Getting Disability Benefits for a Child With Epilepsy

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Epilepsy is a neurological disorder of the brain that causes repeated seizures, which are defined as episodes of electrical activity in the brain that cause convulsions, loss of consciousness, or changes in behavior. Epileptic seizures can be caused by cerebral palsy or brain trauma, tumor, or infections, but sometimes the cause is not known.

Types of Childhood Epilepsy

Some types of epileptic seizures cause loss of consciousness and convulsions, such as generalized tonic-clonic seizures (grand mal seizures), while other seizures, such as absence seizures (petit mal seizures), focal seizures (partial seizures), and psychomotor seizures (complex partial seizures), can cause alterations of awareness (e.g., involuntary staring spells) or unusual behavior.

Do Children with Epilepsy Qualify for Social Security Disability Payments?

Children with epilepsy can be eligible for Supplemental Security Income (SSI) if their parents have low income or assets. When a child with epilepsy turns 18, if a parent is eligible for or collecting Social Security retirement or Social Security disability income (SSDI) benefits, the child will become eligible for SSDI (at that point, however, the adult child would have to qualify for benefits under the SSA's adult listing for epilepsy).

The SSA details how often the child’s seizures must occur, depending on the type of seizure disorder (convulsive or nonconvulsive), for it to qualify as a disability. In addition, generally the child must experience alteration of awareness or loss of consciousness during the seizures to qualify for disability, unless he or she also suffers from cognitive, communicative, or emotional problems, or experiences side effects from medication that disrupts daily activites. Here are the details.

Convulsive Epilepsy

SSA disability listing 111.02 is for those children who have been diagnosed with epilepsy with convulsive seizures (usually grand mal seizures, a.k.a. generalized tonic-clonic). To meet this listing, the child must have:

  • more than one major convulsive seizure per month
  • after following prescribed treatment for at least three months, AND
    • have daytime episodes with convulsions and loss of consciousness, OR
    • nighttime episodes with residual effects during the daytime, such as fatigue, confusion, or disorientation, that interfere with the child’s daytime activities.

OR, for children with less frequent seizures:

  • at least one major convulsive seizure in the year before applying for benefits
  • after following prescribed treatment for at least three months, AND
  • one of the following:
    • significant adverse side effects of medication, such as nausea, fatigue, dizziness, depression, or headaches, that interfere with the child’s major daily activities
    • an IQ of 70 or less
    • a speech, hearing, or eyesight defect that significantly interferes with communication, OR
    • a significant emotional or mental disorder diagnosed through a mental status examination, such as depression or marked attention deficit disorder (ADD) or attention-deficit hyperactivity disorder (ADHD).

Nonconvulsive Epilepsy

SSA disability listing 111.03 is for children who have an established disorder of nonconvulsive epileptic seizures, such as absence (petit mal) seizures, partial (psychomotor or focal) seizures, or myoclonic/Lennox-Gastaut seizures. To meet this listing, the child must meet all of the following requirements:

  • more than one minor motor seizure per week
  • after following prescribed treatment for at least three months, and
  • alteration of awareness or loss of consciousness during the seizures.

Note that febrile seizures do not qualify under this listing because it requires an established diagnosis of epilepsy. Nor would seizures that cause muscle twitches and jerks without affecting awareness (e.g., mild infantile or juvenile myoclonic seizures).

What Should Your Child's Medical Record Include?

After you file your child’s application for SSI, your claims examiner will request your child’s medical records from your treating doctor. Your child’s records need to include:

  • diagnosis of epilepsy
  • results of a neurological examination
  • detailed doctor’s description of the typical seizure the child experiences (e.g., convulsions, loss of consciousness, alteration of awareness, staring spells)
  • description of the child’s pre- and post-seizure phenomena, such as aura, disorientation, exhaustion, nausea, or headache
  • side effects of the anticonvulsant medication, documented by the doctor
  • frequency of the child’s seizures, and whether they occur during the day or night
  • history of the child’s seizure activity, include onset date
  • results of an EEG showing a pattern characteristic of seizure activity (for nonconvulsive seizures), and
  • documentation of any injuries caused during epileptic seizures, such as tongue biting or falling.

If your child has not had an EEG, the SSA may request one, especially in the case of petit mal or other nonconvulsive seizures.

Applying for Disability Benefits for a Child With Epilepsy

To set up an appointment to submit an application for SSI (or SSDI as an adult child) through your local SSA office, call the SSA at 800-772-1213. After you submit all the necessary medical and financial information to the SSA, a claims examiner will request your medical records, review them with a medical consultant, and make a decision on whether to approve SSI for your child’s epilepsy. It may take three to six months for the SSA to determine whether your child is eligible for disability benefits.

by: , J.D.

This article is provided for informational purposes only. If you need legal advice or representation,
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