Most children’s Social Security disability cases are decided using Functional Equivalence. If you need some background before diving into this, check out my earlier piece on the basics of Social Security and children’s disability benefits.
If you cannot clearly prove that a child meets or medically equals a listing, it often a good idea to prepare to prove the case using functional equivalence.
First off, do not worry about the terminology (such as “medically equals” and “functionally equivalence”).
- Medically equals is like a jigsaw puzzle piece that perfectly fits into a space. The evidence requirements in a Social Security listing perfectly matches up with the medical evidence.
- Functional equivalence is more like playing horseshoes (where you still get points even if the horseshoe isn’t around the bar). Functional equivalence simply means that even if the disabling condition isn’t in the Listing, or the the medical evidence isn’t a perfect match for what the listing are looking for, the conditions is “as bad as” a listing level condition, so the child should be found disabled. It is almost like squinting at a case to see if it is close enough.
However, Social Security obviously isn’t really squinting at the case. So, how does Social Security actually determine Functional Equivalence?
The process is fairly simple: to decide Functional Equivalence, Social Security looks at children’s functions in 6 areas (or “domains”):
- Acquiring and using information.
- Attending and completing tasks.
- Interacting and relating with others.
- Moving about and manipulating objects.
- Caring for yourself.
- Health and physical well-being.
To win a child’s Social Security disability case for functional equivalence, you need to have either a) an extreme in limitation in one domain; or b) a marked limitation in two domains.
However, what constitutes a marked or an extreme limitations can be hard to determine.
Here are the Social Security definitions:
We will find that you have an “extreme” limitation in a domain when your impairment(s) interferes very seriously with your ability to independently initiate, sustain, or complete activities. Your day-to-day functioning may be very seriously limited when your impairment(s) limits only one activity or when the interactive and cumulative effects of your impairment(s) limit several activities.
“Extreme” limitation also means a limitation that is “more than marked.” “Extreme” limitation is the rating we give to the worst limitations. However, “extreme limitation” does not necessarily mean a total lack or loss of ability to function. It is the equivalent of the functioning we would expect to find on standardized testing with scores that are at least three standard deviations below the mean.
We will find that you have a “marked” limitation in a domain when your impairment(s) interferes seriously with your ability to independently initiate, sustain, or complete activities. Your day-to-day functioning may be seriously limited when your impairment(s) limits only one activity or when the interactive and cumulative effects of your impairment(s) limit several activities. “Marked” limitation also means a limitation that is “more than moderate” but “less than extreme.”
If you have read this and you still do not know whether a limitation is “less than marked,” “marked,” or “extreme,” then YOU ARE NOT ALONE!
The standard of “at least three standard deviations below the mean” may work in the “acquiring and using information” domain where Social Security looks at grades and objective test results. However, when it comes to social functioning, statistical standard deviations are not helpful.
There is a LOT of guesswork is deciding if a limitation is mild, moderate, marked, or extreme.
A good rule of thumb: a complete inability to function in an area is probably extreme or marked. However, the difference between a moderate and marked limitations is often in the eye of the beholder.
So, it often helps to get some real world notes and letters from people who see the child on a regular (if not daily) basis describing the child’s difficulties and struggles.
Here are some of the questions Social Security considers when deciding the level of limitation for each domain.
- What activities is the child able to perform?
- What activities is the child not able to perform?
- Which of the child’s activities are limited or restricted compared to other children his or her age who do not have impairments?
- Where does the child have difficulty with his or her activities? At home, in childcare, at school, or in the community?
- Does the child have difficulty independently initiating, sustaining, or completing activities?
- What kind of help does the child need to do his or her activities? How much help does the child need, and how often does the child need it?
Keep in mind there is a lot of room for argument in functional limitations cases. Hearings often go back and forth on the issue of whether limitations are less than marked, marked, or extreme. Having a strong advocate becomes very important at this stage.
For more information on this topic, check out §416.926a Functional equivalence for children.
CC Photo by ~Brenda-Starr~