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Narcolepsy

The medical term “narcolepsy” is actually derived from the French word “narcolepsie” which came from two Greek words “narke” meaning stupor or numbness and “lepsis” which means seizure. Medically, narcolepsy is considered a neurological disorder. The symptoms for narcolepsy include, according to the National Institute of Neurological Disorder and Stroke, periods of extreme daytime sleepiness and sudden, unpredictable, irresistible occurrences of sleep.

It is important to note that the medical community as well as Social Security views the condition of narcolepsy as a neurological condition rather than a mental condition. Unfortunately, narcolepsy is not a medical impairment which is found on the Commissioner’s lists of medical conditions which can serve as the basis for disability without considering the age, education and work experience of the claimant. That said, the Commissioner has implemented a policy within her POMS (Program Operations Manual System) POMS DI 24580.005 which provides a blue-print on how the condition of narcolepsy may equal (as opposed to meet) Listing 11.03.

Listing 11.03 addresses minor motor seizures – epilepsy. The Commissioner acknowledges much that is helpful to the claimant in the POMS cited above. First, the Commissioner wrote that with the exception of sleep studies, lab tests are generally normal. Second, routine EEG studies are usually normal. Third, abnormal rapid eye movement (REM) sleep patterns may or may not be present in true narcolepsy cases. In addition, the Commissioner acknowledges that narcolepsy is not normally treated with anticonvulsant medication. Instead it is treated with “stimulants and mood elevators for which there are no universal laboratory blood level determinations available.” The Commissioner did note that in over 70% of the narcolepsy cases the claimant’s narcolepsy will be accompanied by a condition known as cataplexy. (Cataplexy is the loss of muscle tone [with or without collapse] during which the person always remains conscious.) If the person has cataplexy in association with narcolepsy then the Commissioner will not require a sleep study in order to prove the existence of narcolepsy. The Commissioner does think that the narcolepsy should be evaluated after 3 months of prescribed treatment.

A diagnosis of narcolepsy is not sufficient by itself to prove that the condition equals Listing 11.03. What more is needed? What is needed is proof of the severity of the condition. Proof of the severity of narcolepsy is usually made through an analysis of the medical records and chart notes of the treating physician. Hopefully, the chart notes also contain a detailed explanation of the types of medication used and a description of their effectiveness. The notes should also describe the narcoleptic attacks along with associated events such as cataplexy, hypnagogic hallucinations (hallucinations which occur between sleeping and awakening) and sleep paralysis (which is an inability to move while drifting into sleep). Often time, the best way to keep a treating physician informed of the narcoleptic attacks is to keep a contemporaneous journal of the attacks for his/her review. In addition to proving useful to the treating physician, it also can be helpful in the Social Security case as part of the proof of the severity of the attack.