Social Security Disability: Backlog Reduction Efforts Under Way:
Significant Challenges Remain (Chapter Report, 07/11/96, GAO/HEHS-96-87).
Pursuant to a congressional request, GAO examined the growth in the
backlog of pending cases at the Social Security Administration's (SSA)
Office of Hearings and Appeals (OHA), focusing on SSA initiatives to:
(1) reduce backlogged cases; and (2) make the disability appeals process
more timely and efficient.
GAO found that: (1) the growth in OHA backlogs is a direct result of
increased applications and appeals to OHA, as well as SSA inattention to
long-standing problems; (2) these problems include multiple levels of
claims development and decisionmaking, fragmented program
accountability, decisional disparities between disability determination
services and OHA adjudicators, and SSA failure to communicate its
management authority over administrative law judges (ALJ); (3) SSA
initiated short-and long-term efforts to manage its disability
determination and appeals process in 1994; (4) the SSA Short-Term
Disability Plan (STDP) should reduce OHA backlogs to a manageable level
by December 1996; (5) STDP relies on the temporary reallocation of SSA
resources and process changes to stem the flow of cases requiring ALJ
hearings; (6) start-up delays and limited timeframes have affected SSA
ability to reduce the number of backlogged cases; (7) SSA tracks and
monitors STDP allowances to ensure decisional accuracy; (8) the SSA
redesign plan is aimed at addressing systemic problems within the SSA
disability program and reducing claims processing; (9) the redesign plan
is still in its early stages, and does not address the types of
management actions that are legally permissible for ALJ hearings; and
(10) many ALJ believe that they are legally exempt from management
control, and SSA is frustrated in its efforts to manage the appeals
process and reduce the number of pending cases.
--------------------------- Indexing Terms -----------------------------
REPORTNUM: HEHS-96-87
TITLE: Social Security Disability: Backlog Reduction Efforts Under
Way: Significant Challenges Remain
DATE: 07/11/96
SUBJECT: Claims processing
Social security benefits
Disability benefits
Administrative law judges
Federal social security programs
Administrative hearings
Income maintenance programs
Claims reconsiderations
Disability insurance
IDENTIFIER: Supplemental Security Income Program
SSA Short Term Disability Plan
Social Security Disability Insurance Program
SSA Program Operations Manual System
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Cover
================================================================ COVER
Report to the Ranking Minority Member, Committee on Ways and Means,
House of Representatives
July 1996
SOCIAL SECURITY DISABILITY -
BACKLOG REDUCTION EFFORTS UNDER
WAY; SIGNIFICANT CHALLENGES REMAIN
GAO/HEHS-96-87
OHA Backlog
(105141)
Abbreviations
=============================================================== ABBREV
AO - adjudication officer
ALJ - administrative law judge
APA - Administrative Procedure Act
DDS - disability determination services
DI - Disability Insurance
HHS - Department of Health and Human Services
HOCALJ - hearing office chief administrative law judge
OHA - Office of Hearings and Appeals
POMS - Program Operations Manual System
RCALJ - regional chief administrative law judge
SSA - Social Security Administration
SSI - Supplemental Security Income
STDP - Short-Term Disability Plan
Letter
=============================================================== LETTER
B-261609
July 11, 1996
The Honorable Sam M. Gibbons
Ranking Minority Member
Committee on Ways and Means
House of Representatives
Dear Mr. Gibbons:
This report, prepared at your request, examines the growth in the
backlog of pending cases at SSA's Office of Hearings and Appeals,
agency initiatives to reduce it, and concerns associated with SSA's
efforts.
As arranged with your office, unless you publicly announce the
contents of this report earlier, we plan no further distribution
until 30 days from its issue date. At that time we will send copies
to other interested parties. We will also make copies available to
others upon request.
Please contact Roland Miller, Assistant Director, at (202) 512-7246
if you have any questions. Other GAO contacts and major contributors
to this report are listed in appendix V.
Sincerely yours,
Jane L. Ross
Director, Income Security Issues
EXECUTIVE SUMMARY
============================================================ Chapter 0
PURPOSE
---------------------------------------------------------- Chapter 0:1
The Social Security Administration (SSA) operates the nation's
largest programs providing cash benefits to people with severe
long-term disabilities. In 1995, about 5.7 million disabled workers
and their dependents received Disability Insurance (DI) benefits, up
from 3.9 million at the end of 1985. During this same period, the
number of disabled recipients of Supplemental Security Income (SSI)
increased from 2.5 million to 4.9 million. Over the past decade, SSA
has struggled to deal with unprecedented growth in appeals of its
disability decisions and the resulting backlog of cases awaiting a
hearing decision. Processing delays related to a backlog of more
than half a million appealed cases have created hardships for
disability claimants, who often wait more than a year for a final
disability decision.
As a result of the impact of these long delays on applicants, the
former chairman of the House Committee on Ways and Means asked GAO to
determine (1) those factors contributing to the growth in the backlog
of appealed cases, (2) what steps SSA has taken in the past to
address this backlog problem, (3) what SSA is currently doing to
reduce the appellate backlog, and (4) what needs to be done in the
long term to make the disability appeals process more timely and
efficient.
BACKGROUND
---------------------------------------------------------- Chapter 0:2
SSA, together with state agencies called disability determination
services (DDS), makes the initial eligibility determination.
Claimants whose initial benefit claim is denied may request a
reconsideration of their claim by different staff at DDS. If the
reconsideration review results in a second denial, claimants may
appeal to an administrative law judge (ALJ) located in SSA's Office
of Hearings and Appeals (OHA).
Despite numerous studies of SSA's disability programs and continued
agency attempts to improve the disability appeals process, between
1985 and 1995, OHA's pending case backlog--the number of appealed
cases waiting for a decision--grew from 107,000 to 548,000, and
case-processing time increased from 167 to 350 days. At the rate
claims are currently being processed, it would take more than a year
to dispose of the claims now awaiting an OHA decision.
RESULTS IN BRIEF
---------------------------------------------------------- Chapter 0:3
The growth in OHA's backlog of pending cases and increasing case-
processing time are the result not only of a surge in initial
applications and appeals to OHA but also of SSA's inattention to
several long-standing problems. These problems include (1) multiple
levels of claims development and decision-making, (2) fragmented
program accountability, (3) decisional disparities between DDS and
OHA adjudicators, and (4) SSA's failure to consistently define and
communicate its management authority over the ALJs.
Despite agency initiatives taken over the last decade to handle
increasingly larger workloads, the backlog of appealed cases has
outpaced OHA's case-processing capacity. In 1994, SSA initiated both
short- and long-term efforts in response to criticism of its ability
to effectively manage the disability determination and appeals
process. SSA's Short-Term Disability Plan (STDP) represents its
near-term effort to reduce OHA's backlog of pending cases to a
manageable level by December 1996. The plan relies primarily on the
temporary reallocation of agency resources and process changes to
stem the flow of cases requiring an ALJ hearing and reduce OHA's
backlog of cases. Although STDP is under way, start-up delays and
the limited impact of key initiatives have affected SSA's ability to
achieve its backlog reduction goals. Some SSA and OHA officials are
also concerned that pressure to meet the plan's goals within
increasingly limited time frames may put the agency at risk of
incorrectly allowing claims. However, SSA is closely monitoring and
tracking STDP allowances to ensure decisional accuracy. In contrast
to STDP, SSA's Plan for a New Disability Claim Process--commonly
referred to as the "redesign plan"--represents the agency's long-term
strategy for addressing the systemic problems contributing to
inefficiencies in its disability programs and significantly reducing
the time it takes for claimants to receive a disability decision.
SSA's redesign plan includes initiatives still in the early
implementation and planning stages that SSA believes will improve
program efficiency in the first three problem areas mentioned above.
The plan does not, however, address the need for SSA to consistently
define and communicate to regional and hearing office management the
types of management actions that are legally permissible for managing
ALJ activities without hindering judicial independence. Because this
issue has not been adequately addressed, SSA has found that many ALJs
believe they are legally exempt from nearly all management control,
and the agency has been continually frustrated in its efforts to
manage the appeals process and reduce its backlog of pending cases.
PRINCIPAL FINDINGS
---------------------------------------------------------- Chapter 0:4
INCREASING WORKLOADS AND
LONG-STANDING PROBLEMS HAVE
CONTRIBUTED TO OHA'S CASE
BACKLOG
-------------------------------------------------------- Chapter 0:4.1
Between 1985 and 1995, initial applications for DI and SSI increased
by 57 percent, from 1.6 million to 2.5 million. During the same
period, appeals to OHA increased more than 140 percent, and the
number of cases awaiting an OHA decision grew from 107,000 to about
548,000. Many factors have contributed to the growth in disability
applications and the accompanying growth in OHA's case backlog,
including an expansion of the disability eligibility criteria,
program outreach efforts, and poor economic conditions. GAO also
found that long-standing problems associated with SSA's disability
programs have contributed further to the backlog. These problems
fall into four basic categories: multiple levels of claims
development and decision-making, fragmented program accountability,
decisional disparities between DDS and OHA adjudicators, and SSA's
failure to consistently define and communicate its management
authority over the ALJs.
DESPITE PREVIOUS EFFORTS,
OHA'S BACKLOG HAS CONTINUED
-------------------------------------------------------- Chapter 0:4.2
Over the last decade, SSA has relied primarily on hiring more ALJs
and support staff and the use of overtime to handle increasingly
larger workloads. Between 1985 and 1995, SSA increased ALJ staffing
levels by 49 percent and field office support staff by about 45
percent. The use of overtime has also increased more than 850
percent since 1990. In addition to allocating more resources to OHA,
SSA conducted at least three reviews between 1990 and 1992 to examine
the issues affecting SSA's disability programs and recommend
improvements to the disability process. Despite SSA's efforts, the
backlog of appealed cases has outpaced OHA's case- processing
capacity. Key SSA and OHA officials told GAO that previous
initiatives attempted to make the hearings process more efficient,
but that their impacts were limited by SSA's focus on minor process
changes and applying more resources to the appeals process rather
than addressing the long-standing problems central to the backlog of
claims awaiting processing.
IN THE NEAR TERM, BACKLOG
REDUCTION EFFORTS FOCUS ON
STDP
-------------------------------------------------------- Chapter 0:4.3
STDP represents SSA's current effort to achieve some near-term
reductions in OHA's pending case backlog. STDP addresses the backlog
crisis from an agencywide perspective, rather than viewing it as an
SSA or OHA problem, and establishes specific case-processing goals
and timeframes for accomplishing them. STDP also relies heavily on
temporary reallocations of program resources and process changes to
reduce OHA's backlog to 375,000 cases by December 1996. The plan's
goals are being addressed primarily by two key initiatives that
expand OHA prehearing conferencing proceedings and SSA regional
screening unit activities. These initiatives target certain appealed
cases for review, and possible allowance, by either OHA attorneys or
SSA regional staff before beginning more costly and time-consuming
ALJ hearings.
Implementation delays associated with the expanded prehearing
conferencing initiative and the limited impact of regional screening
units have impeded SSA's ability to achieve STDP's goals. To fully
implement prehearing conferencing, SSA was required to pursue
regulatory changes giving OHA attorneys the authority to issue
allowance decisions for certain appealed cases. However, the process
of defining the specific authority and responsibilities these
attorneys would have under STDP was lengthy, and the initiative was
delayed for almost 6 months. Also, SSA originally projected that
including OHA staff attorneys in regional screening units would
result in 38,000 screening unit allowances by December 1995.
However, this goal was not met, and the screening units allowed a
total of only 28,376 cases through February 1996.
From the time STDP was announced in November 1994 to the end of
fiscal year 1995, OHA's case backlog increased from 488,000 to
548,000 cases. In order to reach its goal of reducing OHA's backlog
to 375,000 cases by December 1996, SSA will have to increase its
efforts considerably. Many SSA and OHA officials have voiced concern
that agency pressure to reach STDP's goals within increasingly
limited timeframes could result in inappropriately awarded cases.
SSA intends to closely monitor management and quality assurance
information to identify any effect STDP may have on overall program
allowance rates.
SSA'S REDESIGN PLAN IS AIMED
AT ADDRESSING SEVERAL
LONG-STANDING PROBLEMS, BUT
A KEY ISSUE REMAINS
UNRESOLVED
-------------------------------------------------------- Chapter 0:4.4
SSA's redesign plan represents SSA's long-term strategy for improving
the quality, accuracy, and efficiency of disability claims service to
the public. The plan includes initiatives that SSA believes will
address several long-standing problems contributing to program
inefficiencies. These initiatives aim to streamline complex claims
processes, improve organizational and process accountability, and
provide more consistent decisional policies to DDS and OHA
adjudicators. With full implementation of the plan, SSA expects
average case-processing time through the hearings stage to decrease
from more than a year in 1995 to 225 days by 2000. At the time of
GAO's review, however, SSA was engaged in the early planning and
testing stages of the redesign effort, and none of the initiatives
had been fully implemented.
A significant problem the redesign plan does not address, however, is
the need for SSA to consistently define and communicate its
management authority over the ALJs. Since the 1970s, many ALJs have
successfully opposed certain agency initiatives to increase their
productivity on the grounds that SSA's actions violated portions of
the Administrative Procedure Act (APA) that protect ALJ decisional
independence. As a result of the long-standing controversy regarding
the management constraints imposed by APA, SSA has been continually
frustrated in its efforts to manage nondecisional ALJ activities,
such as directing hearing office work flow, establishing clear lines
of authority within hearing offices, and implementing uniform
policies and procedures.
Addressing the APA issue continues to be important today, because the
success of the redesign plan may be affected by the degree of ALJ
cooperation received and the extent to which SSA can mandate ALJ
compliance with the plan's initiatives. If SSA does not address this
matter, it may jeopardize its efforts to reduce OHA's backlog of
pending cases and achieve its long-term service delivery goals.
AGENCY COMMENTS
---------------------------------------------------------- Chapter 0:5
In its written comments on a draft of this report, SSA agreed with
GAO's conclusion that the scope of SSA's management authority over
its ALJs should be clarified. SSA also provided comments and
observations about those areas in which it believed adjustments
should be made to the report. Where appropriate, the report has been
revised. A number of SSA's specific comments and GAO's evaluation of
these comments are included in chapter IV; the full text of SSA's
comments and GAO's response are included as appendix III.
INTRODUCTION
============================================================ Chapter 1
The Social Security Disability Insurance (DI) and Supplemental
Security Income (SSI) programs are the nation's two largest federal
programs providing cash payments to people with severe long-term
disabilities. Between 1985 and 1995, the number of DI recipients
increased almost 50 percent to about 5.7 million, and the number of
disabled SSI recipients increased from 2.5 million to 4.9 million.
In fiscal year 1995, the Social Security Administration (SSA)
distributed over $61 billion in disability benefits for its DI and
SSI programs.
Over the past decade, SSA's Office of Hearings and Appeals (OHA) has
experienced unprecedented growth in both its backlog of DI and SSI
hearings requests and the time it takes to process a disability
appeal. While the agency has undertaken several efforts over the
years to address the backlog issue, workload increases and
long-standing problems associated with the program have impeded their
success. The rapid growth in OHA's pending case backlog and longer
case-processing times have caused hardship for those disability
claimants who are unable to work or to afford needed medical
treatment while awaiting a final decision. On average, it takes more
than a year to receive a final OHA decision from the time a claimant
first files an application of disability. This extended waiting
period has raised congressional concerns about SSA's disability
decision-making process.
THE DISABILITY DETERMINATION
PROCESS
---------------------------------------------------------- Chapter 1:1
The DI program, enacted in 1956 under title II of the Social Security
Act, provides monthly cash insurance benefits to insured severely
disabled workers. The SSI program, enacted in 1972 under title XVI,
provides monthly cash payments to aged, blind, or disabled people
whose income and resources fall below a certain threshold. The
Social Security Act defines disability under both programs as an
inability to engage in substantial gainful activity by reason of a
severe physical or mental impairment. The impairment must be
medically determinable and expected to last at least a year or result
in death.
Claimants file an application for disability benefits--both DI and
SSI--with one of SSA's over 1,300 field offices. Applications, along
with supporting medical evidence, are then forwarded to the
appropriate state disability determination service (DDS). SSA
arranges with state DDSs to make the initial medical determination of
eligibility in accordance with SSA's policies and procedures.
Claimants who are dissatisfied with the initial DDS determination may
request a "reconsideration" of the claim within 60 days of their
notice of decision. During the reconsideration review, all evidence
is reevaluated by DDS personnel who were not involved in the original
decision, and a new, independent decision is made on the merits of
the case.
Claimants who disagree with the reconsideration decision have the
right to a hearing before an administrative law judge (ALJ) in SSA's
OHA. A request for hearing may be filed by mail or telephone, or in
person at either an SSA field office or an OHA hearing office. Upon
receipt of a hearing request, hearing office support staff review and
prepare the case file for hearing. If necessary, staff may recommend
to the ALJ that additional medical evidence be developed before
holding a hearing. The hearing is generally the first time in the
disability determination process that a claimant has the opportunity
for a face-to-face meeting with a decisionmaker. At the hearing, the
claimant and witnesses--who may include medical or vocational
experts--provide testimony. The ALJ inquires into the issues,
receives relevant documents into evidence, and allows the claimant or
the claimant's representative to present arguments and examine
witnesses. If necessary, the ALJ may further update the evidence
after the hearing. When this process is completed, the ALJ issues a
decision based on his or her assessment of the evidence in the case.
Claimants who disagree with an ALJ denial are given another 60 days
to request that the case be reviewed by SSA's Appeals Council. A
request for review must be filed through either a field office or a
hearing office or directly with the Appeals Council. The Appeals
Council may dismiss the request, affirm an ALJ's decision, remand the
case to an ALJ for further action, or issue a new decision. To
determine the appropriate action, Council members, assisted by a
large staff of analysts, decide whether the decision was supported by
the evidence. The Appeals Council's decision--or the decision of the
ALJ, if the Appeals Council dismisses the request--becomes SSA's
final decision. After all SSA administrative remedies are exhausted,
a claimant has further appeal rights within the federal court system,
up to and including the U.S. Supreme Court. (See fig. 1.1.)
Figure 1.1: Disability
Determination and Appeals
Process
(See figure in printed
edition.)
ALJ DECISIONAL INDEPENDENCE IS
PROTECTED BY THE ADMINISTRATIVE
PROCEDURE ACT
---------------------------------------------------------- Chapter 1:2
The Administrative Procedure Act (APA), enacted by the Congress in
1946, protects the decisional independence of ALJs. To ensure ALJ
independence, APA grants ALJs certain specific exemptions from normal
management controls. For example, federal agencies may not apply
performance appraisal requirements to ALJs and may remove ALJs only
for "good cause," as determined by the Merit Systems Protection
Board.
These safeguards were put in place to ensure that ALJ judgments were
independent and that ALJs would not be paid, promoted, or discharged
arbitrarily or for political reasons by the agency. However, ALJ
independence is not unlimited. Because they are SSA employees, ALJS
are subject to agency rules and regulations, and they must apply even
those with which they disagree. Further, ALJ independence does not
negate SSA's authority to implement procedures for supervising and
reviewing the ALJ decision-making process to ensure that agency
policies and procedures are followed.
The role of ALJs at SSA differs from that of other ALJs in the
federal government in that SSA ALJs are responsible for both
developing the hearings evidence and deciding the case. In other
executive branch agencies, the responsibility for developing evidence
is left to the claimants and their representatives. SSA hearings
also differ from those of other executive branch agencies in that
they are informal, nonadversarial proceedings; that is, SSA does not
present a case challenging a claimant's disability claim.\1 Most
other executive branch ALJs hold hearings that are formal,
adversarial, and similar to a trial. During such hearings, attorneys
on both sides present witnesses and documentary evidence and
cross-examine witnesses in order to present the facts in a light
favorable to their case.
--------------------
\1 Although the government does not present a case during an SSA
hearing, an ALJ retains the authority to call impartial medical and
vocational experts to present evidence about a claimant's medical
condition or vocational capabilities.
OHA ADMINISTRATION
---------------------------------------------------------- Chapter 1:3
OHA headquarters is located in Falls Church, Virginia, apart from SSA
headquarters in Baltimore. OHA operates 10 regional offices, 132
hearing offices, 3 class action management centers, and 5 word
processing centers. Of OHA's 7,100 employees, about 1,000 are
located in Falls Church. OHA is headed by the Associate Commissioner
for Hearings and Appeals, who is responsible for administering the
hearings and appeals process and reports directly to SSA's Deputy
Commissioner for Programs and Policy. (See app. I for an SSA
organization chart and app. II for an OHA organization chart).
OHA's Chief ALJ reports directly to the Associate Commissioner for
Hearings and Appeals and is responsible for managing about 5,000
hearing office employees located in 10 regions. Each OHA region is
headed by a regional chief ALJ (RCALJ), who is responsible for the
operations of hearing offices in his or her respective region. In
every hearing office, a hearing office chief ALJ (HOCALJ) oversees
day-to-day office operations and provides guidance to ALJs,
professional staff, and support personnel.
OBJECTIVES, SCOPE, AND
METHODOLOGY
---------------------------------------------------------- Chapter 1:4
Due to the rapid growth in OHA backlogs and case-processing times and
their impact on public service, in July 1994 the former Chairman, and
now Ranking Minority Member, of the House Committee on Ways and Means
asked us to examine SSA's efforts to address the problem. More
specifically, the objectives of our assignment were to determine (1)
those factors contributing to the growth in the backlog of appealed
cases, (2) what steps SSA has taken in the past to address this
backlog problem, (3) what SSA is currently doing to reduce the
appellate backlog, and (4) what needs to be done in the long term to
make the disability appeals process more timely and efficient.
In conducting our review, we
-- analyzed data on OHA workloads, backlogs, and processing times;
-- reviewed over 50 government and nongovernment studies conducted
over the past 20 years on the disability determination and
appeals process (see app. IV);
-- examined SSA's previous initiatives to address OHA backlogs and
improve the hearings and appeals process; and
-- reviewed SSA's Short-Term Disability Plan (STDP) and the
agency's longer-term Plan for a New Disability Claim Process
(redesign plan).
To supplement information obtained from the various reports and
initiatives outlined above, we
-- interviewed key SSA and OHA headquarters and regional management
officials, as well as managers responsible for the development
and implementation of SSA's STDP and redesign plan;
-- obtained the views of hearing office officials--chief ALJs,
supervisory staff-attorneys, and hearing office
managers--regarding SSA's previous and current efforts to
improve program efficiency and address OHA's pending case
backlog; and
-- interviewed officials at state disability determination services
in Florida, Georgia, Massachusetts, New York, and Texas to
obtain their views on the status and expected impacts of the
STDP initiatives.
Our review was performed at SSA and OHA headquarters; four SSA
regions--Atlanta, Boston, Dallas, and New York; and five OHA
regions--Atlanta, Boston, Dallas, New York, and Philadelphia. By
examining workload and performance indicators, we judgmentally
selected regions and OHA hearing offices that would provide us with
varied workload levels as well as varied experiences in managing
their workloads. The selected offices also provided us with some
geographical dispersion. We conducted our review between July 1994
and February 1996 in accordance with generally accepted government
auditing standards.
INCREASING WORKLOADS AND
LONG-STANDING PROBLEMS HAVE
CONTRIBUTED TO OHA'S CASE BACKLOG
============================================================ Chapter 2
Over the last decade, OHA's backlog of pending cases and
case-processing times have grown rapidly, and claimants are waiting
longer for disability decisions. SSA has acknowledged that current
workload levels have placed the disability program under increasing
public and congressional pressure, and that aggressive measures are
necessary to address this "crisis" situation.
The growth in OHA's backlog of cases has been caused, in part, by the
rapid surge in disability program applications and ever-increasing
appeals to OHA. But backlog growth has also resulted because SSA has
not adequately addressed several long-standing problems associated
with its disability programs. These problems have been identified in
numerous internal and external studies conducted over the last 2
decades. We reviewed these studies and found that SSA's key
long-standing problems can be classified into four basic categories:
multiple levels of claims development and decision-making, fragmented
program accountability, decisional disparities between DDS and OHA
adjudicators, and SSA's failure to consistently define and
communicate its management authority over the ALJs.
HEARINGS BACKLOG AND
CASE-PROCESSING TIMES HAVE
INCREASED WITH WORKLOAD GROWTH
---------------------------------------------------------- Chapter 2:1
The number of disabled beneficiaries has steadily increased over the
last decade. In 1985, there were 3.9 million DI recipients. In
1995, almost 5.7 million disabled workers and their dependents
received more than $40 billion in DI benefits. Most of this growth
occurred in the last 3 years, when 1.1 million beneficiaries were
added to the rolls. The SSI program grew even more over the last
decade, when the number of SSI recipients increased from 2.5 million
to 4.9 million.
Many factors have contributed to the number of people seeking
disability benefits and the subsequent growth in the OHA workload,
including the expansion of DI eligibility criteria, program outreach
efforts, and poor economic conditions.\2 Between 1985 and 1995,
initial DI and SSI applications increased by 57 percent, from 1.6
million to 2.5 million. DDS denial rates for initial applications
also increased during the same period, further enlarging the pool of
applicants who could request an appeal. The number of requests for
OHA hearings increased by 140 percent, from 245,000 in 1985 to
589,000 in 1995.
As we have reported previously, the rising rates at which
applications for disability benefits and accompanying appeals are
being filed have caused tremendous workload pressures and processing
delays for OHA.\3 Between 1985 and 1995, OHA's pending case backlog
grew from 107,000 to about 548,000 cases. In addition, the average
processing time for cases appealed to OHA--measured from the time a
request for hearing is filed by the claimant--increased 110 percent,
from 167 days to 350 days. Moreover, aged cases (those pending 270
days or more) increased from 5 percent of pending cases to 39 percent
during the same period. Some applicants who have been awarded
benefits on appeal to OHA after twice being denied by DDSs have
waited more than a year after first applying. Table 2.1 shows the
rapid growth in OHA's workload, pending case backlog, and the time it
takes to process an appealed case.
Table 2
1: Growth in OHA's Workload, Backlog,
and Case-Processing Times, 1985-95
Averag
e Percen
Worklo Backlo case- tage
ad g proces of
(case (pendi sing aged
receip ng time cases\
Fiscal year ts) cases) (days) a
-------------------------------------- ------ ------ ------ ------
1985 245,09 107,04 167 5
0 2
1986 230,65 117,38 172 4
5 4
1987 278,44 148,39 198 9
0 8
1988 290,39 158,89 216 9
3 2
1989 302,45 159,26 217 11
2 8
1990 310,52 172,75 212 9
9 6
1991 329,34 183,47 229 10
6 1
1992 391,29 218,42 223 7
4 3
1993 509,44 357,56 238 16
3 4
1994 539,87 485,83 305 32
1 7
1995 588,59 547,69 350\ 39\
6 0\
----------------------------------------------------------------------
\a Cases that have been pending 270 days or more.
--------------------
\2 GAO reported in February 1994 that increasing unemployment and
expanding eligibility requirements, along with several other factors,
contributed to growth in the disability rolls. See Social Security:
Disability Rolls Keep Growing While Explanations Remain Elusive
(GAO/HEHS-94-34, Feb. 8, 1994).
\3 Disability Insurance: Broader Management Focus Needed to Better
Control Caseload (GAO/T-HEHS-95-164, May 23, 1995) and Social
Security Disability: Management Action and Program Redesign Needed
to Address Long-Standing Problems (GAO/T-HEHS-95-233, Aug. 3, 1995).
LONG-STANDING PROGRAM PROBLEMS
HAVE CONTRIBUTED TO OHA'S CASE
BACKLOG
---------------------------------------------------------- Chapter 2:2
In addition to the dramatic increases in workload discussed above,
long-standing problems associated with the disability determination
and appeals process have contributed to the backlog growth and
increased case-processing time at OHA. In 1992, as part of its
efforts to develop a number of strategic priority goals, SSA reviewed
numerous internal and external studies of the disability
determination and appeals process, several of which were completed
more than 20 years ago. The agency acknowledged that, despite rapid
workload increases and enormous changes in available technology,
demographics, and the types of disabilities qualifying for benefits,
disability processes had remained basically the same since the DI
program was established in the 1950s.
We also reviewed the above studies, and several other government and
nongovernment reviews conducted over the last several decades, and
categorized the key long-standing problems affecting SSA's disability
programs as (1) multiple levels of claims development and
decision-making, (2) fragmented accountability for claims processing,
(3) decisional disparities between DDS and OHA adjudicators, and (4)
SSA's failure to consistently define and communicate its management
authority over the ALJs. The relationship of these problems to OHA's
pending case backlog and increased case-processing time is discussed
below.
MULTIPLE LEVELS OF CLAIMS
DEVELOPMENT AND
DECISION-MAKING
-------------------------------------------------------- Chapter 2:2.1
SSA's internal planning documents show that multiple levels of claims
development and decision-making throughout the disability program
have negatively affected OHA's ability to provide timely and
efficient service to all claimants who appeal. Within SSA, a denied
disability claim may pass through as many as four decision-making
levels (initial, reconsideration, ALJ hearing, and Appeals Council)
before a final decision is rendered. As a claim moves from one level
to the next it is readjudicated, and multistep procedures for review,
evidence collection, and decision-making are employed.
In addition to delays associated with multiple layers of review and
decision-making, delays also occur as a claim moves from one employee
or facility to another and waits at each employee's desk to be
processed. As workloads have grown, the amount of time a claim waits
at each processing point has increased. Since 1985, average
case-processing time at OHA has grown from 167 days to about 350
days. Following a 1992 review of OHA operations, SSA found that
claimants can wait as long as 550 days to receive a hearing decision
notice.\4 The same report noted that, in the case of one claim, only
4 days of the 550 involved actual work on the claim. Some of the
delay is necessary, however, because of scheduling and due process
notice requirements. Other delays are often claimant initiated and
may lead to hearing postponements or the need to further develop the
evidentiary record.
--------------------
\4 Department of Health and Human Services, SSA, Office of Workforce
Analysis, Process Review Report: The Office of Hearings and Appeals
(Washington, D.C.: HHS, June 1992).
FRAGMENTED PROGRAM
ACCOUNTABILITY
-------------------------------------------------------- Chapter 2:2.2
SSA has acknowledged that no single organizational component is
accountable for the overall efficiency of disability claims
processing, and that fragmentation issues have negatively affected
the efficiency of the process. Currently, several organizational
components are involved in disability claims processing--field
offices, DDSs, hearing offices, and the Appeals Council--and each is
accountable and responsible for reaching its own goals without
responsibility for the overall disability claims process. SSA's own
internal reviews have found that poor coordination among components
has reinforced a lack of understanding among OHA staff of the roles
and responsibilities of other components and created the perception
that no one is in charge of the disability programs.
Fragmentation in the disability process is further evidenced by OHA's
organizational and operational separation from the rest of SSA.
OHA's headquarters is located in Falls Church, Virginia, while SSA's
headquarters is located in Baltimore. OHA regional staff are also
separated from SSA regional staff. SSA's own reviews have found that
organizational fragmentation has led to a lack of interaction between
OHA and the rest of SSA and fostered a "stepchild" mentality among
many OHA employees. For example, SSA found that OHA staff had little
sense of belonging to the wider SSA and were unfamiliar with its
organizational structure, philosophy, and goals. This mentality has
affected SSA's ability to implement operational plans for the
disability programs.
Finally, SSA lacks a common automated database for managing claims as
they move through the various components involved in the disability
determination process. Consequently, as a claim moves from one
organizational level to another, some data must be manually reentered
into the computer by the various components, and the status of
disability claims is not adequately recorded for reference by others.
Outdated manual processes and fragmented automated systems have made
improving the disability determination and appeals process difficult.
DECISIONAL DISPARITIES
BETWEEN DDS AND OHA
ADJUDICATORS
-------------------------------------------------------- Chapter 2:2.3
In 1994, ALJs allowed benefits in about 75 percent of the cases they
decided. By awarding a relatively high percentage of cases that DDSs
have previously denied, ALJs may encourage more appeals to OHA.
While all of the reasons for decisional disparities are not
conclusively known, many have hypothesized that possible causes
include the de novo hearings process, which allows claimants to
submit additional evidence upon appeal; face-to-face interviews
between ALJs and claimants; decisional errors by both DDSs and ALJs;
and different applications of disability decisional policies at the
DDS and ALJ levels.
Some decisional disparities may be attributable to OHA's de novo
hearings process. Under this process, the ALJ does not review the
DDS' decision or rule on its adequacy. Instead, the ALJ conducts
what is called a de novo hearing in which evidence is considered and
weighed again, and the ALJ issues a decision based on his or her own
findings. With the de novo hearing, claimants may submit new
evidence to the ALJ that may not have been available at the time of
the DDS review and decision. SSA's reviews have found that more than
a quarter of ALJ awards are based on such new evidence, which may
include claimant testimony that their condition has worsened since
the original DDS review. Thus, by design, some differences in
decisional results are built into the system.
Also, face-to-face interviews between ALJs and claimants may lead to
disparate decisions. The ALJ hearing is generally the first time
that claimants have the opportunity for a meeting with a
decisionmaker. Unlike DDSs, which perform a paper review of the file
to determine disability, ALJs personally interview claimants
concerning their disability claim. A 1982 SSA study reported that a
personal appearance by claimants during the hearing increased the
likelihood of an ALJ allowance.\5 In 1989, we reported that hearings
provide ALJs with the opportunity to extensively question claimants
and that, as a result, ALJs often reverse DDS decisions because they
determine that claimants are more limited in their activities than
DDSs had perceived.\6
Errors made by both DDS staff and ALJs may also contribute to
disparities. In a 1994 SSA study, a group of medical consultants and
disability examiners found a 29-percent DDS error rate for cases
appealed to OHA.\7 In the same study, a group of ALJs found a
19-percent error rate in ALJ allowances. These relatively high rates
of error suggest that obtaining consistency across the two levels may
be difficult.
Finally, some disparities may be attributable to SSA's differing
mechanisms for providing decisional guidance to DDSs and ALJs. To
determine disability, SSA has a single standard composed of various
statutes, regulations, Social Security Rulings, and court rulings
governing eligibility. DDS decisionmakers are required to use SSA's
Program Operations Manual System (POMS), which is SSA's detailed
interpretation of the standard. ALJs, on the other hand, are not
required to use POMS, which provides little decisional latitude.
Instead, they base their decisions on their own interpretation of the
statutes, regulations, Social Security Rulings, and court rulings.
To an undetermined extent, different interpretations of the same
disability standard may cause DDSs and ALJs to reach disparate
decisions on the same claim.
--------------------
\5 Secretary of HHS, Report on Implementation of Section 304(g) of
P.L. 96-265, Social Security Disability Amendments of 1980 (the
Bellmon Report) (Washington, D.C.: HHS, Jan. 1982).
\6 Social Security: Selective Face-to-Face Interviews With
Disability Claimants Could Reduce Appeals (GAO-HRD-89-22, Apr. 20,
1989).
\7 HHS, SSA, Office of Program and Integrity Reviews, Findings of the
Disability Hearings Quality Review Process (Washington, D.C.: HHS,
Sept. 1994).
PROBLEMS WITH SSA'S
MANAGEMENT AUTHORITY OVER
ALJS
-------------------------------------------------------- Chapter 2:2.4
APA protects ALJ decisional independence. Although ALJs are SSA
employees, APA prohibits SSA management from taking actions that
might interfere with an ALJ's ability to conduct full and impartial
hearings. However, SSA has not consistently defined and communicated
to regional and hearing office management the types of management
actions that are legally permissible for managing ALJs without
hindering judicial independence.
SSA's 1992 Office of Workforce Analysis report found that many ALJs
are operating under the belief that they are exempted by APA from
nearly all management control. As a result, SSA has experienced
numerous legal and operational challenges to its efforts to better
manage the appeals process. SSA management has also been reluctant
to exercise its management authority over ALJs for fear it will
violate APA. The APA issue continues to be important today, because
the success of the redesign plan may be affected by the degree of ALJ
cooperation and the extent to which SSA can mandate ALJ compliance
with the plan's initiatives.
In 1989, we reported that, since the 1970s, ALJs had successfully
opposed management initiatives to increase their productivity on the
grounds that such SSA actions interfered with their decisional
independence.\8 Many ALJs believe they need to closely protect their
judicial independence because of what they perceive as past excesses
of agency authority. For example, in 1977 several ALJs sued SSA when
it attempted to impose case production quotas on them. The ALJs
alleged that SSA's actions violated their decisional independence
under APA and the Fifth Amendment of the Constitution. SSA
ultimately settled the lawsuit, rescinded its policy of establishing
quotas for ALJ dispositions, and revised transfer and training
policies to remove any mention of production figures. In the early
1980s, SSA began targeting the decisions of ALJs with high award
rates for special review. According to SSA, these reviews were
conducted in response to congressional concerns that ALJs with high
allowance rates could be more prone to errors. As a result of these
reviews, some ALJs were to be subject to retraining and possible
disciplinary actions. The initiative prompted a lawsuit by the
Association of Administrative Law Judges, which claimed that the
practice of targeting selected ALJs violated their decisional
independence. Before the court's ruling, SSA entered into a
settlement agreement with the ALJs and rescinded its practice of
targeting individual decisionmakers.
Although APA is an important safeguard of due process, SSA's own
studies confirm that, in many instances, the act has been interpreted
in a way that has impeded SSA's ability to effectively manage
day-to-day hearing office work and to implement uniform policies and
procedures. For example, SSA's 1992 Office of Workforce Analysis
report noted that an "extreme" interpretation of APA by many ALJs had
led to a lack of clear lines of management authority within hearing
offices and impeded effective service delivery. SSA also found that
hearing offices lacked procedural consistency and effective
mechanisms to share "best practices," because many ALJs believed
judicial independence entitled them to establish their own "unique"
work flow procedures. The report also noted that inconsistent
procedures resulted in significant variations in the content and
organization of hearing office files and created obvious problems
when case files were transferred among offices to balance OHA's
workloads.
SSA also reported a wide variety of organizational configurations
among hearing offices, despite an agency effort to actively encourage
"pooling" hearing office resources to increase efficiency and
distribute work more evenly. Many ALJs opposed the pooling
initiative, preferring instead a "unit" system in which each ALJ had
his or her own personal staff. SSA reported that several ALJs had
rejected the pooling configuration despite the agency's findings that
the "unit" system unnecessarily increased case-processing time.
However, the report did not include any directives or recommendations
for mandating ALJ compliance with SSA's pooling efforts.
In an early 1990s plan to improve the disability appeals process, SSA
noted that significant ambiguities existed regarding the limits APA
imposed on SSA management practices and that APA issues underlie many
of the problems affecting the disability program's variations in
hearing office procedures, work flow, and workload management. In
April 1995, SSA once again acknowledged the constraints APA imposed
on its ability to manage and called for better clarifying APA
principles.
Our most recent field work confirmed that SSA still has not
consistently defined and communicated the types of management actions
that are legally permissible under APA. During our review, a number
of SSA and OHA managers and staff told us that despite SSA's
recognition of the problems associated with ensuring ALJ compliance
with agency initiatives, it has not resolved the issue. Staff
commonly complained that ALJs often used APA protections to oppose
initiatives they did not agree with and conceded that managers were
reluctant to mandate ALJ compliance for fear of violating the act.
They also told us that ALJ opposition to prior agency initiatives to
improve the appeals process has contributed to the growth in OHA's
backlog of cases and that reducing the backlog will be difficult
unless SSA addresses the APA issue. Officials in SSA's Office of
General Counsel also noted that while SSA is aware of the management
tools available to it, there have been inconsistencies in the way
this information has been communicated agencywide. In their opinion,
SSA needs to develop a consistent APA message and thoroughly
communicate it to both SSA and OHA field personnel.
--------------------
\8 Social Security: Many Administrative Law Judges Oppose
Productivity Initiatives (GAO-HRD-90-15, Dec. 7, 1989).
BACKLOG REDUCTION AND PROCESS
REDESIGN INITIATIVES UNDER WAY
============================================================ Chapter 3
During the past decade, OHA's backlog of pending cases continued to
grow, even though SSA hired more professional and support personnel
and increased its reliance on overtime to service the appeals
workload. In 1994, SSA initiated both short- and long-term plans in
response to the continued rapid growth in OHA's pending case backlog
and increasing criticism of SSA's ability to effectively manage the
DI and SSI caseloads.
STDP represents SSA's near-term effort to reduce OHA's backlog of
pending cases and improve case-processing times. The plan does not
directly address the long-standing problems affecting SSA's
disability appeals process but instead relies on temporary
"emergency" measures to alleviate workload pressures at OHA until
SSA's longer-term strategy is under way. Although STDP's initiatives
are now under way, implementation delays and the limited impact of
key initiatives may impede SSA's short-term efforts to achieve its
backlog reduction goals.
SSA's second initiative--its Plan for a New Disability Claim Process,
or redesign plan--when fully implemented, is intended to result in
significant long-term improvements in the quality, accuracy, speed,
and efficiency of disability claims processes. The plan is scheduled
to be implemented in phases that will be completed sometime in fiscal
year 2000. The redesign effort, which provides a framework for
radically reengineering the entire disability process, is aimed at
addressing three of the four long-standing problems we identified:
multiple levels of claims development and decision-making, fragmented
program accountability, and inconsistent decisions between DDS and
OHA adjudicators.
While SSA believes the redesign plan will eventually address many
systemic program problems, the plan was still in the early
implementation and testing stages at the time of our review. More
importantly, the redesign plan does not include an initiative to
clearly and consistently define and communicate SSA's management
authority over the ALJs. APA constraints have been a source of
considerable management difficulties for many years, and if SSA does
not act to address this issue, it may be hindered in its current
efforts to reduce OHA's pending case backlog and improve
case-processing times.
PREVIOUS SSA EFFORTS DID NOT
REDUCE BACKLOG
---------------------------------------------------------- Chapter 3:1
Over the last decade, SSA attempted to address the growth in OHA's
backlog of pending cases. Between 1985 and 1995, SSA increased field
office ALJ staffing levels by 49 percent and support staff by about
45 percent (see table 3.1). From 1990 to 1995, the agency also
increased its use of overtime more than 850 percent, from about
74,000 hours to 713,000 hours. Although the number of cases OHA
processed annually increased from 246,000 in 1985 to about 527,000 in
1995, the growth in OHA's workload during that time outpaced its
case-processing capacity.
Table 3.1
OHA Field Office Staffing Levels, 1985-
95
Suppor
t
staff\
Fiscal year ALJs\a a
------------------------------------------------------ ------ ------
1995 1,053 5,044
1994 1,002 4,743
1993 830 4,316
1992 819 4,143
1991 859 4,308
1990 786 3,809
1989 703 3,571
1988 715 3,636
1987 651 3,498
1986 699 3,444
1985 707 3,478
----------------------------------------------------------------------
\a Represents the average number on duty during the fiscal year.
In addition to devoting more staff resources and overtime to the
backlog crisis, SSA initiated at least three major studies between
1990 and 1992 to identify issues affecting the performance of its
disability programs.\9 These reviews resulted in recommendations for
improving program efficiency through such actions as standardizing
some hearing office procedures, sharing agency "best practices" among
offices, and improving access to training and automation for OHA
personnel. During our field work, a number of SSA and OHA officials
told us that prior agency initiatives were limited in their
effectiveness because SSA focused primarily on minor process changes
and applying additional resources to the disability program rather
than addressing long-standing, systemic problems central to the
backlog of cases awaiting processing. Several officials also noted
that previous initiatives for improving the appeals process were
limited in their effectiveness because SSA was reluctant to mandate
ALJ compliance with them.
--------------------
\9 HHS, SSA, Office of Workforce Analysis, Process Review Report:
The Office of Hearings and Appeals (Washington, D.C.: HHS, June
1992); HHS, SSA, Management and Administrative Systems Review Team,
Implementation of the Commissioner's Decisions on Enhancing OHA
Management and Administrative Systems (Washington, D.C.: HHS, Oct.
22, 1992); and HHS, SSA, Workgroup on OHA Workload Issues,
Recommended Actions to Address Hearings Workload (Washington, D.C.:
HHS, Dec. 22, 1992).
BACKLOG REDUCTION EFFORTS FOCUS
ON STDP
---------------------------------------------------------- Chapter 3:2
SSA issued its STDP in 1994 in order to make some immediate progress
toward reducing OHA's backlog of pending cases. STDP includes 19
initiatives to expedite the disability determination process and
reduce OHA's pending case workload from its October 1994 level of
488,000 to 375,000 cases by December 1996. The plan's goals are
based primarily on two key initiatives that expand OHA prehearing
conferencing proceedings and SSA regional screening unit activities.
These initiatives target certain appealed cases for review and
possible allowance by OHA attorneys or SSA regional staff before the
ALJ hearing stage is reached.
RESOURCE REALLOCATIONS ARE A
COMPONENT OF STDP
-------------------------------------------------------- Chapter 3:2.1
STDP relies heavily on the temporary reallocation of program
resources to help OHA prepare cases and draft disability decisions.
Under the plan, 150 OHA and SSA staff have been detailed to help
prepare cases for hearings. Case preparation includes assembling and
reorganizing claimant files, date stamping exhibits, and preparing
evidence lists. Reallocating resources is intended to ensure that
case files are organized in a way that facilitates the processing of
disability cases. An additional 150 nonhearing office personnel have
also been detailed to help draft hearing decisions.
To further improve decision-writing capacity, 800 additional
computers have been provided for use by OHA personnel. This influx
of computers is intended to reduce OHA's current dependence on manual
processes and support personnel during the preparation of hearing
decisions and to limit the movement of documents back and forth
between staff for proofreading and editing.
PREHEARING CONFERENCING
INITIATIVE HAS EXPERIENCED
DELAYS
-------------------------------------------------------- Chapter 3:2.2
The initiative expected to have the greatest impact on reducing OHA's
backlog of cases involves the expansion of OHA prehearing
conferencing. However, implementation delays associated with
prehearing conferencing have affected SSA's ability to achieve STDP's
goals.
Before STDP, prehearing conferencing involved the review of certain
appealed cases by OHA staff attorneys and paralegal specialists in
the various OHA regions. These individuals conferred with claimant
representatives after reviewing cases, conducted limited case
development, and drafted decisions to be reviewed and approved by
ALJs. With expanded prehearing conferencing under STDP, OHA
attorneys have been given quasi-judicial powers, such as the
authority to issue allowance decisions for certain appealed cases
without ALJ involvement or approval. Under the initiative, OHA
attorneys now engage in extensive development of the case record,
conduct conferences with claimant representatives and sources of
medical and vocational evidence, and are empowered to issue allowance
decisions. If they cannot allow the claim on the basis of their
review of the evidence, it is scheduled for hearing before an ALJ.
OHA guidelines for prehearing conferencing give 595 senior attorneys
the authority to issue allowance decisions. To fully implement the
initiative, SSA had to pursue a regulatory change giving OHA staff
attorneys the authority to decide certain appealed cases that were
formerly limited to ALJ jurisdiction. But the process of defining
the specific duties and responsibilities these attorneys would have
under STDP was lengthy, and implementation did not begin until July
1995, or almost 6 months after the projected start date. Delays also
occurred with other initiatives designed to support prehearing
conferencing. For example, backlog reduction goals for prehearing
conferencing are partly dependent upon STDP initiatives to provide
more computers and staff to assist OHA with case preparation and
decision-writing. But due to protracted collective bargaining
negotiations with SSA's union and other difficulties, full
implementation of these initiatives was delayed for several months.
Through expanded prehearing conferencing, SSA had originally expected
to process 98,000 additional cases by December 1995 and 126,000 more
by December 1996. However, 1995 goals were not achieved, and senior
staff attorneys issued only 22,271 additional allowance decisions
nationwide through February 1996.
SCREENING UNITS ARE NOT
SUFFICIENTLY REDUCING THE
NUMBER OF CASES REQUIRING AN
ALJ HEARING
-------------------------------------------------------- Chapter 3:2.3
A second major initiative under STDP is intended to further reduce
the flow of cases from DDSs to OHA hearing offices by increasing the
effectiveness of SSA regional screening units. However, these units
have not performed as expected.
Before STDP, SSA established screening units in each region to review
DDS reconsideration denials. Before an ALJ hearing occurred,
screening unit examiners reviewed these cases to determine if an
allowance could be made on the basis of evidence in the case file.
Although screening unit allowances required ALJ approval, they
expedited the decision-making process and prevented many cases from
going into OHA's hearings backlog.
Under STDP, OHA staff attorneys have been assigned to all SSA
regional screening units to dispose of more appealed claims before
they reach an ALJ hearing. The decision to add OHA attorneys was
based upon the experiences of SSA's Boston and New York regional
offices, which had tested the use of OHA attorneys in screening units
and were obtaining higher allowance rates. According to SSA, the
opportunity for screening unit examiners to discuss issues with an
attorney gives examiners helpful insight into the intent of the POMS
requirements and enables them to reverse incorrect DDS
reconsideration denials earlier in the process.
Most cases reviewed by the screening units are selected on the basis
of computer-generated profiles that identify disability claims likely
to be incorrectly denied by DDSs. SSA officials contend that
"profiling" minimizes the risk of making incorrect allowances.
However, to increase screening unit outputs, the case selection
criteria were expanded in January 1995 to include all hearing
requests accompanied by any additional evidence, even if the case did
not meet the profile. Consequently, screening units are now
reviewing some cases that are not necessarily error prone.
Screening units, like prehearing conferencing, are not achieving
STDP's allowance goals. Before STDP, existing screening units were
expected to allow about 20,000 cases per year. With the introduction
of OHA senior attorneys, SSA expected to allow 38,000 cases annually,
or about 3,167 cases per month. However, screening units had allowed
a total of only 28,376 cases through February 1996. Only two of
SSA's screening units--Boston and New York--are allowing cases at a
level that may facilitate reaching STDP's 1996 goals. SSA officials
overseeing the initiative told us that regional differences in
allowances were primarily due to the reluctance of some hearing
offices to provide sufficient staff and senior attorney support to
the regional screening units.
STDP MAY HAVE UNINTENDED
EFFECTS
-------------------------------------------------------- Chapter 3:2.4
Despite slippage in the implementation of STDP's major initiatives,
SSA management has not revised its original backlog reduction goals
or the timeframes for accomplishing them. As a result, a number of
SSA and OHA personnel involved in the design and implementation of
STDP are concerned that the plan may have unintended negative
impacts.
When STDP was announced in November 1994, it called for reducing
OHA's backlog from 488,000 to 375,000 (113,000 cases) by December
1996. However, by the end of September 1995, OHA's backlog had
increased to 548,000 cases. To achieve the plan's original goal of
reducing pending cases to 375,000, SSA would have to increase its
backlog reduction target from the original 113,000 cases to about
173,000 during the remaining timeframe. Many SSA and OHA officials
have expressed concern that the growth in OHA's pending case backlog
over the last several months, combined with STDP's aggressive goals,
may create pressure to inappropriately allow cases. As a means of
determining STDP's impact on OHA decision-making, SSA management is
closely monitoring and tracking OHA allowance rates.
Finally, the prehearing conferencing initiative under STDP has
diverted almost 600 attorneys from their regular decision-writing
duties. SSA intends to offset this loss in decision-writing
resources with 150 temporary detailees from various components and
increased overtime for support and professional staff. However, many
SSA and OHA officials are concerned that the number of detailees is
insufficient to offset the loss of experienced decision-writers.
SSA'S REDESIGN PLAN IS AIMED AT
ADDRESSING SEVERAL
LONG-STANDING PROBLEMS
---------------------------------------------------------- Chapter 3:3
Unlike STDP, the redesign plan includes initiatives that SSA believes
will address some of the program's long-standing problems: multiple
levels of claims development and decision-making, fragmented program
accountability, and decisional disparities between DDS and OHA
adjudicators. In announcing the plan in September 1994, SSA
acknowledged that a longer-term strategy was needed to address the
systemic problems placing the DI and SSI programs under increasing
stress. The agency also noted that, to substantially improve the
level of service to claimants, incremental improvements to the
process were no longer feasible. At the time of our review, SSA was
in the early implementation planning and testing stages of the
redesign effort, and none of the initiatives had been fully
implemented.
To address the problem of multiple levels of claims development and
decision-making, the redesign plan includes initiatives to eliminate
both DDS reconsideration and Appeals Council reviews. In place of
the reconsideration review, SSA plans to establish an Adjudication
Officer (AO) position as the focal point for prehearing activities.
The AO's duties will include (1) identifying the specific issues in
dispute, (2) determining if additional evidence development is needed
to support a claim, (3) reaching agreement with claimants or their
representatives on the issues not in dispute, and (4) deciding
appealed claims on the basis of the evidence developed. By focusing
prehearing responsibilities on a single adjudicator, SSA expects that
the time needed to ensure the completeness of the record will be
substantially reduced and that more appealed cases will be resolved
without ALJ involvement.
The redesign plan also includes initiatives that SSA believes will
address the problem of fragmented program accountability. To improve
overall accountability for claims processing, SSA plans to revise its
management information processes to better assess the agency's
service to claimants. Information regarding staff actions at each
step of the process is to be made available to all components, and a
single measure of time from the claimant's first point of contact
with SSA until final notification of a decision will be developed.
SSA has proposed developing or revisiting other measures related to
cost, productivity, pending workload, and accuracy to better assess
the performance of each participant, and the agency as a whole. The
plan also calls for installing a common database for claims control
and management purposes, rather than relying on the currently
fragmented automated systems.
To address organizational fragmentation issues, SSA plans to
emphasize accountability and teamwork throughout the disability claim
process. At the initial DDS level, a Disability Claims Manager
position will be established as the focal point for moving the claim
through the earliest stages. For OHA's prehearing activities, the AO
position will be the responsible agent. At the hearing level, the
ALJ will be the responsible official. SSA plans to hold these
individuals accountable for their part of the disability
determination and appeals process and require them to work with other
components to ensure timely case processing.
The disability redesign plan also includes several initiatives to
reduce decisional disparities between DDS and OHA decisionmakers by
(1) providing an opportunity for the initial decisionmaker to meet
claimants face-to-face, (2) improving SSA's quality assurance
processes, and (3) unifying policy guidance at both the DDS and ALJ
levels. Under the redesigned process, claimants will be provided the
opportunity to meet with a DDS decisionmaker before the claim is
initially decided. This meeting is intended to ensure that all
available evidence has been presented and that claimants understand
what evidence will be considered in reaching the decision. SSA also
plans to improve its quality assurance processes by extending such
reviews to all levels of the adjudicatory process and using the
results to identify areas for improving agency policies and training.
To further ensure consistent standards for decision-making, the
redesign plan includes an initiative to develop a single presentation
of all substantive policies used in the determination of disability.
Both DDS and ALJ adjudicators will be required to follow these same
policies. SSA plans to provide policy clarifications and nationwide
training to both DDS and ALJ decisionmakers to facilitate the use of
the new policies. However, SSA has not proposed any changes to the
de novo hearings process and the ability of claimants to submit new
medical evidence upon appeal. According to SSA, revising these
processes would require a legislative change, which was not within
the scope of the plan at its initial stage.
REDESIGN DOES NOT ADDRESS SSA'S
MANAGEMENT AUTHORITY OVER ALJS
---------------------------------------------------------- Chapter 3:4
SSA's disability redesign plan includes initiatives that SSA believes
will address several of the long-standing problems affecting program
performance, but the plan does not specifically address how SSA will
consistently define and communicate its management authority over the
ALJs.
Although APA is an important safeguard of due process, SSA has not
consistently defined and communicated to its field staff the actions
that can be legally employed by managers to increase program
efficiency without hindering judicial independence. For years, SSA
has acknowledged the management difficulties associated with the APA
issue, and the need to develop specific guidelines of allowed and
prohibited practices that are fully understood by everyone involved.
More recently, the Director of SSA's redesign effort again
acknowledged that APA procedures and mandates should be better
clarified and refined to fit SSA's mass adjudication approach to its
disability programs.
CONCLUSIONS, AGENCY COMMENTS, AND
OUR EVALUATION
============================================================ Chapter 4
SSA's disability programs have been the subject of numerous internal
and external studies over the last 2 decades. Despite these studies
and continuing agency efforts to improve the disability determination
and appeals process, OHA's case backlog has reached crisis levels.
In an environment of unprecedented disability program growth, SSA has
both a short- and a long-term approach to better service its DI and
SSI workloads. In the near term, STDP is designed to expedite the
disability appeals process and reduce OHA's pending case backlog to a
manageable level. In developing its long-term Plan for a New
Disability Claim Process, SSA has also acknowledged the need for the
agency to move ahead with more dramatic program changes.
Considering the current backlog crisis at OHA, STDP's approach for
temporarily reducing OHA backlogs is reasonable in that it
establishes specific goals and timeframes for reducing OHA backlogs.
It also represents an SSA-wide commitment involving the reallocation
of resources from both within and outside OHA, and coordination and
cooperation among all organizational components involved in the
adjudication process. Disposing of cases earlier in the decisional
process may also be less costly and time consuming than allowing them
to reach the ALJ hearing stage.
Although backlog reduction efforts are receiving greater agencywide
emphasis under STDP, implementation delays associated with prehearing
conferencing and the limited impact of regional screening have
adversely affected SSA's ability to achieve the plan's backlog
reduction goals. Many OHA and SSA staff are also concerned that the
continued growth in OHA's pending case backlog and SSA's reluctance
to adjust the plan's goals may affect the quality of decisions and
lead to increased pressure to inappropriately award cases.
To ensure decisional accuracy, SSA intends to monitor the quality of
STDP decisions and the overall allowance rate for its disability
programs. The agency's reliance on computer-generated profiles to
select certain error-prone cases for review under STDP is also
intended to reduce the risk of inappropriate decisions. However, the
screening unit case selection criteria have been expanded to include
some nonprofiled cases, and prehearing conferencing regulations do
not preclude OHA senior attorneys from reviewing nonprofiled cases in
the future.
Although the redesign plan includes initiatives that SSA believes
will address several long-standing program problems, it does not
specifically address the need to consistently define and communicate
the types of management actions SSA can legally employ to better
manage ALJ activities. For years, SSA has recognized that ALJ
management issues underlie many of the problems affecting its
disability programs, and that it should better define and thoroughly
communicate a consistent APA message to field staff. We believe that
addressing the APA issue will be a challenge for SSA. However, it is
a challenge that must be overcome if SSA is to resolve the current
disability backlog crisis and achieve its long-term service delivery
goals.
SSA'S COMMENTS AND OUR
EVALUATION
---------------------------------------------------------- Chapter 4:1
In providing comments on this report, SSA identified a number of
actions that it has taken since 1992 to streamline and expedite the
processing of hearing workloads. These actions include developing a
plan to standardize disability claim file preparation, creating a
Practices and Procedures Exchange Workgroup within OHA, suspending
the preparation of medical summaries, standardizing decision-writing
instructions, and encouraging ALJs to write some of their own
decisions. However, the agency did not provide data regarding the
impact of these initiatives on reducing OHA's backlog of pending
cases. Our data show that, despite SSA's efforts, OHA's backlog has
continued to grow since 1992.
In regard to STDP, SSA acknowledged that, because of increases in
hearing receipt projections and the pace of STDP implementation, the
plan's backlog reduction goals would not be met by December 1996.
However, SSA officials stated that a shortfall in screening unit
allowances would have only a limited impact on meeting STDP's overall
goals. We disagree with SSA's assessment, since SSA originally
intended that the screening units would be second only to prehearing
conferencing in terms of impact and would result in 38,000 additional
allowances through December 1996. Not meeting screening unit
allowance targets will, in our opinion, hinder OHA's backlog
reduction efforts. SSA did not provide us with revised backlog
reduction goals for STDP or any documentation indicating that they
would be changed in the near future.
Regarding our concerns that pressure to meet STDP's goals may have
unintended effects, SSA has advised its adjudicators that STDP should
not be interpreted to inappropriately allow cases. SSA also noted
that through the deployment of resources not previously devoted to
hearing office workloads, the decision-writing pending workload has
been reduced from over 43,000 to about 28,000 cases.
Finally, SSA agreed that clarifying the scope of its authority over
ALJs under APA would be appropriate and stated it is developing such
a document. However, the agency questioned the statement in our
report that many ALJs believe they are exempt from nearly all
management control. This was not our conclusion, but one that was
reported by SSA's Office of Workforce Analysis following its 1992
review of OHA operations. SSA also disagreed with our statement that
ALJs have successfully opposed agency productivity initiatives.
However, ALJ opposition to agency initiatives to improve productivity
has been documented in prior SSA and GAO reviews and through field
work conducted during this assignment. The full text of SSA's
comments and our response are included in appendix III.
SSA ORGANIZATIONAL CHART
=========================================================== Appendix I
(See figure in printed
edition.)
OHA ORGANIZATIONAL CHART
========================================================== Appendix II
(See figure in printed
edition.)
(See figure in printed edition.)APPENDIX III
COMMENTS FROM THE SOCIAL SECURITY
ADMINISTRATION AND OUR EVALUATION
========================================================== Appendix II
those in the report text appear at the end of this appendix.
(See figure in printed edition.)
(See figure in printed edition.)
(See figure in printed edition.)
(See figure in printed edition.)
(See figure in printed edition.)
The following are GAO's comments on the Social Security
Administration's letter dated May 14, 1996.
GAO COMMENTS
-------------------------------------------------------- Appendix II:1
1. Our analysis notes that the growth in OHA's backlog of pending
cases has been due to the "rapid surge" in disability program
applications, ever-increasing appeals to OHA, and SSA's not
addressing several long-standing problems associated with its
disability programs.
2. This report does not challenge SSA's staffing and overtime
allocations. However, it does confirm that SSA has relied heavily on
increasing OHA staffing levels and the use of overtime to address the
backlog problem. Although SSA identified a number of additional
actions taken over the last several years to expedite the hearings
process, it did not provide data regarding their impact on reducing
OHA's backlog. Our data show that, despite SSA's efforts, the
backlog has continued to grow.
3. We disagree with SSA's statement that a shortfall in screening
unit allowances will have only a limited impact on meeting STDP's
goals. It was originally intended that the screening units would be
second only to prehearing conferencing in terms of impact and result
in 38,000 additional allowances by the end of December 1996.
Therefore, not meeting screening unit allowance targets will hinder
SSA's backlog reduction efforts.
4. SSA disagreed with the statement in our report that many ALJs
believe they are exempt from nearly all management control. While
SSA viewed this as "conjectural," it should be noted that this was
not our conclusion, but one that was reported by SSA's Office of
Workforce Analysis in 1992. SSA also disagreed with our statement
that ALJs have opposed agency efforts to improve productivity.
However, ALJ opposition to agency productivity initiatives has been
documented in prior SSA and GAO reviews and through field work
conducted during this assignment.
5. Upon review of the source documents, our reference to an
"official" agency policy of pooling hearing office staff was revised.
However, our data still support the statement that ALJs opposed SSA's
efforts to actively encourage the "pooling" of hearing office
resources to increase efficiency and distribute work more evenly.
6. Upon review of the source documents and SSA's comments, the
report was revised to better reflect the range of factors affecting
overall case processing time at OHA.
7. We are aware of the judgmental aspects of disability
decision-making and the "zone of choice" under which decisions can be
rendered. However, SSA's own reviews have reported a relatively high
error rate for both DDS and OHA decisions. Errors at any level may
contribute further to decisional inconsistencies between the two
levels.
8. Where source documents were provided by SSA, changes were made to
the report to more accurately reflect the growth in the DI and SSI
programs from 1985 to 1995, and the total number of OHA case
dispositions for fiscal year 1995. We also incorporated SSA's
statement that a previous agency effort to review the decisions of
ALJs with high allowance rates was initiated in response to Senator
Bellmon's concern that these decisions could be more prone to errors.
STUDIES ON SSA'S DISABILITY
DECISION-MAKING PROCESS
========================================================== Appendix IV
This appendix is divided into two parts: the first contains studies
done by the Department of Health and Human Services (HHS), of which
SSA was a part until 1995; the second contains studies done by
others.
STUDIES DONE BY HHS
-------------------------------------------------------- Appendix IV:1
Dr. Shirley Chater, Commissioner of Social Security. "Reinventing"
the Social Security Administration, testimony before the Subcommittee
on Social Security, Committee on Ways and Means. Washington, D.C.:
HHS, Oct. 28, 1993.
HHS, Office of the Inspector General. Management Oversight Review
Report on Office of Hearings and Appeals, Social Security
Administration. Washington, D.C.: HHS, May 1981.
HHS, SSA. Defining World Class Service at the Social Security
Administration, discussion paper. Washington, D.C.: HHS, Feb. 14,
1994.
_____. Disability Process Redesign: Next Steps in Implementation.
Washington, D.C.: HHS, Nov. 1994.
_____. Improving Service Delivery at the Social Security
Administration. Washington, D.C.: HHS, Oct. 21, 1993.
_____. Plan for a New Disability Claim Process. Washington, D.C.:
HHS, Sept. 1994.
HHS, SSA. Report on a Study of Social Security Beneficiary Hearings,
Appeals, and Judicial Review. Washington, D.C.: HHS, May 15, 1975.
_____. SSA Strategic Priority: Improve the Appeals Process, report
of the Strategic Priority Workgroup. Washington, D.C.: HHS, Jan.
1992.
_____. SSA Strategic Priority Transition Guidance. Washington,
D.C.: HHS, June 1992.
_____. The Social Security Strategic Plan: A Framework for the
Future. Washington, D.C.: HHS, Sept. 1991.
HHS, SSA, Disability Advisory Council, John E. Affeldt, M.D.,
Chairman. Report of the Disability Advisory Council. Washington,
D.C.: HHS, Mar. 1988.
HHS, SSA, Office of the Commissioner, Office of Strategic Planning.
Implementation of the Social Security Administration's Strategic
Plan: A Status Report. Washington, D.C.: HHS, June 1993.
HHS, SSA, Office of the Deputy Commissioner for Finance, Assessment,
and Management, Management and Administrative Systems Review Team.
Implementation of the Commissioner's Decisions of Enhancing OHA
Management and Administrative Systems. Washington, D.C.: HHS, Oct.
23, 1992.
HHS, SSA, Office of Program and Integrity Reviews. Findings of the
Disability Hearings Quality Review Process. Washington, D.C.: HHS,
Sept. 1994.
HHS, SSA, Office of Workforce Analysis. Process Review Report: The
Office of Hearings and Appeals. Washington, D.C.: HHS, June 1992.
HHS, SSA, Workgroup on OHA Workload Issues. Recommended Actions to
Address Hearings Workload. Washington, D.C.: HHS, Dec. 22, 1992.
Secretary of Health and Human Services. Report on Implementation of
Section 304 (g) of P.L. 96-265, Social Security Disability
Amendments of 1980 (the Bellmon Report). Washington, D.C.: HHS,
Jan. 1982.
STUDIES DONE BY OTHERS
-------------------------------------------------------- Appendix IV:2
Administrative Conference of the United States. Disability Benefit
Claim Processing and Appeals in Germany, the Netherlands, Sweden, the
United Kingdom, Canada, and the United States. Washington, D.C.:
U.S. Government Printing Office, Dec. 1993.
_____. Procedures for Determining Social Security Disability Claims
(recommendation 78-2). Washington, D.C.: U.S. Government Printing
Office, 1978.
_____. Report and Recommendation on the Social Security
Administration's Administrative Appeals Process. Washington, D.C.:
U.S. Government Printing Office, July 1989.
_____. Social Security Disability Program Appeal Process:
Supplementary Recommendation (recommendation 90-4). Washington,
D.C.: U.S. Government Printing Office, June 8, 1990.
_____. The Fourth Bite of the Apple: A Study of the Operation and
Utility of the Social Security Administration's Appeals Council.
Washington, D.C.: U.S. Government Printing Office, Jan. 28, 1988.
_____. The Social Security Disability Program: A System in Crisis.
Washington, D.C.: U.S. Government Printing Office, Oct. 27, 1971.
_____. The Use of Medical Personnel in Social Security Disability
Determinations (recommendation 89-10). Washington, D.C.: U.S.
Government Printing Office, 1989.
Arner, Frederick B. A Model Disability Structure for the Social
Security Administration. Washington, D.C.: Alfred P. Sloan
Foundation, Sept. 1989.
Association of Administrative Law Judges in the Department of Health,
Education, and Welfare. Crisis in the Disability Insurance Program:
The Attack on the Judges. Washington, D.C.: Department of Health,
Education, and Welfare, May 5, 1975.
Center for Administrative Justice, Milton M. Carrow, Director, and
Jerry L. Mashaw, Project Director. Final Report of the Social
Security Administration Hearing System. Washington, D.C.: Center
for Administrative Justice, Oct. 1977.
Cofer, Donna Price. Judges, Bureaucrats, and the Question of
Independence: A Study of the Social Security Administration Hearing
Process. Westport, Conn.: Greenwood Press, 1985.
Committee on Ways and Means, House of Representatives. Committee
Staff Report on the Disability Insurance Program. Washington, D.C.:
House of Representatives, July 1974.
Federal Courts Study Committee, Judge Joseph F. Weis, Jr., Chairman.
Report of the Federal Courts Study Committee. Washington, D.C.:
U.S. Government Printing Office, Apr. 2, 1990.
U.S. General Accounting Office. Administrative Law Process: Better
Management is Needed. GAO/FPCD-78-25, May 15, 1978.
_____. Management Improvements in the Administrative Law Process:
Much Remains to Be Done. GAO/FPCD-79-44, May 23, 1979.
_____. Social Security Administration Policies for Managing Its
Administrative Law Judges. GAO/HRD-81-91, June 2, 1981.
_____. Social Security Disability: Action Needed to Improve Use of
Medical Experts at Hearings. GAO/HRD-91-68, May 20, 1991.
_____. Social Security Disability: Management Action and Program
Redesign Needed to Address Long-Standing Problems, testimony of Jane
L. Ross, Director, Income Security Issues, before the Subcommittee
on Social Security, Committee on Ways and Means, House of
Representatives. GAO/T-HEHS-95-233, Aug. 3, 1995.
_____. Social Security: Many Administrative Law Judges Oppose
Productivity Initiatives. GAO/HRD-90-15, Dec. 7, 1989.
_____. Social Security: Production Initiatives in OHA's Region V
Comply With Law and Guidelines. GAO/HRD-91-36BR, Dec. 21, 1990.
_____. Social Security: Racial Differences in Disability Decisions
Warrant Further Investigation. GAO/HRD-92-56, Apr. 21, 1992.
_____. Social Security: Reforms in the Disability Determination and
Appeals Process. GAO/T-HRD-91-2, May 24, 1991.
_____. Social Security: Results of Required Reviews of
Administrative Law Judge Decisions. GAO/HRD-89-48BR, June 13, 1989.
_____. Social Security: Selective Face-to-Face Interviews With
Disability Claimants Could Reduce Appeals. GAO/HRD-89-22, Apr. 20,
1989.
Gwirtzman, M., Dillman, J., Dislom, E., and others. Social Security
in America's Future: Final Report of the National Commission on
Social Security. Washington, D.C.: National Commission on Social
Security, Mar. 1981.
Mashaw, Jerry L. Administrative Justice: A Management Model. New
York: The Ford Foundation, June 27, 1979.
_____. Bureaucratic Justice: Managing Social Security Disability
Claims. New Haven, Conn.: Yale University Press, May 18, 1983.
Rosenblum, Victor G. "The Administrative Law Judge in the
Administrative Process: Interrelations of Case Law with Statutory
and Pragmatic Factors in Determining ALJ Roles," reprinted in Recent
Studies Relevant to the Disability Hearings and Appeals Crisis,
unnumbered Committee print, 94th Congress, first session.
Washington, D.C.: U.S. Congress, Dec. 20, 1975.
Special Committee on Aging, U.S. Senate. Disabled Yet Denied:
Bureaucratic Injustice in the Disability Determination System, staff
report, 101st Congress, second session. Washington, D.C.: U.S.
Senate, Dec. 1990.
Stone, Deborah, A. The Disabled State. Philadelphia: Temple
University Press, 1984.
Subcommittee on Oversight of Government Management, Committee on
Governmental Affairs, U.S. Senate. Social Security Disability
Reviews: The Role of Administrative Law Judge, 98th Congress, first
session. Washington, D.C.: U.S. Senate, June 8, 1983.
Subcommittee on Social Security, Committee on Ways and Means, House
of Representatives. Delays in Social Security Appeals, 94th
Congress, first session. Washington, D.C.: House of
Representatives, Sept. 19, 26; Oct. 3, 20, 1975.
_____. Social Security Administrative Law Judges: Survey and Issue
Paper, 96th Congress, first session. Washington, D.C.: House of
Representatives, Jan. 27, 1979.
_____. Social Security Hearing and Appeal: Pending Problems and
Proposed Solutions, 97th Congress, first session. Washington, D.C.:
House of Representatives, Oct. 27, 1981.
The President's Private Sector Survey on Cost Control (the Grace
Commission). Task Force Report on the Department of Health and Human
Services, Social Security Administration. Washington, D.C.: The
Grace Commission, June 13, 1983.
GAO CONTACTS AND ACKNOWLEDGMENTS
=========================================================== Appendix V
GAO CONTACTS
Roland Miller III, Assistant Director, (202) 512-7246
Daniel Bertoni, Evaluator-in-Charge, (202) 512-5988
ACKNOWLEDGMENTS
In addition to those named above, the following individuals made
important contributions to this report: Diana Eisenstat, Associate
Director, Income Security Issues; Robert Rosensteel, Senior
Evaluator; William Hutchinson, Senior Evaluator; and Carlos Evora,
Evaluator.
*** End of document. ***