Consensus Study Report

NATIONAL ACADEMIES PRESS 500 Fifth Street, NW, Washington, DC 20001

This activity was supported by contracts between the National Academy of Sciences and the U.S. Social Security Administration (Contract No. 28321318D00060015). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-70196-9
International Standard Book Number-10: 0-309-70196-1
Digital Object Identifier: https://doi.org/10.17226/26941

This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2023 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Advances in the diagnosis and evaluation of disabling physical health conditions. Washington, DC: The National Academies Press. https://doi.org/10.17226/26941.

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process, and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

Rapid Expert Consultations published by the National Academies of Sciences, Engineering, and Medicine are authored by subject-matter experts on narrowly focused topics that can be supported by a body of evidence. The discussions contained in rapid expert consultations are considered those of the authors and do not contain policy recommendations. Rapid expert consultations are reviewed by the institution before release.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

COMMITTEE ON IDENTIFYING NEW OR IMPROVED DIAGNOSTIC OR EVALUATIVE TECHNIQUES

JOSEPH A. BUCKWALTER (Chair), Professor and Steindler Chair, Department of Orthopedics and Rehabilitation, University of Iowa College of Medicine

ALINE CHARABATY, Assistant Clinical Director, Division of Gastroenterology, Johns Hopkins School of Medicine

MELISSA DAVIS, Assistant Professor and Vice Chair, Medical Informatics, Department of Radiology and Biomedical Imaging, Yale School of Medicine

AMY HOUTROW, Professor and Endowed Chair, Departments of Physical Medicine & Rehabilitation and Pediatrics, University of Pittsburgh

JILL DE JONG, Associate Professor, Hematology–Oncology and Stem Cell Transplant, Department of Pediatrics, The University of Chicago

SUZANNE GROAH, Director, Spinal Cord Injury Rehabilitation and Recovery Program, MedStar National Rehabilitation Hospital

JONATHAN S. LEWIN, Executive Vice President for Health Affairs, Emory University, Emeritus

ROGER J. LEWIS, Professor of Medicine, David Geffen School of Medicine, University of California, Los Angeles

KATHY SIETSEMA, Professor Emeritus of Clinical Medicine, David Geffen School of Medicine, University of California, Los Angeles

VIVIANY R. TAQUETI, Director, Cardiac Stress Laboratory, Brigham and Women’s Hospital, Harvard Medical School

KIM ALLAN WILLIAMS, Sr., Chair, Department of Medicine, University of Louisville School of Medicine

Study Staff

LAURA AIUPPA DENNING, Senior Program Officer

CAROLYN FULCO, Scholar (until September 2022)

BERNICE CHU, Program Officer (until August 2022)

BLAKE REICHMUTH, Associate Program Officer

JOSEPH GOODMAN, Senior Program Assistant

SHARYL NASS, Director, Board on Health Care Services

Consultant to the Committee

NANETTE WENGER, Professor of Medicine, Department of Cardiology, Emory University School of Medicine

Consulting Writers

ROBERT POOL

MEGAN SNAIR

Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its

release. The review of this report was overseen by ROBERT B. WALLACE, The University of Iowa, and DAN G. BLAZER, Duke University Medical Center. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Contents

BOXES, FIGURES, AND TABLES

ACRONYMS AND ABBREVIATIONS

SUMMARY

1 INTRODUCTION

Social Security Administration Disability Determination

Models of Disability

Study Approach

Organization of the Report

References

2 DIAGNOSIS, EVALUATION, AND DISABILITY

Diagnosing Health Conditions

Assessing Functional Status

Considerations in the Use of Diagnostic and Evaluative Tests to Assess Children

References

3 OVERVIEW OF SELECTED TECHNIQUES FOR DIAGNOSING AND EVALUATING PATIENTS

Laboratory-Based Diagnostic Medicine

Medical Imaging

Digital Diagnostic Technologies

Functional Assessments

References

4 TECHNIQUES FOR CARDIOVASULAR SYSTEM DISORDERS

Overview of Selected Techniques

Imaging Techniques

Intravascular Hemodynamic Assessment

Electrophysiologic Testing

Emerging Diagnostic Techniques

References

5 TECHNIQUES FOR NEUROLOGICAL DISORDERS

Overview of Selected Techniques

Selected Diagnostic Techniques for Neurologic Disorders

Selected Functional Assessments for Neurologic Disorders

Emerging Diagnostic and Evaluative Techniques

References

6 TECHNIQUES FOR RESPIRATORY DISORDERS

Overview of Selected Techniques

Selected Respiratory Diagnostics for Assessment of Anatomical or Physiologic Function

Indirect or Potential Relevance to Physical Function

Emerging Diagnostic and Evaluative Techniques

References

7 TECHNIQUES FOR HEMATOLOGICAL DISORDERS

Overview of Selected Techniques

Selected Diagnostic Techniques for Hematologic Disorders

Emerging Diagnostic Techniques

References

8 TECHNIQUES FOR DIGESTIVE SYSTEM DISORDERS

Overview of Selected Techniques

Selected Diagnostic Techniques for Digestive Disorders

Selected Evaluative Techniques for Digestive Disorders

Emerging Diagnostic and Evaluative Techniques

References

9 FINDINGS AND CONCLUSIONS

Overall Conclusions

References

APPENDIXES

A Examples of Functional Criteria in the Social Security Administration’s Adult Listing of Impairments

B Selected Functional Assessments for Debilitating Neurologic Conditions

C Biographical Sketches of Committee Members

This page intentionally left blank.

Boxes, Figures, and Tables

BOXES

S-1 Statement of Task

1-1 Statement of Task

1-2 Social Security Administration Listings of Impairments for the Five Body Systems in the Report

4-1 Select New or Improved Diagnostic and Evaluative Techniques in Cardiovascular Disease Since 1990

5-1 Select New or Improved Diagnostic and Evaluative Techniques in Neurologic Disease Since 1990

6-1 Selected New or Improved Respiratory Techniques Since 1990

7-1 Select New or Improved Hematologic Techniques Since 1990

8-1 Select New or Improved Gastroenterological Techniques Since 1990

FIGURES

1-1 SSA five-step sequential disability evaluation process

1-2 SSA eight-step sequential continuing disability review evaluation process

1-3 International Classification of Functioning, Disability, and Health Framework

8-1 The digestive system components

TABLES

2-1 Physical Development Milestones that Most Children (≥75%) are Expected to Achieve, for Ages 1 to 5 Years

5-1 Uses of Magnetic Resonance Imaging in Neurological Diagnoses

6-1 Typical CPET Findings in Uncomplicated Respiratory Disease

6-2 Modified Medical Research Council Breathlessness Scale

8-1 Examples of Prognostic Scoring Systems for Liver Disease

8-2 Examples of Patient-Reported Outcomes and Clinical Scales for Digestive Disorders

Acronyms and Abbreviations