Does Down Syndrome Qualify for Social Security Disability Benefits?
If a loved one has non-Mosaic Down syndrome, they may be eligible for certain financial benefits through the Social Security Administration (SSA). Specifically, the SSA offers disability benefits to individuals diagnosed with non-Mosaic Down syndrome and other congenital disorders that may prohibit them from gaining and maintaining employment.
What Exactly is Non-Mosaic Down Syndrome?
The reason someone diagnosed with non-Mosaic Down syndrome is generally eligible for disability benefits is because this is a genetic disorder that can significantly impact an individual’s ability to work on either a part-time or full-time basis. Non-Mosaic Down syndrome occurs when someone has three copies of chromosome 21 in all of their cells (referred to as a “chromosome 21 trisomy”). Individuals with non-Mosaic Down syndrome generally have specific characteristics, including:
- Facial or other physical features
- Delayed physical development, and
- Intellectual disabilities
Applying for Disability Benefits with Non-Mosaic Down Syndrome
If apply for disability benefits based upon a diagnosis of non- Mosaic Down syndrome, a claims reviewer with the SSA will likely refer to Listing 10.00 within the agency’s “Blue Book” (i.e. the manual relied upon by SSA when examining disability benefit applications). Listing 10.00 is titled as “Congenital Disorders that Affect Multiple Body Systems.”
Listing 10.00 outlines the specific test results or symptoms that are necessary to qualify for disability benefits. Non-Mosaic Down syndrome is listed as a qualifying congenital disorder. Furthermore, an applicant with Trisomy 21 or Translocation Down syndrome will likely qualify for disability benefits when they undergo a karyotype analysis. Other acceptable evidence includes medical records supplied by a treating doctor that confirms a karyotype analysis was performed in the past and the applicant has the physical and intellectual signs of Down syndrome.
The evidence required to substantiate a disability benefits claim based on Down syndrome includes the following:
- a laboratory report of karyotype analysis signed by a doctor
- a laboratory report of karyotype analysis not signed by a doctor with a statement by a physician that the applicant has Down syndrome
- a doctor’s report stating the applicant has chromosome 21 trisomy or chromosome 21 translocation consistent with a prior karyotype analysis, with the distinctive physical features of Down syndrome.
- a doctor’s report stating the applicant has Down syndrome with the distinctive physical features of Down syndrome and evidence demonstrating the applicant’s functioning is at a level consistent with non-mosaic Down syndrome.
Mosaic Down Syndrome and Disability Benefits
When someone is seeking benefits based upon a diagnosis of Mosaic Down syndrome (which comprises around only two percent of the Down syndrome population), the application process is generally considered to be more difficult when compared to an applicant with non-Mosaic Down syndrome. The SSA applies a more stringent review process for an applicant with Mosaic Down syndrome because the severity of impairments associated with Mosaic Down syndrome fluctuates greatly from person to person. As a result, the SSA generally requires an applicant to submit evidence that they are suffering from a specific physical or mental limitation that has left them disabled and unable to attain gainful employment.
An applicant with Mosaic Down syndrome is typically evaluated by the SSA under the disability listing(s) that fall within whichever physical or mental disorder they have. Examples of common types of physical and mental challenges that an applicant with mosaic Down syndrome may have includes the following:
- Hearing or vision issues
- Congenital heart disease
- Thyroid issue (hypothyroidism or hyperthyroidism)
- Sleep apnea or other sleeping disorder
Qualifying for Disability Benefits If You Do Not Meet the Blue Book Criterion
If you are seeking disability benefits, but your condition does not meet the specific requirements listed in the SSA’s Blue Book, do not give up hope. It may still be possible to obtain disability benefits. In this scenario, the SSA will generally assess the applicant’s “functional capacity” based upon a residual functional capacity (RFC) report.
The objective of an RFC is to give your medical provider the opportunity to fully describe the ramifications of your disabling condition and how it has impacted your ability to attain and maintain full-time or part-time employment.
Completing the RFC properly is critically important because the SSA generally does not award disability benefits on the basis of a medical diagnosis alone, except for specific circumstances such as the diagnosis of non-Mosaic Down syndrome. In most instances, the SSA will seek to assess a disabled individual’s ability to perform work-related activities that are required to achieve gainful employment. The questions that comprise the RFC form are generally focused on getting an assessment of the ability to engage in physical activities that routinely arise in a work environment.
For example, if an applicant is seeking disability benefits with Mosaic Down syndrome while also suffering from congenital heart disease, their RFC report will likely highlight the limited amount of physical exertion the applicant is able to perform in a work environment. Another example is when an applicant has difficulty with hearing and they worked in a job that requires a level of hearing ability (e.g., customer service, sales, etc.).
The RFC form, which is provided by the SSA, is considered to be relatively straightforward to complete. Nevertheless, you should invest sufficient time and effort in completing this form since it is a key factor in the review process conducted by the SSA. A properly completed, and sufficiently detailed, RFC form will go a long way in establishing that you are totally disabled. This is due to the fact that, as mentioned previously, your treating doctor is provided a platform to detail their medical opinion concerning your condition and how it has hindered your ability to work. Basically, this means a properly completed RFC report has the potential to corroborate and legitimize your disability claim.
Learn More About Social Security Disability Benefits
If you have a loved one diagnosed with non-Mosaic Down syndrome and want to learn more about their potential eligibility for disability benefits through the SSA, take action by filling out the free evaluation form on this page. Once the form is submitted, it will be analyzed by a seasoned disability attorney who can help assess your potential legal options.