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 be noted 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.
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 vary depending on the progression of the disease and whether the patient has periods of exacerbations and remissions.
To qualify for disability, Social Security requires that your disability has lasted or is expected to last 12 months. This 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. The 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.
The effects of multiple sclerosis on the body can be great, and MS can affect multiple parts of the body. Some symptoms include:
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.
Multiple sclerosis has a specific listing in Social Security's blue book (the listing of impairments that automatically qualify for disability) under the section for neurological disorders. Listing 11.09 is for adults and 111.09 for children. The listing was updated significantly in 2016. In order to meet the listing, you must now show that you have at least one of the following:
Note that marked means worse than moderate, but less than extreme.
For children with multiple sclerosis, meeting the first set of symptoms will qualify them for SSI (if they meet the financial requirements).
In addition to qualifying under the specific MS listing, individuals who suffer from MS may 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 overall severity and must be considered by Social Security in its overall analysis of whether you are disabled. Note that a drop in I.Q. of at least 15 points that results in marked limitations is no longer is method of qualifying for benefits for multiple sclerosis.
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). However, there are many other brain problems that can cause MRI imaging abnormalities. With MS, the radiologist will typically report white matter lesions involving the connecting nerve bundles in the brain. But they are not diagnostic by themselves.
Another test sometimes used to help with the diagnosis of multiple sclerosis is the spinal tap or lumbar puncture. A number of proteins may exist in the cerebrospinal fluid that suggest MS, but these are of limited value and not agreed-upon. To detect damage to the optic nerve, a possible problem with MS, visual evoked potentials may show abnormality in the brain’s electrical response to a flashing light.
The medical evidence must objectively support a diagnosis MS; Social Security is under no obligation to accept your doctor’s diagnosis of MS, especially since this is a diagnosis with 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.
The medical evidence required to prove MS-related impairments includes medical reports from treating physicians and tests related to the alleged impairment. For example, specific eye tests results demonstrating a loss of visual acuity, peripheral vision, or visual efficiency are required to prove a severe decrease in vision. 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 deficient that, even in the better eye and even after best correction has been made, the residual eyesight is 20/200 or worse. Therefore, most patients with MS do not have visual loss severe enough to qualify under the listing for vision loss (in fact, Social Security removed vision problems from its listing for multiple sclerosis).
If you are trying to claim severe fatigue and weakness caused by MS, doctor's documentation must show that the fatigue and weakness are a result of the MS.
If you're an adult and are not found to be disabled under the above disability listing, Social Security will evaluate your ability to perform any job based on your current impairments, age, education, and work experience. Social Security will first assess your physical, mental, and sensory limitations using a Residual Functional Capacity (RFC) form.
Social Security will create a physical RFC for you that includes any physical and sensory limitations you have. It will go over your ability to sit, stand, and walk, as well as your capacity to lift, carry, and push or pull items. For those with MS, some of the physical impairments that could appear on your 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 common in MS, should be included in the 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 a return to work if they are considered severe enough.
Next Social Security will compare your RFCs to the jobs that are available to someone with your education and experience to see if there's any work you can do. Social Security will also take into account your age; after a certain age, Social Security won't expect you to learn a new job. 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 and what to do before applying for disability for MS.