literature to determine the latest standards of care, the latest technology for the understanding of disease processes, and the latest science demonstrating the effect of cardiovascular disorders on patients’ health and functional capacity” and “to make concrete recommendations that are designed to improve the utility of the cardiovascular listings for evaluating cardiovascular disability claims by improving the sensitivity and specificity of the listing criteria to identify individuals who meet SSA’s definition of disability” (see Box 1-1 in Chapter 1 for relevant excerpts from the contractual statement of work).

The IOM formed a committee of cardiovascular experts (see Appendix A for their biographies). The committee met four times in plenary session. Much of the work was performed by groups of committee members assigned to address specific cardiovascular conditions. Committee members heard presentations and received position statements from clinical experts and advocacy groups and considered their comments. They reviewed the relevant scientific literature, based their recommendations on existing evidence, and drew on the clinical practice guidelines of the American College of Cardiology (ACC) and American Heart Association (AHA). The body of this report contains the committee’s consensus conclusions and recommendations concerning the cardiovascular system listings (Chapters 5 through 14). A description of the literature search methodology and an analysis of the ACC/AHA guidelines are found in Appendixes B and C, respectively.

SOCIAL SECURITY DISABILITY

The Social Security Act defines disability as “the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) 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.” Under the Supplemental Security Income (SSI) program, a child is “considered disabled if he or she has a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months.”

The SSA disability standard is not based on a diagnosis or on degree of anatomical impairment alone. Rather, it focuses on the functional limitations imposed by one or more impairments and how they affect an individual’s capacity to work given the limitations caused by the medical impairment or impairments and his or her age, education, and work history, or in the case of children, how the impairment or impairments limit age-appropriate activities at home, at school, and in the community. Deciding if someone meets the SSA disability standard by considering these factors



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