Identification Number:
DI 25235 TN 4
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Case Processing Instructions for Title XVI Child Claims
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 252 – Title XVI Child Claims Based on Disability
Subchapter 35 – Case Processing Instructions for Title XVI Child Claims
Transmittal No. 4, 04/01/2021

Audience

PSC: DE, DEC;
OCO-OEIO: CR, ERE, FDE, RECONE;
OCO-ODO: DE, DEC, DS, RECONE;
ODD-DDS: ADJ, DHU;

Originating Component

ODP

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

Summary of Changes

DI 25235.005 Medical Diary Criteria for Certain Title XVI Disabled Infants

We updated the numbering of the functional equivalence examples based on new musculoskeletal listings.

DI 25235.005 Medical Diary Criteria for Certain Title XVI Disabled Infants

A. Policy

The general diary policies in DI 26525.001 and DI 26525.025B. apply to title XVI disabled child cases. However, additional criteria for medical diaries apply for certain infants. The basic principle for setting diaries is: Set a MIE diary for the date the infant is expected to be found no longer disabled; otherwise, set a MIP or MINE diary as appropriate to the evidence in the case.

B. Procedure

1. Diary Date for Infants with Congenital Organ Dysfunction – Functional Equivalence Example 3 (DI 25225.060)

Example 3 in DI 25225.060 says we will find an infant disabled until attainment of age 1 if the: “Child has a major congenital organ dysfunction which could be expected to result in death within the first year of life without surgical correction, and the impairment is expected to be disabling (because of residual impairment following surgery, or the recovery time required, or both)….”

a. When To Set Diary at Age 1

Set the diary date at age 1, unless the child is expected to be still disabled at that date. Use MIE Reason Code C, per DI 26525.025B.2.

b. When To Set Later Diary Date

If the child is expected to remain disabled at age 1, set a later MIE diary date based on the evidence in the case record and on clinical judgment regarding when it is expected that the child’s impairment(s) will no longer be disabling. If appropriate to the evidence, set a MIP or MINE diary. Consider all evidence about the child’s impairment that is available at time of adjudication. Guidelines for establishing MIE, MIP, and MINE diaries are in DI 26525.025, DI 26525.035, and DI 26525.045, respectively.

2. Low Birth Weight Infants

See DI 25235.006 for LBW diary guidelines.

3. Systems Limitations Affecting Diary Date

If systems limitations preclude a diary for the child’s first birthday, or for the date by which medical improvement is expected to have occurred, set the diary for the earliest date allowed by the system (i.e., 6 months following the date of adjudication).


DI 25235 TN 4 - Case Processing Instructions for Title XVI Child Claims - 4/01/2021