Narcolepsy and Cataplexy

Narcolepsy and other sleep disorders can support a finding of “disabled” from Social Security disability but you will need documentation from your doctor that your symptoms would significantly affect your capacity to perform reliably on the job.

Social Security defines disability in terms of work capacity. In other words, do the symptoms of your daytime sleep disorder significantly interfere with your ability to perform a job.  Note that SSA is not asking if you can perform your past work or an interesting and fulfilling job, but any job.  For example, could you reliably perform a simple, sit-down, entry level job like packing ink pens in a box or monitoring a security camera?

It does not matter that one of these simple, unskilled jobs would bore you or that you might only earn minimum wage.  It also does not matter that you cannot drive or that you do not live near a bus line.  The only question: if you were asked to perform the duties of one of these “warm body” jobs, could you do it?

In a narcolepsy case, the symptoms I see that would impact my client’s job performance include such things as:
excessive unscheduled breaks (i.e., 3 unscheduled episodes of daytime sleeping lasting 15 minutes or more)

  • poor concentration because of fatigue
  • slow pace of work
  • inability to tolerate even moderate stress (stress can bring on an attack)
  • unable to work around hazardous equipment and dangerous machinery
  • unable to work at unprotected heights
  • unable to operate machinery
  • unable to perform work on a time deadline

Often narcolepsy is associated with other medical conditions or mental health conditions.  For example, I often see evidence of depression in my narcolepsy clients and depression can impact job function as well:

  • unable to behave in an emotionally stable manner
  • poor capacity to interact appropriately with co-workers, supervisors or the general public
  • excessive absences from work
  • medication side effects

Cataplexy and Social Security Disability

I understand cataplexy to be an extreme form of narcolepsy in which a patient loses muscle tone and function for a few seconds to a few hours.  Sometimes cataplexy patients experience hypnic jerks which look like seizures.  Cataplexy patients are at increased risk of falling or choking and these cases are often approved by Social Security disability

Presenting a Winning Claim

There are three arguments available to disability claimants in Social Security disability cases, although not all of these arguments apply in a narcolepsy case:

  1. do you meet a listing?
  2. Do you meet a grid rule
  3. has your functional capacity been so reduced by your symptoms that you would not be reliable enough to perform even a simple, entry level job?

In narcolepsy cases, I rely on argument 3 (functional capacity).  Currently there is no listing for narcolepsy and the grid rules do no apply because narcolepsy is a non-exertional impairment.

There is a listing for non-convulsive epilepsy that I can use to argue that my client’s condition equals a listing but my experience has been that Social Security judges are more receptive to a functional capacity argument.

Presenting a Functional Capacity Argument in a Narcolepsy Case

In my experience, medical records discuss narcolepsy and sleep apnea together.  Sleep apnea can be a serious medical issue but judges rarely award benefits solely on sleep apnea because it is so common especially among people that are overweight.

Narcolepsy, by contrast is a neurological condition that may be affected by fatigue associated with sleep apnea but not necessarily.  When I prepare a narcolepsy case I make sure that objective test results (ECG, EEG, sleep study) are in the record.  Further, I ask the treating physician, preferably a neurologist, to complete a functional capacity form that identifies the frequency and duration of daytime episodes.

I also ask my client and his/her spouse or significant other to keep a symptom diary to document the frequency and severity of narcoleptic episodes.

Presenting a Functional Capacity Argument in a Cataplexy Case

Cataplexy cases tend to be easier to present to a Social Security judge because, in general, my client will exhibit symptoms during the hearing itself.  In my experience patients with cataplexy experience more symptoms when they are under stress and, not surprisingly, a Social Security hearing constitutes a stressful environment.

Since cataplexy symptoms are, by definition, totally debilitating, we usually need to show that my client experiences muscle paralysis two or three times a day for 15 minutes or so to win as vocationally, two unscheduled work breaks a day would be considered excessive by most vocational expert witnesses.