There are numerous disorders that fall into the neurological category which range from epilepsy to spinal cord injuries.  All of these disorders will have some form of effect on a particular segment of the neurological system.  Since the type and number of neurological impairments are so great, we will cover only those you are most likely to encounter.

General Evaluation

     Neurological disorders are some of the most interesting impairments to evaluate, because their effects are so closely associated with human anatomy and/or mental dysfunction.   No matter what neurological disorder you are dealing with, you must identify both the physical and the psychological effects.  As we discuss these impairments, you will notice how frequently both the mental and physical capabilities of a claimant can be affected.  Always look for both types of restrictions in order to maximize your argument for a reduced RFC.

     The following is a list of the most commonly seen neurological disorders.  We will discuss each disorder as to its effect on an individual's ability to perform work. 

Late effects of Poliomyelitis
Malignant neoplasm of brain
Parkinson's Disease
Diseases of the spinal cord
Multiple Sclerosis
Cerebral Palsy
Epilepsy
Migraine
Cerebral vascular disease
Intracranial injuries

Poliomyelitis:

     This disorder is rarely seen the U.S. today, but just forty years ago it was considered a plague.  Then it was not uncommon to see numerous individuals paralyzed for life because of this disease.   This curse was controlled with the advent of the polio vaccine.  Recently, medical science has noticed a strange low level recurrence of this disorder, in individuals who had suffered the more serious paralytic form of this disease in earlier life.

     The recurrence has caused a worsening of symptoms in a few patients, increasing their physical limitations.  A few have shown dramatic increases in physical paralysis.  Polio is caused by a virus and in serious cases, can cause limb and respiratory paralysis.  

     You may encounter an individual who has been stricken with this disease in his childhood.   He has now gotten older and is unable to do physical labor due to the lingering effects of the disease.  Most often these sufferers will have some form of partial paralysis of the limbs.  List the physical restrictions alleged by the claimant noting the supportive physical findings.  As with any impairment, use your common sense in formulating your argument.

     An example of a common sense approach would be to point out how the medical findings support the alleged physical restrictions.  Then compare those restrictions to claimant's work history and his remaining skills.   If the claimant's remaining skills will not reasonably allow him to find work, you have a reasonable case argument.  

     Do not forget to evaluate all of the claimant's impairments simultaneously.  Evaluate any secondary impairments as to their collective effect on the claimant's ability to work.  The collective impairment approach will usually supply you with more physical restrictions, thereby increasing you chances of winning the case.

Neoplasm of  the brain:

     Neoplasm is a fancy term meaning cancer.  Brain tumors, or neoplasm of the brain may be malignant or benign.  These terms refer to the activity level of the tumor.  A malignant tumor is active and growing, while a benign tumor is inactive and is usually less threatening to the life of the claimant.  In either case, the location of the brain tumor is the primary determinant of the seriousness and symptoms experienced by the claimant.

     There are several ways a tumor in the brain can affect a claimant.  The most common symptoms are loss of memory, cognitive skills (math skills, etc.), speech, hearing, vision and orientation.  It is also not uncommon for a person suffering from a brain tumor to experience personality and mood changes.  He/she may also become psychotic or completely detached from reality.  A person with a brain tumor should be evaluated as to the effects of his/her specific symptoms and the RFC determined from those symptoms.

Parkinson's Disease:  

     This disease occurs because of a slow and progressive destruction of a cell in the brain which is responsible for the secretion of a chemical called dopamine.  Without this substance, the person will experience muscular tremors which could be incapacitating.  Loss of fine motor control (detailed hand movements, etc.) is common and would limit a person from doing most types of work which require such movement.  A watchsmith occupation, for example, would certainly be impossible.

     As the disease progresses, the claimant may experience muscular rigidity, hand tremor, emotional changes, and difficulty walking.  Speech is often severely affected, causing the claimant's speech to be unintelligible.  Some patients with Parkinson's will suffer muscular weakness, and severe mental deterioration.  All of the above symptoms can be easily used to show a claimant's reduced ability to work.

Spinal cord disease:

     Disorders of the spinal cord can be caused by both injuries and disease.  This includes those injuries or diseases which may have occurred at birth, (congenital disorders).  No matter what the cause, spinal cord damage can produce anything from persistent pain to total paralysis of the affected areas of the body.

     The features you should always look for in spinal cord disease and mechanical back disorders are pain, radiation (pain radiating into arms, legs, etc.), decreased ROM, number of surgeries performed in the past, interference with ambulation, need for braces, canes or any other assistive device.  You should also study the extent of the paralysis if any.

     If you view every back disorder in this way, noting all restrictive findings, you will find it fairly easy to build a case.  Do not forget to develop a detailed description of pain and the limitations it may be causing.

Multiple Sclerosis:

     This disorder is of unknown etiology and affects the brain and spinal cord.  It has a wide variety of symptoms which depend on what area of the brain or spinal cord is being affected.  Symptoms range from mental incapacity to total disorientation of the muscular system.

     Evaluation of this disorder should concentrate on the symptoms of a specific patient, since two people with the disease may have very different symptoms.  The Merck Manual has a very good breakdown of the various symptoms of multiple sclerosis and also covers the areas of the body the disease may attack.   Pain can also be an issue in this disorder, so don't overlook it as a limiting factor.

Cerebral Palsy:

     This term represents a number of progressive or non-progressive motor disorders which result from pre-birth or perinatal damage to the central nervous system.  The most common symptoms seen in these types of disorders are associated with impairment of voluntary movement.

     Cerebral palsy can result in full or partial paralysis, muscular atrophy, weakness, sensory and reflex disturbance of involved muscles.  The most common symptom noted is associated with a gait or walking abnormality.    CP can also cause decreased coordination, tremors, seizures and mental retardation.  The number and types of symptomatic problems caused by this disorder are so great that its evaluation should be approached on an individual basis.  Take the time to note the claimant's specific symptoms and use them as the basis of your argument.

Epilepsy:

     Epilepsy is a general term for seizure disorders which are the result of some form of focal brain damage.  Claimants who have this disorder will usually respond to medication trials, and the seizure frequency will be reduced.  However, in some cases the patient will not respond to treatment, and these individuals are poor candidates for some types of work.  One major seizure a month is considered to be severe enough to meet the medical listings.  Any claimant suffering from a documented seizure disorder with two or more seizures per year, should not work at heights, around open areas of water, with any type of potentially dangerous machinery or operate motor vehicles.  These restrictions can eliminate a lot of  jobs.  

     As you can see, just having the diagnosis can significantly restrict a claimant's RFC.   If this disorder is in combination with another significant impairment, there is an even better chance for a vocational allowance based on the low number of jobs available to a person with these types of physical restrictions.  

     Also keep in mind that persons who suffer just occasional seizure activity may have a gradual reduction in cognitive functioning.  This is due to the brain damage caused by the seizure activity itself.  If you suspect this is occurring, make sure claimant is given an IQ or memory skill test.

Migraines:

     Migraine headaches are not uncommon and are usually not considered to be totally disabling.  However, if associated with another significant impairment, you may have an allowable situation.

     Migraine headaches can cause severe, long-lasting pain that can be completely debilitating while the pain last.  People suffering from this disorder often cannot tolerate light, noise, or physical movement.  There may be serious visual disturbance during a migraine episode.  Relief is achieved with the use of medication and quiet rest.  When this disorder occurs, note the frequency and description of pain.  What does the claimant do to relieve the pain?  How does the pain affect the claimant's normal daily activities?  Use claimant's symptoms as the structural basis for your argument for a reduced RFC.

Cerebral vascular disease:

     A cerebral vascular accident (stroke) is a commonly seen and very serious disorder of the central nervous system.  A stroke can be caused by a number of circumstances, all of which interfere with the normal flow of blood to the brain.  Circulation disruption to the brain will cause a patient to experience full or partial paralysis, loss of cognitive skills, speech, memory and orientation. 

     SSA will review a post-CVA patient's condition three months after the stroke for percent of recovery.  If the claimant is showing significant recovery, SSA will assume a complete (or at least enough to work) recovery is occurring and deny the case on a durational bases.

     You must argue that although some recovery may be present, the claimant will not be capable of work in twelve months from the date of the stroke.  Note and mention any areas in which the claimant may be getting worse as a result of the stroke.  Always make sure you evaluate both the physical and mental restrictions which may be associated with this condition.

     Do not hesitate to argue any additional medical impairments being suffered by the stroke victim.  If claimant is not showing much improvement in speech or any other residual symptom of the stroke, you will have a very good case for an allowance.  If additional medical impairments are argued, try and show how they interact to further reduce the claimant's RFC.