    [House Hearing, 115 Congress]
    [From the U.S. Government Publishing Office]

                          DETERMINING ELIGIBILITY FOR
                     DISABILITY BENEFITS: CHALLENGES FACING
                       THE SOCIAL SECURITY ADMINISTRATION

    =======================================================================

                                     HEARING

                                   BEFORE THE

                        SUBCOMMITTEE ON SOCIAL SECURITY

                                     OF THE

                          COMMITTEE ON WAYS AND MEANS
                         U.S. HOUSE OF REPRESENTATIVES

                         ONE HUNDRED FIFTEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                               SEPTEMBER 6, 2017

                                   __________

                              Serial No. 115-SS06

                                   __________

             Printed for the use of the Committee on Ways and Means

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

                        U.S. GOVERNMENT PUBLISHING OFFICE
    33-616                      WASHINGTON : 2019

    -----------------------------------------------------------------------------------

                          COMMITTEE ON WAYS AND MEANS

                          KEVIN BRADY, Texas, Chairman

    SAM JOHNSON, Texas                   RICHARD E. NEAL, Massachusetts
    DEVIN NUNES, California              SANDER M. LEVIN, Michigan
    PATRICK J. TIBERI, Ohio              JOHN LEWIS, Georgia
    DAVID G. REICHERT, Washington        LLOYD DOGGETT, Texas
    PETER J. ROSKAM, Illinois            MIKE THOMPSON, California
    VERN BUCHANAN, Florida               JOHN B. LARSON, Connecticut
    ADRIAN SMITH, Nebraska               EARL BLUMENAUER, Oregon
    LYNN JENKINS, Kansas                 RON KIND, Wisconsin
    ERIK PAULSEN, Minnesota              BILL PASCRELL, JR., New Jersey
    KENNY MARCHANT, Texas                JOSEPH CROWLEY, New York
    DIANE BLACK, Tennessee               DANNY DAVIS, Illinois
    TOM REED, New York                   LINDA SANCHEZ, California
    MIKE KELLY, Pennsylvania             BRIAN HIGGINS, New York
    JIM RENACCI, Ohio                    TERRI SEWELL, Alabama
    PAT MEEHAN, Pennsylvania             SUZAN DELBENE, Washington
    KRISTI NOEM, South Dakota            JUDY CHU, California
    GEORGE HOLDING, North Carolina
    JASON SMITH, Missouri
    TOM RICE, South Carolina
    DAVID SCHWEIKERT, Arizona
    JACKIE WALORSKI, Indiana
    CARLOS CURBELO, Florida
    MIKE BISHOP, Michigan

                         David Stewart, Staff Director

                     Brandon Casey, Minority Chief Counsel

                                     ______

                        SUBCOMMITTEE ON SOCIAL SECURITY

                          SAM JOHNSON, Texas, Chairman

    TOM RICE, South Carolina             JOHN B. LARSON, Connecticut
    DAVID SCHWEIKERT, Arizona            BILL PASCRELL, JR., New Jersey
    VERN BUCHANAN, Florida               JOSEPH CROWLEY, New York
    MIKE KELLY, Pennsylvania             LINDA SANCHEZ, California
    JIM RENACCI, Ohio
    JASON SMITH, Missouri

                                C O N T E N T S

                                   __________

                                                                       Page

    Advisory of September 6, 2017, announcing the hearing............     2

                                   WITNESSES

    Bea Disman, Acting Chief of Staff, Social Security Administration     6
    Kathryn Larin, Director of Education, Workforce, and Income
      Security Issues, Government Accountability Office..............    22
    Elizabeth McLaren, Bureau Chief, Iowa Disability Determination
      Services, on behalf of National Council of Disability
      Determination Directors........................................    39
    Marilyn Zahm, President, Association of Administrative Law Judges    50
    Lisa Ekman, Director of Government Affairs, National Organization
      of Social Security Claimants' Representatives, on behalf of the
      Social Security Task Force Consortium for Citizens with
      Disabilities...................................................    62

                            QUESTIONS FOR THE RECORD

    Questions submitted by The Honorable Sam Johnson, Chairman,
      Subcommittee on Social Security, Committee on Ways and Means,
      to Kathryn Larin, Director of Education, Workforce, and Income
      Security Issues, Government Accountability Office..............    97
    Questions submitted by Amy Shuart, Staff Director, Subcommittee
      on Social Security, Committee on Ways and Means, to Elizabeth
      McLaren, President-Elect, National Council of Disability
      Determination Directors........................................   100
    Questions submitted by The Honorable Sam Johnson, Chairman,
      Subcommittee on Social Security, Committee on Ways and Means,
      to Bea Disman, Acting Chief of Staff, Social Security
      Administration.................................................   103
    Questions submitted by The Honorable Sam Johnson, Chairman,
      Subcommittee on Social Security, Committee on Ways and Means,
      to Marilyn Zahm, President, Association of Administrative Law
      Judges.........................................................   118

                           SUBMISSIONS FOR THE RECORD

    Peter J. Martinelli, U.S. Administrative Law Judge, Office of
      Hearings and Appeals, Social Security Administration (SSA).....   119
    National Association of Disability Examiners (NADE)..............   128
    Philip B. Litteral, President, National Association of Disability
      Representatives (NADR).........................................   138
    Anthony M. Reardon, National President, National Treasury
      Employees Union (NTEU).........................................   142

                          DETERMINING ELIGIBILITY FOR
                     DISABILITY BENEFITS: CHALLENGES FACING
                       THE SOCIAL SECURITY ADMINISTRATION

                                  ----------

                          WEDNESDAY, SEPTEMBER 6, 2017

                 U.S. House of Representatives,
                           Committee on Ways and Means,
                               Subcommittee on Social Security,
                                                        Washington, DC.

        The Subcommittee met, pursuant to call, at 10:03 a.m., in
    Room 2020, Rayburn House Office Building, Hon. Sam Johnson
    [Chairman of the Subcommittee] presiding.
        [The advisory announcing the hearing follows:]

                                ADVISORY

                    FROM THE COMMITTEE ON WAYS AND MEANS

                        SUBCOMMITTEE ON SOCIAL SECURITY

                                                    CONTACT: (202) 225-1721
    FOR IMMEDIATE RELEASE
    Wednesday, September 6, 2017
    SS-06

                     Chairman Johnson Announces Hearing on

                Determining Eligibility for Disability Benefits:

                     Challenges Facing the Social Security

                                 Administration

        House Ways and Means Social Security Subcommittee Chairman Sam
    Johnson (R-TX), announced today that the Subcommittee will hold a
    hearing entitled ``Determining Eligibility for Disability Benefits:
    Challenges Facing the Social Security Administration.'' The hearing
    will focus on the Social Security Administration's plan to reduce the
    hearing backlog and claimant wait times, other efforts to modernize and
    improve the disability determination process, and tools available to
    expedite decisions for those with certain severe conditions. The
    hearing will take place on Wednesday, September 6, 2017 in room 2020 of
    the Rayburn House Office Building, beginning at 10:00 a.m.

        In view of the limited time to hear witnesses, oral testimony at
    this hearing will be from invited witnesses only. However, any
    individual or organization may submit a written statement for
    consideration by the Committee and for inclusion in the printed record
    of the hearing.

    DETAILS FOR SUBMISSION OF WRITTEN COMMENTS:

        Please Note: Any person(s) and/or organization(s) wishing to submit
    written comments for the hearing record must follow the appropriate
    link on the hearing page of the Committee website and complete the
    informational forms. From the Committee homepage, http://
    waysandmeans.house.gov, select ``Hearings.'' Select the hearing for
    which you would like to make a submission, and click on the link
    entitled, ``Click here to provide a submission for the record.'' Once
    you have followed the online instructions, submit all requested
    information. ATTACH your submission as a Word document, in compliance
    with the formatting requirements listed below, by the close of business
    on Wednesday, September 20, 2017. For questions, or if you encounter
    technical problems, please call (202) 225-3625.

    FORMATTING REQUIREMENTS:

        The Committee relies on electronic submissions for printing the
    official hearing record. As always, submissions will be included in the
    record according to the discretion of the Committee. The Committee will
    not alter the content of your submission, but we reserve the right to
    format it according to our guidelines. Any submission provided to the
    Committee by a witness, any materials submitted for the printed record,
    and any written comments in response to a request for written comments
    must conform to the guidelines listed below. Any submission not in
    compliance with these guidelines will not be printed, but will be
    maintained in the Committee files for review and use by the Committee.

        All submissions and supplementary materials must be submitted in a
    single document via email, provided in Word format and must not exceed
    a total of 10 pages. Witnesses and submitters are advised that the
    Committee relies on electronic submissions for printing the official
    hearing record.

        All submissions must include a list of all clients, persons and/or
    organizations on whose behalf the witness appears. The name, company,
    address, telephone, and fax numbers of each witness must be included in
    the body of the email. Please exclude any personal identifiable
    information in the attached submission.

        Failure to follow the formatting requirements may result in the
    exclusion of a submission. All submissions for the record are final.

        The Committee seeks to make its facilities accessible to persons
    with disabilities. If you are in need of special accommodations, please
    call 202-225-1721 or 202-226-3411 TDD/TTY in advance of the event (four
    business days notice is requested). Questions with regard to special
    accommodation needs in general (including availability of Committee
    materials in alternative formats) may be directed to the Committee as
    noted above.

        Note: All Committee advisories and news releases are available at
        http://www.waysandmeans.house.gov/

        Chairman JOHNSON. Good morning to all of you, and welcome
    to today's hearing on the challenges Social Security faces when
    deciding if a person should receive disability benefits. Since
    I have been Chairman, we have held 18 hearings, including
    today, on the disability insurance program, on one topic or
    another. Now, that is a lot of hearings, but the disability
    insurance program is too important for Social Security not to
    get it right.
        Americans pay taxes on their hard-earned wages for the
    promise of future Social Security benefits when the worker
    retires, is unable to work due to a disability, or dies. These
    benefits are an important part of a family's financial
    security, and Americans rightfully expect that when they apply
    for benefits, if they are eligible, that they will receive them
    quickly. But for those applying for disability benefits, that
    isn't the case.
        Today, over 1 million people are waiting for a hearing with
    Social Security administrative law judges, and on the average
    these folks will wait around 600 days to get that hearing. That
    is nearly 2 years. And that is after waiting almost 4 months,
    on the average, for an initial decision, and more than 3 months
    for a second look, known as reconsideration.
        While not all of them will qualify for benefits, all of
    these people deserve an answer in a timely fashion. And for
    those who don't qualify for benefits, these long wait times
    make getting back to work even harder.
        With backlogs at record highs, it is more important than
    ever for Social Security to ensure that the Compassionate
    Allowances program is working as intended. The Compassionate
    Allowances program was created in 2008 as a way to help those
    with the most severe impairments jump to the front of the line.
    But as we will hear today, this program doesn't always work the
    way it should.
        It is clear Social Security has serious problems when it
    comes to making sure people get the disability decisions as
    quickly as possible. But Social Security problems and the
    disability insurance program are more than just long wait
    times. Since 2003, Social Security's disability programs have
    been on the GAO's high risk list, in large part because of
    outdated criteria to determine eligibility for disability
    benefits. While some progress has been made, there is more work
    to be done to modernize Social Security's disability program.
        As we know, more money isn't always the answer. This year,
    the Social Security Administration received $90 million in
    dedicated funding to address a disability backlog. Yet, wait
    times continue to grow. Social Security used some of this
    funding in much-needed information technology improvements that
    should pay dividends in the long run. The Social Security
    Administration must find ways to be more efficient and
    modernize the disability insurance program. And today, we are
    going to hear about how Social Security plans to do just that.
    This won't be easy work and there is plenty to do.
        Social Security needs more than just a plan to fix this; it
    needs real leadership, and that is a large part of management's
    problem. Since 2013, Social Security has had an Acting
    Commissioner. In February, Ranking Member Larson and I, along
    with our colleagues from the Human Resources Subcommittee, sent
    a letter to President Trump, asking that he nominate a
    Commissioner without delay.
        Social Security needs a Senate-confirmed Commissioner who
    can lead the agency and focus on providing the service
    Americans expect and deserve. Social Security provides
    important benefits that many Americans rely on. With the right
    leadership and a good plan, Social Security can get back on the
    right track, but until then, this Subcommittee will keep asking
    tough questions about how to get this done. The American people
    deserve nothing less.
        And I am sure that my compatriot next to me agrees with
    that. With that, I will recognize Mr. Larson.
        Mr. LARSON. Well, I thank our distinguished Chairman, and I
    certainly concur with that. And, most importantly, concur in
    saying your continued leadership to your country in every
    capacity is greatly respected. And I would say that we are in
    agreement on a number of the problems that Social Security is
    set with. As you know, Mr. Chairman, millions of Americans rely
    on Social Security for basic income when they retire, or if
    they are severely disabled or can no longer work. Social
    Security is also there to help widows and children who have
    lost a parent. There is no private plan on the market, simply
    put, that can compare to Social Security. That is just a fact.
        And we are living that fact currently. And the people at
    Social Security deserve a lot of credit. In the midst of
    Harvey, and what is going on and the devastation and the people
    of Texas in the greater Houston area, and with Irma bearing
    down upon Florida now, I think it is heartening to know that
    Social Security hasn't missed a payment. And that on the
    ground, Social Security has people working with the Red Cross
    and other volunteer agencies. And even in the case where people
    do not have electronic transfers, that they are there to help
    and make sure that America gets what is America's number one
    program, the Social Security program.
        Natural disasters remind us of how important it is to fight
    back against calls to cut Social Security, and instead, come
    together in a bipartisan way to make commonsense adjustments to
    strengthen Americans insurance plan and protect the benefits
    Americans have earned and rely on. Both the Chairman and I have
    offered comprehensive plans to address the long-term shortfall
    in the Social Security system so Americans can continue to
    count on these benefits, whether they become disabled or
    retired or they should die prematurely, leaving their young
    children behind.
        By offering--while differing in our approaches, I hope we
    will be able to have a hearing. I keep on plugging for a
    hearing in Plano, Texas, with our distinguished Chairman, but
    anywhere in the country where we will have an opportunity to
    let the Congress work its will. Let the vitality of ideas come
    forward. We both share the same goals, we just have a different
    path of getting there.
        But today's hearing is focused on a problem of record-high
    delays in processing disability applications. This is just
    simply unacceptable, and deplorable, at its very core, of what
    everyday average citizens in this country have to endure. As
    the Chairman pointed out, more than 600 days? It is
    unconscionable.
        Since 2010, the number of beneficiaries, though, has grown
    by 13 percent as baby boomers reach retirement age, and
    especially as we saw after the Great Recession, a number of
    people who lost jobs and are scrambling for their positions.
    Social Security operating budget in this same period of time
    has fallen by more than 10 percent, after accounting for
    inflation. This has made it difficult, if not impossible, for
    Social Security to serve our constituents promptly when they
    need help the most. And that is where I think that money does
    matter, and that money in these budgets, so that we can get the
    front-line people who can handle these.
        We have had many discussions about technology and there has
    been technological advances, but not on the grand scale that we
    need to address this, and nothing on a scale that will assist
    us in a way that that caseworker can--who can deal with an
    individual personally, like what these people are currently
    enduring and suffering through in Houston.
        There are delays throughout the Social Security
    Administration. Today's hearing is focused on the lengthy
    waits, and the Chairman went over this, the administrative law
    judge who can decide on disability benefits appeal. These
    hearings are important. And for the first time, an applicant
    can get to meet face to face with an examiner, in many
    instances, these hearings are the first time the Social
    Security administrator has an applicant's complete medical
    evidence in hand, and the applicant can seek help from an
    attorney or a professional, which is important, given how
    complex the law is in this area.
        But so far this year, the wait, as the Chairman
    underscored, is 600 days. I have several constituents in my
    district, and I am so glad that Ms. Ekman is here today, and we
    are going to get to hear from her. But when you find that
    people are committing suicide; when you find that, in many
    cases, they lose their homes; when you look at what happens to
    them mentally, and I am talking about people that have served
    in our armed services who have post-traumatic stress, who then
    find that their greatest post traumatic stress becomes dealing
    with the Social Security system that is there to help them.
        And so, it is unconscionable that this goes on, and we have
    to solve this problem on behalf of the citizens we are sworn to
    serve, by correcting and making sure that America's primary
    insurance program for its citizens is there to provide them
    relief on a timely basis. I say ``insurance program'' because
    that is what it is. Citizens have contributed to this program.
    They deserve the best, as the Chairman underscored in his
    remarks, from this Committee. I am looking forward to the
    testimony today. Thank you, Mr. Chairman.
        Chairman JOHNSON. Thank you. As is customary, any Member is
    welcome to submit a statement for the hearing record. And
    before we move on to our testimony today, I want to remind our
    witnesses to please limit your oral statements to 5 minutes.
    However, without objection, all of the written testimony will
    be made part of the hearing record. We have 5 witnesses today,
    and seated at the table are: Bea Disman, Acting Chief of Staff,
    Social Security Administration; Kathryn Larin, Director of
    Education, Workforce, and Income Security Issues, Government
    Accountability Office; Elizabeth McLaren, Bureau Chief, Iowa
    Disability Determination Services, on behalf of the National
    Council of Disability Determination Directors; Marilyn Zahm,
    President, Association of Administrative Law Judges; and Lisa
    Ekman, Director of Government Affairs, National Organization of
    Social Security Claimants' Representatives, on behalf of the
    Social Security Task Force Consortium for Citizens with
    Disabilities.
        Ms. Disman, welcome. Thank you for being here, and please
    proceed.

    STATEMENT OF BEA DISMAN, ACTING CHIEF OF STAFF, SOCIAL SECURITY
                             ADMINISTRATION

        Ms. DISMAN. Thank you, Chairman. Chairman Johnson and
    Ranking Member Larson, and Members of the Subcommittee, I am
    Bea Disman, Acting Chief of Staff for the Social Security
    Administration. Before I begin, on behalf of the Social
    Security----
        Mr. LARSON. Is your mic on, ma'am?
        Ms. DISMAN. Yes. Before I begin, on behalf of the Social
    Security Administration, our thoughts are with those affected
    by the devastation in Texas and parts of Louisiana by Hurricane
    Harvey. We know Chairman Brady's district in Houston is
    especially affected by the storm, and that districts across
    Texas, like Chairman Johnson's, are providing disaster relief
    services.
        Even though some of our field offices were closed, as Mr.
    Larson said, we were on-site with FEMA over the weekend at
    three sites in Texas, and two in Louisiana, where Social
    Security and Supplemental Security Income beneficiaries could
    request immediate payment in person if they did not receive
    their regular payment. We will continue to be on-site in three
    locations in Texas this whole week. And all but two of our
    field offices in Texas have opened again.
        Thank you for inviting me to discuss how we are taking a
    systematic approach to modernize our disability policies and
    processes. We appreciate the Subcommittee for its ongoing
    oversight of the disability programs and your recommendations.
    With over 50 years of experience at Social Security, I can
    assure you that we are committed to serving the public
    effectively and compassionately, and to preserving the
    integrity of the Social Security programs. We are mission-
    focused, mission-driven, in developing disability policy and
    processes.
        The Social Security Act defines disability as the inability
    to engage in any substantial gainful activity due to a
    medically determinable physical or mental impairment that is
    expected to last at least 1 year or result in death. While this
    definition provides the statutory foundation of our Social
    Security disability insurance, and SSI income processes, our
    management of the program is also informed by both technology
    and policy advances.
        Changes in healthcare delivery require us to rethink our
    use of medical source information and its supportability and
    consistency. With that in mind, the policy updates and
    revisions we have recently made establish the foundation for an
    integrated systematic approach to disability decisionmaking.
    For example, we have revised most of our listings of impairment
    criteria. After we finish the updates in fiscal year 2018, we
    will then update the listings on a flow basis using a 3- to 5-
    year update cycle. We have the expertise in place to meet this
    objective. We are developing an occupational information system
    that will be the primary source of occupational information
    used in disability adjudication.
        We are committed to providing accurate, high-quality policy
    research in support of this initiative. And we have been
    working with the Bureau of Labor Statistics, which has been
    collecting data for us since 2015. We plan to implement this
    occupational information system in 2020, with the introduction
    of a vocational income tool that adjudicators will use to
    decide claims.
        In January 2016, we developed our plan to improve hearing
    workloads and service delivery. We updated this plan in August
    of 2017 to meet our changing needs. We greatly appreciate the
    $90 million anomaly funding that Congress has provided. The
    plan will permit us to enhance our business efficiencies, such
    as expanding our prehearing conferences. It will also allow us
    to increase our adjudicator capacity by hiring additional ALJs,
    decision writers, and other support staff. The plan also
    supports technological investments in our hearings process,
    such as using natural language processing to improve the
    quality of our decisions.
        The quality of our decisions has always been a paramount
    concern to us. To this end, we are establishing the Office of
    Analytics, Review, and Oversight, which will improve
    coordination on the oversight of the disability adjudication
    process. This new office centralizes all agency offices that
    analyze data in our disability programs and conduct quality
    reviews of our DDS and hearings process.
        We appreciate GAO's work in assessing our Compassionate
    Allowances, or CAL program. CAL delivers faster services by
    making policy compliant benefit decisions quickly to eligible
    individuals with the most serious disabilities. We are working
    to incorporate their recommendation to strengthen the CAL
    program. For example, we have updated our CAL website to be
    more transparent, and to include useful information for
    advocates to submit CAL conditions.
        CAL will be the focus of our November National Disability
    Forum. We are looking forward to holding our outreach meetings
    again, with an eye to improving how we communicate about our
    CAL policies and updates. We are enhancing our internal
    processes as well as developing and updating CAL conditions,
    including the development of enhancements that would give us
    more flexibility to the program.
        Thank you for your interest in discussing disability with
    us. SSA disability programs serve the most vulnerable segments
    of our society. Moving forward, we are and will continue to be
    mission-driven, mission-focused, as we serve the millions of
    individuals who need our help. We look forward to continuing to
    work with you and the Subcommittee.
        [The prepared statement of Ms. Disman follows:]
        [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

        Chairman JOHNSON. Thank you, ma'am. Ms. Larin, you are
    recognized.

     STATEMENT OF KATHRYN LARIN, DIRECTOR OF EDUCATION, WORKFORCE,
      AND INCOME SECURITY ISSUES, GOVERNMENT ACCOUNTABILITY OFFICE

        Ms. LARIN. Chairman Johnson, Ranking Member Larson, and
    Members of the Committee, I am pleased to be here today to
    discuss GAO's report on the Social Security Administration's
    Compassionate Allowance initiative. This initiative, known as
    CAL, expedites the processing of disability claims for those
    with certain conditions, a process that could otherwise take
    months. While CAL has been effective in fast-tracking
    eligibility determinations for some applicants, questions have
    been raised about how the initiative has been implemented.
    Specifically, my remarks today will focus on three issues: how
    SSA identifies conditions for inclusion on the CAL list; how
    claims are designated for expedited processing under CAL; and
    how SSA ensures the accuracy and consistency of CAL decisions.
        First, on identifying conditions for inclusion on the CAL
    list. We found that SSA lacks a formal and systematic approach
    for identifying CAL conditions. Since the CAL initiative began
    in 2008, the number of conditions included has grown from 50 to
    228. Some conditions were added to the original list following
    a series of public hearings. But since 2011, SSA has relied
    primarily on advocates for certain diseases and disorders to
    bring conditions to its attention.
        However, SSA has not provided guidance on its web page on
    how to make suggestions. It has not consistently communicated
    with those who suggested additions about the status of their
    recommendations. And has not conducted outreach efforts to help
    ensure that all advocates are aware of the initiative.
        Relatedly, SSA does not have clear or consistent criteria
    that it uses to determine whether to designate a condition as
    CAL. As a result, SSA may be overlooking conditions that may be
    appropriate for inclusion.
        Turning now to how claims are designated as CAL. We found
    that SSA's procedures do not ensure that all claims are
    accurately identified for CAL processing. SSA relies primarily
    on selection software that uses a word search of the impairment
    description to determine whether the claim refers to a CAL
    condition. But when the text provided by claimants is
    ambiguous, incomplete, or inaccurate, the software won't catch
    the condition as a CAL condition.
        For example, we found that the software accurately flagged
    stage 4 lung cancer as advanced staged lung cancer, a CAL
    condition, but it did not flag a claim where the claimant
    described their condition as lung cancer terminal. Disability
    examiners have the opportunity to ensure that claims are
    correctly designated as CAL, even when the software makes
    errors, by manually changing a flag. But we found that staff
    vary in when or whether they add or remove CAL status from
    disability claims.
        SSA does not have clear guidance on when to change CAL
    designations. And we found that some examiners didn't
    understand the importance of making such changes. For example,
    we found that in 2016, over half of all disability offices did
    not manually add more than a single CAL designation to a claim.
        Finally, on the accuracy and consistency of CAL decisions.
    We found that SSA uses detailed condition descriptions known as
    impairment summaries as a key tool to ensure accurate claims
    decisions. However, these summaries are not regularly updated.
    We found that a third of CAL impairment summaries are more than
    5 years old. Even though medical experts we consulted suggested
    that given advances in medical research, summaries should be
    updated every 1 to 3 years.
        In addition, while SSA collects data on things like denial
    rates for specific conditions and claims processing times, they
    don't leverage this data to inform improvements in the accuracy
    and consistency of CAL claims decisions.
        In conclusion, CAL is viewed positively by SSA and many
    stakeholders, and appears to be effectively expediting the
    processing of disability claims with this designation. However,
    weaknesses in CAL have led to unintended consequences. Absent
    improvements in how they identify CAL conditions, designate CAL
    claims, and ensure the accuracy and consistency of CAL
    decisions, SSA is missing an opportunity to make needed
    improvements to this important initiative.
        This concludes my prepared statement. I am happy to answer
    any questions you may have.
        [The prepared statement of Ms. Larin follows:]
        [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

        Chairman JOHNSON. Thank you very much. Ms. McLaren,
    welcome. Thank you for being here. You may proceed.

             STATEMENT OF ELIZABETH MCLAREN, BUREAU CHIEF,
     IOWA DISABILITY DETERMINATION SERVICES, ON BEHALF OF NATIONAL
             COUNCIL OF DISABILITY DETERMINATION DIRECTORS

        Ms. MCLAREN. Chairman Johnson, Ranking Member Larson, and
    Members of the Subcommittee, thank you for this opportunity to
    testify on behalf of members of the National Council of
    Disability Determination Directors, or NCDDD, and the State
    administrators of the Disability Determination Services, or
    DDS, across the Nation.
        Currently, we direct the work of over 16,000 employees,
    processing nearly 4.7 million disability cases a year. Today, I
    am here to provide you with the on-the-ground perspectives of
    the DDS community regarding the disability process. NCDDD
    recommends consistent policy application across the Nation.
    Therefore, we support the reinstatement of the reconsideration
    step, or the first appeal of the initial DDS denial to all
    States.
        Introduced in 1999 in 10 States, the prototype pilot
    removes the reconsideration appeal level in State DDS's. In
    these 10 States, the first level of appeal is a hearing with an
    administrative law judge at the Office of Disability
    Adjudication and Review. The President's 2018 budget request
    includes a proposal to reinstate reconsideration in those 10
    States. We believe the reinstatement would help alleviate the
    ODAR backlog.
        Initially, this change would give those State citizens the
    same opportunity to get benefits sooner at less cost. NCDDD has
    previously supported this recommendation during testimony to
    this Committee in 2012. Then and today, we make this
    recommendation with the caveat that sufficient funding and
    additional resources must be included for DDS operations,
    chiefly related to staffing, funding, and infrastructure.
        NCDDD is in favor of continuing refinement of the
    Compassionate Allowance, or CAL initiative, and the associated
    fast-track processes. In fiscal year 2016, the DDS has
    processed over 16,000 CAL-only cases, and nearly 62,000 CAL-
    and QDD-designated cases. While these numbers represent a small
    percentage of the millions of initial claims the DDS's will
    process in a year, NCDDD believes in the CAL process, and we
    believe it should continue to be supported, but with some
    improvement.
        DDS's find that CAL is useful in identifying impairments
    and prioritizing cases that have a high potential for favorable
    determination. However, SSA's software has room for
    improvement, as it sometimes misidentifies cases as CAL, and at
    other times, fails to identify a CAL condition. We suggest
    refinements to the software to correct this issue.
        We also propose that SSA continuously update both the
    condition list and the impairment summaries for CAL. NCDDD is
    concerned about eliminating the use of the disability examiner
    authority for QDD in CAL cases at the end of fiscal year 2018,
    as required by the bipartisan Budget Act of 2015. This
    authority currently allows a disability examiner to make fully
    favorable determinations in certain QDD or CAL cases without
    the approval of a medical consultant.
        The DDS's give this authority to well-trained, seasoned
    adjudicators who can work independently without medical
    consultation. We believe the loss of this disability examiner
    authority will have detrimental impact on DDS operations and
    our service to those applicants who are most in need.
        NCDDD supports and recommends the development of a new
    occupational information system to replace the outdated
    Dictionary of Occupational Titles, or DOT, and its companion
    volumes. In a large percentage of cases, disability
    determinations require assessment of an applicant's ability to
    perform their tasked work.
        The 1991 edition of the DOT is a tool provided to the DDS's
    by SSA. This aged resource is a foundational piece of the
    disability determination process. We understand that SSA has
    been working with the Bureau of Labor Statistics on a solution,
    but the completion date is still years away. The lengthy
    timeline for this change is discouraging to the DDS community,
    as we now have to work through complex issues with outdated
    information and antiquated systems that are not aligned with
    the framework of determining disability. We advocate for haste
    in the development of a new tool.
        In conclusion, NCDDD advocates that we retain and/or
    implement tools and policies that enable the DDS's to continue
    to provide compassionate service to the public with timely,
    cost effective, high-quality disability determinations.
        On behalf of the NCDDD, thank you again for an opportunity
    to testify. I would like to thank our SSA partners for their
    collaboration, and commend the DDS staff across the Nation for
    their exemplary work for the American public. I would be glad
    to answer any questions you have.
        [The prepared statement of Ms. McLaren follows:]
       [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

        Chairman JOHNSON. Thank you. Ms. Zahm, welcome. Thanks for
    being here. You may proceed.

                 STATEMENT OF MARILYN ZAHM, PRESIDENT,
                ASSOCIATION OF ADMINISTRATIVE LAW JUDGES

        Judge ZAHM. Thank you. Chairman Johnson, Ranking Member
    Larson and Members of the Subcommittee, thank you for this
    opportunity to address you who have the stewardship of this
    program in your hands. I am Marilyn Zahm, a United States
    Administrative Law Judge for 23 years and elected President of
    the Association of Administrative Law Judges.
        The AALJ represents 1400 Federal administrative law judges
    located in 166 hearing offices across the country. I am
    speaking today on behalf of my judicial colleagues.
        SSA judges have been doing triage work in hearing rooms
    across the country without adequate time, resources, or staff.
    We urge Congress to draft legislation to revitalize the
    adjudicatory system. Each of you has heard stories from your
    constituents, just as we judges hear stories in our courtrooms,
    of the hardship that waiting 2 years for a hearing and decision
    takes on those who appear before us.
        However, there are some practical solutions to the problems
    that we face in the adjudicatory system. I will focus on four
    issues and our solutions: adopt an AALJ's recommended efficient
    adjudication procedures; protect and preserve the independent
    judiciary; provide judges with adequate support staff; and
    provide judges sufficient time to perform their work. I will
    briefly discuss each of these.
        Since 2011, the agency has imposed an estimated 1,000
    changes to its policies and procedures manual, most of which
    are unnecessary, and simply add to the time it takes to hear
    and decide cases. We have proposed a number of solutions to
    make the adjudicatory process more efficient and more
    effective. Streamlined fully favorable templates, which, if
    implemented, could save half a million work hours per year. An
    expedited dismissal process that has the potential to conserve
    400,000 hours annually. Rules of procedure for those who appear
    before us: properly drafted regulations; elimination of the 10
    regional offices for ODAR; and redeployment of their 400 staff
    to the hearings operation.
        The American people are entitled to an impartial
    decisionmaker. The agency, however, continues to push an
    initiative that would disable all statutory protections to
    ensure that Federal agencies cannot improperly influence their
    adjudicators. It seeks to use in-house attorneys over whom it
    exercises control, instead of independent judges to hear and
    decide cases.
        This is not a new initiative. The agency proposed this last
    year, but under pressure from Congress, backed away from the
    proposal. Nevertheless, the agency has again announced this
    plan. There should be a chart appearing on your TV screens,
    which highlights the differences between ALJs and the agencies
    attorney examiners. As you can see, ALJs have decisional
    independence; in-house attorneys do not. They are controlled by
    the agency. If you control the people who make the decisions,
    you can control their decisions.
        The agency's probationary period proposal for newly hired
    ALJs with its argument for a judicial performance plan is also
    a well-worn attempt to eliminate statutory protections for the
    American people. This idea should be unequivocally rejected. We
    Americans deserve an independent judiciary.
        Judges are hamstrung without adequate support staff. Hiring
    freezes and attrition have eroded our clerical and attorney
    writing staffs. In many hearing offices, agency management has
    stripped judges of their assigned clerical support. In order to
    be efficient, judges need to work with the same staff. Each
    judge needs to have one clerical staff member and two attorneys
    assigned to us to work directly with us.
        Each disability case involves a person who is likely to
    desperately need income. Each claim paid has an approximate
    value of $300,000. Judges need to carefully and thoroughly
    evaluate each case, and we need sufficient time to do this job.
    The agency's quota, demanding judges dispose of 500 to 700
    cases annually, was created by dividing the number of pending
    cases by the number of judges several years ago. This means
    that judges have an average of 2.5 hours to fully adjudicate a
    case. That means reviewing the entire file of hundreds of
    medical documents, sometimes thousands; holding a hearing at
    which the claimant and expert witnesses are questioned;
    drafting instructions for a decision and editing that decision;
    2\1/2\ hours.
        Judges who take the time to follow the rules, regulations,
    and policies----
        Chairman JOHNSON. Can you finish pretty quickly because
    your time is up.
        Judge ZAHM. Oh, I am sorry. Thank you for your attention.
        [The prepared statement of Judge Zahm follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

        Chairman JOHNSON. Thank you. Thank you. You know, it is
    hard to quiz a judge. Ms. Ekman, you are recognized.

       STATEMENT OF LISA EKMAN, DIRECTOR OF GOVERNMENT AFFAIRS,
          NATIONAL ORGANIZATION OF SOCIAL SECURITY CLAIMANTS'
     REPRESENTATIVES, ON BEHALF OF THE SOCIAL SECURITY TASK FORCE
               CONSORTIUM FOR CITIZENS WITH DISABILITIES

        Ms. EKMAN. Good morning, Chairman Johnson, Ranking Member
    Larson, Members of the Subcommittee. Thank you for the
    opportunity to testify at this hearing. My name is Lisa Ekman,
    and I am the Director of Government Affairs for the National
    Organization of Social Security Claimants' Representatives, or
    NOSSCR.
        I am testifying today on behalf of the co-chairs of the
    Social Security task force of the Consortium for Citizens with
    Disabilities, or CCD. The Social Security disability programs
    provide the modest but vital benefits to millions of people
    with disabilities so severe they are unable to perform
    substantial work, many of whom would live in abject poverty or
    be homeless without them.
        Unfortunately, it took an average of 628 days for people
    who received an eligibility determination from an ALJ during
    the month of July to get access to these vital benefits. That
    wait time, which is far too long, is due, in large part, to
    chronic underfunding of the Social Security Administration's
    administrative budget since 2010. Prior to 2010, Congress
    invested resources in SSA, and SSA had been bringing the wait
    time down. SSA has shown what it can do when it is given
    adequate resources.
        Having to wait that long for a hearing can have devastating
    consequences for an individual and his or her family. Some
    people lose their homes, some declare bankruptcy and some even
    die. Here is one such story. Ms. S was a resident of McKinney,
    Texas, Mr. Chairman. She led a comfortable life, a middle-class
    life while working as a property manager and inspector.
    However, she developed a number of conditions, including
    chronic pain syndrome, fibromyalgia, cervical spondylosis,
    thoracic and lumbar spine pain, migraine headaches,
    intracranial hypotension, and fibromuscular dysplasia. This was
    followed by ever-increasing depression and anxiety, especially
    after she could no longer work.
        She tried every treatment doctors offered to reduce her
    pain and allow her to continue working, but by 2009, she just
    could not work anymore. She waited a long time for her hearing,
    which was finally scheduled in January of 2016, but she faced a
    terrible choice: miss an appointment for a test that might
    identify treatment to alleviate her pain that took months to
    schedule or postpone her hearing.
        The hearing was postponed and rescheduled for April 2016,
    but unfortunately, Ms. S committed suicide several weeks before
    her hearing. She was 45 years old. She received a posthumous
    fully favorable decision, and her 15-year-old son now receives
    survivor's benefits.
        My written testimony contains many other stories from--
    collected from claimants' representatives from all over the
    United States which highlight the hardship and debt pain
    inflicted on individuals with disabilities when they are forced
    to wait months, or even years, for a hearing on their claim.
    And these heartbreaking stories are, unfortunately, becoming
    more commonplace.
        During fiscal year 2016, 8700 people died waiting for a
    hearing for an ALJ. That is nearly one every hour. The hearing
    backlog must be addressed. The Social Security task force
    respectfully recommends the following actions for Congress and
    SSA to consider:
        Congress should provide SSA with adequate funding to
    administer the Social Security Old Age Survivors and Disability
    programs. Only sustained, adequate funding, will allow SSA to
    reduce the time it takes to get a disability determination from
    an ALJ without negatively impacting customer service in its
    other core functions.
        The task force appreciates the backlog reduction efforts
    that SSA is making within the inadequate budget it receives.
    And the CARES Plan obtained some promising initiatives, but
    more should be done to assist the nearly 1.1 million people
    facing this daunting wait.
        SSA should work to ensure that a hearing is only held when
    necessary. And so first, SSA should do a better job of
    collecting full medical evidence at the initial application and
    reconsideration levels to ensure the decision is made on as
    complete and evidentiary record as possible.
        Second, SSA should resume a robust program of reviewing
    claims for on-the-record decisions, cases where recent evidence
    clearly shows eligibility without requiring a hearing. I
    understand that this is part of the CARES Plan, but the
    attorneys who would conduct these reviews are not doing them
    because they have been pulled into addressing another horrible
    backlog, and that is, the writing of decisions after a hearing
    is held. This is yet another example of the consequences of
    inadequate funding and trying to shift things around to make it
    work within the budget that they have.
        Third, Congress can assist to get the decision right the
    first time by facilitating reviews of more DDS denials, to
    ensure that these decisions are correct and prevent the need
    for an appeal. SSA should be permitted to use its dedicated
    program integrity funds to conduct these reviews, and they
    should increase the number of reviews.
        Finally, SSA should consider revising some recently or
    finalized regulations the task force believes will harm
    applicants who are otherwise eligible for benefits and leads to
    increased appeals, including the Federal court.
        One controversial rule regards the evaluation of medical
    evidence. The relationship between a person and their treating
    provider is unique, and opinions of treating providers deserve
    more weight than the opinion of someone who examines an
    individual once or reviews the claims file. The elimination of
    the treating physician rule is likely to lead to more appeals,
    more remands, and more delays as a result.
        Thank you again for the opportunity to testify today, and I
    am happy to answer any questions you might have.
        [The prepared statement of Ms. Ekman follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

        Chairman JOHNSON. I thank all of you. As is customary, for
    each round of questions, I will limit my time to 5 minutes, and
    ask my colleagues to also limit their questioning time to 5
    minutes as well.
        Ms. Disman, as I said in my opening remarks, waiting almost
    2 years to get a hearing decision is too long. Today, you have
    shown us Social Security's plan to get people hearings on time.
    But under that plan, people still aren't going to get a timely
    decision until at least 2022. Why is this plan taking so long?
        Ms. DISMAN. Thank you.
        Chairman JOHNSON. Turn your mic on.
        Ms. DISMAN. Thank you, Mr. Chairman. Let me first say, in
    being with the Social Security Administration for over 50
    years, and starting as an interviewer of disability
    applications, I share the concern, as do my colleagues, with
    the long wait for hearings as well as other issues that have
    been identified by the witnesses here. To listen and read the
    stories that were presented about people being deceased before
    a hearing took place is unacceptable to all of us.
        However, we have to put everything on the table when we
    look at the hearings process. We have to look at all aspects of
    it. It is not just the hiring of human resources, it is being
    strategic; otherwise, you will have what happened before. We
    had an aggressive plan before. We reduced the hearings backlog.
    What happened was, baby boomers came of age, and they became
    disability-prone; the recession hit; the increased receipts of
    applicants were upon us. And, basically, we had not updated our
    business processes, or had the IT technology to really
    modernize where we are going.
        So why does the plan take so long? We have to look at all
    aspects of it, in addition to making sure that we have
    sufficient staffing. I am pleased to say that this year, we are
    hiring 130 ALJs in addition to the 200-and-some-odd that we
    hired last year. We are also hiring over 600 support staff.
    Unfortunately, we hired more ALJs and didn't have the
    comparable support staff, because the agency had a self-imposed
    freeze. So we were able to hire one aspect, but it makes sense
    if you are hiring more judges, you need the decision writers,
    and you need the support staff to work with them.
        So our commitment is to bring over 600 on before the end of
    the year, and that is with the help of the anomaly money. So it
    does take a long time to deal with systemic problems, but I
    want to assure you, for the Acting Commissioner and myself, all
    options are on the table. We are looking at all
    recommendations. As a matter of fact, Judge Zahm and I have met
    a couple of times, and I have actually looked at the 45
    recommendations that she has made. One of them, which is a
    short form or template for the fully favorable, is something
    that the agency is looking at right now to move forward and to
    get agreement on a direction.
        So, we ask you to work with us. Your Committee has come up
    with great ideas, and we appreciate your support for Social
    Security all these years.
        Chairman JOHNSON. You have been working with us, and we
    have been working with you for the whole time I have been in
    the Congress, and I haven't seen much improvement. It wasn't
    that long ago that Social Security was facing a different
    disability backlog, and telling our Subcommittee how that
    backlog was going to be tackled. Yet, less than 10 years later,
    here we are again with another disability backlog, and I don't
    know that your new plan is going to stop that cycle.
        How can you assure us that in 10 years, we are not still
    talking about another disability backlog?
        Ms. DISMAN. Well, my hope, Mr. Chairman, is that being
    strategic and looking at all aspects of the backlog will enable
    us to minimize the cycle. Now, we can't help what happens
    externally, whether there is another recession and more
    filings, or whether you have the issue--for example, there was
    a period of time where we couldn't hire administrative law
    judges because of the Office of Personnel Management, and
    thankfully, Congress helped us correct that situation.
        But if we don't have a plan that is strategic and deals
    with the core of our problems, just giving us the budget won't
    stem the cycle that you have just referenced. For example, when
    I looked at the actuary projections of receipts for disability,
    they are going down now. Well, that is good news for us because
    that allows us to work on the backlog. By the way, the cases
    are averaging over 600 days, because we are working on the most
    aged cases now, and that means the processing time goes up.
        But having said that, and working on the cycle that we are
    doing, we need to make sure we have fixes that prevent or
    minimize these swings in the workloads. And that is where we
    are all working very hard together.
        Chairman JOHNSON. Thank you, ma'am. Mr. Larson, you are
    recognized.
        Mr. LARSON. Well, I share the Chairman's concern, and 600
    days is just flat out unacceptable. And we are the United
    States of America, these are our fellow citizens, this is a
    program that they have paid for. So I have heard a lot of
    discussion today, so what I am going to ask everybody is, you
    know--we cite the figure that there has been a 13 percent
    increase of baby boomers coming through the thing, but a 10
    percent decrease.
        If you have a 10 percent increase, could you turn this
    around? And what would that timeframe then be?
        Ms. DISMAN. I would have to look at the particular
    statistics.
        Mr. LARSON. Okay. That is not an answer.
        Ms. DISMAN. But I want to give you an answer: Let me just
    say, for every $100 million that is given in our budget--first
    of all, we want the President's budget because the President's
    budget commits a plan for us to balance the workload. But for
    every extra $100 million, I will give you two examples: We can
    do another 100,000 of disability applications, or another
    50,000 of hearing decisions. So I will take your question
    back----
        Mr. LARSON. Why does that take so long, Ms. Larin? You have
    said there is a number of recommendations that don't seem to be
    followed. What would you say in this case? Would the additional
    money help or not help?
        Ms. LARIN. I think where GAO's work--what GAO's work speaks
    to is, is SSA using the resources that they currently have as
    efficiently and effectively as they can?
        Mr. LARSON. Are they?
        Ms. LARIN. We found several instances where we don't
    believe that they are. Where they could be more effective and
    more efficient.
        Mr. LARSON. So in a case where they are not, what is--what
    can the government then do? What does GAO then recommend?
        Ms. LARIN. Well, we have several recommendations on how
    they can better use the information that they have, the
    administrative data that they are collecting, to inform how
    they can make quicker decisions, more accurate decisions, and
    more consistent decisions.
        Mr. LARSON. Will that result in a savings of money and time
    and effort?
        Ms. LARIN. Well, it certainly would save in the time and
    effort if they were more efficient and more effective in making
    their decision.
        Mr. LARSON. Ms. McLaren, what would you say about
    additional resources, you very definitely indicated that in
    your remarks?
        Ms. MCLAREN. Certainly. You know, the DDSs are always in
    need of more resources as well. You know, the work we do in the
    DDSs is similar to what they face in the ALJ courts. The
    disability examiners are stretched thin because we have a
    hiring issue as well there. If we had more adequate resources
    to take the time that is necessary to perform the reviews,
    there might be an impact. And we also, back to the statements
    that----
        Mr. LARSON. That is a very troubling thing. We say, and my
    colleagues over here will say, look, more money isn't the
    answer. We just say to you, look, we recognize that you are
    down, if we give you more money and--you can't give us an
    answer. And so it is very disturbing to people that want to
    help and see the citizens get help. We hear Ms. Ekman talking
    about--putting a real face on this, and then we go round and
    round and round without the ability seemingly to help. Judge,
    you----
        Judge ZAHM. Give me a clerk and two attorneys. Give my
    judges a clerk and two attorneys and we can go to town. We will
    be able to turn out a lot more decisions. And----
        Mr. LARSON. What does that mean, ``a lot more decisions''?
    We have a 600, you know, this backlog. What does that exactly
    mean?
        Judge ZAHM. I would say that judges, if given proper
    staffing, could probably add another 50 to 100 hearings per
    judge, and we have 1600 judges, per year, if you gave us
    staffing, and if you change the procedures that are roadblocks.
        Mr. LARSON. If we change the procedures, what is the
    number? Do you reduce it or do we just add more judges, more
    staff, more----
        Judge ZAHM. No, no, no. We definitely can reduce the
    backlog.
        Mr. LARSON. To what?
        Judge ZAHM. Give me a minute and let me figure it out.
        Mr. LARSON. Ms. Ekman, explain again what people are
    actually going through and how incompetent, in the face of
    that, we all seem.
        Ms. EKMAN. Thank you, Mr. Larson. People are losing their
    homes, they are dying, and they are becoming bankrupt while
    they wait for a decision. I think, Mr. Larson, when you
    chronically underfund an agency, you can't expect a small
    increase in funding in the short term to fix those problems.
    You need adequate funding sustained over a long period in order
    for SSA to get itself out of the hole that Congress has dug for
    them by giving them inadequate resources.
        You can't fix your problems by shifting money from one
    place to another without expecting all of the service that SSA
    provides to America to suffer. And, unfortunately, it is going
    to take a number of years even if you were to give
    significantly increased funding for SSA to be able to dig
    itself out of the hole they have been put in by inadequate
    funding over the last 7 years.
        Mr. LARSON. Well, it sounds like they could also make some
    changes that are being recommended by the GAO as well. I would
    be interested in finding out why it is that GAO can't get
    together with your group and come up with a comprehensive
    solution to this, that Congress can get its hands around,
    instead of these endless tastes-great/less-filling debates that
    we seem to have and nothing gets done.
        Chairman JOHNSON. I appreciate your questions. I appreciate
    your questions, and I totally agree with what the Ranking
    Member said. I hope you all are listening to his questions. And
    some of the answers that we are getting are, you know,
    nebulous, fruitless, something. Mr. Rice, you are recognized.
        Mr. RICE. Thank you, Mr. Chairman. I am looking at this
    chart of disability by wait times. It starts in 1986 and goes
    to 2016, 30 years, and the trend doesn't look very favorable.
    It is apparent that it is not a new problem. This is something
    that has been evolving over 30 years. But I also see that there
    are peaks and then there are valleys. And what I want to know
    is, what is the trend? Is this getting better or is it worse?
    Ms. Disman.
        Ms. DISMAN. The trend is getting better. Over the last 7
    months, we have reduced the pending. We are working on the aged
    cases. We have a number of initiatives that we started, but
    unfortunately, because of the decision writing backlog we had
    to stop. But with the hiring that we are going to do, there is
    some incredibly promising initiatives. We have to deal with----
        Mr. RICE. Okay. Thank you. I want to ask, what is the
    trend, in your opinion, Ms. Larin?
        Ms. LARIN. Federal disability programs have been on GAO's
    high risk list for many, many years. And----
        Mr. RICE. Is the trend favorable today or not?
        Ms. LARIN. We have not----
        Mr. RICE. Is it going to get worse or get better?
        Ms. LARIN. Well, we haven't seen much of an improvement.
        Mr. RICE. Okay. Ms. McLaren.
        Ms. MCLAREN. Initial disability applications are down, so
    are the appeals at the reconsideration level. So from a DDS
    perspective, we would see decreasing numbers in the front----
        Mr. RICE. So you think the trend is good and we are going
    to start to see decreasing numbers?
        Ms. MCLAREN. Some of those issues I couldn't speak to,
    those are SSA's issues.
        Mr. RICE. Thank you. Ms. Zahm--Judge Zahm.
        Judge ZAHM. The trend is down because applications are
    down.
        Mr. RICE. So you see it getting better, Ms. Ekman?
        Ms. EKMAN. Thank you, Congressman. We have not seen an
    improvement yet. I think--and the----
        Mr. RICE. What would be your opinion? Do you see one on the
    horizon or not?
        Ms. EKMAN. We see promising initiatives. It is going to
    take some time for them to----
        Mr. RICE. Thank you. I want to know about the trend in
    claims. I know we had a huge upswing in claims as people talk
    about the baby boomers aging and the recession, which force
    people to look for alternative sources of income. You say that
    the claims are down 600,000 in the last year. Is that right?
        Ms. DISMAN. What we were talking about--I can give you a
    figure of what they are down. The actuary shows they are down
    by about 100,000 from the prior year and 100,000 before that.
        Mr. RICE. What are the total numbers of claims per year?
    Someone said 4 million. Is that right?
        Ms. DISMAN. Well, the total number of claims per year that
    we are dealing with, I need to get back to you on that figure.
        Mr. RICE. Roughly. Judge Zahm, do you know the total number
    of claims per year?
        Judge ZAHM. No.
        Mr. RICE. Okay. Do you know, Ms. McLaren?
        Ms. MCLAREN. Yes, it is 4.7 million, but that includes all
    initial recon and CDR claims----
        Mr. RICE. So we have a 100,000 drop out of 4 million?
        Ms. MCLAREN. Right.
        Mr. RICE. All right. What percentage of claims--you know,
    the whole reason we have to have hearings is to make sure
    people are eligible. Right? If we knew--if they came into the
    office and said, I am disabled, and we could just believe that
    they met all the qualifications, we wouldn't have to have the
    hearings, right? What percentage of hearing applicants, Judge
    Zahm, are approved versus rejected? Do you know that?
        Judge ZAHM. At the hearings level it is approximately 45
    percent of applicants are approved.
        Mr. RICE. And ultimately, on appeals and on through, do you
    know the answer to that?
        Judge ZAHM. No, probably not a whole heck of a lot
    different.
        Mr. RICE. Ms. Ekman.
        Ms. EKMAN. Overall, after all levels of appeal, it is about
    4 in 10 that get approved. Initial claims, there is about 1 in
    3 that are approved. So 2 out of 3 are denied at the initial
    level.
        Mr. RICE. Wait a minute. She said 45 percent and you are
    saying 1 in 3.
        Ms. EKMAN. Well, at the initial level. And it is 45 percent
    at the hearings level. And so once you go through all the
    levels of appeal, you have to remember, too, a lot of people
    drop out, so the number of initial claims, only a percentage of
    those go forward to request hearings.
        Mr. RICE. The CAL program--I will go to you, Ms. Disman. I
    know it is expedited, so how much quicker is it than the
    regular program? How many more--what is the difference in wait
    times?
        Ms. DISMAN. It is substantial. If you take a look at the
    CAL conditions.
        Mr. RICE. Is it 200 days?
        Ms. DISMAN. The average is about 39 days for a CAL
    condition.
        Mr. RICE. Wow.
        Ms. DISMAN. As opposed to the average processing time for
    initial applications which is somewhere between 110 to 114
    days.
        Mr. RICE. Wow. What percentage of people get approved in
    the CAL program?
        Ms. DISMAN. Around 3 percent.
        Mr. RICE. Three? So 97 percent are in the other?
        Ms. DISMAN. Right. That is correct.
        Mr. RICE. Okay. And then, finally, is there any mechanism
    even quicker than CAL? I mean, when you--when they meet with
    somebody, and there is no question they are clearly disabled,
    is there anybody that just gets an instantaneous approval?
        Ms. DISMAN. Well, there is not instantaneous, but there are
    two other processes. One is TERI cases, where an individual has
    a disability which is likely to end in death and very seriously
    indicated as a TERI. The other is quick disability decisions.
    These were all implemented in the beginning of the rise of
    disability pendings over the years. So if it is not a CAL, it
    can be picked up as a quick decision case, it can be picked up
    as a TERI. They all work with each other.
        Mr. RICE. Thank you, ma'am.
        Chairman JOHNSON. Thank you for your questions.
        Mr. Pascrell, you are recognized.
        Mr. PASCRELL. Mr. Chairman, thank you. And I am interested
    in all the questions from all of our comrades here. Excellent.
    Maybe we should do this with Social Security, same approach,
    questions and answers.
        I have a question for you, Ms. Disman, and thank you for
    all your service. I mean that sincerely.
        We know that many initial SSDI applications are denied. Ms.
    Disman, let me ask you this, can you explain to me why that is?
    And is there anything we can do to try to reduce the
    inappropriate denials?
        Ms. DISMAN. Well, thank you, first of all. And I just want
    to reminisce about you and I appearing together in New Jersey
    on radio when I was regional----
        Mr. PASCRELL. We have the worst record in New Jersey. Did
    you know that?
        Ms. DISMAN. I won't even talk about that. Those were my
    years as Regional Commissioner.
        Mr. PASCRELL. I don't mean any inference to you. But I am
    saying New Jersey is way behind everybody else, it looks like,
    even though no State really stands out as getting a gold star.
    But go ahead, I am interrupting you.
        Ms. DISMAN. But in any event, if you look at the initial
    disability application--I used to head the quality function of
    Social Security where we actually looked at these initial
    disability applications. They are, if you look at their
    accuracy, their net accuracy is at 97 percent. Their decisional
    accuracy is at about 95 percent. What happens between the time
    of the initial denial? Time passes. The condition worsens.
    There is also new medical evidence that is introduced that
    wasn't introduced at the beginning.
        So where the DDSs on average have about a 35 percent
    allowance rate, you will see as it goes through its various
    stages, for example at the reconsideration stage when new
    evidence is submitted and the condition may change a little,
    another 12 percent get approved. And then you had, as Judge
    Zahm mentioned, you know, at the hearing level about 45
    percent.
        So it doesn't mean that the DDS's initial decision was
    incorrect, because they do look at 50 percent of the
    allowances, and there is a sample of denials as well, to see
    what is the quality of the decision.
        Mr. PASCRELL. Now, let's compare that to other agencies in
    other departments when we see problems of responding to our
    taxpayers and constituents and our family. I have seen the
    tendency in some of those other departments and agencies that
    remain nameless right now, if they are cutting my budget so I
    cannot spend X amount of dollars on page 38 of the budget you
    refer to--I didn't refer to it, you referred to it--there is a
    $64 billion cut in Social Security disability funds over the
    next 10 years.
        Now, if I am the bureaucrat and the administrator, call us
    whatever you wish, making decisions about, well, if I have less
    benefit money to provide, I need to find a way to get rid of a
    lot of these applicants, because there may be less applicants
    this year, but there is a steady pace of increasing if you look
    back at it over the next--the last 15 years. And by the way, if
    we continue with the last 6 months, we will have the same
    amount as last year. I will tell you the numbers, and you know
    the numbers better than I do.
        So I am saying, is there anything like that happening
    within the disability network of denying early on, let them
    appeal down the road?
        Ms. DISMAN. I would say absolutely----
        Mr. PASCRELL. Is that familiar to you, Ms. Disman?
        Ms. DISMAN. I would say absolutely not. I will tell you
    that our employees--and I do want to talk about what is in the
    budget, but absolutely not.
        Mr. PASCRELL. Yeah.
        Ms. DISMAN. Our employees believe in the mission. That is
    to get the right decision to the right person on time. I was
    trained that way when I came in over 50 years ago.
        Mr. PASCRELL. So we have less money over the next 10 years,
    according to the President's budget, which you talked about. We
    will find a way, if those people are eligible, to get them the
    assistance that they need?
        Ms. DISMAN. Absolutely.
        Mr. PASCRELL. Okay. Let me continue, please.
        So there are no easy fixes. We know that. Making a proper
    SSDI eligibility determination is extremely complex. I feel
    like I am starting to sound like a broken record, though,
    lately, because I keep coming back to the same point that
    virtually all of the Social Security Subcommittee hearings we
    have had since I joined the Subcommittee, but many of the
    problems that this Subcommittee has been examining with the
    Social Security Administration are firmly rooted, I will
    contend, in the lack of resources the agency has been given.
        Look, we don't want anybody to get Social Security
    disability that doesn't deserve it. You have changed the rules.
    And some of them I think are excellent so that we don't have to
    face that issue later on. So we are going to find a way to find
    the rules to have less people who are eligible because you have
    less funds to provide. I mean, the numbers are the numbers. I
    didn't make them up. And I don't think you made them up, Ms.
    Disman. I know your background.
        So you can defend it all you want, but we are trying to get
    to some kind of agreement here so that we can move forward. And
    not everything is in, you know, stark white and black. We know
    that. And there is no easy answers. None. This is complex
    stuff. But I am looking at the history. I am looking at what is
    going to happen by the end of this year. And I don't see any
    improvement whatsoever, to go back to the gentleman's question
    before.
        So, you know, no wonder why some of us are a little
    puzzled. I mean, I am always a little puzzled, but this is
    something that we need to take a much more serious look at, and
    I thank the Chairman for putting us together today.
        Chairman JOHNSON. Thank you, sir. The gentleman's time has
    expired.
        Mr. Renacci, you are recognized.
        Mr. RENACCI. Thank you, Mr. Chairman. And I also want to
    thank Ranking Member Larson for both of you putting this
    together, and I want to thank the witnesses. And this won't be
    a pile-on, although it does seem like it is.
        And I am going to go back to what my friend Mr. Larson
    said, because it is always easy to talk about money. And he
    said over here we are going to talk about money, and you are
    right because I was in business. And in my 30 years in
    business, when we were having troubles, people would walk up
    and say, well, we just need more money. And it is always easy
    to say, yup, we just need more money, and just give me more
    money, and if you keep giving me more money--the problem is
    here we don't have any more money.
        In Washington, every day we are borrowing from China. We
    have enough issues already, and we just don't have the money,
    so we have to be more efficient. And that is what we used to do
    in the business world. That is what families are asked to do.
    We have to become more efficient.
        So I want to talk about efficiency more than money. And we
    have to figure out how do we become more efficient, because
    there is just no more money. We can talk about it all day, but
    the American people are tired of talking about money when we
    have a $20 trillion deficit, and it continues to grow.
        So I want to talk about one example, because the trend
    line--I do like my friend's example of the trend. The trend is
    not good. I put the black line as the trend line. We can go up
    and down and up and down, but the trend is continually going
    up, so that is an issue.
        What is troubling is that a constituent of mine--and I will
    just use one example. We have a constituent, John, from Parma,
    Ohio, who applied for disability in February of 2015, and who
    my office is still working on to get him a final decision. For
    John, this has really been a frustrating process for him and
    his family. This is simply unacceptable. Unfortunately, I have
    many other constituents who are facing the same circumstances.
    That is February of 2015.
        So what we did was we went out and we started to talk to
    some of the judges in our area to try to figure out what was
    going on. And our Social Security--when we talked to our
    judges, and my staff talked to them in northeast Ohio, they
    have told us that the rules--and I want to go back. Social
    Security recently finalized regulations that generally require
    all evidence to be submitted to the ALJ no later than 5 days
    before a hearing. The judges are stating, they told us that the
    rule fails to fully address the issue of ensuring that they as
    judges have all the information they need prior to the hearing.
        So that is important in a timeline. That is important in a
    decision. And I think it is important that we look at at least
    that. So, basically, the rule is not working.
        But I want to ask Judge Zahm, what are your thoughts on
    that? The judges are saying they need the information.
        Judge ZAHM. Yes. The judges who spoke with you and your
    staff are 100 percent correct. This is the situation. Judges
    are most efficient when we have evidence submitted to us before
    the hearing so that the judge and the medical experts can
    review that evidence and be prepared for the questioning of the
    claimant at the hearing and for the questioning of the experts.
    Then when the testimony is over, we can make a decision right
    away right there. It is fast. It is efficient.
        But what has happened is that the agency had a 10-year
    pilot program in New England that required evidence to be
    submitted 5 days in advance. By all accounts it worked well, so
    the agency decided to extend it nationwide. So far so good.
        Then the rule was drafted, and the rule didn't require just
    the submission of evidence, it also said, and if you don't have
    the evidence you can just tell us what evidence is missing and
    your attempts to get it. So now, 5 days before the hearing I
    still don't have the evidence. What is worse is they have told
    me what evidence I don't have and it is too late to get it. So
    the intent of the rule was undermined by poorly being drafted.
        We need a rule that says 5 days before the hearing get your
    evidence in. People get 75 days' notice before the hearing, so
    they have plenty of time. And if they can't get it, because
    sometimes providers are recalcitrant, let me know. I will
    subpoena it. I need the evidence the day of the hearing so I
    can be efficient.
        Mr. RENACCI. I appreciate that. And again, that doesn't
    take more money, that just takes more efficiency.
        Judge ZAHM. Exactly.
        Mr. RENACCI. Ms. Disman, do you want to----
        Ms. DISMAN. Yes. And certainly, we--the national uniformity
    rule was intended to do as you articulated. It was taking 73
    days on average for the scheduling of a hearing, so this was
    giving 75 days for the reps to present the evidence.
    Unfortunately, we have had a few reps informing us before 5
    days. These sources are medical.
        So what we are in the midst of doing now is using a
    clarifying ruling to deal with those situations. We will also
    have our new Office of Quality and Review and Oversight do a
    study of these cases. The rule went into effect the beginning
    of May. We wanted to do some data analysis to see where it is.
    At the same time, the ruling that we will have will lay out
    factors of what does it mean when you are coming in front of
    us, what do you need to provide?
        The one thing we don't want to do is prevent due process on
    behalf of our claimants. We want to make sure they are afforded
    the best while we are more efficient in what we do.
        Mr. RENACCI. Well, I thank you. And I know I have run out
    of time, but again, this isn't more money, this is just a
    procedure and time and getting things done and getting things
    to the judges.
        I yield back.
        Chairman JOHNSON. Mr. Kelly, you are recognized.
        Mr. KELLY. Thank you, Chairman. Thank you all for being
    here.
        As we listen to this, and again, it does come down, as Mr.
    Renacci was talking about, to the amount of money we have to
    work with and then the size of the Social Security
    Administration. So when we talk about not having enough people,
    and hearing you talk, Judge, what I don't understand is how did
    we figure out that we needed to hire more judges but didn't
    figure out that they needed to have support staff? How do those
    decisions come about?
        Now, as a person who has always been in the private sector,
    it is hard for me to understand that money is the answer to
    this. As Mr. Renacci just said, it is efficiency that really
    drives us most of the time because we just don't have, in the
    private sector, large sums of money to work with. So I was
    really--I was puzzled. So we said, yeah, we need more judges,
    but nobody thinks that they need more support staff. That is
    almost incomprehensible, but that is the issue that you talked
    about.
        Judge ZAHM. Yes. And to the extent that you give me no
    support staff, I cannot be efficient.
        Mr. KELLY. Okay. And so I have to tell you what we face as
    Members of Congress in our offices. We have people coming to us
    with this problem. It is a very difficult system to navigate.
    Let me just read something to you, because we are talking about
    efficiency and effectiveness, and we are talking about making
    sure that we don't have unapplied time, because that is what
    drives everybody's model off the charts.
        In looking over disability insurance statistics for my
    congressional district in western Pennsylvania, I noticed that
    the average processing time is much higher than the national
    average. In our Pittsburgh office, my understanding is the
    average processing time is 698 days. The national average is
    599 days. Both are lengthy, but it takes almost 2 years for a
    claim to be processed with almost 8,200 cases pending in
    Pittsburgh alone. This is an incredible mountain we have to
    climb. That is thousands of western Pennsylvanians with their
    lives on hold for almost 2 years while their claim is being
    processed. Now, a constituent brought this up to me.
        Meanwhile, I just read a report by the Social Security
    Commissioner's Office that last year, 2016, the agency spent
    over $16 million on union representational activities. In fact,
    16 employees spent 100 percent of their time solely on union
    activities. In addition to these 16 employees, almost another
    1,500 used official time on a part-time basis for a total of
    255,000 official hours spent on union activities.
        I have an extremely hard time explaining to my constituents

    that call our office seeking help with their disability claims
    that taxpayer dollars are being spent to the tune of $16
    million on
    union activities while they are waiting for a decision from a
    Federal agency.
        Of course, this is not just an issue at the Social Security
    Administration. In 2014, government employees spent nearly 3\1/
    2\ million hours conducting union business, costing taxpayers,
    hardworking American taxpayers, $162.5 million. That is not my
    number, that is OPM.
        So when we are saying we don't have enough people and they
    don't have enough time, how do we find 255,000 hours to spend
    on union activity when we have people waiting to hear their
    claim being processed? Now, I know people say, well, you don't
    want to go down that road. I do want to go down that road
    because do you know who picks up the tab on this? Hardworking
    American taxpayers. They are asking us, how can you look the
    other way when this is going on, when we have people waiting
    over 2 years for a claim to be processed? This is not your
    problem. This is the problem with government.
        Now, Ms. Disman, what is the average time it takes a
    Federal employee to process a disability claim nationally, just
    a ballpark average?
        Ms. DISMAN. Well, I was going to give you an example of a
    decision writer.
        Mr. KELLY. Just give me a ballpark, how much time does it
    take?
        Ms. DISMAN. So one decision writer can write in a year 220
    decisions.
        Mr. KELLY. They can write 220 decisions. Okay.
        Ms. DISMAN. So if you multiply that by the work years that
    you are talking about, you will have a sense of what can be
    done in writing decisions.
        Mr. KELLY. Okay. Let me ask you then, if these 16 employees
    that spend 100 percent of their time dedicated to union
    activities could instead have been working on processing
    disability claims, do you think that would have helped reduce
    the backlog?
        Ms. DISMAN. That would have contributed to more decisions
    being written.
        Mr. KELLY. Okay. And if the 255,000 official hours spent on
    union activities funded by American taxpayers, by the way, were
    spent on processing disability claims, do you think this would
    further help reduce the backlog?
        Ms. DISMAN. Well, I think you have to look at the whole
    program.
        Mr. KELLY. No, I just want an answer. Would it reduce the
    backlog? I don't want to hear about things in totality, because
    that is how we always get lost in this government. We get so
    lost in the fact that we forget that every single penny came
    out of the pocket of a hardworking American taxpayer.
        I know how Social Security works because I am from the
    private sector, and I know it is all based on wage taxes. But
    when I look at this and I keep hearing all we need is more
    money, all we need is more people, and then I say to these
    people, ``Well, what is everybody doing now?'' I don't know,
    Judge, how you could look at more judges coming onboard but
    nobody being hired to the support staff. Maybe asking some of
    those other folks that spent 255,000 hours, do you want to
    really help out with claims and backlogs? Maybe that would be
    the answer.
        Now, I get spun up about this because we keep chasing a
    rabbit we can't catch. And we keep talking about we need more
    money, we need more people, and I keep seeing the backlog keeps
    rising. And all we say to those people back home is just stay
    tuned, we are going to get to you eventually.
        So I know my time is up. Mr. Chairman, I thank you. I yield
    back.
        Chairman JOHNSON. Thank you. Thank you for your
    questioning.
        And, Ms. Sanchez, you are recognized.
        Ms. SANCHEZ. Thank you, Mr. Chairman.
        You know, time and time we hold hearings criticizing the
    Social Security Administration for backlogs, technology issues,
    or fraud, and as Members of Congress we never end up doing
    anything about it. And there tends to be one common thing among
    all the concerns that we keep raising, and I think the line of
    question-
    ing that just went down is sort of a red herring, but it all
    boils
    down basically to lack of funding. And I know people don't want
    to spend funding, but the Social Security Administration has
    been flat funded since 2011. Okay? In 6 years, you cannot buy
    the same amount of paper that you could 6 years earlier with
    the same amount of money. There is this thing called inflation
    that contributes to the cost of doing business.
        In addition, we have an aging baby boomer population and an
    increased demand on limited resources. And I am just going to
    take a guess, and you all can correct me if I am wrong, but I
    am guessing that probably disability claims have been on the
    rise over the course of the 30-year history. I doubt that the
    number of claims has stayed flat.
        So we can't expect Social Security, or any other Federal
    Government agency for that matter, to do more with less and
    less. As the increase in demand goes up, you need an increase
    in resources to deal with the issue. And there is no substitute
    for resources. No amount of congressional hearings and waving
    our arms and screaming into a microphone is going to make up
    for the fact that you guys are not receiving the funding that
    you should receive, that it is not keeping pace with the
    demand.
        So here we are again one more time talking about the
    disability backlog, reprimanding Social Security, but not
    considering actual ways to fix it. And there is no doubt the
    backlog is unacceptable. Six hundred days is too long for
    people in need to wait for a decision. And as Ms. McLaren
    testified, the longer people wait, the greater the hardships
    that they face.
        So it is imperative that Social Security has the number of
    ALJs it needs, the attorneys and support staff to process those
    reviews in a timely manner. Social Security is meant to be
    there when beneficiaries need it the most.
        Now, I happen to have worked for a Federal district court
    judge, and I know what a lack of resources can mean for getting
    through case work. You know, we all want the Social Security
    Administration magically to be able to process these claims in
    a very quick turnaround, but heaven forbid, we don't want you
    guys to make a mistake. We want the decisions to be correct
    ones. Well, correct decisions mean that you need all of the
    information, and it takes time to get that information
    sometimes from the recipients themselves, from the petitioners
    themselves.
        You know, we all want everything to work perfectly, and we
    live in an imperfect world. And certainly, if we don't allocate
    the resources needed, we are not going to see any trend
    reversal.
        So I want to go to Ms. Zahm, because you were kind of
    interrupted by Mr. Larson. You were trying to do a back of the
    envelope calculation about how many cases could be taken out of
    that backlog if you had just one ALJ hired, one law clerk, and
    an attorney to help them. Can you give me a back of the
    envelope calculation?
        Judge ZAHM. Yes. But let me just correct: one clerical
    employee, two attorneys.
        Ms. SANCHEZ. My apologies.
        Judge ZAHM. Because then if somebody implements it, and I
    don't get the other attorney----
        Ms. SANCHEZ. Roughly how many cases?
        Judge ZAHM. I think between 150- and 200,000 extra
    decisions a year. Now, we already put out 700,000 decisions a
    year. That will make a dent in the backlog.
        Ms. SANCHEZ. Yeah. Nobody talks about what you are getting
    right, you know?
        Judge ZAHM. Yes.
        Ms. SANCHEZ. Everybody wants to focus on everything that is
    falling apart. Well, I happen to be a believer in government. I
    believe that government can do things competently, if they are
    given the right people for the right job and the right
    resources.
        Ms. Disman, how big of an impact has level funding had on
    Social Security Administration's ability to process claims?
        Ms. DISMAN. Well, I think if you look at what we have
    achieved, Social Security has managed to identify priorities
    and to establish the processing of claims for our constituents,
    and also has used technology to enhance services and to provide
    different ways of providing the same service.
        Ms. SANCHEZ. But the question was how has level funding
    impacted the ability to write more decisions in a year? Has it
    positively impacted that or has it negatively impacted that?
        Ms. DISMAN. Well, I think we can certainly say that with
    more funds we can do more.
        Ms. SANCHEZ. Excellent. And how much funding would SSA need
    to bring the wait time down to the goal of 270 days, do you
    have an idea?
        Ms. DISMAN. Well, I would actually like to come back with
    that for the record, because it makes a number of assumptions.
    I think you heard from our DDS community about the
    reintroduction of the reconsideration process. If we introduce
    that process, it means less cases will go to the administrative
    law judge. So let me send that back to you with a number of
    assumptions behind it.
        Ms. SANCHEZ. I appreciate that. And do you think that with
    demand growing, you can keep level funding SSA and expect that
    somehow we are going to reverse the trend of this backlog?
        Ms. DISMAN. I think that we have enough in the President's
    budget to be able to start the downward trend. It is taking
    longer than----
        Ms. SANCHEZ. But could you get it to the recommended 270
    days if you stay at a flat level funded? And that is not to say
    that there is no cuts, because we have even heard about cuts
    potentially.
        Ms. DISMAN. Well, if the President's budget and the budget
    that we are going to be submitting to Congress for 2019 all
    assume that we will continue to get a specific funding level to
    allow us to reduce the backlog.
        Ms. SANCHEZ. But would you get the----
        Chairman JOHNSON. The time of the lady has expired.
        Ms. SANCHEZ. Excuse me, but my last colleague was granted
    additional time, and I have one last question I would like to
    submit for the record and allow the witnesses to respond to in
    writing, not verbally.
        Chairman JOHNSON. Sure.
        Ms. SANCHEZ. My question is, with level funding, you said
    that you can start the downward trend in the backlog. How many
    years would it take you to catch up the backlog and get it down
    to the recommended 270 days? And I will allow you to submit
    that answer in writing.
        And I thank the Chairman, and I yield back.
        Chairman JOHNSON. Thank you.
        Mr. Smith, you are recognized.
        Mr. SMITH. Thank you, Mr. Chairman. Thank you for having
    this hearing.
        Ms. Disman, could you tell me how many administrative law
    judges there were in 2011?
        Ms. DISMAN. If my memory serves me correct, and I will
    change that for the record if it was wrong, there were about
    1,100.
        Mr. SMITH. Okay. And currently there is how many?
        Ms. DISMAN. Over 1,600.
        Mr. SMITH. So the lowest backlog we had was in 2011 in
    recent history. And it showed that it was like 350, around
    there somewhere, and now we are at 600. In fact, in Missouri,
    we are at 672, which is worse than the national average. Why
    have we almost doubled when we have almost doubled how many
    administrative law judges we have, according to those numbers?
        Ms. DISMAN. Well, I think if you look at the issues, it is
    the composition of staff that we were able to hire over the
    years. It is the length of time it takes to hire staff. It
    takes time to train staff and have them be proficient. And the
    backlog was the increase in receipts that came in at the
    initial disability level and made its way through the ALJ
    level.
        So this didn't happen overnight. If you look at a curve you
    will see each year it being incremental, and then we had
    problems over the years on actually hiring judges.
        Mr. SMITH. I am just really confused. If in 2011 we had 11-
    or 1,200 people, whatever that is, administrative law judges,
    and today we have 1,600, that is a sizeable increase. And I
    mean, does it take 5 years to train people so that they can go
    through the cases, or I just don't--I can't get--I can't
    comprehend that.
        Ms. DISMAN. We had a period of time where we couldn't hire
    administrative judges, so if you look at it, about 245 were
    hired last year with another 130 this year. And we lose about
    100 ALJs a year.
        Mr. SMITH. So you hired about 350 new ones in the last year
    and a half. Okay. That is helpful. That is the kind of stuff
    you need to tell me.
        Mrs. Zahm, in your testimony, you made the comment that
    there has been more than 1,000 new regulations. What were those
    regulations implemented from? Was it legislation or just that
    the Social Security Administration decided to come up with
    something different?
        Judge ZAHM. It was the latter. The agency made changes to
    the Hearings and Appeals Manual that we use to adjudicate
    cases. Approximately 1,000 since 2011. They have complicated
    and made more time consuming our jobs, but also in that same
    period of time, since 2011, the size of our files have
    increased 55 percent, and that doesn't even count the increase
    from fiscal year 2017. So we have files increasing, numbers of
    applications going up since 2011 and----
        Mr. SMITH. How much? What percent have they gone up since
    2011? Do you have that number?
        Judge ZAHM. That Ms. Disman would know.
        Mr. SMITH. Okay. I will get to her again.
        You said that out of those thousand rules, there is several
    that are not necessary. Could you give me a couple examples of
    not necessary rules that are costing the judiciary time?
        Judge ZAHM. Yes. Okay. For instance, when a claimant tells
    us that they have new medical evidence, they send in documents
    saying Dr. Jones, Dr. Smith, whatever, I have been to the
    hospital, the clerk has to contact the claimant and say you
    need to get these documents. They have to wait 30 days. The
    documents won't come in. If it is an unrepresented claimant,
    they are not coming in. They have to recontact the claimant and
    say why aren't they submitted and then hear a story. They then
    have to go and say to the judge, what do you want us to do?
    And, of course, the judge will always say, I want you to get
    those documents.
        With unrepresented people, why are we doing this? They are
    not going to get the documents. If they get them, they won't be
    complete. The clerk should simply, once they are notified that
    there is another medical provider, send for the documents. That
    would be less time consuming than this dance between us, the
    claimant, the judge, whatever. It takes time, it takes staff
    time, and at the end of the day, we are going to ask for those
    documents anyway, so why don't we just do it to begin with?
        Mr. SMITH. Okay. Good point. You said that last year
    750,000 claims were processed?
        Judge ZAHM. About 700,000 claims, I believe, where
    dispositions were issued at the--that might be 690, whatever.
    About 700,000.
        Mr. SMITH. And I just wanted to clarify Mrs. Sanchez'
    question and Mr. Larson's, I think. You said that by one new
    administrative law judge and the appropriate personnel for
    their office would create a reduction in backlog by what amount
    a year?
        Judge ZAHM. I estimate between 150- and 200,000 extra
    dispositions if you gave us staff.
        Mr. SMITH. For each one administrative law judge or----
        Judge ZAHM. No. Overall based upon--we already put out
    about 700,000. I think we could do an extra 150- to 200,000 if
    I had a clerk and two attorneys.
        Mr. SMITH. With how many lawyers hired, though?
        Judge ZAHM. I don't know exactly how many the agency has.
        Mr. SMITH. Okay. All right.
        Judge ZAHM. I don't know how many more.
        Ms. SANCHEZ. If the gentleman would yield.
        It sounds like you are saying not with additional judges
    but just getting the staffing for the current judges that
    exist.
        Judge ZAHM. Right. Exactly.
        Mr. SMITH. Oh, under the current administrative law judges
    to make sure that they are fully staffed?
        Judge ZAHM. Exactly.
        Mr. SMITH. Okay. Thank you.
        Chairman JOHNSON. The time of the gentleman has expired.
        I ask for unanimous consent to insert in the report Mr.
    Kelly's reference to the record. Without objection, so ordered.
        [The submission of The Honorable Sam Johnson follows:]
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        Chairman JOHNSON. As we have heard today, Social Security
    has a lot of work to do, and people are waiting too long to get
    a hearing, and that is simply unacceptable. The good news is
    that Social Security has a plan, but the bad news is it is
    going to take, according to them, until 2022 to get it done.
    Social Security needs to get their wait times under control and
    the American people deserve no less.
        I want to thank our witnesses for your testimony and thank
    you for your patience out there. Thank you also to our Members
    for being here.
        Mr. LARSON. Could I have just----
        Chairman JOHNSON. Mr. Larson, you are recognized for a
    comment.
        Mr. LARSON. Yes. I just also wanted to thank the panelists
    and the Chairman here. I would like to have Ms. Ekman--because
    you didn't get the opportunity to follow up on a number of the
    things that you heard from the only person here who is carrying
    the perspective of the individuals who are impacted by these
    excessive wait times. I think there is the desire from
    everybody here to get after this issue. And, Mr. Chairman, I
    thank you because we unearthed a lot of things.
        What would you recommend, Ms. Ekman, that we do to take a
    number of the positive and constructive things that we have
    heard and turn it into a plan of action?
        Ms. EKMAN. Thank you, Ranking Member Larson. I think
    everyone sitting at this table would agree that the earlier we
    can get a complete evidentiary record in the application
    process, the better and quicker decisions we can make. We would
    recommend that SSA maybe take a little bit longer at the
    initial decision to more fully develop the record. Many
    claimants are unrepresented, and as Judge Zahm said,
    unrepresented claimants can often not be very helpful because
    they are in dire medical straits often when they are going
    through their initial application in assisting in that process.
    Doing more reviews of denials, which less than 3 percent of
    denials are currently reviewed, to ensure that the decision is
    correct could assist in that.
        I think one thing that does not help is creating arbitrary
    deadlines prior to a hearing for the submission of evidence. We
    all agree we want the evidence in, and if there are a few bad
    actors who are not getting the evidence in, Social Security has
    a lot of tools at their disposal to take care of those
    particular representatives. What we should not be doing is
    passing rules that arbitrarily exclude evidence based on a
    timeline that hits the claimant over the head instead of
    addressing any bad actions by representatives.
        So I think what we need to do is figure out how to get the
    evidence in early in the process and have SSA assist claimants
    to do that so that we can avoid having to go through further
    stages of appeal.
        Mr. LARSON. I want to thank you again. I want to thank all
    the witnesses and the Chairman.
        I would just make one final comment about what we were
    discussing earlier, but we don't believe on either side that
    money in and of itself is the solution, but we cannot overlook
    the fact that we have had a large increase of baby boomers
    coming through this process at this time either. So it is very
    helpful to find out how we can combine both what we like to
    think is technology's assistance but also then, with some of
    the very commonsense recommendations that the judge has made
    and with some of the recommendations of GAO, that perhaps we
    are well on our way to do a combination of both, and finding
    where it is where actual money in the system could best benefit
    and whether it is additional clerks or it is the streamlining
    of information, lesser regulations, or actually getting to some
    of these commonsense recommendations that we could actually
    make progress instead of just having hearings.
        But, again, Mr. Chairman, thank you. This is a tremendous
    hearing.
        Chairman JOHNSON. Thank you all for being here, and thank
    you for your testimony. Thanks also to our Members that are
    here.
        With that, the Subcommittee stands adjourned.
        [Whereupon, at 11:38 a.m., the Subcommittee was adjourned.]
        [Questions for the Record follow:]
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