[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]


=======================================================================
-----------------------------------------------------------------------

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.

-----------------------------------------------------------------------

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 [email protected].
     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.

------------------------------------------------------------------------
                    Action                                Date          
------------------------------------------------------------------------
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.                                                               
------------------------------------------------------------------------

    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