Skip to main content

Currently Skimming:

Summary
Pages 1-12

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 1...
... . First, SSA asked IOM to recommend ways to improve the use of medical expertise in the disability determination process, including how medical expertise can best be provided to support case adjudication by the 54 Disability Determination Services (the state agencies that make the initial disability determinations for SSA, called DDSs)
From page 2...
... , which are used to screen applicants for quick approval of disability benefits. Specifically, SSA asked IOM to reexamine the conceptual basis of the Listings, consider alternative conceptual models, improve consistency in their application by program decision makers, and recommend a system for keeping the Listings current over time.
From page 3...
... The Listings describe impairments that SSA considers severe enough to prevent an individual from doing "any gainful activity."2 The "any gainful activity" standard is a stricter standard, i.e., a higher degree of impairment severity, than the "any substantial gainful activity" standard in the statutory definition of Social Security disability. The Listings serve as a screening tool to expedite the identification of individuals who clearly meet the definition of disability in the Social Security Act.
From page 4...
... However, even if the evidence does not show that an individual meets the exact requirements of a particular listing, the individual can still be found disabled at step 3 of the sequence if his or her impairment is equal in severity to the requirements of a listing, referred to as "medical equivalence." By identifying a portion of the allowance cases early in the process, the Listings reduce case-processing time. Reduction of case-processing time is one of SSA's key goals for improved customer service, and concerns with claim-processing time also have been an important factor in a recent major SSA initiative to revise the disability program's administrative review process.
From page 5...
... FINDINGS AND RECOMMENDATIONS Value and Utility of the Current Listings The committee believes that using the Listings as an administrative screening tool to identify and quickly allow obviously disabled applicants provides significant value and utility to a variety of different constituencies, including claimants, DDSs and SSA, and the general public. The committee could find no compelling reason for SSA to abandon the Listings process.
From page 6...
... One alternative to a body-system-based list of diagnoses and impairments would be to develop and apply a generic functional evaluation that does not attempt to assess the severity of impairment but goes directly to the functional capacities of claimants to engage in substantial gainful activity. However, the opinion of the committee is that a generic functional screening tool equal to the complexity of disability does not exist at this time.
From page 7...
... These include changes in disease patterns, advances in scientific knowledge and medical practice, advances in assistive technologies, and changes in the workplace affecting workers in terms of job requirements and potential sources of injury. The Office of Medical Policy, the staff component within SSA that is responsible for maintaining the Listings, is small and does not have experts in all the major specialties (although it can draw on the advice of specialists in the federal DDS)
From page 8...
... was implemented. However, SSA's disability programs would benefit from external advice of clinical and other experts on disability determination criteria and procedures, and the involvement of external advisory groups would also serve to increase the understanding and acceptance of SSA disability determination requirements in the medical community.
From page 9...
... Evaluating Multiple Impairments Finding a combination of impairments equal in severity to a listed impairment justifies an allowance at step 3. Evaluating equivalence to a listing requires a medical assessment of whether the findings related to an individual's impairments are "at least of equal medical significance to those of a listed impairment." In practice, determining whether multiple impairments combine to equal listing-level severity medically is very difficult and quite subjective.
From page 10...
... , which can be easily and quickly applied, to more subjective, ill-defined, person-level, functional criteria, which are difficult and time consuming to apply. The earlier listings criteria were no doubt more clinical, shorter, and easier to apply, but there is no evidence that these earlier versions of the Listings were more accurate as a screening tool than more recent versions.
From page 11...
... This might be done by supplementing existing surveys. The results would be useful for program planning and for evaluating the effectiveness of the Listings and other aspects of the disability decision process.


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.