Tips on Applying for Disability Benefits for a Child with Down Syndrome

Down syndrome and mosaic Down syndrome can qualify your child medically to receive disability benefits through the Social Security Administration’s (SSA’s) Supplemental Security Income (SSI) program.

 Tip #1: Understand the SSI program

It is important to understand that medically qualifying is only part of the eligibility determination process. There are also financial considerations the SSA reviews when making a decision on your child’s eligibility for SSI. This is because SSI is a need-based program for which applicants must have very limited income and other financial resources to pay for their everyday needs.

When deciding if children qualify for SSI, the SSA looks at the financial resources of the child, including sources like child support. They also factor in a portion of the income of the child’s parents as well as other sources of financial resources the parents may have. You can learn more about the financial rules for SSI here: http://www.ssa.gov/ssi/

 Tip #2: Understand how your child can medically qualify for benefits 

The SSA has set procedures for reviewing the medical records of applicants to determine if they are medically eligible for benefits. Your child’s records will be reviewed in relation to listings in the Blue Book, which is a manual of disabling conditions and the medical evidence needed to prove disability.

For Down syndrome, the Blue Book listing appears in Section 110.06. This listing requires one of the following:

• A physician-signed lab report documenting Down syndrome through a karyotype analysis
• A lab report not signed by your child’s doctor which is accompanied by a signed statement from the physician attesting to the validity of the report
• A detailed report from your child’s doctor, documenting the chromosomal mutations of Down syndrome, the physical features of the disorder in your child, and/or reporting your child functions at a level consistent with having Down syndrome

If your child has mosaic Down syndrome, the SSA evaluates medical records under the appropriate listings for the body system(s) that are affected by the disorder. These may include any or all of the following Blue Book sections:

• Musculoskeletal – Section 101.00
• Special senses and speech – Section 102.00
• Neurological – Section 111.00
• Mental disorders – Section 112.00

Even if your son or daughter does not exactly meet any Blue Book listing with mosaic Down syndrome, the SSA will review your child’s medical records to see if they “medically equal” a listing. This simply means that if your child’s functional limitations are equal in severity to a listed condition, then they will be found medically qualified for SSI benefits.  

For more information on medically qualifying with Down syndrome, visit: http://www.disability-benefits-help.org/disabling-conditions/down-syndrome-and-social-security-disability

 Tip #3: Check to see if your child qualifies for a compassionate allowance 

The SSA’s compassionate allowances (CAL) program is a rapid review and approval process that applies to some disabling conditions. Down syndrome is not among the conditions that are considered under the CAL program however. This means your child’s application for benefits must proceed through the standard review process, which in turn means you may wait several months for a decision on your child’s claim for benefits.

For a complete list of all conditions that qualify for a compassionate allowance, visit: http://www.ssa.gov/compassionateallowances/conditions.htm

 Tip #4: Learn how to file an application on behalf of a child

SSI applications filed for children must be completed in the local SSA office. The application process involves an interview, conducted by an SSA representative. During the course of that interview, you will provide the SSA rep with the details necessary to complete the application forms. You will also need to provide copies of medical records, school records, if applicable, and documentation related to your financial situation.

In-person applications can only be completed by appointment. To schedule an appointment, you must call your local SSA office, or the main SSA helpline at 1-800-772-1213.

 Tip #5: Appeal if your claim is denied

It’s uncommon for Down syndrome claims to be found medically ineligible. It’s more common for mosaic Down syndrome claims to be denied for medical reasons. It is possible however that your child’s claim may be denied based on technical or financial eligibility. Either way, if your child’s claim is denied you should file an appeal, if you are able to do so.

Denials are communicated via standard postal mail and arrive in the form of a notice. That notice will include a formal deadline for requesting an appeal or reconsideration. The deadline is 60 days from the date the notice was issued. Ensure you file your appeal within this timeframe to prevent closure of your child’s SSI application.

Article by Ram Meyyappan
Social Security Disability Help