DI 21501.085 Illinois APTD/AB State Plan
1. Definition of blindness (651)
The Public Code of Illinois gives the Department of Public Aid the authority to define blindness in terms of ophthalmic measurements or ocular conditions. The following definition has been adopted for use in determining blindness as an eligibility factor:
In terms of ophthalmic measurements, central visual acuity of 20/200 or less in the better eye with corrective glasses is considered economic blindness. A field of vision loss in which the visual field efficiency is reduced to 30 per cent or less may be considered equally disabling, as may certain ocular conditions which do not necessarily involve visual acuity or field vision loss but which constitutes a severe visual handicap.
2. Corrective treatment (670)
The caseworker is responsible for conveying to the applicant or recipient any recommendations made by the Supervising Ophthalmologist for corrective treatment or rehabilitation and for assisting the applicant or recipient in planning for such treatment or rehabilitation if the recommendations are accepted.
The refusal of an applicant or recipient to accept a treatment plan does not affect his eligibility for assistance. However, by interpreting the advantages to be gained through cooperation in a treatment plan that may correct or arrest the existing eye condition, the caseworker may succeed in interesting the applicant or recipient in accepting such a plan. Advice and consultation with the Supervising Ophthalmologist is available, if needed.
B. Permanent and total disability
1. Definition of permanent and total disability (701)
Article VII-A, Section 7A-2 of the Public Assistance Code of Illinois defines permanent and total disability as follows:
“A person shall be deemed to be permanently and totally disabled within the meaning of this Article if he has a physical or mental impairment, disease or loss which is of a permanent nature and which substantially impairs his ability to perform labor or services or to engage in useful occupations for which he is qualified, as determined by Rule and Regulation of the State Department.”
2. Explanation of terms related to disability (702)
For purposes of determining eligibility for AABD (D) the term “permanent and total disability” is not necessarily considered in its absolute sense but is evaluated in relation to the individual's condition and his circumstances as discussed below and in 703.
3. Permanent and total disability (702.1)
“Permanent and Total Disability” means a physical or mental impairment, disease, or loss of major importance which is permanent in nature and which substantially impairs the individual's ability to perform or engage in useful labor or useful service or useful occupations for which he is qualified.
“Permanence” refers to a condition which is (1) irreversible, or (2) progressive and not amenable to treatment, or (3) which requires treatment which is extremely hazardous or of questionable benefit.
The term “permanently” refers to a physiological, anatomical or emotional impairment verifiable by medical findings. The 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 which is considered as not likely to respond to any known therapeutic procedures shall be deemed to be permanent; furthermore, any condition which is considered 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, inadvisable, or the individual refuses treatment and his decision is reasonable.
“Permanence” does not rule out the possibility of vocational rehabilitation or even recovery from the 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 actual physical improvement, the classification is proper. Thus the term “permanent” is not used in the sense of “everlasting” or “unchangeable,” but may be used relatively in the sense of continuing indefinitely as distinct from “temporary” or “transient.”
4. Total disability (702.3)
“Total disability” refers to the severity of the effect of the permanent impairment, disease, or loss of the individual's ability to function in his particular situation at the time of his application for AABD(D) or of redetermination of his eligibility. Determination of total disability takes into consideration social and vocational factors in addition to the medical findings.
In order for disability to be considered total the physical or mental impairment, disease or loss must be of major importance and of such degree or severity that it substantially impairs the individual's ability to function adequately in his particular situation.
5. Additional terms (702.4)
“Substantially impairs” means that an individual is unable to perform or engage in useful labor or useful service or useful occupations for which he is qualified on a predictable or continuing basis.
“Useful Labor,” “Useful Service,” and “Useful Occupations” mean any employment, occupation, work, service, or activity which persons commonly pursue for the purpose of providing a livelihood for themselves and their dependents or of carrying out responsibility, such as homemaking for one or more persons in addition to oneself. The foregoing terms do not apply to types of employment, occupation, work, service, or activity not existent in the community in which the applicant or recipient lives; nor to activities of the nature of hobbies or pastimes which do not provide the individual with a bona fide opportunity to earn a livelihood; nor to activities prescribed by a physician for therapeutic reasons and carried on under the supervision of the physician; nor to that part of a rehabilitation program which is officially designated as “training” and which is carried out under the supervision of the rehabilitation agency; nor to remunerative activities created for him on the basis of sympathy more than on the basis of the value of the activities.
Engaging intermittently in useful labor, useful service, or useful occupations will not necessarily exclude the individual from being considered totally disabled. The fact that an applicant has never, as an adult, been able to perform or engage in useful labor, useful service, or useful occupations because of a disability will not necessarily exclude him from consideration.
“Physical impairment, disease, or loss” means one or more functional or organic conditions, existing from birth, acquired during the lifetime of the individual, or resulting from accident.
“Mental impairment, disease, or loss” means one or more mental defects or mental disorders, including the conditions commonly referred to as reactions, and personality disorders.
6. Degree of disability (703)
Disabled persons may range from those who are completely invalid (as demonstrated by the fact that they are bed-fast, chair-fast, or require considerable help in locomotion) to persons who are feasible sujects for vocational rehabilitation. Persons with paraplegic, hemiplegia, or serious othopedic crippling conditions could be considered completely invalid. Another group, although partially ambulant, are quite limited in activity; these might include persons with moderately severe coronary disease with poor prognosis, far advanced cancer patients, etc.
Medical, psychological, social, educational and occupational factors are very important in determining whether or not a disability is a complete occupational handicap for a specific individual. Two persons with the same permanent disability may, because of variations in education, vocational experience or skills, emotional stability, and native intelligence and adaptability, show entirely different reactions to the disability and to the problem of continuing a useful occupation. It is essential, therefore, that such factors be evaluated and considered in determining whether the applicant is permanently and totally disabled as defined.
In many cases, no decision as to total disability can be made without such social data as will describe the individual's education and work history, the activities required of him in his home or in his job, living and working conditions, interests, native capacities and extent to which he has adjusted to the loss he has sustained. The nature of the social data must provide a base to make it possible to relate the medical findings to the types of activity the individual is competent to perform.
As an example of the effect of a permanent disability, consider the permanent loss of use of an arm. An unskilled, semi-literate laborer, age 55, would be completely handicapped for return to his former occupation of manual labor. Because of his lack of education and his age, the possibility of his adjustment to any other type of work is very slight and probably he should be considered totally disabled. An attorney with the same disability, however, would not be handicapped for his regular occupation but could continue the practice of law. Therefore, he would not be considered eligible for AABD(D) on the basis of loss of an arm.
A bed-fast or chair-fast individual might become wholly or partially self-supporting if his intelligence and education made it possible for him to operate a small business enterprise.
7. Homemakers (703.1)
Many applicants for AABD(D) will have had no recent employment history, or occupation other than homemaking in their own homes. In addition to determining that these applicants are prevented by their impairment from engaging in any useful occupation within their competence and existing in the community, it is necessary to show that they are unable to perform homemaking functions in their own homes.
“Homemaking” means the performance of essential homemaking functions for two or more persons (including the applicant) on a predictable and continuing basis. Essential homemaking functions are planning and preparing meals, washing dishes, cleaning the house, making beds, washing and ironing clothes, shopping for food and supplies. Homemaking differs from employment as a domestic, maid, or housekeeper.
An individual living alone or in the home of others (as with adult children) is not considered to be doing homemaking functions as listed above. Help with housework or cooking does not constitute homemaking.
The determination of the disability of a homemaker is based upon both ability to engage in a useful occupation outside the home, and ability to carry out the major duties of homemaking.
8. Mentally deficient persons (703.2)
Mentally deficient persons coming to the attention of county departments will fall into the following general groups:
a. Severe mental deficiency
Persons with extremely low intelligence who are unable to assume responsibility for their own physical needs or for any decisions affecting their everyday life.
b. Moderate mental deficiency
Persons with low intelligence whose judgment and insight are so limited that they require supervision in decisions affecting their everyday life, but who are able to get along in the community when the are under the continuous supervision of relatives. These persons may never have attended school or may have completed only one or two grades.
c. Mild mental deficiency
Persons who are capable of getting along in the community while living independently or in a family group, but whose judgment and insight are limited so that they require some help in making decisions affecting their welfare.
d. Borderline mental deficiency
High grade mental deficients who can assume responsibility for themselves in the community and are employable within certain limitations. This group is not considered totally disabled for purposes of this program if the only disability is the mental deficiency.