Disabilities in Paralympic swimming could impact a swimmer's ability to execute an effective swim-start. We examined how swim-start performance differed between severity and type of physical disability. Swim-starts were measured in 55 elite Paralympic swimmers from eight different Paralympic classes; S14, S13, S10-S6, S3 grouped as no- (classes S13 S14), low- (S9 S10), mid- (S7 S8) or high- (= S6) severity of physical disability and also by type of physical disability (upper, lower, and palsy) to provide meaningful comparisons. The swimmer's competitive level was determined by the international point score (IPS). Swimmers with no physical disability were significantly faster in most swim-start phases compared with those with physical disabilities, as were swimmers with low-severity disabilities compared with the mid- and high-severity groups. Block velocity was highly negatively correlated (r = -0.57 to -0.86) with 15-m swimming time for all groups except high-severity disabilities. Free-swim velocity is a priority area for improving swim-starts for swimmers regardless of disability, given large correlations between this measure and IPS. Swimmers with lower body or high-severity disabilities spent a smaller percentage of time overall in the underwater phase. Assessment of four specific phases of the swim-start highlight distinctive priorities for coaches working with Paralympic swimmers in an applied biomechanical manner.