Sleep Is Relaxing ... but What If You Have Narcolepsy?
2016
Narcolepsy patients may qualify for SSDI or SSI benefits in the presence of solid medical
evidence
and
sufficient
work
credits.
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Most people love sleeping and welcome the prospect of relaxation and comfort that come with it. But what if sleep turns villain? That is what conditions like narcolepsy can do and make the very thought of sleep a frightening one. Is narcolepsy a serious disability and what is the federal government’s take on this disorder? In the United States, to receive social security disability benefits, a person must be able to show that he/she is unable to work and earn a substantial lucrative income by performing “past work” (jobs they have engaged in for the past 15 years) or “other work” (other jobs they are qualified for based on the skill and experience they have). The SSA (Social Security Administration) takes a decision on disability claims on the basis of a comprehensive medical records review as well as a review of the work history of the applicant. Living with a disability is difficult and expensive, and benefits paid by the government are a great relief for the disabled. Narcolepsy Is a Serious Disability Narcolepsy is a dangerous condition that can lead to injuries as a result of loss of muscle control that is one of the symptoms of this condition. It is a sleep disorder that is caused by a problem associated with the nervous system. People who have this condition experience extreme drowsiness during the day, typically every 3-4 hours. They may fall asleep any time and this is what makes the illness dangerous. There is no cure for this condition though medications and scheduled naps can reduce the symptoms. Not Listed in the SSA’s Blue Book but May Qualify for Benefits Narcolepsy is not however, included among the SSA’s list of impairments that qualify for disability benefits. When reviewing an application for narcolepsy, the administration considers whether the applicant can qualify under the listings that address epilepsy. If the applicant’s narcolepsy causes frequent sleep attacks, he/she may qualify for benefits under Section 11.03 of the Blue Book that addresses non-convulsive epilepsy. The applicant must be able to prove that:
He/she has at least one episode of narcolepsy per week
These episodes have a significant impact on his/her ability to perform daily activities
The condition persists in spite of at least 3 months of treatment
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It is difficult to obtain disability benefits for this condition, but with reliable legal counseling and representation, applicants can go on to win their claim. Recent news highlighted how a ten-year-old school boy in the UK with narcolepsy won £120,000 in damages. He was awarded the money after appealing against the government that had earlier refused to pay as he was not “severely disabled” enough. This boy developed narcolepsy after he was given the H1N1 2009 influenza vaccine known as Pandemrix in January 2010. He also suffers from cataplexy that affects muscle control. In the UK, narcolepsy does not at present qualify as a disability unlike in the US, where affected people can apply for disability benefits. In this particular case, the family’s lawyer said that they had to convince the court that the boy was 60% disabled or more. On the basis of his symptoms, the court concluded that the boy was 72% disabled. No doubt, reliable medical documentation is absolutely necessary to establish narcolepsy. Qualifying for Narcolepsy Disability Benefits In the US, when applying for disability benefits for narcolepsy, applicants will have to submit detailed medical records including clinical histories, treatment histories, written statements from the treating physicians, and lab reports. Applicants may qualify under SSDI (Social Security Disability Insurance) or SSI (Supplemental Security Income).
To qualify for SSDI, the applicant must have earned enough work credits and also prove he/she qualifies medically for disability benefits. To earn sufficient work credits, a person must have worked five of the past 10 years. People who are not old enough to have a 10-year work history must have worked half of the time he/she could have worked since turning 18. A person who is 22 years must have worked 2 of the past 4 years to have earned the required work credits.
People who have not worked and earned the required credits may qualify under SSI, a needs-based program. This entails certain income and asset restrictions.
The SSA may also evaluate an applicant’s residual functional capacity or RFC, which indicates what the applicant’s limitations are and what type of work he/she can do. If they decide that the applicant’s narcolepsy symptoms are severe enough and that there is no job he/she can do, the applicant may be eligible for disability benefits under a “medicalvocational allowance.” If the RFC proves that the applicant’s disability could result in a 20% decrease in productivity and it is unlikely that he/she could engage in gainful, full-time work, the claim may be approved.
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The SSA directs that the severity of narcolepsy must be evaluated after a period of 3 months of prescribed treatment. The applicant should ensure that the following are made available to the social security administration.
Statements from the treating doctor clearly explaining how long each sleep attack lasts and the number of such attacks experienced
Statements from the treating doctor as regards whether the claimant has been following all prescribed treatment, including prescribed medications used to treat narcolepsy
Results of ECGs, EEGs, multiple sleep latency test (MSLT), polysomnograms and so on
Documentation describing after effects of the sleep attacks that have an impact on the applicant’s daily functioning. This may include statements from the treating doctor as well as other relevant people.
If an application is denied, an appeal can be filed within 60 days from the date of the denial notice. The SSA approves less than 20% of reconsideration requests (at the first stage of the appeal process), and it is usually at the second stage of the appeal process (i.e. the disability hearing before an administrative law judge) that applicants have a good chance of winning the claim. Statistics prove that applicants retaining the services of a disability attorney are more likely to win benefits compared to those who represent themselves. Attorneys handling narcolepsy cases make use of medical review services for the analysis of various medical documents applicable. This enables them to have a good understanding of the case, the medical details that are relevant and prepare the case in the best interests of their clients.
www.mosmedicalrecordreview.com
(800) 670 2809