatic
increase in improper payments, and unnecessary wasted time for both the
claimants and SSA resources.
I am totally against the implementation of the Accept Allegation of
Month of Entitlement--Effective September 2008. The majority of the
general public, and especially Americans with disabling conditions, are
in no way knowledgeable enough to properly make this life altering
decision without full disclosure and human assistance. This again will
cause many unnecessary under and over payments and could result in
permanent harm to disability claimants.
The American people must always be given the option to file their
claims using whatever method best suits their capabilities, and be
ensured that the results will be accurate and in their best interest,
no matter what option they choose. It must become mandatory that every
internet claim submitted, must be fully reviewed and followed up by
personal contact between an SSA employee and the claimant to ensure its
total accuracy. Every effort must be made on the part of the SSA to
continue provide personal customer service to the most vulnerable
citizens of this nation. Anything less than that is unconscionable and
totally unacceptable.
Unacceptable Office Closures
I am very discouraged by the number of SSA Office closures that I
continually hear about. It is another example of poor customer service
to the American people when the need for that service is only going to
increase over time as the population ages. In fact a record number of
offices were closed in 2007 and more closures are on the horizon. This
puts more stress and strain on the health of disability applicants, and
increased financial burden, when they have to travel several miles just
to do business with Social Security. They often have to wait months for
claim processing appointments, and have to stand in lines for hours as
well when they can get to the nearest SS office at all. There is no
good excuse for this. Where is the oversight?
I support the Social Security Customer Service Improvement Act,
H.R. 5110, which was introduced by Representative Brian Higgins (D/NY),
on January 24, 2008, which contains procedures that the SSA
Commissioner must follow before closing an office. I urge Congress to
quickly pass this proposed legislation and pass additional legislation
putting a moratorium on all office closures, before more disabled
Americans are harmed and inconvenienced.
I highly recommend that for the best, most efficient customer
service to the American people, that ALL SSA operations be federalized,
and that ALL phases of the Social Security Disability program, initial
decisions, reconsiderations, hearings and appeals be moved to, and
handled out, of the individual field offices throughout the country. I
also recommend that more offices be opened to properly serve the public
and to implement the changes properly.
The Nightmare Continues--Excerpts From Social Security Administration:
Inadequate Administrative Funding Contributes to the Disability
Claims Backlog Crisis and Service Delivery Challenges--Prepared
by the National Council of Social Security Management
Associations (NCSSMA) March 13, 2008
Due to budget constraints in recent years the amount of
administrative funding the Social Security Administration (SSA) has
received through the appropriations process has been significantly
below the level necessary to keep up with the agency's workloads.
As a result, the backlog of unprocessed disability claims has grown
to unprecedented levels and the system is now in a state of crisis. As
the backlog grows, claimants face multi-year delays for hearings on
their claims for benefits. The long wait for their day in court often
leads to homelessness, lack of medical care and the loss of family and
friends. And sadly, thousands die while waiting for a hearing.
The effects of the backlog also extend throughout the agency. As
SSA works to address the crisis, the agency is forced to divert its
limited resources away from its day-to-day operations in Field Offices
and Payment Processing Centers in order to try to manage the disability
backlog. SSA disability claims and hearings continue to grow and
hearing processing times are at record highs. If SSA does not receive
funding above the President's Budget Request for FY 2009, the hearings
backlog will still be quite significant.
The 800 Number had a busy rate of 7.5% in FY 2007 and handled about
59 million calls through agents and automation. At the same time over
60 million phone calls are directed to SSA Field Offices each year. In
FY 2006, 51% of callers who tried to reach a Field Office received a
busy signal.
Staffing is at its lowest level in 35 years: Staffing at SSA will
reach its lowest level since 1972, before SSI was established; yet, SSA
today has about twice the number of beneficiaries it had in 1972. Since
the beginning of Fiscal Year 2006, SSA Field Offices have lost nearly
1,800 Claims Representatives and over 460 Service Representatives. The
Teleservice Centers have lost about 560 Teleservice Representatives. In
Fiscal Year 2008 Field Offices will not be able to adequately address
staffing losses. The Disability Determination Services (DDSs) have lost
over 1,200 positions since the beginning of Fiscal Year 2006, as a
result their staffing levels are down nearly 8%. The Program Center
that handles disability actions (Office of Disability Operations) has
about 750,000 actions pending. This compares to 511,000 actions pending
at the beginning of FY 2007. The average amount of time it takes for a
Benefit Authorizer to process a Post Eligibility case they are assigned
as of the end of February 2008 is 327 days. For Claims Authorizers it
is 378 days.
SSA's workloads continue to rise: Congress continues to add to
SSA's workloads--for example, by assigning SSA responsibility for
administering portions of Medicare Parts B and D, and conducting Social
Security Number verifications and other immigration-related activities.
However, SSA's administrative funding has not kept pace with the
agency's increased responsibilities. 870,000 people on average visit
SSA Field Offices each week. Since the beginning of the year, SSA Field
Offices have been averaging about 950,000 visitors per week. In two
separate weeks at the beginning of Calendar Year 2008, SSA offices set
all time record highs for visitors. As of FY 2008 SSA has a backlog of
3,300 work years. This is expected to grow to 8,100 work years in FY
2009. This backlog includes hearing cases, overpayments and
underpayments on cases, check problems, earnings record corrections and
recomputation of benefit, Medicare enrollment actions and returning
phone messages.
In Closing On Behalf Of The Social Security Disability Coalition:
The Social Security Disability program, which was originally set up
to help us is currently failing miserably at this task, and in fact, in
many cases it is causing devastating, irreversible harm to our health
and financial wellbeing. We have contributed our hard earned money to
this system hoping we would never need it until we were ready to
retire. Where is the money going that has been mandatorily been taken
from our paychecks every week? Why should we have to become homeless,
bankrupt, starve, lose our healthcare coverage, suffer untold stress on
top of our illnesses and even die trying to get our benefits? Why
should we have to hire lawyers, wait years for hearings, go before
administrative law judges and be treated like criminals on trial? Why
have you ignored this crisis for so long, and done virtually nothing to
reform it? We, the disabled citizens of this nation, have been forced
to tackle a very daunting system and we challenge you to do the same,
and correct these problems which have festered for decades. We ask that
you please start taking care of the U.S. citizens living in this
country first before the rest of the world, especially the sick and the
dying, who trust you with their very lives and whom elected you into
office. It is your duty as elected officials to serve all those that
voted you into that office, and even those of us who didn't. When the
next election comes around we will not forget those who have forgotten
us. We may be disabled but we still have, and will use our right to
vote. They say you can judge a country by how it treats its most
vulnerable citizens. Based on current statistics, the USA should hang
its head in shame! It is our hope, and our right as American citizens,
to expect that you will come together as elected officials, and finally
act swiftly to do what is proper to protect and serve us.
I not only have complaints, but also solutions, so I hope you will
join me in my quest for total reform of this program. Thank you for
your time and consideration.
Sincerely,
Linda Fullerton
President/Co-Founder--Social Security Disability Coalition
[email protected]
585-225-3019/585-235-8412
PO Box 26378
Rochester NY 14626
Social Security Disability Coalition--offering FREE information and
support with a focus on SSDI reform:
http://groups.msn.com/Social Security Disability Coalition
Sign the Social Security Disability Reform Petition--read the horror
stories from all over the nation:
http://www.petitiononline.com/SSDC/petition.html
Please check out my website ``A Bump On the Head'' at:
http://www.frontiernet.net/lindaf1/bump.html
Social Security Disability Nightmare--It Could Happen To You!
http://www.frontiernet.net/lindaf1/
SOCIALSECURITYDISABILITYNIGHTMARE.html
CBS Evening New With Katie Couric--Disabled And Waiting--1/14/08
http://www.cbsnews.com/stories/2008/01/14/cbsnews--investigates/
main3712627.shtml
Statement of the National Association of Disability Representatives
The National Association of Disability Representatives is a
professional organization comprised of non-attorneys and attorneys who
assist people in applying for disability income assistance from the
Social Security Administration. Our members help individuals and their
families navigate an often complex and lengthy process to demonstrate
their eligibility for disability benefits. As advocates for claimants,
we want to commend Chairman Rangel and all of the Committee Members who
have demonstrated a keen interest in pushing for improvements in the
SSA disability determination process, and especially in the
unconscionable delays that are part of the current system.
Because NADR members are on the ``front lines'' helping persons
with disabilities complete applications, claimants, gather and submit
evidence, and attend Administrative Law Judge hearings with applicants,
we see first-hand the serious toll that the long wait for decisions can
take on people, most of whom are already experiencing significant life
changes, traumas, and hardships. The average processing time for cases
at the hearing level is now 535 days. Beyond this unconscionable
hearing delay, claimants must again wait for a decision, and if
successful, must wait still longer for actual payment of their claims.
Those facing grave or terminal illnesses may not live to see the
fiduciary promise they paid for each week in their paycheck from their
Social Security taxes. Families who need care-givers or other
assistance to provide necessary relief and support in helping their
loved ones may have to hang on for years, trying to balance family
needs without any help. This strains marriages, parent/child
relationships, and impoverishes people at a time when their need is
greatest.
As an illustration of the hardship real people have suffered as a
result of the hearing backlog, following is the story of a claimant
represented by a NADR member:
David filed concurrent claims for Social Security
Disability Insurance Benefits and Supplemental Security Income
disability benefits on November 9, 2004, alleging onset of disability
on June 15, 2004. Medical records indicated David suffered from
diabetes mellitus, hypertension, hypotension, chronic anemia, arterial
calcification of his left lower extremity and chronic diarrhea. The
initial claim was denied on February 25, 2005. Upon reconsideration,
the claim again was denied on June 24, 2005. An ALJ hearing was
requested July 22, 2005. On March 13, 2008, nearly 3\1/2\ years after
David filed his initial claim, a fully favorable decision was issued.
Unfortunately, at that point David had been dead for almost a year and
a half.
Other NADR members have reported the following examples of
claimants who died while waiting for a hearing:
Chiquita filed her claim on January 25, 2006. She
requested a hearing on April 26, 2006. She died on March 22, 2007 while
awaiting a hearing.
Barry filed his claim on March 3, 2005. He requested a
hearing on June 6, 2006. He died on April 27, 2007 while awaiting a
hearing.
Alex filed his claim on September 13, 2006. He requested
a hearing on December 29, 2007. He died on January 17, 2008 while
awaiting a hearing.
Amazingly, these stories are happening to individuals who are
``insured'' for disability, having paid their Social Security taxes,
including those that fund SSA disability benefits. Most assume that
these benefits will only be needed at retirement. Yet, when accidents
or illness strike, people reasonably expect to receive the critical
support that disability payments can offer. And, they most certainly
expect to get it within a reasonable timeframe. Unfortunately, many
Americans are not finding the government reliable in this arena.
Scope of Problem
The hearing level backlog has increased dramatically from the FY
1999 level of 311,968 cases, reaching 752,000 cases in FY 2008.
Cases Pending
2002: 468,262 requests for a hearing
2007: 717,000 (300,000 requests over a year old).
2008: 752,000
We applaud Congress' effort last year to address the backlog by
appropriating, for the first time in 15 years, not just the President's
budget request, but an additional $148 million for SSA administrative
expenses. While this is an important first step, sustained increases in
funding over several years are needed to get the backlog under control.
The President has requested an additional $600 million for SSA's
administrative expenses for FY 2009, bringing total funding to $10.327
billion. NADR believes that, at a minimum, SSA should be funded at the
level of the President's request plus $240 million for integrity work.
We recommend that Congress provide SSA with $11 billion in FY 2009 in
order to truly have an impact on the disability backlog, while
continuing to carry on other related administrative functions to serve
beneficiaries and applicants.
That said, it will take more than additional funding to address the
issues SSA faces as a result of the dwindling resources and increased
workload it has sustained over the past decade.
NADR Supports Earlier Decisions by Expanding QDD, by Developing the
Technology Necessary to Allow for Compassionate Allowances and by
Prioritizing Backlog Cases for Quick Decisions
NADR believes SSA can expedite movement through the backlog by
targeting certain claims that can be resolved quickly--i.e. that have a
high likelihood for ``on the record'' decisions. These same criteria
can also be applied to SSA's Quick Disability Determinations (QDD) and
the Commissioner's proposed new screening mechanism for Compassionate
Allowances so that cases with a likely outcome of disability are
processed fastest. Prioritizing of select cases can be started
nationally, or in two or three demonstration projects that target areas
with both ``medium'' and ``high'' backlogs.
What are the cases that can be culled from initial applications and
backlogs for speedy review?
1. Claimants 55 and Older & Cases Involving Claimants with Limited
Education
(Age/Grid Issues)
Currently SSA evaluates claims using criteria that include age and
education. In a nutshell, the older a claimant (particularly those who
attain age 55 and over) and the more limited the education that a
claimant has, the greater the latitude allowed to obtain a favorable
determination. When an individual achieves age 55, the grids will find
a person disabled when they have a limited education, have only
performed unskilled work in the past 15 years, and are limited in their
ability to sit for six hours in an eight hour day and lift more than 10
pounds occasionally. There are certainly additional nuanced issues
which must be considered in many cases but we believe that a cursory
review, based upon a computer run of persons who are over age 55 or
have attained age 55 during the application process, have a limited
education, and are physically limited in their capacity to lift, sit
and/or stand, may provide an expedited conclusion of disability with
reduced processing time. If a person has turned age 55 while awaiting a
hearing, this may further increase the potential of a favorable finding
based upon the grids.
2. Cases Denied Because the Claimant Did Not Meet the Requirement of
Being Impaired for 12 Consecutive Months (Durational Denial)
The definition of disability requires that a person cannot be found
disabled unless their disabling condition has lasted or can be expected
to last for 12 consecutive months, or that the condition is expected to
result in their death (durational requirement). Oftentimes individuals
with various impairments have applied for benefits within a month or
two after they have discontinued work. Many are quickly found to be
``not disabled,'' as there is a projection or expectation that the
impairment, while severe, will be resolved within the 12 month window.
These cases, when appealed, are then placed into the queue with all
other persons who have requested such. Since it typically takes nearly
a year to have a case heard by an Administrative Law Judge, persons
with durational denials may be easily screened after the 12th month,
given a quick review, and with minor updates of medical information,
found either eligible or continue to wait for the hearing
3. Back Cases with Multiple Spinal Surgical Interventions
Severe back pain significantly limits an individual's capacity to
sustain substantial gainful activity. Persons who have had more than
three back surgeries or have been diagnosed with ``failed back
syndrome'' are oftentimes deemed eligible for disability due to this
impairment. Yet, at the DDS levels, reviewers often do not adequately
consider how pain, fatigue, and the side effects of pain medication
impact an individual's capacity to sustain work. In our experience,
persons with a diagnosis of ``failed back syndrome''--those who have
had several surgical interventions that have left the individual with
significant pain, requiring regular utilization of pain medication or
the need for additional surgery--will ultimately be found disabled.
These cases make sense to prioritize.
4. Claimants with a Significant History of Mental Health Impairments
Individuals with severe mental health difficulties will oftentimes
but periodically have problems caring for themselves effectively. They
may meet Social Security's ``C'' criteria at times but due to the
cyclical nature of their disease, not at others. Individuals with
mental health impairments that wax and wane, that are usually widely
recognized as disabled, such as those with repeated hospitalizations or
those who have been institutionalized, can be quickly and efficiently
identified as persons who have disabling mental health conditions. For
example, a longitudinal history of the following would provide trusted
markers that demonstrate serious mental health impairments:
Consistently low ``Global Assessment of Functioning
(GAF)'' scores (rating criteria determined by a mental health
professional in accordance with the DSM-IV);
Necessity to live in structured living environments;
Special education placements throughout their school
career.
SSA should pull and review from the backlog all cases that match
these criteria.
5. Improve Communication Between Representative and Administrative Law
Judge
There are periods of time subsequent to a file being reviewed or
``pulled'' that a claim sits, simply waiting for administrative action.
During this time the issues that need clarification have been
identified but not revealed to the representative. There is little to
no communication from the Administrative Law Judge to the
representative thus, when entering a hearing, the representative rarely
knows the specific reasons that the ALJ believes the hearing was
necessary. It would be valuable and highly cost effective if a
statement of issues could be presented at the time the file is pulled
or the hearing is scheduled so the representative can investigate and
provide documentation that addresses the judge's concerns. This may
reduce or even eliminate the need for some hearings. As an example,
oftentimes it only becomes evident when before the ALJ, that the only
reason a hearing is being held is because earnings have been identified
that are over substantial gainful activity and after the person says
they are disabled. This can be anything from incorrect earnings--to
insurance payments--to supported work. A brief discourse before the
hearing asking for clarification of this issue may preclude the need
for a hearing by the representative obtaining the necessary
documentation.
Conclusion
We appreciate the opportunity to present our views on ways to
reduce the social security backlog. Our goal is to help our clients get
the assistance they need in the most efficient way possible. We have a
long way to go in transforming SSA's disability program into a more
timely and responsive safety net, but your leadership and attention
gives many of us reason to hope for improvements. We look forward to
continuing to work with Congress and with SSA Commissioner Michael
Astrue to assure that SSA is able to provide people with disabilities
the benefits to which they are entitled in a timely fashion.
Statement of National Law Center on Homelessness & Poverty
This testimony is submitted on behalf of the National Law Center on
Homelessness & Poverty and the National Policy and Advocacy Council on
Homelessness. The National Law Center on Homelessness & Poverty (NLCHP)
serves as the legal arm of the national movement to prevent and end
homelessness. The National Policy and Advocacy Council on Homelessness
is a grassroots, anti-poverty organization. NLCHP and NPACH work with
legal services attorneys, healthcare providers, case managers, and
social service and housing agencies that assist homeless persons with
disabilities who are seeking Supplemental Security Income (SSI) or
Social Security Disability Insurance (SSDI) benefits.
Serving homeless people poses a tremendous challenge to the already
overburdened SSI/SSDI applications process. However, relatively small
regulatory changes combined with effective outreach would grant a
lifeline to America's most vulnerable citizens while freeing up SSA
resources to focus on the remainder of the SSI/SSDI application
backlog.
Each year more than three million Americans experience
homelessness. Many homeless people are likely eligible for SSI or SSDI.
According to the largest and most rigorous Federal study of
homelessness ever done in the U.S.--the National Survey of Homeless
Assistance Providers and Clients (NSHAPC)--at least 32% of the overall
homeless population had serious mental health problems and at least 46%
had one or more chronic health conditions, such as AIDS, cancer, or
lost limbs.
At present, the SSI/SSDI application process has largely failed
these people.
According to the NSHAPC data, only 11% of homeless people received
SSI benefits, compared to 29% of formerly homeless people surveyed.
Further, two local studies found that only 10-15% of homeless
applicants were initially approved, compared to 37% of all applicants
nationwide. Lengthy appeals, costly in time and dollars, follow initial
denials.
Barriers that prevent eligible homeless persons from receiving SSI
and SSDI benefits include: (i) difficulty staying in contact with SSA;
(ii) difficulty in retaining or researching necessary documents and
information; (iii) lack of an approved, state-issued ID to allow access
to SSA offices in Federal buildings or to prove identity, and (iv)
difficulty obtaining medical records for purposes of documenting a
disability. Even when medical records are available, they may not be
from the limited types of healthcare professionals recognized as
``acceptable medical sources'' by SSA for the purpose of providing
primary medical evidence of a disability.
SSI and SSDI benefits provide more than a source of income for
homeless people. In many states, receipt of SSI benefits provides
access to medical care through the Medicaid program. In many
communities, receipt of benefits also makes clients eligible for
supportive housing, providing a permanent route out of homelessness.
We believe that SSA has the authority to make regulatory changes
and issue directives that could significantly address some or all of
these barriers. Some SSA offices have implemented processes that have
helped improve access for homeless people. However, these steps are
incomplete, apply only in a few places and allow significant barriers
to remain.
An examination of these points shows that positive changes are
possible.
Barriers and Problems that Contribute to SSA Backlog
Homeless applicants for SSI and/or SSDI face many bureaucratic
barriers that are extraordinarily difficult to overcome. These barriers
needlessly contribute to denials and lengthy appeals that continue
while an individual remains living on the street without any source of
income.
Studies have shown that persons with disabilities who are homeless
for long periods of time often consume disproportionate amounts of
emergency medical services, law enforcement resources, and social
service agency time and attention.
Homeless applicants for SSI/SSDI also may have difficulty
navigating the complex SSI/SSDI application process, resulting in
incomplete or technically incorrect applications, filing repeatedly and
failing to follow appeals processes in ways that allow accurate
outcomes. Lack of an address also makes it difficult for SSA offices to
follow-up with clients to obtain additional information.
These injuries are compounded when the homeless applicant is left
with no access to the services or housing that could help end
homelessness for the individual and long-term homelessness for states
and communities. The record is rife with stories of otherwise eligible
SSI/SSDI applicants, faced with delays that may last from 1-3 years,
simply succumbing to worsened or terminal health conditions.
In short, the current process is a systemic and personal disaster--
a disaster made all the worse because it is avoidable.
Over the years, community providers, homeless advocates, and those
focused specifically on assisting homeless individuals through the SSI/
SSDI process have developed an intimate familiarity with the problems
in the system and in so doing have identified an array of potential
solutions.
(1) SSI/SSDI application procedures fail to recognize unique needs
of different target populations. The SSI/SSDI application process
presumes that communication by mail is a sufficient means of notifying
applicants of appointments, requests for information and their progress
through the system. Homeless applicants along with those marginally or
transiently housed are thus left unserved.
Applicants are expected to provide comprehensive and complete non-
medical or non-disability information as well as medical histories. But
roughly half of SSI/SSDI applicants allege a mental impairment. This
impairment by its very nature complicates the document collection and
retention process.
A few local programs have succeeded in addressing some of these
barriers. A cooperative program between SSA and the Massachusetts'
Disability Determination Services ensures that homeless applications
are ``flagged'' and referred to a special team that processes homeless
applications. Creation of this special unit has resulted in increased
approvals of homeless applications.
Through demonstration projects such as the Baltimore SSI Outreach
Project and the SSA funded HOPE grants, SSA recognized the need to
provide greater assistance to homeless individuals. These demonstration
projects have been successful in improving the quality of the
applications submitted to SSA and improving results for applicants.
Unfortunately, however, these programs' processes have not been
integrated nationally into SSA's instructions to their field offices,
and as a result of the end of the demonstration projects, funding has
largely stopped for these community providers. What is needed is
funding not for demonstration projects but rather for changed
institutionalized processes.
Recommendation:
Require SSA to form partnerships and to establish flexible
processes nationally for the populations applying for SSI/SSDI who
require special assistance to navigate the process. Require SSA to work
with State Disability Determination Services offices to establish teams
that will specialize in serving the mixed populations of applicants who
need additional help and services. These specialists could work
collaboratively with community groups to ensure the kinds of
collaboration needed to process claims efficiently and accurately on
initial application.
Require SSA to report housing status along with data already
reported on the applicant population and outcomes (included in SSA
homelessness plan and not yet done).
(2) SSA offices are not able to maintain field representative
staff, making it harder to reach homeless persons with disabilities. As
the demand on SSA has increased and staffing has decreased, many SSA
offices no longer have field representatives. These staff were able to
go out in the community to assist the populations of individuals, such
as homeless adults, to apply for benefits. In addition, these
representatives often formed collaborative relationships with community
providers who could assist with locating people and providing
information. The reduction in field representative staffing has
contributed to greater difficulty in processing claims for this very
heterogeneous population.
Recommendation:
Restore hiring of field representatives to SSA offices.
(3) Photo identification required to access Federal buildings
prevents homeless persons from getting to the SSA office. Many homeless
adults lack photo IDs needed to enter Federal buildings. Although the
application process per se does not require a photo ID, accessing the
SSA office often does.
Recommendation:
Federal buildings with SSA offices should establish procedures for
acceptance of alternative ID, such as a letter of introduction from a
shelter or community service provider. A process under which people
without ID can be escorted from a building entrance to an SSA office
within should be implemented.
(4) Limits on communication with SSA other than by mail make it
difficult to reach homeless applicants. As noted above, people without
fixed address are not going to be served by the SSA policy of generally
communicating by mail. But even for applicants who are willing to go to
SSA offices (if they are allowed in), the reduced staffing in SSA
offices means that staff are not readily available to answer questions.
Waits to meet with staff in person are long. Rarely can one contact a
claims representative by phone. As a general practice, applicants are
not given the phone number for their claims representative. Rather,
people are urged to contact a toll-free number at a different location
where staff are often unfamiliar with the details of particular claims.
Information provided through this service thus is often inaccurate.
Because of this poor communication, homeless applicants often do
not know how and when to follow up and frequently receive a technical
denial because of their lack of follow-through. Without an advocate to
assist with applications, many homeless adults simply cannot navigate
the process. Tenacious homeless applicants will frequently re-apply
over and over again but because of their reliance on incorrect
information and the barriers described herein their efforts remain
futile and simply serve to clog the system.
Recommendation:
Require local SSA offices to provide phone contact information for
claims representatives to applicants whom they assist. Provide phone
information on the SSA website for supervisors and managers in these
offices.
Staff the SSA local offices sufficiently so that long waits,
communication only by mail can be avoided and so that partnerships with
the community are fostered and established on an ongoing basis.
(5) Documentation for non-medical criteria is difficult for
homeless persons to obtain. The application process with SSA is
dependent on an applicant's ability to provide necessary documentation
such as birth certificates, immigration papers, any and all
documentation of any assets, etc. Most homeless adults do not have
these papers and cannot afford even the minimal fees required to obtain
copies of such papers. Once again, this leads to technical denials,
which means wasted time on the part of the applicant and wasted time
and resources of the SSA staff--waste that contributes to backlogs.
Recommendation:
Provide SSA with the ability to access birth certificates and other
needed documents without cost to the applicant, especially for
individuals in dire need such as homeless applicants.
(6) Cognitive impairments may make it more difficult for homeless
persons to complete the application process. Homeless applicants often
have serious mental health problems and other health issues that may
impair their ability to think clearly and to provide clear and
comprehensive medical information. Information that may exist is missed
without anyone to ask for it and obtain it. Critical aspects of
disability such as histories of trauma, histories of brain damage, and
learning problems are often missed as the applicant is unaware or does
not know how to describe such problems in a way that doesn't feel
demeaning or stigmatizing. Often, a person with these problems has
simply adapted to them and, therefore, is not able to report them in a
useful way for the disability determination process.
Recommendation:
Encourage SSA to develop a culture whereby the agency is part of a
community network and is seen as receptive to suggestions and requests
from those who are assisting applicants.
Fully fund the low-cost programs that collaborate with SSA to help
homeless applicants through the process. Outreach programs such as HOPE
and the highly successful SOAR initiative have shown promise in
developing procedures wherein case workers can help applicants assemble
the requisite documentation and present the material in a form
acceptable to DDS staff. SOAR trained sites have increased rates of
initial approval for homeless applicants to an average of 62%.
Technical denials and the need for appeals are reduced when homeless
people are helped through the system and into housing. SSA also
benefits as this most challenging segment of their client population is
removed from the backlog.
(7) Sporadic, incomplete, transient treatment histories make it
difficult to obtain medical records. Many homeless applicants have not
had consistent treatment for their medical problems. Emergency room
visits are common; notes from these visits are cursory. Serious and
ongoing health problems are treated on an acute basis only. Putting
together a true picture of impact on functioning and ability to work is
extraordinarily challenging and beyond the means of already overtaxed
SSA staff.
Many communities do not provide regular access to physicians and/or
psychologists who are viewed as the only acceptable medical sources for
diagnostic information for most health problems. Nurse practitioners,
physicians' assistants, and social workers are often the main providers
of treatment and yet are considered collateral sources who cannot
provide diagnoses. In most public care settings, individuals spend very
little time with physicians. Yet, physicians are the professionals
asked to provide comprehensive information about applicants.
Recommendation:
Expand the list of acceptable medical sources for applicants
identified as homeless to include nurse practitioners, physicians'
assistants, and licensed clinical social workers. These are the staff
who provide much of the care to uninsured individuals in physical
health and mental health settings. In many rural settings, these are
the only healthcare providers available to low-income and homeless
people.
(8) Reliance on consultative examinations results in underreporting
of disabilities. In the absence of comprehensive medical histories from
an acceptable medical source, consultative exams are scheduled with
physicians and/or psychologists who contract with DDSs to complete such
evaluations. Because notification for these appointments is by mail,
homeless applicants often miss their examination. This lack of follow
through has been identified as the principal cause of technical denials
for homeless applicants.
In addition, people who go to these evaluations often deny their
mental health problems or do not recognize them as such and, therefore,
do not discuss their impact. The examinations are often cursory. They
are always costly.
In some communities, access to a consultant is extraordinarily
limited. For example, in parts of Montana, applicants must travel 70
miles to receive a consultative examination--clearly a challenge for
homeless applicants.
Recommendation:
To reduce the need for consultative examinations, SSA should expand
the list of acceptable medical sources for applicants identified as
homeless to include nurse practitioners, physicians' assistants, and
licensed clinical social workers. SSA also should ensure current
medical providers are contacted and all records obtained prior to
scheduling a consultative exam. Most homeless applicants have complex
histories that are unlikely to be adequately presented to a complete
stranger in the brief amount of time allotted to a consultative
examination. National licensing criteria could be established for this
purpose with the support of both the newly eligible medical sources and
traditional medical sources who would benefit from having those in need
enrolled in Medicare and Medicaid programs rather than receiving costly
uninsured care in emergency rooms.
Additionally, SSA should encourage state Disability Determination
Services to expand their consultative evaluators' list to include
programs and physicians that serve people who are homeless, e.g.,
Health Care for the Homeless clinics and Federally Qualified Health
Centers.
(9) ``Everyone is denied two times and has to go to a hearing.''
The high rates of denials of homeless applications leads many service
providers to believe the process is futile and discourages some groups
from assisting homeless clients to apply for SSI/SSDI benefits. Lack of
awareness by SSA representatives of how homelessness impacts
disabilities further exacerbates the problem.
Recommendation:
SSA should involve community service providers in the training of
SSA claims representatives and DDS claims examiners about specialty
issues and populations who are applicants. For example, homeless
advocates or service providers should provide training on the
demographics of homelessness, and the impact of homelessness on
substance use and co-occurring disorders, HIV/AIDS, and developmental
disabilities.
(10) Lack of understanding of disability determination process by
community service providers impairs their ability to assist homeless
applicants in preparing applications. Despite SSA's provision of
ongoing training, many service providers are not knowledgeable about
the requirements that a person must meet to be eligible for SSI/SSDI.
Therefore, the information that SSA and the DDS need to process claims
may not be provided to those agencies. For many social service
agencies, translating the collection of information in a client's case
file into what SSA and DDS need can be daunting.
Recommendation:
As discussed above, SSA should be enabled to hire specialists to
work collaboratively with community groups to ensure the kinds of
collaboration needed to process claims efficiently and accurately on
initial application.
SSA should also form partnerships and establish flexible processes
nationally for the populations applying for SSI/SSDI who require
special assistance to navigate the process.
Additionally, SSA should update their Plan on Homelessness, a
document that has not been reviewed since 2002. The revised plan should
include procedures for identifying and including key homeless agencies
and their representatives in efforts to implement the updated and
revised plan.
(11) Inherent disconnect in the disability determination process
between information required to make a disability determination and the
information normally contained in medical records. In general, the
information provided to make disability determinations is in the form
of medical records. The purpose of medical records is to assess
symptoms, provide a diagnosis, and prescribe treatment. Rarely do these
records contain the functional impairment information that is part of
the disability determination process, especially for people with mental
impairments. Additional information is often needed to answer the
questions in this process and may not be available without additional
work on the part of community providers
Recommendation:
SSA should bring together a workgroup to develop strategies to
address this inherent disconnect in the process. Such a workgroup
should include direct service providers, community clinicians,
professional school representatives (e.g., medical and other graduate
schools), medical records department representatives and others who are
involved in compiling the information needed to address the SSA
disability criteria.
The solutions outlined here will take time, effort and in many
cases additional Federal investments. However, the payoff in reducing
the SSI/SSDI backlog and the ensuing human toll will ultimately reduce
costs in cities and states that currently must cope with people who are
eligible SSI/SSDI applicants living without assistance for their
disabling conditions. Homeless people with disabling conditions consume
an enormous and disproportionate share of local healthcare and public
safety resources.
Beyond the fiscal argument lies the moral imperative of providing
concrete steps to end homelessness in the United States. Any
examination of reforms to the SSI/SSDI application process should
include improvements to address the barriers presented above. As
advocates working to eliminate homelessness in America we are committed
to working with Congress and all relevant agencies to refine and
implement these ideas.
Statement of the Service Employees International Union
Dear Chairman Rangel and Members of the Committee: On behalf of our
Members, the Service Employees International Union (SEIU) Local 1000
urges the esteemed Members of the House Ways and Means Committee to
increase funding to reduce the backlog in disability claims that are
determined at the Disability Determination Services Division (DDSD)
operating under the Social Security Administration. While we commend
Commissioner Astrue's hiring of 144 Administrative Law Judges at the
hearings level, resources need to be directed to the earlier levels of
the determinations process. Commissioner Michael Astrue admits that
they are working with the lowest staffing levels in over thirty years.
To process claims effectively with a decreased number of staff is
especially untenable in California, where we process 10 percent of the
nation's claims. Thus, the workloads at the branches of the Disability
Determinations Service Division (DDSD) are at an unprecedented high,
and the department expects another increase in disability claims as
baby boomers begin to reach retirement and disability-prone age. SEIU
Local 1000 represents over 1,400 Disability Determination Service
workers in 8 offices across the state. Our members in these offices
deeply believe in the service they provide. They know that receiving
SSI and SSDI is often a life or death situation. Yet the Department
continues to focus on the number of closures of cases, not quality. On
more than one occasion, analysts have been told by their managers that
they ``are not social workers,'' and that ``the priority is closing
cases.'' Instead, the workers believe, the priority should be accurate
and compassionate disability determinations. Nor do they have the tools
to process claims efficiently. In California, for example, they have
fewer physicians to refer claimants to than they did in the past.
Program technicians in several DDSD branches statewide have informed us
of having to schedule appointments for people into the next year. They
also don't have enough in-house medical consultants to refer
psychiatric cases to. As a result, cases are farmed out to other
states, thereby lengthening the processing time of cases. Furthermore,
the fairly recent implementation of the electronic claims processing
system (eDIB) is grossly unpredictable and unreliable. Many support
staff haven't been given the equipment necessary to complete their work
in a paperless environment (i.e., scanners, computer screens, etc). A
report generated by the California DDSD showed that between May 3 and
September 17 of this year, the system incurred slow downs, complete
shut downs, and other problems totaling hundreds of hours. Yet,
analysts are forced by their managers to process the same amount of
cases they would in a regular eight hour day. The caseload is so high
at the California DDSD offices that an alarming number DDSD workers
have gone on leave due to stress, work related injuries or have had
nervous breakdowns. Yet when a worker is out sick, it is the
Department's policy to still assign those person cases, which then go
untouched for days. The policy is absurd because it is impossible for
individuals out on sick leave to physically process claims and to ask
those employees recovering from an illness to perform work assigned to
them during their leave. DDSD workers speak to claimants on a daily
basis. They talk to claimants--veterans, the elderly, and the parents
of disabled children who struggle to make ends meet while they wait for
a decision on their claim. We've seen DDSD workers work through their
lunch hours and breaks. We've seen them come in early and leave late
because they took the time to carefully review people's claims. Yet,
they are facing pressure to close cases as quickly as possible. The SSA
plans to hire more appeals judges, but they also need to hire more
field office staff. Increased staff in the field offices could reduce
the number of appealed decisions reversed. We urge you to increase
funding to California to address the disability backlog at the early
stages of the disability process and protect thousands of individuals
who have no other means of income. If you have any questions about the
disability backlog in California or this letter, please contact Joanna
Gin at (916) 554-1231. Thank you.
Statement of the American Civil Liberties Union
The American Civil Liberties Union (``ACLU'') commends the House
Ways and Means Committee (``Committee'') for holding a hearing on the
Backlog of Social Security Disability Claims and appreciates the
opportunity to submit testimony for the record. The current Social
Security disability claims backlog is both unreasonable and violates
due process. At a time when the Social Security Administration
(``SSA'') is struggling to fulfill one of its principal functions of
administering disability claims, Congress is now seriously considering
imposing a new radical duty on SSA--the checking and verification of
all workers in the U.S. Two bills pending in the House of
Representatives--Secure America Through Enforcement and Verification
Act of 2007 (``SAVE'' Act, H.R. 4088) and the New Employee Verification
Act of 2008 (H.R. 5515)--would impose a mandatory electronic employment
verification system (``EEVS'') on all employers and would place that
verification duty squarely on the SSA. There is no doubt that the
imposition of such a sweeping national mandate would exacerbate the
already unreasonable delays in processing claims for Social Security
disability benefits under Title II of the Social Security Act, 42
U.S.C. Sec. Sec. 401, et seq., and the Supplemental Security Income
Program, Title XVI of the Social Security Act, 42 U.S.C.
Sec. Sec. 1381, et seq. While the ACLU has serious privacy, due
process, and civil rights concerns with these proposals, we urge the
Committee to reject any type of mandatory EEVS proposal primarily in
order to ensure that the SSA can focus on performing its historic and
critical function of processing disability claims in a timely and fair
manner.
The ACLU is a nonpartisan public interest organization dedicated to
protecting the constitutional rights of individuals. The ACLU consists
of more than half a million members, countless activists and
supporters, several national projects, and 53 affiliates nationwide.
The ACLU has been active in protecting the rights of people with
disabilities for over 35 years. At the dawn of the disability rights
movement the ACLU challenged the institutionalization of people with
mental illness in cases in Alabama (Wyatt v. Rodgers, Wyatt v.
Stickney), New York (Willowbrook State School on Staten Island, Index
No. 72 Civ. 356, 357 (JRB) and Florida (O'Connor v. Donaldson, 422 U.S.
563 (1975)). In recent years the ACLU has participated in landmark
litigation under the Americans with Disabilities Act (``ADA'')
including Bragdon v. Abbott, 524 U.S. 624 (1998); Sutton v. United
Airlines, Inc., 527 U.S. 471 (1999); Chevron, USA, Inc. v. Echazabal,
122 S. Ct. 2045 (2002). The ACLU has also played a national leadership
role in drafting and negotiating the ADA of 1990 and the ADA
Restoration Act of 2007.
Delays in processing and deciding Social Security disability claims
have been held to violate the Due Process Clause of the Constitution
and the Administrative Procedures Act (``APA''), 5 U.S.C.
Sec. 706(1).\1\ Although the Supreme Court has rejected ``the
imposition of mandatory deadlines on agency adjudication of disputed
disability claims,'' Heckler v. Day, 467 U.S. 104, 119 (1984) and
prevented courts from imposing class-wide mandatory deadlines, courts
retain other traditional equitable powers where delay is unreasonable
and ``where, in the particular case, the court finds that the interest
of justice so require[s].'' \2\ As a general matter, courts have not
definitively determined what length of time constitutes ``unreasonable
delay.'' However, the Supreme Court in Day left standing the undisputed
trial court finding that the delays suffered by the named respondents
were unreasonable,\3\ which was not disputed by the Federal
government.\4\ In analyzing claims of unreasonable delay under the APA,
the courts have noted that ``delays that might be reasonable in the
sphere of economic regulation are less tolerable when human health and
welfare are at stake,'' and Social Security disability claims clearly
involve ``human health and welfare.'' \5\
---------------------------------------------------------------------------
\1\ See White, et al., v. Mathews, 434 F.Supp. 1252 (D. Conn.
1977), aff'd 559 F.2d 852 (2d Cir. 1977), cert. denied 435 U.S. 908;
Caswell, et al. v. Califano, 435 F Supp 127 (D. Me. 1977), aff'd (1st
Cir.) 583 F. 2d 9.
\2\ Rivera v. Apfel, 99 F.Supp.2d 358 (S.D.N.Y. 2000), vac't on
other grounds, No. 00-6241, 2000 WL 33647061 (2d Cir. Nov 14, 2000)
(citing Day, 467 U.S. at 119 n. 33, 104 S.Ct. 2249).
\3\ Respondent Day was forced to wait 340 days between his hearing
request and reconsideration determination; respondent Maurais waited
280 days between his hearing request and reconsideration determination.
See Day, 467 U.S. at 107 nn. 6-7.
\4\ See Id. 467 U.S. at 111 & n. 15. ``[T]he District Court's
declaratory judgment that the plaintiff class is entitled to relief is
not at issue.'' Id. at 120, (Marshall, J., dissenting). See also,
Barnett v. Bowen, 794 F.2d 17, 22 (2d Cir. 1986) (``The [Supreme] Court
stated that the Secretary did not challenge the district court's
determination that hearings must be held in a reasonable time or that
the delays encountered by plaintiffs violated that requirement.'').
\5\ Telecommunications Research and Action Ctr., et al. v. FCC, 750
F.2d 70, 80 (citing with approval Blankenship v. Secretary of HEW, 587
F.2d 329 (6th Cir. 1978).
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The current delays in Social Security disability hearings and
determinations are clearly unreasonable. The SSA's ``data as of the end
of January 2008 indicate that the number of cases waiting for a hearing
decision was 751,767, leading to average waiting times for FY 2008 of
499 days.'' \6\ ``In fiscal year 2006, 30 percent of [disability]
claims processed at the hearings stage alone, took 600 days or more.''
\7\ Between 2000 and 2006, Social Security disability claims processing
times for hearing and decisions nearly doubled.\8\ These delays are
undoubtedly unreasonable and infringe on disability claimants' due
process rights. According to a Governmental Accountability Office
Report published in December 2007, approximately 60 million phone calls
are placed to SSA Field Offices each year, and over half of these
callers receive a busy signal.\9\ The SSA's staffing is at its lowest
level since 1972. Despite the shortage of personnel, the SSA is facing
an extremely heavy workload with the recently added duties of
processing Medicare Part D and prescription drug claims, as well as
processing retirement claims for the baby boomer generation now hitting
retirement age. Social Security retirement benefits claims are expected
to increase by 13 million over the next decade.\10\ As the SSA
struggles to administer its primary duties of processing retirement and
disability claims, Congress is now considering heaping yet another duty
on the SSA--the verification of all workers in the U.S.
---------------------------------------------------------------------------
\6\ The Disability Backlog at the Social Security Administration,
Before the H. Comm. on Appropriations, Subcomm. on Labor, Health and
Human Services, Education, and Related Agencies, 110th Cong., 2d Sess.
(2008) (statement of Patrick P. O'Carroll, Jr., Inspector General,
SSA), February 28, 2008. Available at http://www.ssa.gov/oig/
communications/testimony_speeches/02282008testimony.htm.
\7\ United States Government Accountability Office, Social Security
Disability, Better Planning, Management, and Evaluation Could Help
Address Backlogs at 3 (December 2007). (``GAO Management Report''.)
Available at http://www.gao.gov/new.items/d0840.pdf.
\8\ Id. at 14.
\9\ Id.
\10\ The Disability Backlog at the Social Security Administration,
Before the H. Committee on Appropriations, Subcommittee on Labor,
Health and Human Services, Education, and Related Agencies, 110th
Cong., 2d Sess. (2008) (statement of Richard Warsinskey, National
Council of Social Security Management Associations, Inc.) Feb. 8, 2008.
Available at http://socsecperspectives.blogspot.com/2008/02/social-
security-advocacy-group-written.html.
---------------------------------------------------------------------------
II. A Recipe for Exacerbating the Social Security Disability Processing
Backlogs--Adding Mandatory Electronic Employment Verification
to SSA's Mandate
Two bills (H.R. 4088, H.R. 5515) introduced in this Congress would
impose a mandatory electronic employment verification system (``EEVS'')
on all employers in the U.S. Both mandatory EEVS bills propose that the
SSA would play the critical function of checking and verifying work
authorization for all workers in the U.S. This massive overhaul calls
for sweeping changes to SSA's historic functions of processing
disability and retirement benefits claims. The SSA has never performed
the complicated task of verifying people's immigration status. The ACLU
urges Congress to reject any type of mandatory EEVS proposal, in order
to ensure that people with disabilities are not further harmed by the
already unreasonable delays in Social Security disability claims
processing.
In addition to having to screen everyone in the U.S. for work
authorization, the SSA would be tasked with responding to the majority
of erroneous EEVS findings, which would include fielding telephone
calls and responding to in-person queries at SSA Field Offices. The SSA
has testified numerous times before Congress that approximately 10
percent of the 240 million Wage and Tax Statements (W-2 forms) received
annually by SSA do not match the names and Social Security numbers in
SSA's records. According to the SSA's Office of Inspector General, the
Social Security database has a 4.1 percent error rate. The vast
majority of errors involve U.S. citizens. The mandatory EEVS proposal
contained in the SAVE Act (H.R. 4088) would strip workers of Social
Security credit for their earnings if they work more than one job
during a year--unless they visit a SSA field office to prove with
documentation that they, in fact, worked two jobs. This provision will
apply to anyone who works more than one job, who changes jobs, or whose
employer changes ownership in a calendar year.
By its own estimates, the SSA calculates that making EEVS mandatory
would result in an additional 3.6 million visits or telephone calls to
SSA field offices per year, which would result in 2,000 to 3,000 more
work years for the SSA. Considering that currently over half of all
telephone calls placed to SSA field offices do not get answered, moving
to a mandatory EEVS regime would result in a practical shutdown of SSA
field offices as SSA is swarmed by irate workers who are desperate to
fix their Social Security records in order to work.
Furthermore, in April 2008 the Congressional Budget Office released
a score report for the SAVE Act (H.R. 4088) and estimated that the SAVE
Act would decrease Social Security trust fund revenue by more than $22
billion over 10 years by increasing increase the number of employers
that will pay workers in the cash economy, outside of the tax system.
III. Mandatory Electronic Employment Verification Poses Serious
Privacy, Due Process, and Civil Rights Concerns.
In addition to crippling the SSA's ability to process disability
claims, a mandatory employment verification system raises serious
privacy, due process, and civil rights concerns. A mandatory EEVS would
require the creation of a new data-exchange system between the SSA and
the Department of Homeland Security (``DHS''). SSA would be required to
share data with DHS based on discrepancies in SSA's database that have
nothing to do with immigration status. According to SSA, reasons for
errors in its database include clerical errors made by employers in
completing their W-2's; the fact that workers might have used one name
convention (such as a hyphenated name or multiple surnames) when
applying for a Social Security card and a different one when applying
for a job; or name changes due to marriage, divorce, religious
conversion, or other reasons. The SSA database does not contain
complete information about workers' immigration status, and the limited
immigration status information that does exist in the database is not
automatically updated when a worker's immigration status or work
authorization status changes.
According to the Office of the Inspector General at SSA, by
conservative estimates, at least 3.3 million non-citizen records in the
SSA database contain incorrect citizenship status codes. A mandatory
EEVS regime would result in the SSA erroneously divulging the private
information of U.S. citizens (including their Social Security numbers)
to the DHS because SSA is unable to accurately identify an individual's
citizenship status via its databases. And the DHS has proven that it
cannot be trusted with private information. The House Oversight and
Government Reform Committee gave a ``D'' to the DHS in computer
security for 2006 (up from an ``F'' for the previous three years). The
DHS's failure to comply with Federal Information Security and
Management Act standards since its inception demonstrates that it
cannot be relied upon to make significant improvements in this area,
which translates down the road into workers' private information being
left vulnerable to hackers and other cyber-threats.
Furthermore, the information-sharing provisions set forth in both
H.R. 4088 and H.R. 5515 do not require independent review, monitoring
of disclosure, privacy protections, notice to workers that their
private information or records have been disclosed, or recourse if
overbroad information is sought or misused.
Finally, moving to a mandatory EEVS would subject many lawful
workers to illegal employment discrimination on the basis of race and/
or national origin. Some employers facing a mandate of verifying all
workers will fire workers or refrain from hiring candidates on the
basis of their race, surname, accent, or other proxies for unlawful
discrimination.
The ACLU appreciates the opportunity to submit this written
statement and urges the Committee to reject imposing the new radical
duty of mandatory electronic employment verification on the SSA.
Statement of the Federal Managers Association
Chairman Rangel, Ranking Member McCrery and Members of the House
Ways and Means Committee:
On behalf of the Federal Managers Association (FMA) and the nearly
1,000 managers in the Social Security Administration's Office of
Disability Adjudication and Review (ODAR), please allow us to take a
moment and thank you for this opportunity to present our views before
the Committee. As Federal managers, we are committed to carrying out
the mission of our agency in the most efficient and cost effective
manner while providing those necessary services to millions of
Americans.
Established in 1913, the Federal Managers Association is the
largest and oldest association of managers and supervisors in the
Federal government. FMA was originally organized to represent the
interests of civil service managers and supervisors in the Department
of Defense and has since branched out to include some 35 different
Federal departments and agencies including many managers and
supervisors within the Social Security Administration (SSA). We are a
nonprofit professional membership-based organization dedicated to
advocating excellence in public service and committed to ensuring an
efficient and effective Federal government. FMA members and their
colleagues in the SSA Office of Disability Adjudication and Review are
responsible for ensuring the success of the administration of Social
Security's disability determination process and in providing needed
services to American customers.
As you are keenly aware, the Social Security Administration plays a
vital role in serving over 160 million American workers and their
families. Each month, SSA pays out benefits to 48 million
beneficiaries. Over 7 million low-income Americans depend on the
agency's Supplemental Security Income (SSI) program to stay afloat in a
cost-inflating world, and nearly 7.2 million disabled Americans receive
benefit payments through Social Security Disability Insurance (SSDI).
At the February 28, 2008 hearing, Commissioner Astrue testified that
SSA's productivity has increased over 15% since fiscal year 2001.
Considering the magnitude of its mission, the Social Security
Administration does a remarkable job administering critical programs.
In the Office of Disability Adjudication and Review, however, there
currently exists a backlog of over 757,000 requests for a hearing. It
already takes over 500 days to process a typical request for hearing
and these delays tarnish SSA's otherwise strong record of service to
the American public. At the beginning of 2002, SSA had 468,262 pending
hearing requests. In six years, that number increased to over 750,000,
despite the fact that dispositions are at record levels. Although
clericals in hearing offices prepared 472,168 cases in FY07, claimants
submitted almost 557,970 new requests during the same period. As such,
the backlog of files simply awaiting preparation for review by an
Administrative Law Judge (ALJ) at the close of January 2008 totaled
442,399 cases; an increase of 3,116 cases since the beginning of fiscal
year 2007. Unless something is done to reverse this trend, the backlog
could realistically reach one million by 2013 with the aging Baby Boom
generation.
As managers and supervisors within ODAR, we are acutely aware of
the impact these backlogs are having on our ability to deliver the
level of service the American public deserves. We are here to confirm
what you've heard several times before--that the ongoing lack of
adequate staffing levels and resources have contributed to these
backlogs. If these inadequacies continue, clearing the backlogs will be
impossible and service delivery will continue to deteriorate.
We at FMA appreciate the attention the Committee is placing on
examining the reasons for the backlog and addressing remedies to the
problem. ODAR began fiscal year 2008 with 419,752 pending cases
awaiting preparation for a hearing. In all likelihood, those cases will
realistically wait at least one year before any action is even
initiated to prepare the case for review and hearing in front of an
Administrative Law Judge. In January, processing times across the
nation ranged from a low of 343 days in the Boston region to a high of
649 days in the Chicago region. The American public deserves better
service.
Within ODAR, production is measured by the number of dispositions
completed per day by an Administrative Law Judge. In FY05 and FY06,
this record-level figure was 2.2 dispositions per day per ALJ. A work
year is approximately 250 work days, yielding a reasonable expectation
that an ALJ can produce an estimated average of 550 dispositions a year
given the current staffing limitations. At the end of January 2007, SSA
employed 1,088 ALJs, resulting in a best case scenario of 557,150
dispositions for FY07, which is about the same number of new cases
filed in a given year.
Earlier this year, hiring letters went out to 144 of the 175
administrative law judges SSA plans to employ this fiscal year. Already
136 judges have accepted. A total of 175 ALJs could translate into an
additional 82,500 dispositions, but only if adequate staff is available
to prepare the cases for review. While this is certainly a step in the
right direction, Administrative Law Judges alone will not solve the
problem. Without additional staffing, the current level of prepared
work would be distributed among more judges, essentially resulting in
the same dispositional outcome. Without adequate support staff to
prepare cases for the judges, both existing and new, we will not
achieve an increase in hearing dispositions--the only solution to
reducing the backlog.
Undoubtedly, adequate clerical support is necessary to prepare
cases for hearing. As it stands, hearing offices do not even have the
staff to accommodate the current judges, let alone enough staff to
process the nearly new 47,000 cases the Office of Disability
Adjudication and Review receives each month. If receipts remained flat,
the backlog will remain at over 700,000 cases, almost one-third of
which are over 365 days old. At the beginning of FY07, ODAR had over
63,000 cases which were over 1,000 days old; a number which is both
unacceptable to the agency as well as the American people it serves.
Commissioner Astrue identified these cases as ODAR's number one
priority and this backlog has since been eliminated. FMA applauds the
Commissioner for his efforts; however, the 900 day old cases are now
approaching this milestone. Currently, just fewer than 54,000 cases
will be over 900 days old by the close of FY08. We are committed to
working with the Commissioner as he tackles this challenge.
With the aging Baby Boom population, it is reasonable to assume
that receipts will continue to out-pace dispositions. As the requests
for hearings continue to rise, more is demanded from ODAR staff on all
levels. The bottom line is that the hearing offices lack sufficient
staff to process the work on hand much less even begin to work on new
cases. It should be evident that under the best case scenario, the
current staffing levels in ODAR barely maintain the status quo. That
means that the backlog stays the same and processing times continue at
an estimated 500 days.
The existing staff must make room for the new cases as they attempt
to address the backlog. In recent years, however, budgetary constraints
have forced the agency to hire additional Administrative Law Judges
without providing adequate support staff to prepare the cases for
hearing. We recognize that the Commissioner is trying to address the
backlog by adding these judges; however, additional ALJs without the
supporting clerical staff to prepare cases in a timely manner will not
solve the problem. By following in his predecessor's footsteps,
Commissioner Astrue will encounter the same problems--no matter how
many new judges come on board, without clerical staff to prepare cases
for them, the backlog cannot be addressed.
As previously stated, there is currently insufficient support staff
to ensure optimal ALJ productivity and to handle the backlog. The
accepted staff to ALJ ratio has been four to four and one half
production staff per ALJ. However, this only ensures productivity
necessary to handle incoming work, not the backlog. For offices with
heavy backlogs, the four and one half to one standard is inadequate.
Management and administrative employees should not be included in these
figures, as they are not the employees performing the production work
on hearing requests. And, of course, staffing shortfalls cannot be
remedied without adequate funding.
The solutions to the backlog problem are simply adequate staffing
levels and timely budgets which will allow us to address the pending
cases. As of last month, the backlog was at 757,221 requests for a
hearing. However, it is worth noting that the agency can reasonably
process 400,000 cases at any given time. As such, the actual
``backlog'' is around 350,000 cases. As noted earlier, a trained,
productive ALJ, with adequate support staff, should be able to produce
about 550 dispositions in a given year. Approximately 1,000 additional
ALJs and 5,000 additional support staff would allow ODAR to work down
the backlog in one year while providing timely processing of new cases
as they arrive. We at FMA recognize that these numbers present a large
funding challenge for Congress.
To enable SSA to meet the goals set forth in Commissioner Astrue's
testimony before your Subcommittee on February 28, 2008, Congress must
approve a sufficient level of funding for the agency. The Continuing
Resolution (CR) which was signed into law in March 2007 was severely
inadequate to address both the staffing and backlog problem at SSA for
fiscal year 2007, despite the meager increase SSA received above the
fiscal year 2006 appropriation. Since 2001, Congress has appropriated,
on average, $180 million less than the President has requested each
year. The dollar value of this differential is equivalent to processing
an additional 177,000 initial claims and 454,000 hearings. Over the
last ten years (FY98--FY07), Congress has appropriated nearly $1.3
billion less than the President's request. Without a doubt, this has
had a devastating effect on the services provided to the American
public, as evidenced by the situation we are in today.
Recognizing the needs of SSA, Congress appropriated $150 million
above the President's request for FY08 in an effort to bring down the
backlog. Congress should be applauded for their commitment to serving
the American people in this capacity. In fact, it is this increase
which is allowing the agency to hire the additional 175 ALJs.
The President requested $10.327 billion for SSA's administrative
expenses in FY09, only $100 million below Commissioner Astrue's request
and six percent more than Congress appropriated this fiscal year.
Furthermore, the House Budget Resolution (H.Con.Res. 312) provided for
an additional $240 million for SSA's administrative expenses. We
applaud these efforts.
To remedy the unprecedented backlog situation, Congress should at a
minimum pass the President's 2009 budget request of $10.327 billion for
SSA's Limitation on Administrative Expenses account. Under his budget,
the agency would be able to process 85,000 more hearings in FY09 than
in FY08. In FY06 and FY07, SSA replaced one worker for every three that
retired. The President's budget will allow for a 1 replacement ratio.
In addition to having an immediate impact on the current backlog,
underfunding the Social Security Administration will negatively impact
every service area of the agency. Staffing at SSA will soon reach its
lowest level since 1972; however, SSA today has nearly twice the number
of beneficiaries it had in 1972. SSA officials estimate that more than
40% of its 65,000 employees will retire by 2014. Reversing this trend
is a necessary step to reducing the backlog.
While the President's budget request for FY09 is a start, it is
certainly not a cure all solution. Throwing money at the problem will
not fully solve it without a well-trained, dedicated staff of Federal
employees willing to avert a crisis in the coming years. We believe
this is the workforce we have now, strengthened under the leadership of
former-Commissioner Barnhart and Commissioner Astrue. By fully funding
the President's request, we can continue this tradition.
In this era of shrinking budgets, SSA has attempted to maximize its
use of scarce resources to provide the best possible service to the
American public. The challenges faced by the managers and supervisors
are not short term; they are a demographic reality. The same citizens
putting stress on the Social Security trust fund because they are
approaching retirement are also entering their most disability-prone
years. ODAR is struggling to handle the current workload and will be
hard pressed to manage the anticipated increase in hearing requests
without additional staff.
We are the men and women who work with disabled Americans everyday.
We see people of all ages come in and out of our offices seeking the
services they depend on for survival from the Social Security
Administration. We are committed to serving a community of Americans in
need, but we need you to provide us with the necessary resources to
help them. Thank you for your time and consideration of our views.