Assessing Marked Limitation for Chronic Migraines Under Listing 11.03

Direct Answer

Based on the provided sources, Listing 11.03 is currently designated "[Reserved]" and contains no operative paragraphs B or C [26]. Consequently, an ALJ cannot find listing-level equivalence under the text of Listing 11.03 itself, because that listing has no substantively operative criteria. Additionally, SSR 11-2p is not among the provided sources, so no authoritative guidance from that ruling can be cited here.

However, the analytical framework for assessing marked limitation in concentrating, persisting, or maintaining pace in the neurological listings is well-established across the operative listings in category 11.00, and that framework governs any medical equivalence analysis.

Analysis

Listing 11.03 Is Reserved

The regulatory text for Listing 11.03 states simply: "11.03 [Reserved]" [26]. This means the listing no longer contains enumerated criteria (paragraphs A, B, or C) against which a claimant's impairment can be measured or to which equivalence can be found. An ALJ evaluating chronic intractable migraines must therefore look to medical equivalence under the remaining operative listings—most commonly Listing 11.02 (Epilepsy) [9] or other category 11.00 listings whose paragraph B/C structures include the mental functioning criteria.

The Paragraph B/C Marked-Limitation Framework Across Neurological Listings

Although Listing 11.03 is reserved, every operative neurological listing that includes a paragraph B or C mental-functioning criterion uses identical language drawn from section 11.00G. The relevant area of mental functioning is:

> "Concentrating, persisting, or maintaining pace (see 11.00G3b(iii))"

This criterion appears in the following operative listings' B or C paragraphs:

• 11.02C4 and 11.02D4 (Epilepsy) [9]
• 11.04C3 (Vascular insult to the brain) [10]
• 11.08C3 (Spinal cord disorders) [11]
• 11.18B3 (Traumatic brain injury) [12]
• 11.05B3 (Benign brain tumors) [13]
• 11.06B3 (Parkinsonian syndrome) [14]
• 11.07B3 (Cerebral palsy) [15]
• 11.09B3 (Multiple sclerosis) [16]
• 11.12C3 (Myasthenia gravis) [17]
• 11.11D3 (Post-polio syndrome) [44]

How an ALJ Should Assess Marked Limitation in Concentration, Persistence, or Pace for Medical Equivalence

When evaluating whether chronic intractable migraines medically equal an operative neurological listing—most plausibly Listing 11.02, given its paroxysmal-episode structure [9]—the ALJ must apply the following principles derived from the operative listing text:

1. The "marked limitation" standard. Each operative listing requiring mental-functioning assessment defines the relevant area as "Concentrating, persisting, or maintaining pace (see 11.00G3b(iii))" [9][10][11][12][13][14][15][16][17][44]. "Marked limitation" under 11.00G2 means more than moderate but less than extreme; it seriously interferes with the ability to independently initiate, sustain, and complete activities.

2. Duration and persistence requirements. Listings that include mental-functioning criteria uniformly require that the marked limitation persist for a defined period—typically "at least 3 consecutive months" [10][11][12][14][17]. The two prolonged migraine attacks per month described in the question must therefore produce functional limitations that endure between attacks, not just during ictal periods, to satisfy this durational requirement.

3. Despite adherence to prescribed treatment. Several listings explicitly condition findings on impairment that persists "despite adherence to prescribed treatment (see 11.00C)" [9][14][17]. Longitudinal treatment records documenting at least two prolonged attacks per month despite prescribed triptan prophylaxis directly parallel this requirement and support equivalence analysis.

4. The physical-functioning prerequisite in paragraph C-type criteria. For listings with a paragraph C structure (e.g., 11.02C, 11.04C, 11.08C), marked limitation in concentrating, persisting, or maintaining pace must be accompanied by marked limitation in physical functioning (see 11.00G3a) [9][10][11]. An ALJ must therefore separately evaluate and document physical-functioning limitation; marked limitation in concentration/persistence/pace alone is insufficient under these paragraphs without the concurrent physical-functioning limitation.

5. The seizure-frequency analogy under Listing 11.02. Listing 11.02C requires generalized tonic-clonic seizures occurring at least once every 2 months for at least 4 consecutive months despite treatment, plus a marked limitation in one enumerated area [9]. Listing 11.02D requires dyscognitive seizures at least once every 2 weeks for at least 3 consecutive months despite treatment, plus a marked limitation [9]. Two prolonged migraine attacks per month despite prophylaxis is analogous in frequency to the 11.02C threshold; the ALJ must determine whether the attack frequency and functional impact are at least of equal medical significance.

Absence of Objective Neuroimaging

None of the operative neurological listings with paragraph B/C mental-functioning criteria require objective neuroimaging abnormalities as a prerequisite for finding marked limitation in concentrating, persisting, or maintaining pace [9][10][11][12][13][14][15][16][17][44]. The listings focus on functional limitation and clinical documentation of episodic manifestations despite treatment, not on imaging correlates. This is consistent with the Listings' inclusion of conditions like epilepsy [9], where interictal examination may be normal and the diagnosis rests on description of typical episodes, not imaging.

Key Points

• Listing 11.03 is [Reserved] and has no operative paragraphs B or C [26]. Equivalence must be assessed against other operative listings.
• SSR 11-2p is not within the provided sources and cannot be cited for authoritative guidance here.
• Marked limitation in concentrating, persisting, or maintaining pace is assessed under the 11.00G3b(iii) framework, which is identically structured across all operative neurological listings with paragraph B/C criteria [9][10][11][12][13][14][15][16][17][44].
• Paragraph C-type criteria require concurrent marked limitation in physical functioning; marked limitation in mental functioning alone is insufficient [9][10][11].
• Despite-adherence-to-treatment language is built into the listings [9][14][17]; longitudinal records documenting breakthrough attacks on prescribed triptan prophylaxis satisfy this condition.
• Objective neuroimaging abnormalities are not required to establish marked limitation in concentration, persistence, or pace under any operative neurological listing's paragraph B or C [9][10][11][12][13][14][15][16][17][44].
• Listing 11.02 provides the strongest structural analogy for paroxysmal neurological episodes occurring with defined frequency despite treatment [9].