Reform of Medical and Social Expert Commission: Expert Teams Establish Disability for Only One Year for Irreversible Health Conditions

Ukraine has begun a large-scale transformation of the medical and social expertise system, replacing the discredited Medical and Social Expert Commission (MSEC) with the assessment of a person's daily functioning (APDF) system. The main goals of the reform were proclaimed to be digitalization, transparency, and compliance with international standards.

However, as practice shows, the "digital signboard" often covers old approaches to patient assessment. The issue of setting disability terms for persons with irreversible anatomical defects and conditions becomes particularly acute. In this article, we analyze the legal conflict between the requirements of CMU Resolution No. 1338 and the actions of expert teams on the ground, using a specific appeal to the editorial office of the "Judicial and Legal Newspaper" as an example.

Case essence: stable pathology versus one-year term

A citizen who underwent the procedure under the new rules points out the inconsistency of the rules with life realities. The expert team recorded the presence of a mechanical aortic valve prosthesis and characterized the condition as a "stable irreversible pathology."

According to paragraph 79 of Appendix 1 to the Criteria approved by CMU Resolution No. 1338, such a condition implies establishing a disability group indefinitely. However, ignoring their own conclusions about "irreversibility," the commission limited the disability term to one year. This creates a situation where a patient with an unchanged medical status is forced to undergo an annual review, which contradicts the logic of the reform.

MOH Argumentation

The Ministry of Health, in its response, emphasizes that it cannot evaluate specific decisions of the expert team based solely on the description of the situation, without analyzing the full package of medical documents, the decision, the team's rationale, and other case materials.

The establishment of the disability group and its duration depends not only on the presence of a particular diagnosis or condition but also on a comprehensive assessment of the body's functional impairments, their stability, prognosis, impact on the person's daily functioning, and other medical data.

At the same time, CMU Resolution No. 1338 indeed provides cases where disability is established indefinitely. In particular, according to paragraph 15 of the Disability Establishment Criteria, disability is established:

• indefinitely — for persons who have anatomical defects or other irreversible impairments of organ and system functions according to part I of the appendix;
• indefinitely — for persons undergoing re-assessment who have had group I disability for 5 years;
• for 5 years — for persons with oncological and oncohematological diseases with an unfavorable prognosis according to part II of the appendix;
• for 5 years — for persons with chronic diseases with severe course according to part III of the appendix;
• for 1 year — for persons who are assigned group III disability for the first time;
• for 2 years — for persons who are assigned group II disability for the first time;
• for 1–3 years — for persons undergoing re-assessment.

Thus, the duration of disability is determined not arbitrarily but according to the criteria approved by the resolution.

At the same time, in practice, even the same diagnosis or medical condition in different people may be accompanied by different degrees of functional impairments, different dynamics of the condition, different prognosis, and different impact on daily functioning. That is why the expert team evaluates not only the fact of the diagnosis but also medical documents, examination results, stability of functional impairments, need for treatment or rehabilitation, and prognosis regarding further changes in recovery or deterioration.

In some cases, repeated assessment after a certain period may be necessary — in particular, to check the dynamics of the condition, effectiveness of treatment or rehabilitation, as well as changes in the degree of limitation of daily functioning. Therefore, evaluation of a specific decision is possible only after analyzing all case materials.

Mechanisms for Protecting Patient Rights

If a person disagrees with the expert team's decision — including regarding the disability group, its duration, or other decision parameters — they have the right to appeal it.

A complaint can be submitted to the Center for Assessment of a Person's Functional State: independently in paper form or through the attending physician in the electronic system. Within the appeal, the decision will be reviewed according to the established procedure.

As the reader notes, veterans and civilians with irreversible conditions continue to be hostages of annual commissions. Without public exposure of such cases, the reform risks remaining only a digital shell of the old system.

At the same time, the Ministry of Health declares interest in legally resolving such disputes — with verification of specific documents, medical data, and rationale for the decision, as well as the possibility of its review if there are grounds for it.

However, the real effectiveness of the APDF system will be measured by its ability to recognize and correct systemic errors of specific expert teams.

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