The Social Security Administration (SSA) published a new Social Security Ruling (SSR), known as SSR 19-4p, involving headaches, which took effect on August 26, 2019. This SSR involves primary headaches, such as migraines, rather than secondary headaches stemming from stroke, hypertension, neck injury, etc. It also provides guidelines on how to fully prepare a case involving a primary headache through the 5-Step Sequential Evaluation.
Include Clear Documentation During Step 2
In order to assist SSA adjudicators in establishing headaches as a medically determinable impairment (MDI), keep clear documentation:
Document the Symptoms and Signs
When headaches occur, ask a third-party to document the observable symptoms and signs such as dizziness, tremors, instability, facial sweating, tearfulness, and the need to lie down. The best third-party in this instance is an acceptable medical source; however, any third party is better than none.
Document the Response to Treatment
Keep an ongoing documentation to note whether headaches improved, worsened, or stabilized. Include any medicinal side effects, such as drowsiness, nausea, or irritability.
Maintain a Headache Journal
It is beneficial for an individual to keep a headache journal, recording when the headaches occur, how long they last, which symptoms are associated with the headaches, and any aggravating factors, such as stress, noise, or medication.
Use Listing 11.02
In addition to SRR 19-2p, use Listing 11.02 at Step 3 for migraines and other headache disorders to support your case. Although this listing refers to epilepsy, it is the most analogous listed impairment for an MDI of headaches. The SSA adjudicator can find an individual’s headaches medically equal to the criteria of Listing 11.02 using the following paragraphs:
11.02(B) involves seizures/headaches at least once every two weeks for at least three consecutive months despite complying with treatment. The adjudicator will use the evidence suggested at Step 2 to further determine if there is a medical equivalency.
11.02(D) involves seizures/headaches at least once every two weeks for at least three consecutive months despite complying with treatment with marked limitation in one area of functioning such as physical functioning; understanding, remembering, and applying information; interacting with others; concentrating, persisting, or maintaining pace; or adapting or managing oneself. The factors in 11.02(B) are also considered.
Residual Functional Capacity
The SSA adjudicator will assess whether the individual’s symptoms are consistent with the medical evidence of record and how they affect work-related activities. The work-related activities most often affected by headaches include concentrating, persisting on tasks, maintaining pace, interacting with others, and attending work on a full-time basis.