Who determines whether persons are disabled and eligible to receive the billions of dollars that are awarded in benefits under federal disability programmes today in the United States? What kinds of standards are applied in making awards to millions of applicants? And how are disability determinations made and claims adjudicated? Frank S. Bloch provides a study of disability determinations in five major federal programmes. His findings, models, and calls for reform, including the greater use of medical personnel, should interest those who want to know more about the medical-legal issues relevant to disability determination, the many factors that impact on disability decisionmaking, and the administrative process for making disability decisions. This survey covers the disability determination process in US social security, railroad, retirement, civil service, veteran, and black lung disability programmes at the federal level. Dr Bloch defines various standards, key issues, the current use of medical personnel and models for their fuller use and for reforming the disability determination process.