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Medical Criteria Needed to Qualify with Myasthenia Gravis

Myasthenia gravis (MG) is an incurable autoimmune condition that causes varying levels of muscle weakness. A myasthenia gravis diagnosis can be devastating. Perhaps the most challenging aspect of the diagnosis is the unpredictable nature of the illness.

For some, MG is mild and can be well controlled. For others, progressive muscle weakness makes it impossible to continue working.

Thankfully, the Social Security Disability Insurance Program (SSDI) was developed to assist people, such as yourself, who have become disabled due to a diagnosis such as myasthenia gravis.

Not everyone who has been diagnosed with myasthenia gravis will qualify for SSDI benefits. Often, even those who need financial assistance are turned away due to their inability to provide sufficient medical evidence documenting their illness and its severity.

The Social Security Administration (SSA) places the onus on the applicant to provide the medical documentation supporting their need to be out of work. As such, it is imperative that you gather all of the required documentation as quickly as possible.

The Importance of the “Blue Book”

The information for qualifying for Social Security disability benefits for myasthenia gravis can be found in section 11.12 of the Blue Book. The Blue Book is a medical guide used by the SSA to determine whether or not a condition such as myasthenia gravis is severe enough to warrant disability payments.

Many people with myasthenia gravis may not meet the listing in the Blue Book, and yet the will remain too ill to work. You should work with your physician to review the Blue Book and ensure that you have completed all of the medical tests required by the SSA.

According to the Blue Book, here is the most relevant information that you will need to provide to give you the best chance of being approved for SSDI disability benefits.

Evidence Needed Related to Your Myasthenia Gravis

The first type of medical evidence that the Blue Book directly requests is a complete medical history of your myasthenia gravis. You should be able to provide a full history of your myasthenia gravis, including your presenting symptoms and progression of your disease.

Your neurologist should perform a full physical and neurological exam and should include the following in his notes:

  • Reflex response
  • Muscle strength and tone
  • Senses of touch and sight
  • Alterations in mental status
  • Gait, posture, coordination, and balance

Be certain 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, specific neurological mental functioning deficits may occur as a result of your myasthenia gravis that might make you eligible for benefits.

Be certain that your neurologist documents any mental limitations including, but not limited to, the following:

  • Any problems that you have understanding, remembering, or applying information
  • Challenges that you might have understanding and learning terms, instructions, or procedures
  • Difficulties that you might have asking and answering questions and providing explanations
  • Any problems that you have in using reason and judgment to make work-related decisions

Any challenges that you might have in interacting with others. Examples might include:

  • Cooperating with colleagues, co-workers, and bosses, including handling conflicts, asking for help when needed, and sustaining conversation
  • Responding appropriately to requests, suggestions, criticism, correction and challenges
  • Keeping social interactions free of excessive irritability, sensitivity, argumentativeness, or suspiciousness

Any difficulty you might experience with concentrating, persisting, or maintaining pace with your work. Examples might include:

  • Keeping up with your working and completing projects in a timely manner
  • Sustaining an ordinary routine and regular attendance at work
  • Working a full day without needing more breaks than the rest of the group
  • Avoiding distractions and not disrupting others

Any challenges that you have regulating your emotions in public. Examples might include:

  • Remaining flexible and adapting to changes as needed
  • Caring for your personal hygiene and appropriate work attire
  • Understanding the difference between acceptable and unacceptable work behavior

The odds are that you work with several physicians. As the SSA gives more leverage to the opinion of medical specialists, it makes sense that you work with your neurologist to gather all of the required medical information.

Evidence Needed Related to Your Myasthenia Gravis Treatments

The treatment for myasthenia gravis varies from person to person. The SSA will need to know precisely 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 sure that your doctor has documented the following:

  • Any and all medications, such as cholinesterase inhibitors, steroids, or immunosuppressant’s that you are receiving as a result of your myasthenia gravis, as well as your response to the medications
  • Any IV therapy you require, such as plasmapheresis or IV immunoglobulin (IVIg), as well as any of the side-effects
  • Any surgical procedures that have been performed, such as a thymectomy, including operative notes from the surgeon
  • All imaging records, such as CT scans or MRIs
  • Any physical therapy or other related therapies that you are receiving

As noted earlier, not every patient will meet a particular qualifying condition’s listing as described by the Blue Book. Still, you may be unable to work. Information on your reactions and side effects to your treatments or medications are essential to provide to the SSA.

You will need to demonstrate that you are too ill to work and that your symptoms are expected to last for at least one year.

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

Some people who have had myasthenia gravis will not qualify for SSDI benefits through the Blue Book neurological listing. However, you still may be too ill to work. For example, MG causes most individuals to feel extreme fatigue.

Fatigue is not listed as a symptom in listing 11.12 of the Blue Book. However, most people will agree that extreme fatigue caused by an illness make it too difficult to work.

The more specific that your doctor is about your limitations, the better your chances are of being approved for disability benefits.

If you do not meet the Blue Book listing, but you are still unable to work due to your limitations, you may still qualify for disability through a residual functioning capacity assessment.

Steps You Can Take to Win Your Disability Claim

The difficulty with earning benefits for myasthenia gravis lies in the fact that the symptoms of the illness may wax and wane. The symptoms may fluctuate or come and go.

If you haven’t applied yet, or if you have applied and were denied, keep in mind that the single best thing that you can do for your case is to gather as much medical information as possible.

You may want to take a few minutes to review section 11.12 with your Neurologist to ensure that you have obtained all of the medical tests required by the SSA, and what additional information may be needed for your approval.

While you don’t need to provide medical documentation to the SSA yourself, it is helpful to be as organized as possible. When you visit your doctor, it is a good idea to present a written list of symptoms and side-effects that you are experiencing.

When you are not feeling well, it can be difficult to perform day-to-day tasks, never mind taking on a project such as an SSDI benefits application. Hiring a Social Security disability attorney or advocate will improve your chances for approval.

An experienced lawyer can help guide you through this cumbersome application process, leaving time for you to take better care of your health.