Allen W. Heinemann, PhD, ABPP

1
Disability Determination Process The Need for
Fundamental Change

• 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

2
The Need for Fundamental Change

• Social Security Advisory Board January 2001
• Major concerns described in report
• Growth in disability claims threaten to overwhelm
  the system
• Inadequate tools exist to make disability
  determination decisions.
• Public perceptions of inequity
• 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

3
5-Step Sequential Disability Determination Process
4
Appeals Process
Initial DDS Determination
Source Social Security Advisory Board, January
2001.
5
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
6
Costs of Appeals

• Many claimants give up and drop out of the system
• For those who dont 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

7
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

8
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

9
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

10
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

11
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.

12
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

13
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.