Applying for Disability Benefits With Multiple Sclerosis (MS)

Multiple sclerosis (MS) is a chronic autoimmune disease that affects your central nervous system, including your brain, spinal cord, and optic nerves. MS causes neurological problems by damaging the insulating sheaths around nerves, known as demyelination.

MS is generally a progressive disease; over time, the symptoms will get worse and more debilitating and, eventually, loss of functions will occur even in periods with few to no symptoms. Each person is different; some have rapidly progressive worsening while others go for years without any significant symptoms.

Is MS a Disability?

To qualify for disability, Social Security requires that your disability has lasted or is expected to last 12 months. This requirement can be an issue for patients with MS, since most forms of MS are "episodic," meaning there are periods when it makes you sick and periods when you have little to no symptoms. The periods of sickness are called episodes, exacerbations, or relapses, and can vary in length and severity. Periods with few symptoms are called remissions.

Social Security does recognize that MS is episodic in nature, so the agency will evaluate the frequency and length of your episodes, the time between your episodes, and the presence of permanent impairments even in times of little to no symptoms, to determine if you are disabled.

Types of Multiple Sclerosis

There are several types of MS, including:

• relapsing-remitting multiple sclerosis (RRMS)
• primary-progressive MS
• secondary-progressive MS, and
• progressive-relapsing MS.

The symptoms of these types of MS vary depending on the progression of the disease and whether the patient has periods of exacerbations and remissions. Primary-progressive MS (PPMS) is generally the most debilitating, but it's also the least common form of MS. Malignant MS, or fulminate MS, refers to a rapidly progressive form of MS with severe relapses within five years after diagnosis.

Disabling Symptoms of MS

The effects of multiple sclerosis on the body can be great, and MS can affect multiple parts of the body. Some symptoms include:

• loss of balance
• problems with walking and coordination
• tremors or weakness in the legs and arms
• banding pain around the torso ("MS hug" or "dysesthesia")
• bowel and bladder problems, including constipation and frequent need to urinate
• vision or hearing loss
• numbness, tingling, or pain in the face, arms, or legs
• problems concentrating and remembering things
• speech problems, including slurred speech, and
• fatigue and/or depression.

Getting Disability for MS

If your multiple sclerosis is advanced, you have a good chance of getting approved for Social Security disability benefits. In order to qualify for Social Security disability benefits for MS, you must meet the requirements of Social Security's disability listing for MS or prove that your MS has limited your functioning so much that you can no longer work.

How to Get Approved Under the Multiple Sclerosis Listing

Multiple sclerosis has a specific listing in Social Security's Blue Book (the listing of impairments that automatically qualify for disability). The MS listing, listing 11.09, falls under the section for neurological disorders. In order to meet the listing, you must show that you have at least one of the following:

• the inability to control the movement of at least two extremities (either an arm and a leg or two arms or two legs) that results in extreme difficulty in:
  • balancing while standing or walking
  • standing up from a seated position, or
  • using the arms.

OR

• "marked" physical problems along with a "marked" limitation of any one of the following:
  • thinking (understanding, remembering, or applying information)
  • interacting with others (social issues)
  • finishing tasks (problems with concentration, persistence, or speed),
  • managing oneself (adapting to changes, responding to demands, setting realistic goals).

Note that marked means worse than moderate, but less than extreme. You can think of it as severe. Also, a drop in I.Q. of at least 15 points that results in marked limitations is no longer a method of qualifying for benefits for multiple sclerosis.

Children with multiple sclerosis must meet only the first set of symptoms to qualify for SSI (if they meet SSI's financial requirements).

In addition to qualifying under the specific MS listing, individuals who suffer from MS could also qualify under other listings if other body systems have been affected by the disease. While it's rare for any one secondary impairment to qualify under another listing, all problems add to the overall severity of a person's impairment. Social Security must consider all conditions in its overall analysis of whether you're disabled.

Get Medical Evidence to Increase Your Chances of Getting Disability for MS

Diagnosis of MS. To qualify under the multiple sclerosis listing, you must first have a diagnosis of MS. The test most used to help diagnose MS is magnetic resonance imaging (MRI). With MS, the radiologist will typically report white matter lesions involving the connecting nerve bundles in the brain. But MRIs are not diagnostic by themselves, because other brain problems can cause MRI imaging abnormalities.

Another test sometimes used to help with the diagnosis of multiple sclerosis is a spinal tap or lumbar puncture (a number of proteins may exist in the cerebrospinal fluid that suggests MS). But some experts think these tests are of limited value. Another option can detect damage to the optic nerve, a possible problem with MS in some people. Doctors use "visual evoked potentials" to show abnormality in the brain's electrical response to a flashing light.

Your medical evidence must objectively support a diagnosis of MS; Social Security isn't under an obligation to accept your doctor's diagnosis of MS, especially since this is a diagnosis with a significant error by doctors. On the other hand, Social Security will accept reasonable evidence for the diagnosis if it's consistent with what most doctors would agree with.

Proof of impairments. Medical evidence in your record should corroborate your diagnosis by showing your MS-related impairments, which can include:

• fatigue
• difficulty walking
• muscle weakness
• vision loss, and
• cognitive changes.

These impairments should be discussed in your doctor's medical reports and treating notes, along with any tests related to the impairments.

For example, to prove a severe decrease in vision, specific eye test results that show a loss of visual acuity, peripheral vision, or visual efficiency are required. For most MS disability claimants, the visual impairment is lost visual acuity, and in this area, SSA is fairly strict. To satisfy the visual acuity criteria, a claimant's eyesight must be so poor that, even in the better eye and even with glasses or contacts, the residual eyesight is 20/200 or worse. Most patients with MS don't actually have visual loss severe enough to qualify under the listing for vision loss (and in fact, Social Security removed vision problems from its listing for multiple sclerosis).

If you're claiming you have severe fatigue and weakness caused by MS, your doctor's documentation must show that the fatigue and weakness are a result of the MS.

How You Can Qualify by Showing MS Limits Your Ability to Work

If Social Security doesn't find you disabled under the above disability listing, they will evaluate your ability to perform any job based on:

• your current impairments
• your age
• your education, and
• your work experience and skills.

Social Security will first assess your physical, mental, and sensory limitations using a Residual Functional Capacity (RFC) form.

Physical RFC. Social Security will create a physical RFC for you that includes any physical and sensory limitations you have. Your RFC will go over your ability to sit, stand, and walk, as well as your capacity to lift, carry, and push or pull items. For most people with MS, some of the physical impairments that will appear on the RFC are:

• difficulty with balance and walking
• numbness and weakness in the arms and legs, and
• tremors or involuntary movements.

Partial hearing loss, low vision, and speech problems, which are also common in MS, will also be included in the RFC.

Mental RFC. Social Security will also create a mental RFC for you that includes any limitations you have in your ability to understand, remember, and carry out instructions. Individuals with MS can suffer from memory loss and have difficulty concentrating on tasks, so if you have these limitations, you'll want to make sure they appear in your medical record so Social Security can include them in your mental RFC. Either of these mental impairments may prevent your return to work if Social Security considers them severe enough.

Next, Social Security will compare your RFCs to the tasks required in your prior work. If they agree you can't perform your old job, they'll look at the jobs that are available to someone with your education and experience to see if there's any work you can do. For more information, see our article on how Social Security evaluates your RFC to decide if you can work. Also, read our tips on getting disability for moderate or intermittent MS.

How Do I Get Approved for Disability for MS?

Your first step is to apply for Social Security disability insurance (SSDI) or Supplemental Security Income (SSI). If you're applying for SSDI, you can file your whole claim online on Social Security's website. Applying online is generally the quickest way to apply for benefits, but you can fill out the application at your own speed. Most SSI applicants can't file the entire application online, but they can get started on Social Security's website.

You can also apply for disability benefits over the phone by calling 800-772-1213 from 8 a.m. to 7 p.m., Monday through Friday. If you're deaf or hard of hearing, you can call the TTY number at 800-325-0778.

For more information, see our article on applying for Social Security disability benefits.