serves the opportunity to meet face-to-face with a decision maker and be informed as to how the disability criterion applies to him as an individual, without waiting a period of several months. Although the disability program incorporates an awesome government structure, this is no excuse for allowing it to become unresponsive to individual claimant needs. An individual's physical or mental condition is of utmost personal importance to him and if denied benefits, he deserves more than a stock denial paragraph.

The proposed H.R. 8018 should help to alleviate this situation. Also, it would help the claimant take an active role in pursuing his disability claim, requiring him to be specific in allegations of error of fact or law. This provision should serve to sharpen and identify the issues at the appeals level, and this procedure does not deviate from normal legal procedure, as we understand it. If the claimant has truly been afforded a personalized rationale of his denial to which he is entitled then he should also be expected and should be more willing to assume this responsibility in the appeals process. It is our belief that a claimant's apathy is due to lack of knowledge rather than lack of concern. The fact that State Agencies will be required to individually rationalize each denial will be a definite asset and should improve the quality of State Agency adjudication.

Mr. BURKE. Thank you.

Mr. Sorenson?

STATEMENT OF MORRIS SORENSON

Mr. SORENSON. Mr. Chairman, I am Morris E. Sorenson, Disability Determination Services, Division of Rehabilitation, Utah State Board of Education.

I have been in this position for the past 15 years. I appreciate the opportunity to appear before this subcommittee to present some ideas from the State level on issues now under consideration.

In my written statement I commented upon proposed legislation contained in H.R. 8018 regarding the appeals procedure. From the State level we feel the measures enunciated in this bill will improve the appeals process and will have a positive effect on the operations at the State level. I would like to briefly cover three points in the following order: One, the need for a single standard of disability; two, the value of the face-to-face contact; and three, the implications of the Privacy Act of 1974.

Point No. 1: At the State level we are greatly concerned over the number and type of reversals of State agency decisions which are being made at the hearing level. We understand the reversal of a State agency decision when the duration factor is a key issue and a substantial period of time has transpired since the State agency denial for lack of duration. However, in a great number of reversals, the decision is not supported by medical evidence or nonmedical factors which lead us to believe that a far different set of standards are applied at the hearing level than are followed by the State agencies.

This is a critical problem and we would recommend to the committee that action be taken to eliminate this inconsistency and provide measures to enable the State agency and the administrative law judges to operate on the same wavelength. In this regard, we feel that disability standards should be based primarily on the objective medical criteria which have proven their validity over the years and which have been the backbone of the social security disability program.

If all levels of adjudication in the disability process follow one standard only, with emphasis on the objective medical aspect, there

would be less cause for the administrative law judges to complain of underdeveloped or poorly documented cases.

The adjudicative process should result in a correct decision which either pays the applicant benefits to which he is entitled, and which will relieve, in most cases, considerable financial distress; or protect the trust fund and the tax revenues against exploitation.

Point No. 2: Utah is one of the 16 states which participates in the demonstration project wherein a face-to-face conference was held with denied claimants at the reconsideration level. We feel that this faceto-face contact provides a sounder and better documented decision. The claimant is informed of the disability severity requirements for eligibility. This personalized face-to-face interview reassures the claimant that his case has been given proper attention and that his rights under the law are being protected. We feel that if this procedure is invoked on a nationwide basis that the number of cases which go to the appellate level will be reduced simply because applicants will be better informed regarding the basic reasons why they are being denied disability benefits.

Inasmuch as the face-to-face contact at the reconsideration level has proven successful in our opinion, we would recommend that a faceto-face contact at the initial level also be carried out.

Ideally, this interview should be conducted by an experienced examiner, trained in disability evaluation. This would be an expensive procedure but in the long run would be beneficial to the program.

This initial interview would provide a more specific explanation of the definition of disability and provide more accurate and complete information regarding the claimant's alleged disability, his work record, and his medical history.

The initial interview would also provide a better explanation of available State vocational rehabilitation services and a better understanding of the social security disability program and its require

ments.

Point No. 3: Implications of the Privacy Act of 1974. Although it is not mentioned in the pending legislation, there is grave concern that the implementation of the Privacy Act as far as disclosing medical evidence is concerned may seriously affect the conduct of not only the reconsideration interview but also the initial development because of the adverse effect which this legislation may have on medical sources.

Our medical staff in Utah is greatly concerned over the fact that the provisions of the Privacy Act may cause physicians to withhold completely their medical reports or limit their reports to an emasculated summary containing insufficient findings for adjudicative purposes. Such an act would have a negative effect on all levels of case processing.

This concludes my statement, Mr. Chairman. [The prepared statement follows:]

STATEMENT OF MORRIS E. SORENSON, COORDINATOR, DISABILITY DETERMINATION SERVICES, DIVISION OF REHABILITATION SERVICES, UTAH STATE BOARD OF EDUCATION

Mr. Chairman, I appreciate the opportunity to appear before the Subcommittee to present some ideas from the State level on issues now under consideration. To improve the present hearings and appeals process, innovations and changes at all levels of adjudication are indicated.

59-762 O 75 - 30

I would like to briefly present the following points which I feel are relevant to the matter of expediting and improving the entire process of determining disability under Social Security :

1. The need for a single standard of disability and the need to redefine the role of the ALJ.

2. Mandatory reconsideration and time required.

3. Informal remand.

4. Reconsideration determination required in 90 days.

5. Value of the face-to-face contact.

6. Defining the Issue and the Hearing.

7. Implications of The Privacy Act of 1974 (Public Law 93-579).

1. Need for Single Standard of Disability.-At the State level we are greatly concerned over the number and type of reversals of State Agency decisions which are being made at the Hearing level. We understand the reversal of a State Agency decision when the "duration" factor is a key issue and a substantial period of time has transpired since the State Agency denial for a lack of duration. However, in a great number of reversals, the decision is not supported by medical evidence or non-medical factors which leads us to believe that a far different set of standards are applied at the Hearing level than are followed by the State Agencies.

This is a critical problem and we would recommend to the Committee that action be taken to eliminate this dual standard and provide measures to enable the State Agency and the Administrative Law Judges to operate on the same "wave length".

In this regard, we feel that disability standards should be based primarily on the objctive medical criteria which have proven their validity over the years and which have been the backbone of the Social Security Disability Program. If all levels of adjudication in the disability process follow one standard only with emphasis on the objective medical aspect, there would be less cause for the Administrative Law Judges to complain of underdeveloped or poorly documented

cases.

As regards the role of the Administrative Law Judge, we recognize that the attorney is trained in the business of securing evidence and applying the rules of evidence in interpreting the meaning of the law. We think it would be fair to say that he has limited competence in rendering medical judgments. At the Hearing level the Administrative Law Judge should limit himself to a determination of whether objective evidence has been acquired, documentation has been complete, regulations have been followed and adjudication has been made according to medical listings and the appropriate application of non-medical factors.

Deficiencies in any of these areas would then result in the case being remanded back to the adjudicating agency at the State level which would then be asked to forward the results of its determination back to the Administrative Law Judge only in the event that the claim was once again denied.

We have seen examples of remarkable naivete on the part of the Administrative Law Judges in rendering their decision. We have even heard some to say in public gatherings that they could determine whether a man is disabled in a matter of minutes just by looking at him. We think there is a natural tendency for a judge given this kind of power to play the role of Robin Hood and give the king's deer to the peasants and therefore to establish himself as a hero in the eyes of the applicant.

The adjudicative process should result in a correct decision which either pays the applicant benefits to which he is entitled and which will relieve in most cases considerable financial distress, or protect the trust fund and the tax revenues against exploitation.

Objectivity must be maintained at all levels including review by the Administrative Law Judge. Again, we would like to emphasize the need for a single standard for disability adjudication at all levels.

2. Mandatory Reconsideration and Time Required.-The time frames for filing reconsideration under Title II and Title XVI are different. In the Title II program a denied claimant is permitted up to six months while in Title XVI only one month. We propose that both programs be uniform and that one month be the time frame. The rules of Administrative Finality would still apply for reopening of any determination within one year for any reason and within one to four years for good cause.

Utah supports the proposal of a mandatory reconsideration for two reasons: 1. It provides an opportunity for review of the previous determination by a different examiner-medical consultant team to check the correctness of the initial denial.

2. Provides an opportunity for the claimant to produce additional medical evidence and/or the State Agency to purchase a consultative examination where one was not obtained earlier.

Emphasis is placed on the fact that when an initial denial was written because of a lack of duration findings, a reconsidered case being processed two or three months hence offers an opportunity to examine the claimant's impairment at a later stage in the period of disability.

3. Informal Remand.-The informal remand procedure has not caused too much increase in the workload for the Utah State Agency because of the small number of cases involved. However, this procedure does refer cases back to the State Agency for “questionable" reasons. For example, an allegation of a "worsening" condition can be made all too frequently with very little objective medical evidence available to substantiate this claim. This is particularly true with cases wherein the State Agency has rendered a decision only one month previously and after obtaining a specialist consultative examination in many instances. Utah does not object to this expedient for attacking the BHA backlog; however, we feel that the procedure should not be followed indefinitely.

4. Reconsideration Determination Required in 90 Days.-As regards the proposal to place a time limit on the process of a request for reconsideration, we do have some reservations. Our primary concern is the fact that we would be given a statutory time limit in which to complete the reconsideration decision. We would be able to complete the decision within 90 days after the case folder has been received by the State Agency. In those cases that are delayed beyond the 90 days, we propose that a process be established which would provide benefit payments pending the final determination. This procedure would be similar to the one used in the SSI program and would provide for benefits up to three months with no attempts to recover overpayments. This should provide sufficient time for all agencies to make a final determination.

5. Value of the Face-to-Face Contact.-Utah is one of the 16 States which participated in the demonstration project wherein a face-to-face conference was held with denied claimants at the reconsideration level. We feel that this face-toface contact provides a sounder and better documented decision. The claimant is informed of the disability severity requirements for eligibility. This personalized, face-to-face interview reassures the claimant that his case has been given proper attention and that his rights under the law are being protected. We feel that if this procedure is invoked on a nationwide basis that the number of cases which go to the appellate level will be reduced simply because applicants will be better informed regarding the basic reasons why they are being denied disability benefits.

Inasmuch as the face-to-face contact at the reconsideration level has proven successful, in our opinion, we would recommend that a face-to-face contact at the initial level also be carried out. This would provide for better documentation of the file and a better understanding of the Program and its requirements. As a matter of observation, we feel that a face-to-face contact at each level would reduce the number who will go to the next level of appeal. We feel that this faceto-face contact is a responsibility of the Program and one which has not been propery carried out to date.

We need to improve the process at intake by better informing and communicating with the claimant. We feel that this personalized interview at the time of the first contact with claimant would reduce the number of problems which later appear and which seemingly result from a lack of understanding on the part of the claimant.

Ideally this interview should be conducted by an experienced examiner trained in disability evaluation. This would be an expensive procedure but in the long run would be beneficial to the Program. This initial interview would provide a more specific explanation of the definition of disability and provide more accurate and complete information regarding the claimant's alleged disability, his work record and a medical history. The initial interview would also provide a better explanation of available State Vocational Rehabilitation Services and a better understanding of the Social Security Disability Program and its requirements.

Initially the face-to-face contact at the initial level would result in higher costs but better services to our disabled citizenry with fewer cases reaching the reconsideration or appellate level.

6. Defining the Issue and the Hearing.-It can be said that almost without exception recipients of a denial letter rarely understand the general explanation which it contains. The proposal in the pending legislation contained in H.R. 8018, Section 205(b) (5) is sound and we feel that it should be implemented. It should be understood by all concerned that implementing this procedure would require additional time on the part of the examiner to prepare a definitive explanation as well as secretarial time for typing this material. Nevertheless, we feel that this is an excellent change which will give the claimant more information as to why his claim is being denied and it may very well be a basis for reducing the overall number of requests for a hearing.

We concur with the proposed change in Section 205(b) (6) of H.R. 8018 which gives the claimant 30 days to file for a hearing. This is a reasonable and worthwhile requirement which we feel, as noted above, should also be invoked in the case of a reconsideration. This would help eliminate requests for a hearing based on such allegations as changing of an "alleged onset date" to conform to a point in time prior to date last insured.

We have some reservation regarding the provision which permits payment to a claimant while an appeal is being conducted. There may be a danger that this provision would provide certain claimants, namely those who do not cooperate, means of receiving payments while they purposely delay or fail to keep C/E appointments. Here again, the presumptive disability provisions may be the course to follow in delayed cases.

7. Implications of The Privacy Act of 1974 (Public Law 93-579).—Although it is not mentioned in the pending legislation, there is grave concern that the implementation of The Privacy Act, as far as disclosing medical evidence is concerned, may seriously affect the conduct of not only the reconsideration interview but also the initial development because of the adverse effect which this legislation may have on medical sources. Our medical staff is greatly concerned over the fact that the provisions of The Privacy Act may cause physicians to withhold completely their medical reports, or limit their reports to an emasculated summary containing insufficient objective findings for adjudicative purposes. Such an action would have a negative effect on all levels of case processing, Mr. Chairman, in conclusion we have presented several means to improve the Hearing and Appeals process. Additionally, we have alluded to the potential problem which The Privacy Act of 1974 may have on the overall program. This concludes my statement. I would be pleased to answer any questions the Subcommittee may have.

Mr. BURKE. Thank you.

Last, we have Mr. Glen Swisher.

STATEMENT OF GLEN SWISHER

Mr. SWISHER. Mr. Chairman, members of the committee, I am Glen Swisher, director of the disability determination program for Missouri.

I have been with the program for 19 years and I consider it an honor and privilege to have the opportunity to meet with you gentlemen and discuss the needs of the program, particularly the hearings and appeals process. Since I am last on the panel, my testimony will sound very much like others, like I have been in collusion preparing testimony, but I assure you we did not discuss preparation of this testimony at any time at all and were not aware of what the others prepared.

My complete statement has been submitted for the record, so I will give a brief summary of my thoughts.

I believe a significant step to improving the appeals process could be taken by assuring the State agencies sufficient resources in both