Statement of Earl Tucker

My Name is Earl Tucker. I am President of AFGE Council 224 which represents the Quality Assurance workers in the Social Security Administration.

The Social Security Administration’s (SSA) is facing major challenges today because of staffing and resource shortages everywhere and not just in   processing our disability cases. The “Improved Disability Determination Process” does not cure the lack of necessary resources to do the job. Even with this new process, it is still going to require an additional $1.2 billion over a ten years period to process disability cases. I think this money could be well spent funding the current process and hiring more staffing. More staffing alone would improve the processing of disability cases without spending over a billion dollar on a plan that may or may not improve the process.

Now that the rules have been finalized on the new disability plan, I still have the same questions that I asked on the proposed rules for the disability plan and some questions even prior to the publishing of the proposed rules.  On the proposed rules and prior, these were some of the questions that I asked:

Below you will find some specific comments to the 79 pages of the proposal. I will be using printed page numbers for reference.

3rd paragraph under "Program Trends" discusses the increase in DIB claims and the greater complexity of claims (due to more mental claims and vocational related issues) that have caused larger workloads.  It is still unclear how the new system will resolve the complexity of these cases.  These cases still require a sufficient number of staff with adequate training that have access to reference materials.  That's the solution, which can be done under the current system.

5th paragraph of Page 5 states that eDib alone is not enough to improve the system.  According to the SSA Commissioner, they have to change the process "to significantly improve disability adjudicators."  Again, how is this manifested?  A good adjudicator is one that is trained, resourced, experienced and not subject to arbitrary speed-up quotas.

Another thing to keep in mind is that an eDib claim takes longer to review by a DQB examiner than a paper one when you have to screen all the pages on a desktop computer monitor page by page subject to the speed of the program and navigate around the file.

See midway down on page 6 where they discuss "both in-line and end-of-line" QA "at every step of the process."  They still have to detail how this will be done.  How exactly do you complete an "in-line" review of a disability case?  Do you halt case development to critique how one handles a medical source while another is on the way that could resolve some issue?

Go to Paragraph 5 on page 9 that goes into the changes.  Again, they boast of a processing time reduced by 25% without providing the basis for this.  How can this be done if you replace the Reconsideration second level review with a Reviewing Official step and the Appeals Council with the Decision Review Board while still retaining the initial step and the ALJ?  You still have the same number of steps, so where is the reduction in time by these changes.

The need for a Quick Disability Determination unit (completing easy cases in 20 days) seems dubious.  We already have provisions to do Presumptive and Teri cases to expedite a decision. People who are "obviously disabled" already receive fast decisions from the DDS, so how will another bureaucratic restructuring solve any problems?  Likely reasons for these cases not being allowed ASAP would be mailing issues, securing adequate documentation, inadequate staffing and increasing work loads at the DDS.  How will the Quick Unit resolve these issues?  NADE wrote that SSA stated that the DDS could not make these allowances "since they wouldn’t have access to medical specialties able to make these diagnoses."  Why not give them the access?  Weren’t all components in the process going to have access to the "same medical and/or vocational experts?" 

Under "State Agency Determinations" on Page 11, they restate the need to document and explain the basis for every decision.  This is one of the most important things at all levels.  This will not happen with only a program reshuffle.

Also on Page 11 is a section on "Expertise and the Federal Expert Unit."  The concept of a national network of medical and vocational experts is worthy.  However, other considerations must be kept in mind.  How can an adequate, independent quality review be completed if every component in the system uses the same medical and vocational experts?  Often DDS errors are caused by inadequate or incorrect input from their medical or vocational staff.  Just how likely would an error from a centralized source be rectified if they are also the quality review source?  A resolution may involve different national networks for different components (DDS, ROQA/DQB, OHA).

Under "Reviewing Official" on page 13, they describe the Reconsideration Step as a "rubber stamp" with no "appreciable value."  Our experience as a DQB examiners does not bear this out.  Reconsiderations many times do reverse initial decisions and they are regularly sampled by the DQB.  Moreover, a current successful program has New York DDS reviewing the Recons of New Jersey and Maryland DDS’.  Such a system would preclude even the appearance of a "rubber stamp" in addition to having a truly independent second pair of eyes from a different DDS reviewing the claim.

I also find it silly to mandate that these Reviewing Officials have to be attorneys.  On the penultimate paragraph on Page 13, they list the reasons (or delusions really) why attorneys should do this.  Yet, the Commissioner forgets that ALJs are attorneys and that studies have found that they often make mistakes.  Law schools do not train you for Social Security disability sequential evaluation process.  The ability to adjudicate and explicate as directed by policy are the important skills.  They are inculcated and maintained with experience, adequate training, and resource access whether you go to law school or not.  Moreover, it is unclear if an adequate number of attorneys could be attracted at the current salary levels offered.

Also, please note in the second paragraph of page 14 that the Reviewing Official (even though he is a lawyer!) still has to send the claim to the Federal Expert Unit (and delay adjudication) before denying the claim again.  When workloads increase, employees may feel pressure to allow the claims to avoid "timeliness" delays.

An important section for us is "Ensuring Quality" on page 23.  They again fawn on "in-line" review of cases without detailing how to do this.  Most importantly, the Commissioner pushes the replacement of DQB’s with a "new centrally-managed quality assurance system," but she fails to detail or explain how this will be done.  How more "centrally managed" could an organization be that reviewed over 326,000 cases in FY 2004?  Currently, 10 regional offices answer to a central office whose job is to maintain consistency.  Even with eDib, there will be some variance how different people, units, or offices view a case.  Moreover, how will more centralization "encourage local flexibility?"  Another issue is how a totally centralized office could handle all the local court-case mandates and idiosyncrasies of case development nationwide.

See the second paragraph on page 24 about judging "service, timeliness, productivity, and cost as components of quality along with accuracy."  I addressed this abstract and untenable wish in my Lewin Report review.

Please See page 29 concerning Reopening.  This extreme restriction of its application is a bad idea.  It is not uncommon that DQB examiners reopen prior claims under the current rules.  In this way we can correct prior denials so that do not have to go through the OHA process.  A common scenario involves people with mental illness who cannot follow deadlines due to their condition.  The restriction on reopening will be a disservice to some of the most vulnerable people in society and propel cases to the OHA that can be resolved beforehand.

Page 31 lists the costs for the proposed rules which are 1.2 billion dollars between 2006 and 2015, according to the Office of the Chief Actuary.  Considering how such estimates usually understate costs and that there are often unforeseen, unfunded hurdles, will long-standing budget deficits permit such expenses?  As always, a proper system needs proper funding.  Our current system has been cheated for a while, so why should we think that the new system will be funded as it should?

These are some additional Questions that I had long before the proposed disability plan:

1) The GAO recently found that the cost-benefit analysis of SSA had underestimated the costs of eDib.  What are your current cost projections for eDib and how much do you expect it to save SSA and the Trust fund?  What are these figures based on?

2)   In your testimony before the House Ways and Means Committee, you stated that “a shift to inline quality review would provide greater opportunities for identifying problem areas and implementing corrective actions and related training.”   Moreover, “an in-line quality review process managed by the DDSs and a centralized quality control unit would replace the current SSA quality control system.”  Later, NADE reported in their meeting with you on 10/24/03 that SSA agreed with having PER reviews “done centrally” and “that DQB will not exist, as we know it.” 

What are your exact plans for the DQB staff and why are you doing this considering the time and effort spent on the proposition that the PER review expanded to Title XVI for greater DQB review?  Why do you want to replace a disability quality assurance system that saves the American taxpayer more than $13 for very $1 invested and has saved over $300 million annually for the Trust funds?  Prior to the PER review, SSA operations and state DDS’ reviewed their own work resulting in a program in disarray and requiring Congress to mandate an independent PER review.  Why do we want to risk this again?  How will accuracy be increased in this system?  How likely is it that Congress will alter the statutory requirements of PER?

3)  What has been the impact and influence of the November 2000 report of the Lewin Group and the Pugh, Ettinger, McCarthy Associates upon your proposed disability program?  Were they consulted or did they have any input on the new system?  When will Booz, Allen, Hamilton finish their review of the California DDS in-line quality review and will their report be made available to us? 

4) Can the new disability system function without your requested increases in the Service Delivery Budget?  Couldn’t an increased budget be used to adequately fund the current system?  The major criticisms you mentioned about the current approach involve inadequate documentation and waiting times.  These problems are caused by staffing issues and work load demands, which with proper budgeting could be minimized in the process currently.

5) Why is an Expert Review (ER) panel needed for Quick Decisions if we have a presumptive allowance process for SSI cases that can be used by the FO and the DDS to currently allow these cases expeditiously?  People who are “obviously disabled” already receive fast decisions from the DDS, so how will another bureaucratic grouping solve scenarios that do not currently exist?  Likely reasons for these cases not being allowed ASAP would be mailing issues, documentation securing, and inadequate staffing and increasing work loads at the DDS.  How will the ER resolve these issues?  NADE wrote that SSA stated how the DDS could not make these allowances “since they wouldn’t have access to medical specialties able to make these diagnoses.”  Why not give them the access?  Weren’t all components in the process going to have access to the “same medical and/or vocational experts?”  Moreover, who is going to provide independent quality review of the ER panel?

6) How can an adequate, independent quality review be completed if every component in the system uses the same medical and vocational experts?  Often DDS errors are caused by inadequate or incorrect input from their medical or vocational staff.  Just how likely would an error from a centralized source be rectified if they are also the quality review source?

7) How will no SSA employee be “adversely affected” by your approach if the quality review is centralized, DQBs are “eliminated,” and eDib greatly reduces the current work of Program Assistants?

8) On what basis do you assert that “processing time will be reduced by at least 25%” if you add an ER and replace the reconsideration step with a Reviewing Official (besides the demands required by reviewing the pilot projects that may become national)?

9)  Our Regional Director has been telling us that the new approach would only effect the QA review in order to mollify us, but this seem very unlikely. The new approach would totally change how the PER and QA process is completed. How could this be done without DQBs since PER review is mandated by Congress?

10)  With the current DQB organizational structure, the performance of any DDS can be scientifically validated. How do you plan to validate statistically the performance of each DDS without the DQBs? Do you want to know the actual performance of each DDS? Do you only want a statistically valid DDS’ performance at the national level?

11) There are many Acquiesence Rulings by the United States District Courts that differ from one District Court to another. How will Acquiesence Rulings of the different District Courts be handle centrally?

In conclusion, the current process has always been under funded and cheated since day one. I believe it still would work if properly funded. I don’t see Congress spending an additional $1.2 billions over 10 years to implement this new disability plan.

Earl Tucker