Improving the Social Security Disability Decision Process (2007) / Chapter Skim
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5 The Listing of Impairments -- Overview
5 The Listing of Impairments -- Overview
Pages 66-77
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From page 66... ...
In addition to efficiency, the Listings are intended to ensure that there is a medical basis for the disability and that all applicants receive equal treatment. As noted by SSA in a more recent regulatory notice from November 2001, Revised Medical Criteria for Determination of Disability, Musculoskeletal System and Related Criteria (66 FR 58010)
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From page 67... ...
Although a few listings (e.g., certain cancers, amyotrophic lateral sclerosis) are evaluated based on diagnosis alone, most require a diagnosis in conjunction with some sort of assessment of impairment severity, either by the presence of specific clinical findings or by some sort of assessment of functional outcomes.
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From page 68... ...
ORIGINS AND DEVELOPMENT OF THE LISTINGS SSA's first experience with implementation of a disability benefit program occurred well before the Disability Freeze program in 1954 or the Disability Insurance Benefits Program in 1956. It came with the Civilian War Benefit (CWB)
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From page 69... ...
Finally, the evi‑ dence must document one of four specific clinical findings (blood pressure read‑ ings) that indicate impairment severity, described in subsections A, B, C, and D
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From page 70... ...
Later, as SSA staff worked on procedures to process large numbers of disability applications throughout the late 1940s, they fixed on a process that involved classifying applicants into eight groups according to disability severity. The most severely impaired were assigned to Group I, and the least severely affected placed in Group VIII.
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From page 71... ...
. While it is recognized that some people with the scheduled disability will engage in substantial gainful activity, the severity should be pitched at a level where experience shows us the majority cannot.
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From page 72... ...
The first Listings were fairly brief. They were organized into 10 categories according to body system, similar to the Veterans Administration's 1945 Schedule for Rating Disabilities: • musculoskeletal system • special sense organs • respiratory system • cardiovascular system • digestive system • genito-urinary system • hemic and lymphatic system • skin • endocrine system • nervous system, including neurology and psychiatry Each section began with a general introduction, followed by the specific Listing criteria, which focused more on the clinical criteria for diagnoses than functional consequences (Cowles, 2005:9)
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From page 73... ...
As SSA noted in a November 2001 final regulation, Revised Medical Criteria for Determination of Disability, Musculoskeletal System and Related Criteria (responding to a public comment that claimed that SSA's proposed listing criteria were inconsistent with the Social Security Act, in 66 FR 58027) : The [Social Security]
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From page 74... ...
. By 1967, the Listings had expanded considerably and evolved from a relatively short set of criteria that relied primarily on diagnoses and "disease specifications" to a much more elaborate set of standards that relied on specific observations, "highly-specific criteria involving signs, symptoms and laboratory findings," and functional outcomes (Cowles, 2005:9, 12, 13)
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From page 75... ...
. One of the competing priorities in the mid-1990s was the agency's effort to fundamentally redesign the disability decision-making process through business process reengineering -- an initiative that became known as "disability redesign." One component of the disability redesign was a project to develop a new approach to making disability decisions to replace the existing sequential evaluation process (SSA, 1994)
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From page 76... ...
• Revised Medical Criteria for Evaluating Skin Disorders (69 FR 32260, June 9, 2004) • Revised Medical Criteria for Evaluating Hematological Disorders and Malignant Neoplastic Diseases (69 FR 67017, November 15, 2004)
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From page 77... ...
1974. Committee staff report on the Disability Insurance Program.
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