Your child under the age of 18 will be considered disabled if he or she has a severe physical disorder, mental disorder, or both that cause marked functional limitations and will last for 12 months or longer, or is expected to result in death. If found disabled, your child will receive benefits from the Supplemental Security Fund (SSI), under Title XVI of the Social Security Act.
The Social Security Administration’s (SSA) regulations require disability evaluation under a procedure known as the “sequential evaluation process.” This process requires a sequential review of your child’s current work activity (if any), the severity of his or her impairment(s), and an assessment of whether his or her impairment(s) results in severe functional limitations.
The sequential evaluation process for evaluating children’s disability claims is explained below.
Step 1: Is your child working above SGA level?
SGA stands for Substantial Gainful Activity and the amount changes each year. For 2014, SGA is $1,090 per month. If your child is working and earns and more than the SGA limit per month, then he or she will be found not disabled.
- If your child is not working or is working and his or her earnings are less than the SGA limit, the adjudicator goes to Step 2.
Step 2: Is your child’s physical and/or mental condition severe?
Your state’s Disability Determination service will deny your child at Step 2 if he or she does not have a medically determinable impairment or if his or her impairment(s) is considered not severe. Your child also will be denied if his or her impairments fail the duration test; that is, if the impairment is not expected to result in death, and has neither lasted 12 months, nor is expected to last longer than 12 months.
- If the impairment(s) is considered severe and meets the duration test, then the claim will proceed to Step 3a.
Step 3a: Does your child’s medical condition meet or equal the severity of a “listing”?
The SSA maintains a list of medical criteria that are considered so severe that you are found disabled if your physical and/or mental disorder matches the criteria. This is called the Listing of Impairments. Part B of this list contains additional medical criteria that apply specifically to the evaluation of childhood disorders. Certain criteria in Part A do not give appropriate consideration to the disorders of childhood or disease processes that differ in their effects on children and adults. In evaluating disability for children, Part B will be used first. If the medical criteria in Part B do not apply, then the medical criteria in Part A will be used. If your child has one or more severe impairments, then DDS will decide if his or her impairment(s) meets one of the Part B listings for children. As with adults, if the impairment does not meet a listing, then DDS will decide if it medically equals a listing.
- If your child has an impairment(s) that meets or medically equals the requirement of a listing and meets the duration requirement of a year or longer, then DDS will find the child disabled and the determination is complete.
- If your child’s impairment(s) does not meet or equal a listing, then the adjudicator goes to Step 3b.
Step 3b: Can a severely impaired child function at home, at school, and in the community?
At this step of the SSI childhood disability sequential evaluation, your child can be found disabled if he or she functionally equals a listing. To functionally equal a listing, the impairment(s) must be of listing-level severity; that is, it must result in “marked” limitations in two domains or an “extreme” limitation” in one domain. DDS assesses the effects of any impairment on your child’s ability to function at home, at school, and in the community, considering such questions as:
a) Which activities is your child able or not able to perform?
b) Which activities are limited in comparison with children of the same age without an impairment?
c) What type and amount of help does your child need to complete age-appropriate activities?
Once DDS has evaluated the extent to which your child can perform activities, it evaluates how much your child is limited in each of six domains. The domains are broad areas of functioning intended to capture what a child can and cannot do. The SSA uses the following six domains:
- Acquiring and using information;
- Attending and completing tasks;
- Interacting and relating with others;
- Moving about and manipulating objects;
- Caring for himself or herself; and
- Health and physical well-being.
If your child’s impairment or combination of impairments results in “marked” limitations in two or more of these domains of functioning, or an “extreme” limitation in one domain, then his or her impairment(s) functionally equals a listing. A marked limitation in a domain is one in which a child’s impairment interferes seriously with his or her ability to independently initiate, sustain, or complete activities. An extreme limitation in a domain is one in which a child’s impairment interferes very seriously with those abilities.
As you can see, determining disability involves a multi-step reasoning process. Your representative can help explain how the sequential evaluation applies in your child’s Social Security Administration disability claim.