Aspects of Disability Decision Making: Data and Materials

Shortly afterwards, SSA published additional regulations (60 FR 47469 (September 13, 1995))that allowed it to test the position of “adjudication officer” in the hearing process, a modificationthat had also been proposed in the 1994 Plan for a New Disability Claim Process.1996 The Senior Citizens Right to Work Act of 1996 (P.L. 104‐121) eliminated SSI and DI benefits for individualsfor whom drug addiction or alcoholism was a “contributing factor material to the determinationof disability,” and required SSA to redetermine the eligibility of people already receivingdisability benefits based on a diagnosis of drug addiction or alcoholism.The Personal Responsibility and Work Opportunity Reconciliation Act (P.L. 104‐193) made severalsignificant changes to the SSI program with respect to disabled children. It:■■made the SSI definition of disability for children stricter, requiring that a child have “a medicallydeterminable physical or mental impairment which results in marked and severe functionallimitations”■■required SSA to eliminate references to maladaptive behavior from the Listing of Impairments;■■required SSA to discontinue individualized functional assessments for children;■■required SSA to conduct CDRs on children who had been allowed based on low birth weightat age 1, and to conduct regular CDRs on other children;■■required redeterminations of disability at age 18 using the adult disability standard; and■■added several new requirements for representative payees of children.As a part of its “Process Unification” initiative, SSA issued a series of nine Social Security Rulings(61 F.R. 34466 (July 2, 1996)) that addressed a range of disability adjudication policies includingthe agency’s policy on the evaluation of pain and other subjective symptoms, treating sourceopinions, and residual functional capacity. SSA conducted agency-wide training for all of its15,000 adjudicators and quality reviewers on the new rulings. Although process unification hadbeen an important component of the 1994 Plan for a New Disability Claim Process, its origins werein the 1980s, when class action lawsuits were filed in several States (including Florida, Iowa, Minnesota,Nebraska, Ohio, Oregon, Tennessee, Utah, and West Virginia) challenging the standardsand practices used by State DDSs in disability claims. Plaintiffs usually claimed that the policiesapplied by the DDS in disability decisions were different and stricter than the policies applied atthe hearing level by administrative law judges. “Process Unification” became the umbrella underwhich the agency attempted to respond to the widespread perception that different standardswere being applied.1997 SSA issued interim final rules (62 FR 6408 (February 11, 1997)), implementing the childhooddisability provisions of P.L. 104‐193 (as further modified by the Balanced Budget Act of 1997(P.L. 105‐33). These rules revised the disability evaluation process for SSI children by:■■defining the statutory standard of “marked and severe functional limitations” in terms of“listing-level severity,” (i.e., an impairment that meets, medically equals, or functionally equalsthe severity of an impairment in the Listing of Impairments);■■deleting references to the former “comparable severity” standard;■■eliminating the individualized functional assessment; and■■removing references to “maladaptive behavior” in the regulations.The rules, with minor revisions, were published as final regulations that became effective in 2001(65 FR 54747 (September 11, 2000)).96 Aspects of Disability Decision Making: Data and Materials