BASIC (03-86)

DI 21501.140 Mississippi APTD/AB State Plan

A. Blindness — definition (Volume III Section D Pages 4400-4402)

A person shall be considered blind who has no vision or whose vision with correcting glasses is so defective as to prevent the performance of ordinary activities for which eyesight is essential. In terms of ophthalmic measurement, central visual acuity of 20/200 in the better eye with correcting glasses is considered economic blindness. Also persons whose central visual acuity is more than 20/200 in the better eye with correcting glasses but who by a rough field test show a marked field defect, may be considered blind. The marked field defect is one in which the peripheral field has contracted to such an extent that the widest diameter of the visual field subtends an angular distance no greater than 20 degrees.

B. Permanent and total disability — definition (Volume III Section D Pages 4803-4808)

The Federal Social Security Act, Title XIV, and the state statute require that a person be found to be wholly prevented from working because of a permanent illness, defect, or injury in order to qualify for APTD. Thus the basic requrement is that a person can be considered eligible on this factor when he has a physical or mental impairment, or a combination of impairments, which is expected to continue and which prevent him from engaging in useful work that is within his competence and that exists in the community in which he lives. Each of these terms is defined below.

  1. Impairment. This means a disease process, a birth defect, or injury, as established by medical findings. Or more than one disease, defect, or injury that together constitutes a major impairment.

  2. Permanent. This term is defined as a physiological, anatomical, or emotional impairment for which there is at present no known cure or reasonable expectation for improvement. This major condition, disease, or loss, either congenital or acquired, is expected to continue throughout the lifetime of the person because the condition is not likely to respond to any known therapeutic procedure; or known treatment that would relieve or remove the condition is unavailable or inadvisable; or the person refuses treatment and his decision is reasonable; and without the treatment the condition will remain static or become progressively worse. The term “permanent” is qualified in several ways. It does not imply that there is no hope that the person will ever improve, as persons sometimes respond favorably after a poor prognosis.

    The following qualifications apply:

    1. The advances in medical science and the discovery of new drugs may bring about the improvement or recovery of the person.

    2. The condition may be one in which proper medical treatment might succeed in bringing about improvement but treatment is unavailable, inadvisable, or reasonably refused.

      1. Treatment is considered unavailable when all local and state resources for treatment have been explored and found not to exist or not to be accessible.

      2. Treatment is considered unavailable when there is known treatment but such treatment is medically unsound because of the person's age or other diagnosis.

      3. Treatment is reasonably refused if the only available therapy is such that it involves a high degree of the risk of life or essential organs or faculties; or that in view of previous medical diagnosis and other health conditions, it holds little or no likelihood of proving effective; or if in the opinion of the State Medical Review Team there exists genuine fear; or a person's religious belief prohibits treatment. A person's refusal of treatment may occasionally constitute inadvisability. For example, if a person refuses treatment because of a genuine fear, treatment would usually be considered inadvisable.

        jThe outcome of treatment appears uncertain and therefore the finding of “permanent” can be made later because of changes resulting from treatment.

  3. Total. The term total means entirely or completely. In APTD total disability means that the person is wholly prevented from working in his usual occupation or in other useful work for which he is qualified and which is available in the community. Each of these terms is also defined.

  4. Useful Work. Useful work is a job in which a person works for another, or self-employment; or in the case of a homemaker, homemaking activities. That is, useful work includes:

    1. Job Activities:

      1. Work that is an essential job or bona fide work opportunity, so that if the person in this position did not do the work, the employer would hire someone else to do it.

      2. Work that is productive and results in benefits to others.

      3. Work that requires some skill or attention to accomplish.

      4. Work that is usually done for pay or is performed as contributing member of the family group such as working in the family crop. This includes similar activities performed for another such as a neighbor or other family member.

    2. Homemaking Activities: For homemaking, useful work consists of those activites required in maintaining a home and in providing care for children. A person who is considered a homemaker must be one who assumes the management of a home, including decision-making, for at least one person in addition to herself or himself. Major homemaking activities are:

      1. Shopping for food and clothing.

      2. Planning, preparing meals, and washing dishes.

      3. Cleaning house (mopping, sweeping, dusting, and moving furniture).

      4. Making beds, washing and ironing clothes.

      5. Also, in some instances, carrying water, bringing in fuel, and building fires.

      6. Care of children when there are infants and young children in the home for whom the person is responsible. Care of children includes: dressing and bathing, feeding, lifting and carrying, training and supervision, as well as physical protection from danger and harm.

        While the wife and mother is usually the homemaker, the responsibility of these activities must in some instances be assumed by another person in the home. In these cases the test of homemaking activities will be applied to the person actually responsible for and assuming these duties. Also if the homemaker is performing these duties in some small part but they are in major part left undone because of the permanent impairment of the homemaker, so as to endanger health and decency of the family members, the homemaker will be considered to be wholly prevented from working in her usual occupation.

  5. Nonuseful Work. Nonuseful work consists primarily of:

    1. A made-up job, given to the person as a matter of sympathy, for which no one else would be hired if the person were to leave or be unable to continue.

    2. A hobby undertaken as therapy or a way of passing the time.

    3. Retraining under the direction of the vocational rehabilitation counselor and the physician.

  6. Work Within Competence and Existing in Community. The term “within his competence” means that a person has the work skills, obtained either by education or experience, which enable him to perform a certain task or kind of work. However, the fact that a person can no longer use these work skills in the same kind of work in which he has been employed does not mean that he may not be able to use them in similar or related work. The person's work history, education, and community in which he lives tell the story about his being able to find alternate employment.

    Existence of work in the community refers to the requirement that a job or opportunity for self-employment must be present in the community in which the applicant lives. The fact that a job does exist elsewhere for which the client is qualified in terms of work skills and experience does not provide the client with his usual work unless of course he wishes to move to the location at which this work is available. Thus he will be wholly prevented from working in his usual job in this circumstance. On the other hand, if a person is physically and mentally competent to do work which is similar to his usual occupation, even though it is less skilled work, and the work is available where he lives, then this person is unemployed rather than prevented from working because of his impairment. An example of both competence and the existence of work in the community is a situation in which the person has been doing office work, either secretarial or bookkeeping, and suffers some impairment so that she can no longer move about to the degree required in her duties; if, however, this person can serve as a telephone operator in an office, not being required to be mobile, then an alternate job is available for her if one exists in that community where she lives. However, a person with little or no education who has always done manual labor and who becomes unable to do strenuous work of this kind is prevented by his illness or injury from performing his usual work and has no skill that will enable him to take a sedentary job.

C. Examples of permanent and total impairments

For the purpose of illustrating permanent and total impairments, the listing below gives physical conditions which many times have resulted in severe reduction in bodily functions and can be considered totally disabling:

  1. Heart Disease—With severe angina pectoris (chest pain) or shortness of breath on even slight exertion.

  2. Hypertension—If it has resulted in such complications as a stroke, heart failure, or kidney failure (uremia).

  3. Lung Disease—If it is severe enough to seriously impair body vigor and result in marked weight loss and shortness of breath on slight exertion.

  4. Diabetes—If it results in complications such as severe neuropathy (pain and weakness of the legs), loss of a leg, or serious kidney disease.

  5. Arthritis—If it results in severe limitation of motion in multiple joints.

  6. Ulcers—If they result in severe complications such as repeated hemorrhage, loss of weight, and weakness, even after adequate medical surgical treatment.

  7. Epilepsy—If seizures cannot be controlled by medicine, so that they occur at frequent intervals (more than once a week), or if accompanied by severe mental retardation.

  8. Mental Illness—If a person is incapable of independent activities because of mental illness and cannot adequately adjust to social and industrial situations.

  9. Malignancy—If there is evidence of recurrence after treatment, or such widespread involvment before treatment that there is no hope for cure, and if the disease results in such pain or impairment of body vigor as to seriously interfere with regular activities.

D. Mental or emotional disorders.

A disorder may arise from mental retardation or deficiency, mental illness, or a severe emotional involvment known as neurosis. The condition may be accompanied by physical aliments or may in itself be of such severity as to interfere with the person's ability to work or engage in homemaking activities. Such conditions are defined as:

  1. Mental Retardation—This may be a congenital condition or the aftermath of some disease or injury. The retardation may be severe, so that the person may not have been able to learn in school, or at least to advance beyond the first, second, or third grade and may not be able to do the simplest kind of work. In other instances, the retardation may be less severe so that the person can do simple work under close supervision. Or the person with only moderate mental retardation may be able to do simple work on a full-time basis; in such cases, if this is the person's regular work, he would not be eligible on incapacity.

  2. Mental Illness. This means a mental disorder based on a pathological condition known as psychosis. The disorder is usually evidenced by behavior or ideas which are sufficiently beyond the so-called normal or average person's conduct or opinion to be noticeably different, bizarre, or erratic. Sometimes the manifestations are alarming and the person's behavior is dangerous to himself and to others.

  3. Personality Disorders or Severe Neurosis. In many instances a person with a personality disorder or a severe neurosis is not prevented from working full-time or from assuming homemaking duties. However, in other instances a person with these problems may be sufficiently disturbed so as to be unable to go about his work in any coordinated or useful way. Some of the manifestations or persons with these problems are:

    1. Long history of inability to get along with people in everyday relationships, such as those with a spouse and children, employer, fellow workers, and members of social groups, or continued avoidance of association with others, extending sometimes into expressed dislike for them.

    2. Changes in mood alternating from elation to sadness; that is, more than ordinary moodiness or slight depression from time to time. <