Establishing Childhood Disability   

To qualify for SSI, a child must satisfy Social Security’s childhood disability standard which is different from the adult standard. Generally, children must establish that they have:

A medical impairment–either physical or mental which results in marked and severe functional limitations, and which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

The Three-Step Standard

To make this determination, Social Security follows a three-step evaluation:

  1. Is the child working and making more than $830 in gross wages (before deductions) per month? If yes, the child is not disabled. If no, go to step 2.

    Admittedly, this is an odd requirement for the childhood disability standard. However, some teenage children do work in part-time jobs or in jobs in which they were placed by their high school vocational education programs or the Office of Rehabilitation Services. Generally speaking, children who are working and making more than $830 per month, could be denied disability by Social Security because of that work.

  2. Does the child have a medically determinable impairment or combination of impairments that causes more than minimal limitations in the child’s functioning? If no, the child is not disabled. If yes, go to step 3.

    This step–called the severity step by Social Security--requires that a child actually have a medical impairment, either physical or mental, as a precondition of being found disabled. This medical impairment or impairments must cause more than minimal limitations on the child’s functioning when compared to other children his or her age.

  3.   

  1. Does the child's medical impairment meet the requirements of the medical criteria that Social Security has developed? If yes, the child is disabled. If no, go to step 3b.

    Social Security has medical criteria, grouped by major body systems, that identify medical conditions it considers to be disabling. These criteria are described in Social Security’s Listing of Impairments or the Listings, for short which are found in the U.S. Federal Code. Generally speaking, Social Security relies on medical doctors to determine whether or not a child’s condition meets the Listings.

  2. Does the child’s medical impairment medically equal the Listings? If yes, the child is disabled. If no, go to step 3c.

    Because it is impossible to describe medical criteria that would cover every medical condition that a child might have, Social Security also considers, for children who do not meet one of the Listings, whether the child’s impairments are the medical equivalent of a condition that is included in the Listings. This allows Social Security to find a child disabled when he or she has a medical condition that is "at least equal in severity and duration to the listed findings." 20 C.F.R. §416.926(a). To make this determination SSA will compare all relevant medical evidence (symptoms, signs, and laboratory findings) and non-medical evidence (e.g. school records, reports of parents, etc.) about a child’s impairment(s) with the medical criteria shown in the listed impairment. Id. Medical equivalence may be found in either of two ways.

    1. If a child has an impairment that is described in the Listing of Impairments, but the child does not exhibit one or more of the medical findings specified in the particular listing; or the child exhibits all of the medical findings, but one or more is not as severe as specified in the listing, SSA will find medical equivalence if the child has other medical findings related to the impairment that are at least of equal medical significance. 20 C.F.R. § 416.926(b)(1); or
    2. If a child has an impairment that is not described in the Listing of Impairments, or the child has a combination of impairments, no one of which meets or is medically equivalent to a listing, SSA will compare the medical findings with those for closely anlogous listed impairments. If the medical findings related to the impairment(s) are at least of equal medical significance to those of a listed impairment, SSA will find that the child’s impairment(s) is medically equivalent to the analogous listing. 20 C.F.R. § 416.926(b)(2).

     

  3. Do the functional limitations caused by the medical impairment cause an extreme limitation in one domain or marked limitations in two of the domains listed below:
  1. Identifying Extreme Limitations

    An extreme limitation is one that interferes very seriously with a child’s ability to independently initiate, sustain, or complete activities. A child’s day-to-day functioning may be extremely limited when an impairment(s) limits only one activity or when the interactive and cumulative effects of a child’s impairment(s) limit several activities. "Extreme" is the rating given to the most severe limitations. However, classification as an``extreme limitation'' does not necessarily require a total lack or loss of ability to function. It is the equivalent of the functioning that would be rated at least three standard deviations below the mean on standardized test scores
    .
  2. For children up to age three, SSA will generally find an "extreme" limitation if the child is functioning at a level that is one-half of chronological age or less when there are no scores from standardized tests in the case record.

    For children from birth to attainment of age 18, SSA will generally find an "extreme" limitation when the child has a valid score that is three standard deviations or more below the mean on a comprehensive standardized test designed to measure ability or functioning in that domain, and the child’s day-to-day functioning in domain-related activities is consistent with that score.

    For the sixth domain of functioning, "Health and physical well-being," SSA considers a child to have an "extreme" limitation if the child is ill because of impairment(s) or has exacerbations of impairment(s) that result in significant, documented symptoms or signs substantially in excess of the requirements for showing a "marked" limitation. SSA further states that if limitations are rated as "extreme" under this definition, the child’s impairment(s) should meet or medically equal the requirements of a listing in most cases.

  3. Identifying Marked Limitations
  4. A marked limitation is one that interferes seriously with a child’s ability to independently initiate, sustain, or complete activities. "Marked"also identifies a limitation that is the equivalent of the functioning expected when standardized test scores are at least two, but less than three, standard deviations below the mean. In addition, for children up to age three, SSA will generally find a "marked" limitation if the child is functioning at a level that is more than one-half but not more than two-thirds of the child’s chronological age when there are no standardized test scores available in the child’s records.

    Under the Health and physical well-being domain, a limitation is considered "marked" in the following circumstance:

    [I]f [a child is] frequently ill because of [his or her] impairment(s) or ha[s] frequent exacerbations of [his or her] impairment(s) that result in significant, documented symptoms or signs. For purposes of this domain, ``frequent means that [the child] have episodes of illness or exacerbations that occur on an average of 3 times a year, or once every 4 months, each lasting 2 weeks or more. We may also find that [a child] ha[s] a ``marked'' limitation if [he or she] ha[s] episodes that occur more often than 3 times in a year or once every 4 months but do not last for 2 weeks, or occur less often than an average of 3 times a year or once every 4 months but last longer than 2 weeks, if the overall effect (based on the length of the episode(s) or its frequency) is equivalent in severity.

  5. General Rule about Deciding Disability
  6. The golden rule of childhood disability determination is this: when assessing a child’s functional limitations, his or her activities are compared to the activities of children the same age who do not have medical impairments. As the regulations state:

    When we evaluate your functioning, we will look at whether you do the things that other children your age typically do or whether you have limitations and restrictions because of your medically determinable impairment(s). We will also look at how well you do the activities and how much help you need from your family, teachers, or others. Information about what you can and cannot do, and how you function on a day-to-day basis at home, school, and in the community, allows us to compare your activities to the activities of children your age who do not have impairments.

 

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