May 2010
Congressional Response Report: Disability Determination Services Medical Consultant Assessments
(A-01-10-11007)
Objective
To review allegations by the American Association of Social Security Disability Consultants that (1) medical consultant (MC) assessments were altered and/or destroyed in the disability determination services (DDS), (2) MCs were pressured to produce specific assessments, and (3) disability examiners (DE) were seeking certain MCs to obtain specific assessments.
Background
The MC does not have sole authority to determine whether a claimant is disabled under Social Security’s criteria. The MC provides expertise in evaluating impairments, documenting findings, and preparing or reviewing assessments. The assessment does not include an opinion on whether the claimant is disabled.
To view the full report, visit http://www.ssa.gov/oig/ADOBEPDF/A-01-10-11007.pdfOur Findings
To perform our review, we researched the Social Security Administration’s (SSA) policies regarding the processing and documenting of MC assessments and reviewed SSA system controls for the disability folder. Additionally, we contacted
468 DDS employees nationwide about processing and documenting MC assessments. Specifically, we contacted
The table below shows the number of DDS employees sampled and who participated in our review.
Number of DDS Staff Who Participated in Our Review |
|||
DDS Position |
Population |
Sampled |
Participants |
Medical Consultant |
2,240 |
208 |
189 (91%) |
Disability Examiner |
8,172 |
208 |
197 (95%) |
Administrator |
52 |
52 |
52 (100%) |
TOTAL |
10,464 |
468 |
438 (94%) |
We also contacted SSA’s Regional Offices and Office of Disability Determinations and other disability insurance providers for information for our review. Furthermore, we reviewed examples of claims with an MC assessment deleted from the disability folder.
Based on feedback from DDS and SSA employees, our examination of controls over the documentation of disability determinations, and our review of some actual cases, we found that generally (1) MC assessments were not altered and/or inappropriately deleted in the DDS, and (2) MCs were not pressured to produce specific assessments. We also found that the majority of DEs responding to our survey did not seek certain MCs to obtain specific assessments.