People with epilepsy may experience convulsive or non-convulsive seizures and their seizure episodes may occur while awake or asleep.
It may take hours for an epileptic to recover from each seizure and in patients where seizures occur several times per week or even several times a day, the debilitating nature of the illness certainly makes maintaining a job difficult if not impossible.
Fatigue, aphasia, and other symptoms that precede and usually follow each seizure episode also make it difficult for some people with epilepsy to maintain employment.
If you are experiencing epilepsy and it impacts your ability to work full time, you may be able to qualify for disability benefits from the Social Security Administration (SSA).
This article will take you through the process on how to qualify for Social Security disability benefits with epilepsy and the next steps you should take with your application.
Is Epilepsy A Disability?
Yes, epilepsy is considered a disability by the Social Security Administration (SSA) and can qualify for disability benefits.
In order for the SSA to consider your epilepsy to be a disability you need to provide enough medical documentation to prove your claim that you cannot work anymore because of your epilepsy and you need to have earned enough work credits through working.
If you are able to prove through the medical listing for epilepsy and have enough work credits, the SSA will consider your epilepsy a disability and you will be able to earn Social Security disability benefits.
The Blue Book is the list of conditions that qualify for disability and it outlines the requirements for disabilities to get approved for Social Security disability benefits with epilepsy.
The SSA’s Blue Book Listing 11.02 is for non-convulsive epilepsy, and you must experience seizures – either during the night or day – and that you suffer pronounced issues after each seizure, which could include difficulty thinking, unusual behaviors, fatigue, or other activities to interrupt your activities during the day.
To qualify through epilepsy, besides meeting the requirements you must also continue to have a seizure at least weekly despite having taken anti-seizure drugs for at least three months.
Can You Get Disability for Epilepsy?
You are able to get disability for epilepsy if your epilepsy is serious enough where it prevents you from being able to work full time.
To get disability for epilepsy, you must show that you suffer daytime seizures that cause you to lose consciousness or convulse or have nighttime seizures that cause severe daytime complications, such as difficulty staying awake, physical movement coordination, or thinking clearly.
Also, to get disability for epilepsy you also need to have enough work credits from working, as Social Security Disability Insurance (SSDI) is for those who at one point could work, but are unable to like a disability like epilepsy.
Work credits are calculated by your age and how long you have worked. To earn one work credit in 2023, you need to have earned $1,640 through work. You can earn up to four work credits for every year you have worked.
If you have enough work credits alongside the medical requirements, you can get disability with epilepsy.
Use our Social Security benefits calculator to see how much you could get with disability benefits with epilepsy.
What Are The Two Types of Disability Benefits That You Can Get For Epilepsy?
There are two types of disability benefits that you can get disability for epilepsy. The first is Social Security Disability Insurance (SSDI). SSDI benefits or disability are benefits for those who could work, but now are unable to because of a disability like epilepsy.
In order to get SSDI with epilepsy, you need to have earned enough work credits from your work history and meet the medical criteria to qualify for SSDI benefits.
The other is Supplemental Security Income (SSI). SSI benefits are for those with a serious disability like epilepsy and with very limited income and resources.
SSI is a needs based program, so you need to be able to meet the financial requirements required to qualify.
Often times children under the age of 18 can qualify for SSI benefits with epilepsy, as they don’t have the work history to qualify for SSDI. In some instances you can earn both SSDI and SSI benefits with epilepsy.
How to Medically Qualifying for Disability with Epilepsy
The SSA maintains a manual called the Blue Book that contains disability listings. Convulsive and non-convulsive epilepsy are included in this manual.
When you submit your disability application, the SSA staff that reviews your claim will compare your medical records and other documentation to the appropriate listing in order to determine if you are eligible for benefits with epilepsy.
To qualify for epilepsy disability under the Blue Book listing, your epilepsy must be severe and uncontrolled by medications, despite you strictly following your doctor’s treatment orders AND the evidence in your medical records must meet or closely match the listing for the type of epileptic seizures you have.
In fact, having medical records that match the epilepsy disability listing and submitting that to the SSA as part of your application can be one of the best signs your disability claim will be approved.
- For convulsive seizures (listing 11.02), the SSA needs to see that you experience:
- Daytime seizures that cause you to convulse or lose consciousness
OR - Nighttime seizures that cause severe complications for you during the day, like problems staying awake, thinking clearly, or coordinating your physical movements.
In addition to experiencing seizures that meet this listing, you must also continue to have seizures at least once a month after you’ve been on anti-seizure medication(s) for at least three months.
- For non-convulsive epilepsy (listing 11.03), the SSA must see you experience:
- Seizures that occur during the day or night
AND - Cause you to experience pronounced issues after each seizure, which may include things like unusual behaviors, trouble thinking, a lack of energy, difficulty staying awake, or other post-seizure symptoms that interrupt daytime activities.
To qualify under the epilepsy listing, you must not only meet the requirements listed above, but must also continue to experience seizures at least once a week even after taking anti-seizure medication(s) consistently for at least a three-month period.
Understanding the technical and medical language that appears in the Blue Book for epilepsy can be challenging. The book itself is written for medical professionals.
Work closely with your doctor to understand the epilepsy listings and to know whether or not you are likely to meet or closely match one of these listings for epilepsy as well.
How to Get Disability For Epilepsy If You Don’t Meet The Criteria
If your epilepsy doesn’t meet or closely match one of the Blue Book listings for epilepsy disability or another condition that epilepsy causes, but still prevents you from working, you may still be able to qualify for disability benefits. You will need to go through an RFC or residual functional capacity analysis.
The RFC process requires you and your doctor to fill out “functional reports.” Other people, like friends, family, or caregivers, may also be asked to complete a report.
These forms give the SSA information on how your epilepsy affects your everyday life and your ability to complete normal, daily tasks.
Be as thorough as possible on these forms and you accurately and honestly explain your physical, mental, and psychological limitations with your epilepsy on the functional report forms.
Don’t leave any questions blank, as this will only lead to further delays and may even result in the SSA denying you benefits.
RFC report forms provide space for you to include “more information” on your epilepsy. Use this space to describe your daily challenges, your seizures, and any symptoms or side effects you experience.
If you are only qualified for one form of work that is dangerous with epilepsy, you will have a higher chance of being approved.
For example, a 50-year-old roofer would have a very difficult time working with epilepsy due to the risk of falling. If he did not go to college and isn’t qualified for any safer form of work, he could be more likely to be approved than a younger, college-educated applicant with epilepsy.
How to Apply for Disability with Epilepsy
Someone with epilepsy can apply for Social Security disability either online or in person at the local SSA office.
The easiest way to apply for disability with epilepsy is online through the SSA’s website. You can start your application at any time.
If you are applying for epilepsy disability in person at the local office, you can complete your SSDI application and you can also apply for Supplemental Security Income or SSI benefits.
Whether you’re applying for SSI, SSDI, or both, you must ensure you provide the SSA specific details throughout your epilepsy application.
These include accurate information on your employment history, education, medical treatment, and income and other financial data.
Gather as many epilepsy records as you can before you begin your application(s) and be sure to fill out all forms consistently and completely.
The SSA will additionally need contact information for your primary care doctor, any hospitals in which you’ve received emergency room or in-patient care, and any other healthcare provider you’ve seen.
This will allow them to obtain your medical records, which are the key to being approved for benefits with epilepsy.
A cornerstone piece of evidence required in your epilepsy disability claim is a detailed report from at least one medical doctor describing an epilepsy seizure they personally witnessed.
Descriptions of your epilepsy seizures from you, your family, or friends can also be helpful, but most people with epilepsy that win benefits have a formal report from a doctor documenting the physical and mental affects of their seizures.
With any luck, you will be approved for epilepsy disability quickly and can focus on your health. Before applying, be sure to read our article on tips for applying with epilepsy.
How Much is an Epilepsy Disability Check Worth?
You can earn as much as $3,627 per month in disability for epilepsy. The average SSDI benefit payment in 2023 is $1,358. The exact amount you earn for disability with epilepsy depends on your work history and the severity of your epilepsy.
You may also be able to earn SSI benefits alongside your SSDI benefits with epilepsy if you meet the criteria for both SSI and SSDI.
To get an estimate of how much money you could receive each month via disability benefits for epilepsy, use our Social Security benefits calculator.
What Are The Financial Costs of Epilepsy
Epilepsy results in ongoing medical expenses but also affects finances in other ways. The disease requires consistent drug therapy, even when medications are not entirely effective in controlling seizures.
Diagnostic tests intended to pinpoint the cause and the effects of seizures and epilepsy can be expensive.
The three most common anti-convulsive medications for epilepsy are phenytoin (Dilantin), carbamazepine (Tegretol, Carbatrol), and divalproex sodium (Depakote).
According to the National Institute of Health, the average cost per month of one epilepsy anticonvulsive prescription is around $30.00, and many epileptics must take a combination of drugs, multiple times per day, in an attempt to control seizures.
However, medication costs are only a drop in the bucket when it comes to what uncontrolled epilepsy actually costs the average patient.
Epilepsy Advocate Magazine reports that frequent ER visits due to uncontrolled seizures result in an average of $35,000 per year in ER bills for an epileptic, and patients admitted to the hospital for seizures pay an average of $1,800 per day for their hospital stay.
Epilepsy Advocate Magazine also reports workers who lose time on the job due to uncontrolled seizures face a lifetime earnings loss of between $140,000 and $317,000.
When someone with epilepsy can continue to work, the costs he or she faces due to seizures are still staggering, but the costs of epilepsy are insurmountable for patients that are unable to work at all.
Thankfully, individuals that have frequent seizures are often able to qualify for Social Security disability and may want to apply for disability with the help of a disability lawyer.
Next Steps to Take
If you have epilepsy and you believe it is severe enough that you will not be able to work, then you should apply for disability benefits with the help of a disability lawyer.
Disability lawyers will be able to help you with your claim and application. A disability attorney can help you make sure you have all the right medical evidence, let you know how much disability you can get and documentation to help prove your claim that you can’t work because of your disability.
A disability lawyer can help appeal your case if it is denied and can help testify on your behalf. In order to get help with qualifying for disability, take our free disability case evaluation today.