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Medical Criteria Needed to Qualify with Multiple Sclerosis

Multiple Sclerosis (MS) is an unpredictable and disabling disease of the central nervous system. The intensity and severity of the condition vary widely from person to person.

While some people may only have mild symptoms such as numbness and tingling, others are affected by blindness and complete paralysis. If you have difficulty working due to your MS diagnosis, the Social Security Disability Insurance Program (SSDI) might be of assistance.

Because multiple sclerosis affects people in such different ways and is so variable day-to-day, not everyone who has MS will be awarded financial assistance for their disability.

In fact, some people experience difficulty proving that they are too ill to work with MS due to the variability in their illness. The key to winning a disability claim for MS lies in providing sufficient medical documentation.

Each person who applies for financial support from the Social Security Administration (SSA) is responsible for providing the evidence regarding their condition and its severity.

While the SSA may offer some assistance in gathering specific information, your ability to provide timely, accurate, and complete medical records about your condition will help your application to be processed more quickly.

The Importance of the “Blue Book”

The SSA lists all of the qualifying medical conditions in a medical guide known as the Blue Book. Each listing in the Blue Book includes the major criteria for evaluating impairments. Multiple sclerosis is a disease of the central nervous system that is listed in section 11.09, of the Blue Book.

Because MS affects other systems of the body beyond the nervous system, applicants may qualify for benefits under separate listings. For example, many people with MS experience difficulty with vision.

As such, they might be evaluated under the criteria listed in section 2.02, visual acuity. Additionally, many people with MS experience mental disorders due to the location of the illness in the brain. Individuals with MS might meet the psychological impairment listings as described in section 12.02.

It is imperative to work with your doctor to determine which listings that you might meet, as well as what medical tests you have on hand and which may still need to be completed.

Ensuring that you have all of your medical evidence in order will be a vital component of your application process. To help you with the information gathering process, here is the most relevant medical evidence that you will need to provide to give you the best chance of being approved for SSDI.

Evidence Needed Related to Your Multiple Sclerosis

The first type of medical evidence that the Blue Book directly requests is a complete medical history of your multiple sclerosis. You should be able to provide a full account of your multiple sclerosis, including your presenting symptoms and progression of your disease. Your neurologist should perform a thorough physical and neurological exam.

Be sure to address the following limitations in motor functioning, if present:

  • Any difficulty that you might experience with movement of two extremities, such as your legs, arms, fingers, wrists, hands, or shoulders.
  • Any difficulty that you might experience moving from a seated position to a standing position
  • Any troubles that you might have maintaining balance standing or walking
  • Any need for use of an assistive walking device, such as two canes, two crutches, or a walker
  • Any challenges you have with using your arms, hands, shoulders or wrists that makes it difficult to perform any work-related activities
  • Any other physical functioning limitations should be carefully documented by your neurologist
  • These limitations must persist for at least 3 months after your injury

According to the Blue Book, certain physical limitation criteria would make you eligible for disability benefits. Be sure that your neurologist documents any physical limitations including, but not limited to, the following:

  • Any difficulty that you might experience with movement of two extremities, such as your legs, arms, fingers, wrists, hands, or shoulders. By two extremities, the SSA means both lower extremities, both upper extremities, or one upper and one lower
  • Any difficulty that you might experience moving from a seated position to a standing position
  • Any troubles that you might have maintaining balance standing or walking, including problems with double vision
  • Any challenges you have with using your arms, hands, shoulders or wrists that makes it difficult to perform any work-related activities
  • Any problems with breathing or any use of assistive breathing devices, such as a CPAP machine should be documented
  • Any issues that you experience with vision
  • Any difficulties that you have with swallowing or eating
  • Any other physical functioning limitations should be carefully documented by your neurologist

According to the Blue Book, certain neurological mental functioning deficits may occur as a result of your multiple sclerosis that might make you eligible for benefits. Be sure that your neurologist documents any mental limitations including, but not limited to, the following:

  • Any problems that you have understanding, remembering, or applying information
  • Any challenges that you might have in interacting with others
  • Any difficulty you might experience with concentrating, persisting, or maintaining pace with your work
  • Any challenges that you have regulating your emotions in public

The SSA will accept medical documentation from any healthcare provider. However, more weight is placed on the opinion of medical specialists. As a result, you should work with your neurologist to gather this medical information.

Evidence Needed Related to Your Multiple Sclerosis Treatments

The treatment for multiple sclerosis varies depending on the type of MS that you have, as well as the severity. The SSA will need to know exactly what treatments you have received, your response to those treatments, and most importantly if your condition has worsened despite those treatments.

The Blue Book indicates that you need to have the above symptoms and that the symptoms must be unresponsive to medication for at least three consecutive months of treatment.

Be certain that your doctor has documented the following:

  • Any and all medications that you are receiving as a result of your multiple sclerosis, as well as your response to the medications
  • Any IV therapy you require, as well as any of the side-effects
  • Any physical therapy, physiotherapy, or other related therapies that you are receiving
  • Any mental health treatment that you receive, such as records from your psychologist or psychiatrist
  • Any complementary and alternative approaches that you are using
  • Information on your reactions and side effects to any treatments or medications

Evidence Needed Related Your Quality of Life and Ability to Care for Yourself

As noted above, some people who have had multiple sclerosis will not qualify for SSDI benefits through the Blue Book neurological listing. However, you still may be too ill to work. If this is the case for you, it becomes even more important that your physician carefully document all of your limitations.

The more specific that your doctor is about your limitations, the better your chances are of being approved for disability benefits. Your physician should document any activities that you may have difficulty with, such as walking, seeing, or general functioning.

Additionally, if your disease has progressed or is expected to advance, as will often be the case, this is also important to note.

Steps You Can Take to Win Your Disability Claim

Many individuals who apply for SSDI for multiple sclerosis are initially denied. However, as it is a progressive disease, those who reapply sometimes win their cases.

If you haven’t applied yet, or if you have applied and were denied, keep in mind that your ability to provide sufficient medical documentation is invaluable. Obtaining medical records can be a cumbersome process.You may need to contact your doctor’s office and your hospital to gather all of your information.

The entire Blue Book is available online, and the section on Neurological disorders is quite detailed, so you may want to review section 11.12 with your neurologist to determine what medical records you have on hand, and what may need to be supplemented to be approved.

There are several ways that your neurologist or primary care physician can help including:

  • Ensuring that your full medical history related to your multiple sclerosis is up to date
  • Listing your past treatments and responses, as well as the plan for the future
  • Documenting all of your medications and experienced side effects
  • Writing a medical statement outlining your limitations and the progression of your illness
  • Describing any changes in your mood, personality, intellectual ability, or memory

A Social Security disability attorney or advocate can assist you in ensuring that you claim for disability is thorough, thus increasing your chances for approval. Consider a Free Evaluation with a Social Security advocate or attorney in your area today—Disability lawyers are only paid if you win your multiple sclerosis claim.