An Individualized Determination in Childhood Disability Claims - Melvin
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An Individualized Determination in Childhood Disability Claims

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The former regulatory approach to childhood disability cases provided that children needed to meet or equal one of the “listed” impairments promulgated by the Commissioner of Social Security disability(formerly the Secretary of Health and Human Services) in order to qualify for benefits.

The “listings” for adult impairments are a defined set of medical criteria for each body system that are conclusively presumed to qualify a person for disability benefits.

Under Social Security’s five-step sequential evaluation process for adult disability, the listings come into play at step three. The steps are:

1) is the claimant performing substantial gainful activity (a standard usually determined by the amount of money one is earning in employment)? If the answer is yes, the person is found “not disabled.” If the answer is no, the inquiry proceeds to the next step.

2) Does the claimant have a medically determinable “severe” impairment? “Severe” is defined as any impairment diagnosed by an appropriate medical provider that has more than a minimal impact on the person’s ability to do basic work activities. This step is intended to ensure that non-meritorious cases are able to be screened out early in the process. Thus, if the individual does not have a “severe” impairment, the claim is denied at step two. If the person meets this de minimis standard, then the inquiry proceeds to the next step.

3) Does the claimant have an impairment, or combination of impairments, that meets or medically equals one of Social Security’s listed impairments. These listings set forth specific medical criteria, all of which must be met in order for a person to meet the listing. Medically equaling a listing can occur when the person has an impairment that is not set forth in one of the listings, but is equivalent in severity to one of the listings. If the claimant meets or medical equals one of the listings, he or she is conclusively presumed to be “disabled”, and the inquiry stops. If the person’s impairments do not fulfill this rigorous standard, the inquiry proceeds to the next step.

4) Can the claimant, given his or her age, education, prior work experience, and functional limitations, perform the duties of his or her prior relevant work? If the answer is yes, the claim is denied. If the answer is no, the inquiry proceeds to the next, and final step of the process.

5) Can the claimant, given his or her age, education, prior work experience, and functional limitations, perform any substantial gainful activity existing in significant numbers in the national economy? If the answer is yes, the person is found “not disabled.” If the answer is no, the person is found “disabled.”

Thus, the step three listings may be regarded as a “shortcut” for determining disability where a person’s impairments are so severe that they are presumed to preclude all gainful employment. The criteria for the listings are necessarily set higher than the statutory standard for determining disability. Each case is determined on an individualized basis, as there are impairments that do not rise to the level of one of the listings, but which still may preclude a person from pursuing full-time, gainful employment.

The former regulations for determining childhood disability provided that a child’s impairment(s) must meet or equal one of the childhood listings or one of the listings that would prevent an adult from doing any gainful activity in order for the child to receive benefits.

A child claimant who was denied benefits brought a case challenging these regulations as being facially invalid because they failed to implement Congressional intent that each claimant should be afforded an individualized disability determination. This claim was certified as a class action.

The U.S. Supreme Court, in the case of Sullivan v. Zebley, 110 S.Ct. 885 (1990), agreed with the plaintiff. In a nutshell, the Court held that requiring children claimants to prove that their impairments meet or equal one of the listings, denies them the individualized determination intended by Congress. One of the reasons is that different impairments may affect different children in different ways. Just because a child’s impairment does not meet the strict criteria for the listings, does not mean that his or her functional capacity is not limited to an extent similar to that which would prevent an adult from working.

The upshot of this case was that Social Security changed their regulations and adopted the principles of the case in their Social Security Ruling (SSR) 91-7c. The effect of this change was that now each child is guaranteed an individualized determination on his or her disability claim.

This material should not be construed as legal advice for any particular fact situation, but is intended for general informational purposes only. For advice specific to any individual situation, an experienced attorney should be contacted.

Contact a Salt Lake City Attorney Committed to Protecting Your Rights

When it comes the family law and social security disability, each client and case is different. It is also important to select an attorney with the experience, skills and professionalism required to address your legal issues. To learn more, contact the Salt Lake City law offices of Melvin A. Cook and schedule an initial consultation to discuss your case.

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