Blind means that the individual is totally without or has impaired vision of not more than 20/200 visual acuity in the better eye and for whom a diagnosis and medical findings show that vision cannot be improved to better than 20/200; or who has loss of vision due wholly or in part to impairment of field vision or to other factors which affect the usefulness of vision to a like degree.

Permanently and totally disabled means that the individual has a permanent physical or mental impairment, disease, or loss, or combination thereof that substantially precludes him from engaging in useful occupations within his competence, such as holding a job or performing homemaking.

1. 1. 

   Permanently refers to a condition which is not likely to improve or which will continue throughout the lifetime of the individual; it may be a condition which is not likely to respond to any known therapeutic procedure, or a condition which is likely to remain static or to become worse unless certain therapeutic measures are carried out, where treatment is unavailable, inadvisable, or is refused by the individual on a reasonable basis; “permanently” does not rule out the possiblity of vocational rehabilitation or even possible recovery in light of future medical advances or changed prognosis; in this sense the term refers to a condition which continues indefinitely as distinct from one which is temporary or transient.

2. 2. 

   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; an individual's disability would usually be tested in relation to ability to engage in remunerative employment; the ability to keep house or to care for others would be the appropriate test for (and only for) individuals, such as housewives, who were engaged in this occupation prior to the disability and do not have a history of gainful employment; eligibility may continue even after a period of rehabilitation and readjustment, if the individual's work capacity is still very considerably limited (in comparison with that of a normal person) in terms of such factors as the speed with which he can work, the amount he can produce in a given time, and the number of hours he is able to work.

1. 1. 

   Employment as a useful occupation refers to a full-time job for which the person is compen-
   sated at the prevailing wages in the community. It excludes hobbies, activities which do not provide a bona fide job opportunity, activity which if discontinued by the individual would not require someone to be hired as a replacement, and activities primarily of a therapeutic or rehabilitative nature. It also excludes those situations where the severely handicapped person through diligent effort does some work or where sympathy or compassion of others provides the opportunity to engage in remunerative work or where the energy output of the handicapped person is far beyond that which is ordinarily required for that activity or where it takes him substantially more time to do the work than a normal person. It does not necessarily exclude persons employed in a sheltered workshop.

2. 2. 

   Homemaking as a useful occupation involves ability to carry major home management and decisionmaking responsibilities and provide essential service within the home for at least one person, in addition to one's self.

3. 3. 

   A person who resides alone shall not be evaluated as a homemaker. Only those individuals, such as housewives, who were engaged in this occupation prior to the disability and who do not have a history of gainful employment are to be evaluated as homemakers.

4. 4. 

   Substantially precludes means the inability of a person to perform activities related to gainful employment well enough for a sufficient number of hours or with sufficient regularity to receive regular payment for the employment; or in the case of the homemaker the person is unable to perform regularly a significant combination of the activities required of a homemaker within acceptable standards. There shall be sufficient medical and social data to support the person's inability to perform on a predictable basis any job for which he has competence and which exists in the community.

5. 5. 

   Competence means the ability to perform the activities required by a useful occupation for which the individual is fitted by age, background, skills, training, education or work experience.

6. 6. 

   A job which exists in the community is one within an area which is reasonably accessible rather than in the immediate neighborhood of the disabled person's home. However, whether it is feasible for a handicapped person to accept a specific job within the larger employment area will depend on such factors as its distance from his home, what methods of transporation are available and his ability to use such forms of transporation, the time consumed in travel and the cost.

A "permanently and totally disabled person" means a person who by reason of a permanent defect or infirmity, whether congenital or acquired by accident, injury or disease, is incapacitated to a degree that substantially prevents him from engaging in a useful occupation such as working at a job within his competence or, in the case of a woman homemaker, prevents her from performing the usual activities in the care of the home.

An applicant for aid to the disabled shall be presumed to be permanently and totally disabled for purposes of a preinvestigation grant (Refer to Bulletin No. 68 series) when there is medical information to indicate that he suffers from a disability or impairment believed to be permanent in nature and which, at the time of such presumption, appears to be total in effect within the meaning of the definition.

1. 1. 

   Mental illnesses including chronic brain disorders, mental deficiency, psychoses, psychoneuroses and personality disorders, which interfere with an individual's social and vocational adjustment may make such a person eligible for assistance under the Aid to the Disabled Program. Such mental disorders must be expected to continue indefinitely and must preclude gainful employment or homemaking on a predictable basis.

2. 2. 

   As in all determinations of eligibility for AD, persons suffering from mental illness are not to be considered eligible or ineligible on the basis of the diagnosis alone. Psychiatric, medical and social evaluations are needed to determine the ability of such persons to function in a productive manner.

3. 3. 

   Since some individuals with mental disorders are able to function in a productive manner for varying periods of time, special consideration must be given to the predictability of such behavior and the existence or lack of supportive factors in the environment.

1. 1. 

   In a large percentage of persons who suffer from alcoholism, the excessive drinking is symptomatic of a personality disorder or a neurosis. In other patients alcoholism may be associated with organic brain injury or disease. For these reasons persons with a diagnosis of chronic alcoholism require a psychiatric evaluation and medical evaluation.

2. 2. 

   Where it has been determined that the alcoholism is symptomatic of or coexists with other forms of mental illness the applicant should be evaluated in relation to the basic psychological disorder and its related social aspects and manifestations.

3. 3. 

   There will remain a category of the addictive alcoholic without recognizable underlying disorder. These persons reach a level of severity in which the individual subordinates all ordinary activity to his attempts to maintain the degree of alcholism which provides him physiological and psychological satisfaction.

4. 4. 

   Since there is variation in the severity of addictive alcoholism and some variation in prognosis, for the purposes of certification for AD the following criteria are required to exist for approval:

   1. a. 

      A history of several years of excessive drinking to the extent that it has adversely affected his interpersonal relationships and his social and economic functioning.

   2. b. 

      Loss of employment and inability to sustain employment because of excessive drinking.

   3. c. 

      Evidence that the alcoholism has reached the addictive state as shown by marked ethical deteriorations, obsessive character of the drinking, the approaching loss of alcoholic tolerance, prolonged bouts, and breakdown of the rationalization pattern.

5. 5. 

   Where neuritis, cirrhosis of the liver and other pathological sequelae of chronic alcoholism exist they are to be considered in determining the severity of the disability. It is not mandatory that such complications be present if the above criteria have been met.

For AD purposes, alcoholism may be defined as a chronic complex disease with important physical, psychological and social facets. It can be identified by excessive drinking and loss of control over intake of alcohol. This loss of control manifests itself in compulsive drinking of alcohol and frequently loss of control over behavior.

Because of the psychological aspect of the disease, a report of a psychiatric evaluation should be secured where possible in addition to the usual medical and social reports.

The medical report is important because of the physical aspect of alcoholism. For example where neuritis, cirrhosis of the liver and other pathological sequelae of the disease exist, this information will be of use to the review team in determining the severity of the disability.

Where a person has received institutional care for alcoholism and/or has received treatment for alcoholism in an Alcoholism or Psychiatric Clinic, a report should be secured from such resource. If adequate for the review team to make a determination, it will be unnecessary to refer the person for psychiatric and medical evaluation.

The following types of information in the social information report, from a psychiatric resource or Alcoholism resource is not available, will aid the review team to make a determination:

1. 1. 

   The extent to which excessive drinking has adversely affected interpersonal relationship (with family and friends).

2. 2. 

   The extent to which excessive drinking has adversely affected employment (loss of jobs or inability to sustain employment.)

3. 3. 

   Signs of ethical deterioration, breakdown of rationalization pattern, etc.

The categorical worker may secure some of this information through direct contact with the person. Some of it may be secured from family, an employer, a Services worker, the case record or other source.

Under AD, narcotic addiction is considered a disease and the adult is evaluated for a permanent and total disability as a sick person.

A report of a psychiatric evaluation should be secured whenever possible on narcotic addicts in addition to the usual medical and social information reports.

Form DSS-1549, Physician's Statement for Determination of Disability for Narcotic Addiction, should be used for medical report in lieu of Form DSS-486, since Form DSS-1549 contains information specifically related to drug usage and treatment.

When a drug addict has received treatment for the addiction in an approved hospital, approved residential, nonresidential or after care facility, etc., a report should be secured from such facility. If the report is adequate for the review team to make a determination, it will be unnecessary to secure medical and psychiatric reports on the patient. However, to be acceptable, such reports must include medical documentation of the addiction.

The following information on the social information report, especially when a report, from a psychiatric resource or drug treatment facility is unavailable, will help clarify the person's situation for the review team:

1. 1. 

   The extent to which narcotic usage has adversely affected interpersonal relationship (with family and friends).

2. 2. 

   The extent to which narcotic usage has adversely affected schooling or has resulted in inability to secure and sustain employment.

3. 3. 

   Evidence of ethical deterioration.

4. 4. 

   Information as to how patient has supported his habit.

5. 5. 

   Information on arrests and criminal acts due to narcotic usage.

The categorical worker may not be able to secure all of the information through direct contact with the person. Some of it may be secured only from family, an employer, a services worker, the case record or other source.