Childhood obesity is an increasingly common health condition. Obesity is diagnosed by measuring a child’s height and weight to determine the child’s body mass index (BMI). If a child’s BMI is at the 95th percentile when compared to other children of the same age and sex, the child is considered to be obese.
Obese children are more likely to suffer from:
If you meet certain income and asset requirements, your child may be eligible for Supplemental Security Income (SSI). To learn about the full financial requirements for SSI, see our article on disability benefits for children. The Social Security Administration (SSA) must also conclude that your child’s medical condition meets the criteria for childhood disability. (If you are an adult, read about disability benefits for obese adults.)
The basic medical requirements to be eligible for childhood SSI are:
If these basic requirements are met, the SSA will evaluate the child’s condition to see whether it meets the SSA’s definition of disabled.
If your child meets the basic requirements for disability, the SSA will next look at your child’s medical records to determine whether your child's obesity meets the requirements of one of Social Security's disability listings or could be considered equivalent to one of the listings. The SSA will approve a medical condition that meets or equals a listing automatically for benefits, as long as the criteria in the listing are met. If the condition doesn't meet or equal a listing, the SSA must then determine whether the child's medical condition functionally meets the listings.
There is no disability listing for obesity; however, the SSA may still find that your child's obesity and other resulting conditions equal a listing. Here is an example of how the SSA might decide that a childhood claim based on obesityequals a listing.
You can learn more about the listing requirements for 101.02 in our article on disability for joint pain.
Similarly, if your child has any difficulties with her heart or lungs due to being overweight, he or she could be evaluated under the cardiovascular or respiratory listings (such as the one for childhood asthma).
If the SSA concludes that your child’s obesity doesn’t meet or equal the joint deformity listing or another listing, the SSA will next examine the impacts of the obesity on your child’s functioning in six specific areas of her life (the SSA calls these “domains”). The domains include learning, completing tasks, and taking care of oneself. If the SSA concludes that the obesity causes a “marked” (serious) limitation in two of the domains, or an “extreme” (very serious) limitation in one domain, your child will be approved for SSI benefits.
Here is an example of how the SSA may find that a child’s obesity functionally equals the listings.
Example: A claim was filed on behalf of a child due to morbid obesity. The SSA concluded that the child's condition did not meet or equal a listing and assessed his obesity to see if it functionally equaled the listings. The child’s records indicated that because of his obesity, the child needed assistance with bathing and dressing (including washing his hair, bathroom hygiene buttoning his clothes, and tying his shoes). An average child of his age could perform these tasks without help. The child’s records also showed that because of his obesity he was unable to perform gross motor movements typical of an average child his age, such as riding a bike, running, hopping, and climbing. His obesity also caused him to experience significant fatigue during the school day that impacted his academic performance. Given the evidence, the SSA concluded that the child experienced marked limitations in his ability to care for himself, in his health and wellbeing, and in his ability to attend and complete tasks. The child was therefore approved for benefits.
To learn more about the domains and how they are assessed, read our article on how to get SSI for a child by functionally equally the listings.
To evaluate whether your child’s obesity functionally meets a listing, the SSA will use Form SSA-538. This form uses evidence such as school reports, individualized education plan (IEP) reports, doctors’ records, and any reports from therapists to assess how your child’s obesity impacts the domains. Even though the SSA will complete this form, you should print out a copy of this form and give it to your child’s educational and medical providers and ask them to fill it out. You can get a sample of Form 538 online from the SSA. If you have an attorney, he or she will make sure that your child’s providers receive the form and that it is completed properly and submitted to the SSA.
Because getting benefits for childhood obesity can be difficult, it may be helpful to talk to an attorney who is experienced in handling childhood disability claims. It is quite difficult to get an approval for disability benefits based on equaling a listing without a lawyer. To talk to an experienced disability attorney in your area, arrange a free consultation here.