Social Security recently issued significant changes to the Listings for Neurological Disorders. These changes impact the type of proof needed to prove entitlement to benefits for several different neurological conditions. In this newsletter we are focusing on the treatment of applications based upon Epilepsy.
At the outset, Listing 11.02 Epilepsy still requires a detailed description of a typical seizure from someone who has observed a seizure, preferably from a medical professional. If there are different types of seizures, the medical record must describe
A significant change is the deletion of language requiring serum drug levels. In the prior Listings, SSA required blood testing to prove that there were therapeutic levels of anti-epileptic medication in the claimant’s blood.
Recognizing that this is difficult with many newer medications, the requirement for blood testing has been removed. However, it is still required that the medical evidence shows “adherence to prescribed treatment” and serum blood levels will be one way to meet that standard.
Seizure analysis focuses upon “counting” the frequency of the seizures. The Regulations state that multiple seizures in a 24-hour period count as just one. Continuous seizures without return to consciousness count as just one. A “dyscognitive” seizure that turns into a tonic-clonic seizure counts only as a tonic-clonic episode. Seizures do not count if a person is not adhering to prescribed treatment without good cause.
There are now four subsections to Section 11.02 which contain the Epilepsy analysis:
11.02(A) states that Generalized tonic-clonic seizures (formerly called ‘grand mal’ seizures) are disabling if occurring at least once a month for at least 3 consecutive months despite adherence to prescribed treatment.
11.02(B) requires evidence of dyscognitive seizures (non-convulsive or non-tonic-clonic) occurring at least once a week for at least 3 consecutive months despite adherence to
11.02(C) states that generalized tonic-clonic seizures which only occur once every 2 months, for at least 4 consecutive months, can still be totally disabling if there is also a “marked limitation” in either: physical functioning; understanding, remembering, or applying information; interacting with others; concentrating, persisting or maintaining pace; or, adapting or managing oneself.
11.02(D) Dyscognitive seizures are totally disabling if occurring at least once every 2 weeks for at least 3 consecutive months, despite treatment, and cause a marked limitation in one of the same five categories as in the prior subsection.
The new regulations contain definitions of “marked” impairment that are consistent with the new mental impairment listings for subsections 2 through 5. A “marked impairment” in physical functioning is de ned as persistent or intermittent symptoms that affect the ability to independently stand, balance, walk, use both up- per extremities, or, symptoms which impact one upper and one lower extremity. These limitations must be serious and preclude the ability to do these activities on a consistent and sustained basis.
The revised listings give advocates more alternative means for proving disability based upon seizure disorders. If you would like to learn more about the Social Security Disability program and how we can help obtain favorable decisions for clients, give us a call to arrange a free in-service training at your facility.
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