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.

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.”

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.

No time factor is involved in the concept of total disability.

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.

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.

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.

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:

1. 1. 

   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.

2. 2. 

   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.

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.

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.

Under the interpretation of a useful occupation there are some activities of a disabled individual which are not considered as useful, such as:

1. 1. 

   Hobbies.

2. 2. 

   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.

3. 3. 

   Occupational therapy prescribed by a physician for remedial purposes.

4. 4. 

   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.

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.

1. 1. 

   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.

2. 2. 

   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.

3. 3. 

   4551.53 Homemaking in a Primitive Setting—In primitive settings homemaking would include carrying water, preparing and carrying fuel, building fires, etc.

4. 4. 

   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.