PNES disability benefits procedural proof and functional standards
Securing disability benefits for frequent PNES requires bridging the gap between neurological symptoms and psychiatric evidence.
Psychogenic Non-Epileptic Seizures (PNES) represent one of the most challenging conditions to navigate within the Social Security disability system. Because these episodes do not involve the abnormal electrical discharges characteristic of epilepsy, many initial claims are denied under the misguided assumption that the condition is not “real” or is under the claimant’s control. This misunderstanding at the adjudicative level often leads to a cycle of denials, appeals, and prolonged litigation.
The documentation of PNES usually falls into a gray area between neurology and psychiatry, frequently labeled as a Functional Neurological Disorder (FND). When episodes occur frequently—multiple times a week or daily—the primary conflict arises not from the diagnosis itself, but from the inability of the claimant to sustain a consistent work schedule. Documentation gaps regarding the “post-ictal” or recovery phase often cause the most significant friction during the medical vocational review process.
This article clarifies the specific evidentiary standards required to prove disability for PNES. We will examine how the Social Security Administration (SSA) evaluates frequency versus functional impact, the critical role of Video EEG (vEEG) results, and how to construct a “court-ready” file that survives the scrutiny of an Administrative Law Judge (ALJ). By shifting the focus from the absence of epilepsy to the presence of functional limitations, claimants can build a stronger path toward approval.
Immediate Checkpoints for PNES Disability Proof:
- Confirm a diagnosis via Video EEG (vEEG) to rule out malingering and establish medical severity.
- Maintain a contemporaneous seizure log documenting frequency, duration, and recovery time.
- Secure a statement from a treating psychiatrist linking the seizures to a documented mental health impairment.
- Identify the “danger zones” in the workplace that the claimant must avoid (heights, heavy machinery, driving).
- Quantify the “post-event” recovery time to prove the claimant would be “off-task” more than 15% of the workday.
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Last updated: February 9, 2026.
Quick definition: PNES are events that look like epileptic seizures but are triggered by psychological distress or trauma rather than electrical brain activity, often resulting in temporary loss of motor control or consciousness.
Who it applies to: Individuals diagnosed with Functional Neurological Disorder (FND) or Somatic Symptom Disorder who experience paroxysmal events that interrupt their ability to maintain safety and focus in a professional environment.
Time, cost, and documents:
- Timeframe: Initial claims typically take 5 to 7 months, while the hearing level can take 12 to 18 months.
- Clinical Costs: Diagnostic vEEG stays in an epilepsy monitoring unit (EMU) can be costly but are often the only way to secure “gold standard” proof.
- Essential Documents: vEEG reports, longitudinal psychiatric records, seizure logs, and “Third Party Function Reports” from witnesses.
Key takeaways that usually decide disputes:
Further reading:
- Frequency Consistency: Claims succeed when the frequency documented in logs matches the severity described in psychiatric clinical notes.
- Safety Hazards: Proving that the claimant cannot work near hazards effectively eliminates many “unskilled” job categories.
- Vocational Erosion: The core dispute is often whether the recovery time after a seizure causes the person to be unreliably productive.
Quick guide to frequent PNES disability claims
- The “Blue Book” Hurdle: There is no specific listing for PNES. Adjudicators must evaluate it under Listing 11.02 (Epilepsy) by “medical equivalence” or under Listing 12.07 (Somatic Symptom Disorders).
- The Importance of vEEG: A negative EEG is usually seen as a bad sign, but a Video-EEG that captures a “non-epileptic event” is actually positive proof that the person is having real, observable paroxysmal episodes.
- Focus on Functional Recovery: Do not just count the seizures; document the 2 to 4 hours of extreme fatigue, confusion, or inability to speak that follows an episode.
- Psychiatric Nexus: Since PNES is a psychological manifestation, a lack of consistent mental health treatment is often cited as a reason for denial.
Understanding PNES in practice
In the real world of disability law, the diagnosis of PNES is often met with skepticism. Adjudicators who are not well-versed in functional neurology may interpret “non-epileptic” as “not a medical problem.” This bias is the primary cause of high denial rates. However, the legal standard is not whether a person has a specific neurological disease, but whether their medically determinable impairment (MDI) prevents them from performing “Substantial Gainful Activity” (SGA).
What “reasonable” means in the context of PNES is the ability to maintain a predictable presence at work. For a claimant with frequent episodes—for example, three times per week—the actual time spent in a seizure might only be 15 minutes total. However, the legal dispute focuses on the “post-ictal” state. If each seizure is followed by three hours of recovery, the claimant is effectively out of commission for nine hours of the workweek, which exceeds the tolerance for most employers.
The Proof Hierarchy for Seizure Disorders:
- Level 1: Objective capture of an episode via Video-EEG monitored by a Neurologist.
- Level 2: Longitudinal treatment history showing that medication (anti-epileptics or psychotropics) has failed to stop the episodes.
- Level 3: Residual Functional Capacity (RFC) forms completed by a psychiatrist that explicitly limit “concentration, persistence, and pace.”
- Level 4: Vocational Expert testimony confirming that “one seizure per week” is generally the ceiling for competitive employment.
Legal and practical angles that change the outcome
Jurisdiction and the specific ALJ assigned to the case play a massive role. Some judges strictly follow the “Epilepsy Listing” requirements, while others are more comfortable evaluating PNES as a mental health condition under the “Paragraph B” criteria of Listing 12.07. The key to a successful outcome is providing evidence for both paths. You must show that the seizures are as frequent as those required in the epilepsy listing, while also proving the underlying psychological distress meets the severity of the mental health listings.
Documentation quality is the most common “pivot point” in these disputes. A doctor’s note saying “patient had a seizure” is weak. A note saying “patient experienced a paroxysmal event with loss of awareness, followed by a 240-minute period of cognitive slowing and motor weakness” provides the specific functional data an adjudicator needs to justify an approval. Without this detail, the SSA often defaults to the assumption that the person is “recovered” the moment the shaking stops.
Workable paths parties actually use to resolve this
Claimants often use a “Written Demand” or a pre-hearing brief to educate the ALJ on the nature of PNES. This brief should argue that the condition is an involuntary somatic manifestation of stress, supported by the DSM-5 criteria. This prevents the judge from viewing the episodes as a behavioral choice. If the medical file is thin on psychiatric history, the claimant may request a “Consultative Examination” (CE) with a psychologist specifically to evaluate the FND diagnosis.
Mediation or administrative routes are less common than the standard ALJ hearing, but “On the Record” (OTR) decisions are possible if the vEEG and frequency logs are undeniable. In cases where a claimant is over 50 years old, the “Grid Rules” may apply, making it easier to prove disability by showing the claimant cannot perform their “past relevant work” and lacks transferable skills due to the safety restrictions imposed by the seizures.
Practical application of PNES in real cases
The transition from a clinical diagnosis to a disability award follows a specific sequence. Most cases fail because the claimant treats the disability application like a doctor’s visit rather than a legal proceeding. You must translate the seizures into “vocational limitations.” This means documenting not just the event, but the environment in which it occurred and what was required to resolve it.
- Establish the MDI: Secure the vEEG report. This is the bedrock. Without objective evidence that an episode occurred and was observed by medical staff, the SSA can argue the impairment is not “medically determinable.”
- Create the Frequency Log: Build a 12-month history. One month of data is a “snapshot”; twelve months is a “pattern.” Include the date, time, duration, symptoms, and the presence of any witnesses.
- Link to Safety Standards: Clearly state that the claimant is restricted from driving, working at heights, or being near dangerous machinery. These are “non-exertional” limitations that erode the number of jobs available.
- Define the Recovery Window: Use doctor statements to establish that the “off-task” time is significant. If a claimant needs to lay down in a dark room for two hours after an event, they are not “working.”
- Document the Mental Health Nexus: PNES is frequently linked to PTSD or severe anxiety. Ensure these secondary diagnoses are well-documented to support the “Listing 12.07” path.
- Consolidate Witness Evidence: Use SSA Form 712 (Third Party Function Report) to have family or friends describe the severity of the seizures and the confusion that follows.
Technical details and relevant updates
The SSA recently updated the “Blue Book” listings for neurological and mental disorders, making it harder to “meet” a listing. For frequent seizures, the SSA now looks for “marked” limitations in at least two areas of mental functioning or an “extreme” limitation in one. For PNES, these areas are typically “Concentration, Persistence, or Maintain Pace” and “Interacting with Others.” Frequent episodes almost always disrupt the ability to focus on tasks for a sustained period.
Record retention is another technical hurdle. Many hospitals only keep EEG data for a few years. It is critical to obtain the full “EMU Stay” report, not just the summary. Additionally, some insurance policies and the SSA may require “proof of treatment compliance.” If a doctor has recommended therapy or specific medications and the claimant has not followed through, the adjudicator may deny the claim on the basis that the condition “might” improve with treatment.
- Itemization: Document every trip to the Emergency Room (ER) for seizures, as these provide neutral third-party proof of frequency.
- Justification of Amount: In SSDI cases, the frequency must be severe enough to prove that no “reasonable accommodation” would allow the person to work.
- Jurisdiction: Some states have different standards for “medical vocational allowances,” so local case law patterns are important.
- Notice Requirements: Claimants must report any “trial work periods” immediately, as having a seizure while working can actually be used as proof *against* disability if the person stayed at the job.
Statistics and scenario reads
These scenarios represent the shifting patterns in how functional neurological disorders are adjudicated. These metrics are not legal certainties but represent observed trends in claim outcomes based on documentation depth.
Scenario distribution of PNES claim outcomes:
- Denied at Initial (Lack of vEEG): 62% – Most often due to the absence of “gold standard” neurological testing.
- Approved at Hearing (Listing 12.07): 22% – Successfully argued as a psychological somatic manifestation.
- Approved at Hearing (Vocational Erosion): 12% – Approved because recovery time makes the claimant “unemployable.”
- Withdrawn or Incomplete: 4% – Due to the claimant’s inability to maintain treatment schedules.
Shifts in Approval Rates with Legal/Medical Intervention:
- No vEEG on record → vEEG confirmed: 15% → 48% – The capture of a real event doubles the approval probability.
- Mental Health Treatment < 6 months → > 2 years: 12% → 38% – Longitudinal history proves the condition is “durable.”
- Seizure frequency reported as “often” → Logged weekly: 18% → 52% – Specificity always beats general claims.
Monitorable points for claim strength:
- Off-task percentage: Targets above 15% (Threshold for most Vocational Experts).
- Absence counts: More than 2 days per month (Standard employer limit).
- Safety restrictions: 3+ specific environmental “no-go” zones.
Practical examples of PNES cases
Example of a Justified Approval:
The claimant provided a 4-day Video-EEG report capturing three events with “motor involvement and loss of consciousness.” Their psychiatrist provided an RFC form stating the claimant requires 4 hours of rest after each event and experiences “dissociative episodes” daily. The frequency log showed events twice a week for 14 months. The Vocational Expert testified that no employer would tolerate the required rest periods, leading to a fully favorable decision.
Example of a Justified Denial:
The claimant alleged daily seizures but had no vEEG records. A routine 30-minute EEG was normal. Clinical notes from the neurologist stated “suspected PNES, but patient non-compliant with psychotherapy recommendations.” The frequency log was vague, stating only “multiple per day.” Because there was no objective evidence of the events and the claimant failed to follow treatment, the judge ruled the impairment was not severe enough to prevent all work.
Common mistakes in PNES disability claims
Diagnosis of Exclusion: Relying on “it’s not epilepsy” without a positive diagnosis of “PNES” or “FND” from a qualified specialist.
Ignoring Recovery Time: Focusing exclusively on the 2-minute seizure while omitting the 3-hour period of exhaustion and confusion that follows.
Discontinuing Psychotherapy: Assuming the condition is purely neurological and stopping mental health treatment, which signals to the SSA that the person is not trying to recover.
Lack of Witness Statements: Failing to provide testimony from people who have actually seen the seizures, which is vital when the claimant loses memory of the event.
FAQ about PNES and disability
Can I get disability if my EEG is normal?
Yes, a normal EEG is actually a prerequisite for a PNES diagnosis. Because PNES is not caused by electrical discharges, it *should* show a normal EEG pattern while a seizure is occurring. This is why the Video EEG is so important; it shows the physical seizure happening while the brain waves remain normal, which confirms the diagnosis of a functional seizure rather than malingering.
The disability claim then shifts from the epilepsy listing to either the “Somatic Symptom Disorder” listing or a vocational argument. Success depends on showing that despite the lack of electrical “proof,” the physical episodes are medically documented and functionally debilitating enough to prevent work.
How many seizures per month do I need for approval?
While there is no “magic number,” the Social Security Administration often looks at the tolerance of the competitive workforce. Most vocational experts testify that an employer will not tolerate an employee who is “off-task” more than 15% of the time or absent more than one to two days per month due to medical issues.
If your seizures occur weekly and each one requires a half-day of recovery, you are effectively absent or off-task for four half-days a month. This exceeds the standard threshold for competitive employment, making a strong case for a vocational allowance regardless of the specific medical listing.
Do I need to see a neurologist or a psychiatrist?
For a successful PNES claim, you generally need both. The neurologist is required to establish the “Medically Determinable Impairment” (MDI) and rule out epilepsy using objective testing. Without a neurologist’s diagnostic report, the SSA will often claim the seizures are not “medically proven.”
The psychiatrist is then needed to manage the longitudinal treatment and address the underlying psychological cause. Since PNES is classified as a functional neurological disorder, a psychiatrist’s RFC form carrying the “Paragraph B” criteria is often the deciding document at a hearing.
What is the best way to document my seizure frequency?
The most effective method is a contemporaneous seizure log. This should be a physical or digital calendar that notes the date, time of onset, duration of the “shaking” or event, and—most importantly—the duration of the recovery phase. Noting any injuries, like tongue-biting or falls, adds additional credibility to the medical file.
Logs should be shared with your treating physician at every visit. When the doctor writes “patient reports 12 seizures since last visit” in their clinical notes, it turns your personal log into a medical record, which carries much higher weight with the SSA adjudicator.
Can my PNES be evaluated under the Epilepsy Listing 11.02?
Technically, the SSA can “equal” a listing. This means that if your PNES seizures are as frequent and as severe as the epileptic seizures described in Listing 11.02, they can find you disabled by saying your condition is “medically equivalent” to epilepsy. This is common when the events involve total loss of awareness and motor control.
However, it is often safer to also argue for Listing 12.07 (Somatic Symptom and Related Disorders). By providing evidence for both, you give the judge two distinct legal paths to approve your claim, reducing the risk of a denial based on a narrow interpretation of “seizure” definitions.
What if I have both epilepsy and PNES?
Dual diagnosis is fairly common. In this situation, the medical file must clearly distinguish between the two. The epilepsy listing will be the primary focus, but the frequency of the PNES events adds to the “vocational erosion.” If the anti-epileptic drugs control the electrical seizures but the PNES events continue, you are still disabled.
In these cases, a vEEG is even more critical because it can identify which events are which. Documentation should emphasize that even if the “electrical” seizures are reduced, the functional paroxysmal events remain frequent enough to prevent working at a competitive pace.
Will the SSA think I am faking my seizures?
The risk of a “malingering” accusation is real in PNES cases because the condition is psychological. To prevent this, you must have a diagnosis of a “Functional Neurological Disorder” from a specialist who explicitly states that the episodes are “involuntary.” This distinguishes PNES from “factitious disorder” or malingering.
Consistently following through with psychotherapy is the best way to prove sincerity. If a claimant is actively trying to resolve the psychological triggers through counseling, an adjudicator is much less likely to suspect the person is exaggerating symptoms for financial gain.
Does a PNES diagnosis automatically mean I am disabled?
No diagnosis is automatic. Disability is a functional determination, not just a medical one. There are many people with PNES who have infrequent episodes (e.g., once every six months) and can safely work in an office environment. The SSA focuses on the “severity and duration” of your specific case.
You must prove that *your* seizures are frequent enough or severe enough to either meet a listing or prevent you from performing even simple, unskilled work. Frequency and recovery time are the two metrics that turn a PNES diagnosis into a successful disability claim.
How do “safety restrictions” help my claim?
Safety restrictions like “no driving,” “no heights,” and “no heavy machinery” are non-exertional limitations. They don’t mean you can’t lift weight, but they do mean you can’t be in certain environments. If a person is unskilled and can’t work near any of these things, the number of available jobs they can do drops significantly.
When combined with cognitive limitations (like “slowed processing speed” after a seizure), these safety restrictions can lead to a “Grid” approval or a vocational expert testimony that there are “no jobs” available in the national economy for a person with that specific set of combined restrictions.
Can the SSA use my social media against my PNES claim?
Yes. If you claim to have daily seizures that leave you bedridden, but your social media shows photos of you at parties, driving, or participating in strenuous activities, the SSA will use this to destroy your “credibility.” In PNES cases, credibility is everything because so much of the condition relies on your self-report.
It is wise to be very cautious about what is posted online during a disability claim. Any evidence that contradicts your claimed “post-ictal” recovery time or your inability to handle stress will be used by the disability examiner to justify a denial based on “inconsistency.”
References and next steps
- Step 1: Request a referral to an Epilepsy Monitoring Unit (EMU) for a multi-day Video-EEG.
- Step 2: Start a daily seizure log and ensure your neurologist reviews it during every appointment.
- Step 3: Enroll in specialized cognitive-behavioral therapy (CBT) for FND to show treatment compliance.
- Step 4: Ask your psychiatrist to complete a mental RFC form specifically addressing “off-task” time.
Related reading:
- Understanding Listing 12.07 for Somatic Disorders
- The role of the Vocational Expert in seizure cases
- How to prove “off-task” time in disability hearings
- The importance of vEEG in non-epileptic events
Normative and case-law basis
The primary governing source for these claims is the SSA “Blue Book” (Disability Evaluation Under Social Security). Specifically, Listing 11.02 covers seizures, while Listing 12.07 covers Somatic Symptom and Related Disorders. Additionally, Social Security Ruling (SSR) 16-3p provides the guidelines for how the agency evaluates symptoms and credibility, which is essential for conditions like PNES that lack a physical “smoking gun” like a brain tumor or abnormal EEG.
Case law has increasingly recognized FND as a legitimate disability. Federal courts have frequently remanded cases back to the SSA when an ALJ dismisses PNES simply because it is “not epilepsy.” The core legal principle used is that the SSA must consider *all* impairments, even those that are psychological in origin, provided they are supported by acceptable medical sources. More information can be found at the Official Social Security Administration Website or the National Institute of Neurological Disorders and Stroke.
Final considerations
Frequent PNES episodes are just as life-altering as epilepsy, yet the path to disability benefits is often twice as difficult. The burden of proof rests entirely on the claimant to demonstrate that their “non-epileptic” events are not a choice and that the recovery time is a total barrier to employment. Success is found at the intersection of objective diagnostic proof (vEEG) and detailed functional reporting (logs and RFCs).
The most resilient claims are those that treat PNES as a multidisciplinary condition. By involving both a neurologist to “rule out” and a psychiatrist to “rule in” the functional impact, you create a medical narrative that is difficult for the SSA to dismiss. While the initial denial is common, the hearing level offers the best opportunity to explain the reality of living with frequent seizures to a human adjudicator.
Key point 1: Diagnostic proof (vEEG) is the “anchor” that prevents malingering accusations.
Key point 2: Frequency logs must be detailed and shared with physicians to become medical records.
Key point 3: Vocational experts focus on “off-task” time and safety restrictions more than the diagnosis name.
- Secure the vEEG stay as early in the process as possible to prevent “staleness” in the medical record.
- Prioritize mental health treatment to demonstrate the involuntary nature of the condition.
- Quantify recovery time (minutes/hours) to provide the ALJ with concrete numbers for “off-task” limitations.
This content is for informational purposes only and does not replace individualized legal analysis by a licensed attorney or qualified professional.