“Permanently and totally disabled” means that the individual has some permanent physical or mental impairment, disease, or loss, or combination thereof, that substantially precludes him from engaging in useful occupations within his competence, such as holding a job.

“Permanently” refers to a condition which is not likely to improve or which will continue throughout the lifetime of the individual: it may be a condition which is not likely to respond to any known therapeutic procedure, or a condition which is likely to remain static or to become worse unless certain therapeutic procedures are carried out, where treatment is unavailable, inadvisable, or is refused by the individual on a reasonable basis: “permanently” does not rule out the possibility of vocational rehabilitation or even possible recovery in light of future medical advances or changed prognosis: in this sense, the term refers to a condition which continues indefinitely as distinct from one which is temporary or transient.

“Totally” involves consideration, in addition to those verified through the medical findings, such as, age, training, skills and work experience, and the probable functioning of the individual in his particular situation in light of his impairment.

“Useful occupation” means productive activity to which a money value is attached or, in the case of the homemaker, involves 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 the homemaker.

Certain activities of seriously incapacitated persons are not classified as useful occupations.

These are:

1. a. 

   Hobbies

2. b. 

   Incidental services provided other persons in the performance of their duties for which no remuneration is paid.

3. c. 

   Activity which does not provide a bona fide job opportunity, i.e., no one would be hired if the individual stopped doing it.

4. d. 

   Occupational therapy or other therapeutic activity prescribed by a physician for remedial purposes.

5. e. 

   Training through a rehabilitation agency under its supervision.

Remuneration received through such activities need not necessarily preclude a determination of permanent and total disability. The remuneration must be considered, however, in determining the amount of the grant.

To be engaged in a useful occupation the individual should be able to perform the duties considered essential to his employment well enough and with sufficient regularity to receive regular payment for his efforts or, in the case of a homemaker, be able to perform the duties of homemaking in a predictable manner.

An individual's ability to perform in a useful occupation will be tested against his known ability to perform the duties of any occupation for which he may qualify as an employed person or as a homemaker, or his capacity to perform the duties of another occupation following a period of vocational rehabilitation or other training.

The homemaker is generally, but not always, the wife and/or mother in the family. To be considered a homemaker, there must be at least one person in the home.

To be defined as homemaker for the purpose of determining disability, the individual must have been a homemaker prior to the disability and must be one who does not require employment to meet his needs without public assistance.

1. a. 

   The following activities are important to the successful performance of homemaking duties:

   1. 1. 

      Shopping for food and supplies.

   2. 2. 

      Planning and preparing meals.

   3. 3. 

      Washing dishes.

   4. 4. 

      Cleaning house (sweeping, mopping, dusting, scrubbing and moving furniture).

   5. 5. 

      Making beds.

   6. 6. 

      Washing and ironing clothes.

2. b. 

   In addition, where the care of young children is the responsibility of the homemaker:

   1. 1. 

      Lifting and carrying infants or small children.

   2. 2. 

      Bathing and dressing young children.

   3. 3. 

      Training and supervising children.

   4. 4. 

      Taking children to sources of medical care.

   5. 5. 

      Accompanying children to community activities.

3. c. 

   Also, in particular settings, limited facilities may make the following necessary:

   1. 1. 

      Pumping and carrying water.

   2. 2. 

      Carrying fuel.

   3. 3. 

      Building fires.

If an individual is unable to perform a significant combination of these activities because of a permanent impairment, she may be found totally disabled. Also, when an individual may still have sufficient capacity to perform some or all of the above services for at least one other person, but is not able to perform for the number of hours daily that are involved or predictably enough to meet the responsibilities involved, she may be found totally disabled.

Substantially gainful employment means that the individual is employed regularly, part-time or full-time at a remuneration equal to the generally accepted rate of pay for the particular kind of work.

Person meeting one or both of the two criteria below may be found to be totally disabled even though they receive remuneration for activities that have some of the characteristics of a useful occupation.

1. a. 

   The individual is unable to perform the essential activities of daily living without the help of another person, and the following apply.

   1. 1. 

      He is able to perform only because sympathy and compassion are the major factors in making possible the opportunity to engage in remunerative work or in homemaking activities, i.e., family or friends help more than usual by running errands, bringing materials, devising special tools, creating a market based more on sympathy than on intrinsic value received, etc.

   2. 2. 

      He is able to perform only because he puts out energy far beyond that which is ordinarily required for the activity, i.e., it takes him six or seven hours to do what most workers could do in one hour.

2. b. 

   The individual is unable to perform on a predictable basis at any job for which he has any competence and which exists in the community. Such facts as the following are necessary to make a determination of permanent and total disability in these cases.

   1. 1. 

      Medical evidence of attacks of pain, shortness of breath, dizziness or unusual exhaustion.

   2. 2. 

      Medical evidence that such attacks or reactions occur at unpredictable intervals.

3. c. 

   Mental Disorder: Persons who are unable to engage in gainful employment or perform the duties of housekeeping due to severe mental illness (psychosis, severe psychoneurosis, and severe mental deficiency) are considered permanently and totally disabled. The condition must be of a permanent nature that is not likely to respond to any available treatment.

4. d. 

   Sheltered Workshop Situations: Unusual or sheltered work situations in which the applicant/recipient would not be able to do the same type work in the competitive market without special consideration to his particular physical and/or mental condition shall not be considered the same as able-bodied employment.

   Two Aid to the Disabled applicants, for instance, may suffer from equally severe arthritis. One client's application may be denied because his disability is not total and the other's application may be approved with no qualifying conditions. The first application was denied because the client had a high school education, was a trained clerk, and had a stable work history. The second application was approved because the client was illiterate, socially deprived, and had an unstable work history consisting of manual labor. On the basis of this social information the Medical Eligibility Section determined that one client's disability did not prevent him from working in occupations within his competence and that the other client's disability did in fact prevent him from working in occupations within his competence.