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

By   /  March 3, 2016  /  490 Comments

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

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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. Usually, gross work earnings as an employee or net income from self-employment is considered to be SGA if the earnings reach $1,820 for a blind person or $1,090 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.

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  • Published: 7 months ago on March 3, 2016
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  • Last Modified: March 4, 2016 @ 4:27 pm
  • Filed Under: SSI

490 Comments

  1. shannon M heaton says:

    Ok heres a toughy….my husband has been on ssi for 8 years after botched back surgery. My kids recieve nothing. However he was able to care for them while i worked. This past june he was in a horrible motorcycle accident at the fault of someone else and it crushed every bone in his face…two compound breaks in leg…amputation of a toe…teeth knocked out….knocked jaw back almost an inch….brain injury where he has problems remembering and his eye will not stay open in sunlight….he was on ssi instead of ssdi bc he lacked 1 point/credit of qualifying for ssdi. Can he now get ssdi? Bc he cannot care for my children while i work and the extra money he or they could recieve could definitely help with childcare expenses.

    • Kay Derochie says:

      Dear Shannon,

      If your husband has not worked since he was denied Social Security Disability (SSDI), he still is not eligible for SSDI because he is still not insured.

      Sincerely,
      Kay

  2. Amanda says:

    I applied for ssi for my 4 year old son in October 2015 he was born with a cateract and had to have surgery at 6 months old. He is currently blind in right eye and has 40/20 in left eye I am appealing is ssi and I keep getting the same papers to send in when he only has his one doctor what is the problem ? Is he not eligible for it?

    • Kay Derochie says:

      Dear Amanda,

      Your son may not be disabled according to Social Security law because he has 20/40 vision in one eye. If you wish to pursue the appeal, provide what is requested or explain why it is not available.

      Sincerely,
      Kay

  3. Hello I have a six year old daughter who has leri weill syndrome it’s a form of dwarfism that causes pigeon toed and some other issues she has to have surgery on her ankle in October she also is plus 6 in one eye plus 6 1/2 in the other.. She is cross eyed and also has surgery to fix that in both eyes in October.. She also has ADHD and very bad anxiety.. Would she get approved

    • Kay Derochie says:

      Dear Kayla,

      It is possible that your daughter is medically eligible for Supplemental Security Income (SSI) disability benefits.

      Sincerely,
      Kay

  4. michelle says:

    my daughter has type one diabetes at the age of 15 months now is 18, she has been living with her father and they have not taken care of her enough to have them in control. she has moved in with me and i finally get her medical records the doctor has the as not controlled and is depressed and has a mental issue is she able to apply and is not allowed to get her driver license until better vists

    • Kay Derochie says:

      Dear Michelle,

      Your daughter might qualify medically for Supplemental Security Income (SSI) benefits. I suggest that she file an application. (Note that, if she is approved, she can expect to have a continuing disability review (CDR) in the future because all of her conditions have the potential of improving with proper treatment. The approval letter will say how far in the future the review will occur.

      Sincerely,
      Kay

      Sincerely,
      Kay

    • Blaize Daniel says:

      hello, 5 years ago i had an anoxic/hypoxic brain injury i was 17 when this took place in the month of my birthday was in a 2 1\2 month coma and lost all my strength i was mentally impaired for awhile but feel able to make my own decisions now, ive never had control of my income but its obvious i can handle my affairs i’m currently in a wheelchair but still have quite a bit of trouble getting through my house my mother has had control of my income since it happened i signed my POA over to her in the beginning i knew i couldn’t handle all the paperwork and such but i feel able to now i may ask questions but its because ive had no experience in the field ive barely been out of my house and i live with my mother she has helped me but ive had such a hard time with this is there any way i can get the rights to my finances thanks

      • Kay Derochie says:

        Dear Blaize,

        You can ask your doctor to certify that you are capable of handling your funds. He or she can do this on a form SSA-787, which can be downloaded and printed out from the Internet. Then take the statement to Social Security and apply to be your own payee.

        Sincerely,
        Kay

  5. Raven Castillo says:

    Hi I have a 2 year old daughter she is very smart but very bad. She randomly hits , bites , scratches, punches , pull hair , Suggs her nails in you , etc to any kid for many reasons sometimes no reason at all . Usually though it’s when someone has something she wants etc . When she gets mad or doesn’t get her way she screams and pulls her own hair and fall down ! She can’t stay concentrated to anything , she doesn’t listen at all ! Im scared to send her to school because she’s a bully. Nothing works she doesn’t stay still ever ! I can never take her In public. She ran up to a little girl once and punched her for no reason. Is she eligible for ssi ?

    • Kay Derochie says:

      Dear Raven,

      Your child might be medically eligible for Supplemental Security Income (SSI). I suggest that in addition to filing the claim that you get her evaluated as soon as possible by a medical professional to see whether there is any medical care that can help her.

      Sincerely,
      Kay

      • Stewart says:

        My Son has asthma. He is required to take 2 type of inhalers 45 minutes before any physical activity and he has to do it 3 times a day. He’s 15 years old. It even flares up if he gets too hot, cold, or around dust.

        • Kay Derochie says:

          Dear Stewart,

          You do not ask a question, but I assume that you are asking my opinion about whether your child would be disabled as defined by Social Security law. You do not indicate how impaired he is when he has flare ups or how long they last or whether his school work is being compromised due to his health, so I can’t offer an opinion on whether he is medically eligible. You might discuss the question with your son’s doctor. Then if you are unsure, filing a claim to get a formal decision could be appropriate.

          Sincerely,
          Kay

  6. Raychel says:

    Hi my 6 yr old daughter was recently diagnosed with adhd and odd she has an iep through school as she has trouble learning she had a school counclor fill out some conner forms she has trouble with space and listening to her teachers her doctor recently put her on meds for the adhd she wasn’t seeing a therapist due to no-one in my area was excepting our insurance. I applied for ssi im a shingle parent of three other children and dont get child support. I recently found a therapist that she now goes to shop you think she will be eligible for ssi???

    • Kay Derochie says:

      Dear Raychel,

      It is possible, but not certain, that your child qualifies for Supplemental Security Income (SSI) disability.

      Sincerely,
      Kay

  7. Ashley P says:

    Hi Kay, My 18 month Old has Asthma, Disphagia, Speech Impaired, and Goes to therapy for Occupational therapy, Speech and Feeding, The Local Office says DDS has made a Decision, but they couldn’t tell me the decision until after I have not received the notice, My Question is Dose Ss Office Usually Tells You the Status if it is Approved? And Also When DDS Sends it back to Your Local Social security Office Dose that means You are Denied????

    • Kay Derochie says:

      Dear Ashley,

      The Social Security Administration and the DDS, which is contracted by Social Security, have a policy of not giving out claim decisions verbally. The file being sent back to the local office is not necessarily a sign of approval or denial.

      Sincerely,
      Kay

  8. Mary says:

    Hi Kay,

    I have been suffering with anxiety, agoraphobia, bipolar disorder and depression since I was 13 years old. My mother never took me to the Dr to get evaluated to get me the help that I needed, it has gotten severely worse the past three years to the point that I can not leave my house without having a mental breakdown in public. I lost my previous job because of this. I am 24 now and It took me two years of calling and canceling appointments before actually going in to get a diagnosis. I had my interview towards the end of May this year and was sent to a Medical Examiner last month in August. Am I likely to get approved? Everyone I ask says that I would be denied because I worked for six months last year but I have been out of a job for 15 months now because I cannot leave my house without having an outburst or a meltdown when I go out in public. If I am denied what are the steps I need to take afterwords? Also my son has anxiety and ADHD and he receives SSI, if I get approved does that mean I get a lesser amount than what he receives? I am the only adult in the house and his SSI is currently the only income we have at the time.

    • Kay Derochie says:

      Dear Mary,

      Your prior work will not keep you from getting Supplemental Security Income (SSI). Your son’s SSI will not be reduced if you receive SSI.

      Sincerely,
      Kay

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