Narcolepsy and Social Security Disability Benefits
By Ram Meyyappan
Social Security Disability
When you file an application for Social Security Disability benefits, your application will be reviewed by a representative of the Social Security Administration (SSA). During this review, the representative will check to make sure you meet some basic program criteria as well as check to see if your condition is listed in the SSA's Blue Book. The Blue Book is a publication put forth by the SSA that lists all of the disabling conditions that could potentially qualify an individual for disability benefits as well as the criteria that must be met in order to qualify under each specific condition.
In the case of narcolepsy, there is no specific listing for the condition. Because of this, those who review cases based on a diagnosis of narcolepsy will often see if the individual who is applying can qualify under the listings that address epilepsy. If your narcolepsy results in frequent sleep attacks, your condition may qualify under Section 11.03 of the Blue Book. This is the section that addresses non-convulsive epilepsy. To qualify for benefits under this Blue Book listing, you must be able to prove that:
- You have at least one episode of narcolepsy per week;
- Your condition must persist in spite of at least three months of treatment; and
- Your episodes have a significant effect on your ability to perform day-to-day activities.
You will need to provide the SSA with medical evidence when submitting your application proving that you suffer from the above-listed criteria in order to be approved for disability benefits. This means providing the SSA with detailed medical records including clinical histories, treatment histories, lab reports, and written statements from your treating physicians. If you can prove that you qualify for disability benefits under Section 11.03 of the Blue Book, your chances of being awarded disability benefits during the initial stage of the application process will be greatly increased.
You can get more information on Narcolepsy and qualifying for disability benefits here: www.disability-benefits-help.org/disabling-conditions/narcolepsy
SSI and SSDI
When applying for Social Security Disability benefits, there are two different programs under which you may qualify: SSDI (Social Security Disability Insurance) or SSI (Supplemental Security Income).
To qualify for SSDI, you must have earned enough work credits in addition to proving that you qualify medically for disability benefits. Generally, to have earned enough work credits, you must have worked five of the past 10 years. If you are not old enough to have a 10-year work history, you must have worked half of the time you could have worked since turning 18. For example, if you are 22, you must have worked two of the past four years in order to have earned enough work credits.
If you have not earned enough work credits to qualify for SSDI, you may be able to qualify for SSI. Unlike SSDI, SSI is a needs-based program. This means that you must meet certain income and asset restrictions in order to qualify. As of 2013, you must earn no more than $710 per month as an individual or $1,066 per month as a couple in order to qualify for SSI. You must also not have more than $2,000 in assets as an individual or $3,000 in assets as a couple in order to qualify for SSI benefits.
Applying for Social Security Disability Benefits
To apply for Social Security Disability benefits due to narcolepsy, you can apply either online at the SSA's website (http://www.socialsecurity.gov/pgm/disability.htm) or in-person at your local Social Security office. When you submit your claim for Social Security benefits, whether you are applying for SSI, SSDI, or both, you need to make sure you submit enough medical evidence to prove that you meet the above-mentioned medical criteria. Also make sure that you fill out the claim forms in their entirety and with very detailed answers. The answers you provide will help the representative reviewing your case determine whether or not you are eligible for Social Security Disability benefits. Once you submit your application and the supporting evidence, it will take approximately three to six months to receive a decision regarding your disability claim.
What to Do in the Case of a Denial
If your application for Social Security Disability benefits is denied, you have 60 days from the date of the denial notice to file an appeal. The first stage of the appeal process is the Request for Reconsideration. It is important to note, however, that chances are that your first appeal will be denied. The SSA approves fewer than 20% of reconsideration requests.
The second stage of the appeal process is when you will have your greatest chance of overturning the SSA's decision to deny your disability claim. This is the stage of the disability hearing. During this hearing you will present your case before an administrative law judge. It is in your best interests to retain the services of a disability attorney for this hearing. Statistics have proven that applicants who work with a disability attorney are more likely to be awarded benefits than applicants who represent themselves. This is likely due to the fact that disability laws can be complicated.
Your disability attorney will be able to help you understand why your initial claim was denied and can take measures to gather additional evidence to support your claim. He or she will also be able to represent you before the administrative law judge at your hearing.
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