Multiple sclerosis (MS) is a chronic and often disabling disease of the central nervous system, which consists of the brain, spinal cord, and optic nerves. MS damages myelin, a fatty substance that normally surrounds and protects the nerves. It can also damage nerves within the central nervous system.
Common Symptoms of MS include:
- Abnormal sensations. MS can cause a “pins and needles” sensation, as well as numbness, itching, burning, and/or stabbing pains.
- Difficulty walking. MS can cause muscle weakness and/or muscle spasms, especially in the legs. It can also cause lack of coordination in which the legs and feet do not respond properly to normal muscle commands. These symptoms can make it difficult to walk.
- Fatigue. One of the most common problems MS clients report to me is severe fatigue, that they just do not have any energy. Chronic fatigue is well recognized in the medical literature as a common symptom of MS.
- Vision problems. MS can cause major problems with vision, such as blurred vision or double vision.
- Difficulty thinking. Another common problem clients report is difficulty thinking, getting forgetful, and having a hard time processing information and making decisions.
- Bladder and bowel problems. MS can cause frequent urination and difficulty emptying the bladder. Bowel problems, especially constipation, are also common.
MS is usually difficult to initially diagnose. The initial symptoms are often subtle and variable and usually go away after a period of time. Moreover, there are many other medical problems than can cause similar symptoms. If you are worried about unexplained symptoms, it is important to see your family doctor. If the symptoms persists, it is appropriate to get a thorough examination by a neurologist. A brain MRI has become a very useful test in diagnosing MS.
Listing 11.09 sets forth the criteria for disability due to MS. (A) addresses disorganization of motor function. (B) addresses visual impairment. (C) addresses fatigue. In many cases, my client’s disease meets the criteria of Listing 11.09 by the time he/she stops working. I usually prepare a questionnaire for the treating neurologist which addresses each of the criteria of 11.09. When the neurologist affirms symptoms that meet the 11.09 criteria, that is very helpful in persuading the Social Security Administration to award disability benefits.
In some cases, there is no treating neurologist, or the MS symptoms do not clearly meet the 11.09 criteria. For example, I have had cases where the most debilitating symptom has been severe fatigue. Fatigue is a subjective symptom that is very difficult to prove.
In these cases I recommend a two-fold strategy. First, I try my best to convince the administrative law judge (ALJ) that the diagnosis of MS is accurate. SSA awards disability based on the severity of symptoms, not a particular diagnosis. However, when I can establish a definitive diagnosis of MS, I have found the ALJs to be more receptive to my client’s testimony on subjective symptoms such as fatigue and pain than in non-MS cases.
I have been handling MS cases for 25 years. It has been my experience that ALJs are very knowledgeable and understanding about multiple sclerosis. The two (unwritten) standards I find an ALJ wants my client to meet are (1) an MRI that shows abnormalities consistent with MS and (2) a medical history that shows the disease is in an advanced stage. If my client and I can show (1) and (2), the ALJ will normally award disability benefits even when we cannot show that the 11.09 criteria are met.
It should be noted that I have not found the Medical Vocational Guidelines (the Grids) helpful in most MS cases. The reason is most of my MS clients have been younger than 50 years old, and these regulations are not helpful to claimants under 50.
In summary, the Social Security Administration recognizes MS as a medical condition that can be disabling. The decision to award disability benefits is based on the severity of symptoms, not the diagnosis. Due to the inherent medical complexity of this disease, and the difficulty in proving its symptoms, I recommend the claimant hire an experienced disability attorney to assist you with your disability case.