Summary: In response to a congressional request, GAO reviewed disability decisions being made by the Railroad Retirement Board and compared the criteria it used with the criteria prescribed by the Social Security Administration (SSA). GAO also reviewed specific cases to test the Board's compliance with established policies and procedures. In 1981, the Board paid $400 million in disability benefits to 59,000 disabled former rail workers and their survivors. Approximately half of the new disability awards made in 1981 were for permanent and total disabilities. The Board approves about twice the number of permanent and total disability claims that SSA approves, and it approves a higher percentage of cases initially denied but subsequently appealed. Social Security trust funds underwrite about 45 percent of the Board's disability benefits costs, and the Board's disability awards impact on Medicare funds. The Board uses the SSA medical criteria to define a permanent and total disability. Examiners reviewed 96 selected cases to determine whether the Board's decisions were made in accordance with SSA criteria. The review showed that: 16 beneficiaries lacked severe impairment or otherwise should not have qualified for a disability benefit, 35 cases had insufficient evidence to support the disability award, and 45 cases were properly documented and awarded. The estimated payments on projected questionable cases could be $12 million for the year with additional Medicare costs totaling $3 million. The examiners found that two thirds of a sample of cases in which the Board denied benefits lacked sufficient evidence to support the denial decision. Unlike SSA, the Board does not have a requirement to reexamine totally disabled beneficiaries every three years to ensure that the continuation of the disability benefit is justified. Eight of the 96 cases reviewed should have been scheduled for reexamination, but were not. The Board also does not have a formal quality control system for its disability cases as SSA does. SSA does not have any quality control system for reviewing the Board's disability cases, but reviews cases where it is possible that the beneficiary and the survivors will be eligible for benefits under both disability programs.
