Identification Number:
DI 26010 TN 5
Intended Audience:See Transmittal Sheet
Originating Office:DCBFM OFPO
Title:Completion of Form SSA-831-U5 in Blindness Cases
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 260 – Statutory Blindness Cases - Development, Evaluation and Processing Issues
Subchapter 10 – Completion of Form SSA-831-U5 in Blindness Cases
Transmittal No. 5, 10/22/2018

Audience

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

Originating Component

ODP

Effective Date

10/19/2018

Background

This is a QAT. These revisions do not change or introduce new policy or procedure.

Summary of Changes

DI 26010.020 Completing Items 16A (Primary Diagnosis) and 16B (Secondary Diagnosis) on the SSA-831 for Title II and Title XVI Blindness Cases

1. DI 26010.020 B. Third Bullet - reorganize the sentence

(Bullet) Moved first sentence to previous bullet . However, if eCAT is used, show the underlying cause as an “Other” impairment.

2. DI 26010.020 B. See Details: referenced exact language in the reference

(Third Bullet)

See DI 26510.015C, for determining the primary and secondary diagnosis codes when Drug addiction and alcoholism (DAA) or symptomatic HIV infection is involved.

DI 26010.020 Completing Items 16A (Primary Diagnosis) and 16B (Secondary Diagnosis) on the SSA-831 for Title II and Title XVI Blindness Cases

In all claims in which statutory blindness is established, you must enter “Statutory Blindness” and diagnosis code 3694 in Item 16A (Primary Diagnosis) or Item 16B (Secondary Diagnosis).

A. “Statutory Blindness” is the primary diagnosis

When “Statutory Blindness” is the primary diagnosis:

  • In Item 16A (Primary Diagnosis), use the term “Statutory Blindness” as the primary diagnosis. Enter body system “02” and impairment code “3694” in the blocks provided.

  • In Item 16B (Secondary Diagnosis), show the underlying cause of the blindness and the corresponding diagnosis code.

B. “Statutory Blindness” is the secondary diagnosis

When “Statutory Blindness” is the secondary diagnosis:

Enter “Statutory Blindness” as the secondary diagnosis when the established onset date is based on another impairment and that impairment’s onset date is before the onset date of statutory blindness.

  • In Item 16A (Primary Diagnosis), enter the diagnosis of the other impairment at the established onset date. Enter the related body system code and diagnosis code.

  • In Item 16B (Secondary Diagnosis), enter “Statutory Blindness” as the secondary diagnosis and show diagnosis code 3694. Because item 16B can only show “Statutory Blindness,” the underlying cause cannot be shown in item 16 of the SSA-831 (Disability Determination and Transmittal) http://inform.ssahost.ba.ssa.gov/PDFs/ssa831u3.pdf In this situation, show the diagnosis code of the underlying cause in item 34, Remarks.

  • In eCAT, show the underlying cause in the Medically Determinable Impairments section.

NOTE: A claimant has statutory blindness only if the visual disorder meets the Listing of Impairments criteria of 2.02 or 2.03A for adults, or 102.02A, 102.02B, or 102.03A for children.

See Details:

  • See DI 26510.015, “Completing Item 16A and 16B - (Primary and Secondary Diagnosis, Body System Code and Impairment Code) on the SSA-831 Disability Determination Transmittal” for background on establishing diagnoses and impairment codes.

  • See DI 26010.025B, third bullet, for onset.

  • See DI 26510.015C, for determining the primary and secondary diagnosis codes when Drug addiction and alcoholism (DAA) or symptomatic HIV infection is involved.

 


DI 26010 TN 5 - Completion of Form SSA-831-U5 in Blindness Cases - 10/19/2018