The term “totally” refers to the ability of the individual to perform the activities required by a gainful
occupation or by homemaking as defined below.
The effect of an existing permanent impairment is considered in relation to the individual's
ability to work in a gainful occupation or as a homemaker at the time when the determination
of disability is made.
“Totally” involves social considerations such as age, training, skills, work experience, and
the probable functioning of the individual in his particular situation and in the
light of his impairment. The social data must provide a sufficient base to make it
possible to relate the medical findings to the types of activity the individual is
competent to perform, or can be trained to perform.
Adults are ordinarily expected to take care of themselves and their families. For
some, this means working in gainful employment. For others, it means working as a
homemaker. In either capacity the individual is required to perform activities beyond
the usual demands of everyday living. When the social findings indicate that the individual
is not currently able to perform the activities required by a gainful occupation or
by homemaking, within the limitations imposed by his permanent impairment he is considered
An individual may be unable, because of his impairment, to continue to earn his living
in his usual occupation. This does not mean that he is totally disabled as regards
other types of occupations which are within his capacity and competence.
In determining the individual's ability to work either in a gainful occupation or
as a homemaker, consideration is given to the following:
The duties of a particular job in terms of knowledge, skill, physical activity, etc.,
The individual's ability to perform the duties of the job on a predictable basis with
The accessibility of the job in terms of the individual's ability to get back and
forth from home to work without undue strain or adverse effect.
The term “prevents”, as used in the statutory definition, is a relative one, meaning substantially precludes,
since it indicates the extent to which an individual's permanent impairment leaves
him unable to perform the duties of a gainful occupation or of homemaking. If an individual
is able to perform such duties well enough and with sufficient regularity to receive
regular payments for his own current efforts, or to carry homemaking responsibilities
on a continuing basis unassisted, he is not considered permanently and totally disabled.
An individual is considered incapable of engaging in a gainful occupation or in homemaking
if medical evidence shows that his condition is such that attacks of pain, shortness
of breath, dizziness, exhaustion or other medically demonstrable reactions occur at
unpredictable intervals and with such intensity as to interfere with the continuous
performance of the activities required.
A plan for occupational therapy or training may be carried out in a sheltered workshop.
However, some persons working in a sheltered workshop or similar protected job setting
are considered to be engaged in a gainful occupation. The determining factor is not
location, but the presence or absence of supervision (by a physician or rehabilitation
agency) and of a remedial or training objective.
Sometimes an individual whose impairment is so severe that it would be assumed that
he could not engage in any occupation is actually doing some remunerative work. In
such cases he is still considered permanently and totally disabled if, after thorough
consideration of all the facts, it is found that
The time and effort expended is far beyond that ordinarily required for the particular
The opportunity to work and market his goods or services is provided out of sympathy
and other persons help more than usual to enable the individual to “carry on.”
It may be necessary to carry out a plan for vocational rehabilitation in order for
the individual to develop competence to engage in a gainful occupation or in homemaking,
within the limitations imposed by his permanent impairment. If so, he is considered
totally disabled while the rehabilitation program is in process.
When an individual is competent to perform the duties of a certain type of occupation
in spite of his permanent impairment and work of this nature exists in the community, he is deemed not totally disabled
but merely unemployed. In deciding whether or not work “exists in the community”, its accessibility to the person will be given consideration in relation to his impairment
(see DI 21501.050B, step (3) above).