Down syndrome is a genetic disorder that affects individuals all around the world. Due to the physical and cognitive challenges these individuals face, the Social Security Administration (SSA) offers benefits specifically designed to assist those with this disability.
There are certain criteria these individuals and their families must meet prior to getting approved for SSD benefits. Below, we discuss these requirements and whether there is a way to expedite the process.
If you need assistance applying for benefits, our Green Bay Social Security Disability lawyers are prepared to help. We offer a free consultation and there are no fees while we work with you.
What Are the Medical Requirements to Prove Down Syndrome for SSD Benefits?
When applying for Social Security Disability (SSD) benefits for Down syndrome, there are specific medical requirements and criteria that need to be met for your application to be approved.
Qualifying for Non-Mosaic Down Syndrome SSD Benefits
According to the Centers for Disease Control (CDC), non-mosaic Down syndrome, also called trisomy 21, affects about 95 percent of all individuals with Down syndrome. This genetic disorder is characterized by the existence of a third copy of chromosome 21, which affects how a baby’s brain and body develop.
Individuals with a diagnosis of non-mosaic Down syndrome may automatically qualify for benefits, as it is listed in the SSA’s Blue Book. However, the SSA still requires medical evidence to prove the disability.
The SSA should accept the following documentation as evidence of non-mosaic Down syndrome:
- A karyotype test signed by a licensed medical doctor.
- An unsigned karyotype test with a statement from a licensed doctor confirming Down syndrome.
- A licensed medical doctor’s report diagnosing the individual with Down syndrome based on distinctive physical features and a prior karyotype test.
If no karyotype test was ever completed on the individual applying for benefits, the SSA will still accept a medical review from a licensed doctor. The review must detail the existence of Down syndrome by evaluating the individual’s distinctive facial features or other physical features in addition to evidence demonstrating functional capacities consistent with a non-mosaic Down syndrome diagnosis.
Qualifying for Mosaic or Translocation Down Syndrome SSD Benefits
Mosaic is the most common type of Down syndrome, but there are two other categories individuals with this genetic disorder may fall under. They are as follows:
- Mosaic Down syndrome, which occurs when only some of an individual’s chromosome 21 has three copies instead of the normal two.
- Translocation Down syndrome, which occurs when an extra part or a whole extra chromosome 21 is present but is attached or “translocated” to a different chromosome instead of being a separate chromosome 21.
The symptoms of these types of Down syndrome are less severe than the mosaic kind, so the SSA does not automatically classify them as a disability in the Blue Book. This means individuals applying for SSD benefits for these kinds of Down syndrome may have to take additional steps to prove their disability before getting approved for benefits.
However, individuals with mosaic or translocation Down syndrome may have medical conditions that automatically qualify them for benefits, including the following:
- Congenital heart defects
- Sleep-related breathing disorders
- Hearing loss
- Intellectual disabilities
- Eye diseases
When filing for SSD benefits due to mosaic or translocation Down syndrome, it may be in your best interest to discuss your options with a knowledgeable attorney.
Do Adults With Down Syndrome Qualify for SSD Benefits?
Yes, adults with Down syndrome can qualify for SSD benefits.
Some parents apply for SSD benefits for their Down syndrome children due to not being able to work full-time to take care of their child. However, there are some families that wait until their children are adults to apply for financial support.
The SSA will process an SSD application for an adult with Down syndrome in much the same way as any other application.
Can an Adult With Down Syndrome Who Works Qualify for SSD Benefits?
Adults with Down syndrome who work may still be able to receive some Social Security benefits, depending on how much they earn and how their disability affects their ability to earn a living.
There are two kinds of benefits these individuals may qualify for. The first is Supplemental Security Income (SSI), which is a government-sponsored supplemental income. The second is auxiliary SSD benefits. These could be obtained by the disabled adult child of an individual already receiving SSD benefits.
Is There a Way to Expedite the Approval Process?
The SSA has a program called Compassionate Allowances (CAL), which helps individuals with easily identifiable disabilities, like Down syndrome, to have their approval process for benefits expedited.
Even if you do submit an application through the CAL process, it is important to include supporting medical evidence to help streamline the application.
Need Help Applying for Benefits? Call Us Today
If you or a loved one are applying for SSD benefits for Down syndrome or another serious medical condition, our knowledgeable attorneys are prepared to help.
We offer a free consultation and you do not pay us anything up front, so there are no risks to you.
Call (877) 888-5201 today to learn more.