Guidelines for various disabilities and procedure for certification.

Ministry of Social Justice and Empowerment

Guidelines for mental illness and procedure for certification – click here

No. 16-18/97-NI.

• 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 & 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.
• 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 –
  • 1. Visual impairment
  • 2. Locomotor / Orthopaedic disability
  • 3. Speech & hearing disability
  • 4. Mental retardation
  • 5. Multiple Disabilities.

  Copy of the Report is enclosed herewith as Annexure.

• The minimum degree of disability should be 40% in order to be eligible for any concessions/benefits.
• 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.
• Specified test as indicated in Annexure should be conducted by the medical board and recorded before a certificate is given.
• 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’.
• The State Governments/UT Administrations may constitute the medical boards indicated in para 4 above immediately, if not done so far.
• 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.

ANNEXURE

Reports of the Committee set UP to review the guidelines for evaluation of various disabilities and procedure for certification and to recommend appropriate modifications/alternations keeping in view the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act 1995. In order to review the definitions of various types of disability, 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, five Sub-Committees were constituted in the areas of Mental Retardation, Orthopedic/Locomotor Disability, Visual Disability, Speech & Hearing and Multiple Disabilities, under the Chairmanship of Dr S.P.Agarwal, Director General of Health Services, vide the Ministry of Social Justice & Empowerment’s Order No.16-18/97-NI.I, dated 28.8.1998 and 21.7.1999. A copy each of the Order is at Appendix.I. These Sub-Committees, after detailed deliberations, have submitted their reports. List of- participants of the meetings taken by the Committee is at Appendix.ll. The reports of the Committees set up to review the guidelines for evaluation of various disabilities and procedure for certification on each of the area of the disabilities are given in Appendix.lll.

No 16-18/97-NI.I Government of India Ministry of Social Justice & Empowerment New Delhi Dated 28lh August 1998.

A. MENTAL RETARDATION

• 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 over all level of intelligence, i.e., cognitive, language, motor and social abilities.
• Categories of Mental Retardation:-

2.1 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.

2.2 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.

2.3 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.

2.4 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,

• Process of Certifications:-

3.1 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.

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

B. VISUAL DISABILITY

• Definition: – Blindness refers to a condition where a persons suffers from any of the condition, namely,

i) total absence of sight; or

ii) visual acuity not exceeding 6/60 or 20/200(snellen) in the better eye with best correcting lenses; or

iii) limitation of field of vision subtending an angle of 20 degree or worse;

• 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:-

a) reduction of fields less than 50 degrees

b) Heminaopia with macular involvement

c) Altitudinal defect involving lower fields.

Categories of Visual DisabilityAll with correction

C. SPEECH & HEARING DISABILITY

• Definition of Hearing: – A persons with hearing impairment having difficulty of various degrees in hearing sounds is an impaired person.
• Categories of Hearing Impairment.

• i) 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.

ii) 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.

iii) 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.

• 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.

D. LOCOMOTOR DISABILITY

• Definition :-

i) Impairment: An impairment in any loss or abnormality of psychological, physiological or anatomical structure or function in a human being.

ii) 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.

iii) 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.

iv) 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.

• Categories of Locomotor Disability

The categories of locomotor disabilities are enclosed at Annexure-A.

• 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.

1.Guidelines for Evaluation of Permanent Physical Impairment of Upper Limb

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

3.Guidelines for Evaluation of Permanent Physical Impairment of Trunk (Spine)

4.Guidelines for Evaluation of PPI in cases of Short Stature/Dwarftsm

5.Guidelines for Evaluation of Permanent Physical Impairment in Amputees

6.Guidelines for Evaluation of Permanent Physical Impairment of Congenital deficiencies of the limbs

7.Guidelines for Evaluation of Physical Impairments in Neurological conditions

8.Guidelines for Evaluation of Physical Impairment due to Cardiopulmonary

Annexure-B.

Certificate of mental retardation for benefits and standard format