research on this—or other brief screening instrument—to be used at the initial stages of the disability determination process to screen out claims based on slight or not-severe limitations in function related to work and to identify those with extremely severe disabilities. Research and data analytic strategies could identify the threshold for slight or not-severe and for extreme or so-severe limitations that would provide an evidence base for this step in sequential evaluation. It might be worth considering applying this standard even prior to the review of A criteria.

RESEARCH ISSUES

There are many compelling issues deserving of research. The committee’s second interim report (Wunderlich and Rice, 1998) is replete with them. The research questions are important, timely, and utilitarian. This review of the SSA’s disability determination of claims based on mental impairment, the APA study, and the WHO ICIDH-2 suggests additional useful, scientific avenues of investigation. However, at present there is no overarching strategy for identifying and prioritizing research necessary to improve the disability determination for SSA.

In the mid-1980s, mental impairments were added to the Listings, many of which take into consideration functional consequences of an impairment. The committee understands and supports the need to revise and update the Listings to restore them closer to their original purpose. However, the committee is not aware of any attempt to evaluate the currency and consistency of listings, or at least those groups of conditions that account for a significant proportion of the disability rolls. SSA appears to have made the decision to replace the current Listings with an index without any attempt to first evaluate the Listings and use the findings to update them or to guide in developing a new index. SSA should specify the desired levels of specificity and sensitivity and evaluate the current listings against those standards to serve as a baseline for creating the new index (Wunderlich and Rice, 1998, p. 19).

The APA study suggests that the medical component of sequential evaluation for claims based on mental impairment works sufficiently well that only refinements to SSA forms, identification of a period of review, and improvement of the medical evidence (e.g., development of a standard form for basic medical evidence) are warranted. The ICF with its cultural sensitivity and applicability to diverse populations is suggestive of ways of improving both the medical evidence and the SSA forms. These seem relatively small issues in the big picture—when or if the big picture is clear.

What is the big picture for SSA? What are the aspects of the determination process that work well and which are those that do not? Using



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