Social Security for Infrequent/Frequent Disabilities

Many health conditions, listed or not, are episodic and disabling because of the frequency of symptoms and/or sequelae of the episode. 11.00D explains:

"In conditions, which are episodic in character…consideration should be given to frequency and duration of exacerbations, length of remissions, and permanent residuals."

Disability Frequency

What is a disabling frequency? Listing level frequency depends on the disorder:

1. Seizures/Epilepsy--more frequently than once a month

2. Asthma--at least once every 2 months or at least 3 times a year.

3. Recurrent Arrhythmia’s--3 times within a consecutive 12-month period.

4. Sickle Cell Crises—3 times in 5 months.

5. Ischemic Heart Disease—3 episodes.(hospitalization for either angioplasty or bypass surgery).

6. Mental Impairments (paranoid/psychotic, affective, anxiety, somatoform, personality and autistic disorders)-- 3 episodes of decompensation in a year, or an average of once every 4 months, each lasting for at least 2 weeks.

7. Autoimmune Disorders—3 times a year, each lasting 2 weeks or a variation of that duration.

A few impairments are acknowledged as episodic yet the listing does not provide a listing level frequency. For instance, Meniere’s disease is characterized by “frequent attacks of balance disturbance” yet no frequency is specified. The introductory language to the listings explains that skin disorders can result in “flareups.” Similar introductory language describes Multiple Sclerosis and Myasthenia Gravis as episodic without mentioning a listing level frequency. Arguably (for those listings which do not have a specific frequency criteria) 3 episodes a year can be used to argue a closely analogous finding.

There are some listed impairments which are episodic but which are not so characterized in the listings. Instead, the listing provides different criteria. But one could urge that the frequency of symptoms is closely analogous to a listed impairment to show that the listed impairment equals a different disorder. For instance, anxiety is often characterized by attacks which present very similar to the symptoms associated with angina. Assuming the claimant has an anxiety disorder which does not meet the criteria in 12.06 one could urge that the disorder equals 4.04B if the claimant shows 3 decompensations but does not have another marked limitation. Although 4.04B requires hospitalizations, decompensation is described in the listings to include other types of exacerbations.

Diabetes can be evaluated in a similar fashion. For instance, uncontrolled diabetes can be very disabling well before neuropathy or retinopathy are actually diagnosed. High blood glucose can result in fatigue. Low blood glucose can cause impaired brain function resulting in light-headedness, sleepiness, confusion, and difficulty speaking. Some individuals also experience nervousness and shakiness, excessive perspiration, anxiety and weakness when their glucose level is low. These symptoms can be easily compared to the fatigue associated with sleep-related breathing disorders (3.10), recurrent arrhythmias (4.00D2b(i), and Multiple Sclerosis (11.09). Alternatively, diabetes often experience fluctuating symptoms in the same pattern or frequency as Meniere’s disease (2.07) or even Bipolar Disorder (12.04A3). You can get creative with your diabetic client when arguing that he/she equals another listing.