Multiple Sclerosis and Social Security Disability Claims
By Pitt Dickey

This column will examine how the Social Security Administration evaluates Disability Insurance Claims for people who are diagnosed with Multiple Sclerosis. The Social Security Administration (SSA) has a set of criteria that it uses called Listings to determine whether a person is eligible for monthly disability insurance payments. To obtain disability insurance benefit payments from the SSA a person must in general have a health problem that can be expected to last at least one year or to result in death and be unable to perform any type of substantial gainful employment.

To see how the SSA reviews claims that involve persons who have Multiple Sclerosis (MS) it is helpful to take a brief look at the medical terms used in describing this illness. Multiple Sclerosis is a nerve disease which effects the nerves in the spinal cord and the brain. Nerves are surrounded by sheath called myelin. This myelin sheath is like a conduit around electrical wiring in your house. When a person develops MS the sheath around the nerves is damaged and interferes with the nerve impulses going from the nerves into the body. The myelin sheath becomes sclerotic which means that it hardens. The nerve impulses then are unable to get to the body in the normal fashion due to the hardening of the conduit around the nerves.

The interference caused by the hardening of the nerve sheath in the spinal cord and in the brain results in such symptoms as vision problems, difficulty in controlling body movements, and changes in sensation. The severity of MS can vary with relapses when the symptoms become worse and remission when the symptoms become less severe. When the brain is affected by MS the patient can have problems with fatigue, coordination, vision, muscle weakness and dizziness. If the spinal cord is involved with the MS the patient may suffer from bladder problems, or numbness and weakness in his legs or arms.

The SSA will award disability for MS if the patient meets one of the following four categories:

1. The patient has problems with body movement which has symptoms of significant and persistent disorganization of motor function in two of the patient's arms or legs. Motor function is the ability of the patient to voluntarily move his body parts. The inability of the patient to control his body movements must be significant and continuing over a period of time. This inability to make voluntary movements must result in sustained disturbance of gross body (large) movements and dexterous (fine) movements of his hands, fingers and arms or result in problems with the person's gait (manner of walking) or station (manner of standing).

2. The patient has serious visual or mental impairments. Under the vision standards, the patient's vision in his better eye after best correction must be 20/200 or less. The patient would also meet the vision standard for disability if the contraction of his peripheral visual field in his better eye is 10 degrees or less from the point of fixation; or at its widest diameter has an angle of vision of no more than 20 degrees; or has 20 per cent or less visual field efficiency.

3. The patient has psychological or behavioral abnormalities associated with brain dysfunction. The patient has a loss of thinking abilities or affective changes which can include disorientation, memory impairment, hallucinations, delusions, personality change, mood disturbance or volatility, or loss of at least 15 points on a standard IQ test from his pre-MS testing level. In addition to one of the symptoms listed above the patient must also have at least two of the following conditions: marked restriction of daily activities, marked difficulties in maintaining social functioning, deficiencies in concentration, or repeated episodes of decompensation in work or work like situations that result in the patient withdrawing.

4. The patient has significant reproducible fatigue of motor function with substantial muscle weakness on repetitive activity resulting from neurological damage in the central nervous system which are involved in the multiple sclerosis process.

It should be kept in mind that a person can still be found to be disabled by an Administrative Law Judge even if he does not meet a particular listing if he has health problems that in combination are the equivalent of a listing. The Judge has the discretion to decide if a person's health problems are serious enough to warrant an award of disability benefits despite not meeting the specific technical requirements of one of the SSA listings for disability.

Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims for over nineteen years. He practices with the firm of Smith Dickey Dempster & Carpenter, P.A. at 555 Executive Place, Fayetteville, N.C. He can be reached at 485-8020 or at pitt@smithdickey.com.