2001 Annual Report Table of Contents

Disability Determination Services Division

Disability Determination Services Division Overview

Every state in the USA operates a Disability Determination Services (DDS) program, handling all Supplemental Security Income and Social Security Disability Insurance claims on behalf of the Social Security Administration (SSA). Last year, the Massachusetts DDS processed close to 80,000 cases. SSA measures the effectiveness of all state DDS agencies on a yearly basis. The MRC-DDS has been awarded numerous commendations over the years for its high quality and efficient performance. The Northeast Regional Office of the SSA has come to rely heavily on the expertise of the Massachusetts DDS, sending many of the claims from other New England states failing under the crushing workload of case processing. Most recently in April 2000, the MRC-DDS won the SSA Commissioner's Citation in recognition of its superior performance in providing services to persons with disabilities and for assisting other DDS agencies in the Northeast region. The Commonwealth reaps tremendous benefits as a direct result of the work carried out at the DDS. Not only do some of the state's most impoverished and disadvantaged citizens get the critical support they need, but Massachusetts also benefits as these claimants receive and spend $202 million in benefits resulting from claims approved by the SSA.

The Disability Determination Services Advisory Committee was formally established in the early 1980's. It functions as a communication bridge between the DDS Division and consumers of its services, the community of persons with disabilities and their advocates.

DDS Advisory Committee Members Name and Affiliation

Sarah Anderson Greater Boston Legal Services
Kathleen Cardin
No. Westport, MA
Chris Czernik
TriCity Homeless Services
Gail Havelick
Department of Public Health
Emily Herzog
Neighborhood Legal Services, Lynn
Bette King
Boston, MA
Linda Landry
Greater Boston Legal Services
Kathy Mooney
Salem, MA
Benjamin Sawyer
Chelsea, MA
Barbara Seigel
Community Legal Services, Cambridge
Joanne Shulman
Framingham, MA
Matlyn Starks
Boston, MA
Francis Verville
Fall River, MA

DIFFICULT DECISIONS BENEFIT EVERYONE

Though not as well known to the general public as the other two divisions of MRC, the Disability Determination Services Division is the second largest program of the agency."We are well known to the 'Feds' though, since we have a reputation for lending an extra hand when needed," proclaimed Tom Collins, DDS Director of Hearings, who also manages special projects. "Not only did we get our budgeted workload done; we were also able to help with many Regional Office initiatives. This was accomplished only due to the dedication and hard work of our DDS staff. From the stockroom to senior management staff, we all pitched in. It's a real team effort," beams Collins. "This year, we processed the majority of cases for the state of Vermont because they experienced major staff losses. Last year we handled cases for the state of New Hampshire," he says proudly.

"The staff of the DDS are a specially trained and diligent group, quietly working behind the scenes day in and day out. Each Vocational Disability Examiner must thoroughly review every Social Security benefits application to appreciate the medical, vocational, administrative and technical aspects of the claim," explains Johnnie Williams, Regional Director and manager of the Continuing Disability Review Unit. This frequently involves telephone interviews with claimants. Examiners must then secure all relevant medical records, vocational history, and often, order consultative examinations with one of the hundreds of outside medical consultants who work with the MRC-DDS across the state. The DDS Examiner and staff medical doctor then evaluate the claim. Sometimes, the claim can be allowed or denied on a medical basis alone. If not, the Medical Consultant must spell out what the claimant can and cannot functionally do. In this situation, the Examiner must then perform a vocational evaluation where the claimant's medical restrictions, age, education and past work experience is considered to determine if the claimant has a disability on a medical and/or vocational basis.

"The Examiner must then adjudicate the case and prepare a written explanation of the decision to applicants whose claims are denied. Some DDS Examiners specialize in handling appeals, conducting hearings, processing continuing disability reviews, or claims from homeless persons and those with HIV" says Williams. As a result of this work, while the national average of initial claims allowed is at 39.9%, the Mass. DDS has an average allowance of 45.4%. This may be due in part to the medical evidence of record request rate, with the MRC DDS at 76.2% against a national average of 71%, allowing the Mass. Examiners to prepare better cases at the time of application. Another example of the effectiveness of the DDS is evident when compared to the national average of total claims allowed, at 2.95 per 1,000 population, with the Massachusetts DDS maintaining an edge over most states with an average allowance of 3.11. "This kind of quality work makes my job a bit easier," explains Collins. Williams agrees.

Another fact these two MRC DDS managers like to point out is that they have a consultative exam rate of only 28.8%.The national average for consultative exams is 41.5%.This translates into most of the disability determination decisions being made based on input from the 'treating source' who best knows the claimant. Thus, the MRC-DDS has saved the federal Social Security Program thousands of dollars during this past fiscal year.

SPECIALTY UNITS - WIN REED, HIV LIAISON

In the spring of 1980, six years into Winston "Win" Reed's work at the Disability Determination Services (DDS) as a disability examiner and alternate supervisor, a friend -"Joe" - told him that he had GRID (Gay Related Immune Disorder). This new illness seen in gay males provoked both fear and shame in the community. By the time Joe told him, he was severely ill, homebound and being cared for by hi smother. His career as one of Boston's newest acclaimed chefs was over and he had no income. During visits, Reed tried to convince Joe to apply for disability benefits, but like many others with GRID, he was afraid of the stigma and too weak to even go to the Social Security Administration (SSA) office. With permission from both SSA and DDS, Reed took a disability benefits application to Joe's home, filled it out, and walked it through SSA and into the DDS. Reed then approached Joe's physician for his medical file in order to complete the claim. Joe finally got his benefits, about two months before he died.

Shortly after, Reed joined the founding group of the AIDS Action Committee (AAC) and the floodgates opened to multiple disability claims and the problems inherent in handling them. "Claims reps were leery of interviewing applicants, no guidelines were in place for the medical evaluation of these new claims and the people with this disability felt stigmatized, avoiding contact with everyone. The need for compassion and confidentiality was obvious to anyone who read or watched the news. So in 1981, Kasper Goshgarian, the DDS Deputy Commissioner, recognizing the need for these claims to be handled as a specialty, appointed me as the AIDS Coordinator," remembers Reed.

The Massachusetts DDS was the first DDS in the nation to treat AIDS in such a manner and it has remained in the forefront of this work ever since. "At that time, we all felt this new illness would be over in a couple of years; years later HIV remains rampant in the USA and is an epidemic on every continent in the world," recalls Goshgarian.

Today there are seven Massachusetts DDS HIV trained examiners, as well as a number of physicians, located in both the Worcester and Boston DDS offices. "Now, there are federal regulations covering HIV claims, put into effect in 1993. Based on these regulations, the Mass. DDS allows approximately 75% of all HIV claims," Reed states proudly. "With a dedicated and nonjudgmental staff, the unit is committed to handling the most difficult claims from a very divergent population, with applicant ages ranging from birth to 80."

DDS works closely with many community and statewide HIV groups, including AAC, AIDS Project Worcester, Cape Cod AIDS Alliance, to name just a few, and every hospital AIDS clinic from Worcester to Boston. "We are in close contact with the MA Insurance Connection (MIC) program under Emergency Aid to the Elderly, Disabled and Children (EAEDC) program established by the Commonwealth to pay medical insurance premiums, a major expense for the HIV disabled population; a call from DDS to MIC is all that is needed to eliminate a major burden from those already swamped with problems. The interaction between DDS and all of these groups is on a first-name basis, resulting in the elimination of red tape that can needlessly delay claims. All of this outreach, advocacy and education by DDS has been extraordinarily successful, not only in helping these groups guide their clients through a confusing and complicated process during a very difficult time, but also in establishing important working relationships for both sides. Because of the confidential nature of the information we need and the work we do as Examiners, this is a key factor in our success," states Reed.

"The past 22 years of HIV liaison work have been frustrating," admits Reed, "but also educational, demanding, and while very depressing, most of all it has been rewarding." Rewarding, because Reed can truly say the DDS HIV team has made a huge difference in the lives of thousands of people with disabilities in this often maligned and misunderstood population.

Two informative brochures have been published in a cooperative effort between the DDS Advisory Committee, Community Legal Services, Greater Boston Legal Services and Tri-City Homeless Services.

Social Security Benefits for Homeless People with Disabilities This guide provides practical tips on how to successfully apply for Social Security benefits when you are homeless and have a disability. It contains instructions on how to complete an application, your rights when applying for SSI and SSDI and answers to questions for homeless persons with a history of substance abuse. Also included are phone numbers of programs that can provide additional information.

An Advocate's Guide to Social Security Benefits (SSI and SSDI) for Homeless People with Disabilities This guide contains an overview of SSI/SSDI, information on the helpful role of an advocate in the application process, application requirements, and the importance of following up. Free legal representation may be available. This brochure also contains phone numbers of programs that can provide additional information.

OUTREACH TO THE UNDERSERVED - Clare Deucher

Imagine the amount of energy and organizational skills that must be needed by a person who has a disability, is unemployed, and applies for Social Security Disability Insurance benefits," muses Clare Deucher, DDS Supervisor and employee of 23 years. No doubt SSA's regulations may seem confusing, and the paperwork, perhaps, overwhelming. "Now, imagine what it must be like for someone who is homeless. Where would you turn for assistance? What agency would go out of its way to understand your unique needs and guide you through the government requirements? How would you be able to obtain the benefits you need to help you get back on your feet and out of a shelter?" asks Deucher, knowing full well who holds the answer.

Deucher was a Vocational Disability Examiner for 18 years before becoming the Supervisor of the Homeless Unit at the Boston DDS, where exceptional services have been provided since about 1985. The unit is comprised of nine staff highly committed to the task of helping consumers in dire need of DDS services. "We are aware of the homeless population's special requirements and the extra effort required t o work with them. For every homeless consumer, a diligent effort is made to obtain the documentation needed to make an informed decision on each individual's disability claim," asserts Deucher.

"Having a small cadre of MRC-DDS employees working with the homeless allows us to form effective relationships with shelter staff, advocates and homeless clinic employees who can assist us in our ultimate goal for each homeless consumer . to receive a fair and thorough decision about their disability eligibility. Such extra efforts might have burned out ordinary people long ago. However, these dedicated DDS Examiners continue to bring compassion to their jobs not typically epitomized by government employees. This thankless work is not suited for everyone, but for the Examiners in the Homeless Unit, it is the most fulfilling work," admits a gratified Deucher.

DDS FACTS AND FIGURES
Total Receipt of Cases76,663
Total Disposition of Cases78,900
Total Budget$30,964,146
Cost Per Case$380
Continuing Disability Review (CDR) Receipts18,614
Continuing Disability Review (CDR) Dispositions20,814
Consultative Examinations Purchased23,502
Consultative Examination Rate28.8%
Medical Evidence of Record Purchased62,117
Medical Evidence of Record Rate76.2%
Total Medical Costs$6,270,326
Accuracy of Decisions as Measured by SSA94.3%
DEMOGRAPHICS OF POPULATION
Total Population (Massachusetts)6,349,097
Initial Claims Filed44,396
% Allowed45.4%
Persons Below Poverty10.7%
Low Income Population31%



This information provided by the Massachusetts Rehabilitation Commission.