BASIC (03-86)

DI 21501.120 Maryland APTD/AB State Plan

A. Blindness

Central visual acuity of 20/200 or less in the better eye with correcting glasses.

Or, if central visual acuity of more than 20/200 in the better eye with proper correction, a field of vision defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends at an angular distance no greater than 20 degrees.

B. Permanent and total disability

Permanent and total disability is defined as any physical or mental impairment or disease which continuously precludes the individual from engaging in any useful occupation, including homemaking.

“Useful occupation” means any gainful occupation within the individual's competence and for the homemaker any gainful occupation within her competence, including the usual homemaking activities.

“Permanent” means the condition is not likely to be substantially improved by any known therapeutic procedures. “Permanent” is determined on the basis of medical facts and information.

“Total” means that the condition substantially prevents the person from performing those activities necessary to carry on any gainful occupation within his competence, including in the case of a homemaker, those activities necessary to carry on ordinary homemaking duties without substantial help. “Total” is determined on the basis of medical facts and those social data which make it possible to relate the medical findings to the types of activity which the individual is competent to perform.

  1. Permanent means that the condition is not likely to be substantially improved by any known therapeutic procedures. It is not used in the sense of unchangeable but as continuing indefinitely in contrast to temporary or transient. The fact that the disability is permanent does not rule out medical treatment which may alleviate the condition or lessen the problem of care.

  2. Total means that the disability substantially precludes the individual from performing those activities necessary to carry on any useful occupation within his competence. Like “permanent” it is not an absolute term, but relative to the person's present capacity and competence. It does not rule out the possibility that with medical treatment or training or both, some individuals might be rehabilitated to a degree which would make them no longer “totally” disabled.

    Relating “total” to the individual's competence requires consideration of his capacity and vocational equipment, not only in relation to his previous occupation, but in relation to other useful occupations. For the individual who has carried on a gainful occupation, this means considering ability to engage in a previous occupation or in a gainful occupation in another field. For the homemaker, it means consideration of ability to carry homemaking activities or to engage in a gainful occupation. It is in the consideration of the person's competency that the use of the Employment Service, Vocational Rehabilitation or other community services may be needed.

    The fact that certain types of gainful occupation actually do not exist as employment opportunities in a community may influence the final decision as to “total.” The person may be “substantially precluded” because the type of work, for which there is capacity, does not exist at all in the community. The decision is not influenced, however, by the lack of job placement for the particular person if such jobs are available.

  3. Useful Occupation means productive activities which may be either gainful occupation or homemaking.

  4. Gainful Occupation means work for which the individual receives money or income in kind. It may be employment for wages or self-employment. It demands the time and the attention of the individual and requires the ability to perform certain mental and physical activities on a regular predictable basis.

    There may be certain activities for which an individual receives remuneration which are not “gainful occupations” for purposes of APTD. Such activities as those which are a part of retraining, occupational therapy or made work based on sympathy rather than value received are not considered “gainful” from the standpoint of the technical factor of permanent and total disability. In these situations earnings or profits generally are less than would be true for the usual job in the same field of activity.

  5. Homemaking means the management of a home, including the responsibility to plan, to make decisions, and to provide the essential services required in a home. Homemaking in this sense is not an employment situation which an individual enters for hire and thus is distinct from domestic employment which is “gainful.” It, however, requires ability to perform both mental and physical activities. In the final decision as to whether or not a person is “substantially Precluded” from homemaking activities, consideration is given to the ability to carry on such activities for at least one person in addition to one's self. Whether or not there are children, and whether or not modern conveniences are available would also influence the extent to which a particular individual was considered totally disabled for homemaking activities.

  6. Alcoholism means an individual has a behavioral disturbance in which excessive drinking of alcohol interferes with the physical or mental health of the individual. In a large percentage of persons who suffer from alcoholism, the excessive drinking is symptomatic of personality disorder or neurosis.

    In other persons, alcoholism may be associated with organic brain injury or disease. For these reasons, persons with a diagnosis of chronic alcoholism may require a psychiatric evaluation as well as a medical and social evaluation.

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

    There will remain a category of the addictive alcoholic without a recognizable underlying disorder. The level of addictive severity reached is such that the individual subordinates all ordinary activity to his attempts to maintain the degree of alcoholism which provides his physiological and psychological satisfactions.

    Since there is a variation in the severity of addictive alcoholism and some variation in prognosis, the following criteria shall be used to provide a basis for APTD certification:

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

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

    3. Evidence that the alcoholism has reached the addictive stages 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.

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

  7. Narcotic Dependency means in some instances, persons who are dependent upon narcotics and have a personality disorder or neurosis. In others an underlying psychosis may be present. For those reasons persons, who have been diagnosed as narcotic dependent may require a psychiatric evaluation as well as medical and social evaluations.

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

    Since narcotic dependence may rapidly establish itself in preadolescence, adolescence and early adulthood and tends to have a poorer prognosis the earlier it occurs, for the purposes of certification for APTD the following criteria are to be used:

    1. A history of excessive narcotic use to the extent that it has adversely affected interpersonal relationships and social functioning.

    2. Depending upon the individual's age, impaired functioning in school or loss of employment and/or inability to secure and sustain employment because of excessive narcotic use.

    3. Evidence that the narcotic use has reached the addictive state as shown by ethical deterioration, regular narcotic usage, the approaching development of physical dependence, and the tendency toward obsessive usage.

    Where other pathological conditions frequently associated with narcotic dependence exist, they are to be considered in determining the severity of the disability. Such complications need not be present for certification to be made.


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DI 21501.120 - Maryland APTD/AB State Plan - 03/07/2013
Batch run: 03/07/2013
Rev:03/07/2013