Childhood SSI and Health and Physical Well-Being

Parents applying for childhood SSI benefits are often confused by how the Social Security Administration evaluates the claim. The SSA looks at the child’s functioning in terms of six domains. This entry dealing with Health and Physical Well-Being is the sixth in a series discussing domains of function.  In this domain, SSA considers the cumulative physical effects of physical or mental impairments and their associated treatments or therapies on a child’s functioning that were not considered in other domains.  When the physical impairment(s), mental impairment(s), or combination of physical and mental impairments has physical effects that cause “extreme” limitation in functioning, the child will generally have an impairment(s) that “meets” or “medically equals” a listing.

A physical or mental disorder may have physical effects that vary in kind and intensity, and may make it difficult for a child to perform activities independently or effectively. One may experience problems such as generalized weakness, dizziness, shortness of breath, reduced stamina, fatigue, psychomotor retardation, allergic reactions, recurrent infection, poor growth, bladder or bowel incontinence, or local or generalized pain.  In addition, the medications or the treatments received may have physical effects that also limit performance of activities.

The child’s illness may be chronic with stable symptoms, or episodic with periods of worsening and improvement.  The SSA considers how one functions during periods of worsening and how often and for how long these periods occur.

Examples of impairments that functionally equal the listings:

• Documented need for major organ transplant (e.g., liver).
• 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.
• Effective ambulation possible only with obligatory bilateral upper limb assistance.
• Any physical impairment(s) or combination of physical and mental impairments causing complete inability to function independently outside the area of one’s home within age-appropriate norms.
• Requirement for 24-hour-a-day supervision for medical (including psychological) reasons.
• Infants weighing less than 1200 grams at birth, until attainment of 1 year of age.
• Infants weighing at least 1200 but less than 2000 grams at birth, and who are small for gestational age, until attainment of 1 year of age. (Small for gestational age means a birth weight that is at or more than 2 standard deviations below the mean or that is below the 3rd growth percentile for the gestational age of the infant.)
• 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 1 year of age.

If you need more information about a Social Security Disability/SSI, personal injury, EEOICPA, long or short-term disability, VA 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.