The State Government shall every year before the 31st March, forward the report to the Central Government about the measures taken for implementing provisions of the Act and various schemes/plans framed by it during the previous calendar year.
33[ANNEXURE I
[See Rule 12(4)]
NORMS FOR RELIEF AMOUNT
| Sl. No. |
Name of the offence |
Minimum amount of relief |
| (1) |
(2) |
(3) |
| 1. |
Putting any inedible or obnoxious substance [Section 3(1)(a) of the Act] |
One lakh rupees to the victim. Payment to then victim be made as follows: |
| 2. |
Dumping excreta, sewage, carcasses or any other obnoxious substance [Section 3(1)(b) of the Act] |
(i) 10 per cent at First Information Report (FIR) stage for serial numbers (2) and (3) and 25 per cent at FIR stage for serial numbers (1), (4) and (5); |
| 3. |
Dumping excreta, waste matter, carcasses with intent to cause injury, insult or annoyance [Section 3(1)(c) of the Act] |
(ii) 50 per cent when the charge sheet is sent to the court; |
| 4. |
Garlanding with footwear or parading naked or semi-naked [Section 3(1)(d) of the Act] |
(iii) 40 per cent when the accused are convicted by the lower court for serial numbers |
| 5. |
Forcibly committing acts such as removing clothes, forcible tonsuring of head, removing moustaches, painting face or body [Section 3(1)(e) of the Act] |
(2) and (3) and likewise 25 per cent for serial numbers (1), (4) and (5). |
| 6. |
Wrongful occupation or cultivation of land [Section 3(1)(f) of the Act] |
One lakh rupees to the victim. The land or premises or water supply or irrigation facility shall be restored where necessary at Government cost by the concerned State Government or Union Territory Administration. Payment to the victim be made as follows: (i) 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court. |
| 7. |
Wrongful dispossession of land or premises or interfering with the rights, including forest rights. [Section 3(1)(g) of the Act] |
| 8. |
Begar or other forms of forced or bonded labour [Section 3(1)(h) of the Act] |
One lakh rupees to the victim. Payment to be made as follows: |
| 9. |
Compelling to dispose or carry human or animal carcasses, or to dig graves [Section 3(1)(i) of the Act] |
(i) Payment of 25 per cent First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; |
| 10. |
Making a member of the Scheduled Castes or the Scheduled Tribes to do manual scavenging or employing him for such purpose [Section 3(1)(j) of the Act] |
(iii) 25 per cent when the accused are convicted by the lower court. |
| 11. |
Performing, or promoting dedication of a Scheduled Caste or a Scheduled Tribe woman as a devadasi [Section 3(1)(k) of the Act] |
|
| 12. |
Prevention from voting, filing nomination [Section 3(1)(l) of the Act] |
Eighty-five thousand rupees to the victim. Payment to be made as follows: |
| 13. |
Forcing, intimidating or obstructing a holder of office of Panchayat or Municipality from performing duties [Section 3(1)(m) of the Act] |
(i) 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; |
| 14. |
After poll violence and imposition of social and economic boycott [Section 3(1)(n) of the Act] |
(iii) 25 per cent when the accused are convicted by the lower court. |
| 15. |
Committing any offence under this Act for having voted or not having voted for a particular candidate [Section 3(1)(o) of the Act] |
|
| 16. |
Instituting false, malicious or vexatious legal proceedings [Section 3(1)(p) of the Act] |
Eighty-five thousand rupees to the victim or reimbursement of actual legal expenses and damages, whichever is less. Payment to be made as follows: (i) 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court. |
| 17. |
Giving false and frivolous information to a public servant [Section 3(1)(q) of the Act] |
One lakh rupees to the victim or reimbursement of actual legal expenses and damages, whichever is less. Payment to be made as follows: (i) 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court. |
| 18. |
Intentional insult or intimidation to humiliate in any place within public view [Section 3(1)(r) of the Act] |
One lakh rupees to the victim. Payment to be made as follows: (i) 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court. |
| 19. |
Abusing by caste name in any place within public view [Section 3(1)(s) of the Act] |
| 20. |
Destroying, damaging or defiling any object held sacred or in high esteem [Section 3(1)(t) of the Act] |
| 21. |
Promoting feelings of enmity, hatred or ill-will [Section 3(1)(u) of the Act] |
| 22. |
Disrespecting by words or any other means of any late person held in high esteem [Section 3(1)(v) of the Act] |
| 23. |
Intentionally touching a Scheduled Caste or a Scheduled Tribe woman without consent, using acts or gestures, as an act of sexual nature, [Section 3(1)(w) of the Act] |
Two lakh rupees to the victim. Payment to be made as follows: (i) 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court. |
| 24. |
34[Section 326-A of the Indian Penal Code (45 of 1860) Voluntarily causing grievous hurt by use of acid. etc. Section 326-B of the Indian Penal Code (45 of 1860) Voluntarily throwing or attempting to throw acid. [Section 3(2)(v), 3(2)(va) read with Schedule to the Act]] |
(a) Eight lakh and twenty-five thousand rupees to the victim with burns exceeding and 2 per cent and above burns on face or in case of functional impairment of eye, ear, nose and mouth and or burn injury on body exceeding 30 per cent; (b) four lakh and fifteen thousand rupees to the victim with burns between 10 per cent to 30 per cent on the body; (c) eighty-five thousand rupees to the victim with burns less than 10 per cent on the body other than on face. In addition, the State Government or Union Territory Administration shall take full responsibility for the treatment of the victim of acid attack. The payment in terms of items (a) to (c) are to be made as follows: (i) 50 per cent at First Information Report (FIR) stage; (ii) 50 per cent after receipt of medical report. |
| 25. |
Section 354 of the Indian Penal Code (45 of 1860) Assault or criminal force to woman with intent to outrage her modesty. [Section 3(2)(va) read with Schedule to the Act] |
Two lakh rupees to the victim. Payment to be made as follows: (i) 50 per cent at First Information Report (FIR) stage; (ii) 25 per cent when the charge sheet is sent to the court; (iii) 25 per cent on conclusion of trial by the lower court. |
| 26. |
Section 354-A of the Indian Penal Code (45 of 1860) Sexual harassment and punishment for sexual harassment. [35[Section 3(a)(va)] read with Schedule to the Act] |
Two lakh rupees to the victim. Payment to be made as follows: (i) 50 per cent at First Information Report (FIR) stage; (ii) 25 per cent when the charge sheet is sent to the court; (iii) 25 per cent on conclusion of trial by the lower court. |
| 27. |
Section 354-B of the Indian Penal Code (45 of 1860) Assault or use of criminal force to woman with intent to disrobe [Section 3(2)(va) read with Schedule to the Act] |
Two lakh rupees to the victim. Payment to be made as follows: (i) 50 per cent at First Information Report (FIR) stage; (ii) 25 per cent when the charge sheet is sent to the court; (iii) 25 per cent on conclusion of trial by the lower court. |
| 28. |
Section 354-C of the Indian Penal Code (45 of 1860) Voyeurism. [Section 3(2)(va) read with Schedule to the Act] |
Two lakh rupees to the victim. Payment to be made as follows: (i) 10 per cent at First Information Report (FIR) stage (ii) 50 per cent when the charge sheet is sent to the court. (iii) 40 per cent when the accused are convicted by the lower court. |
| 29. |
Section 354-D of the Indian Penal Code (45 of 1860) Stalking. [Section 3(2)(va) read with Schedule to the Act] |
Two lakh rupees to the victim. Payment to be made as follows: (i) 10 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 40 per cent when the accused are convicted by the lower court. |
| 30. |
Section 376-B of the Indian Penal Code (45 of 1860) Sexual intercourse by husband upon his wife during separation. [Section 3(2)(va) read with Schedule to the Act] |
Two lakh rupees to the victim. Payment to be made as follows: (i) 50 per cent after medical examination and confirmatory medical report; (ii) 25 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court. |
| 31. |
Section 376-C of the Indian Penal Code (45 of 1860) Sexual intercourse by a person in authority. [Section 3(2)(va) read with Schedule to the Act] |
Four lakh rupees to the victim. Payment to be made as follows: (i) 50 per cent after medical examination and confirmatory medical report; (ii) 25 per cent when the charge sheet is sent to the court; (iii) 25 per cent on conclusion of trial by the lower court. |
| 32. |
Section 509 of the Indian Penal Code (45 of 1860) Word, gesture or act intended to insult the modesty of a woman. [Section 3(2)(va) read with Schedule to the Act] |
Two lakh rupees to the victim. Payment to be made as follows: (i) 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court. |
| 33. |
Fouling or corrupting of water [Section 3(1)(x) of the Act] |
Full cost of restoration of normal facility, including cleaning when the water is fouled, to be borne by the concerned State Government or Union Territory Administration. In addition, an amount of eight lakh twenty-five thousand rupees shall be deposited with the District Magistrate for creating community assets of the nature to be decided by the District Authority in consultation with the Local Body. |
| 34. |
Denial of customary right of passage to a place of public resort or obstruction from using or accessing public resort [Section 3(1)(y) of the Act] |
Four lakh twenty-five thousand rupees to the victim and cost of restoration of right of passage by the concerned State Government or Union Territory Administration. Payment to be made as follows: (i) 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court. |
| 35. |
Forcing of causing to leave house, village, residence desert place of residence [Section 3(1)(z) of the Act] |
Restoration of the site or right to stay in house, village or other place of residence by the concerned State Government or Union Territory Administration and relief of one lakh rupees to the victim and reconstruction of the house at Government cost, if destroyed. Payment to be made as follows: (i) 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court. |
| 36. |
Obstructing or preventing a member of a Scheduled Caste or a Scheduled Tribe in any manner with regard to |
|
| |
(A) using common property resources of an area, or burial or cremation ground equally with others or using any river, stream, spring, well, tank, cistern, water-tap or other watering place, or any bathing ghat, any public conveyance, any road, or passage [Section 3(1)(za)(A) of the Act] |
(A): Restoration of the right using common property resources of an area, or burial or cremation ground equally with others or using any river, stream, spring, well, tank, cistern, water-tap or other watering place, or any bathing ghat, any public conveyance, any road, or passage equally with others, by the concerned State Government or Union Territory Administration and relief of one lakh rupees to the victim. Payment to be made as follows: (i) 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court. |
| |
(B) mounting or riding bicycles or motor cycles or wearing footwear or new clothes in public places or taking out wedding procession, or mounting a horse or any other vehicle during wedding processions [Section 3(1)(za)(B) of the Act] |
(B): Restoration of the right of mounting or riding bicycles or motor cycles or wearing footwear or new clothes in public places or taking out wedding procession, or mounting a horse or any other vehicle during wedding processions, equally with others by the concerned State Government or Union Territory Administration and relief of one lakh rupees to the victim. Payment to be made as follows: (i) Payment of 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court; |
| |
(C) entering any place of worship which is open to the public or other persons professing the same religion or taking part in, or taking out, any religious, social or cultural processions including jatras [Section 3(1)(za)(C) of the Act] |
(C): Restoration of the right of entering any place of worship which is open to the public or other persons professing the same religion or taking part in, or taking out any religious procession or jatras, as is open to the public or other persons professing the same religion, social or cultural processions including jatras, equally with other persons, by the concerned State Government or Union Territory Administration and relief of one lakh rupees to the victim. Payment to be made as follows: (i) 25 per cent at First Information Report (FIR) stage (ii) 50 per cent when the charge sheet is sent to the court. (iii) 25 per cent when the accused are convicted by the lower court. |
| |
(D) entering any educational institution, hospital, dispensary, primary health centre, shop or place of public entertainment or any other public place; or using any utensils or articles meant for public use in any place open to the public[Section 3(1)(za)(D) of the Act] |
(D): Restoration of the right of entering any educational institution, hospital, dispensary, primary health centre, shop or place of public entertainment or any other public place; or using any utensils or articles meant for public use in any place open to the public, equally with other persons by the concerned State Government or Union Territory Administration and relief of one lakh rupees to the victim. Payment to be made as follows: (i) 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court. |
| |
(E) practicing any profession or the carrying on of any occupation, trade or business or employment in any job which other members of the public, or any section thereof, have a right to use or have access to [Section 3(1)(za)(E) of the Act] |
(E): Restoration of the right of practicing any profession or the carrying on of any occupation, trade or business or employment in any job which other members of the public, or any section thereof, have a right to use or have access to, by the concerned State Government/Union Territory Administration and relief of one lakh rupees to the victim. Payment to be made as follows: (i) 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court. |
| 37. |
Causing physical harm or mental agony on the allegation of being a witch or practicing witchcraft or being a witch [Section 3(1)(zb) of the Act] |
One lakh rupees to the victim and also commensurate with the indignity, insult, injury and defamation suffered by the victim. Payment to be made as follows: (i) 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court. |
| 38. |
Imposing or threatening a social or economic boycott. [Section 3(1)(zc) of the Act] |
Restoration of provision of all economic and social services equally with other persons, by the concerned State Government or Union Territory Administration and relief of one lakh rupees to the victim. To be paid in full when charge sheet is sent to the lower court. |
| 39. |
Giving or fabricating false evidence [Section 3(2)(i) and (ii) of the Act] |
Four lakh fifteen thousand rupees to the victim. Payment to be made as follows: (i) 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court. |
| 40. |
Committing offences under the Indian Penal Code (45 of 1860) punishable with imprisonment for a term of ten years or more [Section 3(2) of the Act] |
Four lakh rupees to the victim and or his dependents. The amount would vary, if specifically otherwise provided in this Schedule. Payment to be made as follows: (i) 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court. |
| 41. |
Committing offences under the Indian Penal Code (45 of 1860) specified in the Schedule to the Act punishable with such punishment as specified under the Indian Penal Code for such offences [Section 3(2)(va) read with the Schedule to the Act] |
Two lakh rupees to the victim and or his dependents. The amount would vary if specifically otherwise provided in this Schedule. Payment to be made as follows: (i) 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court; |
| 42. |
Victimisation at the hands of a public servant [Section 3(2)(vii) of the Act] |
Two lakh rupees to the victim and or his dependents. Payment to be made as follows: (i) 25 per cent at First Information Report (FIR) stage; (ii) 50 per cent when the charge sheet is sent to the court; (iii) 25 per cent when the accused are convicted by the lower court. |
| 43. |
Disability. Guidelines for evaluation of various disabilities and procedure for certification as contained in the Ministry of Social Justice and Empowerment, Notification No. 16-18/97-NI, dated the 1st June, 2001. A copy of the notification is at Annexure-II. |
|
| |
(a) 100 per cent incapacitation |
Eight lakh and twenty-five thousand rupees to the victim. Payment to be made as follows: (i) 50 per cent after medical examination and confirmatory medical report; (ii) 50 per cent when the charge sheet is sent to the court; |
| |
(b) where incapacitation is less than 100 per cent but more than 50 per cent |
Four lakh and fifty thousand rupees to the victim. Payment to be made as follows: (i) 50 per cent after medical examination and confirmatory medical report; (ii) 50 per cent when the charge sheet is sent to the court; Two lakh and fifty thousand rupees to the victim. |
| |
(c) where incapacitation is less than 50 per cent |
Payment to be made as follows: (i) 50 per cent after medical examination and confirmatory medical report; (ii) 50 per cent when the charge sheet is sent to the court. |
| 44. |
36[Rape, Unnatural Offences or Gang rape] |
|
| |
37[(i) Rape, etc., or Unnatural Offences (Sections 375, 376, 376-A, 376-E and 377 of the Indian Penal Code (45 of 1860)] |
Five lakh rupees to the victim. Payment to be made as follows: (i) 50 per cent after medical examination and confirmatory medical report; (ii) 25 per cent when the charge sheet is sent to the court; (iii) 25 per cent on conclusion of trial by the lower court. |
| |
(ii) Gang rape [Section 376-D of the Indian Penal Code (45 of 1860)] |
Eight lakh and twenty-five thousand rupees to the victim. Payment to be made as follows: (i) 50 per cent after medical examination and confirmatory medical report; (ii) 25 per cent when the charge sheet is sent to the court; (iii) 25 per cent on conclusion of trial by the lower court. |
| 45. |
Murder or Death. |
Eight lakh and twenty-five thousand rupees to the victim. Payment to be made as follows: (i) 50 per cent after post mortem report; (ii) 50 per cent when the charge sheet is sent to the court. |
| 46. |
Additional relief to victims of murder, death, massacre, rape, gang rape, permanent incapacitation and dacoity. |
In addition to relief amounts paid under above items, relief may be arranged within three months of date of atrocity as follows (i)Basic Pension to the widow or other dependents of deceased persons belonging to a Scheduled Caste or a Scheduled Tribe amounting to five thousand rupees per month, as applicable to a Government servant of the concerned State Government or Union Territory Administration, with admissible dearness allowance and employment to one member of the family of the deceased, and provision of agricultural land, an house, if necessary by outright purchase; (ii)Full cost of the education up to graduation level and maintenance of the children of the victims. Children may be admitted to Ashram schools or residential schools, fully funded by the Government; (iii)Provision of utensils, rice, wheat, dals, pulses, etc., for a period of three months. |
| 47. |
Complete destruction or burnt houses. |
Brick or stone masonary house to be constructed or provided at Government cost where it has been burnt or destroyed.] |
ANNEXURE II
No. 4-2/83-HW. III
Government of India
Ministry of Welfare
Dated : 6th August, 1986
Subject : Uniform Definitions of the Physically Handicapped
At present, different definitions for various categories of handicapped are adopted in various schemes/programmes of the Central and State Governments. In order to have a standard set of definitions, authorised certification authorities and standard tests for purpose of objective certification, Government of India in Ministry of Welfare set up three committees under the Chairmanship of Director-General of Health Service one each in the area of visual handicaps, speech and hearing disorders and locomotor disabilities and a separate Committee for mental handicaps.
2. After having considered the reports of these committees and with the concurrence of the State Governments/UTs and the concerned Ministries/Departments the undersigned is directed to convey the approval of the President to notify the definitions of the following categories of physically handicapped:
1. Visually handicaps.
2. Locomotor handicaps.
3. Speech & hearing handicaps.
4. Mental handicaps.
Report of the Committee as indicated in Annexure-I.
3. Each category of handicapped persons has been divided into four groups, viz., mild, moderate, severe and profound/total. It has been decided that various concessions/benefits would in future be available only to the moderate, severe and profound/total groups; and not to the mild groups. The minimum degree of disability should be 40% in order to be eligible for any concession/benefits.
4. It has been decided that the authorised certifying authority will be a Medical Board at the district level. The Board will consist of the Chief Medical Officer/Sub-Divisional Medical Officer in the District and another expert in the specified field, viz., opthalmic surgeon in case of visual handicaps, either an E.N.T. Surgeon or an audiologist in case of speech and hearing handicaps an orthopaedic surgeon or a specialist in physical medicine & rehabilitation in case of locomotor handicaps, a psychiatrist or a clinical psychologist or a teacher in special education in case of mental handicaps.
5. Specified tests 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 three years.
7. The State Governments/UT Administration may constitute the Medical Boards indicated in Para 4 above immediately.
M.C. Narsimhan,
Joint Secretary to the Government of India
Combined report of the three committees recommending uniform set ofdefinitions, authorities for certification and standard tests forvisual, hearing and speech and locomotor disabilities
List of the Members of the Committees at Annexure-I.
Introduction
India is a vast country with variable social, cultural, geographical and economic background. Despite breakthrough in health services, a number of disabilities continue to appear due to polio communicable and congenital diseases, increased industrialisation and mechanisation vehicular traffic leading to locomotor disabilities; Vitamin-A deficiency, cataract and infections, injuries, nutritional deficiency leading to visual loss; ear infection, external injuries, noise pollution contributing to hearing loss. These are the three major disabilities which manifest themselves as a result of one or more of such factors.
2. Government of India are providing a large number of facilities and concessions to disabled persons. In order to provide these facilities and concessions it is imperative that a standard definition of these disabilities is decided upon. Consequent to recommendation of the National Council for Handicapped Welfare the Committees under the chairmanship of Director-General of Health Service met for the adoption of standard set of definitions which should be uniformly applicable throughout the country.
The exercise of evolving a uniform set of definitions should not be however construed to mean that no definitions have been set forth at present. Definitions of these three major disabilities which are prevalent at present for extending various concessions and facilities to handicapped are given in Annexure-II.
Recommended Definitions
Physical impairment leads to functional limitation and functional limitation leads to disability. Physical impairment, functional limitation and disability have been defined by WHO and this Committee would recommend adopting this classification, which is as follows:
(i) Impairment. An impairment is a permanent or transitory psychological, or anatomical loss and/or abnormality. For example, a missing of effective part, tissue organ or Mechanism of the body such as an amputated limb, paralysis after polio, myocardial infarction, cerebrovascular thrombosis, restricted pulmonary capacity, diabetes, myopia, disfigurement, mental retardation, hypertension, perceptual disturbance.
(ii) Functional limitations. Impairment may cause functional limitations which are the partial or total inability to perform those activities necessary for motor, sensory or mental functions within the range and manner of which a human being is normally capable such as walking, lifting loads, seeing, speaking, hearing, reading, writing, counting, taking interest in and making contact with surroundings. A functional limitation may last for a short time a long time be permanent or reversible. It should be quantiable whenever possible. Limitations may be described as progressive or regressive .
(iii) Disability. Disability is defined as an existing difficulty in performing one or more activities which, in accordance with the subject's age, sex and morative social role, are generally accepted as essential, basic components of daily living, such as self-care, social relations and economic activity. Depending in part on the duration of the functional limitation disability may be short-term, long-term or permanent.
Medically, disability is physical impairment and inability to perform physical functions normally. Legally, disability is a permanent injury to body for which the person should or should not be compensated.
The disability can be divided into 3 periods.
(i) Temporary total disability is that period in which the affected person is totally unable to work. During this time he may receive orthopaedic, opthalmological, auditory or speech or any other medical treatment.
(ii) Temporary partial disability is that period when recovery has reached the stage of improvement to that person may begin some kind of gainful occupation.
(iii) Permanent disability, applies to permanent damage or loss of use of some part/parts of the body after the stage of maximum improvement from any medical treatment has been reached and the condition is stationary.
The classification and various concessions being recommended are for the permanent disability only.
1. Evaluation and Assessment of Visual Disabilities
The group recommended the classification of visual impairment/disability may be categorised in four groups for considering various concessions to visually handicapped.
The question regarding one-eyed person was considered at length. The Committee is of the view that the guidelines recommended for evaluation of visual loss of persons who have lost one eye but have the other eye normal should be totally unambiguous. The Committee feels that such persons may not be clubbed with other visually handicapped so that facilities/concessions available to severely/profoundly visually handicapped and totally blind are not eroded.
If one-eyed persons are clubbed with severely/profoundly visually handicapped and totally blind persons, the Committee feels that most of the concessions especially jobs reserved for the blind persons shall go to one-eyed persons as their visual loss is minimal compared to other 2 categories and in this manner most of the government offices/public sector undertakings will be fulfilling the quota but in actual practice will not be giving jobs to totally blind and persons with severe visual loss. The Committee, however, feels that it should be made clear that loss of one-eye will not be considered as a disqualification on medical grounds unless a particular post is of such a technical nature that it requires of a person the use of both the eyes or 3-dimensional vision. The Committee also recommends that if a person has been declared unfit due to some temporary visual loss/defect, it should not be construed to mean as disabled if such a temporary impairment in the opinion of a Medical Board can be overcome with treatment or visual aids.
Guidelines for evaluation and categorisation of visual disabilities are given in Appendix III.
2. Evaluation & Assessment of Hearing & Speech Disability
The Committee recommended that the definitions which are internationally accepted and have been adopted by WHO may be adopted in this country also for evaluation and categorisation of hearing and speech loss.
The recommended classification and guidelines for evaluation of hearing loss are given in Appendix II. The Committee also considered various facilities/concessions which may be given to hearing handicapped persons and suggestions of the facilities which may be offered to the hearing handicapped for rehabilitation are also given in Appendix II.
3. Evaluation & Assessment of Orthopaedic Disabilities
The Committee recommends that Kessler's method may be taken as a general guideline for evaluating orthopaedic disability. Since issues have been raised regarding the quantification of degree of disability, the authorised Medical Board may also consult any other suitable method and use Kessler's method as a basic guideline.
The Committee is aware that there are other methods of quantification which are at variance with the Kessler's guidelines. However, Kessler's guidelines for evaluation of various degrees of disability, it is expected, would hold good for most of the time. The individual Medical Board could take into consideration other methods which may help the board in evaluating disability in an individual case.
The Authorities to give Certification
A permanent disability certificate will be issued by a board duly constituted by the Central and the State Governments. It is recommended that Medical Board for evaluation of disability should be available minimum at the district level. It is also recommended to have at least 3 members in the board, out of which at least one should be a specialist in the particular field for assessing locomotor/visual/hearing and speech disability, as the case may be.
It is also recommended that the competent authority may also appoint an appellate Medical Board to resolve any dispute.
Concessions/Facilities which may be offered to Disabled Persons
Keeping in view the set of definitions and the categorisation being recommended, various Ministries/Departments and the State Governments shall have to also specify the facilities and concessions which would be available to different categories of the handicapped. The Committee recommends that if a person has the degree of disability below 40% in a particular category, no such benefits/concessions may be given to such a person. All other categories may be extended concessions/facilities like scholarships, job reservation, aids and appliances either free of cost or at concessional rates, conveyance allowance, etc. For hearing handicapped, the Committee recommends that 3-language formula may be revised so that the hearing handicapped have to study one language only.
Ministry of Social and Women's Welfare may make out proposals based on these recommendations with the appropriate Ministry for necessary modifications in the policy of 3-language formula.
The Committee also recommended that Ministry of Health and Family Welfare may also take up amending medical standards for necessary relaxations in respect of mild handicapped in all the categories so that on account of their mild disability, they are not put in a position that neither they are able to get the facility of job reservation nor are eligible otherwise for entering into services in the general category. The medical rules may also indicate in clear terms that loss of one-eye will not be considered a disqualification unless the particular post is of such a technical nature that it requires of a person the use of both the eyes or three-dimensional vision. The same Medical Board at the district level may examine suitability or otherwise of a one-eyed person for a particular post.
The degree and extent of disability of the 3 types, namely, visual, hearing and orthopaedic will be indicated as follows:
| (a) |
mild |
less than 40% |
| (b) |
moderate |
40% and above |
| (c) |
severe |
75% and above |
| (d) |
profound/total |
100% |
For persons suffering from cardio-pulmonary diseases, there may be no reservation in jobs. These persons may, however, be considered for extending other concessions such as exemption in typing, etc.
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/classification/evaluation tests, etc.
Only those persons who have disability more than 40 per cent and above shall be eligible for registration in Employment Exchanges in the category of handicapped and considered against jobs in public sector reserved for the physically handicapped.
ANNEXURE-I
Composition of Committees to recommend standard definitions of disabilities
| Dr D.B. Bisht, Director General of Health Services, Ministry of Health and Family Welfare, Nirman Bhavan, New Delhi. |
Chairman (of all the three committees) |
| On Visually Handicapped |
|
| 1. |
Dr Madan Mohan, Head Department of Opthalmology, All India Institute of Medical Sciences, New Delhi. |
Member |
| 2. |
Dr G.H. Gidwani, Assistant Director General of Health Services, Ministry of Health and Family Welfare, Nirman Bhavan, New Delhi. |
Member |
| 3. |
Sri R.S. Srivastava, Joint Director, Director General of Employment and Training, Ministry of Labour, Shram Shakti Bhavan, New Delhi. |
Member |
| 4. |
Director, National Institute for the Visually Handicapped, Rajpur Road, Dehradun, (Represented by Sri S.R. Shukla, Assistant Director). |
Member |
| 5. |
Dr G. Venkataswami, Arvind Eye Hospital, Madurai, Tamil Nadu. |
Member |
| 6. |
Dr J.M. Pahwa, Chief Medical Officer, Gandhi Eye Hospital, Aligarh. |
Member |
| 7. |
Sri Harcharanjit Singh, Under-Secretary, Ministry of Social and Women's Welfare, New Delhi. |
Member-Secretary |
| On Hearing Handicapped |
|
| 1. |
Dr G.H. Gidwani, Assistant Director General of Health Services, Ministry of Health and Family Welfare, Nirman Bhavan, New Delhi. |
Member |
| 2. |
Sri R.S. Srivastava, Joint Director, Director General of Employment and Training, Ministry of Labour, Shram Shakti Bhavan, New Delhi. |
Member |
| 3. |
Dr S.K. Kacher, All India Institute of Medical Sciences, New Delhi. |
Member |
| 4. |
Dr M. Nithya Seelan, Director, All India Institute of Speech and Hearing, Mysore. |
Member |
| 5. |
Dr N. Rathna, Director, All-Yavar Jung Institute of Hearing Handicapped, Haji Ali Park, Mahalaxmi, Bombay-400034. (Represented by Dr M.N. Nagaraja, Dy. Director in the meeting on 25-6-1984). |
Member |
| 6. |
Sri Harcharanjit Singh, Under-Secretary, Ministry of Social and Women's Welfare, New Delhi. |
Member-Secretary |
| On Orthopaedically Handicapped |
|
| 1. |
Dr G.H. Gidwani, Assistant Director General of Health Services, Ministry of Health and Family Welfare, Nirman Bhavan, New Delhi. |
Member |
| 2. |
Sri R.S. Srivastava, Joint Director, Director General of Employment and Training, Ministry of Labour, Sharam Shakti Bhavan, New Delhi. |
Member |
| 3. |
Dr Narendra Kumar, Indian Council of Medical Research, Ansari Nagar, New Delhi. |
Member |
| 4. |
Director, National Institute of Orthopaedically Handicapped, B.T. Road, Bon Hooghly, Calcutta. |
Member |
| 5. |
Dr A.K. Mukherjee, Director, All India Institute of Physical Medicine and Rehabilitation, Haji Ali Park, Bombay. |
Member |
| 6. |
Dr S.K. Verma, Head of Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi. |
Member |
| 7. |
Dr B.P. Yadav, Head Rehabilitation Department, Safdarjung Hospital, New Delhi. |
Special Invitee |
| 8. |
Dr J.S. Guleria, Prof. and Head of Department of Medicine, Dean, All India Institute of Medical Sciences, New Delhi. |
Special Invitee |
| 9. |
Sri Harcharanjit Singh, Under-Secretary, Ministry of Social and Women's Welfare, New Delhi. |
Member-Secretary |
ANNEXURE-II
Visually Handicapped
The definition adopted for visual handicapped for extending the concession, scholarships, admission to Integrated education system, reservation in jobs, assistance for purchase/fitting of aids and appliances:
The blind are those who suffer from either of the following conditions:
(a) Total absence of sight;
(b) Visual acquity not exceeding 6/60 or 20/200 (snellen) in the better eye with correcting lenses;
(c) Limitation of the field of vision substanding and angle of degree or worse.
Definitions of Hearing Handicapped under various schemes
Scholarships
The deaf are those in whom the sense of hearing is non-functional for ordinary purposes of life. They do not hear/understand sound at all even with amplified speech. The cases included in this category will be those having hearing loss more than 70 decibels in the better ear (profound impairment or total loss of hearing in both ears).
Assistance to Disabled Persons for Purchase/Fitting of Aids/Appliances
The partially hearing are those falling under any one of the categories indicated below:
| Category |
Hearing acuity |
| Mild impairment |
More than 30 but not more than 45 decibels in better ear. |
| Serious impairment |
More than 45 but not more than 60 decibels in better ear. |
| Severe impairment |
More than 60 but not more than 90 decibels in the better ear. |
Reservation Orders Issued by Department of Personnel and Administrative Reforms
The deaf are those in whom the sense of hearing is non-functional for ordinary purposes of life. They do not hear/understand sounds at all events with amplified speech. The cases included in this category will be whose having loss more than 90 decibels in the better ear (profound impairment) or total loss of hearing in both ears.
Locomotor Handicapped
Similarly the definition adopted for Orthopaedically handicapped is not uniform as all orthopaedically handicapped are eligible for getting a scholarship but only those orthopaedically handicapped persons can get the facility of reservations in jobs as have a minimum of 40% disability.
Situation in State Governments
Various State Governments have also adopted different sets of definitions. For example, Government of Tamil Nadu declared one-eyed persons in the same category as blind persons and have extended various concessions including the reservation in jobs under the State Government to one-eyed person also. The Central Government on the other hand has declared that a one-eyed person with one-eye good vision is not medically unfit and can be considered on jobs which do not require a three-dimensional vision to the specific requirement of the jobs.
ANNEXURE III
Visual Impairment disability Categories based on its severity and proposed disability percentages
| |
All with corrections |
Percentage |
| |
Better eye |
Worse eye |
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 |
6/60-4/60 |
3/60 to Nil |
75% |
| |
or Field of vision 110-120 |
|
|
| -do-III |
3/60 to 1/60 or Field of vision 100 |
F.C. at 1 ft. to Nil |
100% |
| -do-IV |
F.C. at 1 ft. to Nil or Field of vision 100 |
F.C. at 1 ft. to Nil or Field of vision 100 |
100% |
| One-eyed persons |
6/6 |
F.C. at 1 ft to Nil |
30% |
The method of evaluation shall be the same as recommended in handbook of Medical Examination.
Impairment of 20%-40% or less may only be entitled to aids and appliances.
ANNEXURE IV
A. Recommendations about the Categories and the Tests Required
I. Recommended Classification
| Sl. No. |
Category |
Type of impairment |
dB level and/or |
Speech discrimination |
Percentage of impair-ment |
| 1. |
I |
Mild hearing impairment |
dB 26 to 40 dB in better ear |
80 to 100% in better ear |
Less than 40% |
| 2. |
II |
Moderate hearing impairment |
41 to 55 dB in better ear |
50 to 80% in better ear |
40%-50% |
| 3. |
III |
Severe hearing impairment |
56 to 70 Hearing impairment in better ear |
40 to 50% |
50 to 75% |
| 4. |
IV |
(a) |
Total deafness |
No hearing |
No discrimination |
100% |
| |
|
(b) |
Near total deafness |
91 dB and above in better ear |
-do- |
100% |
| |
|
(c) |
Profound hearing impairment |
71 to 90 dB |
Less than 40% in better ear |
75%-100% |
(Pure tone average of hearing in 500, 1000 and 2000 Hz by air conduction should be taken as basis for consideration as per the test recommendations.)
Further it should be noted that
(a) When there is only an Island of hearing present in one or two frequencies in better ear, it should be considered as total loss of hearing.
(b) Wherever there is no response (NR) at any of the 3 frequencies (500, 1000, 2000 Hz), it should be considered as equivalent to 130 dB loss for the purposes of classification of disability and in arriving at the average. This is based on the fact that maximum intensity limits in most of the Audiometers is 110 dB's and some audiometers have additional facilities for +20 dB for testing.
II. Recommendations about the categories of disability (Hearing impairment Physical aspect only Test recommended).
(a) Pure tone audiometry (ISO R 382-1970 at present is being used as Audiometric Standard in most of the audiometers. Hence the audiometers used in testing should be accordingly caliberated). Three frequency average at 500, 1000 and 2000 Hz by Air Conditions (AC) will be used for categorization.
(b) Wherever possible the pure tone audiometer results should be supplemented by the Speech discrimination score tested at Sensation level (SL), i.e., the speech discriminations test is conducted at dB above the patient's hearing threshold. The stimuli used be either phonetically balance words (Pb) of the particular language or its equivalent material. At present only a few Indian languages have standard speech material for testing. Hence whenever the standardised test material is not available, either standardised Indian English Test could be made use of, with English knowing population or equivalent material to Pb, be used.
(c) Wherever children are tested and pure tone audiometry becomes not possible free field testing should be employed.
B. Suggestions for the Facilities to be offered to the Disabled for Rehabilitation
| Category I |
No special benefits. |
| Category II |
Considered for Hearing-Aids at free or concessional costs only. |
| Category III |
Hearing aids free of cost or at concessional rates. Job reservation-benefit of special Employment Exchange. |
| |
Scholarships at School: Single language formula. |
| Category IV |
Hearing Aids facilities of reservation special employment exchange. Special facilities in schools like Scholarship, Hearing aids Exemption from 3-language formula (to study in recommended single language). |
It is felt that for consideration of admission under special category for courses conducted by institutions like Indian Institute of Technology (IIT), Industrial Training Institute (ITI) and others, categories 1 and 2 only should be considered for reservation of seats, provided they fulfil the other educational stipulations for the course.
We have considered the different type of hearing affection, i.e., conductive V.S. Sensory neural, and agree that the disability will be judged by the conditions prevalent in the patient at the time of referral and examination. In case of failure of surgery or other therapeutic interventions, the patient will be considered and categorised on the basis of the recommended tests.
ANNEXURE V
1. Guidelines for Evaluation of Various Disabilities
(1) Locomotor Disability
1.1 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 must be made when the clinical condition is fixed and unchangeable.
3. The upper extremity is divided into two component parts, the arm component and the hand component.
4. Measurement of the loss of function of arm component consists in measuring the loss of motion, muscle strength and co-ordinated activities.
5. Measurement of the loss of function of hand component consists in 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 the column of prehension component in the pro forma.
6. The impairment of the entire extremity depends on the combination of the functional impairment of both components.
ARM COMPONENT
Total value of arm component is 90%
Principles of Evaluation of range of motion of joints
1. The value of maximum R.O.M. in the arm components is 90%.
2. Each of the three joints of the arm is weighted equally (30%).
Example
A fracture of the right shoulder joint may affect range of motion so that active abduction is 90%. The left shoulder exhibits a range of active abduction of 180%. Hence there is loss of 50% of abduction movement of the right shoulder. The percentage loss of arm component in the shoulder is 50 0.30 or 15% loss of motion for the arm component.
If more than one joint is involved, same method is applied, and the losses in each of the affected joints are added, say,
| Loss of abduction of the shoulder |
= |
60% |
| Loss of extension of the wrist |
= |
40% |
| Then, loss of range of motion for the arm = (60 0.30) + (40 0.30) |
= |
30% |
Principles of Evaluation of strength of muscles
1. Strength of muscles can be tested by manual testing like 0-5 grading
2. Manual muscle gradings can be given percentages like
| 0. |
|
100% |
| 1. |
|
80% |
| 2. |
|
60% |
| 3. |
|
40% |
| 4. |
|
20% |
| 5. |
|
0% |
3. The mean percentage of muscle strength loss is multiplied by 0.30.
4. If there has been a loss of muscle strength of more than one joint, the values are added as has been described for loss of range of motion.
Principles of Evaluation of Co-ordinated activities
1. The total value for co-ordinated activities is 90%.
2. Ten different co-ordinated activities are to be tested as given in the Pro forma.
3. Each activity has a value of 9%.
Combining values for the Arm Component
1. The value of loss of function of arm component is obtained by combining the value of range of movement, muscle strength and co-ordinated activities, taking the combining formula
where a = higher value, and b = lower value
Example
Let us assume that an individual with a fracture of the right shoulder joint has in addition to 16.5% of motion his arm, 8.3% loss of strength of muslces, and 5% loss of co-ordination. We combine these values as:
| Range of motion Strength of muscles |
: : |
16.5% 8.3% |
] |
8.3(90 16.5) 16.5 90 |
= 23.3% |
| Co-ordination |
: |
5% |
23.3+ |
5(90 23.3) 90 |
= 27.0% |
So total value of arm component = 27.0%
Hand Component
Total value of hand component is 90%.
The functional impairment of hand is expressed as loss of prehension, loss of sensation, loss of strength.
Principles of Evaluation of Prehension.
Total value of Prehension is 30%. It includes:
(A) Opposition (8%). Tested against
Index finger (2%), middle finger (2%),
Ring finger (2%) and Little finger (2%).
(B) Lateral Pinch (5%) Tested by asking the patient to hold a key.
(C) Cylindrical Grasp (6%). Tested for
(a) Large object of 4 inch size (3%),
(b) Small object of 1 inch size (3%).
(D) Spherical Grasp (6%). Tested for
(a) Large object 4 inch size (3%),
(b) Small object 1 inch size (3%).
(E) Hook Grasp (5%). Tested by asking the patient to lift a bag.
Principles of Evaluation of sensations
Total value of sensation is 30%. It includes:
1. Radial side of thumb (4.8%),
2. Ulnar side of thumb (1.2%),
3. Radial side of each finger (4.8%),
4. Ulnar side of each finger (1.2%).
Principles of evaluation of Strength
Total value of strength is 30%. It includes:
1. Grip Strength (20%),
2. Pinch Strength (10%).
Strength will be tested with hand dynamo-meter or by clinical method (Grip Method).
10% additional weightage to be given to the following factors;
1. Infection
2. Deformity
3. Malalignment
4. Contractures
5. Abnormal Mobility
6. Dominant Extremity (4%)
Combining values of the 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.
Combining Values for the Extremity.
Values of impairment of arm component and impairment of hand component are combined by using the combining formula
Example
| Impairment of the arm = 27.0% |
| Impairment of the hand = 64% |
64 |
27(90-64) 90 |
= 71.8% |
Guidelines for Evaluation of Permanent Physical Impairment in lower limbs
The lower extremity is divided into two components and Stability component.
Mobility Component
Total value of mobility component is 90%. It includes range of movement and muscle strength.
Principles of Evaluation of Range of Movement
1. The value of maximum range of movement in the mobility component is 90%.
2. Each of the three joints, i.e., hip, knee, foot-ankle component. It weighted equally 0.30.
Example
A fracture of the right hip joint may affect range of motion so that active abduction is 27 . The left hip exhibits a range of active abduction of 54 . Hence, there is loss of 50% of abduction movement of the right hip. The percentage loss of mobility component in the hip is 50 0.30 or 15% loss of motion for the mobility component.
If more than one joint is involved, same method is applied and the losses in each of the affected joints are added.
For example:
| Loss of abduction of the hip |
= |
60% |
| Loss of extension of the knee |
= |
40% |
| Loss of range of motion for mobility Component = (60 0.30) + (40 0.30) |
= |
30% |
Principle of Evaluation of Muscle Strength
1. The value for maximum muscle strength in the leg is 90%.
2. Strength of muscles can be tested by manual testing like 0 5 grading.
3. Manual muscle gradings can be given percentages like
| Grade 0 |
= |
100% |
| Grade 1 |
= |
80% |
| Grade 2 |
= |
60% |
| Grade 3 |
= |
40% |
| Grade 4 |
= |
20% |
| Grade 5 |
= |
0% |
4. Mean percentage of muscle strength loss is multiplied by 0.30.
5. If there has been a loss of muscle strength of more than one joint, the values are added as has been described for loss of range of motion.
Combining Value for the Mobility Component
Let us assume that the individual with a fracture of the right hip joint has in addition to 16% loss of motion, 8% loss of strength of muscles.
Combining values
Motion 16%
| Strength 8% |
16 + |
8(90-16) 90 |
= 22.6% |
Where a = higher value, b = lower value
Stability Component
1. Total value of stability component is 90%.
2. It is tested by 2 methods
(i) Based on scale method.
(ii) Based on clinical method.
Three different readings (in kilograms) are taken measuring the total body weight (W). Scale A reading and Scale B reading.
Guidelines for Evaluation of Permanent Physical Impairment of Trunk (Spine)
The local effects of lesions of spine can be divided into traumatic and non-traumatic lesions.
| Traumatic Lesions |
|
| Cervical Spine Fracture |
|
| |
Per cent Whole Body Permanent Physical Impairment and Loss of Physical Function to Whole Body. |
| A. |
Vertebral compression 25%, one or two vertebral adjacent bodies, no fragmentation, no involvement of posterior elements, no nerve root involvement, moderate neck rigidity and persistent soreness. |
20 |
| B. |
Posterior elements with X-ray evidence of moderate partial dislocation. |
|
| |
(a) |
No nerve root involvement, healed; |
15 |
| |
(b) |
With persistent pain, with mild motor and sensory manifestations; |
25 |
| |
(c) |
With fusion, healed, no permanent motor or sensory changes. |
20 |
| C. |
Severe dislocation, fair to good reduction with surgical fusion |
|
| |
(a) |
No residual motor or sensory changes; |
25 |
| |
(b) |
Poor reduction with fusion, persistent radicular pain, motor involvement only slight weakness and numbness; |
35 |
| |
(c) |
Same as (b) with partial paralysis, determine additional rating for loss of use of extremities and sphincters. |
|
| Cervical Intervertebral Disc |
|
| 1. |
Operative, successful removal of disc, with relief of acute pain, no fusion, no neurologic residual. |
10 |
| 2. |
Same as (1) with neurological manifestations, persistent pain, numbness, weakness in fingers. |
20 |
| Thoracic and Dorsolumbar Soine Fracture |
|
| |
Per cent Whole Body Permanent Physical Impairment and Loss of Physical Function to Whole Body |
| A. |
Compression 25% involving one or two vertebral bodies, mild, no fragmentation, healed, no neurological manifestations. |
10 |
| B. |
Compression 50% with involvement posterior elements, healed, no neurologic manifestations, persistent pain, fusion, indicated. |
20 |
| C. |
Same as (B) with fusion, pain only on heavy use of back. |
20 |
| D. |
Total paraplegia. |
100 |
| E. |
Posterior elements, partial paralysis with or without fusion should be rated for loss of use of extremities and sphincters. |
|
| Low Lumbar |
|
| 1. |
Fracture |
|
| A. |
Vertebral compression 25% one or two adjacent vertebral bodies little or fragmentation, no definite pattern or neurologic changes. |
15 |
| B. |
Compression with fragmentation, posterior elements, persistent pain, weakness and stiffness, healed, no fusion, no lifting over 25 pounds. |
40 |
| C. |
Same as (B), healed with fusion, mild pain. |
25 |
| D. |
Same as (B), nerve root involvement to lower extremities, determine additional rating for loss of industrial function to extremities. |
|
| E. |
Same as (C), with fragmentation of posterior elements, with persistent pain after fusion, no neurologic findings. |
35 |
| F. |
Same as (C), with nerve root involvement to lower extremities, rate with functional loss to extremities. |
|
| G. |
Total paraplegia. |
100 |
| H. |
Posterior elements, partial paralysis with or without fusion, should be rated for loss of use of extremities and sphincters. |
|
| 2. |
Neurogenic Low Back Pain-Disc Injury |
|
| A. |
Periodic acute episodes with acute pain and persistent body list, test, tests for sciatic pain positive, temporary recovery 5 to 8 weeks. |
5 |
| B. |
Surgical excision of disc, no fusion, good results, no persistent sciatic pain. |
10 |
| C. |
Surgical excision of disc, no fusion, moderate persistent pain and stiffness aggravated by heavy lifting with necessary modification of activities. |
20 |
| D. |
Surgical excision of disc with fusion, activities of lifting moderately modified. |
15 |
| E. |
Surgical excision of disc with fusion, persistent pain and stiffness aggravated by heavy lifting, necessitating modification of all activities requiring heavy lifting. |
25 |
Non-Traumatic Lesions
Scoliosis
The whole spine has been given rating of 100% and regionwise the following percentage are given:
| Dorsal Spine |
|
50% |
| Lumbar Spine |
|
30% |
| Cervical Spine |
|
20% |
Kobb's method for measurement of angle of curve in standing position is to be used. The curves have been divided into three sub-groups.
| |
Cervical Spine |
Thoracic Spine |
Lumbar Spine |
| Less than 30 (Mild) |
2% |
5% |
5% |
| 31 -60 (Moderate) |
3% |
15% |
12% |
| Above 60 (Severe) |
5% |
25% |
33% |
In the curves ranging above 60 , cardiopulmonary complications are to be graded separately. The junctional curves are to be given that rating depending upon level of apex of curve. For example, if apex of dorso-lumbar curve falls in the dorsal spine the curve can be taken as a dorsal curve. When the scoliosis is adequately compensated, 5% reduction is to be given from final rating (for all assessment primary curves are considered for rating).
Kyphosis
The same total rating (100%) as that suggested for scoliosis is to be given for kyphosis. Regionwise percentages of physical impairment are:
| |
Dorsal |
50% |
| |
Cervical Spine |
30% |
| |
Lumbar Spine |
20% |
| For dorsal spine the following further gradings are: |
| |
Less than 20 |
10% |
| |
21 -40 |
15% |
| |
41 -60 |
20% |
| |
Above 60 |
25% |
For kyphosis of lumbar and cervical spine 5% and 7% respectively have been allocated. Paralysis of Flexors and Extensors of Dorsal and Lumbar Spine.
The motor power of these muscles to be grouped as follows:
| |
Normal |
|
| |
Weak |
5% |
| |
Paralysed |
10% |
Paralysis of Muscles of Cervical Spine
For cervical spine the rating of motor power is as follows:
| |
Normal |
Weak |
Paralysed |
| Flexors |
0 |
5% |
10% |
| Extensors |
0 |
5% |
10% |
| Rotators |
0 |
5% |
10% |
| Side bending |
0 |
5% |
10% |
Miscellaneous
Those conditions of the spine which cause stiffness and pain, etc., are rated as follows:
| |
% physical impairment |
| A. |
Subjective symptoms of pain. No involuntary muscle spasm. Not substantiated by demonstrable structural pathology. |
0% |
| B. |
Pain. Persistent muscle spasm and stiffness of spine, substantiated by demonstrable mild radiological changes. |
10% |
| C. |
Same as B, with moderate radiological changes. |
15% |
| D. |
Same as B, with servere radiological changes involving any one of the region of spine (cervical, dorsal lumbar). |
20% |
| E. |
Same as D, involving whole spine. |
30% |
In kypho-scoliosis, both curves to be assessed separately and then percentage of disability to be summed.
Guidelines for Evaluation of Permanent Physical Impairment in Amputees
Basic Guidelines
1. In case of multiple amputees, if the total sum of percentage permanent physical impairment is above 100%, it should be taken as 100%.
2. Amputation at any level with uncorrectable inability to wear and use prosthesis, should be given 100% permanent physical impairment.
3. In case of amputation in more than one limb percentage of each limb is counted and another 10% will be added, but when only toes or fingers are involved only another 5% will be added.
4. Any complication in form of stiffness, neuroma, infection, etc., has to be given a total of 10% additional weightage.
5. Dominant upper limb has been given 4% extra percentage.
Upper Limb Amputations
| |
|
Per cent permanent physical Impairment and Loss of Physical function of each limb |
| 1. |
Fore-quarter amputation |
100% |
| 2. |
Shoulder Disarticulation |
90% |
| 3. |
Above Elbow up to upper 1/3 of arm |
85% |
| 4. |
Above Elbow up to lower 1/3 of arm |
80% |
| 5. |
Elbow diarticulation |
75% |
| 6. |
Below Elbow up to upper 1/3 of forearm |
70% |
| 7. |
Below Elbow up to lower 1/3 of forearm |
65% |
| 8. |
Wrist disarticulation |
60% |
| 9. |
Hand through carpal bones |
55% |
| 10. |
Thumb through C.M. or through 1st M.C. joint |
30% |
| 11. |
Thumb disarticulation through metacarpo-phalangeal joint or through proximal phalanx |
25% |
| 12. |
Thumb disarticulation through inter phalangeal joint or through distal phalanx. |
15% |
| |
|
Index Finger (15%) |
Midd-le Finger (5%) |
Ring Fin-ger (3%) |
Little Fin-ger (2%) |
| 13. |
Amputation through proximal phalanx or disarticulation through M.P. joint |
15% |
5% |
3% |
2% |
| 14. |
Amputation though middle phalanx or disarticulation through P.I.P. joint |
10% |
4% |
2% |
1% |
| 15. |
Amputation through distal phalanx or disarticulation through D.I.P. joint |
5% |
2% |
1% |
1% |
Lower Limb Amputations
| 1. |
Hind Quarter |
100% |
| 2. |
Nip disarticulation |
90% |
| 3. |
Above knee up to upper 1/3 of thigh |
85% |
| 4. |
Above knee up to lower 1/3 of thigh |
80% |
| 5. |
Through knee |
75% |
| 6. |
B.K. up to 8 cm |
70% |
| 7. |
B.K. up to lower 1/3 of leg |
60% |
| 8. |
Through Ankle |
55% |
| 9. |
Syme's |
50% |
| 10. |
Up to mid-foot |
40% |
| 11. |
Up to 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% |
Guidelines for Assessment of Physical Impairment in Neurological Conditions
1. Assessment in neurological conditions is not the assessment of disease but it is the assessment of the effects, i.e., clinical manifestations.
2. Any neurological assessment has to be done after six months of onset.
3. These guidelines will only be used for Central and proper motor neuron lesions.
4. Pro forma A and B will be utilized for assessment of lower motor neuron lesions, muscular disorders and other locomotor conditions.
5. Total percentage of physical impairment in neurological conditions will not exceed 100%.
6. In the mixed cases the highest score will be taken into consideration. The lower score will be added to it and calculations will be done by the formula:
7. Additional rating of 4% will be given for dominant upper extremity.
8. Additional 10% has been given for sensation in each extremity, but the maximum total physical impairment will not exceed 100%.
Motor System Disability
| |
Disability Rate |
| Monoparesis |
25 per cent |
| Monoplegia |
50 per cent |
| Hemiparesis |
|
| Paraparesis |
75 per cent |
| Paraplegia |
100 per cent |
| Hemiplegia |
75 per cent |
| Quadriparesis |
|
| Quadriplegia |
100 per cent |
Sensory System Disability
| |
Disability Rate |
| Anesthesia |
|
| Rypoaesthesia |
Each Limb 10 per cent |
| Paraesthesia |
|
For involvement:
| for involvement of hand/hands foot/feet |
25 per cent |
Guidelines for Assessment of Physical Impairment in Neurological Conditions
1. Assessment in neurological conditions is not the assessment of disease but it is the assessment of the effects, i.e., clinical manifestation.
2. Any neurological assessment has to be done after six months of onset.
3. These guidelines will only be used for Central and upper motor neuron lesions.
4. Pro forma A & B will be utilized for assessment of lower motor neuron lesions, muscular disorders and other locomotor conditions.
5. Total percentage of physical impairment in neurological conditions will not exceed 100 per cent.
6. In the mixed cases the highest score will be taken into consideration. The lower score will be added to it and calculations will be done by the formula:
7. Additional rating of 4 per cent will be given for dominant upper extremity.
8. Additional 10 per cent has been given for sensation in each extremity, but the maximum total physical impairment will not exceed 100 per cent.
Speech Disability
| |
Disability Rate |
| Mild |
25% |
| Moderate |
50% |
| Severe |
75% |
| Very Severe |
100% |
Tested by a 100-word text. Ability to read (in educated), comprehend when read out, answer question on text clearly and ability to write a synopsis (in educated).
Guidelines for Assessment of Physical Impairment in Neurological Conditions
1. Assessment in neurological conditions is not the assessment of disease but it is the assessment of the effects, i.e., clinical manifestations.
2. Any neurological assessment has to be done after six months of onset.
3. These guidelines will only be used for Central and upper motor neuron lesions.
4. Pro forma A and B will be utilized for assessment of lower motor neuron lesions, muscular disorders and other locomotor conditions.
5. Total percentage of physical impairment in neurological conditions will not exceed 100%.
6. In the mixed cases the highest score will be taken into consideration. The lower score will be added to it and calculations will be done by the formula:
7. Additional rating of 4% will be given for dominant upper extremity.
8. Additional 10% has been given for sensation in each extremity, but the maximum total physical impairment will not exceed 100%.
Motor System Disability
| |
|
Disability Rate |
| Monoparesis |
) |
25% |
| Monoplegia Hemiparesis |
) |
50% |
| Paraparesis |
|
75% |
| Paraplegia |
|
100% |
| Hemiplegia |
) |
75% |
| Quadriparesis Quadriplegia |
) |
100% |
Sensory System Disability
| |
|
Disability Rate |
| Anesthesia |
) |
|
| Rypoaesthesia |
) |
Each Limb 10% |
| Paraesthesia |
) |
|
FOR INVOLVEMENT
| for involvement of hand/handsfoot/feet |
|
25% |
Guidelines for Evaluation of Physical Impairmentdue to Cardio-Pulmonary Diseases
Basic Guidelines
1. Modified New York Heart Association subjective classification should be utilised to assess the functional disability.
2. The 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 a cardiopulmonary impairment should also be done in diseases which might have associated cardiopulmonary problems, e.g., amputees, myopachies, etc.
The proposed modified classification is as follows:
| Group 0: |
A patient with cardiopulmonary disease who is a symptomatic (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 ordinary 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 activity. |
ANNEXURE-V
Mental Disorders
Source: Glossary and guide to their classification. A publication by W.H.O.
MENTAL RETARDATION : A condition of arrested or incomplete development of mind which is especially characterized by subnormality of intelligence. The coding should be made on the individual's current level of functioning without regard to its nature of causation such as psychosis, cultural deprivation, Down's Syndrome, etc., where there is a specific cognitive handicap such as in speech the four-digit coding should be based on assessments of cognition outside the area of specific handicap. The assessment of intellectual level should be based on whatever information is available, including clinical evidence, adaptive behaviour and psychometric findings. The IQ levels given are based on a test with a mean of 100 and a standard deviation of 15 such as the Wechsle scales. They are provided only as a guide and should not be applied rigidly. Mental retardation often involves psychiatric disturbances and may often develop as a result of some physical disease or injury. In these cases, an additional code or codes should be used to identify associated condition, psychiatric or physical. The impairment and handicap codes should also be consulted.
| (b) |
MILD MENTAL RETARDATION |
|
| |
|
Feeble-minded High Grade defect Mild mental subnormality |
Moron IQ 50-70 |
| (c) |
OTHER SPECIFIED MENTAL RETARDATION |
|
| |
(i) |
Moderate mental retardation imbecile IQ 35-49 |
Moderate mental subnormality |
| |
(ii) |
Severe mental retardation IQ 20-34 |
Severe mental subnormality |
| |
(iii) |
Profound mental retardation Idiocy IQ under 20 |
Profound mental subnormality |
| (d) |
UNSPECIFIED MENTAL RETARDATION |
|
Mental deficiency NOS Mental subnormality NOS.