The client is permanently incapacitated when, according to medical findings, the impairment is likely to continue throughout his life, or is not likely to improve. If medical indications point to no recovery from his present condition, incapacity is permanent.

This shall apply although there exists a possibility of vocational rehabilitation or even of recovery at some future time if the person should respond favorably to treatment. Individuals sometimes respond favorably to treatment after an unfavorable prognosis or after the condition becomes arrested. The discovery of new drugs and other advances in medical treatment are potentials which may change a permanent condition. However, pending actual rehabilitation or actual recovery resulting from treatment, the condition is considered permanent.

1. a. 

   The client is totally incapacitated when the impairment substantially prevents him from engaging in any useful occupation for which he has competence and which exists in the community.

   A useful occupation is an activity which is designed to add to economic gain, or by which goods are produced or services are performed to which the public attaches a money value. The activity must demand the time and attention of the doer for the ultimate benefit of another person. Examples of activities which are not useful occupations are special hobbies, occupational therapy prescribed for remedial purposes, and training under a vocational rehabilitation plan.

2. b. 

   If the client is a homemaker, she is totally incapacitated if the impairment prevents her from carrying out essential and usual housekeeping activities.

   Housekeeping activities are those necessary to manage the home and to provide essential services within the home for at least one person besides the homemaker. Such activities include: shopping for food and supplies; planning and preparing meals; washing dishes; cleaning house; making beds; washing and ironing clothes; care of young children (including lifting, carrying, bathing, dressing, training and supervising them, accompanying them to community facilities, and source of medical care); in specific settings carrying water and fuel supplies and building fires.

   What activities must be performed by the individual homemaker will depend upon such factors as whether she has children, labor saving devices, aids to getting around (such as a wheelchair), a telephone and stores which deliver groceries.

3. c. 

   If the client has an employed or employable husband, not only shall she be unable to carry out essential and usual housekeeping activities, but her care shall also require securing the help of someone not already living in the household, or the husband's continuous presence in the home. If the husband is an OAA recipient, his employability shall not be a factor in determining the client's eligibility.

4. d. 

   The client is substantially prevented from engaging in a useful occupation or from carrying out essential and usual housekeeping activities:

   1. 1. 

      Although he engages in a limited remunerative activity or homemaking, provided he can do so only with the help of others, or by making extraordinary efforts beyond what is normally required, or at earnings far below what is usually paid; or

   2. 2. 

      Although the impairment appears irregularly, provided it is of sufficient intensity and frequency to prevent him from engaging in a useful occupation or homemaking on a regular and predictable basis.

5. e. 

   Examples of situations:

   Moderate hypertension in a person of sixty or more in whom there is impairment due to the normal aging processes such as vision, hearing, circulation, etc., is probably more disabling than in a person of forty or younger. A man of 62 may be eligible if he has impaired vision and hearing with a moderate hypertension becoming progressively worse, because of the aging process. He would be unable to continue his usual work as a carpenter, and is not qualified for any light work, or another useful occupation existing in his community.

   An individual is 55 years of age, lives in a rural area, and has always made his living doing heavy manual labor. He now has developed a heart condition which is sufficiently severe to prevent him from doing heavy manual labor. He has only a second grade education; he has no special training or skills. His community offers no employment opportunities in light work for a person of his competence. Since he has a permanent impairment (serious heart condition) and no special skills or training to equip him for another job in his community; and since his community has no jobs for a person with his impairment, skills and training, he can be considered as being permanently and totally disabled.

   The next illustration is an example of a condition that substantially precludes useful occupation within the person's competence and training. A tubercular whose condition is arrested and who must, due to lack of training, return to a laborious type of work where he exposes himself to excessive fatigue, dust or fumes, heat or cold and dampness, may be considered as still incapacitated until he can be trained to do something else or by job placement qualified to work in a less hazardous environment, and at work which is not likely to cause a reactivation of his tuberculosis.

   A client who has had major surgery such as an operation on a lung, stomach, back, etc., may or may not have disability after convalescence. He is, of course, totally disabled for the period of surgery and convalescence. Convalescence varies depending on such factors as the duration of a disease process before surgery, the age and general condition of the patient, the magnitude of the surgical procedure, and complications following surgery. The determination of disability after the usual surgical convalescence is an individual problem which is affected by many factors. Most persons can return to their usual occupation with little, if any, restriction. However, physical factors which may affect the length of convalescence, other factors such as attitude toward surgery, the present motivation of the individual, the type work done, etc., affect the extent of disability. No rule can be laid down stating that a client is or is not disabled because of a past history of gastrectomy (removal of part of the stomach), lobectomy (removal of part of the lung), etc. Each case must be evaluated in terms of all available medical and social information.

   When a person has had major surgery, he shall be considered as totally and permanently disabled if he is physically unable to return to his usual occupation in the foreseeable future and until by retraining, job placement, or both, he can be placed in some work compatible with his physical incapacity.

   A client with leprosy or uncontrolled epilepsy is considered totally and permanently disabled.