GAO: Social Security disability decisions lack consistency

The Social Security Administration has not adequately addressed discrepancies in its disability benefits decisions despite a "process unification" initiative it began in 1994, according to a new Government Accountability Office report.

According to GAO, formerly the General Accounting Office, this inconsistency contributed to the watchdog agency's decision to list SSA's disability programs as a high-risk government program.

The report (GAO-04-646) cited a high number of claims denied by state Disability Determination Services, which make initial rulings on all disability claims, but allowed when the cases are appealed to SSA's administrative law judges. If an initial claim is denied by DDS, the claimant may request a review by a different team at the state agency. If denied again, he or she may appeal to an administrative law judge.

In 2003, ALJs approved 61 percent of the claims they reviewed. A high allowance rate at the hearings level may encourage claimants to file appeals, which are far more expensive to process than initial claims, the report said. Though disability benefits account for just 15 percent of SSA's program expenses, they represent 45 percent of administrative costs. In addition, the high number of appeals overburdens the system; it takes about a year to get a disability decision from an ALJ. About 2.5 million people file disability claims with SSA each year.

The agency began investigating the discrepancies between DDS and ALJ rulings in 1980, when Congress requested a study to investigate how well hearings decisions met legal requirements. The study found that ALJs allowed 64 percent of disability cases, while SSA's quality assurance reviewers said only 13 percent should have been allowed.

In 1994, SSA developed its process unification initiative, which included issuing consistent guidelines, providing training, conducting reviews of hearings decisions, and studying factors that contribute to inconsistencies. GAO found that while the agency had made some initial improvements, especially in training and guidance, the agency had largely abandoned its efforts, and after an initial improvement, ALJ allowance rates had climbed since 1999.

In September 2003, SSA Commissioner Jo Anne Barnhart unveiled an overhaul of the disability claims process that includes changes to improve consistency, such as requiring more complete documentation of decisions at the DDS level, and centralizing quality control and medical expertise. Some stakeholders question the availability of resources for these changes, GAO reported.

The new plan will not be put into place until SSA has rolled out its new paperless file system, the accelerated electronic disability system (AeDib), which should also contribute to improved consistency, according to the watchdog agency. GAO warned in an earlier report (GAO-04-466) that inadequate testing of the AeDib system could pose significant risks.