Racial disparities in federal disability benefits

Contemporary Economic Policy, Jan, 2007 by Erin M. Godtland, Michele Grgich, Carol Dawn Petersen, Douglas M. Sloane, Ann T. Walker

If the claimant is not satisfied with the ALJ decision, the claimant may request a review by the Appeals Council, which is the final administrative appeal within SSA. The Appeals Council may grant, deny, or dismiss a request for review. If it agrees to review the case, the Appeals Council may uphold, modify, or reverse the ALJ's action, or it may remand the case back to the ALJ level for an ALJ to hold another hearing and issue a new decision. In fiscal year 2002, the Appeals Council reviewed over 27,000 disability decisions, about one half of which were remanded. (5)

B. Social Security Administration Disability Decision-Making

SSA's regulations provide for disability evaluation under a procedure known as the "sequential evaluation process." For adult claimants, this process requires a sequential five-step review of the claimant's current work activity, the severity of impairment(s), and if necessary, the claimant's residual functional capacity, past work, and age, education, and work experience.

Step 1. Is the claimant working? If the claimant is working and the claimant's average monthly countable earnings are above the SGA level, SSA will find the claimant not disabled, regardless of the claimant's medical condition, age, education, or work experience and will deny the claim. If the claimant's average monthly countable earnings are less than the SGA level, SSA will look at the claimant's medical condition (Step 2).

Step 2. Is the claimant's condition "severe"? The claimant's impairment must significantly limit his or her physical or mental ability to do basic work activities, such as walking, sitting, seeing, and remembering. If it is not severe, SSA will deny the claim, regardless of the claimant's age, education, and work experience. If it is severe, SSA will look further at the claimant's medical condition (Step 3).

Step 3. Is the claimant's medical condition in the list of "disabling" impairments? If the claimant has an impairment that meets the duration requirement and is on SSA's Listing of Impairments, (6) the claimant is considered "disabled" without considering age, education, and work experience. If the medical condition is not on the list, SSA considers whether the condition is of severity equal to an impairment on SSA's list. If so, the claim is awarded. If not, SSA considers additional factors (Step 4).

Step 4. Can the claimant perform past relevant work? If the medical condition is severe but not at the same severity as an impairment on SSA's list, then SSA will review the claimant's residual functional capacity and the physical and mental demands of work performed in the past. If the claimant can do work performed previously, SSA will deny the claim. If not, SSA considers other factors (Step 5).

Step 5. Can the claimant perform other types of work? If the claimant cannot perform past work, SSA will consider the claimant's residual function capacity, age, education, and past work experience to determine whether he or she can perform other work that is available in the national economy. If the claimant cannot perform other work, SSA will approve the claim. If the claimant can perform other work, SSA will deny the claim.