School of Nursing, University of North Carolina, Chapel Hill, North Carolina; Indiana University School of Nursing, Indianapolis, Indiana; School of Nursing, University of Washington, Seattle, Washington.
School of Nursing, University of North Carolina, Chapel Hill, North Carolina.
Womens Health Issues. 2024 May-Jun;34(3):221-231. doi: 10.1016/j.whi.2023.11.008. Epub 2024 Feb 27.
Endometriosis, a chronic noncancerous gynecologic condition commonly characterized by disruptive physical and psychosocial symptoms, can be disabling. Individuals in the United States with endometriosis who are unable to work before retirement age can apply for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI). Given the multi-step process of disability review, it is important to better understand how disability decisions are made. This study aimed to examine approaches and rationales of U.S. federal appeals courts reviewing SSDI and/or SSI claims involving endometriosis-related issues of appeal.
We searched Westlaw and Nexis Uni records, available as of January 2021, for federal appeals of SSDI and SSI claims including endometriosis as an impairment. Two independent reviewers screened full-text cases and extracted data. Framework Analysis was applied to courts' rationales regarding endometriosis-related issues of appeal.
Eighty-seven appeals addressed an endometriosis-related issue. Three themes-evidence, treatment, and time-were identified across the decisions. The courts' discussions across themes exposed rationales and evidentiary requirements that posed challenges for claimants with endometriosis. The courts found subjective reports of symptoms insufficient evidence of impairment and positive responses to treatments to indicate cures or prevent claimants from demonstrating the necessary continuous 12 months of impairment. Some courts expected claimants to use treatments such as contraception or hysterectomy without addressing the risks of such treatments or the fact that they might have been counter to claimants' needs and preferences.
Individuals with endometriosis face evidentiary obstacles and common misconceptions about disease, diagnosis, and treatment in disability claims. SSDI and SSI endometriosis claims are systematically disadvantaged, particularly among those without access to care. The health care, policy, and legal systems can leverage the findings in this study to create a more equitable disability application and review system for those with chronic pain conditions such as endometriosis.
子宫内膜异位症是一种常见的慢性非癌性妇科疾病，其特征通常是身体和心理社会症状紊乱，可能导致残疾。在美国，未到退休年龄就无法工作的子宫内膜异位症患者可以申请社会保障残疾保险（SSDI）和/或补充保障收入（SSI）。鉴于残疾审查的多步骤过程，了解残疾决定是如何做出的非常重要。本研究旨在研究美国联邦上诉法院审查与子宫内膜异位症相关的上诉问题的 SSDI 和/或 SSI 索赔的方法和理由。
我们在 Westlaw 和 Nexis Uni 记录中进行了搜索，这些记录可追溯到 2021 年 1 月，以查找包含子宫内膜异位症作为损伤的 SSDI 和 SSI 索赔的联邦上诉。两名独立审查员筛选了全文案例并提取了数据。应用框架分析来分析法院对与子宫内膜异位症相关的上诉问题的理由。
87 项上诉涉及与子宫内膜异位症相关的问题。在这些决定中确定了三个主题-证据、治疗和时间。法院在各个主题中的讨论揭示了对患有子宫内膜异位症的索赔人提出的挑战的理由和证据要求。法院发现，症状的主观报告不足以作为损伤的证据，对治疗的积极反应并不能表明治愈或阻止索赔人证明必要的连续 12 个月的损伤。一些法院期望索赔人使用避孕药或子宫切除术等治疗方法，但没有解决这些治疗方法的风险，也没有考虑到这些治疗方法可能与索赔人的需求和偏好相悖。
患有子宫内膜异位症的人在残疾索赔中面临证据障碍和对疾病、诊断和治疗的常见误解。SSDI 和 SSI 的子宫内膜异位症索赔受到系统的不利影响，尤其是那些无法获得治疗的人。医疗保健、政策和法律系统可以利用本研究的结果为那些患有慢性疼痛疾病（如子宫内膜异位症）的人创建一个更公平的残疾申请和审查系统。
