U.S. Congressman Sam Johnson (R-TX), Chairman of the House Committee on Ways and Means Subcommittee on Social Security, today announced a hearing on how disability is decided. The hearing will take place on Tuesday, March 20, 2012, in B-318 Rayburn House Office Building, beginning at 10:30 a.m.
In view of the limited time available to hear witnesses, oral testimony at this hearing will be from invited witnesses only. However, any individual or organization not scheduled for an oral appearance may submit a written statement for consideration by the Subcommittee and for inclusion in the printed record of the hearing.
The disability insurance program pays benefits to those who have worked in the past but are determined unable to work because of a disability that is expected to last more than a year or result in death. The responsibility to make the initial finding on disability was assigned to the State Vocational Rehabilitation Agencies or other appropriate State agencies in the Social Security Act Amendments of 1954. All 50 states, plus the District of Columbia and Puerto Rico, maintain fully federally-funded agencies, collectively referred to as Disability Determination Services (DDSs), which decide initial and continuing eligibility of disability claims. The DDS examiner does not see claimants face-to-face and must rely on relevant medical evidence that is provided by the claimant and/or medical sources in deciding whether the individual is disabled, as defined by Federal regulation and Social Security Administration (SSA) policies.
In FY 2011, the DDSs received over 3.3 million initial disability claims, the highest in the SSA's history. Examiners completed nearly 3.4 million initial claims, reducing the backlog of pending applications to 759,000, nearly 300,000 fewer claims than were pending at the end of FY 2010. The average processing time for initial disability claims was 109 days in FY 2011 and is projected to rise slightly in FY 2012. Over the most recent five-year period for which data is available, the percentage of all applications for disability benefits that were allowed ranged from 36-38 percent.
The Social Security Act considers people eligible for benefits when they are unable "to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months." The disability has to be so severe as to prevent them from doing any "substantial gainful work which exists in the national economy," whether a specific job is available or not. The disability must result from a physical or psychological condition that is "demonstrable by medically acceptable clinical and laboratory diagnostic techniques." In 2012, the level of earnings that constitutes performing SGA is $1,010 per month for non-blind individuals and $1,690 for blind individuals.
Most claims are evaluated under a five-step sequential evaluation process. The first two steps screen out individuals who are currently working above the SGA threshold and applicants whose impairments are not severe. The third step compares the individual's condition to the "medical listings" --a regulatory list of conditions that are considered severe enough to prevent a person from doing any gainful activity. If the individual's condition does not meet or equal the severity of a condition in the medical listings, the examiner proceeds to step four, which is assessing the individual's residual functional capacity (what an individual can do despite his or her impairment - including past relevant work). If the individual is found able to perform past relevant work, the claim is denied. If not, the examiner must determine at step five whether the individual can undertake other work. State examiners rely on medical evidence obtained from the claimant's health care providers, and can also consult with medical experts and may purchase one or more consultative examinations.
The SSA also has several fast-track procedures for evaluating claims from individuals with a terminal illness, or who have certain especially severe conditions that are highly likely to be allowed (called Compassionate Allowances and Quick Disability Determinations).
In announcing the hearing, Social Security Subcommittee Chairman Sam Johnson (R-TX) said, "Americans with disabilities deserve to get the right decision as early as possible, but that's just not how it currently works. States struggle on the front lines to make sense of the program's complex rules to decide who gets benefits. At the same time advances in treatment, rehabilitation, and the workplace have created new opportunities for those with disabilities to return to work. Securing the future of the disability insurance program should address these challenges and opportunities while keeping the process fair for both claimants and taxpayers."
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