Down syndrome (also called trisomy 21) is a genetic disorder that causes a wide range of developmental and intellectual delays. Symptoms from Down syndrome can vary between each person with a diagnosis. Cognitive impairments can range from mild to moderate, while physical disorders might include heart defects or gastrointestinal problems.
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 the more common type by far, occurring in over 96% of people diagnosed with Down syndrome.
People with mosaic Down syndrome tend to have less severe intellectual and developmental difficulties than people with non-mosaic Down syndrome and may be less likely to be disabled.
Adults and children with Down syndrome can qualify for disability benefits if their intellectual delays or physical impairments are severe enough. The Social Security Administration (SSA) will review an applicant's medical records for evidence of causes and symptoms of Down syndrome.
Because Down syndrome is a condition that results from having an extra chromosome (a "package" of genes that guide development of the brain and body), a diagnosis of Down syndrome is made by a type of genetic analysis called a karyotype test. Karyotype tests use a blood sample to check the number, length, and shape of chromosomes in a sample of cells.
Down syndrome presents with distinctive physical characteristics that include:
People with mosaic Down syndrome may have fewer of the above physical features depending on how many cells have the typical number of chromosomes. Both mosaic and non-mosaic Down syndrome usually result in cognitive impairments, mainly affecting speech and memory.
Disability applicants with a diagnosis of non-mosaic Down syndrome can automatically qualify for benefits under Social Security's "Blue Book" of listed impairments. Under Listing 10.06, you (or your child) will need to have medical evidence of a Down syndrome diagnosis, preferably a karyotype test showing the presence of extra chromosomes.
The SSA will accept the following documentation as evidence of non-mosaic Down syndrome:
Even if you don't have a karyotype test establishing a genetic abnormality, the SSA can also accept a doctor's report diagnosing you with Down syndrome based on a combination of physical features and functional limitations—such as difficulty with speech and memory—that are frequently found in people with non-mosaic Down syndrome.
The listing requirements for Down syndrome are the same for both adults and children (although the child listing is 110.06). Social Security considers children with non-mosaic Down syndrome to be disabled from birth.
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 they have functional limitations—in addition to their diagnosis—that are disabling.
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:
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 the Social Security listing. But the SSA can still award benefits in the following ways:
Social Security determines disability for adults based on how well they're expected to perform in a work environment, while children's disability is based on how well they're performing compared to other children at a similar stage of development.
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 listings 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 reflect 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."
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:
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.
Social Security provides two types of disability benefits for adults: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). SSDI is available to people who've been employed for long enough to pay Social Security taxes. SSI is available to everybody with limited resources, regardless of work history.
According to a 2015 survey of people with Down syndrome, only 3% were full-time, paid employees. The majority of survey respondents worked part-time or as volunteers, meaning they may not have enough work credits to qualify for SSDI. In that case, they would have to have less than $2,000 in assets to qualify for SSI.
Children who are disabled only receive benefits from SSI. 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. For more information, see our article on disability benefits for disabled adult children.
Filing for disability benefits, whether for yourself or for your child, can be a frustrating and lengthy process. Consider getting help from an experienced disability attorney or advocate. Your lawyer can gather and submit medical records, handle communications with the Social Security Administration, and represent you at a disability hearing.
Updated December 15, 2022