Multiple Sclerosis (MS) is a debilitating disease that currently affects over 400,000 Americans, with 200 new diagnoses every week, Heathline reported. MS affects the way nerve impulses travel through your central nervous system, which is how the brain communicates with rest of the body, and can, in turn, affect
If you or a loved one find you can't do the same activities you did before you were diagnosed with MS, the Social Security Administration (SSA), may be able to assist you. The SSA has two types of benefit programs to provide you with the financial support you may need when dealing with a disabling illness.
The Financial Costs of MS
In study done by the Fielding School of Public Health at the University of California, researchers named MS the second most expensive of chronic conditions, behind only congestive heart failure. Per person, The National Multiple Sclerosis Society estimates that the diseases costs $69,000 each year, which adds up to about $28 billion in total in the United States.
Most of the medical costs come from the medication to treat the illness. A study from Oregon State University and the Oregon Health and Science University found that the average annual price for the disease modifying drugs (DMDs) alone was about $60,000. Though there are many different drugs on the market, Healthline found that all of the DMDs were priced between $4,500 and $6,000 per month.
MS can be diagnosed at any time during a person's life, but most people get the disorder between 20 and 40 years of age. Because MS is diagnosed so young, the financial burden is even greater. Though many patients are covered by insurance, 70 percent report having trouble paying for drugs, 16.4 reported having a lot of difficulty, and 21 percent said they had to sacrifice on food, heat, and other basic living expenses to afford the drugs, the National Multiple Sclerosis Society explained.
Medically Qualifying for Benefits with the Blue Book
When you apply for disability benefits, the SSA evaluates your claim using it's official list of impairments, the Blue Book. If you meet or equal the Blue Book listing for MS, you will be approved for benefits.
MS can be found in section 11.00—Neurological Disorders.
In order to be approved for benefits with MS, you need medical evidence showing that you have MS with at least one of the following:
- Significant and persistent disorganization of motor function in two extremities, resulting in sustained disturbance of large movements, fine motor skills, walking or standing. This can include paralysis, tremor, involuntary movements, loss of control of body movements, and sensory disturbances.
- Visual impairments, including a central vision clarity in your best eye of 20/200 or less despite corrective measures, a contracted visual field due to the widest diameter extending under the angle around the point of fixation being 20 degrees or less, a total vision loss (the mean devotion or defect or MD) is 22 decibels (dB) or higher, a visual field efficiency of 20 percent or less, despite corrective measures, or a visual impairment value is greater than 1.00 in your better eye after corrective measures.
- Mental impairments from organic mental disorders, which are psychological or behavioral abnormalities associated with a dysfunction of the brain. Either you need to meet the requirements in both A and B or all of the requirements in C.
- A. Persistent loss of specific cognitive abilities or affective changes and medical documentation of disorientation to time and place, any kind of memory impairment, disturbances in perception, thinking, or mood, changes in personality, inability to control emotions or impulses, or loss of measured intellectual ability of at least 15 I.Q. points from original I.Q. or overall impairment index clearly within the severely impaired range on neuropsychological testing.
- B. Marked restrictions in daily living activities, Prolonged, repeated episodes of decompensation (mental instability), or issues maintaining social functioning, concentration, persistence, or pace.
- C. Medically documented history of a chronic organic mental disorder that's lasted at least two years and has caused a significant limitation in ability to do basic work activities, with one of the following:
- Prolonged, repeated episodes of decompensating.
- A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate.
- Inability to function outside a highly supportive living arrangement for at least 12 months before application, with an indication of continued need for such an arrangement.
- Significant, reproducible fatigue of motor function with substantial muscle weakness on repetitive activity, demonstrated on physical examination, resulting from neurological dysfunction.
If your MS symptoms are severe enough to restrict you from working or performing daily living activities, talk to your doctor about applying for disability benefits.
Qualifying Without Meeting a Medical Listing
If your MS is severe and keeps you from working, but you don't meet one of the Blue Book listings above, you can also be approved based on the limitations MS causes you, called a medical-vocational allowance. Instead of medical requirements, the SSA finds your Residual Functioning Capacity (RFC).
SSA awards RFC disabilities based on a system of grid rules. They determine the amount of work they feel you can do (sedentary, light, medium, heavy, very heavy) and compare it with your education and work history to figure out if there are any jobs you can do.
Normally, the grid rules start for individuals at 45 years of age, but if you are younger than 45, you can argue that you can't even do sedentary work or that you have nonexertional limitations (or mental), both of which are possible with MS. Common symptoms of the disorder include pain, muscle stiffness or spasms, weakness, fatigue, bladder issues, emotional changes, cognitive dysfunction, and problems with vision, walking, standing, and coordination. You could also be experiencing more severe symptoms, like problems swallowing, speaking, or breathing, tremors, and seizures.
Your approval will also depend on what kind of MS you have. Primary progressive is the more aggressive from, but many episodes in relapsing remitting MS may also be grounds for approval, especially with other constant symptoms.
Because MS has such a wide range of debilitating symptoms, likelihood of approval are high in all careers, but especially so in physically demanding jobs, like construction, or jobs that require a lot of standing, like retail or food service, and in more severe cases, jobs that require fine movement or the employee to make important decisions.
How to Apply for Social Security Disability Benefits
Talk to your doctor before you apply for disability benefits. The application process can be long and grueling, lasting months or years before you start receiving checks, if you're approved. Because the process is so long and stressful, you should only apply if you and your doctor both think your chances of getting benefits are high.
If you do meet one of the Blue Book listings, you will automatically be approved for benefits as long as you can provide all of the medical evidence the SSA requires. Leaving information out can cause the SSA to delay or deny your initial application, forcing your to go through the long appeal process. Save yourself some time by checking out the SSA's website or talking to representative about your documentation requirements.
Important medical evidence for MS may include:
- Medical imaging, most importantly an MRI to show if there is any damage or inflammation in the brain, spinal cord, and other nerve function.
- Spinal tap, to show any abnormalities in the cerebrospinal fluid.
- Blood tests may be used to rule out other disorders.
- Visual testing.
- Neuropyschological I.Q. testing, such as the Luria-Nebraska or Halstead-Reitan.
- A thorough report of the symptoms of your condition from any doctors and psychologists you see.
- Records of hospitalizations or surgeries directly or indirectly related to your MS.
- List of treatments and your body's response to each.
Evoked potentials test (EP), which uses electric impulses to test your brain's responses.
If you're applying for Social Security Disability Insurance, you can use the SSA's online application or find your local SSA office. However, the online application doesn't support claims for Supplementary Security Insurance, so you'll have to apply in person at an SSA office. Either way, make sure to review the SSA complete list of application materials, so you aren't missing any other information, like tax documents or personal identification.
If there are any changes in your MS, like you develop any new symptoms, are hospitalized, or change medications, make sure to alert the SSA immediately. The more proof the SSA has of the way your condition affects you, the more likely they are to approve you earlier rather than later.
If you’re approved for benefits, your spouse and children may also be eligible for benefits. To learn more about the different forms about disability benefits, visit our pages on Social Security Disability Insurance.
For more information, please read our top 3 tips for applying for benefits for MS.