Disability and Down Syndrome: Filing for Social Security Benefits

A diagnosis of non-mosaic Down syndrome automatically qualifies for Social Security (or SSI) disability benefits.

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Down syndrome is a genetic disorder caused by having an extra chromosome. People with Down syndrome typically have some degree of mental retardation and certain physical characteristic, such as an unusually round face, a small chin, a flattened bridge of the nose, epicanthic folds (folds over the inner corner of the eyes), shorter arms and legs, and poor muscle tone. Ninety-five to 99 percent of people diagnosed with Down syndrome have “non-mosaic” Down syndrome, where every cell has an extra 21st chromosome. A very small number of people, however, are diagnosed with “mosaic” Down syndrome, where some of the cells have an extra 21st chromosome and some of the cells have a normal number of chromosomes. People with mosaic Down syndrome tend to have higher IQs than those with non-mosaic Down syndrome and may be less likely to be disabled.

Qualifying for Disability for Non-Mosaic Down Syndrome 

If a person has a diagnosis of non-mosaic Down syndrome, he or she automatically qualifies as disabled under the Social Security Administration's (SSA's) official disability listing for Down syndrome. The SSA considers children with non-mosaic Down syndrome to be disabled from birth.

Evidence Required to Support a Diagnosis of Non-Mosaic Down Syndrome 

If the disability applicant with Down syndrome has had a certain type of chromosomal analysis done called a karyotype chromosomal analysis, and can provide the SSA with a copy of the laboratory report, the applicant will meet the SSA's requirements for approval based on Down syndrome.

Chromosomal Analysis Not Available

If the disability applicant does not have a chromosomal analysis available, the applicant will need to ask his or her doctor to provide a statement that says the applicant has the physical features typical of Down syndrome and that confirms the applicant has had a chromosomal analysis done in the past and that the analysis showed the applicant has Down syndrome. If the applicant can provide this evidence, and nothing in the other evidence the SSA looks at contradicts the conclusion that the applicant has Down syndrome, the applicant will be found to be approved for benefits based on Down syndrome (assuming the applicant meets the financial and legal requirements for SSI or SSDI).

Qualifying for Disability for Mosaic Down Syndrome 

While people with mosaic Down syndrome often suffer from many of the same additional physical impairments that people with non-mosaic Down syndrome suffer from, the SSA does not have a specific disability listing for mosaic Down syndrome. A diagnosis of mosaic Down syndrome alone is not enough to qualify for benefits.

Because the severity of impairments with mosaic Down syndrome can vary widely from person to person, the SSA requires the applicant to prove he or she has specific physical or mental limitations that are disabling. An applicant with mosaic Down syndrome will be evaluated by the SSA under the disability listing(s) that fit whatever other physical or mental impairments he or she has. Some common physical and mental impairments that an applicant with mosaic Down syndrome might have that are "listed" impairments include:

  • hearing loss, such as that caused by recurrent ear infections

       For more information on SSA's disability criteria for these impairments, see our articles on disability for the specific impairment by visiting the links above.

Qualifying for Disability Based on Reduced Functional Capacity

If an applicant has non-mosaic Down syndrome, the SSA will not assess the applicant's ability to work, because a diagnosis of non-mosaic Down syndrome automatically meets SSA's criteria for disability.

However, if an adult applicant has mosaic Down syndrome with other impairments (such as the ones listed above) but does not meet the criteria in the listing for those impairments (because the impairments aren't considered severe enough), the SSA will look at the applicant’s functional capacity.

The SSA will perform an assessment to determine what limitations the applicant has and what kind of work the applicant is still capable of doing despite the limitations; this is called the applicant's residual functional capacity, or RFC. For example, if an applicant suffers from congenital heart disease, his or her RFC assessment may limit the amount of physical exertion the applicant is able to perform in an employment situation. A person who is hard of hearing will have limitations on working in jobs that require good hearing. Depending on an applicant’s IQ, if he or she is mentally retarded, the RFC assessment may severely limit the kinds of work that applicant can perform.

If the SSA finds that an applicant’s RFC is not sufficiently limiting, and that the applicant is capable of performing a job, the SSA can deny the claim. But if the SSA determines that the symptoms associated with the impairment are so limiting that there is no job the applicant can perform, he or she will be awarded benefits under what is called a “medical-vocational allowance.” For more information, see our articles on RFCs and the medical-vocational allowance.

Qualifying for Disability as a Child With Down's

Since children can’t be assessed on how their disability limits their ability to work, the SSA does not assess a child's residual functional capacity. Instead, the SSA uses different tests to determine if a child is disabled.

Definition of Functional Disability for a Child

In general, the SSA may find a child disabled if both of the following are true:

  • The child has a physical or mental condition (or a combination of more than one condition) that results in “marked and severe functional limitations.”  A child will meet this criteria if his or her condition(s) seriously limit daily activities.

  • Just as with an adult applicant, the child’s condition(s) must last at least 12 months or be expected to result in death.

Disability Benefits for Which a Child Can Qualify 

A child (generally considered a person under the age of 18) can qualify for disability benefits in a few different ways.

SSI. A child can receive benefits through the Supplemental Security Income (SSI) program, just like an adult can. Under the SSI program, disabled people with limited resources and income receive monthly payments.  If a child meets the requirements for SSI, they can receive those benefits (keep in mind that some of the parents' income is deemed to the child). For more information, see our articles on eligibility for Supplemental Security Income.

SSDI. Social Security Disability Insurance (SSDI) is available only to disabled people who have worked a certain length of time in jobs that have paid Social Security taxes. A child cannot receive SSDI benefits based on their own earnings (a person isn’t able to work the required length of time before that person turns 18).

However, if a child’s parent is disabled and collects SSDI, the child may be able to receive what is called Social Security dependents’ benefits. The monthly amount of benefits the child receives is based "on the record" of the parent. (“On the record” just means that it is based on the parent’s earnings.)  

A child does not have to be disabled to receive dependents’ benefits. However, if the child is not disabled, the benefits will generally end when the child turns 18. If the child is disabled, the benefits will continue even after turning 18 if the following conditions are met:

  • The disability began before the child was 22; and
  • The child has a parent who is receiving SSDI or Social Security retirement benefits (or is deceased but was insured under the SOcial Security program before death).

For more information, see our article on disability benefits for disabled adult children.

by: , Contributing Author

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