Social Security Administration Disability Research Articles

Assessing Substance Use Disorder Among Social Security Administration Disability Applicants.

Co-occurrence of substance use disorder and mental illness complicates treatment and is associated with increased disability. However, identification of substance use disorder in populations recently engaged in treatment can be challenging. This study aimed to examine traditional screening tools for substance use disorder and proxy characteristics (i.e., demographic characteristics, behaviors, and diagnoses) as predictors of clinician-observed substance use disorder. The Supported Employment Demonstration, funded by the Social Security Administration, studied 2,960 adults whose applications for disability benefits because of mental illness were recently denied. In a subsample (N=1,354) for whom substance use disorder was determined by community-based teams during follow-up, the authors used logistic regression to identify baseline predictors of observed substance use disorder and compared the sensitivity and specificity of detection by using standardized screening tools (Alcohol Use Disorder Identification Test [AUDIT], 10-item Drug Abuse Screening Test [DAST-10]) with detection via decision trees based on proxy characteristics. Using decision trees based on a combination of personal characteristics (sensitivity=0.47, specificity=0.83, area under the curve [AUC]=0.71) or personal characteristics including diagnostic data (sensitivity=0.54, specificity=0.81, AUC=0.72) provided more accurate identification of substance use disorder than using a combination of the AUDIT and DAST-10 (sensitivity=0.34, specificity=0.88, AUC=0.61). Adding the combined AUDIT and DAST-10 substance use disorder indicator to either tree negligibly improved accuracy. In populations recently engaged in treatment, for whom standardized substance use disorder screening tools are less accurate than expected, consideration of personal characteristics could improve the detection of substance use disorder essential for treatment planning.

The Impact of Work Incentives Benefits Counseling on Employment Outcomes: A National Vocational Rehabilitation Study.

Millions of Americans receiving Social Security Administration (SSA) disability benefits aspire to work and reduce reliance on disability benefits, but find the rules about entering or rejoining the workforce too complex or confusing and fear that working will cause loss of important benefits. A case control study was conducted to investigate the impact of receiving work incentives benefits counseling (WIBC) on employment outcomes, and its relationship with demographic covariates for U.S. vocational rehabilitation (VR) clients who are SSA disability benefit recipients. Data for this study were extracted from the Rehabilitation Service Administration (RSA-911) database. Mahalanobis distance matching procedures were used to match clients who received WIBC with those who did not receive it. Chi-square independence tests and independent samples t tests were used to compare receipt of WIBC and employment outcomes based on the demographic variables. Additionally,chi squared automatic interaction detection (CHAID) analysis was used to divide VR clients into homogeneous groups based on the covariates. Clients who received WIBC were more likely to obtain competitive integrated employment (CIE). Impairment type, referral source, long-term employment and education level were significantly associated with CIE for clients who received WIBC. Additionally, VR clients with sensory/communicative impairments and low-income status were less likely to receive WIBC. Modifying VR structure to be more inclusive; understanding of stigma; and increasing the functioning, psychological well-being and self-efficacy of VR clients might improve employment outcomes.

Informatics Research on Mental Health Functioning: Decision Support for the Social Security Administration Disability Program.

The disability determination process of the Social Security Administration's (SSA's) disability program requires assessing work-related functioning for individual claimants alleging disability due to mental impairment. This task is particularly challenging because the determination process involves the review of a large file of information, including objective medical evidence and self-reports from claimants, families, and former employers. To improve this decision-making process, SSA entered an interagency agreement with the Rehabilitation Medicine Department, Epidemiology and Biostatistics Section, in the Clinical Center of the National Institutes of Health, intending to use data science and informatics to develop decision support tools. This collaborative effort over the past decade has led to the development of the Work Disability-Functional Assessment Battery and has initiated an approach to applying natural language processing to the review of claimants' files for information on mental health functioning. This informatics research collaboration holds promise for improving the process of disability determination for individuals with mental impairments who make claims at the SSA.

Impacts of the 2010 VA PTSD Rule Change on Participation in SSA Disability Programs

U.S. veterans who could qualify for disability benefits from both the Department of Veterans Affairs (VA) and the Social Security Administration (SSA) might view them as complementary or as substitutes for each other. For example, people who earn above a certain income lose their Social Security Disability Insurance (SSDI) benefits, whereas VA Disability Compensation (DC) benefits do not change based on income. Veterans with disabilities who wish to work may therefore prefer to receive DC over SSDI, in effect treating the two programs as substitutes. We examined how an eligibility rule change in DC affected participation in DC, SSDI, and Supplemental Security Income to understand whether veterans with disabilities increase or reduce their take-up of SSA disability benefits when access to DC increases. Using Current Population Survey data from 2009 to 2016, we studied a 2010 DC rule change that made it easier for veterans with posttraumatic stress disorder to demonstrate eligibility. After the rule change, veterans with self-reported cognitive difficulties reported increased receipt of DC, reduced receipt of SSDI, and reduced rates of work-limiting disability, seeming to treat the two benefit programs as substitutes.

Cancer-related impairments and functional limitations among long-term cancer survivors: Gaps and opportunities for clinical practice.

This commentary provides a concise overview of the epidemiology of cancer survivorship and work, common functional limitations experienced by cancer survivors, and evidence‐based recommendations for interventions available to improve function. It also describes the US Social Security Administration's disability claims process, its eligibility requirements, and barriers for long‐term survivors in securing approval for disability claims, and offers insights for practicing clinicians in holistically addressing functional limitations in practice.

Setting Expectations for Claimant Ability to Work: Investigating the Occupational Requirements and Functional Capacity of Workers with Early Onset Health Conditions

When determining a claimant’s eligibility for Social Security Disability Insurance (SSDI) benefits, the Social Security Administration (SSA) assesses whether his/her health condition (e.g., back/spine problems) sufficiently impairs his/her functional capacity (e.g., ability to lift/carry weight) so that the he/she is unable to meet the requirements (e.g., need to lift/carry 25 pounds) of his/her previous occupation and other possible occupations. Using data from the Survey of Income and Program Participation (SIPP) and Occupational Requirements Survey (ORS), we compare the occupational requirements of workers with and without a given health condition in order to understand what to expect from claimants with that health condition. Although sample sizes are limiting and ORS data collection is not yet complete, we find some evidence that workers’ occupational requirements accommodate their health conditions. This evidence suggests that claimants with these health conditions may be able to fulfill the requirements in these occupations. We do find some evidence of the opposite causality: Workers may experience health conditions later in life from occupational requirements that may have caused their health conditions. This evidence is a caution against using data without onset information to inform claimant-ability expectations. Overall, this report provides evidence that national surveys with occupation, health, and function questions have the potential to inform revisions to the SSA disability determination process by providing information on people with health conditions who are working and meeting the requirements of a variety of occupations.

Social Security and Disability Due to Mental Impairment in Adults.

The Social Security Administration (SSA) oversees two disability programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Adults with mental impairments represent a very large component of the programs. Policy makers and SSA are concerned about the accuracy of disability determination and also about low levels of labor force participation among individuals with disabilities. Adults with mental impairments are challenging to assess for work-related functional limitations. They are also a challenge to return to labor force participation. SSA has sponsored several demonstration research programs focusing on improving the accuracy of disability determination and on interventions in supported employment to return individuals with mental impairments to competitive employment. This article reviews the demonstration research focused on both entry into the disability system (at the "front door") and potential exit from it (through the "back door"). All of the research holds promise to "right-size" the SSA disability program.

O11.4. EDUCATION, EMPLOYMENT AND DISABILITY AMONG YOUNG PERSONS WITH EARLY PSYCHOSIS PARTICIPATING IN A COORDINATED SPECIALTY CARE PROGRAM

BackgroundComprehensive early treatment programs for individuals with early psychosis have demonstrated success internationally, spurring rapid expansion of the model in the United States. Between 2014–2016, U.S. federal funding to states to support Coordinated Specialty Care (CSC) for individuals with early psychosis increased to $50 million annually (Dixon, 2017). New York State (NYS) was an early adopter and has rapidly expanded CSC across the state. This study prospectively evaluated education and employment outcomes over time within NYS’s CSC program, OnTrackNY.MethodsEmployment and education trajectories were assessed for individuals with early psychosis who had at least one three-month follow-up assessment, from the program’s inception in October 2013, through September 2016 (N=325). Rates of Social Security Administration (SSA) disability enrollment were assessed for individuals enrolled from October 2013 to June 2017 (n=679).Education and employment status was estimated using longitudinal logistic models utilizing generalized estimating equations with an autoregressive covariance structure to account for within-subject correlations over time. To test how education/employment changed over time, pre-specified contrasts were tested from the longitudinal model for the mean change in sequential follow-up visits. A Kaplan-Meier estimator with discrete time to event and censoring at last observed follow-up month with no event was used to estimate the probability of any education/employment by one year after admission and to estimate the risk of disability by two years after admission.ResultsApproximately 40% of individuals with early psychosis were engaged in school or work upon enrollment in a CSC program; engagement increased to 80% after 6 months of care. The estimated probability of being employed or in school at some time during the year after admission was 87.9% (95% Confidence Interval (CI)= [82.9, 92.0]). Relative to women, men had significantly lower odds of education/employment. Relative to non-Hispanic whites, individuals who were Asian, Hispanic or Black had lower odds of education/ employment. Relative to individuals who had not yet completed high school, individuals whose highest educational attainment was High School (HS) or GED had lower odds of educational/employment.At admission, 2.5% (17/679) clients were receiving SSA disability benefits. The Kaplan-Meier estimates that 18.3% (95% CI= [13.9, 23.9]) of clients followed for two years obtained disability benefits. In bivariate cox regression analyses, individuals with lower (worse) occupational and social functioning scores have significantly greater risk of disability enrollment than individuals with higher scores (in multivariate analysis, only lower occupational functioning remains significant). Age, gender, race, ethnicity, and symptom scores were not significantly associated with disability enrollment.DiscussionThis study demonstrates that individuals with early psychosis who receive CSC in non-research community settings achieve significant improvements in education and employment. Gender, race/ethnicity, and baseline education predicted education and employment outcomes, while poorer functioning was associated with risk of SSA disability benefits. CSC teams should make particular efforts to support the work and school goals of individuals who may be more likely to struggle in achieving engagement in work and school.

Predicting Receipt of Social Security Administration Disability Benefits Using Biomarkers and Other Physiological Measures: Evidence From the Health and Retirement Study.

The objective of this study was to assess how well physiological measures, including biomarkers and genetic indicators, predict receipt of Social Security Administration (SSA) disability benefits among U.S. adults aged 51 to 65 years. We used data from the 2006 to 2012 waves of the Health and Retirement Study (HRS), linked to SSA administrative data. Using logistic regression, we predicted benefit receipt (either Social Security Disability Insurance or Supplemental Security Income) using 19 distinct physiological markers, adjusting for age, sex, race, and select medication use. We then calculated the propensity (i.e., predicted probability) that each HRS respondent received benefits and assessed how well propensity score-based classifications could identify beneficiaries and nonbeneficiaries. Thirteen percent of respondents received benefits. Using the propensity score cut point that maximized the sum of sensitivity and specificity, the model correctly predicted 75.9% of beneficiaries and 73.5% of nonbeneficiaries. Physiological measures have moderate power to predict SSA disability benefit receipt.

Incomes and Outcomes: Social Security Disability Benefits in First-Episode Psychosis.

Social Security Administration (SSA) disability benefits are an important source of income for people with psychoses and confer eligibility for health insurance. The authors examined the impact of coordinated specialty care on receipt of such benefits in first-episode psychosis, along with the correlates and consequences of receiving them. The Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, a 34-site cluster-randomized trial, compared NAVIGATE, a coordinated specialty care program, to usual community care over 2 years. Receipt of SSA benefits and clinical outcomes were assessed at program entry and every 6 months for 2 years. Piecewise regression analysis was used to identify relative change in outcome trajectories after receipt of disability benefits. Among 399 RAISE-ETP participants, 36 (9%) were receiving SSA disability benefits at baseline; of the remainder, 124 (34.1%) obtained benefits during the 2-year study period. The NAVIGATE intervention improved quality of life, symptoms, and employment but did not significantly reduce the likelihood of receiving SSA disability benefits. Obtaining benefits was predicted by more severe psychotic symptoms and greater dysfunction and was followed by increased total income but fewer days of employment, reduced motivation (e.g., sense of purpose, greater anhedonia), and fewer days of intoxication. A 2-year coordinated specialty care intervention did not reduce receipt of SSA disability benefits. There were some advantages for those who obtained SSA disability benefits over the 2-year treatment period, but there were also some unintended adverse consequences. Providing income supports without impeding recovery remains an important policy challenge.

Batch Model for Batched Timestamps Data Analysis with Application to the SSA Disability Program.

The Office of Disability Adjudication and Review (ODAR) is responsible for holding hearings, issuing decisions, and reviewing appeals as part of the Social Security Administration's disability determining process. In order to control and process cases, the ODAR has established a Case Processing and Management System (CPMS) to record management information since December 2003. The CPMS provides a detailed case status history for each case. Due to the large number of appeal requests and limited resources, the number of pending claims at ODAR was over one million cases by March 31, 2015. Our National Institutes of Health (NIH) team collaborated with SSA and developed a Case Status Change Model (CSCM) project to meet the ODAR's urgent need of reducing backlogs and improve hearings and appeals process. One of the key issues in our CSCM project is to estimate the expected service time and its variation for each case status code. The challenge is that the systems recorded job departure times may not be the true job finished times. As the CPMS timestamps data of case status codes showed apparent batch patterns, we proposed a batch model and applied the constrained least squares method to estimate the mean service times and the variances. We also proposed a batch search algorithm to determine the optimal batch partition, as no batch partition was given in the real data. Simulation studies were conducted to evaluate the performance of the proposed methods. Finally, we applied the method to analyze a real CPMS data from ODAR/SSA.

Social Security Disability and the AMA Guides

Abstract Two disability programs are administered by the US Social Security Administration (SSA): Disability under Title II of the Social Security Act is referred to as SDI, which is funded via contributions made by the individual worker, and disability under Title XVI of the Act commonly is referred to as SSI, which is funded through general funds from the US Treasury. Both SDI and SSI disability adjudication use the same five-step sequential evaluation process to determine if a claimant fulfills SSA's disability definition. The foundation for determining disability under SSA is medical evidence that establishes a medically determinable impairment based on defined evidentiary criteria. SSA determines disability, does not rate disability, and awards disability benefits only for total disability. Unlike SSA, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) does not determine (or rate) disability. The AMA Guides, Sixth Edition, emphasizes the use of evidence-based diagnosis for determining whole person impairments and contrasts with SSA disability for which a diagnosis is not a requirement and the focus is placed on determining «impairment» based on symptoms, clinical signs, and laboratory/diagnostic findings. SSA determines disability, does not rate disability, and awards disability benefits only for total disability. An impairment rating using the AMA Guides should not be equated to an SSA disability determination.

The relationship between timely delivery of vocational rehabilitation services and subsequent federal disability benefit application and receipt

Abstract Federal/state vocational rehabilitation (VR) agencies offer services to individuals with disabilities that may help them remain in the labor force and avoid entering Social Security Administration (SSA) disability programs. We assess how the availability of VR services within an agency at the time an individual applies to receive VR services is related to subsequent application and receipt of SSA disability benefits. We find that individuals have a higher likelihood of subsequently applying for and receiving disability benefits when they apply in months that the VR agency serves a lower percentage of applicants or has a longer average wait for services. JEL codes H55, H75, J29

Commentary on Measuring Disability

This is a commentary on 5 articles in this issue of Archives of Physical Medicine and Rehabilitation that report on several related studies of new approaches to measuring disability. The project was grounded in theory, beginning with the development of a conceptual framework enhanced by a literature review and expert consultation within and outside of the Social Security Administration. The investigators then used item response theory to develop test items, which they organized into computer adaptive testing instruments and tested them for their psychometric properties. All in all, it is a groundbreaking set of studies and an enormously valuable contribution to the field. Hopefully it will also be tested as an alternative approach to assessing disability in the Social Security Administration disability benefits programs.

Development of a Computer-Adaptive Physical Function Instrument for Social Security Administration Disability Determination

ObjectivesTo develop and test an instrument to assess physical function for Social Security Administration (SSA) disability programs, the SSA-Physical Function (SSA-PF) instrument. Item response theory (IRT) analyses were used to (1) create a calibrated item bank for each of the factors identified in prior factor analyses, (2) assess the fit of the items within each scale, (3) develop separate computer-adaptive testing (CAT) instruments for each scale, and (4) conduct initial psychometric testing. DesignCross-sectional data collection; IRT analyses; CAT simulation. SettingTelephone and Internet survey. ParticipantsTwo samples: SSA claimants (n=1017) and adults from the U.S. general population (n=999). InterventionsNone. Main Outcome MeasuresModel fit statistics, correlation, and reliability coefficients. ResultsIRT analyses resulted in 5 unidimensional SSA-PF scales: Changing & Maintaining Body Position, Whole Body Mobility, Upper Body Function, Upper Extremity Fine Motor, and Wheelchair Mobility for a total of 102 items. High CAT accuracy was demonstrated by strong correlations between simulated CAT scores and those from the full item banks. On comparing the simulated CATs with the full item banks, very little loss of reliability or precision was noted, except at the lower and upper ranges of each scale. No difference in response patterns by age or sex was noted. The distributions of claimant scores were shifted to the lower end of each scale compared with those of a sample of U.S. adults. ConclusionsThe SSA-PF instrument contributes important new methodology for measuring the physical function of adults applying to the SSA disability programs. Initial evaluation revealed that the SSA-PF instrument achieved considerable breadth of coverage in each content domain and demonstrated noteworthy psychometric properties.

Scale Refinement and Initial Evaluation of a Behavioral Health Function Measurement Tool for Work Disability Evaluation

ObjectiveTo use item response theory (IRT) data simulations to construct and perform initial psychometric testing of a newly developed instrument, the Social Security Administration Behavioral Health Function (SSA-BH) instrument, that aims to assess behavioral health functioning relevant to the context of work. DesignCross-sectional survey followed by IRT calibration data simulations. SettingCommunity. ParticipantsSample of individuals applying for Social Security Administration disability benefits: claimants (n=1015) and a normative comparative sample of U.S. adults (n=1000). InterventionsNone. Main Outcome MeasureSSA-BH measurement instrument. ResultsIRT analyses supported the unidimensionality of 4 SSA-BH scales: mood and emotions (35 items), self-efficacy (23 items), social interactions (6 items), and behavioral control (15 items). All SSA-BH scales demonstrated strong psychometric properties including reliability, accuracy, and breadth of coverage. High correlations of the simulated 5- or 10-item computer adaptive tests with the full item bank indicated robust ability of the computer adaptive testing approach to comprehensively characterize behavioral health function along 4 distinct dimensions. ConclusionsInitial testing and evaluation of the SSA-BH instrument demonstrated good accuracy, reliability, and content coverage along all 4 scales. Behavioral function profiles of Social Security Administration claimants were generated and compared with age- and sex-matched norms along 4 scales: mood and emotions, behavioral control, social interactions, and self-efficacy. Using the computer adaptive test-based approach offers the ability to collect standardized, comprehensive functional information about claimants in an efficient way, which may prove useful in the context of the Social Security Administration's work disability programs.

Compassionate allowance for people with schizophrenia?

Disability is common in schizophrenia, perhaps ubiquitous. Affecting roughly 1% of the population, with onset in adolescence or early adulthood, schizophrenia leads to cognitive and functional impairment during the critically productive phases of life. As a result, many people with schizophrenia become chronically disabled and eventually receive disability benefits from the Social Security Administration. In the current configuration of US health services, health insurance coverage is often closely linked to a determination of disability and in many individuals being determined to be disabled (by the SSA or the VA) is the only way that health insurance coverage can be guaranteed. One of the features of schizophrenia is a deficit in cognitive function, including problems with executive function tasks such as planning or responding to complex demands. As a result, the illness often precludes or significantly delays application for disability benefits, with attendant personal and societal cost. It is well known that access to treatment early in the course of illness leads to a better outcome. Thus, a delay in benefits and/or health care can begin a tragic cycle of events that include untreated psychosis, homelessness, and repeat hospitalization. In August 2007, the leadership of the Social Security Administration (SSA) approached the National Institutes of Health (NIH)with a request for assistance in improving SSA's procedures for processing applications to SSA's disability insurance programs (Social Security Disability Insurance and Supplemental Security Income). In particular, SSA described new procedures for “compassionate allowances,...a new method of triaging disability claims for decision. (SSA's) hope is that...the process for identifying compassionate allowances will help SSA to identify manymore individuals who should be allowed quickly and efficiently.” Compassionate allowance means, quite simply, that the definitive diagnosis of a condition, generally without additional exacerbating features, qualifies an applicant for disability benefits. Obvious compassionate

The effect of different criteria on the number of patients blind from open-angle glaucoma

BackgroundThe prevalence of blindness and visual impairment from glaucoma is influenced by the criteria used to define these entities, which differ between countries and regions, as well as among published reports. The objective of the present study was to ascertain the extent to which different criteria of blindness and visual impairment influence estimates of the number of patients classified as blind or visually impaired by glaucoma in a clinic-based population.MethodsWe conducted a retrospective chart review of 914 patients with open-angle glaucoma to compare numbers of patients identified as visually impaired with and without considering visual field status. We also compared proportions classified using World Health Organisation (WHO) and United States (US) blindness criteria, and applying a new US Social Security Administration (SSA) disability criterion: perimetric mean deviation (MD) ≤ -22 dB.ResultsForty patients (4.4%) were bilaterally blind from glaucoma by the WHO criteria. Fifty-two (5.7%) were blind by the the US criterion. Assessing only visual acuity, 14 (1.5%) patients were blind by the WHO criteria and 24 (2.6%) by the US definition. Eighty-five (9.3%) met the US SSA disability criterion. Among those, 52 were impaired also by the WHO definition. No patients impaired according to the WHO criteria had MD values better than -22 dB.ConclusionsExcluding visual field status will seriously underestimate the prevalence of glaucoma blindness. In our patient population, 30% more patients were classified as blind by the US than by the WHO definition. Also, 60% more were identified as visually impaired by the US SSA criterion than by the WHO criteria. Visual field assessment is vital to determine visual impairment caused by glaucoma.

The prospective role of personal health records in streamlining and accelerating the disability determination process

Background The disability community could benefit significantly from the widespread adoption of health information technology, in particular from its ability to streamline and accelerate processing of the estimated 3 million disability benefits applications filed with the Social Security Administration each year. Disability determination is an inefficient, largely paper-based process requiring large volumes of clinical data compiled from multiple provider sources. That, coupled with a lack of transparency within the process, adds unnecessary delays and expense. Objective The objective of this paper is to outline the case for how personal health records, particularly those populated with information from provider-held electronic health records and payer claims data, offer a means to achieve financial savings from shortened disability determination processes, as well as a tool for disability health self-management and care coordination. Methods Drawing from research and policy forums and testimony before the American Health Information Community, the importance of including the disability community as the nation moves forward with health information technology initiatives is explored. Results Our research suggests that systemwide improvements such as the Nationwide Health Information Network and other such health information technology initiatives could be used to bring benefits to the disability community. Conclusions The time has come to use health information technology initiatives so that federal policy makers can takes steps to reduce the inefficiencies in the Social Security Administration disability determination process while improving the program's value to those who need it the most.

Social Security And Mental Illness: Reducing Disability With Supported Employment

Social Security Administration disability programs are expensive, growing, and headed toward bankruptcy. People with psychiatric disabilities now constitute the largest and most rapidly expanding subgroup of program beneficiaries. Evidence-based supported employment is a well-defined, rigorously tested service model that helps people with psychiatric disabilities obtain and succeed in competitive employment. Providing evidence-based supported employment and mental health services to this population could reduce the growing rates of disability and enable those already disabled to contribute positively to the workforce and to their own welfare, at little or no cost (and, depending on assumptions, a possible savings) to the government.