The disability determination dilemma: toward a multiaxial solution.

Recently the United States Social Security Administration Commission on the Evaluation of Pain recommended that a set of criteria be developed that could be used to determine 'impairment due primarily to pain.' The intention was to provide a specific and equitable system for determination of disability of social security claimants who alleged that they were disabled primarily by pain. In this paper, the social security disability determination process is described, criteria for the proposed listing of 'impairment due primarily to pain' are reviewed, and a multiaxial taxometric system for determining disability due primarily to pain is described. The social implications of the proposed listing as well as a multiaxial taxometric approach for the social security disability system are described. Impediments to solutions to the disability determination problems confronting the Social Security Administration are discussed, and a scientific approach is contrasted with the current legal decision making process, as it relates to the awarding of Social Security disability benefits.