As of December 1, 2012, identify a favorable stat blind determination or decision by the following diagnosis and medical listing codes:

• •

  Diagnosis code (DIG) 3694, and

• •

  Medical listing code 2.02 or 2.03A for adults and 102.02A, 102.02B, or 102.03A for a disabled child.

Prior to December 1, 2012, cases do not have this diagnosis code. Identify stat blind claimants on the SSA-831 (Disability Determination and Transmittal) or the SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal) by the medical listing codes in DI 11005.072A.1. in this section.

Be alert to situations where there is a:

• •

  Title XVI stat blind allowance; and

• •

  Title II is technically denied for lack of insured status (090 denial code).

If the field office (FO) discovers the Title XVI claimant meets stat blind insured status, reopen the denial and send the Title II claim to the Disability Determination Service (DDS) for a stat blind determination.

IMPORTANT: Do not apply collateral estoppel.

DDS determination propagates into the appropriate Modernized Claims System (MCS) screens and Title XVI data fields. Contact DDS if there is a question regarding the determination. For stat blind allowances, determination data propagates to the following screens:

1. a. 

   MCS DISABILITY ALLOWANCE/DENIAL (DICL) screen:

   • •

     3694 DIG code,

   • •

     “Y” stat blind indicator on DICL screen, and

   • •

     An adjusted blind onset date (ABOD) if the claimant ceased substantial gainful activity (SGA) after onset of stat blindness.

2. b. 

   Title XVI Disability Clearance Data page:

   • •

     3694 DIG,

   • •

     Claimant is Blind (Y): Y,

   • •

     if applicable, ensure the multi-category eligibility coded,

   • •

     the Supplemental Security Record (SSR) individual recipient identification field (ID) will update to “BI,” “BS,” or “BC.” If the TMR is not changed, contact DDS for clarification.

For Title XVI disability claims, enter blind work expenses (BWEs) as applicable on the Work Expenses-Blind Work Expenses intranet page and the Work Expenses- Impairment Related Work Expenses intranet page.

For information on the screens referenced, see MSOM MCS 009.005, MSOM INTRANETSSI 014.032 Work Expenses - Blind Work Expenses, and MSOM INTRANETSSI 014.033 Work Expenses - Impairment Related Work Expenses.

REMINDER: Effective December 1, 2012, use 3694 DIG code in all stat blind allowances.

NOTE: The DDS blind allowance determination for Title XVI updates the type of case indicator in the type of master record (TMR) and ID fields of the SSR from disabled to blind. If the TMR and ID fields do not update correctly, review the SSA-831, and contact DDS to correct the determination and input.

Situations may arise where the FO must review the DDS determination on the SSA-831. To identify a stat blind allowance on the SSA-831, depending on the details of the claim (Title II or Title XVI, adult or child, SGA or work comparability), DDS may annotate the following items:

There may be cases where the DDS establishes two onset dates:

1. a. 

   A non-blind onset date and a later blind onset date: Item 15 of the SSA-831 will show the earlier (non-blind) onset date. DDS documents the later blind onset date in the SSA-831 remarks section for Title II determinations and in item 18B for Title XVI determinations. The later onset date does not propagate on the MCS DICL screen or the Title XVI Disability Clearance Data page.

   IMPORTANT: DDS leaves item 18B blank in Title II cases when a blind onset is preceded by a non-blind onset. Otherwise, MCS incorrectly calculates the date of entitlement (DOE) for payment based on the later onset. For this reason, the FO may need to review the SSA-831 to process the stat blind determination correctly.

2. b. 

   Two different onset dates for blindness (Title II DIB claims only) – The earlier date signifies the onset of blindness (item 15 of the SSA-831) and the later date (item 18B of the SSA-831) establishes the date the claimant is eligible to receive Title II payments based on the inability to perform SGA. This occurs when the claimant engages in SGA but later stops (prior to filing). The earlier onset establishes the start date of the freeze. The latter date (the adjusted blind onset date (ABOD)), controls the start of the 5-month waiting period and the date of entitlement (DOE) to DIB. The ABOD propagates onto the ABOD field of the MCS DICL screen.

   NOTE: The ABOD field on the MCS DICL screen contains a date later than the blind onset in item 15 (never earlier) when the claimant cannot be entitled to payment until a later date due to SGA.

Do not deny a Title XVI claim alleging blindness or a visual impairment based on SGA prior to a DDS stat blind determination. If the claimant meets all other income and resource requirements, forward the case to DDS for a blind determination. For information on SGA and Title XVI blindness requirements, see DI 11055.001C.2. Once DDS makes a stat blind determination, take the following action:

• •

  Stat blind favorable determination:

  If DDS establishes blindness, apply blind work expenses (BWEs) to the claimant’s earnings. For information on BWEs, see SI 00820.535.

• •

  Stat blind unfavorable determination:

  If the DDS cannot establish blindness, DDS will make an SGA (N33) denial determination. Process the denial determination.

Identify stat blind entitlement on the MBR by any of the following:

• •

  Diagnosis code 3694 (DIG or SDIG) on the DIB line (as of December 1, 2012); or

• •

  0A1 in the RDD field of the beneficiary denial/disallowance data (BEN DENY) line; or

• •

  STAT BLIND indicated in the INSURED data line; or

• •

  An adjusted blind onset date (ABOD) in the BENEFIT data line; or

• •

  DAC code of L, N, P, S, or T in the disability insurance benefit (DIB) line; or

• •

  A special message regarding stat blind determination.

Identify stat blind entitlement on the SSID by any of the following:

• •

  ID of BI, BC, or BS;

• •

  DIG code 3694 (as of December 1, 2012) on the Disability Data (DISB) line; or

• •

  Special message regarding stat blind determination.

NOTE: Review the SSA-831 and any subsequent SSA-833 determination if the MBR or SSID does not indicate stat blind and you have information that indicates a visual impairment.

If a claimant entitled to a freeze only due to SGA stops engaging in SGA and is now eligible for monthly cash benefits, the Office of Disability Operations/Processing Service Center/Disability Processing Branch (ODO/PSC-DPB) is responsible for making a DIB attainment determination (DI 13010.135G). The FO will:

1. a. 

   Take a new disability claim in MCS or obtain a paper SSA-16 (Application for Disability Insurance Benefits).

2. b. 

   Document all work activity on a work activity report (SSA-820 or SSA 821 (Work Activity Report – Self Employed, Work Activity Report – Employee)) and your determination on the SSA-823 (Report of SGA Determination), and store these forms in the certified electronic folder (CEF) (DI 81001.000 Certified Electronic Folder). For information about work activity report, see DI 10515.025.

3. c. 

   Route the claim to the ODO/PSC-DPB by completing the NON-DOFA field on the DECI screen of MCS and select 2=NON-DDS JURIS; and

4. d. 

   Fax an SSA-3601 (Claims Routing form) to processing center (PC) Paperless stating, “DPS PROC TOEL CLAIM MISC – DIB Attainment Case” and include the location of the work activity report.

For PC instructions on processing DIB attainment cases, refer to DI 41005.010.

Monthly benefits are reinstated for stat blind claimants age 55 and over with non-comparable SGA. ODO/PSC-DBP is responsible for all work CDRs involving stat blind beneficiaries age 55 and over. For information on stat blind age 55 and older work CDRs, see DI 13010.135E.