Citations:

Regulations No. 4 - Secs.404.1574, 404.1584, 404.1530

Regulations No. 16 - Secs. 416.974, 416.983, 416.984, 416.930

TN 6 (12-14)

DI 26005.001 Title II Statutory Blindness Evaluation Issues

A. Onset date in statutory blindness cases

For detailed information regarding the onset date in blindness cases, refer to DI 25501.380 Establishing the Established Onset Date (EOD) of Statutory Blindness in Title II Disability Insurance Benefits (DIB) Claims.

  1. If we determine that a claimant for Title II DIB was statutorily blind before he or she stopped working, we must establish two onset dates:

    • The first date is the medical onset of statutory blindness (when the disability freeze must begin), even if the claimant was performing substantial gainful activity (SGA). For a discussion of disability freeze, see DI 26001.010.

    • The second date is the date the claimant stopped SGA.

      Example:

      The claimant applied for DIB on February 12, 2013 alleging blindness since May 5, 2010. Medical evidence shows that he has been statutorily blind since the alleged onset date. However, he performed SGA continuously from 1989 to December 31, 2011. He then stopped work. In this case, two onset dates are necessary.

    • May 5, 2010 is the date of onset for statutory blindness and the beginning of the disability freeze.

    • December 31, 2011 is the date of onset for cash benefit payments (when SGA stopped).

    IMPORTANT: Carefully record onset dates on Form SSA-831 per DI 26010.000. Do not complete Item 18B when the established onset date of disability entered in Item 15A is earlier than the onset of statutory blindness as explained in DI 26010.025A.1. Completing Item 18B in this situation can result in an incorrect payment to the claimant.

  2. Related references:

    • Related references:

    • DI 26010.015 Completing Item 15 (Claimant Disabled) on the SSA-831 for Blindness Cases

    • DI 26010.025 Completing Item 18 (Case of Blindness, as defined in section 1614(a)(2)/(216)(i)) on the SSA-831

    • DI 26010.055 Completing Item 27 (Rationale) on the SSA-831 for Blindness Cases

B. Duration of blindness – Title II and Title XVI

The duration requirement for statutory blindness is different for Title II and Title XVI, and for different types of Title II claims.

1. Title II

  1. The 12-month duration requirement for statutory blindness applies to Title II claims for DIB, Childhood Disability Benefits (CDB), and Disabled Widow(er)’s Benefits (DWB) with the following exceptions.

  2. There is no duration requirement for:

    • DIB, DWB, and CDB when the claimant is age 55 or older and work comparability provisions apply. For more information about the work comparability provisions, see DI 26005.001E in this section.

    • DIB freeze at any age. See DI 26001.010D regarding duration and freeze.

2. Title XVI

There is no duration requirement for statutory blindness for Title XVI adult and child claims. See DI 26005.005 Title XVI Statutory Blindness Evaluation Issues.

The following chart shows the duration requirements for blindness for Title II and Title XVI.

Claim Type

Duration Requirement

References

Title II DIB, DWB, or CDB

(except for the following Title II claims)

Yes, 12 months

DI 25505.025

Title II DIB, DWB, CDB

(age 55 and older) and

work comparability provisions apply

No

DI 25505.025E, and

DI 26005.001E in this section

Title II DIB freeze

(any age)

No; however, the freeze must last at least 5 full calendar months

DI 25505.025E, and

DI 26001.010D

Title XVI (adults and children)

No

DI 25505.025E, and

DI 26005.005 in this section

C. Insured status for statutorily blind claimants

A claimant who is statutorily blind and only meets fully insured status can receive DIB or a disability freeze. See RS 00301.150 Insured Status for Statutory Blindness.

  1. Fully insured means the claimant:

    • must have the required number of quarters of coverage. See RS 00301.105B, and

    • is not required to meet the requirement of substantial recent work (the “20/40” test or alternative earnings test for young workers).

    NOTE: The field office (FO) is responsible for determining insured status. See DI 25501.380B Component roles for establishing the EOD for statutory blindness.

  2. If the claimant only meets fully insured status, the only issue is whether the claimant has statutory blindness.

    • The fully insured provision applies only to statutory blindness.

    • It is not necessary to evaluate other impairments. If the claimant is not blind, a denial based on lack of severity is appropriate.

    • For the respective entries on Form SSA-831, see DI 26010.055A.3, and DI 26510.045A. In the chart under DI 26510.045A, see regulation basis code F1 and footnote 2.

D. SGA earnings guidelines for statutorily blind Title II claimants

The following items address issues specific to statutory blindness and SGA. The FO has jurisdiction for SGA determinations.

See DI 26001.015 Jurisdiction of Blindness Cases for additional information about processing statutory blindness cases involving work activity.

1. General SGA earnings guidelines

SGA earnings guidelines are higher for claimants with statutory blindness than for nonblind claimants. See DI 10501.015 and DI 24001.025 for the tables of SGA earnings guidelines.

2. SGA earnings guidelines for blind claimants

We use the SGA earnings guidelines for blind claimants in the evaluation of work activity for initial and continuing DIB, CDB, and DWB entitlement.

NOTE: If the issue of blindness arises during a work CDR, the FO may send the folder to the DDS for a blindness determination. See DI 13010.135 G.

The higher blind SGA earnings level provides blind DIB, CDB, and DWB claimants and beneficiaries the opportunity to work for higher earnings than claimants and beneficiaries disabled by other impairments without affecting benefit payments.

a. DIB, CDB, and DWB claimants and beneficiaries (any age) – nonblind SGA level

A finding of statutory blindness is significant for DIB, CDB, and DWB claimants and beneficiaries of any age who are working at the nonblind SGA level.

Determine that a statutorily blind claimant or beneficiary is not performing SGA if work is at the nonblind SGA level.

b. DIB claimants and beneficiaries – blind SGA level

Statutorily blind DIB claimants and beneficiaries who are working at the blind SGA level are not eligible for cash benefit payments. However, they may qualify for:

  • a disability freeze, and

  • entitlement under the work comparability provisions if age 55 or older, as explained in DI 26005.001E in this section.

c. CDB and DWB claimants and beneficiaries under age 55 – blind SGA level

A finding of statutory blindness is not necessary for under age 55 CDB and DWB claimants who are working at the blind SGA level. This is because they are not eligible for cash benefits and do not qualify for a disability freeze. The FO will deny the claim or cease benefits.

d. CDB and DWB claimants and beneficiaries age 55 or older – blind SGA level

The higher blind SGA level has the same effect on blind CDB and DWB claimants and beneficiaries age 55 or older as it does on blind DIB claimants and beneficiaries age 55 or older who are working at the blind SGA level. However, the disability freeze does not apply to CDB and DWB.

CDB and DWB claimants age 55 or older who are working at the blind SGA level may qualify for entitlement under the work comparability provisions, as explained in DI 26005.001E in this section.

E. Work comparability provisions for blind DIB, CDB, and DWB claimants age 55 or older

1. Definition of disability under these provisions

Section 223(d)(1)(B) of the Social Security Act contains an alternate occupational definition of disability for blind DIB, CDB, and DWB claimants age 55 or older.

We may find a statutorily blind DIB, CDB, or DWB claimant age 55 or older disabled if he or she is unable to perform SGA requiring skills or abilities comparable to those of any gainful activity in which he or she was previously engaged with some regularity and over a substantial period of time.

This definition of disability for blind claimants age 55 or older differs from the regular definition of disability as follows:

  • There is no duration requirement.

  • Work activity is determined to be “comparable SGA” or “noncomparable SGA.”

  • A claimant may become entitled to benefit status even though he or she is performing SGA at the time of entitlement if the work is noncomparable.

  • A claimant who is performing noncomparable SGA may be entitled to a period of disability and disability benefit status; however, we will suspend cash benefit payments as long as he or she is actually performing SGA.

2. Explanation of comparability terms from the definition of disability

a. Any gainful activity

Consider work as “gainful activity” for the purposes of the comparability provisions if it resulted in earnings averaging more than the blind SGA level.

b. Previously engaged

“Previously engaged” means work done prior to the attainment of age 55 or the onset of blindness, whichever is later.

Compare the work done after this later date with the work done over the 10-year period before this date.

Example:

The claimant became statutorily blind at age 54 but worked until age 57.

Because age 55 is later than the onset of blindness, compare the claimant’s work done after age 55 with the work done before age 55.

Compare the skills and abilities required in the work done from age 55 to 57 with the skills and abilities of the work done during the 10-year period prior to the attainment of age 55.

c. Some regularity and over a substantial period of time

Generally, we will consider a period of previous work sufficiently meaningful for purposes of comparison if it continued with reasonable regularity for at least 1 year (not necessarily 12 consecutive months) in the period of current vocational relevance preceding the attainment of age 55 or the onset of blindness, whichever is later.

If no such 1-year period of work occurred, we will assume the claimant did not previously perform any gainful activity with regularity and over a substantial period. Therefore, work after age 55 or onset of blindness does not indicate the ability to do comparable work as defined

3. When a new application is not needed

If a blind claimant is entitled to benefit status under the comparability provisions, and we suspend benefits due to SGA, the claimant does not need to file a new application to receive disability benefit payments when he or she stops SGA.

This differs from the requirement for DIB claimants in regular freeze status only who must file a new application to receive disability benefit payments when SGA stops. CDB and DWB claimants are not eligible for a freeze.

4. Counting time toward the waiting period while performing SGA

If we determine a DIB or DWB claimant is statutorily blind and performing noncomparable SGA, we may count the period of time beginning with the first month of disability toward the waiting period while the claimant is performing SGA.

If SGA continues for 5 full months or more, disability benefit payments may begin as soon as the claimant stops SGA. This differs from the requirement for DIB claimants in regular freeze status only who must serve a waiting period of 5 full calendar months after SGA stops to receive disability benefit payments.

NOTE: CDB claimants serve no waiting period.

5. Comparability determinations

A disability determination requires a comparison of the claimant’s skills and abilities in the periods before and after the onset of blindness or age 55, whichever is later.

  • The FO is responsible for determinations as to whether work before and after onset of blindness or age 55 (whichever is later) is SGA. This may require use of the blind or nonblind work test of SGA or both in evaluating a single period of work because of the differences in SGA dollar criteria based on the year the claimant performed work.

  • The DDS is responsible for the comparability determination in initial and reconsideration cases, and in continuing disability review (CDR) cases where there is a medical issue. The DDS may request FO assistance if needed to determine a work-comparability issue.

    NOTE: If the DDS needs to contact an employer, review Form SSA-827 for the claimant’s permission to contact employers, as explained in DI 11005.055B.

  • The Office of Disability and International Operations, Program Service Center, Disability Processing Branch, is responsible for work comparability determinations in CDRs without medical issues.

6. General guidelines and examples of noncomparable and comparable SGA

  1. If a claimant is not performing SGA, we assume that the claimant cannot do any work, including work that requires skills and abilities comparable to those of any SGA that the claimant had done with some regularity and over a substantial period.

    However, if, before stopping work, the claimant performed any SGA after the onset of blindness or age 55 (whichever is later), compare the work done before and after the onset of blindness or age 55.

  2. Since the ability to see is usually such an essential requirement of work performed in the competitive labor market, blindness itself constitutes a major loss of job skills and abilities.

    Even though a claimant who is age 55 or older and statutorily blind manages to work despite this severe impairment, we will frequently find that the skills and abilities required by the claimant's current work are not actually comparable to those required by the work he or she did previously. See Examples 1, 2, and 4 at the end of this section.

  3. There are instances when we may find a claimant successfully performing comparable work. This may occur when:

    • there has been a progressive reduction in sight to which the claimant has been making a gradual work adjustment so that he or she is able essentially to continue to perform usual work even after reaching the level of blindness; or

    • the nature of the skills and abilities required in work previously performed with sight are such that he or she can transfer at least some of them to the successful performance of similar or different types of work, even after onset of blindness. See Example 3 at the end of this section.

  4. A difference in types of duties in different jobs is by itself not sufficient for a determination of noncomparability. Also, the fact that later work does not require all of the skills and abilities used in the previous work means that the work is noncomparable.

    The crucial issue is whether the major basic skills and abilities required in work performed after blindness and age 55 are comparable to those required in work performed prior to that time.

    If a claimant uses any new and significant skills in performing later work, find that the work is noncomparable.

  5. In making comparisons, give consideration to such physical requirements as:

    • vision, eye-hand, eye-foot, or other coordination; and

    • ability to travel.

In addition, consider mental requirements such as:

  • educational background,

  • professional and technical knowledge and experience,

  • communication skills, and

  • similar skills and abilities that may remain useful even without sight.

Example 1 – Noncomparable SGA

David became statutorily blind in June 2011 at age 57. His previous regular work, which lasted for 15 years, had been as an auto mechanic, ending in May 2011.

After a brief period of training, he started SGA in August 2011 as a vending stand operator in a public building.

Since the skills or abilities required in this current work are not comparable to those required in his previous work, we found David entitled to DIB under the work comparability provisions, as explained in DI 26005.001E in this section.

His 5-month waiting period was from June through October 2011 even though in some of those months he performed SGA, because that work did not require skills or abilities comparable to those of his previous regular work.

We withheld DIB payments because David was performing SGA. However, in June 2012 he notified the FO that he had stopped working at the end of May 2012. We paid benefits beginning with June 2012.

We will continue to pay David benefits unless he again performs SGA, at which time we will need to determine whether we should suspend benefits immediately or after a trial work period.

Example 2 – Noncomparable SGA

Before she became blind at age 52, Ann had been a mathematics teacher in junior and senior high schools.

After losing her sight, she stopped working as a teacher. She subsequently learned to read and write fluently in Braille. At age 56, she started a new job as an editorial assistant for a Braille book publisher for the blind. She does her work with the help of a Braille keyboard and other special aids.

Ann’s current work differs materially from her previous regular work (before age 55) in the skills and abilities it requires from her previous regular work. She has had to become skilled not only in Braille but also in special writing, editorial review, and publication techniques to be able to perform the duties of her new job adequately.

Because she had to acquire new skills and abilities to be able to work, it is reasonable to find that Ann can no longer perform SGA r