The client is permanently impaired when by medically verifiable findings, the impairment (physical or mental) or combination of impairments is such that it is irreversible, or progressive, and not amenable to treatment, or requiries treatment that is continuous, extremely hazardous, or of questionable benefit. The decision as to premanency is based upon the medical findings available at the time the decision is made. “Permanence” need not be everlasting.

The client is totally disabled when the impairment or combination of impairments, found to be permanent by verifiable medical findings, restricts the client in the performance of the usual activities of daily living to such an extent that he requires services, or the presence of another person to perform these activities, and which permanently precludes the applicant from engaging in a useful occupation as a homemaker or as a wage earner. In relation to the applicant's being precluded from engaging in a useful occupation as a homemaker or as a wage earner, a major relocation of the place of residence of the applicant in order to better his job opportunities is a decision that shall be decided in the context of the social evaluation.

1. 1. 

   A useful occupation is an activity which is designed to add to economic gain, or by which goods are produced or services performed to which the public attaches a money value. Not included in this meaning are, for example, special hobbies, occupational therapy and training under a vocational rehabilitation plan.

2. 2. 

   If the client is a homemaker, she is totally disabled if the impairment is such that she requires the services or the presence of another person to perform the essential and usual housekeeping activities.

   Housekeeping activities are considered to be those necessary to manage the house and to carry out decision making responsibilities and to provide essential services within the home for at least one person besides the homemaker.

   Examples of housekeeping activities may include the following: shopping for food and household supplies, planning and preparing meals, washing dishes, cleaning house, washing and ironing, etc.

   The activities which must be performed by the individual client-homemaker will depend on such factors as whether she has children (young or old), labor saving devices, aids to getting around (such as wheelchair), a telephone and stores which deliver groceries.

   If the client has an employed or employable husband, not only should she be unable to carry out essential and usual housekeeping activities, but her care shall require securing the help of someone not already living in the household, or the husband's continuing presence in the home.

3. 3. 

   The client is prevented from engaging in useful occupation or from carrying out essential and usual housekeeping activities.

   1. a. 

      Although he engages in a limited activity or homemaking, he requires the help of others to do so, or can do so only by exerting extraordinary efforts on his part or

   2. b. 

      Although the impairment appears irregularly provided it is of such intensity and frequency as to prevent him from engaging in usual activities of daily living on a regular and predictable basis.

   644.1 U.S District Court Decision on Eligibility Limited to Persons Requiring Services or Presence of Another Person in Performing Usual Activities of Daily Living.

   The following U.S. District Court Decision is not part of the Texas State plan but is herein included as an interpretation of the plan's criteria.

   17.225 Earline Center, etal. v. Raymond W. Vowell, et al, U.S. District Court, Western District of Texas, Austin Division, Civil Action No. A-1-CA-118. Memorandum Opinion and Order filed May 7, 1973. Roberts, D.J.

   Welfare-APTD-Eligibility Limited to Persons Requiring Services or Presence of Another Person in Performing Usual Activities of Daily Living. Texas could not limit “eligible persons” under the Permanently and Totally Disabled (APTD) program to those requiring the services or presence of another person in performing the usual activities of daily living. Texas Revised Civil Services Handbook, Secs. 2220, 2221. Such a limitation created an eligibility requirement for APTD recipients not contemplated in Title XIV of the Social Security Act, 42 U.S.C. 1351 et seq. and, therefore, was void under the Supremacy Clause. The intent of Congress in establishing the APTD program appeared clearly to have been to provide assistance for persons unable to engage in a useful occupation. The Texas requirement that one also need the services or presence of another person in performing the usual activities of daily living was an additional and wholly unrelated condition for assistance. Thus, Texas attempted to provide benefits for only a sub-class of the whole class intended to be benefited under federal legislation. This restriction could not stand. The state welfare officials were ordered to notify by first class mail at their last known addresses all persons who were denied APTD benefits solely because of the challenged restriction. Retroactive benefits however, were denied on the basis of Rothstein v. Wyman, 467 F. 2d 226. Back reference: 1120. Available from National Clearinghouse for Legal Services.