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PERIODIC REVIEW OF CONTINUING DISABILITY

In another provision of the 1980 Amendments, Congress sought to ensure the integrity of the disability programs by requiring that the status of disability beneficiaries be reviewed at least once every 3 years, unless the individual's disability is considered permanent. Prior to the Amendments, continuing disability reviews were conducted only in selected cases where the individual's condition was expected to improve (medical diary cases), or the individual had returned to work. Congress thought that this highly selective review process was inadequate as a means of ensuring that only persons who continued to be disabled remained on the rolls.

Shortly after implementation of the continuing disability review provision, the periodic review process came under criticism from the public and some members of Congress for the effects it was having on some beneficiaries. There were adverse reactions to both the increased number of cases subjected to review, and the fact that the reviews resulted in the termination of payments to many beneficiaries who had been on the rolls for some years and had not expected the review. Because of the widespread concerns regarding periodic reviews, numerous congressional hearings were convened to review the operation of the continuing disability review program. In all, more than 2 dozen hearings were held during 1982 through 1984. During these hearings, questions were raised about the criteria for selecting cases for review, the effects that the enormous workload were having on the quality of adjudications, the adequacy of the medical evidence relied on in medical cessation determinations, and the standards applied in making such determinations. Some persons expressed concern that continuing disability cases were being adjudicated as if they were initial claims without any presumptive effect being given to the previous finding of disability. Some contended that a determination that disability has ended based on medical factors should only be made if there is evidence of medical improvement. Concerns were also expressed that the criteria for establishing disability based on a mental impairment were too restrictive for younger individuals with severe mental impairments that did not met or equal the Listing of Impairments. It was argued that in such cases, the individual was virtually presumed to have the capacity for unskilled work, resulting in an almost automatic finding of not disabled.

During this same period a growing number of Federal courts were issuing decisions requiring the use of a medical improvement standard in continuing disability reviews. For example, in Finnegan v. Mathews (1981), the Ninth Circuit held that the Secretary may not terminate an individual's disability benefits based an medical factors absent a finding of clear error in the previous determination of disability, or evidence of medical improvement sufficient to establish that the individual is no longer disabled. This holding was reaffirmed by the Ninth Circuit in Patti v. Schweiker (1982), and Lopez v. Heckler (1983). Several other Courts of Appeals issued somewhat similar rulings.

In June 1983, Secretary Heckler announced a package of major reforms affecting the continuing disability review program. These included, among others, a temporary moratorium in the review of most mental impairment cases pending a thorough review of the standards for evaluating certain mental impairments, a substantial increase in the percentage of beneficiaries classified as having permanent disabilities and exempt from normal periodic review, selecting cases for review on a random basis instead of based on specific profiles, and an acceleration of a top-to-bottom review of standards, policies and procedures affecting disability evaluation. These reforms were in addition to many administrative initiatives undertaken in 1982 to improve the periodic review process and the quality of disability determinations.

DISABILITY REFORMS

In response to concerns about the periodic review program and the standards applied in evaluating disability, a number of comprehensive disability reform bills were introduced in both the 97th and 98th Congresses. Among other things, legislation was introduced to provide a disability insurance beneficiary who received an initial determination of medical cessation an opportunity for a face-to-face evidentiary hearing at the reconsideration level of administrative review. Another proposal provided a beneficiary the opportunity to receive conditional benefit payments through the administrative law judge hearing level. These provisions were enacted on January 12, 1983, as part of Public Law 97-455. It was thought that replacing the paper review with an evidentiary hearing at reconsideration would improve adjudications at that level and eliminate the need for some beneficiaries of having to appeal their cases to an administrative law judge. Other measures that were contained in many of the disability reform bills included the establishment of a medical improvement standard for medical cessation, a moratorium on periodic reviews of mental impairment cases pending revision of the criteria for evaluating such impairments, a statutory standard for evaluating symptoms, such as pain, and a provision requiring that the combined effects of a person's impairment be considered at all steps of the sequential evaluation of disability. These areas of disability evaluation were the subject of an increasing number of class-action suits in the Federal courts, many of which resulted in court orders requiring the Secretary to apply particular standards for evaluating disability on a State-wide or circuit-wide basis. These developments, coupled with various concerns regarding periodic reviews, prompted the Congress to pass the disability reform legislation that was signed into law on October 9, 1984, as the Social Security Disability Benefits Reform Act of 1984.