Advances in the Diagnosis and Evaluation of Disabling Physical Health Conditions (2023) / Chapter Skim
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Pages 1-12
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assemble a committee to review new or improved diagnostic or evaluative techniques for assessing physically disabling impairments. SSA is interested in information about diagnostic or evaluative techniques that have become generally available within the last 30 years for assessing physical conditions in five body systems -- cardiovascular, neurological, respiratory, hematological, and digestive.
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Identify and describe new or improved diagnostic or evaluative techniques for assessing physical disabling impairments in the Cardiovascular, Neurological, Respiratory, Hematological, and Digestive body systems, including primary headache disorders, which have become generally available within the last 30 years. The term "generally available," for these purposes, is defined as being qualified for reimbursement under Medicaid or accessible to a majority of qualified health care providers in the United States.
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expected to last for a continuous period of not less than 12 months." SSA considers a medically determinable physical or mental impairment to be an impairment that results from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques. Under Title XVI, a child is considered disabled if the child has a medically determinable physical or mental impairment(s)
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is a primary source of information used by SSA to process claims for Social Security benefits. Sections DI 28020.001 and DI 28020.250 of the POMS provide for the use of the Cumulative List of New or Improved Diagnostic or Evaluative Techniques, which lists the techniques SSA may consider in some circumstances when reevaluating an individual for disability insurance during the CDR process.
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Consequently, the committee decided that the primary focus of this report would be on studies, health conditions, and techniques in the adult population but that it would, where applicable, highlight pertinent informa tion about children. As directed by the Statement of Task, the committee focused on physical impairments but notes that individuals with disabling impairments often have multiple comorbidities, including mental health conditions, that influence and interact with physical health and functioning and thus may affect the approach to assessment.
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Given the broad scope of the task, the techniques selected may not represent an exhaustive review of all possible techniques available in the five health fields, and, depending on the available literature, they address each criterion to varying degrees. Chapters 1 and 2 of the report provide important contextual details about SSA disability evaluation and evidence-based models for assessing physical health conditions in the context of disability assessment.
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Objective data on physical capacity are often measured by exercise-based performance tests, such as routine cardiac stress testing, cardiopulmonary exercise testing, and the 6-minute walk test. Measures of physical capacity use standardized protocols and have participants conduct activities in a controlled setting.
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Notably, literature searches conducted for the study revealed few research studies examining factors in test validity that are related to race, ethnicity, or other population characteristics. While there is a lack of data in this regard, there is ample compelling evidence that there are disparities in access to new and improved diagnostic and evaluative techniques.
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In the context of continuing disability review, new or improved diagnostic tests will often yield little or no information on the functional consequences of previously identified health conditions.
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Results from functional testing are important in disability determinations because there is not always a strong correlation between diagnosis and an individual's functional limitations. Furthermore, rarely is a single evaluative test adequate to determine whether a person can or cannot perform substantial gainful activity.
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The use of patient-reported measures in functional assessments can provide an enhanced understanding of the effects of disease on health, functioning, and quality of life, and thus these are important tools in monitoring disease progression across a wide spectrum of diseases. There are hundreds of validated patient-reported measures relating to nearly all body regions and conditions that are used clinically to assess a range of functional outcomes, such as return to work, physical function, cognitive function, emotional function, support network, and social supports.
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Frequent updates to SSA program guidance performed in a timely manner would help ensure that the disability evaluation process consistently reflects the best current practice in clinical diagnosis and in the evaluation of disability. REFERENCES NASEM (National Academies of Sciences, Engineering, and Medicine)
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