Social Security Disability Benefits for Children
By Pitt Dickey

Disabled children as well as adults can be eligible for Social Security Disability Benefits. This column will examine how the Social Security Administration (SSA) decides if a child under the age of 18 is eligible for Supplemental Security Income payments (SSI). The basic issues to be decided by the SSA in awarding disability benefits to a child are whether the child is presently working for money and the type and severity of the  physical or mental health impairment from which the child suffers.
 
The law regarding SSI eligibility for children was changed in 1996 and made much more difficult to obtain benefits for children under the new law. This change was in reaction by Congress to a multitude of claims for childhood SSI benefits on the basis of attention deficit disorder and hyperactivity claims. Congress determined that the system was being abused by certain claimants using hyperactivity as a means to obtain benefits.  

Under the present law the SSA grants disability benefits under the following circumstances:   The child has a medically determinable physical or mental health impairment which either singly or in combination results in marked and severe functional limitations. The impairments must also be expected to last for at least 12 months or will result in death. To meet the requirement that the impairments are "marked and severe", the impairments must meet a set of criteria called Listings established by the SSA.  

The SSA has a set of sequential steps it uses to determine if a child is disabled for purposes of paying benefits. If the child is performing substantial gainful activity (working and earning above a certain amount of money per month), then the child is found to be not disabled regardless of how serious the impairments may be. If the child is not working, then the next step is to determine if the child has a "severe" impairment which can be determined by medical evidence. If the child does not have a severe impairment then the SSA will deny the claim.

If the child has a severe impairment or combination of impairments then the SSA has to decide if the severe impairment either meets, medically equals, or functionally equals  the criteria for that particular impairment. If the impairment meets the criteria  then the child will be found to be disabled.  The SSA makes its decision on the evidence that is in the child's case record. This evidence will include information from medical sources such as pediatricians, psychologists, speech pathologists, and  physical or occupational therapists.  In addition the SSA will consider non-medical sources of information about the child such as parents, teachers, and grandparents.
 
The SSA weighs such factors as how the child's functioning compares with other children of the same age who do not have impairments, the combined effects of multiple impairments if any, how well the child can sustain and complete activities, the need for structured settings, the  impact of school programs,  and the effect of chronic illness that interferes with the child's activities and the effects of treatment including side effects of medication.

Areas of Functional Evaluation

If the child does not meet the strict Listing standards for disability then the SSA will determine if the child's impairments functionally equal the Listings for disability.  The SSA does an assessment of six areas of functioning called "domains". If the child has marked limitations in at least two of these domains, then the SSA will award disability benefits. 

To decide if a child has "marked" or "extreme" limitations the SSA will consider all of the child's functional limitations resulting from his  impairments.  A child has "marked" impairments if the impairments interfere seriously with his ability to independently initiate, sustain, or complete activities. A child's daily functioning may be seriously limited if  his impairment limits only one activity or when the  cumulative effects of his  impairments limit several activities.  "Marked" means more than moderate but less than "extreme"  to the SSA.  On standardized functional testing, marked means scores that are at least two, but less than three standard deviations below the mean score for the test.

Extreme limitations is the rating given to the worst problems. This would be found if the child tested at least three standard deviations on an approved test. If a child has not attained age 3, the SSA will find an extreme limitation if he is functioning at a level less than ½ of his chronological age. 

The six domains evaluated by the SSA are briefly summarized  as follows:

1. Acquiring and using information: How well the child learns and uses information. Ability to comprehend and express simple and complex ideas.

2. Attending and completing tasks: How well the child is able to focus and maintain his  attention and finishes his activities.  

3. Interacting and relating to others: How well the child maintains and sustains emotional connections with others. Conflict solving abilities are evaluated,.

4. Moving about and manipulating objects: How well the child can move his  body and handling and manipulating objects.  Fine and gross motor skills in participating is individual and group physical fitness activities are evaluated.

5. Caring for himself: How the child gets his physical and emotional needs met. How he copes with stress and changes in his environment.

6. Health and physical well being: The cumulative physical effects of the physical or mental impairments and their therapies on the child's ability to function. 

It should be kept in mind that a child  can still be found to be disabled by an Administrative Law Judge after a hearing  even if he does not meet a particular listing if he has health problems that in combination are the equivalent of a listing.  The  Judge has the discretion to decide if a child's health problems are serious enough to warrant an award of disability benefits despite not meeting the specific  technical requirements of one of the SSA listings for disability.

Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims for over twenty years. He practices with the firm of Smith Dickey Dempster & Carpenter, P.A. at 555 Executive Place, Fayetteville, N.C.  He can be reached at 485-8020.