denied

Social Security pays benefits to people who are unable to perform substantial gainful activity due to a condition or combination of conditions that has lasted or is expected to last at least one year.

The guidelines for determining if a person is visually disabled and entitled to Social Security benefits are very specific. Patients typically have great difficulty navigating this medical-legal quagmire, especially those who have suffered a traumatic brain injury or are visually impaired. They often give up at the first denial of benefits because they do not understand the process. These patients should be encouraged to continue to seek benefits and consult an attorney who specializes in disability law.

According to the Social Security Administration, visual disorders are defined as abnormalities of the eye, the optic nerve, the optic tracts, or the brain that may cause a loss of visual acuity or visual field.  A report of an eye examination that includes measurements of the best-corrected visual acuity or the extent of the visual field, as appropriate is needed to evaluate a visual disorder. The cause of the loss must be documented.

A loss of visual acuity limits the ability to distinguish detail, read, or perform fine work.  Statutory blindness is defined as visual acuity of 20/200 or less in the better eye with the use of a correcting lens; therefore best-corrected visual acuity for distance in the better eye determines if this definition is met.  Documentation should, ideally, use Snellen methodology.

A loss of visual field limits the ability to perceive visual stimuli in the peripheral extent of vision. An eye that has a visual field limitation such that the widest diameter of the visual field subtends an angle no greater than 20 degrees is considered as having visual acuity of 20/200 or less. Visual field loss measurements should be obtained with an automated static threshold perimetry test performed on a perimeter, such as the Humphrey Field Analyzer.

A cortical visual disorder is a disturbance of the posterior visual pathways or occipital lobes of the brain in which the visual system does not interpret what the eyes are seeing.  It may result from such causes as traumatic brain injury, stroke, cardiac arrest, a central nervous system infection such as meningitis, a tumor, or surgery.  It can be temporary or permanent, and the amount of visual loss can vary.  A diagnosis of a cortical visual disorder must be confirmed by documentation of the cause of the brain lesion.  If neuroimaging or visual evoked response (VER) testing was performed, a report or other medical evidence describing these findings is required.

For more information on these definitions and the requirements for documentation, refer to the website: http://www.ssa.gov/disability/professionals/bluebook/2.00-SpecialSensesandSpeech-Adult.htm

Many patients with visual disorders will not meet these requirements. However, in many claims involving visual impairments, they are either the result of other conditions such as multiple sclerosis, traumatic brain injury or diabetes or secondary in severity to other impairments. These individuals may still be considered disabled if their visual condition is considered along with other impairments which are limiting the patients’ ability to work. In these cases, the doctor should provide a report that includes a functional evaluation describing how the visual condition is limiting the patient’s ability to return to work and perform activities of daily living. The functional assessment should consider the following:

  • What objective/clinical findings support the diagnosis and limitations?
  • Have the patient’s impairments lasted or be expected to last 12 months or more?
  • What is the impact of the visual condition on the patient’s ability to work an 8–hr day?
  • Does the visual condition cause your patient to suffer from symptoms such as double vision, headaches, pain, blur, eye strain, excessive tearing?
  • In a typical 8-hr workday, will your patient require rest periods in addition to lunch and a morning and afternoon break period due to the visual impairment?
  • Are environmental restrictions relevant, such as being around moving machinery, exposure to changes in temperature or humidity, exposure to dust fumes and gases, or driving automotive equipment?
  • Does the patient have the visual skills necessary to write, type, work with coins, work with small parts, look up?
  • Is the visual impairment constant or fluctuating? Can the patient be expected to have “good days” and “bad days?”
  • Does the patient’s physical impairment, medication or pain cause decreases in cognitive functions such as memory, concentration, and attention.

The functional limitations from a visual impairment can greatly reduce a claimant’s vocational base, limiting the work he/she would otherwise be capable of performing. It can be the final piece of the puzzle.

This blog post was originally presented by the author and her husband, Lewis Insler,  as a poster at COVD’s 2010 Annual Meeting.

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