Disability Benefits for Epilepsy as an Adult

Epilepsy is a brain disorder that causes repeated seizures, episodes of abnormal electrical activity in the brain that cause convulsions or changes in behavior. Epilepsy can be caused by cerebral palsy, brain injury, brain infections, stroke, or brain tumor, but much of the time the cause is unknown.

Types of Epilepsy

Some types of epilepsy cause convulsions and loss of consciousness, while other types cause staring spells and altered awareness. While most cases of epilepsy can be treated successfully with medication, about 35-40% of people have "medically refractory epilepsy," or "intractable epilepsy," meaning that medication does not prevent seizures.

There are several types of epilepsy, which cause various types of seizures:

• generalized tonic-clonic seizures (convulsive seizures previously called grand mal seizures)
• absence seizures (nonconvulsive seizures previously called petit mal seizures)
• partial seizures (nonconvulsive seizures also called focal seizures), and
• complex-partial seizures (nonconvulsive seizures previously called psychomotor or temporal lobe seizures).

When Do Epileptic Adults Qualify for Social Security Disability Payments?

Adults with epilepsy may be eligible for Social Security disability insurance (SSDI, for those who paid taxes into the Social Security system) or Supplemental Security Income (SSI, for low-income people). To qualify for either SSI or SSDI, epileptic seizures have to occur regularly (see below).

Because epilepsy is often controlled with medication, it is not always a disabling illness. Social Security examiners will want to see evidence that your condition is disabling even though you are taking your medication.

Qualifying for Epilepsy Under the SSA's Official Listing

The SSA sets out what's required to get disability benefits for epilepsy in disability listing 11.02. Note that, because it can take several months of taking medication to control seizures, especially if the medication needs to be adjusted, you must have taken your prescribed medication for at least three months before applying for disability benefits. In addition, if your doctor has told you to abstain from alcohol, and you haven't, you won't be considered to have followed prescribed treatment for three months. (Alcohol use can increase the risk of seizures and weaken the effect of anticonvulsant drugs.)

Listing 11.02 includes different requirements for two main categories of seizures.

Tonic-Clonic Seizures

If you have generalized tonic-clonic seizures, you will be approved for disability benefits if you have:

• seizures that occur at least once every other month for four consecutive months, and a "marked" (severe) limitation in one of the following areas:
  • physical functioning, such as standing, balancing, or using your arms and hands
  • understanding, remembering, or using information in work activities
  • interacting with others
  • concentrating, persisting, or maintaining pace, or
  • controlling emotions and behavior and maintaining well-being in a workplace setting,

OR

• seizures that occur at least once a month for three consecutive months; no marked limitation necessary.

Dyscognitive Seizures

If you have dyscognitive (complex-partial) seizures, you will be approved for disability benefits if you have:

• seizures that occur at least once every other week for three consecutive months, and a "marked" (severe) limitation in one of the following areas:
  • physical functioning, such as standing, balancing, or using your arms and hands
  • understanding, remembering, or using information in work activities
  • interacting with others
  • concentrating, persisting, or maintaining pace, or
  • controlling emotions and behavior and maintaining well-being in a workplace setting,

OR

• seizures that occur at least once a week for three consecutive months; no marked limitation necessary.

If your epilepsy doesn't meet these requirements, you still might be able to get disability benefits based on a "medical-vocational allowance," if you can show that your epilepsy interferes with your capacity to work so much that there are no jobs you can do, considering your prior job experience, your education, and your age.

Qualifying for Epilepsy Under a Medical-Vocational Allowance

If you don't automatically qualify for disability benefits under the SSA's official listing for epilepsy, above (say you have had grand mal seizures twice a year or complex-partial seizures once a month), as the next part of the disability determination process, the SSA is required to consider the effect of your seizures on your daily activities and restrictions that affect your ability to work. The SSA will then determine whether there is any kind of work you can be expected to do.

If you've had at least one grand mal seizure or quite a few dyscognitive seizures in the last year, the SSA will give you a residual functional capacity (RFC) that will list any restrictions your doctor has placed on you as a result of your seizure disorder, such as:

• no driving
• no operating hazardous machinery
• no working in unprotected high places where you might fall during a seizure, and
• no working around hazardous machinery.

Of course, there are many jobs that don't require you to drive, work around hazardous machinery, etc., but if you've always done work that includes one of these activities, you could be approved for disability benefits if you're older than 55 and have little education and transferable skills.

The SSA will look at your education level, age, and experience to determine if there's any kind of work you can be expected to do give your restrictions. If you have other physical or mental impairments that further limit your ability to work, such as cerebral palsy, low IQ, depression, anxiety, or ADHD or ADD, these may further limit the type of work you can do, making it more likely that you could get disability benefits because of reduced functional capacity.

Medical Evidence Required by the SSA

After you file an application for Social Security disability, your claims examiner will request your medical records from your treating doctor. Your records need to include:

• diagnosis of epilepsy
• results of a neurological examination
• detailed doctor's description of the typical seizure you experience, including whether you experience loss of consciousness, convulsions, or loss of bowel or bladder control
• description of all pre- and post-seizure phenomena, such as aura, fatigue, confusion, headache, or nausea
• frequency of seizures, and whether they occur during the day or night
• a statement regarding whether you cooperate with your prescribed anticonvulsant treatment
• objective evidence regarding whether you cooperate with anticonvulsant treatment
• your response to anticonvulsant treatment or surgery (that is, its success and side effects)
• results of an EEG, and
• documentation of any injuries caused during epileptic seizures, including tongue biting.

If you have not been taking the medication your doctor has prescribed for you, your medical record should state why; for instance, because you can't afford the medication. If you can't afford the medicine, the SSA will not deny you benefits for failing to follow the prescribed treatment, unless the SSA finds a free source of medication for you.

If you haven't had the levels of anticonvulsant drugs in your blood tested recently, the SSA will request this (to acquire objective evidence that you have been taking your medication). Likewise, if you don't have an EEG on file, the SSA will request one, although a normal EEG does not rule our epilepsy, since an EEG may be normal in between seizures.

Applying for Disability Benefits for Epilepsy

To set up an appointment to submit an application for SSI or SSDI 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 disability benefits for your epilepsy. It will likely take three to six months for the SSA to determine whether you are eligible for disability benefits.

If you need to apply for SSI for a child with epilepsy, the rules are different; see our article on how children with epilepsy can qualify for SSI.