The Social Security Old-Age, Survivors, and Disability Insurance (OASDI) program provides for monthly disability insurance benefits after the onset of a severe physical or mental impairment. To become entitled to such benefits a worker must:
A worker’s cash benefit is classified as an award at the time of initial payment. Additional auxiliary benefits may also be payable to other family members based on the earnings record of the entitled worker. This study analyzes the experience of disabled workers of the Social Security Disability Insurance (DI) program as described under title II of the Social Security Act.
To qualify for Social Security benefits for themselves and their dependents, individuals must work in employment covered by Social Security or be self-employed for a certain period of time. Credit for this work is based on the amount of wages or self-employment income earned and is measured in quarters of coverage (QCs), or
credits.
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Entitlement to any benefit depends on whether the number of credits earned by a worker is sufficient to meet various insured status requirements. To be considered for disability benefits, a worker must be
disability insured. This requires having obtained a specific number of credits in recent quarters, as well as enough total credits to be
fully insured—at least 6 and no more than 40 credits are required for this insured status.
2 The recency-of-work test is satisfied if the worker has earned at least 20 credits during a 40-quarter period that ends with the quarter in which the disability begins.
A special recency-of-work test for younger workers provides an alternative to the 20/40 requirement. A worker who becomes disabled before the quarter in which he or she attains age 31 satisfies the recency-of-work requirement if credits have been earned for at least one-half of the quarters during the period beginning with the quarter after the quarter the worker attained age 21, and ending with the quarter in which the disability began. If this period contains 12 or fewer quarters—that is, if the disability begins in the quarter the worker attains age 24 or earlier—then a minimum of six credits must be earned in the 12-quarter period ending with the quarter in which the disability began.
Note that an individual who is disabled because of statutory blindness is not required to satisfy the recency-of-work test. Disability insured status is granted if the worker is fully insured only.
An individual must file an application to become entitled to benefits. In general, a claimant may file for DI benefits at any time after onset of disability. A claimant who files after the first month he could have been entitled to benefits may receive retroactive benefits for up to 12 months immediately prior to the month of filing.
Retroactive benefits are also payable for any month of entitlement beginning with the month of filing and leading up to the month of award. The number of months of retroactive benefits paid in these instances ultimately depends on how long it takes to receive a favorable determination of disability.
A claimant may also file for benefits no later than 12 months after the month in which the disability ends. In these instances, retroactive benefits are payable only for those months of entitlement within the 12-month period immediately prior to the month of filing. For purposes of establishing a closed period of
disability freeze3, there are exceptions where the claimant is allowed to file no later than 36 months after the month in which disability ends.
For purposes of entitlement to DI benefits, disability is defined as the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment. The impairment must be expected to result in death or to last for a continuous period of at least 12 months—called the
duration requirement. Specifically, the disability must prevent the claimant from performing previous work, or engaging in any other kind of work in which a significant number of jobs exist. It is immaterial whether such work exists in the claimant’s immediate area, or whether a specific job vacancy exists, or whether the claimant would be hired if he or she applied for work.
When an individual applies for benefits under title II of the Act, a five-step sequential evaluation process is used to decide whether disability exists. Claim processing stops as soon as a favorable or unfavorable determination can be reached.
Step 1—Determine if claimant is engaging in SGA. If the claimant is working and the work is SGA, then he or she is not disabled for Social Security purposes. Otherwise, the adjudicator continues with claim processing.
Step 2—Determine if impairment is “severe”. If the impairment or combination of impairments do not significantly limit the claimant’s physical or mental ability to do basic work activities, then he or she is found to be not disabled. Otherwise, the adjudicator continues with claim processing.
Step 3—Determine if the severity of the impairment(s) meets or medically equals a set of criteria in the Listing of Impairments. If the impairment is counted among examples of impairments that the agency considers severe enough to prevent the claimant from engaging in SGA, and the duration requirement is met, then claimant is disabled. Otherwise, the adjudicator continues with claim processing.
Step 4—Determine if the claimant has the residual functional capacity (RFC) to do his or her past relevant work. An assessment is made of what the claimant is still able to do despite any limitations imposed by the impairment(s). If past work duties cannot be accomplished, then the adjudicator continues with claim processing.
Step 5—Determine if the impairment prevents claimant from engaging in any other work that exists in significant numbers in the national economy. If the claimant is unable to perform any other work given his or her RFC, age, education, and work experience, and the duration requirement is met, then claimant is disabled. Otherwise, he or she is found to be not disabled for Social Security purposes.
Special provisions exist for the evaluation of disability in cases of statutory blindness, and widow(er) or surviving divorced spouse benefits payable before January 1991.
The waiting period for DI benefits consists of 5 consecutive full calendar months beginning with the earliest full calendar month throughout which the worker satisfied both the disability insured requirements and definition of disability. Benefits are not payable during the waiting period. However, the waiting period is waived for individuals who had a prior period of disability which ended within 5 years of the current period of disability. In contrast, there is no waiting period for disability benefits under the SSI program.
Applications for worker disability benefits are taken by SSA field staff over the phone, in person in one of 1,300 local field offices, or over the internet. State agencies make disability and blindness determinations under regulations containing performance standards and other administrative requirements. Prior to a medical determination of disability, a claim may be denied for technical reasons, if the claimant:
Once the technical aspects of the determination process are satisfied, claims are forwarded to the state Disability Determination Services for medical determination. The subsections below discuss in greater detail the following items: SGA, the impairment listings, residual functional capacity, the determination and appeals process, and the determination experience of the DI program.
Substantial work activity involves doing significant physical or mental activities;
gainful work activity is done for pay or profit. In determining whether work is SGA, the state agencies will consider things such as the nature of the claimant’s work, how well the work is performed, whether work is done under special conditions or uses special equipment, the amount of time spent at work, and, of course, earnings. Special evaluation guidelines exist for self-employed persons—agencies must measure the value of the claimant’s services to the operation of the business, number of hours worked, skills, efficiency, duties, and responsibilities.
Certain earnings criteria have been established as reasonable indications of whether an individual is engaging in SGA. The dollar amount associated with defining SGA is specified in Federal regulations, and was originally set at $100 at the inception of the DI program. This amount was updated on an ad hoc basis until January 2001, at which time the regulations were revised to provide for annual indexing of the SGA level based on the increase in average wages. From 1990 through 2000, the SGA level actually consisted of a primary amount and a lower secondary amount. Earnings above the primary amount ordinarily demonstrated SGA, whereas earnings less than the secondary amount demonstrated lack of SGA; earnings between the two amounts required consideration of all circumstances related to work activity. This tier structure was discontinued beginning in 2001. Since 1977, blind persons have been subject to a separate SGA amount.
4 Figure 1 shows a history of these SGA amounts.
To establish a disability, sufficient evidence is required of the claimant’s medical condition(s) in the form of symptoms, clinical signs, and laboratory findings. As mentioned in the description of step 3 of the sequential evaluation process outlined in section I, SSA’s
Listing of Impairments is used to determine the severity of the disability. The listings are a set of medical evaluation criteria in the Federal regulations that describe physical and mental conditions which are so severe that it is presumed that individuals whose medical conditions meet or equal these criteria are disabled regardless of their age, education, or work experience. The listings are arranged by body system (musculoskeletal, cardiovascular, mental, etc.) and include both diagnostic and severity criteria.
Many individuals are found to be disabled even though impairments fail to meet the level of severity detailed in the listings. In these cases, an individual’s medical condition is evaluated in conjunction with age, education, and job skills. These
vocational factors are given increasing weight with the advancing age of the worker, and are particularly significant in the determination of disability among workers age 50 or older.
Impairment(s) and any related symptoms, such as pain, may limit the ability to work. Residual functional capacity measures the most an individual can do despite physical and mental limitations. Careful assessment of RFC is the foundation of steps 4 and 5 of the sequential evaluation process. Limited ability to perform certain physical demands such as sitting, standing, walking, lifting, carrying, pushing, pulling, reaching, handling, or stooping may reduce the ability to do work. Similarly, a limited ability to carry out certain mental activities like understanding, remembering, following instructions, or responding appropriately to supervision may reduce the ability to do work.
Along with RFC, age and education play a vital role in step 5 of the evaluation process. When it comes to age, it is generally considered that younger persons (under 50) will be able to adjust to other work. Greater consideration is given to age and education for those approaching advanced age (50-54); and it is assumed that persons of advanced age (55 or older) are significantly hindered by vocational factors in their ability to adjust to other work.
Regulations describe the process of administrative review performed by the Disability Determination Services (DDS) and the Office of Disability Adjudication and Review (ODAR). The DDS is responsible for developing medical evidence and rendering the initial determination of whether the claimant is disabled or blind under the law. If dissatisfied with the initial DDS decision, the claimant has the right to request further administrative review by the DDS, ODAR, and beyond to the federal courts. The review process consists of several steps, which must be requested within specified time intervals, and in the following order:
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Reconsideration. If dissatisfied with an initial determination, the claimant may ask the DDS to reconsider it.
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Appeals Council (AC) review. If dissatisfied with the decision of the ALJ, the claimant may request that the AC review the decision. This constitutes the administration’s final decision.
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Federal court review. If dissatisfied with the administration’s final decision, the claimant may request judicial review by filing an action in a Federal district court.
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In general, appeals must be filed within 60 days after the date the claimant receives notice of the previous determination or decision. The claimant has the opportunity to submit new material evidence supporting the claim during any step of the review process. The information may be presented by the claimant or a representative, such as an attorney. Failure to appeal a determination or decision within the stated time period will result in loss of the right to any further administrative or judicial review.
Many factors exist that affect the number of disability claims filed as well as the rate at which these claims are allowed or denied. However, the impact of any one factor is difficult to gauge. In general, economic, demographic, and administrative factors all have a direct effect on the size and scope of the DI program. Below is a list of determinants which can significantly influence the number of claims filed and/or the rate of favorable determinations
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Table 1 presents data on the disposition of claims for DI disability benefits across the various stages of review, for calendar years 1998-2009. The data are tabulated by year of filing, with an additional categorization by program involvement—showing claims for DI benefits only or concurrent entitlement to DI and SSI benefits. As mentioned earlier, both programs use the same definition of disability for adults. However, eligibility for SSI benefits is further dependent upon the claimant’s countable assets and income, which may include DI benefits.
The number of claims forwarded to the DDS for DI disabled worker benefits grew to 1.53 million in 2004 from 1.04 million in 1998—nearly a 50 percent increase, with roughly a 10 percent increase occurring in each of 2001 and 2002. General reasons for the increase are the aging of the baby-boom, and higher levels of unemployment resulting from the economic contraction which began in the second quarter of 2001. In addition, the late 1990s exhibited marked increases in the number of disability insured workers, increasing the pool of those that may become eligible for benefits.
The number of disability claims remained steady throughout 2005-08 at roughly 1.4 million per year. Although the baby-boom continues to progress through the peak ages of disability, the level pattern likely reflects the stable demographic and economic conditions of the period—low unemployment, stable labor force participation (ages 16-64), and strong wage growth. In addition, there were no major legislative initiatives which might provide incentives to seek benefits. More recently, the number of claims spiked almost 20 percent to 1.8 million in 2009, triggered by the severe economic recession that began in 2008.
As shown in table 1, the number of favorable initial determinations as a percentage of total claims processed increased to 39.7 percent in 2001 from 33.7 percent in 1997. The growth during this period was likely due to a confluence of factors. The leading edge of the baby-boom began entering their late 40s and early 50s; these are prime ages for musculoskeletal, circulatory, and neoplastic impairments—all high-allowance disorders. Another possible factor was an ad hoc increase in the dollar amount associated with defining SGA. The monthly level for non-blind workers was increased to $700 in 1999. This amount had not been changed since 1990, when it was set at $500. The higher level may have increased the potential of meeting the definition of disability for some claimants.
It is worth noting that allowance rates tend to be much lower among those concurrently filing for DI and SSI benefits than those filing for DI benefits only. This may be due to differences in the composition and economic status of the filers. Concurrent filers tend to be of lesser means (reflective of the nature of the SSI program) and are thus more likely affected by changes in the economy. Often the only alternative to unemployment is to seek aid from Federal, State, or local programs. Therefore, concurrent filers may have less severe disabilities, may provide less evidence of impairment, or are less likely to afford legal representation. The result is a lower proportion of allowances.
Also note that for years with pending workloads, it is likely that the allowance rates will ultimately be lower than those shown in table 1. This is due to the fact that, on average, the processing time involved in an unfavorable decision is longer than that in making a favorable decision.
Allowance rates at the reconsideration level have been very consistent. Although the reconsideration stage is
de novo 6 in concept, it is similar to the initial stage in that disability determination is mostly a “paper review” process where claimants are rarely observed by the decision-maker. Assuming some uniformity among the initial decision-makers, it follows that initial denials are seldom overturned at reconsideration.
The subjectiveness in assessing disability leaves considerable room for differences in the interpretation of evidence. As a result, overturned decisions at ODAR and beyond remain relatively high. Factors that contribute to the high reversal rate include:
Because the way in which the disability process operates has changed over time, there are several items that should be mentioned to assist the reader in interpreting the data presented in table 1. First, beginning in the late 1990s SSA undertook the testing of a variety of alternative approaches to the disability determination process with the goal of streamlining the process while still providing accurate decisions as early in the process as possible. One of the largest such tests has been referred to as the
Prototype Model. Major features of this model include providing additional authority for the DDS examiners in making initial disability determinations, and the elimination of the reconsideration step in the appeals process. This test continues to be run in 10 States representing roughly 25 percent of the initial disability determination workload. The results shown in table 1 reflect a mixture of experience combining the standard decision process with the prototype process, as well as other smaller test processes.
In the past, public pressure has surfaced in controversial areas. Changes in regulations, standards, and methods used to determine the severity of a disability—sometimes in response to legislation or legal suits—have shaped DDS determinations, ODAR decisions, and SSA policy in general. Major topics for deliberation have included:
As the DI program grows and disability claims become more complex to adjudicate, SSA is challenged to improve the accuracy, consistency, and fairness of decisions. To this end, other developments in the disability area deserve mention. The
electronic disability (eDIB) process has substantially streamlined the collection and storage of claim data. Beginning in August 2002, claimants have been able to apply for disability benefits online; as of January 2006, all state DDSs had begun using electronic disability folders.
Electronic filing facilitates initiatives such as quick disability determination (QDD). Under the QDD process, a predictive model identifies claims that have a high potential of allowance, and for which medical evidence can be easily obtained. Claims are automatically referred from the field office to the DDS whose aim is to complete the determination within a 20-day time limit.
The compassionate allowance (CAL) initiative is designed to quickly identify diseases and conditions that are highly likely to qualify under the Listing of Impairments based on minimal medical information. For the rollout of the initiative, 50 conditions were chosen which meet the CAL guidelines. The list has since been expanded to include roughly 90 conditions such as early-onset Alzheimer’s disease, Lou Gehrig’s disease, and various cancers.
Since the payment of the first disability cash benefits in July 1957, the characteristics of the DI program have been shaped by congressional action, public opinion, and court rulings. Program fundamentals such as the definition of disability, the entitlement process, the level of benefits, and the review process for current beneficiaries ultimately determine program cost.
7 Prior to 1960, the DI program applied only to workers age 50 or older. Prior to 1965, a claimant needed to be permanently disabled to qualify for benefits. The
Social Security Amendments of 1967 (Public Law 90-248) eased the insured status requirements for persons under age 31, allowing a substantial number of young beneficiaries to enter the rolls. Then beginning in 1970, program growth began to accelerate for a number of reasons (see table).
Source: Annual Statistical Supplement to the Social Security Bulletin (1957-74); SSA administration records (1975-85). See table 3 for awards in 1986 and later.
The introduction of the Black Lung program (1970) and the SSI program (1974), and a severe economic recession (1974‑75) led to hundreds of thousands of new DI claims. In particular, the SSI program requires applicants to apply for benefits from other programs—including DI—which may offset SSI benefits. As expediency in processing applications was naturally given high priority, the fraction of preeffectuation reviews of DDS initial allowances by the central office fell to roughly 5 percent in 1972 from 70 percent before 1972. This resulted in far more effectuations of allowances than would have otherwise occurred under the more stringent quality control efforts.
The automatic indexing of benefits by the cost-of-living adjustment (COLA) legislated in 1972 contributed to a dramatic increase in replacement rates. The ratio of annual benefits to past earnings rose from 50 percent to roughly 70 percent by the end of the decade. Not only was the agency paying out more in benefits, but it was thought that high replacement rates made benefits more “attractive”, thus providing incentive to file among individuals with a possible qualifying disability. And to those already on the DI rolls, high replacement rates may have created disincentive to leave the program and return to work.
Another trend seen in the early 1970s was the greater tendency of applicants to appeal an unfavorable decision. This significantly increased the number of awards made at the reconsideration and hearings levels, and further contributed to the sharp increase in awards from 1972-76.
In an effort to bring the cost of disability benefits under control and stabilize replacement rates, the
Social Security Amendments of 1977 (Public Law 95-216) revised the formula for determining benefits awarded in 1979 and later. Under the new calculation, the replacement rate for the average earner was projected to remain stable at around 40 percent. The
Social Security Disability Amendments of 1980 (Public Law 96-265) also had a significant impact on the DI program. The 1980 amendments introduced a more restrictive limit on the total monthly amount of Social Security benefits payable on a disabled worker’s account—allowing for higher total family benefits under the old-age program as compared to disability. For those eligible, this provided incentive to apply for or switch to old-age benefits in lieu of disability benefits.
In addition, the amendments mandated DDS performance standards and a preeffectuation review of 65 percent initial DDS allowances. This led the DDSs to give more careful consideration to allowances, and increased the chances of not effectuating an initially favorable determination.
The most controversial provision of the 1980 amendments was the requirement that SSA conduct a continuing disability review at least every 3 years for beneficiaries whose disability may not be permanent. The termination of a large number of beneficiaries (particularly among the mentally impaired) was met with intense public outcry. A temporary moratorium was placed on the review of the disability rolls pending a thorough review of the standards for evaluating certain mental impairments. Although many of those terminated were returned to the rolls through the appeals process, awards continued to decline steadily from 1977-82 prompting SSA’s disability determination policies to come under fire through court appeals and class action suits.
By 1984, DI program policy had undergone another reversal. In response to the clamor over certain provisions of the 1980 amendments, Congress passed the
Social Security Disability Benefits Reform Act of 1984 (Public Law 98-460). Provisions of the Act include: revised mental impairment standards; increased emphasis on treating physician opinion; emphasis given to the combined effects of multiple impairments in the absence of a single severe impairment; required proof of medical improvement prior to termination of benefits; and standards to evaluate pain.
One significant pattern that emerged following the 1984 amendments involved beneficiaries with mental impairments. The revised listings reduced the weight given to medical factors and put greater emphasis on functional capabilities. By 1988, the proportion of awards for mental impairments had exceeded 20 percent, roughly twice the proportion experienced in 1982.
The early 1990s brought a period of rapid growth. The number of awards to disabled workers over 1991-95 were roughly 48 percent higher than the previous 5-year period (1986-90). Amidst a recession during which the unemployment rate rose above 7 percent, mental disorders continued to grow, comprising more than one-quarter of new awards by 1992. In partial response to this rapid growth, Congress enacted the
Contract with America Advancement Act of 1996 (Public Law 104-121), which provided for dedicated funding to conduct continuing disability reviews, and a change in policy for drug addiction and alcoholism to exclude from eligibility individuals for whom DA&A is a materially contributing factor in disability.
The Ticket to Work and Work Incentives Improvement Act of 1999 (Public Law 106-170) established the Ticket-to-Work program, expedited reinstatement provisions for beneficiaries terminated for returning to work, and increased the period of extended Medicare coverage for disabled beneficiaries.
Other events shaping the experience of disability incidence in more recent years include: the elimination of obesity from the listings in 1999 and the issuance of a new musculoskeletal listing in 2002; a correction to the disability rolls made by awarding benefits to disabled persons who were found to have an inaccurate record of insured status; the legislated increase in NRA beginning with those attaining age 65 in 2003; and the severe economic recession which began in the first quarter of 2008.
Table 2 shows the distribution by impairment for awards to DI disabled workers. The leading diagnostic categories for disability entitlement vary by gender and year of award. The share of musculoskeletal disorders has increased steadily every year since 1995 and is now the largest single category of impairment. Over the 5-year period 2005-09, 29.3 percent of all awards were attributable to this category—a trend that is largely explained by demographics. As the baby-boom generation ages, arthritic, back, and bone disorders become more prevalent.
The jump in the percentage of musculoskeletal impairments in 1995 can be explained by a change in reporting method. Prior to 1995, SSA reported the diagnosis of awards based on the distribution of allowances at the initial level. Allowances at the appeals level were then assumed to have the same diagnostic groupings as those at the initial level. Beginning in 1995, the information used to tabulate awards by diagnostic group was expanded to include diagnostic information from the reconsideration step of the appeals process. In addition, diagnosis information from reconsideration denials was used to infer a distribution of awards made at the ALJ level and beyond. These changes revealed a significantly higher proportion of musculoskeletal impairments at the appeals level as can be observed by the sudden jump in the number of musculoskeletal awards in 1995. The accompanying drop in the percentage of mental impairments in that year suggests that at least some of the awards in this category were among those misclassified under the old reporting method. Beginning in 2003, SSA developed a more direct way of assigning diagnoses for all awards regardless of decision level.
Mental impairments rank second in overall percentage of awards, but have been on a slight downtrend since 2002. Mental disorders were the leading cause of disability among each sex until 1996 and accounted for 23.0 percent of all awards over 2005-09. A slight jump in mental disorders occurred over 2003-05 due, in part, to the processing of the
special disability workload (SDW). In 2001, SSA began reviewing a group of several hundred thousand SSI recipients who potentially became disability insured because of earnings while receiving SSI, making them eligible for DI benefits. Many of the resulting awards from this misplaced cohort were for individuals diagnosed with a mental disorder.
Among males, circulatory disorders have always been a leading cause of disability, accounting for roughly 13-16 percent of total awards over the last 10 years. Neoplasms account for roughly 9-11 percent of total awards. Though not shown in the table, there are nearly four times as many circulatory impairments among those age 50 or older as among those age 35-49; and three times as many neoplastic disorders for the same age comparison. Although medical advancements continue against these impairments, their concentration at the older ages suggests they will continue to significantly impact the DI rolls as the population ages.
Awards based on neoplastic and metabolic impairments rank higher among females than males, whereas awards based on circulatory impairments rank lower. The impairment listings were changed in 1999 to eliminate awards based solely on obesity, accounting for the large decline in the percentage of nutritional and metabolic impairments beginning in 2000.
Table 3 shows the number of DI disabled workers awarded benefits by sex and
calendar age—the age attained on the birthday in the year the individual is awarded benefits—at time of award, for calendar years 1986-2009. This historical series is also illustrated in
figure 2.
Table 4 shows the associated disabled worker incidence rates, which are expressed as annual awards per thousand disability insured not already receiving benefits. Adjusted figures are based on the age and sex distributions of the exposed population as of 2000.
Tables 3 and 4 are tabulated as of the year the beneficiary is added to the rolls. Note, however, that the year of award may actually be different from the year of disability onset or entitlement. This is due to factors such as the waiting period, the nature of the determination process, and claims processing times in general. Consequently, the incidence rates shown are not necessarily representative of true morbidity rates for the stated calendar years.
The incidence of disability increases considerably as individuals age. The chance of suffering an impairment increases naturally with advancing age, but also education and job skills are factored into the determination decision. Note that the rates shown in table 4 for ages 60 and older are likely to understate the true incidence of impairment in the insured population since, beginning at age 62, a disabled worker may elect to forgo disability benefits, opting instead to receive reduced old-age benefits. A number of factors influence this decision, including: potentially higher maximum family benefits under old-age as compared to disability; the potential for disability benefit reduction because of Federal or State workers’ compensation offset
8; and the potentially arduous application process and possibility of benefit denial.
Age-specific disability incidence among female workers is typically lower than males. However in 1997, female incidence began to exceed that for males at ages 35-54. Although both genders experienced a general decline in incidence in this age range over the following 5 years, the decline is more pronounced among males. This is likely due to the elimination of DA&A as a disabling impairment and a sharp decline in HIV impairments, both of which are predominantly male incidence categories. It is also interesting to note that the decline in incidence rates among females did not come from a decline in the number of benefits awarded, but from an increase in the exposure. Over the 10-year period ending in 1996, female labor force participation among ages 35-54 increased between 3.5-10.0 percentage points. This contributed significantly to the additional 10.7 million females that became disability insured in that period; for the same age range, male labor force participation decreased by roughly 2.0-2.5 percentage points.
Some of the same factors that affect the number of DI applicants can also affect incidence rates. In general, a decline in incidence between 1975-82 (not shown) is attributable, in part, to stricter program administration. Following a generally declining period in incidence from 1983-89, the program experienced a surge in claims beginning in 1990, and incidence rates rose significantly and remained relatively high through 1995. The economic and political environment of the late 1990s featured robust economic expansion, low unemployment, and restrictions on DA&A and obesity impairments. In addition, continuing advancements in medical treatment, employer-sponsored healthcare, and an opportunity to build wealth in booming investment markets provided incentive to remain in the labor force and contributed to the decline in applications and awards during this period.
The sharp increase in incidence rates over 2001-04 represents a departure from the experience of the late 1990s, which generally showed modest annual declines in the age-sex-adjusted rate. While the aging of the baby-boom is always recognized as a factor in program growth, the increase in incidence in 2001 is likely due in large part to the severe economic contraction experienced in that year. It is also likely that the special administrative activity previously mentioned also had an impact—namely, the disability redesign initiatives (late 1990s) and the identification and processing of the special disability workload (beginning in 2001).
The legislated increase in NRA beginning with those born in 1938 had an obvious and significant effect on the number of disability awards to individuals age 65 or older starting in 2003. The increase in NRA may be an incentive to seek disability benefits for older workers facing higher actuarial reductions for early retirement.
The period 2005-07 saw a small downward trend in awards, whereas 2008-09 saw a significant jump likely due to the severe recession that began in the first quarter of 2008.
Table 5 presents historical termination data for disabled workers. Termination experience is discussed in detail in the next section.
Table 6 shows the number of disabled workers in the
current-payment population, at the end of calendar years 1986-2009. Other DI beneficiaries may have their benefits suspended for reasons such as engagement in SGA following completion of a trial work period, refusal of vocational rehabilitation services, and imprisonment. Because of the increase in NRA beginning with individuals born in 1938, DI beneficiaries age 65 or older appear for the first time in 2003.
As shown in the table below, the number of beneficiaries in current-payment status and
in force (current-pay plus
suspensions) began to grow rapidly beginning in the latter half of the 1980s. The expansion continued throughout the 1990s as the current-pay population increased 68.5 percent. Through 2009, the rolls increased an additional 60 percent. The growth in the in-force population is the difference between awards and terminations, as shown in the table.
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Conversion. Under the Old-Age and Survivors Insurance program (OASI), a disabled worker benefit is automatically converted to a retired worker benefit in the month the beneficiary attains NRA. 9 The last month of disability entitlement would be the prior month. Conversions accounted for 54 percent of total disabled worker terminations in 2009.
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Death. The last month of disability entitlement would be the month prior to the month of death. Beneficiary death accounted for 36 percent of total disabled worker terminations in 2009.
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Recovery. Beneficiaries who have had a medical recovery or successful, sustained re-entry to the workforce are removed from the DI rolls. Typically the last month of disability entitlement would be the second month after the month of recovery. 10 Recoveries accounted for 7 percent of total disabled worker terminations in 2009.
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Beginning at age 62, a disabled worker may elect to receive old-age benefits in lieu of disability benefits. Although most disabled beneficiaries stay in the DI program until NRA, some choose to switch. One of the most common reasons is the receipt of workers’ compensation benefits. Such receipt may partially or totally offset a DI benefit, but would not affect an OASI benefit. Another factor is the difference between the less-generous maximum family benefit payable under the DI program and the maximum payable under the OASI program.
Recovery from disability occurs when the beneficiary is judged to no longer meet the definition of disability either because there is medical improvement, or the individual demonstrates the ability to engage in SGA. The DDS or the central office will conduct a
continuing disability review (CDR) upon, for example:
An important caveat bears mention in regard to interpreting termination rates. Absent any changes in the underlying rate of medical improvement, certain outside factors can impact the level of CDR activity and, in turn, the disability recovery rates. These factors include the size of disability backlogs, budget restrictions, and legislation. Clearly, CDRs can be pursued vigorously only with adequate funding. Less obviously, these factors can affect the composition of the disabled worker population by influencing the nature of allowances and the likelihood of recovery.
Exogenous variables can also impact the overall mortality of the DI rolls. For example, changes in the way medical impairments are adjudicated, the elimination of DA&A from the listings, and an increase in allowances based on vocational factors may artificially lower overall disability mortality.
The Social Security Act contains several provisions to encourage beneficiaries to return to work despite their impairment:
The trial work period provision allows the disabled beneficiary to do substantial work for 9 months—not necessarily consecutive—without losing any benefits. A month is not counted as a trial work month (“service month”) unless the beneficiary earns above a specified amount, or for self-employment, works a specified number of hours.
12 Earnings during the service months are not counted toward SGA, and benefits will continue as long as the beneficiary has not medically recovered. Note that work performed during a TWP cannot be used as the basis for determining that disability has ceased.
Following the TWP and a 3-month grace period, beneficiaries who work at the SGA level in any month lose their benefit for that month. For continued incentive to work, the
extended period of eligibility provision allows the disabled beneficiary to have benefits reinstated for any month in which work activity falls below the SGA level. The reentitlement period begins with the month immediately following completion of the TWP and ends 36 months later. However, if the beneficiary is not engaging in SGA when the reentitlement period ends, the provision allows benefits to continue until SGA is performed. Of course, at any time during the TWP or EPE, if the beneficiary is found to have medically recovered then all benefits are terminated.
After 24 months of disability entitlement, a beneficiary becomes eligible for Medicare coverage—regardless of age—and receives services as long as DI entitlement continues. In the case of an individual engaging in SGA, coverage is provided throughout the TWP and EPE. Medicare benefits were further extended through a provision of the Ticket to Work Act of 1999: effective October 1, 2000, coverage for beneficiaries who return to work will generally continue for an additional 57 months beyond the EPE.
The Ticket to Work Act also allows certain previously terminated beneficiaries to request
expedited reinstatement of disability benefits in the event of impairment-related cessation of SGA. The provision provides a safety net for those who successfully return to work and, consequently, lose entitlement to disability benefits, but then find themselves unable to sustain the work effort. EXR allows an individual to request reinstatement without filing a new application, and provides up to six months of provisional (temporary) cash benefits while SSA conducts a medical review to determine whether the individual can be reinstated.
13 The request for reinstatement must be filed within 5 years of the termination of disability benefits. EXR became effective January 1, 2001.
Special provisions apply to persons disabled more than once. Individuals who become disabled within 5 years of the end of a previous period of disability are not required to satisfy the 5-month waiting period. In addition, the 24-month waiting period for Medicare coverage need not be consecutive months and may be satisfied by combining multiple periods of disability.
The Social Security Amendments of 1965 (Public Law 89-97) modified the definition of disability by replacing the requirement of permanent disability with the requirement that the disability be expected to last at least 12 months. This led to the entitlement of less seriously impaired claimants and, therefore, lower mortality rates among the disabled. The 1967 amendments eased the insured status requirements for claimants under age 31. A growing presence of younger and relatively healthier beneficiaries on the DI rolls further contributed to the decline in DI mortality rates.
While mortality rates fell in the early years of the program, the rates of termination due to recovery generally increased, largely for the same reasons. With the introduction of government-funded rehabilitation programs, the elimination of the “permanently disabled” requirement, and the extension of benefits to younger claimants, the recovery rate among beneficiaries rose substantially through the late 1960s and remained high through the early 1970s. The recovery rate then decreased rapidly through 1975, due in large part to changes in the administration of the program. With the introduction of the Black Lung and SSI programs in the early 1970s, workload pressures resulted in the suspension or curtailment of some administrative review procedures. For example, by 1972 the central office reviewed only 10 percent of the cases in which expected medical recovery had not been found. By 1976, the recovery rate started to rise again due, in part, to the return to pre-1972 levels of 100 percent review of expected medical recoveries.
The substantial DI program growth in the 1970s created pressure for a more thorough review of the rolls. Under then-current policy, reviews were performed only when the beneficiary’s condition was expected to improve, or voluntary reports or posted earnings indicated work activity. As previously discussed, a significant provision of the 1980 amendments required that beneficiaries with non-permanent impairments be reviewed every 3 years, and permanently disabled beneficiaries be reviewed at intervals determined by the Commissioner. Using that legislative mandate, the Administration initiated a major review of the disability rolls that resulted in many terminations because it was determined that recovery had occurred.
After much public clamor over the new rules, a temporary moratorium was placed on the review of the rolls.
14 This caused the pendulum to swing the other way. Many persons were reinstated upon appeal, and legislation in 1984 imposed a medical improvement standard on the CDR process. The result was a sharp drop in recoveries through the rest of the decade.
In the latter part of the 1980s, the agency experienced reductions in both its work force and in administrative funding. By the early 1990s, without enough staff to handle both new claims and disability reviews, the agency reduced the resources it committed to reviews. Beginning in 1994, the number of initial claims began to level-off and the agency wished to increase its review activity. Congress enacted the
Contract With America Advancement Act of 1996 (Public Law 104-121), which included a provision authorizing the appropriation of funds to be used exclusively to conduct additional CDRs. The special funding helped the agency eliminate DI review backlogs by the end of 2000, and SSI backlogs by the end of 2002. However, the agency has not received full funding in recent years and has not been able to process all CDRs coming due.
Table 5 shows a historical series of the number of terminations and gross termination rates (defined as the ratio of the number of terminations to the average number of beneficiaries during the year) for disabled workers, by reason for termination. Most terminations occur as a result of conversion to retirement benefits or death. With the exception of a sharp decrease in conversions in 2003,
15 the year-to-year changes in both categories are relatively small. In contrast, the number of recoveries can vary considerably. This is sometimes the result of special circumstances, and may not indicate a change in the actual rate of recovery. As an example, the spike in recoveries in 1997 is the result of a provision which eliminated drug or alcohol addiction as a basis for disability entitlement. Although categorized in administrative records as “recoveries”, this group of beneficiaries was terminated from the rolls due to a change in law. “Other” is a relatively small category comprised mostly of beneficiaries who switch to old-age benefits prior to NRA.
16
Figure 3 shows the distribution of DI disabled worker terminations by reason.
Figure 4 shows the distribution of DI disabled worker terminations divided by the average number of disabled worker beneficiaries by reason. Until recently, these ratios have been declining mostly because of two somewhat-correlated trends that have developed over the years, namely, the reduction in the average age of beneficiaries and the increased share of mental disability.
As shown in the table below, the average age of male disabled workers in current-payment status steadily declined from 52.8 in 1980 to 49.8 in 1995; over the same period, the proportion of the DI rolls made up of beneficiaries aged 35-49 grew from 20 percent to 34 percent, while the proportion of those aged 50-65 fell from 71 percent to 55 percent. Similar trends were experienced among female disabled workers. A higher incidence of mental disorders led to a decrease in termination rates for mortality and conversion since these beneficiaries are younger and (physically) healthier on average.
Because of the post-war baby boom, the age pattern was reversed beginning in 1995. By 2009, the average male disabled worker in current-payment status was 52.8 years old, and the proportion of beneficiaries aged 35-49 declined to 24 percent, while the proportion of those aged 50-65 grew to 69 percent. Again, similar trends were experienced among females.
As the baby-boom population ages, the DI rolls can be expected to have greater proportions of beneficiaries with musculoskeletal, circulatory, and neoplastic disorders. Just as progress in medicine has significantly contributed to longer life expectancy among the general population, it is likely to also have a considerable impact on some segments of the disability population.
Mortality rates continued to decline in the 1990s particularly after 1995. Contributing to the decline were the diminishing impact of HIV-related impairments and the new policy regarding DA&A. Other significant factors include: (1) a shift in the impairment mix to more musculoskeletal and mental disorders, which tend to be less life-threatening than circulatory or neoplastic disorders; (2) advancements in cancer treatments; and (3) a shift in the age mix to older disabled workers, whose determinations are often based on vocational factors rather than meeting a listing severity. Over the decade of the 2000s the gross death rate continued to decline to roughly 33 deaths per thousand males and 24 deaths per thousand females.
D.
Actuarial Analysis—Death (2001-05)
Tables 7A-7C show the probability of death for male and female DI disabled workers, by
select age at entitlement to disability benefits; and
duration—measured in years since selection. Data reflect the actual experience of the DI rolls from January 1, 2001 through December 31, 2005. The methods used in table construction and graduation are detailed in the appendix.
Mortality among disabled workers generally increases with select age, albeit this trend can be heavily influenced by the severity-mix of disorders at different ages. Also, for any given select age, the probability of death is greatest during the first year of entitlement, then decreases dramatically during the second and third years of entitlement. Death probabilities tend to level off sometime around the fifth or sixth duration for males, and the third or fourth duration for females. For older select ages, mortality trends upward in the later durations because of the effect of age. The sex differential in mortality in the disabled worker population is similar to that of the general population: mortality rates among male disabled workers are higher than female disabled workers for most attained ages. In the appendix we discuss how certain provisions in the law—such as the waiting period and the conversion to old-age benefits—affect the tabulation of mortality.
An analysis of broad age categories may explain some of the trends and characteristics of disability mortality. As of 2009, the top disorders for male awards under age 35 are mental (57%), musculoskeletal (10%), and nervous (9%). Following the predominant mental and musculoskeletal categories (combined 55%), ages 35-49 show a mix of circulatory (9%), nervous (8%), and neoplastic (7%) impairments. Ages 50 or older show the highest concentration of musculoskeletal (34%), along with considerable increases in circulatory (17%) and neoplastic (11%) disorders; though still an important category, the prevalence of mental impairments (10%) has declined considerably since the younger age groups.
Female trends are comparable to those of disabled males except for several differences in leading impairment categories. As of 2009, disabled females under age 35 show the highest concentration of mental (53%), musculoskeletal (14%), and nervous (11%) disorders. Ages 35-49 continue to show high incidence of mental and nervous impairments, along with large increases in musculoskeletal (30%) and neoplastic (9%) disorders. Ages 50 or older show the highest prevalence of musculoskeletal (40%), mental (14%), and neoplastic (12%) awards.
Disability mortality in the 5-year period covered by this study (2001-05) is lower than in the previous 5-year period for about three-quarters of sex-age categories.
17 Among males, mortality in the more recent period is generally 5 to 20 percent lower than mortality in the earlier period, with dramatic reductions of 35-40 percent at some younger select ages. Mortality among females is generally 5 to 15 percent lower than in the earlier period, but is sometimes as much as 25-30 percent lower. The improvements are likely due to both medical progress (for example, in the treatment of HIV) and the changing impairment mix. For example, there is a greater proportion of mental and musculoskeletal disorders in the later period (51 percent versus 45 percent) and disability where drug addiction and alcoholism are material to impairment are not grounds for entitlement in the later period.
Tables 8A-8C show the number of survivors remaining over time from cohorts becoming entitled at various ages. These tables are based on the probabilities of death shown in tables
7A-
7C.
Survival tables make it easy to calculate the probabilities of surviving a given number of years. See the appendix for details on table construction and usage.
Tables 9A-9C show the expected future lifetime of disabled workers, which reflects the survivorship experience shown in tables
8A-
8C. Similar to the general population, disabled females have a longer future lifetime than males. Life expectancy is often greater in the second year of entitlement than in the first year of entitlement, because of the high mortality during the first year on the rolls.
Tables 10A-10A show the
absolute rate of death per thousand entitled disabled workers. These rates are derived from the probabilities of death shown in tables
7A-
7C. In general, absolute rates consider only the effect of a single decrement in a multiple-decrement environment. For example, the absolute rate of death is disaggregated from the rate of recovery and reflects the rate of survival and ultimate termination under death only. The appendix provides further details.
Tables 11 and
12 show the
aggregate probability of death and expected future lifetime, by
select and
attained age. Probabilities are based on aggregate counts of exposure and deaths across all durations. They represent the average probability of death in the next year for beneficiaries originally entitled at a particular select age (table
11), or who have attained a particular age (table
12). Similarly, expected future lifetime represents the average life expectancy of beneficiaries who share a particular select or attained age. Values are exposure-weighted averages of the select-and-ultimate future lifetimes shown in tables
9A-
9C and may be used as a generally indication of the overall average lifetime of a particular entitlement cohort or a group of beneficiaries from various entitlement cohorts who have attained a particular age.
Table 13 shows the aggregate probability of death and expected future lifetime, by
duration. Probabilities are based on aggregate counts of exposure and deaths across all select ages, and represent the average probability of death within the next year. Aggregate future lifetime represents the average life expectancy of beneficiaries who have been entitled for the stated number of years.
E.
Actuarial Analysis—Recovery (2001-05)
Tables 14A-14B show the probability of recovery for male and female disabled workers, by select age and duration. In general, annual probabilities of recovery decline with advancing select age. For any particular select age, the probability of recovery exhibits a bimodal distribution that tends to peak during the second year of entitlement and then peaks again at a higher level in the fifth year of entitlement. This pattern likely reflects the scheduling of Continuing Disability Reviews. Where
medical improvement is expected (MIE), the review is scheduled for 6 to 24 months following the most recent disability decision. Where
medical improvement is possible (MIP) but less likely to occur within the first 2 years, the review is scheduled for 36 months later. Where
medical improvement is not expected (MINE), the review is scheduled between 5 and 7 years later.
The probability of recovery for females is lower than that for males for almost two-thirds of attained ages. This is especially true for attained ages less than 50 and may be due to differences in the mix of impairments among men and women. For example, data show that during the observation period 2001-05, 42 percent of new awards to females under age 50 were for mental disorders, compared to 37 percent for males. Although somewhat speculative, the nature of these types of impairments seems to contribute to slightly lower recovery rates among younger females and consequently slighty longer expected times on the DI rolls.
Probabilities of recovery during the 2001-05 period are generally lower than in the 1996-2000 period, and often much lower.
18 For most ages, the probability of recovery dropped by 10 to 50 percent. It is likely that the higher rates in the earlier period were the result of several transitory factors, so much of the decline is a return to more “normal” rates of recovery. High probabilities over 1996-2000 were due, in part, to eliminating DA&A from the listings. The large number of terminations that occurred among cases where drug addiction and alcoholism were material to impairment were classified as “recoveries”. Also, much of the CDR backlog was worked off with the special funding provided by Public Law 104-121 in 1996.
Tables 15A-15B show the number of persons not yet recovered at different attained ages, for given select ages. They reflect the probabilities of recovery shown in tables
14A-
14B. In this case, “survival” refers to beneficiaries who remain on the DI rolls by
not recovering.
Tables 16A-16B show the expected number of future years of not recovering—up to normal retirement age—for those who have not yet recovered. The values are based on the survivorship experience shown in tables
15A-
15B.
Tables 17A-17B show the
absolute rate of recovery per thousand entitled disabled workers, which are derived from the probabilities of recovery shown in tables
14A-
14B. The appendix provides details on the derivation of these rates.
Tables 18 and
19 show the
aggregate probability of recovery and the expected time on the DI rolls, by
select and
attained age, respectively. The values are based on aggregate counts of exposure and recoveries across all durations and represent the average probability of recovery in the next year for beneficiaries entitled at a particular select age (table
18), or who have attained a particular age (table
19). Similarly, expected time on the DI rolls represents the average number of future years of entitlement—up to NRA—for those still on the rolls. These values are exposure-weighted averages of the values shown in tables
16A-
16B.
Table 20 shows the aggregate probability of recovery and expected time on the DI rolls, by
duration. The probabilities are based on aggregate counts of exposure and recoveries across all select ages, and represent the average probability of recovery within the next year. The expected time on the DI rolls represents the average number of future years of not recovering for those who have not yet recovered.
F.
Actuarial Analysis—Death or Recovery (2001-05)
Tables 21A-21B show the probability of death or recovery for male and female disabled workers, by select age and duration. Values are the sum of the death probabilities shown in tables
7A-
7B and recovery probabilities shown in tables
14A-
14B.
Tables 22A-22C show the number of persons remaining on the rolls at different attained ages, for given select ages. Beneficiaries continue to be followed until death, even after their disability benefits are converted to retirement benefits.
Tables 23A-23B show the expected number of future years on the combined DI and OASI rolls, by select age and duration. Values are based on survivorship experience shown in tables -
22C.
Tables 24A-24B show the expected number of future years on the DI rolls, by select age and duration. Values are based on survivorship experience shown in tables
22A-
22B and do not reflect entitlement beyond conversion to old-age benefits.
Tables 25 and
26 show the
aggregate probability of death or recovery and the expected time on the beneficiary rolls, by
select and
attained age, respectively. The values represent the average probability of terminating due to death or recovery in the next year for beneficiaries entitled at a particular select age (table
25), or who have attained a particular age (table
26). Expected time on the OASDI rolls represents the average number of future years of combined entitlement for those originally entitled to disability benefits, and are exposure-weighted averages of expected time on the rolls shown in tables
23A-
23B. Aggregate expected time on the DI rolls represents the average number of future years of disability entitlement, and are exposure-weighted averages of expected time on the DI rolls shown in tables
24A-
24B.
Table 27 shows the aggregate probability of death or recovery and the expected time on the beneficiary rolls, by
duration. They represent the average probability of leaving the rolls by death or recovery in the next year. As in table 26, aggregate expected times are shown for both OASDI combined entitlement and DI entitlement only.
Tables 28A-
31D show the present value of a stream of payments of $1 to a disabled worker, by select age at entitlement. The various scenarios are based on combinations of several parameters: (a) the frequency of payments—annually or monthly; (b) the timing of payments—beginning (annuity-due) or end (annuity-immediate) of each period; and (c) the duration of payments—for life or up to age 66. Payments are discounted at various annual effective interest rates. Tables
29A-
29D recognize only the risk of death and payments may continue beyond NRA, thus they use survivorship experience shown in tables 8A-8C. Tables
30A-
31D recognize the possibility of both death and recovery and payments are made up until age 66, thus they use survivorship experience shown in tables
22A-
22B. The appendix gives details of the table construction and its usage.
Source: Annual Statistical Supplement to the Social Security Bulletin (1988-2002);
Annual Statistical Report on the Social Security Disability Insurance Program (2003-09).
Source: SSA administration records
(1)
Age-specific and
gross rates computed as the ratio of annual awards, to the exposure of the disability insured population not receiving benefits.
(2)
Adjusted rate (by sex) computed using the age distribution and exposure of the disability insured population not receiving benefits as of calendar year 2000.
(3)
Adjusted rate (total) computed using the combined age-sex distribution and exposure of the disability insured population not receiving benefits as of calendar year 2000.
