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Obtaining disability benefits for Multiple Sclerosis

Appealing for benefits is best done under the guidance of an experienced disability lawyer.

Can I get disability benefits if I am suffering from the effects of Multiple Sclerosis?

Author: Attorney Lonnie Roach
Updated 1/19/2024

Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord. The National Multiple Sclerosis Society estimates that almost one million people in the United States are living with multiple sclerosis. Multiple sclerosis can occur at any age, but in most cases onset occurs between the ages of 20 and 40, and women are more than two to three times more likely to develop the condition.
If you are suffering from the effects of Multiple Sclerosis you may qualify for disability benefits.

Multiple sclerosis is essentially an autoimmune disease; the immune system attacks the fatty protective substance called myelin that covers and protects the nerve fibers in the brain and spinal cord.

This causes communication problems between the brain and the rest of the body and can eventually result in permanent damage and deterioration of the nerves. Some people lose the ability to walk while others go into remission without any new symptoms.

MS disability

If you have an advanced case of MS you have a good chance of qualifying for Social Security Disability benefits. The SSA will want to see medical evidence.

Signs and symptoms of multiple sclerosis vary widely over the course of the disease, depending on the amount of nerve damage and the location of affected nerve fibers.

Common symptoms include:

  •    Numbness or weakness in one or more limbs, usually on one side of the body at a time
  •   Fatigue
  •   Electric shock-like sensations that occur with certain neck movements, especially bending the neck forward
  •    Lack of coordination, tremors, or unsteady gait
  •   Tingling or pain in parts of body
  •   Dizziness
  •   Blurry vision
  •   Partial or complete loss of vision, typically in one eye at a time
  •   Prolonged double vision
  •   Slurred speech
  •   Incontinence

These symptoms can cause you to miss work and jeopardize your ability to maintain employment.

There are four types of MS.

Most people have periods known as relapses with worsening symptoms followed by quiet periods of remission where symptoms improve or disappear completely. This is known as relapsing-remitting MS (RRMS). Relapses can develop over days or weeks while periods of remission may last days or years. Fifty percent of those with relapsing-remitting MS develop a steady progression of symptoms with or without periods of remission within 10 to 20 years of their initial diagnosis. This type of MS is called secondary progressive MS (SPMS). Primary progressive MS (PPMS) is a gradual worsening of the disease; there are no well-defined attacks of symptoms, and there are few or no remissions. Progressive-relapsing MS (PRMS) is the least common form of MS. Only 5% of people have this type of MS where relapses happen every so often, but symptoms continue and get worse between attacks.

Many cases of multiple sclerosis do not progress and some individuals remain in RRMS for 30 years.

It should also be noted that most individuals with MS live an average of only seven years less than the general population. Currently there is no cure for the disease, but treatments can speed recovery from attacks, slow the progression of the condition and manage symptoms. Medications and physical therapy are the most common treatments prescribed, but some patients have found relief from alternative therapies, such as yoga, exercise, magnet therapy, massage and acupuncture.
You will need to demonstrate that you are following your doctor’s treatment plan, and despite that your medical condition still prevents you from working full-time.

Qualifying for Disability for Multiple Sclerosis

The Social Security Administration recognizes multiple sclerosis as a disabling condition in its Blue Book under Section 11.09.

To be eligible for SSDI under this listed impairment, your multiple sclerosis must be characterized by the following:

  1.   Disorganization of motor function in two extremities, resulting in an extreme limitation in the ability to stand up from a seated position, balance while standing or walking, or use the upper extremities.
  2. OR

  3.    Marked limitation in physical functioning and one of the following:

    1.    Understanding, remembering, or applying information; or
    2.   Interacting with others; or
    3.   Concentrating, persisting, or maintaining pace; or
    4.   Adapting or managing oneself.

Applicants who suffer from multiple sclerosis and who use wheelchairs, walkers, have vision problems or cannot drive will probably have no problem meeting the above requirements and be approved for SSDI.

Individuals with mild to moderate MS are usually able to work and do not need disability benefits. However, there are other people with MS who are able to work and perform their daily tasks on a good day, but on other days their symptoms are severe enough to force them to stay home. These are the individuals who have trouble getting approved for Social Security Disability benefits. If you have multiple sclerosis and your symptoms do not meet Social Security’s exact criteria, what can you do to increase your chances of qualifying for SSDI?

First, discuss all your symptoms with your health care providers and let them know how MS interferes with your daily activities – dressing, washing, working, cooking, driving, shopping.

These symptoms include any of the following:

  •    Fatigue
  •   Pain
  •   Blurred vision
  •   Numbness in hands
  •   Mental changes, such as forgetfulness, confusion or getting along with others
  •   Incontinence

Make sure these symptoms and their effects are thoroughly documented in your medical records.

In addition to a diagnosis of MS by a neurologist and a long-term record of your symptoms by a primary care physician, an MRI showing proof of demyelination and a spinal tap that shows increased myelin basic proteins will strengthen your case.

Keep a detailed record of your daily activities.

Social Security will send you a form to fill out called a function report where you can document your problems. The form will have questions, such as “Do you drive?” You do not have to answer with a yes or no; take time to explain that sometimes you can drive a short distance easily, but on other days pain, fatigue or blurred vision prevent you from going anywhere. Social Security may also request testimony from someone else about your condition, such as an employer or colleague. Ask a friend or family member to give a report about your daily activities, choosing one or two people who know you well and are familiar with your challenges.

One way to prove disability is to show you have difficulty walking.

Ask your doctor for a prescription for an assistive device, such as a cane or a walker, even if you already have one or are not able to buy one. Social Security may assume that if there is no prescription for a cane or other assistive device, the patient doesn’t need one.

If you are still working, keep track of absences.

This is important to establish that your productivity at work is declining. You must prove that your medical condition has reduced your work productivity by at least 15 % of the acceptable level. If you consistently need to stop work because of blurry vision or fatigue, or miss work several days per month, you will not be able to maintain full-time employment.

If you have any other medical conditions, such as asthma, arthritis, hearing loss, anxiety or depression, be sure to include them in your medical records because they may be key to proving that you are incapable of doing other work.

Applicants often have more than one illness or injury that prevents them from working full time. By itself one disorder may not meet the requirements of an impairment as stated in Social Security’s Blue Book, but if an applicant has multiple medical conditions, Social Security must consider how those health issues, combined together, limit an applicant’s ability to hold a job and perform necessary daily tasks. Social Security will also evaluate how your limitations affect your ability to work, taking into account whether or not you are able to drive, your age, and level of education.

Once Social Security determines the limitations caused by your condition, they will employ a vocational expert to assess whether a person with these limitations is employable.

Most vocational experts will find a person to be unemployable if their condition or the treatment rendered for the condition causes the person to regularly be absent two or more days a month or be “off-task” 15% or more of the workday.

Because multiple sclerosis is an episodic disease with periods of relapse and periods of remission, it can be tricky to qualify for Social Security Disability benefits.

Also, filing an application may be problematic if your symptoms interfere with writing and filling out forms. Consulting an experienced Social Security Disability attorney to review your case and take over the burdens of gathering evidence and filing your application can prevent costly mistakes and increase your chances for approval.

If you are 55 or older or have another medical condition you may get approval.

Social Security follows a set of rules to determine when the agency expects an applicant to learn a new job.

Applicants who are 55 or older often fall under a grid rule, which means they are not expected to learn a new job. For example, a 55-year-old applicant with no transferable skills might be found disabled. If you can’t go back to your old job, and you don’t have the skills to learn a new one, Social Security will likely grant you disability benefits.

Social Security also has basic financial requirements.

Before you are eligible for Social Security disability benefits, you must satisfy some basic financial requirements.

You must: 1) have a disability that has lasted or is expected to last 12 months; and 2) you must have worked in a job where you paid Social Security taxes long enough and recently enough; and 3) you must not earn more than Substantial Gainful Activity (SGA), which is $1,550 per month in 2024 for nonblind applicants and $2,590 per month for blind applicants.

What if I don’t qualify for SSDI?

If you haven’t worked long enough to earn enough work credits, or if you earn too much income, you may be eligible for disability benefits through another Social Security program, such as Supplemental Security Income (SSI), or from a long-term disability insurance plan through your employer or a privately purchased policy.

SSI is a program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. SSI is based on income instead of work credits, and is financed by general funds of the U.S. Treasury.

I have long-term disability insurance – should I file a claim?

Yes, you should file a claim as soon as you become disabled.

Long-term disability insurance (LTD) is coverage that protects your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company. Policies pay between 50-60% of your salary and benefits continue until you return to work or for the number of years stated in the policy. However, LTD coverage is good only as long as you are employed, so do not quit your job before you file a claim, and be sure to check your policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Additionally, be aware that long-term disability insurance companies can require a claimant to also apply for SSDI.

How do I file for Social Security Disability benefits?

You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security Administration office.

If your initial application is denied, don’t be discouraged. Approximately 65% of initial applications are denied, but you will have the opportunity to appeal.

There are four steps to the Social Security appeal process:

  1.    File a Request for Reconsideration with the Social Security Administration to completely review the case.
  2.    If you don’t agree with SSA’s response to your Request for Reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for the Social Security Administration; they review SSDI cases and either uphold or overturn decisions to deny SSDI benefits. If you are not represented by an attorney at this point, now is the time to obtain legal counsel. This is a critical point in the process and will raise your chance for success.
  3.    If an ALJ does not grant your claim, you can request that the Appeals Council review your case.
  4.    Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.

Do I need a disability attorney for SSDI?

Qualifying for Social Security Disability benefits is problematic because the requirements of Social Security’s impairment listing are very difficult to decipher.

Your chances for approval are increased significantly if you have an experienced disability attorney who can gather your necessary medical evidence and even write a brief explaining why you qualify. At each potential stage of the process, from the initial application stage, the reconsideration stage and the ALJ hearing stage, an attorney can assist you in completing the detailed forms and questionnaires required by Social Security, collecting and submitting relevant medical evidence, and preparing questionnaires for your doctors. At the ALJ hearing phase an attorney will not only continue to assure that the evidence is complete, but prepare you for questioning by the ALJ, prepare an argument on your behalf and question any doctors or vocational experts selected by the ALJ to testify at the hearing. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied. Fees charged by disability attorneys are regulated by federal law and are usually 25% of disability backpay you are owed. There are no out-of-pocket costs, and if you don’t win your case, you won’t be charged anything.

Do I need a disability attorney for a long-term disability insurance claim?

Whether you have a long-term disability insurance policy purchased through a private insurance broker or a group policy purchased with your employer, filing a claim for long-term insurance is a complex process.

The wording of LTD policies can be confusing and the laws and regulations which affect the two types of LTD insurance differ in their procedures for filing claims and appeals. An experienced LTD attorney with thorough knowledge of ERISA laws and regulations will avoid mistakes and increase your chance of success. An attorney will act on your behalf, completing your application and filing your claim in a timely manner. They can also negotiate a settlement or file an appeal for you. If it becomes necessary to file suit, an LTD attorney can prepare your case against an insurer. Most LTD attorneys handle cases on a contingency basis and charge approximately 25%-40% of a claimant’s past due benefits. You do not pay an attorney’s fee unless the attorney wins your case.

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Disability benefits are an important source of income for those who are unable to work. If you are not able to work due to accident or illness, you may be eligible for Social Security Disability or Long Term Disability benefits. If you have applied for benefits and been denied, contact the attorneys at Bemis, Roach and Reed for a free consultation. Call 512-454-4000 and get help NOW.

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"Words can not truly express the gratitude that I feel toward Mr. Lonnie Roach and his professional team. I give them an A+++. Very compassionate and prompt. Their priorities are first and foremost helping you succeed at your case. When you feel helpless, feeling like someone is on your side can mean the world to you. Thank you for working for the people."
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Attorney Lonnie RoachAuthor: Attorney Lonnie Roach has been practicing law for over 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion rated by Martindale Hubbell. Through his extensive litigation Mr. Roach obtained board certifications from the Texas Board of Legal Specialization. Lonnie is admitted to practice in the United States District Court – all Texas Districts and the U.S. Court of Appeals, Fifth Circuit. Highly experienced in Long Term Disability denials and appeals governed by the “ERISA” Mr. Roach is a member of the Texas Trial Lawyers Association, Austin Bar Association, and is a past the director of the Capital Area Trial Lawyers Association (Director 1999-2005) Mr. Roach and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.

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