Many parents wonder whether their child who has been diagnosed with a learning disability will qualify for disability benefits through the SSI program. The answer is that it depends on the severity of the learning disability, the degree to which it interferes with the child's daily functioning, and how well the condition and its related limitations are documented.
While children's Social Security cases are generally harder to win than adult cases, disability benefits are available for children under 18 who suffer from serious physical or mental impairments. A child who has been diagnosed with a learning disability will be eligible for benefits if he or she suffers from certain "marked" (severe) or "extreme" functional limitations that are expected to last at least a year.
Children with learning disabilities typically struggle to keep pace academically with their peers. They may require more time to learn new concepts and acquire new skills. It is not uncommon for children with learning disabilities to score well below average on standardized tests. If a child's learning disabilities are severely limiting the child's ability to learn, complete tasks, and interact with others, Social Security may recognize that child as having a disability. But only the most severely affected children can expect to be granted disability benefits.
A significant fraction of children with learning disabilities have also been diagnosed with a psychiatric disorder such as Attention Deficit Hyperactivity Disorder (ADHD) or a speech disorder. For those children with more than one diagnosis, Social Security will consider the combination of all their impairments in deciding whether to approve or deny their claim for benefits.
Social Security will award disability benefits for a child with a specific learning disorder—or borderline intellectual functioning—if that child meets the requirements of Blue Book Listing 112.11 for neurodevelopmental disorders. This listing used to be only for ADHD, but in 2017, Social Security expanded it to include learning disabilities and tic disorders. Under this listing, a child must have medical documentation showing one of the following:
In addition to meeting one of these three sets of symptoms, the child must experience either an "extreme" limitation in one of the following areas or a "marked" (severe) limitation in two of the following areas:
A "marked" limitation, according to Social Security's regulations, is one that seriously interferes with a child's ability to start or finish activities. It is a "more than moderate, but less than extreme" limitation. "Extreme" limitations are defined as interfering "very seriously" with a child's ability to independently start or finish activities.
The most persuasive evidence to show the severity of a learning disability will be the child's IQ scores, grades, and reports from teachers, counselors, and physicians. For children enrolled in special education classes, obtaining the child's Individualized Education Program (IEP) is also helpful in presenting a fuller picture of the child's level of impairment. (And note that a Social Security regulation (SSR 09-2p) specifically provides that children in special education who achieve good grades or reach the goals set out in their IEP plan may still qualify for disability benefits.)
In cases involving learning disabilities, Social Security is particularly interested in the opinions of medical professionals, primarily psychiatrists and psychologists, about the child's level of functioning. It is often helpful to request that the medical professional fill out a Residual Functional Capacity (RFC) form or write a letter to send to Social Security. The psychiatrist or psychologist should state the child's diagnosis and answer questions including the following:
The more the doctor explains his or her responses, the more likely Social Security is to agree with the conclusions reached.
Letters from teachers, counselors, and even parents can be helpful if they focus on the person's observations and experiences with the child. It is best for these folks to avoid in-depth discussions of the child's medical issues, or any opinion regarding whether the child is "disabled." Social Security generally deems those topics to be beyond the expertise of school employees and parents.
To further aid Social Security in assessing the severity of the child's learning disability, the agency will usually schedule an appointment for the child to undergo a consultative examination (CE) with one of Social Security's doctors. These exams are extremely important and should not be missed. Social Security will often, but not always, give great weight to the opinions of its consulting doctor.
Under Social Security regulations, a child with a learning disability may also qualify for benefits based on a low IQ score. A valid verbal, performance, or full-scale IQ test of 59 or below will qualify a child for benefits. If a child scores from 60 to 70 on such a test, he or she will likely be found disabled if there is an additional physical or mental impairment that significantly limits the child's functioning. For more information, see Nolo's article on disability and low IQ.
Note that children who apply for benefits based on their own disability are eligible only for Supplemental Security Income (SSI), not Social Security Disability Insurance (SSDI). Because SSI, unlike SSDI, is a needs-based program, Social Security will take the child's household income into account in determining whether the child is eligible for benefits. If the combined income of the child and the parents residing with the child exceeds Social Security's threshold, the child will not receive benefits, regardless of the severity of his or her learning disability.