MULTIPLE SCLEROSIS: MS and Social Security Disability – A Guide for Doctors

ms and social security disability

Dear Doctor:

The Social Security Administration (SSA) views the opinion of a treating doctor as extremely valuable in a disability claim.  Your MS patient needs you to provide an opinion based on your understanding of your patient’s symptoms and knowledge of your patient’s impairments.

In this guide you will find: (1) an overview of the criteria considered by the SSA; (2) common symptoms for MS patients; (3) limitations to consider for MS patients; and (4) a sample opinion letter.

Areas of Functioning – MS

The SSA considers these four following specific areas of functioning to determine whether an individual’s MS-related impairments are severe enough to qualify him or her as “disabled.”  Use this as a guide to help you and your patient determine whether he or she might qualify for benefits under SSA’s criteria:

  1. Disorganization of motor function; and/or
  2. Visual Impairment:
    1. Visual Acuity, or
    2. Field of Vision, or
    3. Visual Efficiency; and/or
  3. Mental Impairment:
    1. Disorientation to time and place, or
    2. Memory impairment, or
    3. Perceptual or thinking disturbances, or
    4. Change in personality, or
    5. Disturbance in mood, or
    6. Emotional liability, or
    7. Loss of measured intellectual ability; and/or
  4. Fatigue:
    1. Significant, reproducible fatigue of motor function.

Your patient’s medical evidence should support your opinion.

Potential Symptoms and Signs of MS:

Here are some common symptoms of MS patients.  Be sure to include all that apply to your patient:

  • Chronic fatigue
  • Vertigo
  • Balance problems
  • Nystagmus
  • Paresthesias
  • Double vision
  • Paralysis
  • Reduced bladder control
  • Weakness
  • Emotional lability
  • Intention tremor
  • Confusion
  • Increased deep reflexes
  • Loss of manual dexterity
  • Pain in one eye
  • Poor coordination
  • Blurred vision
  • Numbness
  • Reduced bowel control
  • Prickling Pain
  • Tremors
  • Speech difficulties
  • Sensitivity to heat
  • Dimness of vision
  • Unstable walking
  • Partial blindness
  • Pain
  • Other vision disturbance
  • Muscle spasms
  • Problems with judgment
  • Muscle fatigue of limb
  • Personality change
  • Cerebellar ataxia
  • Difficulty solving problems
  • Muscle atrophy
  • Depression
  • Static tremor
  • Memory Loss
  • Difficulty with coordination
  • Loss of sensation
  • speech impediment

Be sure to include any other symptoms your patient may have, as well.

Limitations – in an 8-hour workday.

What can your MS patient sill do and what can they no longer do?  The SSA wants details.

Describe how physical, visual, and cognitive impairments impact your patient’s ability to participate in daily activities and work on a sustained basis. Reference restrictions on sitting, standing, walking, extremity use, concentration, memory, persistence, or pace.

For example:

  1. Is your patient’s fatigue complaint typical of MS patients?  Will your patient need to take unscheduled breaks during the day (to rest, because of pain, etc.)?
  2. How far (in city blocks) is your patient able to walk without having to rest or having severe pain?  Does your patient need a cane or other device to assist with walking?
  3. How long (hours or minutes) can your patient sit at one time without getting up?  Does your patient need to elevate his or her legs while sitting? How long can he or she stand without sitting or moving around?  Does your patient need to be able to change positions (sit, stand, walk) at will?
  4. How many pounds can your patient lift and carry?  Can your patient reach, twist, bend or squat?  Does your patient have difficulty manipulating fingers, hands, or arms?
  5. Will your patient’s lack of attention and concentration interfere with his or her workday?  How many times per day do you anticipate this happening?  Does your patient’s emotional distress exacerbate symptoms? What level of work stress is your patient able to tolerate?
  6. How many days per month is your patient likely to miss work due to MS symptoms or treatments?

Always report fatigue and its impact. Because fatigue is difficult to measure objectively, provide any supporting evidence you have.

Please click here for a Sample Opinion Letter.

If you have any questions or concerns regarding this guide, please contact us.