A totally and permanently disabled individual is defined as a person who has a mental or physical impairment or a combination of impairments which preclude his engaging in substantially gainful employment within his competence or of performing duties necessary to homemaking. Both medical findings and social information must be available in order to determine total and permanent disability.

A permanently disabled person is defined as one who has a serious physical or mental impairment or a combination of both which will likely continue during the lifetime of the individual or which will not improve in the foreseeable future insofar as medical findings can tell. The condition causing permanent disability must be verified by a physician's diagnosis.

It is recognized that a condition diagnosed as being serious enough to cause permanent disability may respond later to new treatment or to improved techniques. However, unless the medical findings indicate the probability of improvement, the client will be considered as permanently disabled.

A totally disabled person is defined as one who has a serious mental or physical impairment or a combination of both which renders the individual incapable of doing any useful or remunerative work within his competence.

Total disability is determined largely by social data and it will be necessary that such data be available to the review team on all cases. Social data is necessary in order that the team of social worker and physician be in position to relate medical findings to the mental or physical ability of the individual to engage in employment which may be within his competence. Such factors as age, education, training, previous work experience, and mental adaptability have a definite bearing on a person's probability of overcoming a handicap and information concerning these factors must be available. Determination of total disability as an eligibility factor is the major responsiblity of the worker, but a person can be determined to be totally disabled only by relating social information and medical findings.

A completely helpless person is one whose physical or mental condition is such that he is either bedridden, chairfast, or confined to the home and requires help from others in caring for himself. If the condition is mental, it must be such that the person is incapable of mentally working or caring for himself.

Examples of conditions covering complete helplessness are complete paralysis, loss of use of both arms and both legs, and advanced phases of such diseases as cancer, tuberculosis, and some types of heart trouble. These are examples and a person may be rendered completely helpless by many other diseases.

Some people have one or more serious physical or mental handicaps but they can still get around all right, and there is some possibility of treatment or training if medical science and techniques later find a way. These people may be said to be totally and permanently disabled as far as anyone can see at the time.

Examples of such conditions are loss of use of one foot and one hand, loss of both hands or both feet, loss of hearing or speech, affliction by some disease which does not make a person helpless to get around but renders him too weak to work. There are many other ways by which a person may be totally and permanently disabled and still not be completely helpless.

A person who is handicapped because of mental deficiency cannot always be considered totally and permanently disabled. A mentally deficient individual who lives in a family group usually renders specific services to the group. He is capable of performing work in the family if closely supervised, although he might not be able to work out for wages. Such an individual would not be considered totally and permanently disabled because he is rendering services and his food, clothing (i.e., total support) would be considered his payment for these services. It is recognized that some feebleminded individuals are so limited mentally that they require considerable care from someone in a group.

An example of this would be the individual who cannot dress himself and/or may require close supervision so that he does not harm himself. Such an individual is considered totally and permanently disabled. A feebleminded individual who lives alone might be totally and permanently disabled because his mental deficiency limits his ability to work to such an extent that he cannot hold a job for wages, and he renders no service to anyone in a group who might repay him in kind.

The mental ages of mentally deficient individuals is not the only criteria for measuring the extent of disability. (1) His adjustment in his family, (2) the work opportunities available to him, (3) his adjustment in the community should be considered, along with (4) any physical limitations he might have. In establishing total and permanent disability for these individuals the social summary is of primary importance and it should cover all these points so that the review team may make an accurate evaluation of the extent of disability.

An individual cannot be engaged in substantially gainful employment and be totally and permanently disabled. This refers to the individual who is engaged in useful occupations. If an individual is engaged in employment and is able to carry out specific responsibilities in relation to this employment he is probably in a useful occupation. “Useful Occupations” are productive activities which produce goods or services to which the public attaches money value and for which the client receives wages. Any individual engaged in such an occupation is not totally and permanently disabled. However, if a client is unable to live up to the responsibilities of employment in a useful occupation because of his impairment, he may be totally and permanently disabled. He may engage in some type of employment and even receive remuneration for his employment when this remuneration would be on an irregular basis. For a client to be considered totally and permanently disabled and work, the employment could not be on a predictable basis but it would be sporadic because of the limitations set by the client's impairment. The element of pity, or charity for the handicapped individual would probably be the motivating factor behind the granting of this employment to him. All income earned by this client would be budgeted according to the usual procedure. The following examples may be helpful in determining whether or not a client is in substantially gainful employment:

1. 1. 

   A man who picks up some odd jobs each week is employed and cannot be considered totally disabled. His wages may be very little, but this is predictable income.

2. 2. 

   A peanut vender who works on the streets regularly every day or some every week is employed and cannot be considered totally disabled. This also is predictable income.

3. 3. 

   A woman who stays with children of a couple who both work and in return gets free shelter is performing a regular, useful service and cannot be considered totally disabled. This woman is a homemaker as she is capable of doing homemaking duties.

4. 4. 

   A man may be able to do some work for a few days one week but then for weeks he will be unable to do any work; again at some future time he may be able to do a day's work but we do not know when. He can be considered totally disabled as he has an unpredictable income. Another such man with epilepsy who can do some work each week with regularity is ineligible as he has a predictable income.

5. 5. 

   A woman out in the country may be asked once in a while to keep a neighbor's children. She does not know when they will ask her, perhaps once in weeks. There is no other work available she can do. She may be considered totally disabled as this would be unpredictable income. If this woman lived where she could get regular baby sitting to do, she would not be considered totally disabled as this would be predictable income.

A person's chief responsibility in the situation in which he finds himself is taken into consideration in determining eligibility for aid to the totally and permanently disabled. An adult person has a certain place in society and a corresponding responsibility—either responsibility to work to make a living for himself and family or responsibility for keeping house and making a home for others.

Homemaking involves the ability to carry the home-management and decision making responsibilities, and provide essential services within the home for at least one person in addition to one's self. A person having such ability and the opportunity to use it, i.e., is living in the home with one or more persons, will be considered a homemaker if performing any duties which are usually considered necessary to homemaking: shopping for food and supplies, cooking the food, cleaning house, washing dishes, washing and ironing clothes, carrying fuel or water, and caring for young children. If a person is not able because of his impairment to carry on a significant number of these duties he will be considered totally and permanently disabled.

Consideration will be given to the person's ability to carry on normal responsibilities such as walking, standing, bending, lifting, etc. These physical capacities along with mental capacity to make use of them are necessary to a person if he is to be usefully employed.

It is recognized that some persons will make a living under the most adverse physical conditions, because they have the will to do so. Social information will bring out such possibilities. As to homemaking, it may be entirely possible for a person to carry on necessary homemaking activities if the home provides conveniences and facilities even though she be confined to a wheel chair. If the homemaker has to go out of the house to get stovewood to make a fire in the cook stove, though, it would be impossible for her to do so if confined to a chair.

In determining whether or not a person is disabled, it is necessary that disability not be confused with unemployment. For example, the medical findings may indicate that a person is capable of doing light work which is within his competence and it is found that such light work is available in the community but no position is open at the moment; such a person would be unemployed rather than totally and permanently disabled. On the other hand, if medical findings indicate that a person may do light work, but there is no such work in the community or reasonably close to it, the person could not get a job of the nature indicated if he wanted to and would, therefore, be totally and permanently disabled. Then, too, consideration must be given to a person's competence to do work which may be indicated by medical findings. For example, a man who had always done physical labor and had little education could hardly fit into a clerical job even though he were physically able to do it.