The person is able to carry out self-care independently. The concept of disability, the procedure for its establishment and disability groups

03.11.2019 -

Medical and social expertise and disability in case of visual impairment

Medical and social problems of blindness, low vision and disability due to diseases of the organ of vision are studied by clinical and social ophthalmology - a science that studies the medical and social consequences of diseases of the organ of vision, leading to persistent disorders visual functions and social disadvantage.
Her tasks also include medical social expertise.
All these issues in Russia are regulated by the federal law "On the social protection of persons with disabilities in Russian Federation"November 24, 1995 N 181-FZ with latest changes dated July 1, 2011 (N 169-FZ).
Federal law defines public policy in area social protection disabled people in the Russian Federation, the purpose of which is to provide disabled people with equal opportunities with other citizens in the exercise of civil, economic, political and other rights and freedoms provided for by the Constitution of the Russian Federation, as well as in accordance with generally recognized principles and norms international law and international treaties of the Russian Federation.
Federal law defines the basic concepts associated with ideas about disability.
Disabled person - a person who has a health disorder with a persistent disorder of body functions due to diseases, the consequences of injuries or defects, leading to limitation of life and necessitating his social security.
Limitation of life activity - complete or partial loss of the ability or ability of a person to carry out self-service, move independently, navigate, communicate, control their behavior, learn and engage in work activities.

Depending on the degree of disorder of body functions and limitation of life activity, persons recognized as disabled are assigned a disability group, and persons under the age of 18 are assigned the category "disabled child".
Medico-social expertise - determination in accordance with the established procedure of the needs of the person being examined for social protection measures, including rehabilitation, based on an assessment of disability caused by a persistent disorder of body functions.
Medico-social examination is carried out on the basis of a comprehensive assessment of the state of the body based on an analysis of clinical, functional, social, vocational, psychological data of the person being examined using classifications and criteria developed and approved in the manner determined by the Government of the Russian Federation.
Medical and social expertise is carried out by federal institutions of medical and social expertise.
On the federal agencies medical and social expertise are assigned to:
1) establishment of disability, its causes, timing, time of onset of disability, the needs of a disabled person in various types of social protection;
2) development of individual programs for the rehabilitation of disabled people;
3) study of the level and causes of disability in the population;
4) participation in the development integrated programs rehabilitation of the disabled, prevention of disability and social protection of the disabled;
5) determination of the degree of loss of professional ability to work;
6) determination of the cause of death of a disabled person in cases where the legislation of the Russian Federation provides for the provision of measures social support the family of the deceased.
The decision of the institution of medical and social expertise is binding on the relevant state authorities, local governments, as well as organizations, regardless of organizational and legal forms and forms of ownership.
Decree of the Government of the Russian Federation of February 20, 2006 N 95 "On the procedure and conditions for recognizing a person as disabled" (as amended by Decrees of the Government of the Russian Federation of 04/07/2008 N 247 of 12/30/2009 N 1121) determines the procedure for conducting a medical and social examination.
The grounds for recognizing a citizen as disabled are:
a) a health disorder with a persistent disorder of body functions due to diseases, consequences of injuries or defects;
b) limitation of life activity (complete or partial loss of the ability or ability of a person to carry out self-service, move independently, navigate, communicate, control their behavior, study or engage in work activities);
c) the need for social protection measures, including rehabilitation.
The presence of one of these signs is not a sufficient condition for recognizing a person as disabled.
Disability of the I group is established for 2 years, II and III groups - for 1 year. In certain cases, disability is established indefinitely.
Visual impairment refers to the main types of body functions disorders (disturbance of sensory functions). In this regard, if the function of vision is lost, a person may be recognized as visually impaired.
The definition of 3 groups of visual disability is based on the degree of visual impairment and the limitation of the life of a particular patient with the need for social protection.

Degrees of visual impairment

Definition of degrees visual disturbances based on the International Classification of Diseases (ICD) X revision (Geneva, WHO, 1989), which formulates criteria for determining the degree of dysfunction visual analyzer, including the assessment of visual functions (acuity and visual field); basic electrophysiological parameters; visual performance. In accordance with them, four degrees of violations of the functions of the visual analyzer were distinguished (see table).

In accordance with the order of the Ministry of Health and social development of the Russian Federation No. 1013n dated December 23, 2009 "On approval of classifications and criteria used in the implementation of medical and social examination of citizens by federal government agencies medical and social expertise"), the main categories of human life include:
Ability to self-service;
Ability to move independently;
Ability to Orientation;
Ability to communicate;
The ability to control one's behavior;
Ability to learn;
Ability to work.
In a comprehensive assessment of various indicators characterizing the limitations of the main categories of human life, 3 degrees of their severity are distinguished.
As an example, we give the degree of violations of such a basic category of life as:
The ability to self-service - the ability of a person to independently fulfill basic physiological needs, perform daily household activities, including personal hygiene skills. The following degrees of violations are determined:
1 degree - the ability to self-service with a longer expenditure of time, the fragmentation of its implementation, reducing the volume, using, if necessary, auxiliary technical means;
2 degree - the ability to self-service with regular partial assistance from other persons using, if necessary, auxiliary technical means;
Grade 3 - inability to self-service, the need for constant outside help and complete dependence on other people.
Similarly, the assessment of violations and other categories of life. Restriction of at least one main category of a person's life activity, or a combination of them, causing the need for his social protection, is the basis for assigning a disability group.
The degree of impairment of visual functions and limitation of the main categories of life activity, causing the need for social protection, are taken into account when determining disability groups.

Criteria for determining visual disability groups

I disability group it is established at the IV degree of violations of the functions of the visual analyzer (see table) - significantly impaired functions (absolute or practical blindness) and a decrease in one of the main categories of life activity to 3 degrees with the need for social protection.
The main criteria for the IV degree of visual analyzer dysfunction.
a) blindness (vision is 0) in both eyes;
b) visual acuity with correction better eye not higher than 0.04;
c) bilateral concentric narrowing of the boundaries of the visual field up to 10-0° from the point of fixation, regardless of the state of central visual acuity.

II group of disability is established at the III degree of violations of the functions of the visual analyzer - pronounced dysfunctions (low vision high degree), and the reduction of one of the main categories of life activity to the 2nd degree with the need for social protection.
The main criteria for severe visual impairment are:
a) visual acuity of the best eye from 0.05 to 0.1;
b) bilateral concentric narrowing of the boundaries of the field of view up to 10-20 ° from the point of fixation, when labor activity is possible only in specially created conditions.

III disability group is established at the II degree - moderate dysfunctions (low vision medium degree) and a decrease in one of the main categories of life activity to 1 degree with the need for social protection.
Main criteria moderate violations vision functions are:
a) decreased visual acuity in the better seeing eye from 0.1 to 0.3;
b) unilateral concentric narrowing of the boundaries of the field of view from the point of fixation less than 40°, but more than 20°;

The task of the bodies of medical and social expertise is also to determine the ways of rehabilitation of disabled people - a system and process of full or partial restoration of the abilities of disabled people for everyday, social and professional activities. Rehabilitation of disabled people is aimed at eliminating or, if possible, more fully compensating for limitations in life activity caused by a health disorder with a persistent disorder of body functions, in order to socially adapt disabled people, achieve their financial independence and integrate them into society.

In each case, an individual program for the rehabilitation of a disabled person is developed - a complex of optimal rehabilitation measures, which includes certain types, forms, volumes, terms and procedures for the implementation of medical, professional and other rehabilitation measures aimed at restoring, compensating for impaired or lost body functions, restoring, compensating the disabled person's ability to perform certain types activities.

In the process of rehabilitation of the visually impaired, Professor M.I. Razumovsky (2005) recommends taking into account the following points:
Since the main role of a remote analyzer in the blind and visually impaired is played by hearing, which compensates for the visual defect and contributes to the orientation of the visually impaired and blind, production noise should be completely eliminated if possible. When illuminating the workplace, the most rational is the use of individual lamps that allow you to adjust the luminous flux. Taking into account the low functional activity of the visual-nerve apparatus, these persons can perform coarse-precision visual work with an object no less than 5 mm in size. Disabled people with a pronounced and significantly pronounced limitation of life due to a decrease in visual acuity to the possibility of only orientation at the workplace, it is possible to perform work tasks without the use of vision (by the blind method). They are shown the labor arrangement in the system of the All-Russian Society of the Blind.

Consultative and methodological work is also possible using the accumulated professional experience and knowledge in ordinary or specially created production conditions (representatives of art and culture, lawyers, teachers, engineers), etc., as well as home work that does not require visual control.

Patients of middle and old age and sufficiently preserved visual functions, who have a long professional experience and an established working stereotype, should, if possible, be recommended a labor device in their own or another production in the same or close to it specialty, taking into account contraindicated factors of working conditions.

In cases where visual impairment is observed in individuals young age with a small professional experience or no work experience, timely rational professional orientation, and, if necessary, retraining with the acquisition of another specialty, is important in order to prevent disability. In case of stabilization pathological process after surgical intervention in early stage diseases, a positive clinical and labor prognosis allows these patients to choose a specialty from a fairly wide range of jobs available to them.

Blind children undergo a course of rehabilitation in specialized boarding schools, where they receive a general secondary education. They are taught to write and read in Braille dotted alphabet (combinations of 6 raised dots create 63 characters sufficient to indicate letters, numbers, punctuation marks and musical notes). All this is aimed at social adaptation the blind and visually impaired.

Social and psychological adaptation is essential. disabled people, long time or blind from birth, as a rule, work in specially created conditions at the enterprises of societies for the blind. They do not have professions that allow them to work in normal production conditions. Changing the existing social stereotype takes time to implement a number of restoration measures (training, acquiring a new profession, rational employment).

In the structure of visual disability in Russia, the most important pathology is glaucoma, the consequences of injuries of the organ of vision, myopic disease, diseases of the retina and optic nerve, diseases of the lens.
For each pathology there is a list of labor recommendations.
1. Glaucoma. When carrying out labor activities, harmful substances that have a neurotropic and angiotropic effect, ultrasound, vibration and different kinds radiation above the maximum allowable standards, as well as such factors as: heavy physical exertion, forced working posture, excessive neuropsychic stress. Conditions of "hot" or "cold" shops are contraindicated. With closed-angle glaucoma, work at night and work with a long head tilt down. When the field of view is limited, it is impossible to work as a driver of any type of vehicle, at high altitude (crane operator, installer, roofer, firefighter, stuntman, etc.).
2. Injuries, reconstructive operations. Regardless of the time elapsed after surgery and the nature of previous activities, all patients who have undergone trauma and reconstructive surgery are contraindicated in work associated with significant physical activity, torso tilts, high eye strain, exposure to high temperatures, radiation and vibrations, the risk of eye injuries in moving mechanisms, in a dusty room and in contact with toxic substances.
3. High myopia is a contraindication to hard physical labor, sports exercises with sharp rise weights and contact sports, to work with concussion of the body and an inclined position of the head, to visual strenuous work.
4. In case of diseases of the retina and optic nerve, work associated with neurotoxic substances, the risk of intoxication with mercury, arsenic, aniline, methyl alcohol, nicotine, etc. is contraindicated. Vehicle and on top.

5. Cataract. Patients with cataracts are contraindicated in work associated with the need for accurate vision, work among moving mechanisms, at height. It is contraindicated to work in conditions of different types of radiation, vibration, toxic substances and other factors that have a cataractogenic effect.

Legal Basics social assistance disabled people In Russia, the concept of disability, which exists in all civilized countries, based on the highly humane attitude of society towards disabled people, has been adopted and observed. Legislation at both the federal and regional levels defines various forms social security disabled people.

Information about the envisaged rights and obligations of persons with disabilities will help mitigate the burden of the disease placed on the shoulders of relatives. Of particular importance in connection with the rejuvenation of stroke is the employment of disabled people, their professional training and adaptation to new living conditions. These issues are the focus of this lesson.

A disabled person is a person who has a health disorder with a persistent disorder of body functions due to diseases, the consequences of injuries or defects, leading to a limitation of life and causing the need for social protection.

This legal definition is contained in the Federal Law (FZ) of November 24, 1995, as amended on December 31, 2005, “On the Social Protection of the Disabled”. This is the most general concept of a disabled person. Details of this concept are also presented in other legislative acts, such as the Law of the Russian Federation of May 15, 1991, as amended on December 5, 2006 "On the social protection of citizens exposed to radiation due to a disaster at Chernobyl nuclear power plant", Federal Law of January 12, 1995, as amended on December 19, 2005 "On Veterans", etc. (hereinafter, the regulations are given as of May 29, 2007).

On the this lesson discussed only general issues relating to the establishment of disability, pensions for disabled people, their social service. Particular questions concerning legal status certain categories of citizens (military personnel, civil servants, etc.) are not considered in the lesson.

Limitation of life activity - complete or partial loss of the ability or ability of a person to carry out self-service, move independently, navigate, communicate, control their behavior, learn and engage in work activities.

Depending on the degree of disorder of body functions and limitation of life activity, persons recognized as disabled are assigned a disability group. Recognition of a person as a disabled person is carried out by the federal institution of medical and social expertise (bodies of the service of medical and social expertise).

Medical and social expertise - determination in the prescribed manner of the needs of the person being examined for social protection measures, including rehabilitation, based on an assessment of disability caused by a persistent disorder of body functions.

Medical and social expertise is carried out on the basis of a comprehensive assessment of the state of the body based on an analysis of clinical, functional, social, professional, labor, psychological data of the person being examined.

An individual rehabilitation program for a disabled person is a set of rehabilitation measures that are optimal for a disabled person, including certain types, forms, volumes, terms and procedures for the implementation of medical, professional and other rehabilitation measures aimed at restoring, compensating for impaired or lost body functions, restoring, compensating the disabled person’s ability to perform certain types of activities.

The procedure and conditions for recognizing a person as disabled

The procedure and conditions for recognizing a person as a disabled person are regulated by the Decree of the Government of the Russian Federation of 20.02. 2006 "On the procedure and conditions for recognizing a person as disabled."

To be recognized as a disabled person, all of the following conditions must be met:

Impairment of health with a persistent disorder of body functions due to diseases;

Life restriction;

The need for social protection measures, including rehabilitation.

The main types of violations of the functions of the human body include:

Violations of mental functions (perception, attention, memory, thinking, intellect, emotions, will, consciousness, behavior, psychomotor functions);

Violations of language and speech functions (disorders of oral (rhinolalia, dysarthria, stuttering, alalia, aphasia) and written (dysgraphia, dyslexia), verbal and non-verbal speech, voice formation disorders, etc.);

Violations of sensory functions (vision, hearing, smell, touch, tactile, pain, temperature and other types of sensitivity);

Violations of statodynamic functions ( motor functions head, torso, limbs, statics, coordination of movements);

Violations of the functions of blood circulation, respiration, digestion, excretion, hematopoiesis, metabolism and energy, internal secretion, immunity;

Violations caused by physical deformity (deformities of the face, head, torso, limbs, leading to external deformity, abnormal openings of the digestive, urinary, respiratory tracts, violation of body size).

Depending on the degree of disability caused by a persistent disorder of body functions resulting from diseases, a person recognized as a disabled person is assigned I, II or III disability groups.

When establishing a disability group for a person, the degree of restriction of his ability to work is simultaneously determined (III, II or I degree of restriction) or the disability group is established without limiting the ability to work.

Disability of the I group is established for 2 years, II and III groups - for 1 year. To confirm or change the disability group, a re-examination is required after 2 (1) years.

The degree of limitation of the ability to work (no limitation of the ability to work) is established for the same period as the disability group.

Who sends the patient to undergo a medical and social examination?

You can be sent for a medical and social examination:

Medical institution;

The body providing pensions (mainly a territorial branch of the Pension Fund of the Russian Federation);

Body of social protection of the population.

It should be noted that the referral of a person for medical and social examination by the bodies mentioned in clauses 2 and 3 is carried out only if he has medical documents confirming violations of body functions due to diseases.

To pass the medical and social examination, the following package of documents is required:

1. referral for medical and social examination issued by a medical institution (Appendix 1, 2). In this direction, data on the state of health of a citizen should be indicated, reflecting the degree of violation of the functions of organs and systems, the state of the compensatory capabilities of the body, as well as the results of the rehabilitation measures carried out;

2. application of a person sent to undergo a medical and social examination or application of his legal representative. The application is submitted to the head of the institution;

3. medical documents confirming a health disorder (discharge summary, results instrumental research and etc.).

Which authorities should be contacted to undergo a medical and social examination?

Medical and social expertise is carried out in the bodies of the service of medical and social expertise. As a rule, a medical and social examination is carried out in the office at the place of residence of the patient. However, in cases requiring special or special complex types survey, it may be conducted at the main office or the Federal Office. A referral for this is issued respectively by the Bureau of Medical and Social Expertise at the place of residence of the patient or the main Bureau of Medical and Social Expertise.

The attention of listeners should be drawn to the fact that a medical and social examination can be carried out at home if the patient cannot come to the appropriate bureau for health reasons. This must be confirmed by a statement from the medical institution, or may be decided in absentia by the bureau (main bureau, Federal Bureau).

How is the decision of the bodies of medical and social expertise drawn up?

The decision to recognize a citizen as disabled or to refuse to recognize him as disabled is made simple majority votes of the specialists who conducted the medical and social examination, based on the discussion of the results of his medical and social examination. The data of the medical and social examination of the person and the decision of the specialists who conducted the medical and social examination are recorded in the minutes of the meeting and in the act of examination of the person, which are signed by the head of the institution, the specialists who made the decision, and certified by the seal of the institution. The conclusion of the consultant involved in the medical and social examination, the list of documents and the main information that served as the basis for the adoption of the expert decision are entered in the examination report or attached to it.

The decision is announced to the person who underwent the medical and social examination (his legal representative), in the presence of all the specialists who conducted the medical and social examination, who, if necessary, provide explanations on it.

A person recognized as a disabled person is issued:

A certificate confirming the fact of the establishment of disability, indicating the group of disability and the degree of limitation of the ability to work, or indicating the group of disability without limiting the ability to work;

Individual rehabilitation program.

A person who is not recognized as a disabled person, at his request, is issued a certificate of the results of the examination.

The decisions of the bodies of the service of medical and social expertise are binding on all organizations, regardless of the form of ownership, for example, for departments of the Pension Fund, social protection bodies, and government bodies.

Where and in what terms can one appeal against the decision of the Bureau of Medical and Social Expertise?

In case of disagreement with the expert decision of the Bureau of Medical and Social Expertise, the patient or his legal representative may appeal against it on the basis of a written application. The application is submitted to the institution that conducted the examination, or to the main bureau of medical and social expertise.

The Bureau of Medical and Social Expertise, which conducted the examination, within three days from the date of receipt of the application, sends this application with all available documents to the main Bureau of Medical and Social Expertise.

The Main Bureau of Medical and Social Expertise, no later than one month from the date of receipt of the application, conducts a medical and social expertise of the person and, based on the results, makes a decision.

In the event that a citizen appeals against the decision of the main bureau, the chief expert in medical and social expertise for the relevant subject of the Russian Federation, with the consent of the citizen, may entrust the conduct of his medical and social expertise to another team of specialists from the main bureau.

The decision of the main bureau can be appealed to month in Federal Bureau on the basis of an application submitted by a citizen (his legal representative) to the main bureau that conducted the medical and social examination, or to the Federal Bureau.

The Federal Bureau, no later than one month from the date of receipt of the citizen's application, conducts his medical and social examination and, based on the results obtained, makes an appropriate decision.

Decisions of the bureau, the main bureau, the Federal Bureau may be appealed to the court by a citizen (his legal representative) in the manner prescribed by the legislation of the Russian Federation.

How is a person with a disability re-examined?

Re-examination of a disabled person is carried out in the same manner in which disability is established. Re-examination of disabled people of group I is carried out once every 2 years, disabled people of groups II and III - once a year. Re-examination of a citizen whose disability has been established without specifying the re-examination period may be carried out on his personal application (application of his legal representative), or on the direction of a medical institution in connection with a change in health status, or when carried out by the main bureau, the Federal Bureau of Control over Decisions, adopted respectively by the bureau, the main bureau.

You can re-examine in advance, but no more than two months before the expiration of the established period of disability. In this case, it is necessary to submit an application personally by the disabled person or his legal representative. In addition, in connection with a change in the state of health, a medical institution may issue a referral for re-examination before the deadline.

If a disabled person fails to appear at the appointed time for re-examination at the body of the medical and social examination service, pension payments will be suspended for three months, starting from the 1st day of the month following the month in which the specified period expired.

If, during a re-examination in the body of the medical and social examination service, his disability is confirmed before the expiration of the above three-month period, the payment of a disability pension is resumed from the day from which this person was again recognized as disabled. If the disabled person is late with re-examination according to good reason and a disability group equivalent to the previous one for the past time has been established for him, then the payment of the disability pension is resumed from the day from which the person was again actually recognized as disabled, including for the missed period. At the same time, the length of the period that has elapsed since the suspension of the payment of labor pension does not matter. If during the re-examination a different degree of limitation of the ability to work is established (higher or lower), then the payment of a pension for missed time is resumed at the previous degree of limitation of the ability to work. Decisions to resume the payment of a pension are made by the territorial body of the Pension Fund automatically after receiving an extract from the act of re-examination of a disabled person from the territorial body of the medical and social examination service.

Medical and social expertise for visual impairments
(Information letter for healthcare professionals and ITU General Bureaus)

Federal Law No. 181-FZ of November 24, 1995 “On the Social Protection of the Disabled in the Russian Federation” defines the state policy in the field of social protection of the disabled in the Russian Federation, the purpose of which is to provide disabled people with equal opportunities with other citizens in the implementation of civil, economic, political and other rights and freedoms provided for by the Constitution of the Russian Federation, as well as in accordance with the generally recognized principles and norms of international law and international treaties of the Russian Federation.
Federal law defines the basic concepts associated with ideas about disability. A disabled person is a person who has a health disorder with a persistent disorder of body functions due to diseases, the consequences of injuries or defects, leading to a limitation of life and causing the need for his social protection. Limitation of life activity - complete or partial loss of the ability or ability of a person to carry out self-service, move independently, navigate, communicate, control their behavior, learn and engage in work activities. Depending on the degree of impairment of body functions and limitation of life activity, persons recognized as disabled are assigned a disability group (1, 2, 3), and persons under the age of 18 are assigned the category of “disabled child” (Article 1).

Medico-social expertise - determination in accordance with the established procedure of the needs of the person being examined for social protection measures, including rehabilitation, based on an assessment of disability caused by a persistent disorder of body functions. Medico-social examination is carried out on the basis of a comprehensive assessment of the state of the body based on an analysis of clinical, functional, social, vocational, psychological data of the person being examined using classifications and criteria developed and approved in the manner determined by the Government of the Russian Federation (Article 7 ).

Medical and social expertise is carried out by federal institutions of medical and social expertise. The decision of the institution of medical and social expertise is binding on the relevant state authorities, local governments, as well as organizations, regardless of organizational and legal forms and forms of ownership (Article 8).

In order to uniformly apply the wording of the causes of disability by federal institutions of medical and social expertise in determining the causes of disability, depending on the circumstances of the onset of disability, provided for by the legislation of the Russian Federation, on which the level of pension provision of a disabled person, the payment of compensation and the provision of various benefits, the Ministry of Labor and Social Development of the Russian Federation approved Explanation of the Ministry of Labor of Russia dated April 15, 2003 No. 17 “On the determination by federal state institutions of medical and social examination of the causes of disability” (Explanation).

If the disability is the result of a military injury or illness received during the period military service, work injury or occupational disease, the corresponding cause of disability is established. In the event of a disability due to a persistent impairment of visual functions under the age of 18, the cause of disability is established with the motivation “disability since childhood”.

When establishing the cause of disability of citizens who became disabled since childhood as a result of injuries, contusions, injuries associated with hostilities during the Great Patriotic War 1941-1945, the institutions of medical and social expertise are guided by the "On the procedure for establishing disability since childhood due to injury, concussion or injury associated with military operations during the Great Patriotic War or with their consequences" (hereinafter referred to as the Instruction).

The directive proposed to organize a re-examination in medical and labor expert commissions of disabled people from childhood in order to clarify the circumstances of their health disorders and the causes of disability. In the case of a documented fact of the onset of disability due to injury, contusion or injury associated with military operations during the Great Patriotic War or their consequences, it was recommended to determine the cause of disability with the wording “disability from childhood due to injury, concussion or injury (respectively) associated with military operations during the Great Patriotic War.

Thus, the named cause of disability, in accordance with the current legislation of the Russian Federation, can only be established for disabled people from childhood, provided that this disability is established by the direct consequences of injuries (concussion, mutilations) associated with military operations during the Great Patriotic War, and confirmed in established order of the circumstances of these injuries.
In other cases, as a rule, the reason is established " common disease", in accordance with paragraph 3

The task of medical and social expertise is also to determine the ways of rehabilitation of disabled people (the system and process of full or partial restoration of the abilities of disabled people for household, social and professional activities). The rehabilitation of disabled people is aimed at eliminating or, if possible, more fully compensating for restrictions on life activity caused by a health disorder with a persistent disorder of body functions, in order to socially adapt disabled people, achieve their financial independence and integrate them into society (Article 9).
In each case of recognition of a person as a disabled person, an individual program for the rehabilitation of a disabled person (IPR) is developed - a set of rehabilitation measures that are optimal for a disabled person, including certain types, forms, volumes, terms and procedures for the implementation of medical, professional and other rehabilitation measures aimed at restoring, compensating for impaired or lost functions of the body, restoration, compensation for the ability of a disabled person to perform certain types of activities (Article 11.1).

In the process of rehabilitation of the visually impaired, rational employment plays a decisive role. Since the main role of a remote analyzer in the blind and visually impaired is played by hearing, which compensates for the visual defect and contributes to the orientation of the visually impaired and blind, production noise should be completely eliminated if possible.
When illuminating the workplace, the most rational is the use of individual lamps that allow you to adjust the luminous flux. Taking into account the low functional activity of the visual-nerve apparatus, these persons can perform coarse-precision visual work with an object no less than 5 mm in size. Disabled people with a pronounced and significantly pronounced limitation of life due to a decrease in visual acuity to the possibility of only orientation at the workplace are available to perform work tasks without the use of vision (by the blind method), which is possible only in specially created production conditions, including consultative methodical work using the accumulated professional experience and knowledge in ordinary or specially created production conditions (representatives of art and culture, lawyers, teachers, engineers), etc., as well as home work that does not require visual control.

Middle-aged and elderly patients with sufficiently preserved visual functions, who have a long professional experience and an established working stereotype, are recommended, if possible, to work in their own or other production in the same or close to it specialty, taking into account contraindicated factors of working conditions.
In cases where visual impairment is observed in young people with little professional experience or no work experience, timely rational professional orientation becomes important in order to prevent disability, and, if necessary, retraining with the acquisition of another specialty.
In the case of stabilization of the pathological process after surgical intervention at an early stage of the disease, a positive clinical and labor prognosis allows these patients to choose a specialty from a fairly wide range of jobs available to them.

Vocational training or retraining of the blind and visually impaired for social and labor rehabilitation is carried out in special technical schools, professional lyceums and at enterprises of the All-Russian Society of the Blind. Blind children undergo a course of rehabilitation in specialized boarding schools, where they receive a general secondary education, learn to write and read in Braille dotted alphabet (combinations of 6 raised dots create 63 characters sufficient to indicate letters, numbers, punctuation marks and musical notes). All this is aimed at the social adaptation of the blind and visually impaired.

Social and psychological adaptation is essential. Disabled people who have been deprived of sight for a long time or from birth usually work in specially created conditions, including at enterprises of the Society for the Blind. They do not have professions that allow them to work in normal production conditions. Changing the existing social stereotype takes time to implement a number of restoration measures (training, acquiring a new profession, rational employment).

1. Glaucoma. When carrying out labor activities, harmful substances that have a neurotropic and angiotropic effect, ultrasound, vibration and various types of radiation above the maximum permissible norms, as well as such factors as: heavy physical exertion, forced working posture, excessive neuropsychic stress, should be excluded. The conditions of "hot" or "cold" workshops are contraindicated, with angle-closure glaucoma - work at night and work with a long tilt of the head down. When the field of view is limited, it is impossible to work as a driver of any type of vehicle, at high altitude (crane operator, installer, roofer, firefighter, stuntman, etc.).

2. Injuries, reconstructive operations. Regardless of the time elapsed after surgery, and the nature of the previous activity, all patients who have undergone trauma and reconstructive surgery are contraindicated in work associated with significant physical exertion, torso tilts, high eye strain, exposure to high temperatures, radiation and vibrations, the risk of eye injury in moving machinery, in dusty environments and in contact with toxic substances.

3. High myopia is a contraindication to heavy physical labor, sports exercises with a sharp lifting of weights and contact sports, to work with a concussion of the body and an inclined position of the head, to visual strenuous work.

4. In diseases of the retina and optic nerve work associated with neurotoxic substances, the risk of intoxication with mercury, arsenic, aniline, methyl alcohol, nicotine, etc. is contraindicated. It is impossible to work as drivers of any vehicles and at height.

Special requirements for the working conditions of disabled people due to diseases of the organ of vision are set out in clause 6.4 of the "Hygienic requirements for working conditions for disabled people" (Sanitary rules SP 2.2.9.250-09), approved by the resolution of Rospotrebnadzor and the chief state sanitary doctor of the Russian Federation of May 18, 2009 No. 30.

For disabled people with low vision of an average degree, types of work related to IV - VI, VIII, "c", "e", "g", "h" categories of visual work are recommended. Disabled people with low vision of a high degree can perform work related to VI, VIII, "e", "g", "h" categories of visual work. Disabled people with absolute or practical blindness can perform labor operations without visual control, using analyzer systems that compensate for a visual defect (touch, tactile-muscular feeling, hearing).
The hygienic characteristics of working conditions in the workplaces of disabled people due to visual impairments are differentiated depending on the disease of the organ of vision (Table 1).

Table 1 shows the different types ophthalmopathology classes of working conditions.
The workplace for disabled people with complete and practical blindness, as well as with high degree of low vision, should be equipped with a system of tiflotechnical landmarks (tactile, auditory, visual) that provide orientation for these disabled people at the workplace (in accordance with the "Recommendations for the installation of landmark systems at enterprises and in WOC organizations"). Technological equipment of these workplaces (from simple tools to complex technical devices) must be equipped with tiflo technical devices that make it possible to perform work without visual control and exclude the possibility of industrial injury. Illumination in the workplaces of disabled people with eye pathology should be set individually, taking into account the nosological form of the disease, by means of combined lighting. The total lighting in the combined system should be at least 20%.

Sudden changes in illumination during the working day (no more than 30%) are unacceptable. As natural light decreases, artificial light should automatically be connected by stepwise switching on of individual groups of luminaires.
To reduce the sharp uneven distribution of brightness in the field of view of working disabled people, it is necessary to prevent direct sun rays into the room using curtains or blinds, which, however, should not significantly reduce the illumination. Local lamps must be equipped with devices for regulating the direction and intensity of the light flux.

Table 1

The painting of the surfaces of working premises and elements of the workplace of the visually impaired should be carried out in such a way that the light energy reflection coefficient is close to the maximum. The lowest reflection coefficients of surfaces are given in Table 2.

table 2

At the workplaces of the visually impaired, the ratio between the reflectances of work surfaces and workpieces must be at least 1:3, which is achieved by painting work surfaces (or using sets of removable coatings) in colors matched by color contrast to the material being processed:
a) for cold-colored parts (steel, aluminum, etc.) - warm colors (for example, cream);
b) for warm-colored parts (copper, brass, etc.) - cold colors (for example, gray-blue);
c) for dark parts - light colors. For disabled people with congenital color anomalies and diseases accompanied by a violation of color sensitivity, types of work requiring color discrimination should not be provided.

Single workplaces for the blind should be radio-equipped. When placing several workplaces for the blind in one room, the room should be radio-equipped.
Painting of premises at enterprises is carried out taking into account the latitude of the area, the orientation of windows, the available equipment and the color of manufactured products.
For better orientation of workers with residual vision, bright color tones should be painted in the form of stripes along the edges of the aisles, near containers, etc. The aisles are highlighted in light colors against a dark background.
In order to ensure sufficient contrast between the workpiece and the background, it is necessary to use in the workplace, whenever possible, sets of removable covers for work surfaces, matched in color contrast to different materials.
Disabled people with visual loss are not allowed to work with sources of local vibration and noise.

"Rules for providing disabled people with technical means of rehabilitation and certain categories of citizens from among veterans with prostheses (except for dentures), prosthetic and orthopedic products" approved

For persons with diseases and defects of the organ of vision, the Federal List provides for: special devices for reading “talking books” (on flash cards), for optical correction low vision (electronic manual video magnifier, electronic stationary video magnifier, magnifier, magnifier with illumination), medical thermometer with speech output, medical tonometer with speech output, guide dog with a set of equipment.
Provision of disabled TSW who are not included in the Federal List is carried out on the basis of the IPR by the social protection authorities in accordance with the "List of technical means of rehabilitation issued to the disabled free of charge at the expense of the regional budget" (Appendix No. 1 to the order of the Ministry of Social Development and Family Policy of the Krasnodar Territory dated 07.02.2013 No. 170) (Regional list).

For persons with diseases and defects of the organ of vision, the Regional List provides: a mini-laptop with programs for speech screen access, a digital voice recorder, a device for writing in relief-dotted Braille, a slate for writing in Braille, special paper for writing in Braille, a mechanical wrist watch with relief divisions, an alarm clock with a thermometer electronic "talking", a needle threader, a knife-dispenser, an electronic wrist alarm clock with a vibration signal.
“The procedure for providing disabled people with technical means of rehabilitation at the expense of the regional budget” was approved by order of the Ministry of Social Development and Family Policy of the Krasnodar Territory dated February 7, 2013 No. 170.

Deputy Head-Chief Expert
on medical and social expertise of FKU GB ITU in the Krasnodar Territory
T.V. Tereshchenko

Specialists of the Bureau of Medical and Social Expertise recognized 20-year-old Muscovite Ekaterina Prokudina, who has been suffering from childhood cerebral palsy and cannot move independently, a disabled person of the second group, in fact depriving her of the opportunity to undergo an annual Spa treatment, the mother of the girl Marina Prokudina told RIA Novosti.

In accordance with the rules for recognizing a person as a disabled person, approved by a decree of the Government of the Russian Federation of February 20, 2006, a citizen is recognized as disabled during a medical and social examination based on a comprehensive assessment of the state of the citizen's body based on an analysis of his clinical, functional, social, household, professional labor and psychological data using classifications and criteria approved by the Ministry of Health and Social Development of the Russian Federation.

Conditions for recognizing a citizen as disabled are:

Impairment of health with a persistent disorder of body functions due to diseases, consequences of injuries or defects;
- restriction of life activity (complete or partial loss by a citizen of the ability or ability to carry out self-service, move independently, navigate, communicate, control their behavior, study or engage in labor activity);
- the need for social protection measures, including rehabilitation.

The presence of one of these conditions is not sufficient grounds for recognizing a citizen as disabled.

Depending on the degree of limitation of life activity due to a persistent disorder of body functions resulting from diseases, the consequences of injuries or defects, a citizen recognized as disabled is assigned I, II or III disability groups, and a citizen under the age of 18 is assigned the category "disabled child".

Disability of the I group is established for 2 years, II and III groups - for 1 year.

If a citizen is recognized as a disabled person, the cause of disability is a general illness, a labor injury, an occupational disease, disability from childhood, disability due to injury (concussion, injury) associated with military operations during the Great Patriotic War, a military injury, a disease received during the period military service, disability associated with the disaster at the Chernobyl nuclear power plant, the consequences of radiation exposure and direct participation in the activities of special risk units, as well as other reasons, established by law Russian Federation.

Re-examination of disabled people of group I is carried out once every 2 years, disabled people of groups II and III - once a year, and children with disabilities - once during the period for which the category "child with a disability" is established for the child.

A disability group is established for citizens without specifying the re-examination period, and for citizens under the age of 18, the category "disabled child" until the citizen reaches the age of 18:

Not later than 2 years after the initial recognition as a disabled person (establishing the category "disabled child") of a citizen who has diseases, defects, irreversible morphological changes, violations of the functions of organs and systems of the body according to the list according to the application;
- not later than 4 years after the initial recognition of a citizen as a disabled person (establishing the category "disabled child") in the event that it is impossible to eliminate or reduce the degree of limitation of the citizen's life activity caused by persistent irreversible morphological changes, defects and dysfunctions of the organs and systems of the body during the implementation of rehabilitation measures.

The list of diseases, defects, irreversible morphological changes, dysfunctions of organs and systems of the body, in which the disability group (category "disabled child" until the citizen reaches the age of 18) is established without specifying the re-examination period:
1. Malignant neoplasms(with metastases and relapses after radical treatment; metastases without identified primary focus with treatment failure; severe general condition after palliative care, incurability (incurability) of the disease with severe symptoms of intoxication, cachexia and tumor decay).
2. Malignant neoplasms of lymphoid, hematopoietic and related tissues with severe symptoms of intoxication and severe general condition.
3. Inoperable benign neoplasms head and spinal cord with persistent pronounced disorders of motor, speech, visual functions and severe liquorodynamic disorders.
4. Absence of the larynx after it prompt removal.
5. Congenital and acquired dementia (severe dementia, mental retardation severe, profound mental retardation).
6. Diseases of the nervous system with a chronic progressive course, with persistent pronounced disorders of motor, speech, visual functions.
7. Hereditary progressive neuromuscular muscle diseases, progressive neuromuscular diseases with impaired bulbar functions (swallowing functions), muscle atrophy, impaired motor functions and (or) impaired bulbar functions.
8. severe forms neurodegenerative diseases of the brain (parkinsonism plus).
9. Complete blindness in both eyes with the ineffectiveness of the treatment; decrease in visual acuity in both eyes and in the better seeing eye up to 0.03 with correction or concentric narrowing of the visual field in both eyes up to 10 degrees as a result of persistent and irreversible changes.
10. Complete deaf-blindness.
11. Congenital deafness with impossibility of hearing replacement (cochlear implantation).
12. Diseases characterized by increased blood pressure with severe complications from the central nervous system (with persistent pronounced disorders of motor, speech, visual functions), heart muscles (accompanied by circulatory failure IIB III degree and coronary insufficiency III IV functional class), kidneys (chronic renal failure stage IIB III).
13. Ischemic disease hearts with coronary insufficiency III IV functional class of angina pectoris and persistent circulatory disorders IIB III degree.
14. Diseases of the respiratory organs with a progressive course, accompanied by a persistent respiratory failure II III degree, in combination with circulatory failure IIB III degree.
15. Cirrhosis of the liver with hepatosplenomegaly and portal hypertension III degree.
16. Fatal fecal fistulas, stoma.
17. Pronounced contracture or ankylosis of large joints of the upper and lower extremities in a functionally disadvantageous position (if arthroplasty is impossible).
18. End-stage chronic kidney failure.
19. Fatal urinary fistulas, stoma.
20. congenital anomalies development of the musculoskeletal system with severe persistent disorders of the function of support and movement when it is impossible to correct.
21. Consequences of traumatic injury to the brain (spinal) cord with persistent severe impairment of motor, speech, visual functions and severe dysfunction pelvic organs.
22. Defects upper limb: amputation area shoulder joint, disarticulation of the shoulder, shoulder stump, forearm, absence of the hand, absence of all phalanges of the four fingers of the hand, excluding the first, absence of three fingers of the hand, including the first.
23. Defects and deformities of the lower limb: amputation of the area hip joint, disarticulation of the thigh, femoral stump, lower leg, absence of the foot.

Medical and social expertise a citizen is carried out at the bureau at the place of residence (at the place of stay, at the location of the pension file of a disabled person who has left for permanent residence outside the Russian Federation).

In the main bureau, a citizen's medical and social examination is carried out if he appeals against the decision of the bureau, as well as in the direction of the bureau in cases requiring special types of examination.

In the Federal Bureau of Medical and Social Expertise, a citizen is carried out in the event that he appeals against the decision of the main bureau, as well as in the direction of the main bureau in cases requiring particularly complex special types of examination.

A medical and social examination can be carried out at home if a citizen cannot come to the bureau (main bureau, Federal Bureau) for health reasons, which is confirmed by the conclusion of the organization providing medical treatment preventive care, or in a hospital where a citizen is being treated, or in absentia by decision of the relevant bureau.

The decision to recognize a citizen as a disabled person or to refuse to recognize him as a disabled person is made by a simple majority of votes of the specialists who conducted the medical and social examination, based on a discussion of the results of his medical and social examination.

A citizen (his legal representative) may appeal the decision of the bureau to the main bureau within a month on the basis of a written application submitted to the bureau that conducted the medical and social examination, or to the main bureau.

The bureau that conducted the medical and social examination of the citizen, within 3 days from the date of receipt of the application, sends it with all available documents to the main bureau.

The main bureau, no later than 1 month from the date of receipt of the citizen's application, conducts his medical and social examination and, based on the results, makes an appropriate decision.

In the event that a citizen appeals against the decision of the main bureau, the chief expert in medical and social expertise for the relevant subject of the Russian Federation, with the consent of the citizen, may entrust the conduct of his/her medical and social expertise to another team of specialists from the main bureau.

The decision of the main bureau can be appealed within a month to the Federal Bureau on the basis of an application submitted by a citizen (his legal representative) to the main bureau that conducted the medical and social examination, or to the Federal Bureau.

The Federal Bureau, no later than 1 month from the date of receipt of the citizen's application, conducts his medical and social examination and, based on the results, makes an appropriate decision.

Classifications and criteria, used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination, approved by order of the Ministry of Health and Social Development of December 23, 2009.

The classifications used in the implementation of the medical and social examination of citizens determine the main types of violations of the functions of the human body due to diseases, the consequences of injuries or defects, and the degree of their severity, as well as the main categories of human life and the severity of the restrictions of these categories.

The criteria used in the implementation of the medical and social examination of citizens determine the conditions for establishing disability groups (categories "disabled child").

To the main types of violations of the functions of the human body relate:

Violations of mental functions (perception, attention, memory, thinking, intellect, emotions, will, consciousness, behavior, psychomotor functions);
- violations of language and speech functions (disorders of oral and written, verbal and non-verbal speech, violations of voice formation, etc.);
- violations of sensory functions (vision, hearing, smell, touch, tactile, pain, temperature and other types of sensitivity);
- violations of static-dynamic functions (motor functions of the head, trunk, limbs, statics, coordination of movements);
- violations of the functions of blood circulation, respiration, digestion, excretion, hematopoiesis, metabolism and energy, internal secretion, immunity;
- violations caused by physical deformity (deformities of the face, head, trunk, limbs, leading to external deformity, abnormal openings of the digestive, urinary, respiratory tracts, violation of body size).

In a comprehensive assessment of various indicators characterizing persistent violations of the functions of the human body, four degrees of their severity are distinguished:

1 degree - minor violations,
Grade 2 - moderate violations,
Grade 3 - severe violations,
Grade 4 - significant violations.

The main categories of human life include: the ability to self-service; ability to move independently; ability to orientate; ability to communicate; the ability to control one's behavior; ability to learn; ability to work.

In a comprehensive assessment of various indicators characterizing the limitations of the main categories of human life, 3 degrees of their severity are distinguished:

Self-service ability- the ability of a person to independently fulfill basic physiological needs, perform daily household activities, including personal hygiene skills:

1 degree - the ability to self-service with a longer expenditure of time, the fragmentation of its implementation, reducing the volume using, if necessary, auxiliary technical means;
2 degree - the ability to self-service with regular partial assistance from other persons using, if necessary, auxiliary technical means;
Grade 3 - inability to self-service, the need for constant outside help and complete dependence on other people.

Ability to move independently- the ability to independently move in space, maintain body balance when moving, at rest and when changing body position, use public transport:

1 degree - the ability to move independently with a longer expenditure of time, fragmentation of performance and reduction of distance using, if necessary, auxiliary technical means;
Grade 2 - the ability to move independently with regular partial assistance from other persons using, if necessary, auxiliary technical means;
Grade 3 - inability to move independently and needing the constant help of other people.

Orientation ability- the ability to adequately perceive the environment, assess the situation, the ability to determine the time and location:

1 degree - the ability to orient only in a familiar situation independently and (or) with the help of auxiliary technical means;
2 degree - the ability to orientate with regular partial help of other persons using, if necessary, auxiliary technical means;
Grade 3 - inability to orient (disorientation) and the need for constant help and (or) supervision of other persons.

Ability to communicate- the ability to establish contacts between people through the perception, processing and transmission of information:

1 degree - the ability to communicate with a decrease in the pace and volume of receiving and transmitting information; use, if necessary, auxiliary technical means of assistance; with isolated damage to the hearing organ, the ability to communicate using non-verbal methods and sign language services;
2 degree - the ability to communicate with regular partial assistance of other persons using, if necessary, auxiliary technical means;
Grade 3 - inability to communicate and the need for constant help from others.

The ability to control your behavior- the ability to self-awareness and adequate behavior, taking into account social and legal and moral and ethical standards:

1 degree- periodically occurring limitation of the ability to control one's behavior in difficult life situations and (or) constant difficulty in performing role functions affecting certain areas of life, with the possibility of partial self-correction;
2 degree- a constant decrease in criticism of one's behavior and the environment with the possibility of partial correction only with the regular help of other people;
3 degree- inability to control one's behavior, the impossibility of its correction, the need for constant help (supervision) of other persons.

Ability to learn- the ability to perceive, memorize, assimilate and reproduce knowledge (general educational, professional, etc.), mastering skills and abilities (professional, social, cultural, everyday):

1 degree- the ability to learn, as well as to receive education of a certain level within the framework of state educational standards in educational institutions general purpose using special methods training, a special training mode, using, if necessary, auxiliary technical means and technologies;
2 degree- the ability to study only in special (correctional) educational institutions for students, pupils, children with disabilities or at home according to special programs using, if necessary, auxiliary technical means and technologies;
3 degree- inability to learn.

Ability to work- the ability to carry out labor activities in accordance with the requirements for the content, volume, quality and conditions of work:

1 degree- the ability to perform labor activities in normal working conditions with a decrease in qualifications, severity, tension and (or) a decrease in the volume of work, the inability to continue working in the main profession while maintaining the ability to perform labor activities of a lower qualification under normal working conditions;
2 degree- the ability to perform labor activities in specially created working conditions using auxiliary technical means and (or) with the help of other persons;
3 degree- inability to any labor activity or impossibility (contraindication) of any labor activity.

The degree of restriction of the main categories of human life is determined based on the assessment of their deviation from the norm, corresponding to a certain period (age) of human biological development.

Disability pension is one of the types of pension provision.

In accordance with the Federal Law of November 24, 1995 No. 181-FZ “On the Social Protection of the Disabled in the Russian Federation”, a disabled person is a person who has a health disorder with a persistent disorder of body functions due to diseases, the consequences of injuries or defects, leading to a limitation of life and causing the need for his social protection (Article 1). At the same time, life restriction is understood as a complete or partial loss by a person of the ability or ability to carry out self-service, move independently, navigate, communicate, control their behavior, learn and engage in work activities.

Recognition of a person as a disabled person is carried out by federal institutions of medical and social expertise. These institutions include the Federal Bureau of Medical and Social Expertise, the main bureaus of medical and social expertise in the relevant subject of the Russian Federation, which are under the jurisdiction of the Ministry of Labor of Russia, and the main bureaus of medical and social expertise, which are under the jurisdiction of other federal executive bodies. The main bureaus have branches - the bureau of medical and social expertise in cities and regions.

The procedure and conditions for recognizing a person as a disabled person are established by the Government of the Russian Federation. The conditions for recognizing a citizen as disabled are:

a) a health disorder with a persistent disorder of body functions due to diseases, consequences of injuries or defects;

b) restriction of life activity (complete or partial loss by a citizen of the ability or ability to carry out self-service, move independently, navigate, communicate, control their behavior, study or engage in labor activity);

c) the need for social protection measures, including rehabilitation.

The presence of only one of these conditions is not sufficient grounds for recognizing a citizen as disabled.

When conducting a medical and social examination, a person is recognized as a disabled person based on a comprehensive assessment of the state of his body based on an analysis of clinical, functional, social, professional, labor and psychological data using classifications and criteria approved by the Ministry of Health and Social Development of Russia. In these classifications and criteria, definitions are given for the main categories of life activity, with the restriction of which disability is established. For example, the ability to self-service is the ability of a person to independently fulfill basic physiological needs, perform daily household activities, including personal hygiene skills.

According to the degree of severity, the limitations of each category of life activity have three degrees. So, the limitations of the ability to self-service are expressed as follows:

1 degree - the ability to self-service with a longer expenditure of time, the fragmentation of its implementation, reducing the volume using, if necessary, auxiliary technical means;

2 degree - the ability to self-service with regular partial assistance from other persons using, if necessary, auxiliary technical means;

Grade 3 - inability to self-service, the need for constant outside help and complete dependence on other people.

Depending on the degree of limitation of life activity, a citizen recognized as a disabled person is assigned I, II or III disability group, and a citizen under the age of 18 is assigned the category "disabled child". Group I is established when one or more categories of life activity of the 3rd degree are limited, Group II - 2nd degree, Group III - when one or more categories of life activity (with the exception of the ability to work) are limited to 1st degree. The category "disabled child" is established in the presence of life restrictions of any category and any of the three degrees of severity, which are assessed in accordance with the age norm.

Disability of the I group is established for 2 years, II and III groups - for 1 year. The category "disabled child" is set for 1 year, 2 years, 5 years, or until the citizen reaches the age of 18. By general rules after the expiration of the established period, a re-examination of the disabled person is carried out.

The Decree of the Government of the Russian Federation establishes cases when the disability group and the category of "disabled child" before the person reaches the age of 18 are established without specifying the re-examination period. For example, without a re-examination period, the disability group and the category “disabled child” are established no later than 2 years after the initial recognition of a person as a disabled person who has diseases, defects, irreversible morphological changes, dysfunctions of organs and body systems included in the list approved by the Government of the Russian Federation.

In addition to the disability group, when a person is recognized as a disabled person, the cause of disability is also established, which can be a general illness, an industrial injury, an occupational disease, disability from childhood, disability from childhood due to injury (concussion, injury) associated with military operations during the Great Patriotic War, military injury, disease received during military service, disability associated with the disaster at the Chernobyl nuclear power plant, the consequences of radiation exposure and direct participation in the activities of special risk units, as well as other reasons established by the legislation of the Russian Federation.

The date of establishment of disability is the day when a citizen's application for a medical and social examination is received by the bureau. Disability is established before the 1st day of the month following the month for which the next re-examination is scheduled.

A citizen recognized as disabled is issued a certificate confirming the fact of the establishment of disability, indicating the group of disability, as well as an individual rehabilitation program. The procedure for compiling and forms of reference and individual program rehabilitation are approved by the Ministry of Labor of Russia.

The person is able to carry out self-care independently. The concept of disability, the procedure for its establishment and disability groups

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