Evaluation of claims for children still follows the sequential evaluation process. SSA must consider all available, relevant and material evidence, both medical and non-medical. [Note: This differs from the adult listings which only considers the medical evidence]. SSA must consider the combined effects of all the impairments from which the child suffers.
SSA will first determine if the child is performing substantial gainful activity and, if so, the claim is denied. If the child is not working, SSA will then determine if the child has a “severe" impairment. A “severe" impairment is a medically determinable impairment(s) AND the impairment(s) is more than a slight abnormality. SSA must consider, in the case of more than one impairment, whether any one of the impairments alone is more than a slight abnormality OR whether the impairments combined are more than a slight abnormality. If the identified impairment(s) do not cause more than minimal functional limitations, they are only a slight abnormality, do not constitute a “severe" impairment, and a decision of “not disabled" must be issued.
NOTE: In deciding whether the impairment(s) are “severe," SSA is required to consider both medical and non-medical evidence, examine the child’s overall functioning and consider all the child’s impairments. This includes all relevant information from medical sources such as doctors, pediatricians, speech or language pathologists, psychiatrists or psychologists. This includes evidence from other medical sources (nurses, physicians’ assistants, naturopaths, chiropractors, audiologists and therapists) AND non-medical sources as well (educational personnel, social welfare agency personnel, clergy, other caregivers). The Step 2 evaluation is meant to screen out totally groundless claims and is ademinimis standard. If the child has a severe impairment(s) or combination of impairments, the evaluation proceeds.
IV. MEETING OR EQUALING THE LISTINGS - STEP 3
The Listing of Impairments (“Listings") - describe impairments for 14 major body systems considered severe enough to prevent an adult from performing any substantial gainful activity or, for a child, to cause marked and severe functional limitations. The Listings contain two parts; Part A and Part B. Part A contains criteria for persons age 18 and over. Part A may also be applied to the evaluation of children under age 18 if the disease has a similar effect on children and adults. Part B contains medical criteria for the evaluation of impairments for children under age 18. SSA will find a child disabled if the medical findings of the claimed impairment(s) are identical or equivalent to the criteria for the same impairment(s) as described in the appropriate Listings.
Each listing describes different body systems or, in the same body system area, describes different levels of restriction and medical impairment sufficient to be “disabling" and create entitlement to benefits. For example, under the Mental Retardation criteria of Listing 112.05, there are at least 5 ways a child ages 3 to 18 with an I.Q of 60 through 70 can be disabled:
1) having an additional and significant limitation due to other physical or mental impairment (Listing 112.05D);
2) having an additional impairment that satisfies the requirements of
(D)Listing 112.02(B)(2)(a) (if accompanied by another physical or mental impairment imposing additional and significant limitation of function.
There are at least three (3) additional criteria for children ages 1 to attainment of age 3 to be evaluated. Thus, the disabling level of severity may vary widely from body system to body system or within the same body system. A child must now have a medically determinable impairment(s) that
(a) meets a listing;
(b) medically equals a listing; or
(c) functionally equals a listed impairment
B. Meeting the Listings
A child’s’ impairment(s) meets a listing only when accompanied by the specific findings described in the medical criteria for that listing. The symptoms, signs and laboratory findings of the impairment must match the corresponding criteria for the applicable listing to “meet" that listing. When laboratory findings, symptoms or signs of the child’s impairment(s) do not exactly match the regulatory criteria, the listing is not met and the evaluation of “equivalence" must come next.
NOTE: The regulations appear to be in conflict about what evidence is considered in determining if a child meets a listing The regulations refer to “specific medical findings" as a basis for meeting a listing. Also, Part B of the Listings states that it “contains additional medical criteria that apply to the evaluation of impairments." However, as noted in Section III, above, the regulations also require consideration of both medical and non-medical evidence. At most hearings the ALJ asks the medical expert to consider medical evidence only, including symptoms, signs and laboratory findings. NOTE: The advocate should consider objecting to such a question as inconsistent with the Act and Regulations and be prepared to ask the expert a question which does include all of the evidence, medical and non-medical, in the event the ALJ does not ask such a question. The expert should also be asked to identify what documents he received in advance of the hearing, to determine whether he or she even had all of the evidence, such as “reports of contact," SSA forms which include SSA employee observations, school records, or the like.