[Federal Register Volume 62, Number 121 (Tuesday, June 24, 1997)]
[Notices]
[Pages 34097-34101]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-16490]
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SOCIAL SECURITY ADMINISTRATION
Progress Report on Development of a Redesigned Method of
Evaluating Disability in Social Security Claims
AGENCY: Social Security Administration.
ACTION: Notice and solicitation of comments.
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SUMMARY: This notice updates and requests further comment on SSA's
research plan for developing a new method for determining whether an
individual is ``disabled,'' as defined in the Social Security Act (the
Act), for purposes of entitlement or eligibility to disability benefits
under titles II or XVI. Notice of the original research plan, including
a request for comments, was published in the Federal Register on
September 9, 1996 (61 FR 47542). This notice discusses:
Preliminary research that has been conducted on functional
assessment tools and occupational classification systems;
Independent review and oversight of the research,
including the related disability evaluation study (DES), by the
National Academy of Sciences (NAS);
Expert, technical guidance being provided by outside
consultants; and
The role of external stakeholders.
In addition, this notice describes SSA's plans for future research
and development activities.
DATES: Comments should be received in writing on or before August 8,
1997.
ADDRESSES: Please submit comments on the Research Plan or requests to
be placed on the External Stakeholder
[[Page 34098]]
mailing list (see External Stakeholders, below) in one of the following
manners:
By E-mail, to david.barnes@ssa.gov.
By telefax, to 410-966-0148.
By mail, to Disability Process Redesign Staff, Office of
Disability, Social Security Administration, 6401 Security Boulevard,
Room 560 Altmeyer, Baltimore MD 21235.
FOR FURTHER INFORMATION CONTACT: David Barnes, 410-965-9121.
SUPPLEMENTARY INFORMATION:
Background
On September 9, 1996, SSA published, in the Federal Register,
notice of the Research Plan For the Development of a Redesigned Method
of Evaluating Disability in Social Security Claims (61 FR 47542). That
notice described SSA's research plan for developing a new method for
deciding whether an individual is ``disabled'' for purposes of Social
Security disability program claims, but without changing the statutory
definition of disability. The notice also discussed integration of the
DES and the disability decision methodology research. (A summary of the
research plan may also be accessed on the Internet at: http://
www.ssa.gov/DPRT/research.html.)
In the September 1996 notice, SSA also stated its intention to
publish future notices to update the research plan at major milestones
in the research and development process. This is the first of these
intended notices.
Research Plan To Develop Redesigned Disability Decision Methodology
The current research plan includes three steps: (1) Initial
Research; (2) Integration of Initial Research and Development of a
Prototype Disability Decision Process (including DES Stage 1 activity);
and (3) Final Testing (including DES Stage 2 activity). The research
plan also calls for independent review and oversight; use of outside
technical expert consultants; and use of stakeholder input.
Step 1: Initial Research
A. Four Reviews of Current Literature
The research plan calls for four literature reviews to gather
background information and data in subject areas of importance to the
disability decision process. The four reviews, two of which have been
completed, are described below.
1. Functional Assessment Instruments
The purpose of the functional assessment research was to define the
state of the art in assessing functional capacity, and to identify
instruments that might be used in, or adapted for, a new decision
process.
This review has already been conducted by Virginia Commonwealth
University (VCU). It involved thoroughly researching the literature
about systems, methods, and instruments for measuring functional
ability and capacity to perform activities and tasks, and developing a
systematic method of describing, categorizing, comparing, and
evaluating those systems, methods, and instruments for the purpose of
determining their potential application in the disability decision
process.
VCU began research in August 1995. In March 1996, VCU completed its
work and issued its report, titled Summary Report. At SSA's request,
VCU prepared a follow-up report, Report on Findings and Recommendations
for Future Directions which was issued in July 1996. These reports are
available on the Internet (http://www.ssa.gov/DPRT/
functional__assessment.html) and are summarized below.
Summary Report. In the Summary Report, issued in March 1996, VCU
reported that its initial search of literature and other sources
identified approximately 700 functional assessment instruments. In
conjunction with SSA, VCU developed selection criteria in order to
focus on those instruments most appropriate to SSA's needs. Forty-six
(46) instruments met the criteria and were further reviewed and
analyzed. VCU described the 46 instruments and made the following
findings from its analysis of those instruments.
Finding #1: The search yielded a large number of instruments
currently in use.
Finding #2: The search yielded no truly global measure of function.
Finding #3: Most functional assessments in use relied upon self-
reported data.
Finding #4: Self-report scales offer few mechanisms for validation
of data.
Finding #5: Automated functional capacity systems offer more
mechanisms for validation of data, but require more time and equipment.
Finding #6: Self-report questionnaires can be modified to offset
potential exaggeration of symptoms.
Finding #7: Predictive and concurrent validity of clinical
instruments may not generalize to SSA claimant populations.
Finding #8: Specialized training for administering instruments
needs to be a consideration in selection.
Finding #9: Functional assessments often include performance of
social roles and expectations, not just symptoms.
Report on findings and recommendations for future directions. After
receiving the initial report, SSA asked VCU to use the knowledge gained
in their research on functional capacity assessment instruments to
expand and elaborate on their analysis. In July 1996, VCU issued the
Report on Findings and Recommendations for Future Directions.
In this follow-up report, VCU expressed the opinion that the
addition of functional assessment strategies to the SSA disability
determination process would greatly enhance the effectiveness and
efficiency of current assessment strategies. The report stated that the
development and use of appropriate functional assessment instruments
for screening and as domain-specific batteries could complement
clinical assessment, increase the accuracy of residual functional
capacity assessments, and potentially reduce cost related to
administrative reviews and litigation. However, VCU also said that,
currently, there is no one functional assessment instrument which will
measure the effects of all types of impairments on mental and physical
functioning and that the present status of functional assessment is not
sufficiently refined to allow a total reliance on this approach. The
VCU report identified six functional domains that the authors felt
should be addressed in an SSA-devised instrument for the measurement of
general function:
Activities of Daily Living.
Mental Functioning Limitations.
Physical Functioning Abilities.
Psychiatric or Mental Health Status.
Medical Information.
Social Support Networks.
The VCU report recommended that SSA undertake the following
activities as the next steps in the methodology research and
development process:
a. SSA should develop a global functional assessment screening
instrument that could be standardized and validated on the SSA
applicant pool. SSA should directly develop or coordinate the
development of a functional assessment instrument for use in the
disability determination process. The following steps should be
completed.
Determine the domains to be included in the assessment.
Develop a draft instrument for subsequent standardization
and validation.
Standardize and validate the instrument on a
representative sample of SSA applicants.
Based on the results of the initial analyses, develop a
``second draft'' of
[[Page 34099]]
the instrument for additional, more advanced, validation analyses.
Based on the results of the second round of validation
analyses, the instrument can then be readied for large scale field-test
implementation within the national disability determination system.
b. SSA should directly develop or coordinate the development of
detailed assessment batteries in each of the domains identified above.
Initial batteries should be developed in each of the
domains.
Particular care should be given to the development of
batteries in the areas of Mental Functioning Limitations and
Psychiatric or Mental Health Status.
The domain-specific functional batteries should be
prepared for a series of validation analyses.
2. Occupational Classification Systems
The purpose of the review of occupational classification systems
was to review existing systems and methods of classifying occupations,
particularly in terms of the physical and mental capacities required to
do those occupations, and evaluate such systems and methods in terms of
their potential applicability to the redesigned Social Security
disability decision process.
This research related to one of the key concepts in the disability
decision process proposed in the disability process redesign--
``baseline work.'' The redesign plan called for determining disability
in some cases by comparing an individual's functional ability to a
baseline of work that represents substantial gainful activity. This
baseline was expected to describe the basic physical and mental demands
of work (i.e., a range of functional activities that realistically
reflects the demands of occupations that can be performed in the
absence of prior skills or formal job training). The baseline would be
used to evaluate whether an individual's functional ability is
consistent with the ability to perform substantial gainful work
activity.
The review was designed to assist SSA in determining whether there
exists a standard to describe basic physical and mental demands of a
baseline of work (or whether it is feasible to develop such a
standard). If such a standard were not found to exist and could not be
developed, the research should assist in determining an alternative
process(es) determining whether an individual is unable to do not only
his or her previous work, but also unable to engage in any other kind
of substantial gainful work which exists in the national economy.
This research was begun in May of 1996 by the American Institutes
for Research (AIR). In November 1996, AIR issued the Final Report:
Identification and Analysis of Occupational Classification Systems.
This report is available on the Internet at: http://www.ssa.gov/DPRT/
execsum.html.
The initial search yielded 126 documents identifying and describing
33 occupational classifications systems of 5 different types. Although
AIR did not find a candidate system that was exactly or ideally suited
to SSA's needs, it did find one database that closely matches SSA's
needs--the Department of Labor's (DOL's) Occupational Information
Network (O*NET), which is currently under development.
Based on discussions with SSA, together with its review and
analysis of occupational classification systems, AIR made five
recommendations:
Recommendation 1: Use O*NET;
Recommendation 2: Establish a working relationship with the
Department of Labor;
Recommendation 3: Compare the occupational classification and
functional assessment taxonomies before the Disability Evaluation
Study;
Recommendation 4: Conduct analyses of the O*NET database; and
Recommendation 5: Develop a prototype.
3. Other Disability Programs Systems and Methods
The purpose of the third review is to:
Survey existing systems and methods of deciding disability
in other public and private programs, both domestic and foreign; and
Identify methods, instrumentation, criteria, research
findings or other features that may be appropriate to incorporate into,
or otherwise be used in developing, our new decision process.
There are many disability benefit programs and other similar
programs, worldwide, that evaluate individuals to determine whether or
not they have an impairment and to determine the extent to which such
impairment(s) limit their ability to function, particularly in relation
to work. These programs use their own methods, instrumentation, and
criteria to make decisions. Despite significant differences between
other programs' standards or purposes and those established by law for
SSA's disability programs, some other programs may have features that
can be adapted to SSA's new disability decision process, resulting in
time and cost savings.
This research has not been conducted yet. We expect to initiate
this research in the near future. The research should be completed in
early 1998.
Note: This notice does not constitute a request for proposals or
grant applications. Any unsolicited proposals or applications
submitted to SSA at this time, related to this notice, will not be
considered nor will their receipt be acknowledged. Any acquisitiion
or grant activity will be undertaken under the normal procedures for
such activity.
4. Vocational Factors Research
The final review is expected to be a survey and analysis of the
literature on the relationship between what SSA calls ``vocational
factors'' (i.e., age, education, and work experience) and an
individual's ability to work. The statutory definition of disability
specifies that these vocational factors are to be considered when
assessing disability:
An individual shall be determined to be under a disability only
if his physical or mental impairment or impairments are of such
severity that he is not only unable to do his previous work but
cannot, considering his age, education, and work experience, engage
in any other kind of substantial gainful work which exists in the
national economy * * * (Section 223(d)(2)(A) of the Act. Emphasis
added.)
The purpose of the research is to review current thinking on the
actual effects of age, education, and work experience on the ability to
work. With this knowledge base, we will be able to begin developing an
appropriate way to account for those effects in a new decision process.
This research has not been conducted yet. We expect to initiate
this research in the near future. The research should be completed
early in 1998.
Note: This notice does not constitute a request for proposals or
grant applications. Any unsolicited proposals or applications
submitted to SSA at this time, related to this notice, will not be
considered nor will their receipt be acknowledged. Any acquisition
or grant activity will be undertaken under the normal procedures for
such activity.
B. Independent Review and Oversight
On September 26, 1996, SSA awarded a four-year contract to the
Institute of Medicine and the Committee on National Statistics of the
National Academy of Sciences (NAS) to conduct an independent,
scientific review of SSA's research and development of a new disability
decision process, including the DES.
In November 1996, NAS established a committee of 14 experts, the
Committee to Review the Social Security Administration's Disability
Decision Process Research (the committee), which first met in January
1997. The committee's review (study) will provide
[[Page 34100]]
independent scientific analysis of all aspects of SSA's approach and
methods for researching and developing the new decision process and
conducting relevant DES research activities.
Consistent with the need for independence and impartiality, final
decisions about study management and work plan reside with the
committee, which has authority and responsibility for the conduct and
oversight of the study. The committee determines the best means to
approach the conduct of the study, sets its own agenda, and designs its
plan of work.
Study activities may include (but will not be limited to) the
following broad issues:
Review of SSA's research plan and timeline for developing
a new disability decision process;
Review of SSA's DES design and activity;
Review of other related SSA sponsored research, including
research findings; and
A final report containing the committee's findings and
recommendations.
C. Consultants
In September 1996, SSA began consultation with three outside
experts in the subject areas of functional assessment of physical
impairments, occupational analysis, and health measurement. In March
1997, SSA added consultants in two additional subject areas: functional
assessment of mental impairments and research methodology. The five
consultants will provide technical guidance in their respective
specialties to SSA's research workgroup.
D. Internal and External Stakeholders
SSA is committed to conducting this research in an inclusive
environment. To that end, SSA is providing updated information to, and
requesting comments of, the general public in this notice. In addition,
SSA is sending the same notice and request for comments to a
comprehensive list of internal and external stakeholders.
External stakeholders are individuals and organizations with a
special interest in SSA disability programs. By directing updates and
requests for comments not only to the general public, but to a list of
individuals and organizations who have expressed a particular interest
in this project, we hope to receive more specific feedback and
commentary than might be received by simply publishing notices to the
general public. Individuals or organizations interested in being
considered external stakeholders should submit their request as
explained in ADDRESSES, above.
The role of the external stakeholder is to comment on the research,
but not to be an active participant in any research or testing. A
number of individuals and organizations who responded to the September
9, 1996 notice, appear to have misinterpreted the request for comment
as a solicitation of potential sources for research grants or
contracts. Any grant or contracting activity will be clearly described
as such and conducted under the usual grant or contracting procedures
with appropriate public and industry notice.
As noted above, this notice does not constitute a request for
proposals or grant applications. Any unsolicited proposals or
applications submitted to SSA at this time, related to this notice,
will not be considered nor will their receipt be acknowledged. Any
acquisition or grant activity will be undertaken under the normal
procedures for such activity.
Step 2: Integration of Initial Research and Development of a Prototype
Disability Decision Process, Including Stage 1 of the DES
After step one activities are completed, the next step will be to
review the findings of the four initial research surveys (i.e.,
functional assessment instruments, occupational classification systems,
other program methodologies, and vocational factors) and begin the
development of a prototype of a new decision process. This will require
coordination and integration of the knowledge acquired in the
preliminary research, development of proposals for a new disability
decision process, and conceptualization of testing scenarios.
Stage 1 of the Disability Evaluation Study (DES) (for a detailed
explanation of the DES, refer to the notice published in the Federal
Register (61 FR 47542) on September 9, 1996) can provide the facility
to test proposed components of a new decision process (e.g., specific
functional assessment tools), with appropriate control and sampling
techniques. In addition, SSA envisions methodology laboratories within
which other potential components of a new disability decision process
may be tested in a controlled setting.
Step 3: Final Testing and Stage 2 of the DES
The purposes of this final step will be to:
Refine the prototype decision process and develop data
about the potential effects and consequences of implementation of the
prototype; and
specify the precise features of a new decision process and
identify all the likely costs and benefits of implementing that
process.
This will involve additional testing to address scaling,
thresholds, validity, and reliability as well as the potential effects
of a new disability decision method on both applicants and the
adjudication process, e.g., potential changes in decision outcomes in
individual cases or for certain kinds of cases, workload, short and
long-term administrative expenses, trust fund expenditures, and
timeliness of decisions. Analysis of the testing must address: whether
the new process is accurate; whether it changes decision outcomes;
whether it is simple to administer and facilitates consistent decisions
at each adjudicative level; and whether claimants, advocates, and
stakeholders view the new method as straightforward, understandable,
and fair.
The DES will play an important role in gathering test data.
However, it will not be the only source of data. We expect to need
other sources of test data, and these will have to be developed. The
envisioned methodology laboratories may provide controlled settings and
representative samples within which data may be gathered and a new
disability decision process may be tested.
Comments on the September 1996 Notice
The SSA received comments from 27 individuals or groups in response
to the September 1996 Notice concerning the Research Plan. We found the
comments that related to the research plan or to the development of a
new disability decision process very helpful.
Not all of the comments related to the research plan or decision
process. Some comments related to other aspects of SSA's disability
redesign, to rehabilitation or return-to-work issues, or to other
matters beyond the scope of this project.
SSA considered all the comments received, although it does not plan
to respond directly to each comment. Many of the suggestions were
already part of the research plan and added weight for their inclusion
as integral parts of the plan; some of the suggestions are still under
consideration; and others are beyond the scope of this project.
We appreciate all of the input we have received and we encourage
comments on this notice and on future notices, which will update the
status of the research.
[[Page 34101]]
Timeline
A timeline of research plan actions and completion date goals is
shown below.
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Action Date
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Development of Research Plan.................. Completed.
Initial Research on Functional Assessment Completed.
Instruments.
Publication of Research Plan in Federal Completed.
Register; Request for Internal and External
Stakeholder Comments.
Completion of Initial Research on Occupational Completed.
Classification Systems..
Publication of Federal Register Notice 06/97.
Describing Initial Research Products and
Updating Research Plan.
Other Disability Programs Research............ 09/97-02/98.
Vocational Factors Research................... 09/97-02/98.
Integration and Prototype Development......... 09/97-09/98.
Award of DES Contract......................... 12/97.
Federal Register Notice Updating Research 12/97.
Plan; Request for Internal and External
Stakeholder Comments.
Supplemental Research (as needed) and Testing. 04/98-04/99.
DES Stage 1 Planning and Pilot for Field Work 01/98-06/98.
Begins..
Federal Register Notice Updating Research 10/98.
Plan; Request for Internal and External
Stakeholder Comments.
Review of All Research, Comments, and Testing 05/99-10/99.
in Conjunction with DES Stage 1 Data; DES
Stage 2 Pilot.
DES Stage 2 Field Work........................ 10/99-09/00.
Federal Register Notice Updating Research 10/99.
Plan, Including Any Interim Results; Request
for Internal and External Stakeholder
Comments.
Final Review of All Research, Testing, 10/99-12/00
Comments, and DES Data; Recommendations for
Possible New Final Disability Decision
Process.
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Dated: June 16, 1997.
Carolyn W. Colvin,
Deputy Commissioner for Programs and Policy.
[FR Doc. 97-16490 Filed 6-23-97; 8:45 am]
BILLING CODE 4190-29-P
