Functional Equivalence for Children's Disability Applications

The Social Security Administration provides disability benefits for children under the agency's Supplemental Security Income (SSI) program. Children can be considered disabled when they:

• have a medically determinable severe impairment
• that results in marked and severe functional limitations, and
• lasts for longer than twelve months or results in death.

The medical conditions that can qualify children for Social Security disability benefits are called "listed impairments." Children can be eligible for SSI when their medical records meet the requirements of a listed impairment, or if they functionally equal the listed impairments. The section of the Social Security Act that explains functional equivalence is §416.926(a).

What Does Being "Functionally Equal" to the Listings Mean?

Proving the "functional equivalence" of a listing for a child's condition means showing that, even if your child's condition doesn't exactly match the requirements of a listing, their condition still significantly impacts their daily functioning enough for the SSA to consider it basically the same as a listing. You'll need to be able to explain to the Social Security Administration (SSA) how your child's condition affects them daily while they are doing age-appropriate things like playing with others or feeding and dressing themselves.

For a child's condition to be considered functionally equal to a listing, your child must have "marked" (serious) limitations in two of six areas of functioning or one "extreme" (very serious) limitation.

A marked limitation seriously interferes with your child's ability to initiate, sustain, or complete independent tasks. The SSA will look at your child's day-to-day functioning to determine how limited they are. Your child can have a single limitation that seriously interferes with their daily lives or have a combination of limitations that seriously limits their functioning.

An extreme limitation is a limitation that very seriously interferes with your child's ability to initiate, sustain, or complete independent tasks. This does not mean that your child must have a total loss of ability to function in one of the areas of functioning; it may be enough to have very serious interference with independently completing an activity.

Making a Link between the Condition and Functional Limitation

Social Security wants to see how your child's condition directly limits their daily activities. For example, say your child has an anxiety disorder, and they are extremely fearful of going to the dentist for routine checkups. That wouldn't be a limitation that affects your child's daily ability to function, because dental checkups typically happen every six months. But if your child is so scared of brushing their teeth that it starts affecting their dental hygiene, that would be an example of how anxiety affects their daily functioning.

Domains of Functioning

There are six areas—known as domains—of functioning that the SSA considers when determining whether your child's impairments are functionally equivalent to the listings. These six domains are intended to cover everything that your child can and cannot do.

1. Acquiring and Using Information

This domain focuses on your child's ability to learn. Children learn from their environment and develop skills by absorbing what is going on around them. A child's ability to communicate shows how they are using the things they have learned. School-age children should be able to demonstrate their ability to learn and use new information through academics, specifically reading, writing, and math. As children grow older, the skills they learn at school and at home should translate into skills that can be used in the community (and at jobs).

Some examples of marked to extreme limitations in acquiring and using information include:

• only speaking in short, simple sentences
• being unable to understand word concepts, such as space (under/above), size (short/tall), or time (day/night)
• not remembering important information learned in school the day before
• difficulty explaining what they mean, and
• having trouble with simple math problems.

2. Attending and Completing Tasks

This domain focuses on your child's ability to focus and finish activities at an average pace for children of the same age. As children grow, so should their ability to maintain attention and complete tasks. During the time they are at school, children should increase their ability to follow directions, maintain the organization of their school materials, and complete assignments. This attention should also be carried over to activities outside of school, like home chores and organized activities.

Some examples of marked to extreme limitations in completing tasks include:

• being easily distracted or startled by sounds, sights, movements, or touch
• failing to complete even interesting tasks, and
• becoming sidetracked and needing extra help to finish chores.

3. Interacting and Relating to Others

This domain focuses on your child's ability to start and respond to exchanges with other people. Speech is a significant component of this category—others should be able to understand your child most of the time. Close personal relationships with family and friends of the same age should also develop as your child ages, as well as the ability to resolve conflicts.

Your child should be increasingly able to express emotions, respond to others' emotions, and understand and respect others' viewpoints. Your child should be aware of and appreciate the different social rules in different environments (for instance, what is acceptable to do at home instead of at school).

Some examples of marked to extreme limitations in social interactions include:

• not having friends who are the child's age
• having difficulty talking to others
• avoiding people or being afraid of new experiences, and
• having difficulty following game rules, difficulty with speech (being hard to understand) and difficulty communicating with others.

4. Moving About and Manipulating Objects

This domain focuses on how children move physically from one place to another and how they move objects. The expected physical ability of your child ranges with your child's age. As an infant, your child should be able to hold their head up, sit, crawl, and stand while holding onto an object. As the child gets older, they should be able to walk and run without assistance, climb stairs, and use playground equipment independently.

Fine motor skills (such as using a pencil, moving small game pieces, and using scissors) should also meet developmental milestones. As children get to school age, they should be able to physically keep up with others their age and show proper hand-eye coordination.

Some examples of marked to extreme limitations in motor abilities include:

• difficulty going up and down stairs
• an inability to use motor movements for activities like running or riding a bike
• poor hand-eye coordination when using a pencil, crayon, or scissors, and
• dropping small objects.

5. Caring for Self

This domain focuses on children's ability to care for themselves physically and mentally. As a child grows, they should become increasingly independent in making their own decisions. They should also be able to differentiate between right and wrong and understand what behaviors are acceptable. Children should understand their physical and emotional needs and how to effectively control their thoughts and urges to maintain their well-being.

Examples of marked to extreme limitations in this domain include:

• placing objects in the mouth that aren't food
• engaging in age-inappropriate self-soothing behavior such as rocking or thumbsucking
• self-harming or engaging in dangerous activities, and
• not spontaneously pursuing enjoyable activities or interests.

6. Health and Physical Well-Being

This domain focuses on everything not covered in the "caring for yourself" section. The SSA looks at the effects of your child's condition and treatment on your child's ability to function physically. For example, if your child's condition causes "flare-ups" that require hospitalization, the frequency and duration of the hospital stays will be considered.

Examples of marked to extreme limitations in health include:

• needing multiple surgeries or chemotherapy
• being medically fragile and needing intensive medical care, and
• having extensive weakness, dizziness, or fatigue due to the condition.

What Evidence Do DDS Examiners Consider to Determine Your Child's Functioning?

Social Security uses medical evidence, interviews with friends and family, and school evaluations to determine how appropriately a child functions compared with other children of the same age. Additionally, the SSA looks at how the child is functioning compared to teachers' expectations, other children with similar limitations (such as other children in special education classes), and other children the same age with no limitations.

Evidence that can be provided to prove the child's decreased functional abilities include:

• progress notes from the child's doctors, including examinations and the doctors' observations about the child's functioning
• standardized test results
• reports from teachers or other educators, and
• comprehensive evaluations from early intervention and school programs, such as individual education program (IEP) forms.

When the SSA Decides Functional Equivalence

It's unlikely that the SSA will find that your child's condition is functionally equal to the listings on its own—you'll have a better chance of arguing functional equivalence if you have a disability attorney submitting a written brief to the agency.

Most likely, you'll have to apply for SSI disability benefits for your child and get denied at the initial and reconsideration levels. Then you'll need to hire a lawyer to represent your child at a hearing in front of an administrative law judge (ALJ) Your lawyer will write a brief arguing that your child's physical or mental condition is functionally equal to the listings and submit it to the ALJ.

Consider hiring an experienced disability lawyer to represent your child at the appeal hearing; when you interview the lawyer, discuss whether your child's condition might be functionally equal to the listings.

Please see our section on SSI Disability Benefits for Children to learn more.

_{Updated November 14, 2022}