by Greg Trapp, JD
From the Editor: Greg Trapp is the executive director of the New Mexico Commission for the Blind, a position he has held since 1999. Prior to becoming director of the Commission, he was a senior staff attorney with Disability Rights New Mexico. He is also a longtime member of the National Federation of the Blind. Here is what he has to say about the surprisingly complex topic of legal blindness.
Most people are familiar with the term "legal blindness." The phrase has even entered the realm of entertainment with the Legally Blonde movie franchise. The origins of legal blindness can be traced back to 1862. That is when Dutch ophthalmologist Hermann Snellen created the first eye chart that allowed for the accurate and uniform measurement of visual acuity. The "Snellen" chart established the 20/200 acuity measurement that would eventually constitute "legal" or “statutory" blindness. More than 160 years later, ophthalmologists and optometrists continue to use the Snellen chart to measure visual acuity. While the Snellen chart remains in common use, recent decades have seen the increasing adoption of newer tests that are able to more accurately and reliably measure visual acuity. These newer tests use a Logarithm of the Minimum Angle of Resolution, or LogMAR. The LogMAR equivalent to 20/200 vision is 1.0 minutes of visual angle, which is expressed metrically as 6/60 vision. The most common LogMAR charts are the Bailey-Lovie and the Early Treatment Diabetic Retinopathy Study (ETDRS) charts. While LogMAR charts enable vision to be measured more accurately, they have also given rise to potential conflict as they can measure visual acuity that is between 20/100 and 20/200, a range of vision that is not specifically measured by the Snellen chart.
The potential for conflict exists because the use of Snellen and LogMAR charts can result in two persons with identical vision being treated differently, depending on whether their vision is measured using a Snellen or a LogMAR chart. For instance, a person with 20/160 vision would be determined to have 20/200 vision and be legally blind if that person went to an eye doctor who used a Snellen chart. This is due to the fact that the Snellen chart does not have increments between 20/100 and 20/200, so the smallest letters a person with 20/160 vision can read on a Snellen chart would be on the 20/200 line. However, a person with that same 20/160 vision would not be determined to be "legally blind" if that individual went to an eye doctor who used the ETDRS chart which has a 20/160 line. Similarly, it is possible that a person who has previously been measured as having 20/200 vision on a Snellen chart might in actuality have visual acuity that would be measured as 20/125 or 20/160 on an ETDRS chart.
Seeking to address an issue that presented significant concerns of consistency and fairness, the Social Security Administration issued a notice of proposed rulemaking on November 20, 2006. The proposed rule changed how visual acuity and visual field could be tested to meet the definition of legal blindness. The final rule became effective on February 20, 2007. The rule added additional tests that could be used to measure visual field. The rule also maintained the definition of legal blindness, which is “central visual acuity of 20/200 or less in the better eye with best correction, or a limitation in the field of vision in the better eye so that the widest diameter of the visual field subtends an angle of 20 degrees or less.” While the rule did not change the definition of legal blindness, it did establish the use of “Snellen methodology” to determine who would “qualify as legally blind.” Under the rule, "if a person's visual acuity is measured with one of the newer charts, and they cannot read any of the letters on the 20/100 line, they will qualify as legally blind, based on a visual acuity of 20/200 or less." The rule is also set forth in POMS DI 26001.005, which says, "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."
Fans of the superhero movie “The Incredibles” will recall the scene where Mr. Incredible assists a tearful Mrs. Hogenson with her insurance claim. Mr. Incredible was secretly working as a claims adjuster, and he surreptitiously provided the weeping Mrs. Hogenson with the insider information she needed to successfully navigate the opaque inner workings of the insurance company. While “Snellen methodology” may technically not constitute insider information, understanding Snellen methodology can be the key to successfully accessing certain government programs and services.
Mr. Incredible would certainly tell you to consider the impact of Snellen methodology for benefits or programs that use the criteria of legal blindness. For example, Social Security Disability, ABLE accounts, SNAP benefits, tax deductions based on blindness, vocational rehabilitation services, and eligibility to be a vendor under the Randolph-Sheppard Act all potentially use the definition of legal blindness. If you have vision that is worse than 20/100 but better than 20/200, or in some situations, have ever had vision between 20/100 and 20/200, you may potentially qualify for benefits or programs that base eligibility on legal blindness.
Conversely, if you have been measured as having 20/200 vision and are subsequently determined to have 20/125 or 20/160 vision on a LogMAR chart, you may incorrectly be told that you do not qualify for benefits or programs that base eligibility on legal blindness.
It would be a definite advantage if Mr. Incredible was able to assist you with the opaque inner workings of the Social Security Administration. Social Security benefits and programs can be extremely complex, and the Social Security Administration is a difficult bureaucracy to penetrate. If your best-corrected visual acuity for distance in the better eye was determined to be 20/160 using an ETDRS chart, Mr. Incredible would whisper that you should be "classified as legally blind" and medically eligible for Social Security disability benefits. He would also tell you that Social Security has special rules for blind recipients of Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). These special rules include the deduction of blind work expenses under SSI and the higher blind substantial gainful activity level under SSDI. In addition, blind SSDI recipients who are fifty-five and older can fall under a rule that may allow for suspension of benefits in months in which earnings do not exceed the blind substantial gainful activity level. Persons who are blind are also covered by special rules for establishing eligibility for SSDI. Even when the rules are not based specifically on blindness, the ability to use Snellen methodology to establish an earlier date of blindness may be critical. For instance, the Disabled Adult Child (DAC) program provides benefits for persons who became disabled prior to the age of twenty-two and who are either unmarried or married to a person who is also receiving Social Security benefits.
Responding to requests for guidance regarding the Randolph-Sheppard Act and Snellen methodology, the Rehabilitation Services Administration adopted the Social Security Administration's use of Snellen methodology in 2008. For most of the history of the Randolph-Sheppard Act, persons who could see better than 20/200 had been prohibited from being a "blind licensee." The Randolph-Sheppard Act defines a blind person as a "person whose central visual acuity does not exceed 20/200 in the better eye with correcting lenses or whose visual acuity, if better than 20/200, is accompanied by a limit to the field of vision in the better eye to such a degree that its widest diameter subtends an angle of no greater than twenty degrees." According to the Rehabilitation Services Administration 2008 guidance, a person can qualify to be a blind licensee if the person's visual acuity would "convert to 20/200" if it were measured using Snellen methodology.
Like Mrs. Hogenson, you now possess the special information needed to navigate the inner workings of programs that are often opaque and difficult to penetrate. Unfortunately, the traditional interpretation of legal blindness can be deeply engrained within the programs that use 20/200 visual acuity to determine eligibility. Some of those programs may be reluctant to adopt Snellen methodology, and it may take some time, effort, and even litigation to penetrate those bureaucracies. The door has already been opened within the Social Security and Randolph-Sheppard Act programs. Mr. Incredible was frustrated by the system that prevented him from openly helping others, but you are able to freely share this information with those who might benefit. In doing so, you may bring clarity to an opaque system and potentially make an incredible difference in the lives of others.