Social Security Disability Determinations: Recommendations for Reform

Abstract

This report for the Federal Courts Study Committee, which is reprinted as part of a symposium gathering a number of these reports, focuses on the contribution of Social Security disability claims to dramatic increases in the caseloads of the federal courts. After providing general background concerning the statutory and regulatory standards and procedural apparatus for determining whether a claimant is “disabled” so as to qualify for benefits, the report examines the Social Security caseload crisis.

The report gathers caseload statistics at the agency and federal court levels, documenting a dramatic rise in the number of cases at all levels that cannot be linked to any corresponding rise in the number of benefit claims being filed. Instead, the caseload crises appears to be the product of a number of controversial policies and practices adopted by the Social Security Administration (SSA) that led to a dramatic rise in the denial of claims and termination of benefits for claimants already receiving them. These policies included the use of “continuing disability reviews” to terminate benefits even when the claimant’s condition had not changed, the imposition of substantive or evidentiary requirements that made it more difficult to establish disability, administrative oversight efforts widely perceived as pressuring decisionmakers to deny benefits, and an SSA policy of nonacquiescence in adverse judicial decisions. The SSA’s treatment of mental impairments, complaints of pain, and the opinions of treating physicians were particular significant areas of concern. Based on this information and analysis, the report concludes that reform is desirable, that it must balance efficiency and fairness, and it should be comprehensive.

In light of these conclusions, the report offers four recommendations interrelated recommendations designed to streamline the process and improve decisional outcomes. First, federal district court review should be eliminated and that court of appeals review should be limited to statutory and constitutional issues and confined to the federal circuit. Second, Congress should create an Article I court of disability review that would have jurisdiction over Social Security, Veteran’s Benefits, and other disability claims, while eliminated the role of the Social Security Administration’s Appeal’s Council. Third, administrative law judges who decide Social Security claims should be removed from the administrative hierarchy of the SSA and placed in an independent corps (although still bound by agency regulations). Fourth, improvements to state level disability determination services that make initial determinations under contract with SSA should be considered. These recommendations, taken together, would streamline the process by reducing the number of steps, increase the objectivity and accuracy of disability decisions at the administrative level, and allow for the development of a specialized judiciary with greater expertise in disability matters.