The document provides guidelines for assessing disability for determining eligibility for benefits. Old guidelines from 1986 and 1998 are summarized. The process of certification involves a medical board assessment. A minimum 40% permanent impairment is required for benefits. Various body parts and functions are evaluated, with percentages assigned based on impairment levels. The newest guidelines provide more detailed assessments for various disabilities like upper and lower extremities, spine, amputations, and neurological conditions. Assessments consider range of motion, coordination, sensation, strength and additional factors. The maximum impairment percentage is capped at 100%.

1. DISABILITY
ASSESMENT-LATEST
GUIDELINES
DR.R.BALAMURUGAN
M.D PMR ,3 RD YR P.G

2. Old guidelines
 Guidelines for evaluation of various disabilities and
procedure - ministry of welfare’s O.M. No.
4-2/83-HW-III dated 6th Aug 1986.
 Govt of India and Ministry Social Justice and
Empowerment, vide order No 16-18/97-NI dated
28-8-1998 set up four committees under
chairmanships of DGHS, one each in the area of
locomotor/orthopedic, Visual, Speech & Hearing
disability and mental retardation
 On 21-7-1999 one more committee for multiple
disability

3. Process of certification
 Medical board of three members constituted by central
and the state Govt. out of which one member shall be
specialist from either the field of Phy Med and Rehab
or orthopedic
 Two specimen copies of disability certificate
 Chairmen of the board may co-opt other experts
 Medical board may review its decision having regard
to all the facts and circumstances of the case and pass
such order in the matter as it thinks fit

4. Assessment Permanent Impairment
 Minimum degree of disability should be 40% for
any concessions/benefits.
 Medical board duly constituted by central and state
government.
 State government may constitute medical board
consisting of at least three members out of which at
least one shall be a specialist in the particular field
for assessing disability

5.  Specified evaluation test should be conducted by
medical board and recorded before a certificate
given
 The certificate would be valid for five years in -
temporary disability
 State Government administrations may constitute
the medical boards
 DGHS, Ministry of health and family welfare will
be the final authority

6. Guidelines for evaluation of permanent physical
Impairment (PPI)
Upper extremities
 Depends upon the measurement of functional
impairment and not on expression of a personal
opinion
 Clinical condition has reached maximum
improvement from the medical treatment
 Upper arm – Arm and Hand component
 Arm component -Loss of motion, muscle strength
and co-ordinate activities
 Hand component – Prehension, sensation and
strength
 Combination of functional impairments of both

7. Upper Extremities
Arm Component (90%)
Evaluation of Range of Motion
Maximum ROM in arm component is 90%
Each of the three joints of the arm is weighed equally (30%)
Shoulder Normal Active Loss of
ROM
Flexion 0-220 110 50%
Rotation 0-180 90 50%
Abduction 0-180 90 50%
Mean loss of ROM shoulder (50+50+50)/3 50%
Loss motion of arm component is 50X0.30=15%
If more than one joint of the arm is involved the mean loss
percentage
in each joint is calculated separately and the added together

8. Upper Extremities
Coordinated activities (90%)
Ten Coordinated activities tested
Each coordinated activity has value of 9%
1. Lifting overhead objects remove and placing at the same place
2. Touching nose with finger
3. Eating Indian style
4. Combing and plating
5. Putting on shirts/ kurta
6. Ablution in Indian style
7. Drinking glass of water
8. Buttoning
9. Tie Nara/Dhoti
10.Writing

9. Upper Extremities
 Combining values for the Arm component
 Total value of loss of function of Arm component is
obtained by combining the value loss of ROM,
Muscle strength and coordinated activities, using
the combining formula
a+ b(90-a)
90
a= higher value b= lower value

10. Upper Extremities
Hand Component(90%)
 Functional impairment of hands are
Loss of Prehension
Loss of sensation
Loss of strength

11. Upper Extremities
Prehension (30%)
 A. Opposition 8%
Index -2%, Middle-2%
Ring -2%, Little-2%
 B. Lateral pinch 5%
 C. Cylindrical 6%
Large -3%, Small-3%
 D. Spherical grasp 6%
Large-3%, small-3%
 E. Hook grasp 5%

12. Upper Extremities
Sensation(30%)
 Complete loss of sensation
Thumb 9%
Index 6%
Middle 5%
Ring 5%
Little finger 5%
For partial loss of sensation assessment
should be made according to percentage
of sensation

13. Upper Extremities
Strength (30%)
 Grip 20%
 Pinch 10%

14. Upper Extremities
Additional Weightage (10%)
1. Pain
2. Infection
3. Deformity
4. Mal-alignment
5. Contractures
6. Cosmetic disfiguration
7. Dominant extremity -4%
8. Shortening of upper limb
first 1” no weightage
1” Beyond, every inch is-2%
Extra pts should not exceed 10% of the arm component
Total PPI should not exceed 100% in any time

15. Upper Extremities
 Combining value of loss of function of hand
component: By summing up values of Prehension,
sensation, and strength.
 Combining values for the extremity: Impairment of
arm and hand component should be added by using
combining formula
a+b(90-a)
90

16. Guidelines for evaluation of permanent physical Impairment
(PPI)
Lower extremities
 Mobility component (90%)
Range of motion
Muscle strength
 Stability component (90%)

17. Lower extremities
Stability (90%)
 There are 10 activities
Each activity has value of 10%
1. Walking on plane surface
2. Walking on slope
3. Climbing stairs
4. Standing on both legs
5. Standing on affected legs
6. Squatting on floor
7. Sitting cross leg
8. Kneeling
9. Taking turns

18. Lower extremities
Additional weightage
Deformity: a. Functional position 3%
b. Non functional 6%
Pain: Severe 9%
Moderate 6%
Mild 3%
Loss of sensation: Complete loss 9%
Partial loss 6%
Complications: Superfecial 3%
Deep 6%
Shortening: first ½” nil
After ½” every 1’’ 4%

19. Spine (Trunk)
 Spinal deformity tends to change over period of
years the certificate issued should be reviewed
 Impairment should be awarded in relation to spine
 Additional neurological deficit should be added by
combining formula

20. Traumatic and non traumatic Spinal
lesions
Traumatic:
 Cervical spine
 Thoracic and thoraco-lumbar spine
 Lumbar and Lumbo-sacral spine

21. Spinal lesions
Non traumatic lesions:
 Scoliosis: Largest curve
 Cobb’s: line drawn at each end of the primary
curve - plain x-ray
0-20 Nil
21-50 10%
51-100 20%
101 & above 30%

22. Amputee
 In Multiple amputee PPI above 100% should be
taken as 100%
 Stump unfitting –extra 5%
 More than one amputee combining formula
 Complications ex. Neuroma, oteomylities extra
10%
 Dominant upper extremity 4% extra

23. Upper Limb Amputation
PPI & loss of physical
function each limb(%)
 Fore-quarter amputation 100
 Shoulder disarticulation 90
 Above elbow up to upper1/3 of arm 85
 Above elbow up to Lower1/3 of arm 80
 Elbow disarticulation 75
 Below elbow up to upper 1/3 of forearm 70
 Below elbow up to lower 1/3 of fore arm 65
 Wrist disarticulation 60
 Hand through carpal bones 55
 Thumb through C.M. or 1st MC Joint 30
 Thumb disarticluation through 1st MC joint or
Through proximal phalanx 25
 Thumb disarticulation through IP joint or
through distal phalanx 15

24. Upper Limb Amputation-
Finger Amputation
Index Middle Ring little
15% 5% 3%
2%
 Amputation through Proximal 15 5 3 2
phalanx or disarticulation
through MP Joint
 Amputation through proximal 10 4 2 1
phalanx or disarticulation
through PIP Joint
 Amputation through distal 5 2 1 1
phalanx or through DIP Joint

25. Lower Limb Amputations
PPI & loss of physical
function each
limb(%)
 Hind quarter amputation 100
 Hip disarticulation 90
 Above knee up to upper 1/3 of thigh 85
 Above knee up to lower 1/3 of thigh 80
 Through knee 75
 Below up to 8cm 70
 Below up to lower 1/3 of leg 60
 Through ankle 55
 Syme’s amputation 50
 Up to mid-foot 40
 Up to fore-foot 30

26. Lower Limb Amputations
Toes
PPI & loss of physical
function each
limb(%)
Loss of all toes 20
Loss of first toe
10
Loss of second toe 5
Loss of third toe 4
Loss of fourth toe 3
Loss of fifth toe 2

27. Neurological Impairments
 Assessment of clinical manifestations
 Central and upper motor neuron lesions
 Lower motor lesions, muscular disorders and other
locomotor conditions
 Certification- six months after the onset of disease
 Total percentage should not exceed 100%
 Mixed score- combining formula
 Dominant hand 4%
 Loss of sensation 10%

28. Neurological Impairments
 Neurological status
 Intellectual impairment
 Speech
 Cranial nerve involvement
 Motor system
 Sensory system
 Bladder
 Post head injury fits and epileptic convulsions
 Ataxia

29. Neurological Status
 Altered sensorium 100% Physical
impairment

30. Motor System Impairment
Hemiparesis Physical
impairment(%)
Mild 25
Moderate 50
Severe 75

31. Sensory System Impairment
Severity Physical impairment(%)
Anaesthesia Up to 10% for each limb
Hypoaesthesis Depending upon % of loss
of sensation
Paraesthesis Depending loss of
sensation up to
30% depending
upon extent
Hands and feet Depending upon % loss
of sensation

32. Bladder Disability due to Neurological
Impairment
Bladder involvement Physical
impairment(%)
Mild (hesitancy/frequency) 25
Moderate (precipitancy) 50
Severe (occasional but recurrent 75
incontinence)
Very severe (retention/total 100
incontinence

33. Post Head Injury Epileptic
Convulsions
Frequency/severity of Convulsions Physical
impairment(%)
Mild occurrence of one convulsion Nil
Only
Moderate 1-5 convulsions/month on 25
Adequate medication
Severe 6-7 convulsions/month on 50
Adequate medication
Very severe more than 10 convulsions/ 75
Month on adequate medication

34. Ataxia (Sensory or Cerebellar)
Severity of ataxia Physical impairment(%)
Mild (detected on
examination) 25
Moderate 50
Severe 75
Very severe 100

35. Multiple disability
1.Locomotor
2.Vision
3.Speech and hearing
4.Mental retardation
5.Mental illness
Use combining formula
Maximum score should not exceed 100%

36. Anomalies
 Uniform definitions notified by Givt. India is
endowed with anomalies
Example:
PPRP involving one lower limb is 90%
PPRP involving both upper limbs also 90%
Muscular dystrophy involving both upper
limb and lower limbs is only 85.05%
anomalies
 Though true magnitude of physical impairment
exceeds 100%, this system has disadvantage
of ceiling the maximum impairment to 100%

37. Conclusion
 Disability evaluation and certification is must for
every disabled to claim for various concessions
and benefits
 Evaluation of disability percentage should be done
as per guidelines issued in gazette notification.
 The minimum degree of disability should be 40%
in order to be eligible for various concessions and
benefits

38. THANK YOU