Definition/Introduction

One significant component of patient care is determining a patient’s disability level and impairment rating to determine what disability services they can receive. The first step to creating an accurate patient evaluation is ensuring that health care professionals understand the difference between “impairment” and “disability.” An impairment can be understood as any deviation or loss of any body function or body structure[1][2]. Disability is characterized by limitations or reductions in the individual’s ability to participate in their activities of daily living (ADL) due to a disease or health condition[1][3]. It is important to understand there is no definite relationship between disability and impairment. An individual may have significant impairment, such as an amputated arm, but would not be considered significantly disabled because they are still able to successfully engage in their daily tasks. Alternatively, an individual may have an impairment that appears minor but causes significant limitations for that person’s daily activities. For example, an individual with arthritis in their knee becomes unable to tolerate a full day of work, causing them to lose employment. Because impairment and disability will vary for each case, health care providers are encouraged to consider disability in terms of a spectrum of ability to function[4] and rate a patient’s impairment depending on how the impairment impacts the patient’s ADL participation [5][6].

Issues of Concern

In order for individuals to receive aid from disability services, they must establish their impairment or disability through medical evidence. This means that without the evaluation and assessment of a health care provider, individuals may not qualify for disability aid[7][3]. Therefore, health care professionals need to understand how different patients might be eligible for disability aid. Part of the difficulty with disability determination is that multiple services provide disability aid, and each service works differently. For example, the Social Security Administration (SSA) determines disability aid based on its own definitions of impairment and disability. For the SSA to recognize an impairment, the impairment must be medically determined through accepted diagnostic methods. This means assessment through a licensed provider using valid and reliable methods or assessments[7]. For a disability, the SSA requires that a patient’s limitation to activity engagement must be expected to continue, or must have already continued, for a full year[3]. Other disability providers, such as workers’ compensation, state disability programs, and private disability insurance policies all have different qualification requirements and award disability benefits in different ways.

Though many disability service providers use the guidelines established by the American Medical Association’s Guide to Permanent Injury, some disability providers choose not to use them because of concerns about the accuracy of these guidelines[1][8]. Without a universally recognized way of determining disability aid, it is up to health care providers to understand the different disability services and to perform comprehensive evaluations to ensure the best patient care possible.

Clinical Significance

Though the qualifications for different disability services vary, there are similarities in the assessment process. An impairment rating is likely to include a physical/psychological examination, an assessment of causation, and a credibility assessment. It is important to mention that the credibility assessment is not a character judgment about the patient, but rather an assessment of the consistency of the allegations to determine an accurate depiction of the patient’s condition.

Some organizations use Functional Capacity evaluations, though there is mixed evidence about the effectiveness of these evaluations[9]. Other services have specific assessments and require that authorized agents administer the evaluations. For example, the Work Disability Functional Assessment Battery (WD-FAB) is a specific assessment created for workers’ compensation evaluations [10].

Nursing, Allied Health, and Interprofessional Team Interventions

Disability service providers determine from which agents they will accept an impairment rating. Many systems require providers with a physician-level license, though some will accept third-party evidence from physical therapists, occupational therapists, and similar providers. Regardless of who is conducting the evaluation or assisting with providing evidence, health care professionals need to understand the difference between impairment and disability. Evidence shows that disability and impairment are distinctly separate factors. Evidence also suggests that considering disability as a separate factor to impairment may lead to a better understanding of the individual cases for disability determination[5][Level 3].