2). Unlike the DI program, SSI has no prior work requirement. Moreover, because of the statutory design of these programs, the role of assistive technologies is not recognized in making disability decisions. SSA’s slow progress in completing the updates could undermine the purpose of incorporating medical advances into its medical criteria. This limited role of treatment means, by definition, the updates have not fully captured the benefits that treatments can provide to persons with certain impairments. Disability Criteria Not Updated to Reflect Labor Market Changes

The disability criteria used by DI, SSI, and VA programs for determining who is disabled have not incorporated labor market changes. In determining the effect that impairments have on individuals’ earning capacity, programs continue to use outdated information about the types and demands of jobs in the economy. Incorporating Scientific Advances and Labor Market Changes into Disability Criteria Has Several Implications

Incorporating scientific advances and labor market changes into DI, SSI, and VA programs can occur within the existing program design and at a more fundamental level. Within the context of the programs’ existing statutory and regulatory design, agencies will need to continue updating the criteria they use to determine which applicants have physical and mental conditions that limit their ability to work. In addition to continuing their medical updates, SSA and VA need to vigorously expand their efforts to more closely examine labor market changes. More fundamentally, SSA and VA could consider the impact that scientific advances and labor market changes have on the programs’ basic orientation. Agencies would need to address the accessibility of medical and technological advances for program beneficiaries. Appendix I: Comments from the Social Security Administration

Appendix II: Comments from the Department of Veterans Affairs

	GAO Comments

1.
What GAO Found

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.