Disability Evaluation(Archived)

According to the CDC, 1 in 4 Americans lives with a disability. This equates to approximately 61 million Americans. Disability, by nature, is a dynamic concept because it involves the relationship between the patient and their injury, physical environment, social atmosphere, economic factors, and religious beliefs. Patients can be affected in functions related to cognition through functions involved with living independently. Although 2 in 5 patients above the age of 65 have a disability, anyone can become disabled at any time in their life. The number of disabled persons is forecasted to be a rapidly growing statistic for several reasons. One reason is the incidence and prevalence of obesity, heart disease, and diabetes. The aforementioned chronic conditions are all risk factors for disability, and as a result of their increase, the incidence of disability will too increase.  Another reason is the increase in life expectancy due to advances in medicine and surgery. More people are surviving what would previously be considered a life-ending ailment. However, a common complication of surviving one of these previously life-ending ailments is residual limb deformity, chronic pain, and impaired mobility, to list a few. These complications can affect the way a person interacts with their environment, therefore, leading to disability. Disability has a continuously evolving definition and legal interpretation, as can be expected by the continuous change in socioeconomics and prevalence of chronic disease. When discussing disability, it is important to understand the terminology. Simply put, three main words: impairment, disability, and handicap. Impairment is essentially a dysfunction of a body system, such as an organ system or the musculoskeletal system. This can affect how a patient interacts with their home, social, or work environments and can often present as a lack of ability to do something. This is known as a disability. It is important to highlight that not all impairments lead to a disability. Disability can be further categorized into temporary or permanent and partial or total disability. Lastly, the term handicap relates the consequences of a disability for a patient to the community or social environment.  For example, a person with an above-the-knee amputation has difficulty walking long distances and therefore needs to park their vehicle close to the entrance. As a result of the continuous evolution of disablement, its conceptualization has evolved as well. There are three main paradigms through which disablement can be viewed and interpreted.  The medical paradigm is the original model for disability guidelines. The medical model focuses on the pathology causing the impairment. It seeks to relate organ dysfunction at the simplest level to physical dysfunction. The main problem with this interpretation is that not all organ or system dysfunction has a specific treatment, therapeutic endpoint, or clear-cut disability.  The social paradigm interprets the social and functional barriers associated with certain impairments. What special accommodations are required as a result? The benefit of this paradigm is that it allows people with a disabling impairment to become empowered and participate in society. The biopsychosocial paradigm is the preferred interpretation for disablement because it is multifaceted. The biological facet incorporates any mental or physical impairment. The psychological facet attempts to interpret the emotional state of the individual and take into account various personal and religious beliefs. The social facet addresses the environmental and infrastructural changes that are required to make the physical environment adaptable for patients with disabilities. The International Classification of Functioning, Disability, and Health (ICF) currently adopts the biopsychosocial paradigm. The ICF is the current scheme for disability created by the World Health Organization, created in 2001. The ICF is a comprehensive outline that incorporates the confounding factors between disease state and impairment or, more simply put, between health and function. As eluded to earlier, there is a large legal component to disablement. The nature of the concept of disability is typically viewed in terms of ability to work and medical care costs. If someone is unable to work or participate in their environment because of a disability, they will need support from government services and legislation. In the United States, the Americans with Disabilities Act (ADA) was passed in 1990. Simply put, this piece of legislation would guarantee Americans with disabilities the equal right to employment opportunities, transportation, and public access. The ADA defines disability as “a physical or mental impairment that substantially limits one or more of the major life activities, a person who has a history or record of such impairment, or a person who is perceived by others as having such an impairment.”  The ADA is a massive piece of legislation, and so this article will only highlight the stipulations relating to employment. For further information on the ADA, please visit ada.gov. Employment is a major life activity, which in some instances can be life-sustaining. The ADA asks for reasonable accommodation of the employer unless it poses an undue hardship on the employer regarding cost or feasibility. If accommodation is provided, then there is no technical disability associated with a specific impairment in that specific environment. As mentioned before, not every impairment is a disability. For example, a soccer player with a transmetatarsal amputation may have to end his career and thus is disabled. Meanwhile, a computer technician with the same impairment may still be able to work and is therefore not disabled.  Determining the feasibility of reasonable accommodation is up to the employer. Understanding how impairment will affect a particular individual is important because it will dictate if and how compensation is received. There are several rating systems for both impairment and disability to standardize assessment. However, one common flaw to the system is that the impairment system is often used in lieu of the disability rating system due to the complexity of the process. Multiple compensation systems have their own criteria and definitions. This article will touch on some of the common disability systems before going into the rating schema. The Social Security Disability Insurance and Supplemental Social Security Income (SSDI and SSI) are two parallel disability insurance systems dictated by federal government legislation.  SSDI is a system that provides benefits to persons who worked in a qualifying job for at least 5-10 years before the onset of the disability and became disabled before the age of 65. SSI, in contrast, provides income to individuals over the age of 65 or those who are blind or disabled. SSI does not require a work history.  The process to apply for SSI starts with the Disability Determination Service. Application for SSI can either be accepted or rejected. If the latter, then it can be resubmitted for reconsideration, and in some instances, there can be a court hearing. The industrial revolution inspired the Federal Workers’ Compensation Systems at the turn of the 20th century. As more people were employed by factories and worked in dangerous working conditions, the rate of disability or death resulting from work activities increased. As a result, a monetary compensation system was developed for individuals injured while at work or as a consequence of their employment. Some examples of the Federal Worker’s Compensation programs include Federal Employees’ Act, the Longshore and Harbor Workers’ Compensation Act, Energy Employees Occupational Illness Compensation Act, and The Federal Black Lung Program. Many state programs exist as well, and they all have similar fundamental features, which include: compulsory insurance required for all employers, a no-fault system for injuries or illness acquired at work or through the course of work, wage loss benefits, survivor benefits, compensation for permanent partial or permanent total disability, and many more with various stipulations associated. The Veterans Benefits Admiration offers disability for individuals and service members previously in full-time active military service and were discharged generally or honorably. There are three broad categories: (1) A service-connected disability, which is a disability that resulted from direct injury or disease while on active duty; (2) Nonservice-connected disability, which is due to an injury not incurred while on active duty; (3) Presumptive service connection which is a category that covers various chronic conditions that manifest within 1 year from discharge from active duty. The amount of compensation is related to the severity of impairment and disability endured and is not subject to state or federal income tax.  Personal injury claims are insurance provided to individuals who have injury arising out of negligence or intentional act. Personal injury claims typically arise from motor vehicle accidents, slip and fall claims, physical assault claims, and nursing home negligence.