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Improving the Social Security Disability Decision Process
C
Interim Report, December 2005
At the first committee meeting, held on January 30, 2005, the Social Security Administration (SSA) asked the committee to focus its attention initially on tasks 8-10 of its charge (see Appendix B) and, if possible, to issue its findings and recommendations on those tasks as soon as possible. The committee agreed that it would address these issues in an interim letter report. However, the committee also made clear that, after completing all of its deliberations, it might refine those preliminary recommendations.
The committee issued its interim report, Improving the Social Security Disability Decision Process: Interim Report, on these three tasks on December 21, 2005. That interim report is included in this appendix. In the interim report, the committee made 13 recommendations with respect to SSA’s use of medical expertise in its disability decision-making process. Now that the committee has completed all of its deliberations, the committee adopts these recommendations as its final recommendations on these issues, subject to the following additional comments with respect to Recommendations 1-2 and 1-7 (addressing qualification requirements for physicians and psychologists who serve as medical consultants [MCs] for the state Disability Determination Services agencies and as medical experts [MEs] at administrative law judge hearings).
In recommendations 1-2 and 1-7, the committee recommended that SSA require that physicians and psychologists who serve as MCs and MEs be board certified. As the committee noted in the interim report, “board certification is rapidly becoming the standard credential for the practice of medicine or psychology.” The committee realizes that, although board cer-
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tification has become the norm for physicians, relatively few psychologists are board certified. The committee therefore modified its recommendation to recommend that SSA continue the current requirements for psychologists participating as MCs or MEs but establish a long-term goal requiring that psychologists be board certified.
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Improving the Social Security Disability Decision Process
Improving the Social Security Disability Decision ProcessInterim Report
Committee on Improving the Disability Decision Process: SSA’s Listing of Impairments and Agency Access to Medical Expertise Medical Follow-Up Agency
INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract No. SS00-04-60083 between the National Academy of Sciences and Social Security Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.
Copyright 2006 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
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“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
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THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.
www.national-academies.org
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COMMITTEE ON IMPROVING THE DISABILITY DECISION PROCESS: SSA’S LISTING OF IMPAIRMENTS AND AGENCY ACCESS TO MEDICAL EXPERTISE
JOHN D. STOBO (Chair), President, University of Texas Medical Branch at Galveston, University of Texas
FRANK S. BLOCH (Vice Chair), Professor of Law, Vanderbilt University Law School, Nashville, TN
GUNNAR B.J. ANDERSSON, Professor and Chairman, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
RICHARD V. BURKHAUSER, Professor and Chairman, Department of Policy Analysis and Management, Cornell University, Ithaca, NY
DIANA D. CARDENAS, Professor and Chief, Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA (Dr. Cardenas became a professor at the University of Florida.)
SHEILA T. FITZGERALD, Associate Professor, Division of Occupational Health, School of Hygiene and Public Health, Johns Hopkins University School of Nursing, Baltimore, MD
ARTHUR GARSON, Dean, School of Medicine, Vice President, University of Virginia, Charlottesville, VA
KRISTOFER J. HAGGLUND, Associate Dean for Health Policy and Professor of Health Psychology, School of Health Professions, University of Missouri, Columbia, MO
ALLEN W. HEINEMANN, Professor, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Director, Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago
RONALD LEOPOLD, Vice President, MetLife, Alpharetta, GA
LARRY G. MASSANARI, Former Acting Commissioner, Social Security Administration, Exton, PA
STEPHEN G. PAUKER, Professor, Tufts University School of Medicine, Vice Chairman for Clinical Affairs, Department of Medicine, Associate Physician-In-Chief, Tufts-New England Medical Center, Boston, MA
LINDA A. RANDOLPH, President and CEO, Developing Families Center, Inc., Washington, DC
BRIAN M. SCHULMAN, Private Practice in Occupational Psychiatry, Bethesda, MD
PETER W. THOMAS, Principal, Powers Pyles Sutter & Verville, PC, Washington, DC
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CRAIG A. VELOZO, Professor and Associate Chair, Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida; Research Health Scientist, Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System
Project Staff
MICHAEL McGEARY, Study Director
MORGAN A. FORD, Program Officer
SUSAN R. McCUTCHEN, Research Associate
REINE Y. HOMAWOO, Senior Program Assistant
RICK ERDTMANN, Director, Medical Follow-up Agency
PAMELA RAMEY-McCRAY, Administrative Assistant
ANDREA COHEN, Financial Associate
DAVID K. BARNES, Consultant
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Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
Veronica D. Feeg, George Mason University School of Nursing, Fairfax, VA
Claude Earl Fox, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
Linda P. Fried, Johns Hopkins University Center on Aging and Health, Baltimore, MD
Patricia M. Owens, Consultation in Health & Disability Programs, Brooklyn, NY
James M. Perrin, Massachusetts General Hospital, Boston, MA
Harold A. Pincus, University of Pittsburgh Medical Center, Pittsburgh, PA
Glenn S. Pransky, Liberty Mutual Research Institute for Safety, Hopkinton, MA
Stephen T. Wegener, Johns Hopkins University School of Medicine, Baltimore, MD
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Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Joseph P. New-house, Harvard University, and Lee Goldman, University of California, San Francisco. Appointed by the National Research Council and Institute of Medicine, respectively, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
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Improving the Social Security Disability Decision Process
Preface
The Institute of Medicine (IOM) Committee on Improving the Disability Decision Process has been working since it first met in January 2005 to develop recommendations to the Social Security Administration (SSA) on how to improve the medical aspects of its disability determination process. By law, Social Security can only pay benefits to those unable to engage in substantial gainful activity because of a “medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months” (emphasis added). Medical and psychological expertise is critical both in developing the criteria for measuring the severity and functional impact of an impairment or impairments on an applicant’s ability to work and in applying the criteria to individual cases where the medical evidence does not clearly meet the criteria in the eyes of a nonmedical disability examiner.
The committee’s final report is due in 2006, but SSA asked the committee to focus first on the expertise issues and provide early recommendations on the qualifications of the medical and psychological experts involved in the disability decision process in a short interim report. SSA is currently in the process of revamping its disability decision process and, according to a Notice of Proposed Rulemaking (NPRM) published in the Federal Register in July 2005, plans to establish a national network of medical and psychological experts who meet qualification standards set by the Commissioner of Social Security. The NPRM did not specify the qualification standards but noted that they would be promulgated within six months of the effec-
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ANNEX TABLE 3 Case Mix Compared with Mix of Medical Consultant Specialties
Clinical Field
Percentage of MCs in the Clinical Specialty
Percentage of Initial Decisions Involving the Clinical Field
Cardiology
1.7%
6.7%
Child psychiatry
0.6%
0.5%
Child psychology
*
3.7%
Endocrinology
0.2%
3.8%
Family practice
6.8%
0.0%
Gastroenterology
0.3%
2.4%
Internal medicine
16.3%
6.3%
Neurology
1.9%
6.8%
Oncology
0.3%
4.7%
Orthopedics
2.5%
19.9%
Pediatrics
9.8%
0.9%
Psychiatry
10.7%
19.6%
Psychology
31.2%
7.5%
Pulmonology
0.3%
4.7%
Rheumatology
0.3%
6.7%
*Less than 0.1 percent.
NOTE: Part-time medical consultants are assumed to work 20 hours a week.
SOURCE: Unpublished table provided by the Office of Disability and Income Support Programs, SSA
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ANNEX TABLE 4 Number of Medical Experts by Specialty, June 2005
Specialty
Number
Percentage
Clinical psychology
415
22.3
Internal medicine
371
19.9
Psychiatry
235
12.6
Orthopedic surgery
121
6.5
Pediatrics
115
6.2
Neurology
102
5.5
Cardiovascular diseases
71
3.8
Ophthalmology
57
3.1
Family practice
31
1.7
Pulmonary diseases
22
1.2
Child psychiatry
21
1.1
Physical medicine and rehabilitation
20
1.0
Rheumatology
19
1.0
General surgery
18
1.0
Occupational medicine
18
0.8
Gastroenterology
15
0.8
General preventive medicine
15
0.8
Urological surgery
14
0.7
Endocrinology
13
0.6
Child psychology
12
0.6
Neurological surgery
12
0.6
Emergency medicine
11
0.6
Medical oncology
11
0.6
All others
122
6.6
Total
1,861
100.0
NOTE: The number of specialties is more than the number of MEs (1,575), because some practice in more than one specialty.
SOURCE: Unpublished table provided by the Office of Hearings and Appeals, SSA.
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ANNEX TABLE 5 Number of Medical Experts by Specialty and Federal Region, June 2005
Federal Region
Clinical Psychology
Internal Medicine
Psychiatry
Orthopedic Surgery
Pediatrics
Neurology
Cardiovascular Diseases
Ophthalmology
Other
Total
Region I
18
23
16
10
6
9
4
5
18
109
Region II
13
25
20
7
9
7
5
5
29
120
Region III
31
35
28
3
7
13
5
5
45
172
Region IV
110
85
78
42
39
25
20
12
93
504
Region V
73
56
30
20
23
17
7
8
52
286
Region VI
47
46
22
16
6
14
6
6
48
211
Region VII
12
14
3
1
3
1
3
1
16
54
Region VIII
37
7
0
0
2
4
0
1
10
61
Region IX
43
53
32
16
12
8
19
14
47
244
Region X
31
27
6
6
8
4
2
0
16
100
All regions
415
371
235
121
115
102
71
57
374
1,861
SOURCE: Unpublished table provided by the Office of Hearings and Appeals, SSA.
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ANNEX TABLE 6 Impairment Codes of DDS Presumptive Disability Decisions with a Reversal Rate of Less Than 5 percent, CY 2004
SSA Impairment Code
Number of DDS PD Decisions
Number Reversed
Reversal Rate (percent)
4160-Chronic pulmonary heart disease
163
8
4.9
2940-Organic mental disorders
4,505
215
4.8
3060-Somatoform disorders
42
2
4.8
3370-Disorders of the autonomic nervous system
64
3
4.7
4920-Emphysema
193
9
4.7
1830-Malignant neoplasm/ovary and other uterine adnexa
314
14
4.5
1640-Malignant neoplasm/thymus, heart, mediastinum
23
1
4.3
3430-Cerebral palsy
1,835
78
4.3
4430-Peripheral vascular disease
516
21
4.1
2950-Schizophrenic/paranoid functional disorders
4,944
198
4.0
1920-Malignant neoplasm/other parts of the nervous system
76
3
3.9
1900-Malignant neoplasm/eye
31
1
3.2
1710-Malignant neoplasm/connective and other soft tissue
99
3
3.0
1910-Malignant neoplasm/brain
830
23
2.8
3360-Other disorders of the spinal cord
517
14
2.7
1410-Malignant neoplasm/tongue
192
5
2.6
7600-Multiple body dysfunction
714
18
2.5
1510-Malignant neoplasm/stomach
249
6
2.4
1990-Malignant neoplasm/unspecified sites
131
3
2.3
2070-Leukemias
1,058
24
2.3
8060-Vertebral fracture/cord lesion
766
18
2.3
2630-Malnutrition/weight loss
139
3
2.2
7840-Loss of voice
983
20
2.0
2990-Childhood origin psychosis (adult)
637
12
1.9
3180-Mental retardation
9,643
185
1.9
1720-Malignant melanoma of skin
179
3
1.7
5850-Chronic renal failure
4,173
62
1.5
2990-Developmental disabilities including autism (children)
2,558
36
1.4
1620-Malignant neoplasm/trachea, bronchus, lung
2,606
35
1.3
1980-Malignant neoplasm/distant sites
78
1
1.3
3320-Parkinson’s disease
154
2
1.3
1500-Malignant neoplasm/esophagus
367
4
1.1
1630-Malignant neoplasm/pleura
98
1
1.0
3350-Anterior horn cell disorder (ALS)
113
1
0.9
7580-Chromosome anomaly/Down syndrome
1,443
8
0.6
7650-Birth weight under 1200 grams
3,291
12
0.4
1550-Malignant neoplasm of liver and intrahepatic bile ducts
710
2
0.3
0940-Neurosyphilis
3
0
0.0
1560-Malignant neoplasm/gallbladder
56
0
0.0
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SSA Impairment Code
Number of DDS PD Decisions
Number Reversed
Reversal Rate percent)
1570-Malignant neoplasm/pancreas
400
0
0.0
1760-Malignant Kaposi’s sarcoma
8
0
0.0
1780-Malignant neoplasm/skeletal system
4
0
0.0
2730-Disorders of plasma protein metabolism
3
0
0.0
3210-Arachnoiditis
10
0
0.0
5010-Asbestosis
6
0
0.0
7050-Hidradenitis suppurativa
16
0
0.0
9330-Chronic fatigue syndrome
11
0
0.0
SOURCE: Unpublished table provided by the Office of Disability and Income Support Programs, SSA.
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ANNEX TABLE 7 SSA Impairment Codes by Allowance Rate, from Highest to Lowest, CY 2004
SSA Impairment Code
Number of Decisions
Number of Allowances
Allowance Rate (percent)
All codes
2,532,798
947,266
37.4
1550-Malignant neoplasm of liver and intrahepatic bile ducts
4,653
4,616
99.2
1570-Malignant neoplasm/pancreas
3,304
3,258
98.6
3350-Anterior horn cell disorder (ALS)
1,534
1,506
98.2
7650-Birth weight under 1200 grams
17,235
16,890
98.0
7580-Chromosome anomaly/Down syndrome
5,242
5,111
97.5
1980-Malignant neoplasm/distant sites
619
599
96.8
1630-Malignant neoplasm/pleura
806
776
96.3
1560-Malignant neoplasm/gallbladder
450
432
96.0
1620-Malignant neoplasm/trachea, bronchus, lung
19,291
18,307
94.9
1500-Malignant neoplasm/esophagus
2,916
2,744
94.1
2990-Developmental disabilities including autism (children)
10,759
9,920
92.2
1910-Malignant neoplasm/brain
6,302
5,754
91.3
1510-Malignant neoplasm/stomach
1,966
1,779
90.5
5850-Chronic renal failure
22,195
19,998
90.1
1780-Malignant neoplasm/skeletal system
20
18
90.0
1720-Malignant melanoma of skin
1,832
1,618
88.3
2070-Leukemias
6,166
5,408
87.7
1760-Malignant Kaposi’s sarcoma
40
35
87.5
1410-Malignant neoplasm/tongue
1,392
1,197
86.0
2990-Childhood origin psychosis (adult)
3,898
3,352
86.0
2030-Multiple myeloma
2,164
1,859
85.9
1590-Malignant neoplasm/other digestive organs, peritoneum
741
636
85.8
1990-Malignant neoplasm/unspecified sites
552
471
85.3
1830-Malignant neoplasm/ovary and other uterine adnexa
3,394
2,882
84.9
3180-Mental retardation
77,102
65,460
84.9
3360-Other disorders of the spinal cord
3,428
2,856
83.3
7600-Multiple body dysfunction
2,555
2,128
83.3
1920-Malignant neoplasm/other parts of the nervous system
280
230
82.1
1520-Malignant neoplasm/small intestine
552
449
81.3
1890-Malignant neoplasm/kidney, other urinary organs
2,740
2,206
80.5
0420-Malignant neoplasm/bone marrow or stem cell transplantation
5
4
80.0
7400-Anencephalus/catastrophic anomaly
569
453
79.6
2630-Malnutrition/weight loss
1,112
876
78.8
1640-Malignant neoplasm/thymus, heart, mediastinum
173
136
78.6
1700-Malignant neoplasm/bone and articular cartilage
1,550
1,207
77.9
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SSA Impairment Code
Number of Decisions
Number of Allowances
Allowance Rate(percent)
3430-Cerebral palsy
9,864
7,546
76.5
3320-Parkinson’s disease
3,853
2,894
75.1
1950-Malignant neoplasm/other sites
5,399
4,049
75.0
8060-Vertebral fracture/cord lesion
4,699
3,449
73.4
1880-Malignant neoplasm/bladder
1,535
1,122
73.1
7840-Loss of voice
5,162
3,742
72.5
1380-Late effects of acute poliomyelitis
1,859
1,346
72.4
1710-Malignant neoplasm/connective and other soft tissue
902
650
72.1
7410-Spina bifida
1,867
1,344
72.0
1530-Malignant neoplasm/colon, rectum, anus
11,184
8,019
71.7
2950-Schizophrenic/paranoid functional disorders
56,218
40,308
71.7
3300-Cerebral degeneration/childhood
616
439
71.3
3750-Cardiac transplantation
319
226
70.8
1420-Malignant neoplasm/salivary glands
234
165
70.5
4380-Late effects of cerebrovascular disease
32,139
22,529
70.1
1790-Malignant neoplasm/uterus
2,566
1,783
69.5
4430-Peripheral vascular disease
8,979
6,240
69.5
4160-Chronic pulmonary heart disease
2,137
1,481
69.3
2840-Aplastic anemia
738
505
68.4
7830-Malnutrition, marasmus/growth impairment
2,388
1,631
68.3
3590-Muscular dystrophies
3,188
2,155
67.6
3150-Developmental/emotional disorders-infant
4,521
3,034
67.1
0300-Leprosy
3
2
66.7
4960-Cronic pulmonary insufficiency/COPD
40,287
26,348
65.4
1940-Malignant neoplasm/other endocrine glands and related
242
158
65.3
3310-Other cerebral degenerations
3,901
2,536
65.0
2940-Organic mental disorders
57,567
36,958
64.2
3210-Arachnoiditis
231
145
62.8
9070-Late effects/nervous system injuries
6,740
4,125
61.2
3690-Blindness/low vision
24,669
14,752
59.8
4280-Heart failure
15,865
9,440
59.5
1740-Malignant neoplasm/breast
17,865
10,558
59.1
3620-Other retinal disorders
3,455
2,038
59.0
3153-Speech and language delays
32,332
18,914
58.5
4460-Periarteritis nodosa/allied condition
296
171
57.8
1870-Malignant neoplasm/penis, male genital organs
158
91
57.6
7500-Congenital anomalies/upper alimentary tract
372
212
57.0
1850-Malignant neoplasm/prostate
3,233
1,827
56.5
4920-Emphysema
4,382
2,471
56.4
2760-Diabetic acidosis
222
123
55.4
4540-Varicose veins/low extremities
2,374
1,294
54.5
3570-Diabetic/peripheral neuropathy
13,714
7,460
54.4
2020-Lymphoma
7,075
3,799
53.7
3890-Deafness
15,352
8,183
53.3
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SSA Impairment Code
Number of Decisions
Number of Allowances
Allowance Rate (percent)
7460-Congenital heart anomalies
5,542
2,910
52.5
0940-Neurosyphilis
25
13
52.0
0430-Symptomatic HIV positive
18,168
9,429
51.9
8540-Intracranial injury
5,785
2,968
51.3
1900-Malignant neoplasm/eye
194
99
51.0
2770-Disorders of metabolism/cystic fibrosis
1,426
719
50.4
3400-Multiple sclerosis
14,183
7,148
50.4
4250-Cardiomyopathy
15,472
7,581
49.0
1170-Skin/mucus membrane infections
720
351
48.7
7140-Rheumatoid & other inflammatory arthritis
19,437
9,330
48.0
3060-Somatoform disorders
1,425
681
47.8
1860-Malignant neoplasm/testis
791
375
47.4
2960-Mood disorders (children)
21,121
9,927
47.0
2390-Neoplasm/unspecified/unknown behavior
308
144
46.8
7050-Hidradenitis suppurativa
295
135
45.8
4410-Aortic aneurysm
1,341
607
45.3
1730-Other malignant neoplasm of skin
463
209
45.1
3610-Retinal detachment with retinal defects
1,592
716
45.0
2250-Benign neoplasm/brain, nervous system
3,049
1,332
43.7
4590-Other diseases of the circulatory system
7,004
3,061
43.7
3370-Disorders of the autonomic nervous system
1,408
614
43.6
1840-Malignant neoplasm/other female genital organs
1,141
496
43.5
4140-Chronic ischemic heart disease
44,127
19,195
43.5
4030-Hypertensive vascular/renal disease
376
162
43.1
7200-Ankylosing/inflamnatory spondylopathies
1,007
430
42.7
2820-Hereditary hemolytic anemias including sickle cell
4,167
1,771
42.5
5010-Asbestosis
289
122
42.2
7300-Osteomyelitis/other infections involving bone
1,837
775
42.2
1930-Malignant neoplasm/thyroid gland
782
327
41.8
5710-Chronic liver disease/cirrhosis
30,970
12,853
41.5
7150-Osteoarthritis/allied disorders
113,194
45,730
40.4
4480-Diseases of capillaries
145
57
39.3
0930-Cardiovascular syphilis
36
14
38.9
2730-Disorders of plasma protein metabolism
93
36
38.7
3490-Other nervous system disorders
15,534
5,996
38.6
3000-Anxiety-related disorders
46,037
17,724
38.5
3138-Oppositional/defiant disorder
7,776
2,955
38.0
3650-Glaucoma
2,958
1,121
37.9
3580-Myoneural disorders
3,118
1,160
37.2
5810-Nephrotic syndrome
2,447
903
36.9
3120-Conduct disorder
5,856
2,102
35.9
2960-Affective disorders (adult)
277,560
99,089
35.7
7590-Other congenital anomalies
3,324
1,160
34.9
2850-Other anemias
1,864
641
34.4
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Improving the Social Security Disability Decision Process
SSA Impairment Code
Number of Decisions
Number of Allowances
Allowance Rate (percent)
3660-Cataract
2,400
826
34.4
2790-Disorders immune mechanism (except HIV)
1,009
345
34.2
3010-Personality disorders
14,295
4,860
34.0
1360-Other infectious/parasitic diseases
1,488
487
32.7
5780-Gastrointestinal hemorrhage
979
311
31.8
9050-Late effects/musculoskeletal and connective tissue injuries
14,412
4,525
31.4
7100-Diffuse diseases of connective tissue
9,056
2,835
31.3
2880-Diseases of white blood cells
145
45
31.0
3140-Attention deficit hyperactivity disorder
94,862
29,312
30.9
3950-Diseases of aortic valve
3,889
1,190
30.6
4100-Acute myocardial infarction
5,254
1,608
30.6
3070-Eating and tic disorders
349
106
30.4
2870-Purpura/other hemorrhagic conditions
499
151
30.3
2380-Neoplasm/uncertain behavior
204
60
29.4
5190-Other diseases of respiratory system
8,111
2,385
29.4
1350-Sarcoidosis
1,904
554
29.1
5300-Diseases of esophagus
984
286
29.1
3860-Vertiginous syndromes
2,155
625
29.0
7330-Other bone/cartilage disorders
16,067
4,659
29.0
4940-Bronchiectasis
674
193
28.6
7649-Birth weight between 1,200 and 2,000 grams
6,951
1,981
28.5
2810-Deficiency anemias
1,365
388
28.4
4020-Hypertensive vascular disease
7,426
2,109
28.4
3980-Other rheumatic heart disease
629
177
28.1
9490-Burns
1,925
537
27.9
4510-Phlebitis/thrombophlebitis
1,012
280
27.7
4240-Valvular heart diseases/other stenotic defects
3,923
1,067
27.2
3910-Rheumatic fever/heart involvement
169
45
26.6
4270-Cardiac dysrhythmias
4,966
1,311
26.4
2890-Other diseases blood/blood forming organs
1,313
339
25.8
5050-Pneumoconiosis
240
61
25.4
5560-Idiopathic proctocolitis
1,369
344
25.1
6940-Bullous disease
517
128
24.8
4130-Angina pectoris
1,761
426
24.2
2860-Coagulation defects
826
199
24.1
2720-Hyperlipidemia
175
42
24.0
7160-Other and unspecified arthropathies
27,885
6,469
23.2
6960-Dermatitis
1,951
451
23.1
2780-Obesity
20,758
4,754
22.9
5550-Regional enteritis/granulomatous colitis
4,723
1,053
22.3
3680-Visual disturbances
6,158
1,324
21.5
8690-Internal injury
506
108
21.3
8940-Lower limb open wounds
3,117
664
21.3
3152-Learning disorder
36,123
7,622
21.1
8270-Lower limb fractures
34,015
7,075
20.8
OCR for page 237
Improving the Social Security Disability Decision Process
SSA Impairment Code
Number of Decisions
Number of Allowances
Allowance Rate (percent)
2740-Gout
1,511
308
20.4
3195-Borderline intellectual functioning
31,621
6,356
20.1
7240-Back disorders
311,813
62,674
20.1
0110-Pulmonary tuberculosis
472
90
19.1
6950-Ichthyosis
567
103
18.2
7280-Muscle, ligament, fascia disorders
58,995
10,619
18.0
2550-Disorders of adrenal glands
386
69
17.9
2500-Diabetes mellitus
67,988
11,966
17.6
5690-Other disorders gastrointestinal system
13,943
2,440
17.5
9330-Chronic fatigue syndrome
1,974
342
17.3
2530-Disorders of pituitary gland
441
75
17.0
7800-Sleep-related disorder
2,371
403
17.0
7090-Other disorders skin/subcutaneous tissue
3,399
557
16.4
5330-Peptic ulcer
1,022
165
16.1
8390-Dislocations
2,435
392
16.1
3460-Migraine
8,011
1,282
16.0
3540-Carpal tunnel syndrome
5,627
889
15.8
8840-Upper limb open wounds
3,676
573
15.6
5530-Hernias
3,048
451
14.8
8180-Upper limb fractures
12,756
1,862
14.6
8290-Other fractures
8,432
1,214
14.4
4910-Chronic bronchitis
1,653
230
13.9
2510-Hypoglycemia
123
17
13.8
3780-Strabismus/disorders eye movements
557
76
13.6
3450-Epilepsy
37,165
4,980
13.4
7370-Curvature of spine
4,530
607
13.4
4010-Essential hypertension
32,188
3,863
12.0
6080-Disorders of male genital organs
434
49
11.3
5990-Other disorders of urinary tract
3,823
413
10.8
2520-Disorders of parathyroid
265
28
10.6
4930-Asthma
60,855
6,086
10.0
5350-Gastritis/Duodenitis
1,480
144
9.7
8790-Other open wounds
432
42
9.7
3880-Other ear disorders
3,019
281
9.3
8030-Skull fracture without intracranial injury
460
35
7.6
8480-Sprains & strains
19,846
1,111
5.6
2460-Disorders of thyroid
3,592
198
5.5
6290-Disorders of female genital organs
1,582
63
4.0
0440-Asymptomatic HIV positive
8,438
262
3.1
3040-Substance dependence/drugs (child)
100
1
1.0
3030-Addiction disorder/alcohol (adult)
8,069
0
0.0
3030-Substance dependence/alcohol (child)
39
0
0.0
3040-Addiction disorders/drugs (adult)
7,167
0
0.0
Unknown, missing, invalid codes
145,328
8,284
5.7
SOURCE: Unpublished table provided by the Office of Disability and Income Support Programs, SSA.
OCR for page 238
Improving the Social Security Disability Decision Process
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Representative terms from entire chapter:
disability decision
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