Child Social Security Disability Criteria - SSDI & SSI

Three Types of Social Security Benefits for Children

Type 2 - Survivor's Benefits - SSDI

A child does not have to be disabled to receive survivor's benefits. A child must only satisfy non-medical criteria as follows:

1. You are 18 years old or older, you have a disability that began before you became 22 years old, or you are 18 years or older and meet the qualifications as a full-time student;
2. Your parent is deceased;
3. Before death, your parent was insured (had enough work credits) for Social Security benefits;
4. You were dependent on your parent;
5. You are unmarried; and
6. You apply.

Type 3 - Disabeld "Adult Child" (DAC) Benefits - SSDI

You are eligible for "Adult Child" if you satisfy 1) non-medical criteria (discussed here), and 2) Adult SSDI Disability Criteria. The non-medical criteria is as follows:

1. You are 18 years old or older and have a disability that began before you became 22 years old; or you are 18 years or older and qualify for benefits as a full-time student;
2. Your parent is entitled to old-age benefits, disability benefits, or dead;
3. You are dependent on your parent;
4. You are unmarried; and
5. You apply.

"Adult Child" benefits is a strange term. The applicant is not a child, but rather an adult who can be eligible for SSDI benefits if they can prove they became disabled as a "child" - before age 22. "Adult Child" benefit rules allow an applicant to qualify for SSDI benefits when they may not otherwise be able qualify for SSDI or SSI Disabiltiy benefits.

Type 4 - Child Disablility Benefits - SSI

Your child can receive Supplemental Security Income (SSI) disability benefits if both you and your child satisfy Social Security's 1) non-medical criteria and 2) disability criteria. Non-medical criteria is discused in detail here: Non-Medical Criteria (you and your child must meet low-income and limited asset criteria, citizenship or alien criteria, and a few other criteria). The disability criteria is discussed below. SSI is the only Social Security disability benefit available to your disabled child based on their own disability.

Child disability benefits include monthly benefits, back pay, and Medicaid which is discussed in detail - SSI Benefits.

Dependent child benefit onlhy includes bckpay and montly benefits, again, payable to you; amounts can be reviewed here - Dependent Child Benefit Amounts.

Video: SSI Child Disability Criteria

The Three-Step Disability Sequential Evaluation Process

Social Security's child disability criteria is the Three-Step Child Disability Evaluation Process:

1. Your child is not performing "substantial gainful activity" (SGA) and meets the Durational Requirement,
2. Your child's impairment is "severe," and
3. Your child satisfies a listing.

Step 1 - SGA & The Durational Requirement

General. If your child is not engaging in SGA or has not satisfied the Durational Requirement, Social Security will find your child not disabled at Step 1. If your child is not engaging in SGA, and your child has satisfied the Durational Requirement, Social Security will move on to Step 2.

SGA Defined. SGA is the performance of work activity as an employee or a self-employed business owner involving significant physical or mental activities for pay or profit (money or some other sort of financial gain). It is rare for a child to be working. If your child is not working and has not worked during the period your child is alleging disability, the SGA test is met.

Determining SGA. In the rare circumstance your child is working, Social Security will determine if they are engaging in SGA which is done in one of two ways.

First, Social Security will determine how much your child earns monthly. In 2020, if your child earns $1,260 or more monthly, and your child is not working in a sheltered environment where your child's earnings are subsidized, Social Security will find that your child is engaging in SGA, and it will find your child not disabled.

Second, if your child is earning less than $1,260 or more monthly, but there is reason to believe your child is manipulating how much are they are being paid (e.g. they get free rent or your child is a self-employed business owner), Social Security will evaluate your child's work activity. If Social Security determines your child's work activity is similar to the work of unimpaired people in your child's community making $1,260 or more per month, or your child's work is worth $1,260 or more per month, Social Security will find your child is engaging in SGA.

Durational Requirement Defined. The Durational Requirement is 1) the length of time your child must show their medical condition has lasted or will last, and 2) the length of time your child must show they have not engaged in SGA. Even if your child is now not performing SGA, your child must also satisfy the Durational Requirement in one of three ways:

1. Your child's medical condition is expected to result in death,
2. Your child's medical condition has lasted 12 months or more and kept your child from engaging in SGA, or
3. Your child's medical condition is expected to last and keep your child from engaging in SGA for 12 months or more.

How your child satisfies the Durational Requirement depends on the severity of your child's impairment. In most cases, you will have to establish that your child's condition has lasted 12 months or more. If your child is not engaging in SGA, Social Security will primarily rely on your child's medical records to establish whether the medical condition has already met the durational requirement or whether it will meet the durational requirement.

Statutory Blindness. If your child is statutorily blind, they will meet Step 1. SGA and Durational Requirement rules do not apply if your child is statutorily blind. It is irrelevant whether your child is engaging in SGA or has met the Durational Requirement.

Step 2 - Severe

General. A condition is severe if it causes more than a minimal limitation on your child's ability to function. If Social Security finds that your child's condition is not severe, it will find your child not disabled. If Social Security finds your child's condition severe, it moves on to Step 3. Usually, Step 2 is easy to satisfy. Nearly always, if your child's condition affects their ability to function in nearly any way, your child will satisfy this Step.

Step 3 - Listings

Listings Defined. A child's listing is a description of a medical condition, symptoms, and sometimes functional criteria established and considered by Social Security to be severe enough to seriously interfere with your child's ability to carry out normal activities. There is a listing for almost every medical condition. Your child can satisfy more than one listing. Your child can meet, medically equal, or functionally equal a listing. The listings are primarily written in medical terminology and based on medical and clinical testing. You can obtain a Doctor Statement from your child's own doctor about whether your child satisfies a listing. If Social Security finds that your child's condition satisfies a listing, it will find your child disabled. If Social Security finds that your child's condition does not satisfy a listing, it will find your child not disabled, and the case will be denied.

Two Groups of Listings. There are two groups of Listings - Part A (1.00 to 14.00) and Part B (100.00 to 114.00). Part A generally applies to adults (18 and older). Part B applies to children (under 18). If the medical criteria in part B do not apply to the child's condition, then the medical criteria in Part A will be used. If a condition has a similar effect on both adults and children, Part A may also be used in evaluating a child's condition; therefore in this case, a child can satisfy a listing if they satisfy a listing in either Part A or Part B.

Satisfying a Listing. Your child can satisfy a listing in one of three ways:

1. Your child "meets" a listing when their condition, symptoms, and functional limitations are exactly the same as the listing criteria.
2. Your child "medically equals" a listing when your child's condition, symptoms, and functional limitations are not exactly the same as the listing criteria, but your child's condition, symptoms, and functioning are as severe as the listing criteria.
3. Your child "functionally equals" a listing when your child's condition, symptoms, and functional criteria are not exactly the same as the listing criteria, but your child's condition, symptoms, and functioning result in a "marked" limitation in two domains of functioning or result in an "extreme" limitation in one domain of functioning. When Social Security evaluates whether your child functionally equals a listing, it will compare your child to children of the same age, as obviously, the functioning of a 14-year-old is different that the functioning of a three-year-old.

Social Security's six domains of functioning are as follows:

1. Acquiring And Using Information,
2. Attending And Completing Tasks,
3. Interacting And relating With Others,
4. Moving About And Manipulating Objects,
5. Caring For Yourself, and
6. Health And Physical Well-Being.

Social Security defines a "marked" limitation as, "your impairment(s) interferes seriously with your ability to independently initiate, sustain, or complete activities. Your day-to-day functioning may be seriously limited when your impairment(s) limits only one activity or when the interactive and cumulative effects of your impairment(s) limit several activities." A marked limitation also exists when your child's standardized testing scores are at least two, but less than three, standard deviations below the mean, and their day-to-day functioning is consistent with those scores.

Social Security defines an "extreme" limitation as, "your impairment(s) interferes very seriously with your ability to independently initiate, sustain, or complete activities. Your day-to-day functioning may be very seriously limited when your impairment(s) limits only one activity or when the interactive and cumulative effects of your impairment(s) limit several activities. An extreme limitation also means a limitation that is more than marked. An extreme limitation is the rating we give to the worst limitations. However, 'extreme limitation' does not necessarily mean a total lack or loss of ability to function." An extreme limitation also exists when your child's standardized testing scores are at least three standard deviations below the mean, and their day-to-day functioning is consistent with those scores.

Social Security will also find your child has a marked or extreme limitation if they have any of the following "functionally equaling examples":

1. "Any condition that is disabling at the time of onset, requiring continuing surgical management within 12 months after onset as a life-saving measure or for salvage or restoration of function, and such major function is not restored or is not expected to be restored within 12 months after onset of this condition."
2. Ambulation (walking) is possible only with the help of both arms.
3. Inability to function independently outside the home.
4. Medical supervision 24-hours-a-day.
5. "Major congenital organ dysfunction which could be expected to result in death within the first year of life without surgical correction, and the impairment is expected to be disabling (because of residual impairment following surgery, or the recovery time required, or both) until attainment of one year of age."

For the sixth domain of functioning only, "Health and physical well-being," Social Security states is may also consider you to have a marked or extreme limitation if your child has documented (medical records proving it) episodes of illness or exacerbations that occur on an average of three times a year each lasting two weeks or more, or your child's illness or exacerbations are equally severe occurring more often but lasting a shorter duration or occurring less often but lasting a longer duration.

Social Security's definition of "marked" and "extreme" is bad in one part and good in another. First the good. Standardized testing is easy to understand. A child of any age can take standardized testing and their learning and functional abilities can be measured. The test results will show your child's scores, how the scores compare to other children their age, and how many deviations above or below the mean the scores fall (if any). Now the bad. Social Security essentially replaces "marked" with "seriously" and "extreme" with "very seriously" - not too helpful. Social Security also states that test scores will indicate a marked or extreme limitation but only if they are consistent with "marked" or "extreme" day-to-day functioning. So, we are left with interpreting "marked" or "seriously" or "extreme" or "very seriously."

Social Security also gives specific examples of limited functioning for each domain. For each of these examples, just like for all functioning, your child must be markedly or extremely limited.

1. Acquiring and using information. In this first domain, Social Security will evaluate your child's ability to learn information and then use that information to perform a skill. Examples include building with blocks, using scissors, spelling words, vacuuming, performing math, driving, etc. Social Security cites the following examples of limited functioning:
• Your child does not demonstrate an understanding of words about space, size, or time;
• Your child cannot rhyme words or pronounce the sounds in words;
• Your child has difficulty remembering important things they learned in school yesterday;
• Your child has difficulty solving mathematics questions or computing arithmetic answers; and
• Your child talks only in short, simple sentences and has difficulty explaining things.
2. Attending and completing tasks. In this second domain, Social Security will evaluate your child's ability to be attentive and maintain attention. Social Security cites the following examples of limited functioning:
• Your child is easily startled, distracted, or over reactive to sounds, sights, movements, or touch;
• You child is slow to focus on, or fail to complete activities of interest;
• Your child repeatedly becomes sidetracked or frequently interrupts others;
• Your child is easily frustrated and gives up on tasks, including ones they are capable of completing; and/or
• Your child requires extra supervision to keep you engaged in an activity.
3. Interacting and relating with others. In this third domain, Social Security will evaluate your child's ability to talk to others, cooperate with others, emotionally connect with others, use language, follow rules, respond to criticism, and respect the possessions of others. Social Security cites the following examples of limited functioning:
• Your child does not reach out to be picked up and held by a caregiver;
• Your child has no close friends, or their friends are all older or younger than them;
• Your child avoids people they know, or they are overly anxious in meeting new people or trying new things;
• Your child has difficulty playing games or sports with rules;
• Your child has difficulty communicating with others; and
• You have difficulty speaking.
4. Moving about and manipulating objects. In this fourth domain, Social Security will evaluate your child's ability to move their body from one place to another and how they move and manipulate things - gross and fine motor skills. Social Security cites the following examples of limited functioning:
• Your child experiences muscle weakness, joint stiffness, or sensory loss that interferes with their motor activities;
• Your child has trouble climbing up and down stairs, or has disorganized locomotion or balance;
• Your child has difficulty coordinating gross motor movements;
• Your child has difficulty with sequencing hand or finger movements;
• You child has difficulty with fine motor movement; and
• Your child has poor eye-hand coordination when using a pencil or scissors.
5. Caring for yourself. In this fifth domain, Social Security will evaluate your child's ability to maintain a healthy emotional and physical state; cope with stress and changes; and take care of their own health, possessions, and living area. Social Security cites the following examples of limited functioning:
• Your child continues to place non-nutritious or inedible objects in their mouth;
• Your child often uses self-soothing activities showing developmental regression (e.g., thumb sucking, re-chewing food), or they have restrictive or stereotyped mannerisms (e.g., body rocking, head banging);
• Your child does not dress or bathe appropriately;
• Your child engages in self-injurious behavior, or they ignore safety rules;
• Your child does not spontaneously pursue enjoyable activities or interests; and
• Your child has a disturbance in eating or sleeping.
6. Health and physical well-being. In this sixth domain, Social Security will evaluate the cumulative physical effects of all your child's impairments and medical treatment. Social Security cites the following examples of limited functioning:
• Your child's impairment causes symptoms, such as weakness, dizziness, agitation, lethargy, or psychomotor retardation;
• Your child has somatic complaints related to impairments (e.g., seizure or convulsive activity, headaches, incontinence, recurrent infections, allergies, changes in weight or eating habits, stomach discomfort, nausea, headaches, or insomnia);
• Your child has limitations in physical functioning because of medical treatment;
• Your child has exacerbations from one impairment or a combination of impairments that interfere with physical functioning; and
• Your child is medically fragile and needs intensive medical care to maintain a level of health and physical well-being.