Conditions that can lead to disability status in Ukraine: grounds, groups and the assessment procedure

Amputations and limb loss

Amputations are among the conditions that directly affect how a person functions.

Various types of amputation and disarticulation are grounds for referral to assessment.

These may include:

• finger amputation;
• loss of the hand;
• loss of the forearm;
• amputation above the elbow;
• upper limb amputation;
• toe amputation;
• partial foot amputation;
• transtibial amputation;
• transfemoral amputation;
• hip disarticulation;
• bilateral amputations;
• multiple amputation defects.

The official referral criteria specifically mention acquired loss of limbs at various levels. The particular disability group, however, depends among other things on the level of amputation, the condition of the other limb, the prosthetic options available and the degree of functional limitation.

Disability status after amputation

The expert team may consider:

• the level of amputation;
• whether the amputation is unilateral or bilateral;
• the condition of the residual limb;
• the presence of contractures;
• the state of the joints;
• the ability to use a prosthesis;
• the ability to move about independently;
• the need for crutches, a walking frame or a wheelchair;
• the ability to perform everyday and occupational tasks.

Amputation is one of the clearest examples of a situation where what has to be assessed is not only the diagnosis but the person’s actual functioning.

Visual impairment

Severe visual impairment can be grounds for assessment.

The official criteria specifically name, among others:

• blindness in both eyes;
• bilateral anophthalmia;
• total blindness in one eye combined with significant impairment in the other;
• severe visual impairment in both eyes.

Conditions that may potentially lead to disability include:

• optic nerve atrophy;
• severe glaucoma;
• retinal disease;
• complications of diabetes;
• the consequences of eye injuries;
• other irreversible eye conditions.

With other ophthalmic conditions the decision depends on the degree of vision loss and its impact on everyday life.

Chronic kidney disease

Chronic kidney disease occupies a special place.

The referral criteria expressly provide for:

• stage IV chronic kidney disease;
• stage V chronic kidney disease.

The person’s condition is also considered in cases of:

• end-stage renal failure;
• ongoing haemodialysis;
• a need for other renal replacement therapy.

The severity of functional limitations is assessed individually.

Status after organ transplantation

Post-transplant conditions can be grounds for referral to assessment.

For example:

• kidney transplant;
• heart transplant;
• lung transplant;
• liver transplant;
• simultaneous heart and lung transplant;
• pancreas transplant.

The assessment considers the condition of the transplanted organ, the need for ongoing treatment, complications and the effect of the person’s health on daily life.

Cancer

Malignant tumours are one of the most significant groups of conditions for which disability status may be granted.

These include:

• cancers of various organs;
• sarcomas;
• malignant brain tumours;
• metastatic tumours;
• recurrent malignancies;
• severe consequences of cancer treatment.

The following are taken into account:

• the stage of the disease;
• the presence of metastases;
• the results of surgery;
• the effects of chemotherapy;
• the effects of radiotherapy;
• the prognosis;
• functional impairment.

For certain oncological and oncohaematological conditions with an unfavourable prognosis, the law provides for disability status to be granted for five years.

Oncohaematological conditions

This group covers malignant diseases of the blood-forming and lymphatic systems.

For example:

• certain types of leukaemia;
• lymphomas;
• multiple myeloma;
• myelodysplastic and other severe oncohaematological conditions.

The decision depends on the diagnosis, the course of the disease, the prognosis and the person’s functional state.

Heart and vascular disease

Disability status may be granted for severe cardiovascular disease if it leads to persistent limitation of daily activity.

Such conditions potentially include:

• severe heart failure;
• the consequences of myocardial infarction;
• severe arrhythmias;
• cardiomyopathies;
• congenital and acquired heart defects;
• severe coronary heart disease;
• disease of the aorta and large vessels;
• severe hypertension with complications.

A diagnosis of «hypertension» or «coronary heart disease» does not in itself mean disability status is granted automatically. What is assessed is the degree of cardiac impairment and how far the person is limited in physical activity and daily life.

Diseases of the nervous system

Disability status may be granted for severe diseases of the central and peripheral nervous system.

For example:

• the consequences of a stroke;
• multiple sclerosis;
• Parkinson’s disease;
• severe epilepsy;
• amyotrophic lateral sclerosis;
• severe polyneuropathies;
• peripheral nerve damage;
• the consequences of neuroinfections;
• hereditary neuromuscular diseases.

Particular weight is given to impairments of:

• walking;
• balance;
• coordination;
• speech;
• memory;
• hand movement;
• the ability to care for oneself.

The after-effects of a stroke

Having had a stroke does not in itself mean disability status is granted automatically.

What matters are its consequences.

For example:

• paralysis or marked weakness of the limbs;
• balance problems;
• inability to walk unaided;
• speech impairment;
• swallowing difficulties;
• marked cognitive decline;
• a need for constant help from another person.

The more pronounced and persistent these impairments, the stronger the grounds for granting disability status.

Spinal and spinal cord conditions

Grounds may include severe conditions accompanied by persistent impairment of movement or other functions.

For example:

• spinal cord injury;
• paraplegia;
• tetraplegia;
• marked paresis;
• severe consequences of a spinal fracture;
• the consequences of spinal surgery;
• spinal cord tumours;
• severe degenerative spinal disease with neurological impairment.

Ordinary back pain or a herniated disc do not in themselves guarantee disability status. Persistent functional impairment is required.

Joint and musculoskeletal conditions

Severe damage to the large joints and the musculoskeletal system can lead to disability.

For example:

• severe hip osteoarthritis;
• severe knee osteoarthritis;
• joint ankylosis;
• marked contractures;
• rheumatoid arthritis;
• severe systemic connective tissue diseases;
• the consequences of multiple fractures;
• the consequences of serious pelvic trauma;
• marked limb deformities;
• arthrodesis of large joints.

What is assessed is the person’s ability to:

• walk;
• stand;
• use stairs;
• do household tasks;
• work in their occupation.

Joint replacement

Hip or knee replacement is not in itself automatic grounds for disability status.

After successful surgery a person may recover function almost completely.

Disability is considered where there are persistent complications or significant limitations, for example:

• marked restriction of movement;
• severe pain;
• instability of the implant;
• infective complications;
• inability to walk normally;
• repeated complex operations.

Diabetes

A diagnosis of diabetes likewise does not mean disability status is granted automatically.

Complications matter a great deal.

For example:

• diabetic foot;
• amputation;
• marked polyneuropathy;
• severe visual impairment;
• diabetic nephropathy;
• renal failure;
• severe vascular complications;
• frequent severe hypoglycaemia.

In such cases the combined functional impairment is assessed.

Respiratory conditions

Disability status may be granted for severe chronic respiratory disease.

These may include:

• severe chronic obstructive pulmonary disease;
• severe asthma;
• pulmonary fibrosis;
• severe respiratory failure;
• the consequences of major lung surgery;
• severe occupational lung disease.

What matters most is the degree of respiratory failure and the limitation of physical activity.

Tuberculosis

Tuberculosis is a separate category, and the referral criteria take the length of treatment into account.

Where incapacity for work related to tuberculosis is prolonged, a person may be referred for assessment of everyday functioning.

The assessment covers:

• disease activity;
• treatment outcomes;
• organ damage;
• respiratory function;
• the ability to work and care for oneself.

Mental health conditions

Persistent severe mental health conditions can also be grounds for disability status.

What is assessed is the effect of the condition on:

• the ability to live independently;
• orientation;
• communication;
• learning;
• work;
• control of behaviour;
• the need for outside support.

Such conditions potentially include severe chronic mental illness and marked intellectual impairment. The list of diagnoses that are direct grounds for referral specifically includes severe and profound intellectual disability.

Severe intellectual impairment

With marked reduction of intellectual functioning, a person may depend substantially on help from others.

What is assessed:

• the ability to care for oneself;
• orientation;
• the ability to understand instructions;
• the safety of living independently;
• the capacity to learn;
• the capacity to work.

In severe forms the limitations may be significant or almost total.

Hearing loss

Persistent significant hearing loss can also lead to disability status.

What is assessed is not only the audiogram but the ability to:

• understand speech;
• communicate;
• orient oneself in the environment;
• work;
• use hearing aids or other compensatory devices.

Congenital anomalies

Disability status may be granted for congenital defects and anomalies where they substantially affect functioning.

For example:

• congenital absence of a limb or part of one;
• severe heart defects;
• marked developmental disorders of the musculoskeletal system;
• severe neurological conditions;
• genetic disorders.

The decision is determined not only by the name of the congenital condition but by the degree of limitation.

Group I

This is the most severe degree of functional impairment.

It is granted to people whose condition leads to substantial or complete dependence on help from others.

The person may be substantially limited in, or unable to:

• care for themselves;
• move about independently;
• orient themselves;
• communicate;
• control their behaviour;
• perform other basic life functions.

Group II

This usually involves marked persistent functional impairment.

The person may retain some independence but face significant limitations in several areas of daily life.

Group III

Granted for moderate persistent impairment that limits daily activity but leaves the person a considerable degree of independence.

The person may need, for example:

• a prosthesis;
• an orthosis;
• other assistive devices;
• special working conditions;
• adaptation of their activities.