Can My Child Qualify for Disability Benefits with an Immune System Disorder?

We rely on our immune systems to help us avoid and recover from illnesses and injuries. When this crucial body system is compromised by a disease or impairment, the health effects can be debilitating.  If your child is living with an immune system disorder, he or she may be eligible to receive monthly disability benefits from the SSA, or Social Security Administration.  What are the program requirements, and how does your child qualify for assistance?

Does My Child Qualify for Benefits in Pennsylvania?

The SSA projects that in 2014, “over 59 million Americans will receive almost $863 billion in Social Security benefits.”  But while tens of millions of claimants will qualify, many will struggle on their path toward approval.  Statistics estimate that only about 36% of Americans are approved after submitting their first application, meaning well over half of all claimants are initially denied.

While denied claimants do have the power request Reconsideration (and if necessary, to continue through other stages of the appeals process), it is obviously preferable to be approved on the first attempt.  Understanding the basic criteria for children can help a claim succeed.  Your child should:

1. Be younger than 18 years old.  Otherwise, he or she will be evaluated as an adult.
2. Be earning no more than the current Federal Benefit Rate (FBR) of $721 per month.
3. Have a disability which either already has lasted or is expected to last for at least 12 months, or is expected to end in death.
4. Have a disability which creates severe impairments.  Mild, easy-to-manage conditions are not eligible for assistance.

In order to determine whether a child claimant’s disability is in fact “severe,” SSA claims examiners refer to a document known informally as the “Blue Book,” and formally as the Listing of Impairments.  How does the Listing evaluate immune system conditions?

How Your Child Can Qualify with an Immune System Disorder

First, it’s very important to note that there are separate listings for adults (Part A) and children (Part B).  Needless to say, you should refer to the criteria in Part B; otherwise you will be referring to the incorrect set of guidelines.

The Childhood Listings address immune system disorders in Section 114.00, which states:

We evaluate immune system disorders that cause dysfunction in one or more components of your immune system.  […]  We organize the discussions of immune system disorders in three categories: Autoimmune disorders; Immune deficiency disorders, excluding human immunodeficiency virus (HIV) infection; and HIV infection.

Which Immune System Disorders Qualify for Disability Benefits in Pennsylvania?

• 114.02 — Lupus (Systemic Lupus Erythematosus)
• 114.03 — Systemic Vasculitis
• 114.04 — Scleroderma (Systemic Sclerosis)
• 114.05 — Polymyositis or Dermatomyositis
• 114.06 — Undifferentiated and Mixed Connective Tissue Disease
• 114.07 — Immune Deficiency Disorders, Excluding HIV
• 114.08 — HIV
• 114.09 — Inflammatory Arthritis
• 114.10 — Sjogren’s Syndrome

Each of these conditions comes with its own set of requirements in the Listing, some of which are more detailed and elaborate than others.  (However, even if your child’s illness does not exactly match the criteria for his or her condition, he or she may still be able to qualify if he or she can functionally equal the Listings.  This is provided by federal code § 416.926a.)  The listing for HIV, for example, requires that a claimant should demonstrate at least one of the following:

• Bacterial Infections
• Fungal Infections
• Protozoan or Helminthic Infections
• Viral Infections
• Malignant Neoplasms
• Skin or Mucous Membrane Conditions
• Neurological Manifestations of HIV Infection (e.g. peripheral neuropathy)
• Growth Disturbance
• Chronic Diarrhea
• LIP/PLH Complex
• Other Infections (e.g. sepsis, meningitis, pneumonia)
• Other Manifestations of HIV

In turn, each of these requirements comes with its own subset of requirements, some of which can admittedly get very technical.  Your doctor can help you understand any unfamiliar medical jargon when interpreting the listings.

Regardless of which immune condition your child’s claim is citing — whether it be lupus, inflammatory arthritis, Sjogren’s Syndrome, or something else — it must be supported by medical documentation.  The more comprehensive and recent this documentation is (ideally no older than 60 to 90 days), the stronger your claim will be.

However, only certain types of documentation are acceptable.  Generally speaking, the SSA classifies the following as “appropriate medically acceptable imaging”:

• Angiography
• CAT Scans
• MRIs
• X-Rays

In addition to imaging, other pieces of medical information which should be included in your child’s claim where relevant include:

• Lab Reports
• Medical History
• Physical Exam Reports
• Tissue Biopsy Reports

It should also be noted that the Listing criteria may change depending on your child’s age. For example, Sjogren’s Syndrome uses different criteria for the following age groups: birth to age one, age one to age three, and age three to age 18.

Our Pennsylvania Disability Lawyers Can Help You

If your child is living with an immune disorder, he or she may be a good candidate for monthly benefits. An experienced Philadelphia disability benefits lawyer can help guide you through the process.  To set up a completely free and confidential legal consultation, call the law offices of Young, Marr, Mallis & Associates right away at (800) 875-8512, or contact us online today.