Can You Get Disability for Epilepsy? SSA Epilepsy Disability Benefits

Living with epilepsy can be challenging, affecting many aspects of daily life. Because of the way it causes hospitalization, loss of driving ability, and risk of unconsciousness in dangerous places, many people wonder, can you get disability for epilepsy?

Knowing if epilepsy qualifies for disability is important for those who have this condition. Epilepsy is a serious neurological disorder, and knowing the details about eligibility, the application process, and the types of benefits available can help ease some of the stress that comes with this condition. Having a solid epilepsy diagnosis is crucial for applying for disability benefits, as it provides the necessary documentation to prove the impact of seizures on daily life. This article will give you clear and concise information on how to get disability for epilepsy so you can navigate through this process successfully.

Getting Social Security Disability for Epilepsy: Key Takeaways

• Epilepsy qualifies for Social Security disability benefits if it prevents you from working. The condition must significantly impair your ability to perform substantial gainful activity.
• Detailed medical records and evidence are essential for a successful claim. This includes documentation of seizure frequency, treatment history, and the impact on daily life.
• The SSA requires documentation of recurrent seizures despite treatment. For example, tonic-clonic seizures must occur at least once a month for three consecutive months.
• Meeting the specific criteria for seizure frequency and impact is crucial. Non-convulsive seizures must occur at least once a week for three consecutive months.
• Working with a disability lawyer can improve your chances of approval. Disability lawyers help navigate the complex application process and increase approval rates by up to 60%.
• The Social Security Administration (SSA) is responsible for determining eligibility and benefit amounts for individuals with disabilities like epilepsy.
• To qualify for Social Security Disability Insurance (SSDI), individuals must have worked long enough and paid social security taxes.

What is Epilepsy? Symptoms and Side Effects

Epilepsy is a neurological disorder characterized by recurrent unprovoked seizures caused by abnormal electrical activity in the brain. Symptoms can vary widely and include brief loss of attention (absence seizures), severe muscle contractions (tonic-clonic seizures), and sudden jerking movements (myoclonic seizures). Generalized tonic-clonic seizures involve a complete loss of consciousness and are characterized by two main phases: a ‘tonic’ phase where the body stiffens, and a ‘clonic’ phase that includes convulsions and muscle jerking.

Besides seizures, people with epilepsy may experience physical impairments like difficulty walking, cognitive impairments like memory problems, and sensory impairments like vision or hearing issues. Medication side effects like fatigue, dizziness, and blurred vision can also contribute to the disability.

Additionally, people with epilepsy are three times more likely to have mental health conditions like depression or anxiety, which further affect their daily lives. Co-occurring conditions like autism spectrum disorder can worsen these challenges.

Disability Criteria From the SSA

To qualify for disability benefits, a condition must interfere with your ability to work for at least 1 year. The SSA requires detailed medical documentation including diagnoses, treatment plans, and evidence of ongoing impairment. Marked limitations in physical functioning can impact a person’s ability to perform everyday physical tasks. The condition must be severe enough to prevent any substantial gainful activity (SGA).

The SSA evaluates claims based on the criteria in the Blue Book, which lists medical conditions and the required evidence for each. Recurrent and unprovoked seizures are a defining characteristic of epilepsy and must be documented for disability claims. If a condition is not listed in the Blue Book, applicants can still qualify through a Medical Vocational Allowance, which considers age, education, work experience, and residual functional capacity (RFC).

Is Epilepsy a Disability According to the SSA?

Yes, the SSA considers epilepsy a disability if specific criteria are met. The condition must severely limit an individual’s ability to do substantial gainful activity. Frequent uncontrolled seizures despite medical treatment is key. Epilepsy is classified as a seizure disorder, which is a common neurological disease affecting people across diverse demographics.

SSA Disability Requirements for Neurological Impairments

The SSA’s Blue Book lists the requirements for epilepsy under neurological impairments. The Blue Book outlines the requirements necessary for applicants to prove their epileptic seizures are sufficiently severe to qualify for disability benefits. For adults with convulsive epilepsy, the criteria is having tonic-clonic seizures at least once a month for 3 consecutive months despite being on prescribed treatment. Non-convulsive epilepsy like dyscognitive seizures must occur at least once a week for 3 consecutive months despite treatment.

For children, the criteria are the same, tonic-clonic seizures once a month for 3 months or dyscognitive seizures once a week for 3 months despite treatment. Also, documentation must include detailed medical records, EEG results, and a description of the seizure types and frequency. The SSA also considers the impact on daily activities and any co-occurring conditions.

Does Your RFC Mean There’s No Work You Can Do?

Your Residual Functional Capacity (RFC) assesses what work activities you can still do with your epilepsy. If your RFC shows that seizures or related impairments prevent you from doing any work you have done in the past or any other work, you may qualify. This is based on medical records, doctor’s opinions, and your own statements about daily limitations. The RFC assessment includes evaluating limitations in concentrating, persisting, or maintaining pace due to epilepsy.

How Hard Is it to Get Disability for Epilepsy?

Getting disability for epilepsy is tough because of the strict SSA criteria – medical documentation and consistent treatment history is key, and many initial claims are denied because of lack of medical evidence or not meeting the seizure frequency requirements. Having frequent seizures is a key requirement for qualifying for disability benefits, as they must significantly interfere with daily activities and work. Make sure all medical records are up to date, and document the impact of epilepsy on daily activities and work capabilities to increase chances of approval.

The process involves several steps, including application, medical evaluation and potential appeal. Only about 35% of initial claims are approved for SSI and SSDI, though more are awarded on appeal, and working with a disability lawyer can increase the chances of approval by up to 60%. Lawyers can help gather the necessary documentation, present the case and navigate the appeal process if the initial claim is denied.

Which Epilepsy Symptoms Might Limit Your Ability to Work?

Some epilepsy symptoms will limit your ability to work, and it’s those experiences that can qualify you for disability. Severe seizures will result in frequent absences and need for recovery time, limit your ability to drive, and thus make it hard to maintain a regular work schedule. Generalized tonic-clonic seizures occur throughout the brain, progressing through phases such as the tonic phase, where muscles stiffen, and the clonic phase, characterized by rhythmic jerking. Cognitive impairments like memory issues and difficulty concentrating will reduce productivity and reliability. These symptoms will prevent you from doing complex tasks, following instructions, and completing work efficiently.

Physical limitations from medication side effects like dizziness, fatigue, and blurred vision will also hinder performance. These side effects will make it unsafe to operate machinery or do tasks that require precision and alertness. The unpredictability of seizures will also create safety concerns for the individual with epilepsy and their coworkers, especially in environments that require a high level of safety awareness.

Emotional and psychological symptoms like anxiety and depression are common among people with epilepsy and will further impact work performance. These conditions will affect motivation, interaction with colleagues, and overall mental health, and will therefore decrease job performance.

Common Medical Conditions & Comorbidities That May Help You Get Disability for Epilepsy

Co-occurring conditions like depression, anxiety, and autism spectrum disorder will strengthen a disability claim. These conditions will exacerbate epilepsy symptoms and further limit daily functioning. Document all related medical conditions to give a full picture of your health challenges. For example, people with epilepsy are 3 times more likely to have physical, cognitive, or social impairments. Include evidence of these additional conditions in your claim to show the overall impact on your ability to work and daily activities.

Medical Evidence You’ll Need for Your Epilepsy Disability Claim

Strong medical evidence is key to an epilepsy disability claim. This includes medical records from healthcare providers documenting the frequency and severity of seizures, treatment history, and how the condition affects daily activities.

Medical Records

Full medical records from neurologists and other healthcare providers are required. These should include diagnosis, seizure logs, treatment plans, and responses to medications. Detailed descriptions of seizure types, frequency, and duration is important. Records should also show how epilepsy affects daily activities like work, school, and social interactions. Include statements from healthcare providers about the severity of your condition and how it limits your functionality to strengthen your claim.

Medical Evidence

EEG results, MRI scans, and descriptions of seizure types and frequency from medical professionals will support your disability claim. These diagnostic tests will provide objective evidence of epilepsy. Seizure diaries kept by the patient or caregiver can also be useful. These diaries should note the date, time, duration, and type of each seizure and any triggers or post-seizure effects.

Evidence that Work Triggers Your Symptoms

Provide evidence that work triggers or worsens your symptoms. This can be statements from employers, co-workers, or vocational experts. For example, if stress or specific job-related activities increase seizure frequency, detailed records of these incidents can be helpful. Reports from workplace supervisors noting performance issues or safety concerns related to your condition can also support your claim.

Proof of Other Conditions

Include medical records of any other conditions that contribute to your disability. This will give a full picture of your limitations. For example, if you have co-occurring conditions like depression, anxiety, or cognitive impairments, include medical records from relevant healthcare providers. This additional evidence will show the overall impact of epilepsy on your health and daily activities.

How to Apply for Epilepsy Disability Benefits

Applying for disability benefits involves gathering documents, submitting an application, and potentially appealing a decision.

Applying for Social Security Disability Insurance (SSDI) With Epilepsy

SSDI benefits are for adults who were recently employed but can no longer work due to epilepsy. The application process requires medical and employment records. Apply online, in person or by phone. The process can take several months so apply early and make sure all documentation is complete and accurate. Include all medical records, seizure logs, and statements from healthcare providers about how epilepsy affects your ability to work.

SSDI payments vary based on work history with an average monthly payment of $1,537. After you submit your application you will be reviewed and may be asked to provide more information or attend a consultative exam.

Applying for Supplemental Security Income (SSI) With Epilepsy

SSI benefits are for individuals with limited income and resources. The application requires proof of income, resources, and medical documentation. Like SSDI the process can take time so be thorough. Apply online, in person, or by phone, and be prepared to provide medical and financial records. SSI is need-based with maximum monthly payments of $943 for an individual and $1,415 for a couple (as of 2024).

In addition to medical documentation, you will need to provide proof of your financial situation such as bank statements, pay stubs, and information about any other income or assistance you receive. The SSA will review your application and determine eligibility based on both medical and financial criteria.

Work With a Disability Lawyer to Improve Your Odds of Approval

A disability lawyer can help you through the application process, gather necessary documentation, and represent you in appeals if needed. Their expertise will increase your chances of approval and make sure all aspects of your condition are presented to the SSA.

Lawyers know the rules and can present your case in the best possible way. They can help gather more evidence, organize medical records, and represent you at hearings. Working with a lawyer can make the difference between approval and denial especially if your initial claim is denied.

Legal fees for disability lawyers are typically contingent upon winning your case and are capped at 25% of past-due benefits not to exceed $7,200.