More recently, the Social Security Advisory Board issued a 2001 report  that identified many factors that could potentially affect the overall  consistency of disability decision making between adjudication levels. As a result,  some allowances at the hearings level could simply reflect the differing  judgments of two adjudicators reviewing a case. SSA Has Partially Implemented Its Process Unification Initiative

SSA has partially implemented its process unification initiative. Although  the agency initially made improvements in its policies and training  intended to improve the consistency of decisions between adjudication  levels, it has not continued to actively pursue these efforts. As part of the  initiative, the agency also implemented a review of ALJs’ allowance  decisions to identify additional ways to improve training and policies, but  no new changes were made as a result of findings from the review. Finally,  the agency also began two tests of process changes to help improve the  consistency of decisions, but one ongoing test with design problems is not  likely to lead to any conclusive results and the other test has been  abandoned. Stakeholder  groups representing DDS adjudicators told us that SSA’s training does not  sufficiently cover process unification issues. SSA’s Review of ALJ Allowances Has Not Resulted in Improvements to Policy and Training

As part of its initiative, the agency has also implemented a quality review  of ALJ decisions, but the review has not proved useful for identifying any  new changes to SSA’s policies or training that would help to address the  inconsistency of decisions. SSA Lacks a Clear Understanding of the Extent and Causes of Inconsistency between Levels

SSA’s assessments have not provided the agency with a clear  understanding of the extent and causes of possible inconsistencies in  decisions between adjudication levels. The two measures SSA uses to  monitor changes in the extent of inconsistency of decisions have  weaknesses and therefore do not provide a true picture of the changes in  consistency. In addition, SSA has not sufficiently assessed the causes of  possible inconsistency. The agency conducted an analysis in 1994 that  identified some potential areas of inconsistency. SSA’s Assessments Have Not Identified the Areas and Causes of Possible Inconsistency in Decisions between Adjudication Levels

Despite some efforts to assess inconsistency in decisions, shortcomings in  SSA’s analyses also limit its ability to identify areas and causes of possible  inconsistency. SSA expects to gain  some understanding of why about 60 percent of cases denied by the initial  level and appealed to the hearings level are allowed. SSA’s New Proposal Incorporates Efforts to Improve the Consistency of Decisions, but Challenges May Impede Successful Implementation

Some changes included in SSA’s new proposal to overhaul its disability  claims process may improve the consistency of DDS and ALJ decisions,  but challenges may hinder the implementation of the proposal. The Agency and Most Stakeholders Viewed Several Aspects of the New Proposal as Offering Promise for Improving Consistency

SSA told us that several aspects of the new proposal may improve the  consistency of decisions, and although opinions varied among stakeholder  groups, most thought the following four proposed changes have the  potential to improve the consistency of decisions between adjudication  levels: (1) requiring state adjudicators to more fully develop and document  their decisions, (2) centralizing the agency’s approach to quality control,  (3) providing both adjudication levels with equal access to more  centralized medical expertise, and (4) requiring ALJs to address agency  reports that either recommend denying the claim or outline the evidence  needed to fully support the claim. For example, initial claims for disability will  continue to be handled by SSA’s field offices.
Why GAO Did This Study

Each year, about 2.5 million people file claims with the Social Security Administration (SSA) for disability benefits. If the claim is denied at the initial level, the claimant may appeal to the hearings level. The hearings level has allowed more than half of all appealed claims, an allowance rate that has raised concerns about the consistency of decisions made at the two levels. To help ensure consistency, SSA began a "process unification" initiative in 1994 and recently announced a new proposal to strengthen its disability programs. This report examines (1) the status of SSA's process unification initiative, (2) SSA's assessments of possible inconsistencies in decisions between adjudication levels, and (3) whether SSA's new proposal incorporates changes to improve consistency in decisions between adjudication levels.

What GAO Found

SSA has only partially implemented its process unification initiative. Although the agency initially made improvements in its policies and training intended to address inconsistency in decisions made at the two adjudication levels, it has not continued to actively pursue these efforts. Further, as part of this initiative, the agency implemented a review of hearings level decisions to identify ways to improve training and policies, but no new improvements were made as a result of the review. Finally, the agency began tests of two process changes intended to improve the consistency of decision making between the two adjudication levels. One test, which is ongoing, was not well designed and therefore will not provide conclusive results. The other test was abandoned because of implementation difficulties. SSA's assessments have not provided a clear understanding of the extent and causes of possible inconsistencies in decisions between adjudication levels. The two measures SSA uses to monitor inconsistency of decisions have weaknesses, such as not accounting for the many factors that can affect decision outcomes, and therefore do not provide a true picture of the changes in consistency. Furthermore, SSA has not sufficiently assessed the causes of possible inconsistency. For example, SSA conducted an analysis in 1994 that identified potential areas of inconsistency, but it did not employ more sophisticated techniques--such as multivariate analyses, followed by in-depth case studies--that would allow the agency to identify and address the key areas and leading causes of possible inconsistency. SSA has yet to repeat or expand upon this 10-year-old study. SSA's new proposal incorporates changes intended to improve consistency in decisions between levels. However, challenges may hinder its implementation. Most stakeholder groups for adjudicators and claimant representatives told us that a number of aspects of the proposal hold promise for improving consistency. These included one change, being tested as part of the process unification initiative, that requires state adjudicators to more fully develop and document their decisions, as well as several new changes, such as providing both adjudication levels with equal access to medical expertise. However, stakeholder groups also told us that insufficient resources and other obstacles might hinder the implementation of some changes. Adding to uncertainties about the proposal's overall success is its dependence on a new electronic folder system that would allow cases to be easily accessed by various adjudicators across the country. However, this technically complex project has not been fully tested.