PROPOSED IMPROVEMENTS TO THE SOCIAL SECURITY DISABILITY PROGRAM

NOTICE OF PROPOSED RULEMAKING

THE NADE VIEW

After carefully reviewing the NPRM 20 CFR, Parts 404, 405, 416, and 422, NADE (National Association of Disability Examiners) is pleased to provide comments on the proposal to improve the accuracy, consistency, and timeliness of decision making throughout the disability determination process.

NADE is a professional association whose purpose is to promote the art and science of disability evaluation.  The majority of our members are employed by state Disability Determination Service (DDS) agencies and thus are on the “front-line” of the disability evaluation process.  However, our membership also includes SSA personnel, attorneys, physicians and claimant advocates.  It is the diversity of our membership, combined with our extensive program knowledge and “hands on” experience, which enables NADE to offer a perspective on disability issues which is both unique and pragmatic.

NADE agrees that changes in the disability determination process are needed to reduce processing time, particularly at certain steps in the process.  The processing delays of greatest concern currently occur in association with the appeals process at the Administrative Law Judge (ALJ) level.  It currently takes approximately 1,100 days to process an average claim for any individual who goes through every stage of the process.  This is unconscionable and certainly needs reform.  However, we would like to point out that only about 150 days of the current processing time take place in the DDS, yet the proposal appears to make the most changes at this step, by introducing quick decision units and eliminating the reconsideration step.  It is our belief that this proposal, as written, will do little to change the extensively long delays that occur when an individual submits a request for an administrative law judge hearing.  In fact, NADE believes that the insertion of two new federal bureaucracies – the Federal Expert Unit and the Reviewing Official – have the potential to significantly increase the amount of time it takes to arrive at a disability decision, especially at the first appeal step.

NADE members, whether in state DDSs, in SSA, or in the private sector, are deeply concerned about the integrity and efficiency of both the Social Security and Supplemental Security Income (SSI) disability programs.  Any change in the disability process must promote viability and stability in the program as well as maintain the integrity of the disability trust fund by providing good customer service.  At the same time, the trust fund must be protected against abuse.  Quality claimant service and lowered administrative costs should play key roles in the structure of any new disability claims process.  In order to rebuild public confidence in the program, the basic design of any new process should insure that the decisions made by all components and all adjudicators accurately reflect a determination that a claimant is truly disabled as defined by the Social Security Act.

For people with disabilities, it is crucial that SSA reduce any unnecessary delays and make the process more efficient.  Changes made must be practical and affordable, and they must be implemented in a manner that allows appropriate safeguards to assure that timely claimant service is improved.  NADE is not convinced that all parts of the proposed rule will achieve that end.  We are, in fact, concerned that some of the proposed changes will increase both administrative and programmatic costs.

For the past decade, SSA has attempted to redesign the disability claims process in an effort to create a new process that will result in more timely and accurate disability decisions.  Results of numerous tests undertaken by SSA to improve the disability process have not produced the results expected.

There is a pervasive public perception that “almost everyone” is denied disability benefits at the initial and reconsideration levels, and that claimants are found disabled only when they reach the Administrative Law Judge level of appeal.  This perception is totally inaccurate as SSA statistics show that 75-80 out of 100 disability beneficiaries were allowed benefits by the DDS.  Numerous references are made in the NPRM about “making the right decision as early in the process as possible.”  NADE certainly supports that goal, but we wish to point out that sometimes the right decision is a denial of benefits.

Quality/Consistency:

NADE strongly endorses the need for consistency and accuracy of decisions at all levels of the adjudicative process and supports increasing decisional accuracy and consistency in the program and accountability for the quality of disability decisions made by all adjudicators at every step in the process.  NADE strongly supports the emphasis on quality as described in the proposal, increasing accuracy and consistency in the program and insuring that the right determination is made as early as possible in the process.  There is a need for in-line and end-of line quality review at all levels of adjudication, including DDSs, ROs and ALJs.  Accountability and feedback at each level is crucial, including the Field Office.  However, the changes as proposed in the new rules do not go far enough to ensure decisional consistency.

Nationally uniform decisions with consistent application of policy at all adjudicative levels require a consistent and inclusive quality assurance (QA) review process.  A well-defined and implemented QA process provides an effective deterrent to mismanagement, fraud and abuse in the Social Security disability program.  A centralized quality review process of all components involved in disability adjudication would eliminate regional differences in the application of Social Security Administration policies from state to state and component to component.

However, as long as judicial review of disability appeals continue to occur in multiple district courts across the country, a bifurcated disability process will continue to exist as different DDSs, ROs and ALJs operate under different court rulings and regulations depending upon what part of the country the claimant lives in.  For this reason, NADE has long advocated establishment of a Social Security Court.  Both the Social Security and SSI disability programs provide a vital safety net for an extremely vulnerable population.  The accountability to SSA rules, regulations and procedures, should be reasonably and consistently applied at each level of the process.  This cannot be accomplished as long as different parts of the country operate under different rules.

In addition, as long as quality reviews of disability decisions are based on different evidentiary standards, it will be difficult, if not impossible, to achieve consistency in decision-making across all components.  Although the regulations stipulate that all components are to use a preponderance of evidence standard to adjudicate claims and arrive at a disability decision, only the DDSs and RO disability decisions will be reviewed using that standard.  The ALJ decisions will be reviewed using the substantial evidence standard.  Unless this is changed, the consistency of decisions between the various components will be difficult to achieve.

eDIB:

In initial comments about a new disability approach, the Commissioner indicated the foundation for the approach was the successful implementation of an electronic folder system.  NADE fully agrees with the Commissioner on this fact.  NADE remains very supportive of these new technologies as a means for more efficient service to the public.  The proposed disability process improvements are predicated on the new electronic folder system.  For eDib to be successful, it is critically important that adequate infrastructure support and proper equipment is in place to make the process work effectively and efficiently.  Until eDib is fully implemented nationwide, it is impossible to determine critical service delivery issues that impact on daily case processing.  NADE supports continued rollout of an electronic disability folder for the obvious reasons of administrative cost savings in terms of postage and folder storage, as well as time savings from mailing and retrieving paper folders.  At the same time, it must be recognized that an electronic disability case process may have a negative impact on case production capacities at the DDS level.

While eDib may be rolled out nationally in all state DDSs and territories except New York, it is not in use by all adjudicators in all components, and it remains to be seen how the system will handle the increased volume of work and number of users when it is implemented completely in all components of disability case processing. Overall, NADE believes that it is critical in this period of finite resources, that those resources (including personnel) not be diverted from eDib to develop the structure and procedures necessary for implementation of a new adjudicative process.

While the hardware and software for eDib is in place for the vast majority of the DDSs, the system is only currently utilized by a small minority of disability examiners.  Its capacity and success remain to be seen as more users are involved.  Until eDib is fully operational, (including predictive software to identify Quick Disability Decisions) we do not believe it is appropriate to make widespread changes in the adjudicative process.  The full implementation of eDib in itself may result in a significant reduction in processing time at all levels of adjudication without additional sweeping changes to the adjudicative process.

In addition, tools which have been demonstrated to improve efficiency, such as dual monitors, are not yet available to all adjudicators and medical consultants.  Because eDib is still a work in progress, refinements, upgrades and improvements are frequently necessary.  The impact on the system as a whole when these refinements are accomplished is unpredictable, but presently they frequently result in a slowing or shutting down of the system, or parts thereof.  Since DDSs process over 2.5 million cases on an annual basis, any shut down of the system equates to a significant loss of production capacity.  Even a shut-down of only 5 minutes a day equates to over 1,250 work hours lost on a daily basis due to system instability.  Currently, many DDSs experience far more than 5 minutes per day of system instability problems.

In addition, some upgrades and improvements to the system require that the adjudicator relearn basic functionality which again impacts in the ability of the DDSs to process the large volume of cases they receive in a year.  Upgrades to the system are essential to insure that the system operates as efficiently as possible, but it must be recognized that there is a resource impact every time a change is made.

While NADE recognizes the need for, and supports, SSA’s commitment to move to an electronic disability claims process, this tool will not replace the highly skilled and trained disability adjudicator who evaluates the claim and determines an individual’s eligibility for disability benefits in accordance with SSA’s rules and regulations.

Although we understand that electronic case processing procedures for continuing disability reviews (CDRs) are being developed, there is currently no process in place to handle this workload which at this time only exists in paper.  The inability to process the CDR workload electronically will require DDSs to maintain two business processes, one electronic and one paper, and has already been seen to have impact on both administrative and program costs.  In addition, there is a strong potential that program integrity will be compromised.

Specialists and Training:

NADE is concerned that the Disability Process Improvement Initiative, with its increased reliance on medical specialists and attorneys, and its elimination of the triage approach currently being used in 20 DDSs, could increase both administrative and program costs.  If the first level of appeal following a denial by the DDS is handled by a Reviewing Official who is an attorney, rather than by a trained disability adjudicator, such as a disability hearing officer, and if medical specialists replace programmatically trained DDS medical consultants, the disability program’s administrative costs will almost certainly increase.  We also suspect program costs will increase as more claims are allowed on appeal by individuals who lack the requisite medical and vocational training to view such claims from the perspective of SSA’s definition of disability.

Adjudicators evaluating Social Security and SSI disability claims must appropriately and interchangeably, during the course of adjudication, apply the “logic” of a doctor, a lawyer, or rehabilitation counselor, following SSA’s complex regulations and policies to arrive at a disability decision.  Training in all of these areas is critical to effectively adjudicate these cases accurately and in a timely manner.  Failure to do so carries enormous consequences for the Social Security Administration and the huge number of citizens who call upon the Agency for assistance.  NADE places a high value on initial and on-going continuing education training to maintain and enhance disability expertise in the Social Security disability program.

NADE holds annual regional and national training conferences for its members, offering the most up-to-date information in medical treatment and advances in medicine and SSA program changes.  These conferences serve to enhance our members’ knowledge base, develop their professional expertise and further the enhancement of the disability profession.

NADE is committed to furthering the art and science of disability evaluation and the professionalism of its members.  To that end, NADE is proud of its certification program which has been in existence since 1971.  NADE’s certification program recognizes Social Security disability experience, continuing education and training efforts of its members involved in the disability program.

Specific criteria for NADE certification are required in three different categories: as a disability professional, disability support professional or disability medical consultant.

Minimum standards must be met to be eligible for consideration for NADE certification.  Education, training and experience in the disability program are considered.  NADE certified disability professionals are required to obtain 25 hours of continuing education credits every three years in order to continue their certification status.  NADE’s unique training opportunities supplement training provided by SSA, cover medical and policy issues related to disability determinations and provide a forum for which to exchange ideas and best practices among the various states.

Quick Disability Determinations:

NADE supports the concept of quick decisions for those individuals who are obviously disabled.  In the proposed rules, appropriate Quick Disability Determination (QDD) claims would be identified and referred to special units within the DDSs for expedited action.  NADE feels that this workload would not necessarily require that the most experienced disability adjudicators should be assigned to process these cases.  In our considerable practical experience with such cases, we have found that the complexity of these cases is minimal and we believe that the expertise of the more experienced disability adjudicators is best allocated to process more complex cases.  We believe that each DDS Administrator should be allowed to assign their more experienced personnel to process claims as they believe best suits the need of that DDS and the people they strive to serve.

If the decision is made to require the most experienced disability adjudicators to process QDD cases, then NADE believes that it is not necessary to require a medical consultant’s signature on fully favorable allowances.  In addition, specialized units for processing QDD cases are not necessary, as they would reduce production in other types of caseloads normally handled by experienced adjudicators.  We believe that DDSs should have flexibility in assignment of these cases to insure timeliness and accuracy of the decision, while working within budget constraints of the DDS.

It is imperative that predictive software used to identify QDD cases be manageable and that it accurately identify the appropriate cases for quick determinations.  Selection criteria should include issues other than diagnosis, including involvement in current treatment, current insured status and a specifically identifiable impairment proven most likely to result in a totally favorable allowance decision.  SSA field office performance will also be critical for success of the QDD software and all critical information must be supplied to the DDS on receipt of a QDD case from a SSA field office.   The DDSs also should be allowed to screen out cases inappropriately flagged by the software that do not have the potential for a quick determination.

It has been proposed that 98% of these cases will result in a favorable determination of disability.  If that goal, as well as the goal of 20 day processing time is not met, action will be taken to remove this caseload from the DDS.  NADE does not support these punitive actions.  The success of the QDD process will be dependent on many factors outside the DDS control, such as the predictive software, system down time and response time from medical evidence providers.

It is important to note that in Title II claims, those persons found disabled under the Social Security Disability program must complete a five month waiting period to receive benefits.  A disability allowance decision, no matter how quickly it is processed, will not solve the problem of having to wait five full calendar months before being able to receive any cash benefits.

Reviewing Official:

The proposed rules recommend establishing a federal Reviewing Official (RO) as an interim step between the DDS decision and the Office of Hearings and Appeals (OHA).  An interim step outlining the facts of the case and requiring resolution of issues involved could help improve the quality and consistency of decisions between the DDS and OHA components.  NADE supports an interim step because of the structure it imposes, the potential for improving consistency of decisions, reducing processing time on appeals, and correcting obvious decisional errors at the initial level.  However, the Disability Process Initiative is unclear as to the method the RO would use to gather any necessary medical evidence to adjudicate a claim.  If additional evidence is needed, it appears likely that increased costs at the DDS level will result for obtaining additional medical evidence or to purchase consultative examinations.  More information is needed to fully evaluate the impact on the DDS budget if this is the case.

There is little, if any data to support a conclusion that the interim step between the DDS decision and OHA must be handled by an attorney.  In fact, a 2003 report commissioned by the Social Security Advisory Board to study this issue recommended that this position NOT be filled by an attorney.  Assessment of eligibility under the Social Security Disability program requires that the adjudicator at every level possess a great deal of program, medical and legal knowledge.  As currently proposed, the only qualification indicated for a Reviewing Official is that he/she be an attorney.  Individuals who are hired into this new position without previous experience in the disability program will require extensive training and mentoring for a period of a least one year.  It is also unclear in the proposal who would be responsible for training and supervision of the RO.

NADE feels that a review at this interim step should be conducted by a medically and programmatically trained individual such as a disability hearing officer (DHO).  The DHO has received additional training in conducting administrative and evidentiary hearings, decision writing, and making findings of fact, along with detailed case analysis and program information.  The DHO currently makes complex medical-vocational-legal decisions using the Medical Improvement Review Standard (MIRS).  There is currently a training program in place for DHOs through a contract that SSA has with McGeorge School of Law.  The DHO training program could be easily adapted to train experienced disability professionals who already have extensive medical and vocational expertise and disability program knowledge, to perform RO duties.  Since a DHO infrastructure is already in place, national implementation of the DHO alternative could occur quickly and effectively.  Using an already established structure will prevent costly and less claimant-friendly federal bureaucracy.  There would be extreme cost considerations if attorneys were to fill these positions as is currently suggested.  We also would like to point out the obvious fact that the percentage of claimant’s utilizing attorneys to represent them before hearings conducted by Administrative Law Judges has soared in the past twenty (20) years to more than 80%.

Currently, few claimants are represented by attorneys at the reconsideration level.  Eliminating the reconsideration step and replacing it with a new appeal step whereby the claim will be reviewed by an attorney will lead to a higher percentage of claimants hiring attorneys to represent them much earlier in the appeal process than is the current practice.  Not only will this have the potential to impact on the cash benefits awarded to claimants who are successful at this appeal step but we believe it will unnecessarily introduce an adversarial relationship between the claimant and the Reviewing Official (RO).  These negative consequences, and possibly many others, could be avoided and/or their impact significantly reduced, if a non-attorney is used for the Reviewing Official position.

SSA previously piloted a disability redesign project called the Adjudicative Officer.  These pilots proved that non-attorneys could produce a high quality product and a well documented and well reasoned case for the Office of Hearings and Appeals Administrative Law Judge.  The DHO is a highly trained and experienced disability adjudicator with a proven track record of expertise evidenced by well documented, well reasoned and highly accurate decisions.  ALJ reversal rates of DHO decisions on continuing disability review appeals has been approximately 33%, a much lower reversal rate than on reconsideration or prototype appeals.

NADE is also concerned that this first step of appeal not be seen as a quality review of the DDSs.  The remanding of large numbers of cases back to DDSs will create workload issues, divisiveness between the components and do little to improve public service.  We are also concerned that this will invite jurisdictional and policy disputes between the DDSs and this component.  Whether intended or not, cases that are sent to DDSs from SSA components tend to set precedents.  All components must have a clear understanding of everyone’s roles, responsibilities and authorities.  DDSs cannot accept policy direction, whether formal or inferred, from multiple components of SSA.  There is a clear danger that ROs, with remand authority, will complicate the process by sending conflicting messages to DDSs.

Federal Expert Unit:

NADE believes the Federal Expert Unit (FEU) can provide DDSs with additional access to medical and vocational expertise.  Qualification standards for inclusion in the FEU should not exclude the knowledgeable state agency medical consultant.  DDS medical consultants are trained in program requirements and the majority of cases they review include multiple impairments.  Having specialists review impairments individually is a time consuming, costly proposal.  Specialty consultants with limited scope and experience cannot fully assess the combined effects of multiple impairments on the claimant’s functioning.  DDS medical consultants are not only medical specialists—physicians, psychologists, and speech/language pathologists—they are also SSA program specialists.

Adjudication of cases that have more than a single impairment require assessment of how all impairments, alone or in combination affect an individual’s ability to function.  The use of specialists alone would result in numerous hand-offs, adding significantly to processing time.  This would also decrease the quality of decisions if there were no method in place to pull all of the specialty conditions together into an overall, global assessment of their impact on functioning.

Although members of the FEU will surely be qualified to treat patients in their respective fields of specialty, they will also require extensive training in the area of determining disability.  Evaluating disability for Social Security purposes is a far different area of expertise than treating patients.  There is a very real difference between clinical and regulatory medicine, and it takes at least a year to become proficient in Social Security disability rules and regulations.  Again, the responsibility for training, mentoring, and supervising these experts is not established in the proposed rules.  While NADE supports the concept of the FEU being used to supplement the expertise of the medical consultant at the DDS, we feel that most cases at the initial level of adjudication should continue to be reviewed and evaluated by state agency medical consultants.

Examiner/medical consultant communication is essential for efficient development and decision-making and the state agency medical consultant’s expertise is critical to DDS adjudicators.  NADE supports having both medical consultants that are generalists, as well as those with specialist backgrounds, to remain in the DDSs.  Day to day operations of the DDS rely heavily on SSA-trained medical consultants, mostly of primary and general care backgrounds.  NADE recognizes that the qualification standards for medical experts have not yet been determined, but we are concerned that primary care medical consultants will be excluded from the FEU.  At risk of exclusion also appear to be administrative or semi-retired physicians who may not choose to keep up their clinical board certification.

Currently, all DDSs have a contingent of state agency medical consultants.  In some states, they are state employees, and in other states, they are under contract.  These consultants possess a wealth of knowledge and experience, not only in the medical field and in specialty areas, but in the SSA disability program, as well as important knowledge of state health care systems.  They are an extremely valuable resource to the DDSs and the Social Security disability program as a whole.  It is difficult for the DDS to recruit and retain good medical consultants, and it is NADE’s hope that any established new qualification standards do not make it even more difficult to do so.

Vocational consultants:

According to a recent Social Security Advisory Board report, the proportion of initial allowances based strictly on medical factors has declined from 93 percent in the early years of the program to 82 percent in 1983 and to a 2000 level of 58 percent.  The percent of medical-vocational denial decisions has also risen, and is expected to continue to rise, with the increased emphasis on assessment of function and the resultant impact on exer- tional and non-exertional limitations in formulating residual functional capacity determinations.

Vocational consultant expertise in the DDS is critical to assure that vocational issues are correctly addressed and that individual claims are appropriately adjudicated under the medical-vocational guidelines.  While the availability of vocational experts outside the DDS may provide needed expertise and consultant for DDS vocational consultants, NADE supports the designation and training of on-site DDS vocational consultants to further promote and enhance a timely and quality decision-making process at the DDS level.

Many state DDSs utilize vocational consultants who have developed the expertise and program knowledge to assist examiners in applying vocational policy.  In complex cases, they may assist in completing detailed narrative assessments of the vocational factors of a case, evaluating transferability of skills, applying vocational rules and citing jobs available in the national economy.  In other states, experienced examiners or QA reviewers often assume this responsibility on a formal or informal basis.  It is critical that DDSs continue to have on-site vocational expertise available to adjudicators.

SSA continues to rely on the Department of Labor’s hopelessly outdated Dictionary of Occupational Titles, which was last updated in 1992.  Adequate resources and funding must be devoted to improve the tools available to all adjudicators in evaluating complex vocational issues.  NADE also continues to support decreasing the requirement for a fifteen year vocational history.  The rate and pace of change of jobs in the national economy makes a fifteen year vocational history requirement increasingly unfair to the disability applicant.

ALJ:

NADE supports the proposal to retain a de novo hearing before the ALJ, with the requirement that ALJs should provide in their decisions an explanation as to why they agree or disagree with the rationale of the RO’s decision and also that, when they are required to seek medical and/or vocational expertise input from the FEU,  that they must explain why they choose to agree or disagree with such input when they assess the medical/mental residual functional capacity or the evaluation of work and the transferability of vocational skills.   NADE also supports the concept of timely submission of evidence as outlined in the proposal.  Submission of evidence no later than 20 days appears reasonable and may increase the ability to process hearing requests in a timelier manner.  A good cause stipulation for late submission of evidence can provide the claimant or their representative with an additional opportunity to provide evidence, and perhaps negate the need for postponement of a hearing.

NADE supports closing the record after an ALJ decision and issuance of a final agency decision after the ALJ hearing, provided the decision is not overturned on end-of-line quality review.  We support increased medical and vocational training for Administrative Law Judges, similar to what a DDS disability examiner receives.

Decision Review Board:

The establishment of a Decision Review Board (DRB) consisting of both ALJs and Administrative Appeals Judges serving a staggering term to conduct disability review functions is also supported by NADE.  NADE agrees that a gradual roll out process of this body would be most effective.  The NPRM proposes to gradually eliminate the Appeals Council only in those regions where the changes in the NPRM have been implemented which is another area that has NADE support.

Reopenings:

The new rules propose to change significantly SSA’s current reopening regulations. NADE believes that the current regulations should be retained.  They are specific, well articulated and well understood, as well as fairer to the claimant than the proposed new rules.

Reopening of prior applications can be very important for people with disabilities.  There are times when a claimant is unable to adequately explain their limitations as a result of their impairment or has a condition that is not adequately diagnosed at the time of the original adjudication.  Restricting reopening of claims further than current regulations is grossly unfair in these situations.  NADE does not support the more stringent reopening criteria proposed in the new rules.

Demonstration Projects:

NADE fully supports all efforts to enable earlier access to health care, treatment and rehabilitation needs of disabled individuals, as well as efforts to assist those individuals who wish to return to work by providing them the needed services to allow them to do so.  We believe that early intervention efforts will provide improved service to the American public by providing needed services earlier in their disease process and lessening their need for life-long disability benefits.  Early interventions and access to needed health care services would provide not only greater emotional and economic stability for disabled individuals, it would decrease costs to the Social Security disability program as well.  Such interventions are not only good business practice from a financial standpoint, but from a humane and public relations aspect as well.  NADE fully supports all initiatives and demonstration projects designed to assist disabled individuals in their efforts to obtain needed health care, promote self-sufficiency and return to work.

Most Social Security disability beneficiaries have serious health problems, low incomes and limited access to health insurance.  Many cannot afford private health insurance due to the high cost secondary to their pre-existing health conditions.  Members of the National Association of Disability Examiners (NADE) are deeply concerned about the hardship the 24 month Medicare waiting period creates for these disabled individuals, and their families, at one of the most vulnerable periods of their lives.

Early intervention and provision of needed health care services as soon as possible after the onset of disability, and at a time when the individual needs it most, could improve both the quality of life for individuals with disabilities and the number of individuals who are able to go back to work.  NADE supports the elimination or, at the very least a reduction, of the 24 month waiting period for Medicare benefits for all Title II disability beneficiaries.

Summary:

NADE’s key recommendations are to implement only the strategies which balance the dual obligations of stewardship and service.

• Resources should not be diverted from eDib until the system is fully operational in all DDS locations.
• The five month cash benefit and twenty-four month Medicare waiting periods for Social Security disability beneficiaries should be eliminated or reduced.
• Predictive software to identify QDDs should be effective, efficient, and accurate.
• DDSs should retain flexibility in processing QDD claims, both in terms of staff and oversight.
• The Disability Hearing Officer should be utilized in the current infrastructure as an interim appeals step.  It is not necessary that this position be filled by an attorney.
• Qualification standards for inclusion in the FEU should not exclude the knowledgeable state agency medical or vocational consultants.
• Adequate training should be required in medical, vocational and legal program requirements for all decision makers in all components.
• Both in-line and end-of-line quality reviews should be included at all levels of the process, starting at the Field Office and ending at the DRB level.
• The roll out process for the proposal should be gradual and monitored closely.
• It should be recognized that technology is only a tool and does not replace the highly skilled and trained disability examiner.

For the past decade, SSA has attempted to redesign the disability claims process in an effort to create a new process that will result in more timely and accurate decisions.  Results of numerous tests undertaken by SSA to improve the disability process have not produced the results anticipated.  The experience of past pilots has shown that ideas that may sound good in theory have proven to be inadequate to meet the demands for service delivery and affordability when implemented on a wide scale basis.  We fear that there are some portions of this proposed new rule that will result in the same outcomes.  NADE urges caution in rolling out any changes to the disability determination process.  The pace should be gradual enough so that a thorough analysis and evaluation can be made to ensure that any changes made are claimant friendly, cost effective and truly improve the service for individuals with disabilities.

NADE appreciates this opportunity to present our views on the Commissioner’s Disability Process Improvement Initiative and we look forward to working with SSA and Congress as the disability process continues to be refined.

Shari Bratt

NADE President