SSA CHANGES EVALUATION OF NEUROLOGICAL DISORDERS
The SSA changed how they evaluate neurological disorders, such as Epilepsy and Cerebral Palsy. For the first time since 1985, SSA has issued revised listings for Neurological Disorders for adults and children (Listings 11.00 and 111.00). The SSA also made minor corresponding changes to the musculoskeletal system (adult and children) and mental disorders (adult only) listings. The new version of the listings can be found at 81 Fed. Reg. 43048 (July 1, 2016). SSA believes the new changes reflect program experience and advances in medical knowledge.
SSA REMOVES IQ SCORE FROM NEUROLOGICAL LISTINGS
Some specific changes include SSA’s removal of the IQ score from its neurological listings because advances in medical knowledge of cerebral palsy (for adults and children), epilepsy (for children), spinal cord insults (for children), and program experience indicate that an IQ score does not provide the best measure of limitations in cognitive functioning associated with these disorders.
Therefore, it may not indicate listing-level severity under the neurological listings and would be more appropriately used to evaluate mental disorders under the mental disorders body system (listings 12.00 and 112.00).
SSA also clarified in 11.00D2a that an inability to stand up from a seated position means that, once seated, a claimant is unable to stand and maintain an upright position without the risk of falling unless they have the assistance of another person or the use of an assistive device, such as a walker, two crutches, or two canes. The severity of such a limitation is set at a standard much higher than that applicable to a person who is able to do sedentary work and it thereby constitutes an inability to do any work in the national economy.
EPILEPSY AND PRESCRIBED TREATMENT
SSA will evaluate adherence to prescribed treatment for epilepsy patients under 11.00C, particularly for patients prescribed newer anti-epileptic drugs, by considering whether a claimant has taken medications or followed other treatment procedures as prescribed by a physician for three consecutive months. The SSA has always evaluated whether the claimant adheres to prescribed physician treatment.
However, when the SSA last revised these listings in 1985, blood drug levels were strong indicators for prescribed treatment compliance because therapeutic ranges had been established for anti-epileptic drugs (AEDs) and the ranges were often noted in the laboratory results. However, many newer AEDs do not have established therapeutic levels, making lab results difficult for adjudicators to interpret. Removal of the requirement for obtaining blood drug levels addresses this issue and simplifies the evaluation of seizures that satisfy the listing criteria. However, SSA will continue to consider blood drug levels available in the evidence in the context of all evidence in the case record.
The majority of this information was published in the NOSSCR 2016 July Forum, where the reader can obtain the entire article. The SSA will still evaluate the severity of epilepsy based upon the number of breakthrough or uncontrolled seizures that the claimant has on a weekly and monthly basis.