History of SSA During the Johnson Administration 1963-1968

DISABILITY CHANGES

Of particular note are the changes that have taken place in the disability program during these years, 1963-1968.

Broad Program Development

On November 22, 1963, when Lyndon Johnson was sworn in as President of the United States, there were about 82,000 disabled workers plus 625,000 of their dependents receiving about 1.2 billion dollars annually in social security disability benefits. On, January 20, 1969, when the next President is inaugurated, the combined figure of disability beneficiarieswill have risen to over 2.3 million people who will be receiving monthly benefits totalling over 2.5 billion dollars a year. Some of this increase was, of course, due to the natural expansion of the population during this period. But a very large portion of the increase was directly attributable to liberalizations in the disability provisions which took place during the years of President Johnson's tenure in office--liberalizations which were initiated or backed by the President.

Some idea of the directional thrust of the President's position on social security could be gained from the 1964 amendments--passed shortly after he took office. These amendments eliminated a restrictive clause from the law which required that a person had to meet the disability insured status requirements within 18 months of the date he filed his application. Under this restrictive provision, some disabled people who had been unable to work for many years would not be able to qualify for benefits because they had no recent work.{1}

But the major expansions and liberalizations of the program occurred in the 1965 and 1967 amendments to the Social Security Act. As already noted, these changes liberalized the definition of disability to permit workers with shorter term impairments to qualify; extended protection to disabled widows and widowers between age 50 and retirement age; and made it easier for workers disabled while young to earn insured status under the disability program. Following is a resume of the major provisions of the 1965 and 1967 social security disability amendments.

The 1965 Amendments A New Definition

The 1965 Amendments to the Social Security Act were of major importance because, for the first time in the history of the program, the definition of disability was changed. Formerly, a person could become eligible only if his impairment was expected to keep him from working for a long and indefinite time. Under the change, he could qualify if his impairment had lasted (or was expected to last) for as little as 12 months.

Recovered Individuals May Still Collect

Under the 1965 amendment; a person who was disabled for as long as 12 months can collect retroactive benefits even if he has returned to work.

(Formerly, a person could be eligible only if he was disabled when he filed his application.) However, the longer the delay between recovery and application, the fewer months of back benefits he can receive. If more than 14 months elapse between recovery and application, no benefits are payable.

Special Provisions for the Blind

The disability program has always made special provision for people who are totally blind. "Blindness" was defined initially in the social security law as either central visual acuity of 5/200 or less in the better eye with the use of a corrective lens, or visual field reduction to 5 degrees or less. Since the beginning of the disability program in 1954, a worker whose sight is poor enough to meet this statutory definition generally would be considered disabled if he is not doing substantial gainful work. Even if he is performing substantial gainful work, he may still have his social security earnings record "frozen" so that the years in which he has low earnings or none at all will not be counted against him in determining his eligibility for future benefits or in figuring their amount.

In 1965 Congress enacted additional provisions for a blind person according to the definition of the law. One provision permits a person who became unable to work because of blindness beginning before age 31 to quality for disability benefits with fewer social security work credits than other applicants need.

Ordinarily, a worker needs at least five years of social security work credits in the 10-year period prior to his disability before he is insured for disability purposes.

But a person who becomes blind before age 31 needs credits for only half the period between age 21 and the time he becomes blind. Thus, a workerdisabled at age 26, for example, needs 2 1/2 years of social security credits out of the five years between ages 21 and 26. To qualify under this provision, a person needs at least 1 1/2 years of work.

In deciding whether a worker qualifies for disability benefits under this special rule, it does not matter if he is now over 31. What counts is the age at which he became blind.

Another 1965 provision permits blind workers aged 55 and over to qualify for benefits more easily because a slightly more liberal definition of disability applies to them. Even though able to do substantial gainful work, they can receive disability payments as long as they cannot do work that requires skills or abilities comparable to the work done regularly before age 55 or before blindness, whichever is later. (However, benefits cannot be paid for any month in which the beneficiary actually engages in substantial work). A worker who does not meet the statutory definition of blindness but still has a severe visual impairment may qualify for benefits on the same basis as applicants with other conditions--that is, if his sight is poor enough to prevent him from doing any substantial gainful work in keeping with his age, education, and work experience. Over half of the blind workers who become entitled to disability benefits qualify under the general definition rather than under the special one for blindness.

Workmen's Compensation Offset

The 1965 amendments re-introduced into the disability program a provision for social security disability benefits to be reduced in some cases were a worker is also receiving workmen's compensation. In 1957 and 1958, Congress repealed earlier provisions of the Social Security Act, which required the reduction of social security disability benefits were the individual was receiving another Federal disability benefit or a State workmen's compensation payment. Under this provision, the total benefits payable to the disabled worker and his dependents under both programs cannot exceed 80 percent of his average monthly earnings before the onset of disability. In instances where they would, the social security benefit is reduced accordingly (although in no instance would it be reduced to the point where the family is receiving less from both programs than it would from social security alone). The
amount of the reduction will be adjusted periodically to take account of increases in national earnings levels.

The 1967 Amendments--Current Program

Background

When President Johnson in 1967 submitted recommendations for significant further liberalizations of the disability-provisions, it was necessary to request not only additional financing for the recommended program extension but also for the already existing program, which was operating at a deficit of about 15% of payroll.

At the time of Congressional hearings on the proposed legislation, the House Ways and Means Committee (and later the Senate Finance Committee) undertook an extensive review of current program experience and problems. The Committee also explored the potential implications of the substantial body of experience the program had in the Federal courts which had tended to press the program in the direction of greater liberality in the payment of disability benefits.

There had been, for instance, an increasing judicial tendency to put the burden of proof on the Government to identify specific job vacancies for which an applicant might have a reasonable chance to be hired. There had also been a narrowing of the geographic area in which the jobs a person could do must exist to the point where some courts had held that an applicant should not be expected to seek employment beyond a reasonable commuting distance from his home. In other instances, high evidence value had been placed on a medical opinion that a person was disabled, even though this conclusion was not supported by the medical findings.

Clarification of Definition

As a result of the review of program policies and operations, Congress subsequently enacted Presidentially backed legislation which changed the law to clarify the intent with respect to the meaning of disability. The changes, in effect, wrote into the law statements of program policy that had previously appeared only in the Federal Regulations, and inadministrative guidelines and therefore reflected endorsement of the disability evaluation concepts and interpretation of the law the program had been using. The essential concepts thus endorsed include the following:

1. Most disability allowances can properly be made on the basis of an inference of disability where there is animpairment which meets the medical criteria the programuses, and the individual is not engaging in substantial gainful activity.


2. For impairments of lesser severity, weight is to be given to age, education, and work experience in determining whether an individual is disabled, but consideration is not to be given to such factors as whether work exists in the local area, whether there are job openings, orwhether the applicant would actually be hired if he sought work.


3. If an individual demonstrates by working that he has the ability to engage in substantial gainful activity, he isnot to be found disabled even if he would otherwise meetthe requirements.

4. An impairment must be demonstrable by medically acceptable clinical and laboratory diagnostic techniques; statements of the applicant or conclusions by others with respect to the nature or extent of impairment or disability
must be supported by clinical or laboratory findings or other medically acceptable evidence.

It was against this backdrop that the responsible Congressional committees approved the various Johnson Administration proposals for improvement of the disability provisions and for their extension to other groups of individuals. The most significant of these were (1) the provision for disability benefits for certain widows and widowers, and (2) the change in the insured status requirement for younger disabled workers. Before this momentous change, a widow could not get social security payments until she reached age 60, unless she had in her care a child drawing benefits on her husband's account.

Liberalized Earnings Requirement

The other major extension of protection in the 1967 legislation liberalized the earnings requirement for workers disabled while young. Briefly stated, it extends to all workers the "age 31" provisions previously applicable only to the statutorily blind. The younger disabled worker no longer needs five years of work to qualify. For those disabled before age 31, the requirement will range down from 20 to as few as six quarters of work necessary to qualify for benefits.

The 1967 amendments also changed the definition of blindness by substituting for the 5/200 criterion in the earlier law the more liberal test of central visual acuity of 20/200.

There were also two minor amendments; one relates to the method for computing the amount of benefits in cases involving workmen's compensation offset, and the other provides for extension of the time for filing application in the case of individuals who were physically or mentally unable to file within the time previously prescribed in the law.

Benefits for Widows

Under the 1967 amendments, a disabled widow (surviving divorced wife or dependent widower) may receive reduced benefits as early as age 50 if she meets the necessary requirements. One of these is that her disability must begin before or within seven years after her husband's death or within seven years of the end of her entitlement to mothers benefits.

A somewhat stricter definition of disability applies for this group than applies to disabled workers and childhood disability applicants. The essential difference is that, in the absence of work activity, disability for these applicants will be decided solely on medical considerations, without regard to such factors as age, education, or previous work experience.

In effect, the law permits only those cases that meet the disability programs medical evaluation criteria (known as the Listing of Impairments) to be allowed. The Listing of Impairments was developed by the Social Security Administration (with the aid of its Medical Advisory Committee) when the disability program began. The Listing, which is continuously reviewed and updated on program experience and medical advances, describes the most frequently disabling impairments in terms of signs, symptoms, and laboratory findings that reflect the level that would prevent most people so impaired from working for a year or longer.

If an applicant has an impairment (or combination of impairments) that meets or equals the Listings--and he has not been working--he would generally be found disabled.

If a worker or a "childhood disability" applicant has an impairment that falls short of the listed level of severity--but is nevertheless significant--then other factors may be taken into account. The decision then is based on how an applicant's physical or mental handicaps, combined with the limitations of his age, education, training and experience, affect his ability to do his usual job, or any other work.

An older worker, for instance, who has little education or training and whose work experience has been limited to arduous physical labor, may be prevented from doing any kind of work for which he could reasonably be expected to qualify, by an impairment which might not be disabling to another person with a more favorable background.

But in the case of a disabled widow (or widower) the law requires that the claim be decided on medical considerations alone. If the applicant does not have an impairment (or combination of impairments) that meets or equals the level of severity described in the Listings, the claim must be denied.

The Listing of Impairments, which in previous years had been considered a confidential administrative guideline is to be published during the latter half of this year in the Code of Federal Regulations. Anyone interested in reviewing the medical evaluation criteria the program uses may now do so at the nearest social security office. Copies are also being made routinely available to physicians and other professional people for their quick reference.

Costs of Rehabilitation Services from Social Security Trust Funds

From the beginnings of the social security disability program in 1955, one of the primary objectives of the program had been to promote the rehabilitation of social security disability beneficiaries. The Social Security Act had declared it to be the policy of Congress that all applicants for disability benefits be referred to State Vocational Rehabilitation agencies for vocational rehabilitation services. In addition, the disability program has built into it by law several incentive provisions to encourage beneficiaries to return to work. These include a trial work period (except in widows' cases during which an individual has an opportunity to test out his ability to work on a sustained basis without fear of permanent loss of benefits if he should not succeed. Another provides that a worker's benefits may be suspended if he refuses without good cause to accept rehabilitation services offered to him. A third provides special consideration for workers who become disabled again within five years (seven years for a widow) after an earlier disability ceased.

By 1965, it was recognized that the number of disability beneficiaries receiving rehabilitation services remained small due to the limitations on rehabilitation funds available to the State Vocational Rehabilitation agencies since most States fell short of matching the Federal funds available, thereby constituting a substantial obstacle to the rehabilitation of a greater number of social security beneficiaries. Therefore the Senate Committee on Finance recommended in its report to accompany H.R. 6675 that money be made available from the social security trust funds to finance the rehabilitation of selected disability beneficiaries. This recommendation was adopted and was enacted into law as Section 336 of P.L. 89-97 on July 30, 1965. The Committee rationalized that such an expenditure from the trust funds is justified because of the offsetting gains to the trust funds as well as the gains that would flow to the individual concerned and to society when disabled people are returned to gainful work. In making the recommendation, the Committee indicated that the money should be used in such a way that the saving from the amount of benefits that would otherwise have to be paid and the increased contributions to the trust funds paid on the earnings of beneficiaries returned to work would exceed, or at least equal, the money paid from the trust funds for rehabilitation costs.

The Act stated that the services would be provided to selected disability beneficiaries by State Vocational Rehabilitation agencies in the regular State-Federal Vocational Rehabilitation program who amended their State plans to conform to the special provisions of the Act and indicated that the total amount of funds that may be made available could not, in any year, exceed 1 percent of the social security disability benefits paid the previous year. It was further provided that the selection of individuals to receive services shall be made in accordance with criteria formulated by the Secretary which are based upon the effect the provisions of such services would have upon the trust funds.

Regulations to carry out the program, jointly developed by the Rehabilit tion Services and the Social Security Administration, were approved by the Secretary of Health, Education and Welfare and published in the Federal. Register on March 1, 1966. Since that date 90 Vocational Rehabilitation agencies and agencies for the blind in the 50 States and Guam and the Virgin Islands have amended their plans to participate in the program. The State agencies have substantially stepped up their activities to provide rehabilitation services to social security disability beneficiaries and at the end of the third quarter of fiscal year 1968 were providing services with trust funds to over 29,000 beneficiaries and had demonstrated the capacity to fully utilize the funds available. Significant accomplishments have been made in increasing the number of beneficiaries rehabilitated and, although it is too early in the program to permit a comprehensive evaluation of the accomplishments since the majority of the beneficiaries are still in the midst of their rehabilitation programs, preliminary assessment demonstrate that the program has great promise of meeting its objectives. {2}

Footnotes (Footnote numbers not same as in the printed version)

{1} See Social Security Bulletin, May 1965, pages 24-25.

{2} See Section 336, P.L. 89-97.See Title 45, Chapter IV, Part 401. See Subpart D, Federal Register, Volume 31. See Chapter 1-066, HEW Department Organization Manual. See Popick, Bernard "Social Security and Rehabilitation on the Move,"Journal of Rehabilitation, May-June, 1967, pages 10-12.