PROGRAM OPERATIONS MANUAL SYSTEMPart DI – Disability InsuranceChapter 252 – Title XVI Child Claims Based on DisabilitySubchapter 35 – Case Processing Instructions for Title XVI Child ClaimsTransmittal No. 4, 04/01/2021
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.
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.
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)….”
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.
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.
See DI 25235.006 for LBW diary guidelines.
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).