Adjudicators are encouraged to make a PD/PB finding at any point in the Title XVI initial claims development process when the available evidence, although not sufficient for a formal determination, demonstrates a strong likelihood that:

• •

  Disability or blindness will be established when complete evidence is obtained, or the evidence establishes a reasonable basis for presuming the individual is currently disabled, and

• •

  The disabling impairment has lasted or is likely to last at least 12 months.

NOTE: Do not make a PD/PB finding in any case when the available evidence in file is sufficient to make a formal determination.

1. a. 

   Evaluate the categories in DI 11055.231 for a PD/PB finding.

2. b. 

   Consider whether the medical and non-medical information furnished by the applicant or claimant at the time of initial application, and other facts supplied by the field office (FO) interviewer, are sufficient for a PD/PB finding.

NOTE: DDS staff should make a PD/PB finding at any point during the adjudicative process, for any impairment in which the evidence suggests an allowance. However, the available evidence in file must be insufficient for a formal determination.

Make PD/PB findings in appropriate claims, balancing the agency's commitment to expedite provisional Title XVI payments when a claimant meets the PD/PB criteria with the fact that incorrect PD/PB findings run counter to this commitment and create unnecessary additional work.

Because all PD/PB claims require some degree of double handling that could impede the flow of the general Title XVI workload, consider PD/PB findings in these situations:

• •

  Cases the FO flags as meeting the financial conditions for advance payment and in which the FO was unable to make a PD/PB finding (see DI 23020.015);

• •

  Cases in which the formal disability or blindness determination is unduly delayed; and

• •

  Cases in which evidence received during development permits the DDS evaluation team to make a judgment that the total evidence, although not sufficient for a formal determination, is sufficient to make a PD/PB finding. You may consider vocational factors in a PD finding but not in a PB (statutory blindness) finding.

Evidence for PD/PB findings may include:

• •

  Routinely received medical records; or

• •

  Special reports for PD/PB purposes; or

• •

  Facts reported by the FO interviewer.

1. a. 

   Generally, to determine the severity and limiting effects of a respiratory impairment, pulmonary function tests are necessary. Therefore, do not make PD findings for respiratory impairments unless there is convincing evidence that we will allow the claim.

2. b. 

   Do not make PD findings for back impairments unless the case involves traumatic injury to the spinal cord.

3. c. 

   Do not make PD findings for impairments requiring medical deferment unless you have convincing evidence that those impairments meet severity and durational requirements. For medical deferment policy, see DI 25505.035.

PD may apply in the following categories, but exercise caution when predicting severity and duration:

1. a. 

   Diabetes mellitus.

2. b. 

   Epilepsy.

3. c. 

   Essential hypertension.

4. d. 

   Hypertensive heart disease.

5. e. 

   Peptic ulcer.

6. f. 

   Cirrhosis of the liver.

7. g. 

   Bone fractures.

8. h. 

   Mental disorders - (other than intellectual and neurodevelopmental disorders as described in 5.a), where medical evidence is from an acceptable medical source (AMS), establishes a mental disorder, and demonstrates significant limitations in mental functioning (e.g., understand, remember or apply information; interact with others; concentrate, persist or maintain pace; and adapt or manage oneself). Additionally, the available evidence indicates a strong likelihood of an allowance but is insufficient for a formal determination.

The following conditions have a high potential for a PD/PB finding:

1. a. 

   Intellectual disorder or another neurodevelopmental impairment (for example, autism spectrum disorder) with complete inability to independently perform basic self-care activities (such as toileting, eating, dressing or bathing).

2. b. 

   Cancers identified as Stage IV, inoperable, or those that meet a listing based solely upon pathology.

3. c. 

   Central nervous system diseases resulting in significant and persistent motor dysfunction in two or more extremities.

4. d. 

   Renal disease requiring chronic dialysis.

5. e. 

   Symptomatic human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS). For information on PD/PB findings in disability claims involving HIV or AIDS refer to DI 23535.012.

6. f. 

   Cerebral palsy with documented seizure activity in spite of medication compliance.

7. g. 

   Major organ transplants (i.e., lung, liver, heart, kidney, bone marrow, and stem cell transplants), in which the transplant occurred within the period of alleged disability and the case has not been identified as a Terminal Illness (TERI), Compassionate Allowance (CAL), or Quick Disability Determinations (QDD) claims.

8. h. 

   Any QDD exclusion case (cases removed from QDD selection due to lengthy development issues - see DI 23022.055).

9. i. 

   Conditions requiring hospice care that are not currently identified as TERI, CAL, or QDD claims.