The Social Security Administration has regulations that determine that a person is disabled if they meet a “listing”. A listing level of impairment means that it is conclusively determined that the person is disabled if certain conditions are met, such as a particular medical diagnosis, accompanied by defined resulting limitations. In its quest to quantify as many conditions as possible as a listed impairment, or medically equal to a listed impairment, the Social Security Administration attempts to use the nearest listing when considering conditions that are not expressly described in a listing.
For example, where a person is claiming Social Security Disability benefits (SSDI), or Supplemental Security Income (SSI) benefits due to Headaches, consideration will be given to, and “borrow” from the neurological listings for epilepsy. The effect of the injury on the ability to work, the limitations, is the important consideration. Getting a proper report from your physician can make the difference between winning a fully favorable decision or having an unfavorable decision from the administrative law judge (ALJ) in your case. This is one area where your attorney can really help you to present a case to the ALJ that would otherwise be lost.
Headaches are properly considered under Listing 11.03:
11.03 Epilepsy – nonconvulsive epilepsy (petit mal, psychomotor, or focal), documented by detailed description of a typical seizure pattern including all associated phenomena, occurring more frequently than once weekly in spite of at least 3 months of prescribed treatment. With alteration of awareness or loss of consciousness and transient postictal manifestations of unconventional behavior or significant interference with activity during the day.
SSA has long wrestled with a usable format to determine the disabling nature of a claimant’s headaches. The most recent formulation for evaluating the disabling nature of headaches is found at the SSA publication Q&A Tracking number 09-036. The most useful analysis will focus on two key things: (1) frequency/severity of migraines and (2) next day sequelae. As a part of the five step process at hearing, the inability to work a 40-hour work week on a consistent basis will support not only the Step 3 determination for a listing level of impairment, but also a Step 5 determination as to whether the person can do any work that exists in substantial numbers in the national economy. SSA also must consider Listing 12.04 regarding affective disorders.
As you can see, these tests get complicated rather quickly, and the amount of evidence required to prove a case can be very high. Also, even if the claimant does not exactly meet a listing, he or she may medically equal a listing, or have limitations that would preclude gainful employment either due solely to the headache or in conjunction with other limitations.
If you or a loved one has a disabling headache condition it is important to retain the services of a claimant’s representative who is familiar with the requirements of the law, and who can help you to present the correct evidence to the ALJ for consideration of your disability.
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