Section 3. Special Factors in Aid to the Blind

Par. 1. General Statement—In addition to meeting the condition of eligibility described in Section 1 of this chapter, a recipient of Aid to the Blind must have either no vision or vision so defective with correcting glasses as to prevent the performance of ordinary activities for which eyesight is essential.

Par. 2. Definition of “Blindness”—Blindness, for purposes of this chapter, is defined as (a) central visual acuity of 20/200 or less in the better eye with correcting glasses, or (b) 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.

Section 4. Special Factors in Aid to the Disabled

Par. 3. Definition of Terms—In general, “permanently and totally disabled” 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. The impairment may be physical or mental, organic or functional, and of such a degree as to interfere with the individual's faculties, such as senses, reasoning, mobility, et cetera. The impairment may exist from birth, be acquired during the lifetime of the individual, or result from accident. The impairment may be obvious, as in the instance of the loss of a limb, or it may be such that it can be revealed only by medical examination, and it may exist singly or in combination.

The concept of “permanently and totally disabled” must be understood if the program is to avoid the implication that it is merely assistance to individuals who can do things for themselves and who are looked upon, or tend to look on themselves, as no longer effective members of society. As a means of shedding further light on a concept, the various components of the above definition are described separately as follows:

1. 1. 

   Permanently—The term “permanently” refers to a physiological anatomical, or emotional impairment which is verifiable by medical findings. A physician must provide the county welfare board with the information which bears on this aspect of eligibility.

   The impairment must be of major importance and must be a condition not likely to improve or which will continue throughout the lifetime of the individual. Any condition which is not likely to respond to any known therapeutic procedure shall be deemed to be permanent; furthermore, any condition which is considered likely to remain static, or to become worse, shall be deemed to be “permanent” if treatment is unavailable, inadvisable, or if the individual justifiably refuses treatment.

   “Permanence” does not rule out the possibility of vocational rehabilitation or even recovery from the impairment. Individuals will sometimes respond favorably to treatment after an unfavorable prognosis or the condition may become arrested. The discovery of new drugs or other medical advances may also change the prognosis on a previously-regarded permanent condition. Thus, the term “permanently” cannot be defined in an absolute sense but rather must be defined relatively in the sense of continuing indefinitely, as distinct from “temporary” or “transient.”

2. 2. 

   Totally—Like “permanently,” the term “totally” is not absolute since it must be considered in reference to the ability of the person, as revealed by the facts in his case, to perform those activities necessary to carry out certain responsibilities, such as those necessary to employment or homemaking. In addition to medical findings, “totally” involves such other considerations as age, training, skills, and work experience, and the probable functioning of the person in his particular situation in light of his impairment.

3. 3. 

   Substantially Precludes—The term “substantially precludes” has reference to the degree to which an individual's permanent impairment has left him able to participate in those activites which are essential to holding a job or homemaking. If an individual is able to perform such activities well enough and with sufficient regularity to receive regular payments for his efforts or to carry on homemaking responsibilities on a reasonably continuing basis, he cannot be found to be permanently and totally disabled.

4. 4. 

   Useful Occupation—A “useful occupation” generally means productive activity which demands the time and attention of the person for the ultimate benefit of others. Hobbies, activities which do not provide bona fide job opportunities, occupational therapy, and training programs designed for seriously disabled persons are not ordinarily regarded as “useful occupations.”

5. 5. 

   Homemaking—This term involves the ability to carry on home-management and decisionmaking responsibilities, and also includes the extent of capacity to provide essential services within the home for at least one person in addition to one's self as distinguished from the maid or housekeeper who is hired to perform domestic duties for wages in a home maintained by others.

   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 (sweeping, mopping, dusting et cetera); making beds; washing and ironing clothes. In certain settings having primitive facilities, carrying water and fuel and building fires may also constitute important factors in the ability to successfully perform home making duties.

   Par. 6 Acceptance of Medical Treatment—The applicant with a physical or mental impairment which is disabling but which is considered to be amenable to some generally accepted and available therapeutic measure will be expected to follow through with such treatment as a condition of eligibility. Those who decline treatment will normally be denied assistance unless it can be shown that their refusal is based on risks that a “reasonably prudent person” would not undertake. The matter of whether restorative treatment must be pursued as a condition of eligibility for Aid to the Disabled should therefore be considered from the standpoint of whether the person is unreasonable in his refusal or whether his life or remaining capacity is actually endangered.

   Par. 7. Acceptance of Vocational Training or Employment After Training—The inability to continue in a certain type of employment or industry does not, in itself, constitute permanent and total disability within the meaning of this program. Nor does the fact that a person may have to change occupations or work locations to be reemployed within the limitations of his remaining capacity. If a person is determined to be capable of light work such as operating an elevator, answering the telephone, or performing as a watchman, and work of this nature exists in his community or in a community to which he can reasonably be expected to move, such a person will be considered unemployed rather than permanently and totally disabled.