TN 64 (09-09)

DI 11055.001 Title XVI Disability Claims

A. Basic principles of Title XVI disability claims

Two characteristics of Title XVI disability claims:

  • The claimant is disabled or blind, and

  • The claimant has "limited" income and resources.

Disabled or blind adults or children can get Title XVI benefits. There is a separate definition of disability under Title XVI for children from birth to age 18.

The medical standards for disability are, in general, the same in both Title XVI and Title II Disability Insurance Benefits (DIB) programs for individuals age 18 or older, with the exception of statutory blindness. Many individuals eligible under the Title XVI provisions for disability benefits may also be entitled to receive DIB.

NOTE: Always advise claimants of the eligibility criteria under both Title II and Title XVI programs, his or her right to apply, and responsibilities under each program.

References:

  • DI 10105.065, Disability Requirement for Title II

  • SI 00501.001, Eligibility Under the Supplemental Security Income Provisions

  • SI 00601.035, Adjudicating Title II When a Title XVI Application Is Filed

B. Title XVI disability definitions

1. Individuals age 18 or older

A disabled individual, age 18 or older, has a medically determinable physical or mental impairment that results in an inability to engage in any substantial gainful activity (SGA) and

  • is expected to result in death; or

  • has lasted, or is expected to last, for a continuous period of not less than 12 months.

Reference:

DI 10501.001, Meaning of SGA and Scope of Subchapter

2. Individuals under age 18

A disabled individual, under age 18, has a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitation(s) and either

  • is expected to result in death; or

  • has lasted, or is expected to last, for a continuous period of not less than 12 months.

References:

C. Title XVI blindness definition

Blindness under both Title XVI and Title II disability programs is “statutory blindness,” meaning the individual:

  • has central visual acuity of 20/200 or less in the better eye with the use of a corrective lens; or

  • has a limitation in the field of vision in the better eye, so that the widest diameter of the visual field subtends an angle no greater than 20 degrees.

1. No duration requirement for Title XVI statutory blindness

If a Title XVI claimant is statutorily blind and otherwise eligible, he or she is eligible regardless of the anticipated duration of the blindness. Unlike Title II, there is no 12-month duration requirement under Title XVI for statutory blindness.

For information about the 12-month duration requirement for Title II, see DI 00115.015.

2. SGA for Title XVI statutorily blind individuals

A statutorily blind individual is eligible for Title XVI payments even if engaging in SGA, providing that he or she meet all other factors of eligibility; e.g., limited income and resources, and citizenship or qualified alien status.

Reference:

DI 10501.020, Special Development Situations

3. Title XVI claimant disabled, but not blind

For Title XVI purposes, consider the claimant “blind” only if the visual impairments meet the statutory blindness definition.

If the visual impairments do not meet the statutory blindness definition, they may constitute a “disability” provided they meet the required level of severity.

D. Presumptive disability/presumptive blindness (PD/PB)

The law provides that all individuals, both adults and children, filing initial or subsequent Title XVI applications for disability or blindness payments are potential candidates for PD/PB payments.

References:

  • DI 11055.230, Field Office (FO) Responsibilities in Presumptive Disability (PD) and Presumptive Blindness (PB) Cases

  • DI 11055.240, Field Office (FO) Procedures for Processing Presumptive Disability (PD) and Presumptive Blindness (PB) Cases

E. No waiting period and no retroactivity for Title XVI

Unlike Title II, there is no 5-month waiting period, nor is there any retroactivity of bene