TABLE 1


Table 1: Award Rates at DDS and ALJ Levels by Impairment Type
DDS award rates (percent) ALJ award rates (percent)
Physical 29 74
Musculoskeletal 16 75
Back cases 11 75
Other musculoskeletal 23 76
Other physical 36 74
Mental 42 87
Illness 39 87
Retardation 54 84
All impairments 30 77

Note: ALJ data are from an ongoing SSA study. Data include ALJ cases decided from September 1, 1992, through April 30, 1995. Study samples excluded certain types of cases, such as children's cases. DDS data for the same period and types of cases were obtained from SSA's administrative database.

















TABLE 2


Table 2: Five-Step Sequential Evaluation Process for Determining Disability
Step Questions asked in the sequential process Action or decision taken if answer to question is:
Yes No
1 Is the claimant engaging in substantial gainful activity? Stop—claimant is not disabled Go to step 2
2 Does the claimant have an impairment that has more than a minimal effect on the claimant's ability to perform basic work tasks and is expected to last at least 12 months? Go to step 3 Stop—claimant is not disabled
3 Do the medical facts alone show that the claimant's impairment meets or equals the medical criteria for an impairment in SSA's Listing of Impairments? Stop—claimant is disabled Go to step 4
4 Comparing the claimant's residual functional capacity with the physical and mental demands of the claimant's past work, can the claimant perform his or her past work? Stop—claimant is not disabled Go to step 5
5 Based on the claimant's residual functional capacity and any limitations that may be imposed by the claimant's age, education, and skill level, can the claimant do work other than his or her past work? Claimant is not disabled Claimant is disabled


















TABLE 3


Table 3: DDS and ALJ Differences in Functional Assessment Classifications for Physical Impairment Awards
Level of physical exertion determined by functional assessment Percentage of awards
Quality reviewers using DDS approach Original awarding ALJs
Heavy work (or no limiting effect on physical effort) 0 0
Medium work 22 1
Light work 56 8
Sedentary work 15 25
Less than the full range of sedentary work 6 66

Note: Data are for ALJ awards made from September 1992 through April 1995.

















TABLE 4


Senior Attorney Decisions—August 1995-March 1997
Region Reviewed Allowed Payment Rate
I 9,253 2,384 25.8%
II 42,131 12,567 29.8%
III 37,739 7,638 20.2%
IV 70,891 19,133 27.0%
V 56,252 9,160 16.3%
VI 46,519 7,893 17.0%
VII 11,777 1,914 16.2%
VIII 8,394 1,781 21.2%
IX 38,256 7,023 18.6%
X 11,680 2,710 23.2%
Total 332,892 72,203 21.69%


















TABLE 5


Number of Favorable Decisions From August 1995 Through March 1997
Action #7 OTR Action #7 After Hearing Non-Action #7 OTR Non-Action #7 After Hearing
Senior Attorneys 72,203 NA NA NA
ALJs 23,657 69,985 71,170 281,098


















TABLE 6


Appeals Council Review of Unappealed on-the-Record Decisions
Cumulative from August 8, 1995
Effectuation Percent Remand Percent AC Decision Percent TOTAL CASES
Senior Attorneys 787 85.92% 123 13.43% 6 .66% 916
ALJs OTR 662 85.64% 101 13.07% 10 1.29 % 773
Adjudication Officers 60 73.17% 20 24.39% 2 2.44% 82


















TABLE 7


Appeals Council Review of Unappealed on-the-Record Decisions
October 1, 1996 to March 12, 1997
Effectuation Percent Remand Percent AC Decision Percent TOTAL CASES
Senior Attorneys 196 89.09% 23 10.45% 1 0.45% 220
ALJs OTR 163 85.79% 26 13.68% 1 0.53% 190
Adjudication Officers 22 81.48% 4 14.81 1 3.70% 27


















TABLE 8


ALJ Favorable Rates
March 1997 FY 1997 August 1995-March 1997
Cases Reviewed Under Action #7 55.6% 54.8% 57.1%
Cases not Reviewed Under Action #7 47.8% 47.7% 51.4%