Disability Benefits For Children With Congenital Heart Defects

Congenital heart defects (CHD) are Americas #1 birth defect, affecting nearly 1 out of every 100 babies. CHD are the leading cause of all infant deaths in the United States.

Defects can range from a hole in the heart and obstructed blood flow to conditions such as HLHS where multiple parts of the left side of the heart do not develop completely.  Surgeries can range from catheterizations to major open heart bypass surgeries and transplants.  Symptoms may include bluish skin, shortness of breath and fatigue.

SSI disability benefits are available to children with Congenital Heart Defects.  There are several CHD listed on SSA’s compassionate allowance list.  Children may also meet several listings to qualify for benefits.  The listings are:

104.6 – Congenital Heart Disease

To qualify under listing 104.6, the child must have cyanotic heart disease with chronically low blood oxygen, demonstrated by one of the following:

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Evaluating Functional Equivalence In Childhood Disability

In children’s disability cases, if the child’s impairment is not severe enough to meet a Social Security “listing”, meaning an approval for disability benefits, then an assessment must be done to determine if the impairment functionally equals a listing.  For functional equivalence, the child must have one “extreme” or two “marked” limitations in the six domains of functioning. 

The six domains of functioning are:

  1. Acquiring and using information
  2. Attending and completing tasks
  3. Interacting and relating with others
  4. Moving about and manipulating objects
  5. Caring for oneself, and
  6. Health and physical well-being.

The evaluation of how functioning is affected will be done during all of the child’s activities; meaning activities done at home, at school, and in the community.   First, Social Security will identify which of the child’s activities are limited, and which domains are involved in those activities.  They will then determine whether the child’s impairment(s) could affect those domains and account for the limitations.  Second, Social Security will then rate the severity of the limitations in each affected domain(s).  If SSA finds one extreme limitation, or two marked limitations, the child will be approved for disability benefits.

Social Security Administration Adds to Compassionate Allowances List

SSA has announced twelve additional Compassionate Allowances, including several for cardiac patients.  The Compassionate Allowances process quickly identifies diseases and other medical conditions that, by definition, meet SSA’s standard for disability benefits.

Impairments on SSA’s list of Compassionate Allowances are those that provide almost a 100% guarantee that the person will be found disabled.  Compassionate Allowances cases retain priority status on appeal and receive expedited processing.

The twelve new Compassionate Allowances conditions are:

  • Aortic Atresia
  • Eisenmenger Syndrome
  • Endomyocardial Fibrosis
  • Heart Transplant Graft Failure
  • Heart Transplant Wait List – 1A/1B
  • Hypoplastic Left Heart Syndrome
  • Left Ventricular Assist Device (LVAD) Recipient
  • Mitral Valve Atresia
  • Primary Cardiac Amyloidosis
  • Pulmonary Atresia
  • Single Ventricle
  • Tricuspid Atresia

Children’s Disability Benefits

Can my child qualify for disability benefits? This is an often asked question and the answer is yes.  Disabled children are entitled to disability benefits under the Supplemental Security Income (SSI) program.

Similar to adults applying for disability, your child’s case will be examined by the State agency that is assigned to evaluate the case and make a decision on disability.  The process and standard for being examined, however, are a bit different for children.  The process to determine disability for adults focuses on the severity of the claimant’s impairment and how the impairment affects the claimant’s ability to work.  As the majority of those applying for children’s benefits do not work, the process must address separate factors.  Children will be found disabled if two elements are satisfied:

  1. The child’s physical or mental condition or a combination of conditions results in marked and severe functional limitations.  The condition(s) must severely limit your child’s activities, and;
  2. The condition(s) must have been disabling, or be expected to be disabling, for at least 12 continuous months.

Some of the areas examined to determine if there are marked and severe functional limitations are:

  • 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

If the child’s condition(s) results in marked and severe functional limitations for at least 12 continuous months, Social Security will find the child disabled and award SSI benefits.  In most States, children receiving SSI benefits will qualify for Medicaid coverage.

For a No Cost case evaluation, or if you have any questions regarding your child’s eligibility for disability benefits, feel free to contact our office at (508) 421-4610.