Essential tremor, also known as benign essential tremor or familial tremor, is a disorder of the nervous system that causes a rhythmic shaking in the body. The tremor can occur in almost any part of the body, but it most commonly affects the arms and hands. Essential tremors can also affect the voice box and lead to speech problems.
Although essential tremors and Parkinson’s disease appear to have similar symptoms, essential tremors do not cause other life-threatening complications (unlike Parkinson’s disease).
Essential tremors can affect a person’s ability to do fine motor skills like writing, tying shoes, using buttons, and eating. Symptoms can worsen when a person tries to reach or extend the arms.
Treatments include using specialized writing and eating utensils, occupational therapy, and medication, although most medications used to treat the tremors have the potential for serious side effects. For more severe cases, brain surgery may be used in an attempt to alleviate the symptoms of the disorder.
Disability Benefits for Essential Tremor
If your tremor is so serious that you can no longer work because your hands shake too much or you have other disruptive symptoms, you may be able to get federal disability benefits. The Social Security Administration administers two programs: Social Security disability (SSD) and Supplemental Security Income (SSI). The medical eligibility requirements for both programs are the same.
First, your tremor must have prevented you -- or be expected to prevent you -- from doing a significant amount of work (making over $1,070 per month) for at least 12 consecutive months. Second, you must either prove that you don't have the ability to function at a sedentary job or that your tremor fulfills the requirements for Social Security's impairment listing for Parkinson's disease.
Determining Your Ability or Inability to Function
To decide whether there is any work you can do, the SSA will prepare a detailed report called a residual functional capacity assessment (RFC). An RFC is the most you can do on a regular and sustained basis (full-time work). The report will look at how your tremors affect your ability to do certain strength-related (exertional) activities like:
- walking, and
If you have the RFC to do a sit-down job, you will be denied. However, if the SSA concludes your tremors prevent you from doing the full range of physical activities required to do sedentary work, you could be approved.
Considering Your Non-Exertional Limitations
Before deciding that you can do the full range of activities to do sedentary work, the SSA should consider any "non-exertional," or non-strength-related, limitations that you have. Your RFC assessment should address whether your tremors, or your medications, cause any non-exertional limitations. Here are some examples of non-exertional impairments:
- difficulty with manipulative (hand and finger) requirements such as reaching or handling objects
- difficulty with postural (body positions) such as stooping, climbing, or crouching
- difficulty functioning because of nervousness, anxiety, or depression, and
- difficulty paying attention or with concentration.
Having non-exertional limitations written down in your medical records is especially important to winning a claim where your strength is generally unaffected by the medical condition, such as in essential tremors.
Examples of How Essential Tremors Affect the RFC
Here are some examples of how the SSA may use a claimant’s RFC (including non-exertional limitations) to decide a claim for disability based on a benign essential tremor.
The claimant's condition primarily affected her hands and arms and her past work was as a seamstress. Despite medication, she could no longer perform this work because she was unable to thread the machine or manipulate the small objects necessary to her work (like buttons, pins, zippers, and thread.) The SSA prepared an RFC to see if there was any other work she could do. Although the SSA concluded that the tremors did not affect the claimant’s ability to do strength-related work activities, it did determine that the severity of her symptoms significantly impacted her ability to perform certain fine motor skill activities such as writing and typing. Her tremors also worsened if she reached her arms away from her body. The claimant's medical records also stated that the her medication caused serious side effects like impaired concentration, fatigue, daytime sleepiness, and difficulty with balance and coordination. The SSA concluded that, in light of these non-exertional impairments, there were no jobs that she could do on a regular and sustained basis. She was approved for disability benefits.
- The claimant filed for disability because of essential tremors that primarily affected his hands and arms. His past work had been as a warehouse worker and required that he lift and carry small boxes. His medical records indicated that although his symptoms worsened when he extended his arms, the tremors had significantly improved since he began taking medication. The claimant’s records did not indicate that he reported any significant side effects. Based on the evidence in the medical file, the SSA concluded that the claimant could still do his past work, and he was denied benefits.
- The claimant filed for disability due to an essential tremor that affected her voice box and her hands. Her past work had been as a customer service representative, but the tremor affected her speech to the extent that she became difficult to understand, and she was forced to quit. The claimant's medical records indicated that she had some success with medication, but that even moderate stress significantly exacerbated her symptoms. The claimant underwent Botox injections in her hands to try and alleviate the tremors, and although this was somewhat effective, the injections caused severe weakness in her hands and arms that often caused her to drop even lightweight objects. The SSA concluded that the combined effect of the tremors and her medical treatment prevented her from working on a regular and sustained basis, and she was approved for benefits.
Equaling a Listing
If you have tremors in both hands, another way to win your claim for disability is to prove that your condition is equivalent to one of Social Security's medical listings that is similar to your tremor; in this case, Parkinson’s disease. If your your symptoms and limitations are as severe as those in the similar listing, you could be automatically approved for benefits without having an RFC assessment.
The SSA should use your medical records to compare your symptoms with the listing requirements for Parkinson’s to determine if they are “medically” equivalent. But it is often up to the claimant (or his or her lawyer) to raise this theory on appeal.
Here is an example of how the SSA might decide a case based on equivalence to a listing.
- The claimant's essential tremor significantly impacted both of his arms, hands, and fingers. Even though he complied with his prescribed medical treatment, his symptoms prevented him from doing activities like using a pen and reaching forward or overhead to grab and lower items. Although benign essential tremors are not listed in Social Security's disability listings, at his appeal hearing, the claimant's lawyer stated that the claimant's limitations were as severe as the limitations required to meet the listing for "Parkinsoniansyndrome." One of the listing requirements for automatic approval for Parkinson’s is that the claimant experiences a significant “tremor in two extremities" that persistently interferes with the claimant's ability to use his hands and arms for large muscle movements and fine motor tasks. Here, the SSA concluded that because the claimant’s tremor affected both arms and prevented him from doing tasks like writing, reaching, and lifting, the claimant’s symptoms were medically equivalent to the listing’s requirements. He was automatically approved for disability benefits.
Contact an Attorney
The disability process is frequently long and can cause applicants significant stress. And there is no guarantee that you'll win benefits at the end, even if you truly cannot work. If Social Security denied your initial application for disability benefits, before you go to your hearing, it may be helpful to speak about your case with an experienced disability attorney. To find an attorney in your area, fill out our request for a consultation with a disability attorney.