A law firm sent me notification that the Social Security Administration (SSA) is updating their medical criteria for disability evaluation including for Multiple Sclerosis(MS). In other words, they are "tightening" the criteria for most conditions. I hope Mr. Feingold will comment as time permits. I really hope the National Multiple Sclerosis Society is all over this and attempting to protect our community from extreme changes. Note: Please do not depend on me for these changes. I tried to get the most relevant text related to MS, but at this point my brain is fried. The whole thing is confusing trying to link one item to the next without hyperlinks is a real mess or me.
I found the proposed changes here: http://www.gpo.gov/fdsys/pkg/FR-2014...2014-02659.htm
- The proposed listing for multiple sclerosis qualifies the degree of disorganization of motor function needed to meet the listing. by adding the word "extreme." There would have to be "extreme limitation" of motor function in order to meet the proposed listing.
- They are also proposing to to add a childhood Multiple Sclerosis listing.
Proposed Section 11.00D--What do we mean by disorganization of motor function?
In this new section, we define the phrase ``disorganization of motor function''. In proposed 11.00D2, we explain the addition of a severity standard for disorganized motor function, which we refer to as ``extreme limitation.'' We propose to define an extreme limitation as the inability to stand up from a seated position, or the inability to
maintain balance in a standing position and while walking, or the inability to use your upper extremities. We then explain what each of these limitations means.
The below text was obtained from the Federal Register Listing 11.09.
Proposed Section 11.00N—What is multiple sclerosis, and how do we evaluate it under 11.09?
We propose to expand guidance to our adjudicators on evaluating multiple sclerosis (MS) by explaining that the disorder affects several aspects of functioning. In proposed 11.00N2, we explain how we evaluate the effects of MS using proposed criteria for disorganization of motor functioning or a combination of functional limitations.
11.09 Multiple sclerosis, characterized by A or B:
A. Disorganization of motor function (see 11.00D1), resulting in extreme limitation (see 11.00D2) in the ability to stand up, balance, walk, or perform fine and gross motor movements.
OR
B. Marked limitation (see 11.00G2) in physical functioning (see 11.00G3a), and in one of the following:
1. Activities of daily living (see 11.00G3b); or
2. Social functioning (see 11.00G3c); or
3. Completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace (see 11.00G3d).
**
Proposed Section 11.00T—How do we consider your symptom of fatigue in these listings?
In this new section, we propose to expand our guidance on how to consider fatigue so that it applies to more neurological disorders. We explain how we evaluate the intensity, persistence, and effects of fatigue. We also provide general guidance for all neurological disorders that may cause or be associated with fatigue, including multiple sclerosis, post-polio syndrome, and myasthenia gravis. In response to the ANPRM comments, we explain how we evaluate the effects of both physical fatigue and mental fatigue.
Listing 11.09, Multiple Sclerosis
We propose to replace the disorganization of motor function criteria in current 11.09 with the proposed disorganization of motor function criteria. Under the proposed listing, we assess the severity of a visual or mental impairment related to multiple sclerosis using the proposed combination of functional limitations criteria or under a special senses and speech listing in 2.00, or under a mental disorders listing in 12.00, respectively. We also replace the requirement for significant reproducible fatigue with the general criteria described above for evaluating disorganization of motor function and a combination of functional limitations.
11.00 NEUROLOGICAL DISORDERS
N. What is multiple sclerosis, and how do we evaluate it under 11.09?
1. Multiple sclerosis (MS) is a chronic, inflammatory, degenerative disorder of the brain and spinal cord that damages the myelin sheath surrounding the nerve fibers in the brain and spinal cord. The damage disrupts the normal transmission of nerve impulses within the brain, and between the brain and other parts of the body causing impairment in muscle coordination, strength, balance, sensation, and vision. There are several forms of MS, ranging from slightly to highly aggressive. Milder forms generally involve acute attacks (exacerbations) with partial or complete recovery from signs and symptoms (remissions). Aggressive forms generally exhibit a steady progression of signs and symptoms with few or no remissions. The effects of all forms vary from person to person.
2. We evaluate your signs and symptoms, such as flaccidity, spasticity, spasms, in-coordination, imbalance, tremor, physical fatigue, muscle weakness, dizziness, tingling, and numbness when we determine your ability to stand up, balance, walk, or perform fine and gross motor movements using your arms, hands, and fingers. We will consider your other impairments or signs and symptoms that develop secondary to the disorder, such as mental fatigue; visual loss; trouble sleeping; impaired attention, concentration, memory, or judgment; mood swings; and depression in determining a combination of functional limitations.
T. How do we consider your symptom of fatigue in these listings?
Fatigue is one of the most common and debilitating symptoms of some neurological disorders, such as multiple sclerosis, post-polio syndrome, and myasthenia gravis. These disorders may result in physical fatigue (lack of muscle strength) or mental fatigue (decreased awareness or attention). When we evaluate your fatigue, we will consider the intensity, persistence, and effects of fatigue on your functioning. This may include information such as the clinical and laboratory data and other objective evidence concerning your
neurological deficit, a description of fatigue considered
characteristic of your disorder, and information about your
functioning. We consider the effects of physical fatigue on your ability to stand up, balance, walk, or perform fine and gross motor movements using the criteria described in 11.00D. We consider the effects of physical and mental fatigue when we evaluate your combination of functional limitations described in 11.00G.
U. How do we evaluate your neurological disorder when it does not meet one of these listings? If your neurological disorder does not meet the criteria of any of these listings, we must also consider whether your impairment(s) meets the criteria of a listing in another body system.
111.21 Multiple sclerosis, characterized by disorganization of
motor function (see 111.00D1), resulting in extreme limitation (see 111.00D2) in the ability to stand up, balance, walk, or perform fine and gross motor movements.
I found the proposed changes here: http://www.gpo.gov/fdsys/pkg/FR-2014...2014-02659.htm
- The proposed listing for multiple sclerosis qualifies the degree of disorganization of motor function needed to meet the listing. by adding the word "extreme." There would have to be "extreme limitation" of motor function in order to meet the proposed listing.
- They are also proposing to to add a childhood Multiple Sclerosis listing.
Proposed Section 11.00D--What do we mean by disorganization of motor function?
In this new section, we define the phrase ``disorganization of motor function''. In proposed 11.00D2, we explain the addition of a severity standard for disorganized motor function, which we refer to as ``extreme limitation.'' We propose to define an extreme limitation as the inability to stand up from a seated position, or the inability to
maintain balance in a standing position and while walking, or the inability to use your upper extremities. We then explain what each of these limitations means.
The below text was obtained from the Federal Register Listing 11.09.
Proposed Section 11.00N—What is multiple sclerosis, and how do we evaluate it under 11.09?
We propose to expand guidance to our adjudicators on evaluating multiple sclerosis (MS) by explaining that the disorder affects several aspects of functioning. In proposed 11.00N2, we explain how we evaluate the effects of MS using proposed criteria for disorganization of motor functioning or a combination of functional limitations.
11.09 Multiple sclerosis, characterized by A or B:
A. Disorganization of motor function (see 11.00D1), resulting in extreme limitation (see 11.00D2) in the ability to stand up, balance, walk, or perform fine and gross motor movements.
OR
B. Marked limitation (see 11.00G2) in physical functioning (see 11.00G3a), and in one of the following:
1. Activities of daily living (see 11.00G3b); or
2. Social functioning (see 11.00G3c); or
3. Completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace (see 11.00G3d).
**
Proposed Section 11.00T—How do we consider your symptom of fatigue in these listings?
In this new section, we propose to expand our guidance on how to consider fatigue so that it applies to more neurological disorders. We explain how we evaluate the intensity, persistence, and effects of fatigue. We also provide general guidance for all neurological disorders that may cause or be associated with fatigue, including multiple sclerosis, post-polio syndrome, and myasthenia gravis. In response to the ANPRM comments, we explain how we evaluate the effects of both physical fatigue and mental fatigue.
Listing 11.09, Multiple Sclerosis
We propose to replace the disorganization of motor function criteria in current 11.09 with the proposed disorganization of motor function criteria. Under the proposed listing, we assess the severity of a visual or mental impairment related to multiple sclerosis using the proposed combination of functional limitations criteria or under a special senses and speech listing in 2.00, or under a mental disorders listing in 12.00, respectively. We also replace the requirement for significant reproducible fatigue with the general criteria described above for evaluating disorganization of motor function and a combination of functional limitations.
11.00 NEUROLOGICAL DISORDERS
N. What is multiple sclerosis, and how do we evaluate it under 11.09?
1. Multiple sclerosis (MS) is a chronic, inflammatory, degenerative disorder of the brain and spinal cord that damages the myelin sheath surrounding the nerve fibers in the brain and spinal cord. The damage disrupts the normal transmission of nerve impulses within the brain, and between the brain and other parts of the body causing impairment in muscle coordination, strength, balance, sensation, and vision. There are several forms of MS, ranging from slightly to highly aggressive. Milder forms generally involve acute attacks (exacerbations) with partial or complete recovery from signs and symptoms (remissions). Aggressive forms generally exhibit a steady progression of signs and symptoms with few or no remissions. The effects of all forms vary from person to person.
2. We evaluate your signs and symptoms, such as flaccidity, spasticity, spasms, in-coordination, imbalance, tremor, physical fatigue, muscle weakness, dizziness, tingling, and numbness when we determine your ability to stand up, balance, walk, or perform fine and gross motor movements using your arms, hands, and fingers. We will consider your other impairments or signs and symptoms that develop secondary to the disorder, such as mental fatigue; visual loss; trouble sleeping; impaired attention, concentration, memory, or judgment; mood swings; and depression in determining a combination of functional limitations.
T. How do we consider your symptom of fatigue in these listings?
Fatigue is one of the most common and debilitating symptoms of some neurological disorders, such as multiple sclerosis, post-polio syndrome, and myasthenia gravis. These disorders may result in physical fatigue (lack of muscle strength) or mental fatigue (decreased awareness or attention). When we evaluate your fatigue, we will consider the intensity, persistence, and effects of fatigue on your functioning. This may include information such as the clinical and laboratory data and other objective evidence concerning your
neurological deficit, a description of fatigue considered
characteristic of your disorder, and information about your
functioning. We consider the effects of physical fatigue on your ability to stand up, balance, walk, or perform fine and gross motor movements using the criteria described in 11.00D. We consider the effects of physical and mental fatigue when we evaluate your combination of functional limitations described in 11.00G.
U. How do we evaluate your neurological disorder when it does not meet one of these listings? If your neurological disorder does not meet the criteria of any of these listings, we must also consider whether your impairment(s) meets the criteria of a listing in another body system.
111.21 Multiple sclerosis, characterized by disorganization of
motor function (see 111.00D1), resulting in extreme limitation (see 111.00D2) in the ability to stand up, balance, walk, or perform fine and gross motor movements.
Comment