Identification Number:
EM-16018
Intended Audience:All RCs/ARCs/ADs/FOs/WSUs/TSCs/PSCs/OCO/
OCO-CSTs/DDSs/ODAR
Originating Office:DCO OPSOS
Title:Disability Claims Potentially Associated with Flint, Michigan (MI) Water Supply Contamination – Instructions will follow shortly
Type:EM - Emergency Messages
Program:Title II (RSI); Title XVI (SSI); Disability
Link To Reference:See References at the end of this EM.
 
Retention Date: November 17, 2017

Retention Date: November 17, 2016

A. Purpose


This emergency message (EM) provides instructions for processing, flagging, and coding disability claims related to the Flint, Michigan (MI) water crisis. It also includes information about medical evidence and impairments that may result from ingesting toxic lead.

B. Flint, MI Water Crisis

In April 2014, Flint, MI changed its water source from the Detroit Water and Sewerage Department (DWSD) to the Flint River. Corrosive water from the Flint River caused lead from aging water pipes to leach into the water supply. Estimates are that this exposed thousands of Flint residents to unsafe levels of lead in the water supply.

Lead is a highly toxic metal that can cause many health problems when ingested or inhaled. The definitive test for lead exposure is a blood lead level (BLL) test. Results are reported in micrograms per deciliter (µg/dL). An elevated BLL is defined as a BLL of 5 µg/dL or greater in a venous blood sample.

    1. Lead can produce adverse effects on virtually every system in the body; it can damage:
        · the kidneys,
        · the nervous system,
        · the reproductive system, and
        · the cardiovascular system.
    2. It is especially harmful to the developing brains of fetuses and young children. Fetuses, infants, and children under age 5 are at the highest level of risk for irreversible problems resulting from lead poisoning. Adverse effects can occur at low levels of exposure and BLLs do not have to remain persistently high over a certain period for the harmful effects to be permanent.

    3. Adults can experience the same symptoms as children can; however, most adults can tolerate higher blood levels of lead than children and are more likely to have reversible effects once exposure stops. As with most toxic substances, the higher level of exposure and the longer the exposure, the greater degree of irreversibility is expected.

    4. In children, signs and symptoms of the long-term effects of lead exposure and elevated BLLs include:

        · learning and memory problems,
        · decreased verbal abilities,
        · impaired speech and hearing,
        · behavioral problems,
        · hyperactivity,
        · and attention deficit hyperactivity disorder (ADHD).

    5. Other symptoms can include:
        · myalgias or paresthesias,
        · fatigue,
        · irritability,
        · lethargy, and
        · abdominal pain.
    6. Moderate exposure signs and symptoms include:
        · general fatigue,
        · difficulty concentrating,
        · muscular exhaustibility,
        · tremor,
        · headache,
        · abdominal pain,
        · vomiting,
        · constipation, and
        · weight loss.
    7. Some other long-term effects of exposure to high levels of lead are:
        · kidney disease,
        · increased risk of hypertension, and
        · increased risk of gout.
    C. Processing instructions

    SSA created the Flint flag exclusively for the purposes of identification, tracking, and data collection. All components should follow normal business processing for claims identified with a Flint flag. No special handling is required for Flint claims, unless there is evidence that qualifies a Flint claim for priority processing, e.g., TERI, Military Casualty/Wounded Warriors (MC/WW), 100% Permanent and Total (P&T), etc.

    D. Flagging instructions

    We will apply the Flint flag to cases based on an allegation of impairment(s) due to the water contamination in Flint, MI.

    1. Teleservice Center processing instructions for disability cases involving lead poisoning allegations due to the Flint, MI water crisis

      Follow the instructions in the Teleservice Center Operating Guide (TSCOG) TC 10010.040 for developing the disability claim. If the caller alleges filing for benefits due to the water contamination in Flint, MI, use the REMARKS field on the LPFP screen to alert the field office that this case is a Flint lead poisoning case.
    2. Field Office (FO) and Workload Support Units (WSU) instructions for flagging disability cases involving lead poisoning allegations due to the Flint, MI water crisis

      Follow normal case development procedures. Consider the following information:
        a. For new initial claims, reconsiderations, hearing requests, or medical continuing disability reviews (CDR) prior to transfer, attach a Flint flag to these cases in the Electronic Disability Collect System (EDCS) per DI 81010.080B.1.b.
          b. For claims already transferred but part of the manual FO tracking, create a Flint flag in eView per DI 81010.080B.1.a.
            c. For paper claims, use the paper Flint flag in Exhibit 1 of this EM.
            3. DDS instructions for flagging disability cases involving lead poisoning allegations due to the Flint, MI water crisis

              If the FO did not flag the case prior to case transfer or DDS discovers during development that a Flint flag is required, take the following steps:
              a. Add the Flint flag in eView.

              b. Document the claims folder with the reason for adding the Flint flag.

              c. For paper claims, use the paper flag in Exhibit 1 of this EM.

              NOTE: If someone incorrectly added the Flint flag to the claim, document the reason for the removal on a form SSA-5002 (Report of Contact) and remove the flag following the flag deletion steps noted in DI 81020.085D.


            4. ODAR instructions for flagging disability cases involving lead poisoning allegations due to the Flint, MI water crisis

              If the case does not have the Flint flag, but you discover it meets the criteria for Flint flagging, take the following actions:
                a. Add the case characteristic “FLNT” in CPMS for request for hearing level cases.
                  b. Add the “FLNT” case characteristic in ARPS for any case identified by the Office of Appellate Operations (OAO).
                    c. For paper claims, use the paper flag in Exhibit 1 of this EM.

                    NOTE: If an incorrect Flint case characteristic was added to the claim:


                      · Hearing office employees will close the case characteristic and enter a remark documenting the reason for closing the case characteristic in CPMS.
                      · Employees in the OAO will close the case characteristic and enter a remark documenting the reason for closing the case characteristic in ARPS.

                  E. DDS list coding requirement

                  These instructions apply to a subset of Flint cases where case evidence indicates:

                    · Flint-related lead exposure (regardless of allegations) and

                    · A venous blood sample showing 5µ/dL or greater lead level.



                  If case evidence establishes these findings, DDS will code the determination or decision with disability-related list code 429. Do not apply the list code based on flagging criteria.
                    · Enter the code in item 26 of form SSA-831 (Disability Determination and Transmittal) or item 34 of form SSA-832 (Cessation of Continuance of Disability or Blindness Determination and Transmittal-Title XVI) or SSA-833 (Cessation of Continuance of Disability or Blindness Determination and Transmittal-Title II) .

                  F. Case development information

                    Follow normal case development procedures. Consider the following information:
                    · BLLs should be available for claimants alleging impairments resulting from lead exposure. BLLs provide information about level of exposure, and with time, evidence of decreasing blood levels with removal of lead exposure and treatment. Blood levels can provide adjudicators with some indication of possible severity; however, development by adjudicators should focus on evaluation of the claimant’s alleged limitations arising from lead exposure. Request BLLs for claimants alleging lead exposure from the sources identified by the claimant. Because these tests do not directly correlate with severity and because they are available at no or low cost from public heath entities, we do not expect adjudicators to purchase these tests in a consultative exam. For more information, see DI 22510.006.

                    · Cognitive testing, hearing, and speech screenings may be administered by the schools and will be available as part of a claimant’s school or medical record as increasing levels of public health intervention are put into place.

                    · If this testing is not available from the school or public health entities or if an adult is experiencing cognitive or sensory effects secondary to lead exposure and has not had testing, purchase consultative examinations for cognitive testing, hearing, or speech evaluations, as indicated by case facts.

                    · Mental status examination may be appropriate where there are indications of related behavioral problems, depression, anxiety, or post-traumatic stress disorder (PTSD), especially considering the magnitude of the public health event. For more information, see DI 24505.030.


                  Direct all program-related and technical questions to your Regional Office (RO) support staff or Program Service Center (PSC) Operations Analysis (OA) staff. RO support staff or PSC OA staff may refer questions, concerns or problems to their Central Office contacts.

                  Hearing Office (HO) personnel will direct any questions to HO management, who will forward the questions to the RO if needed. RO staff may refer questions or unresolved issues to their Headquarters’ contacts in the Office of the Chief Administrative Law Judge.

                  In OAO, staff and adjudicators will direct any program-related or technical questions to the Executive Director’s Office at |||ODAR OAO.

                  Exhibit 1, Flint Case Flag

                  Microsoft Word 97-2003 Document.docxMicrosoft Word 97-2003 Document.docx


                  References:
                  DI 22510.006, When Not to Purchase a Consultative Examination (CE)
                  DI 24505.030, Expedients to Evaluate and Develop Evidence for Potential Mental and Physical Impairments
                  DI 81010.080, Alerts, Flags, and Messages in the Electronic Disability Collect System (EDCS)
                  DI 81020.085, Certified Electronic Folder (CEF) Flags
                  TC 10010.040, Claims Requiring Disability Reports and Disability Starter Kits
                  EM-16018 - Disability Claims Potentially Associated with Flint, Michigan (MI) Water Supply Contamination – Instructions will follow shortly - 05/17/2016