By Annie Hsia, Interim Program Director

People are often surprised when told that their children may qualify for Social Security benefits. The rules of eligibility for children differ from those of adults. They also differ from education disability rules. Those parents who do pursue Social Security disability benefits are often taken aback when the child’s Individual Education Plan (“IEP”) is considered insufficient by Social Security standards.

There are two (2) programs under which your child may receive Social Security disability benefits.

Children may be able to get Social Security benefits under the account of their parent or legal guardian (“guardian”) if the guardian becomes too disabled to work (determined by Social Security). In this situation, the amount of benefits is calculated based on the parent’s eligibility.[1] This program – called Social Security Disability Insurance (“SSDI”) – is provided under Title II of the Social Security Act (“Act”). One other way to get SSDI on a deceased, retired, or disabled guardian’s account is if the parent or guardian is disabled or deceased; however, this article focuses on the children’s Supplemental Security Income (“SSI”) disability program under Title XVI of the Act who are currently under eighteen (18) years of age and the limitations resulting from the disability(ies).

If a child under eighteen (18) years of age is disabled, s/he can apply for SSI benefits under his/her own account. In order for Social Security to consider a child qualified for SSI, not only must the child meet their definition of childhood disability, s/he must also meet nondisability income and resources requirements. As with adults, the disability must be “medically determinable” and expected to result in death or to last continuously at least twelve (12) months.

Most children do not work. As a result, Social Security’s rules for evaluating if a child is disabled are modified to the following steps:

Step 1: Does your child have a severe impairment or a combination of impairments?

If your child’s impairment(s) are not severe, s/he is not disabled. The Social Security Administration (“SSA”) defines severe impairment(s) as those that significantly and negatively affect one’s ability to work or function in daily life. An application for disability benefits is denied if your child’s impairment(s) are not considered severe; otherwise, go to Step 2.

Step 2: Does your child meet or medically equal a childhood listing under Title 20 of the Code of Federal Regulations?

SSA has listed over a hundred impairments in the Code of Federal Regulations, for adults and for children (“listing”). Each listing spells out very exact criteria that automatically qualify someone for disability. Satisfying the listing criteria is often difficult, however. Social Security has issued complex guidelines in determining whether a child is disabled.

If your child is found to meet or medically equal a childhood listing, your child is disabled under the Act. The amount of benefits is calculated based on income and resources countable under other Social Security guidelines. Otherwise, go to Step 3.

Step 3: Does your child functionally equal a listing?

In February 2009, SSA again published further guidelines for their own employees on how to determine whether a child’s severe
disability(ies) are functionally equivalent to a listing.[2] This aspect is unique to determining children’s disability.

Because of the strict statutory and regulatory language, most child disability applications are decided at this step. Social Security considers six (6) domains of functioning:

For your child to be functionally equivalent to the disability listings, Social Security requires that either at least one (1) of the domains has extreme limitations resulting from the severe impairment(s) or at least two (2) of the domains have marked limitations. This determination is based on medical evidence, standardized test scores, and additional relevant testimony from you, teachers, specialists, treating professionals, and anyone who would have knowledge of your child’s day-to-day functional limitations.

The domains are interrelated with each other, and age is a key factor when considering the child’s abilities in each of the domains. The limitations are considered with respect to others in the same age category: Newborn to age 1, age 1 to 3, age 3 to 6, age 6 to 12, and age 12 to 18. If test scores are available, any score at least three (3) standard deviations below the mean is generally considered to be an extreme limitation, while scores at least two (2) standard deviations below the mean would be considered a marked limitation. All of these complex considerations, along with specific examples of evidence to look for in each domain and each age category, are spelled out in 20 C.F.R. §§ 416.924 et seq.[3]

If your child is found to functionally equal a childhood listing, your child is disabled under the Act. The amount of benefits is calculated based on income and resources countable under other Social Security guidelines on a monthly basis.

Perhaps even more so than adult applications, children’s application for disability benefits may end up denied. A timely appeal would send your child’s case to a different decision maker, who may or may not come to the same conclusion. The general deadline to appeal is within sixty (60) days of the date of the unfavorable determination or decision.

If the first appeal is denied, your child may request a hearing before a federal administrative law judge, who will make an independent decision upon reviewing all evidence previously submitted and any new evidence or testimony you provide. If you have not previously consulted with a specialist in Social Security disability benefits, this is a good time to look for one – there may be no other opportunity in the rest of the appeals process where you and your child can directly meet with the decision maker (i.e., the administrative law judge). An experienced Social Security disability advocate should be able to increase your child’s chances of being found disabled based on the evidence and regulations.

For more information about how to apply for Social Security disability benefits (for you or your child), please visit SSA’s website at www.ssa.gov.