Functional Assessment for Adults with Disabilities (2019) / Chapter Skim
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2 Disability and Function
2 Disability and Function
Pages 21-44
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From page 21... ...
definition of disability and consideration of function within its disability determination process. The latter discussion includes a summary of SSA's collection and use of occupational information that sets the stage for identification of the physical and mental "functional abilities relevant to work requirements" the committee was asked to consider in its Statement of Task.
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As shown in the middle tier of the figure, functioning and disability consist of an interplay among body functions and structures at the organ level, activities at the person level, and participation at the societal level. The bottom tier of the figure depicts the contextual factors (environmental and personal)
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SOCIAL SECURITY ADMINISTRATION'S CONSIDERATION OF FUNCTION As stated in Chapter 1, SSA's definition of disability in adults is "inability to engage in any substantial gainful activity [SGA] by reason of any medically determinable physical or mental impairment 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."1 SGA is work activity that "involves doing significant and productive physical or mental duties" or activities that are "done (or intended)
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. SSA uses a five-step evaluation process in determining whether an adult meets the definition of disability.3 • In the first step, SSA considers applicants' work activity in the past year.
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collects functional information related to the number of hours an employee 6 "Past relevant work" refers to "work that you have done within the past 15 years, that was substantial gainful activity, and that lasted long enough for you to learn to do it" (20 CFR 404.1560)
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The form includes the criteria in the mental disorders listings, and is used to record the presence or absence of the listing criteria and the rating of the degree of functional limitation.11 Two other forms address physical and mental RFC and are described in the following section. Residual Functional Capacity An RFC assessment • is based primarily on medical evidence but may also include ob servation or description of limitations (e.g., lay evidence, including the claimant's statement)
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c. Resolves all issues of functional capacity pertinent to a determina tion of ability to do past relevant work or other work.
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Each mental activity is rated as "no evidence of limitation," "not significantly limited," "moderately limited," "markedly limited," or "not ratable on available evidence." The form also contains a section for the PC to elaborate on the summary conclusions in narrative form, including any clarifying information and explanations of any conclusions that "differ from those of treating medical sources or from the individual's allegations." Occupational Information In addition to RFC, SSA must consider occupational information at steps 4 and 5 of the sequential evaluation process. As described previously, SSA must determine whether individuals' RFC allows them to perform past relevant work at step 4 or, along with such vocational factors as age, education, and work experience, including transferrable skills, allows them to adjust to any other work in the national economy at step 5.
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includes providing information about the assessment of physical and mental "functional abilities relevant to work requirements." The Statement of Task specifically mentions functional abilities relevant to work requirements "as 13 Sources of data include the U.S. Bureau of Labor Statistics (BLS)
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." Occupational Requirements Survey (ORS) Data Elements The data elements on physical and cognitive15 demands in the ORS make up the "functional abilities relevant to work requirements as defined by the … ORS" referred to in the committee's Statement of Task.16 BLS defines "job demands" as "the knowledge, cognitive abilities, and physical actions required to perform critical tasks, as well as environmental conditions experienced while completing critical job tasks" (DOL, 2018, p.
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NET is an additional source of data for the OIS, the abilities captured in O* NET, as well as the data elements captured by the ORS, are relevant to the committee's consideration of "functional abilities relevant to work requirements as defined … for the OIS." O*
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Similarly, assessment of individuals' functional abilities with respect to adaptability and work-related personal interactions is more complex than assessment of whether and how long an individual can sit, stand, or walk. The less direct the correlation between assessment measures for physical and mental functional abilities and the work requirements captured by the ORS for the OIS, the greater will be the challenge for cross-walking between the functional assessment of individuals' abilities and the demands of jobs.
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SSA is interested in an individual's ability to perform sustained workrelated physical and mental activities in a work setting on a "regular and continuing basis," meaning 8 hours per day, 5 days per week, or an equivalent work schedule (SSA, 2018g) .20 As a result, information from functional assessments needs to be considered within the context of completing a job.
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As previously discussed, the major components of the ICF model include health conditions, body function and structure, and activities and participation. Within the context of the committee's charge, the specific health conditions include back disorders, cardiac impairments, and depression, to which the committee added traumatic brain injury (see Chapter 7)
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. In turn, participating in work and being able to hold a job refer to an individual's ability to perform sustained work-related physical and mental activities in a work setting on a "regular and continuing basis" (8 hours/day, 5 days/week [SSA, 2018g]
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Other examples include medications or fluctuations in a condition that prevent or limit the ability to perform sustained work activities and tasks. Another way to think about interrupters is that the health condition and the demands of its treatment conflict with the demands of TABLE 2-1 Terms from the Committee's Conceptual Framework Cross-Linked with Terms and Concepts of the Social Security Administration and the Occupational Requirements Survey Conceptual Social Security Occupational Framework Administration Requirements Survey Health condition; body Listing of Impairments -- function and structure Activities Listing of Impairments Physical and cognitive (activity limitations)
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. Modifications to community and work environments permit work participation by many individuals who otherwise would be unable to do so (NASEM, 2017)
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In addition, several of the cognitive elements, such as pace, adaptability, and personal interactions, also relate to the meta-tasking components of work. The ORS Collection Manual describes classifying jobs according to O*
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2-8. The committee's conceptual framework includes "interrupters," fac tors associated with an individual's health condition and its treat ment that limit the ability to perform sustained work activities on a regular and continuing basis.
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In keeping with current models of disability, assessment of individu als' functional abilities relevant to work requirements is an impor tant part of determining whether they are able to meet workplace demands and sustain work performance on a regular and continuing basis.
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2004. Physical residual functional capacity as sessment form SSA-4734-BK.
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n.d. Mental residual functional capacity assessment form SSA-4734-F4-SUP.
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DISABILITY AND FUNCTION 43 ANNEX TABLE 2-1 Examples of Functional Criteria in the Social Security Administration's Adult Listing of Impairments Listing Examples of Functional Criteria 1.00 Musculoskeletal System • inability to ambulate effectively" " • inability to perform fine or gross movements " effectively" 2.00 Special Senses and Speech • inability to produce by any means speech that can be " heard, understood, or sustained" 4.00 Cardiovascular System • very serious limitations in the ability to independently " initiate, sustain, or complete activities of daily living" • inability to perform on an exercise tolerance test at a " workload equivalent to 5 METS or less" 7.00 Hematological Disorders • arked level of limitation in one of M -- activities of daily living" " -- maintaining social functioning" " -- completing tasks in a timely manner due to " deficiencies in concentration, persistence, or pace" 8.00 Skin Disorders • inability to function outside of a highly protective " environment" 10.00 Congenital Disorders That • evidence demonstrating … function at a level " Affect Multiple Body Systems consistent with non-mosaic Down syndrome" 11.00 Neurological Disorders • disorganization of motor function in two extremities " … resulting in an extreme limitation … in the ability to stand up from a seated position, balance while standing or walking, or use the upper extremities" • arked limitation in M -- "physical functioning" -- understanding, remembering, or applying " information" -- interacting with others" " -- concentrating, persisting, or maintaining pace" " -- adapting or managing oneself" " • ineffective speech or communication" " 12.00 Mental Disorders • significant cognitive decline from a prior level of " functioning in one or more of the cognitive areas" -- complex attention -- executive function -- earning and memory l -- language -- perceptual-motor -- social cognition • extreme limitation of one, or marked limitation of " two, of the following areas of mental functioning" -- understand, remember, or apply information" " -- interact with others" " -- concentrate, persist, or maintain pace" " -- adapt or manage oneself" " • minimal capacity to adapt to changes in … " environment or to demands that are not already part of [individual's] daily life" continued
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44 FUNCTIONAL ASSESSMENT FOR ADULTS WITH DISABILITIES ANNEX TABLE 2-1 Continued Listing Examples of Functional Criteria 14.00 Immune System Disorders • inability to ambulate effectively" " • inability to perform fine or gross movements " effectively" • arked level of limitation in one of M -- activities of daily living" " -- maintaining social functioning" " -- completing tasks in a timely manner due to " deficiencies in concentration, persistence, or pace" SOURCE: SSA, 2017b.
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