Back impairment and disability determination. Another attempt at objective, reliable rating.

Present disability evaluation schedules for the low back are not scientifically based and produce very great interexaminer differences. The authors have developed a new impairment schedule based on a comprehensive review of the medical literature and the collected opinions of a large number of back specialists. Tests of the new schedule show a marked decrease in interexaminer differences compared to the prior California disability rating schedule. The impairment schedule can be readily adapted to any legal system of disability rating and can be modified easily to reflect new medical knowledge. The result should be a disability rating which is more objective, more scientifically valid, and more consistent, reducing litigation, with fairness to both the low-back impaired worker and the employer.

A profile of clients referred for psychiatric evaluation for Social Security Disability Income and Supplemental Security Income: implications for psychiatry.

A study of the psychiatric evaluations of 248 consecutive clients whose cases were in the process of adjudication for approval or renewal of Supplemental Security Income and/or Social Security Disability Income in 1982 and 1983 showed an overrepresentation of individuals with chronic moderate to severe psychiatric impairment. The author suggests that the criteria and guidelines for eligibility for these two programs are too stringent for individuals with psychiatric impairment and that some of these individuals are unable to provide information necessary to build a proper case for disability because of their psychopathology. The implications for psychiatrists, other mental health professionals, and social policy planners are discussed.

[Respiratory handicap. Recognition, evaluation and social benefits]. / Handicap respiratoire. Reconnaissance, évaluation, prestations sociales.

The medico-social aspects of respiratory handicap pose some perplexing problems, notably in their recognition, rigorous evaluation and in the granting of social security benefits. The clinical and respiratory function data should be standardised and classified according to type and significance of respiratory disease and also according to the degree of co-operation and understanding of the patient. The respiratory handicap should be evaluated after considering the functional disability engendered by the disorder and their socio-professional repercussions. The abnormality in the lungs should be measured by resting tests; the degree of disability by exercise studies; the socio-professional handicap by ergonometric tests to assess the scale of the demands and requirements of family and social and professional life, indeed the cultural and economic style of the individual concerned. Such combined studies would enable recognition of severe chronic respiratory handicap leading to decisions for exemption certificates, such as cases of severe respiratory failure in patients requiring supplementary treatment for oxygen therapy or assisted ventilation. The benefits and grants offered to those with respiratory handicaps would involve a number of rights relating to: care, work, costs of replacement of workers in the event of prolonged sick leave or the benefits of an invalidity pension. There will be other allowances such as invalidity cards, lodging special studies and other rights particularly relating to lodging and special equipment. The present scale is difficult to use both because of its lack of specificity and its ill-chosen terminology. For better balance between the handicap and the benefits offered, a common and more flexible system, with a printed table should be at hand for the doctor to use for certain decisions: long term illness, period of invalidity or early retirement because of medical incapacity. Within each table a sub-section should exist to allow for certain aspects of legislation (accidents at work, occupational illness or rights under common law) at the same time certain adjustments may be necessary which take into account the patient, degree of autonomy life style and social and cultural level. A pilot study of respiratory handicap, to standardise tests, and co-ordinate the planning of the medical and social interactions for a better grasp of the disorder and greater uniformity of the regulations within each disablement benefit system as well as between various other social security regimes would be desirable.

A survey version of the Clifton Assessment Procedures for the Elderly (CAPE).

A shortened version of the Clifton Assessment Procedures for the Elderly (CAPE) based on two of the subscales is described and evaluated in relation to the full scales and a measure of composite disability based on the factor analysis of the results of 400 subjects. Its reliability and apparent validity make the new CAPE Survey Score a useful measure for assessment of the dependency levels of the elderly.