Supplemental Security Income (SSI) may be available for a child who has suffered from muscular dystrophy. If the family income falls below certain levels and the child meets the medical requirements, he or she may be entitled to monthly monetary benefits and Medicaid (or state variant) health insurance.
Childhood SSI claims are evaluated differently than adult claims for Social Security Disability or Supplemental Security Income (SSI). The requirements are actually more stringent. If the child is not working and has “severe” impairments, the Social Security Administration (SSA) determines whether the claimant has an impairment or combination of impairments that meets or medically equals the criteria of a listing, or that functionally equals the listings. If the claimant has an impairment or combination of impairments that meets, medically equals or functionally equals the listings, and it has lasted or is expected to last for a continuous period of at least 12 months, he is presumed to be disabled. If not, the claimant is not disabled. There is no further question of vocational steps as with an adult disability claim. Please click here for more information on Childhood SSI claims.
For a child with a muscular dystrophy, the SSA looks first at the listing.
111.13 Muscular dystrophy, characterized by disorganization of motor function in two extremities, resulting in an extreme limitation in the ability to stand up from a seated position, balance while standing or walking, or use the upper extremities.
Disorganization of motor function means interference, due to your neurological disorder, with movement of two extremities; i.e., the lower extremities, or upper extremities (including fingers, wrists, hands, arms, and shoulders). Two extremities mean both lower extremities or both upper extremities, or one upper extremity and one lower extremity. The criteria for disorganization of motor function include limitation in ability to:
· Stand up from a seated position; or
· Balance while standing or walking; or
· Use the upper extremities (e.g., fingers, wrists, hands, arms, and shoulders).
Extreme limitation means the inability to stand up from a seated position, maintain balance in a standing position and while walking, or use upper extremities to independently initiate, sustain, and complete age-appropriate activities. The assessment of motor function depends on the degree of interference with standing up; balancing while standing or walking; or using the upper extremities (including fingers, hands, arms, and shoulders).
· Inability to stand up from a seated position means that once seated you are unable to stand and maintain an upright position without the assistance of another person or the use of an assistive device, such as a walker, two crutches, or two canes.
· Inability to maintain balance in a standing position means inability to maintain an upright position while standing or walking without the assistance of another person or an assistive device, such as a walker, two crutches, or two canes.
· Inability to use upper extremities means a loss of function of both upper extremities (e.g., fingers, wrists, hands, arms, and shoulders) that very seriously limits ability to independently initiate, sustain, and complete age-appropriate activities involving fine and gross motor movements. Inability to perform fine and gross motor movements could include not being able to pinch, manipulate, and use fingers; or not being able to use hands, arms, and shoulders to perform gross motor movements, such as handling, gripping, grasping, holding, turning, and reaching; or not being able to engage in exertional movements such a lifting, carrying, pushing, and pulling.
· For children who are not yet able to balance, stand up, or walk independently, their function based on assessments of limitations in the ability to perform comparable age-appropriate activities with the lower and upper extremities, given normal developmental milestones. For such children, an extreme level of limitation means developmental milestones at less than one-half of the child’s chronological age.
If the Listing cannot be proven, the claim can still be won if an impairment or combination of impairments functionally equals the listings and one must assess the claimant’s functioning in terms of six domains: (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. In making this assessment, one must compare how appropriately, effectively and independently the claimant performs activities compared to the performance of other children of the same age who do not have impairments. To functionally equal the listings, the claimant’s impairment or combination of impairments must result in “marked” limitations in two domains of functioning or an “extreme” limitation in one domain.
Whether it is winning through the Listing or functionally equaling a Listing, the claimant must prove the case through supporting documentation. Commonly, medical records, medical opinions, teacher questionnaires, letters from caregivers are all used to support a Childhood SSI claim.
If you need more information about a Social Security Disability/SSI, personal injury, EEOICPA, long or short-term disability, Railroad Retirement Board disability, or a workers compensation matter, please contact the Law Offices of Tony Farmer and John Dreiser for a free case evaluation. We can be reached at (865) 584-1211 or (800) 806-4611 or through our website.