Disability Benefits for Epilepsy as an Adult

Epilepsy, also known as seizure disorder, is the result of abnormal electrical activity in the brain that causes convulsions or changes in behavior. Seizure symptoms can vary widely—some types of epilepsy cause convulsions and total loss of consciousness, while others involve staring spells and altered awareness.

While most kinds of epilepsy can be treated successfully with anticonvulsant medications, some people have "intractable" epilepsy, meaning that medication doesn't prevent seizures. These seizures can significantly interfere with their daily routine and make it difficult to hold down a regular job.

Is Epilepsy a Disability?

The Social Security Administration (SSA) can award disability benefits to adults who have uncontrolled seizures that keep them from working full-time for at least a year. "Uncontrolled" is the key word here—if your epilepsy is successfully managed with medication, you're unlikely to get disability, even if you need to take seizure precautions at work.

Social Security examiners will need to see evidence that your epilepsy is disabling despite consistent use of prescribed medications. If you're having frequent seizures despite treatment compliance, you'll have a stronger case that you qualify for disability benefits.

Qualifying for Seizure Disorder Under the Listing for Epilepsy

Social Security has a special category (the "listing of impairments") for conditions that the agency considers especially severe. If your medical record contains certain specific evidence required to "meet the listing," you can get disability benefits without having to prove that you can't do any jobs.

The SSA evaluates disability applications for seizures using listing 11.02 for epilepsy. Generally speaking, the listing requires either that you have very frequent seizures, or that you have slightly less frequent seizures as well as significant functional limitations. The exact criteria depend on the type of seizures you experience and how often they occur.

Tonic-Clonic Seizures

Tonic-clonic seizures, previously known as "grand mal" seizures, involve physical convulsions (rigidity followed by a rhythmic jerking) and a loss of consciousness for the duration of the seizure. If you experience tonic-clonic seizures, you can meet listing 11.02 with evidence of either:

• seizures that occur once a month for at least three consecutive months, or
• seizures that occur once every two months for at least four consecutive months, with marked limitations in at least one area of physical functioning (such as fine motor control) or mental functioning (such as memory, social interaction, concentration, or emotional regulation).

Keep in mind that to meet this listing, you'll need to have seizures at the above frequency and severity even though you're taking your medication as directed. If the SSA finds evidence that you aren't following "doctor's orders," you won't qualify for benefits under the listing.

Dyscognitive Seizures

Dyscognitive seizures don't result in convulsions or muscle control. Instead, these types of seizures are characterized by altered consciousness, such as blank staring or repeating sounds. You can meet listing 11.02 for dyscognitive seizures with medical documentation of either:

• seizures that occur at least once a week for at least three consecutive months, or
• seizures that occur at least once every two weeks for at least three consecutive months, with marked limitations in at least one area of physical functioning (such as fine motor control) or mental functioning (such as memory, social interaction, concentration, or emotional regulation).

As with tonic-clonic seizures, you'll need to show that you're experiencing dyscognitive seizures despite "adherence to prescribed medication."

Because it can take some time to properly adjust to your epilepsy medication to the point where your seizures are under control, if you had seizures that occurred within the first three months after beginning your prescribed treatment, the SSA won't count them towards the listing requirements. Keep in mind, too, that if your doctor told you to abstain from alcohol (which interferes with the effectiveness of anticonvulsant drugs) but you haven't, the SSA could deny you benefits.

Getting Disability for Epilepsy With Limitations in Your Residual Functional Capacity

You can still qualify for disability even if your medical evidence doesn't match the listing requirements (for example, you have tonic-clonic seizures twice a year rather than every month). As part of your disability determination, if you don't meet a listing, the SSA is required to consider what effect your seizures have on your ability to work—a process called assessing your residual functional capacity.

Your residual functional capacity (RFC) is a set of limitations representing the most you're able to do at work. If no jobs exist that you can do within the limits of your RFC, Social Security will find that you're disabled. A typical RFC for somebody with epilepsy will likely include restrictions on activities and environments that would be dangerous during a seizure, such as operating hazardous machinery, working at unprotected heights, or driving.

Just having seizure precautions in an RFC is rarely enough to rule out all work. Many jobs won't put you at risk of harm if you have an unexpected seizure. But you may be able to qualify for disability under the medical-vocational grid rules if:

• the only jobs you've done involve exposure to hazards or working with dangerous equipment
• you're at least 50 years old, and
• you have additional exertional limitations, such as an inability to lift over 20 pounds or stand for more than four hours.

People who can't use the grid rules to get disability will need to show that they're unable to do any full-time work—whether because they're physically unable to do a sedentary (sit-down) job, or because they're mentally incapable of performing job duties on a regular basis. This is usually accomplished by having multiple medical impairments that, in combination with epilepsy, cause work-preclusive limitations in their RFC.

Medical Evidence of Seizures You'll Need to Get Disability for Epilepsy

Once you submit your application for benefits, a disability claims examiner will request your medical records from your treating doctor. Your records should include:

• clinical notes containing your diagnosis of epilepsy
• opinions from your doctors regarding what activities you should avoid
• results of neurological examinations
• detailed descriptions of the typical seizure you experience, including whether you experience altered consciousness, convulsions, or incontinency
• descriptions of any pre- and post-seizure symptoms, such as aura (the "warning" you feel that a seizure is about to happen), fatigue, confusion, headache, or nausea
• how frequently your seizures occur, and whether they happen during the day or night
• statements from your doctors about how well your prescribed treatment is working and whether you're taking the medication properly
• objective evidence, such as the results of an X-ray, MRI, CT scan, or EEG, and
• documentation of any injuries caused during epileptic seizures, including tongue biting.

If you haven't been taking your prescribed medication, make sure your records contain an explanation for the lack of treatment (for example, you can't afford the medication). The SSA won't deny your application if you have a good reason why you aren't taking seizure medications, but you'll need to exhaust all available avenues first, such as going to free clinics.

Applying for Disability Benefits for Epilepsy

Many people find that the easiest way to start an application for disability benefits is to file online at SSA.gov. You don't have to finish the application all at once, and can come back to complete it at your convenience.

If you'd like to speak with a Social Security representative instead, you can call the SSA at 800-772-1213 from 8 a.m. to 7 p.m., Monday through Friday. (People who are deaf and hard of hearing can use the TTY number at 800-325-0778). Or, you can go to your nearest Social Security field office and get help in person.

Adults aren't the only ones who can receive disability for epilepsy or seizure disorder—children can also qualify, although the rules are different. If you need to apply on behalf of a child with epilepsy, read our article on how children with epilepsy can qualify for benefits.

If you're not sure whether you're ready to file for benefits, consider a free consultation with an experienced disability attorney. You're under no obligation to hire a lawyer at any stage of the disability process, but having representation is almost always a good idea, since they get paid on contingency and increase your chances of winning.

_{Updated April 22, 2024}