By Robert J. Osborne, Esq.
If a child has a severe impairment or combination of impairments that does not meet or medically equal any listing, the Social Security Administration will decide whether the impairment, or the combination of impairments, results in limitations that functionally equal the listings. This means that the child’s impairment(s) must be of listing-level severity – it must result in “marked” limitations in two domains of functioning or an “extreme” limitation in one domain, as explained below.
In evaluating a claim for Supplemental Security benefits for children, the Social Security Administration will assess the limitations that the child’s impairment(s) cause on a child’s functioning – what the child cannot do, what the child has difficulty doing, what the child needs help doing, or what the child is restricted from doing because of the child’s impairment(s).
When the Social Security Administration makes a finding regarding functional equivalence, it will look at the way in which the effects of all of a child’s impairments interact and combine, including impairments the child has that are not “severe.” When the Social Security Administration assesses a child’s functional limitations, it will consider factors including, but not limited to:
(1) How well the child starts and continues activities, how much extra help the child needs, and the effects of structured or supportive settings;
(2) How the child functions in school; and
(3) The effects of the child’s medications or other treatment.
The Social Security Administration will look at information about how the impairment(s) affect the child’s functioning during all of the child’s activities when the Social Security Administration decides whether an impairment or combination of impairments functionally equals the listings. A child’s activities include what the child does at home, at school, and in the community. The Social Security Administration will look at how appropriately, effectively, and independently the child performs activities compared to other children of the same age who do not have impairments.
Domains
The Social Security Administration considers how a child functions in activities in terms of six domains. The domains are broad areas of functioning meant to capture all of what a child can or cannot do. The Social Security Administration uses the following domains:
(1) Acquiring and using information;
(2) Attending and completing tasks;
(3) Interacting and relating with others;
(4) Moving about and manipulating objects;
(5) Caring for oneself; and
(6) Health and physical well-being.
When the Social Security Administration evaluates a child’s ability to function in each domain, it will ask for and consider information that will help the Social Security Administration answer the following questions about whether the child’s impairment(s) affects effects the child’s functioning and whether the child’s activities are typical of other children of the same age who do not have impairments.
(1) What activities can the child perform?
(2) What activities can the child not perform?
(3) Which of the child’s activities are limited or restricted?
(4) Where does the child have difficulty with activities – at home, in childcare, at school, or in the community?
(5) Does the child have difficulty independently initiating, sustaining, or completing activities?
(6) What kind of help does the child need to do activities, how much help does the child need, and how often does the child need it?
Sources of Information
The Social Security Administration will try to get information from sources who can tell the Social Security Administration about the effects of the child’s impairment(s) and how the child functions. The Social Security Administration will ask for information from a child’s treating and other medical sources. Additionally, the Social Security Administration will ask for information from a child’s parents and teachers. Further, the Social Security Administration may ask for information from others who see the child often and can describe the child’s functioning at home, in childcare, at school, and in the community. Finally, the Social Security Administration may request a consultative examination(s) at the Social Security Administration’s expense.
When the Social Security Administration evaluates a child’s functioning and decides which domains may be affected by the child’s impairment(s), it will look first at the child’s activities and the child’s limitations and restrictions. An activity may involve the use of many abilities and skills, so any single limitation may be the result of one or more impairments. Additionally, any given impairment may have effects in more than one domain, so the Social Security Administration will evaluate the limitations from a child’s impairment(s) in any affected domain(s).
“Marked” and “Extreme” Limitations
“Marked” limitations are “more than moderate” but “less than extreme.” The Social Security Administration will find that a child has a “marked” limitation in a domain when the child’s impairment(s) interferes seriously with the child’s ability to independently start, continue, or complete activities. A child’s day-to-day functioning may be seriously limited when the child’s impairment(s) limits only one activity or when the interactive and cumulative effects of the child’s impairment(s) limit several activities.
“Extreme” limitations are “more than marked.” The Social Security Administration gives an “extreme” rating to the worst limitations. However, “extreme limitation” does not necessarily mean a total lack or loss of ability to function. The Social Security Administration will find that a child has an “extreme” limitation in a domain when the impairment(s) interferes very seriously with the child’s ability to independently start, continue, or complete activities. A child’s day-to-day functioning may be very seriously limited when the child’s impairment(s) limits only one activity or when the interactive and cumulative effects of the child’s impairment(s) limit several activities.