Determining the level of impairment of an individual with spinal cord injury (SCI) is reasonably straightforward. An impairment rating may be determined by analyzing the impact of the SCI on various bodily systems or by considering the injury as a more global diagnostic category. Additionally, specific functional abilities based on the level of neurologic preservation are well established. Thus disability can also be approximated from impairment, or measured directly by functional assessment. Although secondary medical difficulties that may impact impairment and disability can arise at any time after SCI, neurologic and functional abilities are overwhelmingly stabilized by 12 months post injury. A comprehensive history and physical and functional examinations should allow even the inexperienced examiner to obtain a valid determination of impairment after SCI; however, assessing disability and handicap is a more challenging undertaking.