Getting Disability Benefits for Essential Tremor

Essential tremor (ET) disorder, also known as benign essential tremor or familial tremor, is a nervous system disorder that causes rhythmic shaking in the body. Essential tremor affects as many as 10 million people in the United States.

If you have ET, your tremors can occur in almost any part of your body. But essential tremor most often causes trembling in the upper body, especially the arms, hands, head, larynx (voice box), or tongue.

Doctors don't know what causes essential tremor, but it's believed to involve unusual electrical activity processed through the thalamus (a structure in the center of your brain that relays motor and sensory signals to your cerebral cortex). It's thought to be genetic, as more than half of the people with ET inherited the disorder.

You can develop benign essential tremor at any age, but it's most common in mature adults (mainly in their 40s and 50s). And it's progressive—meaning your symptoms will likely get worse over time. Many people with ET can lead relatively normal lives, but for some, the symptoms make everyday activities like working extremely difficult.

Symptoms and Treatment of Essential Tremor

The main symptom of essential tremor is shaking in different parts of your body that you can't control. Other symptoms of essential tremor include:

• shaking voice
• nodding head
• tremors that get worse:
• during emotional stress, or
• during purposeful movement (like stretching your arm out)
• tremors that lesson with rest, and
• trouble balancing (in rare cases).

Essential tremors can affect your fine motor skills, making it difficult to do everyday activities like:

• writing
• tying your shoes
• using buttons, and
• eating.

Although the outward symptoms of essential tremor and Parkinson's disease appear similar, essential tremor doesn't cause other life-threatening complications (unlike Parkinson's disease).

Treatment for Essential Tremor

There's no cure for essential tremor, but many treatments are available to ease the symptoms of ET, such as:

• occupational therapy
• using adaptive devices for activities like writing and eating
• biomechanical loading (applying force to the muscle to control the tremor)
• medication aimed at reducing tremors (which can be effective but can also have serious side effects, like depression)
• MRI-guided ultrasound (a non-surgical method of destroying tissue in the thalamus), and
• brain surgery (to implant a device to stimulate the thalamus).

Unfortunately, not every treatment is effective for everyone with ET.

Disability Benefits for Essential Tremor

If your symptoms are severe enough to prevent you from working—because your hands shake too much or you have other disruptive symptoms—you might qualify for federal disability benefits for essential tremors. The Social Security Administration (SSA) pays disability benefits through two programs:

• Social Security disability insurance (SSDI), and
• Supplemental Security Income (SSI).

The legal and financial eligibility requirements for SSDI and SSI differ. (SSDI eligibility is based on work history, and SSI is based on financial need). But the medical eligibility requirements for both programs are the same.

First, your tremors must have prevented you—or be expected to prevent you—from doing a substantial amount of work (worth about $1,600 a month) for at least 12 consecutive months.

Second, you must prove that your essential tremor symptoms are severe enough to qualify as disabling. You can do that by either:

• "equaling" the requirements of Social Security's impairment listing for Parkinson's disease, or
• showing your tremors affect your functioning so much that you can't do any kind of work.

Equaling a Disability Listing With Essential Tremors

If your tremors seriously limit your ability to use both your hands, you can qualify for disability by equaling the listing for Parkinson's disease (listing 11.06 for parkinsonian syndrome).

If your ET symptoms and limitations are as severe as those in the listing for Parkinson's, you'll likely qualify for benefits by equaling the listing.

You could equal the requirements of the Parkinson's listing if you can't control the movement of both of your arms or hands despite at least three months of treatment. This loss of function must very seriously limit your ability to perform work-related activities involving fine and gross motor movements.

Qualifying for Disability Because You Can't Work

If you can't meet the requirements of a disability listing, Social Security will next consider how your essential tremor affects your ability to work.

How Does Essential Tremor Affect Your Ability to Function?

Social Security will prepare a detailed report called a residual functional capacity (RFC) assessment to decide whether, given your tremors, there's any work you can do. An RFC is the most you can do in a work setting, regularly and sustainably (full-time work).

The report will look at how your tremors affect your ability to do certain strength-related (exertional) activities, like:

• lifting
• carrying
• walking, and
• standing.

If you have an RFC that indicates that you can still do a sit-down job (sedentary work), Social Security will likely deny your disability claim unless you're 50 or older. But if the SSA finds your tremors prevent you from doing the full range of physical activities required to do sedentary work, you could be approved for disability benefits.

How Do Your Non-Exertional Limitations Affect Your Ability to Work?

Before deciding whether you can do the full range of activities to do sedentary work, Social Security will consider any non-exertional (not strength-related) limitations you have. Examples of non-exertional impairments include difficulty with activities like:

• manipulative (hand and finger) requirements, such as reaching or handling objects
• postural movements (body positions) such as stooping, climbing, or crouching
• cognitive functioning (because of nervousness, anxiety, or depression), or
• paying attention, focusing on a task, or concentrating.

Your RFC assessment should address any non-exertional limitations your tremors (or your medication) cause. Having both exertional and non-exertional limitations in your medical records is especially important to winning a claim where your strength is generally unaffected by the medical condition—as with essential tremors.

Examples of How Essential Tremor Can Affect Your RFC

Here are some examples of how Social Security might use RFCs to decide disability claims for benign essential tremors.

How to Apply for Social Security Disability

You should apply for disability benefits as soon as your tremors become bad enough to prevent you from working. The fastest way to apply for benefits is to complete an online application. If you need help accessing the application or filling out the form, you can get someone to help you.

You can also get help with the application from a Social Security representative by:

• calling Social Security's national office at 800-772-1213 (TTY: 800-325-0778), or
• going in person to your local Social Security office (call for an appointment first).

Once you submit your application, you can expect to wait several months for a decision from Social Security. The disability process can be frustratingly long and quite stressful. And there's no guarantee you'll win benefits in the end—even if you truly can't work.

If Social Security denied your initial application for disability benefits, before you go to your hearing, consider speaking with an experienced disability attorney about your case.

Getting VA Disability for Essential Tremor

To qualify for disability compensation from the Department of Veterans Affairs (VA), you'll have to establish a service connection for your impairment. That means you'll have to show that there was an event (an injury, illness, or exposure) during your time on active duty that you can link to the development of your tremors. For example, you might have had a TBI that caused your tremors.

You can also establish a service connection by showing that an in-service event aggravated an existing condition. So, if you had mild essential tremor symptoms and they became much worse because of a service-connected injury or exposure to a neurotoxin, for example, you might qualify for VA disability compensation.

While the VA doesn't have a specific rating for essential tremor disorder, the agency sometimes rates claims for upper extremity tremors using the rating for "paralysis of the median nerve" (diagnostic code 8515). Under this code, you could be assigned a rating from 10% to 50% disability. For example, a 30% rating represents moderate loss of your hands, which might mean a severe tremor in one hand.

Or, if you can show that you can't work in any "substantially gainful" occupation because of your service-connected impairment, the VA could rate you as 100% disabled. (38 CFR 4.16(b).)

Learn more about how VA disability ratings work and how they affect your benefits.