Allen W. Heinemann, PhD, ABPP

Professor, Physical Medicine and Rehabilitation

Feinberg School of Medicine, Northwestern University

Director, Center for Rehabilitation Outcomes Research

Rehabilitation Institute of Chicago

Disability Determination Process:
The Need for Fundamental Change

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The Need for Fundamental Change

• Social Security Advisory Board: January 2001

• Major concerns described in report

1. Growth in disability claims threaten to overwhelm the system

2. Inadequate tools exist to make disability determination decisions.

3. Public perceptions of inequity

4. Unexplained variations in decision making exposes the disability programs to accusations that decisions are not made uniformly and consistently

• Four years later, that need still exists

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5-Step Sequential Disability Determination Process

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Appeals Process…

Initial DDS Determination

Source: Social Security Advisory Board, January 2001.

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Appeals Burden

• Average appeal: 525 days due to backlogged cases

• 628 days to move through the process

• Total appeals time: 1,153 days – roughly 3 years and 2 months

• Additional time required to navigate through the initial decision

Source: Honorable Jo Anne B. Barnhart, Commissioner of Social Security. Testimony before the House Ways and Means Committee, 9/25/03

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Costs of Appeals

• Many claimants give up and drop out of the system

• For those who don't give up, most ultimately receive benefits

• 59% of all appeals are reversed by OHA

• Additional claims are paid as claims continue their way through the remaining stages of the appeals process

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OHA Appeals Outcome

• Large numbers of decisions reversed by ALJs illustrate the complexity in the decision process and opportunities for disagreement

• Worsening medical conditions and the opportunity to meet claimants in person may account for some of these reversals

• However, minor variations do not explain why the same information being viewed by two different systems often results in radically different conclusions

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Disability Research Institute Project

• Rehabilitation Institute of Chicago / Northwestern University researchers are evaluating the functional and occupational factors that affect claim decisions

• Goal: Inform SSA regarding factors that affect different decisions reached by DDS and OHA, particularly at Steps 4 and 5

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Project Design and Sample

• Cross-sectional national sample of disability applications from 2002

• Claims under listings for

• Affective disorders (12.04)

• Anxiety-related disorders (12.06)

• Personality disorders (12.08)

• Stratified by state, age, and benefits decision

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SSA Forms for Data Extraction

• 831 Disability Determination & Transmittal

• 3367 Disability Report, Field Office

• 3368 Disability Report

• 3369 Vocational Report

• 101 Determination of Award

• 561 Request for Reconsideration

• 3341 Reconsideration Disability Report

• 501 Request for Hearing by ALJ

• 1696 Appointment of Representative

• 4734 Physical Residual Functional Capacity Assessment

• 4734-F4-SUP Mental Residual Functional Capacity Assessment

• 2506 Psychiatric Review Technique Form

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Unprecedented Opportunity

• Use of primary "folder data" is the first of its kind

• Previously, no other researchers have had direct access to information necessary to conduct an evaluation of the disability determination process

• All researchers must undergo background/security screenings

• All IRS information (i.e., wages and other earnings) must be removed before data can be accessed.

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Data Analysis

Classification and Regression Tree Analysis (CART)

• Use existing data to predict state DDS disability award decisions and ALJ decisions

• Identify what factors influence a claimants decisions to appeal

• Determine if the mental RFC instrument yields a reliable and valid measure, or if subsets of items form better measures

• Identify what characteristics distinguish awards at step 3 from awards at steps 4 and 5

• Determine how well the Adult Needs and Strengths Assessment (ANSA) instrument predicts disability decisions

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Implications & Next Steps

• Based on findings, a larger sample may be needed to explain variability by region and other issues that may be revealed.

• It has been suggested that some claimants might be less willing return to work because it took so long to receive benefits.

• We hope this study will help create a more fair, equitable, and streamlined system that also promotes return to work.