DI 21501.255 Washington APTD/AB State Plan
A. Blindness - (WAC 388-24-015) - blindness defined
Blindness is defined in terms of ophthalmic measurements as:
Central visual acuity of 20/200 or less in the better eye with the best possible corrective glasses.
Contraction of the peripheral field of vision to within twenty degrees of the fixation point in all quadrants as determined by standard perimetric testing.
Muscle function, measured in all parts of the motor field and charted upon 20 rectangles, 4 ×5 degrees in size equal to 18/20 binocular or monocular.
B. Permanent and total disability (WAC 388-24-370)
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 of:
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 care.
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 be:
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) are required.
C. Refusal to accept available and recommended medical treatment (WAC 388-24-410)
A disability assistance applicant or recipient who refuses without good cause to accept available medical treatment, which can reasonably be expected to render him able to work or do homemaking, shall be ineligible.
“Available medical treatment” shall mean and include medical, surgical, or psychiatric therapy, or any combination thereof.
“Reasonably be expected to render him able to work or do homemaking” shall mean that, in the opinion of the medical consultant, the
recommended medical, surgical, or psychiatric therapy or any combination thereof, is of such a nature and prognosis, that, in the specific instance of the applicant or recipient involved, medical experience indicates that the recommended treatment will restore or substantially improve the individual's ability to work for pay in a regular and predictable manner or to engage in homemaking.
For the purposes of this section, an applicant or recipient has good cause to refuse recommended medical treatment when, according to the best objective judgment of the state review team, such refusal is based upon one or more of the following conditions:
The individual is genuinely fearful of undergoing recommended treatment. Such fear may appear to be unrealistic, or entirely emotional in origin, or irrational; however, fear exists in such a degree that treatment would be adversely affected and the doctor may therefore be dubious about undertaking to treat the individual.
The individual could lose a faculty, or the remaining use of faculty he now has, and refused to accept the risk.
Because of his definitely stated religious scruples, the individual will not accept recommended medical treatment.
The controlling principle in determining whether refusal was for or without good cause rests with the state office review team which will be guided by whether a reasonable, prudent man under similar circumstances would accept the recommended treatment.