Cardiovascular Disability: Updating the Social Security Listings
Objective
SSA uses a five-step evaluation process to determine whether applicants for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are disabled and therefore eligible to receive program benefits. As a key part of this evaluation process, SSA maintains a list of medical conditions—organized by major body system and known as the Listing of Impairments, or simply the Listings—that the agency considers severe enough to prevent a person from doing substantial gainful activity. If an applicant’s condition is on the list, SSA will find that the individual has a qualifying disability. In addition, if an applicant’s condition is not on the list, but SSA determines that the condition is as severe as a medical condition that is on the list, the agency will award benefits. (Applicants who do not qualify for benefits based on the Listings will undergo further evaluation of eligibility based on assessment of their functional capacity, work history, education, and age.) Given their significance in SSA’s disability evaluation process, SSA conducts periodic reviews and revisions of the Listings to ensure that they reflect advances in medical knowledge and clearly identify the agency’s evaluation standards. In August 2009, SSA commissioned the Institute of Medicine (IOM) to conduct an extensive review of the medical research, guidelines, and criteria to produce concrete recommendations designed to improve the utility of the Listings for evaluating cardiovascular disability claims and identifying individuals who meet the agency’s definition of disability.
Status
This project was completed in 2010.
To conduct its review of SSA’s Cardiovascular Listings, IOM convened a committee of cardiovascular experts who, in conjunction with committee staff, examined relevant medical research literature and SSA program data; conducted site visits at seven disability determination offices across the United States; reviewed clinical practice guidelines (specifically those issued by the American College of Cardiology and the American Heart Association); and obtained testimony and comments (both oral and written) from clinical experts and advocacy groups. Based on this body of information, the IOM committee developed a set of consensus conclusions and recommendations concerning updates of the Cardiovascular Listings, which were conveyed to SSA in the committee’s 2010 report. In the course of its work, the committee met four times from December 2009 through June 2010.
The IOM’s report to SSA on the Cardiovascular Listings provided 24 recommendations which included detailed advice for revising these listings, establishing new listings concerning the cardiovascular system, and identifying additional criteria for incorporation in the listings. The report also identified other issues related to the Listings including the impact of comorbidities on individuals with cardiovascular diseases and the existence of critical knowledge gaps—and the research needed to address such gaps—impacting the agency’s ability to improve the quality of the Listings. Based in part on the IOM’s recommendations, SSA issued a Notice of Proposed Rulemaking in June 2022 identifying targeted revisions to the cardiovascular disorders listings to reflect advances in medical knowledge, SSA’s adjudicative experience, and comments received from experts and the public.
Not applicable.