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

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

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

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

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.

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

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  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.

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.

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

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  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.

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:

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  alleges or shows evidence of blindness or a visual disorder;

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  has not been previously found to have statutory blindness; and

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

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  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:

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

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

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  DI 13010.135F Policy for statutory blindness not previously established

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

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

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  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.

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.

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.

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.

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.

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

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  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.