Health claim formAn estimated 400,000 people in the U.S. live with Down syndrome, according to the National Down Syndrome Society. With 1 in 691 children born with Down syndrome, the condition may affect many people in Illinois. People who have Down syndrome suffer from numerous health problems and cognitive delays due to the presence of an extra copy of chromosome 21.

Down syndrome may develop as mosaic Down syndrome, which affects some cells, or non-mosaic Down syndrome, which affects every cell. Mosaic Down syndrome may be difficult to detect, or it may be seriously disabling, depending on its extent. Non-mosaic Down syndrome is more debilitating. The Social Security Administration recognizes this distinction when awarding Social Security Disability benefits.

Disabled from birth

The SSA automatically acknowledges non-mosaic Down syndrome as a disabling condition, as long as there is adequate proof of the condition. An SSD applicant must provide one of four SSA evidence requirements:

  • A lab report of a karyotype analysis with a physician’s signature.
  • An unsigned lab report of a karyotype analysis accompanied by a physician’s statement that the individual suffers from non-mosaic Down syndrome.
  • A statement from a physician saying the individual has non-mosaic Down syndrome and has undergone definitive testing.
  • A physician’s statement that the individual suffers from the condition and exhibits facial, physical or functional features usually associated with the syndrome.

If appropriate documentation is provided, the SSA will consider a child with non-mosaic Down syndrome disabled from birth.

A child with mosaic Down syndrome may still be eligible for SSD benefits. However, the SSA does not have an impairment listing for this condition. Instead, an SSA claims representative may evaluate the child under the SSA’s listing for another impairment associated with Down syndrome, such as congenital heart disease or mental retardation.

If a child with mosaic Down syndrome does not meet any impairment listing criteria, the SSA may consider the child’s functional capacity. The SSA may determine that a child with severe mental or physical impairments is incapable of work because of those impairments.

Age considerations

A disabled child can only receive benefits if he or she meets specific criteria. When children are younger than age 18, SSD benefits are not directly available. However, a child with a low-income family may qualify for Supplemental Security Income. A child with a parent who collects SSD benefits may receive dependent benefits.

After age 18, disabled children are eligible for SSD benefits. However, children who were disabled from birth may not have the necessary work history and earnings record to qualify for benefits. Fortunately, these children may collect an “adult child’s benefit” based on the earning record of a parent who also is eligible for SSD benefits.