DI 21501.240 Utah APTD/AB State Plan
A. Blindness — definition of blindness means visual acuity of 20/200 or less (4541)
As a basis of eligibility for aid to the blind, the Utah State Department of Public Welfare has adopted the following definition:
“In terms of ophthalmic measurement, central visual acuity of 20/200 or less in the better eye with correcting glasses is generally considered as economic blindness. A field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends at an angular distance of no greater than 20 degrees may be considered equally disabling. Applicants with more than 20/200 visual acuity in the better eye with correcting glasses may be considered eligible for blind assistance if the supervising ophthalmologist determines there are other pathological factors.”
B. Permanent and total disability
1. 4551 Definition of permanent and total disability
The definition of permanent and total disability is not limited to cases of invalidity—that is, cases of complete helplessness. On the other hand, inability to continue in a specified type of employment or industry does not, in itself, constitute permanent and total disability. Many individuals will have had employment or be potentially employable if rehabilitated. Some will never have been in the labor force or be considered for it due to the nature of their handicap. The impairment may be physical or mental, organic or functional, and of such a degree as to interfere with faculties, such as senses, reasoning, mobility, etc. It may exist from birth, be acquired during lifetime or result from accident. It may be obvious, such as loss of a limb, or can be revealed only by medical examination.
In general, permanent and total disability means that an individual has some permanent physical or mental impairment, disease or loss that “substantially precludes” him from engaging in useful occupations within his competence, such as holding a job or homemaking.
a. 4551.1 Definition of permanent disability
The term “permanent” means a physiological, anatomical or emotional impairment verifiable by medical findings. The impairment must be of major importance and must be a condition not likely to improve and which will continue throughout the lifetime of the individual. Any condition considered as not likely to respond to any known therapeutic procedures shall be deemed permanent. Any condition which is likely to remain static or to become worse unless certain therapeutic measures are carried out shall be considered permanent so long as treatment is not available, not advisable or the individual refuses treatment and his decision is reasonable.
b. 4551.11 Permanence does not rule out recovery
Permanence does not rule out the possibility of vocational rehabilitation or even recovery. The discovery of new drugs or advances in medical treatment may change a permanent situation. The term need not be considered as “everlasting” or “unchangeable” but as probably continuing indefinitely as distinct from “temporary.”
c. 4551.2 Definition of total disability
Total disability is not absolute since it must be considered in its relation to the ability of the individual to be active in carrying out specified responsibilities in connection with employment or homemaking. Total disability must be related to age, training, skills and work experience and the probable functioning of the individual in his particular situation as related to his disability.
d. 4551.21 No time factor in total disability
No time factor is involved in the concept of total disability.
e. 4551.22 Members of society expected to perform certain activities
As members of society, adults are expected to take care of themselves and their families. For some people this means gainful employment; for others it means the maintenance of a home and caring for children. To do this, individuals must be able to perform certain activities demanded of everyone, such as walking, standing, bending, lifting, using the senses of sight, touch, hearing, ability to talk, learn, act purposefully, remember, etc.
2. Total disability must be related to ability to engage in a useful occupation (4551.23)
The individual's capacity to act in society depends upon a relationship between the kinds of activity necessary as an employable person or homemaker and the use of faculties in carrying such a role.
Total disability must be related to ability to engage in a useful occupation. A man might not be able to carry on his previous occupation because of minor impairment. For example, a violinist because of a finger injury. However, he would not be considered totally disabled because he could perform in many other kinds of useful occupations. On the other hand, a permanent impairment would not limit physical ability to work as a draftsman, but an individual might not be able to develop a competence as a draftsman or in any other useful occupation, so would be totally disabled. If an individual is illiterate, 55 years of age, and has always worked at heavy labor, he probably will not have the skill for sedentary work. Therefore, if the medical evidence shows coronary heart disease with only sedentary work permissible, the individual would be totally disabled for any work which he is competent to perform.
a. 4551.124 When employment exists within capability of the individual he is unemployed and not disabled.
If medical information shows that physical capacity existed for light work such as operating an elevator or acting as a watchman and the individual had competence for such work, and work of this nature existed in the community but no job was available, the individual would be considered as unemployed rather than totally disabled.
b. 4551.3 Definition of substantially precluded
The term “substantially precluded” relates to the extent to which an impairment leaves an individual unable to engage in activities necessary to carry on specified responsibilities such as those related to employment or homemaking.
c. 4551.31 Policy when individuals are bedfast but engage in some gainful activity
If an individual is disabled to the extent he cannot leave his bed, leave his home, get to nourishment or maintain body hygiene without help, he would ordinarily be considered as totally and permanently disabled to the extent that he is not able to engage in a useful occupation, but through supreme effort he does some work. Under these circumstances a decision of permanent and total disability is proper if it is determined that the individual is doing more than can ordinarily be expected, based upon the following considerations:
The individual is able to do something because the family, friends or neighbors help more than is usual because of their sympathy. They run errands, bring materials, help devise and create special tools, or create a market through a church or other organization, etc.
Energy to accomplish must be far beyond what is ordinarily required for the activity, such as taking six or seven hours to do what most workers would do in one hour.
d. 4551.32 Individuals with an impairment who are able to perform regularly for compensation are not eligible for AD.
If an individual is able to perform on a job well enough and with sufficient regularity to receive regular compensation or to carry out homemaking responsibilities on a continuing basis, he cannot be considered as permanently and totally disabled or eligible for AD.
e. 4551.33 Individuals not bedfast and activity not substantially gainful are eligible for AD
There will be a group of individuals who are disabled but not to the extent they are bedfast. They will be able to do many things but be unable to perform work on a predictable basis, for which the individual has competence and which exists in the community. In such cases there must be medical evidence to show that the physical condition is such that attacks of pain, shortness of breath, dizziness, unusual exhaustion, or some medically demonstrable reaction occur at irregular intervals and with such intensity that the individual is precluded from engaging in any useful occupation on a predictable basis. Since irregularity and unpredictability prohibit continuous performance, presumable employment in the usual sense is precluded for an individual so limited by a permanent impairment. Any earnings or profits of such a person would be considerably less than that of a person who performs the same job regularly. If such individuals are doing as much as is medically possible and the activity is not substantially gainful, a decision of permanent and total disability is proper.
3. 4551.4 Definition of useful occupation
The term “useful occupation” means productive activity which adds to the economic wealth, or produces goods or services to which the public attaches a money value, and demands the time and attention of the doer for the benefit of others.
a. 4551.41 Some activities which are not useful occupations
Under the interpretation of a useful occupation there are some activities of a disabled individual which are not considered as useful, such as:
Activity which does not provide a bona fide job opportunity; i.e., if the individual stopped doing it, no one would be hired to replace him.
Occupational therapy prescribed by a physician for remedial purposes.
That part of a rehabilitation program which is officially designated as “training”.
Under such an interpretation of “useful occupation”, individuals may be active in a training program in their own home, in schools, sheltered workshops, factories or other places offering opportunities for training. The determining factor is not location, but the economic value of what is produced. Thus, some persons working in sheltered workshops may be engaging in a useful occupation and some may not, since their activities are part of a rehabilitation plan without economic significance.
b. 4551.5 Homemaking as a useful occupation
Homemaking within the interpretation of useful occupation involves ability to carry home management and decision making responsibilities and provide essential services within the home. If a person is not able to perform a significant combination or grouping of homemaking activities as described below, a decision of disability is proper.
4551.51 Activity Involved in Homemaking—Homemaking activity includes the successful performance of shopping for food and supplies, planning and preparing meals, washing dishes, cleaning house (sweeping, mopping, dusting, moving furniture), making beds, washing and ironing clothes.
4551.52 Homemaking Activities With Children—If there are children, additional activities include lifting and carrying infants, bathing and dressing young children, training and supervising children, accompanying children to community activities, to secure medical care, etc.
4551.53 Homemaking in a Primitive Setting—In primitive settings homemaking would include carrying water, preparing and carrying fuel, building fires, etc.
4551.54 Homemaking Includes At Least Two Persons—Homemaking within the interpretation of a useful occupation includes the ability of home management, decision making and essential services within the home for at least one person in addition to the homemaker.