Symptoms of Multiple Sclerosis
The symptoms that an MS patient experiences may vary from person to person and from time to time. They include muscle spasms, numbness, balance problems, lack of coordination, difficulty with motor function of the arms and legs, unsteady gait, trouble walking, muscle weakness, tremor of the extremities, vision problems (including double vision (diplopia), blurring, or blindness), numbness and tingling, musculoskeletal pain, fatigue, balance problems, dizziness, bladder issues, sexual dysfunction, cognitive impairment, brain fog, difficulty thinking, and depression. Some of these symptoms may be severely disabling (e.g., fatigue, lack of coordination, cognitive dysfunction), and some are not (e.g., sexual dysfunction).
Diagnosis of MS
Of course, when applying for disability benefits for MS, you must first have a firmly established diagnosis of MS by a neurologist. Imaging studies (such as MRI brain scan) and a spinal tap may be required.
The “Listing” for MS
Once you have a diagnosis of MS that is documented and confirmed (e.g., MRI scans, lumbar puncture) in the medical records, Social Security has established certain criteria (which they call a ‘listing”) that, if you meet those criteria, you are automatically deemed to be disabled, without having to prove anything else. The “listing” criteria (Listing 11.09) are described below, but it is not always easy for a claimant to must meet those criteria, because they are very strict. Here is what they include.
- Motor impairment, with constant significant disorganization of function in two extremities that results in persistent disturbance of gross and dexterous movements, or station and gait; or
- Visual impairment, with loss of visual acuity that leaves the vision in the better eye after correction (glasses or contacts) at 20/200; or severe contraction of the visual field, or a visual efficiency in the better eye of twenty percent or less as determined by kinetic perimetry; or
- Mental impairment, with disorientation as to time or place, impairment of short, intermediate, or long-term memory, thinking or perceptual disturbance (including delusions or hallucinations), personality changes, mood disorders, emotional lability (i.e. explosive temper outbursts or sudden crying spells, etc.); or
- Intellectual impairment, with significant restriction of daily activities, social functioning, maintaining concentration, persistence, or pace, and repeated long lasting episodes of decompensation, with documentation by neuropsychological testing; or
- A history of documented MS for at least two years, with more than a minimal limitation in the ability to do basic work activities with symptoms relieved by medication or psychosocial support along with one of the following:
a) residual disease process that has caused a marginal adjustment in which even a small increase in mental demands or change in environment would be predicted to cause the individual to decompensate,
b) or repeated long lasting episodes of decompensation,
c) or a current medical history of one or more years of an inability to functionoutside of a highly supportive living arrangement along with a continued need for this type of living arrangement.
- Substantial fatigue of motor function with significant muscle weakness upon repetitive activity--documented by a physical examination by your physician--caused by neurological dysfunction in areas of the central nervous system acknowledged to be pathologically involved in the MS disease process.
What if You Don't Meet the “Listing?”
Many patients with MS can still get disability benefits, even if they do not meet or equal the impairment listing criteria, under Listing 11.09, because these criteria are very specific. Patients can get a disability award if their MS symptoms have caused significant restriction to their functional abilities and their ability to perform substantial gainful activity, or SGA as it is more commonly known in the parlance of Social Security.
You Need Good Medical Documentation of Your Functional Impairments
Simply having a diagnosis of MS is not enough; it's just the starting point for your disability application. That's because Social Security looks at not only what your diagnosis is (MS) and the symptoms it is causing (motor, visual, mental, or others), but, more importantly, Social Security needs to see how those symptoms impair your ability to function and perform work-related activities (e.g., your ability to sit, stand/walk, or lift/carry; see below).
This is where it's important for you to work with your doctor and make certain that he is recording not only your MS-related symptoms (which doctors are usually pretty good at doing), but that he is also documenting your functional impairments (which some doctors are not so good at doing). It's documentation of your functional impairment that Social Security looks at to give you disability benefits.
Therefore, to improve your chances of getting a disability award, you must get your doctor to consistently enter into your medical records how your symptoms impair your functional ability. For your doctor to do that, you must do your part and tell your doctor, at each office visit, not only what your symptoms are, but also how they impair what you can and cannot do.
Under HIPAA laws and regulations (“Health Insurance Portability and Accountability Act”), you have the right to inspect your medical records (and we recommend that you do so after each office visit), to make certain that the information that you conveying to your doctor, and that you need for your disability claim, is being entered by the doctor (or his nurse) into your “progress notes,” on an on-going basis.
Detailed Medical Documentation
Detailed medical documentation is important for the purposes of a Social Security disability award, as consisting of the following Disability Documentation Triad: (1) Diagnosis. (2) Symptoms. (3) Impairments.
For example, if your neurologist confirms and documents that you have a diagnosis of MS, and if he further documents that you have symptoms from your MS that include substantial fatigue of motor function and weakness (“fatigue”), he must also document how your fatigue causes you to have certain specific functional impairments.
A good way to do that, is for your doctor” (if applicable) to document in the “progress notes” that he prepares at the end of an office visit, that because of your MS-related fatigue, in an 8-hour day, the most you can sit is ____ hours, stand/walk for _____ hours, and lift/carry _____pounds.
Your doctor may document that your condition (if applicable) requires you to lie down and rest for a certain amount of time each day.
"But my doctor says he will put me on disability"
Claimants say this to their lawyers and don't realize that it has absolutely no persuasive force with judges - in fact, it annoys them because doctors are not lawyers who can make a legal conclusion if the claimant is "disabled" under the rules of Social Security Disability; rather the doctors can attest to and document what are the limitations - and detail them clearly.
SSA utilizes the term "Impairments" (and resulting "limitations" - why you cannot work) are the essential bits of information that must be clearly and consistently documented throughout your medical history by the treating sources (medical doctors, psychologists, psychiatrists).
SSA additionally utilizes the term "Residual Functional Capacity" (RFC); this is a key concept related to the resulting physical and/or mental impairments from conditions for which the disability claim is based upon and the impact upon ability to work.
SSA has its own forms that are used for Physical RFC here and for Mental RFC here. These forms can be filled out by the treating source who has the opportunity to examine the patient and understand the limitations which result from his/her condition and thereby document with specificity in the language of SSA disability.
Getting the Right Doctor
It's critical to get a good doctor, who is not only a specialist in MS (e.g., a neurologist), but who will be willing to clearly document and set forth in detail your diagnosis, symptoms, and impairments (the Triad), to get the Social Security disability benefits.
National Institutes of Health (NIH)
UCLA Medical Center
SSA "Listings" or "Blue Book" descriptions of Multiple Sclerosis can be found here (See 11.09)