How you can qualify for disability benefits based on epilepsy or seizure disorders?
It’s National Epilepsy Awareness Month, and we wanted to let you know how the Social Security Administration analyzes seizures when determining if someone who has them meets SSA disability criteria.
Seizure events themselves are rather complicated, and how they are defined by medical providers also varies. Understanding how the SSA looks at and categorizes them will help individuals with seizures..
As with all impairments, Social Security’s general rule for claims is that the seizures must prevent you from working on a full-time basis.
Social Security first considers the type of seizure, dividing them into two distinct types:
- ‘Generalized tonic-clonic’ seizures
- ‘Dyscognitive’ seizures
In other words, the types of seizures are those in which a person:
- Loses consciousness, falls to the ground, and involuntarily shakes
- Does not lose full consciousness or fall to the ground, but experiences a sort of freeze in thinking or time they cannot account for
Other terms for these are grand mal seizures and petit mal seizures, respectively.
For an individual to qualify for benefits, the next thing Social Security looks at is the frequency of seizures:
- Generalized (grand mal): an average of one seizure per month, for at least three consecutive months
- Dyscognitive (petit mal): an average of one seizure per week for at least three consecutive months
For both types, the seizures must occur at these rates even when individuals are taking medications exactly as their physician prescribed.
How can you qualify for disability benefits even if your seizures don’t occur at the SSA’s required average rates?
Even without monthly grand mal seizures or weekly petit mal seizures over three months, some can still qualify for disability benefits if the impact of their seizures prevents full-time work.
For example, a person may have four to five grand mal seizures per year and provide documentation showing they need multiple days to recover after each seizure. These seizures alone, if spread out evenly over a year, would be insufficient for an SSA claim.
However, if the individual can show that the aftermath causes severe, long-lasting cognitive confusion or significant fatigue (which is common), then a judge can still award the claim, finding the individual would miss too much work to remain competitively employed.
What will keep you from winning your claim even if you have frequent seizures?
One of the most important things to remember here is that Social Security looks at the number and impact of seizures with the use of prescribed medication. A full assessment is found only after Social Security determines that seizure medications are being taken as prescribed by a physician.
Judges make this conclusion based on reports of compliance and prescribed medication levels in blood labs. The main thing that will prevent you from winning a claim based on seizures is non-compliance with medical treatment.
The thing we see most in denied seizure claims is individuals who:
- don’t take their daily prescribed medication
- stop taking it because they feel fine
- aren’t willing to try a new medication prescribed by a doctor
While there are probably seemingly good reasons for not taking a medication sometimes—some people report side effects that outweigh the benefits—in a seizure case, compliance with prescribed medication is absolutely necessary.
Many Social Security judges feel seizures are an entirely controllable impairment, if the right dose or combination of medication is found. Finding the treatment can take years for many people, and those who get treatment and work with doctors to try to control seizures are those who judges find sympathetic.
It’s important for individuals to work closely with their doctors toward controlling the amount and intensity of seizures. This includes taking prescribed medications at the right times and not using alcohol or other, illegal substances, since these may be the primary cause of seizures. Refraining from using these substances is also vital to winning your claim.
Sources:
- Disability Evaluation Under Social Security: 111.00 Neurological – Childhood
- Epilepsy with Generalized Tonic-Clonic Seizures Alone
- Mayo Clinic: Epilepsy
- Disability Evaluation Under Social Security: 111.00 Neurological – Adult
