The Social Security Administration will find that an otherwise qualified applicant for SSI or SSDI is disabled if the individual meets the clinical and diagnostic criteria of a listed impairment. There are numerous listed impairments or “Listings” in the regulations which are categorized by body system. Down syndrome, specifically non-mosaic Down syndrome falls under the Listing for “congenital disorders that affect multiple body systems” (Listing 10.00). Listing 10.06 applies specifically to non-mosaic Down syndrome. In order to meet Listing 10.06, certain laboratory findings are required.
Under Listing 10.06, the SSA requires a report of karyotype analysis, which is the definitive test to establish non-mosaic Down syndrome. The SSA will not purchase this test. If a physician has not signed the lab report, the evidence must also include a physician’s statement that the induvial has non-mosaic Down syndrome. The SSA will not accept a fluorescence in situ hybridization (FISH) test as a substitute. The only exception to the karyotype analysis testing is if a physician’s report states that the induvial has the distinct facial or other physical features of Down’s syndrome along with evidence that an individual’s functioning is consistent with a diagnosis of non-mosaic Down syndrome.
With respect to mosaic Down syndrome, the SSA notes that “Mosaic down syndrome can be so slight as to be undetectable clinically, and can be profound and disabling, affecting various body systems”. When the symptoms of mosaic Down syndrome are so severe as to effect multiple body systems, such as the musculoskeletal system, the SSA will evaluate the case based on the Listing(s) for the affected body system(s). Although there is not a specific Listing for mosaic Down syndrome, it could be found to medically equal another Listing, such as the non-mosaic Down syndrome Listing.
It should be noted that even if a Listing is not met or equaled , the applicant with a form of Down syndrome could still be found disabled on the basis that they lack the residual functional capacity (RFC) to perform relevant work. The SSA uses the phrase “Residual Functional Capacity” to refer to the most an individual can do in light of their severe impairments.
If you or someone you know is thinking about applying for disability due to Down syndrome, be advised that you can benefit from working with an experienced disability attorney and a law firm specializing in these claims.