Narcolepsy is a sleep disorder characterized by severe drowsiness and fatigue. Some people with narcolepsy also experience the sudden loss of muscle strength, known as cataplexy. There is no cure for narcolepsy, but treatment – such as stimulant medications, frequents naps, and other forms of behavioral therapy – can help.
We’re frequently asked whether narcolepsy is a disability that can qualify for social security disability (SSD) benefits. The answer is yes, though it’s more difficult than with other disabilities.
Narcolepsy and disability benefits
The Social Security Administration (SSA) does not consider narcolepsy a disability that automatically qualifies applicants for SSD benefits. These disabling medical conditions are found in the SSA’s Blue Book, which contains more than 100 medical conditions the SSA considers disabling enough to qualify applicants for SSD benefits, provided they meet the medical criteria.
To prevail on a narcolepsy disability claim, applicants must instead be able to prove that their condition meets or exceeds one of the Blue Book listings. This means being able to show that the narcolepsy:
- Has lasted, or is expected to last, 12 months or longer, and;
- Interferes with your ability to participate in substantial gainful activity (defined as earning more than $1,260 per month in 2020).
In addition, applicants filing a narcolepsy disability claim must have enough work credits to qualify for SSD benefits. Without sufficient work credits, your SSD disability claim will be denied, even if you can prove the first two criteria.
Meeting this threshold requires that you provide medical evidence and complete a residual functional capacity (RFC) assessment.
Medical evidence of narcolepsy
Prevailing on your narcolepsy disability claim requires medical evidence to support the diagnosis. Medical evidence may include one or more of the following:
- Sleep study results
- Genetic testing
- MRIs or other brain imaging
- Results of muscle testing (if your narcolepsy causes you to lose muscle control)
- Medical records and treatment notes from physicians and specialists
- Journal that shows patterns in your sleep habits. It is best if the journal is a contemporaneous account of your sleeping habits, as opposed to one created after the fact in anticipation of filing a disability claim, but one written for those purposes is still sufficient
You should also provide information regarding any prescribed treatments, including any you stopped because they were ultimately not helpful. For example, if you stopped taking a medication because the side effects were worse than the condition itself.
Records of injuries you’ve suffered as a result of narcolepsy may also be helpful. For example, if you fell asleep while driving and were injured in a subsequent car accident, or if the sudden onset of muscle weakness caused you to drop boxes you were moving at work, the medical records can help show how the narcolepsy negatively affects you beyond simply causing you to fall asleep at unexpected times.
Depending on the severity of your narcolepsy, it may be possible for you to qualify under the Blue Book listing for epilepsy, specifically the listing for dyscognitive seizures. This listing requires that you experience “alterations of consciousness without convulsions or loss of muscle control” at least once a week for three months, even with treatment.
When speaking with your doctor, it is important to use numbers when describing how narcolepsy affects you and your ability to work. This is important for two reasons. One, it helps build a consistent record of your condition and, over time, can show a pattern of how it has not improved despite treatment.
Numbers are also more objective, which means the narcolepsy’s impact on your ability to work is less open to interpretation by the claims examiner. For example, assume your doctor asks you to describe how your narcolepsy affects your daily life. You may say, “I have to take frequent naps.” While this is true, it doesn’t provide much useful information to the disability claims evaluator. “Frequent” is a subjective term – it could mean several times a day or several times a week. It also provides no information on the length of these naps or when they occur, which means the examiner can interpret them to be 20 minutes – which you could potentially take on your lunch break – or that you nap as soon as you get home from work.
Instead, answer the question with as much specificity as possible: “I nap three times a day, every four hours, for roughly 30 minutes to an hour.” This answer makes clear that working would be difficult unless you could find an employer willing to let you nap twice a day for up to an hour each time, an extremely unlikely scenario.
Narcolepsy and residual functional capacity
The SSA also requires a residual functional capacity assessment in addition to medical evidence. The RFC helps the SSA determine what work you are capable of doing despite the narcolepsy.
The RFC considers both physical and non-physical limitations imposed by the disability. For example, if the extreme fatigue you experience during periods of wakefulness makes it difficult for you to concentrate, or the random bouts of muscle weakness make you unable to lift objects. Typically, the SSA will approve an application if the RFC shows that the disability will result in a 20% or more decrease in your daily productivity.
The SSA will review the RFC to determine if narcolepsy makes it impossible for you to return to your prior job. If they find that it does, they will then consider your age, education, and prior work experience to determine if you could perform any other type of work.
For example, if your medical evidence shows that you are prone to suddenly falling asleep on the job, you likely would be unable to continue working a job operating heavy machinery. But you may potentially be able to perform office work, depending on the severity of your symptoms and if you could find an employer who would agree to let you have frequent nap breaks.
Though obtaining SSD benefits due to narcolepsy is difficult, an experienced social security disability attorney can help you navigate the process and gather the appropriate information to best support your disability claim. Consider the Good Law Group for your representation – call (847) 577-4476.