Group II Disability Status: List of Conditions, Assessment Criteria and Complete Document Package

The introduction of the system for assessing a person’s daily functioning under Resolution of the Cabinet of Ministers of Ukraine No. 1338 fundamentally changed the medical and social assessment procedure. While previously people hoped to obtain disability status solely because a serious diagnosis appeared in their outpatient medical record, state expert teams now focus on something different: they assess not the diagnosis itself, but the degree of loss of a person’s everyday autonomy, namely the criteria of daily functioning.

Thousands of people search each month for “which conditions qualify for Group II disability status in Ukraine”, but a diagnosis alone does not guarantee a positive decision. For the procedure to be successful, it is necessary to know in advance the statutory criteria for establishing Group II disability status, the objective grounds for Group II disability status and the list of mandatory medical conclusions and examinations.

Assessment of daily functioning: criteria for establishing Group II disability status by domains of daily activity

An important legal factor is a pronounced degree of limitation, namely degree II: a condition in which a person faces significant difficulties in performing most basic everyday activities. This causes substantial barriers to education, employment, interpersonal interaction and everyday autonomy, requiring systematic assistance from other persons or the use of compensatory rehabilitation measures to maintain an appropriate quality of life.

When an expert team analyses a medical case — whether Group II disability status due to a general condition is being considered or the consequences of severe impairment of individual body systems — the assessment is carried out according to basic categories, that is, domains of daily functioning.

1. Ability to move

A person experiences significant barriers to movement: they are able to cover only short distances or require mandatory assistance when using stairs. Independent walking speed is markedly reduced, while the ability to fully use private and urban public transport is substantially limited, meaning the patient regularly requires support from another person.

Objective numerical assessment indicators include a walking speed of only 20–59 metres per minute, a maximum walking distance of up to 150 metres only with the use of assistive rehabilitation devices such as a cane, crutches, walker or physical support, while the result of the standardised 6-minute walk test does not exceed 100–300 metres.

These criteria most often support Group II disability status in spinal conditions, particularly vertebrogenic myelopathy, absolute spinal canal stenosis and foot paresis, polysegmental joint contractures, as well as decompensated heart disease — pronounced shortness of breath and NYHA class III–IV heart failure with minimal walking activity.

2. Ability to perform self-care

This is characterised by a pronounced loss of everyday autonomy. A person critically requires support from others with self-care approximately every 30–60 minutes during the day, together with the continuous use of assistive devices. Such assistance focuses on essential daily tasks: eating and preparing food, taking medicines on time, personal hygiene, putting on footwear, dressing and moving within the home.

3. Ability to orient oneself

This is caused by profound sensory impairments that substantially restrict the ability to function independently in space. A person must continuously use high-level optical correction, including glasses or special lenses, or hearing prostheses, including binaural hearing aids, regularly use assistive rehabilitation devices and medical devices for spatial adaptation, and also rely on another person for orientation and performance of basic tasks.

These are the criteria used when establishing Group II disability status due to visual impairment where bilateral visual acuity falls below 0.04 or the visual field narrows to 10–15 degrees, as well as terminal forms of hearing impairment that cannot be compensated surgically.

4. Ability to communicate

A person is able to communicate only with a very limited and narrow circle of familiar people, usually family members or personal carers. Continuous involvement of intermediaries or technical communication aids is required to maintain contact with the outside world. Expressive spoken language is markedly reduced or absent, while non-verbal methods of communication, including gestures, symbols and writing, are used significantly more often than ordinary speech.

5. Ability to control one’s behaviour

A person experiences persistent difficulties with self-regulation of actions and compliance with social norms. They require continuous external supervision and control even in a standard, familiar everyday environment. Disorientation in the surroundings often occurs, and correct identification of people and surrounding objects may be impaired. The ability to independently ensure personal safety and hygiene is markedly reduced.

This criterion is significant when Group II disability status is considered for neurological conditions or progressive organic disorders of the central nervous system: consequences of extensive strokes, severe traumatic brain injuries, multiple sclerosis or pronounced dementia.

6. Ability to learn

A person is unable to follow educational programmes under general rules. Learning is possible only for a narrow range of specially selected practical tasks under an exclusively individual educational programme. Most often, education must be organised at home or in specially adapted conditions with constant assistance from corrective specialists and the use of assistive devices even for the perception of basic educational material.

7. Professional ability to work

Under this criterion, a person may either be completely unable to perform any employment activity or retain the ability to work only in specially created individual working conditions.

The ability to work depends on the arrangement of a special workplace, including home-based work, provision of adaptive rehabilitation aids, reduction in qualification level, reduction in workload and regular rehabilitation measures in accordance with the Individual Rehabilitation Programme.

Analysis of these 7 domains enables expert teams to determine accurately the grounds for Group II disability status. If the combination of medical conclusions, instrumental measurements and objective deficits corresponds to degree II limitation of daily functioning, the person is officially granted Group II disability status due to a general condition or a special status associated with the defence of the state or performance of professional duties.

Group II disability status: list of conditions and unconditional grounds

Legislation clearly divides pathological conditions into two categories: anatomical irreversible impairments for which status is established indefinitely, and somatic disorders that are assessed for Group II disability status.

Let us consider which conditions may qualify for Group II disability status by clinical category.

Group II disability status: list of spinal conditions

Degenerative changes, protrusions or osteochondrosis alone are not grounds for disability status. Where Group II disability status is considered for spinal conditions, only the severity of secondary neurological and motor impairments is assessed:

• recurrent compressive disc herniations causing pronounced paresis of the limbs with reduced muscle strength;
• pronounced impairment of the static and dynamic function of the spine: persistent restriction of active and passive spinal movements to minimal values, meaning loss of more than 70–80% of the normal range of motion for the relevant spinal segment;
• unstable deformities: grade IV scoliosis or kyphoscoliosis with pronounced cardiopulmonary insufficiency.

Group II disability status: list of heart conditions

In cardiology, the determining factor is not hypertension or atherosclerosis itself, but the functional reserve of the myocardium. The list of heart conditions for Group II disability status is based on strict parameters of haemodynamic decompensation:

• chronic heart failure stage IIB–III with reduced left ventricular ejection fraction, LVEF < 40%;
• NYHA functional class III–IV heart failure where shortness of breath, tachycardia and pain occur during minimal everyday activity or at rest;
• decompensated complications after reconstructive surgery, large aneurysms of the heart and ascending aorta with a risk of rupture.

Group II disability status due to visual impairment: list of conditions

In ophthalmology, the basic expert criterion is the level of visual function in the better eye with correction. Group II disability status due to visual impairment includes:

• visual acuity of the better or only eye with optimal optical correction from 0.01 to 0.04 — a high degree of low vision, practical blindness;
• bilateral concentric narrowing of the visual field to 10–15 degrees from the fixation point, that is, tunnel vision;
• consequences of deep burns, retinal dystrophy, total corneal opacity in both eyes or secondary glaucoma at the terminal stage.

Group II disability status for neurological conditions

Neurological dysfunction must be persistent and pronounced. Group II disability status in neurology is established for the following conditions:

• consequences of acute cerebrovascular disorders, strokes or severe traumatic brain injuries resulting in hemiparesis with muscle strength of 2–3 points, ataxia or severe sensorimotor aphasia;
• stage III dyscirculatory encephalopathy with pronounced cognitive impairment and complete disorientation in time and space;
• Parkinson’s disease with pronounced akinetic-rigid syndrome, frequent falls and low sensitivity to levodopa;
• multiple sclerosis and other demyelinating diseases with pronounced impairment of gait, coordination and pelvic organ function.

Conditions qualifying for Group II disability status: anatomical defects and irreversible conditions

According to the appendix to Resolution of the Cabinet of Ministers of Ukraine No. 1338, the list of conditions for Group II disability status, including for indefinite establishment of the status, includes:

1. bilateral lower limb stumps at the thigh or lower-leg level;
2. a stump of one leg combined with absence or severe impairment of an arm;
3. ankylosis or pronounced fixed contracture of two major joints of the lower limbs in a non-functional position;
4. stage IV–V chronic kidney disease requiring permanent programmed haemodialysis or peritoneal dialysis;
5. decompensated liver cirrhosis with refractory ascites and portal hypertension;
6. permanent stomas: tracheostomy, ileostomy, colostomy following radical oncological resections where reconstruction is impossible;
7. persistent endocrine disorders with severe organ decompensation: labile diabetes with nephropathy and blindness, severe adrenal insufficiency.

Please note: if your diagnosis is not included in the list of absolute anatomical defects, Group II disability status may be established due to a general condition. The main task in such a case is to demonstrate that the combination of existing chronic disorders forms an overall pronounced limitation of daily functioning.

Medical grounds: how to confirm the condition instrumentally

To confirm conditions for Group II disability status, an evidence base in the form of instrumental measurements is required:

Group II disability status: list of documents

Preparing an incomplete package or lacking the results of measurement-based examinations is a common reason for returning the case to the attending physician. The following mandatory list is defined by law:

1. Identity documents:
   • passport of a citizen of Ukraine or ID card with an extract confirming place of residence;
   • taxpayer registration number, RNTRC;
   • military registration document, mandatory for men aged 18–60.
2. Medical documentation in the Electronic Healthcare System:
   • electronic referral for assessment of daily functioning;
   • discharge summaries from inpatient or outpatient medical records, Forms No. 027/o and No. 028/o;
   • instrumental examination reports specifying concrete numerical results: ENMG, goniometry, echocardiography reports, MRI.
3. Social and employment documents:
   • copy of the employment record book, where available;
   • certificate describing the conditions and nature of work, if the person is employed, substantiating the need for transfer to lighter work or creation of special working conditions.
4. For military personnel and veterans:
   • decision or certificate of the Military Medical Commission issued no earlier than 6 months before the referral;
   • certificate describing the circumstances of the injury, wound, concussion or mutilation;
   • military ID or officer’s identification card.

Stages of obtaining Group II disability status under the new reform

1. Consultation with a family doctor and specialist doctors. Recording complaints and entering information about the dynamics of the condition over the previous 6–12 months into the Electronic Healthcare System.
2. Undergoing instrumental diagnostics. Conducting examinations that reflect anatomical impairments and functional deficits in measurable values.
3. Initiating the referral. Preparation of the electronic package by the attending physician and transfer to the expert team.
4. Review by the expert team, assessment of daily functioning. Examination of medical materials in person or remotely.
5. Obtaining an extract from the decision. Receiving the official document establishing the disability group and the approved Individual Rehabilitation Programme.

Procedure for appealing the expert team’s decision

If the expert team unjustifiably refused to establish disability status or assigned Group III instead of Group II, you have the right to submit a complaint.

• Where to apply: the complaint is submitted to the Centre for Assessment of Functional Status by post at: 1-A Feodosiia Makarevskoho Lane, Dnipro, 49005, through the office or electronically through the physician.
• Procedural deadlines: an administrative complaint may be submitted within 40 calendar days from the date the extract from the decision was generated.
• Judicial protection: if you disagree with the repeated decision, the case is considered under the rules of administrative proceedings.

If you need legal assistance after a refusal, assignment of a lower disability group or cancellation of a previously established status, seek assistance with appealing the expert team’s decision. A lawyer will help analyse the conclusion, medical documents and select the appropriate method of legal protection.

Do you need assistance with establishing or appealing Group II disability status? Prikhodko & Partners will analyse the medical documents, assess the grounds for applying and help protect your rights.