Disability Programs: SSA Has Taken Steps to Address Conflicting  
Court Decisions, but Needs to Manage Data Better on the 	 
Increasing Number of Court Remands (05-APR-07, GAO-07-331).	 
                                                                 
The Social Security Administration's (SSA) Disability Insurance  
and Supplemental Security Income programs provided around $128	 
billion to about 12.8 million persons with disabilities and their
families in fiscal year 2005. Claimants who are denied benefits  
by SSA may appeal to federal courts. Through current initiatives,
SSA is attempting to reduce the number of cases appealed to	 
courts and remanded back to SSA for further review. In addition, 
there have been long-standing concerns about how SSA responds to 
court decisions that conflict with its policies. GAO was asked to
examine: (1) trends over the past decade in the number of appeals
reviewed by the courts and their decisions, (2) reasons for court
remands and factors contributing to them, and (3) SSA's process  
for responding to court decisions that conflict with agency	 
policy. GAO reviewed SSA data and documents on court decisions,  
remands and SSA's processes and interviewed agency officials and 
stakeholders on data trends, reasons for remands, and SSA	 
processes.							 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-07-331 					        
    ACCNO:   A67844						        
  TITLE:     Disability Programs: SSA Has Taken Steps to Address      
Conflicting Court Decisions, but Needs to Manage Data Better on  
the Increasing Number of Court Remands				 
     DATE:   04/05/2007 
  SUBJECT:   Appeals						 
	     Appellate courts					 
	     Claims processing					 
	     Data collection					 
	     Data integrity					 
	     Disability insurance				 
	     Eligibility determinations 			 
	     Federal courts					 
	     Federal social security programs			 
	     National policies					 
	     Persons with disabilities				 
	     Program evaluation 				 
	     Social security beneficiaries			 
	     Social security benefits				 
	     Policies and procedures				 
	     SSA Disability Insurance Program			 
	     SSA Supplemental Security Income			 
	     Program						 
                                                                 

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GAO-07-331

   

     * [1]Results in Brief
     * [2]Background

          * [3]Disability Determination and Administrative Appeals
          * [4]Cases in Federal Court
          * [5]How Federal Court Decisions May Affect SSA Policy
          * [6]Disability Service Improvement Process

     * [7]Court Reviews and Remands Have Increased in Recent Years wit

          * [8]Cases Reviewed by District Courts Increased over the Past De
          * [9]The Proportion of Remanded Cases Varied by Circuit
          * [10]In the Majority of Remanded Cases, Claimants Were Awarded Be

     * [11]Remands Have Been Attributed to a Range of Errors Caused by

          * [12]Stakeholders Attribute Various Reasons for Remands to High S
          * [13]Agency Remand Data Are Incomplete and Not Well Managed

     * [14]SSA Has Taken Several Steps Since 1990 to Align Its Policies

          * [15]SSA Has a Process in Place for Reviewing and Addressing Appe
          * [16]SSA Has Taken Steps to Align Its Policies with Court Decisio

     * [17]Conclusions
     * [18]Recommendations
     * [19]Agency Comments
     * [20]Appendix I: Objective, Scope, and Methodology
     * [21]Appendix II: Summary of Process Unification Rulings
     * [22]Appendix III: Key Federal Court Rulings on Social Security A

          * [23]1983

               * [24]1984

                    * [25]1985
                    * [26]1986
                    * [27]1989
                    * [28]1990
                    * [29]1993
                    * [30]1994
                    * [31]2002
                    * [32]2003

     * [33]Appendix IV: Additional Information on Disability Appeals
     * [34]Appendix V: Summary of Court Holdings for Acquiescence Rulin
     * [35]Appendix VI: Comments from the Agency
     * [36]Appendix VII: GAO Contact and Staff Acknowledgments
     * [37]Related GAO Reports

          * [38]Order by Mail or Phone

Report to Congressional Requesters

United States Government Accountability Office

GAO

April 2007

DISABILITY PROGRAMS

SSA Has Taken Steps to Address Conflicting Court Decisions, but Needs to
Manage Data Better on the Increasing Number of Court Remands

GAO-07-331

Contents

Letter 1

Results in Brief 3
Background 5
Court Reviews and Remands Have Increased in Recent Years with Remands
Often Resulting in SSA's Subsequently Awarding Benefits 12
Remands Have Been Attributed to a Range of Errors Caused by Heavy
Workloads, but SSA Data That Could Shed More Light on the Problem Are
Inadequate 17
SSA Has Taken Several Steps Since 1990 to Align Its Policies Nationally
with Court Decisions 21
Conclusions 27
Recommendations 28
Agency Comments 28
Appendix I Objective, Scope, and Methodology 30
Appendix II Summary of Process Unification Rulings 32
Appendix III Key Federal Court Rulings on Social Security Administration
Disability Adjudication 34
Appendix IV Additional Information on Disability Appeals 36
Appendix V Summary of Court Holdings for Acquiescence Rulings Related to
Disability Determinations 39
Appendix VI Comments from the Agency 42
Appendix VII GAO Contact and Staff Acknowledgments 45
Related GAO Reports 46

Figures

Figure 1: Map of Federal Judicial Circuits 8
Figure 2: Disability Process after SSA Final Decision 10
Figure 3: Federal District Court Decisions on Disability Claims, Fiscal
Year 1995 to Fiscal Year 2005 13
Figure 4: District Court Decisions on Disability Claims 14
Figure 5: District Court Decisions by Circuit (Fiscal Year 2005) 15
Figure 6: SSA Decisions on Remanded Disability Claims, Fiscal Year 1995 to
Fiscal Year 2005 16
Figure 7: SSA Decisions on Disability Claims Following Court Remands by
Judicial Circuit, Fiscal Year 1995 to Fiscal Year 2005 17
Figure 8: Number of Acquiescence Rulings Issued, 1990 to 2006 24
Figure 9: Number of Acquiescence Rulings by Circuit, 1990 to 2006 25
Figure 10: Timeliness of Acquiescence Rulings, 1990 to 2006 26
Figure 11: How Acquiescence Rulings Were Rescinded, 1990 to 2006 27
Figure 12: Appeals Council Denials of Social Security Claims, Fiscal Year
1994 to Fiscal Year 2004 36
Figure 13: SSA Decisions on Disability Claims Following Court Remands 37
Figure 14: Social Security Claims Reviewed in Federal District Courts in
Fiscal Year 2005 by Judicial Circuit 38

Abbreviations

ALJ administrative law judge
CPMS Case Processing and Management System
DI Disability Insurance
DOJ Department of Justice
DSI Disability Service Improvement
FIT Findings Integrated Template
NDMIS National Docketing/Management Information System
ODAR Office of Disability Adjudication and Review
OGC Office of the General Counsel
SSA Social Security Administration
SSI Supplemental Security Income

This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed in
its entirety without further permission from GAO. However, because this
work may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this material
separately.

United States Government Accountability Office

Washington, DC 20548

April 5, 2007

The Honorable Charles B. Rangel
Chairman
The Honorable Jim McCrery
Ranking Minority Member
Committee on Ways and Means
House of Representatives

The Honorable Michael R. McNulty
Chairman
The Honorable Sam Johnson
Ranking Minority Member
Subcommittee on Social Security
Committee on Ways and Means
House of Representatives

The Honorable Sander M. Levin
House of Representatives

In fiscal year 2005, the Social Security Administration (SSA) provided
approximately $128 billion in cash benefits to about 12.8 million persons
through the nation's two largest programs for persons with disabilities
and their families--the Disability Insurance (DI) and the Supplemental
Security Income (SSI) programs. In administering these programs over the
past decade, SSA has faced challenges associated with lengthy
decision-making processes and difficult disability determinations. In an
effort to introduce more efficiency and fairness in its decision making,
SSA has undertaken a "Disability Service Improvement Process," about which
we offered testimony in June of 2006. Among the problems this initiative
is designed to address is the number of SSA disability decisions that are
appealed to the federal courts and subsequently remanded or referred back
to the agency for re-adjudication. Such appeals and remands can add
several years to the time it takes disability claimants to receive final
decisions on their applications. Most appealed cases are reviewed only by
the district courts, the first level of court review. However, if a
disability claim reaches the appellate court or Supreme Court, the
decision may have implications for SSA policy. There has been a
long-standing concern that SSA does not respond adequately to appellate
court decisions that conflict with its own policies by taking timely and
appropriate action to reconcile them. In fiscal year 2005, the Social
Security Administration (SSA) provided approximately $128 billion in cash
benefits to about 12.8 million persons through the nation's two largest
programs for persons with disabilities and their families--the Disability
Insurance (DI) and the Supplemental Security Income (SSI) programs. In
administering these programs over the past decade, SSA has faced
challenges associated with lengthy decision-making processes and difficult
disability determinations. In an effort to introduce more efficiency and
fairness in its decision making, SSA has undertaken a "Disability Service
Improvement Process," about which we offered testimony in June of 2006.
Among the problems this initiative is designed to address is the number of
SSA disability decisions that are appealed to the federal courts and
subsequently remanded or referred back to the agency for re-adjudication.
Such appeals and remands can add several years to the time it takes
disability claimants to receive final decisions on their applications.
Most appealed cases are reviewed only by the district courts, the first
level of court review. However, if a disability claim reaches the
appellate court or Supreme Court, the decision may have implications for
SSA policy. There has been a long-standing concern that SSA does not
respond adequately to appellate court decisions that conflict with its own
policies by taking timely and appropriate action to reconcile them.

You asked that we examine: (1) the trends of the past decade in the number
of appeals reviewed by the district courts and their decisions; (2) the
reasons for court remands and factors that may contribute to the incidence
of those remands; and (3) SSA's process for responding to appellate court
decisions that conflict with agency policy and the agency's response in
recent years.

To address the first research objective, we analyzed data from SSA on the
number and types of decisions made by federal district courts for fiscal
years 1995 to 2005. We also grouped and analyzed district court decisions
by circuit for fiscal year 2005, the only year for which complete data by
circuit were available. Furthermore, we analyzed agency data on the
decisions SSA made after a case was remanded (i.e., allowances or denials
of claims) for fiscal years 1995 to 2005. We also analyzed these remand
data to identify trends over time and by circuit, a category that we
created using SSA data on claimant state of residence. SSA officials were
interviewed to gather information on potential reasons for any trends. To
address the second objective, we obtained data on cited reasons for
remands from two SSA databases that are maintained by two separate offices
in SSA responsible for litigating claims in court and re-adjudicating
remanded cases. We compared the data to determine how effectively SSA was
capturing information on reasons for remands within the agency. In
addition, we interviewed SSA officials and other stakeholder groups,
including federal court judges and claimant representatives, on reasons
for remands and factors that influenced them. For the third objective, we
interviewed SSA officials and obtained available documents on how SSA
determines whether a court of appeals decision conflicts with its policies
and what option to pursue to address conflicting decisions, e.g., appeal
or issue an acquiescence ruling whereby the agency agrees to abide by the
court judgment in future cases, albeit only in that jurisdiction. We also
obtained data on the number of acquiescence and other rulings that SSA
issued since establishing its regulations on acquiescence in 1990. For
acquiescence rulings, we further reviewed SSA's timeliness in issuing
acquiescence rulings, as well as the number issued by circuit and how SSA
replaced acquiescence rulings with nationwide policies. We were unable to
independently determine how significantly any given court decision
conflicted with SSA policy or whether SSA should have pursued one option
over another. We also interviewed SSA officials and relevant
stakeholders--including selected federal court judges and claimant
representatives from the Seventh and Ninth circuits, which represent those
with the lowest and highest numbers of SSA policy changes associated with
acquiescence rulings--to obtain information on how court decisions and
their related agency rulings have affected SSA's disability adjudication
policy in recent years. After interviewing officials and reviewing related
data reports and manuals, all quantitative data used in this report were
assessed and, with the exception of the reason for remand data, were
determined to be sufficiently reliable for the purposes of this report.
Issues related to the reason for remand data are discussed further on
pages 20 to 21. All work was conducted between February 2006 and January
2007 according to generally accepted government auditing standards. See
appendix I for more information on our methods.

Results in Brief

Over the past decade, the number of disability appeals reviewed by the
district courts and the proportion of remands increased, and SSA
subsequently granted benefits to claimants in many of the remanded cases.
Between 1995 and 2005, the number of cases reviewed by federal district
courts grew by 20 percent--from about 10,300 to some 12,400--which roughly
corresponds to workload increases at SSA during the same period. During
this period, the courts upheld SSA's decisions to deny benefits in 44
percent of cases on average and reversed 6 percent. However, the most
frequently occurring decisions were remands back to the agency for further
review (50 percent), essentially resulting in additional work for SSA. The
proportion of reviewed cases that were remanded increased by 36 percent
over this period, with 1998 being the pivotal year when the proportion of
remands exceeded affirmations. According to some SSA officials, this
notable increase may have been due to new national guidelines for SSA
adjudicators--known as the process unification rulings--that may have also
led to federal courts using more remands to ensure that the guidelines
were followed. With regard to the disposition of cases by geographic
jurisdiction or judicial circuit, there was substantial variation in 2005,
the year for which detailed data were available. Federal district courts
in the Second Circuit--which serves part of the Northeast--affirmed 19
percent and remanded 74 percent of cases, while district courts in the
Sixth Circuit--which serves Michigan, Ohio, Kentucky, and
Tennessee--affirmed 61 percent and remanded 35 percent. According to SSA
officials, case outcomes may vary from circuit to circuit because of
differences such as judges' interpretations of laws and the volume of
cases that circuits examine. We also found that once cases were remanded
back to SSA for re-adjudication, the majority of claimants--66
percent--were awarded benefits. According to agency officials, the
changing nature or severity of claimants' disabilities over the often
lengthy period of appeal may contribute to the extent of allowances for
remanded cases.

While stakeholders suggested that remands result from a range of errors
caused by heavy workloads, SSA data that would confirm and perhaps
elaborate on these errors are incomplete and not well managed.
Administrative law judges (ALJ), who adjudicate cases appealed within SSA;
claimant representatives; and others whom we interviewed said district
courts often remand cases back to the agency for re-adjudication due to
errors associated with poor decision writing and improper use of evidence.
For example, many stakeholders said SSA decision makers had failed to
properly consider the opinions of treating physicians. Many agency
officials as well as outside stakeholders attributed the errors resulting
in remands to a heavy workload. For example, ALJs we spoke with expressed
the view that their caseload--around 50 to 60 cases per month--undermined
the quality of their written decisions. SSA introduced new
decision-writing templates for ALJs and their staff in order to ensure
more legally sufficient documentation of decisions and improve the
efficiency of the administrative-hearings process. However, the agency's
ability to identify trends in reasons for remands and take corrective
actions to reduce remands is limited by the absence of reliable data. We
found that SSA's data were incomplete and that the collection of these
data, conducted by two separate offices, was inconsistent and inefficient.
SSA officials acknowledged that improvements to these data and their
management were needed, but currently lacks specific plans and timetables
for addressing these problems.

SSA has a process in place for addressing appellate court decisions that
conflict with agency interpretation of law or regulations and has taken
steps since 1990 to align its policies nationally with appellate court
decisions. Specifically, SSA's offices of General Counsel (OGC) and
Disability Programs regularly review appeals court decisions for their
policy implications. When SSA has determined that an adverse appellate
court decision conflicts with its own interpretation of disability
statutes or regulations, the agency then decides either to pursue further
judicial review of the issue or accede to the court's decision only within
the specific circuit. SSA accedes to appellate court rulings within the
specific circuits by issuing acquiescence rulings, which are meant to be
temporary guidance for program implementation until the agency can
determine how to address court decisions in a way that minimizes regional
variations. Since establishing regulations on acquiescence in 1990, SSA
issued 45 acquiescence rulings in response to appellate court decisions,
although there have been fewer such rulings in recent years. SSA officials
said fewer acquiescence rulings have been needed because new guidelines
for adjudicators, the process unification rulings of 1996, clarified SSA
policy and filled gaps in policy that were previously open for the courts
to fill, leading to a closer alignment of agency policy and court
interpretations of disability law. Also, nearly half of the acquiescence
rulings issued during the period of our study have been rescinded and
eventually replaced with new laws and regulations to ensure consistency in
program implementation. We also found that acquiescence rulings were
issued significantly sooner, following the agency's establishment in 1998
of a new 120-day guideline.

To ensure the agency has accurate and well-managed information to use in
identifying corrective actions for reducing remands, we recommended that
the Commissioner of SSA: (1) take steps to ensure the reliability of data
on the reasons for remands and (2) coordinate agency data collection on
remands and ascertain how best to use this information to reduce the
proportion of cases remanded by federal courts.

In comments to our draft report, SSA agreed with both of our
recommendations for improving data on remands and outlined actions it
plans to take to improve the reliability and collection of remand data.
See appendix VI for a copy of SSA's comments. SSA also provided a number
of technical comments, which we generally incorporated where appropriate.

Background

Disability Determination and Administrative Appeals

In fiscal year 2005, the Social Security Administration (SSA) paid
approximately $128 billion in cash benefits to about 12.8 million
beneficiaries through the two largest federal programs available to
persons with disabilities and their families: the Disability Insurance
(DI) program and the Supplemental Security Income (SSI) program. Both
programs serve those who are medically determined to be unable to engage
in any substantial gainful activity due to a severe physical or mental
impairment that is expected to last at least 12 months or result in
death.^1

Claimants must apply to SSA to receive disability benefits from these
programs and if awarded benefits, claimants may also have to requalify for
support through what are known as continuing disability reviews.^2 In most
of the country currently, claimants who are denied initial or continuing
benefits by SSA may appeal their denials administratively up to three
times, each time for review by a different adjudicatory entity.^3 These
entities are 1) the state disability determination service that performs
the initial review of disability claims and, in most states, a
reconsideration determination, 2) an administrative law judge (ALJ) in
SSA's Office of Disability Adjudication and Review, and 3) a group of
appellate reviewing officials within SSA known as the Appeals Council. The
number of claims or appeals reviewed at each level in 2005 were: over 2.6
million by state agencies, almost 520,000 by ALJs, and over 94,000 by the
Appeals Council.

^1 For a child to be considered disabled and therefore eligible for SSI,
the child must have a physical or mental condition, or a combination of
conditions, that results in marked and severe functional limitations. The
child's condition or conditions must have lasted, or be expected to last,
at least 12 months or be expected to result in death.

^2 Children who receive SSI are also subject to a re-determination of
their eligibility at age 18.

Disability determinations at all of these levels are often complex and
necessarily involve some degree of subjectivity by adjudicators, and the
nature of these decisions have contributed to long-standing concerns about
the extent to which adjudicators across the agency consistently interpret
and implement SSA's national disability policy. To help achieve more
consistent application of policy between the state disability
determination service level and the ALJ level, in 1996, SSA established
the process unification rulings, a set of nine Social Security rulings for
all SSA disability adjudicators to follow in matters involving difficult
judgments, such as the weight to be given to opinions of claimants'
treating physicians versus medical opinions from other sources, and the
evaluation of pain and other subjective symptoms. See appendix II for more
details on process unification rulings.

^3 As a part of the Disability Service Improvement process, SSA is
gradually implementing changes to the appeals process, starting with the
Boston regional office in August 2006.

Cases in Federal Court

After claimants exhaust all administrative review options within SSA, they
may then appeal their claims outside the agency to federal court. A
claimant must first file an appeal with a federal district court within
one of 12 federal judicial regions, known as judicial circuits. Figure 1
provides information on which states and territories are included in these
circuits.

Figure 1: Map of Federal Judicial Circuits

Note: There is a thirteenth federal judicial circuit, known as the Federal
Circuit, which does not hear SSA disability cases.

In deciding the case, a district court judge or magistrate usually either
affirms an agency decision, reverses the decision (essentially affirming
the claimant's case), or remands it back to SSA for further review.^4
According to SSA officials, remanded cases are generally reviewed by the
ALJ who made the original decision.^5 Judges can also dismiss a case if
its scope is outside the court's legal jurisdiction. Furthermore, if SSA
prefers not to defend a case that has been filed, usually because of an
error it has identified, the agency may request that the judge remand the
case back for the agency's review.^6

Court remands have implications for SSA's workload, the types of decisions
SSA adjudicators make on remanded cases, and the time claimants must wait
for decisions on their cases. Generally, when cases are remanded, ALJs
must perform new hearings, which could involve new evidence presented at
the time of court reviews. These remanded cases add to the already high
workloads that ALJs have in reviewing denials by the agency's disability
determination service offices. The load may also affect ALJ decisions: In
its September 2006 report, the Social Security Advisory Board found a
small correlation between increased ALJ workload and increased
allowances.^7 Furthermore, although remanded cases are given priority in
the line of cases that must be reviewed by ALJs, a substantial amount of
time may pass before new decisions can be made at this administrative
level, and the ALJ's decision may undergo another review by the Appeals
Council. In fiscal year 2006, it took SSA nearly a year on average to
process court remanded cases from the district courts.

After a district court decision, both the claimant and SSA may appeal the
case to a circuit court of appeals (also called an appellate court) and,
beyond this, to the Supreme Court. However, few cases reach these
appellate court levels and most disability cases are resolved in the
district courts. According to SSA, no more than 20 district court cases
have been appealed by the agency to the appellate courts each year since
2000. The Supreme Court has only reviewed four cases involving disability
claims since 1991. See figure 2 for an overview of the disability appeals
process.

^4 The court may also modify SSA's decision. According to SSA officials,
modified decisions are generally remanded to the agency and are therefore
classified as remands.

^5 Court remanded cases are generally re-adjudicated by ALJs but may also
be reviewed by the Appeals Council.

^6 When a case reaches the federal courts, SSA is generally represented by
U.S. Attorneys working for the Department of Justice (DOJ).

^7 The Social Security Advisory Board is a bipartisan board that provides
advice to the President, Congress, and the Commissioner of Social Security
on matters related to Social Security and SSI. For more information about
the Board's report, see Daub, Hal et al., Improving the Social Security
Administration's Hearing Process, (Washington, D.C.: September 2006).

Figure 2: Disability Process after SSA Final Decision

Note: This figure depicts the typical appeals process. Circuit court
decisions can be appealed to the Supreme Court. SSA decisions on remanded
cases can be appealed back to the federal courts. For court remands
involving continuing disability reviews, SSA decides to cease or continue,
rather than deny or grant benefits.

How Federal Court Decisions May Affect SSA Policy

SSA is not obligated to follow a district court decision that conflicts
with agency policies beyond that specific case.^8 However, the agency is
required to follow appellate court decisions for cases within that
circuit, unless the agency seeks further judicial review. If the Supreme
Court issues a decision, SSA is bound to follow the decision nationally.
Several district, appellate, and Supreme Court decisions have affected
disability policy in the past two decades. Appendix III outlines some
cases that have resulted in such changes.

^8 An exception is district court decisions involving class action
lawsuits, since these decisions apply to multiple individuals that may
reside in other circuits.

SSA implemented its current policy of acquiescence in 1990 in response to
the concerns of external stakeholders, including claimant representatives,
that SSA had failed in the 1980s to offer timely and appropriate responses
to appellate court decisions.^9 With the acquiescence ruling, SSA agrees
to follow the appellate court's holding on new cases only when they fall
within the jurisdiction of that appellate court. SSA rescinds an
acquiescence ruling if one of the following occurs: 1) the Supreme Court
overrules or limits the relevant appellate court decision; (2) an
appellate court overrules or limits itself on the relevant issue; (3)
Congress enacts a law that obviates the acquiescence ruling; or (4) SSA
clarifies, modifies, or revokes the regulation or ruling that was the
subject of the pertinent appellate court decision.

Disability Service Improvement Process

With new regulations issued in March 2006, SSA began implementing the
Disability Service Improvement (DSI) process in August 2006 on a limited
basis--i.e., in states in the Boston Region--and plans to gradually roll
out the initiative to other regions. The regulations include changes to
the appeals process within the agency that could potentially affect the
number and types of cases that will go to federal courts in the future.
Among these changes is the gradual replacement of the Appeals Council with
a Decision Review Board, designed to ensure the accuracy of SSA decisions
and reduce remands from federal courts. The Board would only review select
cases based on whether they are considered likely to have contained errors
or involved new policies, rules, and procedures. Under the DSI process,
claimants who are unhappy with ALJ decisions, therefore, could no longer
turn to the Appeals Council, but rather must appeal directly to the
federal courts. In our June 2006 testimony, we reported that the public
and stakeholders were concerned that replacing the Appeals Council with a
Decision Review Board may increase the number of cases appealed to, and
thus the workloads of, the federal courts.^10 In its response to these
concerns, SSA officials maintained that DSI improvements will ultimately
reduce the need for court appeals and also reduce remands. As part of its
DSI initiative, the agency is making a systematic effort to collect and
analyze data on court decisions in the course of training staff and
keeping ALJs current. Such monitoring and data collection are consistent
with the Office of Management and Budget's and GAO's internal control
standards for all federal agencies.^11

^9 The agency adopted the policy in 1985, but established regulations
explaining how it would implement this policy in 1990.

^10 See GAO, Social Security Administration: Agency Is Positioning Itself
to Implement Its New Disability Determination Process, but Key Facets Are
Still in Development, [39]GAO-06-779T (Washington, D.C.: June 15, 2006).

Court Reviews and Remands Have Increased in Recent Years with Remands Often
Resulting in SSA's Subsequently Awarding Benefits

Between fiscal years 1995 and 2005, the number of disability appeals
reviewed by the courts and decisions to remand these cases increased, and
in the majority of remanded cases, claimants were subsequently granted
benefits by SSA. In 2005, the year for which disaggregated data were
available, GAO found the proportion of remands by district courts varied
significantly by circuit. However, GAO did not find substantial variation
by judicial circuit in SSA decisions on court remanded cases.

Cases Reviewed by District Courts Increased over the Past Decade, as Did the
Proportion Remanded Back to the Agency

We found that federal district courts reviewed an increasing number of
disability cases over the past decade, which corresponded with the
increasing number of cases processed by SSA. Although the number of cases
reviewed by federal district courts fluctuated over time, they generally
increased by 20 percent from about 10,300 in fiscal year 1995 to about
12,400 by fiscal year 2005. (See fig. 3.) According to SSA officials, the
increase in the number of claims reviewed by the courts may be a result of
the increase in the number of claims that passed through the Appeals
Council, SSA's final decision-making body, over the same time period.^12

11 For more information on internal control standards, see GAO, Standards
for Internal Control in the Federal Government, [40]GAO/AIMD-00-21 .3.1
(Washington: D.C.: November 1999) and Office of Management and Budget,
Circular No. A-123, Management's Responsibility for Internal Control
(Washington: D.C.: Dec. 21, 2004).

^12 GAO found that the number of claims that were denied by the Appeals
Council and eligible for appeal to the courts increased from fiscal years
1994 to 2004 by about 36 percent. (See app. IV, fig.12.) We are providing
information on Appeals Council decisions over a slightly earlier period
than district court data to account for the time lag between Appeals
Council and district court decisions.

Figure 3: Federal District Court Decisions on Disability Claims, Fiscal
Year 1995 to Fiscal Year 2005

Over the same period, remands were generally the most common district
court decision, and their proportion increased by 36 percent from 1995 to
2005. Of those SSA cases decided by the district courts on the merits and
not dismissed, 50 percent were remanded, 44 percent were affirmed, and 6
percent were reversed on average.^13 (See fig. 4.) Notably, the proportion
of remands reached its peak in 2001. Although a range of factors may
affect the extent of court remands, some SSA officials suggested that the
Appeals Council, having reviewed a record number of ALJ decisions in 2000,
may have made mistakes in a greater share of cases that were subsequently
appealed to, then remanded by, the district courts.

^13 The courts reviewed approximately 132,000 claims over this period, and
of these claims, about 7 percent were dismissed.

Figure 4: District Court Decisions on Disability Claims

Note: This figure excludes cases that were dismissed.

The proportion of remands exceeded the proportion of affirmances in 1997
and continued to increase until 2001. Specifically, in 1995 only 36
percent of SSA decisions were remanded by the courts while 57 percent were
upheld or affirmed. However, by 1998, the proportion of remands increased
to 49 percent, while the proportion of affirmances declined to 46 percent.
When we showed SSA officials these trends, they generally attributed the
shift to the process unification rulings, which the agency had established
in 1996. According to SSA officials, the increased remands reflected
district court efforts to assure that SSA adjudicators were following the
agency's new procedures.

The Proportion of Remanded Cases Varied by Circuit

GAO found substantial variation in the proportion of cases remanded by
judicial circuit in fiscal 2005, the only year for which data by circuit
were available. (See fig. 5.) Although remands and affirmances were the
most frequently occurring types of decision in each circuit, the
proportion of each varied considerably among the circuits. Specifically,
the percent of remands ranged from a low of 35 percent to high of 78
percent, while affirmances ranged from 22 percent to 61 percent.

Figure 5: District Court Decisions by Circuit (Fiscal Year 2005)

Note: This figure excludes cases that were dismissed.

SSA officials were not in agreement about why there might be differences
in the types of decisions across judicial circuits. According to some,
differences might be due to judges in different circuits interpreting
disability laws differently. Others told us that disparities in the number
of claims appealed to district courts across circuits may contribute to
these differences. (See app. IV, fig. 14 for more information on the
number of cases reviewed by circuit for fiscal year 2005.) Currently, SSA
does not have sufficient data that would allow them to determine why these
decisions vary by circuit but plans to obtain this information as part of
the DSI process implementation.

In the Majority of Remanded Cases, Claimants Were Awarded Benefits

Of the 57,000 cases remanded by the district courts between 1995 and 2005,
SSA awarded benefits to the majority of claimants--about 66 percent--upon
re-adjudication, with the remainder being denied (about 30 percent) or
dismissed (5 percent). (See fig. 6.) Agency officials said the large
percentage of awards in remanded cases were due, in part, to the fact that
the lengthy period of the appeals process increased the likelihood that
the nature or severity of claimants' disabilities would change. The
officials also attributed the awards to information in the court's written
judgments that made it possible for ALJs, in reviewing cases anew, to make
more accurate decisions. The proportion of allowances in court-remanded
cases after re-adjudication is just below the average allowance rate of 70
percent for all ALJ decisions.

Figure 6: SSA Decisions on Remanded Disability Claims, Fiscal Year 1995 to
Fiscal Year 2005

Note: Some percentages may exceed 100 due to rounding. Because cases can
be appealed and remanded more than once, GAO included in its analysis only
claims that SSA determined had never before been remanded to the agency
from the courts. Such cases made up about 92 percent of the sample of
remands re-decided by SSA between 1995 and 2005. See appendix III, figure
13 for information on the number of cases re-decided by SSA over this
period.

We did not find substantial variation in SSA decisions on court-remanded
claims across judicial circuits. As shown in figure 7, the proportion of
allowances for remanded cases ranged from 62 percent to 72 percent by
circuit--relative to a national average of 66 percent.

Figure 7: SSA Decisions on Disability Claims Following Court Remands by
Judicial Circuit, Fiscal Year 1995 to Fiscal Year 2005

Note: GAO used the claimants' state of residence reported by SSA to
determine judicial circuit.

Remands Have Been Attributed to a Range of Errors Caused by Heavy Workloads, but
SSA Data That Could Shed More Light on the Problem Are Inadequate

According to agency officials and stakeholders, a range of errors
precipitated by heavy workloads is responsible for court remands of SSA's
disability determinations, but SSA data that would confirm or clarify
reasons for remands are incomplete and not well managed. SSA has
acknowledged the need to reduce remands and in 2006, along with other
initiatives, introduced a new writing tool for ALJs in order to improve
efficiency and better document decisions. However, agency data that would
inform the problem and help address remands are incomplete and not well
managed.

Stakeholders Attribute Various Reasons for Remands to High SSA Workloads

Stakeholders commonly cited two reasons for remands: written explanations
that did not support the decisions and inadequate documentation of
consideration given to medical evidence. They expressed the view, however,
that errors made with respect to documenting decisions were due, in large
part, to heavy SSA adjudicator workloads. Poor decision writing by ALJs
and their staff was cited by all groups of stakeholders we interviewed,
including SSA officials, district court judges, claimant representatives,
and other stakeholders. Specifically, district court judges said they did
not always believe that SSA's decisions were wrong, but that the written
explanations did not always support those decisions. Some claimant
representatives said that poorly written decisions may be symptomatic of
improper consideration of evidence and procedures by ALJs.

With regard to the inadequate documentation of consideration given to
medical evidence as a reason for remands, district court judges and
claimant representatives we interviewed said ALJs either do not document
how they weighed treating physicians' opinions and assessed claimant
statements about pain and other symptoms, or they do not consider them as
required by the process unification rulings. ALJs we interviewed responded
that addressing such evidence is sometimes very difficult and cited cases
in which the treating physician appeared to be simply repeating claimants'
opinions about their inability to work, rather than offering substantive
information about the conditions that would prevent work. Some district
judges agreed that considering and incorporating medical evidence into a
decision can be difficult, but stressed the importance of articulated and
well-documented opinions in order for district court judges to make a
decision other than to remand.

Stakeholders we interviewed varied in their opinions regarding whether
requirements of the process unification rulings were overly cumbersome
and, therefore, resulted in remands. Members of the Appeals Council and
the Social Security Advisory Board staff we spoke with believe that the
process unification rulings provide important guidance, but have also made
procedures for making decisions and decision-writing more cumbersome. On
the other hand, representatives of the Association of Administrative Law
Judges told us that they have not heard such complaints and, while
acknowledging that decision-making involved more work, believe the rules
did not make decision-writing overly cumbersome.

At the same time, many of those we interviewed, including ALJs and
district court judges, said the heavy ALJ workload was behind the apparent
errors in documenting agency determinations that lead to remands. Some
ALJs asserted that the frequency of court remands has not been
unreasonable considering the number of cases that they must review.^14
These ALJs also said their workload expectations of 50 to 60 hearings a
month affected the time and attention they could give to each case.^15
They asserted that they would need to write significantly fewer decisions
in a month in order to assure that the work would withstand scrutiny by
the federal courts. They noted that other ALJs who are able to write
decisions that the courts uphold produce as few as five a month. Because
the time needed to review cases and write decisions varied, however,
representatives of the Association of Administrative Law Judges were
unable to suggest an ideal number of cases that would be reasonable for
ALJs to process. Specifically, these representatives said that decisions
to deny benefits take substantially longer to document than those
involving allowances. These representatives also stated that the number
and quality of staff that ALJs have available to help process and write
decisions vary.^16

Finally, stakeholders also suggested that a variety of other factors
contribute to remands, such as: ALJs' providing poor instructions to
decision writers, SSA's not providing adequate feedback to ALJs on reasons
for remands, and federal courts' having bias against ALJs' decisions. Some
stakeholders further stated that federal court bias may be rooted in
concerns over how well decisions are generally written, expectations about
how determinations should be made, and concerns with the amount of time
and attention given to cases under the current workload.

Acknowledging the need to address remands from the federal court, SSA is
taking steps to mitigate common documentation errors. One step has been to
promote the use of a decision-writing tool known as the Findings
Integrated Templates (FIT). This tool contains more than 1,600 templates
for presenting analysis of evidence and ensuring that required statutes
and regulations are followed. These templates are also designed to prevent
common mistakes, such as failure to establish an appropriate date for the
onset of disability benefits. SSA officials also said this tool is
intended to help manage workloads by reducing the potential for
miscommunication between ALJs and their staff and the time spent writing
decisions. According to SSA officials, SSA plans to monitor the extent to
which decisions written with this tool are remanded from the federal
courts. Appeals Council judges we interviewed have reviewed some decisions
written with FIT and have found them to be better articulated than
decisions that did not rely on this tool. However, both Appeals Council
judges and ALJ association representatives mentioned that the tool will
not replace the need for additional, competent decision-writing staff.

^14 For example, in fiscal year 2005, ALJs issued 524,362 decisions.

^15 However, because claimants may not appear as scheduled at hearings and
SSA officials may not always be able to schedule this many cases, ALJs on
average reviewed about 35 cases per month in fiscal year 2006.

^16 Disability decisions are typically written by SSA decision-writers,
who follow ALJ instructions on supporting the conclusion and citing
pertinent evidence or testimony.

Additionally, SSA is pursuing a broader set of initiatives under its
Disability Services Improvement (DSI) initiative that it hopes will result
in more accurate decisions earlier in the process and, thereby, ultimately
reduce workloads at the ALJ level. For example, as a part of DSI, SSA is
implementing an expedited determination process for clear-cut cases, which
it calls its Quick Disability Determinations. The agency also plans to add
a level of reviewing attorneys, known as federal reviewing officials, who
can affirm, reverse, or modify appealed agency decisions prior to their
reaching ALJs. However, DSI is currently underway only in the Boston
Region, and SSA has yet to evaluate the effectiveness of this initiative.

Agency Remand Data Are Incomplete and Not Well Managed

While SSA collects data on reasons for remands, we found that the data are
not well managed, incomplete, and therefore not reliable. Two separate SSA
offices recently began collecting data on remanded cases to identify and
track the reasons for remands in order to help train ALJs and their staff
on how to reduce the number of remands. Nevertheless, while the two
offices were collecting and using the data for the same
purpose--training--they told us that they were not collaborating. When the
two offices--the Office of Disability Adjudication and Review (ODAR) and
the OGC--developed lists of categories to group reasons for remands, the
offices did not consult with each other. As a result, the lists of
categories used by these offices are not the same, and SSA officials told
us that the offices may well classify similar remands differently.
Moreover, some remand categories in the two data systems may be
duplicative, resulting in an inefficient use of agency resources. SSA
officials acknowledged that better data reliability and collaboration
between the two offices are needed and that, while the agency plans to
develop a common vocabulary for remand reasons, it has yet to develop
specific plans and timetables for addressing these issues.

Through our conversations with SSA officials and reviews of reports, we
also found that these data were not consistently entered into the agency's
databases. Within both systems, at least one reason should be entered per
remanded case, but this did not always occur; instead, we found the extent
to which this information was entered varied by database and SSA regional
office. For the OGC reports, we found that the number of reasons recorded
exceeded the number of cases, as would be expected; however officials were
not confident that the data on remands reasons were accurate or complete
because the officials have not been able to assess the quality of the
data. Within the ODAR reports for fiscal years 2005 and 2006, on the other
hand, there were substantially fewer reasons reported than cases.^17
Regional reports showed that SSA's Seattle and New York offices have been
collecting the most information on remands. Notably, the agency's Boston
office--which is the first to implement the structural changes of DSI--and
the Philadelphia office have collected the least amount of information.
SSA officials told us that they were aware that remand data were not
entered into ODAR's system consistently in early fiscal year 2005, and
said they subsequently reiterated the importance of collecting this
information to staff. SSA officials also mentioned that they are
considering making remand reasons a mandatory field in the ODAR database
to improve collection.

SSA Has Taken Several Steps Since 1990 to Align Its Policies Nationally with
Court Decisions

SSA officials have a process in place for determining whether appellate
court decisions conflict with the agency's interpretation of disability
statutes or regulations, and the agency has taken steps in recent years to
align its policies nationally with appellate court decisions. In those
cases where the agency acceded to certain appellate court rulings by
issuing acquiescence rulings, we found that about half of the rulings were
eventually replaced with national policy. Also, we found that the number
of acquiescence rulings has declined in more recent years, a decline that
SSA officials mainly attributed to the agency's implementation of its
process unification rulings of 1996, which officials believe created less
room for differences of opinion between the courts and the agency
regarding broader policies. Moreover, we found that the timeliness of
acquiescence rulings had improved since 1998, when SSA established a
timeliness goal of 120 days.

^17 Specifically in fiscal year 2005, ODAR data listed 7,244 cases as
being remanded but 4,668 reasons for remands. In fiscal year 2006, the
data listed 6,290 cases as being remanded and 5,434 reasons for remands.

SSA Has a Process in Place for Reviewing and Addressing Appellate Court
Decisions that Conflict with the Agency's Interpretation of Law or Regulations

When an appellate court decision is rendered, SSA officials review the
decision to determine whether it conflicts with agency interpretation of
law or regulations. The primary office responsible for this evaluation is
the OGC, SSA's office responsible for legal matters. For disability
issues, OGC works in conjunction with the Office of Disability Programs,
SSA's office responsible for policy matters.^18 These offices may consult
with the Office of Disability Adjudication and Review, which rendered the
agency's final decision prior to its being appealed to federal court, as
well as the Department of Justice (DOJ), the entity generally responsible
for representing SSA in federal court.

If SSA determines that the appellate court decision conflicts with its
policy, then it decides whether to appeal the case to the Supreme Court or
to modify its policy to conform with that decision.^19 According to
officials, SSA rarely challenges appellate court decisions, and decisions
to appeal are ultimately the prerogative of DOJ, because DOJ represents
SSA in court. Some of the situations in which SSA would consider appealing
to the Supreme Court are: a conflict between circuits; an issue of
exceptional importance involving high visibility or significant funds; a
statute or regulation held by the courts to be unconstitutional; or an
important regulation held to be invalid.

If SSA decides to follow the appellate court decision, it issues an
acquiescence ruling that applies only within that circuit. However,
because these rulings result in inconsistent policies throughout the
country, the agency has added a clarification in the preamble to its 1998
regulations that acquiescence rulings are generally temporary policies
that are not intended to remain in effect permanently. Therefore, after
issuing an acquiescence ruling, SSA attempts to pursue a uniform national
policy through various means, such as modifying regulations or rules,
issuing new regulations or policy interpretations, seeking legislative
changes, or re-litigating the issue within the same circuit.^20 When SSA
successfully incorporates the acquiescence ruling into national policy, it
rescinds the acquiescence ruling.^21

18 For nondisability issues, OGC works in conjunction with the appropriate
component, such as the Office of Income Security Policy.

^19 SSA may also ask the original panel of circuit court judges to rehear
an issue, or ask the entire U.S. Court of Appeals to rehear an issue(s) en
banc.

When SSA finds it necessary to issue an acquiescence ruling, it has
procedures in place for informing adjudicators of these departures from
national policy. According to officials, SSA communicates these and other
rulings to SSA officials who make claims determinations, such as ALJs,
through a variety of sources including: the Federal Register, SSA's
internal operations manual, the agency's Web site, and e-mails. In some
instances, officials learn about these rulings through training sessions.
However, because most acquiescence rulings since the 1990s concerned
narrow issues, SSA officials said the rulings have not warranted special
training for adjudicators.

SSA Has Taken Steps to Align Its Policies with Court Decisions by Issuing
Acquiescence Rulings More Quickly and Following with Changes in National Policy

SSA has taken steps to align its policies with the court decisions by
issuing acquiescence rulings in a timely manner and following up with
changes to its national policies. Since the implementation of its current
acquiescence policy, SSA has issued 45 acquiescence rulings, the majority
of which relate to determining whether a claimant is eligible for
disability benefits. (Fig. 8 shows the number of rulings issued each year
from 1990 to 2006, and app. V provides synopses of court holdings
concerning disability determinations that led to acquiescence rulings.)
Most of these rulings were issued between 1990 and 2000, when SSA
published an average of four acquiescence rulings per year. In contrast,
during the 6-year period from 2001 to 2006, the agency issued only five
such rulings. SSA officials attributed the decline in acquiescence rulings
to implementation of its process unification rulings, which they believe
created less room for differences of opinion between the courts and the
agency regarding broader policies. Specifically, officials commented that
the process unification rulings clarified SSA policy as well as filled
gaps in policy that were previously open for the courts to fill, and noted
that, while the courts are not bound by these and other Social Security
Rulings, the courts have frequently deferred to SSA's rulings. ^22 As a
result, SSA has seen a decline in the number of significant court cases
involving disability law over time. (See app. III for a listing of key
court cases.)

^20 One way SSA interprets policies is to issue Social Security Rulings,
which may be based on case decisions made at all administrative levels of
adjudication, federal court decisions, Commissioner's decisions, opinions
of OGC, and other policy interpretations of the law and regulations. Our
analysis showed that of SSA's 68 Social Security Rulings issued since
1990, 24 percent were based on court decisions. About half of these
rulings are related to disability issues.

^21 Other circumstances leading to rescission of an acquiescence ruling
include a Supreme Court decision overruling or limiting a circuit court
holding that is the basis of an acquiescence ruling; a circuit court
overruling or limiting itself on an issue that was the basis of an
acquiescence ruling; or enactment of a federal law that removes the basis
for the holding in a decision of a circuit court that was the subject of
an acquiescence ruling. See 20 CFR 404.985 (e).

Figure 8: Number of Acquiescence Rulings Issued, 1990 to 2006

We found that the number of acquiescence rulings issued by SSA varied by
circuit during our study period (1990 to 2006), ranging from one in the
First Circuit to eight in the Ninth Circuit. (See fig. 9.) SSA officials
pointed out that the number of acquiescence rulings the agency issues in a
given circuit is a function of the number and types of decisions issued by
the appellate court within that circuit. For example, officials said that
the Ninth Circuit has the largest disability caseload, and therefore, one
would expect it to have the highest number of acquiescence rulings.^23
Also, because the Ninth Circuit's decisions largely concerned technical
issues, SSA officials said they were less amenable to Supreme Court
Review. This official added that the Ninth as well as Eighth Circuits have
had precedent-setting decisions.

^22 Although Social Security Rulings do not have the force and effect of
law or regulations, they are binding on all components of SSA.

^23 See appendix IV, figure 14 for more information on caseloads by
circuit.

Figure 9: Number of Acquiescence Rulings by Circuit, 1990 to 2006

Since SSA established a regulation in 1998 that included a timeliness goal
for issuing acquiescence rulings, the promptness of issuances has
improved. (Fig. 10 depicts the timeliness of acquiescence rulings issued
from 1990 to 2006.) Prior to establishing the regulation, SSA took more
than a year to issue over 80 percent of the rulings. Since then, 54
percent of acquiescence rulings were issued within the guideline of 120
days (or 4 months). For those rulings that were not issued within 120
days, in most instances the timeliness goal did not apply because SSA
either sought further judicial review or needed to coordinate with DOJ or
other federal agencies.

Figure 10: Timeliness of Acquiescence Rulings, 1990 to 2006

Note: Percentages do not add up to 100 due to rounding.

Once SSA has issued acquiescence rulings, the agency has frequently
succeeded in replacing them with uniform national policies. We found that
since 1990, nearly half of all acquiescence rulings (21 of 45) were
rescinded and replaced by more permanent guidance.^24 Further, most of
these rescissions resulted from the agency's issuing or modifying rulings
or regulations. (Fig. 11 shows how acquiescence rulings were rescinded.)
According to officials, acquiescence rulings are most commonly rescinded
when the agency revises, publishes, or revokes rules and
regulations--actions that are fully within the agency's control. Six other
rescissions occurred through other means: three from Supreme Court rulings
upholding SSA's policies and three from changes in law made by Congress.

^24 According to our analysis, 27 of the 45 rulings relate directly to
determining whether a claimant is eligible for disability benefits. As
indicated in appendix V, more than half (15 of 27) of these acquiescence
rulings were rescinded.

Figure 11: How Acquiescence Rulings Were Rescinded, 1990 to 2006

However, according to SSA, some issues brought about by federal court
decisions, such as those involving the Constitution or federal law, have
led to acquiescence rulings that have not been rescinded by the agency.
For example, acquiescence ruling 91-1(5), which involves a claimant's
right to cross-examine an examining physician, remains in effect because
SSA officials believe the only option for rescinding the ruling would
require re-litigating the case.^25 However, according to SSA officials,
the relevant circuit appellate court and the Supreme Court have declined
to review this ruling. Other reasons that acquiescence rulings may remain
in effect include a lack of practical implications of the acquiescence
ruling for other circuits or the fact that an acquiescence ruling was only
recently issued. Replacing the acquiescence ruling with nationwide policy
typically takes a significant period of time--in one case, 16 years.

Conclusions

On the whole, SSA has taken many steps to align its policies with court
decisions and establish uniform national standards. The fact that the
agency made some substantial changes to its policies in the mid-1990's may
account for the reduced incidence of acquiescence rulings in the past 5
years.

^25 SSA may re-litigate the case within the same circuit when the General
Counsel of SSA, in consultation with DOJ, concurs that re-litigation of an
issue is appropriate and SSA has published a notice in the Federal
Register of its intent to re-litigate an acquiescence ruling issue. In
addition, SSA may re-litigate a case when one of the following events
occurs: an action by both Houses of Congress indicates that an appellate
court decision was decided inconsistently with congressional intent, a
statement in a majority opinion of the same circuit indicates that a court
might no longer follow its previous decision, subsequent appellate court
precedent in other circuits supports SSA's interpretation of the Social
Security Act or regulations, or a subsequent Supreme Court decision
presents a reasonable legal basis for questioning the appellate court
decision.

On the other hand, the high proportion of remanded and awarded claims for
the past decade has likely cost SSA additional time and resources to
process, and may have impeded the timely award of benefits to eligible
individuals. While the DSI improvement initiative is designed to
ameliorate this problem, the lack of reliably collected and well-managed
data on court remands is likely to inhibit that effort. Although SSA
plans, through the implementation of DSI, to gradually address the heavy
workload that has been cited by many for contributing to errors that lead
to remands, the agency cannot pinpoint specific reasons for remands and
take corrective action without more reliable data. To the degree that the
agency does collect some data, the fact that collection is carried out by
two different offices risks inconsistency and divergent interpretations.
This lack of complete and consistent information ultimately undermines the
agency's ability to serve people with disabilities and their families.

Recommendations

To ensure the agency has accurate and well-managed information to use in
identifying corrective actions for reducing remands, we recommended that
the Commissioner of SSA implement the following two measures:

           o take steps to ensure the reliability of data on reasons for
           remands, and
           o coordinate agency data collection on remands and ascertain how
           best to use this information to reduce the proportion of cases
           remanded by federal courts.

Agency Comments

SSA provided us with comments on a draft of this report, which we have
reprinted in appendix VI. In its comments, SSA agreed with both of our
recommendations for improving data on remands and outlined actions it
plans to take to enhance data reliability and collection. Specifically, in
an upcoming update to the Case Processing Management System, SSA plans to
make the reasons for remands a mandatory data input field. In addition,
SSA plans to establish an intercomponent work group to address issues
related to remand data, and analyze data on the use of the Findings
Integrated Templates and court decisions.

SSA also provided technical comments which generally improved the accuracy
of the report, and we have incorporated them as appropriate.

Copies of this report are being sent to the Commissioner of SSA,
appropriate congressional committees, and other interested parties. The
report is also available at no charge on GAO's Web site at
http://www.gao.gov .

Please contact me on (202) 512-7215 if you or your staff has any questions
concerning this report. Contact points for our Offices of Congressional
Relations and Public Affairs may be found on the last page of this report.
Other major contributors to this report are listed in appendix VII.

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

Appendix I: Objective, Scope, and Methodology

We designed our study to obtain information on (1) the trends of the past
decade in the number of appeals reviewed by the district courts and their
decisions; (2) the reasons for court remands and factors that may
contribute to the incidence of those remands; and (3) SSA's process for
responding to appellate court decisions that conflict with agency policy
and the agency's response in recent years. To obtain information on these
issues, we collected relevant quantitative and qualitative data from SSA;
interviewed SSA officials and stakeholders within and outside the agency,
such as district court judges, claimant representatives and experts; and
reviewed agency policies and regulations that address appellate court
rulings that conflict with SSA disability program policies. To determine
the completeness and accuracy of data we obtained, we took steps,
described below, and determined that these data, with the exception of
reasons for remand, were sufficiently reliable for use in this report. We
conducted this work between February 2006 and January 2007 according to
generally accepted government auditing standards.

To address the first research objective, we obtained national data from
SSA on the number and decisions of cases reviewed by federal district
courts--the first level of federal court review--for fiscal years 1995 to
2005 and analyzed these data for trends over time. Our analysis excluded
cases that were dismissed because dismissals are generally decided on
technical and procedural grounds rather than on the merits of the claim.
For fiscal year 2005, the only year for which complete data were
available, we obtained information from SSA on court decisions by state.
We then categorized and analyzed these data by circuit. Furthermore, we
obtained and analyzed agency data on the decisions SSA made on disability
cases after they were remanded (i.e., allowances or denials of claims) for
fiscal years 1995 to 2005. We also categorized and analyzed these data by
circuit using information on the claimant's state of residence. SSA
officials were interviewed to gather information on potential reasons for
any trends. In addition, we interviewed SSA officials and reviewed
previously issued agency reports and data manuals to assess the
reliability of these data.

To address the second objective, we also obtained data on cited reasons
for remands from two SSA databases, the Case Processing and Management
System (CPMS), and the National Docketing/Management Information System
(NDMIS), which are maintained by two separate offices in SSA responsible
for re-adjudicating remanded cases and litigating claims in court. We
compared the data to determine how and what SSA is reporting on reasons
for remands within the agency. After interviewing agency officials and
reviewing reports, we determined that these data were not sufficiently
reliable for providing detailed information on reasons for remands,
although some information was used to illustrate what SSA currently
collects. In addition, we interviewed SSA officials and other stakeholder
groups, including federal court judges and claimant representatives from
the Seventh and Ninth circuits and experts, on reason for remands and
factors that influenced them. Stakeholders from these two circuits were
selected because these jurisdictions represent those with the lowest and
highest numbers of SSA policy changes resulting from acquiescence rulings.
Information from these interviews is not generalizable to all circuits or
stakeholders.

For the third objective, we interviewed SSA officials and obtained
available documents on how SSA determines whether a court of appeals
decision conflicts with its policies and what option to pursue to address
conflicting decisions, e.g., appeal or issue an acquiescence ruling
whereby the agency agrees to abide by the court judgment in future cases,
albeit only in that jurisdiction. We also obtained data on the number of
acquiescence and other rulings that SSA issued since establishing its
policy of acquiescence in 1990. For acquiescence rulings, we further
reviewed SSA's timeliness in issuing acquiescence rulings as well as the
number issued by circuit and how SSA replaced acquiescence rulings with
nationwide policies. We were unable to independently determine the extent
to which court decisions conflicted with SSA policy or whether SSA should
have pursued one option over another. We also interviewed SSA officials
and relevant stakeholders, including selected federal court judges and
claimant representatives, to obtain information on how court decisions and
their related agency rulings have affected SSA disability adjudication
policy in recent years.

Appendix II: Summary of Process Unification Rulings

           o SSR 96-1p: "Application by the Social Security Administration of
           Federal Circuit Court and District Court Decisions." Policy
           interpretation stating that SSA decision-makers will be bound by
           SSA's nationwide policy until an acquiescence ruling is issued and
           that SSA does not acquiesce to federal district courts within a
           circuit.

           o SSR 96-2p: "Giving Controlling Weight to Treating Source Medical
           Opinions." Policy guidance for applying the regulatory provision
           that requires the adoption of a treating source's medical opinion
           on the nature and severity of an impairment when the opinion is
           not inconsistent with other substantial evidence in the claimant's
           file and the opinion is supported by medically acceptable
           diagnostic techniques.

           o SSR 96-3p: "Considering Allegations of Pain and Other Symptoms
           in Determining Whether a Medically Determinable Impairment is
           Severe." Policy interpretation on the consideration of symptoms in
           determining whether an impairment is "severe" at step 2 of the
           sequential evaluation process.

           o SSR 96-4p: "Symptoms, Medically Determinable Physical and Mental
           Impairments, and Exertional and Nonexertional Limitations." Policy
           interpretation explaining, among other things, that symptoms are
           not medically determinable impairments; that limitations, not
           impairments, are categorized as "exertional" or "nonexertional";
           and that symptoms may result in nonexertional or exertional
           limitations.

           o SSR 96-5p: "Medical Source Opinions on Issues Reserved to the
           Commissioner." Policy interpretation on evaluating medical source
           opinions on issues such as whether an individual's impairment(s)
           meets or is equivalent in severity to the requirements of a
           listing in SSA's Listing of Impairments; what an individual's
           residual functional capacity is; whether an individual's residual
           functional capacity prevents him from doing past relevant work;
           and how the vocational factors of age, education, and work
           experience apply.

           o SSR 96-6p: "Consideration of Administrative Findings of Fact by
           State Agency Medical and Psychological Consultants and Other
           Program Physicians and Psychologists at the ALJ and Appeals
           Council Levels of Administrative Review; Medical Equivalence."
           Policy interpretation regarding weight given to Disability
           Determination Services level medical and psychological consultant
           findings at the ALJ and Appeals Council levels. Explanation of
           requirements for ALJs and the Appeals Council to obtain the
           opinion of a physician or psychologist designated by the
           Commissioner in making a determination about equivalence to the
           listings.

           o SSR 96-7p: "Evaluation of Symptoms in Disability Claims:
           Assessing the Credibility of an Individual's Statements." Policy
           interpretation on when the evaluation of symptoms, including pain,
           requires a finding about the credibility of an individual's
           statements about pain and symptoms, and the factors to be
           considered in assessing the credibility of such statements.

           o SSR 96-8p: "Assessing Residual Functional Capacity in Initial
           Claims." Policy clarification of the term residual functional
           capacity and discussion of the elements considered in assessing
           residual functional capacity.

           o SSR 96-9p: "Determining Capability to Do Other
           Work--Implications of a Residual Functional Capacity for Less Than
           a Full Range of Sedentary Work." Policy interpretation on the
           impact of a residual functional capacity assessment for less than
           a full range of sedentary work on an individual's ability to do
           other work.

Appendix III: Key Federal Court Rulings on Social Security Administration
Disability Adjudication

1983

Heckler v. Campbell, 461 U.S. 458 (1983) The U.S. Supreme Court upheld
SSA's use of its vocational grid regulations.

1984

Hyatt v. Heckler, 579 F.Supp. 985 (W.D.N.C. 1984) In a class action, the
U.S. District Court for the Western District of North Carolina found SSA's
policy on pain contrary to Fourth Circuit law. This ruling enjoined SSA
from refusing to follow the law of the circuit.

Lopez v. Heckler, 725 F.2d 1489 (9th Cir. 1984) The Ninth Circuit Court of
Appeals enjoined SSA to uphold prior decisions requiring SSA to apply a
medical improvement standard before terminating benefits.

1985

Stieberger v. Heckler, 615 F.Supp. 315 (S.D.N.Y. 1985) In a class action,
the U.S. District Court for the Southern District of New York ruled that
SSA had violated the rights of claimants by not following circuit court
law on the weight to give treating physician evidence. After this decision
SSA introduced its policy of Acquiescence Rulings when the agency is not
willing to implement an appellate decision nationwide. Acquiescence
rulings explain how SSA applies decisions of Courts of Appeals in the
circuit in which the decision was rendered.

1986

Schisler v. Heckler, 787 F.2d 76 (2nd Cir. 1986) The Second Circuit Court
of Appeals found that a treating physician's opinion on the subject of
medical disability is binding unless contradicted by substantial evidence.

1989

Hyatt v. Heckler, 711 F.Supp. 837 (W.D.N.C. 1989) On remand, the U.S.
District Court for the Western District of North Carolina found SSA's
policies on pain did not conform to circuit law. The court ordered these
policies to be cancelled and drafted a new ruling on pain for North
Carolina adjudicators.

1990

Sullivan v. Zebley, 493 U.S. 521 (1990) The U.S. Supreme Court struck down
SSA's regulations for determining whether a child is disabled because the
regulations denied benefits to children whose impairments did not meet or
equal the listing of impairments and did not allow the child to qualify
for benefits based on an individualized functional assessment.

1993

Schisler v. Sullivan, 3 F.3d. 563 (2nd Cir. 1993) The Second Circuit Court
of Appeals upheld SSA's 1991 regulations on the opinions of treating
physicians as a valid use of SSA's regulatory power.

1994

Hyatt class action settlement SSA agreed to re-adjudicate 77,000 cases
under the 1991 regulations on the evaluation of pain and other symptoms.

2002

Barnhart v. Walton, 535 U.S. 212 (2002) The U.S. Supreme Court upheld
SSA's interpretation that the claimant's inability to work last, or be
expected to last, 12 months. The court also upheld SSA's regulation
precluding a finding of disability when the claimant returns to work
within a 12-month period.

2003

Barnhart v. Thomas, 540 U.S. 20 (2003) The U.S. Supreme Court upheld
denial of benefits to a claimant who was still able to do her previous
work without determining whether that type of work continued to be
available in the national economy.

Appendix IV: Additional Information on Disability Appeals

Appeals Council denials of Social Security disability claims increased by
about 36 percent from about 48,300 in Fiscal Year 1994 to about 65,800 in
Fiscal Year 2004.

Figure 12: Appeals Council Denials of Social Security Claims, Fiscal Year
1994 to Fiscal Year 2004

SSA decisions on disability claims following remands from federal district
courts increased from about 3,000 in Fiscal Year 1995 to almost 7,500 in
Fiscal Year 2005.

Figure 13: SSA Decisions on Disability Claims Following Court Remands

The twelve judicial circuits with district courts that review Social
Security disability claims varied in the number of claims they reviewed in
Fiscal Year 2005. For example, the District of Columbia District Court
reviewed less than 100 claims, while the district courts in the Ninth
Circuit reviewed almost 3,000.

Figure 14: Social Security Claims Reviewed in Federal District Courts in
Fiscal Year 2005 by Judicial Circuit

Appendix V: Summary of Court Holdings for Acquiescence Rulings Related to
Disability Determinations Appendix

Acquiescence ruling                                                        
number and circuit  Rescinded? Court holding                               
AR 90-3 (4th        X          The court held that social security         
Circuit)                       regulations allow the use of a vocational   
                                  expert only at step five of the sequential  
                                  evaluation process; and therefore, reliance 
                                  on a vocational expert is improper in       
                                  making the step four determination as to    
                                  whether a claimant can return to past       
                                  relevant work.                              
AR 90-4 (4th                   The court held that SSA can re-open an      
Circuit)                       otherwise final administrative              
                                  determination at any time when a claimant,  
                                  who had no individual legally responsible   
                                  for prosecuting the claim at the time of    
                                  the prior determination, established a      
                                  prima facie case that mental incompetence   
                                  prevented him from understanding the        
                                  procedure to request administrative review, 
                                  unless SSA holds a hearing and determines   
                                  that mental incompetence did not prevent    
                                  the claimant from filing a timely appeal.   
AR 91-1 (5th                   The court held that entitlement to a        
Circuit)                       subpoena for cross-examination purposes of  
                                  an examining physician is automatic and     
                                  must be granted.                            
AR 92-2 (6th                   The court held that in deciding the appeal  
Circuit)                       of a determination that an individual's     
                                  disability has medically ceased, the        
                                  adjudicator must consider the issue of the  
                                  individual's disability through the date of 
                                  the Secretary of Health and Human Services' 
                                  final decision, rather than only through    
                                  the date of the initial cessation           
                                  determination.                              
AR 92-4 (11th       X          The court held that an Appeals Council      
Circuit)                       dismissal of a request for review of an ALJ 
                                  decision for reasons of untimeliness is a   
                                  "final decision" and subject to judicial    
                                  review.                                     
AR 92-6 (10th       X          The court held that a person's return to    
Circuit)                       substantial gainful activity within 12      
                                  months of the onset date of his or her      
                                  disability, and prior to an award of        
                                  benefits, does not preclude an award of     
                                  benefits and entitlement to a trial work    
                                  period.                                     
AR 92-7 (9th                   The court held that an initial              
Circuit)                       determination in the Social Security or SSI 
                                  programs must be reopened when the notice   
                                  of the initial determination did not        
                                  explicitly state that the failure to seek   
                                  reconsideration results in a final          
                                  determination, and the claimant did not     
                                  pursue a timely appeal.                     
AR 93-1 (4th        X          The court held that a claimant for          
Circuit)                       disability or SSI benefits who has an IQ    
                                  score in the range covered by listing       
                                  12.05C and who cannot perform his or her    
                                  past relevant work because of a physical or 
                                  other mental impairment has per se          
                                  established the additional and significant  
                                  work-related limitation of function         
                                  requirement.                                
AR 93-2 (2nd        X          The court held that, in making a            
Circuit)                       determination following an individual's     
                                  re-entitlement period that an individual    
                                  with a disabling impairment has engaged in  
                                  substantial gainful activity, the Secretary 
                                  of Health and Human Services may not        
                                  consider work and earnings by the           
                                  individual in a single month rather than an 
                                  average of work and earnings over a period  
                                  of months.                                  
AR 94-2 (4th        X          The court held that, in making a disability 
Circuit)                       determination on a subsequent disability    
                                  claim with respect to an un-adjudicated     
                                  period, an adjudicator must adopt a finding 
                                  regarding a claimant's residual functional  
                                  capacity, made in a final decision on a     
                                  prior disability claim arising under the    
                                  same title of the Social Security Act       
                                  unless there is new and material evidence.  
AR 95-1 (6th        X          The court held that, in order to find that  
Circuit)                       the skills of a claimant who is close to    
                                  retirement age are "highly marketable"      
                                  within the meaning of the Secretary of      
                                  Health and Human Services' regulations, SSA 
                                  must first establish that the claimant's    
                                  skills are sufficiently specialized and     
                                  coveted by employers as to make the         
                                  claimant's age irrelevant in the hiring     
                                  process and enable the claimant to obtain   
                                  employment with little difficulty.          
AR 97-2 (9th        X          The court held that a claimant for          
Circuit)                       Disability Insurance or SSI benefits based  
                                  on disability who has an amputation of a    
                                  lower extremity and cannot afford the cost  
                                  of a prosthesis has an impairment that      
                                  meets the listings.                         
AR 97-4 (9th                   The court held that, in making a disability 
Circuit)                       determination on a subsequent disability    
                                  claim with respect to an un-adjudicated     
                                  period, where the claim arises under the    
                                  same title of the Social Security Act as a  
                                  prior claim on which there has been a final 
                                  decision by an ALJ or the Appeals Council   
                                  that the claimant is not disabled, SSA      
                                  must: (1) apply a presumption of continuing 
                                  nondisability and, if the presumption is    
                                  not rebutted by the claimant, determine     
                                  that the claimant is not disabled; and (2)  
                                  if the presumption is rebutted, adopt       
                                  certain findings required under the         
                                  applicable sequential evaluation process    
                                  for determining disability, made in the     
                                  final decision by the ALJ or the Appeals    
                                  Council on the prior disability claim.      
AR 98-1 (8th        X          The court held that a person's return to    
Circuit)                       substantial gainful activity within 12      
                                  months of the onset date of his or her      
                                  disability, and prior to an award of        
                                  benefits, does not preclude an award of     
                                  benefits and entitlement to a trial work    
                                  period.                                     
AR 98-2 (8th        X          The court held that a claimant for          
Circuit)                       Disability Insurance benefits or SSI        
                                  benefits based on disability who has mental 
                                  retardation or autism with a valid IQ score 
                                  in the range covered by Listing 12.05C and  
                                  who cannot perform his or her past relevant 
                                  work because of a physical or other mental  
                                  impairment has per se established the       
                                  additional and significant work-related     
                                  limitation of function requirement of the   
                                  regulations.                                
AR 98-3 (6th                   The court held that, in making a disability 
Circuit)                       determination or decision on a subsequent   
                                  disability claim with respect to an         
                                  un-adjudicated period, where the claim      
                                  arises under the same title of the Social   
                                  Security Act as a prior claim on which      
                                  there has been a final decision by an ALJ   
                                  or the Appeals Council, SSA must adopt the  
                                  finding of the demands of a claimant's past 
                                  relevant work made in the prior decision    
                                  unless new and material evidence or changed 
                                  circumstances provide a basis for a         
                                  different finding.                          
AR 98-4 (6th                   The court held that in making a disability  
Circuit)                       determination or decision on a subsequent   
                                  disability claim with respect to an         
                                  un-adjudicated period, where the claim      
                                  arises under the same title of the Social   
                                  Security Act as a prior claim on which      
                                  there has been a final decision by an ALJ   
                                  or the Appeals Council, SSA must adopt the  
                                  finding of a claimant's residual functional 
                                  capacity made in the final decision by the  
                                  ALJ or the Appeals Council on the prior     
                                  disability claim unless new or additional   
                                  evidence or changed circumstances provide a 
                                  basis for a different finding.              
AR 99-2 (8th        X          The court held that SSA is required to find 
Circuit)                       that a claimant close to retirement age and 
                                  limited to sedentary or light work has      
                                  "highly marketable" skills before           
                                  determining that the claimant has           
                                  transferable skills and, therefore, is not  
                                  disabled.                                   
AR 99-3 (5th        X          The court held that SSA is required to find 
Circuit)                       that a claimant close to retirement age and 
                                  limited to sedentary or light work has      
                                  "highly marketable" skills before           
                                  determining that the claimant has           
                                  transferable skills and, therefore, is not  
                                  disabled.                                   
AR 99-4 (11th                  The court held that an Appeals Council      
Circuit)                       dismissal of a request for review of an ALJ 
                                  decision for reasons of untimeliness is a   
                                  "final decision" and subject to judicial    
                                  review.                                     
AR 00-1 (4th                   The court held that, in making a disability 
Circuit)                       determination on a subsequent disability    
                                  claim with respect to an un-adjudicated     
                                  period, SSA must consider a finding of a    
                                  claimant's residual functional capacity     
                                  made in a final decision by an ALJ or the   
                                  Appeals Council on the prior disability     
                                  claim as evidence and give it appropriate   
                                  weight in light of all relevant facts and   
                                  circumstances but that SSA does not have to 
                                  adopt the finding.                          
AR 00-2 (7th        X          The court held that a determination of      
Circuit)                       medical equivalence under the regulations   
                                  must be based solely on evidence from       
                                  medical sources.                            
AR 00-3 (10th       X          The court held that an ALJ, when receiving  
Circuit)                       evidence from a vocational expert must ask  
                                  the expert how the testimony or information 
                                  corresponds to information provided in the  
                                  Dictionary of Occupational Titles and must  
                                  ask the expert to explain the difference if 
                                  the testimony or evidence differs from the  
                                  Dictionary.                                 
AR 00-4 (2nd        X          The court held that SSA has the burden of   
Circuit)                       proving at step five of the sequential      
                                  evaluation process that the claimant has    
                                  the residual functional capacity to perform 
                                  other work which exists in the national     
                                  economy.                                    
AR 00-5 (6th                   The court held that a claimant's return to  
Circuit)                       substantial gainful activity within 12      
                                  months of the alleged onset date of his or  
                                  her disability, and prior to an award of    
                                  benefits, does not preclude an award of     
                                  benefits and entitlement to a trial work    
                                  period.                                     
AR 01-1 (3rd                   The court held that SSA may not apply the   
Circuit)                       Medical-Vocational Guidelines (grid rules)  
                                  as a frame work to deny disability benefits 
                                  at step 5 of the sequential evaluation      
                                  process when a claimant has a nonexertional 
                                  limitation without either: (1) taking or    
                                  producing vocational evidence; or (2)       
                                  providing notice of the agency's intention  
                                  to take official notice of the fact that    
                                  the particular nonexertional limitation     
                                  does not significantly erode the            
                                  occupational job base.                      
AR 03-1 (7th )                 The court held that for cases concerning    
                                  Listings 12.05 or 112.05 decided by ALJs or 
                                  the Appeals Council before September 20,    
                                  2000, which have been remanded by the       
                                  courts to SSA, the ALJ should apply the     
                                  pre-September 20, 2000 version of the       
                                  Listing as interpreted by the Seventh       
                                  Circuit.                                    
AR 04-1 (9th                   The court held that for certain applicants  
Circuit)                       under age 18, ALJs and Administrative       
                                  Appeals Judges must make reasonable efforts 
                                  to ensure that a qualified pediatrician or  
                                  other specialist evaluates the case.        

Source: Applicable appellate court decisions and GAO analysis.

Appendix VI: Comments from the Agency

Appendix VII: GAO Contact and Staff Acknowledgments

GAO Contact

Daniel Bertoni, (202) 512-7215, [email protected]

Staff Acknowledgments

Robert E. Robertson (Director), Michele Grgich (Assistant Director),
Danielle Giese (Analyst-in-Charge), Susan Bernstein, Candace Carpenter,
Joy Gambino, Suneeti Shah, Albert Sim, Ellen Soltow and Rick Wilson made
significant contributions to this report. Luann Moy, Vanessa Taylor, and
Walter Vance provided assistance with research methodology and data
analysis. Daniel Schwimer provided legal counsel.

Related GAO Reports

Social Security Administration: Agency Is Positioning Itself to Implement
Its New Disability Determination Process, but Key Facets Are Still in
Development. [43]GAO-06-779T . Washington, D.C.: June 15, 2006.

Social Security Administration: Administrative Review Process for
Adjudicating Initial Disability Claims. [44]GAO-06-640R . Washington,
D.C.: May 16, 2006.

High-Risk Series: An Update. [45]GAO-05-207 . Washington, D.C.: January
2005.

SSA's Disability Programs: Improvements Could Increase the Usefulness of
Electronic Data for Program Oversight. [46]GAO-05-100R . Washington, D.C.:
December 10, 2004.

Social Security Administration: More Effort Needed to Assess Consistency
of Disability Decisions. [47]GAO-04-656 . Washington, D.C.: July 2, 2004.

Social Security Administration: Strategic Workforce Planning Needed to
Address Human Capital Challenges Facing the Disability Determination
Services. [48]GAO-04-121 . Washington, D.C.: January 27, 2004.

Social Security Disability: Disappointing Results from SSA's Efforts to
Improve the Disability Claims Process Warrant Immediate Attention.
[49]GAO-02-322 . Washington, D.C.: February 27, 2002.

Standards for Internal Control in the Federal Government.
[50]GAO/AIMD-00-21 .3.1 Washington, D.C.: November 1999.

(130555)

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Highlights of [58]GAO-07-331 , a report to congressional requesters

April 2007

DISABILITY PROGRAMS

SSA Has Taken Steps to Address Conflicting Court Decisions, but Needs to
Manage Data Better on the Increasing Number of Court Remands

The Social Security Administration's (SSA) Disability Insurance and
Supplemental Security Income programs provided around $128 billion to
about 12.8 million persons with disabilities and their families in fiscal
year 2005. Claimants who are denied benefits by SSA may appeal to federal
courts. Through current initiatives, SSA is attempting to reduce the
number of cases appealed to courts and remanded back to SSA for further
review. In addition, there have been long-standing concerns about how SSA
responds to court decisions that conflict with its policies.

GAO was asked to examine: (1) trends over the past decade in the number of
appeals reviewed by the courts and their decisions, (2) reasons for court
remands and factors contributing to them, and (3) SSA's process for
responding to court decisions that conflict with agency policy. GAO
reviewed SSA data and documents on court decisions, remands and SSA's
processes and interviewed agency officials and stakeholders on data
trends, reasons for remands, and SSA processes.

[59]What GAO Recommends

GAO recommends that the Commissioner of Social Security take steps to
improve the reliability and collection of data on remands. SSA agreed with
GAO's recommendations and outlined actions it plans to take to implement
them.

Between fiscal years 1995 and 2005, the number of disability appeals
reviewed by the federal district courts increased, along with the
proportion of decisions that were remanded. More disability claims were
remanded than affirmed, reversed, or dismissed over the period, and the
proportion of total decisions that were remands ranged from 36 percent to
62 percent, with an average of 50 percent. Remanded cases often require
SSA to re-adjudicate the claim, with the result that--along with the
passage of time and new medical evidence--the majority of remanded cases
result in allowances.

Percent of Federal District Court Decisions by Type, Fiscal Year 1995 to
Fiscal Year 2005

According to SSA officials and outside observers, a range of errors
prompted by heavy workloads is responsible for court remands of SSA's
disability determinations, but data that would confirm or clarify the
issue are incomplete and not well-managed. SSA has only recently begun
collecting data on remands, and we found these data to be incomplete.
Additionally, this information is collected by two different offices that
have created somewhat different categories for the data, making some of
the information inconsistent and possibly redundant. Meanwhile, SSA has
acknowledged the need to reduce remands and, in 2006 along with other
initiatives, introduced new decision-writing templates to improve
efficiency and reduce errors.

SSA has a process in place for determining whether appellate court
decisions conflict with the agency's interpretation of disability statutes
or regulations and has taken steps in recent years to align its national
policies with appellate court decisions. For example, officials and
stakeholders attributed a downward trend in appellate court decisions that
conflict with agency policy to significant policy changes instituted by
SSA in the mid-1990s. In addition, for those cases where the agency
acceded to conflicting appellate court decisions by issuing acquiescence
rulings within the related circuits, we found that about half of the
rulings issued were eventually replaced with national policy. Moreover,
GAO found that the timeliness of acquiescence rulings had improved since
1998, when SSA established a timeliness goal of 120 days.

References

Visible links
  39. http://www.gao.gov/cgi-bin/getrpt?GAO-06-779T
  40. http://www.gao.gov/cgi-bin/getrpt?GAO/AIMD-00-21.3.1
  43. http://www.gao.gov/cgi-bin/getrpt?GAO-06-779T
  44. http://www.gao.gov/cgi-bin/getrpt?GAO-06-640R
  45. http://www.gao.gov/cgi-bin/getrpt?GAO-05-207
  46. http://www.gao.gov/cgi-bin/getrpt?GAO-05-100R
  47. http://www.gao.gov/cgi-bin/getrpt?GAO-04-656
  48. http://www.gao.gov/cgi-bin/getrpt?GAO-04-121
  49. http://www.gao.gov/cgi-bin/getrpt?GAO-02-322
  50. http://www.gao.gov/cgi-bin/getrpt?GAO/AIMD-00-21.3.1
  58. http://www.gao.gov/cgi-bin/getrpt?GAO-07-331
*** End of document. ***