TN 43 (12-13)

DI 11005.071 Title II Statutory Blindness Insured Status and Freeze Development

Citations:

Regulations 20 CFR § 404.130 and 404.320

A. Title II insured status for statutory blindness

1. Disability insured status not met based on the alleged onset date (AOD)

For stat blind, the claimant must have fully insured status. If a visually impaired or blind claimant does not meet non-blind insured status, meaning both fully and currently insured, the field office (FO) will:

  • Determine whether the claimant meets blind insured status by obtaining an Informational/Certified Earnings Record System (ICERS) or using the Disability Insured Status Calculator Online (DISCO).

  • If claimant meets blind insured status, provide the Disability Determination Services (DDS) or the Office of Disability Adjudication and Review (ODAR) with the blind insured status dates.

  • Be alert to the presence of lag earnings as recent or current earnings may change the date last insured (DLI). (For information about lag earnings, see RS 01404.005.)

NOTE: For information on insured status, see RS 00301.000. To provide insured status dates to the DDS on the Electronic Disability Collect System (EDCS) 3367, see DI 11005.045C.1.

2. Disability insured status met based on AOD

When a claimant alleges blindness or a visual impairment and meets disability insured status (fully and currently insured), the blind date first insured (DFI) and blind DLI may be material to the alleged onset date. Document the blind insured status dates when:

  • AOD is prior to the non-blind DFI and the blind DFI is earlier than the non-blind DFI;

  • Non-blind DLI is before the filing date or is likely to expire before a determination or decision is rendered; or

  • You determine the blind insured status dates are material to the AOD.

3. Statutory blind insured status examples

Example 1: AOD after non-blind DLI

Mr. Norah alleges a visual impairment along with a few other conditions. His alleged onset date (AOD) is 07/15/2012, and his non-blind DLI is 12/31/2010. You verify his insured status under the blind requirements and his blind DLI is 12/31/2023. Although Mr. Norah does not meet insured status as of his AOD based on the non-blind DLI, he meets insured status under the blind requirements. Provide DDS with the blind DLI and forward the claim to DDS for a blind determination.

Example 2: AOD before Non-Blind DLI

On 09/20/2012, Ms. Wright files a disability application based on blindness with an onset date of 08/01/2009. Her non-blind DLI is 06/30/2012, and her blind DLI is 04/01/2020. In this example, because the non-blind DLI is before the filing date DDS needs to know both the non-blind and blind DLI. If DDS cannot establish onset prior to the non-blind DLI, DDS may establish onset using the blind DLI. Provide DDS with both DLIs and forward the claim for a medical determination.

Example 3: Claimant working above non-blind SGA guidelines

Mrs. Kim alleges vision loss that began 02/23/2012 and is getting progressively worse. Her non-blind DLI is 04/01/2016, and her blind DLI is 09/30/2021. She works part-time and earns $1300 per month. Since her earnings are above the non-blind substantial gainful activity (SGA) amounts for 2013 but below the blind SGA amounts, forward the case to DDS and request a blind determination. Provide the non-blind DLI. The blind DLI is not material to establish an onset date as she meets insured status into the future based on the non-blind requirements.

Example 4: AOD before non-blind and blind DFI

Mr. Johnson alleges blindness as of birth, 08/12/1970. His non-blind insured period is 04/01/2000 through 06/30/2016, and his blind insured period is 01/01/1998 through 12/31/2024. In this example, the AOD is before the blind and non-blind DFI. Therefore, the blind DFI is material. Provide the DDS with the blind DFI.

Example 5: Non-blind DLI prior to filing date

Ms. Navarro files a Title II disability application on 05/12/13 with an AOD of 01/01/13. Her non-blind DLI is 03/30/13 and her blind DLI is 09/30/2023. Because Ms. Navarro’s non-blind DLI expires shortly after her AOD and prior to her filing date, provide DDS with the blind DLI.

B. Title II statutory blind freeze applications

A visually impaired or blind number holder (NH) who meets all other non-medical requirements and performs above blind SGA levels may file a Title II disability claim to be entitled to a freeze only without cash benefits. For information on freeze eligibility, refer to DI 10105.005C.

NOTE: Claimants filing for disabled widow(er)’s benefits (DWB) or childhood disability benefits (CDB) cannot be entitled to a freeze only; see DI 10105.005.

1. Claimant elects to file a disability claim for freeze purposes

When a blind or visually impaired claimant requests to file a disability claim for purposes of entitlement based on a freeze, the FO will:

  • Enter a “Y” response to the BLIND and FREEZE question on the Disability Information (DISB) screen in Modernized Claims System (MCS).

  • Complete the SSA-3368 (Disability Report – Adult) and SSA-3367 (Disability Report – Field Office) in the Electronic Disability Collect System (EDCS).

  • Document any work activity on the SSA-820 (Work Activity Report – Self-Employed Person) or SSA-821 (Work Activity Report – Employee) and your determination on the SSA-823 (Report of SGA Determination).

  • Document your request for a stat blind determination on the SSA-3367 in EDCS; see DI 11005.045.

  • Forward the claim to DDS for a stat blind determination.

NOTE: Do not apply the non-medical completion process to blind or visual impairment allegation cases. For information on non-medical completion, see DI 11010.115.

2. DDS determines stat blind allowance for freeze entitlement:

Upon receipt of the claim from DDS, the FO will:

  • Change “Y” to the freeze question on the DISB screen in MCS to “N.”

  • Enter disallowance reason 0A1 on the BECF screen in MCS.

  • Enter 03 DIB TECH DENY on the DECI screen in MCS.

  • Prepare and release a notice to the claimant as indicated in DI 11010.345E.2.

  • After adjudication, verify that the DIB line of the master beneficiary record (MBR) contains diagnosis code 3694.

  • Add a special message to the MBR to alert others of the freeze only entitlement.

NOTE: For stat blind denials, follow usual processing procedures for denied disability claims.

3. Freeze claimant files subsequent application for other Title II benefits:

When a claimant entitled to a freeze subsequently files for other title II benefits, see:

4. How to identify entitlement to a “freeze only” on the MBR

Stat blind beneficiaries entitled to a disability freeze only (due to performance of SGA) may contact the FO to report they are no longer working and request monthly payments or to file for other benefits. It is important to be able to identify freeze-only entitlements to determine the appropriate next step (e.g., DIB attainment cases).

Identify freeze only entitlement on the MBR by the Ledger account file (LAF) code of “ND” on the BENEFIT line with one or more of the following:

  • STAT BLIND on the INSURED status line.

  • LAF-ND on the BENEFIT line.

  • Onset date on the date of disability onset (DDO) field of the BEN DENY line.

  • Denial code 0A1 on the DISALOW/DEN RSN field of the BEN DENY line. (For more information on denial codes, see SM 00380.040 and SM 00380.100.)

  • Diagnosis code 3694, primary or secondary, on the DIB line (effective December 1, 2012).

  • A special message regarding stat blind freeze determination.


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DI 11005.071 - Title II Statutory Blindness Insured Status and Freeze Development - 05/01/2015
Batch run: 05/01/2015
Rev:05/01/2015