DI 21501.215 Rhode Island APTD/AB State Plan
A. Blindness—Definition of Blindness
To be eligible for AABD because of blindness a person's vision must meet the following definition: In terms of ophthalmic measurement, central visual acuity of 20/200 or less in the better eye with correcting glasses, or a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual fields subtends an angular distance of no greater than 20 degrees.
B. Permanent and Total Disability
1. DEFINITION OF PERMANENT AND TOTAL DISABILITY
To be eligible for AABD because of permanent and total disability a person must have a permanent physical or mental impairment, disease or loss, other than blindness, that substantially precludes him from engaging in useful occupations within his competence such as holding a job or homemaking.
The term “permanently” refers to a physical, mental, or emotional impairment verifiable by medical findings. The impairment must be of major importance, not likely to improve or which will continue throughout the person's lifetime. Any condition will be deemed to be permanent if it is considered by the medical reviewer as not likely to respond to any known therapeutic procedures, or likely to remain static or become worse unless certain therapeutic measures are carried out and treatment is unavailable, inadvisable, or the individual refuses treatment and his decision is reasonable.
“Unavailable” means that recommended treatment which a physician has determined may stop the progress of the condition, is not available in Rhode Island or some point to which the individual can readily go to get the treatment, or the individual or the State or other resources cannot pay for the treatment and transportation to a place where he can obtain it.
“Inadvisable” means that in an individual's particular situation, the physician states that it is not wise for the individual to undergo certain therapeutic measures.
“Reasonably refuses treatment” means that when treatment has been recommended which may prevent the progress of the condition and the individual has genuine fears as to the outcome of the treatment or has religious scruples, the refusal by the individual to undergo treatment could result in a finding of eligibility with respect to this part of the definition.
The term “totally” refers to the ability of the person to perform those activities necessary to carrying out specified responsibilities such as those necessary to employment or homemaking. Totally involves considerations of age, training skills, and work experience and the proper functioning of the individual in his particular situation in light of his impairment. This social data provides a basis to make it possible to relate the medical findings to the types of activity the individual is competent to perform. Considered in the determination of the totality of the disability will be the person's ability to carry out his individual role as an employable person or as a homemaker.
Regarding employment, a person will be considered totally disabled if he is not able to continue in his previous occupation, or other useful occupation which exists in the community, and does not have the ability to be reasonably expected to develop competence for any other useful occupation. This will be determined by considering:
The previous type of usual employment and the effect of the disability on his ability to continue with this unemployment.
The client's age, education, ability, and remaining capacities and the effect of these on his potential for retraining for other employment.
The availability of a job within his competence in his community.
The ability of the client to work on a regular and predictable basis.
In these considerations, “useful” occupations will be interpreted to mean a productive activity which adds to the economic wealth or produces goods or services to which the public attaches a money value. However, some activities which a disabled person is able to perform and for which he may be paid, will not be considered as useful occupations because of their purpose and nature. Included as such activities are those jobs which, (1) do not provide a real job opportunity, i.e., made work because of the feeling of compassion or sympathy on the part of the employer, and if the disabled person stopped doing it, no one would be hired to replace him; (2) are occupational therapy, i.e., motivation activity prescribed by a physician for remedial purposes for the individual and carried out under his supervision; (3) are part of a rehabilitation program which is officially designated as “training” and which is carried out under supervision of the rehabilitation agency.
Therefore, a person engaged in activity which is part of a training program, under Community Workshops and/or Vocational Rehabilitation, in his home, at community workshops, or other places offering opportunity for training, is still considered to be totally disabled as the work performed is done under supervision with a therapeutic or training objective as part of a rehabilitative plan. Remuneration received for this kind of activity must be taken into consideration as all other income in determining the eligibility factor of need.
Homemaking as a “useful” occupation involves ability to carry home-management and decision making responsibilities and to provide essential services within the home for at least one person in addition to one's self.
To make a decision of total disability in regard to homemaking, the team will determine that the individual, because of his permanent disability, is unable to perform a significant combination or grouping of the following activities which are important for the successful performance of the occupation of homemaking: shopping for food and supplies, planning and preparing meals, washing dishes, cleaning house (sweeping, mopping, dusting, moving furniture), making beds, washing and ironing clothes, carrying fuel, tending fires, etc.
In addition, if the care of young children is within the homemaking responsibilities the ability to perform the following activites will be taken into consideration: lifting and carrying infants, and in an emergency, preschool children, bathing and dressing young children, training and supervising children, accompanying children to community activities, to sources of medical care, etc.
Inability to perform one-half or more of a significant grouping of these duties as they relate to the individual situation will constitute total disability. Also considered totally disabled will be a homemaker who has the ability to perform all of these duties but not on a predictable basis or for as many hours of the day as are considered necessary in the particular situation.
The decision of total disability as regards a homemaker is also contingent upon the person's capacity to engage in other useful occupations.