SSA and VA Disability Programs:

Re-Examination of Disability Criteria Needed to Help Ensure Program Integrity

GAO-02-597: Published: Aug 9, 2002. Publicly Released: Aug 9, 2002.

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The three largest disability programs collectively provided $89.7 billion in cash benefits to 10.2 million adults in 2001. However, the Disability Insurance (DI) program, Supplemental Security Income (SSI) program, and VA disability criteria reflect neither medical and technological advances nor the labor market changes that affect the skills needed to perform work and work settings. If these federal disability programs do not update scientific and labor market information, they risk overestimating the limiting nature of some disabilities while underestimating others. Twelve years ago, both the Social Security Administration and the Department of Veterans Affairs (VA) began reviewing relevant medical advances and updating the criteria they use to evaluate claims. However, the time the agencies are taking to revise the medical criteria could undermine the very purpose of the update. Moreover, because of the limited role of treatment in the statutory and regulatory design of these programs, the updates have not fully captured the benefits afforded by advances in treatment. Also, the disability criteria used by DI, SSI, and VA programs have not incorporated labor market changes. These programs continue to use outdated information about the types and demands of jobs needed to determine the impact that impairments have on individuals' earning capacity. To incorporate scientific advances and labor market changes into the DI, SSI, and VA programs, steps can be taken within the existing program design, but some would require more fundamental change. Agencies need to continue their medical updates and vigorously expand their efforts to more closely examine labor market changes. At a more fundamental level, SSA and VA could consider changes to the disability criteria that would revisit the programs' basic orientation.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: VA has not acted to implement this recommendation.

    Recommendation: To further advance the discussion of issues raised in this report, the Secretary of Veterans Affairs should use VA's annual performance plan to delineate strategies for and progress in periodically updating the Schedule for Rating Disabilities and labor market data used in its disability determination process.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: SSA has made substantive progress towards more comprehensively considering the effect of medical treatment and assistive technologies on program eligibility. Specifically, SSA has developed several demonstration efforts designed to test the impact of providing certain DI beneficiaries increased medical support and other employment assistance. These efforts include: Accelerated Benefits, which will provide immediate Medicare coverage and subsequent employment supports to individuals determined eligible for DI and who have a medical impairment expected to improve within 2-3 years; Mental Health Treatment Study, whereby DI beneficiaries who have schizophrenia or affective disorders will receive comprehensive health care and employment supports; and HIV/AI Demonstration, whereby current DI beneficiaries in California with a diagnosis of HIV, immune disorder, and/or auto-immune disorder will have immediate access to comprehensive health care services as well as employment services coordination. Further, SSA has contracted with IOM/NAS to conduct a broad review of SSA's medical listings, including assessing the adaptability of the listings with respect to variable access to health care services in determining whether an individual's condition meets or equals the Listings. An interim report was issued in Dec. 2005, and the final report is due summer of 2006.

    Recommendation: To further advance the discussion of issues raised in GAO's report, the Commissioner of Social Security should study and report to Congress the effect that a comprehensive consideration of medical treatment and assistive technologies would have on the DI and SSI programs' eligibility criteria and benefit package. The analysis should estimate the effects on the size, cost, and management of these and other relevant programs and identify the legislative action, if any, necessary to initiate and fund such change.

    Agency Affected: Social Security Administration

  3. Status: Closed - Implemented

    Comments: SSA has taken a number of decisive steps toward updating its medical listings and labor market information. According a final rule published March 2006, SSA has revised medical criteria for several impairment areas in FY 2005, and is providing cross-component training on these new provisions. SSA also invited public comment for several other medical listings in 2005 through publication of advance notices, and has sought additional comments on current policy and future content of medical criteria through public outreach events. Regarding vocational policy, SSA is building a policy access tool (Disability Online) intended to provide electronic access to all vocational rules and training materials.

    Recommendation: To further advance the discussion of issues raised in GAO's report, the Commissioner of Social Security should use SSA's annual performance plan to delineate strategies for and progress in periodically updating the Medical Listings and labor market data used in its disability determination process.

    Agency Affected: Social Security Administration

  4. Status: Closed - Not Implemented

    Comments: VA has not acted to implement this recommendation.

    Recommendation: To further advance the discussion of issues raised in this report, the Secretary of Veterans Affairs should study and report to Congress the effect that a comprehensive consideration of medical treatment and assistive technologies would have on the VA disability programs' eligibility criteria and benefit package. The analysis should estimate the effects on the size, cost, and management of the program and other relevant VA programs and identify the legislative action, if any, necessary to initiate and fund such change.

    Agency Affected: Department of Veterans Affairs

 

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