Page 1453

West Virginia Income Maintenance Manual Chapter 18

West Virginia Income Maintenance Manual Page 35 Chapter 18 WV WORKS Activities/Requirements

18.4.7.B.2 Content of the Physician’s Statement Generally, the statement must contain enough information to allow the Case Manager to determine if the participant is disabled. If the physician makes a definite statement that the participant is permanently and totally disabled, no further information is needed. Usually, however, the physician describes the situation, and the Case Manager must make the determination. In these situations, the statement must contain: • The type of condition, including the diagnosis if known; • Any unusual limitations the condition imposes on the participant's lifestyle; and • The length of time the condition is expected to last. This is required only to set a control for reevaluation; there is no durational requirement for which the condition must exist or be expected to exist. 18.4.7.B.3 Making the Determination Once the necessary information is received, the Case Manager makes the determination based on the following guidelines: • If the condition is one listed in Appendix C of Chapter 13 as a guideline for presumptively approving an AFDC-Related Medicaid case, disability is established. No durational time limits are imposed. • Any other condition must impose limitations on the participant's normal way of life. For example, a case of hypertension, requiring only a special diet and daily medication, does not substantially alter an individual's way of life, since eating is part of his daily routine, and taking medication does not significantly interrupt normal activities. However, a diagnosis of hypertension requiring daily medication, special diet, frequent rest periods and avoidance of stress substantially limits a normal lifestyle. 18.4.7.C Establishing Incapacity The definition of incapacity and the procedures for making the determination found in Section 13.3.3 apply here.