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Proactive Claim Documentation: Narcolepsy

Cutter Hall Karlock, LLC
Feb. 6, 2016

Narcolepsy is a chronic and potentially debilitating neurological disorder caused by the brain’s inability to regulate sleep-wake cycles normally. The disorder is characterized by an intense urge to sleep during the daytime, and is often accompanied by disturbed night-time sleep. Narcolepsy may also involve unpredictable attacks of cataplexy, a sudden loss of muscle tone which in its most severe form may cause an individual to physically collapse. For individuals who suffer from narcolepsy, symptoms of extreme daytime fatigue and the need for frequent daytime napping may make it impossible to sustain a predictable daily routine, let alone maintain a regular work schedule.

Generally, when evaluating a claimant’s eligibility to draw a benefit under its disability program, the Social Security Administration defines “disability” as the inability to work by reason of a medically determinable impairment that has lasted or can be expected to last for at least 12 months. An individual who suffers from uncontrolled narcolepsy may be unable to attend work on a regular basis or may risk falling asleep on the job, preventing them from performing their job duties and resulting in termination. When presenting a claim for Social Security Disability based on narcolepsy, the case will usually revolve around the severity and frequency of daytime narcolepsy symptoms, and the different ways in which such symptoms would interfere with the performance of a typical full time job. An Administrative Law Judge presiding over a Social Security Disability claim must consider issues such as absenteeism and time off work tasks when determining whether or not a claimant is disabled. The Judge will rely on the testimony of a vocational expert to explain how many absences are allowed by the typical employer and how much time off task is permitted during the work day.

As an initial matter, it will be imperative to have a proper medical diagnosis of narcolepsy, which is made by a set of medical tests called a sleep study. However, the symptoms associated with narcolepsy may vary widely depending on the patient, and it may be possible for many individuals to control the most debilitating symptoms of narcolepsy with regular sleep routines and prescription stimulants. Further, fatigue is an extremely subjective symptom that is not easily measurable by objective testing, and a Judge who intends to deny a finding of disability may assert that the claimant is exaggerating his or her description of symptoms for purposes of self-gain. For these reasons, a positive sleep study and diagnosis of narcolepsy will not automatically result in an award of Social Security Disability benefits. The proper documentation of ongoing symptoms is critical to build and present the strongest case possible.

At the administrative hearing, a disability claimant will be able to describe narcolepsy symptoms and how they impact daily functioning. In addition to considering the claimant’s hearing testimony, a disability Judge is also required to review all of the records contained in the case file, which will usually include several years’ worth of medical records, statements submitted by the claimant and others about disabling symptoms, and medical opinions that have been offered by examining and non-examining physicians. The Judge will evaluate whether the claimant’s hearing testimony about the severity and frequency of symptoms is consistent with the other evidence in the file, including what the claimant has reported to medical providers over time.

For individuals who are applying for Social Security Disability based on narcolepsy, it may be helpful for them to use a simple calendar to track daytime sleep, levels of fatigue, and/or cataplexy events. This calendar can be submitted into the disability file as a longitudinal recording of symptoms, and can also be shared regularly with the treating sleep medicine specialist at office appointments, so that the physician’s notes are complete and consistent. Additionally, it can be helpful for a disability claimant to communicate with the treating sleep physician in a very specific fashion, so that the physician’s notes will be thorough. Instead of reporting generalities, such as “I’m still not doing well,” a patient should take advantage of office visits to report specific examples of how their narcolepsy symptoms interfere with particular activities of daily living.

It may also be helpful to get written statements from friends, family members, or former coworkers who have witnessed narcoleptic events. These individuals can describe to the Judge what the events look like to an outsider and how frequently they occur. If the treating sleep medicine specialist is willing to write a statement in support, it could be extremely helpful to obtain the physician’s written opinion about the claimant’s need for unpredictable daytime naps or the likely rate of absenteeism resulting from the condition. The disability Judge is required to consider all of these pieces of evidence, and if the evidence is all consistent, it will be much more difficult for the Judge to deny the claim.

Finally, because some individuals diagnosed with narcolepsy are able to find therapies that control their disabling symptoms, it is very important to bring to the Judge’s attention all of those therapies that a disability claimant has attempted and failed. This could include various prescription stimulants or anti-depressants, changes to the sleep schedule, regular exercise, and dietary adjustments. Some patients may even try alternative therapies such as meditation, light therapy, acupuncture, and massage. A disability claimant who has attempted and failed a wide variety of recommended therapies to control his or her symptoms may appear more credible to a disability Judge than one who has only attempted oral medications.

With the proper documentation, it is possible to succeed in a Social Security Disability claim based on narcolepsy. If you or a loved one is preparing to file for disability based on narcolepsy, you may wish to first consult with a local attorney experienced in narcolepsy claims for assistance and advice. Call us at Cutter, Hall, Karlock to discuss the particulars of your case and allow us to assist you in proactively documenting your claim!