TN 2 (12-14)
DI 26001.005 Evidence of Blindness
Evidence requirements for statutory blindness are different for Title II and Title XVI.
A. Title II evidence of statutory blindness
For Title II claims:
We need evidence from an acceptable medical source to establish a medically determinable visual impairment.
Acceptable medical sources for visual disorders include licensed:
Physicians (medical or osteopathic doctors); and
Licensed optometrists for impairments of visual disorders, or measurement of visual acuity and visual fields only, depending on the scope of practice in the State in which the optometrist practices.
For more information about who are acceptable medical sources to establish whether an individual has a medically determinable impairment(s), see DI 22505.003.
For additional information about evidence needed to evaluate visual disorders and statutory blindness under Title II, see “How do we evaluate visual disorders?” in DI 34001.012A.
B. Title XVI evidence of statutory blindness
For Title XVI claims:
We need an eye examination by a physician (medical or osteopathic doctor) skilled in diseases of the eye or by an optometrist.
We do not need documentation of the cause of the blindness.
For additional information about evidence needed to evaluate visual disorders and statutory blindness under Title XVI, see “How do we evaluate visual disorders?” in DI 34001.012A. and DI 34005.102A.
20 CFR 416.913(f) Evidence we need to establish statutory blindness
C. Measurement of visual acuity and visual fields – Title II and Title XVI
1. Measurement of visual acuity and visual fields in adults and children
For detailed information about how we measure visual acuity and visual fields for adults and children, refer to the following related adult and child references:
b. Child (under age 18)
c. Other related reference
DI 24535.005 Titles II and XVI: Evaluating Visual Field Loss Using Automated Static Threshold Perimetry – SSR 07-01p
2. Low vision visual acuity categories
The following low vision visual acuity categories indicate that no optical correction will improve the claimant’s visual acuity:
If the claimant’s central visual acuity in an eye is recorded as CF, HM, LP or LPO, or NLP, we will determine that the claimant’s best-corrected central visual acuity is 20/200 or less in that eye.
3. Conversion of visual acuity measurements
If the claimant’s visual acuity is measured for a distance other than 20 feet, we will convert it to a 20-foot measurement. For example, if visual acuity is measured at 10 feet and is reported as 10/40, we will convert this measurement to 20/80.
4. Pinhole or automated refraction acuity
We will not use the results of pinhole testing or automated refraction acuity to determine best-corrected central visual acuity. These tests provide an estimate of potential visual acuity but not an actual measurement of best-corrected central visual acuity.
D. Visual acuity test chart measurements for statutory blindness
1. Snellen methodology
When we measure the claimant’s best-corrected central visual acuity, we use visual acuity testing for distance using Snellen methodology or any other testing methodology that is comparable to Snellen methodology, such as the Bailey-Lovie and Early Treatment Diabetic Retinopathy Study (ETDRS).
2. Other test charts
Most test charts that use Snellen methodology do not have lines that measure visual acuity between 20/100 and 20/200. However, some newer test charts have lines that measure visual acuity between 20/100 and 20/200, such as the Bailey-Lovie and ETDRS.
If visual acuity is measured with one of these newer charts, and the claimant cannot read any of the letters on the 20/100 line, we will consider that the claimant has statutory blindness based on a visual acuity of 20/200 or less. For example, if best-corrected visual acuity for distance in the better eye is 20/160 using an ETDRS chart, we will find the claimant has statutory blindness.
A claimant does not have statutory blindness if he or she can read at least one letter on the 20/100 line. For example, the best-corrected visual acuity in the better eye is 20/125+1 using an ETDRS chart. The claimant does not have statutory blindness because he or she is able to read one letter on the 20/100 line.
3. Related references
DI 34001.012A.5.b. and DI 34005.102A.5.b.(ii) Other test charts
E. Measurements of near vision and distance vision
We use distance vision to measure visual acuity for determining statutory blindness.
Measurements of near vision, such as those obtained by a Jaeger eye chart, are not appropriate for determining statutory blindness. However, we may use measurements of near vision to help determine the claimant’s residual functional capacity.
F. Determining statutory blindness for infants and very young children, and for adults and other children, who cannot participate in visual acuity or visual field testing
1. When we need other evidence to determine statutory blindness
Infants and very young children, because of their age, cannot participate in visual acuity testing using Snellen methodology or other comparable testing. Some adults and other children may also be unable to participate in testing using Snellen methodology for other reasons, such as intellectual disability.
For infants and very young children, and for adults and other children who are unable to participate in testing using Snellen methodology or other comparable testing, we need other evidence to establish statutory blindness as discussed in DI 26001.005F.2. and DI 26001.005F.3. in this section.
2. Infants and very young children
For infants and very young children, we generally use listing 102.02B. Evidence we use to meet the listing may include clinical findings of fixation and visual-following behavior. If both these behaviors are absent, we will consider the anatomical findings or the results of neuroimaging, electroretinogram, or visual evoked response (VER) testing when this testing has been performed.
For additional information regarding children who are unable to participate in visual acuity testing, see DI 34005.102A.5.a.(iv) and DI 34005.102A.5.b.(i).
3. Adults and other children
For adults and other children who cannot participate in testing, we need documentation of all of the following on an eye examination:
A detailed description of the adult’s or child’s ability to perceive light or hand movements, follow objects, accept objects offered, and recognize familiar people.
The findings on examination of the external eye including eyelid, external ocular movements, cornea, and sclera; and
The findings on examination of the interior eye (ophthalmoscopy) including anterior chamber, iris, pupil, lens, posterior chamber, and fundus (including the optic disc).
This documentation may reveal abnormal anatomical findings, if any, that indicate a visual acuity of 20/200 or less in the better eye.
When the evidence described above does not provide an adequate basis for statutory blindness, the results of neuroimaging (usually, magnetic resonance imaging) may document abnormalities in components of the neural visual pathways (optic nerve, optic chiasm, optic tract, and visual cortex), such as septo-optic dysplasia, that indicate a visual acuity of 20/200 or less in the better eye.
5. VER or electroretinogram testing
When neuroimaging and the routine eye examination evidence do not provide an adequate basis for statutory blindness, VER or electroretinogram testing may provide additional information for evaluating visual acuity loss for adults and children who cannot participate in testing using Snellen methodology.
Determine the testing needed on a case-by-case basis.
6. Determine if visual disorder meets a listing
Consider how the claimant's visual capability corresponds with his or her ocular pathology and, using reasonable judgment, determine whether his or her visual acuity loss meets listing 2.02 for adults, or listings 102.02A or 102.02B for children; or whether his or her visual field loss meets listing 2.03A for adults, or listing 102.03A for children.
NOTE: When the disability determination services (DDS) has a case in which the claimant cannot participate in visual acuity (or visual field) testing, and the DDS has a question about which tests are appropriate to determine visual acuity (or visual fields) for the particular case, contact the regional Center for Disability with case-specific questions for referral to the Office of Disability Policy, as appropriate.