By definition a person is a child if they are under the age of eighteen (18). Social Security law and regulations have separate criteria for children and for adults. We are only looking at the criteria for a child in this paper.
Social Security has established what are referred to as “Listings of Impairments” which are included as an appendix to its regulations. For each of the major body systems, the Listings describe impairments that are considered severe enough to establish disability. The fifteen (15) categories that currently exist are very specific in their criteria. Medical condition must be regarded as having “marked” limitations in two domains (defined below) of functioning or an “extreme” limitation in one domain.
The other approach to disability for a child is what is referred to as a “Functional Equivalence.” In this, a child must have a severe impairment or combination of impairments that do not meet any of the Listings. At the same time, the child may have functional limitations that are so severe that there are multiple marked limitations or an extreme limitation.
Social Security will assess the functional limitations of the child to see what the child cannot do, is having difficulty doing, needs help doing or has restrictions from doing because of the impairment. They will look at the total person and assess the cumulative effects of all impairments that the child has including impairments that are not severe. When assessing the child’s functional limits, Social Security will consider all relevant factors.
Social Security looks at the child’s records to determine how the child is functioning during activities to decide whether the impairment or combination of impairments is equal to a Listing. Activities considered are everything that is done at home, at school and in the community. They look at how appropriately, effectively and independently the child performs activities compared to the performance of other children of that age group who do not have such impairments.
Social Security considers activities in terms of six (6) domains. These are broad areas of functioning intended to capture all of what a child can or cannot do. The law describes of each domain and gives examples of specific activities for a child in each age group. A range of development and functioning is provided. The domains used are:
- Acquiring and using information,
- Attending and completing tasks,
- Interacting and relating to others,
- Moving about and manipulating objects,
- Ability to care for self,
- Health and physical well-being of the child.
The basic questions in the decision-making process include:
- What activities that the child is able to perform.
- What activities that the child is not able to perform.
- In which activities is the child is limited or restricted compared to other similar aged children.
- Whether the child has difficulty with activities at home, child care, at school or in a community.
- Does a child have difficulty independently initiating, sustaining or completing activities?
- What kind of help does the child need to do activities, how much help is needed and how often is the help needed.
In obtaining this information, Social Security will look at treating physicians and other medical sources that the child has seen and is especially interested in those medical sources giving opinions concerning limitations and restrictions. Parents and teachers and other people regularly interacting with the child may have good information. Additionally, the Social Security Administration may have the child go to a consultative examination at their expense.
In determining whether limitations are “marked” and/or “extreme,” Social Security looks at all relevant information in the case including signs, symptoms and laboratory findings, descriptions from parents, teachers and others about the functioning of the child. The medical evidence may include formal testing that provides information about development and functioning in terms of percentiles, percentage of delay, or age of grade equivalence. The test scores are considered together with the degree of limitations in any particular domain.
The information found in this report is extracted from the Code of Federal Regulations which describes the criteria in great detail. Every child needs to be encouraged to function at his or her highest level, yet when medical problems interfere with the child’s ability to keep up with other children, many times a disability claim is appropriate.
Contact OWM Law regarding your matter concerning Social Security. We would be happy to provide you with advice and assistance.
This article was written by: David S. Kaplan, Esquire