What medical conditions are required to meet SSI disability qualifications and to get an SSI approval?

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Find out how disability is defined for SSI and what SSI disability qualifications adults and children must meet to get SSI.

The SSI Definition of Disability for Adults

Any medical or psychiatric condition can be the basis for meeting the SSI disability qualifications if you are limited in the manner described in the SSI definitions of disability.

SSI disability qualifications are different for adults and children. Adults who apply for SSI benefits are evaluated using the same definition of disability that is used for Social Security Disability applicants. According to Social Security and SSI disability laws, disability is an adult’s “the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted, or can be expected to last, for a continuous period of not less than twelve months. Our article What Is Disability According to Social Security Disability Laws? explains the definition and our article How Does the Social Security Administration Apply Social Security Disability Laws to Determine If I Am Disabled? includes a step-by-step explanation of how Social Security applies adult disability laws to your situation to determine if you are disabled.

When a child who is eligible for SSI turns eighteen, his or her eligibility for SSI has to be re-reviewed. The former child’s medical condition will undergo a new disability review to determine whether he or she meets the adult definition of disability. Additionally, his financial eligibility and potential benefit amount will be re-determined without consideration to his or her parents’ income and resources.

The SSI Definition of Disability for Children

A child is disabled for SSI purposes if he or she has “a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than twelve months.”

Determining a Child’s SSI Disability Status

If a child who is under age eighteen applies for SSI benefit and it is determined that he or she meets the non-medical eligibility requirements, the local Social Security office determines whether the child is performing work that is Substantial Gainful Activity, which is called SGA for short. In 2020, usually gross work earnings as an employee or net income from self-employment is considered to be SGA if the earnings reach $2,110 for a blind person or $1,260.00 for a non-blind person. If the child is performing SGA is performing SGA, then the child is not disabled. As mentioned, a more complete discussion of SGA can be found in the article What Is Disability According to Social Security Disability Laws?

If the child is not performing Substantial Gainful Activity, then the claim will be sent to the Disability Determining Services, which is called DDS for short. To conduct a medical review of your child’s claim, the DDS will review the medical and other information you provide on the SSI application form. The DDS may also ask you for additional information, contact your child’s medical providers and educators, or ask that your child to attend a Consultative Examination. The examination, if requested, will be for evaluation purposes only and will not include any treatment. For more information about Consultative Examinations and about who decides if your child is disabled, see our articles When Applying for Disability Benefits Will I Have to See a Social Security Doctor? and Who Decides If I Am Disabled? If Both My Doctor and the Social Security Disability Doctors Say I Am Unable to Work, Will I Be Approved?

In its first step, the DDS evaluates whether your child has a physical or mental impairment that is medically determinable and whether it is severe enough to cause more than minimal functional limitations. If no impairment is supported or functional limitations are only minor, the claim will be denied. On the other hand, if your child has a severe impairment, then the review proceeds to the next step.

In this step, your child’s condition is compared to a list of illnesses with accompanying severity criteria that are considered disabling. If your child’s diagnosis and level of severity are in the listings or are medically equivalent to one of the listings, the claim will be approved. If not, the review moves to the next step, which is to determine whether your child’s level of impairment is functionally equal to the listings.

In this final step the DDS evaluates the effects of your child’s impairments on his or her ability to function at home, at school, and in the community. To perform the review, the DDS considers questions such as “How does the child function compared to unimpaired children of the same age?” “What kind of help and how much help does the child need to complete age-appropriate activities?” and “What are the effects of treatment on the child’s day-to-day functioning?”

It is important to have people who have first hand knowledge of your child’s functional limitations provide statements for the claim. Teachers, behavioral and speech therapists, and caregivers’ insights can be elucidating and valuable to your child’s claim.

After DDS has a clear picture of your child’s function they consider six broad areas of function to determine how your child functions in those areas. The six areas, called domains, are acquiring and using information, attending to and completing tasks, interacting and relating with others, mobility and ability to manipulate objects, caring for himself or herself, and maintaining health and physical well-being.

Two terms come into play at this point: “marked” and “extreme.” Social Security defines a “marked” limitation in several ways in their rules, but the most general definition is that a limitation is marked if “a child’s impairment interferes seriously with his or her ability to initiate, sustain, or complete activities.” A limitation is defined as “extreme” when “a child’s impairment interferes very seriously” with the ability to function in one of the domains.

If your child has “marked” limitations in two of the domains or an “extreme” limitation in one, then his or her impairment is considered to be functionally equal to the listings and he or she meets the SSI disability qualifications.

Determining Disability for Newborn Babies

A newborn baby with a low birth weight may be eligible for SSI benefits. The qualifying low- weight level depends upon the gestational age at birth. For a list of qualifying birth weights, see our article I Am Very Ill. Can I Apply for SSI Benefits and Have My SSI and Disability Expedited?

Continuing Disability Review

SSI law requires that we review your child’s medical condition every three years for children under age eighteen whose condition is expected to improve. In addition, a medical review is usually conducted by age one for babies who received an SSI approval based on low birth weight.
Reviews are also done at intervals to determine whether adult SSI recipients still meet SSI disability qualifications. For more information about adult continuing disability reviews and how to prepare for them, please see our articles Will My Social Security Disability Claim Be Reviewed Again after I Am Approved for Benefits? and How Can I Prepare for a Continuing Disability Review of My Social Security Medical Disability Claim?

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