Parkinson’s disease (PD) is a disorder of the central nervous system caused by a dopamine abnormality in the brain. PD is characterized by hand tremors, rigidity (stiffness), slowness of movement (called bradykinesia), and a shuffling gait (called parkinsonian gait or festinating gait). In end-stage cases, patients may suffer from speech problems (dysarthria) and the inability to stand upright (postural instability).
The symptoms associated with PD are known as parkinsonian syndrome (PS) or parkinsonism, but PS can also be caused by other disorders, including brain trauma, brain infections, brain tumors, drugs, toxins, and strokes.
PD or PS symptoms make it difficult for many people to work. While treatment using L-dopa and other drugs helps some people manage the symptoms, as the disease progresses, the medications have less effectiveness and the symptoms return. Parkinson’s disease mainly affects older people, but can affect younger people who have suffered damage to the brain though infection or drugs.
To qualify for disability benefits, your condition must be severe enough to meet requirements the Social Security Administration (SSA) has set out in its impairment listing on parkinsonian syndrome (listing 11.06), or it must interfere with your functioning to such an extent that the SSA agrees that there are no jobs that you can do.
Listing 11.06 for parkinsonian syndrome was updated significantly in late 2016. Now, to automatically qualify for disability benefits under listing 11.06, the SSA requires that you have either:
Note that marked means worse than moderate, but less than extreme.
Many Parkinsons’s patients whose disease has progressed will fit the above listing, but there are many early-stage Parkinsons’s patients, or patients whose symptoms are being somewhat controlled by medication, whose impairments will not match the listing. These patients will not be automatically approved for disability benefits, and will have to hope that their reduced functional capacity will qualify them for benefits (see below).
Your medical record should include your diagnosis of Parkinson’s disease, your symptoms, and any neuroimaging tests that confirm the diagnosis.
In your Social Security application, be sure to include information on your motor impairments and any side effects of medication and mental impairments. For instance, note how much difficulty you have with balance, walking, standing, or getting to places and how this makes it difficult for you to get things done. Explain if you have tremors or other involuntary movements (dyskinesia) or stiffness that make it difficult for you to work. Include as much detail as possible, including whether your tremors make it difficult for you to write or type, use utensils, or tie shoelaces, for instance. Be sure your doctor comments in your medical record on how these motor impairments interfere with your ability to work.
If your motor difficulties diminish in between flare ups, which may make it difficult to qualify under the official listing above, make sure you include information about any side effects of your medication and the extent of your fatigue and emotional problems, which are usually persistent and not related to flare ups.
Side effects from medications can be blurred or double vision, nausea, frequent urination, drowsiness, excessive sweating or drooling, or unpredictable responses to medication. Also include any intellectual difficulties you have with concentration, memory, communication (speaking clearly), planning and organization, or information processing, as well as emotional problems such as depression, anxiety, and stress. The more of the above symptoms you have, the more likely it is that the SSA will find you unable to work.
If you have been diagnosed with Parkinson’s disease but you don’t fulfill the requirements above, as part of the disability determination process, the SSA is required to consider how your symptoms reduce your ability to work. If the SSA concludes that there are no jobs you can do based on your limitations, you may still be able to qualify for disability benefits under what’s called a medical-vocational allowance, particularly if you are 50 years or older.
First the SSA will consider your symptoms and the restrictions your doctor has placed on you and will give you a rating of the type of work it thinks you can do (medium work, light work, sedentary work, or less than sedentary work). This is called your residual functional capacity (RFC). For instance, if your doctor says you cannot carry items weighing more than 25 pounds due to poor balance, you should receive a light work RFC. If your doctor says you are unable to stand for six to eight hours per day because of your stiffness and gait problems, your RFC should be no higher than sedentary work. If your tremors make it difficult for you to do fine manipulations some of the time, you probably cannot do even sedentary work, so you should get a less than sedentary RFC.
The SSA will then determine whether it thinks you can find a job that matches your RFC, taking into consideration your age, experience, and educational level. An older person without skills or higher education who has a sedentary RFC is much more likely to be found disabled than an educated younger person. In considering whether you qualify for disability benefits under a medical-vocational allowance, the SSA should also consider any mental impairments. If you have significant depression or anxiety that affects your ability to work, you should be given a mental RFC as well.
You can call the SSA at 800-772-1213 to set up an appointment to submit a disability application through your local SSA office. Once you have submitted all necessary medical and financial information to the SSA, a claims examiner and medical consultant will consider your claim, request more medical information if necessary, and make a decision on your entitlement to SSDI or SSI disability benefits. If you qualify under the official listing for parkinsonian syndrome, you could be approved within about three months. If your case is borderline and moves to the RFC process, expect it to take longer.