Episodic Medical Conditions: You would be surprised how many of them can prevent work and result in disability

Many disability claimants suffer from “episodic” medical conditions. These are conditions that result in sporadic and usually irregular symptoms.  The patient is often “ok” to work when they aren’t experiencing an episode.  But during the episode, any kind of work is unthinkable.  Some episodic conditions also result in a “sequelae.”  That is, after the episode there are other symptoms which cause equally disabling functioning.

To show the decision-maker at Social Security that the condition is disabling, claimants must establish the frequency of symptoms and/or sequelae of the episode.

In conditions, which are episodic in character…consideration should be given to frequency and duration of exacerbations, length of remissions, and permanent residuals.  11.00D of the Listings of Impairment.

In the Listings of Impairment some of these conditions are specifically mentioned.  The required frequency of symptoms (to establish disability) is also specifically mentioned.  See the list below.

  • seizures/epilepsy: more than once a month
  • asthma: at least once every 2 months or at least 3 times a year
  • recurrent arrhythmias: 3 times within a consecutive 12-month period
  • sickle-cell crises:  3 times in 5 months
  • ischemic heart disease: 3 episodes within 12 months (hospitalization for either angioplasty or bypass surgery)
  • mental disorders which fall into these categories: psychotic, affective (mood including bipolar) anxiety, somatoform, personality and autistics: 3 episodes of decompensation in a year or an average of once every 4 months, each lasting for at least 2 weeks.
  • autoimmune disorders: 3 flare-ups each lasting 2 weeks

The Listing of Impairments also contains language that suggests that the conditions below can be disabling due to frequent attacks or flare ups.  The frequency is not specifically mentioned in the listing.

  • meniere’s disease
  • skin disorders
  • multiple sclerosis
  • myasthenia gravis

There are also other conditions that are not in the Listing of Impairments that are episodic in nature and can preclude work:

  • migraine headaches
  • uncontrolled diabetes (despite compliance with treatment)
  • chronic pancreatitis

These conditions can affect functioning just like listed impairments.  In fact, Social Security has noted that epilepsy is similar to headaches.

[W]e may find that an individual’s migraine headaches (an unlisted impairment) are medically equivalent in severity to listing 11.03, a seizure disorder listing that is the most closely analogous listing we have for comparison. When we do, we find that the individual is disabled from migraine headaches that are equally as severe as the seizures described in listing 11.03.  71 FR 10426

SSA has issued several rulings about specific impairments which are not listed.  They include:

        • Chronic Fatigue Syndrome,
        •  Obesity,
        • Interstitial Cystitis Post-polio Sequelae and
        • Reflex Sympathetic Dystrophy Syndrome/Complex Regional Pain Syndrome.

Each of these rulings explains that these conditions may result in medical findings (such as frequent episodes) which are disabling because they are similar or equivalent to listed impairments.

Finally, some episodic conditions require so much medication to control, that the side-effects of these medications can also cause disability.

The key to establishing frequency of symptoms and or disabling side-effects to treatment is to insure that medical records provide the necessary documentation.  If you suffer from episodically disabling impairments, talk to your doctor about documenting the evidence in the chart or medical record.  Doctors often ask about frequency in an examination but may not be consistent in writing it down.  If the evidence isn’t in the medical record, the Social Security decision-maker may have a tough time believing the allegation in forms or in hearing testimony.