How does Social Security look at children’s disability cases based on epilepsy or other seizure disorders?

Social Security first considers the Listing of Impairments. The Listings are a set of descriptions of medical conditions which can be disabling. The Listings tell you the what kind medical evidence you need and the medical findings to prove that the condition is disabling.  While the Listings are not the only way to be found disabled, they are very important in children’s disability cases.

For seizure disorders, there are two critical Listings.

• 111.02 Major motor seizure disorder
• 111.03 Nonconvulsive epilepsy
  

Listing 111.02 Major motor seizure disorder

This Listing primarily applies in convulsive seizure disorder cases.

A. Convulsive epilepsy. In a child with an established diagnosis of epilepsy, the occurrence of more than one major motor seizure per month despite at least three months of prescribed treatment. With:

1. Daytime episodes (loss of consciousness and convulsive seizures); or

2. Nocturnal episodes manifesting residuals which interfere with activity during the day.

B. Convulsive epilepsy syndrome. In a child with an established diagnosis of epilepsy, the occurrence of at least one major motor seizure in the year prior to application despite at least three months of prescribed treatment. And one of the following:

1. IQ of 70 or less; or

2. Significant interference with communication due to speech, hearing, or visual defect; or

3. Significant mental disorder; or

4. Where significant adverse effects of medication interfere with major daily activities.

To be found disabled under this Listing, you must show be able to prove either the

• “A” criteria: 2 or more convulsive seizures per month with loss of consciousness, during the day, or at night with side effects (residuals) that last into the daytime hours; or the
• “B” criteria: 1 convulsive in the last year and one of the 4 subparts.

111.03 Nonconvulsive epilepsy

This listing deals with non-convulsive seizures which may or may not include loss of consciousness.

In a child with an established seizure disorder, the occurrence of more than one minor motor seizure per week, with alteration of awareness or loss of consciousness, despite at least 3 months of prescribed treatment.

In both of these Listing, there has to be a well-established diagnosis, and the seizures have to continue despite 3 or more months of treatment.

Disability cases based on seizure disorders are a very special kind of disability case.

If your case goes in front of an Administrative Law Judge, you can expect to be asked these questions:

• How often do you have seizures?
• What happens during a seizure?
• How do you feel after a seizure?  
• What do you have to do after a seizure (lie down, sleep etc)? And for how long?
• Are you treating with a doctor?
• Are you taking your medications as prescribed? How long have you been taking your medications?

While seizure disorders (epilepsy, partial complex seizures, etc.) are often disabling, simply having a seizure disorder is not enough to be found disabled. In many cases, medications control the frequency or severity of seizures.

Of course, in many cases, they do not. 

But, to improve your chances of winning your case, you have to be ready to talk about your seizures, how often they happen and how they effect you.

Attorney Anthony Reeves writes about what to do and not to do when applying for Social Security disability benefits for a seizure disorder (whether due to epilepsy or pseudo-seizures).

Most people think that epilepsy is so traumatic that an individual should be approved fairly easily.  Due to its unpredictability, the symptoms can affect you in a variety of different ways.   Despite the severity of this condition, it is difficult to demonstrate that the condition can prevent from performing work on a full time basis.

Anthony provides a list of 5 things you should do to improve your chances of winning:

1. Track how often you have seizures.
2. Take your medications. 
3. Track your after-effects.
4. Track your restrictions.
5. Don’t minimize or exaggerate your symptoms.

These are great tips and I encourage everyone to read Anthony’s article on this topic.

via The LegalBEAT Part 2 - Social Security Tips for disability cases, Part II: Epilepsy.

If you have a family member, or a friend, with epilepsy or another seizure disorder, it can be scary and you may not know what to do when a seizure happens.

Scott Mehle, executive director of Tallahassee’s Epilepsy Association of the Big Bend, recently discussed this:

“They should just know what to do and not do when someone happens to have a seizure in public. Keeping the seizing person safe from injury is primary. Don’t restrain them. Don’t insert anything into their mouths . . . just gently turn them on their sides. Remove furniture or objects that are sharp or hard and cushion their heads,” he said.

“If after five minutes the seizure continues, then call 911. Most seizures, as bad as they look, are not medical emergencies.”

Link: Living with epilepsy: Medication, planning can help smooth out life | Tallahassee Democrat.  Update: article taken down.

The diagnosis of complex partial seizures brings a wide set of complications to a Social Security disability case. I have seen cases where benefits were denied because EEG results were normal. This exemplifies the confusion between partial complex seizures and epileptic seizures

I have tried to bridge this gap in understanding by working with my clients’ doctors in providing Social Security with an explanation of this devastating condition.

I recently found a wonderful article with shines a clear light on the debilitating effects of complex partial seizures:

During a complex partial seizure, the patient may not communicate, respond to commands, or remember events that occurred. Consciousness might not be impaired completely. During a complex partial seizure, some patients may make simple verbal responses, follow simple commands, or continue to perform simple or, less commonly, complex motor behaviors such as operating a car. Complex partial seizures typically arise from the temporal lobe but may arise from any cortical region.

Automatisms are quasi-purposeful motor or verbal behaviors that commonly accompany complex partial seizures. The behavior is called quasi-purposeful because it is repeated inappropriately or is inappropriate for the situation. Verbal automatisms range from simple vocalizations, such as moaning, to more complex, comprehensible, stereotyped speech.

…

Seizures often begin with a brief aura (simple partial seizure) lasting seconds and then becomes a complex partial seizure. The type of aura is related to the site of cortical onset. Temporal-lobe seizures often begin with a rising abdominal sensation, fear, unreality, or déjà vu. Parietal-lobe seizures may begin with an electrical sensation, tingling, or numbness. Occipital-lobe seizures may begin with visual changes, such as the perception of colored lines, spots, or shapes or even a loss of vision.

Read the entire article here.