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entitled 'Disability Programs: SSA Has Taken Steps to Address 
Conflicting Court Decisions, but Needs to Manage Data Better on the 
Increasing Number of Court Remands' which was released on April 5, 
2007. 

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Report to Congressional Requesters: 

United States Government Accountability Office: 

GAO: 

April 2007: 

Disability Programs: 

SSA Has Taken Steps to Address Conflicting Court Decisions, but Needs 
to Manage Data Better on the Increasing Number of Court Remands: 

GAO-07-331: 

GAO Highlights: 

Highlights of GAO-07-331, a report to congressional requesters 

Why GAO Did This Study: 

The Social Security Administration’s (SSA) Disability Insurance and 
Supplemental Security Income programs provided around $128 billion to 
about 12.8 million persons with disabilities and their families in 
fiscal year 2005. Claimants who are denied benefits by SSA may appeal 
to federal courts. Through current initiatives, SSA is attempting to 
reduce the number of cases appealed to courts and remanded back to SSA 
for further review. In addition, there have been long-standing concerns 
about how SSA responds to court decisions that conflict with its 
policies. 

GAO was asked to examine: (1) trends over the past decade in the number 
of appeals reviewed by the courts and their decisions, (2) reasons for 
court remands and factors contributing to them, and (3) SSA’s process 
for responding to court decisions that conflict with agency policy. GAO 
reviewed SSA data and documents on court decisions, remands and SSA’s 
processes and interviewed agency officials and stakeholders on data 
trends, reasons for remands, and SSA processes. 

What GAO Found: 

Between fiscal years 1995 and 2005, the number of disability appeals 
reviewed by the federal district courts increased, along with the 
proportion of decisions that were remanded. More disability claims were 
remanded than affirmed, reversed, or dismissed over the period, and the 
proportion of total decisions that were remands ranged from 36 percent 
to 62 percent, with an average of 50 percent. Remanded cases often 
require SSA to re-adjudicate the claim, with the result that—along with 
the passage of time and new medical evidence—the majority of remanded 
cases result in allowances. 

Figure: Percent of Federal District Court Decisions by Type, Fiscal 
Year 1995 to Fiscal Year 2005: 

[See PDF for Image] 

Source: GAO analysis of SSA data. 

[End of figure] 

According to SSA officials and outside observers, a range of errors 
prompted by heavy workloads is responsible for court remands of SSA’s 
disability determinations, but data that would confirm or clarify the 
issue are incomplete and not well-managed. SSA has only recently begun 
collecting data on remands, and we found these data to be incomplete. 
Additionally, this information is collected by two different offices 
that have created somewhat different categories for the data, making 
some of the information inconsistent and possibly redundant. Meanwhile, 
SSA has acknowledged the need to reduce remands and, in 2006 along with 
other initiatives, introduced new decision-writing templates to improve 
efficiency and reduce errors. 

SSA has a process in place for determining whether appellate court 
decisions conflict with the agency’s interpretation of disability 
statutes or regulations and has taken steps in recent years to align 
its national policies with appellate court decisions. For example, 
officials and stakeholders attributed a downward trend in appellate 
court decisions that conflict with agency policy to significant policy 
changes instituted by SSA in the mid-1990s. In addition, for those 
cases where the agency acceded to conflicting appellate court decisions 
by issuing acquiescence rulings within the related circuits, we found 
that about half of the rulings issued were eventually replaced with 
national policy. Moreover, GAO found that the timeliness of 
acquiescence rulings had improved since 1998, when SSA established a 
timeliness goal of 120 days. 

What GAO Recommends: 

GAO recommends that the Commissioner of Social Security take steps to 
improve the reliability and collection of data on remands. SSA agreed 
with GAO’s recommendations and outlined actions it plans to take to 
implement them. 

[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-331]. 

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Daniel Bertoni at (202) 
512-7215 or bertonid@gao.gov. 

[End of section] 

Contents: 

Letter: 

Results in Brief: 

Background: 

Court Reviews and Remands Have Increased in Recent Years with Remands 
Often Resulting in SSA's Subsequently Awarding Benefits: 

Remands Have Been Attributed to a Range of Errors Caused by Heavy 
Workloads, but SSA Data That Could Shed More Light on the Problem Are 
Inadequate: 

SSA Has Taken Several Steps Since 1990 to Align Its Policies Nationally 
with Court Decisions: 

Conclusions: 

Recommendations: 

Agency Comments: 

Appendix I: Objective, Scope, and Methodology: 

Appendix II: Summary of Process Unification Rulings: 

Appendix III: Key Federal Court Rulings on Social Security 
Administration Disability Adjudication: 

Appendix IV: Additional Information on Disability Appeals: 

Appendix V: Summary of Court Holdings for Acquiescence Rulings Related 
to Disability Determinations: 

Appendix VI: Comments from the Agency: 

Appendix VII: GAO Contact and Staff Acknowledgments: 

Related GAO Reports: 

Figures: 

Figure 1: Map of Federal Judicial Circuits: 

Figure 2: Disability Process after SSA Final Decision: 

Figure 3: Federal District Court Decisions on Disability Claims, Fiscal 
Year 1995 to Fiscal Year 2005: 

Figure 4: District Court Decisions on Disability Claims: 

Figure 5: District Court Decisions by Circuit (Fiscal Year 2005): 

Figure 6: SSA Decisions on Remanded Disability Claims, Fiscal Year 1995 
to Fiscal Year 2005: 

Figure 7: SSA Decisions on Disability Claims Following Court Remands by 
Judicial Circuit, Fiscal Year 1995 to Fiscal Year 2005: 

Figure 8: Number of Acquiescence Rulings Issued, 1990 to 2006: 

Figure 9: Number of Acquiescence Rulings by Circuit, 1990 to 2006: 

Figure 10: Timeliness of Acquiescence Rulings, 1990 to 2006: 

Figure 11: How Acquiescence Rulings Were Rescinded, 1990 to 2006: 

Figure 12: Appeals Council Denials of Social Security Claims, Fiscal 
Year 1994 to Fiscal Year 2004: 

Figure 13: SSA Decisions on Disability Claims Following Court Remands: 

Figure 14: Social Security Claims Reviewed in Federal District Courts 
in Fiscal Year 2005 by Judicial Circuit: 

Abbreviations: 

ALJ: administrative law judge: 

CPMS: Case Processing and Management System: 

DI: Disability Insurance: 

DOJ: Department of Justice: 

DSI: Disability Service Improvement: 

FIT: Findings Integrated Template: 

NDMIS: National Docketing/Management Information System: 

ODAR: Office of Disability Adjudication and Review: 

OGC: Office of the General Counsel: 

SSA: Social Security Administration: 

SSI: Supplemental Security Income: 

United States Government Accountability Office: 
Washington, DC 20548: 

April 5, 2007: 

The Honorable Charles B. Rangel: 
Chairman: 
The Honorable Jim McCrery: 
Ranking Minority Member: 
Committee on Ways and Means: 
House of Representatives: 

The Honorable Michael R. McNulty: 
Chairman: 
The Honorable Sam Johnson: 
Ranking Minority Member: 
Subcommittee on Social Security: 
Committee on Ways and Means: 
House of Representatives: 

The Honorable Sander M. Levin: 
House of Representatives: 

In fiscal year 2005, the Social Security Administration (SSA) provided 
approximately $128 billion in cash benefits to about 12.8 million 
persons through the nation's two largest programs for persons with 
disabilities and their families--the Disability Insurance (DI) and the 
Supplemental Security Income (SSI) programs. In administering these 
programs over the past decade, SSA has faced challenges associated with 
lengthy decision-making processes and difficult disability 
determinations. In an effort to introduce more efficiency and fairness 
in its decision making, SSA has undertaken a "Disability Service 
Improvement Process," about which we offered testimony in June of 2006. 
Among the problems this initiative is designed to address is the number 
of SSA disability decisions that are appealed to the federal courts and 
subsequently remanded or referred back to the agency for re- 
adjudication. Such appeals and remands can add several years to the 
time it takes disability claimants to receive final decisions on their 
applications. Most appealed cases are reviewed only by the district 
courts, the first level of court review. However, if a disability claim 
reaches the appellate court or Supreme Court, the decision may have 
implications for SSA policy. There has been a long-standing concern 
that SSA does not respond adequately to appellate court decisions that 
conflict with its own policies by taking timely and appropriate action 
to reconcile them. 

You asked that we examine: (1) the trends of the past decade in the 
number of appeals reviewed by the district courts and their decisions; 
(2) the reasons for court remands and factors that may contribute to 
the incidence of those remands; and (3) SSA's process for responding to 
appellate court decisions that conflict with agency policy and the 
agency's response in recent years. 

To address the first research objective, we analyzed data from SSA on 
the number and types of decisions made by federal district courts for 
fiscal years 1995 to 2005. We also grouped and analyzed district court 
decisions by circuit for fiscal year 2005, the only year for which 
complete data by circuit were available. Furthermore, we analyzed 
agency data on the decisions SSA made after a case was remanded (i.e., 
allowances or denials of claims) for fiscal years 1995 to 2005. We also 
analyzed these remand data to identify trends over time and by circuit, 
a category that we created using SSA data on claimant state of 
residence. SSA officials were interviewed to gather information on 
potential reasons for any trends. To address the second objective, we 
obtained data on cited reasons for remands from two SSA databases that 
are maintained by two separate offices in SSA responsible for 
litigating claims in court and re-adjudicating remanded cases. We 
compared the data to determine how effectively SSA was capturing 
information on reasons for remands within the agency. In addition, we 
interviewed SSA officials and other stakeholder groups, including 
federal court judges and claimant representatives, on reasons for 
remands and factors that influenced them. For the third objective, we 
interviewed SSA officials and obtained available documents on how SSA 
determines whether a court of appeals decision conflicts with its 
policies and what option to pursue to address conflicting decisions, 
e.g., appeal or issue an acquiescence ruling whereby the agency agrees 
to abide by the court judgment in future cases, albeit only in that 
jurisdiction. We also obtained data on the number of acquiescence and 
other rulings that SSA issued since establishing its regulations on 
acquiescence in 1990. For acquiescence rulings, we further reviewed 
SSA's timeliness in issuing acquiescence rulings, as well as the number 
issued by circuit and how SSA replaced acquiescence rulings with 
nationwide policies. We were unable to independently determine how 
significantly any given court decision conflicted with SSA policy or 
whether SSA should have pursued one option over another. We also 
interviewed SSA officials and relevant stakeholders--including selected 
federal court judges and claimant representatives from the Seventh and 
Ninth circuits, which represent those with the lowest and highest 
numbers of SSA policy changes associated with acquiescence rulings--to 
obtain information on how court decisions and their related agency 
rulings have affected SSA's disability adjudication policy in recent 
years. After interviewing officials and reviewing related data reports 
and manuals, all quantitative data used in this report were assessed 
and, with the exception of the reason for remand data, were determined 
to be sufficiently reliable for the purposes of this report. Issues 
related to the reason for remand data are discussed further on pages 20 
to 21. All work was conducted between February 2006 and January 2007 
according to generally accepted government auditing standards. See 
appendix I for more information on our methods. 

Results in Brief: 

Over the past decade, the number of disability appeals reviewed by the 
district courts and the proportion of remands increased, and SSA 
subsequently granted benefits to claimants in many of the remanded 
cases. Between 1995 and 2005, the number of cases reviewed by federal 
district courts grew by 20 percent--from about 10,300 to some 12,400-- 
which roughly corresponds to workload increases at SSA during the same 
period. During this period, the courts upheld SSA's decisions to deny 
benefits in 44 percent of cases on average and reversed 6 percent. 
However, the most frequently occurring decisions were remands back to 
the agency for further review (50 percent), essentially resulting in 
additional work for SSA. The proportion of reviewed cases that were 
remanded increased by 36 percent over this period, with 1998 being the 
pivotal year when the proportion of remands exceeded affirmations. 
According to some SSA officials, this notable increase may have been 
due to new national guidelines for SSA adjudicators--known as the 
process unification rulings--that may have also led to federal courts 
using more remands to ensure that the guidelines were followed. With 
regard to the disposition of cases by geographic jurisdiction or 
judicial circuit, there was substantial variation in 2005, the year for 
which detailed data were available. Federal district courts in the 
Second Circuit--which serves part of the Northeast--affirmed 19 percent 
and remanded 74 percent of cases, while district courts in the Sixth 
Circuit--which serves Michigan, Ohio, Kentucky, and Tennessee-- 
affirmed 61 percent and remanded 35 percent. According to SSA 
officials, case outcomes may vary from circuit to circuit because of 
differences such as judges' interpretations of laws and the volume of 
cases that circuits examine. We also found that once cases were 
remanded back to SSA for re-adjudication, the majority of claimants--66 
percent--were awarded benefits. According to agency officials, the 
changing nature or severity of claimants' disabilities over the often 
lengthy period of appeal may contribute to the extent of allowances for 
remanded cases. 

While stakeholders suggested that remands result from a range of errors 
caused by heavy workloads, SSA data that would confirm and perhaps 
elaborate on these errors are incomplete and not well managed. 
Administrative law judges (ALJ), who adjudicate cases appealed within 
SSA; claimant representatives; and others whom we interviewed said 
district courts often remand cases back to the agency for re- 
adjudication due to errors associated with poor decision writing and 
improper use of evidence. For example, many stakeholders said SSA 
decision makers had failed to properly consider the opinions of 
treating physicians. Many agency officials as well as outside 
stakeholders attributed the errors resulting in remands to a heavy 
workload. For example, ALJs we spoke with expressed the view that their 
caseload--around 50 to 60 cases per month--undermined the quality of 
their written decisions. SSA introduced new decision-writing templates 
for ALJs and their staff in order to ensure more legally sufficient 
documentation of decisions and improve the efficiency of the 
administrative-hearings process. However, the agency's ability to 
identify trends in reasons for remands and take corrective actions to 
reduce remands is limited by the absence of reliable data. We found 
that SSA's data were incomplete and that the collection of these data, 
conducted by two separate offices, was inconsistent and inefficient. 
SSA officials acknowledged that improvements to these data and their 
management were needed, but currently lacks specific plans and 
timetables for addressing these problems. 

SSA has a process in place for addressing appellate court decisions 
that conflict with agency interpretation of law or regulations and has 
taken steps since 1990 to align its policies nationally with appellate 
court decisions. Specifically, SSA's offices of General Counsel (OGC) 
and Disability Programs regularly review appeals court decisions for 
their policy implications. When SSA has determined that an adverse 
appellate court decision conflicts with its own interpretation of 
disability statutes or regulations, the agency then decides either to 
pursue further judicial review of the issue or accede to the court's 
decision only within the specific circuit. SSA accedes to appellate 
court rulings within the specific circuits by issuing acquiescence 
rulings, which are meant to be temporary guidance for program 
implementation until the agency can determine how to address court 
decisions in a way that minimizes regional variations. Since 
establishing regulations on acquiescence in 1990, SSA issued 45 
acquiescence rulings in response to appellate court decisions, although 
there have been fewer such rulings in recent years. SSA officials said 
fewer acquiescence rulings have been needed because new guidelines for 
adjudicators, the process unification rulings of 1996, clarified SSA 
policy and filled gaps in policy that were previously open for the 
courts to fill, leading to a closer alignment of agency policy and 
court interpretations of disability law. Also, nearly half of the 
acquiescence rulings issued during the period of our study have been 
rescinded and eventually replaced with new laws and regulations to 
ensure consistency in program implementation. We also found that 
acquiescence rulings were issued significantly sooner, following the 
agency's establishment in 1998 of a new 120-day guideline. 

To ensure the agency has accurate and well-managed information to use 
in identifying corrective actions for reducing remands, we recommended 
that the Commissioner of SSA: (1) take steps to ensure the reliability 
of data on the reasons for remands and (2) coordinate agency data 
collection on remands and ascertain how best to use this information to 
reduce the proportion of cases remanded by federal courts. 

In comments to our draft report, SSA agreed with both of our 
recommendations for improving data on remands and outlined actions it 
plans to take to improve the reliability and collection of remand data. 
See appendix VI for a copy of SSA's comments. SSA also provided a 
number of technical comments, which we generally incorporated where 
appropriate. 

Background: 

Disability Determination and Administrative Appeals: 

In fiscal year 2005, the Social Security Administration (SSA) paid 
approximately $128 billion in cash benefits to about 12.8 million 
beneficiaries through the two largest federal programs available to 
persons with disabilities and their families: the Disability Insurance 
(DI) program and the Supplemental Security Income (SSI) program. Both 
programs serve those who are medically determined to be unable to 
engage in any substantial gainful activity due to a severe physical or 
mental impairment that is expected to last at least 12 months or result 
in death.[Footnote 1] 

Claimants must apply to SSA to receive disability benefits from these 
programs and if awarded benefits, claimants may also have to requalify 
for support through what are known as continuing disability 
reviews.[Footnote 2] In most of the country currently, claimants who 
are denied initial or continuing benefits by SSA may appeal their 
denials administratively up to three times, each time for review by a 
different adjudicatory entity.[Footnote 3] These entities are 1) the 
state disability determination service that performs the initial review 
of disability claims and, in most states, a reconsideration 
determination, 2) an administrative law judge (ALJ) in SSA's Office of 
Disability Adjudication and Review, and 3) a group of appellate 
reviewing officials within SSA known as the Appeals Council. The number 
of claims or appeals reviewed at each level in 2005 were: over 2.6 
million by state agencies, almost 520,000 by ALJs, and over 94,000 by 
the Appeals Council. 

Disability determinations at all of these levels are often complex and 
necessarily involve some degree of subjectivity by adjudicators, and 
the nature of these decisions have contributed to long-standing 
concerns about the extent to which adjudicators across the agency 
consistently interpret and implement SSA's national disability policy. 
To help achieve more consistent application of policy between the state 
disability determination service level and the ALJ level, in 1996, SSA 
established the process unification rulings, a set of nine Social 
Security rulings for all SSA disability adjudicators to follow in 
matters involving difficult judgments, such as the weight to be given 
to opinions of claimants' treating physicians versus medical opinions 
from other sources, and the evaluation of pain and other subjective 
symptoms. See appendix II for more details on process unification 
rulings. 

Cases in Federal Court: 

After claimants exhaust all administrative review options within SSA, 
they may then appeal their claims outside the agency to federal court. 
A claimant must first file an appeal with a federal district court 
within one of 12 federal judicial regions, known as judicial circuits. 
Figure 1 provides information on which states and territories are 
included in these circuits. 

Figure 1: Map of Federal Judicial Circuits: 

[See PDF for image] 

Source: Administrative Office of U.S. Courts (data), map, Map Resources 
(presentation). 

Note: There is a thirteenth federal judicial circuit, known as the 
Federal Circuit, which does not hear SSA disability cases. 

[End of figure] 

In deciding the case, a district court judge or magistrate usually 
either affirms an agency decision, reverses the decision (essentially 
affirming the claimant's case), or remands it back to SSA for further 
review.[Footnote 4] According to SSA officials, remanded cases are 
generally reviewed by the ALJ who made the original decision.[Footnote 
5] Judges can also dismiss a case if its scope is outside the court's 
legal jurisdiction. Furthermore, if SSA prefers not to defend a case 
that has been filed, usually because of an error it has identified, the 
agency may request that the judge remand the case back for the agency's 
review.[Footnote 6] 

Court remands have implications for SSA's workload, the types of 
decisions SSA adjudicators make on remanded cases, and the time 
claimants must wait for decisions on their cases. Generally, when cases 
are remanded, ALJs must perform new hearings, which could involve new 
evidence presented at the time of court reviews. These remanded cases 
add to the already high workloads that ALJs have in reviewing denials 
by the agency's disability determination service offices. The load may 
also affect ALJ decisions: In its September 2006 report, the Social 
Security Advisory Board found a small correlation between increased ALJ 
workload and increased allowances.[Footnote 7] Furthermore, although 
remanded cases are given priority in the line of cases that must be 
reviewed by ALJs, a substantial amount of time may pass before new 
decisions can be made at this administrative level, and the ALJ's 
decision may undergo another review by the Appeals Council. In fiscal 
year 2006, it took SSA nearly a year on average to process court 
remanded cases from the district courts. 

After a district court decision, both the claimant and SSA may appeal 
the case to a circuit court of appeals (also called an appellate court) 
and, beyond this, to the Supreme Court. However, few cases reach these 
appellate court levels and most disability cases are resolved in the 
district courts. According to SSA, no more than 20 district court cases 
have been appealed by the agency to the appellate courts each year 
since 2000. The Supreme Court has only reviewed four cases involving 
disability claims since 1991. See figure 2 for an overview of the 
disability appeals process. 

Figure 2: Disability Process after SSA Final Decision: 

[See PDF for image] 

Source: GAO analysis. 

Note: This figure depicts the typical appeals process. Circuit court 
decisions can be appealed to the Supreme Court. SSA decisions on 
remanded cases can be appealed back to the federal courts. For court 
remands involving continuing disability reviews, SSA decides to cease 
or continue, rather than deny or grant benefits. 

[End of figure] 

How Federal Court Decisions May Affect SSA Policy: 

SSA is not obligated to follow a district court decision that conflicts 
with agency policies beyond that specific case.[Footnote 8] However, 
the agency is required to follow appellate court decisions for cases 
within that circuit, unless the agency seeks further judicial review. 
If the Supreme Court issues a decision, SSA is bound to follow the 
decision nationally. Several district, appellate, and Supreme Court 
decisions have affected disability policy in the past two decades. 
Appendix III outlines some cases that have resulted in such changes. 

SSA implemented its current policy of acquiescence in 1990 in response 
to the concerns of external stakeholders, including claimant 
representatives, that SSA had failed in the 1980s to offer timely and 
appropriate responses to appellate court decisions.[Footnote 9] With 
the acquiescence ruling, SSA agrees to follow the appellate court's 
holding on new cases only when they fall within the jurisdiction of 
that appellate court. SSA rescinds an acquiescence ruling if one of the 
following occurs: 1) the Supreme Court overrules or limits the relevant 
appellate court decision; (2) an appellate court overrules or limits 
itself on the relevant issue; (3) Congress enacts a law that obviates 
the acquiescence ruling; or (4) SSA clarifies, modifies, or revokes the 
regulation or ruling that was the subject of the pertinent appellate 
court decision. 

Disability Service Improvement Process: 

With new regulations issued in March 2006, SSA began implementing the 
Disability Service Improvement (DSI) process in August 2006 on a 
limited basis--i.e., in states in the Boston Region--and plans to 
gradually roll out the initiative to other regions. The regulations 
include changes to the appeals process within the agency that could 
potentially affect the number and types of cases that will go to 
federal courts in the future. Among these changes is the gradual 
replacement of the Appeals Council with a Decision Review Board, 
designed to ensure the accuracy of SSA decisions and reduce remands 
from federal courts. The Board would only review select cases based on 
whether they are considered likely to have contained errors or involved 
new policies, rules, and procedures. Under the DSI process, claimants 
who are unhappy with ALJ decisions, therefore, could no longer turn to 
the Appeals Council, but rather must appeal directly to the federal 
courts. In our June 2006 testimony, we reported that the public and 
stakeholders were concerned that replacing the Appeals Council with a 
Decision Review Board may increase the number of cases appealed to, and 
thus the workloads of, the federal courts.[Footnote 10] In its response 
to these concerns, SSA officials maintained that DSI improvements will 
ultimately reduce the need for court appeals and also reduce remands. 
As part of its DSI initiative, the agency is making a systematic effort 
to collect and analyze data on court decisions in the course of 
training staff and keeping ALJs current. Such monitoring and data 
collection are consistent with the Office of Management and Budget's 
and GAO's internal control standards for all federal agencies.[Footnote 
11] 

Court Reviews and Remands Have Increased in Recent Years with Remands 
Often Resulting in SSA's Subsequently Awarding Benefits: 

Between fiscal years 1995 and 2005, the number of disability appeals 
reviewed by the courts and decisions to remand these cases increased, 
and in the majority of remanded cases, claimants were subsequently 
granted benefits by SSA. In 2005, the year for which disaggregated data 
were available, GAO found the proportion of remands by district courts 
varied significantly by circuit. However, GAO did not find substantial 
variation by judicial circuit in SSA decisions on court remanded cases. 

Cases Reviewed by District Courts Increased over the Past Decade, as 
Did the Proportion Remanded Back to the Agency: 

We found that federal district courts reviewed an increasing number of 
disability cases over the past decade, which corresponded with the 
increasing number of cases processed by SSA. Although the number of 
cases reviewed by federal district courts fluctuated over time, they 
generally increased by 20 percent from about 10,300 in fiscal year 1995 
to about 12,400 by fiscal year 2005. (See fig. 3.) According to SSA 
officials, the increase in the number of claims reviewed by the courts 
may be a result of the increase in the number of claims that passed 
through the Appeals Council, SSA's final decision-making body, over the 
same time period.[Footnote 12] 

Figure 3: Federal District Court Decisions on Disability Claims, Fiscal 
Year 1995 to Fiscal Year 2005: 

[See PDF for image] 

Source: GAO analysis of SSA data. 

[End of figure] 

Over the same period, remands were generally the most common district 
court decision, and their proportion increased by 36 percent from 1995 
to 2005. Of those SSA cases decided by the district courts on the 
merits and not dismissed, 50 percent were remanded, 44 percent were 
affirmed, and 6 percent were reversed on average.[Footnote 13] (See 
fig. 4.) Notably, the proportion of remands reached its peak in 2001. 
Although a range of factors may affect the extent of court remands, 
some SSA officials suggested that the Appeals Council, having reviewed 
a record number of ALJ decisions in 2000, may have made mistakes in a 
greater share of cases that were subsequently appealed to, then 
remanded by, the district courts. 

Figure 4: District Court Decisions on Disability Claims: 

[See PDF for image] 

Source: GAO analysis of SSA data. 

Note: This figure excludes cases that were dismissed. 

[End of figure] 

The proportion of remands exceeded the proportion of affirmances in 
1997 and continued to increase until 2001. Specifically, in 1995 only 
36 percent of SSA decisions were remanded by the courts while 57 
percent were upheld or affirmed. However, by 1998, the proportion of 
remands increased to 49 percent, while the proportion of affirmances 
declined to 46 percent. When we showed SSA officials these trends, they 
generally attributed the shift to the process unification rulings, 
which the agency had established in 1996. According to SSA officials, 
the increased remands reflected district court efforts to assure that 
SSA adjudicators were following the agency's new procedures. 

The Proportion of Remanded Cases Varied by Circuit: 

GAO found substantial variation in the proportion of cases remanded by 
judicial circuit in fiscal 2005, the only year for which data by 
circuit were available. (See fig. 5.) Although remands and affirmances 
were the most frequently occurring types of decision in each circuit, 
the proportion of each varied considerably among the circuits. 
Specifically, the percent of remands ranged from a low of 35 percent to 
high of 78 percent, while affirmances ranged from 22 percent to 61 
percent. 

Figure 5: District Court Decisions by Circuit (Fiscal Year 2005): 

[See PDF for image] 

Source: GAO analysis of SSA data. 

Note: This figure excludes cases that were dismissed. 

[End of figure] 

SSA officials were not in agreement about why there might be 
differences in the types of decisions across judicial circuits. 
According to some, differences might be due to judges in different 
circuits interpreting disability laws differently. Others told us that 
disparities in the number of claims appealed to district courts across 
circuits may contribute to these differences. (See app. IV, fig. 14 for 
more information on the number of cases reviewed by circuit for fiscal 
year 2005.) Currently, SSA does not have sufficient data that would 
allow them to determine why these decisions vary by circuit but plans 
to obtain this information as part of the DSI process implementation. 

In the Majority of Remanded Cases, Claimants Were Awarded Benefits: 

Of the 57,000 cases remanded by the district courts between 1995 and 
2005, SSA awarded benefits to the majority of claimants--about 66 
percent--upon re-adjudication, with the remainder being denied (about 
30 percent) or dismissed (5 percent). (See fig. 6.) Agency officials 
said the large percentage of awards in remanded cases were due, in 
part, to the fact that the lengthy period of the appeals process 
increased the likelihood that the nature or severity of claimants' 
disabilities would change. The officials also attributed the awards to 
information in the court's written judgments that made it possible for 
ALJs, in reviewing cases anew, to make more accurate decisions. The 
proportion of allowances in court-remanded cases after re-adjudication 
is just below the average allowance rate of 70 percent for all ALJ 
decisions. 

Figure 6: SSA Decisions on Remanded Disability Claims, Fiscal Year 1995 
to Fiscal Year 2005: 

[See PDF for image] 

Source: GAO analysis of SSA data. 

Note: Some percentages may exceed 100 due to rounding. Because cases 
can be appealed and remanded more than once, GAO included in its 
analysis only claims that SSA determined had never before been remanded 
to the agency from the courts. Such cases made up about 92 percent of 
the sample of remands re-decided by SSA between 1995 and 2005. See 
appendix III, figure 13 for information on the number of cases re- 
decided by SSA over this period. 

[End of figure] 

We did not find substantial variation in SSA decisions on court- 
remanded claims across judicial circuits. As shown in figure 7, the 
proportion of allowances for remanded cases ranged from 62 percent to 
72 percent by circuit--relative to a national average of 66 percent. 

Figure 7: SSA Decisions on Disability Claims Following Court Remands by 
Judicial Circuit, Fiscal Year 1995 to Fiscal Year 2005: 

[See PDF for image] 

Source: GAO analysis of SSA data. 

Note: GAO used the claimants' state of residence reported by SSA to 
determine judicial circuit. 

[End of figure] 

Remands Have Been Attributed to a Range of Errors Caused by Heavy 
Workloads, but SSA Data That Could Shed More Light on the Problem Are 
Inadequate: 

According to agency officials and stakeholders, a range of errors 
precipitated by heavy workloads is responsible for court remands of 
SSA's disability determinations, but SSA data that would confirm or 
clarify reasons for remands are incomplete and not well managed. SSA 
has acknowledged the need to reduce remands and in 2006, along with 
other initiatives, introduced a new writing tool for ALJs in order to 
improve efficiency and better document decisions. However, agency data 
that would inform the problem and help address remands are incomplete 
and not well managed. 

Stakeholders Attribute Various Reasons for Remands to High SSA 
Workloads: 

Stakeholders commonly cited two reasons for remands: written 
explanations that did not support the decisions and inadequate 
documentation of consideration given to medical evidence. They 
expressed the view, however, that errors made with respect to 
documenting decisions were due, in large part, to heavy SSA adjudicator 
workloads. Poor decision writing by ALJs and their staff was cited by 
all groups of stakeholders we interviewed, including SSA officials, 
district court judges, claimant representatives, and other 
stakeholders. Specifically, district court judges said they did not 
always believe that SSA's decisions were wrong, but that the written 
explanations did not always support those decisions. Some claimant 
representatives said that poorly written decisions may be symptomatic 
of improper consideration of evidence and procedures by ALJs. 

With regard to the inadequate documentation of consideration given to 
medical evidence as a reason for remands, district court judges and 
claimant representatives we interviewed said ALJs either do not 
document how they weighed treating physicians' opinions and assessed 
claimant statements about pain and other symptoms, or they do not 
consider them as required by the process unification rulings. ALJs we 
interviewed responded that addressing such evidence is sometimes very 
difficult and cited cases in which the treating physician appeared to 
be simply repeating claimants' opinions about their inability to work, 
rather than offering substantive information about the conditions that 
would prevent work. Some district judges agreed that considering and 
incorporating medical evidence into a decision can be difficult, but 
stressed the importance of articulated and well-documented opinions in 
order for district court judges to make a decision other than to 
remand. 

Stakeholders we interviewed varied in their opinions regarding whether 
requirements of the process unification rulings were overly cumbersome 
and, therefore, resulted in remands. Members of the Appeals Council and 
the Social Security Advisory Board staff we spoke with believe that the 
process unification rulings provide important guidance, but have also 
made procedures for making decisions and decision-writing more 
cumbersome. On the other hand, representatives of the Association of 
Administrative Law Judges told us that they have not heard such 
complaints and, while acknowledging that decision-making involved more 
work, believe the rules did not make decision-writing overly 
cumbersome. 

At the same time, many of those we interviewed, including ALJs and 
district court judges, said the heavy ALJ workload was behind the 
apparent errors in documenting agency determinations that lead to 
remands. Some ALJs asserted that the frequency of court remands has not 
been unreasonable considering the number of cases that they must 
review.[Footnote 14] These ALJs also said their workload expectations 
of 50 to 60 hearings a month affected the time and attention they could 
give to each case.[Footnote 15] They asserted that they would need to 
write significantly fewer decisions in a month in order to assure that 
the work would withstand scrutiny by the federal courts. They noted 
that other ALJs who are able to write decisions that the courts uphold 
produce as few as five a month. Because the time needed to review cases 
and write decisions varied, however, representatives of the Association 
of Administrative Law Judges were unable to suggest an ideal number of 
cases that would be reasonable for ALJs to process. Specifically, these 
representatives said that decisions to deny benefits take substantially 
longer to document than those involving allowances. These 
representatives also stated that the number and quality of staff that 
ALJs have available to help process and write decisions vary.[Footnote 
16] 

Finally, stakeholders also suggested that a variety of other factors 
contribute to remands, such as: ALJs' providing poor instructions to 
decision writers, SSA's not providing adequate feedback to ALJs on 
reasons for remands, and federal courts' having bias against ALJs' 
decisions. Some stakeholders further stated that federal court bias may 
be rooted in concerns over how well decisions are generally written, 
expectations about how determinations should be made, and concerns with 
the amount of time and attention given to cases under the current 
workload. 

Acknowledging the need to address remands from the federal court, SSA 
is taking steps to mitigate common documentation errors. One step has 
been to promote the use of a decision-writing tool known as the 
Findings Integrated Templates (FIT). This tool contains more than 1,600 
templates for presenting analysis of evidence and ensuring that 
required statutes and regulations are followed. These templates are 
also designed to prevent common mistakes, such as failure to establish 
an appropriate date for the onset of disability benefits. SSA officials 
also said this tool is intended to help manage workloads by reducing 
the potential for miscommunication between ALJs and their staff and the 
time spent writing decisions. According to SSA officials, SSA plans to 
monitor the extent to which decisions written with this tool are 
remanded from the federal courts. Appeals Council judges we interviewed 
have reviewed some decisions written with FIT and have found them to be 
better articulated than decisions that did not rely on this tool. 
However, both Appeals Council judges and ALJ association 
representatives mentioned that the tool will not replace the need for 
additional, competent decision-writing staff. 

Additionally, SSA is pursuing a broader set of initiatives under its 
Disability Services Improvement (DSI) initiative that it hopes will 
result in more accurate decisions earlier in the process and, thereby, 
ultimately reduce workloads at the ALJ level. For example, as a part of 
DSI, SSA is implementing an expedited determination process for clear- 
cut cases, which it calls its Quick Disability Determinations. The 
agency also plans to add a level of reviewing attorneys, known as 
federal reviewing officials, who can affirm, reverse, or modify 
appealed agency decisions prior to their reaching ALJs. However, DSI is 
currently underway only in the Boston Region, and SSA has yet to 
evaluate the effectiveness of this initiative. 

Agency Remand Data Are Incomplete and Not Well Managed: 

While SSA collects data on reasons for remands, we found that the data 
are not well managed, incomplete, and therefore not reliable. Two 
separate SSA offices recently began collecting data on remanded cases 
to identify and track the reasons for remands in order to help train 
ALJs and their staff on how to reduce the number of remands. 
Nevertheless, while the two offices were collecting and using the data 
for the same purpose--training--they told us that they were not 
collaborating. When the two offices--the Office of Disability 
Adjudication and Review (ODAR) and the OGC--developed lists of 
categories to group reasons for remands, the offices did not consult 
with each other. As a result, the lists of categories used by these 
offices are not the same, and SSA officials told us that the offices 
may well classify similar remands differently. Moreover, some remand 
categories in the two data systems may be duplicative, resulting in an 
inefficient use of agency resources. SSA officials acknowledged that 
better data reliability and collaboration between the two offices are 
needed and that, while the agency plans to develop a common vocabulary 
for remand reasons, it has yet to develop specific plans and timetables 
for addressing these issues. 

Through our conversations with SSA officials and reviews of reports, we 
also found that these data were not consistently entered into the 
agency's databases. Within both systems, at least one reason should be 
entered per remanded case, but this did not always occur; instead, we 
found the extent to which this information was entered varied by 
database and SSA regional office. For the OGC reports, we found that 
the number of reasons recorded exceeded the number of cases, as would 
be expected; however officials were not confident that the data on 
remands reasons were accurate or complete because the officials have 
not been able to assess the quality of the data. Within the ODAR 
reports for fiscal years 2005 and 2006, on the other hand, there were 
substantially fewer reasons reported than cases.[Footnote 17] Regional 
reports showed that SSA's Seattle and New York offices have been 
collecting the most information on remands. Notably, the agency's 
Boston office--which is the first to implement the structural changes 
of DSI--and the Philadelphia office have collected the least amount of 
information. SSA officials told us that they were aware that remand 
data were not entered into ODAR's system consistently in early fiscal 
year 2005, and said they subsequently reiterated the importance of 
collecting this information to staff. SSA officials also mentioned that 
they are considering making remand reasons a mandatory field in the 
ODAR database to improve collection. 

SSA Has Taken Several Steps Since 1990 to Align Its Policies Nationally 
with Court Decisions: 

SSA officials have a process in place for determining whether appellate 
court decisions conflict with the agency's interpretation of disability 
statutes or regulations, and the agency has taken steps in recent years 
to align its policies nationally with appellate court decisions. In 
those cases where the agency acceded to certain appellate court rulings 
by issuing acquiescence rulings, we found that about half of the 
rulings were eventually replaced with national policy. Also, we found 
that the number of acquiescence rulings has declined in more recent 
years, a decline that SSA officials mainly attributed to the agency's 
implementation of its process unification rulings of 1996, which 
officials believe created less room for differences of opinion between 
the courts and the agency regarding broader policies. Moreover, we 
found that the timeliness of acquiescence rulings had improved since 
1998, when SSA established a timeliness goal of 120 days. 

SSA Has a Process in Place for Reviewing and Addressing Appellate Court 
Decisions that Conflict with the Agency's Interpretation of Law or 
Regulations: 

When an appellate court decision is rendered, SSA officials review the 
decision to determine whether it conflicts with agency interpretation 
of law or regulations. The primary office responsible for this 
evaluation is the OGC, SSA's office responsible for legal matters. For 
disability issues, OGC works in conjunction with the Office of 
Disability Programs, SSA's office responsible for policy 
matters.[Footnote 18] These offices may consult with the Office of 
Disability Adjudication and Review, which rendered the agency's final 
decision prior to its being appealed to federal court, as well as the 
Department of Justice (DOJ), the entity generally responsible for 
representing SSA in federal court. 

If SSA determines that the appellate court decision conflicts with its 
policy, then it decides whether to appeal the case to the Supreme Court 
or to modify its policy to conform with that decision.[Footnote 19] 
According to officials, SSA rarely challenges appellate court 
decisions, and decisions to appeal are ultimately the prerogative of 
DOJ, because DOJ represents SSA in court. Some of the situations in 
which SSA would consider appealing to the Supreme Court are: a conflict 
between circuits; an issue of exceptional importance involving high 
visibility or significant funds; a statute or regulation held by the 
courts to be unconstitutional; or an important regulation held to be 
invalid. 

If SSA decides to follow the appellate court decision, it issues an 
acquiescence ruling that applies only within that circuit. However, 
because these rulings result in inconsistent policies throughout the 
country, the agency has added a clarification in the preamble to its 
1998 regulations that acquiescence rulings are generally temporary 
policies that are not intended to remain in effect permanently. 
Therefore, after issuing an acquiescence ruling, SSA attempts to pursue 
a uniform national policy through various means, such as modifying 
regulations or rules, issuing new regulations or policy 
interpretations, seeking legislative changes, or re-litigating the 
issue within the same circuit.[Footnote 20] When SSA successfully 
incorporates the acquiescence ruling into national policy, it rescinds 
the acquiescence ruling.[Footnote 21] 

When SSA finds it necessary to issue an acquiescence ruling, it has 
procedures in place for informing adjudicators of these departures from 
national policy. According to officials, SSA communicates these and 
other rulings to SSA officials who make claims determinations, such as 
ALJs, through a variety of sources including: the Federal Register, 
SSA's internal operations manual, the agency's Web site, and e-mails. 
In some instances, officials learn about these rulings through training 
sessions. However, because most acquiescence rulings since the 1990s 
concerned narrow issues, SSA officials said the rulings have not 
warranted special training for adjudicators. 

SSA Has Taken Steps to Align Its Policies with Court Decisions by 
Issuing Acquiescence Rulings More Quickly and Following with Changes in 
National Policy: 

SSA has taken steps to align its policies with the court decisions by 
issuing acquiescence rulings in a timely manner and following up with 
changes to its national policies. Since the implementation of its 
current acquiescence policy, SSA has issued 45 acquiescence rulings, 
the majority of which relate to determining whether a claimant is 
eligible for disability benefits. (Fig. 8 shows the number of rulings 
issued each year from 1990 to 2006, and app. V provides synopses of 
court holdings concerning disability determinations that led to 
acquiescence rulings.) Most of these rulings were issued between 1990 
and 2000, when SSA published an average of four acquiescence rulings 
per year. In contrast, during the 6-year period from 2001 to 2006, the 
agency issued only five such rulings. SSA officials attributed the 
decline in acquiescence rulings to implementation of its process 
unification rulings, which they believe created less room for 
differences of opinion between the courts and the agency regarding 
broader policies. Specifically, officials commented that the process 
unification rulings clarified SSA policy as well as filled gaps in 
policy that were previously open for the courts to fill, and noted 
that, while the courts are not bound by these and other Social Security 
Rulings, the courts have frequently deferred to SSA's rulings.[Footnote 
22] As a result, SSA has seen a decline in the number of significant 
court cases involving disability law over time. (See app. III for a 
listing of key court cases.) 

Figure 8: Number of Acquiescence Rulings Issued, 1990 to 2006: 

[See PDF for image] 

Source: GAO analysis of SSA data. 

[End of figure] 

We found that the number of acquiescence rulings issued by SSA varied 
by circuit during our study period (1990 to 2006), ranging from one in 
the First Circuit to eight in the Ninth Circuit. (See fig. 9.) SSA 
officials pointed out that the number of acquiescence rulings the 
agency issues in a given circuit is a function of the number and types 
of decisions issued by the appellate court within that circuit. For 
example, officials said that the Ninth Circuit has the largest 
disability caseload, and therefore, one would expect it to have the 
highest number of acquiescence rulings.[Footnote 23] Also, because the 
Ninth Circuit's decisions largely concerned technical issues, SSA 
officials said they were less amenable to Supreme Court Review. This 
official added that the Ninth as well as Eighth Circuits have had 
precedent-setting decisions. 

Figure 9: Number of Acquiescence Rulings by Circuit, 1990 to 2006: 

[See PDF for image] 

Source: GAO analysis of SSA data. 

[End of figure] 

Since SSA established a regulation in 1998 that included a timeliness 
goal for issuing acquiescence rulings, the promptness of issuances has 
improved. (Fig. 10 depicts the timeliness of acquiescence rulings 
issued from 1990 to 2006.) Prior to establishing the regulation, SSA 
took more than a year to issue over 80 percent of the rulings. Since 
then, 54 percent of acquiescence rulings were issued within the 
guideline of 120 days (or 4 months). For those rulings that were not 
issued within 120 days, in most instances the timeliness goal did not 
apply because SSA either sought further judicial review or needed to 
coordinate with DOJ or other federal agencies. 

Figure 10: Timeliness of Acquiescence Rulings, 1990 to 2006: 

[See PDF for image] 

Source: GAO analysis of SSA data. 

Note: Percentages do not add up to 100 due to rounding. 

[End of figure] 

Once SSA has issued acquiescence rulings, the agency has frequently 
succeeded in replacing them with uniform national policies. We found 
that since 1990, nearly half of all acquiescence rulings (21 of 45) 
were rescinded and replaced by more permanent guidance.[Footnote 24] 
Further, most of these rescissions resulted from the agency's issuing 
or modifying rulings or regulations. (Fig. 11 shows how acquiescence 
rulings were rescinded.) According to officials, acquiescence rulings 
are most commonly rescinded when the agency revises, publishes, or 
revokes rules and regulations--actions that are fully within the 
agency's control. Six other rescissions occurred through other means: 
three from Supreme Court rulings upholding SSA's policies and three 
from changes in law made by Congress. 

Figure 11: How Acquiescence Rulings Were Rescinded, 1990 to 2006: 

[See PDF for image] 

Source: GAO analysis of SSA data. 

[End of figure] 

However, according to SSA, some issues brought about by federal court 
decisions, such as those involving the Constitution or federal law, 
have led to acquiescence rulings that have not been rescinded by the 
agency. For example, acquiescence ruling 91-1(5), which involves a 
claimant's right to cross-examine an examining physician, remains in 
effect because SSA officials believe the only option for rescinding the 
ruling would require re-litigating the case.[Footnote 25] However, 
according to SSA officials, the relevant circuit appellate court and 
the Supreme Court have declined to review this ruling. Other reasons 
that acquiescence rulings may remain in effect include a lack of 
practical implications of the acquiescence ruling for other circuits or 
the fact that an acquiescence ruling was only recently issued. 
Replacing the acquiescence ruling with nationwide policy typically 
takes a significant period of time--in one case, 16 years. 

Conclusions: 

On the whole, SSA has taken many steps to align its policies with court 
decisions and establish uniform national standards. The fact that the 
agency made some substantial changes to its policies in the mid-1990's 
may account for the reduced incidence of acquiescence rulings in the 
past 5 years. 

On the other hand, the high proportion of remanded and awarded claims 
for the past decade has likely cost SSA additional time and resources 
to process, and may have impeded the timely award of benefits to 
eligible individuals. While the DSI improvement initiative is designed 
to ameliorate this problem, the lack of reliably collected and well- 
managed data on court remands is likely to inhibit that effort. 
Although SSA plans, through the implementation of DSI, to gradually 
address the heavy workload that has been cited by many for contributing 
to errors that lead to remands, the agency cannot pinpoint specific 
reasons for remands and take corrective action without more reliable 
data. To the degree that the agency does collect some data, the fact 
that collection is carried out by two different offices risks 
inconsistency and divergent interpretations. This lack of complete and 
consistent information ultimately undermines the agency's ability to 
serve people with disabilities and their families. 

Recommendations: 

To ensure the agency has accurate and well-managed information to use 
in identifying corrective actions for reducing remands, we recommended 
that the Commissioner of SSA implement the following two measures: 

* take steps to ensure the reliability of data on reasons for remands, 
and: 

* coordinate agency data collection on remands and ascertain how best 
to use this information to reduce the proportion of cases remanded by 
federal courts. 

Agency Comments: 

SSA provided us with comments on a draft of this report, which we have 
reprinted in appendix VI. In its comments, SSA agreed with both of our 
recommendations for improving data on remands and outlined actions it 
plans to take to enhance data reliability and collection. Specifically, 
in an upcoming update to the Case Processing Management System, SSA 
plans to make the reasons for remands a mandatory data input field. In 
addition, SSA plans to establish an intercomponent work group to 
address issues related to remand data, and analyze data on the use of 
the Findings Integrated Templates and court decisions. 

SSA also provided technical comments which generally improved the 
accuracy of the report, and we have incorporated them as appropriate. 

Copies of this report are being sent to the Commissioner of SSA, 
appropriate congressional committees, and other interested parties. The 
report is also available at no charge on GAO's Web site at 
http://www.gao.gov. 

Please contact me on (202) 512-7215 if you or your staff has any 
questions concerning this report. Contact points for our Offices of 
Congressional Relations and Public Affairs may be found on the last 
page of this report. Other major contributors to this report are listed 
in appendix VII. 

Signed by: 

Daniel Bertoni: 
Director, Education, Workforce, and Income Security Issues: 

[End of section] 

Appendix I: Objective, Scope, and Methodology: 

We designed our study to obtain information on (1) the trends of the 
past decade in the number of appeals reviewed by the district courts 
and their decisions; (2) the reasons for court remands and factors that 
may contribute to the incidence of those remands; and (3) SSA's process 
for responding to appellate court decisions that conflict with agency 
policy and the agency's response in recent years. To obtain information 
on these issues, we collected relevant quantitative and qualitative 
data from SSA; interviewed SSA officials and stakeholders within and 
outside the agency, such as district court judges, claimant 
representatives and experts; and reviewed agency policies and 
regulations that address appellate court rulings that conflict with SSA 
disability program policies. To determine the completeness and accuracy 
of data we obtained, we took steps, described below, and determined 
that these data, with the exception of reasons for remand, were 
sufficiently reliable for use in this report. We conducted this work 
between February 2006 and January 2007 according to generally accepted 
government auditing standards. 

To address the first research objective, we obtained national data from 
SSA on the number and decisions of cases reviewed by federal district 
courts--the first level of federal court review--for fiscal years 1995 
to 2005 and analyzed these data for trends over time. Our analysis 
excluded cases that were dismissed because dismissals are generally 
decided on technical and procedural grounds rather than on the merits 
of the claim. For fiscal year 2005, the only year for which complete 
data were available, we obtained information from SSA on court 
decisions by state. We then categorized and analyzed these data by 
circuit. Furthermore, we obtained and analyzed agency data on the 
decisions SSA made on disability cases after they were remanded (i.e., 
allowances or denials of claims) for fiscal years 1995 to 2005. We also 
categorized and analyzed these data by circuit using information on the 
claimant's state of residence. SSA officials were interviewed to gather 
information on potential reasons for any trends. In addition, we 
interviewed SSA officials and reviewed previously issued agency reports 
and data manuals to assess the reliability of these data. 

To address the second objective, we also obtained data on cited reasons 
for remands from two SSA databases, the Case Processing and Management 
System (CPMS), and the National Docketing/Management Information System 
(NDMIS), which are maintained by two separate offices in SSA 
responsible for re-adjudicating remanded cases and litigating claims in 
court. We compared the data to determine how and what SSA is reporting 
on reasons for remands within the agency. After interviewing agency 
officials and reviewing reports, we determined that these data were not 
sufficiently reliable for providing detailed information on reasons for 
remands, although some information was used to illustrate what SSA 
currently collects. In addition, we interviewed SSA officials and other 
stakeholder groups, including federal court judges and claimant 
representatives from the Seventh and Ninth circuits and experts, on 
reason for remands and factors that influenced them. Stakeholders from 
these two circuits were selected because these jurisdictions represent 
those with the lowest and highest numbers of SSA policy changes 
resulting from acquiescence rulings. Information from these interviews 
is not generalizable to all circuits or stakeholders. 

For the third objective, we interviewed SSA officials and obtained 
available documents on how SSA determines whether a court of appeals 
decision conflicts with its policies and what option to pursue to 
address conflicting decisions, e.g., appeal or issue an acquiescence 
ruling whereby the agency agrees to abide by the court judgment in 
future cases, albeit only in that jurisdiction. We also obtained data 
on the number of acquiescence and other rulings that SSA issued since 
establishing its policy of acquiescence in 1990. For acquiescence 
rulings, we further reviewed SSA's timeliness in issuing acquiescence 
rulings as well as the number issued by circuit and how SSA replaced 
acquiescence rulings with nationwide policies. We were unable to 
independently determine the extent to which court decisions conflicted 
with SSA policy or whether SSA should have pursued one option over 
another. We also interviewed SSA officials and relevant stakeholders, 
including selected federal court judges and claimant representatives, 
to obtain information on how court decisions and their related agency 
rulings have affected SSA disability adjudication policy in recent 
years. 

[End of section] 

Appendix II: Summary of Process Unification Rulings: 

* SSR 96-1p: "Application by the Social Security Administration of 
Federal Circuit Court and District Court Decisions." Policy 
interpretation stating that SSA decision-makers will be bound by SSA's 
nationwide policy until an acquiescence ruling is issued and that SSA 
does not acquiesce to federal district courts within a circuit. 

* SSR 96-2p: "Giving Controlling Weight to Treating Source Medical 
Opinions." Policy guidance for applying the regulatory provision that 
requires the adoption of a treating source's medical opinion on the 
nature and severity of an impairment when the opinion is not 
inconsistent with other substantial evidence in the claimant's file and 
the opinion is supported by medically acceptable diagnostic techniques. 

* SSR 96-3p: "Considering Allegations of Pain and Other Symptoms in 
Determining Whether a Medically Determinable Impairment is Severe." 
Policy interpretation on the consideration of symptoms in determining 
whether an impairment is "severe" at step 2 of the sequential 
evaluation process. 

* SSR 96-4p: "Symptoms, Medically Determinable Physical and Mental 
Impairments, and Exertional and Nonexertional Limitations." Policy 
interpretation explaining, among other things, that symptoms are not 
medically determinable impairments; that limitations, not impairments, 
are categorized as "exertional" or "nonexertional"; and that symptoms 
may result in nonexertional or exertional limitations. 

* SSR 96-5p: "Medical Source Opinions on Issues Reserved to the 
Commissioner." Policy interpretation on evaluating medical source 
opinions on issues such as whether an individual's impairment(s) meets 
or is equivalent in severity to the requirements of a listing in SSA's 
Listing of Impairments; what an individual's residual functional 
capacity is; whether an individual's residual functional capacity 
prevents him from doing past relevant work; and how the vocational 
factors of age, education, and work experience apply. 

* SSR 96-6p: "Consideration of Administrative Findings of Fact by State 
Agency Medical and Psychological Consultants and Other Program 
Physicians and Psychologists at the ALJ and Appeals Council Levels of 
Administrative Review; Medical Equivalence." Policy interpretation 
regarding weight given to Disability Determination Services level 
medical and psychological consultant findings at the ALJ and Appeals 
Council levels. Explanation of requirements for ALJs and the Appeals 
Council to obtain the opinion of a physician or psychologist designated 
by the Commissioner in making a determination about equivalence to the 
listings. 

* SSR 96-7p: "Evaluation of Symptoms in Disability Claims: Assessing 
the Credibility of an Individual's Statements." Policy interpretation 
on when the evaluation of symptoms, including pain, requires a finding 
about the credibility of an individual's statements about pain and 
symptoms, and the factors to be considered in assessing the credibility 
of such statements. 

* SSR 96-8p: "Assessing Residual Functional Capacity in Initial 
Claims." Policy clarification of the term residual functional capacity 
and discussion of the elements considered in assessing residual 
functional capacity. 

* SSR 96-9p: "Determining Capability to Do Other Work--Implications of 
a Residual Functional Capacity for Less Than a Full Range of Sedentary 
Work." Policy interpretation on the impact of a residual functional 
capacity assessment for less than a full range of sedentary work on an 
individual's ability to do other work. 

[End of section] 

Appendix III: Key Federal Court Rulings on Social Security 
Administration Disability Adjudication: 

1983: 

Heckler v. Campbell, 461 U.S. 458 (1983) The U.S. Supreme Court upheld 
SSA's use of its vocational grid regulations. 

1984: 

Hyatt v. Heckler, 579 F.Supp. 985 (W.D.N.C. 1984) In a class action, 
the U.S. District Court for the Western District of North Carolina 
found SSA's policy on pain contrary to Fourth Circuit law. This ruling 
enjoined SSA from refusing to follow the law of the circuit. 

Lopez v. Heckler, 725 F.2d 1489 (9th Cir. 1984) The Ninth Circuit Court 
of Appeals enjoined SSA to uphold prior decisions requiring SSA to 
apply a medical improvement standard before terminating benefits. 

1985: 

Stieberger v. Heckler, 615 F.Supp. 315 (S.D.N.Y. 1985) In a class 
action, the U.S. District Court for the Southern District of New York 
ruled that SSA had violated the rights of claimants by not following 
circuit court law on the weight to give treating physician evidence. 
After this decision SSA introduced its policy of Acquiescence Rulings 
when the agency is not willing to implement an appellate decision 
nationwide. Acquiescence rulings explain how SSA applies decisions of 
Courts of Appeals in the circuit in which the decision was rendered. 

1986: 

Schisler v. Heckler, 787 F.2d 76 (2nd Cir. 1986) The Second Circuit 
Court of Appeals found that a treating physician's opinion on the 
subject of medical disability is binding unless contradicted by 
substantial evidence. 

1989: 

Hyatt v. Heckler, 711 F.Supp. 837 (W.D.N.C. 1989) On remand, the U.S. 
District Court for the Western District of North Carolina found SSA's 
policies on pain did not conform to circuit law. The court ordered 
these policies to be cancelled and drafted a new ruling on pain for 
North Carolina adjudicators. 

1990: 

Sullivan v. Zebley, 493 U.S. 521 (1990) The U.S. Supreme Court struck 
down SSA's regulations for determining whether a child is disabled 
because the regulations denied benefits to children whose impairments 
did not meet or equal the listing of impairments and did not allow the 
child to qualify for benefits based on an individualized functional 
assessment. 

1993: 

Schisler v. Sullivan, 3 F.3d. 563 (2nd Cir. 1993) The Second Circuit 
Court of Appeals upheld SSA's 1991 regulations on the opinions of 
treating physicians as a valid use of SSA's regulatory power. 

1994: 

Hyatt class action settlement SSA agreed to re-adjudicate 77,000 cases 
under the 1991 regulations on the evaluation of pain and other 
symptoms. 

2002: 

Barnhart v. Walton, 535 U.S. 212 (2002) The U.S. Supreme Court upheld 
SSA's interpretation that the claimant's inability to work last, or be 
expected to last, 12 months. The court also upheld SSA's regulation 
precluding a finding of disability when the claimant returns to work 
within a 12-month period. 

2003: 

Barnhart v. Thomas, 540 U.S. 20 (2003) The U.S. Supreme Court upheld 
denial of benefits to a claimant who was still able to do her previous 
work without determining whether that type of work continued to be 
available in the national economy. 

[End of section] 

Appendix IV: Additional Information on Disability Appeals: 

Appeals Council denials of Social Security disability claims increased 
by about 36 percent from about 48,300 in Fiscal Year 1994 to about 
65,800 in Fiscal Year 2004. 

Figure 12: Appeals Council Denials of Social Security Claims, Fiscal 
Year 1994 to Fiscal Year 2004: 

[See PDF for image] 

Source: GAO analysis of SSA data. 

[End of figure] 

SSA decisions on disability claims following remands from federal 
district courts increased from about 3,000 in Fiscal Year 1995 to 
almost 7,500 in Fiscal Year 2005. 

Figure 13: SSA Decisions on Disability Claims Following Court Remands: 

[See PDF for image] 

Source: GAO analysis of SSA data. 

[End of figure] 

The twelve judicial circuits with district courts that review Social 
Security disability claims varied in the number of claims they reviewed 
in Fiscal Year 2005. For example, the District of Columbia District 
Court reviewed less than 100 claims, while the district courts in the 
Ninth Circuit reviewed almost 3,000. 

Figure 14: Social Security Claims Reviewed in Federal District Courts 
in Fiscal Year 2005 by Judicial Circuit: 

[See PDF for image] 

Source: GAO analysis of SSA data. 

[End of figure] 

[End of section] 

Appendix V: Summary of Court Holdings for Acquiescence Rulings Related 
to Disability Determinations: 

Acquiescence ruling number and circuit: AR 90-3 (4th Circuit); 
Rescinded?: X; 
Court holding: The court held that social security regulations allow 
the use of a vocational expert only at step five of the sequential 
evaluation process; and therefore, reliance on a vocational expert is 
improper in making the step four determination as to whether a claimant 
can return to past relevant work. 

Acquiescence ruling number and circuit: AR 90-4 (4th Circuit); 
Rescinded?: [Empty]; 
Court holding: The court held that SSA can re-open an otherwise final 
administrative determination at any time when a claimant, who had no 
individual legally responsible for prosecuting the claim at the time of 
the prior determination, established a prima facie case that mental 
incompetence prevented him from understanding the procedure to request 
administrative review, unless SSA holds a hearing and determines that 
mental incompetence did not prevent the claimant from filing a timely 
appeal. 

Acquiescence ruling number and circuit: AR 91-1 (5th Circuit); 
Rescinded?: [Empty]; 
Court holding: The court held that entitlement to a subpoena for cross-
examination purposes of an examining physician is automatic and must be 
granted. 

Acquiescence ruling number and circuit: AR 92-2 (6th Circuit); 
Rescinded?: [Empty]; 
Court holding: The court held that in deciding the appeal of a 
determination that an individual's disability has medically ceased, the 
adjudicator must consider the issue of the individual's disability 
through the date of the Secretary of Health and Human Services' final 
decision, rather than only through the date of the initial cessation 
determination. 

Acquiescence ruling number and circuit: AR 92-4 (11th Circuit); 
Rescinded?: X; 
Court holding: The court held that an Appeals Council dismissal of a 
request for review of an ALJ decision for reasons of untimeliness is a 
"final decision" and subject to judicial review. 

Acquiescence ruling number and circuit: AR 92-6 (10th Circuit); 
Rescinded?: X; 
Court holding: The court held that a person's return to substantial 
gainful activity within 12 months of the onset date of his or her 
disability, and prior to an award of benefits, does not preclude an 
award of benefits and entitlement to a trial work period. 

Acquiescence ruling number and circuit: AR 92-7 (9th Circuit); 
Rescinded?: [Empty]; 
Court holding: The court held that an initial determination in the 
Social Security or SSI programs must be reopened when the notice of the 
initial determination did not explicitly state that the failure to seek 
reconsideration results in a final determination, and the claimant did 
not pursue a timely appeal. 

Acquiescence ruling number and circuit: AR 93-1 (4th Circuit); 
Rescinded?: X; 
Court holding: The court held that a claimant for disability or SSI 
benefits who has an IQ score in the range covered by listing 12.05C and 
who cannot perform his or her past relevant work because of a physical 
or other mental impairment has per se established the additional and 
significant work-related limitation of function requirement. 

Acquiescence ruling number and circuit: AR 93-2 (2nd Circuit); 
Rescinded?: X; 
Court holding: The court held that, in making a determination following 
an individual's re-entitlement period that an individual with a 
disabling impairment has engaged in substantial gainful activity, the 
Secretary of Health and Human Services may not consider work and 
earnings by the individual in a single month rather than an average of 
work and earnings over a period of months. 

Acquiescence ruling number and circuit: AR 94-2 (4th Circuit); 
Rescinded?: X; 
Court holding: The court held that, in making a disability 
determination on a subsequent disability claim with respect to an un-
adjudicated period, an adjudicator must adopt a finding regarding a 
claimant's residual functional capacity, made in a final decision on a 
prior disability claim arising under the same title of the Social 
Security Act unless there is new and material evidence. 

Acquiescence ruling number and circuit: AR 95-1 (6th Circuit); 
Rescinded?: X; 
Court holding: The court held that, in order to find that the skills of 
a claimant who is close to retirement age are "highly marketable" 
within the meaning of the Secretary of Health and Human Services' 
regulations, SSA must first establish that the claimant's skills are 
sufficiently specialized and coveted by employers as to make the 
claimant's age irrelevant in the hiring process and enable the claimant 
to obtain employment with little difficulty. 

Acquiescence ruling number and circuit: AR 97-2 (9th Circuit); 
Rescinded?: X; 
Court holding: The court held that a claimant for Disability Insurance 
or SSI benefits based on disability who has an amputation of a lower 
extremity and cannot afford the cost of a prosthesis has an impairment 
that meets the listings. 

Acquiescence ruling number and circuit: AR 97-4 (9th Circuit); 
Rescinded?: [Empty]; 
Court holding: The court held that, in making a disability 
determination on a subsequent disability claim with respect to an un-
adjudicated period, where the claim arises under the same title of the 
Social Security Act as a prior claim on which there has been a final 
decision by an ALJ or the Appeals Council that the claimant is not 
disabled, SSA must: (1) apply a presumption of continuing nondisability 
and, if the presumption is not rebutted by the claimant, determine that 
the claimant is not disabled; and (2) if the presumption is rebutted, 
adopt certain findings required under the applicable sequential 
evaluation process for determining disability, made in the final 
decision by the ALJ or the Appeals Council on the prior disability 
claim. 

Acquiescence ruling number and circuit: AR 98-1 (8th Circuit); 
Rescinded?: X; 
Court holding: The court held that a person's return to substantial 
gainful activity within 12 months of the onset date of his or her 
disability, and prior to an award of benefits, does not preclude an 
award of benefits and entitlement to a trial work period. 

Acquiescence ruling number and circuit: AR 98-2 (8th Circuit); 
Rescinded?: X; 
Court holding: The court held that a claimant for Disability Insurance 
benefits or SSI benefits based on disability who has mental retardation 
or autism with a valid IQ score in the range covered by Listing 12.05C 
and who cannot perform his or her past relevant work because of a 
physical or other mental impairment has per se established the 
additional and significant work-related limitation of function 
requirement of the regulations. 

Acquiescence ruling number and circuit: AR 98-3 (6th Circuit); 
Rescinded?: [Empty]; 
Court holding: The court held that, in making a disability 
determination or decision on a subsequent disability claim with respect 
to an un-adjudicated period, where the claim arises under the same 
title of the Social Security Act as a prior claim on which there has 
been a final decision by an ALJ or the Appeals Council, SSA must adopt 
the finding of the demands of a claimant's past relevant work made in 
the prior decision unless new and material evidence or changed 
circumstances provide a basis for a different finding. 

Acquiescence ruling number and circuit: AR 98-4 (6th Circuit); 
Rescinded?: [Empty]; 
Court holding: The court held that in making a disability determination 
or decision on a subsequent disability claim with respect to an un-
adjudicated period, where the claim arises under the same title of the 
Social Security Act as a prior claim on which there has been a final 
decision by an ALJ or the Appeals Council, SSA must adopt the finding 
of a claimant's residual functional capacity made in the final decision 
by the ALJ or the Appeals Council on the prior disability claim unless 
new or additional evidence or changed circumstances provide a basis for 
a different finding. 

Acquiescence ruling number and circuit: AR 99-2 (8th Circuit); 
Rescinded?: X; 
Court holding: The court held that SSA is required to find that a 
claimant close to retirement age and limited to sedentary or light work 
has "highly marketable" skills before determining that the claimant has 
transferable skills and, therefore, is not disabled. 

Acquiescence ruling number and circuit: AR 99-3 (5th Circuit); 
Rescinded?: X; 
Court holding: The court held that SSA is required to find that a 
claimant close to retirement age and limited to sedentary or light work 
has "highly marketable" skills before determining that the claimant has 
transferable skills and, therefore, is not disabled. 

Acquiescence ruling number and circuit: AR 99-4 (11th Circuit); 
Rescinded?: [Empty]; 
Court holding: The court held that an Appeals Council dismissal of a 
request for review of an ALJ decision for reasons of untimeliness is a 
"final decision" and subject to judicial review. 

Acquiescence ruling number and circuit: AR 00-1 (4th Circuit); 
Rescinded?: [Empty]; 
Court holding: The court held that, in making a disability 
determination on a subsequent disability claim with respect to an un-
adjudicated period, SSA must consider a finding of a claimant's 
residual functional capacity made in a final decision by an ALJ or the 
Appeals Council on the prior disability claim as evidence and give it 
appropriate weight in light of all relevant facts and circumstances but 
that SSA does not have to adopt the finding. 

Acquiescence ruling number and circuit: AR 00-2 (7th Circuit); 
Rescinded?: X; 
Court holding: The court held that a determination of medical 
equivalence under the regulations must be based solely on evidence from 
medical sources. 

Acquiescence ruling number and circuit: AR 00-3 (10th Circuit); 
Rescinded?: X; 
Court holding: The court held that an ALJ, when receiving evidence from 
a vocational expert must ask the expert how the testimony or 
information corresponds to information provided in the Dictionary of 
Occupational Titles and must ask the expert to explain the difference 
if the testimony or evidence differs from the Dictionary. 

Acquiescence ruling number and circuit: AR 00-4 (2nd Circuit); 
Rescinded?: X; 
Court holding: The court held that SSA has the burden of proving at 
step five of the sequential evaluation process that the claimant has 
the residual functional capacity to perform other work which exists in 
the national economy. 

Acquiescence ruling number and circuit: AR 00-5 (6th Circuit); 
Rescinded?: [Empty]; 
Court holding: The court held that a claimant's return to substantial 
gainful activity within 12 months of the alleged onset date of his or 
her disability, and prior to an award of benefits, does not preclude an 
award of benefits and entitlement to a trial work period. 

Acquiescence ruling number and circuit: AR 01-1 (3rd Circuit); 
Rescinded?: [Empty]; 
Court holding: The court held that SSA may not apply the Medical-
Vocational Guidelines (grid rules) as a frame work to deny disability 
benefits at step 5 of the sequential evaluation process when a claimant 
has a nonexertional limitation without either: (1) taking or producing 
vocational evidence; or (2) providing notice of the agency's intention 
to take official notice of the fact that the particular nonexertional 
limitation does not significantly erode the occupational job base. 

Acquiescence ruling number and circuit: AR 03-1 (7th ); 
Rescinded?: [Empty]; 
Court holding: The court held that for cases concerning Listings 12.05 
or 112.05 decided by ALJs or the Appeals Council before September 20, 
2000, which have been remanded by the courts to SSA, the ALJ should 
apply the pre-September 20, 2000 version of the Listing as interpreted 
by the Seventh Circuit. 

Acquiescence ruling number and circuit: AR 04-1 (9th Circuit); 
Rescinded?: [Empty]; 
Court holding: The court held that for certain applicants under age 18, 
ALJs and Administrative Appeals Judges must make reasonable efforts to 
ensure that a qualified pediatrician or other specialist evaluates the 
case. 

Source: Applicable appellate court decisions and GAO analysis. 

[End of table] 

[End of section] 

Appendix VI: Comments from the Agency: 

Social Security: 
The Commissioner: 

March 13, 2007: 

Mr. Dan Bertoni, 
Director, Education, Workforce, and Income Security Issues: 
U.S. Government Accountability Office: 
441 G Street, NW: 
Washington, D.C. 20548: 

Dear Mr. Bertoni: 

Thank you for the opportunity to review and comment on the Government 
Accountability Office (GAO) draft report, "Disability Programs: SSA 
Needs to Manage Data Better on Court Cases Requiring Re-adjudication" 
(GAO-07-331). The attached comments provide specific responses to the 
recommendations and identify technical corrections that should be made 
to enhance the accuracy of the report. 

If you have any questions, please contact Ms. Candace Skurnik, 
Director, Audit Management and Liaison Staff, at (410) 965-4636. 

Sincerely, 

Signed by: 

Michael J. Astrue: 

Enclosure: 

We are in the process of reevaluating DSI and looking at more direct 
ways to reduce backlogs. Your analysis will be helpful to that effort--
thanks!  

Social Security Administration: 
Baltimore MD 21235-0001: 

Comments On The Government Accountability Office (GAO) Draft Report, 
"Disability Programs: SSA Needs To Manage Data Better On Court Cases 
Requiring Re-Adjudication" (GAO-07-331): 

Thank you for the opportunity to review and comment on the draft 
report. Generally we agree with the report's findings and 
recommendations. We appreciate your acknowledgement that, over the 
years, the Social Security Administration (SSA) has collected reliable 
data that identified the number of cases being processed by the Agency, 
including the number of cases being processed after remand. It also 
correctly concludes that, until recently, we did not systematically 
collect information regarding the specific reasons that cases were 
remanded by the Federal courts. 

Regarding the differences in remand data provided by the Office of 
Disability Adjudication and Review (ODAR) and the Office of the General 
Counsel (OGC), we offer the following explanation: 

In March 2005, ODAR implemented the new Case Processing Management 
System (CPMS). CPMS is a web-based, user-friendly system that provides 
significant case processing and workload management enhancements for 
ODAR. Among other things, the new system features interactive screens, 
a secure and centralized repository of data, improvements in hearing 
scheduling capabilities, and hyperlinks to reference material, as well 
as interfaces with other SSA systems. While the system contains a 
"reason for remand" data field, the current release does not require a 
remand field entry. As indicated in our response to recommendation 
number 1 below, the CPMS update, scheduled for June 2007, will require 
a mandatory input of the remand reason codes on all pending Appeals 
Council and court remands. This will provide more complete data for 
analysis as to why cases are remanded from this system. 

In March 2006, OGC began collecting more explanatory data about remand 
reasons. The system allows for the collection of multiple reasons, 
which explains why GAO found that the number of reasons exceeded the 
number of remand cases. OGC has been using the information collected in 
that system for a number of purposes, including working with individual 
hearing offices (HO) under ODAR to alert them to some of the issues 
being raised by the courts, providing training at the national level to 
new Administrative Law Judges (ALJ), and augmenting the arguments we 
make in our briefs to address the courts' concerns. Since the OGC 
system is so new, a standardized procedure for validating the data on a 
regular basis is not currently in place. 

In summary, we recognize the need to establish an accurate and 
consistent management information system to manage our remand case 
workloads and we fully support GAO's recommendations. Below you will 
find a description of the actions we plan to take to address the 
specific recommendations. We are also providing some technical comments 
that we believe will enhance the accuracy of the report. 

Recommendation 1: 

The Commissioner of Social Security should take steps to ensure the 
reliability of data on reasons for remands. 

Response: 

We agree. An update of the CPMS, scheduled for June 2007, will require 
a mandatory input of the "remand reason" codes on all pending Appeals 
Council and court remands. This will provide more complete data for 
analysis as to why cases are remanded. In addition we will continue to 
enhance CPMS to collect data on the Disability Service Improvement 
(DSI) workload, including Decision Review Board remands processed in 
the HO. 

We are also forming an intercomponent workgroup, which will include 
ODAR and OGC, to outline a plan to ensure the reliability of remand 
data, to coordinate the collection of remand data, and to improve the 
legal sufficiency of hearing decisions to reduce the proportion of 
cases remanded by the courts. 

Recommendation 2: 

The Commissioner of Social Security should coordinate data collection 
on remands and ascertain how to best use the data. 

Response: 

We agree. As noted above, the intercomponent workgroup will coordinate 
an Agency plan for data collection and use of the data to reduce the 
proportion of cases remanded by the courts. 

In an effort to further enhance the consistency of our decisions and 
minimize the number of remands, we have implemented the Findings 
Integrated Templates (FIT). Preliminary data from the Appeals Council 
for February 2006 through December 2006, relative to the implementation 
of FIT for drafting ALJ decisions, suggests a direct correlation 
between the increased usage of FIT and the improvement in quality and 
legal sufficiency of AU decisions. We have just begun to receive court 
decisions involving FIT opinions and it is too early in the process to 
make any definitive determinations concerning remand rates at that 
level. We will continue to monitor the FIT/non-FIT remand rates at the 
Appeals Council and in the courts. Additionally, it should be noted 
that the system release, scheduled for June 2007, will provide 
enhancements to the FIT program including a user option to retrieve 
Acquiescence Rulings (AR) for a particular Federal court circuit. 

[End of section] 

[See PDF for image] 

[End of figure] 

[End of section] 

Appendix VII: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Daniel Bertoni, (202) 512-7215, bertonid@gao.gov: 

Staff Acknowledgments: 

Robert E. Robertson (Director), Michele Grgich (Assistant Director), 
Danielle Giese (Analyst-in-Charge), Susan Bernstein, Candace Carpenter, 
Joy Gambino, Suneeti Shah, Albert Sim, Ellen Soltow and Rick Wilson 
made significant contributions to this report. Luann Moy, Vanessa 
Taylor, and Walter Vance provided assistance with research methodology 
and data analysis. Daniel Schwimer provided legal counsel. 

[End of section] 

Related GAO Reports: 

Social Security Administration: Agency Is Positioning Itself to 
Implement Its New Disability Determination Process, but Key Facets Are 
Still in Development. GAO-06-779T. Washington, D.C.: June 15, 2006. 

Social Security Administration: Administrative Review Process for 
Adjudicating Initial Disability Claims. GAO-06-640R. Washington, D.C.: 
May 16, 2006. 

High-Risk Series: An Update. GAO-05-207. Washington, D.C.: January 
2005. 

SSA's Disability Programs: Improvements Could Increase the Usefulness 
of Electronic Data for Program Oversight. GAO-05-100R. Washington, 
D.C.: December 10, 2004. 

Social Security Administration: More Effort Needed to Assess 
Consistency of Disability Decisions. GAO-04-656. Washington, D.C.: July 
2, 2004. 

Social Security Administration: Strategic Workforce Planning Needed to 
Address Human Capital Challenges Facing the Disability Determination 
Services. GAO-04-121. Washington, D.C.: January 27, 2004. 

Social Security Disability: Disappointing Results from SSA's Efforts to 
Improve the Disability Claims Process Warrant Immediate Attention. GAO- 
02-322. Washington, D.C.: February 27, 2002. 

Standards for Internal Control in the Federal Government. GAO/AIMD-00- 
21.3.1 Washington, D.C.: November 1999. 

FOOTNOTES 

[1] For a child to be considered disabled and therefore eligible for 
SSI, the child must have a physical or mental condition, or a 
combination of conditions, that results in marked and severe functional 
limitations. The child's condition or conditions must have lasted, or 
be expected to last, at least 12 months or be expected to result in 
death. 

[2] Children who receive SSI are also subject to a re-determination of 
their eligibility at age 18. 

[3] As a part of the Disability Service Improvement process, SSA is 
gradually implementing changes to the appeals process, starting with 
the Boston regional office in August 2006. 

[4] The court may also modify SSA's decision. According to SSA 
officials, modified decisions are generally remanded to the agency and 
are therefore classified as remands. 

[5] Court remanded cases are generally re-adjudicated by ALJs but may 
also be reviewed by the Appeals Council. 

[6] When a case reaches the federal courts, SSA is generally 
represented by U.S. Attorneys working for the Department of Justice 
(DOJ). 

[7] The Social Security Advisory Board is a bipartisan board that 
provides advice to the President, Congress, and the Commissioner of 
Social Security on matters related to Social Security and SSI. For more 
information about the Board's report, see Daub, Hal et al., Improving 
the Social Security Administration's Hearing Process, (Washington, 
D.C.: September 2006). 

[8] An exception is district court decisions involving class action 
lawsuits, since these decisions apply to multiple individuals that may 
reside in other circuits. 

[9] The agency adopted the policy in 1985, but established regulations 
explaining how it would implement this policy in 1990. 

[10] See GAO, Social Security Administration: Agency Is Positioning 
Itself to Implement Its New Disability Determination Process, but Key 
Facets Are Still in Development, GAO-06-779T (Washington, D.C.: June 
15, 2006). 

[11] For more information on internal control standards, see GAO, 
Standards for Internal Control in the Federal Government, GAO/ AIMD-00-
21.3.1 (Washington: D.C.: November 1999) and Office of Management and 
Budget, Circular No. A-123, Management's Responsibility for Internal 
Control (Washington: D.C.: Dec. 21, 2004). 

[12] GAO found that the number of claims that were denied by the 
Appeals Council and eligible for appeal to the courts increased from 
fiscal years 1994 to 2004 by about 36 percent. (See app. IV, fig.12.) 
We are providing information on Appeals Council decisions over a 
slightly earlier period than district court data to account for the 
time lag between Appeals Council and district court decisions. 

[13] The courts reviewed approximately 132,000 claims over this period, 
and of these claims, about 7 percent were dismissed. 

[14] For example, in fiscal year 2005, ALJs issued 524,362 decisions. 

[15] However, because claimants may not appear as scheduled at hearings 
and SSA officials may not always be able to schedule this many cases, 
ALJs on average reviewed about 35 cases per month in fiscal year 2006. 

[16] Disability decisions are typically written by SSA decision- 
writers, who follow ALJ instructions on supporting the conclusion and 
citing pertinent evidence or testimony. 

[17] Specifically in fiscal year 2005, ODAR data listed 7,244 cases as 
being remanded but 4,668 reasons for remands. In fiscal year 2006, the 
data listed 6,290 cases as being remanded and 5,434 reasons for 
remands. 

[18] For nondisability issues, OGC works in conjunction with the 
appropriate component, such as the Office of Income Security Policy. 

[19] SSA may also ask the original panel of circuit court judges to 
rehear an issue, or ask the entire U.S. Court of Appeals to rehear an 
issue(s) en banc. 

[20] One way SSA interprets policies is to issue Social Security 
Rulings, which may be based on case decisions made at all 
administrative levels of adjudication, federal court decisions, 
Commissioner's decisions, opinions of OGC, and other policy 
interpretations of the law and regulations. Our analysis showed that of 
SSA's 68 Social Security Rulings issued since 1990, 24 percent were 
based on court decisions. About half of these rulings are related to 
disability issues. 

[21] Other circumstances leading to rescission of an acquiescence 
ruling include a Supreme Court decision overruling or limiting a 
circuit court holding that is the basis of an acquiescence ruling; a 
circuit court overruling or limiting itself on an issue that was the 
basis of an acquiescence ruling; or enactment of a federal law that 
removes the basis for the holding in a decision of a circuit court that 
was the subject of an acquiescence ruling. See 20 CFR 404.985 (e). 

[22] Although Social Security Rulings do not have the force and effect 
of law or regulations, they are binding on all components of SSA. 

[23] See appendix IV, figure 14 for more information on caseloads by 
circuit. 

[24] According to our analysis, 27 of the 45 rulings relate directly to 
determining whether a claimant is eligible for disability benefits. As 
indicated in appendix V, more than half (15 of 27) of these 
acquiescence rulings were rescinded. 

[25] SSA may re-litigate the case within the same circuit when the 
General Counsel of SSA, in consultation with DOJ, concurs that re- 
litigation of an issue is appropriate and SSA has published a notice in 
the Federal Register of its intent to re-litigate an acquiescence 
ruling issue. In addition, SSA may re-litigate a case when one of the 
following events occurs: an action by both Houses of Congress indicates 
that an appellate court decision was decided inconsistently with 
congressional intent, a statement in a majority opinion of the same 
circuit indicates that a court might no longer follow its previous 
decision, subsequent appellate court precedent in other circuits 
supports SSA's interpretation of the Social Security Act or 
regulations, or a subsequent Supreme Court decision presents a 
reasonable legal basis for questioning the appellate court decision. 

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