Multiple sclerosis causes many people to sporadically miss work or stop working altogether. When MS forces you out of work, important disability benefits may be available to you from the Social Security Administration (SSA), or you may have coverage through an employer’s benefit plan or under a private disability policy. Veterans with MS may be eligible for service-connected compensation from the VA.
But obtaining disability benefits for MS can be quite difficult to do on your own.
If you need to file a claim for disability based on multiple sclerosis, this article will help you understand what your claim needs to prove. If your disability claim has already been denied, you will learn how you can fight back with the right information and change the game.
Characteristics of Multiple Sclerosis Make Winning Disability Benefits a Challenge
MS can affect any part of the central nervous system and cause neurologic problems with muscle control and strength, spasticity, vision, balance, gait, sensation, pain, bowel and bladder control, emotional regulation, memory, fatigue, and mental disorders.
Multiple sclerosis can be hard to definitively diagnose. Equally important, while MS continually progresses, the symptoms of it tend to “wax and wane.”
MS also frequently causes autonomic dysfunction which affects breathing, heart rate, blood pressure, temperature, sweating, and blood glucose. These neurologic problems can lead to cognitive and/or physical defects and disability.
Issues Unique to Multiple Sclerosis Disability Claims
Due to the nature of the disease, MS disability claims have distinct hurdles. For example, claim reviewers:
- Will argue that, because you have worked for many years with MS, why are you suddenly no longer able to work now? This is especially true with disability insurance companies, who may build an entire denial on this basis for MS-related claims.
- Do not recognize the degree of impact a combination of impairments has on MS patients. Multiple sclerosis never stops progressing even during periods of remission. With each relapse, there is never a complete recovery to the pre-relapse baseline.
- Are unaware that hot environments, or getting hot from overexertion, can make physical symptoms or cognitive abilities worse for people living with MS. This is complicated further because RFC testing cannot effectively test for these issues.
- Vastly underestimate the disabling nature of MS fatigue. This alone can greatly obstruct one’s ability to function at home and work
It’s up to you to furnish clear explanations with supporting evidence for these and any issues unique to your situation. You want the person deciding your claims’ fate to duly measure these facts during the decision process.
Proving disability for MS is more complex than most realize. Through years of experience, our attorneys know what each disability provider needs to see, and how to control the situation when an insurance company or government entity acts in error or does not play fair.
How Do I Prove Multiple Sclerosis Disability for SSDI Benefits?
You might think with a diagnosis for a chronic, progressive disease like MS, you are automatically entitled to Social Security Disability Insurance benefits. But a diagnosis is not enough. To automatically qualify for MS, you must meet certain criteria that are listed in the Social Security Blue Book.
This can be difficult to do. The reality is, most people living with MS will not meet all the technical medical criteria.
But this is no reason to give up. When MS symptoms are not severe enough to meet or equal SSA’s Blue Book listing, Social Security offers another path to winning benefits known as medical-vocational allowance. Here, SSA looks at your functional, vocational abilities by evaluating your Residual Functional Capacity (RFC).
RFC is what you can still do despite your physical or mental impairments. In this approach, you need to prove to the SSA that your symptoms are severe enough to keep you from regularly engaging in any work activity. You need to show the SSA how your MS impacts your life daily.
Evidence to support your claim should include
- Your Medical Records — SSA needs your medical history including your MS diagnosis, diagnostic test results, records of your ongoing treatment and medication, hospital visits, and prescribed assistive devices.
- A Psychological Evaluation — SSA may consider your ability to understand, remember and apply information, concentrate, sustain a steady work pace, and/or interact with others. You don’t have to be completely unable to carry out an activity, as long as the degree of limitation seriously limits your ability to function independently and effectively, and to complete work-related mental activities.
- Your Treating Physician’s Statement and Recommendation — SSA will have specific questions for your doctors that will help them understand the nature and frequency of your symptoms, and your ability to work. It is a good idea to provide these questions to your doctor ahead of time. Your doctor will also fill out RFC forms to show your physical and mental limitations in your ability to work.
- A Journal of Your Symptoms. We recommend our clients keep a journal of their daily activities and how they are affected by their MS symptoms. For example, fatigue is a major crippler for many with MS. Most tests and exams never document the disabling effect that fatigue has on a person living with MS. So you want to document your different symptoms, and clearly state how those symptoms affect your ability to work. This will become a daily record about not only work issues, but Activities of Daily Living, and tracking worsening symptoms. Share all of these insights with your doctor. Testimony from friends or family that help reveal how your symptoms disable you can also be very helpful.
An attorney who is board certified by the National Board of Social Security Disability Advocacy will know these and other means to help Social Security adjudicators decide to award benefits based on multiple sclerosis. These factors apply throughout an initial filing or during the appeals process.
How to Win Long Term Disability (LTD) Insurance Claims Based on MS
LTD claims for multiple sclerosis are often denied by insurance carriers. Many claims wind up in litigation. Case law is filled with accounts of insurance companies such as Liberty Mutual, Aetna, Hartford, and many others that have unfairly denied claims based on MS. Denied claims that are not appealed with attorney representation are mostly abandoned in frustration.
Insurers have various ways to punch holes in a claimant’s initial LTD application. For instance, insurance companies won’t deny that you have MS. But they will maintain that your MS does not prevent you from doing your job, or any job for that matter. Also, many MS symptoms are self-reported and therefore ignored for the most part by the insurance company. Examples include fatigue, cognitive limitations, memory loss, depression, and medication side effects.
If you are filing an initial application for disability benefits with your insurer, you need to develop your claim with as much medical and vocational evidence as possible.
If an insurance company has denied your MS-related claim, the best way to reverse their decision is to appeal their denial item by item. Be proactive, as you may need to further test for and document all of your functional limitations – both physical and cognitive. Supporting testimony from colleagues, friends and family members who have witnessed the disabling symptoms firsthand can strengthen your case, as will expert witness testimony.
These are just some key pieces of evidence needed to prove you have reached the point where your MS impairs your ability to work.
Whether you are considering applying for LTD benefits, or the insurance company has denied your claim, get in touch with us as soon as possible to understand your options. We provide superior help with the application process, ERISA disability appeals, and the filing of lawsuits in multiple sclerosis claims. If your insurance company is set on denial, you will know your claim is fully developed to stand trial.
For Veterans, Multiple Sclerosis is a presumptive condition.
Under VA rules, MS is a presumptive condition, and benefits are based on the presumption that the disability is service-connected.
“Presumptive” means that you do not need a nexus statement. If you were diagnosed with MS during your service in the military – or within seven years after honorable discharge – you may be eligible for disability compensation without having to prove that your MS is linked to your service.
The VA allows this seven-year presumptive period because MS is unpredictable and mimics many other diseases, and diagnoses for veterans’ cases may not happen until many years of symptoms and treatment regimens have passed. Neurologic symptoms occurring within seven years of discharge, regardless of date of diagnosis, can be used to support service-connection for MS.
If diagnosis occurs after the seven-year presumptive period, you may still be service-connected for MS. But you must first create a timeline that supports your entitlement to service connection.
MS is rated at a minimum of 30% based on the VA rating schedule. After the minimum rating of 30%, every veteran is rated individually as the disease affects each person uniquely in symptoms and severity. Multiple sclerosis often leads to life-changing disabilities for veterans, and the VA may not evaluate the long term effects of MS properly. Don’t let the VA underrate you. If MS restricts your ability to work, you may also qualify for Total Disability Based on Individual Unemployability (TDIU).
If you need a reconsideration of your MS-related veteran’s claim, or if you need help establishing service connection, call our firm without delay. Your best option is to talk to a VA-accredited lawyer who can help you take the necessary steps to prove your case to the VA.
Speak With an MS Disability Claims Lawyer Now
There is often a higher degree of difficulty with MS disability claims. Our firm can help give you the best chance of getting the full benefits you deserve. Whether you were denied disability benefits, or you’re just now filing – we welcome your call. Learn how we can make the difference in your case.