Epilepsy And Social Security Disability
By Pitt Dickey
This column will exam how the Social Security Administration evaluates Disability Insurance Claims for people who suffer from convulsive disorders such as epilepsy. The Social Security Administration (SSA) has a set of criteria that it uses called Listings to determine whether a person is eligible for monthly disability insurance payments. To obtain disability insurance benefit payments from the SSA a person must in general have a health problem that can be expected to last at least one year or to result in death and be unable to perform any type of substantial gainful employment. To simplify the test, it is not enough that the disabled person can’t go back and perform his former work for health reasons, the worker must also be unable to perform any type of full time work that exists in the American economy.
To see how the SSA reviews claims that involve persons who suffer from epilepsy it is helpful to take a brief look at the medical terms used in describing epilepsy. Epilepsy occurs when nerves in the brain react abnormally and send recurring abnormal signals to the body. There are two types of seizures that occur in persons who suffer from epilepsy.
Grand Mal Seizures or Generalized Seizures happen when large bursts of electrical energy go through all of the brain suddenly. Typically a person having a generalized seizure has symptoms which can result is a sudden loss of consciousness, the person may fall down, and undergo a stiffening of the muscles called tonic contractions. These are usually followed by clonic contractions in which the persons muscles cause a twitching and jerking of the persons arms and legs.
Partial Seizures occur when the electrical disturbance in the brain effects only one portion of the brain. The partial seizure then effects just the part of the body controlled by that particular part of the brain that is having the disturbance. If the seizure starts in one part of the brain and then spreads through the rest of the brain it is called a partial seizure secondarily generalized. Some patients will have a sensation called an aura which is a change in their feelings or ability to move that gives them advance notice that they are about to have a seizure.
Partial Seizures are divided into Simple Partial Seizures and Complex Partial Seizures. A patient having a simple partial seizure does not lose consciousness while having the seizure. A person having a complex partial seizure will have his consciousness effected either by losing consciousness or even though he may appear to be conscious he will be in an altered consciousness or dreamlike state and be unable to respond logically to outside stimulus.
The SSA evaluates all convulsive disease according to the degree of impairment suffered by the person according to the type, frequency, duration and after effects of the seizure on the person. The SSA requires that there be at least one medical description of a typical seizure experienced by the person. The description must include whether or not the person had the aura sensation, tongue bites, sphincter control problems, injuries associated with the seizures, and any post seizure after effects such as weakness or confusion. The doctor making the report regarding the seizure should also indicate which parts of the seizure description is from his own observations and which part of the description comes from other sources. If professional testimony is not available as to witnessing the seizure then other lay witnesses can provide this information to the SSA. The epilepsy must also be documented by at least one Electroencephalogram. (EEG) An EEG is a recording of the electrical activity in the brain. The EEG can be used to demonstrate seizure activity in a person’s brain by reading the electrical activity report.
A person meets the SSA Listing for major motor seizures such as Grand Mal or psychomotor seizures if the seizure is documented by an EEG and the detailed description of the a typical seizure and that the seizures have occurred more than once per month in spite of at least three months of prescribed treatment. The patient must also have at least one of the following:
A. Daytime episodes (with loss of consciousness and convulsive seizures) or
B. Nocturnal episodes with residuary effects which interfere significantly with activity during the day.
The SSA Listing for minor motor seizures such a petit mal psychomotor or focal must be documented by an EEG and have a detailed description of a typical seizure which occurs more frequently than once a week in spite of at least three months of prescribed treatment. The petit mal seizure must also have alteration of awareness or loss of consciousness and transient post seizure manifestations of unconventional behavior or significant interference with activity during the day.
Further information on epilepsy can be obtained from the Epilepsy Foundation of North Carolina, 3001 Spring Forest Road, Raleigh, N.C. 27616.
It should be kept in mind that a person can still be found to be disabled by an Administrative Law Judge even if he does not meet a particular listing if he has health problems that in combination are the equivalent of a listing. The Judge has the discretion to decide if a person’s health problems are serious enough to warrant an award of disability benefits despite not meeting the specific technical requirements of one of the SSA listings for disability.
Pitt Dickey has practiced law handling Social Security disability cases in Fayetteville since 1978. He practices with the firm of Smith, Dickey, Dempster, Harris, P.A. at 315 Person Street and can be reached at 910 – 484-8195 or [email protected] or www.smithdickeydempster.com