In order for a child to be found disabled, they must either meet or functionally equal a “listing” (a list of impairments that the Social Security Administration (“SSA”) has said will result in a finding of disability if the impairment is severe enough). Thus, if a child has an impairment that is on the list, and it is as severe as required by SSA, that child “meets” the listing. However, if the impairment does not meet the specific criteria in the listing, the child can still be found disabled if the impairment “functionally equals” a listing. This is done by showing that the child is either “marked” in 2 of the 6 domains, or “extreme” in 1 of the 6. SSA has defined being marked or extreme in a domain as having impairment or impairments that interferes seriously with your ability to independently initiate, sustain, or complete activities. Obviously to prove an extreme limitation, you would have to prove it interferes more substantially than a marked limitation, although the definition is more involved than this.
The 6 domains are: “acquiring and using information; attending and completing tasks; interacting and relating with others; moving about and manipulating objects; caring for yourself; and health and physical well-being. This article deals with the third domain: “health and physical well-being.”
So, how does one prove that a child is marked or extreme in this domain? Social Security Ruling (“SSR”) 09-8p gives us some guidance. This domain considers “. . . the cumulative physical effects of physical and mental impairments and their associated treatments on a child’s health and functioning. Unlike the other five domains of functional equivalence (which address a child’s abilities), this domain does not address typical development and functioning. Rather, the “Health and physical well-being” domain addresses how such things as recurrent illness, the side effects of medication, and the need for ongoing treatment affect a child’s body; that is, the child’s health and sense of physical well-being.”
The first point to note from this, is that the SSA will take into account effects from both the impairment itself or from treatment. Thus, if a child feels dizzy because it is a symptom of his or her impairment, or because it is a side effect of medication, it will be considered.
This ruling also explicitly notes that symptoms can fluctuate, and they will consider “…the frequency and duration of exacerbations, as well as the extent to which they affect a child’s ability to function physically.”
Some examples of limitations given in this ruling are whether the child:
- Has generalized symptoms caused by an impairment(s) (for example, tiredness due to depression).
- Has somatic complaints related to an impairment(s) (for example, epilepsy).
- Has chronic medication side effects (for example, dizziness).
- Needs frequent treatment or therapy (for example, multiple surgeries or chemotherapy).
- Experiences periodic exacerbations (for example, pain crises in sickle cell anemia).
- Needs intensive medical care as a result of being medically fragile