TN 68 (07-14)

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

Citations:

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:

  • is determined presumptively disabled or blind; and

  • meets all other non-medical factors.

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).

Reference:

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:

  • we are likely to allow the claim on formal determination; and

  • there is an allegation listed in the PD/PB categories chart in DI 11055.231.

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

<