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A seizure is a sudden discharge of electrical activity in the brain, which can cause a person’s appearance or behavior to change dramatically in a short period.
It might result in severe symptoms such as:
- muscle cramps
- loss of consciousness
- changes in behavior or feeling
There are, however, cases where a seizure does not cause any symptoms at all. A seizure is a single event, but more than one seizure is diagnosed as epilepsy. Repeated seizures result in a condition called epilepsy, which causes abnormal electrical activity in the brain that can lead to seizures or behavior changes. Seizures can be caused by cerebral palsy, brain injury, brain infection, stroke, or brain tumor, but the cause is unknown in most cases.
Types of Epilepsy
Epilepsy is a disorder of the brain that is characterized by seizures and unconsciousness. Other symptoms of epilepsy include gazing spells and changes in consciousness. Although most cases can be successfully treated with medication, many people suffer from “drug-refractory epilepsy” or “refractory epilepsy,” which means that drugs cannot prevent seizures.
There are many types of these disorders, which can cause various types of seizures:
- Generalized tonic-clonic seizures (convulsive seizures, formerly called grandiose seizures)
- Absence seizures (non-convulsive seizures formerly called minor seizures)
- Partial seizures (non-convulsive seizures, also called seizures) and
- Complex partial seizures (non-convulsive seizures formerly called psychomotor or temporal lobe seizures).
When will an adult with Epilepsy qualify?
Individuals who have been diagnosed with this disease may be eligible for Social Security Disability Insurance (SSDI) if they have a qualifying work history when they paid taxes into the Social Security System, or for Supplemental Security Income (SSI), for low-income people if they meet the poverty threshold defined by SSA. To qualify for SSI or SSDI, seizures must occur regularly (see below).
Because epilepsy is usually controlled with medication, it is not always a disabling disease. Even if you are taking medication, the Social Security examiner will want to see evidence that your condition is disabling.
Eligibility for epilepsy according to the SSA Blue Book
SSA has published the eligibility requirements for obtaining Disability for epilepsy and other seizure disorders in Disability Listing 11.02. Please note that taking medications to control seizures can take several months before they are effective, especially if medication adjustments are necessary. Therefore, you may want to have a medical history of taking prescription medications for at least three months before applying for Social Security Disability Benefits.
Also, if your doctor tells you to stop drinking and you do not, you may not be considered to have followed the prescribed three-month treatment. Drinking alcohol increases the risk of seizures and weakens the effects of anticonvulsants.
Listing 11.02 includes different requirements for the two main types of seizures:
Tonic-clonic seizure
This type of seizure involves a loss of consciousness and violent muscle contractions. Formerly called a “grand mal” seizure, this is typically what most people think of when they think of a seizure. You may be approved for benefits if medical documentation shows that you have:
- Generalized seizures occurring at least once a month for at least 3 consecutive months
- Seizures occur despite adherence to prescribed treatment
Dyscognitive seizures
Formerly known as “complex partial seizures” or “focal dyscognitive seizures,” this type of seizure causes a person to experience a loss of consciousness or change in consciousness level. People with this condition may not know they had a seizure and may not respond to their environment. You may be approved for benefits if medical documentation shows that you have:
- Seizures occurring at least once a week for at least 3 consecutive months
- Seizures occur despite adherence to prescribed treatment
If your epilepsy does not meet these requirements, you may alternatively be able to prove that your condition seriously affects your ability to work. By showing that your condition prevents you from engaging in substantial gainful activity, you may still be able to establish entitlement to monetary benefits under a medical-vocational allowance, which is an assessment based on your previous work experience, your education, and your age.
Medical evidence required by the SSA
After submitting your Social Security disability application, the claims reviewer will ask your treating physician for your medical records. Your record should include:
- Diagnosis of epilepsy
- Neurological examination results
- Detailed physician description of typical seizures you experienced, including whether you experienced loss of consciousness, seizures, or loss of bowel or bladder control
- Description of all pre-seizure and post-seizure phenomena, such as aura, fatigue, confusion, headache, or nausea
- Frequency of seizures and whether they occur during the day or night
- A statement as to whether it cooperates with the prescribed anticonvulsant treatment
- Objective evidence on whether it cooperates with anticonvulsant treatment.
- Your response to anticonvulsant treatment or surgery (i.e., its success and side effects)
- EEG results
- Record of injuries caused during seizure, including tongue biting
It is best to seek the help of a competent attorney for Social Security Disability benefits to ensure that you receive the financial support you need in a timely manner. A disability claim is a systematic process. You must follow the SSA’s process and procedures, submit relevant documentation to prove the disability, and hope that the SSA will approve your application. Or, you can hire a knowledgeable attorney who understands the process and can work your claim from beginning to end.
