You may qualify for disability benefits if seizures prevent you from working. The Social Security Administration (SSA) offers financial assistance to individuals whose medical conditions, including seizure disorders, are severe enough to hinder their ability to engage in substantial work. Qualifying for these benefits depends on meeting specific medical and non-medical criteria.
Understanding Eligibility for Disability Based on Seizures
The Social Security Administration evaluates disability claims based on the severity and frequency of seizures and their impact on an individual’s ability to perform work. This evaluation uses the SSA’s “Listing of Impairments” (Blue Book), which includes specific criteria for neurological disorders like epilepsy. For adults, listings 11.02 and 11.03 address convulsive and nonconvulsive epilepsy.
To meet Listing 11.02 for convulsive epilepsy, an individual must have generalized tonic-clonic seizures at least once a month for three consecutive months, despite prescribed treatment. For nonconvulsive epilepsy under Listing 11.03, dyscognitive seizures must occur at least once a week for three consecutive months, or at least once every two weeks for three months with marked physical or mental limitations. A detailed description of a typical seizure pattern is required for evaluation.
If a seizure disorder does not precisely meet a listing, the SSA may still approve benefits if the condition is “medically equal” to a listing or significantly reduces the individual’s “residual functional capacity” (RFC). An RFC assessment determines an individual’s ability to perform work activities, considering physical and mental limitations such as walking, standing, sitting, lifting, remembering instructions, or interacting with others. This helps the SSA understand if any work can be performed despite the condition.
Comprehensive medical records are essential for proving eligibility. These records should include detailed doctor’s notes, seizure logs documenting frequency and severity, neurological reports, electroencephalogram (EEG) results, and a complete history of medications and their effectiveness. Testimony from others who have witnessed seizures can also provide important evidence regarding the type and frequency of events.
Types of Disability Benefits Available
Individuals with seizure disorders may qualify for one of two main types of Social Security disability benefits: Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
SSDI is available for individuals with a qualifying work history, meaning they have worked long enough and recently enough in jobs where they paid Social Security taxes. The required work history depends on the individual’s age when their disability began. SSDI benefits are funded through payroll taxes, and family members may also be eligible.
SSI is a needs-based program for individuals with limited income and resources, regardless of work history. To qualify, an individual must meet strict financial criteria, including limits on countable income and assets. Both SSDI and SSI provide monthly payments; SSDI typically offers higher maximums and includes Medicare, while SSI includes Medicaid.
The Application Process
Applying for disability benefits due to seizures requires thorough documentation and involves several key steps. The application can be initiated online, by phone, or in person at a local Social Security office. Provide comprehensive information about your medical condition and its impact on daily life.
Essential documentation beyond medical records includes:
Personal identification, such as birth certificates and Social Security cards.
Proof of U.S. citizenship or lawful alien status.
Details about your marital status and any dependent children.
Your work history for the past 15 years, including job duties and earnings records like W-2 forms or tax returns.
Financial information, such as bank account details and any other benefits received.
Once submitted, the application is sent to the state’s Disability Determination Services (DDS). DDS gathers medical evidence directly from healthcare providers listed in the application. DDS staff, including medical and psychological experts, review all information to determine if the applicant meets the SSA’s definition of disability. They may also schedule a consultative examination (CE) if more medical information is needed.
What to Do if Your Claim is Denied
Initial denials of disability claims are common, but a denial does not signify the end of the process. Applicants have the right to appeal the decision, and there are multiple levels within the appeals process. Adhere to strict deadlines, typically 60 days from the date you receive the denial letter, to file an appeal.
The appeals process generally consists of four levels. The first level is Reconsideration, where a different examiner reviews the claim and any new evidence. If denied again, the next step is a hearing before an Administrative Law Judge (ALJ). This stage often provides the best chance for approval, as the judge makes an independent decision and the claimant can present testimony and evidence.
If the ALJ hearing results in another denial, the claim can be appealed to the Appeals Council, which reviews the judge’s decision for errors. The Appeals Council may reverse the decision, remand the case back to an ALJ for further review, or deny the request. The final level of appeal is a review in Federal Court. Gathering new or updated medical evidence is important throughout the appeals process. Legal representation from a disability attorney or advocate can be beneficial, particularly for the ALJ hearing.