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Pursuant to a congressional request, GAO reviewed the Social Security Administration's (SSA) decisionmaking process for disability determinations and efforts to improve the process, focusing on: (1) factors that contribute to differences between disability determination services' (DDS) and administrative law judges' (ALJ) decisions; and (2) SSA's actions to make decisions in initial and appealed cases more consistent.

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Recommendations for Executive Action

Agency Affected Recommendation Status
Social Security Administration 1. SSA is beginning to implement initiatives to reduce inconsistent decisions between DDSs and ALJs, realizing that the lengthy and complicated decisionmaking process and inconsistent decisions between adjudicative levels compromise the integrity of disability determinations. SSA should take immediate steps and be accountable for ensuring that they are implemented as quickly as feasible. For example, using available quality assurance systems, SSA should move quickly ahead to improve feedback to adjudicators at all levels. In addition, to better ensure that adjudicators review the same record, the agency should increase the number of cases it plans to return to DDSs when new evidence is submitted on appeal.
Closed - Implemented
SSA issued regulations that established quality assurance procedures to help identify and resolve differences in how policies are understood and implemented at the different adjudication levels. SSA began reviewing claims using the new procedures and established a goal of reviewing 10,000 cases annually. SSA issued instructions requiring its hearing offices to return appealed cases that had new medical evidence introduced to the DDSs, where medical experts would evaluate and reexamine cases. According to SSA, it was not able to achieve its original estimate of the number of appealed cases returned to DDSs because hearing offices generally received new medical evidence too late to warrant returning the case. SSA decided to combine this initiative with other initiatives in its Hearings Process Improvement (HPI) plan issued in August 1999. The goals of the HPI plan are to reduce hearing office processing time, increase productivity, and enhance customer service.
Social Security Administration 2. Given the magnitude and seriousness of the problem, the Commissioner of Social Security should, under the Results Act, articulate the process unification results that the agency hopes to achieve and establish a performance goal by which it could measure and report its progress in shifting the proportion of cases awarded from the ALJ to the DDS level.
Closed - Not Implemented
The primary action recommended is included in a more recent GAO report. In March 12, 1999, GAO recommended that SSA develop a comprehensive set of performance goals and measures to assess and monitor changes in the disability claims process (see HEHS-99-25). Since the prior recommendation to set performance goals and measures for SSA's process unification initiative is included in this more recent recommendation, separate tracking of the prior recommendation is no longer necessary.

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