Getting Disability for Multiple System Atrophy (MSA), or Shy Drager Syndrome

Multiple system atrophy, or MSA, is a rare and progressively worsening neurodegenerative disorder that affects the autonomic nervous system. Other names for the disorder are Shy-Drager Syndrome, neurologic orthostatic hypotension, Shy-McGee-Drager Syndrome, Parkinson's Plus Syndrome, atriatogrinal degeneration, sporadic olivopontocerebellar atrophy, MSA-P (predominant Parkinsonism), and MSA-C (with cerebellar features). Whatever the name, MSA is a very serious disease that eventually leads to significant disability and death.

The symptoms of MSA include:

• difficulty moving facial muscles
• difficulty chewing and swallowing
• incontinence or other bladder issues
• balance and coordination issues
• dizziness
• slowed movement
• tremors
• voice changes, and
• blood pressure changes, especially upon standing.

How Is MSA Diagnosed?

There is no specific test for MSA, and it is often confused with Parkinson's disease because of the similarity of some of the symptoms. However, MSA is distinct in that it causes damage to the autonomic nervous system, which controls bodily functions such as heart rate, blood pressure, digestion and bladder functioning.

Diagnosis is based primarily on doctor observation. However, a brain MRI showing abnormalities in the striatum, pons, and cerebellum can be highly suggestive of MSA. In evaluating whether you are disabled due to MSA, Social Security will look for clinical evidence of autonomic system dysfunction, your response to treatment, neurological reports, and evidence of limitations on your activities of daily living (ADLs) submitted by a relative or caregiver.

Does My MSA Diagnosis Qualify Me for Disability Benefits?

In order to qualify for benefits under either Social Security Disability Income (SSDI) or Supplemental Security Income (SSI), you must have a disability or a combination of disabilities that has lasted or can be expected to last 12 months or more (or result in death).

In addition, you qualify for SSDI only if you have worked long enough and recently enough to earn enough quarters of coverage by paying Social Security taxes. You qualify for SSI, which is a needs-based program, if you meet certain income and resource limits.

Social Security will evaluate whether you have a disability in one of three ways. Either your disability will be found to "meet a listing" or "equal a listing, or your impairments must render you unable to do your previous or any other work for which you are qualified. Because of the severity of the disorder and its poor prognosis, Social Security has identified MSA as one of the disorders that can qualify for a fast-tracked approval under the Compassionate Allowance program.

Do I Meet the Listing for MSA?

Social Security has a list of impairments that are automatically considered disabling if certain symptoms and test results are established by your medical evidence. There is no specific listing for MSA, but Social Security usually evaluates MSA under the disability listing for Parkinson's disease.

To qualify for benefits under the Parkinson's listing (11.06), your medical records must document 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), despite at least three months of treatment. This must result in extreme difficulty in the ability to balance while standing or walking, to stand up from a seated position, or to use the arms.

OR

• "Marked" physical problems along with a "marked" limitation in any one of the following:
  • thinking (understanding, remembering, or applying information)
  • interacting with others (social problems), or
  • finishing tasks (problems with concentration, persistence, or speed).

Note that marked means worse than moderate, but less than extreme.

Does My MSA Equal a Listing?

If you don't meet the specific criteria described above, your condition may still be found to be disabling if your symptoms are of equal severity to those in one of Social Security's other listings. Since MSA affects many bodily functions, there are several listings that can be used to evaluate the severity of your disability.

If you have problems with communication or movement, you might be able to equal the listing for cerebral nervous system vascular accident (stroke) in two extremities. If your MSA impacts your cognitive abilities, such as significant memory impairment or disorientation to time and place, you might equal the listing for organic mental disorders. if your MSA has caused significant damage to your vision, Social Security might also evaluate you under the listing for visual disorders.

Will I Qualify for the Compassionate Allowance Program?

The compassionate allowance program was designed by Social Security to quickly identify those disorders that would very likely meet a listing with minimal evidence. If you have one of the disorders qualifying for compassionate allowance, your claim will be entitled to expedited review and you may get your benefits in a short period of time. However, just because you have MSA, it does not mean that you will automatically qualify for compassionate allowance nor automatically qualify for benefits. The strength of the medical evidence you submit is crucial to the determination as to whether your claim will be considered under the compassionate allowance program. There must be a clear-cut diagnosis of MSA and it must be supported by evidence such as MRIs, neurological evaluations, and doctors' treatment notes. It can be helpful to submit a letter from your doctor specifically setting forth your diagnosis and the findings that led to the diagnosis. For further information about this program, see our article on Social Security's compassionate allowances.

If the medical evidence is not sufficient to qualify you for compassionate allowance, your claim will still be reviewed under the same time frame and guidelines as any other disability.

How Can I Prove Disability Because I Can't Work?

If you don't meet or equal a listing, Social Security will examine the impact of your MSA on your ability to work. You can still qualify for disability benefits if you can show Social Security that you are unable to return to your past work or any other work for which you are qualified.

Since MSA affects so many bodily functions, there are many issues that may impact your ability work, but whether you are found disabled will depend on how far the degeneration has progressed. If you are having significant balance and coordination issues, for example, there may be a safety issue in the workplace that would make it impossible for you to return to work. If you are experiencing significant muscle rigidity, making fine and gross motor coordination difficult, there are very few jobs you can do without the use of your arms and hands and you would qualify for disability. If you have significant cognitive decline, you might be unable to concentrate on tasks in the workplace or even remember what you are supposed to do.

If these limitations are well established in the medical records, your claim is likely to be approved. If you are older than 50, Social Security will also take into account your age, education and job skills to determine whether there is any job you can possibly learn to do. The older you are, the more likely you are to be found disabled, because Social Security does not expect you to switch vocations when you are older than 50 or 55. Because MSA is generally found in adults aged 50 and above, it can be relatively easy to prove an inability to work when you have MSA, and thus qualify for disability benefits.