Compression and Rationalization: Demarcating the Roles of DDS and ALJs in the Disability Determination Process

by Harold J. Krent

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I. Introduction

The four-stage administrative review structure for assessing claims of disability under the Social Security Act has been widely analyzed. Claimants first present claims to state Disability Determination Services (DDS), which assess the claims pursuant to a delegation from the federal agency. A state DDS disability examiner works with a medical or psychological consultant in determining whether the claimant is disabled. Then, in forty states, disappointed claimants can seek review by different decisionmakers within the DDS and furnish supplemental information about their disability if they so choose. At the third stage, claimants can seek a hearing before a Social Security Administration (SSA) Administrative Law Judge (ALJ) and present new evidence of disability as well as examine witnesses. Currently, claimants must wait on average for over a year before receiving that hearing due to the backlog. If a claimant loses before the ALJ, he or she can appeal to the Appeals Council within the agency that can then issue a final decision on behalf of the agency based in most cases on the written record. Problems of accuracy and efficiency exist at each of the four stages. For instance, ALJs reverse DDS determinations at a rate of almost fifty percent, and in some of those cases, the claimant has presented no new evidence.  Moreover, even though SSA cannot formally appeal the award of a claim, congressional investigators and the agency itself have concluded that ALJ grants of disability are seriously flawed. Federal district court judges reverse or remand denials of claims in almost fifty percent of the cases they hear.

Systems of mass adjudication pose serious challenges with respect to accuracy, efficiency, and fairness. To consider alternatives to the current system, I examined different administrative systems both within and without the United States.

The comparative assessment revealed that at least some of the inefficiency in ALJ adjudication stems from the ALJ de novo review of the medical evidence. There are two dimensions to the issue: first, why should ALJs second-guess medical experts’ assessment of the medical evidence; and second, ALJs – who have no formal medical training – are forced to assess the evidence anew in the many cases in which medical evidence is introduced after the DDS determination. The essay concludes by suggesting a reform for the future under which ALJs would defer to others’ assessment of medical evidence and would focus instead principally on the fact-specific vocational evidence presented at the hearing.

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