with data that SSA already produces routinely or could obtain from a sample of case files.

One important lack of information the committee faced consistently was the dearth of data on the relationship between severity of anatomical impairment or other markers in the medical record with the likelihood that a claimant with those characteristics are allowed, first at Step 3, then at Step 5. SSA itself has programmatic data that could be used to address this question. For example, a sample of Step 5 allowances for a specific impairment could be analyzed retrospectively to see if there is a common feature in the medical record. If so, that feature could be made a listing-level criterion and thus allow these claimants more quickly. Currently, for example, an ejection fraction of 30 percent or less with certain symptoms or signs or very serious limitations on activities of daily living meets the heart failure listing, and an ankle-brachial index (ABI) less than 0.50 meets the peripheral artery disease (PAD) listing. An analysis of claims process data could find that functionally limited claimants with heart failure with an ejection fraction of 35 percent are nearly always allowed at Step 5, or that claimants with PAD with an ABI of 0.55 are invariably allowed at Step 5, and the listings could be revised accordingly. Similar analyses could be done of allowances that equal a listing; for example, if the rate of allowances equaling the listing for a particular impairment was increasing unexpectedly, the research might find that the medical community has adopted a new test to diagnose or determine the severity of the condition, and that test could be added to the listing so claimants could more easily and reliably be allowed at Step 3.

Another critical area where research is needed is on the effects of comorbidities that claimants with a cardiovascular impairment often have. Again, SSA has data that can be analyzed to illuminate the impact of these effects. A research project along these lines was suggested in the conclusion of Chapter 15. The project would track the percentage of claims of heart failure with a diagnosis of major depression and various ejection fraction cutoff points, for example, 35 and 40 percent, that are allowed at Step 5. If the rate is very high for any of these cutoff points, that is, 95 percent or higher, SSA could create a listing criterion for major depression in combination with that specific ejection fraction value.

SSA could also pretest the impact of a proposed change in a listing by prospectively comparing a sample of claims while going through the regular process. The committee was pleased to learn that since the release of the 2007 Institute of Medicine report on improving the Social Security disability decision process (IOM, 2007), SSA has engaged a National Institutes of Health group in conducting such analyses of disability program data. Analyses of the use of the Listings are being done within SSA’s Office of Disability Programs.

Another area of interest would be to study the degree of variability among examiners, or interrater reliability, in applying the Listings, which



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