TN 34 (03-16)
DI 23535.010 Disability Determination Services (DDS) Responsibilities in Presumptive Disability/Presumptive Blindness (PD/PB) Cases – Title XVI only
A. Identifying PD/PB cases
1. General guidelines for identifying PD/PB cases
You may make a PD/PB finding at any point in the Title XVI initial claims development process when the available evidence, although not sufficient for a formal determination, demonstrates a strong likelihood that:
disability or blindness will be established when complete evidence is obtained, or the evidence establishes a reasonable basis for presuming the individual is currently disabled, and
the disabling impairment has lasted or is likely to last at least 12 months.
NOTE: Do not make a PD finding in any case when the available evidence in file is sufficient to make a formal determination.
2. Basis for a PD/PB finding
Evaluate the categories in DI 11055.231 for a PD/PB finding.
Consider whether the medical and non-medical information furnished by the applicant or claimant at the time of initial application, and other facts supplied by the field office (FO) interviewer, are sufficient for a PD/PB finding.
NOTE: DDS staff may make a PD/PB finding at any point during the adjudicative process, for any impairment in which the evidence suggests an allowance. However, the available evidence in file must be insufficient for a formal determination.
B. Making PD/PB findings
1. General guidelines for making PD/PB findings
Balance the responsibility to make PD/PB findings in appropriate cases against the need to process all Title XVI disability or blindness cases expeditiously. Proper identification of PD/PB claims is encouraged to expedite claimant benefits whenever the claimant meets the PD/PB criteria. However, improper PD/PB findings are counterproductive to the timely adjudication of other disability claims.
Since all PD/PB claims require some degree of double handling that could impede the flow of the general Title XVI workload, only consider PD/PB findings for the following:
Cases the FO flags as meeting the financial conditions for advance payment and in which the FO was unable to make a PD/PB finding (see DI 23020.015);
Cases in which the formal disability or blindness determination is unduly delayed;
Cases in which evidence received during development permits the DDS evaluation team to make a judgment that the total evidence, although not sufficient for a formal determination, is sufficient to make a PD/PB finding. You may use vocational factors in a PD finding but not in a PB (statutory blindness) finding.
2. Types of PD/PB evidence
Evidence for PD/PB findings may include:
Routinely received medical records; or
Special reports for PD/PB purposes; or
Facts reported by the FO interviewer.
3. Impairments with limited PD potential
Do not make PD findings for mental impairments, other than intellectual disability or another neurodevelopmental impairment (for example, autism spectrum disorder) with complete inability to independently perform basis self-care activities (such as toileting, eating, dressing, or bathing) made by another person who files on behalf of a claimant who is at least 4 years old. (see DI 11055.231).
Generally, to determine the severity and limiting effects of a respiratory impairment, pulmonary function tests are necessary. Therefore, do not make PD findings for respiratory impairments unless there is convincing evidence that we will allow the claim.
Do not make PD findings for back impairments unless the case involves traumatic injury to the spinal cord (see DI 11055.231).
Do not make PD findings for impairments requiring deferred development unless you have convincing evidence that those impairments meet severity and durational requirements.
4. Impairments requiring PD caution
Exercise caution in the following categories because of the difficulty predicting severity and duration:
hypertensive heart disease;
cirrhosis of the liver, and
5. Impairments with high PD/PB potential
The following conditions have a high potential for a PD/PB finding:
intellectual disability or another neurodevelopmental impairment (for example, autism spectrum disorder) with complete inability to independently perform basic self-care activities (such as toileting, eating, dressing or bathing);
cancers identified as Stage IV, inoperable, or those that meet a listing based solely upon pathology;
central nervous system diseases resulting in significant and persistent motor dysfunction in two or more extremities;
renal disease requiring chronic dialysis; or
symptomatic human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS). For information on PD/PB findings in disability claims involving HIV or AIDS refer to DI 23535.012.
C. Examples of choosing the right onset for PD/PB findings
To assist you in determining the correct date for PD/PB cases, we provide the following examples. Do not enter a PD or PB onset earlier than the month in which the claimant filed his or her application.
If you make the PD or PB finding in the month in which the claimant filed his or her application, enter the application date.
EXAMPLE: Claimant met PD eligibility requirements in the same month the claimant filed the application
Mr. Jones filed a Supplemental Security Income (SSI) application based on disability on 04/15/15. The FO determined that Mr. Jones met all the non-medical eligibility requirements in April 2015 and input the PD decision. The FO enters 04/15/15, the date of application, so that Mr. Jones receives payment beginning May 2015.
If the current month is the month immediately following the month of filing, use the application date as the onset date.
EXAMPLE: Claimant met PD eligibility requirements in the month immediately following the month the claimant filed the application
Ms. Smith filed an SSI application on March 24, 2015. The FO determined she met the non-medical eligibility requirements in March 2015.
The DDS determined that she was presumptively disabled, inputting the PD finding on April 2, 2015. The DDS enters 03/24/15 (the application date) so that Ms. Smith may receive payments beginning April 2015.
If you make the PD or PB finding two or more months after the month of filing, enter the month and year prior to the month in which you made the PD or PB finding.
EXAMPLE: Claimant met PD eligibility requirements after the month the claimant filed the application
Mrs. Williams filed an SSI application on April 5, 2015. The FO determined she met the non-medical eligibility requirements in April 2015. The DDS determined that she was presumptively disabled, inputting the PD finding on June 2, 2015. The DDS enters 05/01/15 (which is the month, day, and year prior to the month the DDS made the PD finding) so that Mrs. Williams may receive payments beginning June 2015.
NOTE: If you enter a month and year different from the filing date, then the day must equal “01” (i.e., the first day of the month).