The Social Security Administration has issued its first updated rules since 1985 for evaluating neurological conditions under Listing 11.00, including Parkinson’s disease, epilepsy, and Huntington’s disease. One major change in the new listings is the removal of the IQ score criteria from the neurological listings. SSA states that IQ scores do not provide the best measure of limitations in cognitive functioning associated with neurological disorders. This change should simplify the evidence requirements to support a finding of disability in individuals with a neurological, rather than mental impairment.
In making the changes, SSA agreed that Parkinson’s disease is progressive and never improves, so a proposed mention of improvement after a period of treatment was removed from the final listing. In addition, SSA includes criteria for evaluating “disorganization of motor function” for Parkinsonian syndromes, and includes a definition of an “extreme limitation.” If, however, SSA does not find disability based on extreme limitation alone, it will find disability based on “marked” limitation in physical functioning and “marked” limitation in one of four areas of mental functioning. (Listing 11.00D)
The clarification should be helpful in establishing disability because it includes both physical and mental limitations commonly found in Parkinsonian syndromes. Additional clarifications involve the inability to rise from a seated position without an assistive device (like a cane or crutches) and to maintain balance once standing without such devices. (Listing 11.00D2a and b). SSA considers the unassisted inability to rise and stand to be “extreme limitations” severe enough to rule out the ability to engage in gainful work activity.
Another significant change also affects epilepsy patients. The prior rules required blood drug levels during a three-month period to test compliance with medications and therapeutic ranges for epileptic medications. However, newer anti-epileptic medications do not have established therapeutic ranges. Thus interpreting lab results was difficult. SSA simplified the evaluation by removing the criterion from the evaluation. (Listing 11.00C).
SSA also made significant changes to medical criteria for evaluating Huntington’s disease. Previously, SSA characterized HD primarily as a movement disorder, a narrow understanding of the disease disproven decades ago as the cognitive and behavioral aspects of the disease became better understood. The new criteria directly address both the functional cognitive and mental symptoms of the disease, including marked limitations in executive function, social interactions, concentration, and self-control. (Listing 11.17)
Unfortunately, SSA declined to create a separate category for migraine headaches, as symptoms were too subjective for this impairment to be listed separately. However, migraine headaches can medically equal Listing 11.03 Epilepsy, non-convulsive, as the most closely analogous impairment. SSA did note that it would provide impairment-specific training on the evaluation of migraine headaches. But, there was no timetable for this training.
Although the changes should simplify the evaluation process for neurological disorders, these cases will still require strong medical and non-medical evidence that the impairment is severe and interferes with the ability to engage in basic work-related activity. Consistent documentation and a supportive medical statement by a treating physician or medical specialist is still the best source of supportive evidence.
The new rules became effective on September 29, 2016. You can find the notice at 81 FR 43048.