When evaluating a claimant’s disability application, the Social Security Administration makes a medical assessment to determine whether an individual’s impairment(s) meets or equals a listing in the Listing of Impairments, or if the individual’s impairment(s) are at a level that precludes his/her ability to perform any past relevant work or any other work in the national economy.
In order for an individual’s impairment(s) to meet a listing, his/her impairment(s) must meet ALL the criteria of one of the listed impairments in the listings. If an individual’s impairment(s) meets the requirements of a listed impairment, the Social Security Administration, after reviewing your medical records, will find that individual is disabled.
As it relates to Multiple Sclerosis ("MS"), the Social Security Administration places MS under the 11.00 Neurological impairments, specifically under Listing 11.09 Multiple Sclerosis. In order to meet the requirements of Listing 11.09, an individual with MS must suffer from:
- A) Disorganization of motor function in two (2) 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.
- B) Suffer from marked limitation in physical functioning AND in one of the following areas:
- 1) Understanding, remembering, or applying information;
- 2) Interacting with others;
- 3) Concentrating, persisting, or maintaining pace;
- 4) Adapting or managing oneself.
In order to meet the requirement of "disorganization of motor function," an individual must suffer an interference, due to his/her neurological disorder, with movement in two (2) extremities (both upper extremities, both lower extremities, or one lower extremity and one upper extremity), causing an extreme limitation with activities such as standing up from a seated position; balance while standing or walking; or use of the upper extremities.
According to the Social Security Administration, an "extreme limitation" is the inability to stand up from a seated position, maintain balance in a standing position and while walking, or use your upper extremities to independently initiate, sustain, and complete work-related activities. The assessment of your motor function depends on the degree of interference you experience with standing up; balancing while standing or walking; or using your upper extremities.
The inability to stand up from a seated position means that once an individual is seated, that person is unable to stand and maintain an upright position without assistance of another person or the use of an assistive device, such as a walker, two crutches, or two canes.
The inability to maintain balance in a standing position means that an individual is unable to maintain an upright position while in a standing or walking without the assistance of another person or an assistive device, such as a walker, two crutches, or two canes.
The inability to use one’s upper extremities means that an individual suffers from a loss of function of both his/her upper extremities that seriously limits his/her ability to independently initiate, sustain, and complete work-related activities involving fine and gross motor movements. Examples of an inability to perform fine and gross motor movements includes not being able to pinch, manipulate, and use one’s fingers; or not being able to use one’s hands, arms, and shoulders to perform gross motor movements, such as handling, gripping, grasping, holding, turning, and reaching; or not being able to engage in exertional movements, such as lifting, carrying, pushing, and pulling.
Interestingly, the Social Security Administration does not define what a "marked" limitation is, only that it is something above "moderate" but below "extreme." A marked limitation, however, does not require an individual to me bed-ridden or confined to a hospital. Instead, a marked limitation for physical functioning would be an impairment that, due to the signs and symptoms of one’s neurological disorder (in this case, MS), seriously limits one’s ability to independently initiate, sustain, and complete work-related physical activities.
For example, an individual may have marked limitations in his/her physical functioning when his/her neurological disease causes persistent or intermittent symptoms that affect his/her ability to independently initiate, sustain, and complete work-related activities, such as standing, balancing, walking, using both upper extremities for fine and gross movements, or results in limitations in using one upper and one lower extremity. The persistent and intermittent symptoms, though, must result in serious limitation in one’s ability to perform a task or activity on a sustained basis. Furthermore, the Social Security Administration defines "marked" by the overall effect an individual’s neurological symptoms has on an individual’s ability to perform such physical activities on a consistent and sustained basis. Once again, one need not be totally precluded from performing a function or activity to have a marked limitation, so long as the degree of limitation seriously limits one’s ability to independently initiate, sustain, and complete work-related physical activities.
Lastly, the Social Security Administration defines "physical functioning" as specific motor abilities, such as independently initiate, sustaining, and completing the following activities: standing up from a seated position, balancing while standing or walking, or using both one’s upper extremities for fine and gross movements. Physical functioning may also include functions of the body that support motor abilities, such as the abilities to see, breathe, and swallow.
Examples of when an individual’s limitations with seeing, breathing, or swallowing may, on their own, rise to being considered a "marked" limitation include prolonged and uncorrectable double vision causing difficulty with balance; prolonged difficulty breathing requiring the use of a prescribed assistive breathing device, such as a portable continuous positive airway pressure machine; or repeated instances, occurring at least weekly, of aspiration without causing pneumonia.
In the alternative, an individual may have a combination of limitations related to an individual’s neurological disorder that together rise to a "marked" limitation in physical functioning. In fact, the Social Security Administration may find that an individual suffers a "marked" limitation in this area if, for example, your symptoms, such as pain or fatigue, as documented in your medical record, caused by your neurological disorder or its treatment, seriously limit your ability to independently initiate, sustain, and complete these work-related motor functions, or the other physical functions or physiological process that support those motor functions. Furthermore, the Social Security Administration may also find that you are seriously limited in an area if, while you retain some ability to perform the function, you are unable to do so consistently and on a sustained basis. The limitation in your physical functioning must last, or be expected to last, at least twelve (12) months.
If the Social Security Administration determines that your MS diagnosis does not meet or medically equal a listed impairment, the Social Security Administration will continue to evaluate your claim using the sequential evaluation process in order to determine what functional limitations, both exertional (physical) and non-exertional (mental/cognitive), result from your MS, or other, impairment(s).
As one can see, your medical records are vital to your claim for SSDI benefits and/or SSI payments. If your impairments do not meet or equal a listing, we must look to what functional limitations result from your impairments and then compare your restrictions with the demands of any past relevant work you have performed in the last fifteen (15) years. Furthermore, depending on your age: 18-49, 50-54, 55-59, or 60+; your education: marginal (6th grade or less), limited (7th grade to 11th grade), or high school education and above (12th/HS graduate+); and to what degree your impairment(s) limit you, you may or may not be found disabled.
As a result, your medical records (and medical treatment) are vital to your claim for SSDI benefits and/or SSI payments for not only the Social Security Administration but also any attorney reviewing the merits of your case.
The information contained herein is for general information purposes only and is not meant for your reliance on, or to form a basis, for any legal, business, or other decisions. As always, if you have any legal questions, consult an attorney.