§7 Findings: Precedents (H7 steelman)

Date: 2026-08-11. Equal-effort steelman per M3 / protocol tilt audit. Adjudicates H7. Cross-cites §2 (front door), §3 (CDR vs prosecutions / anchor 10), §4 (Medicaid buy-ins), §6 (PRWORA child track). Does not re-litigate GBMT-11 care delivery (IMD/988).

Programs: SSDI front-door harshness is Title II/XVI adjudication shared. Precedents mix cash-program integrity (CDR, PRWORA), coverage separation (Medicaid buy-in), and foreign partial-disability systems with stated financing preconditions. VA rating is a partial-disability schedule precedent only (protocol §1.5).

Search log (PRISMA-lite)

1. H7 steelman — three pre-registered legs

H7 — STEELMAN, unfashionable direction: the system is harsh at the front door and the integrity panic is backwards. Initial allowance rates are low, many eventually-allowed claimants wait through hardship, CDRs already remove large numbers, and the fiscal risk that matters for SSDI is aging and earnings history — not street-level fraud.

(a) Initial allowance rates below 40%

FY2024 SSA ODSSI workload: initial allow 38% (deny 62%) on 2,086,885 decisions; SAOR national initial 38.3%. Hearing allow 51% on a much smaller, selected docket (289,492 hearings). Initial APT 231 days; hearing APT 342 days (above the 270-day goal) — §2 / Phase 0 anchors 2–3.

Leg (a): Met.

(b) Hearing allowances are eventual allowances of the same claim

Hearing-level dockets are appeals of prior denials (initial → reconsideration → ALJ), not independent first looks at new applications. Cohort and process syntheses treat “final allowance” as the outcome of appealing an initial denial: of those who appeal, a large majority of eventual awards land at hearing or above (NAP interim disability-decision process synthesis; Urban Institute FY2018 flow: of claimants who reach ALJ, ~63% allowed; ~80% of all ultimate awards still occur at DDS initial/reconsideration — hearing awards are the long-wait minority of the same claim).

Hearing allowance ≠ “new disability invented at ALJ.” It is selection through denial plus appeal of the same application, often after hundreds of days (§2). Fresh applications after abandoned appeals are a separate path and are not the hearing docket’s modal object.

Leg (b): Met (structural + published cohort/process evidence). If a future extract cannot separate same-claim appeal allowances from rare hearing-level new claims, report opacity — current public process description does not require that ambiguity to meet the protocol bar.

(c) CDR cessations dwarf fraud prosecutions (person counts)

From §3 / anchor 10 (directionally verified):

Even the narrow ~39k cessation figure exceeds CDI judicial actions by roughly two orders of magnitude. AFR text already separates medical CDR exits from “original determination incorrect” and from intentional fraud (§3).

Leg (c): Met (ordinal person-count; exact same-year paired CSV still polish).

Fiscal risk footnote (steelman, not a scored criterion)

Age-sex-adjusted DI incidence fell after 2010 (Trustees Fig. V.C3: 6.4 → 2.9–3.3); H1 attributes long-run growth to composition/insured status, not street fraud (§1). DI Trust Fund short-horizon panic is historically a vehicle for reform packages, not evidence that intentional fraud drives the actuarial balance.

2. Domestic precedents — what happened when this was tried

2.1 PRWORA-adjacent (adult + child)

Adult integrity adjacent: PRWORA ended SSI eligibility based on drug addiction or alcoholism as a primary impairment and tightened other screens — a definition/eligibility cut, not a fraud-rate discovery. Measured caseload effects ran through eligibility rules and CDR/redetermination administration, not through a new intentional-fraud series.

Child track (cross-cite §6): PRWORA replaced the individual functional assessment with a “marked and severe” child standard. Caseload moves since are driven by poverty, school evidence, and child CDR intensity (GAO-12-497; SSA SSB v84n4), not adult SGA/Ticket frames. Precedent lesson: harsh front- door / integrity statutes change who counts, and CDRs change who stays — neither validates an IP-percentage-as-fraud narrative (KC1).

2.2 CDR intensification episodes

Periodic full-medical-review and mailer CDRs are the standing integrity machine. When funded and staffed, they produce tens to hundreds of thousands of reviews and tens of thousands of cessations per year (§3). When under- funded (child CDR collapse FY2000→2011 per GAO), backlogs grow and later catch-up waves drive caseload declines (§6). Precedent lesson for architecture #6: CDR + wage reporting capacity beats prosecution theater on person-count and on AFR’s own construct boundaries. Cessation ≠ original fraud.

2.3 VA schedule-for-rating as partial-disability precedent

VA disability compensation uses the Veterans Affairs Schedule for Rating Disabilities — 0–100% in 10% increments, with partial payments that do not require inability to engage in SGA (CRS R41289; SSA EN-64-125). SSDI remains binary (disabled for SGA or not). Precedent value for architecture #7: the United States already operates a graduated schedule in a large federal disability cash program. Transferability caution (mandatory): VA is service-connected, rating-based, and work-compatible by design; SSDI is insured-status + SGA. Importing a schedule without rewriting the SGA cliff and Medicare/Medicaid link is not a drop-in reform.

2.4 State Medicaid buy-ins

BBA / Ticket-era Medicaid buy-ins separate health coverage from cash exit for workers with disabilities (national enrollment last comprehensively tallied ~193k in 2011 — stale; §4). Matched and pre/post evaluations (WA MBI; Mathematica MBI “three E’s”) associate buy-in participation with higher work or earnings vs conventional Medicaid — the coverage-separation channel that survived BOND’s null mean-earnings cash offset (§4). Precedent lesson: cliff-relevant wins have come from coverage continuity, not from fraud crackdowns or Ticket motivation alone.

3. International — cautionary and conditioned

3.1 UK ESA / PIP (cautionary)

UK migration from IB/ESA and DLA→PIP, plus Work Capability Assessment / reassessment waves, produced sustained tribunal overturns, claimant harm narratives, and repeated “not fit for purpose” process critiques (NAO/DWP reform record; ongoing PIP assessment reviews). Caution for US “get tougher screening” architectures (#9): reassessment intensity without adjudication capacity and without separating living-cost benefits from work tests recreates backlog, error, and political backlash — the opposite of H7’s measured claim that the US front door is already harsh and that CDRs already exit large numbers.

3.2 Netherlands / Nordic (financing preconditions stated)

Netherlands WIA: residual earnings-capacity rating with partial benefits; employers finance up to two years of sickness benefits and face experience-rated contributions for early years of partial DI (CBPP synthesis; SSA SSB v86n1 on Dutch determination methods). This is not a listings rewrite alone — it is an employer-financed rehabilitation-first regime.

Nordic family (Sweden/Norway/Denmark pattern in comparative DI literature): partial benefits + rehabilitation/activation norms typically sit on universal or employment-linked health coverage and active labor-market institutions. Transferability note for architecture #7: US SSDI lacks the employer-sickness mandate and the non-cliff health coverage stack those models presuppose. Score partial-disability ideas with those preconditions explicit, or demote them on O5/O4.

4. H7 adjudication

Protocol rule: supported if all three hold; refuted if two of three fail.

Verdict: SUPPORTED (strong steelman). Per KC4 re-rank path: whitepaper may lead with front-door harshness and demote fraud-first / definition-tightening architectures before full scoring waste — consistent with KC1 already firing on measurement.

Confidence: strong on (a) and (c); moderate-to-strong on (b) (process- structural + published cohort syntheses; not a new microdata extract this pass).

Implications

• Architecture #9 (definition tightening) enters demoted relative to #1/#2 (adjudication capacity / ALJ consistency) and #6 (CDR + wage reporting).
• Architecture #7 (partial disability) stays live only with VA/NL financing and coverage preconditions stated — not as fraud-substitute theater.
• H7 equal-effort obligation is discharged; tilt audit counterweight stands.