Intellectual disability often comes with limitations in functioning. This makes it hard for intellectually disabled people to retain employment and provide for themselves. So, does Social Security Disability Insurance (SSDI) offer benefits for intellectual disabilities?
Yes, Social Security Disability Insurance provides benefits to intellectually disabled people through Listings 12.02 and 12.05. Individuals can also obtain benefits through a medical-vocational allowance if their condition does not match a listing.
Read below as we discuss in more detail how people with intellectual disabilities can qualify for SSDI.
What is an Intellectual Disability?
Intellectually disabled refers to individuals who struggle with limitations in their mental, communication, social, and self-care abilities. Intellectually disabled children often do not reach their milestones on time.
They struggle with learning to speak, walk, and care for themselves like their peers.
Mental or physical problems that children encounter during their teen years can cause intellectual disability. They can also be caused by injuries and limitations in the brain prior to the child’s birth. Fetal alcohol syndrome, Down syndrome, birth defects, genetic conditions, and infections that affect the brain are some of the common causes of intellectual disability that occur prior to birth.
For intellectual disabilities with adult-onset, some of the most common causes are head injury, stroke, and brain infection.
SSDI Qualification Guide for Intellectual Disabilities
The Social Security Administration (SSA) uses a 5-step method to determine whether you are eligible for disability benefits for the SSDI and/or Supplemental Security Income (SSI) programs.
There is a decision-maker or adjudicator involved in every step of a disability claim. The decision-maker during the initial application and reconsideration processes is a Disability Determination Service (DDS) examiner who consults with a DDS physician.
During the hearing phase, the Administrative Law Judge (ALJ) is the decision maker, and they frequently work with a Medical Expert (ME). The adjudicator uses the following evaluation at each phase:
1. Technical Criteria
To begin, you can’t work more than what Social Security calls a “Substantial Gainful Activity” (SGA) level. This means that you are not allowed to have a monthly gross income that is greater than $1,470.
The SGA rule is the most essential non-medical criterion that needs to be met in order for the claim to move forward to Step 2, which is a comprehensive medical review.
If you fail to satisfy the non-medical eligibility criteria, your application will not proceed to Step 2 and will be technically denied, regardless of how severe and debilitating your intellectual disability may be.
Although it is possible to file an appeal against a technical denial, in most cases, the appeal will be unsuccessful if the details are correct.
2. Severe Disability
The second step involves determining whether or not the symptoms you are experiencing are severe. Every piece of medical evidence is collected in order to ascertain the severity of your impairments.
You should make sure that your attorney or non-attorney representative is heavily involved in this process, if you have one.
Additionally, the judge may ask you to fill out activities of daily living and vocational questionnaires. These give you a chance to talk about how your symptoms have affected your normal functioning.
The adjudicator can also set up a Consultative Examination (CE) with a doctor hired by DDS to do medical exams for employees. The adjudicator will determine the severity of your symptoms after reviewing all of the evidence.
To be considered severe, the symptoms must make it hard for you to do essential tasks that you would normally do at work.
Physical problems, such as not being able to walk, stand, lift, push, carry things, etc., can be a sign of severity. The inability to communicate verbally, visually, aurally, concentrate, follow simple directions, get along with colleagues, etc., might also be considered severe.
If it is decided that your symptoms are severe, your claim moves on to Step 3. If not, it is turned down at Step 2, and you can file an appeal.
3. Blue Book Listing
The third step involves determining whether or not your condition is comparable to or equal to a medical “Listing.” Claims involving intellectual disabilities or mental retardation are examined in accordance with Listing 12.05 Mental Retardation or Listing 12.02 Neurocognitive Disorders.
4. Past Work
During the fourth step, you will be evaluated to determine whether or not you are capable of carrying out the tasks that you have previously completed. The adjudicator will take into account your Residual Functional Capacity (RFC) in order to help them make this determination.
The adjudicator will evaluate your capacity to carry out a variety of tasks, including sitting, standing, walking, lifting, pushing, pulling, reaching, handling, stooping, crouching, remembering, and understanding, among other things.
Some of the restrictions in your RFC may include the following:
- not being able to stand and walk for longer than four hours in an 8-hour workday;
- not being able to sit for more than 2 hours;
- not being able to lift and carry more than 10 pounds;
- not being able to climb ropes or ladders;
- not being able to manage your focus, persistence, or pace
After figuring out your RFC, the adjudicator will make a list of your Past Relevant Work (PRW). This includes any job you had in the 15 years before your alleged onset date (AOD).
Once your list of past relevant work has been finalized, the adjudicator will now be responsible for classifying it. Your previous work experience will be categorized according to the level of exertion required as well as the level of skills needed.
For instance, a nurse works at the medium exertional level, and their job is regarded as skilled. On the other hand, a security guard works at a light exertional level, and their job is regarded as being semi-skilled.
After the adjudicator has classified all of your PRW, the next step is to determine whether or not you have the functional ability to perform any of the work that you have done in the past.
5. Any Other Work
Step 5 considers whether you can reasonably be expected to do any other type of work, even if you have never done it before. For this purpose, the adjudicator uses the same Residual Functional Capacity that was used in Step 4. They also look at your age, education, and work experience.
Given your age, education, and past work experience, the adjudicator might determine that you can do another type of work and consider you not disabled.
You will be provided the option of appealing this denial. However, if the adjudicator concludes that you are unable to perform any other kind of work, you will be found to be disabled, and your claim will be approved for disability benefits.
Intellectual Disability Listings in the Blue Book
There are two main intellectual disabilities included in the book. Let us examine each of them in detail.
Listing 12.02: Neurocognitive Disorders
This listing is intended for people who have suffered a traumatic brain injury or another condition that has affected their brain function. You must fulfill requirements A and B or A and C.
Requirement A
A major decline in cognitive abilities impacts your ability to maintain complex attention, executive function, learning and memory, language, perceptual-motor, or social-cognitive functions.
Requirement B
Severe problems with at least one of the mental abilities below:
- being able to understand, remember, or use information;
- interact with others;
- focus, persist, or maintain pace; and/or
- adapt to new situations or manage themselves.
Requirement C
The mental disorder must be “serious and persistent.”
The disorder has been medically proven to exist for at least two years, and you are currently receiving medical treatment, mental health therapy, psychosocial support, or a highly structured setting that is helping to lessen the symptoms and signs of your disorder.
You also have marginal adjustment, which means you are not very good at adapting to changes in your environment or to demands that are not already a part of your everyday life.
In short, you are required to demonstrate that your capacity for thought has been significantly impaired ever since the accident or injury.
Listing 12.05: Mental Retardation
This listing is intended for people who were born with a condition that makes them intellectually disabled.
There was a lot of litigation and confusion over Listing 12.05C in the past. In 2017, the Social Security Administration removed listing 12.05C and replaced it with the listing below.
- Below-average general intellectual functioning, which can be demonstrated by a cognitive inability to perform satisfactorily on standardized tests of intellectual functioning
- Significant deficits in adaptive functioning, as demonstrated by reliance on other individuals for basic personal care like eating, dressing, and bathing
- Evidence from both current and past cognitive and adaptive functioning suggests that the disorder started before the age of 22.
OR
- An IQ score of 70 or lower AND significant deficits in adaptive functioning, which are shown by serious limitations in one or two of the following areas of mental functioning:
- the ability to comprehend, retain, or apply information;
- engage in social interactions;
- focus, persist, or maintain pace; or
- adjust to new situations or manage one’s own behavior;
- There is evidence from the medical records and the present level of intellectual and adaptive functioning that the disorder started before the age of 22.
This listing describes a person who is essentially incapable of caring for themselves.
The listings provided by the SSA are typically hard to meet. The intellectual listings are no different, as you can see from the requirements above.
While it is possible that you will be found disabled based on 12.02 or 12.05 if you meet the criteria that have been presented above, you can still obtain disability benefits by proving your disability in other ways, even if your condition does not match this listing.
How to Apply for SSDI If You Have an Intellectual Disability
In order for the Social Security Administration to grant approval for a disability claim that falls under the Intellectual Disabilities category, the agency requires specific documentation. This documentation includes medical records, proof of work and employment history (if any), and other evidence that the condition meets other Blue Book requirements.
The process of applying for disability benefits can be extremely time-consuming and complicated, particularly if you are not familiar with the process and how theSSA operates.
Initial claims are frequently rejected, and the claimants are then forced to file an appeal. There are some individuals who never go through the appeals process because they believe their claim will never be approved.
If you are going through the process of applying for Social Security Disability Insurance, you might want to get in touch with a lawyer or SSA advocate who specializes in SSDI benefits.
Experienced disability lawyers can help their clients fill out the correct forms, file their paperwork on time, and get the relevant medical proof to demonstrate their disability.
How Appeals Work
If an application is turned down, there are several ways to appeal. The first step is to file a request for reconsideration. In this stage, you essentially request that the disability examiner review your claim again.
Next, there is a hearing in front of an Administrative Law Judge (ALJ). This is the stage where your chances of being approved for your disability claim are highest, and the importance of having a disability lawyer increases as well.
If you received a denial at the hearing level, you still have the chance to appeal through the Appeals Council so they can have a look at the judgment made by the ALJ.
Many applications that were initially rejected are granted approval after an appeal. At each stage, appeals must be submitted within 60 days of the denial of the claim. It is critical to have adequate medical documentation at each stage of the process.
Conclusion
Intellectual disabilities can cause immense limitations in daily and professional functioning, often making it difficult for people with this condition to stay afloat financially. Luckily, the SSDI program does offer benefits to intellectually disabled people, provided they fulfill the requirements stated in this article.
