Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI): Proposed Changes to the Disability Determination and Appeals Processes

Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI): Proposed Changes to the Disability Determination and Appeals Processes

Order Code RL33179
CRS Report for Congress
Received through the CRS Web
Social Security Disability Insurance (SSDI) and
Supplemental Security Income (SSI): Proposed
Changes to the Disability Determination and
Appeals Processes
Updated April 24, 2006
Scott Szymendera
Analyst in Social Security
Domestic Social Policy Division
Congressional Research Service ˜ The Library of Congress

Social Security Disability: Proposed Changes to the
Disability Determination and Appeals Processes
Summary
The Social Security Administration (SSA) maintains multi-stage determination
and appeals processes for applications to the Social Security Disability Insurance
(SSDI) and Supplemental Security Income (SSI) programs. These processes begin
with an initial determination of disability by a state agency, followed by multiple
opportunities for administrative appeals. Unsuccessful applicants are also entitled
to appeal their decisions to the federal courts.
These processes have been criticized by the SSA, the Social Security Advisory
Board, the Governmental Accountability Office, and others for the timeliness of the
final decision, for rendering initial decisions that are reversed on appeal, and for
inconsistency across states.
In response to these criticisms, the SSA recently proposed changes to the
disability determination and appeals processes. These changes would allow clearly
disabled applicants to get a final decision in 20 days and would bring in-line and end-
of-line quality reviews into the processes. The reconsideration stage would be
replaced with a review by a federal official and the Appeals Council would be
replaced by a board that would review cases likely to contain errors.
Critics of these reforms have expressed concerns that the changes would put
additional procedural burdens on persons with disabilities and make it more difficult
for them to navigate the system and have all of the evidence in support of their cases
heard.
On March 31, 2006, the SSA issued final rules governing the disability
determination and appeals processes. These final rules will go into effect in the SSA
Boston region on August 1, 2006, with a national implementation expected after a
period of at least one year. The final rules deviate only slightly from the proposed
rules. For a complete overview and analysis of the final rules, see CRS Report
RL33374, Social Security Disability Insurance (SSDI) and Supplemental Security
Income (SSI): The Disability Determination and Appeals Process, by Scott
Szymendera.

Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Social Security Disability Insurance and Supplemental Security Income . . . . . . . 3
The Disability Determination and Appeals Processes . . . . . . . . . . . . . . . . . . . . . . 4
Initial Determination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Hearings and Appeals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Reconsideration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Administrative Law Judge Hearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Appeals Council . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Federal Courts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Issues Surrounding the Current Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Timeliness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Inconsistency Across States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Proposed Changes to the Disability Determination and Appeals Processes . . . . 14
Timetable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Proposed Quick Disability Determination (QDD) . . . . . . . . . . . . . . . . . . . . 14
Proposed Federal Expert Unit (FEU) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Proposed Initial Disability Determination . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Proposed Federal Reviewing Official (RO) . . . . . . . . . . . . . . . . . . . . . . . . . 15
Proposed Closing of the Record After the ALJ Hearing . . . . . . . . . . . . . . . 15
Proposed Decision Review Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Proposed Judicial Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Issues Surrounding the Proposed Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Proposed Additional Time Limits for Applicants . . . . . . . . . . . . . . . . . . . . 17
Proposed Evidentiary Time Limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Proposed Changes to the Right of a Claimant to Have a Case
Reopened After an ALJ Decision . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Proposed Replacement of the Appeals Council with the Decision
Review Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Rights of Claimants to Appeal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Own Motion Authority of the SSA . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Evidence Rules and Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Final Rules and Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
List of Figures
Figure 1. The Five-Step Disability Determination Process . . . . . . . . . . . . . . . . . 5
Figure 2. SSDI and SSI Appeals, FY2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Figure 3. Average Case Processing Times, FY2004 . . . . . . . . . . . . . . . . . . . . . . 11
Figure 4. Proposed Disability Determination and Appeals Processes . . . . . . . . 22
List of Tables
Table 1. Reason for Final Medical Allowance, 2002 . . . . . . . . . . . . . . . . . . . . . . 6
Table 2. Reason for Final Medical Denial, 2002 . . . . . . . . . . . . . . . . . . . . . . . . . 7
Table 3. Allowance Rates at Each Adjudicative Level, 2002 . . . . . . . . . . . . . . . . 9
Table 4. State Variation in Disability Allowance and Reversal Rates, 2000 . . . 13
Table 5. State Variation in Disability Examiner Pay and Productivity . . . . . . . . 13

Social Security Disability: Proposed
Changes to the Disability Determination and
Appeals Processes
Introduction
This report explains the large and complex system used by the Social Security
Administration (SSA) to determine eligibility for disability benefit programs and to
adjudicate disputes that arise from these determinations. Persons with disabilities in
each congressional district are affected by this system. In addition, the fact that
initial decisions are often reversed on appeal and the length of the appeals process
places burdens on the Social Security Disability Insurance Trust Fund and the general
revenue of the United States.
The disability determination and appeals processes used by the SSA have been
called the “largest system of administrative adjudication in the Western world.”1 In
Fiscal Year (FY) 2004, the SSA and its network of state disability determination
services processed more than 2.4 million initial Social Security Disability Insurance
(SSDI) applications and more than 2.2 million applications for Supplemental
Security Income (SSI) benefits. That same year, the 944 SSA Administrative Law
Judges issued rulings on 495,029 appeals of initial disability determinations and the
SSA Appeals Council ruled on 97,701 appeals of Administrative Law Judge
decisions.2
The number of cases appealed, and the number of these cases that result in a
reversal of the initial determination, indicate that in many cases, persons with
disabilities who meet the statutory eligibility requirements for the SSDI or SSI
programs may not receive the benefits to which they are entitled. These claimants
are then forced into the complex and multi-layered appeals system with its own
procedural rules and quasi-judicial framework. For some applicants, a final decision
on their claim can take several years.
Decisions that are reversed on appeal and the length and complexity of the
appeals process increase the administrative costs paid by the SSA. In the case of
SSDI applicants, these costs are paid out of the Social Security Disability Trust Fund
and are funded by payroll taxes whereas SSI administrative costs come from the
general revenue of the United States. In FY2005, SSDI administrative costs are
1 Lance Liebman, Disability Appeals in Social Security Programs (Washington: Federal
Judicial Center, 1985), p. 1.
2 Social Security Administration, Annual Statistical Supplement to the Social Security
Bulletin, 2005, 2005, pp. 2. F5, 2.F6, 2.F8, 2.F9, 2.F11.

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budgeted to be 2.6% of benefit payments whereas SSI administrative costs are
budgeted to be 7.8% of benefit payments.3
The number of initial decisions reversed on appeal and the length and
complexity of the disability appeals process also have a public policy impact. In
establishing the SSDI and SSI programs, Congress set requirements for program
participation and the receipt of benefits and charged the SSA with the task of
providing that persons who meet these standards are given the benefits to which they
are entitled. However, in many cases, this is either not occurring or occurring only
after a lengthy delay and deserving beneficiaries, who by the very nature of their
disability and work status are often among the least well-off in society, are forced to
navigate a long and difficult process to receive their benefits. In other cases, persons
who do not meet the statutory definition of disability are receiving benefits because
of inaccurate determinations or appellate decisions.
To best provide readers with an understanding of the current disability
determination and appeals processes as well as the changes to these processes
proposed by the SSA, this report is organized into the following five major sections:
! The first section is an overview of the SSDI and SSI programs;
! The second section describes, in detail, the current disability
determination and appeals processes;
! The third section provides a discussion of the issues surrounding
these processes that have been raised by observers;
! The fourth section describes, in detail, the changes to these systems
proposed by the SSA; and
! The final section provides a discussion of some of the issues raised
regarding these proposed changes.
On March 31, 2006, the SSA issued final rules governing the disability
determination and appeals processes. These final rules will go into effect in the SSA
Boston region on August 1, 2006, with a national implementation expected after a
period of at least one year. The final rules deviate only slightly from the proposed
rules. For a complete overview and analysis of the final rules, see CRS Report
RL33374, Social Security Disability Insurance (SSDI) and Supplemental Security
Income (SSI): The Disability Determination and Appeals Process, by Scott
Szymendera.
3 Data taken from the Social Security Administration FY2005 President’s Budget, available
at [http://www.ssa.gov/budget/FactCard2005.pdf].

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Social Security Disability Insurance and
Supplemental Security Income
The SSA administers two programs, SSDI and SSI, that provide income and
benefits to persons unable to work because of serious disabling conditions.4 In both
programs, disabled individuals must pass the same statutory test of disability as
outlined in Titles II and XVI of the Social Security Act.5
The SSDI program pays benefits to disabled individuals under the provisions
of Title II of the Social Security Act. SSDI benefits are paid to those who meet the
statutory test of disability and have completed a five-month waiting period from the
onset of disability.6 Program beneficiaries must have a sufficient work history in
employment covered by Social Security to qualify for benefits.7 Benefits and
administrative costs are paid out of the Social Security Disability Insurance Trust
Fund, which is funded by a portion of the payroll taxes collected on earnings. There
is no means test for the SSDI program. The SSDI program pays monthly benefits
based on past earnings and, after two years, participants are eligible to receive
Medicare hospitalization insurance (Part A) and purchase Medicare supplemental
insurance (Part B) or enroll in a Medicare Advantage Plan.8
Under the provisions of Title XVI of the Social Security Act, disabled
individuals and those 65 and older are entitled to benefits from the SSI program if
they meet the statutory test of disability and have income and assets that fall below
levels set by program guidelines. SSI benefits are paid out of the general revenue of
4 For more information on the SSDI and SSI programs, see CRS Report RL32279, Primer
on Disability Benefits: Social Security Disability Insurance (SSDI) and Supplemental
Security Income (SSI), by April Grady and Julie M. Whittaker.
5 42 U.S.C. §§ 423(d)(1) and 1382c. A person is disabled under the terms of the statute if
he or she is unable to engage in any Substantial Gainful Activity (SGA, for 2005 earnings
of $830 per month for non-blind persons and $1,380 per month for blind persons) because
of a medically determinable physical or mental impairment. This impairment must be
expected to result in the impaired person’s death, or be expected to last at least 12
consecutive months. In addition, this impairment must prevent a person from engaging in
his or her previous work or in any other work that exists in the national economy. The
Supreme Court held in Barnhart v. Thomas 124 S. Ct. 376 (2003) that the previous work test
does not require that an individual’s prior job exists in the national economy.
6 For more information on the five-month waiting period, see CRS Report RS22220, Social
Security Disability Insurance: The Five-Month Waiting Period for SSDI Benefits, by Scott
Szymendera.
7 A detailed explanation of the insurance requirements can be found at [http://www.ssa.gov/
dibplan/dqualify3.htm] and in CRS Report RL32279, Primer on Disability Benefits: Social
Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), by April
Grady and Julie M. Whittaker.
8 For more information, see CRS Report RS22195, Social Security Disability Insurance
(SSDI) and Medicare: The 24-Month Waiting Period for SSDI Beneficiaries Under Age of
65, by Julie M. Whittaker.

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the United States and all participants receive the same basic monthly benefit.9 In
most states, adults who collect SSI are automatically entitled to coverage under the
Medicaid health insurance program.10
The Disability Determination and
Appeals Processes
Decisions on applications to SSDI and SSI require that evaluations be made
about the severity of reported disabling conditions. These tasks are complicated by
the fact that scholars and advocates continue to struggle to define the concept of
disability, the nature of impairment, and how different conditions can limit essential
life and work activities.11 This differs from the Social Security retirement program,
which needs only to confirm an applicant’s age and insured status before paying out
benefits.
Initial Determination
The disabled worker submits an application to the SSA. The evaluation of
disability takes place in the appropriate state Disability Determination Services
(DDS) office. The DDS is a state agency with state employees who evaluate SSDI
and SSI applications according to federal guidelines. The DDS determines whether
someone is disabled according to a five-step sequential evaluation process. Current
work activity, severity of impairment, and vocational factors are assessed in that
order. An applicant may be denied benefits at any step in the sequential process even
if the applicant may meet a later criterion. For example, a worker that meets the
medical listings for disability but earns an amount exceeding the Substantial Gainful
Activity (SGA) earnings limit would be denied benefits at Step 1. The five steps are
as follows and are depicted in Figure 1.
9 The basic monthly federal benefit amount for 2005 is $579 for a single person and $869
for a couple. This amount is supplemented by 44 states and the District of Columbia.
Arizona, Georgia, Kansas, Mississippi, the Commonwealth of the Northern Mariana Islands,
Tennessee, and West Virginia do not offer a state supplement. A participant in the SSI
program receives the federal benefit amount, plus any state supplement, minus any
countable income. SSI benefits are not available to residents of Puerto Rico, Guam, or the
United States Virgin Islands. Residents of these jurisdictions are eligible to receive federal
benefits from their commonwealth or territorial government under provisions of Title XIV
and Title XVI of the Social Security Act. These benefits are administered by the
Department of Health and Human Services.
10 Thirty-nine states, the District of Columbia, and the Commonwealth of the Northern
Mariana Islands grant Medicaid eligibility to all adult SSI recipients, or have Medicaid
eligibility rules that are the same as those of the SSI program. For more information, see
[http://www.ssa.gov/work/ResourcesToolkit/Health/medicaid.html].
11 For an overview of this debate, see Barbara M. Altman, “Disability Definitions, Models,
Classification Schemes, and Applications,” in Gary L. Albrecht, Katherine D. Seelman, and
Michael Bury, Handbook of Disability Studies (Thousand Oaks, CA: Sage Publications,
2001).

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! Step 1. Work test. Is the individual working and earning over SGA?
If yes, the application is denied. If no, the application moves to Step
2.
! Step 2. Severity test. Is the applicant’s condition severe enough to
limit basic life activities for at least one year? If yes, the application
moves to Step 3. If not, the application is denied.
! Step 3. Medical listings test. Does the condition meet SSA’s
medical listings, or is the condition equal in severity to one found on
the medical listings?12 If yes, the application is accepted and
benefits are awarded. If no, the application moves to Step 4.
! Step 4. Previous work test. Can the applicant do the work he or she
had done in the past? If yes, the application is denied. If not, the
application moves to Step 5.13
! Step 5. Any work test. Does the applicant’s condition prevent him
or her from performing any other work that exists in the national
economy? If yes, the application is accepted and benefits are
awarded. If no, the application is denied.
Figure 1. The Five-Step Disability Determination Process
Source: The Congressional Research Service (CRS).
12 The medical listings can be found in the Social Security Administration publication
Disability Evaluation Under Social Security, available at [http://www.ssa.gov/disability/
professionals/bluebook/Entire-Publication1-2005.pdf]. This publication is commonly
referred to as the SSA Blue Book. (Hereafter cited as SSA Blue Book.)
13 Cases of children applying for SSI benefits are not subject to the work test but instead to
a test of functional capacity.

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Meeting or exceeding the medical listings is the most common reason why
applications to the SSDI and SSI programs are accepted. In 2002, over 44% of SSDI
applicants and 53% of SSI applicants were admitted to the disability rolls because of
successfully meeting the medical listing test (Step 3 of the five step evaluation
process). Among those denied entry into the programs, the most common reason was
for failing the any work test found in Step 5 with over 30% of all SSDI denials and
24% of all SSI denials occurring at this stage.14 Table 1 summarizes the reasons for
final medical allowances. For example, 37.3% of those admitted into the SSDI
program met the severity of the medical listings and an additional 7% of those
admitted were judged to have a condition that is equal in severity to one found in the
medical listings.
Table 1. Reason for Final Medical Allowance, 2002
(by year of application)
Medical and
Equals
Meets Severity
Vocational
Program
Severity of
Otherb
of Listings
Factors
Listingsa
Combined
Social Security Disability
37.3%
7.0%
38.9%
16.8%
Insurance (SSDI)
Supplemental Security Income
38.8%
15.7%
24.4%
21.0%
(SSI)
Source: Table prepared by the Congressional Research Service (CRS) from data provided by Social
Security Administration, Annual Statistical Report on the Social Security Disability Insurance
Program, 2003, 2004, p. 137; SSI Annual Statistical Report, 2003, 2004, p. 123.
a. Includes SSI child cases that functionally equal the level of severity of listings.
b. Includes cases in which a disability was previously established or for which no information is
available.
Table 2 summarizes the reasons for final medical denials. For example, 16.9%
of those denied entry into the SSDI program were denied because their impairments
were not judged to be sufficiently severe.
14 Social Security Administration, Annual Statistical Report on the Social Security Disability
Insurance Program, 2003, 2004, pp. 137-138; SSI Annual Statistical Report, 2003, 2004,
pp. 123-124.

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Table 2. Reason for Final Medical Denial, 2002
(by year of application)
Impairment
Impairment
Able to
Did Not or Is
Does Not
Able to
Impairment
Do Other
Program
Not Expected
Cause Severe
Do past
Otherc
Not Severe
Type
to Last 12
Functional
Workb
Workb
Months
Limitationsa
Social Security
Disability
9.1%
16.9%
—
27.9%
30.2%
16.0%
Insurance (SSDI)
Supplemental
Security Income
5.8%
12.6%
17.8%
15.7%
24.2%
23.9%
(SSI)
Source: Table prepared by the Congressional Research Service (CRS) from data provided by Social
Security Administration, Annual Statistical Report on the Social Security Disability Insurance
Program, 2003 (Washington: GPO, 2004), p. 138; SSI Annual Statistical Report, 2003 (Washington:
GPO, 2004), p. 125.
a. Used only for SSI applicants under the age of 18.
b. Applies only to SSI applicants over the age of 18 and all SSDI applicants.
c. Includes cases denied for reasons of substance abuse, cases in which an applicant did not supply
sufficient information or failed to cooperate with regulations, cases in which an applicant
returned to work during processing, and cases denied for unspecified reasons.
Hearings and Appeals
Applicants to the SSI and SSDI programs who are dissatisfied with the decisions
of the DDS may appeal their cases. In FY2004, approximately 63% of applications
to the SSI and SSDI programs were denied and nearly 35% of those denied filed an
appeal of their denial.15 The appeals process begins with a reconsideration of the
decision, followed by an Administrative Law Judge hearing, a decision by the
Appeals Council, and a hearing in the federal court system.
Reconsideration. After the initial denial by the DDS, an applicant may ask
for a reconsideration by a different DDS officer in his or her state. During this first
appellate stage, the entire application and record of the applicant is reviewed as if it
were a new case. The SSA is currently running a prototype project in 10 states that
eliminates this reconsideration step.16 In FY2004, approximately 14% of cases
reconsidered by the DDS resulted in a reversal of the previous denial of benefits.
Administrative Law Judge Hearing. If the applicant is not satisfied with
the decision at the reconsideration stage, he or she may ask for a hearing before an
SSA Administrative Law Judge (ALJ) within 60 days of the reconsideration decision.
15 Data taken from the website of the Social Security Administration and available at
[http://www.ssa.gov/disability/disability_process_welcome_2004.htm].
16 The Disability Redesign Prototype began in 1999 and is currently operating statewide in
Alabama, Alaska, Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York
and Pennsylvania; and in the Los Angeles area of California.

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During this hearing, held either in person or via video conference, the applicant has
the opportunity to present his or her case and any evidence to support the appeal.
The SSA is not represented at this hearing and can not contest the applicant or the
evidence. Although a case is officially closed after the decision of the ALJ, the ALJ
does have some authority to reopen a case if new evidence is presented. In FY2004,
63% of cases heard by an ALJ resulted in a favorable decision for the claimant.
Appeals Council. The decision of the ALJ may be appealed by the applicant
to the SSA Appeals Council within 60 days. The Appeals Council may either review
a case or let the decision of the ALJ stand. The Appeals Council conducts a review
of the ALJ hearing and decision and though the applicant may be present and give
a statement, the Appeals Council does not conduct a formal hearing. The Appeals
Council can decide to let the previous decision stand, remand the case back to an ALJ
for a new decision, or reverse the decision of the ALJ. In FY2004, the Appeals
Council ruled on only 4% of all initial applications and awarded benefits in 25% of
these cases.
Federal Courts. The Appeals Council is the final administrative step in the
SSA appeals process. Applicants dissatisfied with the decision of the Appeals
Council or ALJ may file a case in the United States District Court within 60 days of
the decision; an unfavorable decision in the District Court can be appealed to the
United States Court of Appeals and United States Supreme Court. Less than 1% of
all applications for benefits end up in the federal court system and only a handful of
cases are appealed to the United States Court of Appeals.17 The last petition for the
writ of certiorari of a disability determination case granted by the United States
Supreme Court came in 2003 in the case of Barnhart v. Thomas, and the denial of
benefits in this case was upheld by the Court.18
Figure 2 summarizes the number of cases appealed at each stage of the process
and is based on aggregate data for FY2004. During this fiscal year, 37 out of every
100 applications resulted in a favorable decision at the initial determination stage of
the process. Of these 100 applicants, 22 appealed their initial denial to the
reconsideration stage where 3 applications were accepted. Of the initial 100
applicants, 19 appealed to the ALJ stage and 4 appealed to the Appeals Council.
Ultimately, of these 100 applications, 53 were awarded benefits, with 37 of those
awards coming at the initial determination stage, 3 at the reconsideration stage, 12
at the ALJ stage, and 1 at the Appeals Council stage.
17 Administrative Office of the United States Courts, Federal Judicial Caseload Statistics,
March 31, 2004, 2005, pp. 30-34, 43-44.
18 124 S. Ct. 376 (2003).

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Figure 2. SSDI and SSI Appeals, FY2004
100
90
37
80
70
Allowances
60
Cases
Denials
50
ge of
a
ent 40
c
Per
22 APPEAL
19 APPEAL
4 APPEAL
63
30
20
3
12
10
19
1
7
0
3
Initial Claims
Reconsiderations
Hearings
Appeals Council
Review
Source: The Congressional Research Service (CRS). Data taken from the SSA website at
[http://www.ssa.gov/disability/disability_process_welcome_2004.htm].
Note: Aggregate data for FY2004, not a tracking of individual cases.
Table 3 summarizes the allowance rate at each stage of the process for 2002.
During that year, nearly 78% of SSDI and just over 64% of SSI cases heard by ALJ’s
resulted in allowances.
Table 3. Allowance Rates at Each Adjudicative Level, 2002
ALJ Hearing
Program
Initial DDS
Reconsideration
and Above
Social Security Disability Insurance
38.2%
10.5%
77.9%
(SSDI)
Supplemental Security Income (SSI)
36.7%
10.1%
64.1%
Source: Table prepared by the Congressional Research Service (CRS) from data provided by Social
Security Administration, Annual Statistical Report on the Social Security Disability Insurance
Program, 2003, 2004, pp. 136-138; SSI Annual Statistical Report, 2003, 2004, pp. 117-119.

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Issues Surrounding the Current Processes
Researchers and others, including the nonpartisan Social Security Advisory
Board,19 have raised the following issues with respect to the disability determination
and appeals process:
! timeliness,
! accuracy, and
! national consistency of the decisions made.
In addition, the Commissioner of Social Security has testified about the
problems caused by the lack of timeliness and the number of initial decision reversed
on appeal in the current processes.20
Timeliness
Some observers, including the Social Security Advisory Board, are concerned
about the length of time involved in the entire disability determination and appeals
processes.21 In addition, the Government Accountability Office (GAO) and others
have commented that the length of the determination and appeals process is a
contributing factor to the historically low return to work rates of SSDI and SSI
beneficiaries.22 Although successful applicants can receive benefits retroactive to the
19 The Social Security Advisory Board was created in 1994 with the passage of the Social
Security Independence and Program Improvements Act of 1994, P.L. 103-296. The board
is made up of seven members who serve six year staggered terms. Three members of the
board are appointed by the President with the advice and consent of the Senate with no more
than two of these members being from the same political party. Two members, one from
each party are appointed by the President pro tempore of the Senate with the advice of the
chairman and ranking member of the Committee on Finance. Two members, one from each
party, are appointed by the Speaker of the House with the advice of the chairman and
ranking member of the Committee on Ways and Means.
20 U.S. Congress, House Committee on Ways and Means, Testimony Social Security
Commissioner, Jo Anne B. Barnhart, Social Security Administration’s Management of the
Office of Hearings and Appeals, hearings, 108th Cong. (2003).
21 General Accounting Office, SSA Disability Redesign: Focus Needed on Incentives Most
Crucial to Reducing Costs and Time, GAO /HEHS-97-20, 1997; General Accounting Office,
Social Security Disability: Disappointing Results from SSA’s Efforts to Improve the
Disability Claims Process Warrant Immediate Attention, 2002; Social Security Advisory
Board, How SSA’s Disability Programs Can be Improved, 1998.
22 Monroe Berkowitz, “Improving the Return to Work of Social Security Disability
Beneficiaries,” in Jerry L. Mashaw, et al., Disability Work and Cash Benefits (Kalamazoo,
MI: W. E. Upjohn Institute for Employment Research, 1996); Richard V. Burkhauser and
David Wittenburg, “How Current Disability Transfer Policies Discourage Work: Analysis
from the 1990 SIPP,” Journal of Vocational Rehabilitation, vol. 7 (1996), pp. 9-27; General
Accounting Office, SSA Disability: Program Redesign Necessary to Encourage Return to
Work, GAO/HEHS 96-62, 1996; General Accounting Office, Social Security: Disability
Programs Lag in Promoting Return to Work, GAO/HEHS-97-46, 1997; Joann Sim,
(continued...)

CRS-11
date of application, during the determination and appeals processes they are not
working and receive no medical or cash benefits through the SSDI or SSI programs.
In FY2004, applicants waited an average of 95 days for an initial determination
of their disability status from the state DDS agency. Reconsiderations by the DDS
took an average of 97 additional days. After requesting a hearing before an ALJ,
claimants waited an average of 394 days before getting a decision and the wait or a
decision from the Appeals Council took an average of 251 additional days. When
time spent on due process concerns and making appointments is included, a disability
claim that was considered at each stage of the determination and appeals processes
averaged 1,048 days to be resolved by the SSA.23
Figure 3. Average Case Processing Times, FY2004
1200
Total 1048 Days
1100
1000
Due
Process/Appointments
900
211 Days
800
Appeals Council
700
251 Days
S
Y
600
DA
500
400
ALJ Hearing 394 Days
300
200
Reconsideration 97
Days
100
Initial Decision 95
Days
0
Source: CRS figure from data provided by Social Security Administration, Fiscal Year 2004
Performance and Accountability Report (Washington: GPO, 2005), p. 17.
Note: Due Process/Appointments includes time taken by applicants to file appeals and make
appointments and can occur at any stage in the process.
22 (...continued)
“Improving Return-to-Work Strategies in the United States Disability Programs, With
Analysis of Program Practices in Germany and Sweden,” Social Security Bulletin, vol. 59,
no. 3 (1999), pp. 41-50.
23 Social Security Administration, Fiscal Year 2004 Performance and Accountability Report,
2005, p. 17.

CRS-12
Accuracy
Ensuring that initial and appellate disability decisions, both allowances and
denials, are accurate is one of the key goals identified by the SSA in its FY2004
Performance and Accountability Report. Using data from its own internal quality
assurance system, which re-examines a sample of decided cases, the SSA estimates
that 96.5% of initial disability determinations were accurate based on the evidence
presented at the time of the determination. The SSA also reports that the accuracy
rate for decisions made by Administrative Law Judges is 90%.24 Despite this
assertion, in 2003, Administrative Law Judges, the Appeals Council, and the Federal
Courts reversed initial decisions in over 78% of the SSDI cases they heard and 64%
of the SSI cases they heard.25 In many cases, this is due to additional evidence not
presented at the initial determination stage.
Some researchers have suggested that SSA disability decisions are not as
accurate as the agency claims they are. An external study commissioned by the SSA
in 1994 found serious flaws in the quality assurance process at the agency.26 In
addition, a 2004 report that used self-reported disability data to examine the accuracy
of initial and appellate decisions between 1992 and 1996 concluded that
approximately 20% of SSI and SSDI applicants from that time period who ultimately
received benefits were not disabled, while 60% of those ultimately denied benefits
were disabled.27
Inconsistency Across States
Initial disability determinations for SSDI and SSI applicants are made by
independent state DDS offices. Although these offices are funded by the SSA,
disability determinations are made by state employees. These state employees make
determination decisions based on the statutory definition of disability found in Titles
II and XVI of the Social Security Act and the Social Security publication Disability
Evaluation Under Social Security.28 Despite this federal guidance, the Social
Security Advisory Board has found inconsistencies across the states in
! DDS allowance rates;
24 Social Security Administration, FY2004 Performance and Accountability Report, 2005,
pp. 91-92.
25 Social Security Administration, Annual Statistical Report on the Social Security Disability
Insurance Program, 2003, 2004, pp. 134-136; SSI Annual Statistical Report, 2003, 2004,
pp. 117-122.
26 The Lewin Group, Inc., Paul Ettinger McCarthy Associates, L.L.C., and Cornell
University, Evaluation of SSA’s Disability Quality Assurance (QA) Processes and
Development of QA Options That Will Support the Long-Term Management of the Disability
Program: Final Report (Falls Church, VA: The Lewin Group, Inc., 2001).
27 Hugo Benitez-Silva, Moshe Buchinsky, and John Rust, How Large Are the Classification
Errors in the Social Security Awards Process?, National Bureau of Economic Research,
Working Paper no. 10219, 2004.
28 SSA Blue Book.

CRS-13
! rates of reversal of DDS decisions on appeal; and
! DDS employee pay and productivity.
Although there is evidence that disability rates vary by state, differences in the
reversal rates on appeal of state DDS decisions point to some inconsistencies at the
initial determination level.29 Data on state variation in DDS determinations and
reversal rates can be found in Table 4. For example, 59% of SSI applications were
approved in the initial decision stage by the DDS in New Hampshire, compared to
27% in West Virginia.
Table 4. State Variation in Disability Allowance and
Reversal Rates, 2000
SSI Initial Decision
SSDI Initial Decision
Administrative Law
Allowance Rate
Allowance Rate
Judge Reversal Rate
Highest state
59% (NH)
65% (NH)
86% (ME)
Median
39%
45%
66%
Lowest state
27% (WV)
31% (TX)
35% (DC)
Source: The Congressional Research Service (CRS). Data taken from Social Security Advisory
Board, Disability Decision Making, Data and Materials (Washington: GPO, 2001), pp. 51, 70.
Note: Reversal rates do not account for dismissed cases.
Table 5 provides data on DDS pay and productivity. In the table, disability
examiners in Connecticut were the highest paid in the country with average salaries
of $70,000.
Table 5. State Variation in Disability Examiner
Pay and Productivity
Average Disability Examiner
Decisions per Staff Year,
Annual Salary, FY1999
FY2000
Highest State
$70,000 (CT)
356 (MS)
National Average
$45,000
250
Lowest State
$30,000 (SD)
196 (MI)
Source: The Congressional Research Service (CRS). Data taken from Social Security Advisory
Board, Disability Decision Making, Data and Materials (Washington: GPO, 2001), pp. 64, 67.
Note: Decisions per staff year is calculated as total number of decisions made divided by the number
of employees.
29 John L. McCoy, Miles Davis, and Russell E. Hudson, “Geographic Patterns of Disability
in the United States,” Social Security Bulletin, vol. 57, no. 1, (1994), pp. 25-36; William J.
Nelson, Jr., “Disability Trends in the United States: A National and Regional Perspective,”
Social Security Bulletin, vol. 57, no. 3 (1994), pp. 27-41.

CRS-14
Proposed Changes to the Disability Determination
and Appeals Processes
On May 25, 2003, Commissioner of Social Security, Jo Anne B. Barnhart,
announced in testimony to the House Committee on Ways and Means that the SSA
would undertake fundamental reform of the disability determination and appeals
processes. This reform effort has two stated goals: (1) to make the right decision as
early in the process as possible; and (2) to foster return to work at all stages of the
process.30
After announcing this new reform effort, the Commissioner met with several
Members of Congress and organizations representing people with disabilities,
beneficiaries, claimants’ attorneys, and SSA and DDS employees. Based on these
meetings, the initial reform plan discussed in 2003 was slightly revised and new rules
were proposed. These proposed new rules would make a series of changes to the
current Social Security disability determination and appeals processes used by
applicants to the SSI and SSDI programs. Figure 4, in the Appendix, contains a
graphical overview of the proposed disability adjudication and appeals processes.
Timetable
The proposed changes to the disability determination and appeals processes
were formally introduced, in the form of a Notice of Proposed Rulemaking, in the
Federal Register on July 27, 2005. As required by the Administrative Procedures
Act,31 the SSA gave the public 90 days from the date of the NPRM to submit
comments on the rules. This public comment period ended on October 25, 2005. In
her hearing testimony, the Commissioner indicated that the SSA will review these
comments and expects to announce final rules that incorporate them sometime in
January, 2006. These rules would then be implemented during the Spring of 2006.
The NPRM states that this implementation would begin in one of the smaller of the
SSA’s geographical regions. The Commissioner testified that the SSA would wait
at least one year after implementation in one region before implementing the new
rules nationwide and would use this time to evaluate the impact of the new rules.
Each stage of the proposed new processes is discussed in detail below.
Proposed Quick Disability Determination (QDD)
All initial disability claims would be screened by the SSA, and those deemed
likely to meet the statutory definition of disability and to have readily available
supporting evidence would be transferred to a Quick Disability Determination (QDD)
unit established in each state. The unit would have 20 days to evaluate each case and
either award benefits or transfer the case back to the state DDS for standard
30 Testimony of Social Security Commissioner Jo Anne B. Barnhart, in U.S. Congress,
House Committee on Ways and Means, Social Security Administration’s Management of
the Office of Hearings and Appeals, hearings, 108th Cong., 1st sess., Sept. 25, 2003, Serial
No. 108-40 (Washington: GPO, 2003).
31 5 U.S.C. § 553.

CRS-15
processing. All positive determinations made by this unit would be made in
consultation with a medical or psychological expert who meets a set of standards
established by the SSA. This differs from the current process, which has no
expedited system for handling cases likely to meet the definition of disability.
Proposed Federal Expert Unit (FEU)
A Federal Expert Unit (FEU) would be established to assist with disability
determinations at all levels of the administrative process. The FEU would be
operated by the SSA and would oversee a national network of medical and vocational
experts that would meet specific standards set by the SSA. The FEU, or experts from
the national network, would serve as consultants at all levels of the administrative
process. Experts currently employed by DDS agencies would be eligible to join the
national network if they meet the standards set by the SSA. The goal of the FEU and
the national network is to ensure that decision-makers at all stages of the
determination and appeals processes have access to experts who meet one set of
consistent national standards. This differs from the current process in which each
DDS agency is free to use their own experts who do not have to meet any national
standards.
Proposed Initial Disability Determination
Cases not decided by the Quick Disability Determination Unit would be
processed by state disability determination services agencies. With the exception of
the assistance of the FEU, this process would remain unchanged.
Proposed Federal Reviewing Official (RO)
The current reconsideration step would be eliminated and replaced with a review
by a Federal Reviewing Official (RO). The RO would be a lawyer and an employee
of the SSA. An applicant dissatisfied with the decision of the state DDS would be
able to request a review by the RO. The RO would review the decision of the DDS
but would not hold a hearing or meet with the applicant in person. The RO could
collect evidence and order a consultative examination with the assistance of the FEU.
The RO could reverse, remand, modify, or affirm the decision of the DDS. In cases
where the RO would reverse the decision of the DDS, the evidence in the case would
have to be reviewed by the FEU. All decisions made by the RO would have to be in
writing and would be sent to the DDS and used by the SSA for quality control
purposes.
Proposed Closing of the Record After the ALJ Hearing
Applicants dissatisfied with the decision of the RO would continue to be able
to request a hearing before an ALJ. As is currently the case, this would be a de novo
hearing in which the applicant could bring forward any new evidence that he or she
feels is material. However, an applicant would be required to present all evidence
to the ALJ no later than 20 days before the date of the hearing. In most cases, the
decision of the ALJ would be final and would close the record. With limited
exceptions, no new evidence could be considered after the decision of the ALJ had

CRS-16
been made. The decision of the ALJ would have to be in writing and would have to
specify why the ALJ agrees or disagrees with the decision of the RO.
Proposed Decision Review Board
The Appeals Council would be eliminated and replaced by a Decision Review
Board made up of experienced ALJs and other adjudicators appointed to staggered
terms by the SSA. The Decision Review Board would not review cases decided by
ALJs on appeal, but would use a computer screening model to identify ALJ decisions
likely to contain errors or likely to result in a review by the federal courts. The
Decision Review Board would have the authority to affirm, modify, or reverse the
decisions of ALJs, even when those decisions were favorable to applicants. Cases
dismissed by the ALJ would be heard by the Decision Review Board on appeal
because these cases are not subject to review by the federal courts.32 The decision of
the Decision Review Board would be in writing and would specify the reasons for
the decision. The Decision Review Board would have 90 days to rule on any case.
After 90 days, if no ruling is made, the decision of the ALJ stands.
Proposed Judicial Review
A claimant dissatisfied with the decisions of either the ALJ or the Decision
Review Board would retain his or her current right to ask for a judicial review of the
SSA’s decision in the United States District Court. Claimants would have 90 days
from the date of the ALJ decision, rather than the current 60 days, to file for this
review.
Issues Surrounding the Proposed Rules
On September 27, 2005, the Subcommittees on Human Resources and Social
Security of the House Committee on Ways and Means held a joint hearing on the
proposed changes to the disability determination and appeals processes.33
Representatives from the judicial, disability advocacy, and legal communities
testified as to the strengths and weaknesses of the proposed changes.34 This
testimony, and the public statements of the groups, raised three dominant issues as
having the potential to negatively affect persons with disabilities as they navigate the
proposed determination and appeals processes. The issues include
32 The ALJ may make a decision on a case or dismiss it entirely. Dismissals can not be
appealed to the federal courts.
33 U.S. Congress, House Committee on Ways and Means, Subcommittee on Human
Resources and the Subcommittee on Social Security, Joint Hearing on Commissioner of
Social Security’s Proposed Improvements to the Disability Determination Process, 109th
Cong., 1st sess., Sept. 27, 2005 (not yet available).
34 A complete list of witnesses and copies of all testimony is available on the website of the
House Committee on Ways and Means at [http://waysandmeans.house.gov/hearings.asp?
formmode=detail&hearing=442&comm=4].

CRS-17
! the imposition of additional time limits on applicants;
! the closing of the record after the ALJ hearing; and
! the elimination of the Appeals Council.
Proposed Additional Time Limits for Applicants
The proposed rules include several binding time limits that applicants would
have to follow; otherwise, they would lose the right to pursue their appeals or present
evidence in support of their cases. Although these time limits are designed to shorten
the length of the appeals process, they could limit the current flexibility applicants
have to schedule hearings and prepare their cases. The National Organization of
Social Security Claimants’ Representatives (NOSSCR), a group that represents
lawyers who handle disability appeals, fears that these time limits could become
“procedural traps” for claimants who do not have legal representation.35
The proposed rules would add the following time limits:
! 10 days from the receipt of a notice of the date of an ALJ hearing to
object to the time or place of the hearing;36
! 10 days to object to the issues specified in the notice of the ALJ
hearing;37
! 20 days before the date of an ALJ hearing to request that witnesses
be subpoenaed;38
! 10 days to submit new evidence after the decision of the ALJ;39
! 10 days after a case is dismissed to ask the ALJ to vacate the
dismissal;40 and
! 10 days from the receipt of a notice that the Decision Review Board
will review a case to submit a written statement to the Decision
Review Board.41
None of the proposed time limits could be waived by an ALJ, and none of the
proposed rules include any provisions for a good cause or other extension.
35 National Organization of Social Security Claimants Representatives, NOSSCR Comments
on Proposed Changes to Disability Claim Review Process, Oct. 25, 2005, available on
NOSSCR’s website at [http://www.nosscr.org/NOSSCRdibfinal.pdf].
36 20 CFR § 405.317 (proposed in Administrative Review Process for Adjudicating Initial
Disability Claims, 70 Federal Register 43590, July 27, 2005).
37 Ibid.
38 20 CFR § 405.332 (proposed in Administrative Review Process for Adjudicating Initial
Disability Claims, 70 Federal Register 43590, July 27, 2005).
39 20 CFR § 405.373 (proposed in Administrative Review Process for Adjudicating Initial
Disability Claims, 70 Federal Register 43590, July 27, 2005).
40 20 CFR § 405.382 (proposed in Administrative Review Process for Adjudicating Initial
Disability Claims, 70 Federal Register 43590, July 27, 2005).
41 20 CFR § 405.425 (proposed in Administrative Review Process for Adjudicating Initial
Disability Claims, 70 Federal Register 43590, July 27, 2005).

CRS-18
Proposed Evidentiary Time Limit. In addition to the time limits mentioned
above, the new rules propose a time limit for the submission of evidence to an ALJ.
Section 205 of the Social Security Act provides that the decision of an ALJ shall be
made “on the basis of evidence adduced at the hearing.”42 Current regulations do not
specify any timetable for the submission of evidence and allow the ALJ to make a
judgement based on evidence presented before a hearing or during the hearing itself.
The proposed rules would require that all evidence be submitted by a claimant
no later than 20 days before the date of an ALJ hearing. Under this proposed rule,
a claimant would not be given the opportunity to present new evidence at the hearing
and evidence submitted after the 20-day deadline would not be considered unless the
ALJ believes that the claimant had good cause, as specified in the new rules, for
missing the deadline.
The Consortium for Citizens with Disabilities and NOSSCR both raised
concerns at the hearing that claimants could be penalized for an inability to gather
medical evidence in time, even if this delay was through no fault of their own.43 In
addition to the procedural burden this deadline might place on a claimant, NOSSCR
believes that this rule violates the “adducement” clause of the Social Security Act and
previous rulings of the United States Court of Appeals that have required ALJ’s to
fully develop the record of a case before making a decision.44
Proposed Changes to the Right of a Claimant to
Have a Case Reopened After an ALJ Decision
The new disability determination and appeals processes proposed in the NPRM
would significantly change the rights of claimants to have their cases reopened after
the decision of an ALJ, with the goal of bringing some finality to the administrative
phase of the appeals process. Several witnesses at the hearing testified as to the
hardship this could place on applicants who have legitimate claims for benefits but
who are unable to submit evidence in time to have it considered.45
42 405 U.S.C. 405(b)(1).
43 Statements of Marty Ford, Consortium for Citizens with Disabilities and Thomas D.
Sutton, National Organization of Social Security Claimants' Representatives, Commissioner
of Social Security’s Proposed Improvements to the Disability Determination Process, Joint
Hearing Before the Subcommittee on Human Resources and the Subcommittee on Social
Security, House Committee on Ways and Means, 109th Cong. (2005).
44 National Organization of Social Security Claimants Representatives, NOSSCR Comments
on Proposed Changes to Disability Claim Review Process, October 25, 2005, available on
NOSSCR’s website at [http://www.nosscr.org/NOSSCRdibfinal.pdf].
45 Statements of Marty Ford, Consortium for Citizens with Disabilities; Thomas D. Sutton,
National Organization of Social Security Claimants' Representatives; and Frank S. Bloch,
Vanderbilt University School of Law, Commissioner of Social Security’s Proposed
Improvements to the Disability Determination Process, Joint Hearing Before the
Subcommittee on Human Resources and the Subcommittee on Social Security, House
Committee on Ways and Means, 109th Cong. (2005).

CRS-19
Current Rules to Reopen a Case.46 Under the current rules, the decision
of the ALJ can be reopened either at the request of the SSA or the claimant. The
SSA or the claimant can request that an ALJ reopen a case for any reason if the
request is made within 12 months of the initial ALJ decision. In addition, the SSA
or the claimant can request that an ALJ reopen a case at any time, up to four years
after the initial decision, if there is good cause as defined in the regulations. “Good
cause” is defined as occurring when one of the following has occurred:
! New and material evidence is furnished;
! A clerical error in the computation of benefits was made; or
! The evidence clearly shows that an error was made.
Proposed Rules to Reopen a Case.47 The rules proposed by the SSA
would restrict the rights of claimants to request that cases be reopened after the
decision of the ALJ. Claimants would have a much shorter time in which to ask for
a reopening and would only be able to submit new evidence if their conditions
changed after the hearing. New evidence relating to a disability that existed at the
time of the hearing would not be sufficient to reopen a case.
Under the proposed rules, claimants would have 10 days from the date of the
ALJ decision to request that a case be reopened. In addition, the claimant must show
that one of the following circumstances has occurred:
! An unforeseen and material change in the applicant’s condition
between the end of the hearing and the date of the decision;
! At the hearing the ALJ allowed the applicant to submit evidence
after the decision; or
! The applicant had good cause for missing the deadline to submit
evidence to the ALJ.
For the purposes of this proposed rule, “good cause” is defined as occurring
when one of the following has occurred:
! The actions of the SSA were misleading;
! The applicant has a physical, mental, educational, or linguistic
limitation that would prevent a reasonable person from compliance;
or
! Some other unusual or unavoidable circumstance beyond the control
of the applicant prevented compliance.
Claimants unable to get their cases reopened by the ALJ would have to appeal
to the federal courts or reapply for benefits.
46 20 CFR §§ 404.987-404.989.
47 20 CFR §§ 405.20, 405.373 (proposed in Administrative Review Process for Adjudicating
Initial Disability Claims, 70 Federal Register 43590, July 27, 2005).

CRS-20
Proposed Replacement of the Appeals Council
with the Decision Review Board
The proposed rules would replace the existing Appeals Council with the
Decision Review Board and would limit the right of claimants to appeal decisions
made by ALJs to this new board, with the goal of bringing finality to the appeals
process after the decision of the ALJ. The Decision Review Board would retain the
own-motion authority to review favorable and unfavorable ALJ decisions.
The Judicial Conference of the United States, made up of federal judges, has
expressed concern that eliminating the Appeals Council will increase the number of
cases being filed in the United States District Courts. Because the federal courts lack
the specific expertise and experience in handling disability cases that the Appeals
Council has, the Conference recommends that the Appeals Council, in its current
form, be retained to serve as a final level of administrative appeal for claimants
dissatisfied with the decision of an ALJ.48
Rights of Claimants to Appeal.
Current Rules, the Appeals Council.49 Under the current rules, the final
administrative appeal offered to claimants is a review by the Appeals Council.
Claimants dissatisfied with the decision of an ALJ or with the dismissal of their case
by an ALJ have up to 60 days from the date of the decision to request a review of
their case by the Appeals Council. Unlike the ALJ, the Appeals Council is not
required to hear all appeals that are filed and can select the cases that it wishes to
consider.
Proposed Rules, the Decision Review Board.50 Under the proposed
rules, the Appeals Council would be replaced by a Decision Review Board, which
would constitute the final administrative appeal offered to claimants. However,
unlike the Appeals Council, claimants dissatisfied with the decision of an ALJ would
not have the right to request a review by the Decision Review Board. Only claimants
whose cases were dismissed by an ALJ would have the right to request a review.
Similar to the Appeals Council, the Decision Review Board would set its own docket
and not be required to rule on all cases presented to it on appeal.
48 Statement of the Honorable Judge Howard D. McKibben, Judicial Conference of the
United States, Commissioner of Social Security’s Proposed Improvements to the Disability
Determination Process, Joint Hearing Before the Subcommittee on Human Resources and
the Subcommittee on Social Security, House Committee on Ways and Means, 109th Cong.
(2005).
49 20 CFR §§ 404.911, 404.968.
50 20 CFR §§ 405.382, 405.405 (proposed in Administrative Review Process for
Adjudicating Initial Disability Claims, 70 Federal Register 43590, July 27, 2005).

CRS-21
Own Motion Authority of the SSA.
Current Rules, the Appeals Council.51 Under the current rules, the
Appeals Council has the authority to review cases that have not been appealed by
claimants. These cases can include decisions of an ALJ that were favorable to
claimants. However, in such cases, the claimant can be paid interim benefits while
the Appeals Council considers the case.
Proposed Rules, the Decision Review Board.52 Like the Appeals
Council, the Decision Review Board would have the authority to review ALJ
decisions, including those decisions that were favorable to claimants. However, no
provision exists in the proposed rules for interim payments to claimants while their
cases are being reviewed by the Disability Review Board.
Evidence Rules and Procedures.
Current Rules, the Appeals Council.53 Under the current rules, the
Appeals Council considers all evidence previously presented to the ALJ and any new
evidence that relates to the period before the ALJ hearing. Claimants may request
to appear before the Appeals Council and present an oral argument in support of their
case.
Proposed Rules, the Decision Review Board.54 Because the record is
considered closed after the decision of the ALJ, the Decision Review Board could
only consider evidence presented to the ALJ and could not consider new evidence.
Claimants would not be permitted to present an oral argument to the Decision
Review Board but could request permission to submit a brief written statement.
Final Rules and Implementation
On March 31, 2006, the SSA issued final rules governing the disability
determination and appeals processes. These final rules will go into effect in the SSA
Boston region on August 1, 2006, with a national implementation expected after a
period of at least one year. The final rules deviate only slightly from the proposed
rules. For a complete overview and analysis of the final rules, see CRS Report
RL33374, Social Security Disability Insurance (SSDI) and Supplemental Security
Income (SSI): The Disability Determination and Appeals Process, by Scott
Szymendera.
51 20 CFR § 404.969.
52 20 CFR §§ 405.410, 405.415 (proposed in Administrative Review Process for
Adjudicating Initial Disability Claims, 70 Federal Register 43590, July 27, 2005).
53 20 CFR § 404.976.
54 20 CFR § 405.425 (proposed in Administrative Review Process for Adjudicating Initial
Disability Claims, 70 Federal Register 43590, July 27, 2005).

CRS-22
Appendix
Figure 4. Proposed Disability Determination and
Appeals Processes
Medical
In
Review
-Line Q
no
u
a
lit
y
As
s
u
rance and/or En
d
-of-Line Q
u
a
lit
y
Co
n
trolW
ill Be
Us
appeal
e
d
At
All St
a
g
e
s
Source: The Social Security Administration, available at
[http://www.ssa.gov/disability-new-approach/NewApproachFlowchart.pdf].
Note: A detailed diagram of the existing determination and appeals processes is available on the SSA
website at [http://www.ssa.gov/disability/disability_process_files/od_process.pdf].