Spina Bifida and Disability Benefits

A congenital disorder present from birth, spina bifida can cause growth impairments, musculoskeletal deformities, neurological disorders, and intellectual deficits, among other complications. For many with spina bifida, their symptoms and complications are tremendous barriers to normal activities of childhood and to employment in adulthood. As such, spina bifida can qualify children and adults for disability benefits from the Social Security Administration (SSA).

Medically Qualifying for Benefits with Spina Bifida

When the SSA reviews a disability application, they first try to match medical records to a listed condition. Although there is no Social Security Disability (SSD) listing for the condition, spina bifida can qualify for benefits under a number of other listings, including:

  • Section 1.00k2 – for spinal arachnoiditis
  • Section 1.00k2b – for spinal stenosis
  • Section 1.04 or 101.04 – for disorders of the spine
  • Section 100.00 – for children with growth impairments
  • Section 11.00 or 111.00 – for neurological disorders
  • Section 111.00 – for menigomyelocele and related disorders
  • Section 12.05 or 112.05 – for intellectual deficits
  • Section 112.12 – for children with emotional or developmental disorders

Even if your spina bifida does not closely match a Blue Book listed condition, you may still be able to receive benefits. If the SSA is unable to match your medical records to a listed condition, they will perform a “residual functional capacity” (RFC) analysis, which looks at how your symptoms affect your everyday abilities, including your ability to hold a job.

When considering whether a child qualifies medically for benefits, the SSA’s functional capacity analysis looks at how the applicant’s medical condition affects his or her abilities to participate in normal, age-appropriate activities.

Whether you meet or match a listing in the Blue Book or potentially qualify through an RFC analysis, the SSA will need detailed information from you on:

  • Employment history, for adults, or school records, for children
  • Medical records, including surgeries, medications, physical therapy, and other treatments
  • The names and contact information for all healthcare providers
  • A statement from a primary care physician detailing symptoms and complications, and their affects on everyday life
  • Lab reports, x-rays, CT scans, and other diagnostic tests, documenting the extent of musculoskeletal, neurological, and other affects of spina bifida
  • Intellectual assessment and psychological or psychiatric evaluations evaluation results, if appropriate
  • Information on mobility assistance devices required

The SSA takes into account all medical conditions when determining eligibility for SSD benefits. Spina bifida often occurs along with other congenital disorders and complications. If any organs are compromised or developmental problems are present, these must also be well documented within your medical records for the SSA to review. Work closely with your doctor to document your condition, including all your complications. Consider also asking your primary physician to review Blue Book listings to ensure your medical records meet SSA documentation requirements.

Getting Help with Your Claim

To apply for benefits on behalf of a minor child, you must participate in an interview with an SSA representative. The same is required for adults who apply for Supplemental Security Income (SSI) benefits. Call 1-800-772-1213 to schedule an appointment.

Most disabled adults qualify through the Social Security Disability Insurance (SSDI) program, even if they also receive SSI. The application for SSDI can be completed online, in person, or in some cases, via a phone interview.

However you decide to apply, you may need to seek help from a Social Security advocate or attorney, a friend or family member, or a social worker. If your spina bifida does not closely match a listed condition, getting help with your claim is even more important because proving your claim will be more challenging.

Find Out If I Qualify for Benefits!