Deputy Commissioner for Disability and Income Security Programs, Martin Gerry's Testimony
Before The Ways And Means Subcommittee On Social Security
On The Social Security Definition Of Disability
Mr. Chairman and Members of the Subcommittee:
Thank you for inviting me today to discuss the definition of disability used by the Social Security Administration (SSA) in evaluating applicants for Social Security and Supplemental Security Income (SSI) disability benefits. I will briefly describe the programs to which the definition applies and will then elaborate some more on the definition in the Social Security Act (the Act) and in SSA regulations.
Social Security and SSI Disability Programs
The Act provides cash benefits to individuals with disabling physical and mental disorders under two major programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Often, receipt of disability benefits also provides access to health care.
SSDI comprises a number of disability benefits for workers and their dependents and survivors. Entitlement is based on contributions to the Social Security trust funds through Federal Insurance Contribution Act (FICA) taxes. Individuals who qualify for SSDI benefits are entitled to receive medical benefits from the federal Medicare program generally after they have been entitled to benefits for 24 months. SSDI benefits include:
- Disability Insurance Benefits. This is a cash benefit paid to workers who have not reached retirement age, who are disabled or blind as defined in the Act, and who meet other requirements for entitlement described below.
- Widow's and Widower's Insurance Benefits based on disability. Disabled widows or widowers of workers may receive benefits if they are at least 50 years old. In general, the disability must have started before the worker died or within seven years after the worker's death. Surviving divorced spouses with disabilities may also qualify for this disability benefit.
- Child's Insurance Benefits based on disability. An unmarried, disabled child of a worker who has died, retired, or is receiving disability insurance benefits may receive this benefit. In general, the individual must be unmarried and 18 years old or older to qualify. The individual must have been continuously disabled since before attaining age 22.
The same definition of disability applies to all these benefits. Benefits can also be payable to non-disabled spouses and children of SSDI recipients.
SSI is a means-tested program that provides a basic floor of income for individuals with limited incomes and resources. SSI benefits are paid to aged (age 65 and older), blind, and disabled individuals who have limited means. Individuals under age 65, including children (individuals under age 18) must be blind or disabled to qualify for benefits. The same definition of disability that applies for SSDI also applies for SSI benefits for adults. Children under the age of 18 have a different definition of disability for SSI which was enacted in 1996.
In addition to this basic floor of income, individuals eligible for SSI can benefit from Medicaid health insurance coverage from the States.
The Social Security Act
The Social Security Act broadly defines disability for adults as the inability to engage in any substantial gainful activity (SGA) due to a physical or mental impairment that has lasted or is expected to last at least one year or to result in death. Neither shorter-term disability nor partial disability is encompassed. The Act requires the Commissioner of Social Security to prescribe rules for obtaining and evaluating evidence and making disability decisions. The law further requires that initial disability determinations be made by State agencies, called Disability Determination Services (DDSs), following Federal rules and guidelines and fully financed by Federal funds.
As prescribed in SSA's regulations, disability in adults is evaluated under a five-step "sequential evaluation process." The steps are followed in order until a decision is made. The first step is to determine whether the individual is engaging in SGA. Under current regulations, in the case of blind individuals, the SGA earnings limit is set by statute, and is currently $1,300 a month. For individuals with other disabilities, if a person is earning more than $780 a month, he or she will be considered to be engaging in SGA. However, SSA does not necessarily count all the person's earnings. For example, we deduct impairment-related work expenses when we determine the amount of earnings to count. Both amounts are indexed annually to average wage growth.
If it is determined that the individual is engaging in SGA, a decision is made at the first step that he or she is not disabled without considering medical factors. If an individual is found not to be engaging in SGA, the existence, severity and duration of the person's impairment are explored. At this step, and throughout the remainder of the process, we consider all of a person's physical and mental impairments, both singly and in combination.
If the individual does not have a medical impairment, or the impairment or combined impairments are determined to be "not severe" (i.e., they do not significantly limit the individual's capacity to perform basic work activities), the individual is found not disabled at the second step. If the impairment is "severe," we proceed to the third step, where a determination is made as to whether the impairment "meets" or "equals" the criteria of one of the medical listings published in regulations by SSA.
Listing of Impairments
The Listing of Impairments describes, for each major function of the body, impairments that are considered severe enough to prevent a person from doing any gainful activity, as opposed to any substantial gainful activity. The Listings are not required by statute, but SSA has been using them in one form or another since it first started evaluating disability claims, updating them as needed, to screen the most obviously disabled applicants. Most of the listed impairments are permanent or expected to result in death, or a specific statement of duration is made. For all others, the evidence must show that the impairment has lasted or is expected to last for a continuous period of at least 12 months.
At this third step, the presence of an impairment that meets the criteria in the Listing of Impairments (or that is of equal severity) is usually sufficient to establish that an individual who is not working is disabled, without the need to consider the individual's age, education, or work experience. However, the absence of a listing-level impairment does not mean the individual is not disabled. Rather, it merely requires the adjudicator to move on to the next step of the process.
If a "severe" impairment neither "meets" nor "equals" a listing (which would result in a finding of disability), SSA assesses the individual's residual functional capacity--what an individual can still do despite his or her impairment--and uses that assessment in the last two steps of the process. At step four, we consider whether the person has the residual functional capacity to meet the physical and mental demands of past relevant work. If the impairment does not prevent the individual from meeting the demands of past relevant work, the person is found not disabled.
Finally, if the impairment does prevent the individual from performing past relevant work (or if the person did not have any past relevant work) it must be determined whether the impairment prevents the person making an adjustment to other work at step five. As the statutory definition states, the individual must be "not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy...."
The statutory standard is a method of judging disability. For example, the law specifies that the work the person can do does not have to exist in the immediate area in which he or she lives, and that a specific job vacancy does not have to be available to him or her. Work in the national economy is defined in statute as work which exists in significant numbers either in the region where such individual lives or in several regions of the country.
SSA has developed a vocational "grid" designed to minimize subjectivity and promote consistency in applying the vocational factors. The grid regulations relate age, education, and past work experience to the individual's residual functional capacity to perform work-related physical and mental activities. If the applicant has a particular level of exertion work capability--characterized by the terms sedentary, light, and medium--an automatic finding of "disabled" or "not disabled" may be required when such capability is applied to various combinations of age, education, and work experience. Otherwise, we use the rules as a framework for decision making.
Other Definitions of Disability
There are numerous other definitions of disability for different purposes. Workers compensation, vocational rehabilitation, State Medicaid programs, and private disability insurers each has its own definition of disability for its own purpose.
One notable example is The Americans with Disabilities Act (ADA). Its definition of disability is different from SSA's definition. The purpose of the ADA is to:
(1) provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities;
(2) provide clear, strong, consistent, enforceable standards addressing discrimination against individuals with disabilities;
(3) ensure that the Federal Government plays a central role in enforcing the standards established in this Act on behalf of individuals with disabilities; and
(4) invoke the sweep of congressional authority, including the power to enforce the fourteenth amendment and to regulate commerce, in order to address the major areas of discrimination faced day-to-day by people with disabilities.
In 1999, the United States Supreme Court held in a 9-0 decision that the pursuit, and receipt, of SSDI benefits does not automatically prevent the recipient from pursuing an ADA claim. The court's decision further noted that both ADA and SSDI claims "can comfortably exist side by side" and recognized that the two laws do not share a common definition of disability.
One of the most valuable services SSA can provide to policymakers is the information they need for making sound decisions. SSA places a high priority on policy analysis and research that will provide the information necessary to evaluate and strengthen the nation's disability programs.
Many experts believe that providing intervention methods to disabled individuals as close to the disability onset as possible significantly improves their chance of starting or returning to work. We plan on testing several models including such interventions as integrated service supports and collaboration with employers. We also plan to study the extent to which the listings are predictive of work ability.
Finally, I thank you, Mr. Chairman, Mr. Matsui, and all the members of the Subcommittee, for beginning the public process of exploring the definition of disability for Social Security benefits. Obviously, any potential changes would have to be considered in terms of the long-term solvency of the combined trust funds. I stand with the Commissioner in her pledge to work with the Administration, with the Congress, and with the dedicated and experienced employees of the Social Security Administration to find the best solutions for this and other issues facing the Agency.
Again, thank you for inviting me to be here today. I look forward to working with you to improve Social Security's disability programs.