To obtain and summarize baseline demographic information about disabled
adults who are considered candidates for VR.
Social Security Administration
SSA administers two disability programs, Social Security DI and
SSI, which pay benefits to qualified disabled individuals. The DI
program, authorized by title II of the Social Security Act, provides
benefits to insured disability workers and their families in amounts
determined by the wage earner`s work history. The SSI program,
authorized by title XVI of the Social Security Act, provides payments
to financially needy, aged, blind, and disabled persons, including
individuals that do not have the required insured status to receive
Social Security DI payments. In 1993, the DI program and SSI program
paid out $34.6 billion and $17.3 billion, respectively to approximately
5.3 million and 4.2 million disabled beneficiaries and their families.
In its March 1988 report to the Congress, the Disability Advisory
Council reported that in any given year, "fewer than 15 percent
of beneficiaries are referred for VR services and only a small portion
of these individuals received services." The SSA`s published
statistics also showed that less than one-half of one percent of
disabled individuals approved for DI or SSI are removed from the
disability roles due to their return to work.
Claims representatives in SSAs field offices (FO) take initial
disability claims information from applicants. If the applicant meets
the nonmedical criteria, then medical documentation is forwarded
to State disability determination services (DDS) offices for further
processing. The SSA FO completing the disability claim for the applicant,
prepares a paper Form SSA-831 containing identifying data such as
name, Social Security number, type(s) of claim, sex, etc., then keys
this data into the SSA-831 system.
Disability Determination Services
DDSs are State organizations funded by SSA. They are responsible
for adjudicating disability claims based on Federal statutes and
SSA rules and regulations governing the DI program. They also determine
whether medical and work history information shows that the applicant
has the potential for rehabilitation and should be referred to the
Vocational Rehabilitation Agency (VRA). This determination is performed
by applying screening criteria developed jointly by SSA, DDSs and
Vocational Rehabilitation Agencies (VRA). If an examiner decides
to refer the applicant for VR services, copies of the application
and any relevant medical or vocational evidence are forwarded to
the VRA. Upon completion of the medical determination, the DDS inputs
decisional data such as past occupation and education, impairment,
allowance or denial, as well as the decision to refer or not refer
the applicant for VR.
State VR Agencies
The Rehabilitation Act of 1973, as amended, authorizes the Department
of Education`s VR program to provide comprehensive VR services.
This program is designed to help those with physical and mental disabilities
return to the work force. This is primarily done through Federal
funding to State VRAs that directly provide services. These services
can include counseling, work evaluation, work adjustment training,
job skills training, job-seeking skills training and medical rehabilitation
The Federal/State VR program is operated and administered through
a combination of about 80 State general and blind-only VRAs and various
other State and private facilities. The VRAs provide individualized
VR services to accepted beneficiaries according to a written rehabilitation
plan that is developed jointly by a VRA counselor and the individual.
Counselors at VRAs evaluate whether there is a reasonable expectation
that the individual may benefit from VR services in terms of employability.
This judgment is based on the individual`s impairment and the
availability of services and resources.
SSA reimburses the States for the cost of rehabilitation in those
cases where the services are found to have resulted in the beneficiary`s
performance of substantial work for a continuous period of at least
9 months. Payment can also be made for services provided to a beneficiary
who, without good cause, refuses to continue to accept VR services
or fails to cooperate, if the beneficiary`s benefits have been
suspended. Under the current program, States must submit individual
claims for reimbursement, showing the cost of VRA`s services
provided each beneficiary and the period during which services were
The Social Security Act and implementing regulations permit the
Commissioner of Social Security to enter into agreements or contracts
with alternative service providers in cases where a State agency
declines to participate in providing VR services.
Past Relevant Studies
In March 1988, the Report of the Disability Advisory
Council recommended that the Congress direct SSA
to collect data concerning the characteristics and outcomes of
beneficiaries who are and are not served by State VRAs. Further,
the report stated that "Implementation of this recommendation
will assist SSA in validating its current VR referral criteria
and in determining which beneficiaries are the best candidates
for VR services. It will also provide data on the relative cost-to-benefit
ratios of SSA`s VR programs. . . ."
In April 1990, the HHS/OIG released a report entitled, "Social
Security Payments for Vocational Rehabilitation" (OEI-07-89-00950).
The report recommended that "SSA should strengthen the linkage
between the SSA VR payment program and actions to . . . rehabilitate
SSA clients." Further, it recommended that SSA require States
to establish a formal automated mechanism to screen and enroll
those SSA clients who show the greatest potential for successful
On May 13, 1994, the Joint Vocational Rehabilitation Referral Task
Force issued its final report which identified obstacles to achieving
greater numbers of referral acceptances by the VRAs under the existing
process. The report found that DDS referrals are not monitored and
that no regular follow-up exists. In discussing methods to make the
best use of DDS/VRA resources, the task force described an automated
screening system developed by the New York VRA. This system
is designed to consider the screening logic typically followed by
a VR counselor. The task force ". . . encouraged the use of
automation for screening referrals."
SSA collects and maintains data on disability applicants in a computerized
data base called the Disability Determination File (SSA-831). SSAs
FOs and DDSs input information into this data base including the
applicants name, Social Security number, type of claim, sex,
race, age, alleged impairment, occupation, education, referral determination,
and decision on the claim. From this data base we selected all adult,
nonblind DI and SSI applicants who filed initial claims and who were
issued a medical decision in CY 1992. We included applicants whose
claims were approved, as well as those whose claims were denied.
This resulted in a data base of 2.5 million applicants.
We originally intended to gather baseline data about disabled adults
who were considered candidates for VR. With such data, we had hoped
to evaluate referral practices. However, we were unable to carry
out our study. We discovered that needed codes were missing from
Our review was conducted between December 1994 and December 1995
in Baltimore, Maryland. We conducted this inspection in accordance
with the Quality Standards for Inspections issued by
the President`s Council on Integrity and Efficiency.