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Background  Disability certification is a critical mechanism enabling persons with disabilities to access healthcare, rehabilitation, social welfare measures, and government entitlements under the Rights of Persons with Disabilities (RPwD) Act, 2016. Despite increasing global recognition of disability as a public health priority, data from Northeast India remain limited. This study aimed to evaluate temporal trends in disability certification applications, service utilization patterns, demographic characteristics, and trauma-related locomotor disability burden at a tertiary care center in Northeast India. Methods  A retrospective review of disability certification applications submitted between January 2018 and November 2024 was conducted. Data regarding demographic characteristics, domicile, disability type, and severity were extracted from institutional certification records maintained by the Nodal Officer for disability certification. Applications were evaluated by the Institutional Medical Board according to RPwD guidelines. Results  Of the 132 disability certification applications received between January 2018 and November 2024, 113 were included in the final analysis after excluding 19 incomplete records. Applications showed a progressive increase over time, peaking in 2023, with a temporary decline during the COVID-19 pandemic. Most applicants were male (77.0%) and belonged to the 19-35-year age group (38.9%). Applicants domiciled in Northeast India, predominantly from Meghalaya, constituted the majority of applicants. Physical disabilities accounted for most certifications, with locomotor disability being the predominant subtype. Trauma-related locomotor disabilities were observed particularly among working-age males. Moderate disability severity predominated, while visual impairment was predominantly observed among older adults. Conclusion  The study underscores the increasing awareness and accessibility of disability certification services under the RPwD Act, particularly among rural and underserved populations. However, the low representation of individuals with mental illness, intellectual disability, specific learning disability, autism spectrum disorder, and multiple disabilities highlights the need for more inclusive and multidisciplinary assessment frameworks. Targeted outreach programs and community-based services are essential to address the potential underutilization of certification services in remote regions, particularly among individuals with trauma-induced disabilities.