Multiple Sclerosis and Social Security disability

Multiple Sclerosis (MS) is a chronic illness that affects the central nervous system, which includes the brain and spinal cord. MS occurs when the body’s immune system mistakenly attacks the protective covering of nerve fibers, known as myelin.

Myelin acts like insulation around electrical wires, allowing nerve signals to travel quickly and efficiently. When myelin is damaged, the nerve signals are disrupted, leading to a wide range of symptoms. The symptoms associated with MS vary depending on the areas of the brain and spinal cord that are affected, and can vary widely from person to person.

In many cases, MS symptoms lead to disability over time. As MS progresses, the damage to nerve fibers accumulates, which can result in significant limitations. Some common effects include:

• Mobility Issues: Muscle weakness, difficulty walking, and even paralysis can occur, especially when the nerves controlling motor functions are damaged.
• Coordination and Balance: As MS affects the brain regions responsible for motor coordination, individuals may have trouble maintaining balance or performing tasks that require fine motor skills, such as writing or typing.
• Cognitive and Emotional Changes: MS can affect memory, attention, and problem-solving skills.
• Fatigue: One of the most common and debilitating symptoms of MS is fatigue. This type of fatigue can be overwhelming and is not simply tiredness; it can significantly impair a person’s ability to complete routine, daily activities.

In my view, MS presents two principal challenges for those applying for Social Security disability.

First, as a progressive disease, it can be hard to determine at which point along the progression the symptoms become disabling. That point is almost impossible to discern from the treatment notes alone. The objective evidence in the medical file never tells the complete story, because MS patients with similar lesions on their MRIs can have symptoms that vary dramatically in their severity.

Second, it is often the constant fatigue that prevents MS patients from being able to work and even maintain their daily activities. Unfortunately, there is no way to objectively measure fatigue. And while the treatment notes will often cite fatigue, they usually do not detail the severity of the fatigue.

The treating neurologist can usually help, by providing an opinion regarding the severity of the patient’s symptoms.