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Is Cataplexy a Disability?

Narcolepsy with Cataplexy | SSD Insurance Claim | LaBovick Law Group of West Palm Beach, Florida August 14, 2019 1:57 pm | Categorised in:

What Is Cataplexy?

Cataplexy is a medical condition where you experience sudden episodes of muscle weakness accompanied by full conscious awareness. If you know someone with cataplexy, you may see the person suddenly go limp, slump over, and fall down. This is because the individual’s muscles lose tension all of a sudden, causing falls, etc. While there is no known cause or trigger for cataplexy, it is said to typically occur during periods of emotion or stress. It occurs during waking hours and not at night while sleeping. This muscle weakness is a brain disorder and is a type of narcolepsy. Narcolepsy is a sleep disorder caused by a central nervous system malfunction. This condition is thought to be caused by a lack of hypocretin in the brain, which regulates sleep. A lack of hypocretin is thought to be caused by the immune system attacking the parts of the brain that produce this chemical.

When considering narcolepsy and cataplexy together, they appear to be quite different conditions. One condition causes unexpected episodes of sleep: the other condition causes unexpected episodes of muscle weakness. However, the conditions are typically considered together. When an individual is diagnosed with narcolepsy, that diagnosis goes with or without cataplexy. Meaning, you either have narcolepsy with cataplexy or narcolepsy without cataplexy. This condition can be quite debilitating considering the primary symptoms include extreme drowsiness, falling asleep without warning, and sudden muscle weakness. People who experience narcolepsy without cataplexy are not emotionally triggered and generally have less severe symptoms of narcolepsy.

Narcolepsy with Cataplexy

Narcolepsy with cataplexy is generally treated with medications including anti-depressants along with stimulant medications such as Adderall. Other forms of treatment include learning to adjust to the symptoms such as sticking to a schedule, taking naps during the day, exercising, and avoiding all drugs and alcohol. Once these conditions present, they typically do not go away, but simply need to be treated. One thing you may not know is that narcolepsy with cataplexy is not an inherited condition. Just because a parent may suffer from this condition does not mean his or her children will. Only a small percentage of cases show familial relation.

As you can imagine, suffering from narcolepsy with cataplexy can be quite disabling. Experiencing episodes of random extreme sleepiness or muscle weakness leading to total body collapse can be quite scary, and frankly unsafe. Individuals suffering from this condition certainly should not be driving vehicles. If they are experiencing severe symptoms, they should not be working either. These symptoms are dangerous not only to the individual, but also to those nearby. If you have narcolepsy with cataplexy and experience symptoms on a daily basis, you should apply for Social Security Disability (SSD).

SSD Insurance: Qualification and Evaluation

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SSD is a federally mandated insurance program. The way it works is that when you work, you pay taxes based upon your income into the Social Security system. Those taxes generally qualify you for SSD insurance. As with anything in life, there are always exceptions. In this case, you need to have paid taxes into the Social Security system for the past five out of ten years to qualify for SSD insurance. If you have, then the Social Security Administration will review your situation to see if you meet its definition of disability.

When evaluating an SSD insurance claim, the Social Security Administration (SSA) will use a five-step process. The first step is to determine if you are working and earning over what the SSA deems to be substantial gainful activity. This is a monthly amount you are able to earn while still applying for the program. If your monthly earnings exceed substantial gainful activity, then you will automatically be turned down for the program. But if you are either not working at all or your earnings are less than substantial gainful activity, the SSA will move on to step two.

The second step in the evaluation is to determine whether you suffer from a severe physical and/or mental condition. The term severe in this situation requires proof that your condition poses more than a minimal impact upon your ability to work. This threshold is quite low, requiring only a “minimal effect.” Most cases pass step two, as long as you have medical records to prove the condition.

The third step considers whether you meet one of the SSA’s listed impairments. These “Listings” are a group of conditions the SSA has deemed so severe that you will be found disabled without further evaluation. The Listings require a certain level of proof, not just simply a diagnosis.

Narcolepsy with Cataplexy and Listing 11.02

In cases of narcolepsy with cataplexy, there is no specific Listing. However, this condition can be reviewed under Listing 11.02 for epilepsy. This would be a situation where you would try to equal a Listing by showing that, while you don’t have that specific diagnosis, you do have the same symptoms and limitations. Listing 11.02 requires proof of one of the below:

  1. Generalized tonic-clonic seizures, occurring at least once a month for at least three consecutive months despite adherence to prescribed treatment. In the case of narcolepsy, you would simply change out “seizures” for “narcolepsy.”
  2. Dyscognitive seizures, occurring at least once a week for at least three consecutive months despite adherence to prescribed treatment. Similar to one, you would replace dyscognitive seizures with narcolepsy.
  3. Generalized tonic-clonic seizures or dyscognitive seizures, occurring at least once every two months for at least four consecutive months, despite adherence to prescribed treatment; and a marked limitation in physical functioning, understanding and applying information, interacting with others, concentration, or adapting or managing oneself.

Determining Your RFC

Social Security Disability Attorneys | RFC Assessment | LaBovick Law Group of West Palm Beach, FloridaIf you are unable to prove your symptoms match up with the requirements of Listing 11.02, the next step would be for the SSA to determine what you are physically and mentally capable of doing in spite of your symptoms and limitations. This is called determining your residual functional capacity (RFC). Once your RFC is determined, the SSA will consider your ability to perform your past work, along with any other work in the national economy. If your RFC is determined to preclude all work, then you will be found disabled under the SSA’s regulations.

Stress Less During the SSD Application Process

As you can imagine, this is not an easy process. It takes time, investigation, and treatment notes to support an SSD insurance claim. At the LaBovick Law Group, we strive to take the stress of the SSD application process away from our clients. We work hard with the SSA so you are able to focus on your medical conditions. Call us today for a free consultation at (561) 625-8400 and let us navigate this stressful process for you.