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 6 domains (areas of functioning), 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 fourth domain: “moving about and manipulating objects.”
So, how does one prove that a child is marked or extreme in the domain of moving about and manipulating objects? Social Security Ruling (“SSR”) 09-6p gives us some guidance. This domain considers “. . . the physical ability to move one’s body from one place to another, and to move and manipulate things. These activities may require gross or fine motor skills, or a combination of both.” Gross motor skills refers to the ability to handle and manipulate large objects (i.e., using door knobs, holding drinks, etc.). Fine manipulation refers to the ability to handle and manipulate smaller objects (i.e., using buttons, zippers, picking up coins off of a table, etc.). Thus, this domain considers the child’s ability to not only move themselves and body parts, but also their ability to use objects.
Note that it is insufficient that the child simply has limitations engaging in these sorts of activities. Rather, the limitations must be so severe that it interferes seriously with the child’s ability to independently initiate, sustain, or complete such activities. Furthermore, the limitations must result from a medical impairment, either physical or mental (although side effects from medications can also be considered).
It is also important to note that the ability to move about and manipulate objects may vary depending on the child’s age. For example, a 17 year old child who is unable to walk at all would likely be marked or extreme in this domain. However, for a newborn, this is of course not abnormal, and would likely not result in a similar finding.