1. What are the characteristics of claims that take a long time to adjudicate?

  2. What are the characteristics of claims that are denied at steps 4 and 5 that are appealed and have the disability decision reversed?

  3. Can SSA identify the types of medical evidence that are most difficult and/or take the most time to obtain?

The above information can begin to establish priorities for additional research. The information tells us what is working well and what is problematic. If it is working, why change?19

Nonetheless, with improvements in the submission of medical evidence, the number and percent of claims that can receive a disability determination at steps 2 and 3 are likely to be increased, thus reducing the number that continue in the determination process. Information based on ICF items might be requested as part of a standard submission of medical evidence.

The next issue is to sort the claims remaining after the slightly limited and very severely limited have been handled. For these claims, additional functional assessment—but no consideration of age, education, and work history—is planned in the proposed process. This is where new functional assessment forms or instruments are required. Research would have to explore these alternatives and the medical evidence needed for the assessment.

The above statements are consistent with Recommendation 4-1 made by the IOM committee in its second interim report (Wunderlich and Rice, 1998, p. 21).20

Problems Already Identified by Research

The lack of sufficient medical evidence and the low quality of the medical evidence that is provided were identified as serious issues by participating psychiatrists in the APA study. This was their impression even though the claims had been through an SSA review for the quality of the evidence. In other words, they may have been better or more complete than average claims adjudicated in the DDSs. In addition to the APA’s

19  

This may be the information to which the committee alluded in its second interim report (Wunderlich and Rice, 1998, p. 13) in discussing the nature and extent of the problem with the disability decision process. The above information may provide sufficient information to act as a needs assessment.

20  

The committee recommended that early in its redesign effort, the SSA should specify how it will define, measure, and assess the criteria it will use to evaluate the current disability determination process, as well as any alternative processes being developed.



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