Concept Of Disability

DISABILITY DEFINITION           

DEFINITION & TYPES OF DISABILITY

Govt of India, in terms of “Person with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995, defines disability as:

“Disability” means-

  1. Blindness;
  2. Low vision;
  3. Leprosy-cured;
  4. Hearing impairment;
  5. Locomotor disability;
  6. Mental Retardation;
  7. Mental illness;

Blindness” refers to a condition where a person suffers from any of the following conditions, namely:-

  1. Total absence of sight. or
  2. Visual acuity not exceeding 6160 or 201200 (snellen) in the better eye with correcting lenses; or
  3. Limitation of the field of vision subtending an angle of 20 degree or worse.

“Leprosy cured person” means any person who has been cured of leprosy but is suffering from-

  1. Loss of sensation in hands or feet as well as loss of sensation and paresis in the eye and eye-lid but with no manifest deformity;
  2. Manifest deformity and paresis; but having sufficient mobility in their hands and feet to enable them to engage in normal economic activity;
  3. Extreme physical deformity as well as advanced age which prevent him from undertaking any gainful occupation, and the expression “leprosy cured” shall be construed accordingly.

“Hearing impairment” means loss of sixty decibels or more in the better year in the conversational range of’ frequencies.

“Locomotor disability” means disability of the bones, joints muscles leading to substantial restriction of the movement of the limbs or any form of cerebral palsy.

“Cerebral palsy” means a group of non-progressive conditions of a person characterized by abnormal motor control posture resulting from brain insult or injuries occurring in the pre-natal, peri-natal or infant period of development.
“Mental retardation” means a condition of arrested or incomplete development of mind of a person which is specially characterized by sub normality of intelligence.
“Mental illness” means any mental disorder other than mental retardation.

According to National trust for the welfare of persons with autism, cerebral palsy, mental retardation and multiple disabilities Act, 1999,

“Autism” means a condition of uneven skill development primarily affecting the communication and social abilities of a person, marked by repetitive and ritualistic behaviour.

“Cerebral Palsy” means a group of non-progressive conditions of a person characterized by abnormal motor control posture resulting from brain insult or injuries occurring in the pre-natal, perinatal or infant period of development.

“Mental Retardation” means a condition of arrested or incomplete development of mind of person which is specially characterised by sub-normality of intelligence.

“Multiple Disabilities” means a combination of two or more disabilities as defined in clause (i) of section 2 of the Person with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995.

In broader terms, WHO defines disability as follows:

“Disability is an umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. Thus disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives.”

Furthermore, International Classification of Functioning, Disability and Health (ICF) developed by the World Health Organization (WHO) identifies different components of functioning, disability and health. These components are followings:

Body functions are the physiological functions of body systems (including psychological functions).
Body structures are anatomical parts of the body such as organs, limbs and their components.
Impairments are problems in body function or structure such as a significant deviation or loss.
Activity is the execution of a task or action by an individual.
Participation is involvement in a life situation.
Activity limitations are difficulties an individual may have in executing activities.
Participation restrictions are problems an individual may experience in involvement in life situations.
Environmental factors make up the physical, social and attitudinal environment in which people live and conduct their lives.

WHAT IS DISABILITY CERTIFICATE

The Disability Certificate is not just a document for a person with disability but a proof of his/her disability and an important tool for availing the benefits / facilities / rights that they are entitled to, from the Central as well as State Government under various appropriate enabling legislations. Disability Certificates are issued by three-member Medical Boards constituted at the District level, involving a cumbersome and time consuming procedure making access to the certificates difficult. Only, about 35% of persons with disabilities had been issued disability certificates as in October, 2010.

The Ministry of Social Justice and Empowerment had notified procedures for the Medical Boards of District Civil hospitals for issuance, assessments and the format of Disability Certificate. Details of the existing procedures are listed below.

However in view of the difficulties faced by people across the country in availing of Disability Certificates and the procedural problems, the Ministry of Social Justice and Empowerment, is currently reviewing the matter and has sought comments and suggestions from the concerned agencies/users.

1.   Conditions for obtaining Disability Certificate

In order to become eligible for obtaining the Disability Certificate, a person with disability should fulfill the following conditions:

  1. To be a Indian citizen.
  2. To possess medical reports explaining type of his/her disability.
  3. The minimum degree of disability should be 40% in order to be eligible.

2.  Procedure for obtaining Certificate

  • Parent of a person with disability, or a person himself, should approach to the District hospital with his request for obtaining Disability Certificate providing the following documents:-
    1. Copy of I.D. of the person with disability and 2 photographs showing the disability part.
    2. Copy of all medical and psychological reports available.
  • Medical Board distributes the cases to the medical sub-committees specialized for different types of disabilities, according to the medical diagnosis of the person with disability.
  • Medical Board issues the Disability Certificate to the person with disability that he should receive from the District Hospital, after its verification by the Head of the Medical Board.
  • The State Governments / UT Administrations may constitute the medical boards
  • The Director General of Health Services Ministry of Health and Family Welfare will be the final authority, should there arise any Controversy/doubt regarding the interpretation of the definitions/classifications/evaluations tests etc.

3.  Process of Certifications:

      i. Mental Retardation
A disability certificate shall be issued by a Medical Board consisting of three members duly constituted by the Central/State Government. At least, one shall be a Specialist in the area of mental retardation, namely, Psychiatrist, Pediatrician and clinical Psychologist.

The examination process will consist of three components, namely, clinical assessment, assessment of adaptive behavior and intellectual functioning.

      ii. Visual Disability
A disability certificate shall be issued by a Medical Board duly constituted by the Central/State Government having, at least three members. Out of which, at least one member shall be a specialist in ophthalmology.

      iii. Speech and Hearing Disability
A disability certificate shall be issued by a Medical Board duly constituted by the Central and the State Government. Out of which, at least, one member shall be a specialist in the field of ENT.

      iv. Locomotor Disability
A disability certificate shall be issued by a Medical Board of three members duly constituted by the Central and the State Government, out of which, at least, one member shall be a specialist from either the field of Physical Medicine and Rehabilitation or Orthopedics.

      v. Multiple Disability

The procedure will remain the same as of various single disabilities. The final disability certificate for multiple disability will be issued by Disability Board which has given higher score of disability by combining the score of different disabilities using the combining formula, i.e.,

a + b (90-a).                                 90

In case, where two scores of disability are equal, the final certificate of multiple disability will be issued by any one of them as decided by Local authority.

      vi. Permanent/temporary certificate

The certificate would be valid for a period of five years for those whose disability is temporary. For those who acquire permanent disability, the validity can be shown as ‘Permanent’.

If permanent disability certificate is not issued, then the Medical Board has to specifically mention whether the condition is progressive/non-progressive/likely to improve/not likely to improve and the Re-assessment is not recommended or re-assessment is recommended after a given period.

      vii. Procedure for obtaining Disability Card

A parent of the person with disability, or that person himself, will approach to the District Hospital providing all necessary documents and reports as following:

§  Copy of the Disability Certificate.

§  Two (2) personal photos.

§  Copy of I.D. of the person with disability.

§  Copy of the residence.

§  Disabled Welfare Department/ District hospital should issue the disability card to the person at the same time, after the sighing authority has signed it.

      viii. Advantages granted to the owner of Disability Card

After perusal of the disability certificate, issued in any manner, should be a certificate valid for all practical and theoretical purposes, where the factor of an individual being a person with a disability is material.

All these schemes and services provided to Persons with disabilities differ from state wise. Some services are common but this need to standardize for every individual.

  • Award of Scholarship to the disabled students
  • Programme for assistance for higher education to disabled
  • Assistance for prosthetic aids and appliances to disabled
  • Free travels in state transport buses for disabled, issue of free bus pass
  • Provision for loans for self employment
  • Grant of Incentive for Marriage between Disabled and normal persons.
  • Grant of Fuel subsidy to disabled person who own motorized vehicle.
  • Payment of Un-employment Allowance to educated disabled persons
  • Financial assistance to totally disabled persons
  • Incentive for Eye Donors
  • Reimbursement of maintenance cost of tricycles
  • Supply of sarees and dhoties to disabled persons
  • State award for the welfare of the handicapped
  • Supply of prosthetic appliances to disabled persons
  • Supply of cooling glasses, Braille watches and walking sticks
  • Group insurance for disabled government employees
  • Group insurance for disabled other than government employees
  • Financial assistance towards funeral expenses of the disabled
  • Supply of invalid carriages (motorized tri-cycles) to the persons with disabilities
  • Supply of musical / sports items to physically handicapped
  • Welfare associations group insurance for disabled
  • Annual tour for disabled persons
  • International day for the disabled

GUIDELINES FOR EVALUATION OF DISABILITIES AND PROCEDURE FOR CERTIFICATION

  1. In order to review the guidelines for evaluation of various disabilities and procedure for certification as given in the Ministry of Welfare’s O.M. No. 4-2/83-HW.-III, dated the 6th August, 1986 and to recommend appropriate modifications/alterations keeping in view the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995, Government of India in Ministry of Social Justice and Empowerment, vide Order No. 16-18/97-NI. I, dated 28-8-1998, set up four committees under the Chairmanships of Director General of Health Services-one each in the area of mental retardation, Locomotor/ Orthopaedic disability, Visual disability and Speech and Hearing disability. Subsequently, another Committee was also constituted on 21-7-1999 for evaluation, assessment of multiple disabilities and categorization and extent of disability and procedures for certification.2. After having considered the reports of these committees the undersigned is directed to convey the approval of the President to notify the guidelines for evaluation of following disabilities and procedure for certification:-

 

  • Visual impairment
  • Locomotor / Orthopaedic disability
  • Speech and hearing disability
  • Mental retardation
  • Multiple Disabilities.
  1. The minimum degree of disability should be 40% in order to be eligible for any concessions/benefits.

4. According to the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Rules, 1996 notified on 31.12.1996 by the Central Government in exercise of the powers conferred by sub-section (1) and (2) of section 73 of the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 (1of 1996), authorities to give disability Certificate will be a Medical Board duly constituted by the Central and the State Government. The State government may constitute a Medical Board consisting of at least three members out of which at least one shall be a specialist in the particular field for assessing locomotor /Visual including low vision/hearing and speech disability, mental retardation and leprosy cured, as the case may be.

5. Specified test as indicated in Annexure should be conducted by the medical board and recorded before a certificate is given.

6. The certificate would be valid for a period of five years for those whose disability is temporary. For those who acquire permanent disability, the validity can be shown as ‘Permanent’.

7. The State Governments/UT Administrations may constitute the medical boards indicated in para 4 above immediately, if not done so far.

8. The Director General of Health Services Ministry of Health and Family Welfare will be the final authority, should there arise any Controversy/doubt regarding the interpretation of the definitions/classifications/evaluations tests etc.

  • MENTAL RETARDATION

 

  1. Definition: Mental retardation is a condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills manifested during the development period which contribute to the overall level of intelligence, i.e., cognitive, language, motor and social abilities.
  2. Categories of Mental Retardation:
    1. Mild Mental Retardation: The range of 50 to 69 (standardised IQ test) is indicative of mild retardation. Understanding and use of language tend to be delayed to a varying degree and executive speech problems that interfere with the development of independence may persist into adult life.
    2. Moderate Mental Retardation: The IQ is in the range of 35 to 49. Discrepant profiles of abilities are common in this group with some individuals achieving higher levels in visuo-spatial skills than in tasks dependent on language while others are markedly clumsy by enjoy social interaction and simple conversation. The level of development of language in variable: some of those affected can take part in simple conversations while others have only enough language to communicate their basic needs.
    3. Severe Mental Retardation: The IQ is usually in the range of 20 to 34. In this category, most of the people suffer from a marked degree of motor impairment or other associated deficits indicating the presence of clinically significant damage to or mal-development of the central nervous system.
    4. Profound Mental Retardation: The IQ in this category estimated to be under 20. The ability to understand or comply with requests or instructions are severally limited. Most of such individuals are immobile or severally restricted in mobility, incontinent and capable at most of only very rudimentary forms of non-verbal communication. They posses little or no ability to care for their own basic needs and require constant help and supervision.
  3. Process of Certifications:-
    1. A disability certificate shall be issued by a Medical Board consisting of three members duly constituted by the Central/State Government. At least, one shall be a Specialist in the area of mental retardation, namely. Psychiatrist, Paediatrician and clinical Psychologist.
    2. The examination process will consist of three components, namely, clinical assessment, assessment, of adaptive behaviour and intellectual functioning.

 

  1. VISUAL DISABILITY
  1. Definition: – Blindness refers to a condition where a persons suffers from any of the condition, namely,
    1. total absence of sight; or
    2. visual acuity not exceeding 6/60 or 20/200(snellen) in the better eye with best correcting lenses; or
    3. limitation of field of vision subtending an angle of 20 degree or worse;
  2. Low Vision: – Persons with low vision means a person a with impairment of vision of less than 6/18 to 6/60 with best correction in the better eye or impairment of field in any one of the following categories:-
  1. reduction of fields less than 50 degrees
  2. Heminaopia with macular involvement
  3. Altitudinal defect involving lower fields.
  • Categories of Visual Disability: All with correction
Category Better eye Worse eye % age impairment
Category 0 6/9-6/18 6/24 to 6/36 20%
Category I 6/18-6/36 6/60 to Nil 40%
Category II 6/40-4/60 or field
of vision 10o -20o
3/60 to Nil 75%
Category III 3/60 to 1/60 or field
of vision 10o
F.C. at 1 ft. to Nil 100%
Category IV F. C. at 1 ft. to Nil
or
field of vision 10o
F.C. at 1 ft. to Nil 100%
One eyed persons 6/6 F. C. at 1 ft. to Nil
or field of vision 10o
30%

Note: F.C. means Finger Count

  • Process of Certification

A disability certificate shall be issued by a Medical Board duly constituted by the Central/State Government having, at least three members. Out of which, at least one member shall be a specialist in ophthalmology.

  1. SPEECH AND HEARING DISABILITY
  1. Definition of Hearing: – A persons with hearing impairment having difficulty of various degrees in hearing sounds is an impaired person.
  2. Categories of Hearing Impairment.
Category Type of Impairment D B Level Speech discrimination % age of impairment
I Mild hearing Impairment DB 26 to 40
dB in better ear
80 to 100% in
better ear
Less than
40% to 50%
II (a) Moderate
hearing
41 to 60 dB in
better ear
50 to 80%in
better ear
40% to 50%
II (b) Serve hearing
Impairment
61 to 70 dB
hearing Impairment
in better ear
40 to 50% in
better ear
51% to 70%
III Profound hearing Impairment
Total deafness
71 to 90 dB

91 dB and
above/in
better ear/to
hearing

Less than 40%
in better ear
Very Poor
discrimination
71% to 100%

100%

    1. Pure tone average of learning in 500, and 2000 HZ, 4000 HZ by conduction (AC and BC ) should be taken as basis for consideration as per the test recommendations.
    2. When there is only as island of hearing present in one or two frequencies in better ear, it should be considered as total loss of hearing.
    3. Wherever there is no response (NR) at any of the 4 frequencies (500, 1000,2000 and 4000 HZ), it should be considered as equivalent to 100 dB loss for the purpose of classification of disability and in arriving at the average.
  1. Process of Certification
    A disability certificate shall be issued by a Medical Board duly constituted by the Central and the State Government. Out of which, at least, one member shall be a specialist in the field of ENT.
  1. LOCOMOTOR DISABILITY
  1. Definition:
    1. Impairment: An impairment in any loss or abnormality of psychological, physiological or anatomical structure or function in a human being.
    2. Functional Limitations: Impairment may cause functional limitations which are partial or total inability to perform those activities, necessary for motor, sensory or mental function within the range or manner of which a human being is normally capable.
    3. Disability: A disability, is any restriction or lack. ( resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.
    4. Locomotor Disability: Locomotor disability is defined as a persons inability to execute distinctive activities associated with moving both himself and objects, from place to place and such inability resulting from affliction of musculoskeletal and/or nervous system.
  2. Categories of Locomotor Disability
    The categories of locomotor disabilities are enclosed at Annexure-A.
  3. Process of Certification
    A disability certificate shall be issued by a Medical Board of three members duly constituted by the Central and the State Government, out of which, at least, one member shall be a specialist from either the field of Physical Medicine and Rehabilitation or Orthopaedics.

Two specimen copies of the disability certificate for mental retardation and others (visual disability, speech and hearing disability and locomotor disability) are enclosed at Annexure-B.

It was also decided that whenever required the Chairman of the Board may co-opt other experts including that of the members constituted for the purpose by the Central and the State Government.

On representation by the applicant, the 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.

 

ANNEXURE- A: LOCOMOTOR DISABILITY

REVISED GUIDELINES FOR EVALUATION OF THE PERMANENT PHYSICAL IMPAIRMENT

1.1 Guidelines for Evaluation of Permanent Physical Impairment of Upper Limb

  1. The estimation of permanent impairment depends upon the measurement of functional impairment and is not expression of a personal opinion.
  2. The estimation and measurement should be made when the clinical condition has reached the stage of maximum improvement from the medical treatment. Normally the time period is to be decided by the medical doctor who is evaluating the case for issuing the PPI Certificate as per standard format of the certificate.
  3. The upper limb is divided into two component parts; the arm component and the hand component.
  4. Measurement of the loss of function of arm component consists of measuring the loss of motion, muscle strength and co-ordinated activities.
  5. Measurement of loss of function of hand component consists of determining the prehension, sensation and strength. For estimation of prehension opposition, lateral pinch cylindrical grasp, spherical grasp and hook grasp have to be assessed as shown in Hand Component of Form A: Assessment Proforma for upper extremity.
  6. The impairment of the entire extremity depends on the combination of the functional impairments of both components
  1. 2 ARM COMPONENT
    Total value of arm component is 90%

1.2.1 Principles of evaluation of range of motion (ROM) of joints

  1. The value of maximum ROM in the arm component is 90%
  2. Each of the three joints of the arm is weighed equally (30%;

Example:
The intra articular fractures of the bones of right shoulder joint may affect range of motion even after healing. The loss of ROM should be calculated in each arc of motion as. envisaged in the Assessment Form A (Assessment Proforma for Upper Extremity).

Arc of ROM Normal value Active ROM Loss of ROM
Shoulder Flexion- 0-220 110 50%
Rotation 0-180 90 50%
Abduction-Adduction 0-180 90 50%

Hence the mean loss of ROM of shoulder will be 50+50+50/3 =150/3 = 50%
Shoulder movements constitute 30% of the motion of the arm component, therefore the loss of motion for arm component will be 50 X 0.3d = 15% If more than one joint of the arm is involved the loss of percentage in each joint is calculated separately as above and then added together.

1.2.2. Principles of evaluation of strength of muscles:

  1. Strength of muscles can be tested by manual method and graded from 0-5 as advocated by Medical Research Council of Great Britain depending upon the strength of the muscles.
  2. Loss of muscle power can be given percentages as follows:
Manual muscle Strength grading Loss of Strength in percentage
0 100%
1 80%
2 60%
3 40%
4 20%
5 0%
  1. The mean percentage of loss of muscle strength around a joint is multiplied by 0.30.
  2. If loss of muscle strength involves more than one joint the mean loss of percentage in each joint is calculated separately and then added together as has been described for loss of motion.

1.2.3 Principles of evaluation of coordinated activities:

1 The total value for coordinated activities is 90% Ten different coordinated activities should be tested as given in Form A. (Appendix.I of Annexure-A)

2. Each activity has a value of 9%

1.2.4 Combining values for the Arm Component:

The total value of loss of function of arm component is obtained by combining the value of loss of ROM, muscle strength and coordinated activities, using the combing formula.

a+b(90-a)
      90

where a = higher value
b = lower value

Example:
Let us assume that an individual with an intra articular fracture of bones of shoulder joint in addition to 16.5% loss of motion in arm has 8.3% loss of strength of muscles and 5% loss of coordination. These values should be combined as follows:

Loss of ROM – 16.5% 16.5+8.3(90-16.5)
90
Loss of strength of muscles – 8.3% =23.33%
To add
Loss of coordination – 5% 23.3+5(90-23.3)=27 0%
90

So the total value of loss of function in Arm component will be 27.0%

1.3 HAND COMPONENT:

  1. Total value of hand component is 90%.
  2. The functional impairment of hand is expressed as loss of prehension, loss of sensation and loss of strength.

1.3.1 Principles of evaluation of prehension:

  1. Total value of prehension is 30% it includes
Opposition 8%
Tested against Index finger -2%
Middle finger-2 %
Ring -2%
Little finger – 2%
    1. Lateral pinch -5% – Tested by asking the patient to hold a key between the thumb and lateral side of index finger.
    2. Cylindrical grasp – 6% Tested for
      1. Large object of 4 inches size -3%
      2. Small object of 1 inch size – 3%
    3. Spherical grasp -6% Tested for
      1. Large object of 4 inches size – 3%
      2. Small object of 1 inch size – 3%
    4. Hook grasp – 5% -Tested by asking the patient to lift a bag

1.3.2. Principles of Evaluation of sensation:

  1. Total value of sensation in hand is 30%
  2. It should be assessed according to the distribution given below:
    1. Complete loss of sensation
      1. Thumb ray 9%
        Index finger 6%
        Middle finger 5%
        Ring finger 5%
        Little finger 5%
    2. Partial loss of sensation: Assessment should be made according to percentage of loss of sensation in thumb/finger(s)

1 33. Principles of Evaluation of strength

  1. Total value of strength is 30%
  2. It includes:
    1. Grip strength 20%
    2. Pinch strength 10%

Strength of hand should be tested with hand dynamo-meter or by clinical method (grip method).

Additional Weightage – A total of 10% additional weightage can be given to following accompanying factors if they are continuous and persistent despite treatment

  1. Pam
  2. Infection
  3. Deformity
  4. Mat-alignment
  5. Contractures
  6. Cosmetic disfiguration
  7. Dominant extremity-4%
  8. Shortening of upper limb

First 1″ – No weightage
For each 1″ beyond first 1″ -2%

The extra points should not exceed 10% of the total Arm Component and total PPI should not exceed 100% in any case.

1.3.4. Combining values of hand component:

The final value of loss of function of hand component is obtained by summing up values of loss of prehension, sensation and strength.

1.3.5. Combining values for the Extremity:

Values of impairment of arm component and impairment of hand component should be added by using combining formula:

a+b (90-a) a= higher value
90    b= lower

Example:
Impairment of Arm – 27% 64+27(90-64)
90
Impairment of hand – 64% =71.8%

The total value can also be obtained by using the Ready Recknoer table for combining formula given at Appendix ll of Annexure A.

  1. Guidelines for Evaluation of permanent physical Impairment in Lower Limb. 

    The measurement of loss of function in lower extremity is divided into two components: Mobility and standing components

2.1 Mobility Component:-

  1. Total value of mobility component is 90%
  2. It includes range of movement (ROM) and muscle strength

2.1.1. Principles of Evaluation of Range of Movement:

  1. The value of maximum range of movement in mobility component is 90%
  2. Each of three joints i.e. hip, knee and foot-ankle component is weighed equally – 30%.

Example:
A fracture of right hip joint bones may affect range of motion of the hip joint. Loss of ROM of the affected hip in different are should be assessed as given in Form B (Assessment Proforma for lower extremity). (Appendix.I of Annexure.A)

Affected Joint – Rt. Hip:
Arc of Movement
Normal ROM Active ROM Loss in percentage
Flexion-Extension 0-140 70 50%
Abduction-Adduction 0-90 60 33%
Rotations 0-90 30 66%

Mean loss of ROM of Rt Hip =50+33+66= 50%
3

Since the hip constitute 30% of the total mobility component of the lower limb the loss of motion in relation to the lower limb will be 50 x 0.30=15%

If more than one joint of the limb is involved the mean loss of ROM in percentage should be calculated in relation to individual joint separately and then added together as follows to calculate the loss of mobility component in relation to that particular limb.

For example.

Mean loss of ROM of Rt. Hip 50%
Mean loss of ROM Rt. Knee 40%
Loss of mobility component of Rt. Lower Limb will be
(50 x 0.30)+(40 x 0.30) = 27%

2.1.2. Principle of Evaluation of Muscle Strength:

  1. The value for maximum muscle strength in the limb is 90%.
  2. Strength of muscles can be tested by Manual Method and graded 0-5 as advocated by MRC of Great Britain depending upon the residual strength in the muscle group.
  3. Manual muscle grading can be given percentage like below:
Power Grade of Ms Loss of strength in percentage
0 100%
1 80%
2 60%
3 40%
4 20%
5 0%
  1. Mean percentage of muscle strength loss around a joint is multiplied by 0.30 to calculate loss in relation to limb.
  2. If there has been a loss muscle strength involving more than one joint the values are added as has been described for loss of ROM.

 

2.1.3. Combining values for mobility component:

1. The values of loss of ROM and loss of muscle strength should be combined with the help of
combining formula: a+b(90-a)
                                      90
(a = higher value, b = lower value)

Example: Let us assume that the individual with a fracture of right hip bones has in addition to 16% loss of motion, 8% loss of muscle strength also.

Combined values

Motion-16% 16+8(90-16)
90

Strength-8% =22.6%

2.2 Stability component:

1. Total value of the stability component is 90%

2. It should be tested by clinical method as given in From B (Assessment Proforma for lower extremity). There are nine activities, which need to be tested, and each activity has a value of ten per cent (10%). The percentage valued in relation to each activity depends upon the percentage of loss stability in relation to
each activity.

2.3 Extra points:
Extra points have been given for pain, deformities, contractures, loss of sensations and shortening Maximum points to be added are 10% (excluding shortening). Details are as following.

i) Deformity In functional position
In non-functional position
3%
6%
ii) Pain Sever (grossly interfering with function)
Moderate (moderately inter-fering with function)
Mild (mildly interfering with function)
9%
6%

3%iii)Loss of sensationComplete Loss Partial Loss9%iv)ShorteningFirst 1/2″
Every 1/2″ beyond first 1/2″Nil
4%v)ComplicationsSuperficial complications
Deep complications3%

  1. Guidelines for Evaluation of Permanent Physical Impairment of Trunk (Spine)
    Basic guidelines:
  1. As permenanent physical impairment caused by spinal deformity tends to change over the years, the certificate issued in relation to spine should be reviewed as per the standard format of the
    certificate given at Annexure B of Appendix III.
  2. Permanent physical impairment should be awarded in relation to spine and not in relation to whole body.
  3. Permanent physical impairment due to neurological deficit in addition to spinal impairment should be added by combining formula. The local effects of the lesions of the spine can be conventionally divided into traumatic and non-traumatic. The percentage of PPI in relation to each situation should be valued as follows:

 

3.1 TRAUMATIC LESIONS:

3.1.1 Cervical spine injuries Percentage of PPI
in relation to Spine
i) 25% or more compression of one or two adjacent vertebral bodies with No involvement of posterior elements, No nerve root involvement, moderate Neck rigidity and persistent 20%

Soreness.

ii) Posterior element damage with radiological Evidence of moderate parties dislocation/subluxation including whiplash injury.
a) With fusion healed, No permanent motor or sensory changes. 10%
b) Persistent pain with radiologically demonstrable instability. 25%
iii) Severe Dislocation:
a) Fair to good reduction with or without fusion with no residual motor or sensory involvement; 10%
b) Inadequate reduction with fusion and persistent radicular pain 15%
3.1.2. Cervical Intervertebral Disc Lesions Percentage of PPI In relation to Spine
i) Treated case of disc lesion with persistent pain and no neurological deficit 10%
ii) Treated case with pain and instability 15%
3.1.3. Thoracic and Thoracolumbar Spine Injuries:
i) Compression of less than 50% involving one vertebral body with no neurological manifestation 10%
ii) Compression of more than 50% involving single vertebra or more with involvement of posterior elements, healed, no neurological manifestations persistent pain, fusion indicated 20%
iii) Same as (b) with fusion, pain only on heavy use of back 15%
iv) Radiologically demonstrable instability with fracture or fracture dislocation with persistent pain. 30%

 

3.1.3. Thoracic and Thoracolumbar Spine Injuries:

i) Compression of less than 50% involving one vertebral body with no neurological manifestation 20%
ii) Compression of more than 50% involving single vertebra or more with involvement of posterior elements, healed, no neurological manifestations persistent pain, fusion indicated 20%
iii) Same as (b) with fusion, pain only on heavy use of back 15%
iv) Radiologically demonstrable instability with fracture or fracture dislocation with persistent pain. 30%


3.1.4 Lumbar and Lumbosacral Spine: Fracture

a) Compression of 25% or less of one or two adjacent Vertebral bodies, No definite pattern or neurological Deficit 15%
b) Compression of more than 25% with disruption of Posterior elements, persistent pain and stiffness, healed With or without fusion, inability to lift more than 10 kgs. 30%
c) Radiologically demonstrable instability in low lumbar or Lumbosacral spine with pain 35%

3.1. 5 Disc lesion:

a) Treated case with persistent pain 15%
b) Treated case with pain and instability 20%
c) Treated case of disc disease with pain activities of lifting moderately modified 25%
d) Treated case of disc disease with persistent pain and stiffness, aggravated by heavy lifting necessitating modification of all activities requiring heavy weight lifting 30%

 

3.2 NON TRAUMATIC LESIONS:

3.2.1 Scoliosis:

Basic guidelines following modification is suggested.
The largest structural curve should be accounted for while calculating the PPI and not the compensatory curve or both structural curves.

3.2.2 Measurement of Spine Deformity:

Cobb’s method for measurement, of angle of curve in the radiograph taken in standing position should be used. The curves have been divided into following groups depending upon the angle of major structural scoliotic deformity.

Group Cobb’s Angle PPI in relation to Spine
I 0-20 NIL
II 21-50 10%
III 51-100 20%
IV 101 and above 30%

3.2.3 Torso Imbalance:

In addition to the above PPI should also be evaluated in relation the torso imbalance. The torso imbalance should be measured by dropping a plumb line from C7 spine and measuring the distance of plumb line from gluteal crease.

Deviation of Plumb line PPI
Upto 1.5 Cm 4%
1.6 – 30 Cm 8%
3.1 – 50 Cm 16%
5.1 and above 32%

3.2.4 Head Tilt over C7 spine PPI

Upto 15 4%
More than 15 10%

3.2.5 Cardiopulmonary Test

In cases with scoliosis of severe type cardiopulmonary function tests and percentage deviation from normal should be assessed by one of the following method whichever seems more reliable clinically at the time of assessment. The value thus obtained may be added by combining formula.

a. Chest Expansion PPI
4 – 5 Cm. Normal
Less than 4 cm reduction in Chest expansion 5% for each cm
No expansion 25%
b counting in one breathe:
Breathe Count PPI
More than 40 Normal
0-40 5%
0-30 10%
0-20 15%
0-10 20%

3.2.6 Associated Problems: To be added directly but the total value of PPI in relation to spine should not exceed 100%.

a) Pain
-mildly interfering with ADL
-moderately restricting ADL
-severely restricting ADL
4%
6%
10%
b) Cosmetic Appearance:
-No obvious disfiguration with clothes on Nil
-mild disfigurement
-severe disfigurement
2%
4%
c) Leg Length Discrepancy.
-First½ ” shortening
-Every½” beyond first½”
Nil
4%
d) Neurological deficit – Neurological deficit should be calculated as per established method of evaluation of PPI in such cases. Value thus obtained should be added telescopically using combining formula.
3.3 KYPHOSIS
Evaluation should be done on the similar guidelines as use for scoliosis with the following modifications:
3.3.1 Spinal Deformity PPI
Less than 20 Nil
21-40 10%
41-60 20%
Above 60 30%
332 Torso Imbalance – Plumb line dropped from external ear normally falls at ankle level. The deviation from normal should be measured from ankle anterior joint line to the plumb line.
Less than 5 cm in front of ankle 4%
5 to 10 cm in front of ankle 8%
10 to 15 cm in front of ankle 16%
More than 15 cm in front of ankle 32%
(Add directly)

Miscellaneous conditions:
Those conditions of the spine which cause stiffness and pain etc. are rated as follows.

Conditions Percentage PPI
A Subjective symptoms of pain, no involuntary muscle spasm,, not substantiated by demonstrable structural pathology -0%
B Pain, persistent muscles spasm and stiffness of spine, substantiated by mild radiological change. -20%
C Same as B with moderate radiological changes -25%
D Same as B with severe radiological changes involving any one of the regions of spine -30%
E Same as D involving whole spine -40%
  1. Guidelines for Evaluation of PPI in cases of Short Stature/Dwarftsm:
  1. Recumbent length or longitudinal height below 3rd percentile or less than 2 Standard Deviation from the mean is considered to have short stature.
  2. The evaluation of a Short Statured person should be considered only when it is of disproportionate variety and is accompanied by an underlying pathological conditions, e.g., Achondroplasia,Chandrodysplasia Punctata, spondyloepiphysical dysplasia,mucopoly and acchrydosis, etc.
  3. The ICMR norms as enclosed at Appendix III of Annexure. A should be used as a guideline for the height.
  4. Every 1″ vertical height reduction should be valued as 4% permanent physical impairment.
  5. Associated skeletal deformities should be evaluated, separately and total percentage of both should be added by combining formula.
  1. Guidelines for Evaluation of Permanent Physical Impairment in Amputees:
    Basic Guidelines:
  1. In cases of multiple amputees if the total sum of permanent physical impairment is above 100%, it should be taken as 100% only.
  2. If the stump is unfit for fitting the prosthesis additional weightage of 5% should be added to the value.
  3. In case of amputation in more than one limb percentage of each limb is added by combining formula and another 10% will be added but when only toes or fingers are involved only 5% will be added.
  4. Any complication in form of stiffness of proximal joint, neuroma infection, etc., should be given upto a total of 10% additional weightage.
  5. Dominant upper extremity should be given 4% additional weightage.
Upper Limb Amputations
PPI and loss of physical function of each limb
1. Fore-quarter amputations 100%
2. Shoulder Disarticulation 90%
3. Above Elbow upto upper 1/3 of arm 85%
4. Above Elbow upto lower 1/3 of forearm 80%
5. Elbow disarticulation 75%
6. Below Elbow upto upper 1/3 of forearm 70%
7. Below Elbow upto lower 1/3 of forearm 65%
8. Wrist disarticulation 60%
9. Hand through carpal bones 55%
10. Thumb through C.M. or though 1st MC joint 30%
11. Thumb disarticulation through metacarpophalangeal Joint or through proximal phalanx. 25%
12. Thumb disarticulation through inter phalangeal joint or Through distal phalanx. 15%
Index Finger (15%) Middle Finger
(5%)
Ring Finger (3%) Little Finger (2%)
13. Amputation through Proximal phalanx or Disarticulation through M.P. Joint 15% 5% 3% 2%
14. Amputation through Middle phalanx or Disarticulation through PP joint. 10% 4% 2% 1%
15. Amputation through Distal phalanx or disarticulation through DIP joint. 5% 2% 1% 1%

1.3 Lower Limb Amputations:

1. Hind quarter 100%
2. Hip disarticulation 90%
3. Above knee upto upper 1/3 of thigh 85%
4. Above knee upto lower 1/3 of thigh 80%
5. Through keen 75%
6. B.K. upto 8 cm 70%
7. B.K. upto lower 1/3 of leg 60%
8. Through ankle 55%
9. Syme’s 50%
10. Upto mid-foot 40%
11. Upto fore-foot 30%
12. All toes 20%
13. Loss of first toe 10%
14. Loss of second toe 5%
15. Loss of third toe 4%
16. Loss of fourth toe 3%
17. Loss of fifth toe 2%
  1. Guidelines for Evaluation of Permanent Physical Impairment of Congenital deficiencies of the limbs.
    6.1 Transverse Deficiencies-
  1. Functionally congenital transverse limb deficiencies are comparable to acquired amputations and can be called synonymously as congenital amputation, however, in some cases revision of amputation is required
    to fit in a prosthesis.
  2. The transverse limb deficiencies therefore should be assessed on basis of the guidelines applicable to the evaluation of PPI in cases of amputees as given in the preceding chapter.
For example: PPI
Transverse deficiency Rt. Arm complete
(shoulder disarticulation)
90%
Transverse deficiency at thigh complete
(hip disarticulation)
90%
Transverse deficiency Proximal Upper arm
(Above elbow Amp.)
85%
Transverse deficiency at lower thigh
(Above knee Amp. Lower 1/3)
80%
Transverse deficiency forearm complete
(elbow disarticulation)
75%
Transverse deficiency lower forearm
(Below Elbow Amp.)
65%
Transverse deficiency carpal complete
(wrist disarticulation)
60%
Transverse deficiency Metacarpal complete
(Disarticulation through carpal bones)
55%

6.2 Longitudinal Deficiencies:

6.2.1 Basic Guidelines

  1. In cases of longitudinal deficiencies of limbs due consideration should be given to functional impairment.
  2. In upper limb, loss of ROM loss muscular strength and hand functions like prehension, etc should be tested while assessing the case for PPI.
  3. In lower limb clinical method of stability component and shortening of lower limb should be given due weightage.
  4. Apart from functional assessment the lost joint/part of body should also be valued as per distribution Given in chapter Guidelines for Evaluation of PPI in upper extremity and lower extremity The values so obtained should be added with the help of combing formula.

Example:
Congenital Absence of humorous where forearm bones directly articulate with scapula.

There will be mild reduction in ROM and strength of muscles in the existing joints apart from loss of body part.

Loss of shoulder joint can be given – 30%
Loss of ROM of Elbow/Shoulder and Wrist

All the components should be added together by the combining formula of
a + b (90-a)  90

6.2.2 In cases of loss of single bone in forearm the evaluation should be based on the principles
of evaluation of Arm component which include Evaluation of ROM, Muscle strength-and coordinated activities. The values so obtained should be added together with the help of combining formula.

6.2.3 In cases of loss of single bone in leg the evaluation should be based on the principles of evaluation of mobility component and stability components of the lower extremity. The values obtained should be added together with the help of combining formula.

7. Guidelines for Evaluation of Physical Impairments in Neurological conditions.

1.1 Basic Guidelines:

  1. Assessment in neurological conditions is not the assessment of disease but the assessment of its effects, i.e. clinical manifestations.
  2. These guidelines should only be used for central and upper motor neurone lesions.
  3. Proformas (form A and B) will be utilized for assessment of lower motor neurone lesions, muscular disorders and other locomotor conditions.
  4. Normally any neurological assessment for the purpose of certification has to be done six months after the onset of disease however exact time period is to be decided by the Medical Doctor who is evaluating the case and has to recommend the review of certificate as given in the standard format of certificate.
  5. Total percentage of physical impairment in any neurological condition should not exceed 100%
  6. In mixed cases the highest score will be taken into consideration. The lower score will be added telescopically to it by the help of combining formula a+b(90-a) 90
  7. Additional rating of 4% will be given for dominant upper extremity.
  8. Additional weightage up to 10% can be given for loss of sensation in each extremity but the total physical impairment should not exceed 100%.

7.2 Table-l

Neurological Status Physical Impairment
Altered sensorium 100%

7.3 Table-II
Intellectual Impairment (to be assessed by Clinical Psychologist)

Degree of Mental Retardation IQ Range Intellectual Impairment
Border line 70-79 25%
Mild 50-69 50%
Moderate 35-49 75%
Serve 20-34 90%
Profound Less than 20 100%

7.4 Table – III

Speech defect Physical Impairment
Mild dysarthria Nil
Moderate dysarthria 25%
Servere dysarthria 50%

7.5 Table – IV

Type of Cranial Nerve Involvement Physical Impairment
Motor cranial nerve 20% for each nerve
Sensory cranial nerve 10% for each nerve

Sensory cranial nerve 10% for each nerve

7.6 Table-V

Motor system Disability
Neurological Involvement Physical Impairment
Hemiparesis:-
– Mild 25%
– Moderate 50%
– Severe 75%

7.7 Table-VI

Sensory System Disability

Extent of Sensory Deficit Physical Impairment
Anaesthesia Upto 10% for each limb
Hypoaesthesia Depending upon % of
Paraestheis Loss of sensation up to 30% depending
Hands/feet sensory loss Upon % of loss sensation

7.8 Table – VIII
Bladder disability due to neurogenic Involvement

Bladder Involvement Physical Impairment
Mild (Hesitancy/Frequency) 25%
Moderate (precipitancy) 50%
Severe(occasional but recurrent Incontinence) 75%
Very Severe (Retention/Total Incontinence) 100%

7.9 Table – VIII
Post Head Injury Fits and Epileptic Convulsions

Frequency/Severity of Convulsions Physical Impairment
Mild – occurrence of one convulsion
Only
Nil
Moderate 1-5 Convulsions/month on
Adequate – Medication
25%
Severe 6-10 Convulsions/month on
Adequate medication
50%
Very Severe more than 10 fits/months
On adequate – Medication
75%

7.10 Table – IX
Ataxia (Sensory or Cerebellar)

Severity of Ataxia Physical Impairment
Mild (Detected on examination) 25%
Moderate 50%
Severe 75%
Very Severe 100%

8 Guidelines for Evaluation of Physical Impairment due to Cardiopulmonary Diseases.

8.1 Basic Guidelines:-

  1. Modified New York Heart Association subjective classification should be utilised to assess the functional disability.
  2. The assessing physician should be alert to the fact that patients who come for disability claims are likely to exaggerate their symptoms. In case of any doubt patients should be referred for detailed physiological
    evaluation.
  3. Disability evaluation of cardiopulmonary patients should be done after full medical, surgical and rehabilitative treatment available, because most of these diseases are potentially treatable.
  4. Assessment of cardiopulmonary impairment should also be done in diseases which might have associated cardiopulmonary problems, e.g.,amputees, myopathies, etc.
  5. For respiratory assessment, routine respiratory functions test should be done, however, in cases of interstitial lung diseases, diffusion studies may be done.
  6. In cases of Angina pectoris (chest pain) base line studies in resting ECG should be done. When there is persistence of symptoms, exercise or stress test should be done.

8.2 The proposed classification with loss of function is as follows:-

Group 0:                                       A patient with cardiopulmonary disease who is asymptomatic (i.e. has no symptoms of breathlessness, palpitation, fatigue or chest pain).
Group 1: A patient with cardiopulmonary disease who becomes symptomatic during his ordinary physical activity but has mild restriction (25%) of his physical activities.
Group 2: A patient with cardiopulmonary disease who becomes symptomatic during his ordinary physical activity and has 25-50% restriction of his ordinary physical activities.
Group 3: A patient with cardiopulmonary disease who becomes symptomatic during less than ordinary physical activity so that his ordinary physical activities are 50-75% restricted.
Group 4: A patient with cardiopulmonary disease who is symptomatic even at rest or on mildest exertion so that his ordinary physical activities are severely or completely restricted (75-100%).
Group 5: A patient with cardiopulmonary disease who gets intermittent symptoms at rest (i.e. patients with bronchial asthma, paroxysmal nocturnal dyspnoea, etc.)
  1. Definition of Multiple Disabilities:
    Multiple disabilities means a combination of two or more disabilities as defined in clause (i) of Section (2) of the Persons with Disabilities. (Equal Opportunities, Protection of Rights and Full Participation) Act, 1’995, namely –
  1. Locomotor disability including leprosy cured
  2. Blindness/low vision
  3. Speech and hearing impairment
  4. Mental retardation
  5. Mental illness.
  1. Guidelines for Evaluation: –
    In order to evaluate the multiple disability, the same guidelines shall be used as have been developed by the respective sub-committees of various single disability, viz. Mental retardation, locomotor disability, visual disability, and speech and hearing disability and recommended in the meeting held on 29.2.2000 under the Chairmanship of Dr. S.P. Agarwal, Director General of Health Services, Government of India, with reference to Order No.16-18/96-Nl.l, dated 28th August, 1998 and communicated to Ministry of Social Justice and Empowerment, Government of India, vide letter No.S-13020/4/98-MH, dated 16th March, 2000.

However, in order to arrive at the total percentage of multiple disability, the combining formula

a + b (90-a). as given in the “Manual for Doctors to Evaluate 90

Permanent Physical Impairment, Developed by Expert Group meeting on Disability Evaluation”, shall be used, where “a” will be the higher score and “b” Will be the lower score. However, the maximum total percentage of multiple disabilities shall not exceed 100%.

For example, if the percentage of hearing disability is 30% and visual disability is 20%, then by applying the combining formula given above, the total percentage of multiple disability will be calculated as follows:-

30 + 20(90-30) = 43%
90

3. Procedure for Certification of Multiple Disability:-
The procedure will remain the same as has been developed by the respective sub-committees on various single disabilities and finalized in a meeting under the Chairpersonship of Dr. S.P. Agarwal held on 29.2.2000. The final disability certificate for multiple disability will be issued by Disability Board which has given higher score of disability by combining the score of different disabilities using the combining formula,
i.e., a + b (90-a). In case, where two scores of disability are
90
equal, the final certificate of multiple disability will be issued by any one of them as decided by Local authority.

APPENDIX I OF ANNEXURE A

FROM A

ASSESSMENT PERFORMA FOR UPPER EXTERMITY

Name ……………………..Age………………….Sex…………….Diagnosis……………….

Address………………………………O.P.D…………………….Deptt……………………….

ARM COMPONENT (Total Value 90%)

Arm Component Component Normal Value(Degrees) Rt. Side Lt. Side Loss of %
Rt. Side
Loss of %
Lt. Side
Mean % Loss Rt. Lt. Sum of %
Loss Rt. Lt.
Combining
Value Rt. Lt.
% Summary
Value for component
Range of Movement(Active) Value 90% Elbow 1. Flexion-Extension Arc
2. Rotation Arc
3. Abduction-Adduction
Arc
0-220o 0-180o
0-180o
Shoulder Range of Movement ( Active) Value 90% Wrist 1. Flexion-Extension Arc 2. Radial-
Ulnaardeviatior Arc
0-160o 0-55o
Muscle Strength Value 90% Shoulder 1. Flexion
2. Extension
3. Rotation – Ext
4. Rotation – Int.
5. Abduction
6. Adduction
Muscle Strength Value 90% 1. Flexion
2. Extension
3. Pronation
4. Supination
Muscle Strength Value 90% 1. Dors Flexion
2. Palmar Flexion
3. Radial Deviation
4. Ulnardeviatior
Coordinated Activities Value 90% 1. Lifting overhead objects remove and placing at the same place 9%
2. Touching nose with end of extremity 9%
3. Eating Indian Style 9%
4. Combing and Plaiting 9%
5. Putting on a shirt/kurta 9%
6. Ablution glass of water 9%
7. Drinking Glass of water 9%
8. Buttoning 9%
9 Tie Nara Dhoti 9%
10. Writing 9%
HAND COMPONENT ( TOTAL VALUE 90%)
30% prehension

1. Hand Component
A.
Opposition(8%)

B. Lateral Pinch
(5%)

C. Cylindrical Grasp

D. Spherical Grasp

E. Hook Grasp

Movement

1. Index
2. Middle
3. Ring
4. Little

Key Holding

a. Large Object ( 4o)
b. Small Object (1o)

a. Large Object ( 4o)
b. Small Object (1o)

Lifting Bag

Normal Value

2]
2] 8%
2]
2]
5%

3}
3} 6%

3}
3} 6%

5%

2. Sensation 30% 1. Radial Side }
2. Ulnar Side } Thumb
3. Radial } Fingers
4. Ulnar}
4:1

(4.8 : 1.2)

3. Strength 30% 1. Grip Strength
2. Pinch Strength
20%

10%

Summary value for upper extremity is calculated from component and hand component values Add 4% for dominant extremity 10%. Additional weightage to be given to infection, deformity, malalignment, contracture, cosmetic appearance and abnormal mobility.

APPENDIX  I OF ANNEXURE A

FROM B

ASSESSMENT PROFORMA FOR LOWER EXTERMITY

Name………………….Age…………………..Sex………………..Diagnosis…………………..

Address………………………..O.P.D. No………………………..Deptt………………………….

Diagnosis…………………………………………………………

MOBILITY COMPONENT (Total Value (90%)

Joint Component Normal Value Rt. Side Lt. Side Loss of %
Rt. Side
Loss of %
Lt. Side
Mean %
Rt. Lt.
Mean 0.30
Rt. Lt.
Combing Value Rt. Lt. % Summary Value for mobility Component a+b (90+a)
90
Range of Movement (Active)
HIP
1. Flexion-Extension arc
2. Abduction
Adduction
3. Rotation arc
0-140º

0-90º

0-90º

Range of
Movement
(Active) KNEE
1. Flexion
Extension are
0-125º
Range of Movement
(Active)
ANKLE
and
FOOT
1. Dors flexion Panterlexion are
2. Invesior –
Extension are
0-70º

0-60º

HH 1. Flexor
Muscles
2. Extensor
Muscles
3. Abductor
Muscles
4. Adductor
Muscles
5. Rotator
Muscles
(Ext. Int.)
Muscles Strength
KNEE
1. Flexor
Muscles
2. Extensor
Muscles
Muscle
Strength
ANKLE
and
FOOT
1. Panterliexor
Muscles
2. Darsiflexor
Muscles
3. Invertor
Muscles
4. Exertor
Muscles

STABILITY COMPONENT (Total Value 90%)
Based CLINICAL METHOD of Evaluation

1. Walking on plain surface 10
2. Walking on slope 10
3. Climbing Stairs 10
4. Standing on both legs 10
5. Standing on affected leg 10
6. Squatting on floor 10
7. Sitting Cross leg 10
8. Kneeling 10
9. Taking turns 10
Total 90

10% is given for complications like (I) Infection (ii) Deformity (iii) Loss of sensation.

APPENDIX II OF ANNEXURE A

Ready Reckoner Table for A + B(90-A)/90

B(1) B(2) B(3) B(4) B(5) B(6) B(7) B(8) B(9) B(10) B(11) B(12) B(13) B(14) B(15)
A(1) 1.99 3.98 3.97 4.96 5.94 6.93 7.92 8.91 9.90 10.89 11.88 12.87 13.86 14.84 15.83
A(2) 2.98 3.96 4.93 5.91 6.89 7.87 8.84 9.82 10.80 11.78 12.76 13.73 14.71 15.69 16.67
A(3) 3.97 4.93 5.90 6.87 7.83 8.80 9.77 10.73 11.70 12.67 13.63 14.60 15.57 16.53 16.67
A(4) 4.96 5.91 6.87 7.82 8.78 9.73 10.69 11.64 12.65 13.50 14.44 15.39 16.33 17.28 18.33
A(5) 5.94 6.89 7.83 8.78 9.72 10.67 11.61 12.56 13.50 14.44 15.39 16.33 17.28 18.22 19.17
A(6) 6.93 7.87 8.80 9.73 10.67 11.60 12.50 13.46 14.38 15.30 16.27 17.20 18.13 19.07 20.00
A(7) 7.92 8.84 9.77 10.69 11.61 12.53 13.46 14.38 15.29 16.20 17.11 18.07 18.99 19.91 20.83
A(8) 8.91 9.82 10.73 11.64 12.56 13.47 14.38 15.29 16.20 17.10 18.02 18.93 19.84 20.76 21.67
A(9) 9.90 10.80 11.70 12.60 13.50 14.40 15.30 16.20 17.10 18.00 18.90 19.80 20.70 21.60 22.50
A(10) 10.89 11.87 12.67 13.56 14.44 15.33 16.22 17.11 18.00 18.89 19.78 20.67 21.56 22.44 23.33
A(11) 11.88 12.76 13.63 14.51 15.39 16.27 17.14 18.02 18.90 19.78 20.66 21.53 22.41 23.29 24.17
A(12) 12.87 13.73 14.60 15.47 16.33 17.20 18.07 18.93 19.80 20.67 21.53 22.40 23.27 24.13 25.00
A(13) 13.86 14.71 15.57 16.42 17.28 18.13 18.99 19.84 20.70 21.56 22.41 23.27 24.12 24.98 25.83
A(14) 14.84 15.69 16.53 17.38 18.22 19.07 19.91 20.76 21.60 22.44 23.29 24.13 24.98 25.82 26.67
A(15) 15.83 16.67 17.50 18.33 19.17 20.00 20.83 21.67 22.50 23.33 24.17 25.00 25.83 26.67 27.50
A(16) 16.82 17.64 18.47 19.20 20.11 20.93 21.76 22.58 23.40 24.22 25.04 25.87 26.69 27.51 28.33
A(17) 17.81 18.62 19.37 20.24 21.06 21.87 22.68 23.49 24.30 25.11 25.92 26.73 27.54 28.36 29.17
A(18) 18.80 19.60 22.33 21.20 22.00 22.80 23.60 24.40 25.20 26.00 26.80 27.60 28.40 29.20 30.00
A(19) 19.79 20.58 23.30 22.16 22.94 23.73 24.52 25.31 26.10 26.89 27.68 28.47 29.26 30.04 30.83
A(20) 20.78 21.56 24.27 23.11 23.89 24.67 25.44 26.22 27.00 27.78 28.56 29.33 30.11 30.89 31.67
A(21) 21.77 22.53 25.23 24.07 24.83 25.60 26.37 27.13 27.90 28.67 29.43 30.20 30.97 31.73 32.50
A(22) 22.76 23.51 26.20 25.02 25.78 26.33 27.29 28.04 28.80 29.56 30.31 31.07 31.82 32.58 33.33
A(23) 23.44 24.49 27.17 25.08 26.72 27.47 28.21 28.96 29.70 30.44 31.19 31.93 32.68 33.42 34.17
A(24) 24.73 25.47 28.13 26.93 27.67 28.40 29.13 29.87 30.60 31.33 32.07 32.80 33.57 34.27 35.00
A(25) 25.72 26.44 29.10 27.89 28.61 29.33 30.06 30.78 31.50 32.22 32.94 33.67 34.39 35.11 35.83
A(26) 26.71 27.42 30.07 28.84 29.56 30.27 30.98 31.69 32.40 33.11 33.82 34.53 35.21 35.96 36.67
A(27) 27.70 28.40 31.03 29.80 30.50 31.20 31.90 32.60 33.30 34.00 34.40 25.40 36.10 36.80 37.50
A(28) 28.69 29.38 32.00 30.76 31.44 32.13 32.80 33.51 34.40 34.89 35.58 36.27 36.96 37.64 38.33
A(29) 29.68 30.36 32.97 31.71 32.39 33.07 33.74 24.42 35.10 35.78 36.46 37.13 37.81 38.49 39.17
A(30) 30.67 31.33 32.00 32.67 33.33 34.67 35.33 36.00 36.67 36.67 37.33 38.00 38.67 39.33 40.00
A(31) 31.66 32.31 34.97 33.62 34.28 34.93 35.59 36.24 36.90 37.96 38.21 38.87 39.50 40.18 40.83
A(32) 32.64 33.29 33.93 34.58 35.22 35.87 36.51 37.16 37.80 38.44 39.09 39.73 40.38 11.02 11.67
A(33) 33.63 34.27 34.90 35.53 36.17 36.80 37.43 38.07 38.70 39.33 39.97 40.60 41.23 41.87 42.50
A(34) 34.62 35.24 35.87 36.49 37.11 37.73 38.36 38.98 39.60 40.22 40.84 41.47 42.09 42.71 43.33
A(35) 35.61 36.22 36.83 37.44 38.06 38.67 39.28 39.89 40.50 41.11 41.72 42.33 42.94 43.56 44.17
A(36) 36.60 37.20 37.80 38.40 39.00 39.60 40.20 40.80 41.40 42.00 42.60 43.20 43.80 44.40 45.00
A(37) 37.59 38.18 38.77 39.36 39.94 40.53 41.12 41.71 42.30 42.89 43.48 44.07 44.66 45.24 45.83
A(38) 38.58 39.16 39.73 40.31 40.89 41.47 42.04 42.62 43.20 43.78 44.36 44.93 45.51 46.09 46.67
A(39) 39.57 4013 40.70 41.27 41.83 42.40 42.97 43.53 44.10 44.67 45.23 44.80 46.37 46.93 47.50
A(40) 40.56 41.11 41.67 42.22 42.78 43.33 43.89 44.44 45.00 45.56 46.11 46.67 47.22 47.78 48.33
A(41) 40.54 40.09 42.62 43.18 43.72 44.27 44.81 45.36 45.90 46.44 46.99 47.53 48.08 48.62 49.17
A(42) 42.53 43.07 43.60 44.13 44.67 45.20 45.73 46.27 46.80 47.33 47.87 48.40 48.93 49.47 50.00
A(43) 43.52 44.04 44.57 45.09 45.61 46.13 46.66 47.18 47.70 48.22 48.74 49.24 49.79 50.13 50.83
A(44) 44.51 45.02 44.53 46.04 46.56 47.07 47.58 48.09 48.60 49.11 49.62 50.13 50.64 51.61 51.67
A(45) 45.50 46.00 46.50 47.00 47.50 48.00 48.50 49.00 49.50 50.00 50.50 51.00 51.50 52.00 52.50

 

 

READY RECKONER TABLE FOR A + B(90-A)/90

B(1) B(2) B(3) B(4) B(5) B(6) B(7) B(8) B(9) B(10) B(11) B(12) B(13) B(14) B(15)
A(46) 46.49 46.98 47.47 47.96 48.44 48.93 49.42 49.91 50.40 50.89 51.38 51.87 52.36 52.84 53.33
A(47) 47.48 47.96 48.43 48.91 49.39 49.87 50.34 50.82 51.30 51.78 52.26 52.73 53.21 53.69 54.17
A(48) 48.47 48.93 49.40 49.87 50.33 50.80 51.27 51.73 52.20 52.67 53.13 53.60 54.07 54.53 55.00
A(49) 49.46 49.91 50.37 50.82 51.28 51.73 52.19 52.64 53.10 53.56 54.01 54.47 54.92 55.38 55.83
A(50) 50.44 50.89 51.33 51.78 52.22 52.67 53.11 53.56 54.00 54.44 54.89 55.33 55.78 56.22 56.67
A(51) 51.43 51.87 52.30 52.73 53.17 53.60 54.03 54.47 54.90 55.33 55.77 56.20 56.63 57.07 57.50
A(52) 52.42 52.84 53.27 53.69 54.11 54.53 54.96 55.38 55.80 56.22 56.64 57.07 57.49 57.91 58.33
A(53) 53.41 53.82 54.23 54.64 55.06 55.47 55.88 56.29 56.70 57.11 57.52 57.93 58.34 58.76 59.17
A(54) 54.40 54.80 55.20 55.60 56.00 56.40 56.80 57.20 57.60 58.00 58.40 58.80 59.20 59.60 60.00
A(55) 55.39 55.78 56.17 56.56 56.94 57.33 57.72 58.11 58.50 58.89 59.28 59.67 60.06 60.44 60.83
A(56) 56.38 56.76 57.13 57.51 57.89 58.27 58.64 59.02 59.40 59.78 60.16 60.53 60.91 61.21 61.67
A(57) 57.37 57.73 58.10 58.47 58.83 59.20 59.57 59.93 60.30 60.67 61.03 61.40 61.77 62.13 62.50
A(58) 58.36 58.71 59.07 59.42 59.78 60.13 60.49 60.84 61.20 61.56 61.91 62.26 62.62 62.98 63.33
A(59) 59.34 59.69 60.03 60.38 60.72 61.07 61.41 61.76 62.10 62.44 62.79 63.13 63.48 63.82 64.17
A(60) 60.33 60.67 61.00 61.33 61.67 62.00 62.33 62.67 63.00 63.00 63.67 64.00 64.33 64.67 65.00
A(61) 61.32 61.64 61.97 62.29 62.61 62.93 63.26 63.58 63.90 64.22 64.54 64.87 65.19 65.51 65.83
A(62) 62.31 62.62 62.93 63.24 63.56 63.87 64.18 64.49 64.80 65.11 65.42 65.73 66.04 66.36 66.67
A(63) 63.30 63.60 63.90 64.20 64.50 64.80 65.10 65.40 65.70 66.00 66.30 66.60 66.90 67.20 67.50
A(64) 64.29 64.58 64.87 65.16 65.44 65.73 66.02 66.31 66.60 66.89 69.18 67.47 67.76 68.04 68.33
A(65) 65.28 65.56 65.83 66.11 66.39 66.67 66.94 67.22 67.50 67.78 68.06 68.33 68.61 68.89 69.17
A(66) 66.27 66.53 66.80 67.07 67.33 67.60 67.87 68.13 68.40 68.67 68.93 69.20 69.47 69.73 70.00
A(67) 67.26 67.51 67.77 68.02 68.28 68.53 68.79 69.04 69.30 69.56 69.81 70.07 70.32 70.58 70.83
A(68) 68.24 68.49 68.73 68.98 69.22 69.47 69.71 69.96 70.20 70.14 70.69 71.93 71.18 71.42 71.67
A(69) 69.23 69.47 69.70 69.93 70.17 70.40 70.63 70.87 71.10 71.33 71.57 71.80 72.03 72.27 72.50
A(70) 70.22 70.44 70.67 70.89 71.11 71.33 71.56 71.78 72.00 72.22 72.44 72.67 72.89 73.11 73.33
A(71) 71.21 71.42 71.63 71.84 72.06 72.27 72.48 72.69 72.90 73.11 73.32 73.53 73.74 73.96 74.17
A(72) 72.20 72.40 72.60 72.80 73.00 73.20 73.40 73.60 73.80 74.00 74.20 74.40 74.60 74.80 75.00
A(73) 73.19 73.38 73.57 73.76 73.94 74.13 74.32 74.51 74.70 74.89 75.08 75.27 75.46 75.64 75.83
A(74) 74.18 74.36 74.53 74.71 74.89 75.07 75.24 75.42 75.60 75.78 75.96 76.13 76.31 76.49 76.67
A(75) 75.17 75.33 75.50 75.67 75.83 76.00 76.17 76.33 76.50 76.67 76.83 77.00 77.17 77.33 77.50
A(76) 76.16 76.31 76.47 76.62 76.78 76.93 77.09 77.24 77.40 77.56 77.71 77.87 78.02 78.18 78.33
A(77) 77.14 77.29 77.43 77.58 77.72 77.87 78.01 78.16 78.30 78.44 78.59 78.73 78.88 79.02 79.17
A(78) 78.13 78.27 78.40 78.53 78.67 78.80 78.93 79.07 79.20 79.33 79.47 79.60 79.73 79.87 80.00
A(79) 79.12 79.24 79.37 79.49 79.61 79.73 79.86 79.98 80.10 80.22 80.34 80.47 80.59 80.71 80.83
A(80) 80.11 80.22 80.33 80.44 80.56 80.67 80.78 80.89 81.00 81.11 81.22 81.33 81.44 81.56 81.67
A(81) 81.10 81.20 81.30 81.40 81.50 81.60 81.70 81.80 81.90 82.00 82.10 82.20 82.30 82.40 82.50
A(82) 82.09 82.18 82.27 82.36 82.44 82.53 82.62 82.71 82.80 82.89 82.98 83.07 83.16 83.24 83.33
A(83) 83.08 83.16 83.23 83.31 83.39 83.47 83.54 83.62 83.70 83.78 83.86 83.93 84.01 84.09 84.17
A(84) 84.07 84.13 84.20 84.27 84.33 84.40 84.47 84.53 84.60 84.67 84.73 84.80 84.87 84.93 85.00
A(85) 85.06 85.11 85.17 85.22 85.28 85.33 85.39 85.44 85.50 85.56 85.61 85.67 85.72 85.78 85.83
A(86) 86.04 86.09 86.13 86.18 86.22 86.27 86.31 86.36 86.40 86.44 86.49 86.53 86.58 86.62 86.67
A(87) 87.03 87.07 87.10 87.13 87.17 87.20 87.23 87.27 87.30 87.33 87.37 87.40 87.43 87.47 87.50
A(88) 88.02 88.04 88.07 88.09 88.11 88.13 88.16 88.18 88.20 88.22 88.24 88.27 88.29 88.13 88.33
A(89) 89.01 89.02 89.03 89.04 89.06 89.07 89.08 89.09 89.10 89.11 89.12 89.13 89.14 89.16 89.17
A(90) 90.00 90.00 90.00 90.00 90.00 90.00 90.00 90.00 90.00 90.00 90.00 90.00 90.00 90.00 90.00

AMENDED RULES FOR PERSONS WITH DISABILITIES

[To Be Published In The Gazette Of India, Extraordinary,
Part Ii, Section 3, Sub-Section (I)]
Government Of India
Ministry Of Social Justice And Empowerment

NOTIFICATION

NEW DELHI, 2009
In exercise of the powers conferred by sub-sections (1) and (2) of section 73 of the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 (1 of 1996), the Central Government hereby makes the following rules to amend the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Rules, 1996, namely:-

  1. (1) These rules may be called the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Amendment Rules, 2009.

(2) They shall come into force from the date of their publication in the Official Gazette.

  1. In the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Rules, 1996, –

(i) for rule 2 , the following rule shall be substituted, namely:-


“2. Definitions.-

  1. In these rules unless the context otherwise requires,-
  1. “Act” means the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 (1 of 1996);
  1. “certificate” or “disability certificate” means a certificate issued in pursuance of clause (t) of section 2 of the Act;
  2. “multiple disabilities” means a combination of two or more disabilities as defined in clause (i) of section 2 of the Act;
  3. “Form” means a form appended to these rules.
  1. Words and expressions defined in the Act but not defined in these rules, shall have the meanings respectively assigned to them in the Act.”;

(ii) for CHAPTER II, the following Chapter shall be substituted, namely :-

“CHAPTER II:  DISABILITY CERTIFICATE

  1. Application for issue of disability certificate –
  1. A person with disability desirous of getting a certificate in his favour shall submit an application in Form I, and the application shall be accompanied by –
  2. proof of residence, and
  3. two recent passport size photographs.
  1. The application shall be submitted to –
  1. a medical authority competent to issue such a certificate in the district of the applicant’s residence as mentioned in the proof of residence submitted by him with the application, or
  2. the concerned medical authority in a government hospital where he may be undergoing or may have undergone treatment in connection with his disability :

Provided that where a person with disability is a minor or suffering from mental retardation or any other disability which renders him unfit or unable to make such an application himself, the application on his behalf may be made by his legal guardian.

  1. Issue of disability certificate –
  1. On receipt of an application under rule 3, the medical authority shall, after satisfying himself that the applicant is a person with disability as defined in sub-clause (t) of section 2 of the Act, issue a disability certificate in his favour in Form II, Form III or Form IV as applicable.
  2. The certificate shall be issued as far as possible, within a week from the date of receipt of the application by the medical authority, but in any case, not later than one month from such date.
  3. The medical authority shall, after due examination, –
  4. give a permanent disability certificate in cases where there are no chances of variation, over time, in the degree of disability, and
  5. shall indicate the period of validity in the certificate, in cases where there is any chance of variation, over time, in the degree of disability.
  6. If an applicant is found ineligible for issue of disability certificate, the medical authority shall explain to him the reasons for rejection of his application, and shall also convey the reasons to him in writing.
  7. A copy of every disability certificate issued under these rules by a medical authority other than the Chief Medical Officer shall be simultaneously sent by such medical authority to the Chief Medical Officer of the District.
  1. Review of a decision regarding issue of, or refusal to issue, a disability certificate –
  2. Any applicant for a disability certificate, who is aggrieved by the nature of a certificate issued to him, or by refusal to issue such a certificate in his favour, as the case may be, may represent against such a decision to the medical authority as specified for the purpose by the appropriate Government:

Provided that where a person with disability is a minor or suffering from mental retardation or any other disability which renders him unfit or unable to make such an application himself, the application on his behalf may be made by his legal guardian.

  1. The application for review shall be accompanied by a copy of the certificate or letter of rejection being appealed against.
  2. On receipt of an application for review, the medical authority shall, after giving the appellant an opportunity of being heard, pass such orders on it as it may deem appropriate.
  3. An application for review shall, as far as possible, be disposed of within a fortnight from the date of its receipt, but in any case, not later than one month from such date.
  1. Certificate issued under rule 4 to be generally valid for all purposes

A certificate issued under rule 4 shall render a person eligible to apply for facilities, concessions and benefits admissible under schemes of the Government and of Non-Governmental Organizations funded by the Government, subject to such conditions as may be specified in relevant schemes or instructions of Government, etc., as the case may be.” ;

(iii) for rule 43, the following rules shall be substituted, namely:-

“43. Qualification for appointment of Chief Commissioner –

In order to be eligible for the appointment as Chief Commissioner, a person must satisfy the following conditions, namely:-

  1. he should have special knowledge or practical experience in respect of matters relating to rehabilitation of persons with disabilities;
  2. he should not have attained the age of sixty years on the 1st January of the year in which the last date for receipt of applications, as specified in the advertisement issued under sub-rule(1) of rule 43 A, falls;
  3. if he is in service under the Central Government or a State Government, he shall seek retirement from such service before his appointment to the post; and
  4. he must possess the following educational qualification and experience, namely

(A) Educational qualifications.-

  1. Essential: Graduate from a recognised university
  2. Desirable: Recognised degree/diploma in Social Work/ Law/ Management/ Human Rights/ Rehabilitation/ Education of Disabled Persons.

(B) Experience.-

Should have at least twenty-five years experience in one or more of the following types of organizations at specified levels:-

  1. In a Group ‘A’ level post in Central/State Government /Public Sector Undertaking/Semi Government or Autonomous Bodies dealing with disability related matters and/or social sector (health/education/poverty alleviation/ women and child development); or
  2. A senior level functionary in a registered national or international level voluntary organisation working in the field of disability/social development; or
  1. Senior Executive position in a leading private sector organisation, involved in social work and in charge of handling social development activities of the organization:

Provided that out of the total twenty-five years experience mentioned above, at least three years of experience in the recent past should have been in the field of empowerment of persons with disabilities
43A. Mode of appointment of the Chief Commissioner –

  1. About six months before the post of Chief Commissioner is due to fall vacant, an advertisement shall be published in at least two national level dailies each in English and Hindi inviting applications for the post from eligible candidates fulfilling the criteria mentioned in rule 43.
  2. A Search-cum-Selection Committee shall be constituted to recommend a panel of three suitable candidates for the post of the Chief Commissioner.
  3. Composition of the Committee will be governed by relevant instructions issued by the Department of Personnel and Training from time to time.
  4. The panel recommended by the Committee may consist of persons from amongst those who have applied in response to the advertisement mentioned in sub-rule (1) above, as well as other eligible persons whom the Committee may consider suitable.
  5. The Central Government shall appoint one of the candidates recommended by the Search-cum-Selection Committee as the Chief Commissioner.

43B. Term of the Chief Commissioner –

  1. The Chief Commissioner shall be appointed on full-time basis for a period of three years from the date on which he assumes office, or till he attains the age of sixty-five years, whichever is earlier.
  2. A person may serve as Chief Commissioner for a maximum of two terms, subject to the upper age limit of sixty-five years.

43C. Salary and allowances of the Chief Commissioner –

  1. The salary and allowances of the Chief Commissioner shall be the salary and allowances as admissible to a Secretary to the Government of India.
  2. Where a Chief Commissioner, being a retired Government Servant or a retired employee of any institution or autonomous body funded by the Government, is in receipt of pension in respect of such previous service, the salary admissible to him under these rules shall be reduced by the amount of the pension, and if he had received in lieu of a portion of the pension, the commuted value thereof, by the amount of such commuted portion of the pension.

 

43D. Other terms and conditions of service of the Chief Commissioner –

  • Leave

The Chief Commissioner shall be entitled to such leave as is admissible to Government servants under the Central Civil Service (Leave) Rules, 1972.

  • Leave Travel Concession

The Chief Commissioner shall be entitled to such Leave Travel Concession as is admissible to Group ‘A’ officers under Central Civil Service (LTC) Rules, 1988.

  • Medical Benefits

The Chief Commissioner shall be entitled to such medical benefits as is admissible to Group ‘A’ officers under the Central Government Health Scheme (CGHS).

43E. Resignation and removal –

  1. The Chief Commissioner may, by notice in writing, under his hand, addressed to the Central Government, resign his post.
  2. The Central Government shall remove a person from the office of the Chief Commissioner, if he –
  3. becomes an undischarged insolvent;
  4. engages during his term of office in any paid employment or activity outside the duties of his office;
  5. gets convicted and sentenced to imprisonment for an offence which in the opinion of the Central Government involves moral turpitude;
  6. is in the opinion of the Central Government, unfit to continue in office by reason of infirmity of mind or body or serious default in the performance of his functions as laid down in the Act;
  7. without obtaining leave of absence from the Central Government, remains absent from duty for a consecutive period of 15 days or more; or
  1. has, in the opinion of the Central Government, so abused the position of the Chief Commissioner as to render his continuance in office detrimental to the interest of persons with disability:

Provided that no person shall be removed under this rule except after following the procedure, mutatis mutandis, prescribed for removal of a Group ‘A’ employee of the Central Government.

  1. The Central Government may suspend a Chief Commissioner, in respect of whom proceedings for removal have been commenced in accordance with sub-rule (2), pending conclusion of such proceedings.

43F. Residuary provision –

Conditions of service of a Chief Commissioner in respect of which no express provision has been made in these rules shall be determined by the rules and orders for the time being applicable to a Secretary to the Government of India.”;

(iv) after rule 45 and before FORM DPER-I, the following Forms shall be inserted, namely:-

“Form-I

 

APPLICATION FOR OBTAINING DISABILITY CERTIFICATE BY PERSONS WITH DISABILITIES
(See rule 3)

  1. Name: (Surname) _____________ (First name) _____________ (Middle name) _____________
  2. Father’s name: _____________ Mother’s name: _____________
  3. Date of Birth: (date) _______ / (month)___________ / (year)_________
  4. Age at the time of application: _______ years
  5. Sex: _______ Male/Female
  6. Address:

(a) Permanent address
__________________________
__________________________

(b) Current Address (i.e. for communication)
__________________________
__________________________

(c) Period since when residing at current address
__________________________

  1. Educational Status (Pl. tick as applicable)
  1. Post Graduate
  2. Graduate
  3. Diploma
  4. Higher Secondary
  5. High School
  6. Middle
  7. Primary
  8. Illiterate
  1. Occupation _______________________________________
  2. Identification marks (i) __________ (ii) __________
  3. Nature of disability: locomotor/hearing/visual/mental/others
  4. Period since when disabled: From Birth/Since year ____________
  5. (i) Did you ever apply for issue of a disability certificate in the past ______YES/NO

(ii) If yes, details:

  1. Authority to whom and district in which applied ___________________________________
  2. Result of application _________________________________
  1. Have you ever been issued a disability certificate in the past? If yes, please enclose a true copy.

Declaration: I hereby declare that all particulars stated above are true to the best of my knowledge and belief, and no material information has been concealed or misstated. I further, state that if any inaccuracy is detected in the application, I shall be liable to forfeiture of any benefits derived and other action as per law.

______________
(Signature or left thumb impression of
person with disability, or of his/her legal
guardian in case of persons with mental
retardation, autism, cerebral palsy and
multiple disabilities)

Date:

Place:

Encl:

  1. Proof of residence (Please tick as applicable)
  2. ration card,
  3. voter identity card,
  4. driving license,
  5. bank passbook
  6. PAN card,
  7. passport,
  8. telephone, electricity, water and any other utility bill indicating the address of the applicant,
  9. a certificate of residence issued by a Panchayat, municipality, cantonment board, any gazetted officer, or the concerned Patwari or Head Master of a Govt. school,
  10. in case of an inmate of a residential institution for persons with disabilities, destitute, mentally ill, etc., a certificate of residence from the head of such institution.
  11. Two recent passport size photographs

(For office use only)

Date:
Place:

Signature of issuing authority
Stamp

Form-II

Disability Certificate
(In cases of amputation or complete permanent paralysis of limbs
and in cases of blindness)
(See rule 4)

Recent PP Size Photograph(showing face only) of Person with Disability

 (NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE
CERTIFICATE)

 

 

Certificate No. Date:

This is to certify that I have carefully examined Shri/Smt./Kum.__________________________________________________________ son/wife/daughter of Shri_________________________________________________ Date of Birth (DD / MM / YY) ___ ____ ____ Age_______years, male/female Registration No.________________ permanent resident of House No.___________________Ward/Village/ Street________________________Post Office________________________________ District_________State______________, whose photograph is affixed above, and am satisfied that :

(A) he/she is a case of:

 locomotor disability

 blindness

(Please tick as applicable)

(B) the diagnosis in his/her case is ___________

(A) He/ She has ____________%(in figure)___________________________ percent (in words) permanent physical impairment/blindness in relation to his/her_________(part of body) as per guidelines (to be specified).

  1. The applicant has submitted the following document as proof of residence:-
Nature of Document Date of Issue Details of authority issuing certificate

(Signature and Seal of Authorised Signatory of
notified Medical Authority)

Form-III

Disability Certificate
(In case of multiple disabilities)
(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE
CERTIFICATE)
(See rule 4)

Recent PP Size Photograph(showing face only) of Person with Disability

 

 

 

 

Certificate No. Date:

This is to certify that we have carefully examined Shri/Smt./Kum.__________________________________________________/son/wife/ daughter of Shri__________________________________________________________ Date of Birth (DD / MM / YY) ___ ____ ____ Age_______years, male/female____________________ Registration No.___________________________permanent resident of House No.___________________Ward/Village/Street_________________________________Post Office____________________________District_________State______________, whose photograph is affixed above, and are satisfied that:

(A) He/she is a Case of Multiple Disability. His/her extent of permanent physical impairment/disability has been evaluated as per guidelines (to be specified) for the disabilities ticked below, and shown against the relevant disability in the table below:

S. No. Disability Affected Part of Body Diagnosis Permanent physical impairment/mental disability (in %)
1 Locomotor disability @
2 Low vision #
3 Blindness Both Eyes
4 Hearing impairment £
5 Mental retardation X
6 Mental-illness X

(B) In the light of the above, his /her over all permanent physical impairment as per guidelines(to be specified), is as follows:-

In figures:- __________________percent

In words:-_______________________________________________________percent

  1. This condition is progressive/ non-progressive/ likely to improve/ not likely to improve.
  2. Reassessment of disability is:

(i) not necessary,

Or

(ii) is recommended/ after _______years____________months, and therefore this certificate shall be valid till (DD / MM / YY) _____ _____ _____

@ – e.g. Left/Right/both arms/legs

# – e.g. Single eye/both eyes

£ – e.g. Left/Right/both ears

  1. The applicant has submitted the following document as proof of residence:-
Nature of Document Date of Issue Details of authority issuing certificate
  1. Signature and seal of the Medical Authority.
Name and seal of Member Name and seal of Member Name and seal of the
Chairperson

Form-IV

Disability Certificate
(In cases other than those mentioned in Forms II and III)

(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE
CERTIFICATE)
(See rule 4)

 

Recent PP Size Photograph(showing face only) of Person with Disability

 

 

Certificate No. Date:

This is to certify that I have carefully examined Shri/Smt./Kum._______________________________________________________son/ wife/daughter of Shri______________________________________________________ Date of Birth (DD / MM / YY) ___ ____ ____ Age_______years, male/female____________________ Registration No.________________permanent resident of House No.___________________Ward/Village/ Street________________________Post Office________________________________ District_________State______________, whose photograph is affixed above, and am satisfied that he/she is a case of________________________ disability. His/her extent of percentage physical impairment/disability has been evaluated as per guidelines (to be specified) and is shown against the relevant disability in the table below:-

S. No. Disability Affected Part of Body Diagnosis Permanent physical impairment/mental disability (in %)
1 Locomotor disability @
2 Low vision #
3 Blindness Both Eyes
4 Hearing impairment £
5 Mental retardation X
6 Mental-illness X

(Please strike out the disabilities which are not applicable.)

  1. The above condition is progressive/ non-progressive/ likely to improve/ not likely to improve.
  2. Reassessment of disability is :

(i) not necessary,

Or

(ii) is recommended/ after _______years__________months, and therefore this certificate shall be valid till (DD / MM / YY) _____ _____ _____

@ – e.g. Left/Right/both arms/legs

# – e.g. Single eye/both eyes

£ – e.g. Left/Right/both ears

  1. The applicant has submitted the following document as proof of residence:-
Nature of Document Date of Issue Details of authority issuing certificate

(Authorised Signatory of notified Medical Authority)
(Name and Seal)

Countersigned

Signature/Thumb Impression of the person in whose favour disability certificate is issued.

{Countersignature and seal of the
CMO/Medical Superintendent/Head of
Government Hospital, in case the
certificate is issued by a medical
authority who is not a government
servant (with seal)}

 

 

 

Note: In case this certificate is issued by a medical authority who is not a government servant, it shall be valid only if countersigned by the Chief Medical Officer of the District.”

Note: The principal rules were published in the Gazette of India vide notification number S.O. 908(E), dated the 31st December, 1996.

Form-V

Intimation of Rejection of Application for Disability Certificate (See rule 4)

No.____________________ Dated:

To,

(Name and address of applicant for Disability Certificate)

Sub.: Rejection of Application for Disability Certificate

Sir / Madam,

Please refer to your application dated ____ for issue of a Disability Certificate for the following disability: _____________________________________________

  1. Pursuant to the above application, you have been examined by the undersigned/ Medical Board on _______, and I regret to inform that, for the reasons mentioned below, it is not possible to issue a disability certificate in your favour:

(i)

(ii)

(iii)

  1. In case you are aggrieved by the rejection of your application, you may represent to ________________________________, requesting for review of this decision.

Yours faithfully,

(Authorised Signatory of the notified Medical Authority)
(Name and Seal)

(Dr. Arbind Prasad)
Joint Secretary to the Govt. of India
Ministry of Social Justice and Empowerment

LIST OF HOSPITALS FOR ISSUE OF DISABILITY CERTIFICATES TO THE PERSONS WITH DISABILITIES

Medical Authorities notified for Central Government Hospitals/Institutes for issue of Disability Certificates for various kind of Disabilities

The Central Government amended the (Central) Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Rules in December, 2009. The amended Rules enable simplified and decentralized procedure for issuance of Disability Certificate.  The amended Rules replace “Medical Board” by “Medical Authorities”, to be notified by the appropriate government. The disability certificate is to be issued as far as possible, within seven days from the date of receipt of application but in any case not later than 1 month. Provision for review of the decision regarding the issuance or otherwise of the certificates has also been incorporated.

Pursuant to the amendment to the Central Persons with Disability Rules, guidelines were issued to State Governments in February, last year to effect suitable changes in their Rules and notify the Medical Authority.  In the guidelines, multi-tier medical authorities have been suggested so that in respect of obvious disabilities, the disability certificate can be issued at the level of Primary Health Centres (PHCs), Community Health Centres (CHCs), and Hospitals at the Sub-Divisional level, in case of non-obvious single disabilities, certificates can be issued by a single specialist and only in case of multiple disabilities, a multi member board would be required to issue the certificate. In addition, provisions have been made for taking services of non-government specialists and testing facilities in case these are not available in government hospitals.

Ministry of Health and Family Welfare have since issued notification for medical authorities for Central Government Hospitals/Institutes for issuing disability certificates for various kind of disabilities. List of notified medical authorities is given below. So far the State Governments of Bihar, Goa and Gujarat have already issued notification appointing medical authorities and simplifying procedure. Ministry of Social Justice & Empowerment is pursuing the matter with the remaining State Governments.

S. No. Type of Disability Hospital/Institution which is being specified as the “Medical Authority” for the purpose of the disability mentioned in Col.2 Medical Officer working in the Hospital/ Institution mentioned in Col.3 who would  be competent to issue certificate of disability
(1) (2) (3) (4)
1. Locomotors  & Leprosy cured disability 1.       All India Institute of Physical Medicine and Rehabilitation, Mumbai Specialist working on regular basis in the field of Physical Medicine and Rehabilitation (PMR)/ *Orthopedics
2.       Dr. R.M.L. Hospital, New Delhi
3.       Safdarjung Hospital, New Delhi
4.       Lady Harding Medical College and associated S.K. Hospital and Kalawati Saran Hospital, New Delhi
5.       All India Institute of Medical Sciences, New Delhi
6.       Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry.
7.       Post Graduate Institute of Medical Education and Research, Chandigarh
8.       National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka
9.       Regional Institute of Medical Sciences, Imphal, Manipur
10.   North Eastern Indira Gandhi Institute of Health and Mecial Sciences, Shillong, Mehgalaya
2. Hearing Impairment
  1. All  India Institute of Speech and Hearing, Mysore
Specialist working on regular basis in the field of ENT
  1. Dr. R.M.L. Hospital, New Delhi
  1. Sardarjung Hospital, New Delhi
  1. Lady Harding Medical College and associated S.K. Hospital and Kalawati Saran Hospital, New Delhi
  1. All India Institute of Medical Sciences, New Delhi
  1. Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry
  1. Post Graduate Institute of Medical Education and Research, Chandigarh
  1. National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka
  1. Regional Institute of Medical Sciences, Imphal, Manipur
  1. North Eastern Indira Gandhi Institute of Health and Medical Sciences, Shillong, Meghalaya
3. Mental Illness and mental retardation 1.       Central Institute of Psychiatry, Ranchi Specialist working on regular basis in the field of Psychiatry
2.       Dr. R.M.L. Hospital, New Delhi
3.       Safdarjung Hospital, New Delhi
4.       Lady Harding Medical College and associated S.K. Hospital and Kalawati Saran Hospital, New Delhi
5.       All India Institute of Medical Sciences, New Delhi
6.       Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry
7.       Post Graduate Institute of Medical Education and Research, Chandigarh
8.       National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka
9.       Regional Institute of Medical Sciences, Imphal, Manipur
10.   North Eastern Indira Gandhi Institute of Health and  Medical Sciences, Shillong, Meghalaya
4. Blindness & Low  Vision 1         Dr. R.M.L.Hospital, New Delhi Specialist working ofnregular basis in the field of Ophthalmology
2         Safdarjung Hospital, New Delhi
3         Lady Harding Medical College and associated S.K. Hospital and Kalawati Saran Hospital, New Delhi
4         All India Institute of Medical Sciences, New Delhi
5         Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry
6         Post Graduate Institute of Medical Education and Research, Chandigarh
7         National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka
8         Regional Institute of Medical Sciences, Imphal, Manipur
9         North Eastern Indira Gandhi Institute of Health and  Medical Sciences, Shillong, Meghalaya
5. Multiple Disability 1         Dr. R.M.L.Hospital, New Delhi A Medical Board comprising of one Chairman and three members as per following details:

 

One Specialist each from the Departments of Physical Medicine and Rehabilitation (PMR)/ *Orthopedics, ENT, Psychiatry and Ophthalmology.

 

The senior most specialist shall be the chairman of the Board

2         Safdarjung Hospital, New Delhi
3         Lady Harding Medical College and associated S.K. Hospital and Kalawati Saran Hospital, New Delhi
4         All India Institute of Physical Medicine and Rehabilitation Mumbai
5         All India Institute of Medical Sciences, New Delhi
6         Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry
7         Post Graduate Institute of Medical Education and Research, Chandigarh
8         National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka
9         Regional Institute of Medical Sciences, Imphal, Manipur
10     North Eastern Indira Gandhi Institute of Health and  Medical Sciences, Shillong, Meghalaya

Review Board: A Review Board is notified at each of the Hospital/Institute, Mentioned in Column 3 of the table above, to consider applications for review of disability certificates issued or refusal to issue such a certificate.  The Review Board shall consist of Head of Departments of Physical Medicine and Rehabilitation (PMR)/* Orthopedics, ENT, Ophthalmology and Psychiatry.  No member of the Review Board shall be the Specialist or a chairman/member of the Review Board shall be the Head of Department, Physical Medicine and Rehabilitation (PMR)/*Orthopedics

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