John C. Ritter
John C. Ritter
|02/55-01/59||Claims Representative||Ft Lauderdale, FL|
|01/59-10/60||Field Representative||Nashville Tenn|
|10/60-06/61||Claims Unit Supervisor GS-10||St. Petersburg, FL|
|06/61-02-64||Staff Assistant. (Management)||Atlanta Regional Office|
|02/64-01/66||State Operations Adviser||Baltimore|
|01/66-11/67||State Operations Adviser||Baltimore|
|11/67-01/71||Assistant Regional Representative||Atlanta Regional Office|
|01/71-10/72||Associate Regional Representative||Atlanta Regional Office|
|10/72-01/74||Regional Representative (Disability)||Atlanta Regional office|
|01/74-02/80||Assistant Regional Commissioner, Disability||Atlanta Regional Office|
|03/80-09/80||Special Disability Advisor||Atlanta Regional Office|
|10/80-08/84||Assistant Regional Commissioner, Programs||Atlanta Regional Office|
|08/84-03/87||Director, Division of Field Disability Operations||Baltimore|
|03/87-02/93||Executive Program Policy Officer||Baltimore|
|02/93-09/95||Director, Litigation Staff||Baltimore|
|Chair, Commissioner's Zebley Implementation Task Force - 02/90-02/93
Chair, Commissioner's DA&A Task Force- 03/91- 02/93
|Commissioner's Citation (individual) July 1989
Commissioner's Citation (group) August 1992
Deputy Commissioner Citation November 1994
Associate Commissioner Citation August 1988
Associate Commissioner Citation April 1992
Associate Commissioner Citation April 1991
John Ritter retired from SSA at the end of August 1995, after a career spanning 40 years. Educated at the University of Miami where he took a degree in personnel and industrial management, John came to work for SSA on February 28, 1955. During much of his career he worked in the disability program, at both Regional and Headquarters levels, and he was an eyewitness to many of the policy developments in the disability program over the years. For the last 2 years of his career, John was the Director of SSA's Litigation Staff.
Ritter Oral History
This oral history interview was conducted on August 16, 1995 in the Historian's Office at SSA Headquarters in Baltimore, Maryland. The interviewer was Larry DeWitt, SSA Historian. The tapes of the interview were transcribed by Bob Krebs, of the Historian's Office. (The interviewer's comments and any editorial clarifications appear in italics to distinguish them from Mr. Ritter's comments.) Mr. Ritter was given an opportunity to make edits and corrections in the raw transcript.
Q: John, lets just start at the beginning of your career and tell us how it is you came to work for SSA. What were the circumstances of you coming to SSA and what was your first job?
Ritter: My first job was a Claims Representative (Claims Rep) in Fort Lauderdale, Florida. At the time I had been driving a cab, of all things, night shift, and I was looking around for a job. I had previously worked at a metal-frame window factory, and I got tired of that, although the opportunities looked good. Anyway, I quit there and ended up driving a cab for a little while, and I saw an announcement in the paper about the Federal Service Entrance Examination for a Social Insurance Representative. I had no idea what it was, but I put in for it. Took the federal service exam. Passed it and got picked-up as a Claims Rep in Fort Lauderdale in February of 1955.
When I went to Fort Lauderdale the district office was in an old a five-room bungalow that had been converted into office space. I was one of three Claims Representatives. The other two Claims Reps at that time I believe were Helen Boltz and Grace Pogue. Paul L. Byerley was the manager and he was a very interesting fellow. Very, very traditional, old-line Princeton educated and very rigid in his work habits and in his supervision, but an extremely caring person. He was one of those people that likes to do everything himself and he personally did all of the training in the Claims Manual, which was not nearly as big as it is now, but he personally did the training and I was with him a good two hours a day.
Q: Did you come to Baltimore for your Claims Rep Training (CRT)?
Ritter: Yes. Came to CRT training in March of 1955 for three weeks. Matter of fact, if you want it, I've got a list of the people who were in that class. I found out years later that Andy Ciulla was in that class with me as well as another fellow named Jim Haas who later became Regional Commissioner in Kansas City. Frances McDonald was the head of training.
Q: It looks like this list has fifty people on it. Was your class that big or were there separate classes?
Ritter: That was the class. They had some breakout sessions and rotating sessions, but most of it was a big room in the OddFellows hall across from the YMCA downtown between Mulberry and Franklin Streets.
Q: As I understand it, we used to bring everyone to Baltimore for their training class. Was that part of the practice?
Ritter: Yes. They were still using the old Candler Building. That's were the systems operation was, it was called the Division of Accounting Operations then and Joe Fay was head of the thing. And we went down there and spent a couple of days.
Q: Was that your first time to Baltimore?
Ritter: I had lived in Baltimore as a small child, but that was the first time I ever visited Baltimore myself. One thing interesting about the Candler Building in those days, the Candler Building was a Coca-Cola building. Candler was founder of Coca-Cola. I learned some of this later. It was noticeable that in the Candler Building many of the brass door knobs said Coca-Cola on them. I have no idea where those door knobs are today, I suspect they're collectors items.
Q: One of the things that we used to do, that I don't think we do so much anymore, is provide a big segment on the history and philosophy of the program, put some kind of philosophical context behind the training class.
Ritter: Yes. They taught us what the purpose of the program was. Why certain provisions were in there. The emphasis was always on the fact that, and they practically beat it into you and we still do of course but in those days it was even stronger, is that Social Security wasn't intended to be something you live on the rest of your life in retirement. It was intended to be a supplemental source of income to help you in retirement. It wasn't intended to be a sole support mechanism.
Q: So you finished CRT class and then you went back to Fort Lauderdale?
Ritter: Yes, I went back to Fort Lauderdale.
Q: Sounds like a small office.
Ritter: Very small. By the time I left, there were maybe eight or nine Claims Reps. But I enjoyed the job, I enjoyed it very much being a Claims Rep.
Of course I came in just when disability came along. The disability amendments had just been passed four months earlier and that was back when we had just the "disability freeze." I was in on the very early disability claims and we had an interview guide that was in the form of a temporary instruction. I doubt that there are very many people around now that would recognize the term TI206. Temporary Instruction 206 was the only guidance that was provided to Claims Reps on how to interview the claimant, what kind of questions to ask, and the interview was just written up on an old OAC-5002 Report of Contact.
Q: You didn't have an application form, per se?
Ritter: We had an application form, but the interview was on this standard Report of Contact form. The number of the form was the same then as it is now for disability, but they were OAC forms instead of SSA forms, Old Age Claim was the acronym, and then they converted all the forms to SSA forms later on. But the interviews in those days for some reason did take a while. We weren't too sure what questions to ask, and we weren't too sure what to do with the answers when we got them. We wrote them all up on a narrative report of contact, which took a while.
Ed. Note:The current interview forms are the SSA 3368 & SSA 3369.
Q: That's for disability claims you're talking about?
Ritter: That was disability, and for the first couple of years I was there, until '57, it was just a "disability freeze." Then they passed a law in the '57 Amendments, I believe it was, that started paying cash benefits to people who were disabled at age fifty and above. And that's when the claims load started getting heavier. They did start structuring the interview later and started providing more structured forms. The earliest claims were very, very rough interviews.
Ed. note:The law was amended in August 1956.
Q: What about the retirement and survivors case load?
Ritter: Case loads were pretty heavy in those days. We had a lot of amendments coming along. We had state and local coverage changes, we had special provisions for groups that had not been covered before. Somewhere around 1950, before I came along, they changed the law to provide for a new start date for computations, because a lot of people were covered by the 1950 amendments and in order to keep them from being disadvantaged and having to wait years and years to meet the insured status requirements they changed the insured status requirements.
So about the time I came along in 1955, a lot of people who had been newly covered under the 1950 amendments started filing claims, and so we had a big surge of claims up into the mid-'50s.
I can't recall all of the changes, but there were a number of changes in through there. I know at the time the optimum workload for a Claims Rep in an office was about 90 claims pending. At one point I think we got up to 250. Right now I can't remember the event, but twice during the four years I was in Fort Lauderdale there were major amendments that inundated us with claims. I recall interviews stacked up like two or three hours. And at times we had to send people home and have them come back the next day if we had too many in the office late in the afternoon. We never left as along as there was anybody in the waiting room, that was just one of Mr. Byerley's rules and it was a good one, I think.
Q: In terms of the business process, at that point in time it was basically a paper process. We don't have any automation to speak of. You have clerical support though, you had what we later called Claims Development Clerks, I don't know if they were called that at that time.
Ritter: They were just called Claims Clericals when I was there. Service Representatives (Service Reps) and Data Review Technicians (DRTs) came along later.
Q: We would take the claim and send it to the Program Service Center (PSC) to be adjudicated?
Ritter: Yes. The first thing we would do, there was a little yellow form called an OAC-790 which was a one-third of a page, snap-out form that was a earnings records request. And that would have to come to Baltimore. It took about two weeks to get an earnings record back, and then you would send it to the PSC.
The PSCs were called Area Offices then, and the Area Offices would look over cases and if there was anything wrong with the case they would send you what they called an "A" or "P" memo. An "A" memo was an error, that meant you did something wrong in the adjudication and you had to patch it up. You didn't like to get "A" requests because they were errors that were looked at closely by the supervisor. "P" memos were called "postadjudicative." That meant that the claim was okay, but there was some other action that was going to be necessary to follow through, and they didn't charge you for an error on those.
We eventually got an assistant manager in the office somewhere around 1957, and his name was R.G. Ray.
Q: One last thing about that job. You mentioned the Claims Manual earlier. What was the Claims Manual like during that time? Was it your right-hand tool? Did it have a central place in your life as a Claims Rep?
Ritter: Oh yes. The manual was much less lengthy then it is now, obviously. It was three volumes, you had the Field Office part, the Payment Center part, and I can't remember what the third part was called, but it was the central office part explaining the account number and earnings reporting process. At any rate, the Payment Center part we didn't have to fool to much with, that just told us what the Area Office procedures were. But the field office claims of the Claims Manual, you tended to learn pretty much all that was in it, as a Claims Rep unless you wanted to sit there and flick through the thing while the claimant was sitting there. By the time I left Fort Lauderdale it was rare that I had to make any reference to the Claims Manual.
Ed. Note:Payment Centers were the name given to Area Offices before they were renamed PSCs.
Q: All right, so next I believe you left Fort Lauderdale to become a Field Representative somewhere. Is that right?
Ritter: I enjoyed being a Claims Rep, it was a good job, and I wasn't to anxious to leave the Fort Lauderdale area. But the Assistant Regional Representative, who was the Regional Manager, they each had a network comparable to the Area Directors today, they would make their routine visits and they started putting some pressure on Claims Reps who were mobile and could move around to put in for other jobs. So I was sort of nudged into putting in for some vacancies, which I decided I would go ahead and do. I was selected for a Field Representative (Field Rep) job up in Nashville, Tennessee. I had stayed four years in Fort Lauderdale, which brought me up to late 1959. The amendments had just passed giving Social Security coverage to farmers and they had a special rule on insured status that enabled any farmer to become fully insured based on farm employment or farm operation if they materially participated in the management of the farm. This gave them coverage for just six quarters. That must have been the '58 or '59 amendments, because just when I got to Nashville, TN the farm workers and farm operators had just had time to get their six quarters in. So we were inundated with farm claims.
Ed note: Self-employed farmers were first covered in 1954, materially participating farmers were covered under the 1956 Amendments.
Nashville, TN had a big service area and as a Field Rep I had four Contact Stations on the eastern part of the state, ranging from twenty miles to ninety-five miles away. The farthest was Spencer, TN. I was out on an average of three nights a week. I was in on Mondays and usually in on Fridays. The farm claims were very heavy, plus we had disability.
We did a lot of claims by personal contact. With farmers you just went out to their house if they had written in or called. I went out one time and took a farm claim from a farmer who had just gotten his insured status with six quarters of coverage. All they had to do is show a gross income of $600 and they were deemed to have a $400 net profit, which was all you needed to get insured status. So it was pretty easy for farmers to get insured under those provisions. So I was taking this claim from this farmer, and we were supposed to ask if they have any kind of disability, and he said yes he had a disability. And since he was filing, his wife could also file for wives' benefits because she had children in her care, which turned out to be disabled children, five of them, plus the wife was disabled. I think that interview took with the five kids and the man his wife about five hours one afternoon. As a result, I ended up there for supper and I and didn't get away until about eight o'clock.
I had some interesting times, it was a fun job, but then I think I've had fun in all my jobs.
Q: It sounds like you did mostly claims work as a Field Rep. Did you do public information work? Did you have speeches to make?
Ritter: Oh yes, we did public information, we had speeches. In between the Contact Station workload we still had to maintain our public relations (PR) activities. The manager there encouraged us very strongly to get involved in the community affairs of the Contact Stations where we were at.
So I ended up going to Chamber of Commerce meetings from time to time and made I guess on the average probably about four speeches of one sort or another per week, for Rotarians, Chamber of Commerce, Moose, Elks the various groups that wanted to have someone come in and talk to them about Social Security. We had spot announcements that went out every week or two. We made new spot announcements that were recorded on disks, the old ordinary phonograph record type.
Q: What were people interested in at that time when you went to the Chamber of Commerce and the Elks club or whatever?
Ritter: Farm coverage, insured status, how much you can earn, can you still work when you retire. They were interested in how benefits were computed.
Q: So it was practical nuts and bolts things of the program?
Ritter: Yes, nuts and bolts stuff. They were just interested in what you have to do to become entitled; how long did it take to become entitled; how was the benefit amount computed; and what were the survivor benefits. Disability was still relatively new, but there was a lot of interest in disability. In the Nashville area a lot of interest in farms, what constituted a farm.
Those were difficult interviews because in order to be covered for Social Security as a farmer, you could be covered either way. You could be a sharecropper or a renter and be earning your income based on working someone else's farm, but at the same time the owner of that farm that you were sharecropping for couldn't necessarily be covered for Social Security unless he or she quote "materially participated" end quote in the operation of that farm.
So there was a very, very long couple of forms that you had to fill out on such interviews. I think that was a 7156 for the owner and a 7156A for the renter and they both had to show that the owner was more than a front-porch manager. Had to show the owner actually operated it. Then he/she too could get Social Security coverage, but those were often very, very difficult interviews.
Q: After the Field Rep job you went on to what?
Ritter: I went from Fort Lauderdale down to St. Petersburg, Florida as a Supervisor. They had posted some vacancies that I thought I'd just put in for. Back in those days when I put in for jobs I just put in for everything that was available. I didn't have any particular preference where I went and I was selected for St. Petersburg.
Let me just back up for a minute. One thing about Nashville, TN, that I did not mention, was the manger. The manager was a fellow named Hugh L. Johnson, who I had contact with a few years later. I suspect there are a few people around Headquarters that still know him, he was well known to the Bureau Director, who at that time was Victor Christgau. And I know there were many times when Victor Christgau would call down to the Nashville office and have Hugh Johnson dictate his speeches for him. It was an interesting experience to be working with a manager who was that close to what amounts to what the Commissioner was in those days, so it was a mainstream office in Nashville that had pretty heavy interaction with Headquarters.
St. Petersburg, I only stayed there about a year before moving on to the Regional Office. That was a good job. It was interesting living in St. Petersburg, there was nothing particularly spectacular about the workloads. The workloads seemed always to be heavy in those days, there was always some kind of amendments or some kind of legislative events taking place that would drag people in.
That went well, then somewhere around 1960 they advertised some vacancies in the Regional Office for staff jobs. I applied for those and got selected to work in the Regional Office.
The Regional Commissioner, they called them Regional Reps at that time, was a fellow named James W. Murray, who was there for many years. I believe he had been there since 1942. Later on he was the first director of the Bureau of Health Insurance (BHI) when it was established.
Ed. Note: James Murray started with SSA in 1936 and followed Hugh McKenna as Director of the Bureau of District Office Operations. Art Hess was the first Director of BHI.
When I worked for Jim Murray, the title of my job was Staff Assistant for Management. As Staff Assistant, what I got into mostly was disability and coordinating the State Agency operation, State Agency budgets and dealing with the Division of Disability Operations (DDO) staffs in Central Office. They called them State Relations Officers, who used to visit the Disability Determination Services (DDSs), the Disability Determination Units (DDUs) at the time.
The State Relations Officers worked out of Baltimore, and my job was to work with them and sort of keep on top of the States, process their budget and make sure they got what they needed, but not more than they needed. I established quite a working relationship with Headquarters and the old Division of Disability Operations. That's what corresponds now to the Office of Disability.
Baltimore was once again having major workload problems, both in Headquarters and the field. And they had what they called a "dragnet" program where they would go out to the field and try to attract people to come in and work in Headquarters, because there was a strong feeling on the part of SSA management at the time that they needed more people at Headquarters with field experience. They felt that Headquarters experience was not enough to fully understand how the Agency operates, and how to do your job well. So they had this "dragnet" process, and I got picked up on the dragnet at a grade GS-12 staff job in the Division of Disability Operations. I think I ended up there because of my regional work with the people in the State Relations Branch in DDO. We seemed to hit it off, so I ended up going to DDO.
Q: Now the time that you came to Central Office was around the time Medicare came in. Did Medicare have any impact on your work at all?
Ritter: It impacted only to the extent during the four years that I was up here in Baltimore, four years I guess it was. I came here in '63, I think it was '66 that Medicare came along, and what happened was a lot of the DDO folks wanted to get into something new and moved over to the Bureau of Health Insurance (BHI). I stayed on the DDO side, so the workload changed because we had less people.
Q: How did you find the transition from the field to Headquarters? You talked about this dragnet program where they wanted to bring people in from the field because you had a different perspective and a different experience in the field. How was it on the other side of that coin when you got here and had the Central Office experience, what was that like?
Ritter: I had no problem with it. I sort of adapted to it pretty quickly. I enjoyed it. I found that my field experience was indeed very helpful up here. Got me involved in a lot of things that I otherwise might not of gotten involved in. Although I would have to say that in a number of instances I knew there were a lot of people, several that I knew personally, who came here to Headquarters and for one reason or another couldn't cope with Headquarters. I think part of it might have been family relationships, wives and kids who maybe didn't like the change. A lot of people who changed jobs and moved to new locations like that may have been in one location so long that the trauma of moving a family was much more severe. But I had already moved around so I adapted pretty well.
I have to admit that working in Headquarters was then and still is quite different from working in the field. It's a bigger operation, in many ways less personal, more bureaucratic. Working in the field was always more, I hate to use the word, but more of a true team-type operation with more personal relationships and more personal accountability in the field than there was in Headquarters.
Q: What were some of the hot issues during that four-year period when you first came to Central Office? What was going on at that time, was there anything that stands out or was it basically the routine day-to-day work?
Ritter: No, it wasn't really that routine. The Harrison Subcommittee had just completed their review of the disability program and they were very, very critical of the way the disability program was managed and operated. There were all kinds of, I guess you would call them reform activities, underway to get a better handle on the disability process.
Headquarters expanded their role in terms of State Relations Officers. State Relations Officers were grade GS-14 at that time and they traveled extensively. We accelerated efforts to be on-site in more DDSs, we established sort of a comprehensive review program that had been effect before, but it was accelerated so that we visited more agencies more often.
The main thing I recall at that time was the productivity, much the same as it is now, there had been a decline in productivity and some indication of inconsistency. All the case reviews were done up here in Headquarters and there was always an emphasis on consistency.
Q: It's interesting to me that you mention that even as early as the mid-1960s there was controversy about our management of the disability program. Since you were in on the beginning of the disability program, is it true that essentially from the beginning of the program it's always been controversial in that way? That there has always been some degree of dissatisfaction in some quarters with our management of that process?
Ritter: Oh yes. The Harrison Subcommittee had quite an impact on SSA. That was one of the reasons DDO was included in this dragnet to get more people in Headquarters.
They also had just established a special internal audit function under the direction of a fellow by the name of Joe Tyssowski. And the internal audit function was to maintain control over how the DDO was managing itself and taking care of things. It was also intended to oversee how effective the State Relationship Officers were in their dealings with the States.
They don't have that internal audit function anymore, but I think that in itself was an indication there was increased scrutiny over how we were managing the disability program. I think it was not so much a matter of anybody thinking that it was being ignored, it was a matter that there were a lot of questions about how it should be managed and were we doing it uniformly and did we really know what was going on in the DDSs when they were making decisions.
There was strong emphasis, I think stronger than it is today, on medical staff. There was an increased effort to make sure that the medical staff was involved more heavily in policy and more heavily in the general operation of the program. The Chief Medical Consultant was a fellow by the name of Bill Roemmich and he was a very high-profile doctor, very heavily involved in making policy. I would say in those days that the policy making function was much more dominated by physicians than it is today.
Q: So after five or six years at Central Office in DDO you went back to the Regional Office, is that right?
Ritter: Yes. In 1966 when they established HCFA or the Bureau of Health Insurance, there was a 1966 Reorganization. Because of the establishment of the Bureau of Health Insurance and the fact that disability program activities were accelerating with increased focus following the Harrison Subcommittee, they felt they had to get better broad- based program management of what was going on in the field and the way to do that was to have on-site managers. So what they did was reorganize and establish regional representatives for all of the programs in addition to the regional rep who was already there managing the day to day operations of the field offices.
We had a Regional Rep for disability, who at that time was Josiah A. Florenoy in Atlanta, who I used to work for here in Baltimore. There was a Regional Rep for the Bureau of Health Insurance and there was a Regional Representative for the Bureau of Retirement and Survivors Insurance. These three Regional Reps answered directly to their respective Bureau Directors who also answered direct to the Commissioner, Bob Ball.
When Joe Florenoy went out to Atlanta and set up his office they soon started advertising the need for Assistant Regional Representatives, grade GS-14 jobs. I was a grade GS-13 then in Headquarters. So I put in for the Assistant Regional Representative job in Atlanta. I was selected by Joe for that job and went back to Atlanta to work with him. I had already been promoted to a grade GS-15 in a new position that was essentially a deputy to him that was called a Senior ARR, Assistant Regional Representative. So when Joe retired in 1977 I was selected as the Regional Representative.
So from 1971 on I was the Regional Representative for Disability in the Atlanta Region. And that was essentially the Regional on-site management of the DDS operations. While you have certain obligations to the Regional Commissioner for Field Operations, who was Jim Murray, my immediate supervisor was the Bureau Director, Bernie Popick. We were the sole managers of what went on in the disability program in the field.
During that time the big thing that was happening that made the job more interesting was Black Lung. In 1969 the Black Lung legislation was passed which allowed benefits for pneumoconiosis. It had a heavy, heavy impact on only a small number of States. Pennsylvania, West Virginia, Virginia, Tennessee, Kentucky-- and I'm sure I'm leaving some out.
But anyway it was for coal miners, but these claims were high volume because there had been a lot of difficulties with coal miners being unemployed, unable to work. This law was a very generous law in terms of providing coal miners benefits under certain circumstances which fit a good many miners. The workloads were heavy and we had trouble managing them and there was a great deal of congressional pressure, but these workloads had to be managed at all cost. They were, in effect, the number-one disability priority.
My recollection is that for a period of two-and-a-half to three years the Division of Disability Operations even suspended all Continuing Disability Reviews (CDRs), in order to have enough staff in Central Office to handle the Black Lung caseload. I think that was one of the first times that the political pressure ever really came into play to influence how the Agency was managed. In other words, congressional pressure from a few congressman like Perkins in Kentucky literally set our priorities for us and even though these were cases in only a few States it became a national priority.
Most of the resources needed to process these cases were Central Office, because once the DDS gathered all the information the cases would come in to here for final processing, all the Black Lung cases. And you had to have two or three reads of each X-ray, it was very labor-intensive and required very special radiology training. It preoccupied the medical staffs time up here, it preoccupied our time in the field. It essentially took priority over everything in SSA until SSI came along.
Q: Would you characterize how well we implemented that? There is this general view of of SSA that we have over the years taken on a series of challenges, survivors benefits, disability benefits, etc. and did them all pretty successfully until we came to SSI, which we'll talk about next. Was that the case with Black Lung, or did we have some trouble administratively? How would you assess it?
Ritter: I would say we had trouble administratively, but the trouble was the sacrifices that had to be made in order to process the Black Lung cases.
I think the idea of having a Bureau Director get on the phone with you and say "John, this is the most important thing we've got, you've got to get these cases in Kentucky out, and that is your number-one priority." To have that clearly stated, was sort of a precedent.
I think that was the first time we ever had political pressure from a handful of congressmen to really start driving the Agency to do things that, to a large extent, were not necessarily their program priorities.
I think the fact the we suspended all CDRs during that length of time in order to process Black Lung, probably was the first step in getting us in the situation that we are today, which became worse in the 1980s. Once you backlogged your CDRs then we opened ourselves up to a whole lot of criticism which started about 1976 when GAO came along and said we were not doing all our CDRs. We did the same thing when SSI came along.
I think the reason people probably don't remember the Black Lung being as serious as it was is because it only directly affected a very small number of States and Headquarters. For the most part, for most of the States around the country and most of the Regional Offices, Black Lung was just invisible, it was just something that showed up in the papers. It was only those of us who had one or two heavy-workload Black Lung States that got the brunt of the pressure from Central Office to move the cases. The fact that Baltimore chose to have all these cases adjudicated in one place, in Headquarters, placed a heavy burden on Central Office that they weren't staffed for and that's why the CDRs were put on the back burner.
I would have to say up until that time, nationally, I think there was little controversy about the disability program in general. When SSI came along in 1973 and 1974, there were a lot of changes that took place. On paper I'm not sure whether SSA got much additional staff, but we essentially had to take on the SSI program with very, very little increase in resources, partly because they wanted to keep costs down, but also because there was a strong feeling that a lot of these cases would be duplicate cases. That we would have to be processing them as Title II cases anyway and so we really didn't know how to figure out the cost of the cases, but what happened there was, again we had the SSI workloads, we had just started doing CDRs again and the SSI workloads started backlogging.
We had two kinds of SSI workloads. We had the grand-fathered cases, the cases that we picked up from the States, that had to be processed and transferred over to the federal rolls. Then we had the regular new SSI cases. With all those workload pressures, once again, CDRs were given a low priority and very, very, very few CDRs, except those that were literally walk-ins, people who walked in and said "I'm recovered," or if we had some tangible evidence that a person had recovered, we'd do a CDR.
But you didn't have any routine CDR operation and that plus the earlier Black Lung inattention to CDRs is probably what started us on our problems in 1976 when GAO did their first review and started alluding to the fact that we weren't taking a look at the rolls. That there were people who probably weren't disabled, that we weren't doing much to get them off the rolls. That was followed by a 1979 report that really came down on us and said you guys aren't doing enough with the disability program. GAO had done a survey that indicated a significant percentage of the people that were on the rolls were no longer disabled. There was heavy criticism of the program. Congress got involved and that whole period of time, unfortunately, coincided with the Administration's new emphasis on Debt Management.
Q: Are we talking about the early 1980s?
Ritter: We've crept up to the 1980s now.
Q: Before we get to the eighties, let me just ask one other question about SSI. Did SSI impact you and your job in any particular way in Atlanta in the Regional Office?
Ritter: Yes. The one thing that happened that was different as a result of SSI was the fact that Headquarters formerly had done all case reviews, which you call quality assurance reviews. Prior to the SSI program, all DDS cases were reviewed in Baltimore, every one of them. There was not a sample review, every single case came up here, was reviewed by a Disability Examiner, and then payment was authorized by an Authorizer.
When SSI came along it was apparent to Central Office they not only couldn't handle that workload up here, they didn't really want that workload up here. So they established what was known as the Claims Review Sections. It was later called the Disability Adjudication Branch and now its the OPIR QA (Office of Program and Integrity Review Quality Assurance) Review out in the field for disability. The old Claims Review Section was established, I believe, in 1974. And that was established to perform a review of the SSI cases.
Q: Now, this is in the Regional Offices?
Ritter: In the Regional Offices. We hired something like sixty people. A significant number of them came from Headquarters. A fellow by the name of John McHugh came down from Baltimore to be the GS-13 supervisor. We hired a bunch of examiners from Baltimore. We also hired a lot of disability people from the DDSs. That was the first time, that I know of, that the Agency ever did any significant outside hiring of DDS people. We had hired a few in the past, but not on any kind of big scale. Just in Atlanta we hired something like 25 or 30 people from the DDSs in the Region. We brought them into Atlanta and formed this Claims Review Section, which did a sample review of all of the SSI cases. At that same time, Baltimore switched their review of title II DDS Decisions over to a sample review.
Q: Now, in terms of your career, you were in several different job titles in the Atlanta Regional Office during that roughly ten-year period, up until late 1980, all of which had to do with disability in one fashion or another?
Ritter: In one form or another. They had a reorganization in 1979 that restructured the ROs (Regional Offices) and there was a period of time there when all of the jobs weren't filled and there was indecision about how they were going to fill them. When everything was hashed out I was selected as the Assistant Regional Commissioner for Programs in Atlanta, which included not only disability, but also all other program activities in the Region, as well as the systems operation.
Q: So now we are up to the beginning of the 1980s. What was happening in the program at that point?
Ritter: Well, what happened in 1980 was, after the 1979 GAO report and the heavy, heavy criticism of SSA for not doing CDRs, we also were faced with a Presidential emphasis on debt collection. Initially, there was no real direct connection between the CDR activity and debt collection. Debt collection was a national emphasis of the White House on all federal agencies. It was not precipitated in any way by our little disability program and our CDRs. It was a national thing that came out because the Secretary and others were appalled at the amount of federal debt, student loans was one big area, where the federal government was not collecting the money it was owed.
So we had this debt collection initiative. It didn't take very long at all for SSA management to recognize that if we can find those people who weren't disabled we can go back and get them off the rolls and collect benefit overpayments from these people who should not have been paid to begin with and that can count in our debt collection. So the CDR process became a major, major piece of SSA debt collection activity.
I would have to say that if there is one period of time in the disability programs's history that was probably the worst time for us in the field. In those early '80s because the emphasis was so overwhelming on debt collection and CDRs, we were literally mandated and forced to do things that neither we nor the DDSs felt like we should be doing.
We had, just in the Atlanta region alone, many, many cases where an adjudicator would look at a case and find out that the person was put on maybe four, five, six years, up to fifteen years earlier and either through DDS error or because of a reversal at the ALJ level that this person really wasn't disabled. We had people that would be ceased and given denial cessation notices that would ask them to refund five, ten, fifteen years back payment. We had about a half a dozen people, just in the Atlanta Region alone, commit suicide. That got on the front pages.
I would have to really say, if there was a period in time when I don't think Headquarters listened to what was going on out in the field, it was during that time, because I was at meeting after meeting where we would be trying to point out that we were not doing the right thing, there's something wrong here. We shouldn't be holding peoples liable for our own errors, that far back. Even the DDSs had been protesting. And we had been passing their protests on. In fact, in violation in terms of our agreement with the States, twenty-three governors declared moratoriums on CDRs, and just said "we're not going to do them because they're wrong to do them this way."
Ultimately, it was all hashed by Congress, and we ended up with the provision in the law that we have today, that is, in its own way, unfortunate since the medical improvement standard they passed now says we can't cease anybody unless they improve. The only reason that provision was ever passed is because of our practice in those days of going back and deciding retrospectively that we didn't like some decision we made five or ten years before that. It was a rough time. I don't think the Agency has ever recovered from that. We had more court cases then, I think at one point in the mid-80s, 92% of all cases pending in district courts were disability cases.
Q: It was the Disability Benefits Reform Act of 1984 that put in that change in the law, right? That we're talking about the medical improvement standard and sort of at the end of this period of ferment about CDRs and what we were doing.
Ritter: We got back on the CDR track to the extent we could. Although, since then funding has been so limited that the Office of Disability has never gotten back on a full track of doing CDRs and even today we are doing far less CDRs then we should be doing. Again, today there is much, much congressional pressure on SSA to do more CDRs. But I would say the 80s were the worst time for this program. I think the Agency and its over- zealousness for debt collection did itself and the program damage during that period that we may never recover from.
Q: Now in your job as Assistant Regional Commissioner for Programs you said you had other responsibilities beyond disability. What were some of those other things you were doing during that period?
Ritter: We were having a lot of activity on expanding our systems operation. The Office of Systems was coming out with new processes to expand automation, the predecessors to the local area networks, and all that.
We had a lot of systems activity involving the SSI program. The SSI program is a heavily systems-driven program and there were a lot of SSI problems in the field and all of them involved systems inputs. I mean you couldn't do anything in SSI that didn't involve the system, and so our systems staff was probably half involved with SSI cases.
The RSI side of the office didn't give us too much trouble, although we had a few state and local problems. Those were largely resolved when they changed the law to cover most state and local employees. Prior to that time state and local coverage issues involving the States were the big workload on us.
We did have one that is still in the process of being resolved. When I was down there it was a hospital in Florida, Jackson Memorial Hospital, that had a big sick leave credit problem that we were in disagreement over and I think that is in the process of being resolved now. But aside from local events like that, the RSI program was pretty stable and not a major problem. Disability seemed to dominate the ARC Programs job also because the disability program with CDRs and with everything else seemed to be the driving workload in Regional Offices.
Q: So then toward the end of 1984 you came back to Headquarters again? How did that happen?
Ritter: I was pretty happy in Atlanta and I didn't plan on leaving. Although my wife is from Baltimore, I met her when I was up here the first time in 1966. I never really had any strong desire to come back to Baltimore, and neither did she. But on the other hand it wasn't something we wouldn't do. And I've always had an interest in boats and ships, and getting to Baltimore from time to time, visiting her folks, I always enjoyed it.
Nonetheless, I didn't have any plans to come back up here. But when Pat Owens took over the Office of Disability, Martha McSteen was the Acting Commissioner, Pat and Martha were not happy with the way the disability program had been managed before they came along and they were looking to make some changes. One of Martha's big emphases was on getting more people with field experience into Headquarters. She felt that Central Office people just did not understand what's going on out in the field. Of course, that's what all the Regional Commissioners thought.
As part of her efforts to get people to come into Headquarters she had Pat Owens call me one day to ask if I'd be interested in taking over the job of Director of the Division of Field Disability Operations, because the then director, David Smith, was planning on retirement, that was Dave Smith. I told Pat I really didn't want to, but I'd think it over and call her back. So I thought it over for the weekend, called on a Monday morning and told Pat, no, I didn't really want to do it, I was really happy down there and I didn't want to leave, it was a bad time to be selling a house in those days, and I just didn't want to leave. Two days later I had a call from Martha, who asked me if I would reconsider, and I told her no. And she said, well then I'm going to at least bring you up here on detail for a while. I said, what's a while? She said, nine or ten months. I said, do I have any choice? She says, well you have a choice about whether you come up here permanent or not, but I need someone up here and I want you up here. So I told her that I felt like if I was going to come up here for nine months I may as well move and I sort of accepted an offer I couldn't refuse. So that was how I ended up here in Baltimore.
Q: Is it correct to think that this dissatisfaction that you mentioned that the Acting Commissioner and Pat Owens had with the management of the disability program and this idea that we needed to go back to the field again and get field input, that both of those were in effect a reaction to what had gone on in the early 80s and all the controversy with the program. Do you see it as that or was it something else?
Ritter: No, I think that was it. One thing you have to remember too is that Martha, as well as the Regional Commissioner I worked for, Gordon Sherman, both considered, I think, themselves the ones who really know how to run our program. I can say without any fear of exaggeration that the regional people in Atlanta and Dallas and probably in most other ROs had a relatively low opinion of Central Office's responsiveness to their concerns, willingness to listen and willingness to address policy issues that the field felt were valid.
Before Martha came up here she had even established a Dallas Region policy council that was in collaboration with our Atlanta Regional Office, which is how I got to know Martha, where we would have joint meetings and get Central Office participants down there. Frankly, it was for the purpose of badgering and trying to bully them into being more responsive to policy concerns. I'm in agreement to a large extent with that view and still am to this day that I don't think that Central Office has ever been willing enough to admit existing problems in policy. It was always too easy to say "no other Regions have that problem," when in fact we might know that at least four other Regions had it. We would be told, "no, no there's something wrong down there, the instructions are adequate you guys don't need any additional policy guidance." There's a lot of reasons for that. The issues that were raised were not the kind of issues that were easy to resolve. So the easiest way out was to avoid them.
So Martha came up here with a strong level of discontent with the way the Office of Disability had been managed in terms of its responsiveness to her. And it wasn't just during that early '80s period. It went back a long ways that she always felt, and most of the Regions did, that whether it was Bernie Popick or Sam Crouch or Dick Kirchner, Rhoda (Davis), whoever was in the disability program, none of them really listened to the field. So Martha was going to change that.
Q: So you came to Baltimore to change that and participate in that. Did it change? What happened?
Ritter: Not a whole lot changed. We had a lot more interaction with the Regions and did have more active visits. Rhoda (Davis) had established a series of Disability Manager Forums for the DDS Administrators to come in and meet periodically and discuss issues with Headquarters. I think that these helped create an increased level of responsiveness to field needs with Martha and Pat, but I don't think it ever totally satisfied anyone.
We had adequate funds in those days to travel, to do training, to do comprehensive reviews, and I think those were the kinds of things that helped. I think that the image problems that Central Office has have almost always been, and are currently, due to the fact that we do not have enough contact with the DDSs. We don't do much training, but we should. We don't have a very extensive visit program to DDSs. We work through Regional Offices, which are short of funds. And I think that resource constraints have prevented a lot of interaction that might have been helpful. I think things improved, perhaps on the surface, but I don't know that there was any real change in Regional and Central Office and DDS relationships.
Q: So what was your particular job when you came here?
Ritter: It was the Director of Field Disability Operations (DFDO), which from Martha's standpoint, was the central focus in the Office of Disability for responsiveness to the field. Controlled their budget. Listened to their problems. Identified issues that needed to be resolved. And she relied heavily on DFDO to know what was going on. To be sure the poor performers were having corrective action plans submitted. That we were doing things to maintain a high level of accuracy.
The DFDO was very, very similar to the ARC Disability or the Regional Rep Disability job, except instead of being for a Region it was for the nation, and it put us in sort of a quasi-supervisory position over the Regional Office disability staffs, in that they got most of their direction and guidance from us.
Q: Now this was right after the disability reform legislation of 1984. Was that a big task to implement that and make the policy changes that were required? And were you involved in that?
Ritter: I was involved indirectly, however, it impacted mostly on the Division of Medical and Vocational Policy. The challenge was getting the regulation out and getting the cases moving. I was involved in it to the extent that I had responsibility for setting up the Continuing Disability Review Task Force, which was the group that was to formulate the plan for getting back into CDRs now that we had the 1984 amendments. And to come up with some kind of an implementation plan to project how many CDRs we could do. How would we get them processed? How would we categorize them?
Ted Girdner was the person we picked to be the day-to-day chief of that group. Except for resource problems, I think the group came up with a good plan for processing--the problem is we never quite got the money to actually process the cases that we had originally planned to process.
Q: We should mention that at some point prior to the 1984 legislation a moratorium was put in place on CDRs, and we stopped doing them altogether. Is that correct?
Ritter: That's correct. Right after the twenty-three state governors, that I mentioned earlier, stopped doing CDRs it didn't take but four or five months before Secretary Heckler decided that she couldn't live with being in a confrontational position with the States over a program activity that she and SSA were being heavily criticized for. So she also declared a moratorium, and said she was not going to do anymore CDRs until we get this thing resolved and ask Congress to come up with a legislative fix to it, which they did.
Q: So that by the time you were contemplating this plan to restart CDRs. . .
Ritter: This was to implement the restart of CDRs, using the new medical improvement standard and getting back on some kind of schedule.
Q: So at this point we've had a few years, two or three or more years of essentially we didn't do any CDRs and a backlog of unworked cases had been building. Is that correct?
Ritter: That's right. During the ill conceived and ill fated CDR Debt Collection debacle the biggest year I think we ever had in doing CDRs was in 1983 or '84 when we did between five and six hundred thousand. Then they dropped off to practically nothing, because the only ones we did after the moratorium were the ones that were obvious, usually, where someone came in and told me they went back to work, and were not disabled. We had a few of those cessations.
We used to have an average of about 300,000 CDRs that, under the normal rules, would have been done each year. So some portion of that 300,000 you'd think would have to be done, should be done. I can't give you a good estimate on the number or percentage at this point, but those were the cases that were backlogged. And I think we estimated at the time, that we were starting up after the 1984 amendments, that there was something like 600,000 CDRs backlogged, but some of them were CDRs that were really likely to recover, others, possibly.
So that's what this CDR Task Force was supposed to come up with, was a plan whereby we would decide how to prioritize the CDRs so that we could give the ones that had the highest likelihood of medical improvement the first priority in getting them off the rolls. So we came up with these three categories: medical improvement expected; medical improvement possible and the third category was medical improvement not expected.
Q: Am I correct, John, in believing that we never really recovered from this build-up of backlog that happened as a result of the moratorium, and that we still have a backlog until this day that we're struggling with?
Ritter: That's correct. And during the hearing the Agency had less than a month ago, one of Congressman Bunning's big pushes was CDRs.
The big issue on CDRs, of course, is program costs. The Disability (DI) Trust Fund has been under a lot of fire because the high program costs are depleting the Trust Fund to the point where they had to reallocate funds from the RSI (Retirement & Survivors Insurance) Trust Fund to the DI Trust Fund. Congress did this about a year ago. And program costs with the actuarial projections showing that the disability program could have been extinct by 1997, the Disability Trust Fund was very alarming to everybody.
The fact that we have people on the rolls that may not be disabled is also causing Congress a great deal of concern. No one knows how many there are, and no one knows how many we'll be able to take off with the medical improvement standard, because right now under that provision we can't take off an individual who is clearly not disabled unless they have improved, even if the original decision of allowance was clearly incorrect. So therefore, if you have some situations that arise when maybe an ALJ put someone on that the DDS didn't think was disabled, you've got to show the person improved over what the ALJ said before you can take the person off.
Q: Now John can you give us your assessment of what happened. It's pretty easy to understand during the moratorium how the backlog built up and why we couldn't work it down, but what about after your task force developed its plan?
Ritter: Resources, money. We couldn't get the money to do CDRs. Every year when the budget would come up the one item that was always cut out was CDRs. That was the first thing that had to give. Their priority was placed on processing people that walked in the door, new claims. For my part, I think CDRs should have always been given a higher priority. Through the decision making process between SSA, HHS (Department of Health & Human Services) and OMB (Office of Management & Budget), CDR funding was never provided in more than very modest amounts that would enable us to process cases that came directly to our attention. I can't give you a number, again, but the numbers were very, very small, the number of CDRs that were being processed.
Q: If I have your career highlights correct, early in 1987 you took a new position as Executive Program Policy Officer. What was that?
Ritter: When Dorcas Hardy came in she decided that the disability program was such a critical program, politically, that she felt that should be headed up by a person with good political instincts. Someone who could deal with the political realities, deal with congress. So she brought in Dave Rust, whom she had worked with in HHS and asked him to head it up.
When he came in he had very, very little knowledge of the disability program and he felt like he needed somebody in his front office that could work with him on a day-to-day basis on the program issues. He had just selected his deputy, who was Huldah Lieberman, and so he and Huldah got together and talked about who might be suitable for that, and they came up with me and asked me if I would come up there and work in that capacity. It sounded like a nice change. A job where maybe I might have some greater influence over some of the things that I thought were problem areas in the program.
It was exciting, for the first time in my career, to work directly for a political appointee. It was a very good experience working with Dave; he was a very interesting person. He was about as different as he could have been from my perspective of what I expected of a political appointee. He was very subtle in his political views and it was an interesting experience.
Q: So you were essentially a policy advisor, is that right?
Ritter: Yes. What it ended up was I reviewed all incoming and outgoing program correspondence to pick up things that needed to get more attention, to identify the things that should get to Dave's attention. To alert Dave and Huldah to things they should be aware of, especially if something came in that was more critical than it might appear on the surface. I got involved with Dave in a lot of interaction with congressional staffs. He took me with him to most congressional hearings, all congressional staff briefings, and it was not long before I was even doing some of them by myself. He relied very heavily on all of his staff and I worked with him very extensively on a day-to- day basis, especially on Congressional and Interagency matters.
Q: What were some of the policy issues that you were dealing with during this period?
Ritter: Some of it was getting various regulations out. We were trying to develop regulatory positions. On a pretty wide range of things. One of the things that Dave had to address was improving DDS performance, increasing productivity. Dorcas wanted administrative costs reduced and felt like the DDSs should be producing more cases and should be producing more consistent results in terms of QA (quality assurance). So we had a lot of program oversight that was aimed at getting more consistency among the DDSs.
Q: Toward the end of this period, in the early 1990s, you chaired two task forces that I wanted to ask you about. One was the Zebley Implementation Task Force and one was the Drug Addiction and Alcoholism Task Force. Can you tell us about those?
Ritter: Those were two of the most interesting assignments I had in my career. Lou Enoff was here during both of those periods of time and the first task force I got on was the Zebley Implementation Task Force.
What happened was a case involving a claimant named Brian Zebley had challenged our regulation on the basis that we were not applying the standard consistent with the definition of disability and the disability standard that was applied for adults, and that the congress intended children be allowed where they had a disability that was comparable to adults. What had happened with our childhood program is that since we didn't have a work history to deal with in children and we didn't have a vocational aspect of the disability to evaluate the decision when the SSI program first came along for disabled children--this is strictly an SSI benefit--the decision was made in 1974 to write up special medical listings and decide these cases on the basis of medical issues alone.
We had two or three courts over the years say that was fine, because children were different and since they didn't have a vocational history using special childhood listings was fine. But when it got to the Zebley case the Circuit Court decided that, no, that was wrong, this wasn't a comparable process. We were following a five-step sequential process for adults and we considered things like vocational skills, education and experience and that kind of stuff and we should have some process, not maybe the exact kinds of things to evaluate, but the Circuit Court said the process should be comparable to that in adults and we shouldn't be allowing or denying children solely on the basis of medical evidence alone.
The Agency took that case to the Supreme Court and we lost. The Supreme Court said, no, the plaintiffs in Zebley were correct. You do not have a comparable process and that you must have a process whereby you consider the non-disability factors that affect a child's day-to-day life just in a similar manner you consider an adult's ability to work. That more or less translated out into the age-appropriate activities that a child might engage in that in some way might be a comparable way of looking at an adult's activities.
So the decision in Zebley was one that for the first time actually struck down a national regulation, it was a nationwide class action, which meant we had to review every single case that had been denied where we could find a claimant and they responded to a notice back to 1980, according to the court order.
The potential workload was half a million cases. When the Commissioner realized that the impact of that decision meant that we had to reprocess 550,000 retroactive claims, and that we couldn't do that until we had written new regulations to implement the court decision, she and Deputy Commissioner Lou Enoff decided that this was a big enough and important enough task that it should be the focus of an intercomponent Commissioner's task force that would undertake the implementation of the Supreme Court decision in Zebley. I was asked if I would chair that task force. I agreed to do it and I sent a memo out to all the Deputies requesting a designated person from each SSA component that could in any way be involved in the Zebley implementation.
As I said, the Zebley implementation ranged from writing the regulation to actually processing the cases. So we started meeting on a weekly basis as a group and laid out what were things we had to do. And of course we all felt like we couldn't let a caseload of a half a million cases just sit waiting for a new regulation. So we went to OGC (Office of General Counsel) and asked them if we could develop some kind of interim standard that would enable us to process some of these cases that we felt sure, under the new ruling, would be allowances and that based on the Supreme Court ruling essentially we'd go back and look at some of these cases to see if we couldn't get some of them processed now, and that none would ever be denied until the new regulation came out.
So, concurrently with working up the new regulation--which we made a commitment to do in, I think it was like within twelve months, the Supreme Court decision was in February of 1990 and I believe that was one of the few times that the agencies ever got a regulation out when they said they would, I think we actually got that regulation published in February 1991--we were able to process 150,000 of the retroactive cases with this interim standard during that first year, while we were waiting to get the regulation published. Once we got the regulation published, of course, then we had to come up with a plan to process what still amounted to a half a million, because while we processed 150,000 old cases there were 150,000 new cases that came in during that time. So we still had about the same caseload.
One of the major problems we encountered in the Zebley implementation were the negotiations with plaintiff's counsel, because the implementation effort had to be reduced to a settlement agreement with Jonathan Stein, plaintiff's counsel in Philadelphia. And that probably took a great deal more of my time than the actual task force meeting did, because we were on the phone a lot with Jonathan trying to get his agreement as to what would be the various steps in the implementation: what information would he get?; how long would we have to take these various steps? All in all, I think we worked out a settlement agreement that we have been able to comply with, but it was a very, very difficult negotiation process with him.
There was also the fact that the workload processing itself took its toll on OD and other components, because these cases represented a largely unbudgeted caseload, at that time. We did go to congress to request additional funds, and here again I believe this is the only time we've ever succeeded in doing this, but because of the large volume of re-adjudications and the fact that this was a national Supreme Court decision. The task force developed a budget request that the Commissioner agreed to and went to Congress to get us $32 million extra to process these cases over a three- year period. That money was to cover not just DDS decision cost, but also field office costs, OHA costs, the whole works. And I think largely we were able to keep tabs on that workload and we ended up processing the cases pretty much on time in that three- year period.
One of the things that I did enjoy about the task force was that it was one of those things where the task force representatives that were selected by the Deputies were, in my opinion, their A-team, people who could and did make decisions and commitments on behalf of their Deputy, and I had no real trouble with haggling or negotiating with components. Everyone seemed to recognize the magnitude of the problem and it was a very smooth-working task force that I think was largely successful because it was one of those situations where it wasn't much question about the need to do what you had to do. I know a lot of task forces come along and there are questions like: why are we doing this?; is this really necessary? You didn't have any of that with the Zebley task force. Everything was cut and dried. We had a Supreme Court decision. It was a job that had to be done, and I probably saw the best overall team effort in that Zebley task force that I've ever seen in the Agency. And I think it's because everybody recognized their common goal and there was no question about it.
Q: Did we finish processing that Zebley workload, was that completed? And then would you talk a little bit about what has happened since then in the political arena, because now I believe there are discussions going on in Congress to go back and essentially undo the Zebley court decision by changing the rules. So could you talk a little bit about those two things?
Ritter: Sure. One of the things we did when the new childhood regulation was written was to, and I guess I would maybe try to resist the temptation to editorialize on the wisdom of what we did, but the decision was made by the Associate Commissioner Susan Parker at that time, to take this opportunity with the childhood regulation we were writing with Zebley to make other changes that she and others felt should be made. So the regulation really was used as a basis to rewrite of the whole disability process, with regard to children.
We called together a large group of childhood and pediatric experts from around the country and they met as sort of a group to help develop the best criteria for evaluating children. But the regulation probably went into much more detail and into many more specifics than was actually required by the Supreme Court decision.
One of the approaches we took that is giving us a little bit of trouble now is this individualized functional assessment. And here again, I don't know whether it was avoidable or not, it may not have been. But in coming up with the individualized assessment we have ended up with one category of childhood impairments, those in the behavioral area, which are giving us a lot of trouble because there has been a lot of allegations and indications that parents and children are faking these behavioral disorders in order to get benefits. And the press of course has picked this up to the extreme of even saying that all a child has to do is misbehave in school and be unmanageable and we'll pay them disability benefits. OD did some studies and reviews and did not find that to be the case.
Nonetheless, these allegations continue, and I think they're exacerbated by the fact that when we process ordinary disability cases we've always had an allowance rate of around 35 percent, traditionally. Sometimes it's gone up a little higher than that, but generally it hangs around a 35 percent allowance rate. Even before Zebley we were allowing 40 percent of the children. So the children were not being denied at a higher rate. The reason we were re-adjudicating the cases under Zebley wasn't because there was evidence that we actually had denied kids that should have been paid. It was because we weren't using the proper standard. But what happened when our new regulation went out, and here again it might have been some psychological affect on the DDSs and others, the allowance rate came up pretty high. It came out initially up in the 50-60 percent range, and a lot of that was due to the nature of the caseload. The fact that we had kids that were disabled, and when you have a heavy backlog of cases in large numbers and a significant portion of them are disabled, the allowance cases tend to be processed more quickly. And the denial cases, because they tend to require more development before you can finally deny them, take longer.
So we had a period of time there were this 50-60 percent allowance rate surged up. It was distorted by this delay in processing the more difficult denials; nonetheless, that alarmed a lot of people and focused more attention on us. So the combination of the apparent high allowance rate plus allegations by teachers and others who claimed we were paying kids who shouldn't get paid, has brought a lot of focus of attention on the disability program. The allowance rate finally came back down to somewhere around 45 percent on an ongoing basis, so it's not that far out of line with what it was before.
What has happened is that the volume of childhood claims being filed, as a result of the Zebley regulation, tripled. Whereas, we used to get about eighty or ninety thousand childhood claims each year, before the Zebley regulation, that workload has surged to close to 250,000, and it's maintained there. So the childhood workload has attracted more claimants. So, even though the allowance rate has dropped back down to where it was, when you look at the volume of cases, we are allowing a lot more childhood cases then we did before. I don't think we've ever figured out whether that's just the effect of publicity, whether these kids were already out there and weren't going in before, because the program wasn't that well publicized, we don't know.
However, we are faced with higher SSI program costs more because of the volume of childhood claims, than the allowance rate. So with all that program cost publicity about the allegations that we were paying kids based on these behavioral disorders that didn't exist or that were just faked, Congress has been threatening, if not actually proceeding, to change the provisions in the law with regard to SSI children. To tighten up on the regulations and bring the program cost down in that manner.
I guess I can't have any kind of judgement on that, because even though the allowance rate is reasonably low and fairly closely to what it was before Zebley, you do have this high volume of cases out there and the publicity on the cases has been alarming. You know, you wonder sometimes if some of this is true. I think the problem is that the Office of Disability got too deeply involved in mental cases, which started before Zebley, and mental psychiatric evaluation is probably the most subjective of all the disability areas. I know that even in terms of our own internal process we have our highest reversal rate at appeals levels on psychiatric cases, whether they are children or adults.
What has happened is that the SSI childhood workload probably increases dramatically as a result of the Zebley regulation by making people more aware of the fact that there were other impairments that hadn't been that well publicized before.
This entire area of mental impairment evaluation has always been the most difficult to deal with and we have never been able to write a good mental impairment regulation. It has been my view that the Agency used the Zebley Supreme court decision as an excuse or vehicle to, as one high level manager said, to "do the right thing for children". In doing so we went far beyond the mandate of the Supreme Court and made hasty program policy changes, in the name of the Supreme Court, that should have been set aside for far more careful and well thought out development.
One secondary factor in increasing the childhood workloads was certainly the public awareness created by the Zebley case. The continued public pressure from plaintiffs' counsel, combined with inconsistency between DDS adjudicator interpretation of SSA' vague policy the regulations and the SSA QA reviewers interpretation of what they viewed as SSA policy (they found incredibly high error rates in DDS allowances, not denials!) of the led adjudicator doubt to be resolved in favor of allowance in a great many instances where allowance was not intended.
Q: Let me just close the loop on that one question I asked earlier. We have completed the backlog?
Ritter: Essentially the backlog has been completed. I think we've got roughly 15,000 of the 550,000 cases that were in a stage of "cleanup" now. And what that means is we are having trouble matching up these last 15,000 records with what happened to them. During the whole Zebley process we lost control of a lot of cases that should of been Zebley cases that were allowed and paid through the regular process before they were identified as Zebley cases. So they may have been paid, but they didn't get tracked as Zebley cases. So we think that most of these 15,000 cases that we're dealing with now are cases that have been processed to completion and probably paid, but we're having trouble matching up the files.
Q: You mentioned one other thing that I wanted to ask about briefly and that's the mental impairment regulation. Isn't it the case that also during this same period of time we did a revision to the mental impairment regulation?
Ritter: We did one revision to the mental impairment regulation around 1985 or '86 and that has caused us a little problem in that a lot of the disability evaluation of mental impairments has been questioned in court. And as a consequence of some problems that we've had with some court decisions in mental cases, the adult mental listings are also being revised again. To my knowledge those have not got out yet.
Q: Is it the case that mental impairments as a portion of the disability workload have in recent years accounted for a large portion of the allowances, is that true or not?
Ritter: They certainly account for a higher proportion of cases then they used to. I think forty percent of all SSI cases are disability and something like sixty percent of all childhood SSI cases are mental. In the Title II workload the percentage of mental cases is lower. Right off hand I can't recall the allowance rate on the mental cases, but we do tend to have more mental impairment allowances. I know we certainly have allowances, they are the most frequently reversed at the appeals level.
Q: Do you see that trend of an increase in either applications or allowances, or whatever it is, to be a reflection of any changes we've done in regulations or do you think other things are happening that are driving that?
Ritter: I think the public awareness of mental disorders has caused a lot of people to file claims. We also have a lot of cases where a mental disorder is never alleged until an attorney represents the claimant at a hearing. Many mental impairments are never even alleged or identified until they're at the final administrative appeals level with the ALJ.
There has been an increased public awareness of mental impairments over the past ten years. More and more national focus has been on mental illness and more focus on dealing with mental illnesses, has probably brought more people in to us, because we have a disability program that recognizes mental illnesses. And, of course, every time we get a new regulation out the publicity around the new regulation brings more people in, and ever since we got the adult mental regulations out in 1986 or so, we've seen a significant increase in mental impairment allegations.
In addition it needs to be kept in mind that the expansive SSI outreach effort launched by Commissioner King played a major role in increasing SSI workloads (90% of SSI cases are disability cases). This was undertaken at the very same time that we were cutting DDS workloads and disability funding. Knowing the cases could not be processed within the funding levels being requested left serious questions as to what we were really doing to the agency and the disability program. It was as if there were two totally separate agencies; one administering their program without any regard to the capacity of the other to handles the caseload created. At that time we watched OSSI be praised for their great success at the same time the Agency was being condemned for it's inability to process the workloads.
Interestingly, while the Agency previously publicly praised itself for the very successful outreach effort when it was being undertaken, today, when Congress asks why did SSI workloads increase so much, the Agency tends to deny that outreach was any kind of a major factor.
Q: Now let's turn to the Drug Addiction and Alcohol (DA&A) Task Force that you mentioned earlier. Tell us about what that issue was and what your role was and what the task force's role was?
Ritter: The DA&A had been a long standing problem for the field and Headquarters in that when the disability provisions in the SSI program came along they included in mental impairments, drug addiction and alcoholism. And SSA's rules over the years have been a bit ambiguous about how disabled you have to be in order to be considered disabled as a result of a drug addiction or alcoholism disorder. And for many many years it was SSA policy that drug addiction and alcoholism were only disabling if the use of the drugs or alcohol had caused some other disability like severe liver disease or chronic brain syndrome, something like that. And we didn't pay individuals based purely on the basis of an addiction. A number of years ago there was a court case that challenged that. As a result, we revised our policy to recognize that, yes indeed, there were people who were so addicted, so out of control, so beyond control with their addiction that they were effectively disabled. And we revised our regulations to provide that where an individual had an impairment, that was alleged to be due to drug addiction or alcoholism, we could pay them on that basis even though they didn't have some other disability, if it could be shown that it was indeed disabling to the point where they couldn't work.
We had a provision in the law that stated that in an SSI case where drug addiction or alcoholism was involved that the individual had to have a representative payee and had to be participating in some kind a treatment program, or otherwise they wouldn't be paid. If you go back and look at the data up to about 1987 there were very, very few cases allowed on the basis of drug addiction or alcoholism. Even though all States were supposed to have a drug addiction and alcoholism monitoring agency that would oversee and manage the treatment program for drug addicts and alcoholics, there was no strong enforcement of that on the part of the Agency and as a consequence a lot of States didn't even have a program for treating these individuals and they were just paid benefits. They might have a representative payee if we knew they were a drug addict or an alcoholic, but as far as the treatment provision, that went largely ignored in many States where they didn't have adequate facilities to offer that kind of treatment and we didn't have a monitoring agency designated there.
Commissioner Gwendolyn King became concerned about the extent to which SSA could be criticized for not complying with the requirements of the law and for having so many people out there as drug addicts or alcoholic that we might be paying who should be in treatment. About that time, because of all the stress placed on mental impairments, here again I think this was probably triggered by the attention given to regulations that came out of 1986 that sort of clarified how we evaluate drug addiction and alcoholism, we saw an increasing number of drug addiction and alcoholism cases. And it appeared that the rate of growth in the number of drug addiction and alcoholism cases was growing at the rate of fifty to one hundred percent per year. I think in January of 1989 there were 23,000 DA&A cases on the rolls. By the end of that year I believe it was fifty some thousand and I believe by the end of 1992 it was about eighty.
Q: Now at this point we're only talking about SSI, right?
Ritter: Yes. Title II has not, until this recent legislation, been a big issue. When this dramatic increase started in 1989 or so, the Commissioner became concerned that we had to do something with the DA&A process and had to make sure we were getting people into treatment and that we weren't going to be faced with the same kind of criticism we were on the CDR process, where we had a statutory obligation to be doing something and we weren't doing it. And that we shouldn't be paying drug addicts and alcoholics if they could be rehabilitated, treated and put back on the labor market.
So, in a similar manner to the Zebley task force that Dorcas Hardy proposed, Gwendolyn King asked the Office of Disability to set up a task force on her behalf that would look at the ways we could expand the treatment potential for claimants and get these people in treatment on a national scale in all States. I was asked to chair that group. The main function of that workgroup was to develop a plan of action and implementation of that plan of action to try and establish treatment sources and monitoring facilities for DA&A addicts in all places in the country.
Because SSA is not a treatment agency, only evaluation of severity, I established contact with what was then called ADAMHA (Alcohol, Drug Abuse, and Mental Health Administration), which is the Public Health Services' component that handled drug addiction and mental disorders, now called SAMHSA (Substance Abuse and Mental Health Services Administration). We met with the head of the ADAMHA in Rockville (Maryland) and established an excellent working relationship with them and two or three key members of their staff joined our group to help develop a plan to try and come up with access to a treatment facility in all States.
ADAMHA already had treatment facilities in their block grant structure to deal with drug addiction and alcoholism disorders in all States throughout the country. And those are referred to in their vernacular as their drug addiction and alcoholism units. They were State Agency functions, but they were financed under block grants and under the block grants they would use those funds as they saw best within the State to meet the needs of alcoholics and drug addicts.
ADAMHA also had a number of other specialized activities that they were engaged in, using research grant money and special projects money they got from the federal government to their budget. They had a model cities program where they had several locations around the country, like Baltimore, where they were trying out special centralized facilities, special monitoring facilities, specialized treatment. They have all kinds of specialized treatment programs.
So what we were trying to do was see if there was some way we could piggyback on their effort and come up with national availability of treatment sources. They were very cooperative and helpful. They called together meetings of all their national, fifty some odd State, drug addiction and alcohol coordinators in the regions and we had two or three meetings with them over the period from 1989 to 1992. And we developed a Request for Proposals (RFP) that would solicit, around the country, monitoring agencies from all parts of the nation in every State. We worked closely with them on this advertisement, this RFP, which SAMHSA agreed to get out from their agency in an effort to try and recruit, not just their drug addiction and alcoholism people, but other agencies, private and public, to participate with SSA in providing treatment for the drug addiction and alcoholism claimants who were supposed to get treatment as part of their payment requirement.
We sent the advertisement out, and then about the time the responses started coming back in, SAMHSA reorganized, and my position changed, I moved over to the Litigation Staff and the drug addiction and alcoholism effort was transferred elsewhere in OD. They did a lot more work on it after I left. They had to do another RFP because they didn't get enough responses on the one SAMHSA set up. So SSA did a new proposal and budgeted for it, I think it was 1993, and I think now we do have a monitoring agency in every State.
So my role in the original DA&A Task Force really was just sort of a precursor to the current effort OD is undertaking. Our effort was an effort, to be honest, was to get ADAMHA to work with us in proposing a legislative change that would turn responsibility over to the Public Health Service for the monitoring and treatment oversight role of these drug addicts and alcoholics. We have never seen that, or at least I have never seen that, as a legitimate role for SSA. ADAMHA was receptive to this idea. At the time I was moved to the Litigation Staff SAMHSA had just come into being and there was a change in administration and we never really got back to the idea of whether or not SAMHSA, or the Public Health Service, should really be taking on this responsibility. I would hope that might come up again in future years.
I still maintain in my personal view that this is not a role SSA should be dealing with. We're not a treatment agency and I think we're not the proper or appropriate agency to do this. There is a structure within the Public Health Service that I think could and should address this, if it was made part of their responsibility by statute.
Q: You mentioned your last position at SSA, which you have been in for the past two-and-a-half years, is the Director of the Litigation Staff. Would your tell us a little about what that involves and what you've been doing for the past two-and-a-half years?
Ritter: Actually, the Litigation Staff job has probably been the most interesting in my career. It's a job that deals with always the unusual and the exceptions. It's always problems. The cases that have been appealed, lost or won in court. It's dealing with people, on a wide range of issues, who do not like what our program provides or what we have provided. It tends to focus on weaknesses in the program. And I think what I've enjoyed about the litigation staff job is that it does give you a different perspective on many of the provisions in the law and regulations we take for granted. While we read so easily what we claim our regulations mean it is interesting that when read by someone else and argued in court as to what they think the same words mean, we find out how persuasive their arguments can be from their perspective and see that in some of our own rules and regulations, that we think were eminently clear, that when argued from other perspectives turn out not to be so clear at all. And we also find that there is a wide variance in the extent to which the circuit courts and the district courts interpret our own writings consistently with the way we think they should be interpreted or were intended.
I think one of the most disturbing parts of being in the Litigation Staff has been, especially in recent years, the difficulty of trying to defend challenges to our process in court that focus on the high reversal rate in the Office of Hearings and Appeals, at the ALJ level. We are seeing an increased number of cases where claimants are challenging us almost purely on the basis that the DDS is obviously wrong because your own OHA ALJs are reversing their decisions 75 percent of the time. That's a hard argument to argue against because often the ALJs are reversing the cases based on the same evidence the DDS had before it.
I think this is an area I found very disturbing because the Agency has not been able to address this problem to find out why there is this difference and actually do something about it. The current reegineering effort is certainly focused on trying to do something about this. I think it remains yet to be seen how successful it will be and in fact how long it will take, because we've got a program that, in my mind, contradicts itself internally. We deny on the one hand and our quality assurance units say, hey these cases were fine. They're 95 percent accurate, and then they go on to an ALJ and they're reversed three- quarters of the time. I think that is a contradiction that is going to give us trouble more and more over the years, and I think we need to do something about it. Hopefully, the reengineering effort will address that.
I think the other thing about working in the Litigation Staff, that was interesting, is the much, much wider range of interaction that you have with people. Working with the Department of Justice and a wide range of attorneys, having lengthy six to eight hour conference calls on settlement issues. Participating in court hearings has been a very, very enlightening experience and I actually think that if more people who administer the SSA program could view litigation as closely as I have the past two- and-a-half years, it would be a good experience, in the care you have to take in writing policy.
One of the errors that SSA has made with great deliberateness over the years is a tendency to write difficult policy areas and leave abundant wriggle room for interpretation, when we're not quite sure what we want to say. And I think what I have seen is that wriggle room being used against us in court and it's hard to argue against. We have some cases were we have found ourselves using opposing arguments in different cases, where we've used one argument in one case and then used a different argument on that same issue for a different purpose in another case. And when you go back and look at the regulation or issue involved, it can be interpreted (either way). And I think one thing litigation should do for the Agency is make them more attentive to the precision and deliberateness with which we write our policies, so that there is less question about what we intended. Unfortunately, that is not what SSA has done.
I view the current reengineering effort underway in the Agency to be symptomatic of the Agency's inability to directly face the problems of the disability program head on, deal with them and manage the process. The Commissioner announced to the congress and the public that we were reengineering the disability process because it was "broken" and beyond repair in it's present form.
The disability process was not broken. The fact is that what was broken was not the program process in place but SSA's management attention to the program which allowed, even precipitated, fragmentation of authority and single purpose management decisions that were uncoordinated and incompatible. The ALJ outcomes at the OHA level have made clear how little SSA has done to manage the program. Agency decisions at the ALJ level that consistently reverse nearly 80% of the DDS decisions appealed to that level cannot, by any reasonable persons standards, be ignored because they clearly illustrate for all to see an inconsistent agency application of it's own policy and regulations. Yet, that is exactly what SSA does; the response is always a defensive and embarrassed denial saying that these are not reversals of DDS decisions; they are simply new decisions, etc, etc. The complete and utter absence of any meaningful impartial Agency program policy oversight or guidance aimed at consistent policy interpretation at both the DDS and the OHA levels (but, not under the control of OHA) is one of the most critical needs facing the Agency, yet, this area of need is all but ignored in the reengineering plan.
As for DDSs, the Agency's budgeted productivity per work year, for example, over the past five years has been raised from 210 to nearly 275 by 1995 and will be near 300 by 1997. Budgeted DDS funding for medical evidence is reduced each year allowing less and less evidence to be purchased. We do this at the same time we see ALJs complain of inadequate documentation and medical evidence and request the needed evidence from the same DDS who made the original decision. And, at the same time we are increasing productivity, reducing staffing and reducing medical evidence expenditures program policies and documentation requirements are not reevaluated or reassessed in any way to accommodate and facilitate this increased productivity and lower cost. In fact, the opposite took place with increasing documentation demands being placed on DDSs through both legislative and regulatory change. There should be no doubt that "more, more, cheaper, cheaper, and faster, faster" comes with a price tag that SSA has been unprepared to pay. As a consequence of this failure to support the needs of the program we now declare it broken beyond repair.
The current reengineering effort's intent was clearly laudable; streamline the program, make it more cost efficient, bring policy and procedural guidance to realistic and affordable levels, and bring the high variance between ALJ and DDS outcomes within a reasonable range. This effort, however, was essentially compromised at the outset by categorical judgement that the entire disability determination process at the DDS level (not the OHA level-that was skillfully avoided) was "broken", no portion was salvageable and all was beyond any repair.
As a consequence, this effort focused a shotgun pattern of remedies that in many cases project change to process that were not only not broken but did in fact work well. It is ludicrous to propose that 35 years of experience with the disability program by so many highly capable people produced no useful experience from which one could learn and improve. Yet, that is exactly what the reengineering plan did; it essentially said that all SSA managers who preceded the present management failed and that the program was so flawed that it was beyond repair. The reengineering plan now under way, premised on the declaration that all was broken, proceeds to try and change and revise all in it's path. A more coherent approach would have been to carefully evaluate exactly what the problem areas were, the reasons for their existence, and how they could be fixed. You cannot do that and totally ignore the OHA/ALJ process.
There are clearly some very good aspects of the reengineering plan and they do represent solid efforts to improve where improvement is needed. These, however, become obscured and lost in the vastness of the effort that is focussed on so many changes that have some cosmetic value but will change little and do not address the basic need to just simply take control, meet the real problems head on, and just plain manage the process.
Q: Last question if I may. Your career with SSA has lasted more than forty years. Give me your overall assessment or your reactions or anything you want to tell us about your career at SSA.
Ritter: I have enjoyed my work. I have always felt like if what you do for a living or what you're doing isn't fun, you probably ought to find something else to do because I can't imagine a more miserable situation. I know there are people who have this experience, but fortunately I haven't. If you're not happy in what you're doing, life can be a series of many years of long days. I can't say that has ever been a problem for me. I have always had fun in every job I've ever had. Some years have been more fun then others, but I can honestly say that every job I've ever had in SSA was enjoyable.
I tend to try to make what I do to be enjoyable. If I get bored I start looking around, stirring up things that maybe I shouldn't, but it keeps me busy and I think its been forty years that I've enjoyed. I can't think of any other job I could of had, right off hand, that I would have enjoyed any more.
I've especially enjoyed people. I've met a lot of really wonderful people over the years and I think right now SSA's going through a very, very hard time. I cannot deny that I think this probably isn't as good a time as any to leave. I would have to be honest and say right now SSA is going through the worst times I've ever seen it go through. And I'm not quite as optimistic about the future as I always have been in the past. I think things look a little more bleak down the road for a wide variety reasons. I know there are those on the ninth floor that wouldn't want me to say this publicly and I wouldn't, but even now as I look at the Social Security program, I have to look at it from the standpoint of my kids. And I have to admit that I'm not sure, it certainly isn't as good a deal as it was when I was young. And at the rate we're going, unless we do something to get better management, of both SSA and the program, the thought does cross my mind, is Social Security going to be a good investment for my kids.
I don't know. Its been a fun forty years. I wouldn't trade it for anything.