In considering permanent and total disability, it is necessary to appraise both total
and permanent as factors in determining eligibility. It is not possible to consider
them as separate entities, but it is necessary to think of them in conjunction and
to weigh them in relation to a given individual's experience, ability and age. In
order to clarify these elements, however, it will be helpful to isolate the parts
and then consider their integration.
The element of permanence relates to the medically disabling condition. The impairment
must be of major importance and not likely to benefit from any treatment possible
in the light of current medical knowledge. There is always the possibility of new
scientific discovery, and it is recognized too that sometimes individuals who have
been given a conscientious but unfavorable prognosis show unexpected improvement.
The term, therefore, is used in a relative sense, and includes conditions which in
the opinion of the medical consultant will continue throughout the lifetime of the
individual.
In addition to this, any condition may be considered permanent for purposes of eligibility
which is, in the opinion of the medical consultant, likely to remain static or become
worse unless certain treatment is carried out which is either unavailable, inadvisable
or refused by the individual on reasonable grounds. Some types of treatment, particularly
those which are the result of new methods or scientific advancements, are available
only in the larger medical centers. Others may in some situations be inadvisable because
of the possibility that no benefit will result or because of the possibility that
remaining function may be lost. Even when there is a reasonable probability that benefit
will result, the individual may be opposed to the procedure because of genuine personal
scruples, religious or otherwise, or reasonable fear of loss of the remaining function.
The element of totality must be related to the particular individual under consideration
and what he can be expected to do in view of his training general ability, and aptitude.
Some individuals will never be genuinely disabled in spite of the most permanent handicap
because of an innate aptitude or ability and will put their remaining powers to constructive
use. Others will be totally disabled because they lack this ability and have no training
or experience to enable them to utilize their remaining potentialities or because
the disability has arrived when they are at an age to make further learning or adjustment
impossible. This can be evaluated only from a complete social history which contains
information about previous experience and education and gives some idea of general
ability.
These two parts shall be considered together for conclusion regarding an individual's
classification as permanently and totally disabled. In effect, it must be shown that
he is disabled for any occupation within his individual capacity or competence, which is performed in a location accessible to him. Disability must not be confused with unemployment. For example, a person who is able
to engage in any gainful or useful occupation of a type existing in his community
would not be classified as permanently and totally disabled, but unemployed. However,
work which is made available to an individual because of the interest or compassion
of interested persons in the community, but which would not ordinarily exist or which
the individual would not be able to do in sufficient quantity to maintain himself,
will not be considered a gainful occupation. It may serve a useful purpose for him
by providing an outlet for interest and energy and may bring some financial return
which should be treated as a resource and considered accordingly in budgeting a case.