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The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs
SSA also refined its regulations and guidelines, changed the instructions and training to state Disability Determination Services to make eligibility criteria and evidentiary requirements more stringent, made quality assurance reviews more stringent, and increased the number of continuing disability reviews (CDRs).
These actions had a dramatic impact on applications for benefits and initial award decisions. The proportion of claims awarded benefits by the DDSs declined from 46 percent of the claims in 1975 to 31 percent in 1980 (see Table 2-1), and terminations rose to almost 143 per 1,000 beneficiaries by 1980 (see Table 2-2). The rate of applications also declined from 15 per 1,000 insured workers in 1975 to 12.6 in 1980. Although the economy was in decline, the number of new awards dropped sharply and the number of persons discontinued for “medical and return-to-work recovery” reasons increased (SSA, 2001d).
Period of Slow Growth
These legislative and administrative changes and resulting practices faced strong resistance both in the courts and in state governments, and led to widespread criticism in the media. Negative publicity over the large numbers of beneficiaries—particularly the mentally impaired—being removed from the disability rolls led to a reconsideration of the changes in disability programs.
By 1984, another reversal in attitudes occurred followed by another round of legislative and administrative changes. SSA placed an administrative moratorium on the conduct of CDRs. A series of congressional hearings were held highlighting the plight of beneficiaries removed from the rolls. Several legislative and judiciary actions undid many of the stringent policies that had produced the retrenchment during the late 1970s and early 1980s. Court cases and class action suits increased dramatically, and many persons were returned to the rolls through court appeals. Congress enacted the Social Security Benefits Reform Act of 1984. Its provisions included more liberal standards for mental impairments that emphasized the individual’s ability to perform substantial gainful work, consideration of combined effects of multiple impairments in the absence of a single severe impairment, requirement for proof of medical improvements before termination of benefits, and use of SSA’s regulatory standards to evaluate the effect of pain on disability. Court decisions on class action suits during the middle 1980s resulted in placing more emphasis on the opinion of treating physicians in the disability determination process, the role of pain as a disabling factor, and evaluation of a person’s functional limitations in addition to the medical condition.