TN 16 (04-23)

DI 28005.090 Evaluating Continuing Disability Review (CDR) Cases Involving Blindness

A. Statutory blindness background

1. Blindness listing

To establish statutory blindness, the impairment must meet listing 2.02, 2.03A. 102.02A, 102.02B, or 102.03A. For a comprehensive overview of statutory blindness evaluation for Title II and Title XVI individuals, see DI 26001.001.

2. Medical improvement review standard (MIRS) evaluation of blindness

a. Overview of Title II statutory blindness evaluation when the disabled insurance beneficiary's (DIB) entitlement or insured status has changed at the CDR

There are several considerations involving the evaluation of statutory blindness for Title II beneficiaries at CDR. The disability determination services (DDS) may encounter different scenarios for Title II blindness at CDR, including:

  • Title II individuals with fully insured status where the individual met a statutory blindness listing at the comparison point decision (CPD), or

  • Title II decisions for individuals allowed for an impairment(s) unrelated to blindness at the CPD alleging statutory blindness at CDR.

Please see DI 28005.090D for blindness evaluation directions for each of these scenarios.

b. Overview of Title XVI statutory blindness evaluation at CDR

If the CDR contains a new allegations of blindness that was not previously established at the CPD, it is important to develop the potential blindness at the CDR, even if the individual has established disability previously on the basis of an impairment(s) unrelated to blindness.

Because of possible payment advantages to Title XVI recipients found “blind” rather than “disabled,” undertake development for blindness whenever there is a reasonable basis to believe the visual disorder may meet the statutory definition of blindness, even when the medical evidence of record already establishes disability.

EXCEPTION: A disabled individual who is in a Federal living arrangement D (FLA/D) (i.e., lives in a medical treatment facility where Medicaid pays over 50 percent of the cost of care) is not eligible for any additional benefit amount based on blindness. Do not develop for statutory blindness in this situation, see DI 26005.005. If the individual’s living situation changes and they no longer reside in a FLA/D, the individual may be eligible for the additional benefit amount again based on blindness.

3. Diary considerations and development

Statutory blindness, as defined in DI 26001.001B, generally corresponds with setting a medical improvement not expected (MINE) diary, except blindness due to cataracts or detached retina not correctable by surgery or other treatment, as defined in DI 26525.045B.2c.

Development instructions for individuals who meet the statutory blindness requirements by meeting listings 2.02, 2.03A, 102.02, or 102.03A, is located in DI 28040.130B2.

B. Introduction to evaluation of statutory blindness in CDRs

The CDR sequential evaluation process applies the medical improvement review standard (MIRS) in determining whether an individual is still blind. For information on the CDR sequential evaluation process, see DI 28005.005. Where appropriate, the flexible approach in DI 28005.005C applies. Actions after a finding that blindness ended are discussed in DI 28005.090C.5. in this section.

Establishing statutory blindness or affirming that blindness continues is often an important consideration even when disability continues based on non-blind impairments. Because substantial gainful activity (SGA) limits and other work incentive provisions are higher for blind individuals, this may benefit Title II beneficiaries if the individual attempts to return to work. For Title XVI recipients, additional possible payment advantages, as stated in DI 26005.005 may exist when statutory blindness is established or affirmed on CDR.

C. Step-by-step discussion of the sequential evaluation process for statutory blindness in CDRs

While an individual may continue to be found disabled based on other impairments unrelated to blindness, in certain scenarios we must first consider whether the individual is blind. For CDRs involving allegations of statutory blindness only, we follow an abbreviated medical improvement review standard (MIRS) process outlined below. For additional detailed information on different scenarios when we apply the abbreviated sequential evaluation process below, see DI 28005.090D.

1. Is there medical improvement (MI)?

Decide whether MI occurred in the individual's blindness.

  • If MI did occur, go to step 2.

  • If MI did not occur, go to step 3.

2. Is MI related to the ability to work?

Decide whether MI is related to the ability to work. For consideration of prior listings, see DI 28015.050.

  • If MI is not related to the ability to work, go to step 3.

  • If MI is related to the ability to work, go to step 4.

3. Is there an exception to MI?

Decide whether an exception to MI applies.

  • If one of the Group I exceptions applies, go to step 4.

  • If one of the Group II exceptions applies with respect to the individual's blindness, find that disability due to blindness has ended, and go to step 5.

  • If no exception applies, find that disability due to blindness continues.

4. Does the impairment meet a listing that indicates blindness?

Decide whether the impairment currently meets the statutory blindness requirements of the Listing of Impairments (Listing 2.02 , 2.03A, 102.02A, 102.02B, or 102.03A).

  • If yes, find that disability due to blindness continues.

  • If no, find that disability due to blindness has ended, and go to step 5 below.

5. Blindness has ended; are there any disabling impairment(s) unrelated to blindness?

If blindness has ended, determine whether the individual continues to be disabled due to other impairment(s) unrelated to blindness by applying the steps in DI 28005.005. Follow applicable procedures to determine if disability continues.

DIB entitlement will continue for statutorily blind beneficiaries who meet "Fully Insured" status for blindness only (i.e., do not meet 20/40 or Special Insured status), and are subsequently determined no longer statutorily blind, but still disabled (i.e., have a non-blind impairment). This also applies to the Title II portion of concurrent Title II and Title XVI cases involving "Fully Insured" status for blindness only.

D. Overview of the sequential evaluation process when statutory blindness is established or alleged

The table below outlines the sequential evaluation process to use for different scenarios based on allegations of statutory blindness.

Determining the Steps to Assess Blindness in CDRs

Blind Status at CPD

Alleged impairments at CDR

Evaluation Process

Statutorily blind at CPD (see DI 26001.001 for definition and criteria of blindness)

Established by either:

  • Meeting (or continuing to meet on CDR) Listing 2.02 or 2.03A for adults or Listing 102.02A, 102.02B or 102.03A for children; or

  • Primary diagnosis code of 3694 "statutory blindness" in Item 16A on SSA-831 or Item 21 on the SSA-832 or 833

  • For CPD before 01/14/2014, diagnosis code reflected the underlying cause of blindness- see DI 26510.015G.

Stat blind only, no other impairments

Follow steps to evaluate blindness in DI 28005.090C.

Stat blind at CPD (same criteria above to establish)

Stat blind and other impairments

  • Stat blind no longer alleged, but other impairment(s) unrelated to blindess alleged; or

  • No disabling impairments.

First, consider if statutory blindness still applies. Follow instructions to evaluate blindness in DI 28005.090C. Even if the individual no longer alleges blindness, if the CPD basis was statutory blindness, the disability examiner still needs to determine whether medical improvement in the vision impairment has occurred.

Not stat blind at CPD, newly alleged vision impairment at CDR

Allowed at CPD for an impairment(s) unrelated to blindness, but is alleging statutory blindness at the time of the CDR

Follow appropriate steps in DI 28005.015 for Title II or adult Title XVI individuals or DI 28005.030 for Title XVI children. See DI 28005.090E for assessing new allegations of blindness at CDR.

E. New allegations of blindness at CDR

To determine whether to develop the blindness issue in cases where blindness is alleged but is not established, and disability continues on a basis other than blindness, follow the instructions in DI 26005.001 and DI 26005.005.

F. References

  • DI 13010.135 Title II Continuing Disability Considerations in Blindness Cases

  • DI 26001.005 Evidence of Blindness

  • DI 26001.010 Title II Disability Freeze

  • DI 26005.001 Title II Statutory Blindness Evaluation Issues

  • DI 26005.005 Title XVI Statutory Blindness Evaluation Issues

  • DI 28010.001 Definition and Overview of Medical Improvement (MI)

  • DI 28040.210 Evaluation and Determination When Reviewing Medical Evidence in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases

  • DI 34001.012 Special Senses and Speech – Adult

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DI 28005.090 - Evaluating Continuing Disability Review (CDR) Cases Involving Blindness - 11/15/2022
Batch run: 04/01/2024