May 9, 2019

Assessment of Work-Related Functional Abilities Is Important In Disability Determination

WASHINGTON – Assessments of a person’s ability to function at work provide important information for disability determinations, and many validated tests are available to assess work-related physical and mental functions. However, because no single test of function is likely to provide all of the information needed to evaluate an individual’s ability to work, it is important to consider information from multiple sources, including health records, functional assessments, and standardized reports from the applicant and relevant health care providers, says a new report from the National Academies of Sciences, Engineering, and Medicine.

The report, Functional Assessment for Adults with Disabilities, contains findings and conclusions regarding the collection of health data and the assessment of functional abilities that can help determine an individual’s eligibility for Social Security disability benefits.  

The U.S. Social Security Administration (SSA) provides disability benefits through the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs. As of December 2017, SSDI had approximately 10.4 million beneficiaries and SSI had about 7.1 million recipients who are blind or otherwise disabled.

While an individual may be able to perform certain physical demands of a job, such as lifting or standing, during a single performance-based assessment, that does not mean he or she can do so repeatedly or continuously throughout the work week. An individual’s capacity to work may also be adversely affected if he or she experiences comorbid physical-mental health conditions or medication side effects. For example, common side effects for treatment of pain — including nausea and difficulty concentrating — can further impair a person’s ability to function at work.

Additionally, when assessments of functional ability are conducted outside of an actual work setting, they may not sufficiently capture whether an individual can work full-time on a regular, continuing basis. Testing is typically administered in a quiet, controlled setting, and thus is not always reflective of the environmental factors (e.g. temperature, noise, and heights) and social demands the individual may encounter at work. 

Assessments that integrate information about impairments and abilities, including multiple tests of different types, repeated over time, provide the most useful information. Tests that only assess one disease or body function may overlook the coexistence of physical and mental health disorders; the progression, or worsening, of disease(s); and intermittent or fluctuating symptoms. Multiple, repeated assessments may produce more detailed and accurate information for disability evaluations.

Numerous challenges complicate accurate assessment of an individual’s work-related functional capacity. The validity of assessments of functional abilities may be compromised by factors such as testing of maximal versus typical performance, testing of episodic activity versus sustained task performance, and varying use or adaptation of tests across diverse populations. Additionally, measures of physical, psychological, or cognitive severity may not correlate with an individual’s ability to meet the physical and mental demands of work.

Socio-economic status, health and general literacy, and demographic factors may limit the quality and quantity of information available for a disability applicant. Health exams that are relevant to disability determinations, including cardiovascular tests and psychological tests, may not be available to people who are underinsured or uninsured. In addition, the tests for functional assessment vary in the degree to which they have been evaluated or adapted for use in different populations. This may limit the availability of appropriate tests that can provide valid and reliable information.

The study — undertaken by the Committee on Functional Assessment for Adults with Disabilities — was sponsored by the U.S. Social Security Administration. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. For more information, visit nationalacademies.org.

Resources:
Report Highlights

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