TN 2 (12-14)

A. Title II – Disability determination services (DDS) blindness determinations

The field office (FO) will send Title II claims described in DI 26001.015A.1. through DI 26001.015A.5. in this section to the DDS for a determination of statutory blindness when there is an allegation or evidence of blindness or a visual disorder.

The FO will provide the DDS with relevant information regarding insured status and work activity.

The DDS should process these claims as follows:

1. Disability insurance benefits (DIB) claims when the claimant is fully insured for blindness only

When the claimant is fully insured for blindness only, do the following:

• Make a determination on the issue of statutory blindness only. Do not consider other impairments.

• If the claimant is not statutorily blind, deny the claim. Use denial basis code “F1,” as explained in DI 26010.040B.

2. DIB and freeze-only claims when the claimant is performing substantial gainful activity (SGA)

When the claimant is performing SGA, make a determination on the issue of statutory blindness only. Do not consider other impairments.

a. Claimant is not blind

If the claimant is not statutorily blind, deny the claim.

Use denial basis code “N1” or “N2” as appropriate, see DI 26010.040C. and DI 26510.045A.

b. Claimant is blind

If the claimant is statutorily blind, allow the claim.

• If work is below the blind SGA level, the claimant is entitled to both cash benefits and a freeze.

• If the claimant is under age 55 and work is above the blind SGA level, the claimant is entitled to a freeze but not cash benefits.

• If the claimant is age 55 or older and is performing noncomparable SGA, the claimant is entitled to both cash benefits and a freeze. However, we will suspend payments while the claimant is performing SGA.

For a discussion of work comparability provisions, see DI 26005.001E.

NOTE: If statutory blindness was previously established, and benefits ceased due to SGA, the FO will send the new claim to the Program Service Center (PSC) as a DIB attainment case. If a DIB attainment case is misrouted to the DDS, return the case to the FO to forward to PSC. See DIB attainment case processing in DI 13010.135G. and DI 41001.001C.

Related reference:

DI 26001.010 Title II Disability Freeze

3. Childhood disability benefits (CDB) and disabled widow(er) benefits (DWB) claims when the claimant, regardless of age, is performing SGA at the nonblind SGA level

When a CDB or DWB claimant is performing SGA at the nonblind SGA level, make a determination on the issue of statutory blindness only. Do not consider other impairments.

• If the claimant is blind, allow the claim per DI 26010.070B. The claimant is entitled to cash benefits.

• If the claimant is not blind, complete Form SSA-831 per DI 26010.070A. The FO will prepare a personalized SGA denial notice per DI 11010.345E.2.

4. CDB and DWB claims when the claimant is age 55 or older and is performing SGA at the blind SGA level

When a CDB or DWB claimant age 55 or older is performing SGA at the blind SGA level, make a determination on the issue of statutory blindness only. Do not consider other impairments.

• If the claimant is blind, make a work comparability determination. For work comparability provisions, see DI 26005.001E.

• If the claimant is not blind, complete Form SSA-831 per DI 26010.070A. The FO will prepare a personalized SGA denial notice per DI 11010.345E.2.

NOTE: The DDS is responsible for work comparability determinations for initial and reconsideration claims, and continuing disability reviews (CDR) with medical issues. The Office of Disability and International Operations, PSC, Disability Processing Branch, is responsible for work comparability determinations in CDRs without medical issues.

5. Title II work CDR

When a beneficiary is performing SGA:

a. The FO will send a brown folder with required forms to the DDS for a blindness determination if the beneficiary:

• alleges or shows evidence of blindness or a visual disorder;

• has not been previously found to have statutory blindness; and

• is either eligible for Title XVI, which requires a blindness determination; or

• has work activity that is between the nonblind and blind SGA levels.

b. The DDS will make a determination of statutory blindness only following the instructions in DI 13010.135G.2.

Related references:

• DI 10501.015C Tables of SGA Earnings Guidelines and Effective Dates Based on Year of Work Activity

• DI 10515.010 Processing Claims of Blind Persons Involving Work in 1978 or Later

• DI 13010.135F Policy for statutory blindness not previously established

B. Title II – When we do not require a DDS determination of statutory blindness

1. DIB claims

a. If the claimant alleges or shows evidence of a visual disorder, we do not need a blindness determination if:

• we can make a favorable determination based on a nonblind impairment(s); and

• we can reasonably determine that the visual disorder did not meet the statutory definition of blindness prior to the onset date of disability.

In this situation, a regular determination of disability is sufficient. A finding of statutory blindness provides no additional payment or freeze benefits unless the onset of blindness is before the onset of nonblind disability.

Example:

The claimant applied for DIB on November 10, 2013. He alleged disability as of January 15, 2013, when he stopped working due to emphysema, diabetes, and increasingly poor vision.

Medical evidence shows that his respiratory impairment meets listing 3.02 for chronic obstructive pulmonary disease (COPD) since the alleged onset date. A report from his treating ophthalmologist indicates that he has diabetic retinopathy, and his last examination on February 1, 2013 showed his best-corrected visual acuity was 20/80 bilaterally with normal visual fields.

In this example, current vision testing is not necessary because the claimant is disabled due to COPD since January 15, 2013. There is no possibility of an earlier blind onset date since the claimant was not statutorily blind when the ophthalmologist examined him on February 1, 2013.

b. If the claimant later returns to work, the FO will conduct a work CDR. The FO will consider the nonblind and blind SGA levels at that time. If indicated, the FO will send the case to the DDS for a statutory blindness determination as part of the work CDR. See DI 26001.015A.5. in this section.

2. CDB and DWB claims when the claimant is not performing SGA

We do not require a blindness determination for CDB and DWB claimants who are not performing SGA. A regular disability determination is sufficient. Statutory blindness provides no additional payments, and a disability freeze does not apply to CDB and DWB claims.

3. CDB and DWB claims when the claimant is under age 55 and performing SGA at the blind SGA level

If the FO determines that an under-age-55 CDB or DWB claimant is performing SGA at the blind SGA level, we do not require a determination of statutory blindness. The FO denies the claim per DI 10515.010B.3.a.

C. Title II blindness determination table

The following chart shows when we need a statutory blindness determination for Title II claims when there is an allegation or evidence of a visual disorder:

D. Title XVI – When we require a DDS determination of statutory blindness

1. Allegation or evidence of blindness or a visual disorder – adults and children

We must consider blindness in Title XVI adult and child claims when there is an allegation or evidence of blindness or a visual disorder, even if the claimant is disabled by a nonblind impairment.

For Development for blindness under Title XVI when disability is already established, see DI 26005.005B.

2. Allegation or evidence of blindness or a visual disorder, and the claimant is performing SGA

Under Title XVI, SGA is not a consideration for determining if a claimant has statutory blindness. The DDS can establish statutory blindness regardless of SGA. The FO considers the claimant’s earnings under the income and earnings rules.

If a claimant who is performing SGA alleges or shows evidence of blindness or a visual disorder, and we have not previously established statutory blindness, the FO will send the case to the DDS for a blindness determination.

• If the claimant is statutorily blind, the DDS does not need to consider the SGA issue in the determination.

• If the claimant is not statutorily blind, the DDS will make a denial determination. The basis for denial is that the claimant is performing SGA. Use basis code “N33”. See DI 26510.045B.

  NOTE: If the issue of blindness arises during a work CDR, the FO may send the folder to the DDS for the blindness determination. See DI 13010.135 G and I.