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For your child to receive SSI or the Title II benefits of Social Security Disability Insurance (SSDI) or Childhood Disability Benefits (CDB), your child must be “disabled” – according to Social Security’s definition of disability. Social Security has two different definitions of disability: one for children and one for adults. This article explains Social Security's definition of adult disability.
Remember, you are on Planet Social Security, which has unique definitions for words – including “disability.” For example, many parents assume their child's diagnosis proves their disability. Don’t count on that. Generally speaking, a diagnosis alone is not enough to prove disability. From Social Security’s perspective, if your child has a diagnosis, your child may have a medical impairment but not necessarily a disability.
Some parents assume that if they are guardians of their child, their child will be “disabled” according to Social Security’s definition of disability. No – guardianship status is not part of Social Security’s definition of disability.
Social Security’s definition of disability is about the individual’s inability to work due to provable medical conditions. Social Security’s definition is all about one’s capacity to work. A diagnosis alone generally does not equal disability because many people with different disabilities can work substantially and gainfully.
Social Security defines disability as the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months.
Let’s Break Down the Definition Into Three Chunks:
Chunk One
… the inability to do any substantial gainful activity…
For your child to be eligible for disability benefits, your child must be unable to engage in what Social Security calls substantial gainful activity (SGA). If your child earns wages (whether full or part-time) more than a certain monthly amount (net impairment-related work expenses discussed in a later chapter), your child will generally be considered to be engaging in SGA.
SGA is a number that typically increases yearly due to cost-of-living adjustments. For non-blind individuals, the monthly SGA amount for 2023 is $1470. For non-blind individuals, SGA applies to both Title II Social Security benefits and Supplemental Security Income (SSI) benefits. For blind individuals, the monthly SGA amount for 2023 is $2460. For blind individuals, SGA does not apply to SSI benefits.
Chunk Two
…by reason of any medically determinable physical or mental impairment…
In 2022, Social Security denied initial claims (not including appeals) for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) 62 percent of the time. In other words, slightly more than one in three people were awarded benefits on their first try.
Why such a high denial rate? It’s primarily because the individual’s current medical records do not prove their medical conditions impair their ability to engage in substantial gainful activity.
An individual’s current medical records are often inadequate in establishing their inability to engage in substantial gainful activity for two primary reasons:
As a result, the doctor never records in the individual’s medical chart how the medical condition impairs their ability to work.
Chunk Three
…which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months.
This part of the definition of disability is called the durational requirement. For most of you reading this book, your child's impairment meets this third requirement.
Evidence of Disability
As you know, for your child to receive SSI, SSDI, or CDB, your child must be “disabled.” You must prove essentially that your child has a medical condition (mental and/or physical) that causes symptoms so severe that for a period that lasted or is expected to last for 12 months, your child cannot engage in substantial gainful activity in any job in the national economy.
How do you prove your case?
The answer is relatively straightforward but not necessarily easy to do: The essential evidence to prove your child’s disability is what your child’s current medical providers write in your child’s current medical charts. Your child’s medical chart is a record of your child’s medical history: current and past diagnoses, treatments, medications, orders, notes, test results, assessments, and so forth.
When applying for a disability benefit, remember those words — 1) current and 2) medical. To successfully qualify for SSI for your child, you must prove your child’s case with current medical information. If your child does not have current medical evidence to prove their case, Social Security will likely deny them.
That makes sense, doesn’t it? Social Security wants to know whether your child can work at the time your child applies. Generally, old medical information will not prove to what extent your child can work when your child applies for benefits.
Applying for SSI or SSDI is essentially a medical case. For example, you or your child may claim your child is disabled and cannot engage in substantial gainful activity. However, Social Security is looking for what your child’s medical providers write in your child’s medical charts. In sum, it’s vital that your child see their doctor, or preferably a specialist, regularly and discuss the symptoms that limit their ability to work. Only by doing so will your child’s functional limitations appear in your child’s medical charts.
Although Social Security is looking for medical evidence, evidence about your child’s inability to engage in substantial gainful activity may also come from many other places. For example, if your child has a mental illness, you will likely need evidence from your child’s psychiatrist, therapist, or Ph.D. Psychologist. While your child’s psychiatrist may focus most of their time managing your child’s medication, your child’s therapist may be in a better position to describe how your child’s mental illness impairs their ability to work.
Similarly, school IEPs can provide evidence. However, IEPs can be a double-edged sword. They should be consistent with any other medical evidence you have. For example, some IEPs may say, “Johnny is way above average,” relative to his peers with a disability. However, comparing Johnny to an average student his age would be more accurate and persuasive.
Social Security considers all the evidence in a case.
The Five-Step Sequential Evaluation Process
Social Security uses a five-step process to determine adult disability. Social Security applies the five-step process sequentially. If Social Security finds an individual is disabled or not disabled at a step, they make their determination and do not go on to the next step. If Social Security cannot find that an individual is disabled or not disabled at a step, they go on to the next step.
Each step can be expressed as a question. Here are the five sequential questions asked by an adjudicator about an individual claimant applying for disability:
Think of the first three steps as screens. In the first step, if the individual is engaging in substantial gainful activity (SGA) the person is denied without consideration of medical criteria. In the second step, people without a severe impairment are denied. In the third step, those people with the most highly disabling impairments will be determined to be “disabled.”
Let’s discuss each question individually:
Is the Individual Working Above SGA Level?
It’s okay to work. However, if the individual’s countable earned income exceeds substantial gainful activity (SGA), then Social Security will determine the individual is not disabled. For example, in 2023, if the individual’s countable earned monthly income is above $1,470, the application is denied even if the individual has a medical impairment. (SGA does not apply to statutorily blind individuals applying for SSI).
Is the Individual’s Physical and/or Mental Condition Severe?
At this step, Social Security wants to ensure the individual has a medically determinable physical or mental impairment (or a combination of impairments) that is severe and meets the duration requirement. For example, if your child was born with Down Syndrome, they meet the 12-month durational requirement.
Does the Individual’s Medical Condition Meet Or Equal the Severity of a Listing?
If possible, you want to ace this third step. If your child meets or equals the Listing of Impairments, Social Security will determine your child is disabled. If not, your child must move on to steps 4 and 5.
Here is how Social Security explains its Listing of Impairments:
_____________________________________________________________________________
The Listing of Impairments describes, for each major body system, impairments considered severe enough to prevent an individual from doing any gainful activity (or in the case of children under age 18 applying for SSI, severe enough to cause marked and severe functional limitations). Most of the listed impairments are permanent or expected to result in death, or the listing includes a specific statement of duration. For all other listings, the evidence must show that the impairment has lasted or is expected to last for a continuous period of at least 12 months. The criteria in the Listing of Impairments are applicable to evaluation of claims for disability benefits under the Social Security disability insurance program or payments under the SSI program.
Part A of the Listing of Impairments contains medical criteria that apply to the evaluation of impairments in adults age 18 and over. The medical criteria in Part A may also be applied in evaluating impairments in children under age 18 if the disease processes have a similar effect on adults and younger children.
The criteria in the Listing of Impairments apply only to one step of the multi-step sequential evaluation process. At that step, the presence of an impairment that meets the criteria in the Listing of Impairments (or that is of equal severity) is usually sufficient to establish that an individual who is not working is disabled. However, the absence of a listing-level impairment does not mean the individual is not disabled. Rather, it merely requires the adjudicator to move on to the next step of the process and apply other rules in order to resolve the issue of disability.
______________________________________________________________________________
Before applying for benefits, you can prepare. For example, let’s say your child is on the autism spectrum. You could do this:
12.10 Autism spectrum disorder (see 12.00B8), satisfied by A and B:
1 Qualitative deficits in verbal communication, nonverbal communication, and social interaction; and
2 Significantly restricted, repetitive patterns of behavior, interests, or activities.
AND
1 Understand, remember, or apply information (see 12.00E1).
2 Interact with others (see 12.00E2).
3 Concentrate, persist, or maintain pace (see 12.00E3).
4 Adapt or manage oneself (see 12.00E4).
_____________________________________________________________________________
Now that you know what you must prove, does your child’s medical and other records provide sufficient evidence to prove Social Security’s criteria of disability for autism? Do your child’s medical or other records need to be updated? Social Security is typically looking for current medical evidence to prove whether or not your child can perform substantial gainful activity.
Or for example, if your child has an intellectual disorder, you must prove this at step 3:
______________________________________________________________________________
12.05 Intellectual disorder (see 12.00B4), satisfied by A or B:
A. Satisfied by 1, 2, and 3 (see 12.00H):
1. Significantly subaverage general intellectual functioning evident in your cognitive inability to function at a level required to participate in standardized testing of intellectual functioning; and
2. Significant deficits in adaptive functioning currently manifested by your dependence upon others for personal needs (for example, toileting, eating, dressing, or bathing); and
3. The evidence about your current intellectual and adaptive functioning and about the history of your disorder demonstrates or supports the conclusion that the disorder began prior to your attainment of age 22.
OR
B. Satisfied by 1, 2, and 3 (see 12.00H):
1. Significantly subaverage general intellectual functioning evidenced by a or b:
a. A full scale (or comparable) IQ score of 70 or below on an
individually administered standardized test of general intelligence;
Or
b. A full scale (or comparable) IQ score of 71-75 accompanied by a verbal or performance IQ score (or comparable part score) of 70 or below on an individually administered standardized test of general intelligence; and
2. Significant deficits in adaptive functioning currently manifested by extreme limitation of one, or marked limitation of two, of the following areas of mental functioning:
a. Understand, remember, or apply information (see 12.00E1); or
b. Interact with others (see 12.00E2); or
C. Concentrate, persist, or maintain pace (see 12.00E3); or
d. Adapt or manage oneself (see 12.00E4); and
3. The evidence about your current intellectual and adaptive functioning and about the history of your disorder demonstrates or supports the conclusion that the disorder began prior to your attainment of age 22.
______________________________________________________________________________
Pay attention to those four standards of mental functioning:
These areas of mental functioning may be documented from various sources. Does your child need a job coach to help them follow instructions? Does your child have a home aide to help with cleaning or cooking? What support does your child need at home to remember things? Does your child work part-time? If so, what does their employer or supervisor say about their ability to learn, remember, and follow instructions? Do co-workers, supervisors, program staff, doctors, teachers, transition planners, and family members have observations or reports?
Here is a further explanation of these standards of mental functioning directly from Social Security’s listing of impairments:
______________________________________________________________________
E. What are the paragraph B criteria?
1. Understand, remember, or apply information (paragraph B1). This area of mental functioning refers to the abilities to learn, recall, and use information to perform work activities. Examples include: understanding and learning terms, instructions, procedures; following one- or two-step oral instructions to carry out a task; describing work activity to someone else; asking and answering questions and providing explanations; recognizing a mistake and correcting it; identifying and solving problems; sequencing multi-step activities; and using reason and judgment to make work-related decisions. These examples illustrate the nature of this area of mental functioning. We do not require documentation of all of the examples.
2. Interact with others (paragraph B2).This area of mental functioning refers to the abilities to relate to and work with supervisors, co-workers, and the public. Examples include: cooperating with others; asking for help when needed; handling conflicts with others; stating own point of view; initiating or sustaining conversation; understanding and responding to social cues (physical, verbal, emotional); responding to requests, suggestions, criticism, correction, and challenges; and keeping social interactions free of excessive irritability, sensitivity, argumentativeness, or suspiciousness. These examples illustrate the nature of this area of mental functioning. We do not require documentation of all of the examples.
3. Concentrate, persist, or maintain pace (paragraph B3). This area of mental functioning refers to the abilities to focus attention on work activities and stay on task at a sustained rate. Examples include: initiating and performing a task that you understand and know how to do; working at an appropriate and consistent pace; completing tasks in a timely manner; ignoring or avoiding distractions while working; changing activities or work settings without being disruptive; working close to or with others without interrupting or distracting them; sustaining an ordinary routine and regular attendance at work; and working a full day without needing more than the allotted number or length of rest periods during the day. These examples illustrate the nature of this area of mental functioning. We do not require documentation of all of the examples.
4. Adapt or manage oneself (paragraph B4). This area of mental functioning refers to the abilities to regulate emotions, control behavior, and maintain well-being in a work setting. Examples include: responding to demands; adapting to changes; managing your psychologically based symptoms; distinguishing between acceptable and unacceptable work performance; setting realistic goals; making plans for yourself independently of others; maintaining personal hygiene and attire appropriate to a work setting; and being aware of normal hazards and taking appropriate precautions. These examples illustrate the nature of this area of mental functioning. We do not require documentation of all of the examples.
_____________________________________________________________________________
Note: Social Security fast-tracks benefits to certain individuals whose medical conditions clearly meet disability standards – so-called Compassionate Allowances. These medical conditions include certain cancers, adult brain disorders, and rare disorders that affect children. Social Security also uses a computer screening process to make quick disability determinations in some cases.
Can the Individual Do the Work They Did Previously?
If your child’s impairment(s) is severe but does not meet or medically equal a listing in Step 3, Social Security can still find your child disabled in Step 4 or Step 5. Social Security decides the most your child is physically and mentally able to do, despite the limitations of your child’s impairments. Social Security calls this a Residual Functional Capacity (RFC) assessment.
In Step 4, given your child’s RFC, Social Security asks if your child is physically and mentally able to do any job they performed in the past.
Can the Individual Do Any Other Type of Work?
In Step 5, if your child cannot do the work they did in the past or has no prior work experience, Social Security considers your child’s RFC limitations and assesses whether your child can do any other work in the national economy despite their medical impairment. Social Security considers your child’s medical conditions, age, education, past work experience, and any transferable skills they may have. If your child cannot do other work, Social Security will determine your child qualifies for benefits. If Social Security determines your child can do other work, Social Security determines your child does not have a qualifying disability, and the claim is denied.
For your child to receive SSI or the Title II benefits of Social Security Disability Insurance (SSDI) or Childhood Disability Benefits (CDB), your child must be “disabled” – according to Social Security’s definition of disability. Social Security has two different definitions of disability: one for children and one for adults. This article explains Social Security's definition of adult disability.
Remember, you are on Planet Social Security, which has unique definitions for words – including “disability.” For example, many parents assume their child's diagnosis proves their disability. Don’t count on that. Generally speaking, a diagnosis alone is not enough to prove disability. From Social Security’s perspective, if your child has a diagnosis, your child may have a medical impairment but not necessarily a disability.
Some parents assume that if they are guardians of their child, their child will be “disabled” according to Social Security’s definition of disability. No – guardianship status is not part of Social Security’s definition of disability.
Social Security’s definition of disability is about the individual’s inability to work due to provable medical conditions. Social Security’s definition is all about one’s capacity to work. A diagnosis alone generally does not equal disability because many people with different disabilities can work substantially and gainfully.
Social Security defines disability as the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months.
Let’s Break Down the Definition Into Three Chunks:
Chunk One
… the inability to do any substantial gainful activity…
For your child to be eligible for disability benefits, your child must be unable to engage in what Social Security calls substantial gainful activity (SGA). If your child earns wages (whether full or part-time) more than a certain monthly amount (net impairment-related work expenses discussed in a later chapter), your child will generally be considered to be engaging in SGA.
SGA is a number that typically increases yearly due to cost-of-living adjustments. For non-blind individuals, the monthly SGA amount for 2023 is $1470. For non-blind individuals, SGA applies to both Title II Social Security benefits and Supplemental Security Income (SSI) benefits. For blind individuals, the monthly SGA amount for 2023 is $2460. For blind individuals, SGA does not apply to SSI benefits.
Chunk Two
…by reason of any medically determinable physical or mental impairment…
In 2022, Social Security denied initial claims (not including appeals) for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) 62 percent of the time. In other words, slightly more than one in three people were awarded benefits on their first try.
Why such a high denial rate? It’s primarily because the individual’s current medical records do not prove their medical conditions impair their ability to engage in substantial gainful activity.
An individual’s current medical records are often inadequate in establishing their inability to engage in substantial gainful activity for two primary reasons:
- Most doctors do not know Social Security’s criteria for determining disability; and
- Most patients do not discuss with their doctor how their medical condition impairs their ability to work.
As a result, the doctor never records in the individual’s medical chart how the medical condition impairs their ability to work.
Chunk Three
…which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months.
This part of the definition of disability is called the durational requirement. For most of you reading this book, your child's impairment meets this third requirement.
Evidence of Disability
As you know, for your child to receive SSI, SSDI, or CDB, your child must be “disabled.” You must prove essentially that your child has a medical condition (mental and/or physical) that causes symptoms so severe that for a period that lasted or is expected to last for 12 months, your child cannot engage in substantial gainful activity in any job in the national economy.
How do you prove your case?
The answer is relatively straightforward but not necessarily easy to do: The essential evidence to prove your child’s disability is what your child’s current medical providers write in your child’s current medical charts. Your child’s medical chart is a record of your child’s medical history: current and past diagnoses, treatments, medications, orders, notes, test results, assessments, and so forth.
When applying for a disability benefit, remember those words — 1) current and 2) medical. To successfully qualify for SSI for your child, you must prove your child’s case with current medical information. If your child does not have current medical evidence to prove their case, Social Security will likely deny them.
That makes sense, doesn’t it? Social Security wants to know whether your child can work at the time your child applies. Generally, old medical information will not prove to what extent your child can work when your child applies for benefits.
Applying for SSI or SSDI is essentially a medical case. For example, you or your child may claim your child is disabled and cannot engage in substantial gainful activity. However, Social Security is looking for what your child’s medical providers write in your child’s medical charts. In sum, it’s vital that your child see their doctor, or preferably a specialist, regularly and discuss the symptoms that limit their ability to work. Only by doing so will your child’s functional limitations appear in your child’s medical charts.
Although Social Security is looking for medical evidence, evidence about your child’s inability to engage in substantial gainful activity may also come from many other places. For example, if your child has a mental illness, you will likely need evidence from your child’s psychiatrist, therapist, or Ph.D. Psychologist. While your child’s psychiatrist may focus most of their time managing your child’s medication, your child’s therapist may be in a better position to describe how your child’s mental illness impairs their ability to work.
Similarly, school IEPs can provide evidence. However, IEPs can be a double-edged sword. They should be consistent with any other medical evidence you have. For example, some IEPs may say, “Johnny is way above average,” relative to his peers with a disability. However, comparing Johnny to an average student his age would be more accurate and persuasive.
Social Security considers all the evidence in a case.
The Five-Step Sequential Evaluation Process
Social Security uses a five-step process to determine adult disability. Social Security applies the five-step process sequentially. If Social Security finds an individual is disabled or not disabled at a step, they make their determination and do not go on to the next step. If Social Security cannot find that an individual is disabled or not disabled at a step, they go on to the next step.
Each step can be expressed as a question. Here are the five sequential questions asked by an adjudicator about an individual claimant applying for disability:
- Is the individual working above the SGA level?
- Is the individual’s physical and/or mental condition severe?
- Does the individual’s medical condition meet or equal the severity of a Listing?
- Can the individual do the work they did previously?
- Can the individual do any other work?
Think of the first three steps as screens. In the first step, if the individual is engaging in substantial gainful activity (SGA) the person is denied without consideration of medical criteria. In the second step, people without a severe impairment are denied. In the third step, those people with the most highly disabling impairments will be determined to be “disabled.”
Let’s discuss each question individually:
Is the Individual Working Above SGA Level?
It’s okay to work. However, if the individual’s countable earned income exceeds substantial gainful activity (SGA), then Social Security will determine the individual is not disabled. For example, in 2023, if the individual’s countable earned monthly income is above $1,470, the application is denied even if the individual has a medical impairment. (SGA does not apply to statutorily blind individuals applying for SSI).
Is the Individual’s Physical and/or Mental Condition Severe?
At this step, Social Security wants to ensure the individual has a medically determinable physical or mental impairment (or a combination of impairments) that is severe and meets the duration requirement. For example, if your child was born with Down Syndrome, they meet the 12-month durational requirement.
Does the Individual’s Medical Condition Meet Or Equal the Severity of a Listing?
If possible, you want to ace this third step. If your child meets or equals the Listing of Impairments, Social Security will determine your child is disabled. If not, your child must move on to steps 4 and 5.
Here is how Social Security explains its Listing of Impairments:
_____________________________________________________________________________
The Listing of Impairments describes, for each major body system, impairments considered severe enough to prevent an individual from doing any gainful activity (or in the case of children under age 18 applying for SSI, severe enough to cause marked and severe functional limitations). Most of the listed impairments are permanent or expected to result in death, or the listing includes a specific statement of duration. For all other listings, the evidence must show that the impairment has lasted or is expected to last for a continuous period of at least 12 months. The criteria in the Listing of Impairments are applicable to evaluation of claims for disability benefits under the Social Security disability insurance program or payments under the SSI program.
Part A of the Listing of Impairments contains medical criteria that apply to the evaluation of impairments in adults age 18 and over. The medical criteria in Part A may also be applied in evaluating impairments in children under age 18 if the disease processes have a similar effect on adults and younger children.
The criteria in the Listing of Impairments apply only to one step of the multi-step sequential evaluation process. At that step, the presence of an impairment that meets the criteria in the Listing of Impairments (or that is of equal severity) is usually sufficient to establish that an individual who is not working is disabled. However, the absence of a listing-level impairment does not mean the individual is not disabled. Rather, it merely requires the adjudicator to move on to the next step of the process and apply other rules in order to resolve the issue of disability.
______________________________________________________________________________
Before applying for benefits, you can prepare. For example, let’s say your child is on the autism spectrum. You could do this:
- Go to Social Security’s website at SSA.gov;
- Click on the header's search icon on the home page;
- Write in “listing of impairments;”
- Click on the second offering — “Listing of impairments - Adult Listings (Part A);”
- Scroll down to “12.00 Mental Disorders” and click on it;
- Scroll down to “12.10 Autism Spectrum Disorder” and click on it;
- Here’s what you need to prove for Step 3:
12.10 Autism spectrum disorder (see 12.00B8), satisfied by A and B:
- Medical documentation of both of the following:
1 Qualitative deficits in verbal communication, nonverbal communication, and social interaction; and
2 Significantly restricted, repetitive patterns of behavior, interests, or activities.
AND
- Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning (see 12.00F):
1 Understand, remember, or apply information (see 12.00E1).
2 Interact with others (see 12.00E2).
3 Concentrate, persist, or maintain pace (see 12.00E3).
4 Adapt or manage oneself (see 12.00E4).
_____________________________________________________________________________
Now that you know what you must prove, does your child’s medical and other records provide sufficient evidence to prove Social Security’s criteria of disability for autism? Do your child’s medical or other records need to be updated? Social Security is typically looking for current medical evidence to prove whether or not your child can perform substantial gainful activity.
Or for example, if your child has an intellectual disorder, you must prove this at step 3:
______________________________________________________________________________
12.05 Intellectual disorder (see 12.00B4), satisfied by A or B:
A. Satisfied by 1, 2, and 3 (see 12.00H):
1. Significantly subaverage general intellectual functioning evident in your cognitive inability to function at a level required to participate in standardized testing of intellectual functioning; and
2. Significant deficits in adaptive functioning currently manifested by your dependence upon others for personal needs (for example, toileting, eating, dressing, or bathing); and
3. The evidence about your current intellectual and adaptive functioning and about the history of your disorder demonstrates or supports the conclusion that the disorder began prior to your attainment of age 22.
OR
B. Satisfied by 1, 2, and 3 (see 12.00H):
1. Significantly subaverage general intellectual functioning evidenced by a or b:
a. A full scale (or comparable) IQ score of 70 or below on an
individually administered standardized test of general intelligence;
Or
b. A full scale (or comparable) IQ score of 71-75 accompanied by a verbal or performance IQ score (or comparable part score) of 70 or below on an individually administered standardized test of general intelligence; and
2. Significant deficits in adaptive functioning currently manifested by extreme limitation of one, or marked limitation of two, of the following areas of mental functioning:
a. Understand, remember, or apply information (see 12.00E1); or
b. Interact with others (see 12.00E2); or
C. Concentrate, persist, or maintain pace (see 12.00E3); or
d. Adapt or manage oneself (see 12.00E4); and
3. The evidence about your current intellectual and adaptive functioning and about the history of your disorder demonstrates or supports the conclusion that the disorder began prior to your attainment of age 22.
______________________________________________________________________________
Pay attention to those four standards of mental functioning:
- Understand, remember, or apply information. This first area of mental functioning focuses on one’s capacity to understand, remember, and apply information to work effectively. For example, can your child follow instructions if given a list of things to do? For example, can your child follow a recipe? Can your child learn new information and apply it to their work? Can your child self-correct themselves when they make a mistake?
- Interact with others. This second area of mental functioning focuses on how appropriately your child interacts with others. For example, does your child respond appropriately to social cues? Can your child respond appropriately to a store boss or a customer? Does your child have inappropriately long, one-sided conversations? Does your child know when to ask for help? How does your child respond to criticism or frustration?
- Concentrate, persist, or maintain pace. This third area of mental functioning focuses on your child’s ability to focus their attention and stay on task for a full day without needing excessive rest periods. Can your child complete a work task at a consistent pace? Can your child work without getting distracted? Will your child need extra supervision to complete tasks and stay focused?
- Adapt or manage oneself. This fourth area of mental functioning focuses on your child’s ability to manage oneself: personal hygiene, wearing appropriate clothes, controlling their emotions, reading, writing, managing money, and distinguishing between appropriate and inappropriate behavior in a work setting. Can your child work independently on a sustained basis at work? Can your child adapt to changes?
These areas of mental functioning may be documented from various sources. Does your child need a job coach to help them follow instructions? Does your child have a home aide to help with cleaning or cooking? What support does your child need at home to remember things? Does your child work part-time? If so, what does their employer or supervisor say about their ability to learn, remember, and follow instructions? Do co-workers, supervisors, program staff, doctors, teachers, transition planners, and family members have observations or reports?
Here is a further explanation of these standards of mental functioning directly from Social Security’s listing of impairments:
______________________________________________________________________
E. What are the paragraph B criteria?
1. Understand, remember, or apply information (paragraph B1). This area of mental functioning refers to the abilities to learn, recall, and use information to perform work activities. Examples include: understanding and learning terms, instructions, procedures; following one- or two-step oral instructions to carry out a task; describing work activity to someone else; asking and answering questions and providing explanations; recognizing a mistake and correcting it; identifying and solving problems; sequencing multi-step activities; and using reason and judgment to make work-related decisions. These examples illustrate the nature of this area of mental functioning. We do not require documentation of all of the examples.
2. Interact with others (paragraph B2).This area of mental functioning refers to the abilities to relate to and work with supervisors, co-workers, and the public. Examples include: cooperating with others; asking for help when needed; handling conflicts with others; stating own point of view; initiating or sustaining conversation; understanding and responding to social cues (physical, verbal, emotional); responding to requests, suggestions, criticism, correction, and challenges; and keeping social interactions free of excessive irritability, sensitivity, argumentativeness, or suspiciousness. These examples illustrate the nature of this area of mental functioning. We do not require documentation of all of the examples.
3. Concentrate, persist, or maintain pace (paragraph B3). This area of mental functioning refers to the abilities to focus attention on work activities and stay on task at a sustained rate. Examples include: initiating and performing a task that you understand and know how to do; working at an appropriate and consistent pace; completing tasks in a timely manner; ignoring or avoiding distractions while working; changing activities or work settings without being disruptive; working close to or with others without interrupting or distracting them; sustaining an ordinary routine and regular attendance at work; and working a full day without needing more than the allotted number or length of rest periods during the day. These examples illustrate the nature of this area of mental functioning. We do not require documentation of all of the examples.
4. Adapt or manage oneself (paragraph B4). This area of mental functioning refers to the abilities to regulate emotions, control behavior, and maintain well-being in a work setting. Examples include: responding to demands; adapting to changes; managing your psychologically based symptoms; distinguishing between acceptable and unacceptable work performance; setting realistic goals; making plans for yourself independently of others; maintaining personal hygiene and attire appropriate to a work setting; and being aware of normal hazards and taking appropriate precautions. These examples illustrate the nature of this area of mental functioning. We do not require documentation of all of the examples.
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Note: Social Security fast-tracks benefits to certain individuals whose medical conditions clearly meet disability standards – so-called Compassionate Allowances. These medical conditions include certain cancers, adult brain disorders, and rare disorders that affect children. Social Security also uses a computer screening process to make quick disability determinations in some cases.
Can the Individual Do the Work They Did Previously?
If your child’s impairment(s) is severe but does not meet or medically equal a listing in Step 3, Social Security can still find your child disabled in Step 4 or Step 5. Social Security decides the most your child is physically and mentally able to do, despite the limitations of your child’s impairments. Social Security calls this a Residual Functional Capacity (RFC) assessment.
In Step 4, given your child’s RFC, Social Security asks if your child is physically and mentally able to do any job they performed in the past.
Can the Individual Do Any Other Type of Work?
In Step 5, if your child cannot do the work they did in the past or has no prior work experience, Social Security considers your child’s RFC limitations and assesses whether your child can do any other work in the national economy despite their medical impairment. Social Security considers your child’s medical conditions, age, education, past work experience, and any transferable skills they may have. If your child cannot do other work, Social Security will determine your child qualifies for benefits. If Social Security determines your child can do other work, Social Security determines your child does not have a qualifying disability, and the claim is denied.