Sex and Gender Identification and Implications for Disability Evaluation (2024)
Chapter: Part III: Sex, Gender, and Disability Determinations Introduction
Part III
Sex, Gender, and Disability Determinations Introduction
With an understanding of the collection of sex and gender data in clinical practice (Part I) and a foundation of care and treatment for transgender and gender diverse (TGD) people and people with variations in sex traits (VSTs) (Part II), the final portion of this report examines the specific disability Listings within the statement of task and responds to the Social Security Administration’s (SSA’s) questions about whether changes in disability criteria may be warranted to assess these conditions accurately for TGD applicants and applicants with VSTs, considering current guidelines and standards of care.
Chapter 8 reviews Listings for adult and childhood respiratory disorders, including asthma, chronic obstructive pulmonary disease, and cystic fibrosis. Here, the committee examines the sex-specific pulmonary function tests contained in disability criteria—including spirometry and diffusing capacity of the lungs tests—assessing whether these tests are appropriate for measuring pulmonary function among TGD people and people with VSTs, or whether alternative measures may be more appropriate.
Chapter 9 examines the pediatric weight-for-length and body mass index–for-age tables. Both are gendered and may have implications for appropriate measurement for childhood disability applicants who are TGD or who have VSTs.
Chapter 10 reviews adult and childhood kidney disease and the use of estimated glomerular filtration rate (eGFR)—a common test of kidney function that has sex-specific criteria. Here the committee assesses whether eGFR is appropriate for measuring kidney function among TGD and VST populations, or whether alternative measurements may be more appropriate.
Chapter 11 focuses on reproductive cancers, including “cancers of the female genital tract” (which includes cancers of the uterus, uterine cervix, vulva, vagina, fallopian tubes, and ovaries) and cancers of the prostate gland, testicles, and penis. Here, the committee reviews current guidelines that recommend screening based on organs rather than gender identity or sex recorded at birth, and evaluates whether the language SSA uses to describe reproductive cancers could be updated to be more inclusive of TGD people and people with VSTs.
Chapter 12 reviews the gender-specific language under the disability Listing “HIV infection manifestations specific to women,” and, similar to the analysis of reproductive cancers in Chapter 11, reviews whether language under this Listing could be worded differently to capture data on TGD people and people with VSTs more accurately.
Finally, in Chapter 13, the committee gives an overview of the various types of experts who inform SSA disability determinations at different stages in the process. The committee draws a few conclusions about where, within its current policies and processes, SSA might consider opportunities to ensure that these experts have the information and tools they need to make appropriate disability determinations for TGD applicants and applicants with VSTs.
