How to Get Disability Benefits for a Child With Epilepsy

Epilepsy is a neurological disorder of the brain that causes repeated seizures, which are defined as episodes of electrical activity in the brain that cause convulsions, loss of consciousness, or changes in behavior. Epileptic seizures can be caused by cerebral palsy or brain trauma, tumor, or infections, but sometimes the cause is not known.

Types of Childhood Epilepsy

Some types of epileptic seizures cause loss of consciousness and convulsions, such as generalized tonic-clonic seizures (grand mal seizures), while other seizures, such as absence seizures (petit mal seizures), focal seizures (partial seizures), and psychomotor seizures (complex partial seizures), can cause alterations of awareness (e.g., involuntary staring spells) or unusual behavior.

Do Children with Epilepsy Qualify for Social Security Disability Payments?

Children with epilepsy can be eligible for Supplemental Security Income (SSI) if their parents have low income or assets. When a child with epilepsy turns 18, if a parent is collecting Social Security retirement or Social Security disability income (SSDI) benefits, the child will become eligible for SSDI (at that point, however, the adult child would have to qualify for benefits under the SSA's adult listing for epilepsy).

The SSA details how often the child’s seizures must occur, depending on the type of seizure disorder, for them to qualify as a disability. The SSA has combined the listings for convulsive and nonconvulsive epilepsy into one listing, listing 112.02. Here is what listing 112.02 requires.

Generalized Tonic-Clonic Seizures

Generalized tonic-clonic seizures are also known as grand mal seizures or convulsive seizures. To meet the listing for this type of epilepsy, your child must have generalized tonic-clonic (grand mal) seizures that occur at least once a month for three consecutive months, despite taking prescribed medication for three consecutive months.

Dyscognitive Seizures and Absence Seizures

Dyscognitive seizures, which include partial seizures (a.k.a. focal seizures) and complex partial seizures (a.k.a. psychomotor seizures), and absence seizures (a.k.a. petit mal seizures) are characterized by an altered state of awareness or responsiveness. To meet the listing for this type of epilepsy, your child must have dyscognitive or absence seizures that occur at least once a weekfor three consecutive months, despite taking prescribed medication for three consecutive months.

Social Security will not consider psychogenic nonepileptic seizures and pseudoseizures under this listing. The agency will consider febrile seizures but only if seizures also occur during nonfebrile periods and a diagnosis of epilepsy has been established. Note that the listing no longer requires you to provide evidence of your child's loss of consciousness, alteration of awareness, or cognitive, communicative, or emotional problems due to the seizures.

What Should Your Child's Medical Record Include?

After you file your child’s application for SSI, your claims examiner will request your child’s medical records from your treating doctor. Your child’s records need to include:

• diagnosis of epilepsy
• results of a neurological examination
• detailed doctor’s description of the typical seizure the child experiences (e.g., convulsions, loss of consciousness, alteration of awareness, staring spells)
• description of the child’s pre- and post-seizure phenomena, such as aura, disorientation, exhaustion, nausea, or headache
• side effects of the anticonvulsant medication, documented by the doctor
• frequency of the child’s seizures, and whether they occur during the day or night
• history of the child’s seizure activity, include onset date
• results of an EEG showing a pattern characteristic of seizure activity (for nonconvulsive seizures), and
• documentation of any injuries caused during epileptic seizures, such as tongue biting or falling.

If your child has not had an EEG, the SSA may request one, especially in the case of petit mal or other nonconvulsive seizures.

Applying for Disability Benefits for a Child With Epilepsy

To set up an appointment to submit an application for SSI (or SSDI as an adult child) through your local SSA office, call the SSA at 800-772-1213. After you submit all the necessary medical and financial information to the SSA, a claims examiner will request your medical records, review them with a medical consultant, and make a decision on whether to approve SSI for your child’s epilepsy. It may take three to six months for the SSA to determine whether your child is eligible for disability benefits.