Oksana's son does not speak, walks with difficulty, and has epilepsy. At 20, he can eat on his own but cannot control his bodily functions.
Yet Oksana, who asked that her last name not be published for fear of repercussions, says that when he turned 18, it took her an entire year to convince officials that he qualified as disabled.
She now says bitterly of the process: "In Russia, to obtain disability status, you have to be healthy."
Rules Tightened In Wartime
In early April 2022, six weeks after Russia launched its full-scale invasion of Ukraine, the government of President Vladimir Putin further tightened its rules for the recognition of disabilities -- something it had done several times in the past decade.
The new changes came as the war began to drive up military spending and increase pressure on the federal budget.
The financial incentive seems clear: The updated rules meant fewer people could now qualify as disabled and thus receive government assistance, cutting costs for the state.
Reducing the number of those registered with disabilities by roughly 1 million could save the state an estimated 120 billion rubles ($1.6 billion) a year, RFE/RL's Russian investigative unit, Systema, found.
By the beginning of 2025, the official count was a little over 11.1 million, roughly 2 million lower than in 2010 and about 1 million lower than in 2017, government documents show.
Putin's government does not publish figures of casualties from its forces in Ukraine, but the Center for Strategic and International Studies estimated last June that more than 950,000 Russian soldiers had been killed or wounded since February 2022 -- without specifying how many were left permanently disabled.
Western intelligence agencies now estimate the number of Russian casualties at well over 1 million, with perhaps a quarter killed and the rest wounded.
"The authorities understood that the war would increase the number of people with disabilities," said a former medical and social assessment specialist, speaking on condition of anonymity for fear of repercussions for commenting publicly on the matter. "So they decided to make the statistics look better -- and save money."
A System Designed To Exclude?
The tightening of disability criteria began well before Russia's full-scale invasion.
Changes introduced in 2014 -- the year Russia seized Crimea and fomented war in eastern Ukraine -- put an emphasis on a person's ability to work or maintain what officials deemed a "normal life," even in the presence of serious medical conditions.
Over time, additional amendments made the process increasingly bureaucratic and restrictive, Russians who have worked with disabled people told Systema.
The April 2022 government decree raised the bar even further. It lists three conditions for recognizing a person as disabled: the persistent impairment of bodily functions; the "complete or partial loss of a citizen's ability or capacity to care for themselves, move independently, orient oneself, communicate, control their behavior, study, or engage in work activities"; and the need for rehabilitation.
But it stipulates that one condition alone is not grounds for recognition of a person as disabled. That means a combination of the conditions is needed, a requirement that the former medical and social assessment specialist said could enable the authorities to deny disability status in almost any case.
Even people classified with the most severe level of disability -- Group One -- must regularly collect documents, undergo repeated examinations, and pass medical and social assessments every two years. Those with less severe disabilities are required to confirm their status every year.
While the decree allows for permanent disability status, specialists say the wording is vague enough to allow officials to grant it selectively -- or not at all.
'As If the Stents Will Disappear'
Marina, 70, was advised to hire a private consultant to help secure permanent disability status. The service costs her about 100,000 rubles ($1,310).
She has heart stents yet must undergo annual examinations to confirm her condition.
"As if the stents will just disappear," she said.
"If I undergo coronary angiography every year," Marina told Systema, "I'll die from the tests sooner than from a heart attack."
