More than 2.9 million people worldwide have been diagnosed with Multiple Sclerosis (MS), including close to 1 million people in the United States. Disability benefits and Multiple Sclerosis are linked in that MS is considered a “qualifying disability” to receive disability benefits from the Social Security Administration (SSA). MS can also serve as the basis to apply for long-term disability benefits under an employer-sponsored insurance policy.
However, relying exclusively on an MS diagnosis when applying for disability benefits is not recommended. Why? Because a diagnosis is typically not enough for the SSA to make a disability determination. MS is considered to be a progressive disease, which means many patients (particularly those diagnosed with early-stage MS) may not actually display symptoms. This means some people diagnosed with MS may be able to continue working for years, or possibly decades, after being diagnosed. Nevertheless, MS symptoms progress as time goes on and symptoms become more prominent and potentially debilitating. In some patients, MS becomes so severe that it is completely debilitating and prevents individuals from being able to work. Let’s take a closer look at the link between disability benefits and Multiple Sclerosis.
Difference Between SSA Disability Benefits and Long-Term Disability Benefits
Disability benefits through the SSA are administered through the Social Security Disability Insurance (SSDI) program. SSDI is a government-sponsored disability insurance benefit payable to individuals who have worked a sufficient number of years and paid premiums to qualify for coverage. In contrast, long-term disability benefits are offered through an employer-sponsored insurance policy. Social Security disability benefits are governed by the Social Security Act. Most long-term disability benefit insurance plans are governed by the federal ERISA statute and state insurance laws.
Common Symptoms Associated with Multiple Sclerosis
MS is considered to be a chronic autoimmune disease impacting the central nervous system. Symptoms associated with MS include, but are not limited to, the following:
- Tremors in the arms and legs
- Weakness in the arms or legs
- Numbness or tingling in the face, arms, or legs
- Speech problems
- Lack of coordination
- Difficulty walking
- Loss of balance
- Extreme fatigue
- Vision issues
- Hearing loss
- Difficulty concentrating and recollecting basic facts
- Difficulty chewing and swallowing
Advancements in Potentially Identifying Underlying Cause of MS
Recent medical research indicates there may be a potential link between contracting the Epstein-Barr virus (EBV) and eventually developing MS. This possible connection was highlighted in a large, multi-decade study involving more than 10 million young adults. The study revealed that individuals who suffered an EBV infection saw a 32-fold increase in the risk of developing MS. No other viral infections were shown to increase MS risk.
Research into identifying the underlying cause, or causes, of MS will continue. Nevertheless, at this time, MS remains incurable, but can be managed (to a degree) with medical treatment.
MS “Flare Ups” Present Challenges to Qualifying for Long-Term Disability Insurance Benefits
One of the biggest hurdles associated with receiving disability benefits due to an MS diagnosis is the inherent unpredictable nature of the disease. For example, individuals diagnosed with Relapsing-Remitting Multiple Sclerosis (RMMS), may experience extended periods of remission followed by sporadic flare-ups triggered by a multitude of issues (e.g., stress, hot weather, etc.). This means, on certain days, an individual with RMMS can go to work and be fully functional. However, on other days, it may be challenging to even get out of bed. This presents significant challenges in terms of maintaining gainful employment. Individuals diagnosed with Primary Progressive Multiple Sclerosis (PPMS) may experience a steady escalation in MS symptoms over a period of time.
For individuals diagnosed with either type of MS, it is important to understand that your doctor may inadvertently undermine your long-term MS disability benefits claim by failing to clearly describe your disability, or by sending mixed messages to your insurance company about the extent and impact of your condition.
Even if you can prove disability, you may still face hurdles in being approved for long-term, ongoing disability benefits. Why? Because some insurance companies utilize different tactics in an effort to avoid making payments to people whom they believe could be gainfully employed. In addition to reviewing your medical records and speaking to your doctors, insurance companies are known to retain private investigators or to monitor your social media activity. In these situations, the difference between good days (or better days) and worse days could work against you, making it seem as though you are more capable than you normally are, even if only for a finite period of time. If you are encountering significant challenges and pushback to your long-term disability benefits application, then it may make sense to contact an experienced MS disability benefits lawyer to discuss your legal options.
SSA Assessment of MS Disability Benefits Application
As mentioned earlier, along with long-term disability insurance benefits, individuals diagnosed with MS can apply for SSA disability benefits. When evaluating your MS disability benefits application, the SSA will likely conduct an initial assessment to determine if you meet Section 11.09 of the SSA’s Blue Book, which sets forth the impairment criterion for someone diagnosed with MS. If you meet the threshold contained in the Blue Book listing, then your benefits application is likely to be approved.
To qualify for SSA disability benefits under this Listing, you must provide evidence (e.g., medical records) indicating you experience disorganization of motor function in two extremities that limit your ability to stand up from a seated position, balance while standing or walking, or use the upper extremities.
However, many people with severe MS may not meet or equal this listing, and may instead struggle with other symptoms that prevent working. For the majority of people who don’t meet a Listing, Social Security will consider whether you can return to any work you performed in the 5 years before your disability and whether you can adjust to other work for which you might be qualified based on your age, education and work experience. Social Security evaluates your ability to work by assessing your “residual functional capacity” (RFC). This RFC is a summary of what Social Security believes is the most that you can still do after considering your impairments.
SSA might consider factors like your ability to sustain a full workday, whether you are limited in being able to use your vision throughout a full day, your ability to use your hands, as well as how much you can lift and carry, and how long you can sit, stand and walk. It’s especially important in multiple sclerosis cases that non-exertional impairments, like those caused by “brain fog” or other symptoms are well documented by your doctors.
The SSA may also consider your age, education, and work experience. They will then assign a residual functional capacity (RFC), which is effectively a medical-vocational assessment of the type of work you may be able to do. This assessment will consider any marked functional limitations in the following areas:
- Your ability to interact with others in a workplace setting
- Your capacity to concentrate or maintain pace
- Your capacity to understand, retain, or interpret information
- Your ability to adapt or manage yourself in a workplace setting
If you are able to provide evidence substantiating how these limitations could interfere with your ability to work or prevent you from working at all, Social Security may approve your claim.
Securing MS Long-Term Disability Benefits
If you encounter challenges applying for, or receiving, disability benefits through the SSA or through your employer-sponsored long-term disability insurance plan, then contact Bross & Frankel to discuss your legal options. Our team of experienced MS disability benefits attorneys can assist you in building a compelling set of records and materials to substantiate your claim, including:
- Creating and maintaining logs and journals to document both good days and bad days caused by an MS flare up
- Documenting changes in your ability to engage in work activities
- Utilizing your job description to explain the hardships you face in attempting to work with MS
- Compiling and reviewing medical records and other proof of disability
- Guiding medical professionals in responding to inquiries by an insurance company
- Appealing a long-term disability denials denial in court
Have Questions About the Link Between Disability Benefits and Multiple Sclerosis? Bross & Frankel is Ready to Help.
If your Multiple Sclerosis has made working every day impossible, you need to know there are other options out there. At Bross & Frankel, our long-term disability attorneys understand the progression of MS. We know how to work with employers, doctors, and your insurance company to get you the benefits you need to stop working and still meet your needs. Contact us or call us today at (856) 795-8880 for a complimentary consultation.