On December 17, 2008, GAO issued a report concerning our findings on the Social Security Administration's (SSA) collection of medical evidence in the disability determination process. In the course of our review, an issue arose that was outside the scope of our work but is important to how SSA communicates its disability determinations to claimants. During this review, we examined a limited random selection of electronic folders for initial disability determinations for fiscal year 2007. The folders included notices sent to each denied claimant to explain the reasons for the denial of their claim and the evidence used to make the determination. Our findings related to these notices and current SSA policy regarding them is the subject of this report. This report also contains a recommendation that warrants SSA management's consideration.

Notices sent to denied claimants may provide inconsistent and sometimes misleading information about the evidence obtained. Our review of a sample of electronic folders with initial determinations revealed, in some cases, that notices provided claimants with a confusing list of reports from medical sources that did not clearly indicate the medical evidence the Disability Determination Services (DDS) used to reach its determination. In response to DDS requests for medical records, some providers responded that they have no records, either for the individual or the period in question. In some cases, the notice sent to these claimants may include only those providers who actually submitted medical records. However, some notices include all providers who responded to the medical records request. By also including those providers who responded that they have no records, without distinguishing between these varied responses, SSA is providing additional information that may confuse claimants. Federal regulations require that notices providing an unfavorable determination to a claimant discuss, in understandable language, the evidence used to reach a determination on the claimant's case. SSA, however, instructs DDSs to include lists of all medical sources that respond to DDS requests, whether or not they provided medical evidence. SSA does not instruct staff to distinguish between sources that provide medical evidence and those that do not. Moreover, the notices typically go so far as to state that the denial was based on input received from specific providers, even those who could not produce any records. Thus, applicants may lack information needed to follow up with specific providers who may have relevant records.

Status Legend:

Review Pending-GAO has not yet assessed implementation status.

Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.

Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.

Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.

• Review Pending
• Open
• Closed - implemented
• Closed - not implemented

Recommendation for Executive Action

Recommendation: In order to provide claimants clearly understandable information concerning the evidence used as a basis for SSA's denial of their disability claims, SSA should modify its guidance to require that notices to claimants identify medical sources in a manner that clearly distinguishes (1) sources that provided requested medical evidence, (2) sources that responded to the request but did not provide evidence, and (3) sources that did not respond.

Agency Affected: Social Security Administration

Status: Open

Comments: Although SSA agreed with the recommendation, it noted that implementing it will require more study and some programming changes in computer systems. As of July 2011, SSA had not amended the pertinent guidance concerning these decision notices. In FY12, SSA reported that the cost for changing the numerous current Disability Determinations legacy systems to identify sources in a manner that clearly distinguishes sources that provided medical evidence versus sources that responded without records is cost prohibitive, especially as they are devoting resources to developing the new common disability case processing system (DCPS). SSA Headquarters components (Office of Disability Determination (ODD), Office of Disability Systems (ODS), Office of Open Government (OOG) and Office of Disability Programs (ODP)) are working together to ensure the DDS decisional notices are clear to the reader and consistent within DCPS. The beta functionality for DCPS will automatically default the sources that provided requested medical evidence to the personal decisional notices and the user will have the ability to manually enter sources that responded to the request, but did not provide evidence. DCPS will be first introduced in September 2012, with national rollout beginning in 2014.