Seizure Disorders (Epilepsy) C&P Exam Prep

Seizure Frequency Count - Major Seizures

What it measures: Average number of major (tonic-clonic/grand mal or psychomotor with unconsciousness) seizures per year and per week. This is the primary driver of the VA rating percentage for major seizures.

What to expect: The examiner will ask how often you have major seizures. Be prepared to give an honest average over the past 12 months. If frequency varies significantly, explain the range (e.g., 'I had 8 seizures last year, but in bad months I had 2 per month and in good months none.'). Reference your seizure diary.

Pain considerations: While seizures themselves are not painful in the traditional sense, document post-ictal headaches, muscle soreness, bite injuries to tongue or cheek, and injury-related pain from falls during seizures. These contribute to overall functional impairment.

Seizure Frequency Count - Minor Seizures

What it measures: Average number of minor seizures (absence, focal/Jacksonian, psychomotor without unconsciousness, atonic, or brief interruptions of consciousness) per week and per year. Minor seizure frequency drives a separate rating calculation.

What to expect: The examiner will ask how often you experience 'smaller' episodes - staring spells, brief confusion, involuntary movements, sensory disturbances, or momentary loss of awareness. These are rated separately from major seizures.

Pain considerations: Minor seizures can cause post-ictal fatigue, confusion, and disorientation that may last minutes to hours. These residual effects significantly impact daily functioning and should be fully described.

Neurological Examination

What it measures: Baseline neurological function between seizures, including motor strength, coordination, reflexes, sensation, cranial nerves, gait, and cognitive screening. Looks for interictal (between-seizure) deficits.

What to expect: The examiner will perform a standard neurological exam. They will test reflexes with a hammer, check your grip strength, ask you to walk, test sensation with a pin or vibration, and may ask basic cognitive questions. You will likely be in remission (not actively seizing) during this exam.

Pain considerations: Report any chronic headaches, muscle pain from post-ictal states, or pain from injuries sustained during seizures. These are real functional impairments the examiner should document.

EEG / MRI / CT / CSF Review

What it measures: Objective diagnostic evidence confirming the epilepsy diagnosis, seizure type, and any underlying structural pathology. The examiner will review results if available.

What to expect: The examiner will ask about and review results of any EEG (electroencephalogram), MRI, CT scan, or cerebrospinal fluid examination you have had. They will document dates and findings.

Pain considerations: Not applicable to this test type.

100%

Average 1 major seizure or more per week. This is the maximum schedular rating for epilepsy based on seizure frequency alone.

From 38 CFR: Under 38 CFR 4.124a, average at least 1 major seizure per week warrants 100%. Major seizures include generalized tonic-clonic (grand mal) convulsions and psychomotor seizures characterized by automatic states and/or generalized convulsions with unconsciousness.

60%

Average 1 major seizure in 2 months (approximately 5-8 per year), OR averaging more than 10 minor seizures per week.

From 38 CFR: 38 CFR 4.124a: Average at least 1 major seizure in 2 months over the past year warrants 60%. Alternatively, more than 10 minor seizures per week warrants 40% and is the threshold for the second-highest minor seizure rating.

40%

Average 1 major seizure in 3 months over the past year, OR averaging 5-10 minor seizures weekly.

From 38 CFR: 38 CFR 4.124a: Average at least 1 major seizure in 3 months warrants 40%. Average 5-10 minor seizures per week also warrants 20% (minor seizure scale).

20%

Average 1 major seizure in 4 months over the past year (1-2 per year), OR averaging at least 1 minor seizure per week.

From 38 CFR: 38 CFR 4.124a: Average at least 1 major seizure in 4 months warrants 20%. At least 1 minor seizure per week warrants 10%.

10%

A confirmed diagnosis of epilepsy with at least 1 seizure in the past 2 years. Seizures currently in remission but diagnosis is established and service-connected.

From 38 CFR: 38 CFR 4.124a: A confirmed diagnosis with at least 1 seizure in the past 2 years - even if currently in remission on medication - warrants a minimum 10% rating. The presence of a confirmed diagnosis and required medication use is key.

Major Seizure Description

How to describe it: Describe the full sequence: what you experience immediately before (aura, if any), what happens during the seizure (if you have any awareness), and what happens after (post-ictal state). Include duration of each phase. Give witnesses' accounts of the convulsive phase since you may not remember it. Example: 'I get a strange smell as a warning, then I lose consciousness and my wife says I shake my whole body for 2-3 minutes. Afterward I am confused and exhausted for 3-4 hours and cannot work the rest of the day.'

Example: On my worst days, I have had two major seizures within 24 hours. During the seizure I am completely unaware, my wife says I turn blue and shake violently. I wake up on the floor, having bitten my tongue badly and urinated on myself. I am so exhausted and confused afterward that I cannot drive, cook, or work for the remainder of the day. I have fallen and cut my head open during a seizure, requiring stitches.

Examiner listens for: Specific seizure type classification (tonic-clonic, psychomotor with unconsciousness), confirmed loss of consciousness, post-ictal duration and severity, injury history, witness corroboration, frequency pattern, and whether seizures occur despite medication compliance.

Avoid: Do not say 'I just black out for a second' if you actually have full generalized tonic-clonic convulsions. Do not minimize post-ictal states as 'feeling a little tired' when you are actually unable to function for hours. Do not omit injuries sustained during seizures.

Minor Seizure Description

How to describe it: Describe the specific features of each minor episode type you experience. Example: 'I have absence episodes where I stare blankly for 30-60 seconds and cannot respond to people around me - I have no memory of these. I also have focal episodes where my right hand jerks uncontrollably for about 30 seconds. I have about 5-7 of these per week.' Be specific about which body parts are involved, whether you maintain consciousness, and what you are unable to do during and after the episode.

Example: On bad days I have focal seizures in my right arm every 1-2 hours. During these I cannot hold objects, cannot type, and cannot drive. I have dropped hot items and been burned. Even after the jerking stops I have weakness in my arm for 30-60 minutes. On those days I cannot perform my job duties at all.

Examiner listens for: Distinction between consciousness-preserved and consciousness-impaired episodes, specific motor or sensory phenomena, frequency in a typical week, duration, and functional impact during and after each episode.

Avoid: Do not lump all your seizure types together without distinguishing major from minor. Do not say 'it is not that bad' about absence episodes that actually cause you to stop working multiple times per day. Do not omit automatic behaviors (lip smacking, fumbling with clothing) that you may not even be aware of.

Post-Ictal State and Residual Symptoms

How to describe it: Describe everything that happens after a seizure: how long you are confused, how long until you can speak clearly, how long until you can drive or work, whether you have headaches, nausea, muscle soreness, or depression after each event. Example: 'After every major seizure I am confused for 1-2 hours, have a severe headache for the rest of the day, and feel deeply depressed and exhausted for 24 hours. I cannot return to work the day of a seizure.'

Example: After a major seizure I wake up on the floor not knowing where I am. My whole body aches from the convulsions. I have a splitting headache. I feel profoundly depressed and sometimes cry without knowing why. I sleep for 4-6 hours and wake up still not feeling right. The entire next day I am foggy and cannot make decisions or concentrate.

Examiner listens for: Duration and severity of post-ictal confusion, functional disability during post-ictal state, headaches, mood changes, cognitive impairment, and whether these interictal symptoms are separately documented.

Avoid: Do not say you 'recover quickly' if post-ictal symptoms actually disable you for hours or days. Do not fail to mention post-ictal mood changes or cognitive fog - these may support separate ratings for associated conditions.

Functional and Occupational Impact

How to describe it: Describe specifically what activities you cannot do because of your seizures. Include driving restrictions (by law or by your neurologist's recommendation), occupational restrictions (cannot work at heights, near open water, near open flames, with heavy machinery), and social restrictions. Example: 'I have not been able to drive for 3 years. My neurologist has restricted me from any work involving machinery. I have lost two jobs because employers could not accommodate my seizure disorder.'

Example: I cannot drive, which means I cannot get to work without depending on others. I cannot be left alone with my grandchildren. I had to leave my career as an electrician because working at heights is too dangerous. I cannot swim, bathe alone, or cook on a gas stove without supervision. My seizure disorder has completely changed every aspect of my life.

Examiner listens for: Specific work-related restrictions, documentation of driving prohibition, caregiver needs, history of job loss attributable to the seizure disorder, and whether the veteran can live independently.

Avoid: Do not say your seizures 'have not really affected your work' if you have had to change jobs, reduce hours, or receive accommodations. Do not omit the driving restriction - it is a major functional impairment the examiner needs to document.

Seizure-Related Injuries and Safety Concerns

How to describe it: List every injury you have sustained as a direct result of a seizure: head injuries, lacerations, fractures, burns, dental injuries from tongue or cheek biting, bruises from falls. Bring ER records or medical notes documenting these. Example: 'I have fractured my wrist once and received stitches to my forehead twice from falling during seizures. I regularly bite my tongue during episodes.'

Example: During a seizure last year I fell down a flight of stairs and fractured two ribs. I have permanent scarring on my tongue from biting. I have had multiple ER visits for seizure-related head trauma. My doctor insists I never be alone near water or heights.

Examiner listens for: Documentation of actual physical injuries sustained during seizures, pattern of injury risk, and whether injuries support a residual injury rating under the DBQ.

Avoid: Do not omit past injuries assuming they are not relevant - they document severity and corroborate your account of losing consciousness and control during major seizures.

Cognitive and Psychiatric Manifestations

How to describe it: Describe any problems with memory, concentration, thinking, mood, or perception that you experience in connection with your epilepsy - whether during, immediately after, or between seizures. These may qualify for a separate nonpsychotic organic brain syndrome rating. Example: 'Between seizures I have significant memory problems - I cannot remember conversations I had the day before. I have difficulty concentrating for more than 15 minutes. My family says my personality has changed significantly since my seizures began.'

Example: I cannot retain new information. I have walked out of stores forgetting why I was there. I forget the names of people I have known for years. I have episodes of intense d-j- vu and fear during minor seizures that feel terrifying. My mood is extremely unstable - I go from calm to deeply depressed within hours for no clear reason.

Examiner listens for: Cognitive deficits suggesting organic brain syndrome, mood and personality changes consistent with epilepsy-related psychiatric manifestations, and whether these symptoms are occurring between (not just during) seizures.

Avoid: Do not attribute memory and cognitive problems solely to stress or aging - in the context of epilepsy they may support a separate ratable condition. Do not fail to mention personality changes that family members have noticed even if you yourself are unaware of them.