Aspects of Disability Decision Making: Data and Materials

1989 The Omnibus Budget Reconciliation Act of 1989 (P.L. 101‐239) required the Secretary of HHS toestablish and conduct an ongoing program of outreach to children who are potentially eligible forSSI benefits because of disability or blindness.1990 SSA published new regulations (in 20 CFR 404.985 and 416.1485) reinforcing its existing acquiescencepolicy and expanding it to include all levels of the adjudication process (55 FR 1012 (January11, 1990)).On February 20, 1990, the Supreme Court in Sullivan v. Zebley, 493 U.S. 521 (1990), ruled that thegovernment’s policy on disability determinations for SSI children held children erroneously to astricter definition of disability than the standard for adults.The Omnibus Budget Reconciliation Act of 1990 (P.L. 101‐508) made several important changes tothe law. It:■■reduced the percentage of favorable DDS decisions that must be reviewed by SSA from65 percent to 50 percent;■■required review of a sufficient number of unfavorable determinations to ensure a high degreeof accuracy;■■made permanent the statutory provision for continued payment during appeal of adverseCDRs; and■■changed the definition of disability for widows and widowers to the same definition used forworkers.The law also required the Secretary of HHS to make reasonable efforts to ensure that, when evaluatingdisability for a child, a qualified pediatrician or other individual who specializes in a field ofmedicine appropriate to the disability of the child evaluate the case.SSA published rules expanding the Listing of Impairments with respect to the evaluation of mentaldisorders in children (55 FR 51208 (December 12, 1990)).1991 SSA issued new regulations in response to the Zebley Supreme Court decision implementing anew disability evaluation process for SSI children (56 FR 5534 (February 11, 1991)). The newrules established a procedure for evaluating whether a child’s impairments were “functionallyequivalent” to the Listing of Impairments and, if not, for making an “Individualized FunctionalAssessment” to determine disability based on less severe functional limitations.SSA issued new regulations (56 FR 36932 (August 1, 1991)) implementing provisions of The SocialSecurity Disability Benefits Reform Act of 1984 requiring that SSA establish standards for consultativeexaminations, consider all of the evidence available in a claimant’s case record, and developa complete medical history covering at least the preceding 12 months. The new regulations alsoaddressed the evaluation of pain and other symptoms, and provided rules on the evaluation ofmedical opinion evidence, including the opinions of claimants’ treating physicians.1992 Beginning in 1992, State-wide class action suits were filed in Iowa, Nebraska, Oregon, and Utahagainst State DDSs and the Federal government alleging that adjudicators used improper policiesand procedures when making disability determinations. The issues included development andconsideration of treating source medical evidence and opinion; evaluation of the credibility of anindividual’s statement of symptoms, including pain; appropriate use of vocational resources andevaluation of vocational evidence; and Federal oversight of the DDSs. The cases were settled withagreements that included re-evaluation of certain previously denied claims and ongoing communicationswith plaintiffs’ representatives to discuss concerns related to the disability determinationprocess.94 Aspects of Disability Decision Making: Data and Materials