Disabled Tap Identification Card Application Form Page 3
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4section vi – medical disability criteria
mobility impairments
Non-ambulatory: Requires use of a wheelchair.
A
Mobility-Aided: Requires use of an
or larger leg brace, walker, or crutches to achieve mobility.
AFO
B
Arthritis: Therapeutic Grade III or worse, Functional Class III or worse, Anatomical Grade III or worse.
C
Amputation/Deformity: Traumatic loss of muscle mass or tendons or x-ray evidence of bony or
D
fibrous ankylosis, joint subluxation or instability of both hands, one hand and foot, or amputation at
or above tarsal region.
Stroke: Causing Pseudobulbar Palsy, sustained functional motor deficit of gross/dexterous movement
E
or gait, ataxia a=ecting two extremities.
physical impairments
Respiratory: Class
III
or greater.
F
Cardiac: Vascular impairments of Functional Class
or
and Therapeutic Class
or
.
III
IV
C, D
E
G
Dialysis: Individuals who require kidney dialysis to live.
H
Neurological Impairments: As contained in Disability Evaluation Under Social Security Publication.
I
Chronic Progressive Debilitating Disorders: Diseases that are characterized by chronic symptoms
J
such as fatigue, weakness, weight loss, pain and changes in mental status which interfere in daily living
activities and significantly impair mobility.
>
Progressive and uncontrollable malignancies
>
Advanced connective tissue disease such as Lupus Eythematousus, Sclerodema or Polyarteritis Nodosa
>
Symptomatic
: (
or
) in
defined clinical group
, Subgroups
HIV
AIDS
ARC
CDC
IV
A-E
visual impairments
Legally Blind.
K
Visual Acuity: No better than 20/200 after correction in best eye, or visual field is contracted to 10 degrees
L
or less from point of fixation or subtends to angle no greater than 20 degrees.
mental impairments
Mental/Emotional: Individual with a mental or emotional impairment listed in Diagnostic and Statistical
M
Manual IV of the American Psychiatric Association, the severity of which meets or exceeds standards
outlined in the Disability Evaluation Under Social Security Publication. Disability must have been present
for at least 3 months and be expected to continue for at least 3 months past the application date.
Autism: Syndrome consisting of withdrawal, inadequate social relationships, language disturbance and
N
monotonously repetitive motor behavior.
hearing impairments
Total deafness.
O
Persons whose hearing loss is 70 dba or greater in the 1000 and 2000 Hz ranges.
P
See back for more information.
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