Parkinson’s Disease, Epilepsy and Migraines: Updates to Social Security Disability Listings
Earlier this year, the Social Security Administration has issued its first updated rules since 1985 for evaluating neurological conditions under Listing 11.00, including Parkinson’s disease and epilepsy. These revisions will be in effect for five years. The listings address only neurological disorders and complications from those disorders, even if they impact other bodily systems or mental health. A major change that occurred in the new listings is that SSA removed the criterion of an IQ score from its neurological listings on the basis that IQ score does not provide the best measure of limitations of cognitive functioning associated with neurological disorders. This will simplify the evidence required to support a finding of disability in individuals with a neurological, rather than mental impairment. However, IQ will still be used in the evaluation of mental disorders.
A proposed mention of improvement after a period of treatment was removed from the final listing because SSA agrees that Parkinson’s disease is progressive and never improves. In addition, SSA includes criteria for evaluating “disorganization of motor function” for Parkinsonian syndromes (Listing 11.00C). SSA now defines a Listing level disability as one with “significant rigidity, bradykinesia, or tremor in two extremities… result[ing] in sustained disturbance of gross and dexterous movements, or gait and station” (Listing 11.06).
The old listings for epilepsy previously required blood drug levels during a three month period to test compliance with medications and therapeutic ranges for epileptic medications. Newer anti-epileptic medications, however, do not have established therapeutic ranges. This made it difficult to interpret lab results. In response, SSA removed the requirement, which for individuals with epilepsy, simplifies the evaluation of seizures for a listing-level impairment (Listing 11.00A). However, blood levels may still be used to determine a patient’s adherence to their treatment regimens. Levels that do not fall in the normal range for consistent medication usage must be accompanied with a doctor’s note explaining the difference. The SSA includes that daytime episodes or nocturnal episodes with residuals that severely impact daytime performance must occur more than one time a month despite 3 months of prescribed treatment.
In reviewing the thousands of public comments in order to revise these listings, SSA declined to create a separate category for migraine headaches, as symptoms were too subjective for this impairment to be listed separately. However, migraine headaches can medically equal Listing 11.03 Epilepsy, non-convulsive, as the most closely analogous impairment. SSA noted that they would provide impairment-specific training on the evaluation of migraine headaches.
Social Security has attempted to simplify the evaluation process for neurological disorders. As for all medical impairments, their evaluation requires strong medical and non-medical evidence that the impairment is severe enough to interfere with the ability to engage in basic work-related activity. Consistent documentation by a treating physician or medical specialist is the best source of supportive evidence.
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