In summary, the evaluation of claims for disability benefits is a complex and difficult task. This task is also a small component of the many extrinsic factors that have bearing on the shape of the disability program, such as long- and short-range economic factors, the changing characteristics of the general population and labor force, and the general priority and ideology held regarding people with disabilities. This paper has limited its focus to the medical review of claims for disability benefits based on mental conditions and has been informed by the APA’s evaluation of SSA’s standards and guidelines used in disability determination. With the recent revision of WHO’s ICF and the development of related disability assessment and research instruments, a new and valuable resource has become available for use in modifications of the tools used in sequential evaluation.

Building on the research database provided by the APA study, the development of the ICF as a conceptual model, and on a classification system of disablement and functioning and its related instruments, it is possible to suggest recommendations for a research-based agenda to refine sequential evaluation and the standards and guidelines that implement disability determination for claims based on both mental and physical conditions. This is made possible because basic work requirements are consistent across disorder types. Each of the recommendations that have been made is intended to be a component of an explicit research plan developed by an interagency working group.

Finally, it is important to note that all recommendations are made within the context of the SSA’s definition of disability. There are no indications that any change to the statutory definition should be considered.

Americans with Disabilities Act. 1990. Public Law 101–336.

American Psychiatric Association. 1980. Diagnostic and Statistical Manual of Mental Disorders (3rd Ed.) Washington, DC: American Psychiatric Press.

Pincus HA, Kennedy C, Simmens SJ, Goldman HH, Sirovatka P, Sharfstein S. 1991. Determining disability due to mental impairment: APA’s evaluation of Social Security Administration guidelines. American Journal of Psychiatry 148(8):1037–1043.

Pope AM, Tarlov AR. 1991. Disability in America: Toward a National Agenda for Prevention. Washington, DC: National Academy Press.

Social Security Act. as in effect January 2001.

Social Security Administration. 2001. Disability Evaluation under Social Security. Listing of Impairments Adult [Online]. Available: http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm [accessed September 24, 2001].

Social Security Administration Regulations. 20 CFR Ch.III 404.1520 [Online]. Available: http://www.ssa.gov/OP_Home/cfr20/404/404-0000.htm [accessed September 24, 2001].

Social Security Administration Regulations. 20 CFR Ch.III 404.1520a [Online]. Available: http://www.ssa.gov/OP_Home/cfr20/404/404-0000.htm [accessed September 24, 2001].