A New Approach to SSA Disability Determinations – The NADE View

A New Approach to SSA Disability Determinations – The NADE View

After carefully reviewing the current status quo of the Social Security disability claims process and the future challenges facing the program, the National Association of Disability Examiners (NADE) fully supports and agrees with the testimony presented by the Commissioner of Social Security before the House Committee on Ways and Means Social Security Subcommittee on September 25, 2003, that,  – “…designing an approach to fully address the central and important issues raised by the President required a focus on two over-arching operational 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.”

In designing NADE’s View to a New Approach to SSA Disability Determinations, SSA Commissioner Barnhart’s two over-arching operational goals are at the forefront of our recommended approach, as well as the following additional goals:

  • designing a process that adds value at each step
  • designing a process that builds upon existing expertise, and
  • designing a process that keeps the focus on improved public service.

NADE fully supports in-line quality assurance and centralized end-of-line quality control reviews for all components. In-line and centralized end-of-line reviews have been built into our flow chart at all steps of the process.

NADE fully supports closing of the adjudicative record.  NADE continues to believe that closing of the adjudicative record should occur earlier in the process as a means to shorten the appeals process and to ensure that appeal decisions represent a comprehensive review of the technical and substantive accuracy of the initial decision and a legal decision to address points of law.  However, since this view does not have widespread support, NADE does support closing the record after the Administrative Law Judge’s decision since this decision will, in fact, represent the final decision of the Commissioner of Social Security before any subsequent appeals to the federal courts.

NADE also fully supports the elimination of the Appeals Council.  We agree with Commissioner Barnhart that little value is added at this step of the process which is very costly and adds unnecessary time to the process.

NADE continues to support the creation of a Social Security Court.  As long as judicial review of disability appeals continues to occur in multiple district courts across the country, a bifurcated disability process will continue to exist as different DDSs operate under different court rulings and regulations depending upon what part of the country the claimant lives in.

Below are the specific details regarding NADE’s view on a new approach to SSA Disability Determination (see attached flow chart).


NADE agrees with Commissioner Barnhart that the successful implementation of AeDIB is a critical feature of any new approach to SSA disability determinations. NADE remains very supportive of these new technologies as a means for more efficient service to the public.  In order for this initiative to be successful, it is critically important and an absolute necessity that adequate infrastructure support and proper equipment to make the process work effectively and efficiently is in place.  Without sufficient support, adequate resources and proper equipment, any attempts at an efficient paperless process will meet with failure.

The Front End:

In NADE’s new approach, as in Commissioner Barnhart’s new approach, intake of new disability claims at the local Social Security Field Office would not be significantly altered from the current practice. Initial, continuing disability review and appeal applications would still be initiated at the local Social Security Field Office.

NADE respects the unique and important role each component plays in disability case processing.  We believe that it is critically important to build upon the expertise, unique knowledge, skills and abilities of the positions of the Claims Representative in the local SSA field office and the Disability Examiner in the state DDS.  To that end, NADE recently updated its 1986 position paper on the disability examiner, which was shared with Commissioner Barnhart in February 2004.  In addition, NADE, working in conjunction with the National Council of Social Security Management Associations, Inc. (NCCSMA), previously proposed improvements to the front-end of the disability process in our joint paper, “The Front End of the Disability Claims Process”, which was shared with Commissioner Barnhart in December 2002.

The NADE/NCSSMA joint paper recognized the unique strengths of each position, the Disability Examiner and the Claims Representative, and stated, “Because of the complexity of adjudication of disability claims, responsibility for medical development and decision-making … will continue to reside with the DDS.  However, we believe we could explore ways to allow trained CRs to become more viable partners with DEs in the disability claim process.”

NADE and NCSSMA also acknowledged in our joint proposal that “the nationwide implementation of the electronic disability claim folder and other technological advances such as teleconferencing, increases the potential for Disability Examiners (DEs) in the DDSs to participate in, or actually conduct, the medical portion of the initial, reconsideration and continuing disability interview. Incorporating the training and experience of disability examiners into the interview process could make a positive and significant impact.  For example, utilizing Disability Examiners in the interview process would strengthen the initial observations of claimant credibility issues and a claimant’s functional abilities.  This partnering of Disability Examiners with Claims Representatives (CRs) in the claimant interview would greatly enhance the quality of the application process and, ultimately, the decision process.”

NADE and NCSSMA also jointly proposed in our December 2002 paper: “In addition, the availability of this new technology would also make it possible for some Claims Representatives in SSA Field offices to be trained to work as partners with the Disability Examiner in the DDS.  When the DE cannot be involved in the claimant interview, either in person or through the use of technology, some CRs could be trained to provide the eyes and ears of the DE.  With additional training, the CR would be able to include the type of detailed information needed to address many DE issues…”

NADE acknowledges that making either of these types of changes in the basic disability claims interview process would require incredible planning, team work and joint cooperation and collaboration with other components in the disability process, including potentially developing a different (or new) infrastructure.  NADE also recognizes that these changes do not have widespread support, and thus, NADE believes that it would be difficult to implement them at this time.   NADE continues to believe that collaboration and cooperation among the various components can have a very positive impact on the overall service delivery process, in both quality of service and processing time.  Therefore, NADE believes that these types of initiatives should continue to be long-term goals for service delivery improvement.

NADE is heartened by SSA efforts to improve the quality of the disability application submitted to the DDS via training and edits built into the start of the electronic folder, the Electronic Disability Collect System.  However, to produce this quality product, lengthened interview times are required and more resources need to be devoted to the front end of the process.  NADE fully supports in-line quality at the front end and jointly proposed with NCSSMA that “a technical expert for disability located in the field office could enable this approach.”  NADE and NCSSMA jointly support that “establishing a ‘Technical Expert for Disability Quality’ or some other means of reinforcing in-line quality review is a concept that should be developed by SSA in consultation with our respective associations.”

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.  However, we do not believe there is a need to create another federal bureaucratic structure to identify and screen applicants for demonstration projects.  Although few details are available regarding potential demonstration projects, it appears that individuals chosen for participation in these projects would be screened based upon age, education, work history and claimant allegations. This type of data is currently collected in the initial disability interview and using these types of screening criteria would not require system changes or other modifications to the existing process. Therefore, NADE believes that a trained “technical expert in disability” in a SSA field office could screen applicants for disability into these demonstration projects.   Oversight of these projects could be done on a regional basis by regional expert units as proposed by the Commissioner of Social Security.

We believe that early intervention efforts will provide improved service to the American public by providing needed services earlier in their disease process and that has the potential to decrease the lifelong disability payments that some of our claimants eventually receive once they have been determined eligible for benefits.  We are especially pleased to see the moving forward of Youth Transition projects, as younger individuals with disabilities leave school and enter the work force.

NADE also believes that a “technical expert in disability” in the local Social Security Field Office is in the best position to serve as a case manager for ongoing employment support initiatives.  Similar types of activities are currently being performed by Field Office employment specialists in the Ticket to Work program.  NADE supports building upon and using this type of expertise for ongoing employment support initiatives.  Local field office staff already handle all non-medical aspects of disability claims, such as determining technical eligibility of insured status, income, resources and performance of substantial gainful activity; calculating monthly benefit eligibility amounts; calculating trial work period, extended period of eligibility and 1619 provisions and performing annual redetermination eligibility reviews.  NADE feels that there are many efficiencies inherent in local field offices handling this workload.

Quick Decisions:

NADE supports the concept of quick decisions for those individuals who are obviously disabled.  We envision such a process to work similar to the current process that identifies individuals with terminal illnesses (TERI) for SSDI and presumptive disability (PD) for SSI claimants.  Such cases are “flagged” and receive expedited actions throughout the claims adjudication process.

The NADE flow chart shows Quick Decisions to be handled by DDS.  NADE believes that DDSs are best equipped in terms of adjudicative expertise, medical community outreach, and systems support to fast track claims and gather evidence to make a decision timely, accurately, and cost effectively.  DDSs already process at least 20% of allowance decisions in less than 25 days.  In addition, DDS disability examiners are well versed in the evaluation of disability onset issues, unsuccessful work attempts and work despite a severe impairment provisions to quickly and efficiently determine the correct onset for quick decision conditions.

Establishing a regional expert unit to handle this workload, in NADE’s opinion, constitutes an additional hand-off of a claim with no value added to the process.  We see no need to add another layer of bureaucracy to process quick decisions when such cases are already “triaged” and handled expeditiously by the DDS disability examiners. In order to implement a regional expert unit for quick decisions, SSA would need to change its existing infrastructure to make these decisions and provide for hiring, training and housing staff.  Also, business processes would have to be developed to secure and pay for medical evidence of record.

NADE does not support assigning the responsibility for Quick Decisions to the Field Office either.  Even with the additional training proposed in the joint NADE/NCSSMA proposal, we do not believe that Claims Representatives will have the knowledge and skills necessary on an ongoing basis to adjudicate these cases.  We are also concerned that assigning this responsibility to the Field Offices will invite jurisdictional disputes between the DDSs and the Field Offices as to what types of cases or alleged impairments actually constitute potential for “Quick Decisions.”   We are concerned for the potential growth of turf guarding between these components and we believe it will also encourage higher incidences of fraud.  We would take this opportunity to remind SSA that the Social Security Advisory Board and SSA’s Office of Inspector General have both proposed in previous reports and congressional testimony that the experienced disability examiner is the most effective weapon SSA has at its disposal to combat fraud.  In addition, we would point out that some Field Offices already struggle with the concept of recognizing presumptive disabilities and TERI cases.  Adding additional conditions or expanding their responsibilities in this area will require extensive time-consuming and expensive training to an already lengthy claims representative training period.  Our experience with the Disability Claims Manager pilot demonstrated that there is too much complexity in both the claims representative and disability examiner positions to “merge” them into one.

NADE would not oppose Claims Representatives recommending cases for potential quick decisions but we do suggest that more extensive in-line quality assurance and end-of-line quality control be applied to this new process to ensure that those claims that deserve to be identified as having potential for “Quick Decisions” are so identified and that those that do not, are not so identified.

The Commissioner has stated that in private insurance companies, up to 25% of cases can be allowed as quick decisions (defined as within 25 days).  Given that DDSs already process 20% of allowance decisions in less than 25 days, and with the streamlined documentation requirements envisioned in the future process, there is ample reason to believe that DDSs can achieve the 25% envisioned goal, with no additional training or expense required.  NADE does not believe that building another expensive infrastructure to handle this workload is either cost-effective or necessary.

NADE continues to support elimination of the five month waiting period for Title II claimants and is in the process of updating its 1999 position paper on this issue.  As long as the Title II waiting period remains in effect, a quick decision process will have little or no impact on a significant percentage of Title II applicants with clearly disabling conditions.  In addition, consideration needs to be given to elimination of the twenty-four month waiting period for Medicare benefits.  NADE heartily endorses and supports any demonstration project that provides early health care coverage to disabled individuals and we call attention to the fact that, in January 2001, SSA, due to congressional mandate, did eliminate the Title II five month waiting period for cash benefits and the twenty-four month waiting period for Medicare coverage for disability applicants who suffer from Amyotrophic Lateral Sclerosis (ALS).  While we support this exemption for ALS patients, NADE questions the fairness of giving special treatment to one group of disability applicants and not to all, as well as the potential litigation issues involved in such a practice.

Adjudication of Initial Claims:

Under NADE’s approach, DDSs would continue to handle adjudication of all initial claims, as well as continuing disability reviews (which were not addressed in the Commissioner’s new approach to disability determination).

NADE supports the Commissioner’s goal of fully documenting and explaining disability decisions.  We are very concerned that sufficient resources must be in place to allow this to happen.  The message in the past, during times of tight budget constraints, has always been to limit medical costs in disability adjudication and to limit detailed explanation of denial decisions.  Fully documenting and explaining disability decisions will require the full commitment of SSA, the Congress and the American public to provide the necessary resources to administer the disability program effectively to meet this goal.

Enhanced Role for the Disability Examiner:

Of all the reengineered disability processes proposed or piloted in the past, the Single Decision Maker (SDM) process has been the most successful.  Statistical results have shown that disability examiners operating under the single decision maker model in the twenty states where this concept was tested have the same or better quality than disability examiners operating under the traditional disability adjudication model.

NADE fully supports an enhanced role for the disability examiner in disability adjudication and increased autonomy in decision-making for experienced disability examiners on certain cases.  Decisions regarding disability eligibility can be considered to be on a continuum from the obvious allowances on one end, through the mid-range of the continuum where only careful analysis of the evidence by both adjudicator and physician can lead to the right decision, and finally  to the other end of the continuum where claims are obvious denials.  It is at both ends of the continuum where the disability adjudicator can effectively function as an independent decision maker.

SDM is a proven and value-added step of the process that allows the medical consultant time to be invested in more medically complex cases, to assist less experienced adjudicators and medical consultants in mentoring and training, providing expertise and sign-off on specialized exams and tests, and to focus their expertise in public relations activities, such as outreach to improve the quality of record received from medical providers, making personal contacts to obtain information for adjudication, and assisting in recruitment of consultative examination physicians. As SSA continues to face increasing demands to manage its workload more effectively, the SDM is one tool that has been shown to increase productivity with limited resources.

The Single Decision Maker has had the most positive impact on cost-effective, timely and accurate case processing than any other disability claims initiative in many years.  Use of the SDM to make the disability determination, and retaining the availability of medical consultant expertise for consulting on cases without requiring doctor sign off on every case, promotes effective and economical use of resources.  It is common knowledge that some disability claims are more complex than others requiring varying levels of expertise.  It is prudent to expend our medical and other resources where they can most positively impact the quality of the disability claim.

NADE supports utilization of SDM to make the decisions on the types of cases currently being adjudicated under the prototype process SDM regulation.   Studies of the SDM have demonstrated its value as an integral part of the Social Security Administration disability claim adjudication process and it should be embraced by SSA and adopted as standard procedure in all DDSs.  NADE also supports expansion of SDM to continuing disability review cases.

Medical Consultants:

Just as with examiners, it takes time for a medical consultant to become familiar with the SSA program requirements and to become proficient with the process.  NADE strongly supports on-site medical expertise. Examiner/medical consultant communication is essential for efficient development and decision-making. DDS examiners now have face-to-face interaction with Medical Consultants.  In addition to resulting in extremely efficient case development and decision-making, this process adds value in that it provides important medical training of less experienced examiners and ongoing mentoring of all examiners as medical practice evolves.

If, as proposed under the Commissioner’s approach, DDS disability examiners are to adjudicate the more complex disability claims, then it is even more important to their professional development for them to have direct communication with Medical Consultants.  NADE is a professional association whose purpose is to promote the art and science of disability evaluation.  NADE recognizes the unique knowledge, skills and abilities required of disability examiners and has a certification program in place for individuals who meet the requisite training and experience requirements.  NADE certified disability examiners are required to obtain 25 hours of continuing education credits every three years in order to continue to be certified.  NADE sponsors annual regional and national training conferences to offer the most up-to-date information in medical treatment and advances in medicine and to further promote the professionalism of its members.  In addition, NADE recognizes the critical and valuable contributions to the disability adjudication program by medical consultants and also has a certification program in place for medical consultants.  NADE certified medical consultants are required to obtain 25 hours of continuing education credits every three years in order to continue to be certified.

DDS medical consultants play a vital role in disability adjudication and transferring them to a central regional component would fragment and add a layer of confusion to the process.  Establishing priorities in workload handling at a regional level will be difficult and complex, and resolution of problem solving situations in such an environment will be cumbersome and time and resource-intensive.

Currently, all DDSs have a contingent of state agency medical consultants.  In some states, they are state employees; in other states they are under contract.  These medical 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. They also possess an important knowledge of individual state health care systems. These consultants are an extremely valuable resource to the individual DDSs, and the program as a whole.

The majority of disability claims do not have one single discrete impairment but multiple conditions that can impact on functioning.  Adjudication requires the evaluation and assessment of how all of these conditions, alone or in combination, impact on an individual’s functioning.  The use of specialists alone could result in too many handoffs, adding significantly to processing time, as well as decrease 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.

NADE strongly opposes removal of on-site medical expertise in the DDS, but would support specialists within each DDS and/or at a regional level to be available to other DDSs and other SSA components for assistance in case evaluation and adjudication.  Removing this critical resource from the DDS site will have a markedly negative impact on initial case quality. The ability of an examiner to have face-to-face, ongoing access to an in-agency doctor with whom the examiner is familiar and who is familiar with the details of practice in the area, leads to better accuracy, processing time, productivity, costs and customer service.  Additionally, state agency medical consultants have already been trained in SSA disability program specific rules and regulations.  This training will not need to be duplicated in order to implement their use as a regional specialist resource.  Retaining DDS – based medical consultants allows for continuance of case-processing on CDR claims which are not included in AeDib processes at this time and on-site DDS medical consultants can continue to provide medical input in the DDS’s in-line quality reviews.

NADE believes that removal of on-site DDS medical consultants will lead to loss of local knowledge of individual state medical providers, which could lead to longer, less fruitful case development and decision-making and increase case processing costs when specialists without program experience feel compelled to order special studies in areas a program-experienced medical consultant would appropriately assess on evidence in the claim file.

NADE believes that examiner consultations will be less efficient with doctors with whom they do not have an adjudicative team relationship and processing time will increase with the complexity of a regional or national case assignment and case monitoring process with cases outside of the DDS span of control.

NADE believes that the addition of a regional medical expert unit will add confusion and unnecessary time to the process as regional consultants and DDS examiners will be called upon to operate within the frustrating and time-consuming element of differing time zones and hours of work.

Centralizing regional medical expert review units will require massive recruiting and training efforts – all of which is needlessly expensive and time-consuming when the resources and expertise already exist in the state DDSs. In addition, massive amounts of time will be needed to train new consultants, who cannot be expected to replicate the knowledge and experience currently possessed by the DDS medical consultants.

Other complicating features of a centralized regional medical expert special unit include: some states require local licensing (state specific) for the ordering of labs/special studies; resolution of disagreements with regional medical assessments will be complex and time-consuming; and there would be no onsite medical resource for DDS in-line or end-of-line quality review processes.

Nurse Consultants:

NADE does not support the addition of a nurse consultant to the process as proposed by the Commissioner. This adds an unnecessary step to the process between the disability examiner and the medical consultant which does not currently exist.  NADE believes that the addition of this hand-off in the process adds no value and increases the potential for errors in communication. Extensive training in the adjudicative process would be required in order for the nurse to effectively communicate with medical consultants and examiners. There is a critical difference between the clinical perspective that a nurse would be expected to have and the disability assessment perspective required by the program.  The ability of the disability examiner to access face-to-face medical consultations and develop rapport and familiarity between team members should not be altered or breached.

Vocational Consultants:

NADE recommends the use and expansion of vocational consultant expertise on-site in the DDS. According to a recent Social Security Advisory Board report, the proportion of initial allowances based strictly on medical factors has declined from around 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 exertional and non-exertional limitations in formulating residual functional capacity determinations.

Many states 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, 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.

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 consultation 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.

Regional vocational experts available to the other components of the disability process should also be available to DDS vocational consultants to address specific, complex questions that may arise in the DDS. Ensuring that DDS staff has adequate access to vocational expertise improves the accuracy and consistency of determinations. Making the right decision at the DDS level means fewer appeals and timely adjudication with less cost.

SSA, Congress and the American public must make a commitment to adequately finance the disability workload, including the infrastructure for vocational expertise.  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.

Disability Hearing Officer:

NADE fully supports an interim appeal step between the initial denial and the Administrative Law Judge (ALJ) hearing. An interim step is necessary to reduce the number of cases going to the Office of Hearings and Appeals (OHA) as much as possible.  The prototype experience has shown that despite the elimination of the reconsideration step and shifting more DDS resources to doing initial claims, the number of claims appealed to the Office of Hearings and Appeals was still too high for the Administrative Law Judges to efficiently address.  An interim step laying out the facts and issues of the case and requiring resolution of those issues could help improve the quality and consistency of decisions between DDS and OHA components.  There are many positive features of having an interim step between DDS and OHA as proposed by the Commissioner.   NADE is not convinced, however, that customer service is improved from the current process if this remains a paper review at this interim step.

NADE fully supports an interim step because of the structure it imposes, the potential for improving the accuracy of DDS decisions and processing time on appeals, and the correction of obvious decisional errors at the initial level before a hearing. The establishment of uniform minimum qualifications, uniform training and uniform structured decision-writing procedures and formats will enhance the consistency and quality of the disability decisions.

NADE believes that this interim step should include sufficient personal contact to satisfy the need for due process.  NADE does not believe, however, that this interim step needs to be handled by an attorney. There is little, if any, data that supports why this interim step needs to be an attorney. In fact, a 2003 report commissioned by the Social Security Advisory Board to study this issue recommended that this position NOT be an attorney.

Decisions made at all levels of adjudication in the disability process are medical-legal ones.  NADE believes that Disability Hearing Officers can handle the first step of appeal between the DDS initial decision and the ALJ hearing.  Disability Hearing Officers (DHOs) are programmatically trained in disability adjudication as well as in conducting evidentiary hearings and most DHOs are not attorneys.

Using trained Disability Hearing Officers instead of attorneys will be substantially less costly, even if they are re-classified as federal employees.  There is currently an infrastructure in place to support DHOs and using such a structure will prevent creation of a new costly and less claimant friendly federal bureaucracy. Since this infrastructure is already in place, national implementation of the DHO alternative can occur very quickly.

NADE believes that credibility and acceptance by the Administrative Law Judges of the first step of appeal is critical.  Preliminary discussions between NADE and representatives from the Association of Administrative Law Judges indicate that they could support the concept that individuals performing this first step of appeal would not necessarily have to be an attorney. NADE believes that Disability Hearing Officers have the experience, training and capability to produce the type of product envisioned at this level to prepare a case for an ALJ hearing.  In addition, NADE supports the availability of programmatically trained medical and vocational expertise at this step in the process.

The Adjudicative Officer pilots proved that non-attorneys could produce a high quality product.  The DHO is a highly trained and experienced disability adjudicator with a proven track record of expertise evidenced by well documented, well reasoned, correct decisions.  Current ALJ reversal rates of DHO decisions on continuing disability review appeals is approximately 33%, a much lower ALJ reversal rate than on reconsideration or prototype appeals.  Disability Hearing Officers are well-trained in the disability regulations and medical and vocational issues, all of which are critical in preparing a well documented and well reasoned case for the ALJ hearing.

NADE supports the Commissioner’s approach as proposed to structure the first step of the appeal to assure a complete and consistent product is provided to the ALJs.  NADE recommends that all individuals responsible for preparing this product be required to attend a training program similar to the Hearing Officer program at the McGeorge School of Law.

NADE also supports the Commissioner’s approach as proposed to have the ALJ describe in detail in his/her written decision, the basis for rejecting a Recommended Disallowance or describe the evidence gathered during the hearing that responds to the description of the evidence needed to successfully support the claim contained in the Pre-Hearing Report.

NADE is concerned, however, that this first step of appeal not be seen as a quality review of 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.

NADE supports in-line quality assurance and centralized end-of-line quality control reviews at the first step of appeal as well as at the Administrative Law Judge level.

ALJ Hearing:

NADE supports the Commissioner’s approach proposing that cases to be heard by the Administrative Law Judge be fully documented and explained, and all issues be fully addressed and detailed out in the decision.  In the rare case where additional information may be required, NADE supports a budget for OHA to develop and purchase medical evidence of record and consultative examinations and that OHA case processing systems be designed to accomplish this.  Cases should not have to be returned to DDS to obtain additional information.

NADE supports in-line quality assurance and centralized end-of-line quality control reviews of Administrative Law judge decisions, closing of the record after the ALJ decision and issuance of a final agency decision after the ALJ hearing (providing the decision is not over-turned on end-of-line quality control review).  We also support increased medical training for Administrative Law Judges as a more effective and more efficient business process and we support the availability of programmatically trained medical and vocational experts to the Administrative Law Judges.

Social Security Court:

NADE supports creation of a Social Security Court to hear appealed disability cases.  As long as multiple district courts have jurisdiction of disability appeals, the consistency and uniformity of the disability program is in jeopardy.  Currently, multiple disability criteria exist in the country due to different states operating under various acquiescence rulings.  It is imperative to unify the program so that no matter where an individual lives they receive the same disability decision.  A Social Security Court structured similar to the Bankruptcy Court could serve the purpose of unifying the disability program.

Quality Reviews:

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 introducing a new bureaucracy, with remand authority, will complicate the picture.

NADE strongly endorses the need for consistency and accuracy of decisions at all levels of the adjudicative process.  NADE’s view shows in-line quality assurance and centralized end-of-line quality control reviews at all steps of the process.  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. This centralized review unit should be organizationally placed within the component responsible for initiation and implementation of disability policy (currently the Office of Disability Programs).  Accurate interpretation of policy is the underlying factor in consistency of good decision making and siting a quality review component within the same component that issues policy ensures consistent application of policy.

NADE concurs that there is a need for adjudicative accountability at every level in the process.  We find the emphasis on in-line quality assurance reviews, the creation of a feedback loop and centralized end-of-line quality control reviews of every component to be positive aspects of the Commissioner’s new approach.


NADE’s view of a new approach is predicated on the assumption that the electronic folder is fully operational, with the proper infrastructure, equipment and resources to support it and that sufficient staffing and resources would be made available to all components involved in disability adjudication.  NADE’s view is also predicated on the need for SSA to clearly define the elements for fully documenting and explaining an initial case at the DDS level, as well as clearly define the elements that will satisfy the process unification initiatives.  It is critical that SSA provide clarification of what steps must be followed and provide the funds necessary to implement them.  NADE believes that only those steps that add value to the process should be implemented.  NADE is fully committed to working in partnership with SSA and other components to fashion, design and effectuate needed improvements and changes in the program.

Approved by the NADE Board, March 10, 2004