What is Multiple Sclerosis?
Multiple sclerosis (“MS”) is an autoimmune disorder, of unknown cause, in which the body's immune system attacks and damages the myelin sheaths that coat, nourish, and protect nerve fibers in both the brain and spinal cord.
Symptoms of MS
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.
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.
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.
For Further Reading
National Institutes of Health (NIH)
UCLA Medical Center