Financial assistance programs provide benefits for individuals unable to work due to a severe medical condition expected to last at least twelve months. Seizure disorders can qualify a person for these benefits, but eligibility depends on the severity of the seizures and their responsiveness to medical treatment. The determination process focuses on how the disorder impacts a person’s ability to function in a workplace setting and perform daily activities. For a claim based on seizures to be successful, the applicant must demonstrate that their condition prevents them from engaging in gainful employment.
Qualifying Criteria for Seizure Disorders
The federal government uses specific medical criteria to evaluate seizure disorders, focusing on the frequency and type of seizures that persist despite adherence to prescribed treatment. A key distinction is made between generalized tonic-clonic seizures (previously known as grand mal seizures) and dyscognitive seizures (a type of complex partial seizure).
To meet the most direct criteria, an applicant must document generalized tonic-clonic seizures occurring at least once per month over a period of three consecutive months. Alternatively, the criteria can be met if dyscognitive seizures occur at least once per week over the same three-month observation period. The evaluation specifically requires that the seizures cause a loss of consciousness or a significant alteration of awareness, which profoundly limits a person’s ability to work safely.
If a claimant’s seizure frequency is slightly lower, they may still meet the criteria if they can show a significant functional limitation in addition to the seizures. For example, if tonic-clonic seizures occur at least once every two months, the applicant must also demonstrate a marked limitation in areas like physical functioning, concentration, or social interaction. The core requirement for all seizure claims is proof that the condition remains uncontrolled despite the individual following the treatment plan recommended by their physician.
Proving Severity with Medical Documentation
A seizure disorder claim rests on objective medical evidence submitted to the adjudicator. Comprehensive records from a neurologist are required, detailing the diagnosis, the history of treatment, and the specific medications prescribed, including dosages. The records must explicitly state how the disorder impairs the patient’s ability to engage in work-related activities.
A seizure frequency log or diary, maintained by the applicant or a witness, is important for corroborating the frequency claimed. This log should include the date, time, duration, and a description of each seizure event, along with any known triggers and the post-seizure recovery time. This firsthand account helps demonstrate the severity and disruptive nature of the episodes.
Diagnostic test results, such as electroencephalograms (EEGs) or magnetic resonance imaging (MRIs), are necessary to confirm the epilepsy diagnosis and rule out other causes of seizure-like activity. While these tests provide a neurological basis for the condition, they also objectively demonstrate the persistence of abnormal electrical activity or brain abnormalities. The documentation must clearly establish that the seizures are refractory, meaning they are resistant to current medical intervention.
Navigating the Disability Application Process
The path to receiving benefits begins with filing an initial application detailing the medical condition, work history, and daily limitations. After submission, the claim is transferred to a state-level agency, known as Disability Determination Services (DDS), which is responsible for the medical evaluation. The DDS includes claims examiners and medical consultants who gather and review the applicant’s medical evidence.
The initial determination stage can take a significant amount of time, often ranging from four to eight months, as the DDS must obtain records from all listed healthcare providers. One of the first hurdles is Substantial Gainful Activity (SGA), which sets a maximum monthly earnings limit. For 2025, non-blind applicants earning more than $1,620 per month are generally not considered disabled, regardless of their medical condition.
If the initial application is denied, the applicant must follow the appeals process, beginning with a Request for Reconsideration, reviewed by a different examiner at the DDS. This stage typically takes another four to eight months and often results in a denial. A subsequent denial leads to the next level of appeal, which is a hearing before an Administrative Law Judge (ALJ).
The wait time to appear before an ALJ is often the longest phase, commonly extending for 12 to 18 months or more due to backlogs. The ALJ hearing represents the best chance for approval, as the applicant can testify in person and present new evidence to a neutral party. Successfully navigating this administrative path requires consistent documentation at every step.
Evaluation When Criteria Are Not Met
If the seizure disorder does not meet the specific frequency requirements, the claim moves to a functional assessment. This review determines the applicant’s Residual Functional Capacity (RFC), measuring the maximum work-related activities they can still perform. The RFC assessment considers all physical and mental limitations resulting from the seizures and their treatment.
For example, a person with a seizure disorder may be assigned limitations such as an inability to work at unprotected heights or around moving machinery due to the risk of injury during an episode. Side effects of anti-epileptic medications (e.g., fatigue, memory loss, or difficulty concentrating) are also documented as mental limitations in the RFC. These functional restrictions are then combined with vocational factors, which include the applicant’s age, education level, and past work experience.
The goal of the RFC assessment is to determine if the applicant retains the capacity to perform their past relevant work or any other work in the national economy. If the documented functional limitations, when combined with vocational factors, prevent the individual from performing even the simplest, most sedentary jobs, the SSA will find the applicant disabled. This process provides a way for individuals with less frequent but still debilitating seizures to qualify for benefits.