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Seizure Disorders and VA Benefits

By Ray Parrish

Traumatic Brain Injury (TBI), and repeated head concussions are injuries that many recent veterans have to deal with. A common result of these injuries is a chronic, disabling seizure disorder. Getting proper compensation for this problem is difficult without knowing what to look for.

People with epilepsy or a seizure disorder are often victims of misunderstandings, prejudice or outright exploitation and discrimination in employment, housing, government services, finance and small businesses. Since the severity and exact nature of the disability vary with each person, any generalization, such as the VA Rating Schedule, is prone to misapplication. This briefing is intended for veterans' counselors who are trying to present evidence in a disability claim which will accurately portray the nature and severity of the seizure disorder. First off, the person that you are trying to help shouldn't be addressed, thought of or referred to as an "epileptic." It's not merely PC to use the phrase "people with epilepsy," it's a way to train yourself and others to recognize the fact that the person is not defined by the disability. The courage they show by living with this disability is remarkable and should be recognized at every opportunity. We should help them to replace the shame associated with having epilepsy with pride in successfully living with it. "Seizure disorder" is also a term that many prefer to epilepsy.

There are many causes and types of seizures, people may suffer from one or several of these and each person's set of symptoms is unique, although each can find similarities in the history of others who are also living with a seizure disorder. Additionally, sufferers seek relief in a variety of treatments, all of which seem to be a "best guess" on the part of the health care professionals. Most people will try various medications and therapies in their effort to control the seizures and minimize the drug's adverse side-effects. Changes in body chemistry (change in hormone levels due to loss of an organ or menopause) or environmental factors (pollution or allergies) may necessitate changes in medication or treatment. After the seizures themselves, the most common complaint is dealing with the sedative effects of anticonvulsant medications. Most have to adapt to these changes by developing new habits and changing old ones.

Most people are familiar with "grand mal" seizures which are characterized by loss of consciousness lasting several minutes, severe whole body convulsions (which may cause further injuries) and loss of bladder control. Often many hours or days are needed to recover physically and cogitatively. The VA calls these "major" seizures. They term as "minor" seizures all other types of seizures, which have a variety of physical manifestations, such as repetitive movements or tics, and "absence," also called "petit mal" seizures. Petit mal seizures, either alone or together with other types, are most common and most misunderstood. We need to discuss them in depth.

Most importantly, the person having a petit mal seizure will RARELY realize that they just had one! The typical petit mal seizure lasts only a few seconds and is easy to miss unless you are looking at the face of the person having the seizure, and see the blinking eyes or blank stare. "Atypical" seizures may occur without blinking. During the seizure they are temporarily "absent" from reality, though not "unconscious." They actually lose a few seconds of time during the petit mal seizure. This can be very disconcerting, even dangerous, for the person having the seizure, especially if it happens while driving or simply walking where they may stumble and fall or pause in a crosswalk. A petit mal may happen while you're hurrying to get ready in the morning, which may cause you to stumble, fall, hit your head and cause a grand mal seizure.

Seizures are often "triggered" when the person is "startled," which may take surprisingly little, especially if their anticonvulsant medication is "off" for any reason. The trigger might be a car horn, a subway or elevator door opening, a flash of light, a strong odor, a light touch on a shoulder or arm or a call to get their attention, even a mental search for a word during a conversation or consternation when they are criticized or under stress.

The amount of anticonvulsant medications in the blood varies constantly but regularly, depending on how recently it was taken and is a constant variable in determining the likelihood of or the frequency of petit mal seizures. The blood level may be low, because it's in a regular "trough" due to stress or adverse drug interactions decreasing the medication's effectiveness. Several petit mal seizures may occur every minute until the next dose is absorbed and reaches a "therapeutic" level or if the trigger is removed or lessened. Conversely, during times of "peak" blood levels, increased sleepiness may increase the susceptibility to being startled and may look like an absence seizure.

In addition, the combination of seizures and medications means that it takes a constant mental effort to minimize seizure activity and compensate for the effects of the medications, that is, to maintain "normality." This extraordinary amount of focus needed to accomplish routine tasks makes them even more susceptible to being startled. And the necessary attention to their own needs also commonly leads to behavior which can be misperceived (and misdiagnosed) as being thoughtless, self-centered, egotistical or ignoring the needs of others.

Often this behavior interferes with normal behavior so much that it warrants an additional diagnosis of a "mental disorder," such as dementia, paranoid delusions, depression, bi-polar or generalized anxiety disorder. VA disability ratings should include these additional disabilities as secondary to or directly associated with the epilepsy (text in the VA rating schedule immediately following the epilepsy ratings, codes 8910-8914, discusses this and "unemployability"). In addition, paragraphs 4.120 thru 4.122 in the rating schedule should be reviewed before agreeing with ratings assigned by the VA.

Under the VA Rating Schedule's diagnostic code 8911, percentages are given for the amount of seizure activity so a "60%" rating is assigned if seizure activity averages one major seizure every 4 months over the past year or 9 or more minor seizures weekly. This rating also entitles the veteran for consideration of "Total Disability due to Individual Unemployability," which pays compensation at the 100% rate if the disorder prevents "gainful" employment.

Even if you consider a medication to be "successful" if it's "99% effective" in preventing seizures, that 100th time, when a petit mal seizure does occur, is inevitable, but not always observed. Since petit mal seizures last only a few seconds, a sufferer has the opportunity to have a seizure 6-10 times every minute. If we call it six times a minute, that 100th time will happen in less than 17 minutes, more often in "stressful" situations. Not all seizures are observed since it's hard to tell if that "pause" during a telephone conversation was a petit mal seizure. Since this math is never-ending, "hiding the disability" is often impossible and a self-delusion. It's easy to understand why many suffering from a seizure disorder also live with depression, anxiety and mood disorders.

Although the VA needs a doctor to verify a diagnosis, they will accept "competent consistent lay testimony" as to the frequency of seizures. This number determines the rating that the VA gives the disability and the amount of compensation paid monthly. This is one of the few times that counselors, friends and family can "testify" in support of the veteran, by documenting any seizures that they observed. More importantly, this is something that the veteran cannot do with total accuracy, since outside observers may be the only ones aware that a petit mal seizure even happened. And doctors spend too little time with the patient to make a truly comprehensive report. The supporting statements should begin with the phrase "I swear the following to be true" and the signature should be notarized. Present this evidence to both the VA and your doctor. Based on this evidence the doctor can write up an opinion verifying the accuracy of the reports and the severity of the seizure disorder.

So, the ratings given for the physical damage to the nerve, bone, muscle and skin systems should be combined with ratings for the seizures themselves, the mental disorders caused by having the seizures and other disabilities, the side-effects of medication and the effects of their long-term use.