TN 68 (07-14)
DI 11055.230 Field Office (FO) Responsibilities in Presumptive Disability (PD) and Presumptive Blindness (PB) Cases
Section 1631 of the Social SecurityAct
20 C.F.R §§ 416.931 - 416.934
The presumptive disability (PD) presumptive blindness (PB) provisions only apply to Supplemental Security Income (SSI). The purpose of the PD/PB provision is to expedite monthly benefits to claimants that we presume are disabled or blind and are otherwise eligible while the more extensive development is completed.
A. Policy for PD/PB determinations
An individual applying for SSI based on a disability or blindness may receive up to 6 months of payments (beginning the month after the month the application is filed) prior to the final determination of disability or blindness if he or she:
The PD/PB payments end the earliest of the month in which the:
Disability Determination Services (DDS) makes a formal finding on whether the claimant is disabled or blind;
claimant is paid the sixth monthly payment based on PD or PB; or
claimant no longer meets one of the eligibility requirements for SSI (e.g., excess income or resources).
SI 02009.060 Presumptive Disability/Blindness Involvement In Computations
B. FO and DDS authority to make PD/PB determinations
FOs are authorized to make PD/PB determinations for impairments that are readily observable or can be easily confirmed. We list these impairments in DI 11055.231.
However, the DDS may make a PD/PB finding in any case where there is a strong likelihood that the claimant will be allowed on formal determination (DI 23535.010). Appropriate application of the PD/PB provision permits applicants to receive benefits while more extensive development is completed.
1. Eligible claims
Consider every individual filing a SSI claim for benefits, including children, to be a potential candidate for PD/PB benefits. The FO can make a PD/PB determination in any SSI claim in which:
However, if we denied an individual’s prior claim based on medical factors, the FO or DDS may make a PD/PB finding only when:
the individual presents sufficient evidence;
there is documentation of a worsening physical or mental condition;
there is documentation of the existence of a new impairment; or
there is a strong likelihood that the claim will be medically approved.
2. Ineligible claims
PD/PB provisions do not apply in the following situations:
claimant engages in substantial gainful activity (SGA) (see DI 10501.001);
claimant has a history of sustained work while severely impaired, which ended for reasons not related to the impairment;
reconsideration or appeals cases; and
prerelease cases (see SI 00520.910).
C. PD/PB requirements
1. FO PD/PB requirements
The FO may make PD and PB findings based on the claimant's allegations in cases when all of the following apply:
the claimant filed an SSI application (not a reconsideration or other administrative appeal) based on disability or blindness; and
the claimant is not engaging in SGA; and
the claimant's impairment meets a PD/PB criterion in this subsection; and
observations made within the framework of a claims interview, submitted evidence, or third party information is consistent with the claimant’s allegations or contacts with other sources (applicable to categories 2-9 and 17 in DI 11055.231).
2. PD/PB categories
The categories of impairments in DI 11055.231 include any:
impairment that is likely to meet listing level severity; or
claim in which the impairment may, or may not, meet listing level severity, but which is likely to meet the special medical-vocational profile in DI 25010.001B.
3. Information and evidence for a PD/PB determination