Can I Qualify for Disability Benefits with a Congenital Disorder?

The U.S. Census Bureau reports that about one in five Americans lives with a physical or mental disability.  That totals up to around 57 million people, roughly two million of whom reside in New Jersey and Pennsylvania.  The Social Security Administration reports that in 2014, about nine million beneficiaries across the country will receive approximately $10 billion in SSI and SSDI monthly disability benefits.  If you are living with a congenital disorder, you may qualify as well.  But how are congenital disability claims evaluated by the SSA, and how do you get a claim approved?

A congenital disorder is a health impairment which is present at birth.  While numerous conditions are considered to be congenital disorders, from the SSA’s perspective, the phrase “congenital disorder” is effectively synonymous with Down Syndrome.

However, while Down Syndrome is the only congenital disorder which is technically included in the SSA’s Listing of Impairments (a document which claims examiners use to evaluate the severity of a given claimant’s disability), other conditions of this type may still be able to qualify you.  If your RFC (Residual Functional Assessment) determines that you cannot perform basic tasks, you may qualify with a medical-vocational allowance. Additionally, if your condition is very serious or rare, it may be listed as a Compassionate Allowance (CAL).

But before examining how Down Syndrome is assessed against the Listing of Impairments, it is also important to point out the SSA’s general criteria.  These are evaluation points which all applicants should pass, with a few exceptions, such as blind persons.

1. Your income should not exceed $721 per month (or $1,082 per month for couples). This number represents the FBR, or Federal Benefit Rate, which changes from year to year.
2. Your disability must be severe.  Mild, easily controllable impairments will not be considered.
3. Your disability must have lasted, or be projected to last, for at least 12 months, or to end in death.

If you are applying for SSI (Supplemental Security Income), your income and resources must be considered “limited” by the SSA.  If you are applying for SSDI (Social Security Disability Income), you must have earned a certain number of “work credits” over your working years.

Qualifying for Benefits with Down Syndrome

Congenital disorders are covered by Section 10.00 of the Listing (“Congenital Disorders That Affect Multiple Body Systems”).  Section 10.00 consists of only one impairment, non-mosaic Down Syndrome (10.06), which is divided into:

1. Chromosome 21 Trisomy
2. Chromosome 21 Translocation

However, while somewhat hidden in the text of section D3, the Listing does later state:

“When the effects of mosaic Down syndrome… are sufficiently severe we evaluate the disorder under the appropriate affected body system(s), such as musculoskeletal, special senses and speech, neurological, or mental disorders.”

In other words, mosaic Down Syndrome can have negative effects on other parts of the body, which are then evaluated respectively.

Returning to the non-mosaic category, you will need to supply certain medical evidence in order to prove disability.  In keeping with Section 10.06, the SSA will want to see one of the following:

• “A laboratory report of karyotype analysis signed by a physician.”  If the analysis is not signed, you should submit a physician statement alongside the analysis.
• “A physician’s report stating that you have chromosome 21 trisomy or chromosome 21 translocation.”  This should focus on the karyotype analysis and Down Syndrome-related physical features.
• “A physician’s report stating that you have Down syndrome with the distinctive facial or other physical features and evidence demonstrating that you function at a level consistent with non-mosaic Down syndrome.” 

If you or someone you love has been diagnosed with mosaic or non-mosaic Down Syndrome, you may be a strong candidate for SSI or SSDI.  Getting a claim approved to receive monthly benefits can be a challenge, but an experienced disability lawyer can help.  To schedule your free and private legal consultation, call the law offices of Young, Marr, Mallis & Associates at (609) 755-3115 in New Jersey or (215) 701-6519 in Pennsylvania, or contact us online.