Making a Successful Disability Claim Based on Narcolepsy
Narcoleptics have won Social Security disability benefits based on narcolepsy's functional similarity to seizure disorder.
Narcolepsy is a nervous system disorder that causes daytime sleep attacks and a strong feeling of needing to sleep. The exact cause of narcolepsy is unknown, although it does tend to run in families. Common symptoms of narcolepsy include:
- excessive daytime sleepiness
- sudden "sleep attacks,” where you feel a very strong urge to sleep during the day
- cataplexy, which is where you have a sudden loss of muscle strength that can cause you to physically collapse
- sleep paralysis, where you can’t move right before you fall asleep or when you are waking up, and
- hypnagogic hallucinations, which occur between sleeping and waking and can involve seeing or hearing things that aren’t really there.
There is no cure for narcolepsy, but symptoms can sometimes be controlled by scheduling naps and in some cases taking prescription medicine. Narcolepsy can cause difficulty functioning at work or school and can lead to accidents and injuries if a person is so sleepy that he or she can’t function or if the person can’t control the urge to nap.
How Do I Qualify for Disability if I Have Narcolepsy?
There are three ways to qualify for disability: if your medical condition is on the list of impairments the Social Security Administration (SSA) publishes and meets the severity levels described for the specific impairment. Otherwise, you'll need to equal a listing or qualify based on your impairments effect on your ability to work.
Narcolepsy is not one of SSA's “listed impairments,” so you will not be eligible for disability this way. Don’t worry; there are other ways the SSA can find that you are disabled.
Equaling a Listing
Since narcolepsy is not a listed condition, the SSA will look at whether your symptoms associated with narcolepsy are “equal to” a different condition that is listed. In some cases, the SSA has found people with narcolepsy disabled by equaling the listing for epilepsy.
If you suffer from narcolepsy and have frequent sleep attacks, your condition may be found to medically equal to having dyscognitive seizures, which are part of the epilepsy listing. In order for your narcolepsy to be considered equal in severity to the epilepsy listing, you'll need to show that you suffer from:
- sleep attacks that are similar to dyscognitive seizures and occur at least once a week for three consecutive months, or
- sleep attacks that are similar to dyscognitive seizures and occur at least once every other week for three consecutive months and cause 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.
(For more information on getting disability for dyscognitive seizures, see our article on disability for epilepsy.)
Evidence to Give to Social Security
You should make sure the SSA has the following:
- statements from your treating doctor explaining how long each sleep attack usually lasts and the number of sleep attacks you are having
- statements from your treating doctor explaining whether you have been following all prescribed treatment, including any prescribed medications used to treat narcolepsy
- results from any tests done, including ECGs, EEGs, polysomnograms (sleep studies), and the multiple sleep latency test (MSLT), and
- documentation (including statements from your doctor and other relevant people) that describe any aftereffects of your sleep attacks that interfere with your day-to-day functioning.
Qualifying Under a Medical-Vocational Allowance
If the SSA determines that your narcolepsy is not equal to the epilepsy listing, or another listed impairment, it doesn’t necessarily mean your claim will be denied. The SSA has one more step it will go through to determine whether or not you are disabled for purposes of SSI or SSDI.
The SSA will look at all of the evidence in your file, which includes medical evidence and non-medical evidence, such as statements from you, your family and friends, therapists, and so on, to assess your residual functional capacity, or “RFC.” Your RFC dictates what type of work you can do and what your limitations are.
If you have narcolepsy, your RFC assessment will almost certainly be limited at the very least to: no work where you need to drive; no work involving heavy or dangerous machinery; and no work in high, unstable, or otherwise unsafe places.
If the SSA decides that, based on the severity of your narcoleptic symptoms and the work restrictions you need to keep yourself and others safe, there is no job you can perform, you will be eligible for disability under a “medical-vocational allowance.”
If You Need Help Applying for Disability
Applying for disability, whether you apply for SSI, SSDI or both, can be a confusing and complex process, and it can be difficult to win benefits based on equaling another listing without the help of a lawyer. Many communities have legal aid or other services that provide assistance and resources for people applying for disability benefits. Or, contact a local disability lawyer, whose attorney fees will be limited to a percentage of your backpay benefits, if you win disability benefits.