	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. 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. 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. 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. 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. 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. Moreover, we found that the timeliness of  acquiescence rulings had improved since 1998, when SSA established a  timeliness goal of 120 days. 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. In  addition, we interviewed SSA officials and reviewed previously issued  agency reports and data manuals to assess the reliability of these data. We compared the data to determine how and  what SSA is reporting on reasons for remands within the agency.
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. 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.