Can You Get Disability for Narcolepsy?
Narcolepsy can have a serious impact on a person’s ability to work or hold down a full-time job. It’s possible to qualify for Social Security Disability Insurance benefits due to your narcolepsy if your symptoms are sufficiently severe.
Seeking Social Security Disability Insurance benefits, or SSDI, for narcolepsy can be complicated, especially given that it is not a listed qualifying condition in the Social Security Administration’s Blue Book. However, you may qualify for benefits with narcolepsy if you can prove your condition is equivalent to a listed condition or is severe enough to prevent you from performing any kind of work.
Does Narcolepsy Qualify for Disability Benefits?
Narcolepsy is a chronic neurological condition affecting sleep patterns. It can cause excessive daytime sleepiness, fatigue, and episodes of sudden sleep that can significantly limit the ability to work.
The Social Security Administration, or SSA, uses its Blue Book of qualifying conditions to determine whether to approve a claim for benefits. However, Narcolepsy is not one of the listed conditions. However, you may still qualify for benefits if your narcolepsy is equivalent to another listed condition.
When assessing an application for Social Security Disability benefits, or SSDI, the SSA primarily evaluates how your symptoms limit your ability to work. Symptoms of narcolepsy that can affect employment include the following:
- Sudden sleep attacks
- Excessive daytime sleepiness or fatigue
- Sudden muscle weakness, known as cataplexy
- Memory or concentration problems
- Sleepwalking or performing tasks while asleep
If you aren’t sure whether your narcolepsy symptoms are severe enough to qualify for SSDI, an attorney can help. An attorney can explain which symptoms you would need to have, how severe they must be, and which qualifying conditions could be used to assess your claim.
How the SSA Evaluates Narcolepsy Disability Claims
The online version of the Blue Book, “Disability Evaluation Under Social Security,” describes the Listings of Impairments for Adults and Children. Because of narcolepsy’s absence from the Listings of Impairments, the SSA considers SSDI claims for narcolepsy using the requirements for other similar conditions, such as epilepsy, which is covered by Listing 11.02. Equating Listing 11.02 requires objective medical evidence, treatment compliance, third party statements, and documentation of sufficient severe episodes.
Epilepsy is generally used to assess applicants whose narcolepsy causes frequent episodes similar to seizures, including episodes of cataplexy—a temporary loss of voluntary muscular control. Cataplexy is akin to convulsive disorders and so could qualify for disability.
Although narcolepsy and epilepsy are not truly comparable illnesses, when SSA evaluates medical severity, the closest listings to equate narcolepsy with are Listings 11.02B and 11.02D, Epilepsy. The Disability Examiners at the DDS scrutinize the severity of narcolepsy after a period of 3 months of prescribed treatment. You must demonstrate compliance.
Finally, it is important to obtain from an ongoing medical source a description of the medications used and the response to the medication, as well as an adequate description of any alleged narcoleptic attacks and any other secondary events such as cataplexy, hypnagogic hallucinations, or sleep paralysis.
People with narcolepsy can qualify for disability benefits using the episodic requirements for general neurological disease as well. Those whose narcolepsy impacts memory, concentration, and mental functioning can receive approval if symptoms are well-documented frequently.
Using Residual Functional Capacity to Qualify
If the SSA does not find that your narcolepsy symptoms are severe enough to qualify for benefits under an equivalent listing, SSA will assess your Residual Functional Capacity, or RFC. RFC is the most you can do despite the limitations imposed by the narcolepsy and any related symptoms and determines the level of work-related activity an applicant can perform. If there are conditions or impairments, the RFC must consider the combined impact of all the impairments.
Some of the RFC and functional limitations SSA will consider to assess narcolepsy include:
- The inability to operate machinery or drive
- Struggles with concentration, focus, and memory
- The need for frequent rest breaks or a modified work schedule
- Errors caused by falling asleep or excessive drowsiness in the workplace
How To Strengthen Your Narcolepsy Disability Claim
The most common grounds for SSDI denials for claims based on narcolepsy are insufficient medical evidence and inadequate proof of the applicant’s inability to work. Therefore, you should include all evidence from every available source to demonstrate that your disability is as severe and as frequent as you claim.
Knowing the types of evidence to include isn’t always intuitive, and it’s easy to make mistakes. An experienced disability benefits advocate can help you submit a strong initial claim for SSDI and appeal a denial or an unfavorable initial determination.
Medical Evidence
Strong and complete medical evidence is one of the most critical parts of an SSDI application. Without proof of your diagnosis from a medical professional and evidence that you’ve tried to treat it appropriately, the SSA will deny your claim.
Including many types of medical evidence in your SSDI claim can strengthen your application and improve your chances of receiving benefits:
- Sleep study results. A sleep study, also known as polysomnography, can prove that your narcolepsy causes excessive sleepiness that severely limits your functioning.
- Multiple Sleep Latency Test results. MSLT results for people with narcolepsy typically demonstrate rapid sleep onset, meaning that the patient falls asleep seemingly out of nowhere.
- Records of failed treatments. People with narcolepsy often try to treat symptoms by using interventions such as stimulant medication or behavioral therapy. The SSA requires proof that you’ve pursued treatment for your narcolepsy and nothing has worked.
- Physician statements. Statements from medical professionals—preferably narcolepsy specialists—describing your condition’s impact on daily life and ability to work are critical to proving the severity of your disability.
Challenges With Work and Daily Functioning
Your ability to work and perform daily functions are key eligibility criteria. SSDI benefits are intended for people whose disability makes them unable to work or hold full-time employment. This impact must be well-documented for your claim to succeed.
You can strengthen your SSDI claim with evidence of your narcolepsy’s impact on your work and daily life by doing the following:
- Keep a sleep diary tracking the frequency of your sleep attacks. Detailed notes with dates can document how often you fell asleep at inappropriate times and how severe your attacks were when they happened.
- Gather statements from employers, coworkers, and family members about your daily limitations. Statements from people who see you every day can establish how disabling your condition is.
- Demonstrate your inability to maintain stable employment by citing past job impacts, performance improvement plans, or other evidence. This conveys to the SSA the extent to which your narcolepsy has kept you from holding a job.
What To Do if Your Narcolepsy Disability Claim Is Denied
A significant majority of SSDI claims, including claims for narcolepsy, are denied on the initial application. Common reasons for SSDI denial include:
- Lack of sufficient medical evidence or testing
- Lack of evidence demonstrating work impairment or functional limitations
- Technical errors with the application submission
If your SSDI claim for narcolepsy is denied, you have the right to file an appeal within 60 days of receiving the denial.
The SSDI appeals process consists of four steps: requesting a reconsideration, a hearing before an Administrative Law Judge, a review of the hearing decision by the Appeals Council, and filing a lawsuit in federal court. You can prepare for the appeals process by collecting additional evidence and compiling reasons for approving the claim.
Navigating the appeals process on your own may feel impossible, especially while managing your narcolepsy symptoms. Working with an experienced disability benefits advocate can significantly improve your chances of approval.
Get Help With Your Narcolepsy Disability Claim
An SSDI denial doesn’t necessarily mean that you’re ineligible for benefits. Additional evidence and the help of an experienced advocate can strengthen your claim and demonstrate to the SSA on appeal that your claim for narcolepsy benefits should be approved.
At Disability Advice, we offer quality assistance from knowledgeable advocates that consider every aspect of your claim and can help you compile evidence to submit a compelling case.
Whether you’re applying for SSDI for the first time or filing an appeal, Disability Advice can help. Contact us online today for a free review of your SSDI case.
- Free case evaluation
- Assist with denied claims
- Ensure you have all documents
- Make the process easy for you
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