Completeness of the Social Security Administration’s Disability Claims Files
Claimants are required to prove they are disabled by providing medical and other evidence of disability. However, the Social Security Administration (SSA) is responsible for making every reasonable effort to help the claimant get medical reports from medical sources. The Agency considers all evidence in the claimant’s case record when it makes any determination.
On February 20, 2014, SSA’s Notice of Proposed Rulemaking—Submission of Evidence in Disability Claims—was published in the Federal Register. This proposed regulation would require that claimants inform the Agency about, or submit all evidence known to them that relates to, their disability claim (subject to two exceptions).
We identified a population of 627,587 individuals who had a hearing decision in Fiscal Year 2012. From this population, we reviewed a sample of 275 cases to determine whether, at the initial or reconsideration level, the disability determination services (DDS) could have obtained any evidence provided at the hearing level. If the evidence was available at the time of the initial or reconsideration level, we determined why it was not obtained.
Additionally, we determined whether the Office of Disability Adjudication and Review (ODAR) obtained medical evidence from all sources alleged by the claimant at the hearing level.
The objective of our report was to determine whether staff fully developed all available medical evidence before making a disability determination.