Advances in the Diagnosis and Evaluation of Disabling Physical Health Conditions (2023) / Chapter Skim
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1 Introduction
1 Introduction
Pages 13-30
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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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by reason of any medically determinable impairment or impairments -- physical, m ental, or combination -- that can be expected to result in death or which has lasted or can be 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.
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The specific steps in SSA's sequential evaluation process for adults are outlined below. A discussion focused on SSI disability assessment in children follows in a later section.
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At the second step, the disability examiner considers the medical severity and expected duration of the applicant's medically determinable physical or 1 20 CFR § 404.1520.
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. A medically determinable physical or mental impairment is an impairment that results from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques (SSA, 2022a)
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. A continuing disability review (CDR)
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. The Social Security Act requires that SSA perform a CDR at least once every 3 years for beneficiaries with an impairment in which medical improvement is possible and more frequently in cases where the medical condition is expected to improve sooner.
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FIGURE 1-2 SSA eight-step sequential continuing disability review evaluation process.
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Medical evidence may come from the individual's own medical sources, or in some cases, when additional information is needed, the disability examiner will arrange for a consultative examination from an independent source. SSA considers two categories of medical improvement to enable a careful consideration of all factors related to whether an adult continues to receive SSDI or SSI: • Medical improvement not related to ability to do work: Medi cal improvement is deemed to be not related to an individual's ability to work if there has been a decrease in the severity of the impairment(s)
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. Cumulative List of New or Improved Diagnostic or Evaluative Techniques The medical diagnostic or evaluative techniques SSA may use when assessing continuing disability are contained in POMS subchapter DI 33535.000, Cumulative List of New or Improved Diagnostic or Evaluative Techniques.5 The techniques, which have come into use since 1970, include cardiovascular, gastrointestinal, musculoskeletal, ophthalmology, otolaryngology, and psychological tests and miscellaneous tests applicable to several body systems.
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(i) : "An individual under the age of 18 shall be considered disabled for the purposes of this title if that individual has a medically determinable physical or mental impairment, which results in marked and severe functional limitations, and which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." An impairment results from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques.
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The process applies to both adults and children. As in the case of adults, the SSA uses the SSA Cumulative List of New or Improved Diagnostic or Evaluative Techniques in certain, limited situations in the disability evaluations of Title XVI children.
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In Chapter 2, the committee focuses on approaches for assessing functioning and elaborated on the environmental and social factors that influence clinical practice and patient care, including access to the latest diagnostic technologies.
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Consequently, the committee decided that the primary focus of this report should be on studies, health conditions, and techniques in the adult population and that, where applicable, it would highlight pertinent information 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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Functional Assessment for Adults with Disabilities (NASEM, 2019) is an in-depth, extensive review of the literature pertaining to the functional assessment of physical and mental health abilities relevant to work requirements.
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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. The committee conducted a review of the published scientific and medical literature pertaining to diagnostic and evaluative tests to assess physical health and function in general and, specifically, to the cardiovascular, neurological, respiratory, hematological, and digestive body systems.
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Importantly, while there is a lack of data regarding disparities in performance of diagnostic or evaluative techniques, the committee notes there is compelling evidence that there are disparities in access to new and improved diagnostic and evaluative techniques. ORGANIZATION OF THE REPORT Chapter 2 provides important contextual details about evidence-based models for assessing physical health conditions in the context of disability assessment.
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2022g. Understanding Supplemental Security Income continuing disability reviews -- 2022 edition.
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