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

Juvenile arthritis is arthritis diagnosed in children (younger than 16). Formerly it was called juvenile rheumatoid arthritis (JRA), but today it's usually called juvenile idiopathic arthritis (JIA).

Juvenile idiopathic arthritis describes several different types of childhood arthritis:

• oligoarthritis (the mildest form of JIA, and the most common; if it affects five or more joints, it's called extended oligoarthritis)
• polyarthritis-rheumatoid factor positive (inflammation in five or more joints in the first six months, with a positive test for the autoimmune disease marker, or rheumatoid factor; also known as polyarticular JIA)
• polyarthritis-rheumatoid factor negative (inflammation in five or more joints in the first six months, with a negative test for the autoimmune disease marker)
• systemic JIA (usually starts with fever and rash and can cause inflammation in the whole body, not just specific joints and organs)
• psoriatic arthritis (includes joint inflammation and psoriasis and can include pitted fingernails and swollen fingers or toes)
• enthesitis-related JIA (arthritis that involves inflammation where a ligament or tendon attaches to the bone and can include sudden onset of inflammation of the front of the eye), and
• undifferentiated arthritis (arthritis that doesn't fit into another category or meets the criteria for more than one type).

The various types of juvenile arthritis differ in specific signs and symptoms (including the number of joints affected) and family history. But all juvenile arthritis is caused by an abnormal immune system response that causes the child's body to attack itself—especially the joints.

Can My Child Get Disability Benefits?

Children who meet the definition of disabled used by the Social Security Administration (SSA) might be eligible for disability benefits through the Supplemental Security Income (SSI) program. SSI is a needs-based program, so a child's benefits are dependent on parental income—meaning if you make too much money or have too many assets, your child can qualify as disabled and still not be eligible for benefits.

Children aren't eligible for Social Security disability insurance (SSDI) benefits. They can only qualify for SSDI dependents benefits, and only if a parent is eligible for SSDI or Social Security retirement benefits. Learn more about the types of Social Security benefits available for children.

(To learn how to get benefits for an adult, or someone over 18, with arthritis, see our article on getting disability for adults with rheumatoid arthritis.)

Can My Child Get Benefits for Juvenile Rheumatoid Arthritis?

Generally, Social Security 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.

Social Security will consider a child who meets these two basic requirements "disabled" for SSI benefit purposes.

There are some medical conditions that Social Security has decided can be severe enough to qualify for benefits automatically. The criteria that must be met for automatic approval are detailed in the Blue Book of "impairment listings." Social Security includes a listing for inflammatory arthritis in children.

Social Security's Listing for Inflammatory Arthritis

Inflammatory arthritis includes all of the types of juvenile idiopathic arthritis above. The listing for inflammatory arthritis (listing 114.09) details the medical criteria your child must meet to qualify automatically for disability benefits based on JIA (or JRA).

The listing includes different sets of criteria a child can meet to qualify for disability benefits, depending on the affected body part(s). You must have medical records showing that your child experiences all of the criteria under one of the sets of symptoms. Here are the criteria for the three ways to get approved under listing 114.09.

Problems Walking or Using Hands

Your child has ongoing inflammation or the persistent deformity of at least one major joint. That inflammation or deformity affects the child's ability to walk or use one or both hands. Either one of the following sets of conditions can fulfill this requirement:

• trouble with one or more major peripheral joints in each arm (e.g., shoulder, elbow, or wrist/hand) that prevents your child from making fine or gross movements effectively, such as:
• holding a pencil or pen
• typing
• pushing, or
• reaching overhead, or
• trouble with one or more major peripheral weight-bearing joints (e.g., hip, knee, or ankle/foot) that makes it hard for your child to walk without help from either:
• a handheld assistive device that takes two hands (like a walker or crutches), or
• a handheld assistive device that takes one hand (like a cane), and your child can't use the other hand for other activities.

Children with inflammatory arthritis in their peripheral joints may also have Sjögren's syndrome, gout, or Lyme disease.

Problems With the Spine

Inflammation of the joints and ligaments of the spine that meets one of the following sets of criteria:

• The child's upper (cervical) or lower (dorsolumbar) spine is stiff or immobile due to bone fusion (called fixation) and the fixation can be shown on medical imaging (such as an X-ray or CT scan), and either:
  • the affected section of spine can be measured on physical examination as bent at 30° or more, and
  • two or more organs or body systems are also involved, with at least one organ or body system affected to at least a moderate level of severity, OR
  • the affected section of spine can be measured on physical examination as bent at 45° or more.

If you're unclear about what it takes to show that your child's spinal problems should qualify for SSI benefits, it might be helpful to speak with an attorney. An experienced disability lawyer will be familiar with the specific symptoms and test results needed to meet this listing.

Children who meet this listing can have ankylosing spondylitis or another spondyloarthropathy (inflammatory arthritis affecting the spine). Children with idiopathic arthritis in the spine may also have inflammatory bowel disease or Behcet's disease (a form of vasculitis).

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 fulfills both of the following criteria:

• It causes your child to experience at least two "constitutional" signs, like:
• severe fatigue
• fever
• malaise (discomfort), or
• involuntary weight loss, and
• It involves two or more organs or body systems (such as the digestive or cardiovascular systems) with at least one of the organs or body systems affected to at least a moderate level of severity.

Children who have inflammation in a joint that doesn't limit walking or use of the arms and hands might still have serious limitations if they also have constitutional symptoms from systemic arthritis.

Can a Child Who Doesn't Meet the Listing Still Get Disability?

If your child's JIA or JRA doesn't meet the requirements of Social Security's listing for inflammatory arthritis, can the child still qualify for disability benefits? Yes, your child can get SSI without meeting a listing if the child has fallen behind other children of the same age in at least one of the following areas:

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

Specifically, to qualify for disability, Social Security must determine 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. These are the six areas of functioning (called "domains") that Social Security uses to evaluate a child's disability:

• attending and completing tasks
• interacting and relating with others
• moving about and manipulating objects
• 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 is one that very seriously interferes. (Learn more about how a child can functionally equal Social Security's listings.)

Social Security's Childhood Disability Evaluation Form

To assess the extent of your child's disability, Social Security will complete a Childhood Disability Evaluation form (SSA-538). The SSA will use the evidence in your child's file to complete this form, such as:

• doctors' records
• X-ray, MRI, or other imaging records
• report cards
• individual education plan (IEP) reports
• therapist reports, and
• teachers' observations.

A sample of Form SSA-538 is available online. Even though Social Security will complete an SSA-538, if you're working with a disability lawyer or advocate, you should also complete and submit one. A disability attorney can ensure the form is completed correctly and will communicate with your child's educators and doctors, ensuring you have the best evidence to support your child's disability claim.

How Do I Apply for SSI Disability Benefits for My Child?

To apply for disability benefits for your child, you'll first need to notify Social Security that you want to file an SSI application. You can do that by calling Social Security at 800-772-1213 or contacting your local Social Security office.

There are also a couple of ways you can let Social Security know you want to file your child's disability application. You can:

• fill out the online notification form, or
• complete the online child disability report.

Once Social Security is notified that you want to file an SSI application for your child, the agency will schedule an interview with a representative so you can complete the process.

If you're not comfortable filing your child's application yourself, you have the right to get help. A disability lawyer or advocate specializing in children's SSI claims will know how to present your strongest case. Learn more about finding a qualified disability attorney or non-attorney representative.