SSA DISABILITY 

PROGRAMS

Progress and Challenges 

Related to Modernizing

Statement of Daniel Bertoni, Director 

Education, Workforce, and Income Security Issues

Testimony 

Before the Subcommittee on Social 

Security, Committee on Ways and Means, 

House of Representatives

For Release on Delivery 

Expected at 9:30 a.m. EDT

Friday, September 14, 2012

GAO-12-891T

United States Government Accountability Office

GAO
 

Page 1 GAO-12-891T 

Chairman Johnson, Ranking Member Becerra, and Members of the 

Subcommittee:

I am pleased to be here today as you discuss the future of the Social 

Security disability programs. The Social Security Administration (SSA) 

manages two of the largest federal disability benefit programs—Social 

Security Disability Insurance and Supplemental Security Income—which 

provided more than $178 billion in payments to about 14.5 million people 

with disabilities and their families in fiscal year 2011. Given the extensive 

size and cost of its disability programs, SSA must have current and 

appropriate criteria by which to assess whether a claimant’s medical 

conditions affect his or her ability to perform work in the national 

economy. However, in our previous work we designated federal disability 

programs as high risk, in part because the programs do not reflect a 

modern concept of disability. Specifically, we noted that SSA’s disability 

programs emphasize medical conditions in assessing work incapacity 

without adequate consideration of the work opportunities afforded by 

advances in medicine, technology, and job demands. In addition, we 

found that the medical criteria and occupational information SSA uses to 

make disability benefit decisions were out of date. In contrast, modern 

concepts of disability take into account the interaction of health conditions 

and contextual factors—such as products, technology, attitudes, and 

services—on an individual’s functional capacity, rather than viewing 

disability solely as a medical or biological issue.1

My remarks are based on our June 2012 report, and focus on steps SSA 

has taken to incorporate a modern view of disability into its criteria.

Such concepts also 

focus on an individual’s functional abilities in, for example, the workplace 

environment, taking into consideration the presence or lack of assistance. 

Experts also have noted that SSA’s process should give more 

consideration to an individual’s ability to function with an impairment, and 

whether the individual can work if given appropriate supports.

2

 

1

Modern concepts of disability are reflected in the International Classification of 

Functioning, Disability and Health (ICF), which is the World Health Organization’s 

framework for assessing health and disability. 

In 

performing this work, we reviewed relevant federal laws and regulations; 

program documentation, including policies, procedures, and strategic 

2

GAO, Modernizing SSA Disability Programs: Progress Made, but Key Efforts Warrant 

More Management Focus, GAO-12-420 (Washington, D.C.: June 19, 2012).

 
 

Page 2 GAO-12-891T 

goals; relevant literature; and position papers and testimonies from 

disability groups and commissions. We interviewed SSA officials, key 

stakeholders, disability experts, and representatives of other agencies 

that administer disability programs. We conducted our performance audit 

from April 2011 through June 2012 in accordance with generally accepted 

government auditing standards. Those standards require that we plan 

and perform the audit to obtain sufficient, appropriate evidence to provide 

a reasonable basis for our findings and conclusions based on our audit 

objectives. We believe that the evidence obtained provides a reasonable 

basis for our findings and conclusions based on our audit objectives.

We found that SSA has taken concrete steps to incorporate modern 

concepts of disability into its determination criteria, but faces constraints 

to more fully considering assistive devices and workplace 

accommodations.

• Giving greater consideration to a claimant’s functional capacity: SSA 

has begun taking a more modern view of disability that looks beyond 

the claimant’s medical condition by giving greater consideration to his 

or her functional capacity, consistent with the International 

Classification of Functioning, Disability and Health (ICF) framework.3

In updates to some of its medical criteria, SSA has included an 

assessment of an individual’s functional abilities to determine whether 

his or her impairment prevents work. For example, as part of SSA’s 

comprehensive revision to the medical listings4

 

3

The ICF focuses on the ability to function despite a medical impairment, including taking 

into account the impact of environmental factors, such as products and technology, 

attitudes, and services. The World Health Organization developed the ICF as a universal 

classification of disability and health for use in health and health-related sectors, 

especially as a planning and policy tool for decision makers. All 191 World Health 

Organization member states endorsed the use of the ICF as the international standard to 

describe and measure health and disability. 

for the immune 

system, the agency included several functional criteria, such as 

performing activities of daily living, maintaining social functioning, and 

completing tasks in a timely manner despite deficiencies in 

concentration or persistence. Generally, SSA officials, adjudicators, 

and disability experts we spoke with support incorporating appropriate 

functional criteria into the medical listings to facilitate a more reliable 

4

The medical listings reflect medical conditions that SSA has determined are severe 

enough to qualify a claimant for benefits. Our recent report, GAO-12-420, provides 

additional information on the status of SSA’s efforts to update its medical listings. 
 

Page 3 GAO-12-891T 

assessment of an individual’s ability to work. However, some have 

also noted that including functional criteria may result in a more 

subjective assessment by adjudicators because functional evidence is 

inherently more subjective than medical evidence,5

• Sponsoring research on functional capacity and disability 

determinations: Since 2008, SSA has had an interagency agreement 

with the National Institutes of Health (NIH) to conduct short- and longterm research to inform SSA’s efforts to incorporate functional 

information into its disability criteria. For example, SSA is sponsoring 

longer-term NIH research to develop a computer-based tool to rapidly 

and reliably assess the functional abilities of individual claimants for 

disability determinations.

which in turn could 

increase the difficulty of making consistent disability determinations.

6

Although these steps are promising, SSA has not fully incorporated other 

modern concepts of disability into its disability determinations. A modern 

view of disability takes into account factors that can hinder or enhance an 

individual’s ability to function, such as assistive devices or 

accommodations that can mitigate barriers. For example, an assistive 

device can help the visually impaired perform tasks, and an 

accommodation could include making the workplace more accessible for 

SSA and NIH officials anticipate several 

benefits from the functional assessment tool, such as providing more 

consistent and comprehensive information on the impact of functional 

limitations earlier in the disability determination process. This 

information may help adjudicators more quickly, accurately, and 

uniformly assess whether a person can perform certain kinds of work 

given his or her functional and occupational capabilities. While this

research is promising, SSA officials said they have not yet determined 

when or how the tool will be integrated into the disability determination 

process. SSA officials said they expect to pilot the functional 

assessment tool by 2016.

 

5

For example, assessing functional evidence may require SSA examiners to take into 

account a claimants’ own testimony and lay statements, which can be more difficult to 

evaluate relative to medical evidence.

6

Boston University’s Health and Disability Research Institute is developing this tool under 

a subcontract with NIH. The tool is based on Item Response Theory using Computer 

Adaptive Testing. As envisioned, the claimant, a medical provider, or both would respond 

to a series of questions on six areas of functioning (such as mobility and self-care) through 

the computer-based tool.
 

Page 4 GAO-12-891T 

wheelchair users or providing an interpreter for someone who is hearing 

impaired.

While assistive devices and workplace accommodations can play a 

critical role in an individual’s ability to function in the work environment, 

SSA does not always consider them in its assessment of disability.

• Assistive devices: SSA officials and experts we spoke with expressed 

concern about more broadly incorporating assistive devices and 

technologies into the medical listings when they may not be widely 

available. SSA officials told us that they do incorporate assistive 

devices into the medical listings once the devices become standard in 

the medical community—a threshold that SSA officials described as 

generally involving some combination of availability, accessibility, and 

insurance coverage. After an assistive device—such as a prosthetic 

device for walking—is incorporated into a listing, adjudicators must 

evaluate the individual’s ability to walk with the device being used.

• Workplace accommodations: SSA officials said their policy is not to 

consider workplace accommodations for several reasons. First, 

officials cited SSA’s inability to ensure that workplace 

accommodations are provided by employers—a concern shared by 

other disability experts we interviewed. SSA officials also indicated the 

agency would be unable to assess the effectiveness of workplace 

accommodations for claimants. Further, officials noted that SSA 

already faces resource constraints managing its disability claims 

workload and expanding the scope of individualized assessments 

would exacerbate those constraints. Finally, they noted that data on 

the availability and use of workplace accommodations are lacking.

Although giving broad consideration of assistive devices and workplace 

accommodations may be difficult to incorporate into the current disability 

criteria and process, SSA may be missing opportunities to move further in 

this direction. Officials we spoke with from an organization of vocational 

examiners expressed frustration with having seen young individuals who 

could work with minor accommodations being provided disability benefits 

likely throughout their working life, rather than receiving support to pursue 

work. Representatives of the organization added that minor 

accommodations can include a stool for sitting or devices to assist with 

vision impairments. As such, there may be common and inexpensive 

workplace supports to reduce work disability that can be feasible and 

reasonable to incorporate into the current disability criteria and process. 

Further, we reported that there are several possible opportunities for SSA 
 

Page 5 GAO-12-891T 

to learn more about the availability of workplace accommodations. For 

example, in the process of developing its new occupational information 

system,7 SSA may be able to collect some limited information on 

workplace accommodations, such as whether a worker in a particular 

occupation would have the option to sit or stand while working. In 

addition, SSA could collect more information on available 

accommodations through its new Disability Research Consortium8 or an 

upcoming symposium with the Institute of Medicine.9

To help ensure that SSA’s disability decisions are as equitable and 

consistent with modern views of disability as possible, we recommended 

that SSA conduct limited, focused studies on the feasibility of more fully 

considering assistive devices and workplace accommodations in its 

disability determinations. SSA disagreed with this recommendation, 

stating that such studies would be inconsistent with Congress’ intentions. 

We maintain that SSA should conduct such studies, noting that while 

Congress has not explicitly directed the agency to consider assistive 

devices and workplace accommodations in making disability 

determinations, it also has not explicitly prohibited SSA from doing so. 

Further, by conducting studies on this issue, SSA would be in a better 

position to thoughtfully weigh the costs and benefits of these various 

policy options before deciding on an appropriate course of action. A 

 

7

In 2008, SSA began a multi-year project to create a new database of occupations to 

replace the outdated Dictionary of Occupational Titles. If an individual does not have a 

condition that meets or is equal in severity to one or more of the medical listings, SSA 

performs an assessment of the individual’s physical and mental residual functional 

capacity. Based on this assessment, SSA determines whether the individual can perform 

past relevant work or any work that is performed in the national economy. To inform these 

determinations, SSA uses a Department of Labor database, known as the Dictionary of 

Occupational Titles. This database has not had a major update since 1977. Our recent 

report, GAO-12-420, provides additional information on the status of SSA’s efforts to 

create its new occupational information system. 

8

SSA is creating the Disability Research Consortium to serve as a national resource for 

fostering high-quality research, communication, and education on matters related to 

disability policy, such as identifying or eliminating barriers encountered by people with 

disabilities in returning to or staying at work.

9

SSA has asked the Institute of Medicine to plan an international symposium focused on 

how best to use and assess function in the disability determination process. SSA has also 

contracted with the Institute of Medicine to study its medical criteria for determining 

disability and to make recommendations for improving the timeliness and accuracy of its 

disability decisions. 
 

Page 6 GAO-12-891T 

complete discussion of SSA’s comments and our evaluation is provided in 

the report.

SSA has taken important steps toward modernizing its disability criteria 

by sponsoring promising research that may lead SSA to increase its 

consideration of functional ability in its medical listings and other aspects 

of its disability decisionmaking process. However, consistent with a 

modern view of disability, SSA can do more—through its various research 

and contract arrangements—to better determine whether and how 

commonly available assistive devices and workforce accommodations 

might be incorporated into its disability criteria. SSA and others raise valid 

concerns about the universal availability of assistive devices and 

accommodations. However, without such efforts to study how certain 

assistive devices and accommodations are playing a role in helping 

individuals with impairments stay at work or return to work, and their costs 

in comparison to potentially providing years of disability benefit payments, 

SSA may be missing an opportunity to assist individuals with disabilities 

to reengage in the workforce. It may also be missing an opportunity to 

target finite resources efficiently and effectively.

Chairman Johnson, Ranking Member Becerra, and Members of the 

Subcommittee, this concludes my statement. We would be pleased to 

respond to any questions that you or other members of the subcommittee 

may have at this time.

For further information regarding this testimony, please contact me at 

202-512-7215 or bertonid@gao.gov. In addition, contact points for our 

Offices of Congressional Relations and Public Affairs may be found on 

the last page of this statement. In addition to the contact named above, 

individuals who made key contributions to this testimony are Michele 

Grgich, Assistant Director, Kate Blumenreich, and Rachael Valliere. Also 

contributing to this report were Caitlin Croake, Julie DeVault, Alex 

Galuten, Miriam Hill, Sheila McCoy, Carol Petersen, Almeta Spencer, 

Anjali Tekchandani, Kathleen van Gelder, and Walter Vance.

Concluding 

Observations 

Contacts and Staff 

Acknowledgements 

(131194)
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