TN 6 (12-14)

DI 26005.005 Title XVI Statutory Blindness Evaluation Issues

The definition of blindness is the same for Title II and Title XVI. See DI 26001.001A Title II and Title XVI – Statutory Blindness

A. How Title XVI blindness differs from Title II blindness

Although the definition of blindness is the same for Title II and Title XVI, we evaluate blindness differently under Title XVI.

Unlike Title II, to find a claimant statutorily blind under Title XVI, there are no requirements for:

  • duration (see DI 26005.001B.2.),

  • cause of blindness (see DI 26001.005B), and

  • the inability to perform substantial gainful activity (SGA). Blind claimants are eligible for payments even if they are performing SGA, provided the claimant meets the other requirements for eligibility, such as income and resources.

    NOTE: Blind claimants under Title XVI are not subject to any SGA limitations.

B. Development for blindness under Title XVI when disability is already established

Because of possible payment advantages to Title XVI claimants or recipients found “blind” rather than “disabled,” undertake development for blindness whenever there is a reasonable basis to believe the visual disorder may meet the statutory definition of blindness, even when the medical evidence of record already establishes disability.

EXCEPTION: In initial claims, a disabled claimant who is in a Federal living arrangement D (FLA/D) (i.e., lives in a medical treatment facility where Medicaid pays over 50 percent of the cost of care) is not eligible for any additional benefit amount based on blindness. Do not develop for statutory blindness in this situation.

IMPORTANT: If the claimant is statutorily blind, and the field office (FO) checked DI, DS, or DC in Item 8 of Form SSA-831, change the claim type to BI, BS, or BC, as appropriate. See DI 26010.010.

NOTE: If the issue of blindness arises, the FO may send the folder to the DDS for the blindness determination. See DI 13010.135G and I.

C. Presumptive blindness determinations

For information on the development and evaluation of presumptive blindness claims, refer to the Presumptive Disability/Blindness instructions in DI 23535.000.

D. Failure to follow prescribed treatment in Title XVI blindness cases

See instructions in DI 23010.025 Failure to Follow Prescribed Treatment - Special Title XVI Issues – Blindness

E. Multicategory claims

Under Title XVI, a recipient may elect to change to another type of claim category. A person will generally request a change in category to receive a higher payment, such as changing from disabled to blind. A person may also initially apply as disabled or blind after attaining age 65.

1. FO responsibilities

The FO will forward multicategory claims to the disability determination services (DDS) for a disability or blindness determination.

The FO will identify cases by the remark “SSI multicategory case (disability) (blindness) (date)” in Item 11 of Form SSA-831 or Item 5 of Form SSA-3367. This remark will specify the category the claimant has requested and the earliest date for which onset will affect benefits.

2. DDS responsibilities

  1. For multicategory claims, the DDS will do the following:

    • Handle cases referred by the FO for disability or blindness determinations in the same manner as other disability or blindness cases.

    • Process disability or blindness cases of claimants age 65 or older in the same manner as disability or blindness cases of claimants under age 65.

    • Follow normal documentation requirements, development procedures, and evaluation criteria cases except for the establishment of the onset date in allowance determinations.

  2. When establishing the onset date, the DDS will do the following:

    • In disability cases, it is not necessary to establish onset prior to the date shown in Item 11 of Form SSA-831, or Item 2, 3, or 5 of Form SSA-3367, unless there is a question of severity or duration.

    • In blindness cases, it is never necessary to determine whether onset occurred prior to the date shown in Item 11 of Form SSA-831, or Item 2, 3, or 5 of Form SSA-3367, because there is no duration requirement.