Disability Determination for "Episodic" Conditions

For conditions that are episodic in nature - seizures/epilepsy, depression, anxiety and panic attacks, asthma, heart arrhythmias - Social Security considers the frequency and nature of episodes when determining eligibility for disability benefits.

By Suzanne Villalon-Hinojosa, Attorney

Many health conditions are episodic but disabling because of the frequency of symptoms. In these cases, Social Security considers how frequently exacerbations happen and how long they last, as well as the length of remissions and the residual effects of the disease that remain during remissions. For some of these conditions, Social Security specifies exactly how often symptoms must occur for an illness to be considered disabling.

Listing-Level Frequency

How often must someone have disabling episodes of worsening symptoms? The frequency depends on the disorder. These are the conditions for which Social Security provides a disability listing and a "listing-level" frequency of symptoms (meaning the condition is severe enough to qualify for benefits).

Seizures/Epilepsy. More frequently than once a month.

Asthma. At least once every two months or at least three times a year.

Recurrent arrhythmias. Three times within a consecutive 12-month period.

Sickle-Cell Crises. Three times in five months.

Ischemic heart disease (aka coronary artery disease). Three episodes (hospitalization for either angioplasty or bypass surgery) within a consecutive 12 month period.

Mental Impairments (specifically for depression, somatoform, anxiety or paranoid/psychotic, personality, and autistic disorders). Three episodes of decompensation (worsening of symptoms) in a year, or an average of once every four months, each lasting for at least two weeks.

Autoimmune Disorders. Three times a year, each episode ("repeated manifestation") lasting at least two weeks (or less, if the episodes happen more frequently).

Unspecified Frequency

Social Security also recognizes a few impairments as episodic but does not provide, in the listing, a listing-level frequency. For instance, Meniere’s disease is characterized by "frequent attacks of balance disturbance" yet no frequency is specified. And the introductory language to the skin disorder listings explains that skin disorders can result in "flare-ups." Similar introductory language describes multiple sclerosis and myasthenia gravis as episodic without mentioning a listing-level frequency. In these cases (for those listings that do not have a specific frequency criteria), three episodes per year can be used to argue an impairment is disabling.

You can also argue that the frequency of your symptoms is similar that required by a listing for a different disorder. For instance, anxiety attacks requiring hospitalization can be compared to the symptoms associated with angina. The listing for coronary artery disease requires that, to be considered disabled, a patient must have three episodes in a year requiring hospitalization. However, it usually takes a disability lawyer to successfully argue that the symptoms of one disease "equal" the requirements of a listing for a different disease.

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