Epilepsy is a chronic condition that can cause continuous and recurrent seizures. These seizures, in turn, affect the daily activities of the patient, including their ability to work. So, can one receive Social Security Disability Insurance (SSDI) if they have epilepsy?
The Social Security Administration (SSA) considers epilepsy as a qualifying disability. However, applicants are required to provide extensive medical evidence of the condition, including symptoms and treatment side effects to win an SSDI case based on epilepsy.
Read below to find out more about how you can claim SSDI based on epilepsy.
What is Epilepsy?
Epilepsy is a long-term disorder characterized by repeated episodes of seizures. There are primarily two categories of seizures. First, there are seizures that involve the entire brain, which are known as generalized seizures.
Second, there are focal seizures, also known as partial seizures, which are seizures that only affect a single region of the brain.
It is also possible to experience mild seizures, which may be difficult to identify. They may only last for a few seconds, during which time you might not even be aware of what is happening.
On the other hand, more severe seizures can result in muscle spasms that can last anywhere from a few seconds to several minutes (or even longer). You may get disoriented or even pass out during a severe seizure. It’s possible that you won’t recall the seizure until after it’s finished.
Seizures can occur for several reasons. Among them are:
- brain injury
- high fever
- extreme hypoglycemia
- alcohol withdrawal
- an overdose of medication
If you’ve received an epilepsy diagnosis and are unable to work due to seizures, you have the option to submit a claim for Social Security disability benefits. These benefits can offer financial support for essential expenses such as housing, bills, food, and other necessities.
Usually, epilepsy is diagnosed when a person experiences two seizures that are not provoked. Alternately, if they have had a single seizure that was not triggered by any known medical condition, they can be diagnosed with epilepsy.
A person may experience seizures, for instance, if they are experiencing withdrawal from alcohol or severely low blood sugar, but this does not necessarily indicate that they have the condition.
Can You Claim SSDI If You Have Epilepsy?
If epilepsy is making it hard for you to work, the Social Security Administration might consider it a disability. However, just having a doctor say you have a disability might not be enough for the SSA. They’ll need more information about how epilepsy affects you, like details about your symptoms and how you’re being treated.
Epilepsy is classified as a neurological disorder, which implies that it is a condition that affects the brain. Epileptic seizures are brought on by disruptions in the brain’s electrical and chemical activities. Although the exact reasons behind most epileptic seizures remain a mystery, the majority of individuals who develop epilepsy do so as a result of brain injuries, strokes, or drug abuse.
Although medicine can treat epilepsy in 70% of cases, the disorder and its symptoms can make day-to-day activities nearly impossible for those who are unresponsive to medications. Whether you qualify for SSDI based on epilepsy depends on a lot of factors, such as:
- the severity of your symptoms,
- the frequency of your seizures or conditions,
- the efficacy of the treatment options available to you,
- the credibility of the medical evidence you have,
- your age,
- your level of education, and
- the kind of work you have done in the past
It is important to note that the likelihood of receiving SSDI benefits is extremely low if the epileptic seizures are not regular and if they are not properly documented. As a result, epilepsy cases frequently boil down to evidence demonstrating numerous trips to the doctor or hospital, a record of the frequency of seizures, and compliance with medication.
Failing to seek appropriate medical care and failing to adhere to medication dosages might make Social Security disability claims based on epilepsy more challenging.
Epilepsy claims not only require strong medical evidence but also an expert understanding of the SSA review process. When the medical evidence does not support the severity or frequency that is being claimed, the claimant may be considered less credible and denied.
How Much Will I Get in SSDI For Epilepsy?
Someone with epilepsy or a comparable neurological disorder can expect to receive an average monthly benefit of $1,377.36 from Social Security disability. In 2024, the maximum monthly disability benefit for SSDI is approximately $3,822. The maximum benefits are determined by law, and they are the same regardless of the conditions.
The specific amount of your disability check will be determined by your employment or income history. It is also possible to be eligible for both SSDI and Supplemental Security Income (SSI).
Qualifying Based On the Blue Book
Epilepsy is included on the list of medical impairments that qualify for benefits in the Blue Book published by the Social Security Administration.
An applicant’s condition must be serious, frequent, and medically unmanageable for them to be considered for the official listing. In addition, their medical records should be in accordance with or even match the standards set out by the Social Security Administration’s official listing.
If an applicant has convulsive seizures, they must either have seizures at night that severely impair their ability to think clearly, coordinate their movements, or remain awake during the day, or they must have seizures during the day that cause them to lose consciousness or convulse.
The seizures must continue and happen at least once a month despite using anti-seizure medication for at least three months.
If you have non-convulsive epilepsy and are applying for SSDI, you must have seizures at least once a day that lead to serious complications, such as sleepiness, memory issues, abnormal conduct, or trouble thinking clearly.
People who have anti-convulsive epilepsy must have seizures at least once per week, even though they have been taking anti-seizure medicine regularly for at least three months.
Qualifying Based on Medical Vocational Allowance
Even if an SSDI applicant’s epilepsy does not match the SSA’s medical impairment standards, they may be able to qualify for benefits through the medical-vocational guidelines.
Social Security evaluates an applicant’s residual functional capacity or the amount of work they can do despite the constraints resulting from their medical conditions, using their records and other submitted documentation.
When this is taken into consideration in connection with the applicants’ ages, levels of education, and the degree to which their employment skills are transferable, the SSA may determine that candidates with epilepsy who do not meet the listing criteria are nonetheless eligible for disability benefits.
Types of Epilepsy Qualifying for Benefits
The Social Security Administration goes into depth about how it determines whether epilepsy qualifies for disability benefits in its listing of impairments. Most people with epilepsy have two types of seizures:
- generalized tonic-clonic seizures
- dyscognitive seizures
Generalized Tonic-Clonic Seizures
This type of seizure (also called a convulsion) is what most people think of when they hear the word “seizure.” An older term for this type of seizure is “grand mal.” As implied by the name, they combine the characteristics of tonic and clonic seizures. Tonic means stiffening, and clonic means rhythmical jerking.
These are marked by a loss of consciousness, rapid stiffening of muscles, and convulsions. The SSA will evaluate whether:
- The seizures occur once a month for a minimum of three consecutive months despite treatment
- The seizures occur once every two months for a consecutive two months despite treatment
- The seizures cause a marked limitation in physical functioning: understanding, remembering, or applying information; interacting with others; concentrating, persisting, or maintaining pace; or adapting or managing oneself.
Dyscognitive Seizures
These are characterized by a change in consciousness, but they do not involve convulsions or a loss of control over the muscles. Symptoms could include blank staring, changes in facial expressions, and repeated gestures or sounds.
When determining eligibility, the SSA takes into account the frequency and severity of seizures. The SSA will evaluate whether:
- The seizures occur once a week for a minimum of three consecutive months, despite treatment
- The seizures occur once every two weeks for a minimum of three consecutive months, despite treatment
- The seizures cause marked limitations in physical functioning, understanding, remembering, or applying information; interacting with others; concentrating, persisting, or maintaining pace; or adapting or managing oneself.
Even if an epileptic episode does not exhibit all of the symptoms listed above, it may still qualify as long as the symptoms do not allow the individual to work full-time.
Medical Evidence Needed to Apply
To demonstrate that you satisfy the requirements for Social Security that have been outlined above, you will be required to provide comprehensive medical documentation of all diagnoses as well as the outcomes of any particular tests. The Social Security Administration is looking for information such as:
- Proof that you have been taking your medication and receiving your treatment for a minimum of three months in a row (regardless of whether you have seen the same doctor each time)
- The results of imaging procedures using a wide range of diagnostic tools, including X-ray, CT, MRI, PET, SPECT, SPM, ESI, MEG, and EEG
- Non-medical evidence, such as statements made by you, treating providers, or others regarding the ways in which your epilepsy limits your daily activities and your ability to work
- Documentation showing that you have received and adhered to therapeutic recommendations
- Evidence that your symptoms or side effects persist despite your best efforts to adhere to your medication regimen
Can You Qualify for Non-Epileptic Seizures?
Even if a person does not have a diagnosis of epilepsy, they may still experience seizures on occasion.
This condition is referred to as pseudoseizures in the field of mental health. Pseudoseizures can be either convulsive or non-convulsive seizures that are brought on by mental illnesses like anxiety, panic disorder, post-traumatic stress disorder (PTSD), personality disorders, or conversion disorders.
Even though pseudoseizures do not meet the criteria for epilepsy, they can still serve as the foundation for a disability award. But it’s not as easy to prove them, and you have a much lower chance of success.
Psychologists and psychiatrists are the best mental health professionals to diagnose pseudoseizure problems.
Pseudoseizures are evaluated with reference to Listing 12.07 of the mental health listings for somatic symptom disorders. This listing necessitates significant impairments in one’s abilities due to the pseudoseizures.
Individuals who suffer from severe pseudoseizure disorders often struggle to carry out regular activities and have significant restrictions in their capacity to persist at tasks.
Although this may be more difficult to prove than an epileptic seizure, it is certainly not impossible. This type of claim can be made when the seizures persist even after following a mental health treatment plan and taking medication for the condition.
Building a Strong SSDI Case for Epilepsy
You can apply for disability benefits from the Social Security Administration if you have a seizure disorder; however, not everyone will be eligible. For example, the SSA will not pay out benefits for a single seizure; a person can only be considered disabled due to epilepsy if they have had many seizures that have occurred repeatedly.
Although it may be challenging to demonstrate the complete severity of your conditions, patients can construct a strong disability claim by doing the following:
Extensive Medical Evidence
When diagnosing epilepsy, a doctor must conduct extensive testing to identify and rule out other possible causes. The majority of patients will have a battery of electroencephalograms (EEGs) taken to check for any irregularities in their brain’s electrical activity.
A doctor may even recommend that patients wear an EEG monitor for a few days so they can study their brain activity throughout the day.
Patients may also be subjected to digital scans of the head to determine the origin of the abnormality in the brain that triggers the seizures and the precise location of the abnormality. When filing for benefits, it is important to include all of this evidence.
Documenting Symptoms
Applicants are encouraged to maintain a journal documenting their post-seizure experiences, as the symptoms of epilepsy can differ greatly from one individual to the next. They should also document the frequency of seizures, the events leading up to them, and any other difficulties the patient faces.
Documenting Treatment and Side Effects
Seizure medications are often necessary for patients to manage the symptoms of epilepsy. But these drugs have their own set of side effects, such as sleepiness and exhaustion. Be sure to document your symptoms during treatment, including any seizure activity that may have occurred while taking your medication.
Conclusion
People with epilepsy may experience severe symptoms, which may lead to them being disabled and unable to work, causing them to lose their source of income. Fortunately, the SSA does offer disability benefits for epilepsy. You can maximize your chances of approval by following the tips mentioned above in this article.
