Selected Health Conditions and Likelihood of Improvement with Treatment (2020) / Chapter Skim
Currently Skimming:
1 Introduction
1 Introduction
Pages 13-32
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From page 13... ...
. Both programs share a common disability determination process administered by SSA and state agencies as well as a common definition of disability for adults: "the inability to engage in any substantial gainful activity 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" (SSA, 2017)
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establish a consensus committee to study specific, long-lasting medical conditions for adults that are disabling for a length of time but that typically do not result in permanently disabling limitations, are responsive to treatment, and, after a specific length of time of treatment, improve to a point at which the conditions are no longer disabling. In response to that request, the Health and Medicine Division (HMD)
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The following language is in the National Academies contract with SSA: The committee shall not describe issues with respect to access to treat ments. While SSA recognizes people may have difficulty accessing care or particular forms of treatment, some do successfully access those treat ments, and the agency receives information about those treatments in the medical records SSA considers when making disability determinations
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SSDI is financed by the Social Security payroll tax, so any person who qualifies as disabled, according to the SSA definition of disability (inability to engage in any substantial gainful activity) , and has paid Social Security taxes long enough to achieve sufficient work credits can receive SSDI.
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From page 17... ...
SOCIAL SECURITY ADMINISTRATION'S DISABILITY DETERMINATION PROCESS SSA has a five-step sequential evaluation process (see Figure 1-1) to determine whether someone is medically eligible for SSDI or SSI benefits.5 At the first step, SSA determines whether the applicant is currently engaging in substantial gainful activity (SGA)
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Otherwise, the examiner moves on to the fourth step, at which point the disability examiner assesses the applicant's "residual functional capacity" (the maximum level of physical or mental performance that the applicant can achieve, given the functional limitations resulting from his or her medical impairment[s]
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-- that enable SSA to expedite review and decisions for some applications. The CAL process incorporates technology to quickly identify diseases and other medical conditions that, by definition, meet SSA's standards for disability benefits.
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treatment based on the specific criteria, and disabled individuals can be readily identified and awarded benefits, if appropriate." Applicants whose impairments do not meet or medically equal a Listing can still be determined to be disabled at step 5 of the sequential evaluation process on the basis of the combination of their residual functional capacity, age, education, and work experience. Although there has been an established "listing of medical impairments" since the disability program began in 1956, SSA did not publish the Listings in its disability regulations until 1968.10 Since then it has revised the Listings periodically to reflect recent advances in medical knowledge.
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OMB reviews the final rule, and SSA obtains OMB approval and publishes the final rule in the Federal Register. SOCIAL SECURITY ADMINISTRATION'S CONTINUING DISABILITY REVIEW Individuals receiving SSDI benefits or SSI payments (based on disability or blindness)
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• Medical improvement that is related to ability to do work: Medical improvement is related to an individual's ability to work if there has been a decrease in the severity of the impairment(s) present at the time of the most recent favorable medical decision and that person no longer meets or equals the listing, or any subsection of the listing, that the individual met at his or her most recent favor able decision or, if that person did not meet a listing at his or her most recent favorable decision, there has been an increase in his or her functional capacity to do basic work activities.
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reviews apply to individuals with impairments at initial entitlement or after further review in which any improvement is not expected. These are extremely severe impairments shown, on the basis of administrative experience, to be at least static but more likely to be progressively disabling of themselves or by reason of impairment complications.
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Each group considered the specific disease categories listed in the Statement of Task and identified the diseases within those categories that they would study. Each disease outcome chapter provides additional information about the diseases chosen, but in general the committee considered the burden of the disease or the possibility for improvement, or both.
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is based on one's ability to work, specifically the "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 11See https://www.merriam-webster.com/dictionary/disability (accessed March 16, 2020)
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it is noted that people with medically determinable functional limitations are not inherently disabled, that is, incapable of carrying out their personal, familial, and social roles, but rather it is the interaction of their physical or mental limitations with social and environmental factors that determine whether they have a disability. Thus, it is important to have a conceptual framework for 1242 U.S.
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The ICF provides a standard language and a conceptual basis for the definition and measurement of health and disability, integrates the major models of disability, and recognizes the role of environmental factors in the creation of disability as well as the relevance of associated health conditions and their effects. Furthermore, it provides a standardized, internationally accepted language and conceptual framework to facilitate communication across national and disciplinary boundaries.
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From page 28... ...
However, most definitions include the concept of a physical or mental impairment combined with the inability to fulfill social roles or expectations. The definition used by SSA incorporates a length of time and whether a person can perform work (i.e., "the inability to engage in any substantial gainful activity 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")
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Functional outcomes reflect the aggregate effects of physical and cognitive impairments as well as medical morbidities. As such they often align more closely than medical outcomes with the capabilities required for gainful employment.
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2019c. Substantial gainful activity.
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2019f. Understanding Supplemental Security Income continuing disability reviews -- 2019 edition.
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