History of SSA During the Johnson Administration 1963-1968

OPERATING METHODS

MEDICAL ADVISOR PROGRAM

When Congress first enacted the disability provisions of the Social Security Act in 1954 the Office of Hearings and Appeals {1} of the Social Security Administration was confronted with the problem of training and indoctrinating its hearing examiners in medical matters relating to disability evaluation. Since the hearing examiners were not centrally located but were scattered throughout the country it was felt that they needed to be locally provided with medical exerts. Accordingly, the Chief Medical Advisor of the Office of Hearings and Appeals, Dr. Archibald Sinson, began a series of personal visits to cities where there were hearing examiner offices and he succeeded in contracting with one or two of the outstanding medical doctors in these cities to act as advisors to the hearing examiners there. They were to be available to answer questions and provide individual hearing examiners with ready access to information which they could otherwise obtain only by reading medical texts, and also occasionally to lecture on specific medical subjects to a group of the hearing examiners in the office.

Since November 1963 the medical criteria for evaluation of disability have been extensively revised particularly so in response to the 1965 Amendment changes in the duration requirement and again in 1967 as the result of the benefit coverage of disabled widows and widowers. On both occasions the revised criteria were based in large part on findings from on-going studies conducted by the Bureau of Disability Insurance's medical personnel. A pilot project was initiated wherein medical advisors were asked to appear "live" and testify as expert witnesses at hearings. The success of the project, from both the standpoint of the participating hearing examiners and doctors and the improved quality of hearing records, resulted in adoption of the procedure in all hearing examiner offices. This necessitated a major recruitment program to obtain enough doctors in all of the major specialties with which the program was concerned-internal medicine, psychiatry, neurology, orthopedics, neurosurgery--and to a lesser extent in the miscellaneous specialties, such as physical medicine and rehabilitation, ophthalmology, etc.

The recruitment effort was launched in 1964 with three basic objectives in mind: namely, that the expert medical witness be a recognized authority in his field; that there be enough specialists available for a workable rotation system; and that the elements of objectivity, neutrality, and a fair hearing be maintained.

The success of the endeavor is reflected in the numbers and the quality of the medical profession who have been enlisted in the program. From an initial start of several dozen doctors, the roster now includes more than a thousand of the most outstanding medical specialists in the country.{2}

Since the origin of the program medical advisors have been used approximately 7,600 times (5,700 of which have been "live" expert testimony at hearings), and the use can be expected to be increased yearly, particularly since enactment of the 1967 amendments to the Social Security law which extend disability coverage to widows and other beneficiaries. {3}

Not the least benefit of the medical advisor program has been the establishing of a firm and intimate relationship with the leaders of the medical scientific world--the top ranking teachers of medicine and the most prominent practitioners.

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

{1} Now called the "Bureau of Hearings and Appeals"

{2} Medical schools represented by Medical Advisors.

{3} Case list of Medical Advisors.