MULTIPLE SCLEROSIS: SSA’s Listing of Impairments: 11:09 MS

Neurological disorders

(physical and mental)

SSA is supposed to consider all relevant information in your case record to determine the effects of your neurological disorder on your physical and mental functioning .

Your neurological disorder must result in a marked limitation in physical functioning and a marked limitation in at least one of four areas of mental functioning:

·      understanding, remembering, or applying information;

·      interacting with others;

·      concentrating, persisting, or maintaining pace; or

·      adapting or managing oneself.

Marked Limitation

(physical and mental)

To satisfy the requirements of this section, your neurological disorder must result in a marked limitation in physical functioning and a marked limitation in one of the four areas of mental functioning.

Although SSA does not require the use of such a scale, “marked” would be the fourth point on a five-point scale consisting of no limitation, mild limitation, moderate limitation, marked limitation, and extreme limitation.

SSA is supposed to consider the nature and overall degree of interference with your functioning.

The term “marked” does not require that you must be confined to bed, hospitalized, or in a nursing home.

Physical functioning

(physical)

Examples in this section include specific motor abilities, such as independently initiating, sustaining, and completing the following activities:

·      standing up from a seated position,

·      balancing while standing or walking, or

·      using both your 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 your limitation in seeing, breathing, or swallowing may, on its own, rise to 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 aspiration pneumonia.

Alternatively, you may have a combination of limitations due to your neurological disorder that together rise to a “marked” limitation in physical functioning.

SSA may also find that you have a “marked” limitation in this area if, for example, your symptoms, such as pain or fatigue:

·      are documented in your medical record, and

·      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 processes that support those motor functions.

SSA may also find you 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 12 months.

These examples illustrate the nature of physical functioning.

SSA does not require documentation of all of the examples.

Disorganization of motor function

(physical)

This means interference, due to your neurological disorder, with movement of two extremities;

Examples include: the lower extremities, or upper extremities (including fingers, wrists, hands, arms, and shoulders).

By two extremities, SSA means both lower extremities, or both upper extremities, or one upper extremity and one lower extremity.

For this listing, disorganization of motor function results in an extreme limitation in your ability to:

• Stand up from a seated position; or
• Balance while standing or walking; or
• Use the upper extremities (including fingers, wrists, hands, arms, and shoulders).

Marked limitation and physical functioning

(physical)

In this section, a marked limitation means that, due to the signs and symptoms of your neurological disorder, you are seriously limited in the ability to independently initiate, sustain, and complete work-related physical activities.

You may have a marked limitation in your physical functioning when your neurological disease process causes persistent or intermittent symptoms that affect your abilities 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 must result in a serious limitation in your ability to do a task or activity on a sustained basis.

SSA does not define “marked” by a specific number of different physical activities or tasks that demonstrate your ability, but by the overall effects of your neurological symptoms on your ability to perform such physical activities on a consistent and sustained basis.

You need not be totally precluded from performing a function or activity to have a marked limitation, as long as the degree of limitation seriously limits your ability to independently:

·      initiate,

·      sustain, and

·      complete work-related physical activities.

Extreme limitation 

(physical)

This means 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 motor function depends on the degree of interference with standing up; balancing while standing or walking; or using the upper extremities (including fingers, hands, arms, and shoulders).

Inability to stand up from a seated position

(physical)

Inability to maintain balance in a standing position

(physical)

Inability to use your upper extremities

(physical)

Inability to perform fine and gross motor movements

(physical)

·      pinch, manipulate, and use your fingers;

·      or not being able to use your 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 a lifting, carrying, pushing, and pulling.

Marked limitation and mental functioning

(mental)

In this section, marked limitation means that, due to the signs and symptoms of your neurological disorder, you are seriously limited in the ability to function:

·      independently,

·      appropriately,

·      effectively, and

·      on a sustained basis (in work settings.)

SSA does not define “marked” by a specific number of mental activities, such as:

·      the number of activities that demonstrate your ability to understand, remember, and apply information;

·      the number of tasks that demonstrate your ability to interact with others;

·      a specific number of tasks that demonstrate you are able to concentrate, persist or maintain pace;

·      or a specific number of tasks that demonstrate you are able to manage yourself.

You may have a marked limitation in your mental functioning when several activities or functions are impaired, or even when only one is impaired.

You need not be totally precluded from performing an activity to have a marked limitation, as long as the degree of limitation seriously limits your ability to:

·      function independently,

·      appropriately, and

·      effectively on a sustained basis, and

·      complete work-related mental activities.

Understanding, remembering, or applying information

(mental)

This area of mental functioning refers to the abilities to learn, recall, and use information to perform work activities.

Examples include:

·      understanding and learning terms, instructions, procedures;

·      following one- or two-step oral instructions to carry out a task;

·      describing work activity to someone else;

·      asking and answering questions and providing explanations;

·      recognizing a mistake and correcting it;

·      identifying and solving problems;

·      sequencing multi-step activities; and

·      using reason and judgment to make work-related decisions.

These examples illustrate the nature of this area of mental functioning.

SSA does not require documentation of all of the examples.

Interacting with others

(mental)

This area of mental functioning refers to the abilities to relate to and work with supervisors, co-workers, and the public.

Examples include:

·      cooperating with others;

·      asking for help when needed;

·      handling conflicts with others;

·      stating your own point of view;

·      initiating or sustaining conversation;

·      understanding and responding to social cues (physical, verbal, emotional);

·      responding to requests, suggestions, criticism, correction, and challenges;

·      and keeping social interactions free of excessive irritability, sensitivity, argumentativeness, or suspiciousness.

These examples illustrate the nature of this area of mental functioning.

SSA does not require documentation of all of the examples.

Concentrating, persisting, or maintaining pace

(mental)

This area of mental functioning refers to the abilities to focus attention on work activities and to stay on-task at a sustained rate.

Examples include:

·      initiating and performing a task that you understand and know how to do;

·      working at an appropriate and consistent pace;

·      completing tasks in a timely manner;

·      ignoring or avoiding distractions while working;

·      changing activities or work settings without being disruptive;

·      working close to or with others without interrupting or distracting them;

·      sustaining an ordinary routine and regular attendance at work; and

·      working a full day without needing more than the allotted number or length of rest periods during the day.

These examples illustrate the nature of this area of mental functioning.

SSA does not require documentation of all of the examples.

Adapting or managing oneself

(mental)

This area of mental functioning refers to the abilities to  regulate emotions, control behavior, and maintain well-being in a work setting.

Examples include:

·      responding to demands;

·      adapting to changes;

·      managing your psychologically based symptoms;

·      distinguishing between acceptable and unacceptable work performance;

·      setting realistic goals;

·      making plans for yourself independently of others;

·      maintaining personal hygiene and attire appropriate to a work setting;

·      and being aware of normal hazards and taking appropriate precautions.

These examples illustrate the nature of this area of mental functioning.

SSA does not require documentation of all of the examples.