What is a Multiple Sclerosis?
Multiple sclerosis (MS) is an inflammatory disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of parts of the nervous system to communicate, resulting in a wide range of signs and symptoms, including physical, mental, and sometimes psychiatric problems.MS takes several forms, with new symptoms either occurring in isolated attacks (relapsing forms) or building up over time (progressive forms). Between attacks, symptoms may go away completely; however, permanent neurological problems often occur, especially as the disease advances.
While the cause is not clear, the underlying mechanism is thought to be either destruction by the immune system or failure of the myelin-producing cells. Proposed causes for this include genetics and environmental factors such as infections. MS is usually diagnosed based on the presenting signs and symptoms and the results of supporting medical tests.
There is no known cure for multiple sclerosis. Treatments attempt to improve function after an attack and prevent new attacks. Medications used to treat MS while modestly effective can have adverse effects and be poorly tolerated. Many people pursue alternative treatments, despite a lack of evidence. The long-term outcome is difficult to predict, with good outcomes more often seen in women; those who develop the disease early in life; those with a relapsing course; and those who initially experienced few attacks. Life expectancy is 5 to 10 years lower than that of an unaffected population.
Some common symptoms of MS include almost any neurological symptom or sign; with autonomic, visual, motor, and sensory problems being the most common. The specific symptoms are determined by the locations of the lesions within the nervous system, and may include loss of sensitivity or changes in sensation such as tingling, pins and needles or numbness, muscle weakness, very pronounced reflexes, muscle spasms, or difficulty in moving; difficulties with coordination and balance (ataxia); problems with speech or swallowing, visual problems (nystagmus, optic neuritis or double vision), feeling tired, acute or chronic pain, and bladder and bowel difficulties, among others. Difficulties thinking and emotional problems such as depression or unstable mood are also common. Uhthoff’s phenomenon, a worsening of symptoms due to exposure to higher than usual temperatures, and Lhermitte’s sign, an electrical sensation that runs down the back when bending the neck, are particularly characteristic of MS.
Can I receive Social Security Disability benefits for Multiple Sclerosis?
Multiple Sclerosis can cause symptoms, limitations and restrictions that can impact your ability to work. Social Security Disability benefits may be available to you if you suffer from MS.
If you are not engaging in gainful activity due to MS and its symptoms or limitations, the Social Security Administration must determine if you have an impairment that is “severe.” This is step 2 of the evaluation process. (Visit my prior blog post explaining the steps of Social Security’s Sequential Evaluation Process.)
Generally, to establish MS as a medically determinable severe impairment, you should provide:
• Objective medical testing establishing MS (i.e., MRI results, etc.); and/or
• Evidence of consistent and repeated symptoms despite treatment.
At step 3 of the Sequential Evaluation Process, the SSA determines if your condition meets a listing. For multiple sclerosis, SSA will determine if your condition meets Listing 11.09. To meet this listing, you must show:
A. Disorganization of motor function as described in 11.04B; or
B. Visual or mental impairment as described under the criteria in 2.02, 2.03, 2.04, or 12.02; or
C. Significant, reproducible fatigue of motor function with substantial muscle weakness on repetitive activity, demonstrated on physical examination, resulting from neurological dysfunction in areas of the central nervous system known to be pathologically involved by the multiple sclerosis process.
The key to meeting the listing is to have the appropriate objective medical testing and a longitudinal medical history that addresses each of the requirements. A knowledgeable social security attorney can help you determine if your MS meet the listing.
If your related symptoms do not equal a listing, the Social Security Administration will next assess your residual functional capacity (RFC) (the work you can still do, despite your multiple sclerosis), to determine whether you qualify for benefits at steps 4 and 5 of the Sequential Evaluation Process. The lower your RFC, the less the Social Security Administration believes you can do. In determining your RFC, the Social Security Administration adjudicator should consider all of your symptoms in deciding how they may affect your ability to function.
Tips for SSDI Application for Multiple Sclerosis
- Make sure that the medical records diagnosing the Multiple Sclerosis and its progression are included. This is usually done by MRI results but may include other appropriate testing. It is important that you “know your medical records.”
- Make sure your medical records document ALL of your symptoms and limitations, and the residual effects you experience. Your medical records should not just document your MS, they should include notes on your symptoms like how often you feel symptoms, how severe each symptom is and how long each symptom lasts. Make sure that all your medical problems are adequately documented by your doctor, and that you are receiving the appropriate medical attention for all of your disabling symptoms. Make sure any side effects of medication are noted in your records.
- Have someone assist you with your claim if your memory, concentration, etc. prevent you from completing the forms yourself.
- See a specialist. Treatment of MS by a neurologist is important.
- Comply with your doctor’s orders and try what is recommended like physical therapy, cognitive training, diet and exercise, smoking cessation, weight loss, etc. The key is that you want your records to show that you are concerned with your health and are working with your doctor to improve.
- See a mental health professional. If you are suffering from depression or anxiety as a result of the chronic problems and inability to participate fully in life, see a mental health professional to diagnose, treat, and document these conditions.
- See your doctor regularly and keep your appointments.
- If you can, provide evidence of a long work history.
- Provide examples of unsuccessful attempts to return to to work and/or unsuccessful attempts to work in a decreased capacity, if applicable.
- Include information from non-medical sources to support your medical claims. Gather Information from neighbors, friends, relatives, clergy, and/or past employers about your impairments and how they affect your function. Have them document changes that they have seen in your ability over time. These are not given nearly as much weight as testimony from a medical professional, but they don’t hurt.
- Keep a journal. Make regular notes about your impairment, level of function, and treatments.
- If you need assistance with your claim, contact an attorney who specializes in Social Security Disability.