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Department of Labor and Workforce Development
 
Vocational Rehabilitation

9.0 Significance of Disability Determination

Table of Contents

State of Alaska

Department of Labor and Workforce Development

Division: Vocational Rehabilitation

Policy: CS 8.0

Subject: Significance of Disability Determination

Reference:

34 CFR § 361.5 (28), (30) and (31)

34 CFR § 361.36

Effective Date: 10/1/2006

Revised Date: 9/16/2009

                Cheryl Walsh signature

Approved: ____________________________________    9/16/2009__________

                    Cheryl A. Walsh, Director                                   Date

1.0 - Policy Summary

A VR counselor will certify the significance of an individual's disability and will assign the individual to a priority of service category. 

The priority of service categories are used if ADVR is under an order of selection (OOS) to determine the order in which eligible individuals receive VR services.

Factors considered in the certification decision include:

  1. Impairment(s) that seriously limit functional capacities in terms of an employment outcome; and

  2. The requirement of multiple VR services over an extended period of time.

The significance of disability is certified at the time:

  1. An individual is determined eligible for VR services;

  2. An individual is placed in trial work or into extended evaluation; or

  3. There is a significant change in the individual's disabling condition which would result in a change of priority categories.

2.0 - Definitions

Priority Categories: There are three categories used by ADVR to determine the order that eligible individuals will receive VR services if ADVR is operating under an order of selection.  All individuals eligible for VR services are assigned to a priority category based upon the significance of their disability.

Priority Category

Name

Criteria

1

Most Significantly Disabled (MSD)
  1. Has a severe physical, mental or sensory impairment that seriously limits  three or more functional capacities such as mobility, work skills, self-care, interpersonal skills, communication, self-direction, or work tolerance in terms of an employment outcome and

 

  1. Meets the significant disability criteria as defined in Priority Category 2.

2

Significantly Disabled (SD)
  1. Receives Social Security Disability Income or Supplemental Security Income.

 

 OR all of the following:

 

  1. Has a severe physical, mental or sensory impairment that seriously limits one or more functional capacities such as: mobility, work skills, self-care, interpersonal skills, communication, self-direction or work tolerance in terms of an employment outcome and

 

  1. Requires multiple vocational rehabilitation services over an extended period of time.

3

Disabled
  1. Has a physical, mental or sensory impairment;
  2. Has a substantial impediment to employment as a result of the impairment; and
  3. Requires VR services to prepare for, secure, retain or regain employment consistent with the individual’s strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice.

Order of Selection (OOS): When VR services cannot be provided to all eligible individuals, the process which assures that the first priority for VR services is given to the individuals with the most significant disabilities.

Serious functional limitation: As a result of a severe physical, mental or cognitive impairment, a reduction of one's capacity to perform to the degree that the individual requires services or accommodations, not typically provided to others, in order for the individual to work.

A VR counselor may identify a functional loss based on the counselor's observations or an individual's self-report.   Counselor observations alone are not adequate to support the determination of a serious functional loss, but should be used in conjunction with supporting medical information.

If an individual reports a functional loss that is not consistent with or not supported by disability-related documentation, the VR counselor and the individual need to discuss and reach an agreement as to how to obtain the information necessary to verify the functional loss.

The VR counselor synthesizes the medical and assessment information to determine the functional capacity limitations resulting from the disability.

Work-related limitations may result from or be compounded by external factors, such as geographic location, poor public transportation or lack of training.  These factors do not relate to a disability and are not factors in determining a serious functional limitation.  A specific disability diagnosis does not also automatically produce a functional limitation, as each individual's situation is unique.

Functional capacity areas: The functional capacity areas evaluated in relationship to the impact of a disability and an employment outcome are mobility, communication, self care, self direction, interpersonal skills, work tolerance, and work skills.  

Functional Capacity Areas

Area

Definition

Serious Functional Limitation

Mobility

The ability to move from place to place inside and outside the home.

Most common life and work activities are impaired or prevented. 

Work Tolerance

The capacity to meet the demands of the work place regardless of the work skills already possessed by an individual.

Limited endurance requires job modifications, accommodations, or adaptive technology not typically made for other workers.

Self-Care

The ability to perform activities of daily living including eating, toileting, grooming, dressing, cooking, shopping, washing, housekeeping, money management and health and safety.

Assistance, services or adaptive technology is required to accomplish activities of daily living and/or maintain personal safety.

Work Skills

The ability to demonstrate work skills or work experience necessary to obtain and maintain appropriate employment.

Training, supervision, job modification or adaptive technology not typically needed by other workers is required in order to perform work tasks.

Communication

The ability to exchange information effectively.

Unable to communicate effectively or requires assistance, services, adaptive technology, or other alternative modes or communication.

Self-Direction

The ability to independently plan, initiate, organize, make decisions and carry out daily life activity after self-care needs have been met.

A higher level of supervision is required than is typically needed by other workers to accomplish tasks, monitor one’s own behavior, and/or make independent decisions.

Interpersonal Skills

The ability to establish and maintain personal, family or community relationships.

Unable to establish effective relationships or exhibits socially unacceptable behavior.

Extended period of time: ADVR has not specifically defined the minimum -number of months constituting "extended period of time".  The VR counselor must consider each person's circumstances to determine the estimated length of time required to deliver needed services. Six months may be used as a general guideline for an "extended period of time", but should not be applied as an absolute minimum.

3.0 - Procedures

The ultimate purpose for determining the significance of disability is to establish a priority of service to insure that, if ADVR were to go on an OOS, individuals with the most significant disabilities would be served first. 

The Significance of Disability Certificate must be completed at the time an individual is determined eligible for VR services or is moved into trial work or extended evaluation. The same information gathered during the assessment process for eligibility may be used in the significance of disability determination. 

An individual is classified in the highest priority category he/she meets.  The determination may be re-evaluated at any time during the VR process if either the individual or the VR counselor believes there is a significant change in the individual's disabling condition which could result in a change of priority categories.  Under an OOS, a re-evaluation would never result in an individual being moved from an open service category to a closed service category.

If ADVR is not operating under an OOS, the priority classifications are used for planning purposes to ascertain that services can continue to be provided to all who are eligible.

3.1- Documentation

  1. Significance of Disability - Functional Limitations Worksheet:

    • Used to identify capacity areas with serious functional loss;

    • Most common indicators are listed under each capacity area;

    • Use "Other" when the individual experiences a functional loss equivalent to the indicators listed, counselor must write a detailed description; and

    • Check all the indicators that apply in each capacity area.

  2. Significance of Disability Certificate:

    • VR counselor's formal determination of the individual's significance of disability and assignment to a priority of service category;

    • Signed by a VR counselor delegated such authority;

    • Assigns the individual to the highest category they qualify for; and

    • Used in conjunction with the Significance of Disability - Functional Limitations Worksheet.

  3. AWARE 0 Eligibility Determination: Section 1 - Determination

    • Select the disability priority, the same as on Significance of Disability Certificate;

    • Check the appropriate boxes which will support the priority selected, the boxes should correspond to the functional capacity losses as identified on the Significance of Disability - Functional Limitations Worksheet; and

    • The "Other" documentation area may be used as needed to support the determination.

4.0 - Exceptions

Any exception to policy must be approved by the Chief of Rehabilitation Services or his/her designee.

5.0 - FAQs

  1. Question: If the primary reason for the SD determination is for OOS and we are not on an order, why do we have to go through this process?

    Answer: We have learned from other states that going on an OOS can be a very painful process.  Having a system in place to determine the priority of service will help to provide a smooth transition to an OOS. 

    We are also currently required to report if individuals we serve are SD.  We have to make that determination even without an OOS, so going the next step to identify those who are MSD is not much more work.

  2. Question: If only one item needs to be checked under the functional limitations category for the category to be counted, why do I need to "check all that apply"?

    Answer: All of the limitations should be addressed during the eligibility process.  Having them checked on the form simply serves as a reminder.

  3. Question:  Why have the list of indicators for the functional capacity areas (on the worksheet)?    

    Answer: The indicators are examples of what constitutes a serious limitation to a functional capacity.  Any disability is serious to the person who is experiencing it, but we are required by regulation to have a system in place to define and identify those individuals who are MSD. 

    If the "Other" indicator is used, it MUST be comparable to those examples in the category.

  4. Question:  Why do we have to make the SD determination at eligibility?  Can I wait to do it later?

    Answer: No.  If we are on an OOS, eligibility is the time when a person is placed on a waiting list for services based upon their priority.  Also, anyone closed from eligible status is expected by RSA to have a determination made as to their disability status.

  5. Question:  Why do I have to make an SD determination prior to trial work or extended evaluation?

    Answer:  We are required to report the disability status of anyone closed from trial work or extended evaluation.  The VR counselor should have adequate information to make such a decision, as the only individuals in these statuses are ones whom the counselor is questioning their ability to benefit from VR services due to the severity of their disability.

  6. Question:  Can I change the SD determination?

    Answer: Yes, if either the individual or the VR counselor believes there is a significant change in the individual's disabling condition which could result in a change of priority categories.

    Under an OOS, a re-evaluation would never result in an individual being moved from an open service category to a closed service category.

  7. Question: Do I need to write any further explanation in the "Other" block in the Determination section in AWARE?

    Answer: No. 

6.0 - Forms