Is Down Syndrome a Disability You Can Get Benefits For?

Down syndrome—also called trisomy 21—is a genetic disorder that causes a wide range of developmental and intellectual delays. Down syndrome is classified into two types: non-mosaic, where every cell has an extra 21st chromosome, and mosaic, where only some of the cells have an extra chromosome. Non-mosaic is by far the more common type (accounting for over 96% of Down syndrome diagnoses) and is one of the listed impairments in Social Security's Blue Book of medical disorders that can automatically qualify for disability.

Getting approved by "meeting a listing" is one of the quickest ways of establishing that you're disabled. But even if you have a diagnosis of non-mosaic Down syndrome, you'll still have to meet the preliminary requirements for either SSDI or SSI and provide specific medical documentation validating your diagnosis. Knowing what evidence to submit will help make the application process go smoothly and ensure you get your benefit payments in a timely manner.

Is Down Syndrome a Disability?

The Social Security Administration (SSA) awards disability benefits to adults who have a medically determinable impairment that prevents them from engaging in substantial gainful activity for at least one year. (20 CFR § 404.1505(a))(2026). Children can also qualify if they have limitations relative to other children their age that meet a childhood listing or are "functionally equivalent" to a listing.

As mentioned above, non-mosaic Down syndrome is a listed impairment, meaning that Social Security can award disability automatically provided the agency has access to certain medical records that can establish the diagnosis. Adults may be eligible for either Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) depending on their work history and current resources. Children can qualify for SSI only if their family has limited income and assets, but in some instances can be eligible for SSDI as a "disabled adult child."

Qualifying for Disability Benefits for Non-Mosaic Down Syndrome

Adults with non-mosaic Down syndrome will have their applications evaluated under Listing 10.06 in order to determine whether they'll receive benefits. The requirements of Listing 10.06 are fairly straightforward—you'll need one of several forms of medical documentation confirming your diagnosis of non-mosaic Down syndrome. The SSA will accept the following as evidence:

• a karyotype analysis (a blood test that checks for chromosome abnormalities) signed by a doctor
• an unsigned karyotype test, accompanied by a statement from a doctor that you have Down syndrome
• a doctor's report diagnosing you with Down syndrome based on distinctive physical features and a prior karyotype test, or
• a doctor's report stating that you have Down syndrome based on distinctive physical features and evidence of reduced functional ability consistent with the diagnosis.

Children with non-mosaic Down syndrome are evaluated under listing 110.06, but the listing requirements are the same for children as they are for adults. The SSA considers children with non-mosaic Down syndrome to be disabled from birth.

Qualifying for Disability for Mosaic Down Syndrome

Some people with mosaic Down syndrome can have many of the same physical characteristics and cognitive delays as people with non-mosaic Down syndrome, but others might have much milder symptoms. Because the SSA doesn't consider a diagnosis of mosaic Down syndrome to be automatically disabling, applicants with mosaic Down syndrome will need to show that, in addition to their diagnosis, they have disabling functional limitations.

Mosaic Down syndrome can cause limitations in specific parts of the body. Some common conditions that often are present in people with mosaic Down syndrome include:

• congenital heart defects
• sleep-related breathing disorders, such as obstructive sleep apnea
• hearing loss caused by recurrent ear infections
• intellectual disability (low IQ score), and
• eye diseases.

If the above conditions are severe enough, the SSA can find people with mosaic Down syndrome disabled under the listings for the respective impairments, even if they wouldn't qualify based on mosaic Down syndrome alone.

Not very many people with mosaic Down syndrome are found disabled under the strict requirements of a Social Security listing. But the SSA can still award benefits to adults who can show that they're unable to work full-time or children who are "functionally equal" to a listed impairment. In these cases, the SSA determines disability for adults based on how well they're expected to perform in a work setting, while children's disability is based on how well they're performing compared to other children at a similar stage of development.

How Adults With Mosaic Down Syndrome Can Qualify for Disability Without Meeting a Listing

Adults with non-mosaic Down syndrome don't have to show that they're unable to work, because a documented diagnosis of non-mosaic Down syndrome automatically meets Social Security's criteria for disability. But adults with mosaic Down syndrome or other medical conditions that don't quite meet any listing requirements can get benefits if they have a residual functional capacity (RFC) that rules out all jobs.

Your RFC is a set of limitations that reflects the most you're capable of doing, physically and mentally, at work. For example, somebody with mosaic Down syndrome and a heart defect might get out of breath walking longer than 10 minutes, so their RFC would restrict them from doing a job that involves a lot of walking (like restaurant server). Or, somebody with an intellectual disability might not even be able to perform a job with simple, routine tasks.

If Social Security determines that no jobs exist that you can do with the restrictions outlined in your RFC, the agency will award you benefits. Getting benefits this way is known as "medical-vocational allowance."

How Children With Mosaic Down Syndrome Can Qualify Without Meeting a Listing

Children aren't assessed on how their limitations prevent them from working. Instead, the SSA looks at how severely a child is limited in six "functional domains." The functional domains are areas of physical and mental abilities that are intended to cover all the activities children engage in. They are:

• acquiring and using information
• attending and completing tasks
• interacting and relating to others
• moving about and manipulating objects
• caring for self, and
• health and physical well-being.

Children with mosaic Down syndrome can "functionally equal" a listing if evidence in their medical records—like doctor's notes, standardized tests, and teacher's reports—indicates that they have "marked" limitations in two (or an "extreme" limitation in one) of the above areas. For more information, see our article on functional equivalence for children's disability applications.

Medical Evidence of Down Syndrome

Gathering evidence of non-mosaic Down syndrome should be relatively simple—a karyotype test, doctor's diagnosis, and evidence of distinctive physical characteristics are generally enough to prove that you're disabled under the Blue Book listing. The distinctive physical characteristics of Down syndrome include:

• an upward slant to the eyes and flattened facial features
• shortened neck, arms, and legs
• small ears
• protruding tongue
• small hands that have a single crease and short fingers, and
• poor muscle tone or loose joints.

People with mosaic Down syndrome may have fewer of the above physical features depending on how many cells have the typical number of chromosomes. For people with mosaic Down syndrome, the SSA will review your medical records for evidence of physical or mental symptoms that could potentially keep you from doing any full-time work.

Symptoms of mosaic Down syndrome can vary between each person with a diagnosis. Cognitive impairments, mainly affecting speech and memory, can range from mild to moderate, while physical disorders might include heart conditions or digestive problems. Make sure to provide the SSA with clinical notes from your doctors as well as any physical or mental examinations you've had that can establish work-preclusive limitations. (If your doctor is willing and able to provide a medical source statement attesting to those limitations, even better.)

What Type of Disability Benefits Are Available for Down Syndrome?

Most people use the terms SSDI and SSI interchangeably, but they are actually two different types of disability programs run by Social Security. SSDI is available to people who've earned enough in work credits to become fully insured under the program, while SSI is available to everybody with limited income and resources, regardless of work history.

Children who are disabled only receive benefits from SSI, provided their parents' income is low enough to qualify for the program. But if a minor collecting SSI has a disabled or retired parent who is collecting SSDI, the minor may be able to start receiving SSDI as well, so long as they're still disabled when they turn 18. SSDI benefits pay more per month than SSI, so this can be an important resource for people with Down syndrome as their parents age and retire.

What Happens If My Claim Is Denied?

Only about one-third of disability claimants are approved on their first try. If, after reading over the denial letter, you disagree with the SSA's decision, you have 60 days to submit an appeal. Social Security's appeals process typically involves getting another denial before you can request a hearing with an administrative law judge, where you have your best shot at getting benefits.

When you're preparing your appeal, you might want to consider getting help from an experienced disability attorney. Your lawyer can help you gather your medical evidence, correspond with Social Security on your behalf, and represent you at a hearing. Disability attorneys don't get paid unless you win and many offer free consultations, so there's little risk in asking around to find a lawyer who's a good fit for you.