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,
“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
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.
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
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.
Useful Occupation means productive activities which may be either gainful occupation
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.
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
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:
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
Loss of employment and inability to sustain employment because of excessive drinking.
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
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:
A history of excessive narcotic use to the extent that it has adversely affected
interpersonal relationships and social functioning.
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.
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.