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Am Fam Physician. 2023;107(5):490-498

Related Letter to the Editor: Guidelines for Performing Disability Evaluations

Related FPM article: FMLA Does Not Need to Be a Four-Letter Word

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Author disclosure: No relevant financial relationships.

Disability is a physical or mental impairment that substantially limits at least one major life activity. Family physicians are often asked to assess patients with disabling conditions that can impact insurance benefits, employment, and ability to access needed accommodations. Disability evaluations are needed for short-term work restrictions following a simple injury or illness and for more complex cases involving Social Security Disability Insurance, Supplemental Security Income, Family and Medical Leave Act, workers' compensation, and personal/private disability insurance claims. Using a stepwise approach built on awareness of the biologic, psychological, and social elements of disability assessment may facilitate this evaluation. Step 1 establishes the role of the physician in the disability evaluation process and the context of the request. In Step 2, the physician assesses impairments and establishes a diagnosis based on findings from an examination and validated diagnostic tools. In Step 3, the physician identifies specific participation restrictions by assessing the patient's ability to perform specific movements or activities and reviewing the employment environment and tasks. Steps 4 and 5 ensure proper documentation, billing, and coding. In complex cases, consultants such as psychiatrists and physical therapists may assist by providing insight into a patient's mental and physical impairments, activity limitations, and response to treatment.

Disability is a physical or mental impairment that substantially limits at least one major life activity. More than 1 billion people, about 15% of the global population, live with some form of disability.1 In the United States, 1 in 4 noninstitutionalized adults reports having at least one disability.2 Disabling conditions can limit a person's ability to work, participate fully in social roles, maintain a household, and pursue hobbies. Disability can lead to substantial personal, physical, social, emotional, and economic hardships for the patient, caregiver, and family.35

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