Epilepsy and SSDI Benefits in New Jersey

Epilepsy affects millions of Americans, and for many, seizures are frequent, unpredictable, and severe enough to prevent any meaningful employment. If you live in New Jersey and struggle to maintain work because of epilepsy, you may qualify for Social Security Disability Insurance (SSDI). Understanding how the Social Security Administration (SSA) evaluates epilepsy claims — and what mistakes to avoid — can mean the difference between approval and a lengthy appeals process.

How the SSA Evaluates Epilepsy Claims

The SSA uses a formal listing system called the Blue Book to determine whether a condition automatically qualifies as disabling. Epilepsy appears under Listing 11.02, which covers convulsive and non-convulsive epilepsy. To meet this listing, you must show one of the following:

• Generalized tonic-clonic seizures occurring at least once a month despite at least three months of prescribed treatment
• Dyscognitive seizures (formerly absence or complex partial seizures) occurring at least once a week despite at least three months of prescribed treatment
• Seizures occurring at least once every two months with a marked limitation in physical functioning, understanding, interacting with others, or concentrating
• Seizures occurring at least once every two weeks with a marked limitation in one of those same functional areas

The critical phrase throughout is despite prescribed treatment. The SSA expects you to follow your neurologist's treatment plan. If you are non-compliant with medication without a valid medical reason, your claim is in serious jeopardy. Documented side effects, financial inability to afford medication, or a physician's decision to adjust treatment are all legitimate reasons the SSA may excuse non-compliance.

Medical Evidence You Must Provide

A strong SSDI claim for epilepsy is built on thorough, consistent medical documentation. The SSA needs more than a diagnosis — they need detailed records demonstrating the frequency, duration, and type of your seizures, as well as the impact on your daily functioning.

Essential records to gather include:

• Neurologist treatment notes spanning at least 12 months
• EEG results and any MRI or CT imaging of the brain
• Hospital and emergency room records for seizure-related visits
• Medication history, including dosages and any adjustments
• Seizure logs — ideally maintained by both you and a caregiver or family member
• Records of post-ictal symptoms such as confusion, fatigue, or injury following seizures

New Jersey claimants should note that the SSA will request records from every treating provider. If you are treated at a major medical center such as Rutgers Robert Wood Johnson, Hackensack Meridian Health, or the Jefferson Health New Jersey network, ensure your authorization forms are complete so those records are not delayed or overlooked.

When You Do Not Meet the Listing: Residual Functional Capacity

Many epilepsy claimants do not meet Listing 11.02 precisely — their seizures may be somewhat controlled but still occur with enough frequency or unpredictability to prevent safe employment. In these cases, the SSA evaluates your Residual Functional Capacity (RFC), which is an assessment of the most you can do despite your limitations.

For epilepsy, an RFC analysis typically addresses restrictions such as:

• No working at unprotected heights
• No operating heavy or dangerous machinery
• No commercial driving
• Avoidance of temperature extremes or flashing lights that may trigger seizures
• Potential need for unscheduled breaks or absences due to post-ictal recovery periods

If the RFC restrictions are significant enough that no jobs exist in the national economy that you could perform — given your age, education, and work history — the SSA should find you disabled. An experienced attorney can work with your physicians to ensure your RFC accurately reflects your actual limitations and is not understated in the medical record.

New Jersey-Specific Considerations

New Jersey processes SSDI claims through the New Jersey Division of Disability Services, which serves as the state's Disability Determination Services (DDS) agency. Initial decisions are made at this level before any appeal reaches a federal Administrative Law Judge (ALJ).

New Jersey also has its own state driver's license seizure reporting requirements. Under New Jersey law, physicians are not mandated reporters of epilepsy, but the Motor Vehicle Commission (MVC) does require drivers to be seizure-free for a minimum period — typically determined on a case-by-case basis in consultation with a treating neurologist. A driving restriction can actually support your SSDI claim by demonstrating the SSA that your seizures are recognized as genuinely impairing by another government agency.

Additionally, if you are waiting for SSDI approval, consider whether you qualify for New Jersey Temporary Disability Insurance (TDI) or the state's Medicaid program to bridge gaps in income and healthcare coverage during the often-lengthy SSDI process.

Common Reasons Epilepsy Claims Are Denied and How to Fight Back

Initial SSDI denials are common — nationally, roughly two-thirds of initial applications are rejected. Epilepsy claims are denied for several recurring reasons:

• Insufficient seizure frequency documentation: Verbal reports of seizure frequency are not enough. You need objective records corroborating how often seizures occur.
• Gaps in treatment: Missing neurologist appointments or lapses in medication refills signal non-compliance to the SSA.
• Lack of an observational statement: A written statement from a spouse, family member, or caregiver who has witnessed your seizures can powerfully corroborate your account.
• Underreported functional limitations: Many claimants focus solely on the seizures themselves and fail to document post-ictal symptoms — the hours of confusion, exhaustion, and cognitive impairment that follow a seizure and can be just as disabling as the seizure itself.

If your claim has been denied, you have 60 days from the date of the denial letter to file an appeal. The most important stage in the appeals process is the hearing before an Administrative Law Judge, where you appear in person (or via video) and present your full case. At hearings held at the SSA's Newark or Mount Laurel hearing offices, an attorney can cross-examine the vocational expert the SSA relies upon to argue jobs exist that you could perform — often a pivotal part of the hearing.

Do not let a denial discourage you. Many New Jersey claimants who are ultimately approved were initially denied, and the hearing stage is where strong representation makes the largest impact.

Need Help? If you have questions about your case, call or text 833-657-4812 for a free consultation with an experienced attorney.

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