Facts about Down Syndrome and Filing for Disability
These selected pages answer some of the most basic, but also some of the most important, questions for individuals who are considering filing a claim for disability benefits.
Facts about the condition
1. Down syndrome is a condition in which a third copy of the 21st chromosome causes limited cognitive ability and developmental delays.
2. Having an additional 21st chromosome in every cell is also called trisomy 21. More than 90 percent of all Down syndrome cases are trisomy 21. This condition occurs in about one of every 900 children born worldwide.
3. John Langdon Down first described the condition and its characteristics in 1866, giving it the name.
4. Down syndrome is considered a developmental disability; it involves differences and delays in cognitive and physical ability as well as appearance. Developmental disabilities are usually mild to moderate, and severe disability is rare.
5. Down syndrome is the most common severe learning disability from a genetic condition.
6. Distinctive physical features for those with an extra 21st chromosome include a small chin, rounded face, oversized tongue, almond shaped eyes, short limbs, one crease instead of two on the palms, and extra space between first and second toes.
7. Children with Down syndrome are often abnormally flexible and have low muscle tone.
8. Another type of Down syndrome is mosaic down syndrome, where there is an extra 21st chromosome in some but not all cells. This is very rare.
9. The older the mother the higher the likelihood Down syndrome will develop in a fetus. This increase generally begins in the early to mid 30s and increases into the 40s. More younger women have children with Down syndrome because more women under 35 are having babies. After having one child with Down syndrome, the greater the likelihood is that another child will also have the condition.
10. Life expectancy for an individual with Down syndrome has increased greatly over the last century from 10 in 1929 to 50 or older today. Better understanding, tactics for early intervention and better health care have all contributed to this increase.
Qualifying for disability benefits with this condition
Whether or not you qualify for disability and, as a result, are approved for disability benefits will depend entirely on the information obtained from your medical records.
This includes whatever statements and treatment notes that may have been obtained from your treating physician (a doctor who has a history of treating your condition and is, therefore, qualified to comment as to your condition and prognosis). It also includes discharge summaries from hospital stays, reports of imaging studies (such as xrays, MRIs, and CT scans) and lab panels (i.e. bloodwork) as well as reports from physical therapy.
In many disability claims, it may also include the results of a report issued by an independent physician who examines you at the request of the Social Security Administration.
Qualifying for SSD or SSI benefits will also depend on the information obtained from your vocational, or work, history if you are an adult, or academic records if you are a minor-age child. In the case of adults, your work history information will allow a disability examiner (examiners make decisions at the initial claim and reconsideration appeal levels, but not at the hearing level where a judges decides the outcome of the case) to A) classify your past work, B) determine the physical and mental demands of your past work, C) decide if you can go back to a past job, and D) whether or not you have the ability to switch to some type of other work.
The important thing to keep in mind is that the social security administration does not award benefits based on simply having a condition, but, instead, will base an approval or denial on the extent to which a condition causes functional limitations. Functional limitations can be great enough to make work activity not possible (or, for a child, make it impossible to engage in age-appropriate activities).
Why are so many disability cases lost at the disability application and reconsideration appeal levels?
There are several reasons but here are just two:
1) Social Security makes no attempt to obtain a statement from a claimant's treating physician. By contrast, at the hearing level, a claimant's disability attorney or disability representative will generally obtain and present this type of statement to a judge.
Note: it is not enough for a doctor to simply state that their patient is disabled. To satisy Social Security's requirements, the physician must list in what ways and to what extent the individual is functionally limited. For this reason, many representatives and attorneys request that the physician fill out and sign a specialized medical source statement that captures the correct information. Solid Supporting statements from physicians easily make the difference between winning or losing a disability case at the hearing level.
2) Prior to the hearing level, a claimant will not have the opportunity to explain how their condition limits them, nor will their attorney or representative have the opportunity to make a presentation based on the evidence of the case. This is because at the initial levels of the disability system, a disability examiner decides the case without meeting the claimant. The examiner may contact the claimant to gather information on activities of daily living and with regard to medical treatment or past jobs, but usually nothing more. At the hearing level, however, presenting an argument for approval based on medical evidence that has been obtained and submitted is exactly what happens.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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