VOCATIONAL FACTORS IN THE SOCIAL SECURITY DISABILITY DECISION PROCESS: A REVIEW OF THE LITERATURE A Report Prepared under an Interagency Agreement for the Social Security Administration Office of Disability Research by The Federal Research Division Library of Congress December 1998 Authors: Glenn E. Curtis Robert Garian Ihor Gawdiak David L. Osborne Eric Solsten Project Manager: David L. Osborne Federal Research Division Library of Congress Washington, DC 20540-4840 Telephone: (202) 707-3900 FAX: (202) 707-3920 Homepage: www.lcweb.loc.gov/rr/frd TABLE OF CONTENTS Preface ................................................................................................. i Experts Consulted ............................................................................... ii Foreword ............................................................................................. 1 EXECUTIVE SUMMARY ..................................................................... 5 I. INTRODUCTION ......................................................................... 18 II. SOCIAL SECURITY DISABILITY: LEGISLATIVE HISTORY....... 29 III. AGE AND THE ABILITY TO WORK ............................................ 43 Executive Summary .................................................................. 44 Appendix: Figures and Tables .................................................. 93 IV. EDUCATION AND THE ABILITY TO WORK ............................ 103 Executive Summary ................................................................ 103 V. WORK EXPERIENCE AND THE ABILITY TO WORK .............. 122 Executive Summary ................................................................ 123 VI. CONCLUSION .......................................................................... 175 VII.APPENDICES ............................................................................ 181 Private Disability Insurance ..................................................... 182 The Military Disability System ................................................. 184 Medical Surveys: Case Studies .............................................. 188 EXPERTS CONSULTED BY THE FEDERAL RESEARCH DIVISION FOR VOCATIONAL FACTORS RESEARCH Dr. Laurence Branch: PhD in Psychology Professor, Duke University. Expert in cognition and aging. Dr. Richard Burkhauser: PhD in Economics Sarah Gibson Blanding Professor and Chair, Cornell University, Policy Analysis and Management. Expert on disability in the workplace. Dr. Mary Daly: PhD in Economics Senior economist at San Francisco Federal Reserve Bank. Numerous publications in the field of disability in the workplace. Dr. Alan Hartley: PhD in Psychology Professor of Psychology at Scripps College, Claremont, CA. Expert in the field of cognitive processes and intellectual functioning and aging. Dr. Kevin Hollenbeck: PhD in Economics Senior economist at the Upjohn Institute. Previously at The Ohio State University Center on Education and Training for Employment. Expert in issues of education to work, vocational training, and workplace education. Dr. Samuel Osipow: PhD in Psychology Professor of Psychology at The Ohio State University. Expert in occupational stress and vocational behavior. ii FOREWORD In late 1993, the Social Security Administration (SSA) began an initiative potentially to develop a new procedure to evaluate whether an individual claiming benefits on the basis of disability was “disabled,” as defined in section 223(d) of the Social Security Act. In September 1994, the Commissioner of Social Security issued the disability process redesign in the “Plan for a New Disability Claim Process,” in which the agency discussed the need for a structured approach to disability decision making that takes into consideration the large number of claims being processed annually and still provides a basis for consistent, equitable decision-making by adjudicators at each level. The approach, the report states, “must be simple to administer, provide for consistent application of the rules at each level, and result in accurate decisions.” Moreover, the public must perceive the process as straightforward, understandable, and fair. The Commissioner noted that certain aspects of the proposed new methodology would ‘require much study and deliberation with experts and consumers,’ and the subsequent November 1994 report, “Disability Process Redesign: Next Steps in Implementation,” described the need for long-term research, consultation, development, and refinement that would be needed. As part of that research effort, the Federal Research Division (FRD) of the Library of Congress was engaged to survey and analyze the relationship between what SSA collectively calls “vocational factors,” i.e., age, education, and work experience, and an individual’s ability to work. The guidelines or “grids,” published in the 1978 Code of Federal Regulations, provide a framework for decision making. However, SSA staff and administration determined that the grids seemed to fit fewer and fewer cases at that stage of the decision process and required updated research. One reason for the disconnect may have resulted from the fact that the grid regulations, like the medical listings, were intended to be the subject of constant evaluation and change in a changing world. However, the grids have been relatively static over the years, and the current research is the first, systematic effort to update the information necessary to re- evaluate the vocational factors since 1978. The Commissioner of SSA has determined ii that no further decisions will be made concerning the disability process until further research has been conducted. The context of the FRD research project is the need to identify possible changes in the application of the vocational factors in making decisions on disability claims. Although the overall process involves many other factors, such as medical evaluation and administrative procedures, the scope of the FRD project has been limited strictly to the statutorily mandated consideration of the three vocational factors in claims where medical evidence does not provide a conclusive decision. The task was to review literature on those subjects written since the late-1970s (when SSA published the “Medical-Vocational Guidelines” in the Code of Federal Regulations) to determine whether any of the conditions underlying the factors had changed in the intervening two decades. Special emphasis was placed on current literature, with a view toward collecting information that would help construct a system relevant to both present and future claims. In addition to information on the three vocational factors, the report also contains background information on the legislative history of the current SSA disability system with special emphasis on the vocational factors and, for purposes of comparison, summaries of disability determination systems used in the armed forces, the Department of Veterans' Affairs, and private disability insurance companies. Research on the vocational factors was done in coordination with a panel of experts: Dr. Laurence Branch, Professor, Duke University; Dr. Richard Burkhauser, Professor, Cornell University; Dr. Mary Daly, economist at the Federal Reserve Bank San Francisco; Dr. Alan Hartley, Professor, Scripps College; Dr. Kevin Hollenbeck, The Upjohn Institute; and Dr. Samuel Osipow, Professor, The Ohio State University. These experts were chosen after initial study of the subject brought their names to the forefront of those who have spent many years investigating these topics (various aspects of the aging process, disability and the workplace, vocational behavior, and worker training and education). These individuals served as consultants to the research team, making suggestions and guiding the research, and participating in a public workshop held at the Library of Congress in February 1998. Workshop ii participants reviewed the initial research findings and defined and discussed the issues critical to the final compilation of information. In addition, FRD analysts consulted the experts throughout the process as particular problems or issues emerged. Other experts have been consulted as well. The FRD analysts learned immediately that the SSA disability program has characteristics that make it distinct from what most disability specialists understand to be the issues confronting individuals with impairments. First, the program is a medically based one that does not grant partial or short-term disability status--the impairment must be expected to last at least 12 months or result in death. Second, with the exception of eyeglasses, hearing aids, and canes, disability examiners cannot consider assistive devices--the decision on disability status must be based on medical impairment and the ability to perform other work. Third, generally speaking, applicants who come to SSA are looking for financial assistance; they are less inclined to be interested in help with their disability. The FRD research team, after extensive orientation by SSA vocational specialist Elbert Spivey, understood that their task was delimited by the statutory requirements of the SSA program. In the preliminary stages of the project, the FRD research team met with the SSA project working group and attended a two-day meeting of the National Academy of Science Institute of Medicine’s Committee to Review the Social Security Administration’s Disability Decision Process Research. Throughout the process, other briefings, training sessions, and less formal meetings familiarized the analysts

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