TN 43 (12-13)

DI 11005.072 Field Office Disability Claims Process of Statutory Blind Allowances

A. Title II and Title XVI statutory blindness allowances

For statutory blind (stat blind) allowances, be alert to the following data.

1. Diagnosis and listing codes for stat blind

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.

2. Title XVI disability claim allowed and Title II disability claim technically denied

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.

3. Verify correct inputs in the MCS and MSSICS

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

  1. 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. MSSICS Disability Clearance Data (CDIB):

    • 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 MSSICS 023.004, 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 supplemental security record (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.

4. Form SSA-831 in Title II and Title XVI stat blind allowances

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:

ITEM

TITLE II

TITLE XVI

7

FZ for blind freeze-only claims

 

8

 

BI, BS, or BC

15A

Stat Blind onset date unless there is another impairment with an earlier onset

Left blank for blind only determinations

If the non-blind onset date is before the blind onset date, item 15A shows the earlier onset date.

16A or 16B

3694 diagnosis code

3694 diagnosis code

18A

Blind freeze only, NH continues to:

engage in substantial gainful activity (SGA)

or

engage in comparable SGA (Age 55 or over)

 

18B

Under age 55 and:

Unable to engage in SGA continuously.

or

Unable to engage in SGA for a continuous period of at least 12 months, but regained the ability to engage in SGA no more than 14 months before the month of filing.

Age 55 or over and:

Unable to engage in any SGA after the date in item 15.

or

Engaged in comparable SGA after the date in item 15 but subsequently stopped working.

or

Engaged in comparable SGA after the date in item 15 and subsequently changed to non-comparable SGA.

or

Unable to engage in comparable SGA for a period of at least 5 full calendar months but regained ability to engage in comparable SGA no more than 14 months before the month of filing.

or

Continued to engage in non-comparable SGA after the date shown in Item 15A. If so, the date shown is the first day of the latest of:

  1. The month of attainment of age 55;

  2. The first month of the 17-month period before the month of filing the application; or

  3. The first full month that the claimant met the statutory definition of blindness.

Title XVI claimant found stat blind

Date entered will be one of the following:

Date of filing

or

Exact onset, if after month of filing

or

Exact date of medical onset if onset earlier than the month of filing.

19

Block A is checked when:

  • The claimant’s insured status expires after the date of adjudication and disability or blindness is not established through the date of the current determination.

      

    or

  • For a closed period case, when the period of disability ends earlier than the 14th month before the month of filing.

DDS marks Block B when the claimant is found not disabled or blind on or before the date last insured (DLI) and the DLI is before the date of the current determination.

DDS marks Block C in all childhood disability benefit (CDB) over age 55 cases.

DDS will check Block A when disability or blindness cannot be established.

22

A1

A61

23

2.02 or 2.03A for adults

102.02A, 102.02B, or 102.03A for children

2.02 or 2.03A for adults

102.02A, 102.02B, or 102.03A for children

34

  • Two onset dates established (one for disability and one for blindness);

  • Item 18 completed;

  • Item 27 completed or

  • For additional examples of when DDS annotates this field, see DI 26510.095.

Remarks entered as appropriate. For additional examples of when DDS annotates this field, see DI 26510.095.

B. Established blind onset date

1. DDS establishes two onset dates

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

  1. 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 MSSICS CDIB screen.

    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. 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.

2. Title XVI blind onset date and SGA earnings

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.

C. How to identify a stat blind case on the MBR and SSID

One or more indicators may be present.

1. Identifying stat blind entitlement on MBR

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.

2. Identifying stat blind entitlement on SSID

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.

D. Title II stat blind freeze only or age 55 and over stat blind claimant no longer performs SGA and requests monthly benefits

1. DIB attainment

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 (