The primary diagnosis in an allowance refers to the basic condition that rendered
the person disabled, or in a denial, the one that the evidence shows to have the most
significant effect on the person's ability to work.
When the case is a denial, and no diagnosis is established, enter “none
established.” Use impairment code “0000” when there is no medical evidence in the file. Use impairment
code “6490” when medical evidence in the file is not sufficient to establish a diagnosis.
a. Drug addiction and alcoholism (DAA) materiality
When the case is a denial because DAA is material, enter the appropriate code for “alcoholism” (3030 – Substance Addiction or Psychoactive
Substance Dependence Disorders (Alcohol)) or “drug addiction” (3040 – Substance Addiction
or Psychoactive Substance Dependence Disorders (Drugs)) as the primary impairment.
When the case is an allowance because DAA is not
material, enter the mental or physical impairment that would be disabling, absent the effects
of DAA, as the primary diagnosis.
DI 90070.050 DAA Material Determinations
IMPORTANT: A claimant has statutory blindness only if the visual disorder meets Listing 2.02
or 2.03A for adults, or Listing 102.02 or 102.03A for children.
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.
Enter “Statutory Blindness” as the secondary diagnosis when the basis of the EOD is
a different impairment and that impairment’s onset date is before the onset date of