Multiple Sclerosis and Social Security Disability: OCT is Emerging Method of Tracking Nervous System Deterioration

Multiple Sclerosis (MS) is a degenerative disease generally afflicting one in every thousand Americans and often results in claims for Social Security Disability benefits.  It is a condition where the immune systems attacks the protective covering (called myelin) surrounding nerve cells in the brain and spinal cord. Early symptoms (which generally emerge during young adulthood) include tingling, numbness, loss of balance, weakness in the extremities and impaired vision. Less common symptoms at this stage also include slurred speech, sudden paralysis, lack of coordination and impaired mental functioning.

As the disease continues to take its toll, many experience fatigue, heat sensitivity, spasticity, dizziness, trouble thinking, odd sensations (such as “pins and needles”), problems with walking, speech and swallowing, tremors, as well as vision problems. Those afflicted with MS typically have a life expectancy 5-10 years lower than the general population.

There are about four different ways in which the disease typically manifests itself. Relapsing-remitting MS entails a series of episodes between periods of complete or partial recovery and followed by some relapse. Primary-progressive MS manifests itself as a slow decline towards clinical severity, sometimes with minor stabilization. Secondary-progressive MS starts out as relapsing-remitting and later develops into a primary-progressive form. Progressive-relapsing MS involves worsening punctuated by sudden increases in severity. Primary-progressive MS and Relapsing-remitting MS are the types we most often see in our office for Social Security disability (SSD) benefits.

In order to be considered for SSD benefits you must be unable to engage in “substantial gainful activity”.  To qualify for disability benefits based on MS, an individual may meet the Social Security Administration Listing 11.09A for Multiple Sclerosis. Two extremities (be it both arms, both legs or an arm and a leg) must be impaired. A physician must also examine the level of strength as to determine whether or not the individual can perform general tasks relating to their occupation. Coordination and walking ability must also be evaluated. Social Security Administration listing 11.09B has to do with the level of visual impairment resulting from MS. Listing 11.09B also refers to listing 12.02 for measuring cognitive difficulties.  In order to qualify for benefits under listing 11.09C, the patient must be able to demonstrate reproducible motor function problems, substantial weakness on repetitive activity, neurological dysfunction associated with MS.

Modern remedies for MS include treatment for the individual symptoms which may entail a taking a cocktail of medications (to prevent seizures, muscle spasms, fatigue etc.) as well as physical/speech therapy. As of yet, there is no known way to completely halt the progression of the disease.  Many steroids, which are not recommended for long-term use due to their numerous side effects, have been used to slow the progression and lessen the severity of MS episodes. Inteferons have also been approved by the FDA for the treatment of relapsing-remitting MS. Fingolimod is one such variety of interferon that has yet to be certified by the FDA, though it may prove to be successful in the future.  In severe cases, a potentially dangerous drug called Natalizumab maybe be used. Given that one must be diagnosed with a severe case of MS to receive such treatments, most people receiving the drug generally qualify for Social Security benefits.

There are also new emerging treatments for MS that may soon be available. Researchers who have long sought ways to reverse the damage done to nerve fibers have previously used MRI scans as the primary method of tracking the disease’s progression. However, recent evidence from experiments done at John Hopkins University show that widespread nerve damage can be quantified using a less invasive technique known as Optical Coherence Tomography (OCT).

OCT essentially measures the thinning of the back part of the eye (called the retina) that occurs as a result of MS. This degeneration is an effect of the disease that is present even in those who do not experience vision problems.  Thinning of the retina was reported to have been more rapid in MS patients with recently occurring brain lesions. OCT is beginning to emerge as an easier and more cost effective method of measuring the disease’s progression, but researchers are still waiting for more evidence before implementing the practice on a more widespread scale.  Hopefully, these new emerging technologies can help patients fight this often times disabling disease.