Can My Child Qualify for Disability Benefits with a Mental Disorder?

Mental health issues are far more common in the United States than many people realize. According to NAMI, or the National Alliance on Mental Illness, nearly 62 million Americans will experience mental illness at some point in their lives: that’s nearly one fifth of the national population.  Teens and children make up a significant portion of these numbers, accounting for at least four million cases.  If your child is one of the many who is living with a mental illness, he or she could be eligible for monthly disability benefits through the SSA, or Social Security Administration.  How are these conditions evaluated by the SSA, and how does your child qualify for disability?

What Are Disability Benefits?

Millions of Americans live with diseases, disorders, and long-term injuries which are so severe that they completely rule out steady employment.  Of course, life’s financial demands continue to pile up whether a person is working or not: your groceries, prescriptions, bills, and mortgage payments don’t care whether or not you’re clocking in every day.  Needless to say, this can create an extremely stressful situation.

Fortunately, help may be available in the form of SSI (Supplemental Security Income).  SSI is regulated by the Social Security Administration, and is available on a monthly basis to people who meet certain criteria.  Your child may be one of these people.

What Are the SSA’s Disability Requirements for Children?

There are two tiers of requirements your child must be able to pass through in order to qualify for monthly benefits: the general program eligibility requirements, and the medical requirements specific to his or her condition.

First, let’s begin by looking at the general criteria for children:

• Income limits.  If your child is working, their income should not exceed the FBR (Federal Benefit Rate), which is $721 per month as of 2014.  The FBR changes every year, however.
• Age limits.  The SSA considers a “child” to be a person younger than 18.  Once your child reaches age 18, they become an adult by SSA standards and are evaluated by the adult criteria, which are slightly different.
• Severity.  The SSA will only allocate funds to claimants who truly need assistance.  This means that your child’s disability must be severe, to the extent that it results in “marked and severe functional limitations.”  If your child can easily control his or her condition with medication or other treatments, they will not be considered eligible.
• Duration.  The claimant’s disability must either have already lasted or be expected to last for at least 12 months, or be expected to end in death.

It’s worth pointing out that there may be some rare exceptions to certain criteria.  For example, if a disability is rare or very advanced, a claim can be expedited through the Compassionate Allowances program.

Mental Disorders That Qualify for Disability Benefits in Pennsylvania

The medical criteria for specific disabilities are contained within the SSA’s “Blue Book,” also known as the Listing of Impairments.  (However, even if a condition is missing from or does not exactly match a listing, eligibility may still be possible through other avenues such as a Medical-Vocational Allowance.)  The Listing is divided into two separate documents: one for adults (Part A), and one for children (Part B).

In the Childhood Listing, mental health conditions are addressed by Section 112.00, including some of the most common such as ADD/ADHD, autism, and anxiety. Under Section 112.00, all of the following disorders are covered, provided they result in “marked and severe functional limitations”:

• 112.02 — Organic Mental Disorders (abnormalities associated with brain dysfunction)
• 112.03 — Schizophrenic, Delusional, Schizoaffective, and Other Psychotic Disorders
• 112.04 — Mood Disorders
• 112.05 — Intellectual Disabilities
• 112.06 — Anxiety Disorders
• 112.07 — Somatoform, Eating, and Tic Disorders
• 112.08 — Personality Disorders
• 112.09 — Psychoactive Substance Dependence Disorders
• 112.10 — Autistic Disorder and Other Pervasive Developmental Disorders (PDD)
• 112.11 — Attention Deficit Hyperactivity Disorders (ADHD/ADD)
• 112.12 — Developmental and Emotional Disorders of Newborns (birth to age one)

Each of these categories comes with its own set of specific requirements.  For an anxiety disorder, for example, the claimant must meet at least one of seven different possible criteria.

Of course, it is not enough to simply say that your child has a condition.  The disability claim must be substantiated by medical documentation, which ideally should be no more than 60 to 90 days old.  Under federal regulatory codes § 404.1513 and § 416.913, acceptable sources of evidence include licensed:

• Physicians
• Optometrists (for vision disorders)
• Psychologists
• Podiatrists
• Speech-Language Pathologists

Medical reports should include:

• Medical History
• Clinical Findings
• Lab Results
• Diagnosis Statement
• Treatment and Prognosis
• “A statement about what you can still do despite your impairment.”

§ 416.924 goes into greater detail about how the SSA makes disability determinations for children.

Pennsylvania Disability Attorneys Offering Free Consultations

If your child is living with a mental health disorder, call the Philadelphia disability benefits lawyers at Young, Marr, Mallis & Associates today at (609) 755-3115 in New Jersey or (215) 701-6519 in Pennsylvania to learn more about how we can help in a free and private case evaluation.  You can also contact us online.