When determining whether you are qualified for Social Security disability (SSD) benefits, you must meet several requirements. However, those requirements are different for children than they are for adults.
What Qualifies for Children’s Social Security Disability Benefits?
In order to qualify for SSD benefits, a child must have a severe condition that results in marked and severe functional limitations that is expected to last at least one year or to result in death. Unlike an adult, a child does not have to prove that he or she cannot engage in substantial gainful activity. Instead of limitations at work, a child may simply have functional limitations.
Thus, a child must meet the following requirements in order to qualify for SSD benefits:
- Have a severe condition
- Have marked and severe functional limitations as a result of that condition
- Have a condition that is expected to last at least one year or results in death
All three of these conditions must be met; otherwise, a child will not be considered eligible for SSD benefits.
The Social Security Administration (SSA) maintains a list of mental and physical impairments that apply to childhood disability – the Childhood Listing of Impairments. The list provides guidance on how to consider conditions that may be disabling. If a child has an impairment that is not listed, but is as severe as one that is listed, he or she may still qualify for disability benefits.
Childhood listings include:
- Low Birth Weight and Failure to Thrive – This includes low birth weight in infants from birth to age one and failure to thrive from birth to age three.
- Musculoskeletal System – This includes major dysfunction of a joint, reconstructive surgery of a major weight-bearing joint, disorders of the spine, amputation, certain bone fractures, and soft tissue injuries.
- Special Senses and Speech – This includes loss of vision and hearing as well as related disorders.
- Respiratory System – This includes chronic pulmonary insufficiency, asthma, cystic fibrosis, lung transplant, and growth failure due to a respiratory disorder.
- Cardiovascular System – This includes chronic heart failure, recurrent arrhythmias, congenital heart disease, heart transplant, and rheumatic heart disease.
- Digestive System – This includes gastrointestinal hemorrhaging, chronic liver disease, inflammatory bowel disease (IBD), short bowel syndrome (SBS), growth failure due to a digestive disorder, liver transplant, and need for supplemental daily enteral feeding via a gastrostomy.
- Genitourinary Disorders – This includes chronic kidney disease, kidney transplant, nephrotic syndrome, congenital genitourinary disorder, growth failure due to renal disease, and congenital complications of chronic kidney disease.
- Hematological Disorders – This includes hemolytic anemias, disorders of thrombosis and hemostasis, disorders of bone marrow failure, and hematological disorders treated by bone marrow or stem cell transplantation.
- Skin Disorders – This includes ichthyosis, bullous disease, chronic infections, dermatitis, hidradenitis suppurativa, genetic photosensitivity disorders, and burns.
- Endocrine Disorders – This includes any type of diabetes mellitus in a child who requires daily insulin and has not attained age six.
- Congenital Disorders that Affect Multiple Body Systems – This includes down syndrome and catastrophic congenital disorders.
- Neurological – This includes seizure disorder, nonconvulsive epilepsy, brain tumors, motor dysfunction associated with neurological disorders, cerebral palsy, meningomyelocele, and communication impairments associated with neurological disorders.
- Mental Disorders – This includes organic mental disorders, schizophrenia, mood disorders, intellectual disability, anxiety disorders, somatoform and eating disorders, Tic disorders, personality disorders, psychoactive substance dependence disorders, autism, attention deficit hyperactivity disorder, and developmental and emotional disorders of newborns and younger infants.
- Cancer – This includes malignant solid tumors, lymphoma, leukemia, thyroid gland cancer, retinoblastoma, nervous system cancers, neuroblastomas, and malignant melanoma.
- Immune System Disorders – This includes systemic lupus erythematosus, systemic vasculitis, systemic sclerosis, polymyositis or dermatomyositis, connective tissue disease, immune deficiency disorders, HIV infection, inflammatory arthritis, and Sjogren’s syndrome.
Although some of the impairments on the Childhood Listing are similar to those on the Adult Listing, some are different. There are additional conditions, such as failure to thrive, as well as missing listings, such as bipolar disorder. The severity requirements for each condition are also different in most situations. Since children are diagnosed and treated differently than adults, the requirements for impairments to be seen as “severe” are also different.
Marked and Severe Functional Limitations
When considering whether a child is disabled, the SSA will evaluate his or her limitations. If the child’s limitations are found to be “marked and severe,” a child may be eligible for disability benefits. The SSA will look at limitations in the following domains:
- Acquiring and using information
- Attending and completing tasks
- Interacting and relating with others
- Moving about and manipulating objects
- Caring for yourself
- Health and physical well-being
A disability evaluator will consider how well a child can function in each of these categories and determine whether the child has limitations that are not existent, less than marked, marked, or extreme. Children are viewed as a “whole” – that is, even if he or she does not have marked limitations in each category, if he or she has a whole body impairment that results in significant limitations, the child may still be considered disabled.
In determining whether a child has marked and severe functional limitations, a Childhood Disability Evaluation Form should be completed by an evaluating physician or other acceptable medical source. This form provides the SSA with detailed information in each category that can be substantiated with verifiable medical evidence.
In addition to having a severe impairment that results in qualifying limitations, a child’s condition must be expected to last at least one year or to result in death. A treating physician or other acceptable medical source can provide medical documentation about the onset date of a child’s impairment. The doctor can also offer medical evidence that provides information about the longevity of the child’s condition and the prognosis. You must provide medical evidence in order to satisfy this requirement, even if the condition is obviously going to last at least one year or result in death.
To successfully obtain children’s Social Security Disability benefits it is imperative that you provide the SSA with supporting medical evidence proving your child’s disability. You can increase your chances of successfully obtaining SSD benefits for your child by consulting an experienced Social Security disability lawyer for children at Wilkinson & Magruder LLP. Call us today at 706.955.0645.