Complete Section II in every case in which functional equivalence is at issue; e.g.,
the child's impairment or combination of impairments is severe and does not meet or medically equal the listings, unless one of the examples in DI 25225.060 applies.
NOTE: A duration denial (Disposition 6) cannot be made without consideration of functional
The adjudication team must consider all relevant factors and evidence in the case record as discussed in DI 25210.001 ff. and outlined in Section IC of the SSA-538. Consider the following questions about
whether the child's activities are typical of other children the same age who do not
have impairment(s) and if a medically determinable impairment(s) affects his or her
ability to function:
What activities is the child able to perform?
What activities is the child not able to perform?
Which of the child's activities are limited or restricted compared to other children
the same age who do not have impairments?
Where does the child have difficulty with activities at home, in childcare, at school,
or in the community?
Does the child have difficulty independently initiating, sustaining, or completing
What kind of help does the child need to do activities, how much help is needed, and
how often is it needed?
Written answers for each of these questions are not required. But it is necessary
to know the answers to get a clear picture of the child's functioning and to evaluate
his or her limitations. If a child has more than one impairment, no one of which is
“severe,” or no one of which meets, medically equals, or functionally equals the listings,
look comprehensively at the interactive and cumulative effects of all of the child's
impairments on his or her day-to-day functioning. (See POMS DI 25225.010 ff.)
Look first at the child's activities and whether they are limited or restricted in any way. When assessing the child's
functional limitations, decide which domains are affected by the child's impairment(s).
Any activity may involve the integrated use of many abilities and skills. And limitations
in one area may affect the child's functioning in other areas. Therefore, any single
limitation may be the result of the interactive and cumulative effects of one or more
impairments, while any given impairment may have effects in more than one domain.
Thus, it is important to assess the limitations due to single or multiple impairments
in all affected domains.