Can My Child Get SSI Disability for Asthma?

Asthma is a chronic respiratory disorder that causes swelling of the airways, wheezing, coughing, and difficulty breathing. To diagnose asthma in your child, a doctor who specializes in breathing disorders (a pulmonologist) will talk to you about your child's history of symptoms. The pulmonologist will also likely do testing with a type of machine that measures airflow called a spirometer.

The Social Security Administration (SSA) will look at the spirometry results and pulmonologist's notes to determine how severe your child's asthma is. Because asthma symptoms can range in intensity from mild to debilitating, the SSA needs to see evidence that your child's symptoms cause significant functional limitations. (For adults, see our article on disability for adult asthma.)

Symptoms and Causes of Asthma in Children

Asthma in children is frequently genetic and present at birth. But children may develop asthma over time as a result of exposure to allergens, viral infections, pollution, or harmful chemicals.

Asthma is characterized by sudden episodes of symptom exacerbation ("asthma attacks"). During an asthma attack, your child might experience the following symptoms at a greater intensity:

• wheezing (making a high-pitched whistling sound when breathing)
• coughing
• trouble breathing, and
• tightness in the chest.

Common triggers for asthma attacks in children include:

• allergens like pet dander, pollen, or mold
• environmental irritants such as smog or car exhaust
• respiratory viruses that can cause the flu or common colds
• exercise, and
• weather or temperature changes.

Children with asthma are frequently prescribed an inhaler to help the asthma attacks subside. If your child's asthma has lasted for at least one year and persists despite treatment, your child might qualify for Supplemental Security Income (SSI).

SSI Benefits for Children with Asthma

Children can get SSI benefits if they meet Social Security's definition of disability and if their family has little income and few resources. Social Security will consider parental income and resources when deciding whether a child is eligible for SSI. (You can learn more about who qualifies by reading our article on Social Security benefits for children.)

If your family meets the financial eligibility criteria for SSI, Social Security will next determine whether your child's symptoms are severe enough to meet the agency's disability listing for asthma or are functionally equivalent to the listings.

Social Security's Listing for Childhood Asthma

When Social Security claims examiners and disability attorneys talk about "listed impairments," they're referring to certain disorders that the SSA considers to be especially severe. If your child's medical records contain specific test results showing that their ability to breathe is significantly reduced, the agency will find that your child "meets a listing" and award them disability benefits.

Specifically, Social Security's Listing 103.03 for asthma requires that your child has had three "exacerbations," or complications requiring hospitalization, in the previous one-year period. The hospitalizations must have lasted at least 48 hours each and must have occurred at least 30 days apart. If you meet these criteria, the SSA will automatically find your child disabled for at least one year.

If your child hasn't been hospitalized frequently enough to meet Listing 103.03, or it's been over one year since their last asthma attack, they might still qualify for benefits under Listing 103.02 for chronic respiratory disorders. Meeting this listing requires that your child have greatly reduced lung function as determined by one of the following:

• low forced expiratory volume (FEV1) or forced vital capacity (FVC) relative to height and weight
• low levels of oxygen in the blood, requiring at least 90 days of supplemental oxygen, or
• surgical insertion of a tube in the windpipe to help breathing (tracheostomy).

Having Limitations of Listing-Level Severity

Children whose asthma doesn't meet the requirements of the asthma listing may still be eligible for disability if Social Security finds that their condition "functionally equals" the listings—in other words, their symptoms cause limitations just as severe as those in the listings.

What Limitations Does Social Security Look At?

In order for your child functionally equal the listings, asthma must cause your child to have a "marked" limitation in two areas of functioning or an "extreme" limitation in one area of functioning. The areas of functioning are:

• acquiring and using information (such as following instructions)
• attending and completing tasks (such as finishing chores)
• interacting and relating with others (such as making friends)
• moving about and manipulating objects (such as playing with toys)
• caring for personal needs (such as getting dressed), and
• having health and physical well-being (such as not needing hospitalization).

How Does Social Security Assess Your Child's Limitations?

"Marked" limitations mean that your child needs a lot of help to maintain independence in that functional area. "Extreme" limitations are even more restrictive, suggesting that your child can rarely perform those activities by themselves, if at all.

The SSA will look to see how your child's ability to function is affected by asthma. For example, your child may have developed lung damage or peribronchial disease (thickening of the bronchial walls) from asthma, causing persistent difficulty breathing outward and wheezing. Or your child may have side effects from corticosteroid asthma medications such as muscle weakness and fatigue. As a result, they may be physically unable to play with others or pick up after themselves.

If your child is significantly lagging behind other children their age because their asthma prevents them from hitting developmental milestones, Social Security will likely find that they have enough marked or extreme limitations to functionally equal the listings.

Evidence Required for Your Child to Get SSI for Asthma

You'll need a lot of medical evidence about your child's asthma to win an application for SSI benefits. Social Security will look at your child's medical records for evidence that their asthma either meets a listing or functionally equals the listings. To qualify for SSI, you must show that your child's asthma isn't controlled with medications (such as an inhaler) and continues to cause severe symptoms like those described in the listings.

Social Security will also review other information that shows your child's limitations. For example, in children's cases, school records are often helpful evidence of how a child's health condition limits their daily activities. Medical opinions from your child's pediatrician or pulmonologist can provide the SSA with additional insight into their symptoms and restrictions.

If the SSA reviews your child's records and finds that more testing is needed, the agency may order a consultative exam and FEV1 test for your child. Social Security pays the cost of consultative exams. For more information, see our section on consultative exams.