The Effect of a 1999 Rule Change on Obesity as a Factor in Social Security Disability Determinations

DRC Working Paper Number 2016-01
Publisher: Washington, DC: Center for Studying Disability Policy, Mathematica Policy Research
Feb 10, 2016
Authors
Anne Stahl, Jody Schimmel Hyde, and Harnam Singh

Key Findings:

  • After the 1999 rule change, there was an immediate and sharp decline in the number of applications with obesity recorded as the primary impairment. Despite this initial decline, obesity has increasingly been recorded as an impairment since that time (although predominantly as a secondary impairment). By the end of our observation period, the number and share of applications with a recorded obesity impairment were at or above pre-1999 levels.
  • After 1999, relatively few applications with an obesity impairment were categorized in the Endocrine System, the body system under which obesity was listed in the years before the policy change. The largest share of applications with obesity recorded as an impairment are in the Musculoskeletal System category. In addition, because adjudicators still found it to be an important component of reduced functional capacity for many applicants, there was a large increase in applications with obesity in the Unknown Body System category.
  • Among applicants with obesity recorded as an impairment, allowance rates at the initial determination fell dramatically after the 1999 delisting, with the largest decline for those in the Endocrine System category. In contrast, allowance rates at the initial level for those with obesity impairments in other body system categories rose (albeit at a slower rate). Similar to applications, the majority of allowances among those with obesity impairments were recorded under the Musculoskeletal System. 

Obesity prevalence in the United States has risen at a rapid rate in recent decades, a time during which applications to federal disability programs have also increased substantially. SSA removed obesity as a discrete listing in the Listing of Impairments in 1999 in an attempt to more closely align allowances made for obesity with applicants’ ability to engage in substantial gainful activity. This paper uses SSA Disability Determination (831) data to identify trends in recorded impairments of obesity among working-age applicants with initial determinations from 1990 through 2012. We find that the 1999 policy change shifted the recording of obesity from predominantly in the primary impairment field to the secondary impairment field, shifted the body system category of applicants with obesity recorded as an impairment, decreased the share of applications with recorded obesity impairments receiving an initial allowance, and increased the use of vocational factors in allowances made to applicants with obesity impairments.