In general, permanently and totally disabled means that the individual has some permanent
physical or mental impairment, disease or loss that substantially precludes him from
engaging in a useful occupation within his competence, such as holding a substantially
gainful job or homemaking. The impairment may be physical or mental, organic or functional,
and of such degree as to interfere with the individual's faculties, such as senses,
reasoning, mobility. It may exist from birth, be acquired during the lifetime of the
individual, or result from accident. It may be obvious, such as loss of a limb, or
it may be such that it can be revealed only by medical examination. It may exist singly
or in combinations.
The term “permanently disabled” refers to the existence of a physiological, anatomical, emotional and/or mental impairment
verified by medical findings, which is of major importance, and is a condition not
likely to improve, but will continue throughout the lifetime of the individual. Any
condition which is considered by the medical reviewer as not likely to respond to
any known therapeutic procedure shall be deemed to be a permanent impairment. Furthermore,
any condition which is considered as likely to remain static or to become worse unless
certain therapeutic measures are carried out shall be deemed to be permanent so long
as treatment is unavailable, inadvisable, or the individual refuses treatment and
his decision is reasonable. (see WAC 388-24-410) Decision that an impairment is permanent
can be made even though recovery from the impairment may be possible due to:
The discovery of new drugs or other advances in medical treatment is always a potential
which may change a permanent “situation” , but pending the actual physical improvement, the classification is proper. Therefore,
the term permanent need not be everlasting or unchangeable, but is used in the sense
of continuing indefinitely as distinct from temporary or transient.
A physician's medical report must be used to establish the existence of an impairment
and its permanency.
The term “totally disabled” refers to an individual's ability to perform those activities necessary to carry
out specified responsibilities such as those necessary to employment or homemaking.
Totality involves considerations in addition to those verified through the medical
findings such as age, trainings, skills and work experience, and the functioning of
the individual in his particular situation in light of his impairment. Such social
data will describe the individual's education and work history, the activities required
of him in his home or in his job, living conditions, interests, his capacity and limitations,
and the extent to which he has adjusted to his impairment.
Job training may enable permanently and totally disabled persons to acquire a new
skill in spite of his impairment. However, during a reasonable period of training
and until he acquires job competence, he continues to be totally disabled.
The social summary must show how the person reacts in social situations in order to
illustrate that his disability substantially precludes him from engaging in employment
or homemaking in the foreseeable future. The social worker carries the major responsibility
for providing the area review team with the recorded objective social information
bearing on the totality factor.
The term “substantially precludes” relates to the extent to which an individual's permanent impairment has left him
unable to engage in those activities necessary to carry on specified responsibilities
such as employment and homemaking. If an individual is able to perform such activities
well enough and with sufficient regularity to receive substantial payment for his
effort or to carry on homemaking responsibilities on a continuing basis, he is not
considered precluded from engaging in “useful occupations” and cannot be found to be permanently and totally disabled.
The term “useful occupations” means productive activities which add to the economic wealth, or produce goods or
services to which the public attaches a money value. However, the person whose impairment
is so severe that it results in his being unable to leave his bed, leave his home
or maintain body hygiene without help of another person, and for whom the assumption
would commonly be used that he could not engage in any useful occupation, but in fact,
through supreme effort he does some work, shall have his ability evaluated in light
The extent to which sympathy or compassion enters into the opportunity to engage in
remunerative work. In other words, is the individual able to do something because
family, friends, or neighbors help more than is usual—for example, running errands,
bringing him materials, “engineering” the job, helping devise and create special tools, creating a market based more on
sympathy than intrinsic value received, selling through church or other organization
without charging the usual commission, etc.
The extent to which the energy which must be discharged by the person is far beyond
that which is ordinarily required for that activity. For example, does it take him
six or seven hours to do what most workers could do in an hour?
If through careful consideration of such facts, in addition to the medical and social
reports, it can be reasonably concluded that this individual is doing more than can
ordinarily be expected from individuals with impairments of similar severity, but
his activity is not substantially gainful, a finding of permanent and total disability
may be reached.
The term “homemaking” involves the ability to carry the home management and decision making responsibilities
and provide essential services within the home for at least one person in addition
to oneself. This may be either a man or a woman. If homemaking is such that children
are neglected or the other person receives practically no benefit from her efforts,
these facts should be clearly shown in the social summary. If she must have the help
of other persons to complete the essential household tasks, it may be shown that she
is not actually able to perform as a homemaker. The following activities are important
to successful performance of the occupation of homemaking—shopping for food and supplies;
planning and preparing meals; washing dishes; cleaning house; making beds; washing
and ironing clothes and, if the care of young children is within the homemaking responsibility—lifting
and carrying infants; bathing and dressing young children; training and supervising
children; accompanying children to community activities and to sources of medical
A finding that a person is unable to perform the occupation of homemaking would require
that the individual is unable to perform a significant combination or grouping of
these activities because of his permanent impairment. When homemaking is the responsibility
of the applicant, determination shall be made as to whether a permanent impairment
prevents the applicant from totally meeting such responsibility.
Special emotional problems
Alcoholism. For alcoholism to be considered permanently and totally disabling, since
there is such variation in the severity of alcoholism, at least one of the following
criteria are required for approval of disabling assistance:
Evidence that a pathological or demonstrable organic damage has resulted from chronic
alcoholism, such as neuritis or cirrhosis of the liver;
Evidence that the alcoholism has reached the addiction state as shown by marked ethical
deterioration, the obsessive character of the drinking, the approaching loss of alcohol
tolerance, prolonged bouts, and a breakdown of the rationalization pattern;
A history of several years of excessive drinking to the extent that it has adversely
affected his interpersonal relationships and his social and economic functioning.
Loss of employment and inability to sustain employment because of excessive drinking.
Personality inadequacy. Even though the medical report does not show a physical ailment
which of itself is permanently disabling, a person may be found to be permanently
and totally disabled if the medical or psychiatric report together with the social
report supplemented with a psychological report, if indicated, shows an extended history
of a combination of personality problems, character disorders or social inadequacies
including unusual behavior, which prevents the person from making the adjustment required
for an employable person or a homemaker.
This would include the person whose responses to his environment are habitually inadequate
and who seems to have limited or no voluntary control over his reactions. The symptoms
of this emotionally unstable personality usually are demonstrated antisocial or unconventional
behavior of one kind or another, e.g., drug addiction or alcoholism.
The person does not get along with other people and may break many of society's rules.
Most of these persons have had one difficulty after another since childhood with the
typical lack of awareness and lack of remorse that is associated with this kind of
behavior. The repetitive nature of their problems coupled with the lack of motivation
for change produces an individual whose pattern provides a serious permanent impairment
that can be totally disabling. Examples of this kind of personality inadequacy might
The returned patient from a mental hospital who is no longer psychotic but whose
behavior would be unacceptable to a prospective employer or to his family.
The person who has never been able to hold a job due to a pattern of emotional instability,
or other unusual behavior which shows that the individual is unable, for an extended
period, to substantially engage in any gainful occupation or homemaking.
Drug addiction over an extended period of time.
In all cases of personality inadequacy, the reports specified in subsection (7)(b)