Does Epilepsy Qualify for Disability Benefits?
If you have severe and frequent epileptic seizures that interfere with your daytime activities, you may be able to get disability benefits.
Epilepsy is a brain disorder that causes recurring seizures. It can be the result of a condition such as cerebral palsy or strokes, but there is often no known cause. The symptoms of a seizure can range from simple staring spells to convulsions and loss of consciousness. The seizures can also vary in frequency, although in order to be diagnosed with epilepsy you must have had two unprovoked seizures.
Epilepsy is primarily treated with medications, which are successful in reducing the frequency and severity of seizures in more than half of epilepsy patients. However, even mild seizures can be dangerous if they happen at certain times, such as when you’re driving or swimming, and could limit your ability to perform some work activities.
Can You Qualify for Disability Benefits Because of Epilepsy?
Adults with epilepsy may be eligible for Social Security disability benefits. The Social Security Administration (SSA) mainly evaluates epilepsy according to the type, frequency, duration, and nature the seizures. Because epilepsy isn’t necessarily disabling if it’s well-controlled, you will need to prove that your epilepsy interferes with your daily activities even though you’ve taken anticonvulsant medications as prescribed for at least three months. You’ll also need to show that any alcohol or drug use isn’t contributing to your medication’s lack of effectiveness.
When you file for benefits, a claims examiner will be assigned to review the evidence and determine if you’re eligible for benefits. Often a medical consultant hired by the SSA will review your medical records and provide input. If you applied for benefits based on your epilepsy, the claims examiner and medical consultant will be looking for the following items in your records:
- a diagnosis of epilepsy
- a detailed description of your typical seizure, including all pre- and post-seizure symptoms
- a statement from your doctor corroborating your account of the nature and frequency of your seizures
- a description of your seizures from a third-party witness
- a record indicating the frequency of your past seizures
- results of an EEG
- a detailed treatment history, including medications and other treatments that you’ve tried and your response to them
- evidence of your compliance with prescribed medications (for at least three months.) This could include blood tests to show the appropriate levels of the medication in your system.
Qualifying for Benefits Under the SSA’s Official Listing for Epilepsy
The SSA provides a list
of the requirements to qualify for disability benefits based on numerous
specific medical conditions, which are referred to as "Impairment Listings.”
There are two listings for epilepsy – Listing 11.02 for convulsive epilepsy and
Listing 11.03 for nonconvulsive epilepsy.
Convulsive epilepsy primarily refers to grand mal seizures or psychomotor seizures resulting in lack of consciousness. In order to qualify for disability benefits based on Listing 11.02, you will need to show that you suffer from:
- at least one seizure a month, following at least three months of medication treatment, AND
- the seizures are:
- daytime seizures that involve convulsions or loss of consciousness, OR
- nighttime episodes that result in symptoms that interfere with your daytime activities.
Adults with nonconvulsive epilepsy (petit mal or partial seizures) may meet Social Security’s Listing 11.03. In order to qualify under this listing you must prove that:
- you have at least one seizure per week, in spite of at least three months of compliance with prescription medications, AND
- your seizures
- significantly interfere with your daily activities, OR
- cause you to display abnormal post-seizure behavior.
The requirements are a bit different for children with epilepsy; see our article on disability for children with epilepsy for more information.
Qualifying Under Medical-Vocational Guidelines
If you are an adult with epilepsy, but don’t exactly meet one of those listings (for example, if you have grand mal seizures every other month,) you could still be eligible for benefits based on "medical-vocational" guidelines. This means that the symptoms of your epilepsy interfere with your daily activities to such an extent that there are no jobs that you could consistently perform. When making this determination, your claims examiner will not only analyze your medical condition and symptoms, but will also consider other factors, including:
- your age
- your level of education
- your transferrable work skills
- any other medical/psychiatric conditions that affect your ability to work, and
- any restrictions that your doctor has given you, such as no driving, no working around machinery, etc.
However, keep in mind that in order to qualify for disability benefits, you need to be unable to perform any work activities on a full-time basis. Showing that you are unable to do any of your previous jobs is not sufficient to be awarded benefits.
In general, being older, with less education, and fewer transferrable work skills will increase your changes of being awarded benefits. Having additional conditions that negatively affect your ability to work can also increase the likelihood of your application being improved, as will having a treating doctor who's supportive of your claim and willing to provide a comprehensive statement or fill out a questionnaire regarding your inability to work. For more information, see our section on the medical-vocational rules. Also, you may want to read our tips on how to get disability for epileptic seizures.