Compassionate Allowance - Stage V Retinopathy of Prematurity

Certain health conditions are approved for expedited review for Social Security Disability (SSD) benefits, including Stage V Retinopathy of Prematurity (ROP). Faster review and virtually guaranteed approval are available through the Compassionate Allowances (CAL) program.

The CAL Program

While CAL applications are essentially guaranteed approval, you must still complete the full application process and must also provide the Social Security Administration (SSA) with the required medical evidence to prove the diagnosis, severity level, and the prognosis for your child’s ROP.

Supplemental Security Income

Disability benefits for children are available through the Supplemental Security Income (SSI) program, which is the SSA’s program for individuals with limited income and other financial resources. Some sources of income and some types of assets count toward financial eligibility for SSI, while others do not.

Qualifying Medically for SSD Benefits

The SSA always requires specific medical evidence for any condition for which application is made. Disability benefits for ROP are granted when the following evidence is presented:

  • Visual testing, including acuity and field testing in older children
  • Diagnostic staging of the ROP, including documentation of blood vessel involvement and retinal detachment
  • A thorough clinical history, including physical features of the ROP and the onset and progression of symptoms

Even when your child’s application is not qualified under the CAL program, it can still be approved for benefits following the standard SSI review procedures. In these cases, the SSA will thoroughly review your child’s medical records and will compare them with listings in the Blue Book, which is a manual of known disabling conditions.

The sections of the Blue Book that apply to applications for ROP in stages I through IV include:

  • Section 102.02 – Loss of visual acuity
  • Section 102.03 – Contraction of the visual field
  • Section 102.04 – Loss of visual efficiency

If your child’s ROP is stage 5 and therefore qualified for CAL consideration, you will have a decision on your claim for benefits in just a few weeks. However, if his or her ROP is stage I through IV, then your wait for a decision will be longer. The average time to receive a decision on a non-CAL condition is four months.

Applying for Benefits

SSD applications for children must be completed during a personal interview. That interview will take place at the local SSA office. Schedule the interview in advance by calling 1-800-772-1213. Be sure to provide the SSA with copies of your child’s medical records and the necessary financial statements at the time you apply.