Can My Child Get SSI for Juvenile Idiopathic or Rheumatoid Arthritis?

Children who are severely affected by juvenile arthritis may be able to collect SSI.

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Juvenile arthritis, which is often called juvenile idiopathic arthritis (JIA) or juvenile rheumatoid arthritis (JRA), is a general name given to describe several different types of childhood arthritis:

  • oligoarthritis
  • systemic juvenile idiopathic
  • polyarthritis (rheumatoid factor positive), aka polyarticular juvenile idiopathic arthritis
  • polyarthritis (rheumatoid factor negative)
  • psoriatic juvenile idiopathic arthritis
  • enthesitis-related juvenile idiopathic arthritis, and
  • undifferentiated arthritis (arthritis that doesn’t fit into another category or one that meets the criteria for more than one type).

Although the various types of juvenile arthritis differ in their specific signs and symptoms, family history, and the number of joints affected, all juvenile arthritis is caused by an abnormal response by the immune system that causes the body to attack itself—namely the joints.

Can Children Get Disability Benefits?

Children who meet the Social Security Administration’s (SSA's) definition of disabled may be eligible for Supplemental Security Income (SSI), but not Social Security disability. However, childhood SSI benefits are dependent on parental income. This means that if you make too much money, or have too many assets, your child may not be eligible for benefits even if he or she meets the disability requirements. (You can learn more by reading our article on Social Security benefits for children. For information on getting benefits for those over 18, see our article on adult rheumatoid arthritis.)

Can My Child Get Benefits for Juvenile Rheumatoid Arthritis?

Generally, the SSA requires that a child meet the following two criteria to be found disabled.

  • The child has a physical or mental impairment that results in marked and severe functional limitations, and
  • The condition(s) has lasted, or is expected to last, at least 12 consecutive months.

If your child meets these two basic requirements, he or she may be eligible for SSI benefits.

There are some medical conditions that the SSA has decided are serious enough to result in an automatic approval of benefits. These are called “listings.” One of the SSA's listings is for inflammatory arthritis.

Social Security's Listing for Inflammatory Arthritis 

Inflammatory arthritis includes all of the types of juvenile rheumatoid arthritis above. Here are the criteria that must be met to be awarded benefits automatically for JRA (as long as your child qualifies financially for SSI).

Your child’s medical records must show that he or she experiences all of the criteria under one of the following sets of symptoms:

Problems walking or using hands. The ongoing inflammation of or the persistent deformity of a major joint or joints that causes your child trouble walking or using his or her hands. Either one of the following conditions can fulfill this requirement:

  • trouble with one or more major peripheral weight-bearing joints (e.g., hip or knee) that makes it hard for your child to walk without help from either another person or a handheld assistive device (like crutches),
  • trouble with one or more major peripheral joints in each upper extremity (e.g., shoulder, elbow, or wrist) that prevents your child from be able to make fine or gross movements effectively (e.g., holding a pencil or pen, typing, pushing, or reaching overhead).

OR

Problems with organs or body-wide symptoms. Inflammation or deformity in at least one major peripheral joint (knee, shoulder, hip, elbow, hand-wrist, and ankle-foot) that causes fulfills both of the following criteria:

  • involves two or more organs or body systems (e.g., skin, liver, or spleen) with at least one of the organs or body systems affected to at least a moderate level of severity, and
  • causes your child to experience at least two of the "constitutional" signs (like severe fatigue, fever, or involuntary weight loss).

 OR

Problems with the spine. Ankylosing spondylitis or other spondyloarthropathies, with one of the following sets of symptoms:

  • fixation of the dorsolumbar or cervical spine that is shown on medical imaging (such as x-ray or CT scan) and measured on physical examination at 45° or more of flexion from the vertical position (0°), or
  • fixation of the dorsolumbar or cervical spine that is shown by medical imaging and measured on physical examination at 30° or more of flexion measured from the vertical position (0°) that involves of two or more organs or body systems, affecting at least one organ or body system to at least a moderate level of severity.

OR

Developmental delays. Symptoms of inflammatory arthritis that cause your child to fall behind other children his or her age in any of the following areas:

  • motor skills
  • cognitive skills
  • communication, or
  • social functioning.

The requirements for this last section of the listing are complex and depend on the age of your child. You should consult your child’s treating physician to see whether these criteria are met. (Your doctor can learn more about these specific criteria for JIA on the SSA’s website.) It may also be helpful to speak with an experienced disability attorney, who will be familiar with what symptoms and test results are needed to meet this listing.

Can My Child Still Get Disability if She Doesn’t Meet the Listing?

If your child’s JRA doesn’t meet the requirements of Social Security's listing for inflammatory arthritis, he or she may still be eligible for disability if the SSA determines that juvenile arthritis causes your child to have a “marked” limitation in two areas of functioning or an “extreme” limitation in one area of functioning. There are six areas of functioning ("domains") that the SSA uses to evaluate a child’s disability:

  • attending and completing tasks
  • interacting and relating with others
  • moving about and manipulating object
  • caring for personal needs, and
  • the child’s general health and physical well-being.

A “marked” limitation is one that seriously interferes with your child’s ability to “independently initiate, sustain, or complete activities.” An “extreme” limitation as one that very seriously interferes with your child’s ability to “independently initiate, sustain, or complete activities.” (For more information, see our article on how a child can functionally equaling Social Security's listings.)

Form SSA-538

To assess the extent of your child’s disability, the SSA will complete Form SSA-538. The SSA will use the evidence in your child’s file to complete this form. Here are some examples of the information the agency will use:

  • doctors’ records
  • report cards
  • individual education plan (IEP) reports
  • therapist reports, and
  • teachers’ observations.

A sample of Form SSA-538 is available online. Even though the SSA will complete its own SSA-538, you should complete and submit one as well. If you have a disability attorney, he or she will make sure that the form is completed properly and will communicate with your child's educators and doctors for you.

by: , Contributing Author

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