Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Disability assessment and determination in the United States

Linda Cocchiarella, MD, MSc
Section Editor
Joann G Elmore, MD, MPH
Deputy Editor
Howard Libman, MD, FACP


Disability evaluation is an important aspect of clinical care. Accurate evaluation significantly affects the wellbeing of both patients and society, given the impact of disability status on financial remuneration, return to work, personal and workplace productivity, and access for existing and future health care needs.

Both treating and consulting clinicians are often asked to evaluate their patients for disability. Input from treating clinicians is crucial to disability evaluation because they often have the most in-depth and longitudinal knowledge of the patient's conditions and function, may be aware of medical and psychosocial contributions to ongoing disability, and can best advise on severity, permanency, and possible accommodations needed for an impairment.

When treating clinicians are unable to provide a disability evaluation, or when an insurance carrier has concerns that the treating clinician cannot be impartial, a consulting clinician may be hired to provide an opinion as an "independent" medical examiner. There is no doctor-patient relationship between the independent medical examiner and the patient.

Assessment of disability is complex, variable and challenging even among clinicians experienced in disability determination. A number of factors give rise to these challenges [1]:

The determination of disability requires a synthesis of clinical and nonclinical information.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Sep 17, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. http://www.nhchc.org/wp-content/uploads/2012/02/DocumentingDisability2007.pdf (Accessed on August 18, 2015).
  2. Social Security Administration. Disability Evaluation Under Social Security (Blue Book - September 2008). Available at: http://www.socialsecurity.gov/disability/professionals/bluebook/ (Accessed on September 28, 2012).
  3. Social Security Online. Consultative Examinations: A Guide for Health Professionals (The Green Book). SSA Publication No. 64-025. November 1999, ICN 954095. Available at: www.ssa.gov/disability/professionals/greenbook/ce-evidence.htm (Accessed on January 02, 2000).
  4. Cocchiarella L, Anderson GB. Guides to the Evaluation of Permanent Impairment, 5th ed, American Medical Association, 2001 p.565.
  5. Rondinelli R. Guides to the Evaluation of Permanent Impairment, 6th ed, American Medical Association, 2007.
  6. State-by-State Use of AMA Guides, updated July 2009. Available at: www.lexisnexis.com/documents/pdf/20090916052048_large.PDF (Accessed on October 05, 2009).
  7. World Health Organization. International Classification of Impairments, Disability and Health. Geneva, Switzerland 2001.
  8. McFarren TD. AMA Guides: Sixth Edition Arrive on the Scene. Available at: http://law.lexisnexis.com/practiceareas/Workers-Compensation-Law-Blog/Workers-Compensation/AMA-Guides-Sixth-Edition-Arrive-on-the-Scene (Accessed on December 18, 2008).
  9. http://www.nap.edu/openbook.php?record_id=11898 (Accessed on August 18, 2015).
  10. National Council on Disability (NCD). The Current State of Health Care for People with Disabilities. http://www.ncd.gov/publications/2009/Sept302009 (Accessed on August 18, 2015).
  11. Forst L, Friedman L, Chukwu A. Reliability of the AMA Guides to the Evaluation of Permanent Impairment. J Occup Environ Med 2010; 52:1201.
  12. Courtney-Long EA, Carroll DD, Zhang QC, et al. Prevalence of Disability and Disability Type Among Adults--United States, 2013. MMWR Morb Mortal Wkly Rep 2015; 64:777.
  13. Carroll DD, Courtney-Long EA, Stevens AC, et al. Vital signs: disability and physical activity--United States, 2009-2012. MMWR Morb Mortal Wkly Rep 2014; 63:407.
  14. Brault M. Americans with Disabilities: 2005. U.S. Census Bureau; Washington, DC 2008.
  15. Altman B, Bernstein A. Disability and Health in the United States, 2001-2005. National Center for Health Statistics; Hyattsville, MD 2008.
  16. Centers for Disease Control and Prevention (CDC). Public health and aging: projected prevalence of self-reported arthritis or chronic joint symptoms among persons aged >65 years--United States, 2005-2030. MMWR Morb Mortal Wkly Rep 2003; 52:489.
  17. American Society on Aging: Teaching/Training Modules on Trends in Health and Aging. Available at: www.asaging.org (Accessed on November 15, 2012).
  18. Bureau of Labor Statistics. Economic News Release: Workplace Injury and Illness Summary. Available at: http://www.bls.gov/news.release/osh.nr0.htm (Accessed on June 08, 2012).
  19. http://www.bls.gov/news.release/pdf/osh.pdf (Accessed on August 18, 2015).
  20. NIOSH Publication No. 2004-146, Worker Health Chartbook 2004. Available at: http://www.cdc.gov/niosh/docs/2004-146/ (Accessed on November 14, 2012).
  21. Bureau of Labor Statistics. News Release: National Census of Fatal Occupational Injuries in 2010 (Preliminary Results). US Department of Labor. Available online at: http://www.bls.gov/news.release/pdf/cfoi.pdf (Accessed on June 08, 2012).
  22. Landsbergis PA. The changing organization of work and the safety and health of working people: a commentary. J Occup Environ Med 2003; 45:61.
  23. Subramanian A, Desai A, Prakash L, et al. Changing trends in US injury profiles: revisiting non-fatal occupational injury statistics. J Occup Rehabil 2006; 16:123.
  24. Social Security Administration. Status of the Social Security and Medicare Programs: A summary of the 2012 annual reports. Available at: http://www.ssa.gov/oact/TRSUM/index.html (Accessed on June 04, 2012).
  25. Institute of Medicine. "Linking Components of Functional Capacity Domains with Work Requirements." In: Measuring Funcitonal Capacity and Work Requirements: Summary of a Workshop. National Academies Press 1999. Available at: http://www.nhchc.org/wp-content/uploads/2012/02/DocumentingDisability2007.pdf (Accessed on August 18, 2015).
  26. O'Connell J, Quick P, Zevin B, Post P. Documenting Disability: Simple Strategies for Medical Providers. National Health Care for the Homeless Council Website. Available at: documenting-disability-simple-strategies-for-medical-providers (Accessed on January 03, 2013).
  27. Hayashi H, Shimizu H. Essential motion of metacarpophalangeal joints during activities of daily living. J Hand Ther 2013; 26:69.
  28. Hemmerich A, Brown H, Smith S, et al. Hip, knee, and ankle kinematics of high range of motion activities of daily living. J Orthop Res 2006; 24:770.
  29. Namdari S, Yagnik G, Ebaugh DD, et al. Defining functional shoulder range of motion for activities of daily living. J Shoulder Elbow Surg 2012; 21:1177.
  30. Social Security. Code of Federal Regulations, Appedix 2 to Subpart of Part 404 - Medcical-Vocational Guidelines. http://www.ssa.gov/OP_Home/cfr20/404/404-app-p02.htm (Accessed on August 19, 2015).
  31. Social Security Administration. SSR 82-63: TITLES II AND XVI: MEDICAL-VOCATIONAL PROFILES SHOWING AN INABILITY TO MAKE AN ADJUSTMENT TO OTHER WORK. US Social Security Administration website. Available at: www.ssa.gov/OP_Home/rulings/di/02/SSR82-63-di-02.html (Accessed on January 03, 2013).
  32. Jette AM, Haley SM. Contemporary measurement techniques for rehabilitation outcomes assessment. J Rehabil Med 2005; 37:339.
  33. Goldman HH. Commentary on measuring disability. Arch Phys Med Rehabil 2013; 94:1687.
  34. Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980; 66:271.
  35. Kopec JA, Esdaile JM, Abrahamowicz M, et al. The Quebec Back Pain Disability Scale: conceptualization and development. J Clin Epidemiol 1996; 49:151.
  36. Manniche C, Asmussen K, Lauritsen B, et al. Low Back Pain Rating scale: validation of a tool for assessment of low back pain. Pain 1994; 57:317.
  37. Bolton JE, Breen AC. The Bournemouth Questionnaire: a short-form comprehensive outcome measure. I. Psychometric properties in back pain patients. J Manipulative Physiol Ther 1999; 22:503.
  38. Ruta DA, Garratt AM, Wardlaw D, Russell IT. Developing a valid and reliable measure of health outcome for patients with low back pain. Spine (Phila Pa 1976) 1994; 19:1887.
  39. Stratford PW, Binkley JM, Riddle DL. Development and initial validation of the back pain functional scale. Spine (Phila Pa 1976) 2000; 25:2095.
  40. Waddell G, Main CJ. Assessment of severity in low-back disorders. Spine (Phila Pa 1976) 1984; 9:204.
  41. Roland M, Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976) 1983; 8:141.
  42. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30:473.
  43. Chapman JR, Norvell DC, Hermsmeyer JT, et al. Evaluating common outcomes for measuring treatment success for chronic low back pain. Spine (Phila Pa 1976) 2011; 36:S54.
  44. Garratt AM, Ruta DA, Abdalla MI, et al. The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? BMJ 1993; 306:1440.
  45. Roland M, Fairbank J. The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine (Phila Pa 1976) 2000; 25:3115.
  46. Ostelo RW, de Vet HC, Knol DL, van den Brandt PA. 24-item Roland-Morris Disability Questionnaire was preferred out of six functional status questionnaires for post-lumbar disc surgery. J Clin Epidemiol 2004; 57:268.
  47. Davidson M, Keating JL. A comparison of five low back disability questionnaires: reliability and responsiveness. Phys Ther 2002; 82:8.
  48. Pransky G, Feuerstein M, Himmelstein J, et al. Measuring functional outcomes in work-related upper extremity disorders. Development and validation of the Upper Extremity Function Scale. J Occup Environ Med 1997; 39:1195.
  49. Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am 1998; 23:575.
  50. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996; 29:602.
  51. Velstra IM, Ballert CS, Cieza A. A systematic literature review of outcome measures for upper extremity function using the international classification of functioning, disability, and health as reference. PM R 2011; 3:846.
  52. Johanson NA, Liang MH, Daltroy L, et al. American Academy of Orthopaedic Surgeons lower limb outcomes assessment instruments. Reliability, validity, and sensitivity to change. J Bone Joint Surg Am 2004; 86-A:902.
  53. McNair PJ, Prapavessis H, Collier J, et al. The lower-limb tasks questionnaire: an assessment of validity, reliability, responsiveness, and minimal important differences. Arch Phys Med Rehabil 2007; 88:993.
  54. Pain Disability Index. Available at: http://www.med.umich.edu/1info/fhp/practiceguides/pain/detpdi.pdf (Accessed on January 13, 2013).
  55. Barofsky I, Cohen SJ, Sugarbaker PH. Selecting a quality of life assessment instrument: Standardized tests, clinical assessments, or custom-designed instruments. In: Assessment of Quality of Life in Clinical Trials of Cardiovascular Therapies, Wenger NK, Mattson ME, et al (Eds), Le Jacq Publishing Inc, 1984. p.239.
  56. Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain 1975; 1:277.
  57. Chibnall JT, Tait RC. The Pain Disability Index: factor structure and normative data. Arch Phys Med Rehabil 1994; 75:1082.
  58. Richards JS, Nepomuceno C, Riles M, Suer Z. Assessing pain behavior: the UAB Pain Behavior Scale. Pain 1982; 14:393.
  59. Gouttebarge V, Wind H, Kuijer PP, Frings-Dresen MH. Reliability and validity of Functional Capacity Evaluation methods: a systematic review with reference to Blankenship system, Ergos work simulator, Ergo-Kit and Isernhagen work system. Int Arch Occup Environ Health 2004; 77:527.
  60. Spanjer J, Groothoff JW, Brouwer S. Instruments used to assess functional limitations in workers applying for disability benefit: a systematic review. Disabil Rehabil 2011; 33:2143.
  61. O*NET OnLine. Available at: http://online.onetcenter.org/ (Accessed on January 14, 2013).
  62. Dictionary of occupational titles, 4th ed, US Department of Labor Employment and Training Administration, Washington, DC 1991.