Changes in the Listings for Neurological Disorders

The Social Security Administration has issued its first updated rules since 1985 for evaluating neurological conditions under Listing 11.00, including Parkinson’s disease and epilepsy. These revisions will be in effect for five years. The listings address only neurological disorders and complications from those disorders, even if they impact other bodily systems or mental health. A major change that occurred in the new listings is that SSA removed the criterion of an IQ score from its neurological listings on the basis that IQ score does not provide the best measure of limitations of cognitive functioning associated with neurological disorders. This will simplify the evidence required to support a finding of disability in individuals with a neurological, rather than mental impairment. However, IQ will still be used in the evaluation of mental disorders.

Significantly, SSA agrees 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) This clarification will be helpful in establishing disability, because it includes both physical and mental limitations commonly found in Parkinsonian syndromes. One additional clarification involves an individual’s inability to rise from a seated position without the aid of an assistive device, such as a cane or crutches, and to maintain balance once standing without such assistive 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.

A significant change also affects epilepsy patients. The old listings previously required blood drug levels during a three month period to test compliance with medications and therapeutic ranges for epileptic medications. Newer anti-epileptic medications, however, do not have established therapeutic ranges. This made it difficult to interpret lab results. Removing this criterion from the evaluation of epilepsy simplifies the evaluation of seizures for a listing-level impairment. (Listing 11.00C)

In reviewing the thousands of public comments in order to revise these listings, 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 noted that they would provide impairment-specific training on the evaluation of migraine headaches.

Although these changes simplify the evaluation process for neurological disorders, like all medical impairments, their evaluation requires 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 by a treating physician or medical specialist is the best source of supportive evidence.