BASIC (02-01)

A. Policy

Notices that include any description of the disability standard for children must use appropriate language and terminology. The following guidance applies to determinations at step 3 of the childhood sequential evaluation process.

B. Procedure - Language for Claims Filed Before 8/22/96

1. The Disability Standard Changed

The definition of disability for children changed on August 22, 1996. Because children who filed claims before that date may have been provided information about childhood disability that is no longer applicable, include the following language in any notice or letter describing the disability standard for children to such claimants:

“On August 22, 1996, a new law changed the Supplemental Security Income (SSI) program. The new law changed the definition of disability for children. A child must meet certain rules to qualify for SSI payments based on disability under this new definition. A child's health problems must:

• cause marked and severe functional limitations; and

• last, or be expected to last, for at least 12 months in a row, or result in death.

Also, a child cannot be doing any kind of substantial work.

The new law also changes the way we consider certain behavior problems caused by a child's condition or conditions.

The new definition of disability requires more serious limitations than the old definition.”

2. Personalized Language

Follow the guidelines in DI 25235.010C.2.

C. Procedure - Language for Claim Filed on or After 8/22/96

1. Description of the Disability Standard

For claims filed on or after August 22, 1996, in any letter or notice describing the disability standard for children, include the following language:

“A child must meet certain rules to qualify for SSI payments based on disability. The child's health problems must:

• cause marked and severe functional limitations; and

• last, or be expected to last, for at least 12 months in a row, or result in death.

Also, the child cannot be doing any kind of substantial work.”

2. Personalized Language

All of the requirements for a complete and proper personalized disability notice (PDN) outlined in DI 26530.001 apply in childhood disability cases. When the disability determination is a step 3 denial, in the personalized part of the PDN explaining why the child is not disabled, use terminology consistent with the description of the disability standard in 1. above; in particular, explain that the child's impairment(s) does not cause marked and severe functional limitations. For example, the personalized explanation might include language such as:

“Although (name of child's) (name of impairment(s)) results in some problems for (him/her ), including (describe impairment-related limitations ), the evidence we considered does not show that the condition causes marked and severe functional limitations. Therefore, we cannot consider (name of child) disabled.”

D. Procedure - Notices for Certain Individuals Who Attain Age 18

An individual who attains age 18 during the period that his or her claim is being adjudicated may be denied under the childhood disability standard but allowed under the adult standard (or vice-versa) - see DI 25201.010.

1. Individual Denied as Child; Allowed as Adult

If the individual is denied under the childhood standard, but allowed under the adult standard, include the following language in the PDN:

“There are different disability rules for children (individuals under age 18) than for adults (individuals age 18 or older).

“For the period before you attained age 18, we evaluated your claim using the rules for children and found you were not disabled under those rules.

“For the period starting when you attained age 18 (date of attainment), we evaluated your claim using the rules for adults and found you are disabled under those rules.

“Therefore, the first month we can pay you SSI is (month after month of attainment ).”

NOTE: Under a provision of P. L. 104-193, SSI benefits are effective on the first day of the month following the date on which the application is filed, or on which the individual first becomes eligible, whichever is later.

2. Individual Allowed as Child; Denied as Adult

If the individual's impairment is found disabling under the childhood standard (and meets the duration requirement), but found not disabling under the adult standard, include the following language in the PDN:

“There are different disability rules for children (individuals under age 18) than for adults (individuals age 18 or older).

“For the period before you attained age 18, we evaluated your claim using the rules for children, and found you were disabled under those rules, starting (date of onset).

For the period starting when you attained age 18 (date of attainment), we evaluated your claim using the rules for adults, and found you are not disabled under those rules.

Therefore, the last month we can pay you SSI is (second month following attainment).”