Permanent and total disability means that the individual has some physical or mental impairment, disease, or loss from which recovery or substantial improvement cannot be expected, and which substantially precludes him from engaging in any occupation within his competence, such as holding a job or homemaking.

To be eligible for PTD a person must be “permanently and totally disabled” (subsection (2), Section 208.051, R.S. Mo. 1949). In addition, the following Statement on the same subject is contained in sub-section (4) of the same section: “Who is disabled by illness, injury, or other physical or mental impairment which is medically determinable and can be expected to be of long-continued and indefinite duration or to result in death.”

1. a. 

   The phrase “permanent and total disability” is defined as follows in Regulation #95: “Permanent and total disability means that the individual has some physical or mental impairment, disease, or loss from which recovery or substantial improvement cannot be expected, and which substantially precludes him from engaging in any occupation within his competence, such as holding a job or homemaking.”

2. b. 

   The term “disability” ordinarily encompasses one or more organic or functional impairments that interfere with the individual's faculties, such as senses, reasoning, mobility, etc. These impairments may be physical or mental. They may exist from birth, or be acquired during the lifetime of the individual as a result of illness or an accident. They may be obvious or they may be such that they can be revealed only be medical examination. They may be static or progressive. They may exist singly or in combinations.

3. c. 

   The term “permanently” refers to a physiological, anatomical, or mental impairment verifiable by medical findings. The examining doctor carries responsibility for providing the agency with the information which bears on this part of the eligibility factor.

   The impairment must be of major importance and must be a condition not likely to improve or which will continue throughout the lifetime of the individual. Any condition considered by the medical reviewer as not likely to respond to any known therapeutic procedures shall be deemed to be permanent; furthermore, any condition considered as likely to remain static or to become worse unless certain therapeutic measures are carried out shall be deemed to be “permanent” so long as treatment is unavailable, or inadvisable. “Permanence” does not rule out the possibility of vocational rehabilitation or even recovery from impairment. Doctors are aware that individuals will sometimes respond favorably to treatment after an unfavorable prognosis or the condition becomes arrested. The discovery of new drugs or other advances in medical treatment is always a potential which may change a “permanent” situation, but pending the actual physical improvement the classification is proper. Thus, the term need not be used in the sense of “everlasting”, “unchangeable” , etc., but may be used relatively in the sense of continuing indefinitely, as distinct from “temporary” or “transient”.

4. d. 

   The term “totally” like “permanently” is not an absolute term since it must be considered in reference to the ability of the person (as revealed by the facts in his case) to perform those activities necessary to carrying out certain duties such as those necessary to employment or homemaking. “Totally” involves considerations in addition to those verified through the medical findings, such as age, training, skills and work experience, and the probable functioning of the individual in his particular situation in light of his impairment. No time factor is involved in the concept of being “totally” disabled.

5. e. 

   The term “homemaking” as used in Regulation #95 requires a special definition, since it covers the maintenance of a home (and in some cases caring for children) as opposed to gainful employment outside of the home. A “homemaker” is defined as a person who is performing the necessary housekeeping tasks in a household which consists of two or more persons, without regard to relationship of the persons in the household.

   In applying the definition of permanent and total disability to persons who have a medically-diagnosed permanent disability the following principles will be used in determining whether or not the disability is total. Note the difference in the type of information which will need to be obtained from the claimant and the family and recorded on Form PA-24, depending on whether the person meets the requirements for item (1), (2), or (3).

   1. 1. 

      For women who are homemakers, within this definition, the decision will be based on a determination of the applicant's physical or mental ability to perform a major part of the necessary housekeeping tasks in that household. So long as the claimant is actually performing such tasks even though her physician has advised against it, she will not be eligible for PTD.

      The following activities are important to successful performance of the occupation of homemaking: shopping for food and supplies; planning and preparing meals; washing dishes; cleaning house (sweeping, mopping, dusting, moving furniture); making beds; washing and ironing clothes. In addition, if the care of young children is within the “homemaking” responsibility: lifting and carrying infants, and in an emergency, pre-school children; bathing and dressing young children; accompanying children to community activities, to sources of medical care, etc. Also, if the lack of modern facilities make the following necessary to maintenance of the home: carrying water; carrying fuel; building fires.

      A finding that a person is unable to perform the occupation of homemaking would require a determination that the individual is unable to perform a significant combination or grouping of these activities because of her permanent impairment. This finding may also be made for individuals who still have sufficient capacity to perform all of the above services for at least one person in addition to themselves, except that they are unable to perform for the number of hours daily that are involved, or predictably enough to meet the responsibilities involved.

   2. 2. 

      For women living alone, and for women who are in a household with others but are not the homemaker, the decision will be based on a determination of the applicant's ability to accept any type of employment for which wages would be received; the decision would not be based on her ability to take care of her own housekeeping needs.

   3. 3. 

      For men who are performing the homemaking function when there are children or other persons in the household, and when there is no other person who can be classified as a homemaker (as for example when the wife is deceased, absent, or bedfast) he must be measured first against the standard applied for employment outside the home; if eligible for PTD on that basis, he must then be measured against the standard for “homemaker” as defined in 5a above. Before he can be approved for PTD, the man must be found eligible on both standards. Note that this policy does not apply to the single man who keeps house only for himself.