The term “permanently” refers to a demonstrable impairment of mind or body which is verifiable by objective medical findings.

The impairment must be of major importance and must be a condition which is not likely to improve (i.e., to respond to any known therapeutic procedures) or which will continue throughout the lifetime of the individual.

A condition which is likely to improve substantially may still be considered permanent if the healing process is characterized by significant tissue alterations, as in tuberculosis.

Any condition which is likely to remain static or to become worse unless certain therapeutic measures are carried out is deemed permanent when treatment is unavailable or inadvisable.

The fact that an impairment is permanent does not rule out the possibility of vocational rehabilitation, or even of recovery through the advances of medical science. “Permanently” is used not in the sense of “everlasting” or “unchangeable” but, relatively, in the sense of continuing indefinitely.

The term “totally” refers to the ability of the individual to perform the activities required by a gainful occupation or by homemaking as defined below.

The effect of an existing permanent impairment is considered in relation to the individual's ability to work in a gainful occupation or as a homemaker at the time when the determination of disability is made.

“Totally” involves social considerations such as age, training, skills, work experience, and the probable functioning of the individual in his particular situation and in the light of his impairment. The social data must provide a sufficient base to make it possible to relate the medical findings to the types of activity the individual is competent to perform, or can be trained to perform.

Adults are ordinarily expected to take care of themselves and their families. For some, this means working in gainful employment. For others, it means working as a homemaker. In either capacity the individual is required to perform activities beyond the usual demands of everyday living. When the social findings indicate that the individual is not currently able to perform the activities required by a gainful occupation or by homemaking, within the limitations imposed by his permanent impairment he is considered “totally” disabled.

An individual may be unable, because of his impairment, to continue to earn his living in his usual occupation. This does not mean that he is totally disabled as regards other types of occupations which are within his capacity and competence.

In determining the individual's ability to work either in a gainful occupation or as a homemaker, consideration is given to the following:

1. 1. 

   The duties of a particular job in terms of knowledge, skill, physical activity, etc., required

2. 2. 

   The individual's ability to perform the duties of the job on a predictable basis with reasonable regularity

3. 3. 

   The accessibility of the job in terms of the individual's ability to get back and forth from home to work without undue strain or adverse effect.

The term “prevents”, as used in the statutory definition, is a relative one, meaning substantially precludes, since it indicates the extent to which an individual's permanent impairment leaves him unable to perform the duties of a gainful occupation or of homemaking. If an individual is able to perform such duties well enough and with sufficient regularity to receive regular payments for his own current efforts, or to carry homemaking responsibilities on a continuing basis unassisted, he is not considered permanently and totally disabled.

An individual is considered incapable of engaging in a gainful occupation or in homemaking if medical evidence shows that his condition is such that attacks of pain, shortness of breath, dizziness, exhaustion or other medically demonstrable reactions occur at unpredictable intervals and with such intensity as to interfere with the continuous performance of the activities required.

A plan for occupational therapy or training may be carried out in a sheltered workshop. However, some persons working in a sheltered workshop or similar protected job setting are considered to be engaged in a gainful occupation. The determining factor is not location, but the presence or absence of supervision (by a physician or rehabilitation agency) and of a remedial or training objective.

Sometimes an individual whose impairment is so severe that it would be assumed that he could not engage in any occupation is actually doing some remunerative work. In such cases he is still considered permanently and totally disabled if, after thorough consideration of all the facts, it is found that

The time and effort expended is far beyond that ordinarily required for the particular activity

The opportunity to work and market his goods or services is provided out of sympathy and other persons help more than usual to enable the individual to “carry on.”

or

It may be necessary to carry out a plan for vocational rehabilitation in order for the individual to develop competence to engage in a gainful occupation or in homemaking, within the limitations imposed by his permanent impairment. If so, he is considered totally disabled while the rehabilitation program is in process.

When an individual is competent to perform the duties of a certain type of occupation in spite of his permanent impairment and work of this nature exists in the community, he is deemed not totally disabled but merely unemployed. In deciding whether or not work “exists in the community”, its accessibility to the person will be given consideration in relation to his impairment (see DI 21501.050B, step (3) above).

The phrase “gainful occupation” means useful work which adds to the economic wealth of society or produces goods or services to which the public attaches a money value. Useful work includes both gainful occupations and homemaking.

The following types of activity are not encompassed in the interpretation of “gainful occupation”.

1. 1. 

   Hobbies: activities which do not provide a bona fide job opportunity which no one else would be hired to do if the individual stopped working

2. 2. 

   Occupational therapy: activities prescribed by a physician for remedial purposes and carried out under his supervision

3. 3. 

   That part of a rehabilitation program designated as “training and which is carried out under the supervision of the rehabilitation agency”

Any earnings of a person who is classified as permanently and totally disabled, as discussed in the foregoing paragraphs, are taken into consideration in the determination of need.

The term “homemaking” is interpreted as including the individual's ability to carry home-management and decision-making responsibilities and to provide essential services within the home for at least one person in addition to himself.

The following activities are involved in homemaking:

1. 1. 

   Shopping for food and supplies

2. 2. 

   Planning and preparing meals

3. 3. 

   Washing dishes

4. 4. 

   Cleaning house

5. 5. 

   Making beds

6. 6. 

   Washing and ironing clothes

If the care of children is included in the homemaking responsibility, additional activities are required, as follows:

1. a. 

   Lifting and carrying infants and young children

2. b. 

   Bathing and dressing infants and young children

3. c. 

   Training and supervision of children

4. d. 

   Accompanying children on trips away from home

The foregoing is not an all-inclusive list, but a finding that a person is unable to perform the duties of homemaking requires a determination that he is unable to perform a significant combination of these activities because of his permanent impairment. Although there are no stated hours or standards of performance prescribed by others, several hours of arduous work daily are required to meet the standard of providing essential services for at least one person other than the homemaker. (It is estimated that a minimum of approximately 48 hours weekly is required to perform the duties of homemaker for a family of four persons, even with the help of labor-saving devices.)

The fact that someone else performs certain of the activities required of a homemaker, so that the work gets done, does not alter the fact that the disabled person is or is not able to perform these duties.