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Disability Decision Making (Chartbook, 1st Edition)

April 27, 2001

Introduction: The Social Security Advisory Board has been working for more than three years on the question of how SSA can improve its service to the public and for an even longer period of time on the changes that need to be made in the agency’s disability programs. In the course of our work, it has become apparent that administration of the disability programs is at the heart of SSA’s service delivery problems. By comparison, the payment of retirement and survivors benefits, the issuance of Social Security numbers, and other basic functions of the agency run more smoothly. These other responsibilities of the agency, while presenting significant challenges, do not present the enormous management challenges that are presented by the Disability Insurance (DI) and Supplemental Security Income (SSI) disability programs.

Administration of the disability programs will take about two-thirds of the agency’s projected $7.1 billion budget for fiscal year 2001, or nearly $5 billion. In terms of executive management time and concerns, the programs appear to consume even more of the resources of the agency than this number suggests. Yet despite this large expenditure of money and effort, the disability programs continue to manifest serious administrative problems. In August 1998, the Board issued a report on the disability programs indicating how within the terms of the present programs their administration might be improved. SSA itself undertook a number of initiatives beginning in the fall of 1999 and the Board has attempted to monitor the implementation of these initiatives to see whether there are improvements.

As a result of our continuing work on the disability programs, the Board is issuing a new report in January 2001 titled Charting the Future of Social Security’s Disability Programs: The Need for Fundamental Change. The purpose of the report is to provide the new Administration and the new Congress with a framework for considering the fundamental changes that need to be made if the disability programs are to meet the serious challenges they are facing.

This document, Disability Decision Making: Data and Materials, is intended to provide background information to help readers of the report gain a fuller understanding of how the disability programs are being administered and of the major problems that are inherent in the current administrative process. It includes data that raise significant questions, including questions about consistency and equity in decision making. Although as set forth below, this has been a longstanding concern, the fact that some 45 years after the initiation of the program these questions are not only still outstanding − but even more pronounced − is particularly troublesome. The Board recognizes that these questions are exceedingly complex and difficult to answer, but would expect that over time demonstrable progress could be made if they were addressed with a sufficiently high level of concern and effort.

The charts that are included in this document reflect the information that we have been able to assemble at this time. All of the charts are the work of the Board’s staff. The data that were used in preparing them were provided by the Social Security Administration at the request of the Board or have appeared in SSA publications. Presentation of the charts generally follows the sequence of the disability determination process, from initial applications through the administrative and judicial appeals processes.