BASIC (03-86)

DI 21501.185 North Carolina APTD/AB State Plan

A. Blindness—Definition

A person shall be considered blind who has been examined by an ophthalmologist or a qualified eye physician and found to have no vision or vision with glasses that 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 or less in the better eye with correcting lens or a visual field limited to 30 degrees in the widest dismeter, may be considered economic blindness. Central visual acuity of 20/100 in the better eye with correcting lens, in very progressive cases may constitute industrial blindness. Certain ocular conditions, which do not necessarily involve visual acuity or peripheral field loss, may be equally disabling.

Handicapping Eye Conditions:

Certain conditions which do not involve visual acuity or peripheral field loss, but which nevertheless constitute severe handicaps, must be considered in formulating the definition of visual eligibility for blind assistance. These conditions disturb visual functions to a degree which makes impossible the performance of tasks for which vision is essential. Examples of these situations are:

Some types of essential blepharospasm, despite normal visual acuity and normal visual field, constitutes a visual problem which in certain cases may render an individual economically and industrially blind. This is particularly true of those cases in which the blepharospasm is induced or aggravated by the willful intentional necessity of keeping the eyes open. If this condition is sufficiently severe, the condition constitutes an almost completely disabling defect. Such persons should be considered visually eligible for blind assistance. Here again, the problem is individual and should be judged on its own merit.

Muscles Palsies, which limits the rotation of the only seeing eye in those cases where the visual efficiency is border-line constitutes another problem that requires individualization. In general, it is felt that a complete ophthalmoplegia constitutes a defect in which 10 percent may be subtracted from the visual efficiency level and the resultant efficiency be used as a determination of eligibility.

Occasionally there is a problem of a complete ptosis of the lid of the only seeing eye, combined with some impairment of the visual acuity or field efficiency. Most cases are amenable to surgical correction, but there are instances in which surgery is refused and artifical supports do not expose the eye sufficiently to permit the individual to have useful vision. In such a situation, the defect should be considered disabling and the person visually eligible for blind assistance.

A local condition, which exists in a chronic form and which produces sufficient photophobia or blepharospasm that the individual cannot keep his eyes open sufficiently to follow any gainful occupation, should be considered visually eligible for blind assistance.

B. Permanent and Total Disability

“Permanently and totally disabled” means that the individual has some permanent physical or mental impairment, disease, or loss, or combination thereof, that substantially precludes him from engaging in useful occupations within his competence, such as holding a job. “Permanently and totally disabled” is a person who has a physical or mental impairment which substantially precludes him from obtaining gainful employment, and such impairment appears reasonably certain to continue without substantial improvement throughout his lifetime.”

1. INTERPRETATION

“Permanently” is related to the duration of the impairment or combination of impairments. It refers to a condition which is not likely to improve or which will continue throughout the lifetime of the individual. It may be a condition which is not likely to respond to any known therapeutic procedures, or a condition which is likely to remain static or to become worse unless certain therapeutic measures are carried out, where treatment is unavailable, inadvisable, or is refused by the individual on a reasonable basis. “Permanently” does not rule out the possibility of vocational rehabilition or even possible recovery in light of future medical advances or changed prognosis. In this sense the term refers to a condition which continues indefinitely, as distinct from one which is temporary or transient.

“Totally” is related to the degree of disability. It involves considerations in addition to those verified through the medical findings, such as age, training, skills, and work experience, and the probable functioning of the individual in his particular situation in light of his impairment. An individual's disability would usually be tested in relation to ability to engage in remunerative employment. Homemaking would be an appropriate test only for individuals, such as housewives, who were homemakers prior to the disability and have no marketable skills. If the individual has potential for training or employment, referral must be made to Vocational Rehabiliation or other agency for training purposes. Eligibility may continue, even after a period of rehabilitation and readjustment, if the individual's