Occupational and Medical-Vocational Claims Review Study Mark Trapani , Analyst

1. Occupational and Medical-Vocational Claims Review Study Mark Trapani, Analyst Deborah Harkin, Social Insurance Specialist Office of Program Development and Research Preliminary Resultsas ofAugust 30, 2010

2. Purpose • We are conducting this research to identify the primary occupational, functional, and vocational characteristics of DI and SSI adult applicants whose claims were approved or denied at the initial or hearings levels at step four or five of SSA’s sequential evaluation process. • Knowledge of these characteristics will help establish a firm basis for SSA’s subsequent OID research and development activities.

3. Primary Study Questions What occupations are most commonly cited by disability claimants as work that they have performed in the past (i.e., Past Relevant Work)?  What occupations are most commonly identified by DDSs and ALJs in step five denials as work in the national economy that a claimant may perform? What functional limitations of claimants are most commonly identified by DDSs and ALJs? Which Medical-Vocational rules are most commonly cited by DDSs and ALJs as a basis for allowing or denying benefits?

4. Methodology • We randomly selected a nationally representative stratified sample of 5,000 claims decided in fiscal year 2009 consisting of 3,867 initial-level cases and 1,133 hearings-level cases (reflecting the proportion of SSA disability cases decided at each of these two decision levels). • A sample of 5,000 cases is large enough to provide us with a high probability of identifying all occupations that our applicants have engaged in which are substantially represented in the U.S. economy.

5. Methodology Key elements of data collection: • Review of Electronic Folders (EF) for each case in the sample to extract relevant data • Use of SSA adjudication experts to review cases • Reviewer use of carefully designed electronic Data Collection Instrument (DCI) to record data from the case file into the study database • Development of data collection Protocol, or set of instructions, for users to follow when completing the DCI • Pre-testing of DCI to assess reviewer competence and ensure that DCI works as intended (e.g., that questions are clear and that quality controls are effective)

6. Methodology • We devised an approach to quality review that attempted to strike an appropriate balance between our need to ensure an acceptable level of quality or accuracy for our study data and the availability of limited resources to conduct quality reviews. • We applied a Continuous Sampling Plan, or CSP-1, approach; as the quality of the data increases, the degree of inspection decreases and vice versa. • Under the CSP-1 framework, we conducted systematic random reviews of a minimum of five percent of study cases • We supplemented these random reviews with targeted reviews of cases which met certain criteria that indicated they may be more prone to error.

7. Preliminary Results:Limitations in Job Data - PRW • Our preliminary results suggest substantial limitations in the type and extent of occupational information that SSA obtains from claimants as well as limitations in the applicability of the DOT taxonomy to our current caseload. • For about 11 percent of the jobs cited by claimants as work they had performed in the past (and that met our criteria for PRW), we could not clearly identify an applicable DOT job title because either the case file did not contain sufficient information (9.1% of jobs) or none of the job titles listed in the DOT appeared to match the work described by claimants (2.2% of jobs). • For an additional 5 percent of jobs cited by claimants, the past work performed by claimants represented a composite or combination of jobs that could not be clearly associated with a single DOT code/title.

8. Preliminary Results:Limitations in Job Data – Step 4 • In 12.4 percent of the cases denied at step 4 (where DDSs are supposed to identify the past work that a claimant can still perform), we could not clearly identify an applicable DOT job title because either: • the case file did not contain sufficient information (6.4% of cases) • the adjudicator did not clearly identify a DOT title (4.7% of cases), or • none of the job titles listed in the DOT appeared to match the work described in the case (1.3% of cases). • In an additional 1.3% of step 4 denial cases, the job title cited by the adjudicator represented a composite or combination of jobs that could not be clearly associated with a single DOT code/title.

9. Preliminary Results:Limitations in Job Data – Step 5 • When denying a claim at Step 5 and identifying jobs that claimants are allegedly still able to do, we find a substantial number of cases where DDSs identify jobs that appear to be outdated. For example, DDSs cited jobs such as addresser, counter clerk, tube operator, and parlor chaperone as work that claimants could perform even though it is doubtful that these jobs, as described in the DOT, currently exist in significant numbers in our economy.

10. Preliminary Results: Past Relevant Work • Ten most common DOT job titles that our claimants have performed in their past work: • Nurse Assistant (3.0% of total PRW title citations) • Cashier-Checker (3.0%) • Fast-Foods Worker (2.3%) • Home Attendant (2.0%) • Cashier II (1.9%) • Laborer, Stores (1.8%) • Material Handler (1.6%) • Truck Driver, Heavy (1.4%) • Stock Clerk (1.4%) • Construction Worker I (1.4%)

11. Preliminary Results: Past Relevant Work • We have thus far identified 1,076 distinct DOT titles associated with our claimants PRW, which comprise about 8 percent of the total number of titles listed in the DOT. • The 50 most frequently cited DOT titles for PRW comprise 47% of all PRW citations in our sample.

12. Preliminary Results: Past Relevant Work • SVP (Specific Vocational Preparation) levels associated with PRW were distributed as follows: • SVP 1 – 0.6% (of all SVP citations for Past Relevant Work) • SVP 2 – 22.4% • SVP 3 – 23.7% • SVP 4 – 17.6% • SVP 5 – 6.9% • SVP 6 – 9.9% • SVP 7 – 15.4% • SVP 8 – 3.5% • SVP 9 – 0.0% • A substantial majority (nearly 64%) of the jobs held by our claimants have been unskilled and semi-skilled jobs that required a relatively short time (from 1 to 6 mo.) to learn

13. Preliminary Results: Past Relevant Work • Strength levels associated with PRW were distributed as follows: • Sedentary – 10.7% (of all Strength citations for PRW) • Light – 33.8% • Medium – 41.1% • Heavy – 11.7% • Very Heavy – 2.7% • Three-quarters of the jobs held by our claimants were associated with light to medium strength requirements.

14. Preliminary Results: Past Relevant Work • The top 5 most frequent SVP-Strength combinations were as follows: • SVP 3-Light (9.9% of all PRW citations) • SVP 2-Medium (9.8%) • SVP 3-Medium (9.5%) • SVP 4-Medium (8.6%) • SVP 2-Light (8.5%) • These five SVP-Strength combinations comprised nearly half of all such combinations associated with PRW

15. Preliminary Results:Jobs at Step 4 • Ten most common DOT job titles cited by DDSs in Step 4 denials: • Cashier II (3.9% of step 4 title citations) • Fast-Foods Worker (3.5%) • Cashier-Checker (3.4%) • Cleaner, Housekeeping (2.4%) • Home Attendant (1.7%) • Accounting Clerk (1.2%) • Kitchen Helper (1.2%) • Guard, Security (1.1%) • Laborer, Stores (1.1%) • Manager, Office (1.1%)

16. Preliminary Results:Jobs at Step 5 • Ten most common DOT job titles cited by DDSs in Step 5 denials: • Addresser (4.6% of total step 5 title citations) • Cleaner, Housekeeping (2.7%) • Photocopying, Machine Operator (2.5%) • Collator Operator (1.8%) • Surveillance-System Monitor (1.8%) • Table Worker (1.7%) • Assembler, Small Products II (1.4%) • Lens-Block Gauger (1.3%) • Packager, Hand (1.2%) • Counter Clerk (1.2%)

17. Preliminary Results: Functional Limitations • Twenty most common functional limitations cited: • Lift/carry occasionally (76% of all cases) • Lift/carry frequently (76%) • Stand/walk (76%) • Sit (75%) • Climbing ladder/rope (54%) • Climbing ramp/stairs (40%) • Crouching (39%) • Crawling (39%) • Stooping (37%) • Kneeling (35%)

18. Preliminary Results:Functional Limitations • Twenty most common functional limitations cited: [continued] • Carry out detailed instructions (32% of all cases) • Maintain attention (30%) • Understand detailed instructions (29%) • Balancing (29%) • Complete workday (28%) • Be aware of hazards (28%) • Respond appropriately to changes (24%) • Interact with public (24%) • Accept instructions from supervisors (20%) • Perform within schedule (16%)

19. Preliminary Results:Functional Limitations • The top 10 functional limitations comprise nearly 56% of all limitations cited in our sample, and the top 20 limitations comprise about 82% of all limitations cited. • Exertional and Postural limitations represent the most prevalent categories of functional limitations cited in our case files, but various categories of mental limitations are also cited relatively frequently.

20. Preliminary Results:Medical-Vocational Rules • Step 5 decisions are most frequently based on framework application of grid rules with the five most commonly cited as follows (in descending order of prevalence):

21. Preliminary Results: Medical-Vocational Rules

22. Implications • Challenges encountered in this study highlight challenges faced in SSA’s occupational assessments: • Limitations in DOT • Limitations in occupational information obtained from claimants • Relatively small number of job titles account for relatively large proportion of work performed by claimants, suggesting that targeted OIS data collection can produce information broadly applicable to SSA claims

23. Implications • Functional limitation data potentially useful in guiding further efforts to develop content model and person-side instrument

24. Remaining Work • Pre-testing of Hearings-Level (ALJ) DCI • Review of Hearings-Level cases • Completion of Quality Reviews • Final analysis of full sample (initial and ALJ) • Issuance of draft and final reports

25. Questions/Comments?