A person is considered to be permanently and totally disabled if it is established that he has a permanent physical or mental impairment, disease, or loss that substantially precludes participation in a useful, gainful occupation within the person's competence such as employment by others, self-employment, or homemaking. This definition requires that two conditions be present: permanent impairment and total disability.
“Impairment” refers to a disease, loss, injury, or defect. It may be physical or mental, organic or functional and must be sufficiently serious to interfere with the individual's faculties such as sense, reasoning, and mobility. It may exist from birth or be acquired during a personal lifetime. It may be obvious, such as the loss of a limb, or it may be such that it can be revealed only by medical examination. It may be static or progressive. It may exist singly or in combinations.
“Disability” is the incapacity or limitation of function which results from the impairment.
“Permanent” refers to a major physical or mental impairment or combination of impairments which is not likely to improve or which will continue. Permanence is established if:
The impairment is not likely to respond to any known therapeutic procedure; or
The impairment will remain static or become worse unless certain therapeutic procedures are carried out, but such therapeutic measures are unavailable, inadvisable, or the person refuses treatment, and his decision is reasonable.
“Total” refers to the ability of the person, as shown by the facts in his situation, to perform these activities necessary to carry out specified responsibilites such as those required for employment or homemaking. In addition to verified medical facts, “total” involves the consideration of other factors such as age, education, work skills and experience, and the person's functioning in his particular environment with his impairment. No time factor is involved in the concept of total disability.
“Employment” refers to an activity in which a person engages for financial gain, and it must be substantial gainful employment.
In determining whether a person is totally disabled for employment, his work experience or his capacity for work must be considered. For example, a man may be a logger who is no longer able to do that kind of work because of his impairment. He may not have the training or experience to qualify him for lighter employment such as clerical work in an office, or appropriate employment may not in reality exist in his community. Another example is a young man or woman who has never been employed because of his or her impairment. In such instance, the disability decision must be based, in part, upon an evaluation of the person's capacity for employment, considering his or her impairment.
Since a man's role in society is usually that of an employed person, the disability decision about a man is made from the standpoint of employment or competition in the labor market. A woman may have a dual role in society. A single or lone woman, therefore, is considered from the standpoint of employment or competition in the labor market. A married woman who lives in her family group is considered from the standpoint only if she has recent employment experience which indicates that she would be employed full-time if she did not have an impairment.
A person who is working as part of a training program is not “employed” . Such activity may be in the person's own home, in a school, a sheltered workshop, a factory, or other training setting. The determining factor is not the location of the activity, but the presence or absence of supervision, a training goal or objective, and the economic value of the item produced or service provided by the person. The person should be supervised in his training setting.
Employment in a sheltered workshop such as Goodwill Industries usually is not considered to be “employment” in the context of this section even though such training is not part of a training program. One determining factor in such situation is whether the person is capable of competing with nondisabled persons in the labor market. Another determining factor is whether the person's employment activity in a sheltered workshop involves production or service of real economic value such as work on a contract basis for private industry.
To be engaged in useful or gainful employment refers to the production of goods or services which demand the time and attention of the employed person for the ultimate benefit of others and to which the public attaches a money value. Work which is made available to an individual because of the interest or compassion of interested persons in the community, but which would not ordinarily exist or which the person would not be able to do in sufficient quantity to maintain himself, is not considered to be gainful occupation.
“Homemaking” refers to responsibility for making the decision necessary for the management of a home and family and for performing the duties necessary to carry out these decisions. For the purpose of determining a person's disability, homemaking is considered to be a full-time useful occupation which involves responsibility for at least one person in addition to the homemaker. The homemaker is considered independently from other members of household regarding functional capacity to accomplish the role of homemaker. The question is: Can this person accomplish the activities required to fulfill the role of homemaker without the help of others? The presence of another person in the household who helps does not mean the homemaker is ineligible. The homemaker would be ineligible when the recorded medical and social information proved the person to be capable of functioning in the role of homemaker for self and at least one other person.
The essential functions of a homemaker, in addition to the decisionmaking responsibility are: planning and preparing meals, washing dishes, heavy and light housecleaning, washing and ironing clothes, shopping for food and supplies and training and caring for children.
It is difficult to set a generally-accepted standard for homemaking performance since there are no earning or fixed hours of work involved. A standard to be used in determining total disability for homemaking is the adequacy of the woman's performance as a homemaker at the time she applies for assistance as compared to the adequacy of her performance as a homemaker over a period of time prior to her application. Marked deterioration in performance may be shown for one woman, while it may be found that another woman is performing homemaking in a manner which is little or no different from her usual pattern of long standing. Other factors which must be considered and recorded are: Whether any other person or persons are performing the homemaking tasks. If so, state what others do in the home. The tasks done by the homemaker and the circumstances under which they are done, including the length of time required for the applicant to perform the functions, will be recorded. The type and location of the home is important to know; i.e., mobile home, cabin in mountains, large two-story house.
Restoration and Rehabilitation: Permanent and total disability as related to the person's skills, education, social situation and so on may not rule out the possibility of restoration or vocational rehabilitation. Staff will consider this possiblitity for each person who applies.
The decision regarding treatment and possible restoration for the person rests with the person and the physician. Staff will be aware of resources for such services and participate in appropriate planning for the utilization of the resources.
Use of Restoration Services: The client is expected to cooperate in the planning, development and use of any sound restoration plan. This means and includes medical, surgical and psychiatric therapy or any combination of conditions.
The treatment must be generally available, medically advisable and generally accepted. The governing principle is that no individual need take treatment unless it can be demonstrated to be such that a “reasonably prudent man” would accept it.
Use of such services would not be required when it would:
Endanger his life. Or the loss of faculty or the remaining faculty he now has; i.e., partial vision which might be lost completely if surgery accepted.
Cause him severe emotional stress or if he is genuinely fearful of undergoing recommended treatment. His fear may appear unrealistic, or entirely emotional in origin, or irrational; however, such fear would interfere with treatment and make it inadvisable.
Be against his stated religious convictions about medical treatment.