Obtaining Epilepsy Disability Benefits under Social Security, Veterans Disability, or Long Term Disability Insurance
Epilepsy affects over 3 million Americans. Despite all available therapies, many people live with persistent epileptic seizures, and deal with complications from the side effects of treatment.
At Marc Whitehead & Associates, we are dedicated to obtaining disability benefits for clients across the U.S. who have epilepsy and other medical conditions that cause serious seizure disability.
We understand that proving epilepsy to be a disabling condition can be highly problematic. We act with great determination to do all that is required in order for our clients to win epilepsy disability benefits under long term disability insurance policies, the Social Security Disability program or the U.S. Department of Veterans Affairs disability benefits program.
Epileptic seizures occur when permanent changes in a person’s brain cause the brain to be overactive or erratic. The brain sends out sudden, abnormal signals, which result in repeated, unpredictable seizures.
Epilepsy may stem from a medical condition or injury that affects the brain, such as stroke, abnormal blood vessels, dementia, traumatic brain injury, or infections. Sometimes the cause is unknown, which is referred to as idiopathic.
Individuals of nearly any age group can have epilepsy at any time, and about 1 in 26 people will develop epilepsy in their lifetime. Epilepsy and seizures are more common in young children and people over 55, who are more likely to develop conditions like dementia, strokes, Alzheimer’s and other conditions. The Centers for Disease Control (CDC) estimates that there are about 3.4 million people in the U.S. who live with and manage seizures, including 470,000 children. Worldwide, epilepsy is the 4th most common neurological condition, affecting more than 65 million individuals.
Every person who has epilepsy will experience seizures, but not everyone who has a seizure has epilepsy. A single seizure that does not happen again is not epilepsy. And 50% of cases have no obvious identifiable cause.
Individuals who suffer from epilepsy can be severely limited from daily activities and working. Symptoms vary from person to person. Some people may experience staring spells associated by a brief loss of consciousness, while others suffer from violent convulsions and unconsciousness. The type of epileptic seizure and exact symptoms depends on the part of the brain affected and cause of epilepsy.
Winning Epilepsy Disability Benefits on a Disability Insurance Policy
Epileptic seizures can severely limit your daily activities, including employment. Because of the largely unpredictable nature of seizures, many occupations are unsuitable even for those who can control seizures with medication. After a diagnosis of epilepsy, you may not be able to return to work. That’s when you may decide that it’s time to apply for long-term disability.
Individuals living with epilepsy who apply for long-term disability benefits are often unfairly denied by their providers. Insurance companies resort to various reasons for denial. For instance, the may claim that your epilepsy is a pre-existing condition, or challenge the legitimacy of your epilepsy disability (inferring that you are “not disabled enough”) or claim that you should be able to control the epilepsy with medication. Not all cases respond well to medication, and treatments require monitoring by your physician.
Additionally, if you haven’t had a seizure in a 30-day period, an insurer may deny your claim, and insist that you should return to work.
In addition, disability insurance claims are very fact-specific., Approvals are based on how the contract is written, so you must be able to prove that you are disabled under the terms of the policy. Medical and treatment records are important, including records of any underlying conditions that caused or contributed to your epilepsy. The medical evidence is required to prove that your epilepsy is severe enough to prevent you from holding gainful employment.
Never assume that a denial of benefits is the end of your claim. The insurance companies hope that you abandon your claim in response to their delay tactics and claim denials. The truth is, when unfair denials are challenged by recognized legal representation, the facts of your disability will emerge so that justice can be served. That’s why it’s important to appeal, and get help from an experienced disability attorney who can represent you through the appeals process.
Our firm is a respected advocate in the fight against denied ERISA (group) disability insurance, and private long-term disability insurance that is denied in bad faith. We will help you perfect your claim so you can get the benefits you deserve.
Epilepsy and Social Security Disability
Adults with epilepsy can apply for disability benefits through Social Security. But because epilepsy controlled with medication may not be disabling, it’s important to show that it interferes with daily activities despite taking your prescribed medications for at least three months.
The Social Security Administration (SSA) recognizes epilepsy disability in the SSA Listing of Impairments under the following section 11.00 Neurological Listings:
- 11.02 – Epilepsy – convulsive epilepsy (grand mal epilepsy, psychomotor epilepsy)
- 11.03 – Epilepsy – Nonconvulsive epilepsy (petit mal epilepsy, psychomotor, or focal epilepsy)
The SSA will examine your medical records for the frequency of epileptic seizures, and blood work that demonstrates the level of epilepsy medication in your blood. They will also consider testimony from a family member, friend or co-worker who has witnessed your epileptic seizures. You will also need to show that you are unable to perform any type of work because of the seizures, not just your previous or most recent job. If your claim meets the SSA medical listing of impairments, you will quality for disability.
Medical Records Necessary For An SSA Claim
After you file a claim, the SSA claims examiner will request your medical records from your physician. These records should include:
- A diagnosis of epilepsy
- Results of your neurological exam, including EEG results
- Frequency of your seizures, and whether they occur at night or during the day
- Documentation of seizure-related injuries, such as biting of the tongue
- Your doctor’s written description of the usual seizure you’ve experienced, as well as whether you lose consciousness, have convulsions or other effects like loss of bladder/bowel control
- Your doctor’s notes on post-seizure conditions, such as headache, nausea, fatigue, confusion, or “auras”
- Documentation indicating that you are complying with your prescribed anticonvulsant therapy, as well as evidence of compliance
- Your response to the prescribed therapy, including side effects. If you aren’t taking your medication, the reason should also be listed.
The SSA may request a blood test to determine the amount of medication in your system, or an EEG, if you’ve not had one.
Many epilepsy disability claims fall short of meeting the medical listings. When this happens, Social Security will examine the overall effect of your epilepsy disorder on your ability to work an eight-hour day, five days a week.
The basis for the majority of successful Social Security Disability claims is that a person cannot consistently perform basic functions of work such as sitting, standing, walking, lifting, concentrating, and interacting in the workplace.
Social Security claims for seizure disorders are routinely denied at the first stage of the process. The claimant may not have provided sufficient medical records or seizure histories in terms the SSA requires. Claimants also may not realize the importance of proving their vocational limitations according to SSA standards. It’s important to include a wide range of relevant documentation in your claim, not just what the application requests.
If you are having trouble applying to Social Security for epilepsy, or need help with an appeal, call us today. We are Board Certified Social Security attorneys, ready to fight on your behalf beginning with the initial application. Appeals for social security claims begin at the administration level, and may progress to the final appeal, which is a lawsuit filed in the federal court system. We are prepared to take your case at any level.
Never give up. If your claim for Social Security Disability benefits for epilepsy disability was denied, we are able to act as your legal representative.
VA Claims for Epilepsy Disability Benefits
Epilepsy can prevent you from joining the military, so a veteran diagnosed with it will have developed it during his or her time in service. Veterans are particularly vulnerable to epilepsy due to traumatic brain injuries (TBI) that occur during active duty and deployments that can increase your chances of developing epilepsy. Post-traumatic epilepsy (PTE) is a seizure disorder that can be caused by a service-connected TBI.
The Veterans Administration has information for veterans with epilepsy, including the Epilepsy Centers of Excellence. The Epilepsy Foundation offers additional information for veterans with the condition on its website.
The VA uses a schedule for rating service-connected disabilities when determining the level of a veteran’s impairment. Veterans’ disability claims for epilepsy are reviewed under the section for Neurological Conditions and Convulsive Disorders, and specifically under the section entitled The Epilepsies.
VA rating specialists will rate epileptic seizure disorders according to loss of function and the effect of the epilepsy disorder on your ability to work.
Grand mal epilepsy and some psychomotor seizures are rated under the VA rating formula for “major seizures.” A major seizure is identified as tonic-clonic (convulsion with unconsciousness).
Petit mal epilepsy and most other seizure disorders are rated under the VA rating formula for “minor seizures.” A minor seizure is distinguished by a brief interruption in consciousness or conscious control associated with staring or rhythmic blinking of the eyes or nodding of the head (“pure” petit mal), or sudden jerking movements of the arms, trunk, or head (myoclonic type) or sudden loss of postural control (akinetic type).
If your VA disability claim for epilepsy was denied or underrated, or if you have questions about your case, please request a free consultation or call us toll free from anywhere in the country at (800) 562-9830. We understand how the VA’s rating system works, and are ready to help you through the process of applying or appealing.
Our experience with Veterans claims will save you from many glitches and pitfalls that can endanger your claim and obstruct an accurate rating, and considerably increase your chance of securing the benefits your country owes you. We are ready to represent you at any level of your claim, including the VA Regional Office, the Board of Veterans Appeals, and the US Court of Appeals for Veterans Claims. There’s no obligation, and you can call us for a free consultation.
When Epilepsy Disability Keeps You from Working, Contact Us
We want you to know that our attorneys will provide you with powerful and ethical legal support. Our number one goal is to be your greatest asset, by securing helping you obtain the disability compensation you need and are entitled to receive.
To learn more, call our disability attorneys toll free at 800-562-9830 or arrange a free consultation with a lawyer to discuss your case. This is a free consultation, and you are never under any obligation to hire us.