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Social Security Disability Benefits and Down Syndrome

BY MOLLY CLARKE

In many ways, parenting a child who has Down syndrome is very much the same as parenting a child who does not have Down syndrome. Besides food and shelter, all children require love, respect, and meaningful relationships.  In addition to these more basic needs, children with Down syndrome may also require other types of support. This often includes educational assistance, therapy, and specialized care.

Unfortunately, not all families can afford to provide their child with the necessary supportive services. If you find yourself facing these circumstances, your child may be eligible to receive Social Security Disability benefits.  The following information will provide you with a general understanding of Social Security Disability benefits and will prepare you to begin the application process on behalf of your child.

The Social Security Disability Programs

The Social Security Administration (SSA) governs and distributes two different types of benefits.  These include Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Each program has its own qualifying criteria.

To qualify for SSDI benefits, applicants must have worked and paid Social Security taxes in the past. Because children do not have employment history and do not pay taxes, they are not typically good candidates to receive SSDI. However, a child may be eligible to receive SSDI auxiliary or dependent benefits if he or she has an eligible parent. To learn more about SSDI auxiliary benefits, click here. (http://www.disability-benefits-help.org/glossary/auxiliary-benefits)

SSI benefits are often the better fit for children with health conditions and disabilities. SSI is a needs-based program that offers benefits to individuals of all ages who earn very little income.  Eligibility for SSI is based solely on an applicant’s income and financial resources.  Because children do not earn income, child applicants will be evaluated based on a portion of their household income. To learn more about SSI eligibility, click here. (http://www.socialsecurity.gov/ssi/text-child-ussi.htm)

Disability Criteria

In addition to meeting either program’s technical criteria, applicants must also meet the SSA’s disability criteria. These criteria are listed in a publication maintained by the SSA—referred to as the Blue Book. The Blue Book contains specific listings and requirements for all potentially disabling conditions.

Although adults and children have separate Blue Book listings, the listing for Down syndrome is the same for all ages.  For adults, the listing can be found in section 10.06. For children, the listing can be found in section 110.06. Both require the following:

·       A laboratory report of karyotype analysis signed by a physician, or laboratory report of karyotype analysis not signed by a physician and a statement by a physician that the applicant has Down syndrome; or

·       A physician’s report stating that the applicant has chromosome 21 trisomy or chromosome 21 translocation consistent with prior karyotype analysis with the distinctive facial or other physical features of Down syndrome; or

·       A physician’s report stating that the applicant has Down Syndrome with the distinctive facial or other physical features and evidence demonstrating that the applicant functions at a level consistent with non-mosaic Down syndrome.

If you cannot provide medical evidence that your child meets these criteria, he or she will not qualify for disability benefits.

Applying for Social Security Disability Benefits

If you are applying for Social Security Disability benefits on behalf of a child over the age of 18 you can complete the application online or in person at your local Social Security office.

If you are applying for benefits on behalf of a child under the age of 18, you will not be able to complete all of the application online. Instead, you will be required to schedule an interview with an SSA representative. It is important that you call the SSA to schedule your interview immediately. This is because the next appointment may not be available for several months.  

The actual application is made up of several different forms. It is important that the information you provide is detailed and accurate. Any missing or inconsistent information may result in the delay or even the denial of your child’s claim.

Receiving a Decision

After submitting your application, you may not receive a decision right away. In fact, it often takes 3 to 6 months for the SSA to make a decision on an initial disability application. While you wait, it is important that you prepare yourself to face the possibility of being denied. If this happens, you have 60 days in which to appeal this decision.

If your child’s application is not approved, do not give up. Often times, applicants who are denied the first time around are approved during the appeals process. At this time, it may be in your best interest to retain the services of a Social Security Disability attorney or advocate.  He or she will be able to improve your claim and fix any mistakes made on the initial application. 

For more information about Down syndrome and disability benefits visit Social Security Disability Help (http://www.disability-benefits-help.org/disabling-conditions/down-syndrome-and-social-security-disability).